Hypogonadism among patients with transfusion-dependent thalassemia: a cross-sectional study.

Patients with thalassemia major are liable to have complications from blood transfusion and iron excess despite using iron-chelating agents. It is common to have endocrine complications in these patients. Hypogonadism is one of the most common complications in thalassemic patients. Early detection and treatment are essential to restore puberty and prevent complications from hypogonadism. Patients and methods: The authors conducted this cross-sectional study in the Kurdistan Region of Iraq, from 1 July 2022, to 1 December 2022. Eighty patients with ß-thalassemia major who were referred to the endocrinology clinic were enrolled. The patients were evaluated sequentially, starting with a history, followed by a clinical examination and laboratory tests related to endocrine disease. Those who met the inclusion criteria were enrolled in the study, while the others were excluded. Results: Out of 80 patients with major thalassemia who were referred to the endocrinology clinic, 53 (66.3%) were female, and 27 (33.7%) were male, with a mean (SD) age of 24.86±7.66 (14-59) years. Fifty-five (68.75%) of them had hypogonadism, three patients (3.8%) had hypothyroidism, while two (2.5%) had hypoparathyroidism. Five patients (6.3%) had diabetes. None of the patients had adrenal insufficiency. The mean ferritin level in thalassemic patients with hypogonadism and thalassemic patients without hypogonadism was 2326±2625 ng/ml vs. 1220±2625 ng/ml. Conclusion: To minimize the risk of endocrinopathy in patients with thalassemia major, they should receive blood transfusions regularly and initiate chelating agents early, because the leading cause of endocrinopathy in thalassemic patients is related to the severity of anemia and iron overload.

COVID-19 infection leading to acute pustular dermatoses.

Viral infections, including SARS-CoV-2, the virus that causes COVID-19 infection, have been implicated in the development of pustular dermatoses, including generalized pustular psoriasis (GPP) and acute generalized exanthematous pustulosis (AGEP). We performed a literature review of existing cases of GPP and AGEP associated with COVID-19 infection and/or treatment reported over a period of 12 months. We summarize the clinical characteristics of these cases and report an additional six new cases of GPP and AGEP. Seven patients with COVID-19 infection were diagnosed with new-onset or exacerbated GPP, and 33 patients were diagnosed with AGEP. In 55% of the cases, no concomitant potential culprit drug trigger was identified. We present this review of cases of COVID-associated acute pustular dermatoses to further contribute to the spectrum of cutaneous eruption associated with SARS-CoV-2 infection.

Retinal Vessel Density and Treatment Intensity among Adults with Retinal Vein Occlusion: A Swept-Source Optical Coherence Tomography Angiography Study.

Previous studies have shown retinal vein occlusion (RVO) is associated with changes in vessel density visible on swept-source optical coherence tomography angiography (ss-OCTA). This study aimed to characterize retinal changes on ss-OCTA among RVO patients stratified by the need for continuous anti-VEGF therapy. This cross-sectional study of 24 RVO patients ≥ 18 years were imaged with SS-OCT-A. Patients were categorized into continuous vs. limited therapy (≥1 vs. no injections in previous 12 months) based on recurrence of intraretinal fluid (IRF) on OCT. Images were analyzed using ImageJ. T-tests were used to compare vessel density of the macula and peripheral retina. Overall, RVO patients undergoing continuous therapy (n = 14) had higher diabetes prevalence, worse baseline visual acuity, and higher baseline macular thickness compared to the limited (n = 10) therapy group. Continuous therapy was associated with lower macular VD in the combined retina layer and the superficial capillary plexus (SCP), but not in the deep capillary plexus (DCP). Further, the continuous therapy group exhibited lower peripheral VD in the combined retina layer, and no difference in the SCP and DCP layers when analyzed separately. In conclusion, RVO patients requiring continuous anti-VEGF injections demonstrate reduced VD of the macula and in the periphery on SS-OCTA imaging. SS-OCTA may be valuable for monitoring and prognosticating treatment for RVO patients.

The effect of menopausal symptoms on the quality of life among postmenopausal Egyptian women.

Objective: The current study aims to assess the prevalence of menopausal symptoms among postmenopausal Egyptian women and their effect on the quality of these women's lives.Study design: A cross-sectional study was carried out in a tertiary university hospital between January and December 2017. We enrolled 350 postmenopausal women aged 45-70 years. All women were interviewed using the Menopause-Specific Quality of Life (MENQOL) questionnaire after translation into the Arabic language by a certified translation expert. The Mann-Whitney test and the Kruskal-Wallis test were used to compare MENQOL item scores.Results: Low backache was the most common complaint among the study participants (86%). The sexual domain imposed the greatest impact on quality of life (mean = 3.12 ± 1.66), followed by physical (mean = 3.18 ± 0.92), psychological (mean = 3.08 ± 0.98), and vasomotor (mean = 3.01 ± 1.78) domains. Moreover, we found a significant positive moderate correlation between body mass index (BMI) and the total score (r = 0.689, p < 0.001). Multivariable linear regression analysis found that the best-fitting predictors for the MENQOL score were age (p < 0.001), BMI (p < 0.001), and exercise (p < 0.001).Conclusions: Physical symptoms were the most prevalent symptoms in this study. In general, older women, housewives, hand workers, less physically active women, and those of low socioeconomic status had poor quality of life.

Relation of Different Components of Climate with Human Pituitary-Thyroid Axis and FT3/FT4 Ratio: A Study on Euthyroid and SCH Subjects in Two Different Seasons.

BACKGROUND: Various changes in thyroid hormones (TH) and thyroid-stimulating hormone (TSH) level were observed in different seasons among euthyroid and hypothyroid subjects living in areas with an extreme temperature difference between summer and winter. OBJECTIVES: This study aims at finding the effect of temperate climate on the seasonal variations of TSH and TH in euthyroid and subclinical hypothyroidism (SCH) subjects and at evaluating if the test season has an effect on the number of subjects diagnosed as SCH. It basically focuses on the relation of different components of climate with TH and TSH. METHOD: In a prospective study on 152 healthy (euthyroid) volunteers and 25 SCH subjects, the serum hormone levels (TSH, FT4, and FT3) were measured in both the summer and winter seasons and correlated with all the climate components using Pearson's correlation coefficient. The effect of duration of outdoor exposure on hormone levels was compared using a paired sample t-test (P < 0.05). RESULTS: Small but statistically significant increased FT3 level and decreased FT4 level were observed during the winter season in euthyroid and SCH subjects, respectively. There was a significant negative correlation between FT3 and FT3/FT4 ratio with temperature and sunshine duration and a positive correlation with humidity and atmospheric pressure. A positive correlation was found between FT4 and sunshine duration. CONCLUSION: The climate components contributed to the slight variance in hormone levels in different seasons, and the effect was mostly on peripheral conversion of FT4 to FT3 rather than the pituitary-thyroid axis leading to slightly higher FT3 in winter. Seasonal variation does not affect the diagnosis of SCH cases.

Compliance with the guidelines of prescription writing in a central hospital in the West Bank.

This retrospective, cross-sectional study was carried out to evaluate the quality of 2208 outpatient prescriptions in a central hospital in the West Bank, Palestine. The physicians' handwriting was poorly readable or illegible in one-third of the prescriptions. The prescriber's name and signature and patient's name were mentioned in almost all orders whereas the patient's age was stated in 54.9%. The vast majority of physicians (95.5%) prescribed drugs using their trade (brand) names. Drug strength, quantity and dose/frequency were stated in 61.1%, 76% and 73.8% of prescriptions respectively. Only 33 prescriptions (1.5%) contained full directions for use for all drugs. Correlation analysis revealed that the presence of certain prescription elements was statistically significantly associated with the clinic of origin and the number of drugs prescribed. The overall poor legibility and incompleteness of the prescriptions is of concern.

Upper egypt experience in management of paediatric burn: the last six years.

Childhood burns in Egypt are a significant problem, especially in families of low socioeconomic status. These families live in overcrowded flats using kerosene stoves but lacking proper hygiene and adequate safety measures. Over the 6-yr period 2004-2009 a total number of 1999 burned children (1440 children treated as out-patients with less than 10% total body surface area [TBSA] burned plus 559 with more than 10% TBSA burns treated as in-patients) presented to the burn unit of Assiut University Hospital. In the out-patient group (1440 children), the most common site was the upper limb (40% of patients) and the least common was the chest (9%). Scalding was the most common cause (75%), followed by flame (25%). The mean age of children in this group was 4.5 yr. The in-patient group (559 children) was classified into three age groups: group 1 (age below 5 yr), group 2 (5-10 yr), and group 3 (11-16 yr). Group 1 was most affected by burns, with 61% of the cases, while group 3 was the least affected (17%). The most common cause of injury was scalding (68%) and the least common was chemical burn (1%). Regarding gender, boys accounted for 64.5% of the cases and girls 35.5%. Burn size ranged from 10 to 50% TBSA, classified into three groups: group 1 (10-15%), group 2 (16-20%), and group 3 (more than 20%). Most of the affected children were in group 3 (41% of in-patient cases). The mortality rate was 13.1%. The aim of this study was to identify the epidemiological features of burn accidents as the basis for a prophylactic programme to protect young children from scalds and older children from the hazards of fire games and child labour. The study covered the incidence, cause, place, and time of the burns. Demographic aspects, burn severity, socioeconomic factors, and mortality rate were also included in this study of burned children in Upper Egypt aged 0-16 yr in the 6-yr period 2004-09.

Randomized clinical trial of laparoscopic gastric bypass versus laparoscopic duodenal switch for superobesity.

BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic biliopancreatic diversion with duodenal switch (LDS) are surgical options for superobesity. A randomized trial was conducted to evaluate perioperative (30-day) safety and 1-year results. METHODS: Sixty patients with a body mass index (BMI) of 50-60 kg/m(2) were randomized to LRYGB or LDS. BMI, percentage of excess BMI lost, complications and readmissions were compared between groups. RESULTS: Patient characteristics were similar in the two groups. Mean operating time was 91 min for LRYGB and 206 min for LDS (P < 0.001). One LDS was converted to open surgery. Early complications occurred in four patients undergoing LRYGB and seven having LDS (P = 0.327), with no deaths. Median stay was 2 days after LRYGB and 4 days after LDS (P < 0.001). Four and nine patients respectively had late complications (P = 0.121). Mean BMI at 1 year decreased from 54.8 to 38.5 kg/m(2) after LRYGB and from 55.2 to 32.5 kg/m(2) after LDS; percentage of excess BMI lost was greater after LDS (74.8 versus 54.4 per cent; P < 0.001). CONCLUSION: LRYGB and LDS can be performed with comparable perioperative safety in superobese patients. LDS provides greater weight loss in the first year.

Obstructive uropathy in Sudanese patients.

In this paper we describe the causes, patterns of presentation, and management of obstructive uropathy in Sudanese patients in a retrospective multi-center audit. All patients who presented with obstructive uropathy during 2005 were included in this study. All of the patients were subjected to serial investigations including imaging and tests of renal function. Diversion, stenting, and/or definitive surgery were performed in order to relieve the obstruction. Five hundred twenty patients were diagnosed with obstructive uropathy during this period; 345 (66%) patients presented with chronic obstruction and 175 (34%) with acute obstruction. Of the study patients, 210 (40%) presented with significant renal impairment; 50 (23%) of them required emergent dialysis. The patterns of clinical presentation of the obstructed patients included pain at the site of obstruction in 48%, lower urinary tract symptoms in 42%, urine retention in 36.5%, mass effect in 22%, and anuria in 4%. Patients in the pediatric age group constituted 4% of the total. The common causative factors of obstruction included congenital urethral valves, pelvi-ureteral junction obstruction, urolithiasis, and iatrogenic trauma, especially in the obstetric practice. Renal function was completely recovered with early management in 100% of patients with acute obstruction and was stabilized in 90% of patients with chronic obstruction. Four patients were diagnosed with end-stage renal failure; two of them were transplanted. The mortality rate in this study was less than 0.3%.

Familial chronic myelocytic leukaemia-like syndrome probably of congenital origin.

Three Saudi siblings presented with clinical features of chronic myelocytic leukaemia in early infancy. Their parents are first cousins. The mother was 22 years old during her first pregnancy. She had no history of abortion. The possibility of this familial disorder being congenital is discussed.

Colonic malacoplakia and abdominal tuberculosis in a child. Report of a case with review of the literature.

A 4 1/2-year-old girl had colonic malacoplakia of two years' duration, the presenting symptom being rectal bleeding. Abdominal tuberculosis and Escherichia coli lumbar abscess were diagnosed at the age of 3 1/2 years. Despite antituberculous treatment, there was no improvement and she died from protein-losing enteropathy. The patient is discussed and the literature reviewed, with special emphasis on the incidence of malacoplakia in children, the aggressive nature of colonic malacoplakia, and the lack of response to treatment. A brief review of the pathogenesis of malacoplakia is considered.

Sexually transmitted diseases in Sudanese males.

One hundred and thirty-eight male adult patients were examined clinically for STD in two VD clinics in Khartoum Province. Specimens were collected for microbiological investigations. NGU was the commonest STD encountered (35.1%). Next came gonorrhoea (25.9%) and other STD. Syphilis accounted for only 1.3% of the cases investigated. Most of the patients with STD were in the age range 20-39 years. Of the infected patients 49.3% had their infections from prostitutes. Nearly half the patients examined and found infected with STD were in the low-paid socioeconomic group; and 71.4% of them were single. The social and cultural factors related to these results were discussed in the report.