Background:Fasting during the month of Ramadan is of vital significance amongst Muslims; however, little is known about the effects of this kind of fasting on patients with coronary artery disease (CAD).Objectives:This nonrandomized prospective observational pilot study was designed to investigate the effects of Ramadan fast on the symptoms of CAD.Patients and Methods:Patients with documented CAD were consecutively (nonrandomized) included in the study, and those with heart failure (ejection fraction < 50%), renal failure, gout, and insulin-treated diabetes were excluded. Patients had the choice of fasting during Ramadan if they so wished and to break their fast as soon as symptoms such as dyspnea and chest pain occurred (fasting group) or not fasting (control group).Results:A total of 148 patients completed the study. Mean (mean ± SD) age of the patients was 61.5 ± 11.7 years and 50% were male. Finally, 66 patients (44.6%) accomplished Ramadan fast with an average of 22.27 ± 10.46 days of fasting. Occurrence of chest pain was not significantly different between the fasting and non-fasting groups (4 out of 66 [6.1%] vs. 8 out of 82 [9.8%] respectively; P = 0.42). In addition, patients who fasted during Ramadan did not experience a higher frequency of a combined endpoint of chest pain and dyspnea (4 out of 66 cases in the fasting group [6.1%] vs. 11 out of 82 in non-fasting group [13.4%]; P = 0.14).Conclusions:In the present study, the patients with CAD were able to observe Ramadan fast safely and their combined endpoint of chest pain and dyspnea was not significantly different from that of the non-fasting ones. We would suggest that patients with CAD and normal left ventricular function could fast during Ramadan.

Intracranial plasmacytoma is an exceedingly rare presentation of plasma cell neoplasms. Usually presenting late in the course of the disease, progression from the presentation can be abrupt. Hence, a low threshold to biopsy the lesion should be maintained during diagnostic evaluation. Multiple myeloma workup should also be sent and treated concomitantly along with local treatment. Here, we present a case of extramedullary plasmacytoma of the clivus leading to progressive visual deficits with undiagnosed multiple myeloma requiring pulse steroids, intracranial irradiation, and high-dose chemotherapy with improvement in symptoms.

Primary pulmonary leiomyosarcomas (PPLs) are extremely rare tumors of the lungs. They can present with non-specific symptoms or can also be asymptomatic with clues towards diagnosis being found on routine examination or radiographs. We present a case of a 54-year-old woman who presented with worsening shortness of breath and spells of dizziness. Her chest radiographs showed right-sided pleural effusion and CT revealed a large enhancing pleural mass with compression atelectasis and mediastinal shift. She underwent a thoracoscopy and right pleural biopsy. Histopathology and immunohistochemistry were most consistent with leiomyosarcoma. An extensive search for a possible primary in other sites was unrevealing, thus diagnosing the patient with PPL. She was managed with surgery and radiotherapy.

Multiple myeloma (MM) is the second most common hematologic malignancy and most common primary bone malignancy. Ocular manifestations of MM are extremely rare and may be the first presentation leading to diagnosis. Ophthalmologists routinely encounter cavernous sinus syndrome, and there is a wide range of possible etiologies. Here, we present a case of a patient presenting with diplopia, ptosis, and ophthalmoplegia found to have a cavernous sinus plasmacytoma with systemic workup consistent with MM. MM is a rare cause of cavernous sinus syndrome and should be considered in the setting of a skull base mass.

RATIONALE: Eosinophilic esophagitis (EoE) is diagnosed and monitored by identification of esophageal eosinophilia via endoscopic biopsy. The endoscopic reference score (EREFS) is used to describe EoE by grading edema, rings, exudate, furrows, and strictures. This study aimed to predict esophageal eosinophilia with EREFS in pediatric patients. METHODS: This retrospective study stratified 137 endoscopies among 58 patients (ages 5 to 22) by the diagnosis of EoE, defined by a peak eosinophil count >15 eos/hpf. Component and composite EREFS were compared to histology using Fisher's exact and Chi-square tests. Generalized estimating equations were used to assess risk factors for EoE, estimate ROC curves, and determine sensitivity and specificity. RESULTS: On average, a 1-point increase in EREFS was associated with a 9.8-point increase in eosinophilic count (95% CI: 7.0, 12.6; p<0.001). The odds of having EoE were 31 times (95% CI: 6, 159) greater among patients with an EREFS > _4 compared with EREFS < _1. Utilizing exudate and furrows (reduced score) to discriminate among patients with EoE yielded an AUC of 0.88 for the ROC compared with 0.74 for EREFS (p50.15). A cut point of 1 for the reduced score had an 88% sensitivity and 86% specificity; while a cut point of 1 for EREFS yields a 91% sensitivity and 69% specificity. CONCLUSIONS: EREFS correlates with esophageal eosinophilia; however, a reduced score may be more accurate at identifying EoE. These findings suggest that esophageal appearance can screen for EoE, raising the possibility of using less invasive techniques, such as esophageal video capsule, for diagnosis or surveillance. Abstracts AB137 SUNDAY