IS ACROMEGALY A HYPERCOAGULABLE CONDITION? CASE REPORTS AND REVIEW OF THE LITERATURE

Introduction: Cardiovascular complications are a major cause of morbidity and mortality in patients with uncontrolled acromegaly. However, there are no published reports of an increased risk of venous thromboembolism (VTE) in such patients. We report three patients with uncontrolled acromegaly who presented with VTE. Clinical Cases: A 52-year-old male with uncontrolled acromegaly despite transsphenoidal (TSP) surgery and medical therapy presented in 2012 with acute chest pain and shortness of breath that was later con rmed as secondary to pulmonary embolism. A 44-year-old male immigrant, previously treated for acromegaly with radiation therapy alone, in 1992, in his native country, was referred to our centre in 2006 for acromegaly which remained uncontrolled despite medical therapy until 2009 when he achieved remission through TSP surgery. He had several episodes of VTE between 2008 and 2010. A 69-year-old male with uncontrolled acromegaly for 28 years despite two surgical resections and radiation therapy in 1986 and 1992, as well as continuous medical therapy, presented with VTE of the right axillary vein and bilateral pulmonary emboli in 2011. A thrombophilia screen in case 1 showed mild protein S de ciency, case 2 was homozygous for factor V Leiden (FVL) mutation and case 3 was heterozygous for FVL. Extensive investigations revealed no evidence of malignancy and echocardiography showed preserved ejection fraction in all three patients. Conclusion: Patients with uncontrolled acromegaly may be at increased risk of VTE. However, larger studies are required to further assess this association and determine the underlying cause. Key words: Acromegaly, pituitary tumours, thromboembolism

“Ramadan challenges: Fasting against medical advice

AbstractAim: Fasting against medical advice (FAMA) is a major challenge for many physicians who treat patients with diabetes during the month of Ramadan. The significance of this phenomenon has not been evaluated in Muslim populations. The goal of this study was to assess the rate and consequences of FAMA in our high-risk patients.Methods: This is a retrospective case-control study. Patients were divided into two groups: (Group A) included high risk patients who decided to fast against the advice of their health care providers, and (Group B) included the low risk patients who were permitted to fast. Results: A total of 401 patients were evaluated. Out of the whole group, 147 patients were categorized as high risk for fasting. (Group A) included 111/147 patients who decided to fast against medical advice and (Group B) included 254 patients permitted to fast. The average number of fasted days and the proportion of patients who were able to fast the whole month were smaller in Group A than Group B (26±3 SD and 51% versus 29±1 SD and 87%, respectively,

Exploring the challenges and opportunities in the Water, Energy, Food nexus for Arid Region

Water, Energy, and Food sectors are interlinked in a nexus wherein actions relevant to one sector can often influence other sectors to a high degree. Globally, there has been a growing focus on ensuring water, energy, and food security in different kinds of frameworks and models. The current research aims to describe the complex interlinks between the three sectors by evaluating the challenges and opportunities in the following domains: policy, management, and technology. The hypothesis is to provide a basic practice framework to secure better outreach to tackle the interlinks and mismatches within the nexus elements. The methods used a dynamic framework through a transdisciplinary team; the team divided the nexus into six sub-sectors and collecting the primary data through fieldwork interviewing 22 stakeholders and secondary data of 211 literature. The approach of complex adaptive systems and evolving mental models have been used to analyse and develop the framework. The results show that interlinks within the water, energy, and food nexus are quite challenging to be identified since each region has different needs. However, the customized framework covered the gaps holistically, which can be used as a fundamental practice guideline. The study also proposed practical solutions and highlighting the opportunities to secure the future of sustainable development goals