Background: Lynch syndrome LS is a life-threatening condition caused by heterozygous mutations in mismatch repair genes (MMR). People with this syndrome are at increased risk of developing different types of cancers, such as colorectal carcinomas, endometrial cancer, and ovarian cancers. Case Report: The present case report discusses the case of a 36-year-old non-diabetic non-alcoholic female who came to the oncology department with a known history of Lynch syndrome. The patient had a significant past medical history. In 2003, she was diagnosed with left colon cancer for which she had left hemicolectomy followed by adjuvant chemotherapy. In 2004, she developed duodenal cancer for which she had Whipple surgery. Then, she developed ovarian cancer on both sides, which was also treated by surgery and adjuvant chemotherapy. After that, she developed uterine cancer, treated by surgery and adjuvant chemotherapy. The patient had a total colectomy and she underwent two ileostomy procedures. In 2014, immunohistochemistry testing confirmed the diagnosis that she was suffering from Lynch syndrome. Additionally, cancer sequencing panel testing in 2016 and MSH testing in 2018 further confirmed the diagnosis of Lynch syndrome as only the loss of nuclear expression of the PMS2 gene was revealed. Then in 2018, she developed a peritoneal metastasis of ovarian origin. This was the first time she started Pembrolizumab immunotherapy, that was finished at the end of 2019. One intriguing fact is that all her diseases cleared up and she continues to live normal life four years after stopping immunotherapy and she is in complete remission. Also, all her tumor markers have dropped down and normalized. Conclusion: Carrying the PMS2 germline mutation confers an extraordinarily high risk of developing LS-associated cancers. To decrease the morbidity and mortality associated with LS-related cancers, intensive clinical monitoring, pembrolizumab therapy, and preventive surgeries are strongly advised.

Multiple sclerosis is a chronic inflammatory disease of central nervous system that commonly affects young adults. Although ocular movement disturbances are commonly encountered in multiple sclerosis, bilateral horizontal gaze palsy is quite rare. We present a case of young woman presented with dizziness, intractable vomiting and visual disturbances for one week, on examination found to have complete bilateral horizontal gaze palsy while vertical gaze was intact. Brain MRI showed a small lesion in posterior part of medial pontine tegmentum bilaterally which was responsible for patient`s symptoms. She received five doses of one-gram methylprednisolone, her symptoms gradually improved over one week after treatment.

A 38-year-old male presented with a complaint of upper GIT bleeding. The patient is an alcoholic and a smoker for the last 5 years. The patient had vomited blood for the last three days. Endoscopy, Biopsy, Esophagogastroduodenoscopy and CT scan of abdomen and pelvis with IV contrast were recommended. After initial examination and reports, the patient was diagnosed with Gastrointestinal Stromal Tumor. Gastrointestinal stromal tumor was found that was spindle cell type, unifocal and low grade with mitotic speed of 2-3 /5 mm2.The tumor originated in the gastric submucosa and spread to the pericolic fat omentum. The tumor was large, being 9.5cm cm and 6.5 x 5.5 cm in greatest dimension measurements. The tumor measured more than 5 cm, but was less than 10 cm in diameter. The overlying gastric mucosa showed focal mild chronic inflammation. Heliobacter pylori and focal intestinal metaplasia was noted. As a treatment for gastrointestinal stromal tumor, surgery was recommended to remove the large exophytic gastric mass. After surgery, heterologous fragments were received. The mass of the tumor was 0.8cm with a mitotic rate of 2-3 /5 mm2 per 10 high-power fields (HPF). The examination and diagnosis also included some special studies such as immunohistochemistry assay. However, no mutational analysis test was performed. Immunohistochemistry assay was positive for C-KIT (CD117), CD34 and DOG1.

the creative commons attribution noncommercial License. This allows others to remix, tweak, and build upon the work non commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. Abstract A 47 years old man presented to the hospital department with pain in his anterior neck region. The pain was also present when the patient swallowed food. Along with this pain, the patient also complained of suffering from low-grade fever, myalgia, and fatigue. Before coming to the hospital, the patient had taken NSAIDs for 5 days straight, but with no effect on his pain and other conditions except for temporary relief. Then 4 days back, he went to a private hospital where his lab investigations were ordered. The patient came in positive for hyperthyroidism. The medicines prescribed by that hospital setting were of no use and again, did not help in reducing his symptoms. Along with the usual lab investigations and the thyroid profile ordered for this patient, his general physical examination was performed. The patient was afebrile at the time of examination, he had no fine or shaking tremors in his hands. Yet, there was a visible diffuse swelling noticed on his neck, which was very much consistent with the findings of goitre. Apart from this, no cervical lymphadenopathy was appreciated. No other abnormality was detected in the rest of the examination. The patient's CBC report was normal as well.

Laparoscopic surgery has been around in the general surgery world for a long time. It has revolutionized how conventional surgeries used to be carried out. Performing laparoscopic surgery , there is a faster recovery time, complications are less likely, and a significantly lower bleeding and hemorrhage-related risk in these patients. However, some surgeries are still carried out in the traditional 'open 'way. One major reason for this is the lack of skilled professionals available to carry out such complicated cases alone or the fact that some surgeries provide better access to the surgeons when carried out traditionally. This case study revolves around two patients, both of which presented with situs inversus. Situs inversus is a congenital condition where the majority or all of the organs present in the chest and abdomen mirror their normal physiological positions, that is, they are present in the opposite direction of where they normally should be. Since the condition revolves mainly around the 'position 'of the major body organs and does not usually involve any defect or malfunctioning in their ' function', it is usually seen that the affected people are capable of living on their own, without any complications affecting their lives. However, this was not the case with both of the patients that are being discussed in this case study. Both of them developed cholelithiasis. Their case was already bound to face complications owing to their condition-situs inversus. But, due to the presence of efficient and skilled surgeons working on the case, it was seen that laparoscopic cholecystectomy was performed on both of these patients. Whether this surgery was carried out successfully or led to further complications is the focus of this paper. Along with that, this study also aims to revolve to look at the diagnostic measures that led to effectively diagnosing the condition in these patients affected by situs inversus. Case Study

A 30-year-old male patient presented with a mixed complaint. He initially had developed complaints of backache two months ago. This pain was accompanied by the formation of two lumps in the back in the upper and lower regions. However, this was not the reason behind him presenting to the hospital. He complained of hoarseness of the voice, which seemed to have no background. The man is neither an alcoholic nor a smoker. He has no significant medical or surgical history. His work history also remains unrelated to the hoarseness of his voice, as he is not required to speak loudly, which is typically linked to over exertion of the vocal cords. Upon examination, it was learned that the two lumps that the patient had initially observed had grown in number. Now, there were several lumps on his back and shoulder regions. When this particular observation, coupled with the hoarseness of voice, was investigated via diagnostic imaging techniques such as X-ray, CT, and MRI, it was discovered that the patient was suffering from Grade IV Pancreatic Adenocarcinoma. The cancer had progressed significantly as there was numerous organ involvement observed. The liver, adrenal glands, lungs, subcutaneous tissues, and muscles were all seen to be involved. Along with this, he had also developed bilateral deep vein thrombosis on both his lower limbs. Although the patient had no significant symptoms that could have forced an earlier diagnosis, it was evident that the carcinoma was pancreato-biliary in origin. Case Study Chelal et al.; JCTI, 12(3): 22-29, 2022; Article no.JCTI.89111 23 The patient is now undergoing his chemotherapy, and so far, he has shown a remarkable 'partial' response to his treatment cycles. Therefore, a good prognosis is hoped if the progress remains the same over time. This case study aims to reflect on all the possible angles of this patient's presentation. It is also the utmost priority to correlate and investigate the link of his hoarseness with his actual cancer. This case study will guide future physicians and clinicians who will come across confusing cases such as these to reach a conclusive diagnosis. Had it not been for the advanced diagnostic imaging technologies available within reach of both the hospital and the patient, the patient undoubtedly would have only been treated for his hoarseness, leaving the actual disease unchecked, undiagnosed, and untreated.

One of the common questions for patients with a history of cardiovascular disease is whether it is safe for them to fast during Ramadan. Yet, studies on the effects of Ramadan fasting on blood lipids, blood pressure, anthropometric parameters and other cardiovascular risk factors are scarce, and have given inconclusive results. The aim of this study is to investigate the effect of Ramadan fasting on cardiovascular risk factors including biochemical indices, blood pressure and main anthropometric parameters. This Prospective observational study was conducted at the CCU (Coronary care unit) and medical wards of Madinat Zayed hospital one of Al Dhafra hospitals, under Seha Abu Dhabi. Fifty-Six diabetic patients admitted with cardiovascular events including 48 males and 8 females with a previous history of cardiovascular event completed the study. Their age ranged between 32 and 91 years with a mean of 54.0 ± 10 years. A non-significant slight biochemical modification with regard to the metabolic profile pre, during and post-Ramadan period was reported: eGFR, total cholesterol, LDL, and HDL were increased yet, triglycerides and creatinine were non-significantly lower during Ramadan. Findings also showed a non-significant decrease in the post Ramadan blood pressure values which could be attributed to the metabolic switch.

A 22 year old adult male shifted from Congo 2 months ago presented to the Emergency Department with complaints of having a fever for the last three weeks. The fever was associated with chills and sweating, and occasional dizziness. Two weeks later, the man developed a cough, which was productive and caused him to develop shortness of breath with its onset. The patient's overall condition rendered him appetite less, with a poor-quality oral intake of food and fluids. His COVID19 PCR came out negative, and he had no contact with a positive patient.Further history revealed that the patient had developed Malaria a long time ago and was prophylactically treated for it. He is a non-smoker yet occasionally drinks alcohol. His chest x-ray revealed patchy consolidations in the middle and lower zones of the left lung, whereas the chest CT revealed mediastinal lymphadenopathy and air bronchograms. His sputum for AFB and Rapid

Background: Metastasis of the Central Nervous System (CNS) is one of the frequently occurring complications of advanced Non-Small Cell Lung Cancer (NSCLC) and has been observed in 24-44% of patients. Patients suffering from NSCLC along with CNS metastases have a generally poor prognosis. Case Report: A 57-year-old nonalcoholic, non-diabetic, heavy smoker male patient was diagnosed with stage IV NSCLC (non-small cell lung cancer) (Adenocarcinoma), PD-L1 expression 80% with liver, spleen, and brain metastases. In June 2016, the patient was diagnosed with Stage III-A EGFR wild right-sided lung adenocarcinoma (T4N0M0), for which he underwent Curative Concurrent chemo-radiotherapy in Jordan, followed by two cycles of Etoposide plus CDDP (Cisplatin). In February 2017, the patient came to the hospital with the chief complaint of massive hemoptysis. His CT scan showed an appearance in keeping with the right upper-lobe cavitating tumor with possible contralateral lung, splenic, and hepatic metastases. The patient was offered pneumonectomy but refused it. Interventional radiology (IR) tumor embolization of the apical and posterior (A1 and A2) branches of the right superior pulmonary artery with no procedural complication was performed to stop the bleeding. Case Study Chelal et al.; IJMPCR, 15(4): 56-65, 2022; Article no.IJMPCR.91592 57 At the end of that same month, on February 28, 2017, he presented to emergency with seizures, for which a contrast CT scan showed two enhancing lesions, one of the left parietal lobe posteriorly 1.8 cm with marked white matter oedema causing a mass effect and the effacement of the posterior horn of the left lateral ventricle. The second is a small ring-enhancing deposit of the right occipital lobe 6 mm with surrounding oedema. The liver biopsy failed to show any malignancy. After the MDT discussion, the largest lesion in the brain was removed and a small lesion was kept. The left occipital metastasis was resected and was found to be a metastatic adenocarcinoma of lung origin. It was positive for TTF-1 and positive for Moc 31. P63 and CK5/6 were negative (no squamous component is seen). No brain radiotherapy was offered. First-line palliative Nivolumab was started on March 20, 2017. Nivolumab first proved to be highly successful against brain metastases. However, it was discontinued as the patient developed myelitis after seven months of continuous treatment. After the discontinuation and improvement of myelitis symptoms, Nivolumab was resumed. The amazing thing about this treatment approach was that his disease was completely cleared up and he had been in complete remission for five years. Additionally, all of his tumor indicators had decreased and normalized. Conclusion: Our case report demonstrated a full response to first-line Nivolumab in a patient with PD-L1-positive NSCLC having visceral and brain metastases. However, our patient suffered from myelitis, which may have been a Nivolumab-related adverse event. The important point is that he has been achieving a durable complete response for nearly 5 years, so are we talking about the certain biology of a tumor that can be cured by immunotherapy?

A document by Ashraf ALAkkad. Click on the document to view its contents.