Malignant Pheochromocytoma with Widespread Bony and Pulmonary Metastases.

Pheochromocytoma is a rare benign tumor of the adrenal gland. A select few cases may be malignant, and metastatic cases are exceedingly rare. It often presents with symptoms of catecholamine excess, such as sweating, palpitations, headaches, and characteristic paroxysmal hypertension. Due to its diffuse symptoms, it is difficult to diagnose and is often diagnosed late. We describe the unique case of a 44-year-old female patient who presented with uncontrolled hypertension and vomiting, accompanied by lower back pain. She was diagnosed with malignant pheochromocytoma with multiple metastases to the lungs, vertebrae, scapulae, and skull. Because of the advanced state of her disease, the patient was started on treatment with the chemotherapeutic combination of cyclophosphamide, vincristine, and dacarbazine. However, she had a complicated hospital course and died because of aspiration pneumonia and sepsis.

AHSG rs4918 Polymorphism poses a weak predisposition to insulin resistance during pregnancy.

OBJECTIVE: To identify the association between Fetuin-A levels and genetic polymorphism with gestational diabetes mellitus among pregnant women visiting a tertiary care centre. METHODS: This cross-sectional case-control study was conducted at Aga Khan University Hospital, Karachi, from December 2015 to September 2016, and comprised pregnant women in their second trimester. Those with gestational diabetes mellitus were considered the cases while the rest acted as controls. The enzyme-linked immunosorbent assay was used to quantify Fetuin-A levels while genotyping for alpha-2-Heremans-Schmid-glycoprotein rs4918 was performed using restriction fragment length polymorphism technique. Blood samples were collected and serum and deoxyribonucleic acid were extracted and stored at -80°C. SPSS 21 was used to analyse the findings. RESULTS: Of the 88 subjects, there were 44(50%) in each group. Serum Fetuin-A concentration was higher in cases compared to the controls (p<0.01). The genotype data for the cases was 0.668 and for the controls 0.840 (p>0.05). However, the G allele showed a weak risk or predisposition towards gestational diabetes mellitus (p=0.038).. CONCLUSIONS: Increased Fetuin-A levels were found to be related to the occurrence of gestational diabetes mellitus, indicating that Fetuin-A possibly contributes towards insulin resistance.

Assessment of Elementary School Teachers' Level of Knowledge and Attitude regarding Traumatic Dental Injuries in the United Arab Emirates.

INTRODUCTION: In this cross-sectional study, the level of knowledge and attitude of elementary school teachers regarding traumatic dental injuries (TDI) were assessed. MATERIALS AND METHODS: A questionnaire was distributed to 330 elementary school teachers in 30 randomly selected schools in the Emirates of Sharjah and Dubai. The questionnaire collected information on participants' demographic characteristics, first aid training, and attitude about emergency management of TDI. RESULTS: 292 teachers (88%) completed the questionnaires; of these, 95% were females, and 50% of the participants had first aid training. Knowledge about tooth avulsion was inadequate, and first aid training was not associated with correct responses to management of avulsed teeth (p > 0.05). A significantly higher percentage of younger teachers (p < 0.05) expressed the need for future education on TDI management. A significantly higher percentage of participants who had an educational position (95%) indicated that they did not have enough knowledge regarding TDI compared to physical education teachers (79%) and administrators (87%) (p < 0.05). CONCLUSIONS: Elementary school teachers in the UAE have a low level of knowledge regarding the management of dental trauma. Educational programs that address TDI are needed and could improve the elementary school teachers' level of knowledge in emergency management of TDI.