Tuberculous myocarditis is not always fatal: Report of three confirmed cases with uneventful outcome

Tuberculosis (TB) is a leading cause of death worldwide. It can affect any organ. However, cardiac involvement is extremely rare. Anti-TB therapy has been proved to be effective and curative in majority of TB cases except TB myocarditis, where it is found to be fatal. We describe three cases with confirmed TB with impaired left ventricular systolic function and low ejection fraction. All three cases improved clinically and left ventricular function returned to normal within a few weeks after the commencement of TB therapy

Lung granuloma: A clinicopathologic study of 158 cases

Background and Aims: A granuloma is a common pathological diagnosis in lung biopsies and is caused by a variety of etiologies. The aim of this study was to assess the etiology and frequency of different cases of lung granulomas. Methods: The medical records of all patients who had lung granulomas between 2005 and 2013 were retrospectively reviewed. Based on the histological features of the granulomas, along with the clinical, laboratory, and radiological findings, an attempt was made to identify the etiology of the granuloma in each case. Results: A total of 158 patients with lung biopsy specimens showing lung granulomas were identified. The histological findings revealed necrotizing granulomas in 92 (58%) of the cases and nonnecrotizing granulomas in 66 (42%). A definite etiology was determined in 133 cases (84%), whereas in 26 cases (16%), the etiology could not be identified despite an extensive workup. Infection was the most frequent cause of granuloma, accounting for 105 cases (66%). Mycobacterial tuberculosis (TB) was the type of infection that caused the largest number of granulomas, and was responsible for 100 cases (63%). Among the noninfectious etiologies of lung granuloma, sarcoidosis was the most common cause, accounting for 20 (13%) of the cases. Conclusions: Mycobacterial TB and sarcoidosis are the most common causes of lung granulomas in our region. In a substantial proportion of cases, the cause may not be identified despite an extensive workup

Characteristics of bladder neoplasms in the young population of Saudi Arabia

Context: Bladder neoplasms are a well-studied subject in medicine. However, the evidence of bladder neoplasms in children and the young adult population (≤40 years), particularly in Saudi Arabia, is lacking. Aims: The aims of this study were to identify histopathological characteristics as well as clinical features, prognosis, and treatment of bladder neoplasms in this age group in a single tertiary referral center, Riyadh, Saudi Arabia. Settings and Design: A retrospective cohort study. Materials and Methods: Children and young adults (≤40 years) diagnosed with epithelial and mesenchymal bladder neoplasms from 1994 to 2017. Statistical Analysis Used: Descriptive data are presented as mean (standard deviation) or median (interquartile range) for continuous variables and n (%) for categorical variables. Statistical Package for Social Sciences version 23 was used. Results: Thirty-eight cases were identified. The majority, 71.1% (n = 27) were male. The median age of diagnosis was 33 years ranging from 1 to 40 years. Nearly 45% (n = 17) were smokers. Macroscopic hematuria was present in 57.8% (n = 22). The most common histopathology was papillary urothelial carcinoma (n = 18, 58%). All mesenchymal neoplasms accounted for 18.4% (n = 7). Of all malignancies, 63.2% (n = 24) and 44.7% (n = 17) were low stage and low grade, respectively. Transurethral resection of bladder tumor (TURBT) was conducted for 81.6% (n = 31). The mean length of follow-up was 36.05 months (±39.4 months). Recurrence occurred in 15.8% (n = 6) and 7.9% (n = 3) had progression. Distant metastasis was reported in 5.3% (n = 2). Nearly 8% (n = 3) died during their follow-up. Conclusions: Bladder malignancies at the early fourth decade of life tend to be a low stage and low grade. The most common histopathology was papillary urothelial carcinoma. Management should be based on the clinical and histopathological features. However, most of the patient underwent TURBT

Symptoms of Daytime Sleepiness and Sleep Apnea in Liver Cirrhosis Patients

Background/propose: Sleep disturbance and excessive daytime sleepiness (EDS) have been reported in patients with hepatic cirrhosis with no hepatic encephalopathy (HE). The objective of this study was to evaluate daytime sleepiness and risk of obstructive sleep apnea (OSA) among liver cirrhosis patients. Material and methods: A cross-sectional study was conducted at King Abdulaziz Medical City (KAMC)-Riyadh over a period of six months, using a structured questionnaire that investigated: 1) Sleep patterns and daytime sleepiness using the Epworth Sleeping Scale (ESS), and 2) The risk for sleep apnea using the Berlin Questionnaire (BQ). We enrolled patients with a confirmed diagnosis of liver cirrhosis who were being followed at the hepatology and preliver transplant clinics. Results. We enrolled 200 patients with liver cirrhosis, 57.5% of whom were male. The mean age was 60 (± SD 12.2). The reported prevalence of EDS, OSA, and both EDS and OSA were 29.5%, 42.9%, and 13.6%, respectively. The prevalence of EDS was higher in patients with Hepatitis-C and patients with DM, who experienced short sleep duration. We did not find any association between the severity of liver disease and EDS or OSA as measured by Child-Pugh scores (CPS). Conclusions. The risk of OSA and EDS is high among liver cirrhosis patients. Those patients with cirrhosis secondary to Hepatitis C are at higher risk of EDS and OSA. Both EDS and OSA affect patients designated as CPS Class A more frequently than patients designated as CPS Class B