The Impact of Smoking Risk Factors During Pandemic COVID-19

Background: Based on world health organization, the smoking is a reason of death five–six cases per annum. Aims and Objectives: The aim of the study was to assess the age, marital, education, employment, smoking and social statuses on gender in Bahrain population. Materials and Methods: A cross-sectional, two group: male and female comparative by using questionnaire distributed randomly and collected data to be analyzed via SPSS program. Results: In age status, the female found to be below 30 years whereas the male is above 30 years. In marital status, the single, divorced and widow female found to be more in whereas the married male is more than married female. In education status, the Primary, intermediate and secondary male student found to be more whereas the college female student is more. In employment status, the Employed and Retired status found to be more in male whereas the Employment scholarship program, unemployed and Housewife found to be more in female. In Smoke status, the Smoking duration found to be more in female below 10 years whereas the Smoking duration found to be more male above 10 years. Also, the female Smoker consume found to be more below 20 cigarettes whereas male Smoker consume found to be more above 20 cigarettes. Conclusion: most smokers in both are between 21 to 30 years, college students and employees. Therefore, there are serious age, education and employment phase in both gender life

Drug-Induced Kidney Injury Caused by Osimertinib: Report of a Rare Case

Tyrosine kinase inhibitors (TKIs) that target the epidermal growth factor receptor (EGFR) have shown highly favourable outcomes in patients with advanced-stage non-small-cell lung cancer (NSCLC). The adverse effects of EGFR-TKIs are generally less severe than those of conventional cytotoxic therapies. We report a patient with NSCLC who presented with acute kidney injury associated with biopsy-proven acute tubular injury during osimertinib treatment and whose renal function recovered after reducing the osimertinib dose. A 61-year-old male smoker complained of dyspnoea on exertion for 1 month before his visit to the medical centre. He was diagnosed with lung adenocarcinoma of the left lower lobe (cT4N3M1a, stage IVA) and was positive for an <i>EGFR</i> mutation (exon 19 deletion). Osimertinib was initiated at 80 mg/day. At treatment initiation, the patient’s serum creatinine level was 0.64 mg/dL, with microscopic haematuria; by day 83, this level had increased to 1.33 mg/dL, with proteinuria. On day 83, we reduced the osimertinib dose to 40 mg/day and performed a kidney biopsy on day 98. The histological diagnosis was tubular injury with IgA deposition. Based on the clinical course and histological findings, we speculated that the kidney injury was associated with osimertinib. After dose reduction, the patient’s serum creatinine level decreased to 1.07 mg/dL, and proteinuria disappeared. He maintained a partial response for &#x3e;6 months after osimertinib administration. We report the first case of biopsy-proven mild IgA deposition, crescent formation, and tubular injury probably caused by osimertinib and demonstrate how reducing the osimertinib dose could strike a balance between its anti-cancer efficacy and adverse effects.

Unifocal Langerhans Cell Histiocytosis Presenting as Spontaneous Pneumothorax

Langerhans cell is a rare disease affecting the lungs which has a 10 years survival chance having a prognosis of 85%. It is often linked with smoking. We discuss here the correct stepwise approach towards its diagnosis Presenting a 28-year-old male smoker with a history of shortness of breath for 2 months which worsened progressively. His chest X-ray showed spontaneous pneumothorax with greater severity towards the right side. HRCT revealed multiple innumerable well-defined cystic lesions of variable sizes in bilateral lung fields, more prominent in upper lobes. A negative suction Pleur-evac was advised but the patient refused it and eventually pleurodesis using bleomycin was done to prevent pneumothorax in the future. Pleurodesis can improve the symptoms of 88 percent of patients without causing any significant complications. Although pleurodesis does not have any effect on patients' survival, it has a positive impact on their lives continuously by enhancing the quality of life.

Alarming triad of progressive hoarseness in a male smoker

Hoarseness accounts for 1% of all consultations in primary care. Suspicion of malignancy should be considered in individuals with risk factors presenting with unexplained hoarseness lasting more than two weeks. A significant number of patients with laryngeal cancer present at an advanced stage due to lack of awareness regarding vocal health. It is important to educate both the public and primary care health providers concerning laryngeal cancer. We present the case of an 81-year old male smoker who presented to us with a six-month history of progressive hoarseness. He was initially treated in two primary and one secondary care centres, where a diagnosis of laryngeal cancer was not considered. Careful assessment in our centre managed to determine a diagnosis of T3N0M0 glottic carcinoma. We will discuss this alarming triad of progressive hoarseness in a male smoker to help primary care physicians streamline their thoughts and identify red flags in a hoarse patient.

P04.23 Multinodular and vacuolating neuronal tumor - advanced MRI features

BACKGROUND A rare pathology, multinodular and vacuolating neuronal tumors (MVNT) have been first described in 2013 and included in the 2016 World Health Organization Classification of Tumors of the Central Nervous System as having a distinctive radiological and cytoarchitectural appearance. This study aims to evaluate the imaging features of MVNT, it’s differential diagnosis, and possible involvement in adult-onset epilepsy. MATERIAL AND METHODS We present the case of a 29-year-old male, smoker, and drug abuser, who developed a seizure after 25 hours’ sleep deprivation, alcohol, energy drinks, cigarettes, and cocaine consumption. Cerebral CT, MRI, electroencephalogram, MR spectroscopy, and tractography was performed. RESULTS The MRI performed revealed a right, cortico-subcortical pseudo-nodular temporal lesion, non-enhancing, with a slight thickening of the adjacent cortex and right hippocampal involvement. The neurological examination was normal, but the electroencephalogram showed a right temporal irritative pattern. MR- Spectroscopy described a slight increase of choline (Cho), reduction of N-acetylaspartate (NAA), and also increased myo-inositol peak, ruling out a high-grade tumoral substrate. A tractography was also performed, excluding the other alternative diagnosis of focal cortical dysplasia, thus leaving MVNT to be the most probable explanation for the lesion. CONCLUSION Advanced MRI features were useful to increase the diagnosis accuracy. The future management consisted of image surveillance, anticonvulsant treatment, and lifestyle improvement. Adult-onset seizures are among the most frequent discovery possibilities for MVNT. In our case, it is to be seen whether the lifestyle changes and medication will prevent future seizures.

Sebaceous Carcinoma of The Lip: Report of a Case and Literature Review.

Background Sebaceous carcinoma (SC) is a very rare, aggressive, malignant tumor arising in the adnexal epithelium of the sebaceous gland. SC in the oral cavity is extremely rare, in literature there are only 14 cases. We reported the 4th case of sebaceous carcinoma involving the lip Case presentation A 71-year-old male smoker presented an ulcerated lesion in the lateral region of the lower lip. The patient stated that the lesion had been present for 1 year. The past medical history was unremarkable. Extra-oral examination revealed a markedly ulcerated, exophytic, irregularly shaped, indurated mass of the lower right labial region, measuring 1.8 cm in size. The nodular lesion, located at the point of transition between mucosa and skin, showed a central ulceration. No other intraoral lesions were identified. The clinical differential diagnosis included squamous cell carcinoma, basal cell carcinoma with sebaceous differentiation and salivary gland neoplasms. The operation was performed under local anaesthesia. On histopathological examination, the tumor was composed by nodules or sheet of cells separated by a fibrovascolar stroma. The neoplastic tissue was deeply infiltrating, involving the submucosa and even the underlying muscle. Neoplastic cells showed a range of sebaceous differentiation with finely vacuolated rather than clear cytoplasm. Neoplastic cells were positive for S-100 protein, EMA, but negative for CEA. Therefore, based on these findings, a diagnosis of sebaceous carcinoma of the lower lip was rendered. Conclusion The histogenesis, differential diagnosis, and clinicopathologic conditions of this disease in the literature were reviewed. SC should be distinguished from other tumors full of vacuolated clear cells. Some useful biomarkers can be Ki-67, P53, CK, PAS, S-100, EMA, and AR.

A rare case of ciliated muconodular papillary tumor accompanied with adenocarcinoma in situ

Background Ciliated muconodular papillary tumor (CMPT) is an incredibly rare pulmonary tumor. Currently, little is known about CMPT, and it has not yet been classified by the World Health Organization. The clinical manifestation of CMPT is nonspecific and the diagnosis is only based on pathology. CMPT has been documented in limited reports as a benign tumor, thus the treatment is typically with surgical excision if a solid tumor is identifiable. The prognosis of CMPT is very positive, as no recurrence has been reported in the limited literature available. However, CMPT accompanied with adenocarcinoma in situ has not been reported previously in the literature. Case presentation In this report, we presented a case of a 53-year-old male smoker with CMPT associated with adenocarcinoma in situ. This diagnosis was confirmed by pathological examination, including immunohistostaining. No solid resectable lesion was identified on CT scan; therefore, no surgery was performed. The patient’s adenocarcinoma in situ was disseminated in both lungs, thus chemotherapeutic treatment with cisplatin and pemetrexed was given. The patient will be continually followed up closely on a wait-and-watch basis. Conclusions In summary, our report reveals a unique case of CMPT in conjunction with adenocarcinoma in situ, potentially revealing an association between CMPT and malignancy which has not been previously reported. More similar case studies will be beneficial to determine the authentic relationship between CMPT and adenocarcinoma in situ.

Effect of smoking on arterial stiffness in men of working age

The objective of the study was to investigate the prevalence of smoking and its influence on the parameters of arterial stiff ness in men of working age.Material and methods. The study included 86 men aged 37.6 ± 7.6. The prevalence and intensity of smoking was assessed. Among the experimental subjects, 48 people were selected and divided into two groups (smokers and non-smokers) comparable due to other cardiovascular risk factors. In both groups, arterial rigidity was studied by volumetric sphygmography.Results and discussion. The prevalence of tobacco smoking was 46.5%, and half of the smokers had a smoking index greater than 10 packs/years. The CAVI index in smokers was 7.0 ± 1.2; in non-smokers — 6.3 ± 0.5 (p = 0.02). CAVI was increased above the age limit in 22% of smokers, and there were no deviations from the norm in the other group. There was a positive correlation of the CAVI index with both smoking duration (r = 0.67, p < 0.0001) and the pack/years index (r = 0.36, p = 0.04).Conclusion. The prevalence of tobacco smoking among men of working age remains high: about half of them are smokers. Every fifth male smoker has an increase in vascular stiffness above the age norm, which may indicate vascular remodeling.

Case Report: Diabetic urinary auto-brewery and review of literature

Background: Although candiduria is an expected encounter and should not be surprising in uncontrolled diabetes with glucose-enriched urine, urinary auto-brewery is rarely thought of by diabetologists. Moreover, endogenous ethanol production in humans from gut microbiome, urinary tract fungi and bacteria, and intermediary metabolism, has been reported for a long time, particularly in diabetics. Case description: To alert physicians to the overlooked implication of endogenously produced ethanol both as a biomarker for poor control of diabetes and as a complicating factor, we report this case of an elderly male smoker alcohol-abstinent insulin-dependent Type 2 diabetic patient. Because of circumstantial treatment and incompliance for one week, he developed endogenously produced alcohol intoxication. We proposed candidal urinary auto-brewery evidence sourced from the case history, urinalysis, and culture/identification tests - without excluding other sources. Fortunately, his diet and glycemic control were fairly controlled and, liver and kidney functions were almost normal. Amphotericin B I/V for five days, insulin, and a fluid therapy regimen greatly improved the case and cleared both the candiduria and ethanol from the urine and blood and the patient regained his base-line normal life. Conclusion: Symptoms of alcohol intoxication should be expected in patients with uncontrolled diabetes that most often correlates with candiduria and/or constipation. These symptoms can be exaggerated in those already suffering a degree of dementia and/or comorbid psychiatric/neurologic affections. Direct wet mount examination of urine under phase contrast microscopy would show the budding yeast cells. Appropriate antifungal, insulin and fluid therapies regained the base-line norms.

Diagnostic use of Adenosine for Atrial Flutter with regular Tachycardia

Background: Supraventricular tachycardia is the commonest type of narrow complex regular tachycardia seen in an emergency room, which can easily be diagnosed by surface ECG and acutely managed by Adenosine injection. A 59 years old male smoker was presented with palpitation with a pulse rate of 220/min with mild hemodynamic compromise. ECG confirmed narrow complex regular tachycardia, and the initial working diagnosis was established as supraventricular tachycardia[SVT] in the emergency room. Case Presentation: As standard practice, adenosine was given, which failed in terminating the tachycardia but by creating a transient atrioventricular block, slowed down ventricular rate, and sawtooth-shaped P waves of atrial flutter were exposed. In contrast to the expectations, in this case of narrow complex regular tachycardia of supraventricular origin, adenosine could not establish the sinus rhythm but confirmed the diagnosis of atrial flutter with the regular rate with fixed A-V block. Conclusion: Instead of therapeutic use, adenosine has been proven to be of diagnostic value, which can be used when the diagnosis of narrow complex tachycardia is in doubt, however with some cautions.