No abstract

Osteoarticular tuberculosis (TB) of the ankle joint is rare, and there is a delay in diagnosis in most cases. All patients with the disease complained of swelling and pain in the affected ankle. Ankle TB is a disorder that can be simply misdiagnosed. The delay in diagnosis may range from months up to years. All patients in this series had already been diagnosed with ankle TB by the time they visited our hospital. The current case was reported in a middle-aged male nurse with ankle pain, ulcer, and limited range of movement. The classical clinical manifestations of TB were absent on free chest radiography. Ulcer biopsy showed TB infection with no lymph nodes. Nonspecific inflammation was initially treated, but, subsequently, anti-TB treatment was useful.

Introduction: Insulin resistance in obesity and type 2 diabetes mellitus (T2DM) is associated with cardiovascular complications such as atherosclerosis. On the other hand, the reduction of apoptosis in macrophages has been linked with accelerated atherosclerosis. Apoptosis is controlled by a different family of proteins including Bcl-2 and caspases. Methods: To examine apoptosis in insulin resistance, we assessed the mRNA expression by qRT-PCR of several Bcl-2 family members, as well as caspase-3, −7, −8, and −9 in peripheral blood mononuclear cells (PBMCs) isolated from lean, obese, diabetic, and diabetic on metformin individuals. Results: PBMCs of diabetic individuals exhibited reduced expression of caspase-7 and increased expression of Bcl-10, Bad, Bax, Bid, and caspase-3. T2DM on metformin group had significantly higher Bad, Bax, and caspase-7 expression. Discussion: The moderate up-regulation of pro-apoptotic Bcl-10, Bax, Bad, Bid, and the effector caspase-3 coupled with inhibition of caspase-7 in circulating PBMCs of T2DM could be the result of increased inflammation in T2DM. Metformin treatment significantly inhibited the expression of Bcl-10, Bid, and caspase-3 and upregulated Bad/Bax/caspase-7 pathway suggesting the activation of Bad/Bax/caspase-7 apoptotic pathway. Further studies are warranted to elicit the underlying apoptotic pathways of PBMCs in T2DM and following metformin treatment.

Overcrowding in Emergency Department usually results in serious consequences such as delay in facilities, medical errors and medical complications as well. This occurs because delay in transfer of the patients from ED to inpatient departments. We conducted this study to know patients' and their attendants preferences to stay in ED or to be shifted to in-patient units. Data was collected via Arabic translated questioner. A total of 316 applicants included in the study (after inclusion / exclusion criteria), 144 patients with 157 patient attendants. 75 (52.1%) were male, while 69 (47.9%) were females. The preferred area for boarding was ED curtained space for 77.8% of patients and 79% of patient watcher as compared to 11.8% patients and 15.3% attendants who accepted the admission to inpatient hallway (p-value 0.253). Regarding the comparison of boarding time (8 hours and 24 hours), 55.5% of patients preferred in ED with 8 hours scenario versus 29.9% who preferred inpatient hallway (p=0.0897). When 24 hours scenario was compared, it was found that 59% patients preferred ED while 49.7% preferred inpatient hallway (p= 0.252). Current study proves that collectively patients prefer to stay in ED (either curtained space or hallway); this is because the patients received quick facilities and attention from the staff. However, with 24 hours scenario, more patients now preferred to stay in in-patient hallway; this is because of delay in transfer of the patients from ED, and delay or lack in facilities which usually occur during overcrowding. We concluded that patient and their preferences differ in different settings. However, overcrowding in ED should be dealt seriously with transfer of patients to in-patient departments / wards as soon as possible to avoid medical errors and complications.

Background: Ocular manifestations of inflammatory bowel disease (IBD) considered being the most common extraintestinal complication. Eventually, early detection and management improve the patient's quality of life as well as prevent potentially visually threatening complications. Objectives: To assess the prevalence and pattern of ocular manifestations among patients with inflammatory bowel disease during the COVID-19 pandemic. Materials and Methods: Cross-sectional study was performed using anonymous online surveys were administered which included the participant's demographics, prevalence and pattern of IBD intestinal and ocular manifestations, precipitating factors, and quality of life. Data were analyzed using (SPSS) version 20 (Armonk, NY: IBM Corp.). Chi-squared test Mann–Whitney and Kruskal–Wallis tests were applied. A P < 0.05 was considered statistically significant. Informed consent and ethical approval were obtained. Results: A total of 216 participants responded to the survey with 50.50% of females and 49.50% were male. About 90.3% of the participants had their GIT symptoms start before their eye symptoms. Almost two-thirds of the participants, (68.5%) suffered from frequent severe bowel symptoms that prevented them from carrying out work and/or perform the normal daily activity. Furthermore, one-third of the participants (31.6%) are unemployed and described a positive family history (32.8%). More than 75% of participants described eye symptoms associated with the intestinal disease activity which range from mild self-limiting to more severe ones that required hospital visits (50%). Although, majority of participants (90.00%) did not routinely receive official referral to ophthalmologist. The non-significant difference was found between the presence of eye symptoms and participant's gender, marital status, educational level, stress, and smoking habits. Conclusion: Most of the IBD patients suffered from significant ocular manifestations with frequent hospital visits. Misdiagnosis and/or inadequate management negatively affect the quality of life of IBD patients during the COVID-19 pandemic. Risk-based Ophthalmic screening strategy may reduce the impact of IBD.