Reports, Volume 1, Issue 3 (December 2018) – 9 articles

Tuberculosis (TB) is a global public health concern, specifically in countries which have high prevalence of HIV/AIDS, malnutrition, unhygienic conditions, etc. Some evidence has been presented that diabetes mellitus (DM) is a risk factor for TB. On the other hand, among those who have DM, TB infection enhances glucose intolerance and worsens glycemic control. The combination of TB and DM, due to immuno-compromised status of DM, can delay the healing process of TB. The focus of this paper is the World Health Organization directly observed treatment, short course (DOTS) program implemented in Gazan province, Saudi Arabia, to treat TB. The data included some patients with both TB and DM. The data has been analyzed to assess how effective the DOTS program was in managing TB. It was found that DM was not a significant factor in the outcome of TB treatment. We used the same data and observed that the non-significance of DM is due to heterogeneity of patient population, Saudis and Non-Saudis. The prevalence of DM was very high among Saudis. This is understandable in view of different lifestyles. Non-Saudis are predominantly Yemenis. For Saudis, DM was indeed found to play a role in the treatment outcome of TB, after an application of a classification tree methodology on the data. This is the main focus of the paper. Full article

Facial fractures are the third most common type of fracture, with the nose most frequently involved. In the United Kingdom, their incidence is rising among young males particularly, and recent reports suggest that nasal injuries in females are becoming more common, which is attributed to “ladette” culture. The aim of this study was to investigate if there is any correlation in Wales with the rise in female facial fractures reported in England. A retrospective analysis of National Health Service Wales Informatics Service data (NHS WIS) shows that facial fractures were more likely to occur in males, in their teens or twenties, most commonly caused by assault and linked to alcohol consumption in this demographic. The most common cause of facial fracture in Wales was due to an accident which differs from England. The overall number of facial fractures in both males and females did not change significantly. It may be that the binge drinking culture is not as prevalent in Wales as it is in England. The reasons for this may be mutifactorial, reflecting geographical, cultural and socio-economic factors. Our findings do not correlate with the literature regarding the epidemiology of facial fractures. We suggest that binge drinking and “ladette culture” is not seen as commonly in Wales from the point of view of the ill effects of alcohol consumption. Full article

We report a rare case of a 23-year-old male who presented with a four-week history of unilateral recurrent epistaxis and nasal obstruction. This was subsequently diagnosed as high-grade chondroblastic osteosarcoma of the maxillary antrum. Neo-adjuvant chemotherapy was commenced following a multidisciplinary team discussion. The disease progressed through first-line treatment. A radical surgical resection was not possible, and a palliative debulking procedure was performed. The literature comprehensively points towards an early surgical resection with suitable margins at the earliest possible stage. This case highlights that osteosarcoma of the maxilla can be challenging to diagnose and manage. Thus, a high index of suspicion and an early referral to a head and neck specialist is imperative to improve the long-term prognosis in such patients. Full article

Endoscopic sinus surgery is a rapidly advancing area of Otolaryngology. Operations can be lengthy and are often performed by a single surgeon. Repetitive movements can also lead to muscular fatigue. To mitigate against this, we regularly deploy two retractable Flexi™ compact leads, one bigger than the other connected together and suspended from the theatre operating light arm using velcro ties. The leads are then wrapped around the endoscope using a cotton crepe bandage, in a double loop with a reef knot. The larger lead attaches to the focus/zoom adjustment part of the endoscopic camera, and the smaller lead attaches to the scope 20 cm from the tip allowing the scope to float when suspended, with a slight downward tilt towards the patient. The mechanical effect this produces allows an advantageous reduction in the scope’s weight from 404 g un-suspended, to 65 g with the setup described. This subsequently reduces stress on the elbows, shoulders neck and lumbar spine. The Swansea Floating Endoscopic Assistant adheres to basic ergonomic principles and has the potential for application in other areas of Otorhinolaryngology and Skull Base Surgery. Full article

Obesity is a growing health problem worldwide, associated with serious medical and psychosocial comorbidities that increase the risk of mortality. Strong evidence confirms lifestyle modification programmes as the cornerstone of its treatment. However, the available long-term lifestyle modification programmes for weight management delivered in Arabic-speaking countries seem to be lacking in effectiveness in terms of weight-loss maintenance and do not conform to the standard for clinical significance. Factors such as methodological weaknesses in programme transcultural adaptation and the lack of expert clinical supervision before and during implementation seem to underlie this discrepancy. In this case report, we describe for the first time an Arabic-speaking patient with obesity and severe lumbar intervertebral disc degeneration, who successfully underwent weight management by means of a new, well-adapted and well-implemented personalized cognitive behavioural programme for obesity (CBT-OB). After eighteen months, the patient displayed significant weight-loss maintenance (~16% weight-loss), improvement in total and central body fat distribution, reduced pain from disc degeneration, and an increase in high-density lipoprotein (HDL). The CBT-OB programme may be a feasible approach to managing Arab patients with obesity, producing long-lasting weight-loss maintenance improvements in the obesity-related profile. Full article

The monoclonal antibody denosumab reduces bone resorption. Warfarin is an oral anticoagulant used in the prevention and treatment of thrombosis. To date, there have been no studies on the interaction between warfarin and denosumab. The aim of the present study was to assess the maintenance of the Prothrombin Time International Normalized Ratio (INR) in the therapeutic range (TTR) in women under treatment with warfarin and denosumab, in order to evaluate the pharmacological interference of denosumab. No variations of the median TTR were found after undergoing treatment with denosumab: this shows that the intake of denosumab does not require additional checks in anticoagulated patients. Full article

A common cause of abdominal pain is acute pancreatitis, with the majority of cases being attributed to gallstones and excess alcohol. Sickle cell anaemia (SCA) is an autosomal recessive disease causing the production of abnormal haemoglobin. Physiological changes can lead to vaso-occlusion in sickle cell anaemia. Cholelithiasis is frequently seen in patients with SCA and complications from this can increase patient morbidity. We present a rare case of acute pancreatitis inducing a vaso-occlusive crisis. Full article

We describe the case of a 42-year old man who presented with melaena. He was found to have bleeding varices during endoscopic investigation. Subsequent investigation revealed the aetiology to be a portal vein thrombosis (PVT) due to an underlying pro-coagulable state (Factor V Leiden). He was managed with cautious anticoagulation but suffered a life-threatening upper gastrointestinal bleed that was not amenable to endoscopic treatment or transjugular intrahepatic portosystemic shunting (TIPS). As such, the only therapeutic option involved the pursuit of surgical shunt operations. We review the literature regarding this atypical cause of GI-bleeding and discuss medical and surgical considerations for the management of such patients. Full article

We present the case of an eighty-two-year-old man who presented with testicular pain, diarrhoea, fresh rectal bleeding, and weight loss. A clear history was not obtained because of presumed chronic confusion secondary to age related vascular dementia. He was subsequently diagnosed with Fournier’s gangrene and a retrospective obtainment of his collateral history revealed a completely normal pre-morbid cognitive level of function. Thus, his confusion was secondary to an atypical cause of sepsis and he was managed with surgical debridement. We highlight the value of urgent computed tomography (CT) scanning as well as the use of screening tools for assessing cognitive function, particularly in surgical specialties, as well as the importance of obtaining a collateral history and discussing means for better collaborative efforts amongst surgeons and physicians in managing the “confused patient”. Full article