A 68-Year-Old Man with a Cytogenetic Diagnosis of Chronic Myeloid Leukemia and Bone Marrow Findings of Philadelphia Chromosome Translocation Between the Long Arm of Chromosomes 9 and 22, Leading to the BCR-ABL1 Fusion Gene and V617F Mutation in the JAK2 Gene.

BACKGROUND Breakpoint cluster region (BCR)-Abelson murine leukemia (ABL1) and Janus Kinase-2 (JAK2) mutations have been thought to be mutually exclusive in myeloproliferative neoplasms (MNPs), but recent data suggest that they can occur together. CASE REPORT A 68-year-old man was referred to the hematology clinic because of an elevated white blood cell count. His medical history included type II diabetes mellitus, hypertension, and retinal hemorrhage. Fluorescence in situ hybridization analysis of the bone marrow was positive for BCR-ABL1 in 66/100 cells. Conventional cytogenetics was positive for the Philadelphia chromosome in 16/20 counted cells. The percentage of BCR-ABL1 was 12%. Considering the patient's age and medical comorbidities, he was started on imatinib 400 mg once daily. Further tests showed JAK2 V617F mutation positivity and absence of acquired von Willebrand disease. He was then started on aspirin 81 mg and hydroxyurea 500 mg once daily, which was later increased to 1000 mg daily. The patient achieved a major molecular response after 6 months of treatment, with undetectable BCR-ABL1 levels. CONCLUSIONS BCR-ABL1 and JAK2 mutations can co-existence in MNPs. Physicians must suspect the presence of one of the MPNs in chronic myeloid leukemia (CML) patients with persistent or increased thrombocytosis, an atypical course of the disease, or hematological abnormalities despite evidence of response or remission of CML. Therefore, testing for JAK2 should be performed accordingly. Combining cytoreductive therapy with tyrosine kinase inhibitors (TKIs) is a therapeutic option when both mutations are present, and TKI alone is not sufficient to control peripheral blood cell counts.

Brevibacterium Luteolum bacteremia: A case report and literature review.

Brevibacterium species are to be opportunistic pathogens. Although rare, several case reports have mentioned infections ranging from cutaneous infections to bacteremia. Here, we present a case report describing a 64-year-old male pancreatic cancer patient diagnosed with B. luteolum bacteremia.

Obesity Influences on Patients With Non-valvular Cardiomyopathy in Relation to Early In-Hospital Outcomes and Health System Burden.

Background Our study aimed to assess the burden of obesity on the health system and outcomes in patients with non-valvular cardiomyopathy. Methods A retrospective analytical cohort, single-center study was conducted at King Abdullah Medical City (KAMC), Makkah, from June 2019 to June 2020, and includes all non-valvular cardiomyopathy (NVCM) patients. The patients were divided into two groups, obese (BMI≥30) and non-obese (BMI<30). The two groups were compared using a t-test and a chi-squared test for continuous and categorical data and regression analysis. Results A single-center, retrospective study was conducted at KAMC, Makkah, and included all NVCM patients (ejection fraction or EF≤45%) who were admitted during this study period. A total of 626 NVCM patients were included in this cohort study; they had a mean BMI of 29±8.1 and a mean EF of 28.4±9.7. Patients were divided into two groups, obese (BMI≥30) and non-obese (BMI<30). Obese patients represented 37% (n=231) of our study population. The non-ischemic category of cardiomyopathy had a higher prevalence among the obese (35% vs 27%). A higher percentage of obese patients presented with heart failure (HF) symptoms rather than ischemia or arrhythmia (46%, 40%, and 7% for HF symptoms, ischemia, and arrhythmia, respectively). There was no significant difference in NVCM complications, including cardiogenic shock, pulmonary edema, and cardiac arrest, between the two groups. Obese patients had a significantly higher post-myocardial infarction (MI) ejection fraction (29.7±9.7 vs 27.5±9.7, p=0.01). We found a statistically significant positive correlation between BMI and length of in-hospital stay (P=0.04). In-hospital mortality was non-significantly different between our two groups, although numerically, it was higher among the non-obese group (obesity paradox) (10% vs 12%, p=0.2). Type of cardiomyopathy, cerebrovascular stroke, smoking, and sacubitril/valsartan intake were detected as independent predictors of in-hospital mortality among our patients. Conclusions Obesity among NVCM patients sets more burden on health facilities by the prolongation of the in-hospital stay of patients although BMI is not an independent predictor of death in those patients.

Cardiomyopathy Management and In-Hospital Outcomes in a Tertiary Care Center: Clinical Components and Venues of Advanced Care.

Background There are few reports on the prevalence of different types of cardiomyopathy, clinical presentation, severity, short-term outcomes, and implementation of advanced heart failure treatment. This study aimed to assess the prevalence, clinical background of different types of cardiomyopathy and to identify the candidate for advanced treatment in a tertiary care cardiac center with many advantages  Method A single-center retrospective cohort study included 1069 patients admitted to our center and diagnosed with cardiomyopathy during 2019 and 2020  Results Out of 1069 cardiomyopathy patients admitted and diagnosed at our center between 2019 and 2020, 62% had ischemic cardiomyopathy (ICM), 36% had dilated cardiomyopathy (DCM), and 2% had hypertrophic cardiomyopathy (HOCM). ICM patients were older, showed a higher prevalence of both male gender and pilgrims, and they had more frequent cardiovascular risk factors compared to dilated cardiomyopathy group of patients. However, DCM patients with more severe heart failure symptoms (NYHA class III/IV), much worse LVEF, were subsequently considered deemed for aggressive diuretic therapy, and further advanced therapy (Sacubitril-Valsartan and device therapy) compared to ICM patients. ICM patients showed poor in-hospital outcomes compared to DCM group of patients (0.05 and <0.001) for an indication for mechanical ventilation and in-hospital mortality, respectively). Increased age, presence of renal dysfunction and lower LVEF were found the independent predictors of in-hospital mortality among our studied patients  Conclusion There are discrepancies between DCM and ICM patients. Although DCM patients were younger at age and had fewer cardiovascular risk factors, they presented with severe symptoms and dysfunction, hence more eligible candidates for advanced heart failure treatment, and finally showed a lower mortality rate. Increased age, presence of renal dysfunction and lower LVEF were found the independent predictors of in-hospital mortality.