Abstracts from the 6th Annual Conference of Emirates Society of Internal Medicine (ESIM) 2025.

E-Poster

EP1 Extreme Acidemia (pH 6.5) in Septic Shock from MDR Gram-Negative Infection: A Critical-Care Case

Omer Elbashir 1,2 , Abdulrahman Ishag 1

1 Fedail Hospital, Khartoum, Sudan; 2 Double Care Medical Center, Ajman, United Arab Emirates

Correspondence: Omer Elbashir (omer.elrashid9@email.com)

BMC Proceedings 2025, 19(32): EP1

Keywords: Septic shock; lactic acidosis; renal replacement therapy; multidrug-resistant organisms; critical care; tracheostomy

Abstract

Background

Septic shock with extreme acidemia is rare and life-threatening, demanding rapid, coordinated critical-care management. When pH falls to levels typically incompatible with life, therapeutic decisions (airway, vasopressors, renal replacement, and antimicrobials) become uniquely challenging. We report a 71-year-old man with profound acidemia and septic shock to highlight clinical course and management priorities.

Materials and Methods

Single-patient case report. Data were abstracted from the medical record (history, examination, laboratory/ABG trends, imaging, microbiology) and interventions (resuscitation, vasopressors, ventilation, renal replacement therapy, antimicrobials).

Results

A 71-year-old man with hypertension, diabetes, and obstructive sleep apnea presented tachypneic, tachycardic, and hypotensive. Initial arterial blood gas (ABG) showed mixed respiratory/metabolic acidosis (pH 6.8), deteriorating to pH 6.5 despite fluids; he remained conscious (GCS 15/15). Norepinephrine was initiated. Labs indicated renal and hepatic dysfunction with elevated inflammatory markers. He was intubated, admitted to ICU, started on continuous renal replacement therapy (CRRT), later transitioned to intermittent hemodialysis. Prolonged ventilation required tracheostomy on day 15; extubation attempts were unsuccessful. Cultures grew multidrug-resistant Acinetobacter and Klebsiella; antibiotics were escalated per susceptibilities. Despite aggressive, multidisciplinary care, instability persisted due to refractory infection and hemodynamic compromise.

Conclusions

Extreme acidemia in septic shock requires early ABCs, serial ABGs with neurological documentation, immediate broad-spectrum antibiotics and norepinephrine (within 1 hour), and early mechanical ventilation to reduce work of breathing. Consider bicarbonate when HCO₃⁻ <10 mmol/L with hemodynamic compromise, and initiate CRRT early for refractory acidosis or acute kidney injury. Source control and MDR-targeted therapy are pivotal. Further work should refine prognostic thresholds and algorithms for pH <6.8.

Written informed consent for publication in an open-access journal was obtained from the patient.

EP2 Recurrent Pneumococcal Meningitis from Post-Traumatic Frontoethmoidal Encephalocele: A Case Report

Yazan Mazen Yaser Saidismail, Ahmed Darweesh, Maryam Al Ani, Nada Alfalasi, Asif Mohamed Salim, Leena Abdelrahman

Department of Internal Medicine, Dubai Health, Dubai, United Arab Emirates

Correspondence: Yazan Mazen Yaser Saidismail (yazanmelhem2001@gmail.com)

BMC Proceedings 2025, 19(32): EP2

Keywords: Recurrent meningitis; Streptococcus pneumoniae; encephalocele; skull defects; CSF leak; endoscopic repair

Abstract

Background

Recurrent bacterial meningitis (≥2 episodes with complete recovery between episodes) warrants evaluation for skull-base defects with CSF leak and for immune deficiencies. In adults, S. pneumoniae often indicates an anatomic breach (e.g., post-traumatic encephalocele/CSF rhinorrhea), whereas Neisseria suggests complement deficiency.

Case Report

We report a case of a 22-year-old man with his second attack of pneumococcal meningitis within a one-year timeframe after sustaining a road traffic accident about 4 years ago. The patient sustained left frontal bone fracture communicating with the left frontal sinus, along with left frontal encephalocele. His current complaint was fever and cough of one-week duration; they were associated with headache, rhinorrhea, vomiting, sore throat, fatigue, and generalized body pain. The patient denied having any past history of recurrent or severe infections, especially during childhood and adulthood. Upon assessment, his temperature was 37.6 °C, and vitals were within normal limits. Physical examination was remarkable for positive neck stiffness. Otherwise, no skin rashes were noted; neurological assessment included a GCS of 15/15, no focal neurological deficits, and intact cranial nerves. Abdomen was soft, lax, and non-tender; spleen was not palpable. Labs were significant for WBC count of 21,100 cells/uL, CRP of 198.7 mg/L, procalcitonin of 0.64 ng/mL, serum glucose (random) of 146 mg/dL, CSF protein of 209 mg/dL, and CSF glucose of 35 mg/dL (with glucose CSF: serum ratio of 0.24). Both blood and CSF cultures were positive for Streptococcus pneumoniae. HIV test was negative. He was empirically treated with IV ceftriaxone and vancomycin, and later tailored to ceftriaxone after the cultures’ susceptibility results were out.

Conclusions and Recommendations

In adults with recurrent pneumococcal meningitis, prompt skull-base imaging for occult CSF leak/encephalocele and parallel immune evaluation are essential. Definitive endoscopic repair plus pneumococcal vaccination can prevent further episodes. Structured pathways that trigger beta-2 transferrin testing and high-resolution CT/MRI after a second episode may reduce diagnostic delay.

Written informed consent for publication in an open-access journal was obtained from the patient.

References

Cullu, N., Deveer, M., Karakas, E., Karakas, O., Bozkus, F., & Celik, B. (2015). Traumatic fronto-ethmoidal encephalocele: A rare case. The Eurasian Journal of Medicine, 47 (1), 69–71. 10.5152/eajm.2014.50

Gressot, L. V., Patel, A. J., Kitagawa, R. S., Clay Goodman, J., & Gopinath, S. P. (2013). Frontal sinus encephalocele: Case report and review of literature. Clinical Neurology and Neurosurgery, 115 (10), 2174–2177. 10.1016/j.clineuro.2013.05.035

Go, K., Ge, J., Abdelattif, M., & Zaw, M. (2022). Recurrent meningitis in the context of an encephalocele. Cureus, 14 (9), e29594. 10.7759/cureus.29594

Tebruegge, M., & Curtis, N. (2008). Epidemiology, etiology, pathogenesis, and diagnosis of recurrent bacterial meningitis. Clinical Microbiology Reviews, 21 (3), 519–537. 10.1128/CMR.00009-08

EP3 Solitary T9 Plasmacytoma with Concurrent Tuberculous Lymphadenitis Presenting as Acute Myelopathy: A Case Report

Aesha Khalid Sharif, Noura Ali Alowais

Mohamed bin Rashid University, Postgraduate Medical Education Division, Dubai, United Arab Emirates

Correspondence: Aesha Khalid Sharif (aksharif@dubaihealth.ae)

BMC Proceedings 2025, 19(32): EP3

Keywords: solitary bone plasmacytoma; spinal cord compression; vertebra plana; FDG-PET lymphadenopathy; tuberculous lymphadenitis; case report.

Abstract

Background

Solitary Bone Plasmacytoma (SBP) is a localized plasma cell neoplasm of bone or soft tissue, without features of myeloma. When managing patients from TB endemic background, FDG-avid lymphadenopathy may trigger your attention to an ongoing infective process rather than metastasis. We report an unusual presentation of T9 SBP causing cord compression with concurrent biopsy-proven tuberculous lymphadenitis.

Case Presentation

A 26 years’ old Nigerian male, with no known medical background, been under police custody for 2 years, presented with 3-month history of progressive bilateral lower limbs weakness, numbness and decreased sensation extending above the level of his umbilicus. He denied any history of recent trauma, back pain, fever, or flu-like symptoms. He reported good appetite. Review of systems was unremarkable. Upon presentation, he was afebrile and hemodynamically stable. His general examination was normal. His neurological examination involving his upper limbs was normal. However, upon examining the lower limbs it was noted that he had hypertonicity, reduced power of both limbs, along with symmetrical decreased sensation to fine touch and pain. Proprioception was impaired and vibration sensation was absent. He had bilateral clonus with equivocal plantar. He exhibited a positive Romberg’s test and a sensory ataxic gait with normal sphincter function. Collectively, labelled as Grade C according to the American Spinal Injury Association (ASIA) scale. Admitted as a case of transverse myelitis, with progressive bilateral hypesthesia up to the level of T6 with imbalance, and inability to walk. Magnetic Resonance Imaging (MRI) with contrast of the thoracic spine reported a T9 vertebra plana causing severe spinal canal stenosis and myelopathy, with abnormal marrow signal of T8 and T10, highly suspicious for neoplastic process with a secondary T9 pathological fracture. In view of his presenting symptoms, he was taken for a life-saving T8-10 combined fusion and partial tumor excision by spine team. Histopathology reported features keeping with plasma cell neoplasm that were diffusely and strongly positive for CD38 and CD117. They showed Kappa restriction, i.e. monoclonal. After discussion with Hematology team, further workup was ordered, and Multiple Myeloma was ruled out. PET CT Scan was preformed which showed “Multiple cervical and mediastinal hypermetabolic lymph nodes”. A biopsy was taken and reported as Chronic Caseating Granulomatous Lymphadenitis - Tuberculous Type confirming the diagnosis of TB lymphadenitis. In TB-endemic settings, FDG-avid nodes should not upstage SBP without biopsy. Histology and marrow studies remain decisive and should be done to avoid misclassification. A combined approach—urgent decompression, local radiotherapy, and antituberculosis treatment—can optimize neurologic and oncologic outcomes.

Written informed consent for publication in an open-access journal was obtained from the patient.

EP4 Safety and Efficacy of BCG Vaccination to Prevent COVID-19: Updated Systematic Review and Meta-analysis of RCTs

Ahmed Hosney Nada 1,8 , Asmaa Zakria Alnajjar 2,8 , Ismail A. Ibrahim 3,8 , Talya Mansour 4,8 , Tuğba Saka 5,7 , Wael Hafez 6,9 , Bareera Tanveer Malik 7,8

1 Faculty of Medicine, Benha University, Egypt; 2 Faculty of Medicine Al-Azhar University, Gaza, Palestine; 3 Faculty of Health Sciences, Fenerbahce University, Istanbul, Turkey; 4 Faculty of Medicine Beirut Arab University, Lebanon; 5 Faculty of Medicine İstinye Üniversitesi, İstanbul, Turkey; 6 Emirates society of Internal Medicine, EMA, Dubai and NMC Healthcare Abu Dhabi, UAE; 7 Faculty of Medicine and Health Sciences, Kassala University, Kassala, Sudan; 8 Global Alliance of Young Researchers, Istanbul, Turkey; 9 Medical Research and Clinical Studies Institute, The National Research Centre, Cairo, Egypt

Correspondence: Wael Hafez (wael.hafez@nmc.ae)

BMC Proceedings 2025, 19(32): EP4

Keywords: Bacillus Calmette-Guérin; COVID-19; randomized controlled trials; vaccine efficacy; trained immunity; adverse events

Abstract

Background

Despite the availability of multiple COVID-19 vaccines, challenges remain regarding their prevention and control. The Bacillus Calmette–Guérin (BCG) vaccine has been reported to induce trained immunity, a state of enhanced innate immune responsiveness that may provide non-specific protection against infections such as COVID-19. Although its safety and effectiveness in this setting have been examined in several clinical trials, much remains uncertain. This systematic review and meta-analysis assessed the safety and efficacy of BCG vaccination in COVID-19 prevention.

Methods

This systematic review and meta-analysis followed PRISMA guidelines and was registered in PROSPERO (CRD420251082743). A comprehensive search was conducted in PubMed, Cochrane, Scopus, Web of Science, and Embase databases until March 2024. The primary outcomes included COVID-19 infection rate, mortality, hospitalization rate, and ICU admission. The secondary outcomes focused on adverse events.

Results

Fifteen RCTs with 16,347 participants were included in this study. BCG vaccination did not significantly reduce COVID-19 infection (RR = 1.06, 95% CI [0.96–1.17], p = 0.27), ICU admission (RR = 0.44, 95% CI [0.14–1.42], p = 0.17), or hospitalization rate (RR = 0.90, 95% CI [0.60–1.36], p = 0.62). There were fewer deaths in the BCG group (RR = 0.52, 95% CI [0.25–1.08], p = 0.08). Regarding adverse events, BCG vaccination was strongly associated with erythema and may slightly increase the risk of cough, while other systemic symptoms (nausea, muscle/joint pain, sore throat) showed no significant association.

Conclusion and Recommendations

Across 15 RCTs, early BCG revaccination did not prevent COVID-19 infection, hospitalization, or ICU admission; mortality benefit remains unproven. BCG was generally well tolerated, with more local reactions. Routine use of BCG for COVID-19 prevention is not supported; future trials should stratify by prior BCG status, age, circulating variants, and vaccination context.

EP5 Efficacy of Cellex® in Enhancing Cognitive Function Post-Stroke: A Systematic Review and Meta-Analysis of Clinical Trials

Ismail A. Ibrahim 1,5 , Ahmed Ibrahim 2,5 , Sohaila Mourad 2,5 , Bishoy Kamel 2,5 , Mohamed I. Mohamed 2,5 , Wael Hafez 3,6 , Ahmed Hosney Nada 4,5

1 Faculty of Health Sciences, Fenerbahce University, Istanbul, Turkey; 2 Faculty of Medicine, Alexandria University, Alexandria, Egypt; 3 Emirates Society of Internal Medicine, EMA, Dubai, UAE; 4 Faculty of Medicine, Benha University, Egypt; 5 Global Alliance of Young Researchers, Istanbul, Turkey; 6 Medical Research and Clinical Studies Institute, The National Research Centre, Cairo, Egypt

Correspondence: Wael Hafez (wael.hafez@nmc.ae)

BMC Proceedings 2025, 19(32): EP5

Keywords: Cellex; cognitive function; Ischemic stroke; hemorrhagic stroke; systematic review; MMSE; NIHSS; stroke recovery

Abstract

Background

Cognitive deficits after stroke are frequent and predict poor long-term outcomes; however, evidence for adjunct pharmacotherapies is inconclusive. Cellex has been proposed as an add-on therapy; however, individual trials are underpowered. We aimed to investigate the efficacy of Cellex, a novel medication, in improving cognitive function in patients recovering from ischemic or hemorrhagic stroke.

Materials and Methods

This meta-analysis followed PRISMA guidelines and was registered in PROSPERO (CRD42024519134). PubMed, Scopus, Cochrane, Embase, and Web of Science were searched in February 2024 using Medical Subject Headings (MeSH) terms related to Cellex, stroke, and cognition. Eligibility: Studies that enrolled adults (≥18 years) with ischemic or hemorrhagic stroke confirmed by CT/MRI and reported post-stroke cognitive impairment were included. The comparators included placebo and usual care. The exclusion criteria were pre-existing cognitive impairment/dementia, severe comorbidities, other neurodegenerative diseases, Cellex use for non-stroke conditions, or insufficient data. Selection and data extraction: Screening was performed in Rayyan, and data were extracted (study design, sample size, age, follow-up, MMSE, and NIHSS). The risk of bias was assessed using Cochrane ROB-2. Meta-analysis was conducted in RevMan 5.4 using fixed-effects when I2<50% (p>0.1), otherwise random effects were used. Heterogeneity was further addressed through sensitivity analysis using the leave-one-out method.

Results

In our analysis of 11 clinical trials involving 1511 patients, Cellex tended to outperform controls in terms of MMSE scores, showing a mean difference of 1.25 (95% confidence interval [CI] [−0.34, 2.83], p = 0.12). Similarly, for NIHSS scores, Cellex demonstrated a mean difference of 0.58 (95% CI(−0.60, 1.76), p = 0.34]. Two studies underscored the efficacy of Cellex in improving speech function post-stroke, with notable intragroup improvements (p < 0.05). Despite these positive trends, the overall evidence did not decisively support the superiority of Cellex over placebo.

Conclusion and Recommendations

Although Cellex showed promising trends in improving cognitive function post-stroke, its efficacy did not significantly surpass that of the placebo. Further research with larger sample sizes and longer-term outcomes is warranted.

EP6 Acute Kidney Injury Post Palliative Liver Histotripsy Procedure: First Reported Complication in Literature

Yousef Boobes 1,2 , Fatima AlKindi 2,3 , Dana Kidder 1 , Philipp Von Breitenbuch 4

1 Seha Kidney Care, Nephrology, Al Ain, UAE; 2 Department of Internal Medicine, College of Medicine and Health Sciences, UAE University, UAE; 3 Internal Medicine, Tawam Hospital & Sheikh Tahnoon Bin Mohammed Medical City, Seha, PureHealth, Al Ain, UAE; 4 Surgery Department, Tawam Hospital & Sheikh Tahnoon Bin Mohammed Medical City, Seha, PureHealth, Al Ain, UAE

Correspondence: Yousef Boobes (boobes@emirates.net.ae)

BMC Proceedings 2025, 19(32): EP6

Keywords: AKI, liver histotripsy, cancer, steroid, proteinuria

Abstract

Background

Histotripsy is a novel, non-invasive ultrasound-based technology that enables non-thermal mechanical ablation of tissues. It received FDA approval in 2023 for treating unresectable liver tumors. With a success rate exceeding 90%, histotripsy is considered safe. However, acute kidney injury (AKI) has not previously been reported as a complication.

Materials and Methods

We present two cases of AKI with nephrotic-range proteinuria developing shortly after liver histotripsy. Clinical data and management outcomes were studied. Descriptive analysis was used.

Results

Case 1: A 36-year-old female with cholangiocellular carcinoma and hepatic/lung metastases underwent palliative liver histotripsy. Her medical history included allergies to multiple chemotherapeutic agents and antibiotics. Pre-procedure labs indicated mild anemia and normal renal function (s. creatinine 60 µmol/L). Within 24 hours post-procedure, she was diagnosed to have stage III AKI with oliguria, hyponatremia, and massive proteinuria (PCR: 10.13 g/g; ACR: 673.24 mg/mmol). Serology, autoimmune markers, and renal ultrasound were unremarkable. Without biopsy confirmation, she was treated empirically with intravenous methylprednisolone, followed by a tapering oral course. Creatinine peaked at 663.6 µmol/L and normalized over two weeks. Our clinical diagnosis was acute interstitial nephritis with rapidly reversable podocytopathy.

Case 2: A 64-year-old female with metastatic colon cancer on chemotherapy underwent liver histotripsy. She received two doses of ketorolac prior to the procedure. She initially tolerated the procedure but developed nausea and vomiting the following day. Labs revealed stage III AKI (creatinine: 331.8 µmol/L), hyponatremia, hyperkalemia, metabolic acidosis and proteinuria (PCR: 1.49 g/g). She was managed with IV sodium bicarbonate and patiromer. Without biopsy, a presumptive diagnosis of acute interstitial nephritis with possible glomerular involvement was made. Creatinine peaked at 444.4 µmol/L, and renal function normalized within 10 days following steroid therapy.

Conclusions and Recommendations

Although histotripsy has demonstrated favorable safety outcomes in multicenter trials, these cases highlight a potential association with AKI stage III and proteinuria shortly after the procedure. The clinical features suggest acute interstitial nephritis with transient onset of podocytopathy. Despite the absence of kidney biopsy data, both cases showed rapid improvement with steroids. These findings underscore the need for close renal monitoring post-histotripsy, especially in patients with complex oncologic histories.

Written informed consent for publication in an open-access journal was obtained from the patient.

EP7 A Diagnostic Dilemma: Guillain-Barré Syndrome in the Shadow of Poliomyelitis - Case Report

Jafrin Sadiq Abdul Razack 1 , Ahmad Faud 1 , Shoaib Shah Ahamed 1 , Sharanya Suresh Kumar 2 , Asma Alskaf 3

1 Medical Intern, Thumbay University Hospital, Ajman, U.A.E.; 2 General Practitioner, Thumbay University Hospital, Ajman, U.A.E.; 3 Specialist Neurologist, Thumbay University Hospital, Ajman, U.A.E.

Correspondence: Jafrin Sadiq Abdul Razack (Sadiq.jafrin@gmail.com)

BMC Proceedings 2025, 19(32): EP7

Keywords: Guillain-Barré syndrome; poliomyelitis; acute flaccid paralysis; AIDP; plasmapheresis

Abstract

Background

Guillain–Barré Syndrome (GBS) is an acute immune-mediated polyradiculoneuropathy characterized by rapidly progressive, symmetrical weakness, areflexia, and potential autonomic dysfunction. The most common variant, acute inflammatory demyelinating polyneuropathy (AIDP), can be challenging to identify in patients with pre-existing neurological deficits, such as prior poliomyelitis, where baseline asymmetric weakness and muscle atrophy may obscure new deficits. Accurate differentiation is critical, as management strategies differ and delayed recognition increases morbidity 1,2.

Case Presentation

We report a 51-year-old male with a history of suspected poliomyelitis and residual neurological deficits, who presented with acute right lower limb weakness and inability to ambulate following a gastrointestinal illness. Examination revealed symmetrical lower limb weakness with absent reflexes and preserved sensation. Laboratory tests showed mildly elevated inflammatory markers and creatine phosphokinase. MRI excluded compressive spinal pathology. Nerve conduction studies demonstrated chronic changes from prior anterior horn cell disease with new demyelinating features consistent with AIDP. Cerebrospinal fluid analysis was unremarkable. During admission, the patient developed atrial fibrillation, indicating autonomic involvement. Using standardized diagnostic criteria (Brighton), the multidisciplinary team confirmed GBS (AIDP variant) and initiated plasmapheresis. Following treatment, the patient showed stabilization and partial recovery of motor function. This case highlights the importance of considering superimposed GBS in patients with prior poliomyelitis. Prompt CSF and nerve conduction studies, poliovirus screening when indicated, and early immunotherapy (IVIG or plasmapheresis) with close monitoring of respiratory and autonomic function are essential to optimize outcomes.

Discussion This case underscores the diagnostic dilemma of differentiating AIDP from poliomyelitis in patients with prior neurological disease. While both may present with acute flaccid paralysis, distinguishing features include symmetry of weakness, absence of spinal cord gray matter changes on MRI, demyelinating features on nerve conduction studies, and a favorable response to immunotherapy. Autonomic dysfunction, as observed in this patient, further supports the diagnosis of GBS. Early recognition is crucial, as delayed treatment carries a high risk of morbidity.

Conclusion This case highlights the diagnostic challenge of Guillain–Barré Syndrome (AIDP variant) in a patient with prior poliomyelitis and pre-existing neurological deficits. Careful clinical evaluation, neurophysiological studies, and cerebrospinal fluid analysis, guided by standardized criteria (e.g., Brighton), allowed timely identification of superimposed GBS. Screening for poliovirus can help differentiate recurrent or post-polio deficits. Early immunotherapy with plasmapheresis or IVIG, along with supportive care and physiotherapy, contributed to stabilization and partial recovery of motor function. Clinicians should maintain a high index of suspicion for GBS in patients presenting with new or progressive weakness, even in the context of prior neurological disease, to ensure prompt treatment and optimize outcomes.

Written informed consent for publication in an open-access journal was obtained from the patient.

References

Khan, S. A., Das, P. R., Nahar, Z., & Dewan, S. M. R. (2024). An updated review on Guillain-Barré syndrome: Challenges in infection prevention and control in low- and middle-income countries. SAGE Open Medicine, 12 , Article 20503121241239538. 10.1177/20503121241239538

Bellanti, R., & Rinaldi, S. (2024). Guillain-Barré syndrome: A comprehensive review. European Journal of Neurology, 31 (8). 10.1111/ene.16365

EP8 Short-Term Dexketoprofen–Associated Acute Kidney Injury in a Patient with Type 2 Diabetes: Case Report

Jafrin Sadiq Abdul Razack 1 , Sarah Elkhawaga 2 , Noel George Cherian 1 , Ahmad El-Ouweini 3

1 Medical Intern, Thumbay University Hospital, Ajman, U.A.E.; 2 Pharm D Graduate, Gulf Medical University, Ajman, U.A.E.; 3 Clinical Assistant Professor of Pharmacy Practice and Critical Care Clinical Pharmacist, Dubai Medical College, Dubai, U.A.E.

Correspondence: Jafrin Sadiq Abdul Razack (sadiq.jafrin@gmail.com)

BMC Proceedings 2025, 19(32): EP8

Keywords: Non-steroidal anti-inflammatory drugs; dexketoprofen; acute kidney injury; diabetes mellitus; hemodialysis; case report

Abstract

Background Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for postoperative pain management but can precipitate acute kidney injury (AKI) via hemodynamic or interstitial mechanisms, especially in patients with underlying risk factors. While NSAID-induced AKI is usually associated with prolonged use or pre-existing renal disease, severe renal impairment may also occur after short-term exposure. We report a case of KDIGO stage 3 AKI following five days of dexketoprofen use in a patient with type 2 diabetes.

Materials and Methods

This is a case report of a 46-year-old male with moderately controlled type 2 diabetes who underwent fistulectomy and received dexketoprofen for postoperative analgesia. Baseline renal function was normal. Clinical evaluation, laboratory investigations (serum creatinine, urea, pancreatic enzymes), urine output monitoring, and imaging studies were performed to identify the cause of AKI. Management included cessation of NSAIDs, intravenous fluid therapy, and initiation of hemodialysis when renal function deteriorated.

Results Five days postoperatively, the patient presented with fever, epigastric pain, nausea, and vomiting. Laboratory evaluation revealed serum creatinine of 9.18 mg/dL, urea 89.37 mg/dL, and elevated pancreatic enzymes. Urine output declined progressively, and imaging excluded obstructive causes. Despite supportive therapy, renal function continued to worsen, necessitating hemodialysis via a temporary catheter. After multiple ICU dialysis sessions, the patient’s renal function gradually improved, returning to baseline levels prior to discharge in stable condition.

Conclusions and Recommendations

This case demonstrates that NSAID-induced AKI can occur even after short-term administration, particularly in patients with diabetes. Clinicians should exercise caution when prescribing NSAIDs postoperatively, closely monitor renal function, and intervene promptly if impairment develops. Awareness of this risk may prevent severe renal complications and guide safer analgesic practices.

Written informed consent for publication in an open-access journal was obtained from the patient.

EP9 Guillain-Barré Syndrome Axonal Variant Complicated by Hemodynamic Crashes During Plasmapheresis: A Case Report

Hadeel Ali, Tahlil Ibrahim, Ahmed Abdalla, Doaa Elhassan, Alaa Ahmed

Medical Interns, Thumbay University Hospital, Ajman, UAE

Correspondence: Hadeel Ali (hadeelahmed.2000@gmail.com)

BMC Proceedings 2025, 19(32): EP9

Keywords: Guillain-Barré Syndrome, Axonal Neuropathy, Autonomic Dysfunction, Plasmapheresis, Case Report

Abstract

Background

Guillain-Barré Syndrome (GBS) is an acute immune-mediated neuropathy associated with rapid motor weakness and potential autonomic complications 1 . While the demyelinating type is most common, axonal variants such as acute motor axonal neuropathy (AMAN) often cause more severe deficits and prolonged recovery 2 . Autonomic instability, including arrhythmias and hemodynamic crashes, may complicate treatment 3 . This report describes a diagnostically challenging case of axonal GBS in a patient with underlying muscular dystrophy, further complicated by cardiac arrhythmias and hypotensive episodes during plasmapheresis.

Materials and Methods

We present a single-patient case report of a 51-year-old male, a known case of hypertension and muscular dystrophy who developed acute progressive weakness. Neurological assessment, MRI imaging, laboratory tests, and electrophysiological studies were performed. Cerebrospinal fluid (CSF) analysis and spinal MRI were used to exclude alternative diagnoses. The patient underwent plasmapheresis with concurrent cardiac monitoring.

Results

Nerve conduction studies confirmed axonal polyneuropathy consistent with axonal GBS, despite normal CSF findings. The patient’s weakness progressed to quadriparesis, and he developed atrial fibrillation requiring amiodarone and anticoagulation. Plasmapheresis sessions were complicated by recurrent bradycardia and hypotension, necessitating temporary cessation and fluid resuscitation. After five sessions, gradual motor improvement was noted in the upper limbs, though the patient remained ICU-dependent for mobility and was initiated on structured physiotherapy.

Conclusions and Recommendations

This case highlights the importance of early electrophysiologic testing when GBS is suspected but CSF findings are inconclusive. Recognition and management of autonomic instability are critical, particularly during plasmapheresis. Clinicians should maintain a high index of suspicion for axonal GBS in atypical presentations and adopt a multidisciplinary approach to optimize outcomes.

Written informed consent for publication in an open-access journal was obtained from the patient.

References

Kuwabara, S., & Yuki, N. (2013). Axonal Guillain–Barré syndrome: Concepts and controversies. The Lancet Neurology, 12 (12), 1180–1188. 10.1016/S1474-4422(13)70215-1

Leonhard, S. E., Mandarakas, M. R., Gondim, F. A. A., et al. (2019). Diagnosis and management of Guillain–Barré syndrome in ten steps. Nature Reviews Neurology, 15 (11), 671–683. 10.1038/s41582-019-0250-9

Yuki, N., & Hartung, H.-P. (2012). Guillain–Barré syndrome. The New England Journal of Medicine, 366 (24), 2294–2304. 10.1056/NEJMra1114525

EP10 Isolated Ulnar Artery Occlusion with Concurrent Internal Jugular Thrombosis in Severe Iron-Deficiency Anemia: Case Report

Zahraa Haider 1 , Aya Alsabbah 2 , Noor Alhaboobi 1 , Touseef Kazmi 3

1 College of Medicine, University of Sharjah, Sharjah, UAE; 2 Dubai Health, Dubai, UAE; 3 Rashid Hospital, Dubai Health, Dubai, UAE

Correspondence: Zahraa Haider (zahraalhaboobi@gmail.com)

BMC Proceedings 2025, 19(32): EP10

Keywords: iron-deficiency anemia; reactive thrombocytosis; ulnar artery occlusion; internal jugular vein thrombosis; hypercoagulability; case report

Abstract

Background

Severe iron deficiency anemia (IDA) can be accompanied by reactive thrombocytosis and platelet hyper reactivity, which may increase thrombotic risk, particularly in women of reproductive age 1 . While arterial events related to thrombotic risk in severe IDA are rare, occasional reports describe thrombotic events such as abdominal aortic thrombosis and jugular or cerebral venous thrombosis 1,2 . Chronic IDA may predispose young women to thrombotic events in the absence of traditional risk factors or trauma, though isolated ulnar artery occlusion remains rare 3 . This case report highlights the association between severe IDA, thrombocytosis, and thrombotic events in a young, otherwise healthy woman.

Materials and Methods

A 41-year-old woman presented with bluish discoloration of her right index and middle fingers, along with a 2-week history of headache, dizziness, nausea, and visual blurring. Work-up revealed severe microcytic hypochromic anemia (Hb 6.7 g/dL, MCV 59 fL, iron 13 µg/dL, TIBC 509 µg/dL), prompting blood transfusion and IV iron therapy, which improved Hb to 8.1 g/dL. Referred to rheumatology for suspected Raynaud’s phenomenon, she returned with worsening ischemia, and imaging confirmed right ulnar artery occlusion and partial thrombosis of the right internal jugular vein. An embolectomy was performed, and anticoagulation therapy was initiated. A thrombophilia and autoimmune work-up revealed low activated protein C resistance (APCR).

Results

The patient’s vascular status improved post-embolectomy, with laboratory values normalizing. Notably, her platelet count was elevated above normal (442 × 10⁹/L), consistent with reports of young women experiencing simultaneous arterial and venous thromboses in severe IDA with thrombocytosis. Reactive thrombocytosis significantly elevates thrombotic risk, reinforcing the need for early recognition, as IDA with thrombocytosis doubles the risk of thrombosis.

Conclusions and Recommendations

Severe IDA can create a prothrombotic milieu, increasing the risk of both arterial and venous thromboses. Clinicians should maintain high suspicion for thrombosis in severe IDA and evaluate for embolic sources and thrombophilia. Treatment with rapid iron repletion, standard antithrombotic therapy, and follow-up imaging is recommended. Avoid prothrombotic exposures until iron stores recover. Prospective studies should investigate whether expedited iron repletion or prophylaxis reduces thrombotic events.

Written informed consent for publication in an open-access journal was obtained from the patient.

References

Valiyaveettil, D., & Harish, R. (2014). Iron deficiency anemia with thrombocytosis: A rare association. Indian Journal of Hematology and Blood Transfusion, 30 (4), 304–306. 10.1007/s12288-013-0306-3

Keung, Y. K., & Owen, J. (2004). Iron deficiency and thrombosis: Literature review. Clinical and Applied Thrombosis/Hemostasis, 10 (4), 387–391. 10.1177/107602960401000412

Akins, P. T., Glenn, S., Nemeth, P. M., & Derdeyn, C. P. (1996). Carotid artery thrombus associated with severe iron-deficiency anemia and thrombocytosis. Stroke, 27 (5), 1002–1005. 10.1161/01.STR.27.5.1002

EP11 Isolated Pupil-Sparing Third Nerve Palsy as a Relapse of PR3-ANCA Vasculitis: Case Report

Joudi Habbal 1 , Hamda Ali 1 , Emad Khater 2

1 Department of Internal Medicine, SEHA- Sheikh Khalifa Medical City; 2 Department of Nephrology, SEHA- Sheikh Khalifa Medical City

Correspondence: Joudi Habbal (judymh99@gmail.com)

BMC Proceedings 2025, 19(32): EP11

Keywords: ANCA-associated vasculitis; PR3-ANCA; oculomotor (third) nerve palsy; cranial neuropathy; neuro-vasculitis; case report

Abstract

Background

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a rare autoimmune disorder targeting small- and medium-sized vessels. Neurological involvement occurs in approximately 15–20% of patients, most commonly as peripheral neuropathy or mononeuritis multiplex. Isolated cranial nerve palsy is exceptionally rare. It occurs in fewer than 2%, with the third cranial nerve infrequently affected.

Case Presentation

We report a unique case of a 66-year-old male with a 17-year history of biopsy-proven pauci-immune necrotizing crescentic glomerulonephritis and cANCA positivity, previously treated with cyclophosphamide and maintained on azathioprine. He presented with a three-day history of left-sided periorbital pain, ptosis, and binocular diplopia, without systemic symptoms. Neurological examination revealed isolated left third cranial nerve palsy with impaired adduction and ptosis; pupils were spared. ESR was 4 mm/hr and CRP was 1.34 mg/L. MRI/MRA brain excluded ischemia, aneurysm, or compressive lesions. Serum cANCA was elevated (164 RU/mL), with negative pANCA. Given his AAV history, absence of alternative etiologies, and supportive serology, an isolated cranial mononeuritis multiplex flare was diagnosed. He was treated with oral prednisolone (25 mg/day) and continued azathioprine (50 mg/day), resulting in gradual resolution of ptosis and improvement in diplopia over three weeks.

Discussion

This case demonstrates the importance of considering AAV in patients with cranial nerve deficits, even in the absence of systemic symptoms. Unlike typical systemic flares, this presentation occurred with low inflammatory markers and no other organ involvement, highlighting the need for vigilance in neurological assessment. Prompt recognition and immunosuppressive therapy may prevent irreversible deficits.

Conclusion and Recommendations

Clinicians should consider AAV flare in the differential diagnosis of unexplained cranial nerve palsy, even in the absence of systemic symptoms or elevated inflammatory markers. This case underscores the need for heightened clinical suspicion for AAV-related neuropathy in patients with compatible history. Early identification facilitates targeted therapy and favourable neurological outcomes.

Written informed consent for publication in an open-access journal was obtained from the patient.

EP12 Adult Taenia Infection Presenting with Lower Gastrointestinal Bleeding: Case Report

Esraa Abdulla Ibrahim Ockba

Department of Internal Medicine, Dubai Health, Dubai, United Arab Emirates

Correspondence: Esraa Abdulla Ibrahim Ockba (esraaaockba@gmail.com)

BMC Proceedings 2025, 19(32): EP12

Keywords: Taenia Saginata; Taeniasis; Gastrointestinal Hemorrhage; Iron-Deficiency Anemia; Colonoscopy; Praziquantel.

Abstract

Background

Taenia species are cestode parasites for which humans are the definitive host, typically acquired by ingesting raw or undercooked meat containing larval cysts. 1 Taenia saginata is the most common human tapeworm. 2 Adult worms rarely invade the intestinal mucosa, so infection is usually asymptomatic. When symptomatic, patients may present with nonspecific gastrointestinal complaints such as abdominal discomfort, nausea, or diarrhea. 3,4 . Gastrointestinal bleeding is an uncommon complication which may occur from mucosal irritation or ulceration at the ileocecal region where proglottids adhere or transit. 1 We report this case to highlight Taenia infection as a potential culprit for lower gastrointestinal bleeding.

Materials and Methods

We present a case report of a 29-year-old female with no comorbidities presented with 4 days of melena, dizziness, and fatigue. She denied abdominal pain, nausea, vomiting, diarrhea, hematemesis, or other bleeding sites. She had a similar episode 3 months prior, managed with supportive transfusion. Dietary history included intermittent raw meat intake. On examination, she was pale, tachycardic, and hypotensive, with melena on rectal exam. Admission labs (Table 1) revealed severe hypochromic microcytic anemia (Hb 3.5 g/dL) and low ferritin (7.9 ng/mL). Stool examination was negative for ova or parasites. She was stabilized and transfused with three units of packed red blood cells.

Results

Upper GI endoscopy revealed H. pylori–associated non-bleeding erosive gastropathy (Figure 1 A, B), for which eradication therapy was advised. Due to ongoing melena, colonoscopy revealed a 30-cm tapeworm in the cecum and terminal ileum, morphologically suggestive of Taenia saginata (Figure 1 C). The retrieved tapeworm specimen is shown in Figure 1D. The patient received a single 600 mg dose of praziquantel and iron therapy, after which melena resolved and hemoglobin improved to 9.9 g/dL at discharge.

Conclusions and Recommendations

Adult Taenia infection can present with lower GI bleeding, particularly with ileocecal involvement, and may be missed by a single stool examination. When endoscopy reveals cestode segments, obtain species confirmation (morphology ± PCR) to distinguish T. saginata from T. solium, treat with weight-based praziquantel or niclosamide, and arrange stool re-examination at 1–3 months. Prevention through proper cooking of raw meat and reinforcement of household hygiene is essential.

Written informed consent for publication in an open-access journal was obtained from the patient.

References

Settesoldi, A., Tozzi, A., & Tarantino, O. (2017). Taeniasis: A possible cause of ileal bleeding. World Journal of Clinical Cases, 5(12), 432–436. 10.12998/wjcc.v5.i12.432

Braseth, A. L., Elliott, D. E., & Ince, M. N. (2021). Parasitic infections of the gastrointestinal track and liver. Gastroenterology Clinics of North America, 50(2), 361–381. 10.1016/j.gtc.2021.02.011

Paniker, S. G. C. J. (2018). Paniker’s textbook of medical parasitology (8th ed.). Jaypee Brothers Medical Publishers.

Craig, P., & Ito, A. (2007b). Intestinal cestodes. Current Opinion in Infectious Diseases, 20(5), 524–532. 10.1097/qco.0b013e3282ef579e

EP13 Diabetic Ketoacidosis as the Initial Presentation of Undiagnosed Diabetes in an Adult: Case Report

Aia Nana, Dhurgadharshini Sudhakar

Academic Health Center, Thumbay University Hospital, Ajman, UAE

Correspondence: Aia Nana (aiabna3na3@gmail.com)

BMC Proceedings 2025, 19(32): EP13

Keywords: diabetic ketoacidosis; undiagnosed diabetes; adult-onset diabetes; LADA; ketosis-prone type 2 diabetes; case report.

Abstract

Background

Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, occasionally presenting as the first manifestation in previously undiagnosed individuals. In adults, DKA may reflect type 1 diabetes, latent autoimmune diabetes in adults (LADA), or ketosis-prone type 2 diabetes, requiring early etiologic work-up.

Materials and Methods

A 40-year-old male with no known comorbidities presented to the emergency department with severe abdominal pain, nausea, generalized weakness, increased thirst and urination, and breathing difficulty for four days. Clinical evaluation and laboratory investigations, including venous blood gas analysis, were conducted.

Results

Laboratory investigations revealed markedly elevated random blood glucose (GRBS, 491 mg/dL, positive urine ketones (3+), severe metabolic acidosis (venous pH 7.11), and an elevated anion gap (18.4 mmol/L). The patient was diagnosed with DKA and required admission to the intensive care unit for further management. He received 1.5 L isotonic crystalloid in the first hour, insulin 0.1 U/kg/h with potassium protocol; the anion gap closed at 12 hours, transitioned to subcutaneous insulin; length of stay was 4 days; no cerebral edema or hypoglycemia.

Conclusions and Recommendations

DKA should be considered in adults with compatible symptoms even without known diabetes. Immediate protocolized management (fluids, insulin, electrolytes) and early classification testing (autoantibodies, C-peptide) enable a safe transition to outpatient care and tailored long-term therapy. Diabetes surveillance in high-risk population (GRBS, HbA1c) and health awareness programs on diabetes and DKA presentation is essential for better outcomes

Written informed consent for publication in an open-access journal was obtained from the patient.

EP14 Sarcoidosis presenting with Uveitis and Granulomatous Interstitial Nephritis: Case Report

Basel Al Hayki

Department of Nephrology, Ibn Al Nafees Hospital, Manama, Bahrain

Correspondence: Basel Al Hayki (drbasel2002@hotmail.com)

BMC Proceedings 2025, 19(32): EP14

Keywords: sarcoidosis; uveitis; granulomatous interstitial nephritis; renal sarcoid; corticosteroids; case report

Abstract

Background Sarcoidosis is a multisystem inflammatory disease characterized by noncaseating granulomas. While pulmonary involvement is most common, extrapulmonary manifestations such as ocular sarcoidosis and renal sarcoid are under-recognized. Granulomatous interstitial nephritis (GIN) is a rare renal manifestation of sarcoidosis and can be the initial or sole manifestation.

Case Presentation A 47-year-old Bahraini male with no prior medical history presented with progressive blurred vision and was diagnosed with bilateral anterior uveitis. He was treated with local corticosteroids, resulting in partial symptom improvement.Due to incidentally found elevated creatinine (143 µmol/L), he was referred to nephrology. He had no systemic complaints. Review of systems was negative for fever, rash, weight loss, joint pain, cough, or neurological symptoms. Physical examination and vital signs, including blood pressure, were normal.

Laboratory Findings Serum creatinine: 143 µmol/LESR: 2 mm/hrUrinalysis: RBCs 6–8/HPF, WBCs 2–3/HPF, protein 1+Albumin-to-creatinine ratio (ACR): 4.82 mg/mmolANA, anti-dsDNA, ANCA (c/p), anti-CCP: NegativeHIV, Hepatitis B/C, VDRL, TP-PA, RPR: NonreactiveSerum calcium and liver enzymes: NormalACE level: ElevatedQuantiFERON TB: Negative

Imaging Renal ultrasound: Normal-sized kidneys with preserved echogenicityChest X-ray: NormalCT scan (thorax, abdomen, pelvis): Enlarged mesenteric lymph nodesECG and echocardiogram: Normal

Renal Biopsy Histology revealed tubulointerstitial nephritis with noncaseating granulomas, mild tubular atrophy, and interstitial fibrosis. Glomeruli were unremarkable.

Diagnosis

The differential diagnosis was sarcoidosis and tubulointerstitial nephritis with uveitis (TINU) Given the constellation of granulomatous interstitial nephritis, uveitis, CT scan confirming the presence of lymphadenopathy, and elevated ACE levels with exclusion of infectious and autoimmune causes, a diagnosis of sarcoidosis was made.

Treatment and Follow-up The patient was initiated on prednisolone 60 mg daily with complete recovery of eye symptoms and uveitis and renal function within few weeks with plan gradual tapper of steroids.

Conclusions and Recommendations In adults presenting with unexplained uveitis and interstitial nephritis, consider sarcoidosis early. Prompt renal biopsy, advanced thoracic imaging, and metabolic assessment are essential. Multidisciplinary input and early systemic corticosteroids are critical, with steroid-sparing agents for recurrent or dependent cases.

Written informed consent for publication in an open-access journal was obtained from the patient.

EP15 Hidden Danger: Acquired Methemoglobinemia Following Dapsone Therapy

Musab Ahmed, Ahmed Usama, Chryslene Abraham, Rayan Ahmed , Mohamed Mohamedkhair

Thumbay University Hospital, Ajman, UAE

Correspondence: Musab Ahmed (dr.musabahmed1@gmail.com)

BMC Proceedings 2025, 19(32): EP15

The original version of this article was revised: The spelling of author Rayan Ahmed has been amended in abstract EP15.

Keywords: methemoglobinemia; dapsone; saturation gap; methylene blue; co-oximetry; G6PD deficiency

Background

Methemoglobinemia is a disorder in which hemoglobin iron is oxidized from ferrous (Fe2⁺) to ferric (Fe3⁺), impairing oxygen binding and delivery to tissues. It may be congenital or acquired, the latter often from oxidizing drugs such as dapsone. Symptoms range from mild fatigue to life-threatening hypoxia. A hallmark finding is the “saturation gap”, where SpO₂ is low despite a normal or elevated PaO₂ on arterial blood gas.

Case Presentation

A 38-year-old male with dermatitis herpetiformis on dapsone for one month presented with one week of headache, dyspnea, fatigue, and grayish skin and nail discoloration. He was tachycardic and hypoxic (SpO₂ 87% on room air), with normal chest exam, ECG, CXR, and PFTs. In the ED, SpO₂ dropped to 79% despite oxygen via non-rebreather mask. ABG on oxygen revealed pH 7.40, Hb 12.3 g/dL, lactate 1.5 mmol/L, PaCO₂ 38 mmHg, PaO₂ 188 mmHg, SaO₂ 96.6% (co-oximetry), and MetHb 12.9%, confirming a saturation gap and the diagnosis of dapsone-induced methemoglobinemia. He received IV methylene blue (1.8 mg/kg in D5W) and was admitted to ICU and placed on oxygen support. His SpO₂ improved to 95% on room air within 24h. Dapsone was discontinued and therapy adjusted.

Discussion

Dapsone is a well-recognized cause of acquired methemoglobinemia, with up to 15% of treated patients developing elevated MetHb levels. Diagnosis requires high suspicion when hypoxia is disproportionate to clinical findings, especially when a saturation gap exists between SpO₂ on pulse oximetry and SaO₂ on co-oximetry. Treatment includes discontinuation of the offending agent, administration of methylene blue (1–2 mg/kg IV), and screening for G6PD deficiency to avoid hemolysis. Vitamin C and dextrose may be used as adjuncts. Newer multi-wavelength co-oximeters facilitate earlier detection.

Conclusions and Recommendations

In dapsone-treated patients with unexplained hypoxia or cyanosis unresponsive to oxygen, methemoglobinemia should be suspected and confirmed with co-oximetry. Management involves discontinuing the offending drug, screening for G6PD deficiency, and administering methylene blue (1–2 mg/kg IV, repeat if needed), while monitoring for rebound. Patients should also be counseled on early symptom recognition, advised to avoid other oxidant medications, and considered for periodic MetHb monitoring during therapy initiation or dose escalation.

Written informed consent for publication in an open-access journal was obtained from the patient.

EP16 Early Childhood Infections and Pediatric Movement Disorders: A Narrative Review of Clinical Links and Mechanisms (2020–2024)

Mohamed Taha 1 , Mohamed Mohamed 2 , Mohamed Khalifa 2 , Mohamed Mohamedkhair 2,3 , Musab Ahmed 2,3

1 Faculty of Medicine, University of Medical Science and Technology, Khartoum, Sudan; 2 Faculty of Medicine, National University, Khartoum, Sudan; 3 Thumbay University Hospital, Ajman, UAE

Correspondence: Mohamed Taha (mohameddyaeldin@gmail.com)

BMC Proceedings 2025, 19(32): EP16

Keywords: Pediatric movement disorders; Sydenham chorea; PANDAS/PANS; postinfectious autoimmunity; basal ganglia; streptococcal infections.

Background

Early childhood infections are increasingly recognized as potential triggers for pediatric movement disorders. Evidence suggests that selected infections and post-infectious immune responses may precipitate pediatric movement disorders such as Sydenham chorea, largely through basal ganglia–directed autoimmunity and related mechanisms. Associations differ by pathogen, geography, and diagnostic criteria, and remain controversial for entities such as PANDAS/PANS. For this review, we defined early childhood as ages 0–8 years and synthesized recent human data (2020–2024) on clinical presentations, immune mechanisms, and outcomes.

Materials and Methods

We conducted a targeted narrative review of studies published between January 2020 and April 2024. Databases screened included PubMed, Embase, and Web of Science. Search terms combined childhood infection, post-infectious autoimmunity, and movement disorders. Eligible studies included human cohorts, clinical trials, and meta-analyses describing pediatric movement disorders linked to infectious or post-infectious mechanisms. Nine studies were identified for synthesis.

Results

Recent reports highlight pathogen-specific associations between infections and pediatric movement disorders. Dystonia has been described in Japanese encephalitis, CNS tuberculosis, and neurocysticercosis, while ataxia has emerged in children with SARS-CoV-2 infection. Autoantibodies targeting dopamine receptors and other neural components have provided immune-mediated explanation, though vasculopathy, inflammation, and space-occupying lesions may also contribute. Reported treatments include corticosteroids and botulinum toxin, with outcomes varying by infection type and severity.

Conclusions and Recommendations

Recent studies suggest pathogen-specific and mechanism-dependent links between infection and pediatric movement disorders—robust for Sydenham chorea, less certain for PANDAS/PANS, and variable for direct CNS infections. Clinicians should document antecedent infections, use standardized diagnostic criteria and severity scales, and tailor therapy to the mechanism: antimicrobials for active infection, immunomodulation for post-infectious autoimmunity, and symptomatic treatment such as botulinum toxin for focal dystonia. Research priorities include prospective cohorts with clear diagnostic criteria, biobanking, standardized outcome measures, and controlled trials for immunomodulatory therapies in well-defined subgroups.

EP17 ECMO for ARDS in the COVID-19 Era: Patient Selection, Outcomes, and Complications—Narrative Review (2020–2024)

Mohamed Mohamedkhair, Chryslene Abraham, Ahmed Usama, Hadeel Ali, Ahmed Alhag, Musab Ahmed

Thumbay University Hospital, Ajman, UAE

Correspondence: Mohamed Mohamedkhar (mohamedelhassanmd@gmail.com)

BMC Proceedings 2025, 19(32): EP17

Keywords: acute respiratory distress syndrome; veno-venous ECMO; patient selection; timing of cannulation; complications; COVID-19.

Abstract

Background

Acute respiratory distress syndrome (ARDS) is an acute, diffuse, inflammatory lung injury caused by triggers such as pneumonia, trauma, sepsis, and aspiration. According to the Berlin definition, ARDS severity is stratified by oxygenation. In severe ARDS refractory to optimized ventilation, prone positioning, and neuromuscular blockade, veno-venous extracorporeal membrane oxygenation (ECMO) is considered a rescue therapy. Prior randomized and guideline data, including the CESAR and EOLIA trials and ELSO guidance, suggest potential benefit in carefully selected patients within experienced centers. This review compiles recent advancements in ECMO for ARDS, with emphasis on outcomes, complications, and patient selection during the COVID-19 era.

Materials and Methods

Design: Narrative review.

Data sources: PubMed (MEDLINE) and Embase (January 2020–December 2024).

Eligibility: Adult ARDS (Berlin definition) cohorts, randomized trials, and meta-analyses reporting ECMO indications, timing, outcomes (mortality, ventilator-free days), and complications.

Selection: Two reviewers independently screened and extracted data. Risk of bias in trials and observational studies was summarized qualitatively. Nine studies were included.

Results

ECMO use remains largely reserved for the most critically ill, explaining the high crude mortality rates observed (48.4% vs 12.8% in non-ECMO cohorts). These patients also experienced longer hospital stays (31.7 vs 8.3 days) and higher complication rates, including cardiac arrest, acute kidney injury, and sepsis. In tuberculosis-related ARDS, outcomes varied: miliary TB patients showed better survival (90-day survival 81% vs 46% for cavitary TB). Mortality predictors included older age, drug-resistant TB, and high pre-ECMO sequential organ failure assessment (SOFA) scores. During COVID-19, smaller ECMO teams successfully managed inter-hospital transfers with minimal complications.

Conclusions and Recommendations

ECMO for severe ARDS remains a resource-intensive rescue, with outcomes highly contingent on patient selection, timing (preferably <7–10 days of mechanical ventilation), and center expertise. Mortality remains high given the severity of illness, but observational crude comparisons are confounded by indication. Randomized and adjusted analyses, including EOLIA, support benefit in selected patients. Standardized selection pathways and early referral after failure of prone positioning and lung-protective ventilation are pivotal, with ongoing research needed to refine criteria, anticoagulation strategies, and outcomes in high-risk contexts such as COVID-19 and tuberculosis.

EP18 Early Exercise-Based Cardiac Rehabilitation After PCI for ACS: A Systematic Review

Sami Mohamed 1,2 , Yassein Elhussein 3 , Saad Alhammad 4 , Fathima Razana 5 , Hudaisa Ali 5 , Shams Al-Khafaji 5 , Shaikha Alshehhi 5 , Abdelmoniem Elmardi 6,7

1 Department of Clinical Sciences, College of Medicine, Dubai Medical University, Dubai, United Arab Emirates; 2 Department of Internal Medicine, Faculty of Medicine, Nile University, Khartoum, Sudan; 3 Department of Internal Medicine, Wayne State University, Detroit, MI, USA; 4 Department of Rehabilitation Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia; 5 College of Medicine, Dubai Medical University, Dubai, United Arab Emirates; 6 Department of Biomedical Sciences, College of Medicine, Dubai Medical University, Dubai, United Arab Emirates; 7 Nile University, Jeddah Branch, Jeddah, Kingdom of Saudi Arabia

Correspondence: Sami Mohamed (samicm@yahoo.com, dr.sami@dmu.ae)

BMC Proceedings 2025, 19(32): EP18

Keywords

Acute coronary syndrome; percutaneous coronary intervention; early cardiac rehabilitation; in-hospital exercise; major adverse cardiovascular events; meta-analysis

Abstract

Background

Exercise-based cardiac rehabilitation (CR) initiated early after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) is thought to improve long-term cardiovascular outcomes. However, optimal timing and detailed outcomes remain uncertain. This systematic review evaluated the impact of in-hospital initiation of exercise-based CR on long-term clinical outcomes in ACS patients post-PCI, focusing on cardiovascular morbidity, functional capacity, psychological health, and quality of life. Primary outcome was MACE. Secondary outcomes were readmissions, LVEF, 6MWD, anxiety/depression and health-related quality of life (HRQoL).

Materials and Methods

Following PRISMA guidelines, databases (PubMed, Cochrane CENTRAL, Web of Science, ScienceDirect) were systematically searched. Inclusion criteria comprised of adult ACS patients post-PCI receiving early in-hospital CR. We defined early in-hospital CR as supervised mobilization exercise initiated ranging from 12 hours after PCI to one week during the index admission, versus usual care without structured in-hospital exercise Data were narratively synthesized, and risk-of-bias assessed using ROBINS-I and Cochrane tools. The Covidence.org software was used in the process.

Results

Twelve studies (5 RCTs, 7 observational) out of a total of 3103 screened records were included. Studies demonstrated significant variability in interventions and outcomes. Major cardiovascular events (MACE) were notably reduced (HR: 0.77; 95% CI: 0.63–0.95), along with hospital readmissions (RR: 0.79; 95% CI: 0.74–0.85). Cardiac function improved significantly, demonstrated by increased left ventricular ejection fraction (LVEF) (+11.5 percentage points; p<0.001). Substantial functional improvements were evident through increased six-minute walk distance (6MWD) (+118 m; p<0.05). Psychological health improved, with significant reductions in anxiety and depression scores (p<0.01). Exercise-based CR was safe, with no severe adverse events reported.

Conclusions and Recommendations

Early in-hospital initiation of exercise-based CR significantly improves cardiac function, reduces adverse cardiovascular events, and enhances functional and psychological outcomes in ACS patients following PCI. However, multicenter interventions with long term follow up to determine the optimal window is warranted.

EP19 Vascular Access, Interdialytic Weight Gain, and Intradialytic Hypertension in Maintenance Hemodialysis: Cross-Sectional Study at a Tertiary Center

Mohammed Khogalee 1 , Sara Elamin 2 , Sami Mohamed 3,4

1 Department of Internal Medicine, Dibba Hospital, Emirates Health Services, United Arab Emirate; 2 Department of Nephrology, Ahmed Gasim Teaching Hospital, Khartoum, Sudan; 3 Department of Clinical Sciences, College of Medicine, Dubai Medical University, Dubai, United Arab Emirates; 4 Department of Internal Medicine, Faculty of Medicine, Nile University, Khartoum, Sudan

Correspondence: Mohamed Khogalee (mhelawee88@yahoo.com)

BMC Proceedings 2025, 19(32): EP19

Keywords: intradialytic hypertension; vascular access; interdialytic weight gain; ultrafiltration rate; arteriovenous fistula; central venous catheter; hemodialysis

Abstract

Background

Intradialytic hypertension (IDH) is defined priori as a ≥10 mmHg increase in systolic BP from pre- to post-dialysis, and is traditionally linked to extracellular-volume excess, presenting as interdialytic weight gain (IDWG). Yet hemodynamic factors related to vascular-access mode may contribute to blood-pressure rises during hemodialysis. Directly comparing these two pathways could support preventive measures. The aim of the study is to determine the prevalence of IDH and its association with IDWG and with vascular-access mode.

Materials and Methods

A cross-sectional study design was performed at a tertiary hemodialysis center from October 2016 to January 2017. All adults (≥ 18 y) receiving twice-weekly, 4-hour hemodialysis for ≥ 3 months were eligible. Exclusions were acute kidney injury, hospitalization < 4 weeks or incomplete blood-pressure records. Trained nurses prospectively recorded, for six consecutive sessions, pre-/post-dialysis systolic and diastolic blood pressure, body weight, ultrafiltration volume/rate and vascular-access type. Primary outcomes were IDH prevalence and its association with vascular access; secondary outcomes included associations with IDWG (% dry weight) and ultrafiltration (UF) rate (mL/kg/h). Demographics, comorbidities and medication profiles were obtained with a structured questionnaire and record review. IDH was predefined as a ≥ 10 mmHg rise in systolic BP on ≥ 4 of the six sessions. Data analysis was done using the SPSS software. Continuous variables were compared with Student’s t-test and categorical data Chi-square tests.

Results

Eighty-nine patients (mean age 46 ± 14 years; 60 % men) were analyzed. IDH prevalence was 29 % (26/89; 95 % CI 20–39 %). Mean six-session IDWG was 2.2 ± 0.9 kg in the IDH group and 2.5 ± 1.0 kg in controls (mean difference –0.30 kg; 95 % CI –0.73 to 0.13; p = 0.20), indicating no significant association. By contrast, central venous catheters were present in 27 % of IDH cases versus 2 % of controls (OR 22.8; 95 % CI 2.6–198; p = 0.003). Post-dialysis BP remained higher in IDH patients (168 ± 13/94 ± 10 mmHg) than in controls (141 ± 26/77 ± 13 mmHg; both p < 0.001).

Conclusions and Recommendations

IDH affected nearly one-third of patients and was independently associated with catheter use but not with greater IDWG or UF rate in this twice-weekly program. These findings support the hypothesis that access-related hemodynamics contribute to IDH and reinforce prioritizing AVF creation/maintenance; prospective studies with objective volume assessment (bioimpedance/BNP) should test whether transitioning from catheter to AVF reduces IDH.

EP20 Non-parenchymal Neuro-Behçet’s Presenting as Isolated Aseptic Meningitis in a Young Man: Case Report

Mohammed El Lahawi 1 , Mohamed M. Abd Elhamid 2

1 Department of Neurology, Sheikh Khalifa Medical City (SKMC), Abu Dhabi, United Arab Emirates; 2 Department of Internal Medicine, Sheikh Khalifa Medical City (SKMC), Abu Dhabi, United Arab Emirates

Correspondence: Mohammed El Lahawi (mohamedmo3awia9@gmail.com; lahawi@hotmail.com)

BMC Proceedings 2025, 19(32): EP20

Keywords: Behçet’s disease; neuro-Behçet’s; aseptic meningitis; International Criteria for Behçet’s Disease; cerebrospinal fluid; case report.

Abstract

Background

Behçet's Disease (BD) is a multisystem autoinflammatory disorder causing vasculitis affecting vessels of all sizes 1 . Hallmarks include recurrent oral and genital ulcerations and ocular lesions. Neuro-Behçet's Disease (NBD) is a rare severe manifestation that can mimic other neurological disorders 2 . NBD comprises parenchymal (~80%) and non-parenchymal including; venous sinus thrombosis, intracranial hypertension, and isolated meningitis, one of the rarest presentations 3,4 . Diagnosis should reference the International Criteria for Behçet’s Disease and the 2014 International Consensus Recommendations for NBD 5,6 .

Case Presentation

A 24-year-old male presented with a two-week history of dull generalized headache and drowsiness. He was afebrile, stable, and examination was unremarkable. Initial labs and brain CT were normal. Lumbar puncture (LP) showed lymphocytic pleocytosis, elevated protein, and normal glucose; cultures and viral PCR were negative. He was treated empirically with intravenous antibiotics and acyclovir, then discharged after mild improvement.

He was readmitted with worsening headache, photophobia, vomiting, and drowsiness. MRI/MRA/MRV were normal, and a second LP revealed similar findings with higher protein. Anti-tubercular therapy and dexamethasone were initiated, followed by antifungals after a weakly positive cryptococcal titer, without response. One week later he had a tonic-clonic seizure; EEG was normal, and HIV, brucellosis, and Lyme were negative. He subsequently developed maculopapular rash, ankle swelling, and knee arthralgia. Further history revealed recurrent oral ulcers. A diagnosis of NBD was made, antimicrobials were discontinued, and treatment with dexamethasone and colchicine led to complete recovery.

Discussion

This patient had non-parenchymal NBD presenting as aseptic meningitis, a rare subtype (1–1.4.4% of NBD). Unlike parenchymal NBD, which shows cerebral or brainstem lesions on MRI, non-parenchymal NBD may present with normal imaging and aseptic meningitis [3,4]. Consensus guidance recommends high-dose corticosteroids for acute NBD and azathioprine for relapse prevention; while cyclosporine is avoided [5]. In this case, the rheumatologist recommended dexamethasone and colchicine leading to complete recovery.

Conclusion and Recommendations

Clinicians should consider NBD in patients with aseptic meningitis with normal MRI and negative infectious workup. Targeted history for recurrent oral/genital ulcers and early application of ICBD/NBD criteria can prevent protracted empiric antimicrobials and expedite immunosuppression

Written informed consent for publication in an open-access journal was obtained from the patient.

References

Kidd, D. P. (2023). Neurological involvement by Behçet’s syndrome: Clinical features, diagnosis, treatment and outcome. Practical Neurology . Advance online publication. 10.1136/pn-2023-003875

Uygunoglu, U., Saip, S., & Siva, A. (2018). Behçet’s disease and Neuro-Behçet’s syndrome. EMJ Neurology , 77–85. 10.33590/emjneurol/10313735

Fonseca Cardoso, A., Rocha-Filho, P. A., & Melo Correa-Lima, A. R. (2013). Neuro-Behçet: Differential diagnosis of recurrent meningitis. Revista Médica de Chile, 141 (1), 114–118. 10.4067/S0034-98872013000100016

Gritti, P., Lanterna, L. A., Chinaglia, D., Manara, O., Soavi, L., Zilio, A., & Suter, F. (2011). An unusual case of meningitis. Le Infezioni in Medicina, 19 (1), 45–48.

International Team for the Revision of the International Criteria for Behçet’s Disease (ITR-ICBD). (2014). The International Criteria for Behçet’s Disease (ICBD): A collaborative study of 27 countries on the sensitivity and specificity of the new criteria. Journal of the European Academy of Dermatology and Venereology, 28 (3), 338–347. 10.1111/jdv.12107

Kalra, S., Silman, A., Akman-Demir, G., Bohlega, S., Borhani-Haghighi, A., Constantinescu, C. S., Houman, H., Mahr, A, Salvarani, C., Sfikakis, P. P., Siva, A., & Al-Araji, A. (2013). Diagnosis and management of Neuro-Behçet’s disease: International consensus recommendations. Journal of Neurology, 261 (9), 1662–1676. 10.1007/s00415-013-7209-3

EP21 Severe Dengue and Plasmodium falciparum Co-infection with Multiorgan Dysfunction in a Ugandan Adult: Case Report

Mohamed Mohamed 1 , Mohamed Khalifa 1 , Musab Ahmed 1,2 , Mohamed Mohamedkhair 1,2

1 Faculty of Medicine, National University, Khartoum, Sudan; 2 Thumbay University Hospital, Ajman, UAE

Correspondence: Mohamed Mohamed (magibreel@gmail.com)

BMC Proceedings 2025, 19(32): EP21

Keywords: dengue; Plasmodium falciparum; co-infection; thrombocytopenia; multiorgan dysfunction

Abstract

Background

Dengue and malaria are two mosquito-borne diseases that co-circulate in tropical regions and may co-infect the same host, producing overlapping clinical and laboratory findings that complicate diagnosis and management. We present the case of a 24-year-old Ugandan man diagnosed with both severe dengue and Plasmodium falciparum malaria, complicated by profound thrombocytopenia, acute kidney injury, jaundice, and metabolic acidosis.

Case Presentation

A 24-year-old Ugandan male presented with high-grade fever, headache, myalgia and progressive weakness; examination showed hypotension, jaundice, and dehydration. On admission platelets were 22,000/µL, CRP 322 mg/L, and severe metabolic acidosis (pH 7.2, HCO₃⁻ 12 mmol/L, lactate 11 mmol/L). Dengue infection was identified by positive dengue IgM serology, and P. falciparum was confirmed on peripheral smear with parasitemia of 5.9%.

He required ICU care with titrated IV fluids, norepinephrine, IV artesunate, empirical antibiotics, and platelets were transfused for critical thrombocytopenia. Oxygen was weaned from non-invasive ventilation to 4 L/min nasal cannula. By day 3 he was alert and tolerating oral intake; platelets rose to ≈113,000/µL, renal and liver tests normalized, and he was stepped down to the ward and later discharged on oral artemether-lumefantrine (Coartem) without neurological or renal sequelae at follow-up.

Discussion

Dengue malaria co-infection is variably reported with prevalence ranging from <1% to 4% in endemic areas, yet it carries a higher risk of complications compared to single infections. Our patient’s presentation with multi-organ dysfunction, severe thrombocytopenia, and metabolic acidosis mirror severe cases reported in literature but also showed rapid recovery after early ICU admission and simultaneous targeted therapy. Unlike published cases where diagnosis was delayed due to symptom overlap, prompt testing for both pathogens allowed immediate therapy, likely contributing to the favorable outcome. This case highlights that disproportionate thrombocytopenia with hemoconcentration or shock in a falciparum-positive patient should prompt concurrent dengue testing and careful, phase-appropriate fluid stewardship to avoid iatrogenic overload during the critical phase.

Conclusions and Recommendations

In co-endemic settings clinicians should co-test for dengue (NS1/PCR early; paired serology later) and malaria (microscopy ± RDT/PCR) when clinical or laboratory findings are atypical for a single infection. Early concurrent testing and rapid initiation of targeted treatments can significantly reduce morbidity and prevent fatal outcomes.

Written informed consent for publication in an open-access journal was obtained from the patient.

EP22 Correlates of Obesity Among Sudanese Medical Students: A Cross-Sectional Study

Mohamed Khalifa 1 , Mohamed Mohamed 1 , Ibrahim Ali 1 , Mennatallah Rizq 1 , Mohamed Mohamedkhair 1,2 , Musab Ahmed 1,2

1 Faculty of Medicine, National University, Khartoum, Sudan; 2 Thumbay University Hospital, Ajman, UAE

Correspondence: Mohamed Khalifa (mohmdimad1029@gmail.com)

BMC Proceedings 2025, 19(32): EP22

Keywords: obesity; medical students; Sudan; family history; weight perception; cross-sectional study.

Abstract

Background

Obesity among medical students may harm health and weaken their role in guiding patients. Family background and self-perception may influence risk. In this study, we defined obesity using WHO Afro-Arab cutoffs (BMI ≥ 30 kg/m 2 ) and aimed to measure its prevalence while exploring the factors independently associated with it.

Materials and Methods

We conducted a cross-sectional survey at National University–Sudan from August 2021 to October 2022. We used stratified random sampling to select 282 students in years 2 through 5. BMI was calculated from measured height and weight. An online 25-item questionnaire collected information on demographics, chronic illness, first-degree family history of obesity, breakfast and snack habits, physical activity, screen time, sleep, and weight perception. Ethical approval was waived by the university’s ethics committee; verbal consent was obtained. Data were analyzed with chi-square tests and logistic regression. A p-value <0.05 was considered significant.

Results

The obesity prevalence was 11.0% (31/282; 95% CI 7.6–15.2). Rates did not differ between males (12.5%) and females (10.3%) (p = 0.94). Prevalence was higher among students with obese parents (15.5%, 15/97; 95% CI 8.9–24.2) and obese siblings (21.7%, 13/60; 95% CI 12.1–34.2) (p = 0.01 and p = 0.018, respectively), compared with those with no parental or sibling history of obesity (3.5%). Students with chronic illness had a higher prevalence (23.3%) compared to those without (9.5%) (p = 0.039). Nearly half of obese students (48.4%) rated themselves only as overweight (p < 0.001). Students who had breakfast daily and those consuming two or fewer snacks per day had a higher prevalence (p = 0.013 and p = 0.021, respectively). Income was not significant (p=0.41).

Conclusions and Recommendations

One in nine students met obesity criteria. The strongest associations were with family history and misperception of body weight, while most lifestyle factors showed no independent link. We recommend integrating nutrition and weight-perception counseling into medical training and using family history to identify students at risk. Longitudinal studies are needed to clarify pathways. The cross-sectional, self-reported, and single-institution design may limit causal inference and generalizability.

EP23 First-Episode Unprovoked Seizures in the Emergency Department: A Guideline-Compliance Audit at SKMC, Abu Dhabi (Aug 2020–Mar 2023)

Mohammed El Lahawi 1 , Afaf Al Maskari 2 , Neama Luqman 3 , Mohamed M. Abd Elhamid 2 , Mustafa Shakra 1 , Lamya Turkawi 1 , Fazil Thaha Manzil 1

1 Department of Neurology, Sheikh Khalifa Medical City (SKMC), Abu Dhabi, United Arab Emirates; 2 Department of Internal Medicine, Sheikh Khalifa Medical City (SKMC), Abu Dhabi, United Arab Emirates; 3 Department of Internal Medicine, Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, United Arab Emirates

Correspondence: Mohammed El Lahawi (mohamedmo3awia9@gmail.com; lahawi@hotmail.com)

BMC Proceedings 2025, 19(32): EP23

Keywords: first unprovoked seizure; emergency department; guideline compliance; NICE guidelines; neurology referral; quality improvement audit

Abstract

Background

First unprovoked seizures are a frequent presentation to emergency departments (ED), and optimal initial assessment is essential to identify unprovoked seizures, exclude mimics, and reduce recurrence risk. This audit evaluated compliance with SKMC guidelines and international standards (NICE) for assessment and management of first-episode unprovoked seizures. We defined the first unprovoked seizure per NICE as a seizure not precipitated by acute metabolic, toxic, structural, or infectious causes. Audit standards (target ≥90–100%) covered history/exam elements, core labs/ECG, neuroimaging, neurology referral, and documented safety counselling.

Materials and Methods

We retrospectively reviewed adult patients presenting to SKMC ED with a first episode of unprovoked seizure between August 2020 and March 2023, excluding those with prior seizures, secondary causes, or provoked seizures. Data were collected from electronic records (Cerner) using the “unspecified convulsions” code and analyzed for compliance with documentation, investigations, referrals, and patient education against NICE guidelines.

Results

From 404 seizure presentations, 73 patients (18%) were identified as having a first episode of unprovoked seizure and formed the audit cohort. Overall compliance with guideline-based assessment was 64% (non-compliant). Compliance with history-taking, examination, and initial investigations was documented in 70% of patients (n=51). All patients (n=73) underwent neuroimaging (CT head), and 93% (n=68) had metabolic panels performed. Prolactin was inappropriately ordered in 64% of patients (n=47). Urgent ED neurology referral occurred in 45% of patients (n=33), and only 11 patients (15%) attended neurology outpatient follow-up within two weeks. Occupation was documented in 31 patients (42%). Patient education regarding safety and recurrence prevention was inconsistently provided.

Conclusion and Recommendations

Compliance with NICE-aligned ED care for a first unprovoked seizure was suboptimal, especially for standardized documentation, neurology referral, and booking follow-up. We will implement (i) an ED seizure order set and documentation template (auto-populate glucose/electrolytes/ECG/Neurological imaging; suppress prolactin by default), (ii) Create a criterion for urgent ED neurology referral, neurology scheduling ≤14 days, and indications for admission, and (iii) a patient education checklist (driving, water safety, heights/machinery, sleep, alcohol). We plan a re-audit at 24 months with run-charts of key process and outcome metrics.

EP24 D-Lactic Encephalopathy in Short Bowel Syndrome: Recurrent Carbohydrate-Triggered Neurocognitive Episodes in an 18-Year-Old

Harshavardhan Rajagopal 1 , Mark William Noble 1 , Lisa Sharkey 2

1 Department of Internal Medicine, Kings College Hospital London Dubai; 2 Department of Gastroenterolgy and Hepatology,Kings College Hospital London Dubai

Correspondence: Harshavardhan Rajagopal (harsh.f13@gmail.com)

BMC Proceedings 2025, 19(32): EP24

Keywords: D-lactic acidosis; short bowel syndrome; encephalopathy; small intestinal bacterial overgrowth; carbohydrate malabsorption; metabolic acidosis.

Abstract

Background

D-lactic acidosis is an uncommon but important complication of short bowel syndrome (SBS), resulting from bacterial fermentation of unabsorbed carbohydrates in the colon. In short bowel syndrome, colonic fermentation of unabsorbed carbohydrates produces D-lactate, which routine L-lactate assays fail to detect, causing high anion-gap metabolic acidosis with recurrent encephalopathy. The resulting D-lactate is poorly metabolised by humans and can cross the blood-brain barrier, leading to neurological symptoms such as confusion, ataxia, and weakness. Due to its rarity and non-specific presentation, it is often overlooked.

Materials and Methods

We describe an 18-year-old male with SBS following extensive small bowel resection for midgut volvulus in 2022. Clinical records from 2022 to 2024 were reviewed, including hospital notes, laboratory data, and treatment responses. The focus was to correlate episodes of neurological symptoms with biochemical evidence of metabolic acidosis and suspected D-lactic accumulation.

Results

An 18-year-old male with short bowel syndrome after midgut volvulus resection (2022) developed recurrent episodes of acute confusion, lethargy, and proximal weakness, often triggered by high-carbohydrate intake with diarrhea. He was malnourished, with weight loss from 55 kg to 40 kg and BMI ~17. During episodes, he was conscious but lethargic, afebrile, and hemodynamically stable. Arterial blood gases showed acidemia (pH 7.16) with low bicarbonate (9–12 mmol/L) and raised anion gap, while routine assays revealed only mildly elevated L-lactate (2.8 mmol/L). Targeted testing confirmed elevated plasma D-lactate. Management with intravenous/oral sodium bicarbonate, carbohydrate restriction, and gut-directed antibiotics (rifaximin, metronidazole) led to resolution of encephalopathy and prevention of recurrent admissions.

Conclusions and Recommendations

This case illustrates the importance of considering D-lactic encephalopathy in SBS patients with unexplained neurological symptoms. SBS patients presenting with episodic neurocognitive changes and high anion-gap acidosis, clinicians should request plasma D-lactate and initiate dietary carbohydrate restriction alongside correction of acidosis and modulation of gut flora. Early testing and prevention strategies can avert recurrent admissions. Early recognition and management with carbohydrate restriction, correction of acidosis, and modulation of gut flora can prevent recurrent admissions. Greater awareness among clinicians is essential to avoid unnecessary investigations and delays in treatment.

Written informed consent for publication in an open-access journal was obtained from the patient.

EP25 Snakebite Burden in Bangladesh: Insights from a Tertiary Care Hospital

Md Jahangir Kabir 1 , Nurun Nahar 2 , Md Mahfuzer Rahman 3 , Mst Sabina Yesmin 4 , Md Shahriar Morshed 5 , Md Anwar Hossain 6

1 Department. of Medicine, Rangpur Medical College, Rangpur, Bangladesh; 2 Anatomy, Armed Forces Medical College, Dhaka, Bangladesh; 3 Department of Medicine, Shaheed Syed Nazrul Islam Medical College, Kishoreganj, Bangladesh; 4 Radiology & Imaging, Central Police Hospital, Dhaka, Bangladesh; 5 Community Medicine, Rangpur Medical College, Rangpur, Bangladesh; 6 Hypertension and Research Centre, Rangpur, Bangladesh

Correspondence: Md Jahangir Kabir (drjahangirkabirk5@gmail.com)

BMC Proceedings 2025, 19(32): EP25

Keywords: Snakebite, Snake antivenom, Poisonous, Epidemiology

Abstract

Background

Snakebite envenoming, recognized by the World Health Organization (WHO ) (Snakebite Envenoming, n.d.) as a Neglected Tropical Disease in 2017, remains a serious public health threat, particularly in South Asia, which accounts for nearly 70% of global snakebite mortality (The Global Burden of Snakebite: A Literature Analysis and Modelling Based on Regional Estimates of Envenoming and Deaths | PLOS Medicine, n.d.). In Bangladesh, the burden is disproportionately high with an estimated 623 cases per 100,000 persons annually (Annual Incidence of Snake Bite in Rural Bangladesh | PLOS Neglected Tropical Diseases, n.d.), most occurring during the rainy season (Epidemiology, Clinical Profile and Outcome of Patients of Snake Bite in Mymensingh Medical College Hospital, 2025) and mortality (Snakebite in Bangladesh |, n.d.) is primarily linked to neurotoxic bites from kraits and cobras. However, limited hospital-based data exist on the demographic profile, clinical outcomes, and treatment practices of snakebite victims; this study aims to address that gap by analyzing the burden and demography of snakebite patients in a tertiary care hospital in Bangladesh.

Materials and Methods

The study was an observational prospective study conducted over six months from May to October 2024 in the medicine department of Rangpur Medical College Hospital, Bangladesh. A total of 176 admitted patients were included. Data were collected using a structured form, and patients were observed until discharge or death. Results were analyzed using frequency tables and percentages with SPSS version 25.

Results

Among 176 snakebite patients, 67% were male and 45.5% belonged to the 31–45 years age group, with farmers (44.9%) and housewives (30.7%) being the most affected occupations. Bites occurred year-round but peaked in July (48.3%), predominantly affecting the lower limbs (70.5%). The mean bite-to-hospital time was 5.53 ± 4.96 hours for poisonous bites and 4.54 ± 6.58 hours for non-poisonous bites. Overall, 9.7% of cases were poisonous; antivenom was administered in 16 of these, with outcomes being uneventful in 76.5% while 23.5% resulted in death.

Conclusions and Recommendations

This study highlights that snakebites in Bangladesh predominantly affect working-age males and housewives, with most cases occurring in fields during the rainy season. The findings underscore the need for strengthening community awareness on appropriate first aid, ensuring timely hospital access, and improving the availability of antivenom and intensive care facilities. Future research should focus on regional variations and strategies to integrate snakebite management into national health policy.

References

Annual incidence of snake bite in rural Bangladesh. (n.d.). PLOS Neglected Tropical Diseases. Retrieved September 8, 2025, from 10.1371/journal.pntd.0000860

Epidemiology, clinical profile and outcome of patients of snake bite in Mymensingh Medical College Hospital. (2025). Journal of Bangladesh College of Physicians and Surgeons, 27(2). 10.3329/jbcps.v27i2.4249

World Health Organization. (n.d.). Snakebite envenoming. Retrieved September 8, 2025, from https://www.who.int/news-room/fact-sheets/detail/snakebite-envenoming

Global Snakebite Initiative. (n.d.). Snakebite in Bangladesh. Retrieved September 8, 2025, from https://www.snakebiteinitiative.org/page_id-611/

The global burden of snakebite: A literature analysis and modelling based on regional estimates of envenoming and deaths. (n.d.). PLOS Medicine. Retrieved September 8, 2025, from 10.1371/journal.pmed.0050218

EP26 Precision Prediction of Chemotherapy Cardiotoxicity with Genomics, Biomarkers, and AI: Systematic Review (2020–2025).

Aliasgar Taha

Dr. Sulaiman Al Habib Hospital, Dubai, UAE

Correspondence: Aliasgar Taha (atb786110@gmail.com)

BMC Proceedings 2025, 19(32): EP26

Keywords: cardio-oncology; anthracycline cardiotoxicity; genomics; circulating microRNAs; global longitudinal strain; artificial intelligence

Abstract

Background

Chemotherapy-induced cardiotoxicity (CTRCD), defined as a ≥10% decline in left ventricular ejection fraction (LVEF) to <53% or a ≥15% reduction in global longitudinal strain (GLS), affects ~9–20% of anthracycline- and HER2-treated patients despite monitoring. Conventional surveillance methods frequently detect dysfunction only after irreversible myocardial injury. Precision medicine approaches integrating genomics, circulating biomarkers, and artificial intelligence (AI)-enhanced imaging may enable earlier detection and targeted prevention. This systematic review compared the predictive performance of genomic variants, circulating biomarkers, AI imaging, and multimodal models for CTRCD risk stratification.

Materials and Methods

Systematic searches of MEDLINE, Embase, CENTRAL, and Web of Science (1 Jan 2020–30 Jun 2025) identified English-language studies evaluating CTRCD prediction. Eligible designs included genome-wide association studies, pharmacogenomic analyses, biomarker validation cohorts, and AI-enhanced imaging trials. I independently screened studies and extracted data, with reporting guided by PRISMA standards. Evidence was synthesised narratively with emphasis on predictive performance and clinical applicability.

Results

Genomic variants in CBR3, ABCC1, SLC28A3, and RARG (rs2229774; OR 4.7) were consistently associated with anthracycline cardiomyopathy; SNP panels incorporating multiple loci improved predictive accuracy by nearly twofold compared with clinical risk factors alone. Circulating microRNAs, particularly miR-1, miR-499, and miR-146a, rose weeks before EF decline, achieving >80% sensitivity, whereas troponins often remained normal until 4–6 weeks post-therapy. Multi-omics panels integrating proteomic and metabolomic markers increased specificity by ~25% over single biomarkers. AI-driven analyses of GLS achieved an AUC of 0.74 for predicting subclinical dysfunction, outperforming LVEF. Fusion models integrating genomics, biomarkers, and imaging stratified patients into low-, intermediate-, and high-risk groups, reducing misclassification by 30–40% in pilot studies.

Conclusions and Recommendations

Integration of genomic, biomarker, and AI imaging modalities represents a promising shift from reactive to proactive cardio-oncology. However, certainty remains low–moderate due to heterogeneity, small sample sizes, and limited external validation. A stepped workflow is proposed, beginning with baseline clinical models, followed by genomics in high-risk regimens, serial miRNA/hs-troponin monitoring, and AI-GLS, with thresholds guiding initiation of ACE inhibitors/β-blockers and surveillance frequency. Future priorities include prospective multicentre cluster-RCTs, cost-effectiveness analyses, equitable ancestry representation, and robust data governance to support real-world implementation.

EP27 Tuberculous Meningitis Presenting as Acute Ischemic Stroke: GeneXpert-Positive Case with Spinal Arachnoiditis

Mohamed Ibrahim Ragab 1 , Mohamed Salah Noshi 1 , Wael Hafez 2,3,4 , Naama Hussain Alsuwaidi 1 , Abdulrahman Waleed Al Tamimi 1

1 Department of Internal Medicine, Sheikh Shakhbout Medical City, Abu Dhabi, UAE; 2 Department of Internal Medicine, NMC Royal Hospital, Khalifa City, Abu Dhabi, UAE

Correspondence: Mohamed Ibrahim Ragab (mohamid.ibrahim@gmail.com)

BMC Proceedings 2025, 19(32): EP27

Keywords: tuberculous meningitis; stroke mimic; GeneXpert; spinal arachnoiditis; diabetes mellitus; Southeast Asia

Abstract

Background

Tuberculous meningitis (TBM) carries high mortality in endemic regions but often presents nonspecifically, delaying diagnosis 1 . Rarely, TBM can clinically and radiologically mimic acute ischemic stroke (AIS) in afebrile patients 2 . The Emirates Society of Internal Medicine (ESIM), Emirates Medical Association, 46th Street Deira Near International Bowling Centre - Dubai info@ema.ae United Arab Emirates ³. Medical Research and Clinical Studies Institute, The National Research Centre, Cairo, Egypt ⁴. We report a GeneXpert-confirmed TBM case initially managed as stroke, underscoring diagnostic pitfalls and imaging clues.

Case presentation

A 34-year-old Asian woman with poorly controlled diabetes presented with a five-day history of severe headache, fatigue, and vomiting. On admission, she was afebrile with stable vital signs and no focal neurological deficits, Medical Research Council (MRC) TBM stage I at presentation. Inflammatory markers were within normal range. Non-contrast Computed Tomography (CT) head was unremarkable, but Magnetic Resonance Imaging (MRI) brain showed multiple acute infarcts in right hippocampus, right thalamus and left insula cortex. Based on these findings, she was diagnosed with AIS and admitted to the stroke unit, where aspirin and statin therapy were initiated.

Lumber puncture was done 48 hours after presentation due to patient refusal initially. Cerebrospinal Fluid (CSF) analysis revealed white cell counts 440/µL (61% lymphocytes), markedly elevated protein 2.45 g/L, and glucose at 35% of concurrent blood glucose. GeneXpert detected Mycobacterium tuberculosis complex DNA (trace detected). Acid-fast bacilli (AFB) smear was negative; 16 days later Mycobacterium tuberculosis complex were isolated. HIV was negative.

Shortly thereafter, the patient developed urinary incontinence and back pain. Spinal MRI revealed T12 and adjacent L1 endplate STIR hyperintensity as well as contrast enhancement with relative sparing of intervening disc, features suggesting of TB spondylitis. It also showed leptomeningeal enhancement of cauda equina nerve roots, which favour mild early reactive arachnoiditis.

The patient was started on standard RIPE regimen (rifampicin 600 mg daily, isoniazid 300 mg daily, pyrazinamide 1500 mg daily, ethambutol 1200 mg daily) plus adjunctive dexamethasone (0.4 mg/kg/day with tapering over 6 weeks). She improved steadily, with resolution of symptoms, and was discharged after 19 days with a modified Rankin Scale score of 1.

Discussion

This case illustrates the diagnostic challenge of TBM when inflammatory signs are minimal, leading to initial misdiagnosis as stroke. Multiple deep perforator infarcts with basal meningeal enhancement favor TBM-related vasculitis over primary thromboembolism. Mechanisms include basal exudate–induced arteritis, intimal proliferation, and a prothrombotic milieu 3 . Early lumbar puncture with GeneXpert and contrast MRI can prevent hazardous stroke-directed interventions in such mimics 4 .

Conclusions and Recommendations

In endemic settings, TBM should be considered in subacute stroke-like presentations, especially with basal ganglia infarcts and minimal systemic inflammation. Prompt CSF testing (including GeneXpert) and early antituberculosis therapy with adjunctive corticosteroids are critical to optimize outcomes.

Written informed consent for publication in an open-access journal was obtained from the patient.

References:

Seid, G., Alemu, A., Dagne, B., & Gamtesa, D. F. [2023]. Microbiological diagnosis and

mortality of tuberculosis meningitis: Systematic review and meta-analysis. PLOS ONE,

18[2], e0279203. 10.1371/journal.pone.0279203

Guo, Y., Gan, X., Zhang, R., Liu, Y., Wang, E., Lu, S., Jiang, H., Duan, H., Yuan, Z., & Li,W. [2024]. Acute ischemic stroke in tuberculous meningitis. Frontiers in Public Health, 12,1362465. 10.3389/fpubh.2024.1362465

Misra, U. K., Kalita, J., & Maurya, P. K. [2011]. Stroke in tuberculous meningitis. Journal of the Neurological Sciences, 303[1–2], 22–30. 10.1016/j.jns.2010.12.015

Pagliano, P., Spera, A. M., Ascione, T., Esposito, S., & Fusco, F. M. [2020]. Infections

causing stroke or stroke-like syndromes. Infection, 48[3], 323–332. 10.1007/s15010-020-01415-6

EP28 Abdominal Tuberculosis Mimicking Pediatric Lymphoma in a Non-Endemic Setting: A Case Report

Mohamed El-Mezayen 1 , Dalia Atef Abouda 1,4 , Abdelrahman Tawfik 1 , Mohamed Afifie 1 , Aya Fata 1 , Zyad Mady 3 , Abdelrahman Magdi 3 , Ismail A. Ibrahim 2,4

1 Faculty of Medicine, Alexandria University, Alexandria, Egypt; 2 Faculty of Health Sciences, Fenerbahce University, Istanbul, Turkey; 3 NMC Royal Hospital, Abu Dhabi, United Arab Emirates; 4 Global Alliance of Young Researchers, Istanbul, Turkey

Correspondence: Abdelrahman Magdi Abdelsalam Abdalla (Abdulrhman.majdi88@gmail.com)

BMC Proceedings 2025, 19(32): EP28

Keywords: abdominal tuberculosis; child; mesenteric lymphadenopathy; intestinal obstruction; caseating granuloma; interferon-gamma release assay (IGRA)

Abstract

Background

Abdominal tuberculosis (TB) in children presents with constitutional symptoms, splanchnic lymphadenopathy, and inflammatory markers that closely mimic lymphoma, creating a significant diagnostic dilemma in non-endemic settings. This case report aims to highlight the critical role of laparoscopic tissue diagnosis in achieving a definitive diagnosis when initial imaging and microbiological tests are inconclusive.

Materials and Methods

A case study was conducted on a 7-year-old girl from Sudan presenting with intermittent fever, abdominal pain, and weight loss. The diagnostic workup included cross-sectional imaging (CT abdomen), comprehensive blood tests (CBC, inflammatory markers), and initial microbiological assays. After these non-invasive methods failed to provide a diagnosis and the patient's condition deteriorated, a diagnostic laparotomy with biopsy was performed. Histopathological analysis and an interferon-gamma release assay (QuantiFERON-TB Gold) were used to confirm the etiology.

Results

Imaging revealed splenomegaly, pancreatic enlargement, and significant mesenteric lymphadenopathy. Blood tests showed anemia (Hb 9.8 g/dL), thrombocytosis (Plt 450 x 103/µL), and elevated inflammatory markers (CRP 94 mg/L, ESR 79 mm/h). Initial TB workup (sputum smear, PCR) was negative. Histopathology of biopsied lymph nodes confirmed caseating granulomas, and the QuantiFERON-TB Gold test was positive (1.01 IU/mL), confirming abdominal TB.

Conclusions and Recommendations

This case underscores that abdominal TB must remain a key differential diagnosis in pediatric patients from endemic areas presenting with lymphoma-like features in non-endemic settings. When non-invasive tests are negative, early laparoscopic biopsy is decisive for diagnosis. Prompt initiation of anti-tuberculous therapy based on tissue diagnosis can prevent severe complications like obstruction and peritonitis.

Written informed consent for publication in an open-access journal was obtained from the patient’s guardian

EP29 Pooled Prevalence of Hypertrophic Cardiomyopathy Across Echocardiography Cohorts, Population Samples, and Claims Databases: A Systematic Review and Meta-analysis

Amir N. Attia 1 , Kareem W. Raafat 2 , Mohamed Ayman 3 , Ahmed M. Amin 1 , Ahmed I. Elsekhary 1 , Zyad Mady 4 , Noor Aldaosary 4 , Ismail A. Ibrahim 5

1 Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt; 2 Faculty of Medicine, Suez Canal University, Ismailia, Egypt; 3 Faculty of Medicine, Kafr El-Shaikh University, Kafr El-Shaikh, Egypt; 4 Department of Internal Medicine, NMC Royal Hospital, Khalifa City, Abu Dhabi, UAE; 5 Faculty of Health Sciences, Fenerbahçe University, İstanbul, Turkey

Correspondence: Noor Aldaosary (Noor.aldaosary@outlook.com)

BMC Proceedings 2025, 19(32): EP29

Keywords: hypertrophic cardiomyopathy; prevalence; systematic review; meta-analysis; echocardiography; administrative claims data.

Abstract

Background

Published hypertrophic cardiomyopathy (HCM) prevalence estimates vary widely by ascertainment method, raising questions about reliability and underdiagnosis. In this comprehensive systematic review and meta-analysis, we examined the pooled prevalence of HCM across different groups.

Materials and Methods :

We assessed the pooled prevalence of (HCM) using data from three main groups: patients undergoing echocardiography, general population, and claim-based databases. A random-effects model was applied to calculate the prevalence estimates.

Results :

HCM was identified in 2% (95% CI 0.005–0.075.005.075) of 696,624 echocardiogram patients. The prevalence in the general population was 0.17% (95% CI, 0.0010–0.0029.0010.0029) among 69,723 individuals. According to the multiple claims databases, diagnosed HCM prevalence was 0.04% (40 per day 100,000 persons) (95% CI, 0.00026–0.00062) among 311,376,296 participants.

Conclusion :

Pooled prevalence varied markedly by data source, consistent with referral enrichment in echocardiography cohorts and under-ascertainment in claims. Harmonized diagnostic criteria, contemporary population screening (including CMR), and linkage-validated claims algorithms are needed to refine true population prevalence.

EP30 Exploring the Edges of Niemann-Pick Type A/B: A Case Report

Mohamed El-Mezayen 1 , Abdelrahman Tawfik 1 , Abdallah Hadhood 1 , Virginia Gerges 1 Mohamed Afife 1 , Zyad Mady 2 , Batool Sultan 2 , Ismail A. Ibrahim 3,4

1 Faculty of Medicine, Alexandria University, Egypt; 2 NMC Royal Hospital, Khalifa City, Abu Dhabi, United Arab Emirates; 3 Faculty of Health Sciences, Fenerbahce University, Istanbul, Turkey; 4 Global Alliance of Young Researchers, Istanbul, Turkey

Correspondence: Batool Sultan (batoolsultan77@gmail.com)

BMC Proceedings 2025, 19(32): EP30

Keywords: Acid sphingomyelinase deficiency, Niemann-Pick disease, meningoencephalitis; seizures, lysosomal storage disorder, SMPD1, cherry-red spot.

Abstract

Background

Acid sphingomyelinase deficiency (ASMD) is also known as the Niemann-Pick disease. Types A and B are rare autosomal recessive lysosomal storage disorders that are caused by SMPD1 mutations. It is characterized by sphingomyelin accumulation and is a broad clinical spectrum ranging from severe neurodegeneration in type A to a less severe form with primarily visceral (organ-related) symptoms in type B. Intermediate forms (type A/B) show overlapping features of both subtypes. Enzyme replacement improves systemic disease but does not address CNS involvement

Case Presentation

We report the case of a 6-month-old boy with ASMD type A/B, who presented atypically with Meningoencephalitis and seizures as initial manifestations of this condition. There was a positive history of recurrent pneumonia, and Clinical evaluation revealed Macroglossia, dysmorphic features, hepatosplenomegaly, growth failure, cherry-red spots, and sensorineural hearing loss.

Laboratory investigations revealed elevated liver enzyme levels and cerebrospinal fluid abnormalities. Auditory brainstem response confirmed the bilateral sensorineural hearing loss. Genetic testing revealed a homozygous frameshift mutation in SMPD1 supporting the diagnosis of an intermediate ASMD phenotype. Informed consent was obtained from the mother.

Conclusion

Intermediate ASMD can present with early neurologic disease alongside classic visceral signs; prompt enzyme testing and genetic confirmation are essential. Multidisciplinary care with surveillance for pulmonary, hepatic, hematologic, and neuro-otologic complications is critical, recognizing that current ERT does not treat CNS disease

Written informed consent for publication in an open-access journal was obtained from the patient’s guardian.

EP31 Bariatric Surgery for MASLD/NAFLD in Obesity: Systematic Review of Clinical and Histological Outcomes, 2000–2024

Arzu Khattak 1 (arzookhattak@yahoo.com), Mais Dahham Salama 2 (dr.maisdahham98@gmail.com), Nouran Abdellatif 3 (Nouran.Abdellatif.00@gmail.com), Syed Muhammad Hassan Raza 4 , Alya Abdallah Youssef Al Hamadi 5 (alya.alhamadi@mediclinic.ae), Syed Muhammad Zulqarnain 6 (zulqarnaintariq26@gmail.com), Israa Omar Qais 7 (israaqais3@gmail.com), Rawda Ahmed Mehanna 8 (dmcbatch@gmail.com), Hashim Mahmood 9 (hashim252000@gmail.com), Aethar Faraj 10 (aetharf@gmail.com), Fatima Zain Alabedin 11 (faziad212@gmail.com)

1 Dubai Medical College; 2 Postgraduate Clinical Trainee, Dubai Health, Dubai, UAE; 3 Gulf Medical University, United Arab Emirates; 4 House Officer, Jinnah Hospital, Lahore; 5 Medical Intern, Mediclinic Hospital, Abu Dhabi, UAE; 6 House Officer, Jinnah Hospital, Lahore; 7 MBBS, Gulf Medical University, Ajman; 8 Clinical Teaching Assistant, Clinical Sciences Department, Dubai Medical College for Girls, Dubai, UAE; 9 University College of Medicine and Dentistry; 10 Dubai Medical College; 11 GP, Thumbay Hospital, Ajman

Correspondence: Syed Muhammad Hassan Raza (hassanraza3583@gmail.com)

BMC Proceedings 2025, 19(32): EP31

Keywords: Bariatric surgery; MASLD/NAFLD; fibrosis; Roux-en-Y gastric bypass; sleeve gastrectomy

Abstract

Background

Metabolic dysfunction–associated steatotic liver disease (MASLD), formerly NAFLD, is closely linked to obesity and is rising globally. Bariatric surgery is an established treatment for morbid obesity and may modify hepatic disease. In the era of incretin therapies, the magnitude and durability of fibrosis change after surgery remain uncertain, warranting updated synthesis. Objective: To evaluate the effects of bariatric surgery on liver histology, biochemical markers, fibrosis, and metabolic outcomes in MASLD/NAFLD.

Materials and Methods

PRISMA-guided systematic review of PubMed, EMBASE, and Cochrane Library (January 2000–March 2024). Eligible studies were randomized controlled trials and observational cohorts reporting liver outcomes after Roux-en-Y gastric bypass or sleeve gastrectomy. Dual independent screening and data extraction were performed; risk of bias was assessed with RoB 2 (RCTs) and Newcastle–Ottawa Scale (cohorts). Quantitative pooling was limited by heterogeneity in populations, procedures, and follow-up; findings were narratively synthesized.

Results

Across 70+ studies (~1,200 patients), bariatric surgery was consistently associated with marked reductions in hepatic steatosis and inflammation, with steatosis resolution frequently reaching ~70–85% in representative cohorts. NASH improvement was commonly reported. Effects on fibrosis were modest and heterogeneous: both regression and stabilization occurred, but progression was observed in subsets—especially with advanced baseline disease. Metabolic indices improved, including insulin sensitivity and systemic inflammation.

Conclusions and Recommendations

Bariatric surgery is consistently linked to improvement in steatosis and NASH in MASLD/NAFLD, while fibrosis change is variable and generally modest. Longer prospective studies using standardized histologic and imaging (e.g., MRE) endpoints are needed to clarify surgical effects on fibrosis and to define optimal candidacy and procedure selection.

EP32 Septic Pulmonary Embolism Presenting as a Solitary Cavitary Lung Lesion: Case Report

Abirami Annamalai, Daniyal Nagi, Eza Muniran, Hiliary McLoughlin, Maria Nagi, Abdullah Hassan, Tiong Ming Chia

Department of Internal & Respiratory Medicine, Portiuncula University Hospital, Ireland

Correspondence: AL Annamalai K; N Daniyal (daniyal.nagi@hse.ie)

BMC Proceedings 2025, 19(32): EP32

Keywords: Septic pulmonary embolism; solitary cavitary lung lesion; computed tomography pulmonary angiography (CTPA); pulmonary infarction; differential diagnosis; antibiotic therapy

Abstract

Background

Septic pulmonary embolism is uncommon, and can mimic malignancy when presenting as a solitary cavitary lesion; timely recognition prevents invasive work-ups.

Case presentation and Investigations

A 72-year-old woman with longstanding hypertension, chronic alcohol use, plaque psoriasis, and a history of treated pulmonary tuberculosis presented with reduced oral intake, respiratory symptoms, and functional decline. On arrival, she was hemodynamically unstable with signs of respiratory sepsis and volume overload.Chest X-ray showed cardiomegaly, left-sided perihilar consolidation, and a 4.5 cm cavitating lesion in the right upper lobe. All inflammatory markers were raised. She was admitted to ICU and treated with broad-spectrum antibiotics, anticoagulation, and rate control for new-onset atrial fibrillation. A contrast-enhanced CT thorax-abdomen-pelvis confirmed a cavitating lesion with nodular margins and vascular calcification. CT pulmonary angiography revealed large bilateral central main pulmonary artery filling defects and mediastinal/hilar lymphadenopathy. There was no evidence of deep vein thrombosis in the lower limbs.

Microbiological tests including TB screening, fungal serology, HIV, and blood cultures done prior to start of antibiotics were negative. Bronchoscopy was deferred due to anticoagulation. Transthoracic echocardiogram showed EF of 37% with RV strain, global hypokinesis and bi-atrial enlargement.

Results

The patient demonstrated clinical improvement with medical management, including 3 weeks of intravenous piperacillin/tazobactam followed by 2 weeks of oral co-amoxiclav. A repeat CXR at 3 weeks showed complete resolution of cavitary lesion. Although microbiological cultures were negative, the overall presentation was highly suggestive of presumed Septic Pulmonary Embolism (SPE), based on septic picture at presentation, PE on CTPA, cavitary lung lesion and response to antibiotics. Another consideration in the absence of a source of infection and endocarditis can be a Cavitating Pulmonary Infarct. Differential diagnoses such as TB, fungal infection and cavitating malignancy can also be considered. However, these were less likely given negative microbiological testing, absence of risk factors and complete radiographic resolution with antibiotics. She was discharged to rehabilitation with cardiopulmonary follow-up.

Conclusions and Recommendations

Spontaneous resolution of a cavitating lung lesion post pulmonary embolism with conservative therapy supports a diagnosis of septic embolism. When microbiological, neoplastic, and granulomatous causes are excluded, septic pulmonary embolism should be considered. Conservative management is appropriate when invasive diagnostics are risky and patient improves clinically. Sequential imaging and multidisciplinary care are critical.

Written informed consent for publication in an open-access journal was obtained from the patient.

EP33 AI-Assisted Handheld Echocardiography for Real-Time Guidance of Cardiac Views: A Randomized Crossover Study

Sara Al khemeiri 1 , Noha Aboukhater 2 , Moustafa Abdelwanis 3 , Siddiq Anwar 1,4 , Mecit Can Emre Simsekler 3

1 Department of Internal Medicine, Sheikh Shakhbout Medical City, Abu Dhabi, UAE; 2 Department of Cardiology, Sheikh Shakhbout Medical City, Abu Dhabi, UAE; 3 Department of Management Science & Engineering, Khalifa University of Science & Technology, Abu Dhabi, UAE; 4 College of Medicine and Health Sciences, Khalifa University of Science & Technology, Abu Dhabi, UAE

Correspondence: Sara Al khemeiri, (sara_alkhmari97@outlook.com)

BMC Proceedings 2025, 19(32): EP33

Keywords: point-of-care ultrasound; echocardiography; handheld ultrasound; artificial intelligence; image acquisition; parasternal short-axis

Abstract

Background

Point-of-care ultrasonography (POCUS) is increasingly recognized as a valuable bedside tool that enhances diagnostic accuracy, accelerates clinical decision-making, and reduces procedural delays. However, training healthcare providers to acquire high-quality images efficiently is a challenging task. Artificial intelligence (AI)-based POCUS systems have emerged as a promising solution, offering real-time feedback on probe positioning, orientation, and image optimization, thereby supporting clinicians in achieving diagnostically adequate images with greater efficiency and consistency. This study aims to measure the impact of integrating AI-based guidance in POCUS devices on time and the quality of acquired images.

Materials and Methods

Two experiments were conducted in distinct clinical settings to evaluate the impact of AI-assisted POCUS on image acquisition. In the first experiment, 10 residents each obtained parasternal long-axis (PLAX) cardiac views using both conventional POCUS and an AI-assisted module. The primary outcome measured was acquisition time, recorded for both methods. In the second experiment, 21 physicians acquired parasternal short-axis (PSAX) cardiac views using the same two approaches. For this experiment, both acquisition time and image quality were assessed to compare the performance of conventional and AI-assisted POCUS.

Results

In the first experiment, the average acquisition time decreased from 34.6 seconds with conventional POCUS to 22.1 seconds with the AI-assisted module (P = 0.0581). In the second experiment, acquisition time was reduced from 79.57 seconds to 48.42 seconds with AI assistance (P = 0.0006), accompanied by a statistically significant improvement in image quality scores (P = 0.0010).

Conclusions and Recommendations

The findings indicate that AI-assisted POCUS can enhance both the speed and quality of cardiac image acquisition. Further research should involve larger and more diverse clinician populations across multiple healthcare settings to validate these results. In addition, the long-term educational benefits of AI-guided ultrasound training warrant investigation before widespread clinical adoption is recommended.

EP34 Immune Modulators in Early Type 1 Diabetes: Systematic Review and Meta-analysis of Randomized Trials within 100 Days of Diagnosis

Razida Ezzaty 1 , Akmal Alina 2 , Tereza Machado 3 , Ali Al Hasani 4

1 Department of Internal Medicine, Ministry of Health, Kuala Lumpur, Malaysia; 2 Department of Internal Medicine, Ministry of Health, Kuala Lumpur, Malaysia; 3 Faculty of Medical Sciences of Minas Gerais (FCMMG), Minas Gerais, Brazil; 4 Department of General Surgery, Sheikh Khalifa Medical City, Abu Dhabi, UAE

Correspondence: Razida Ezzaty (razidamd@email.com)

BMC Proceedings 2025, 19(32): EP34

Keywords: Type 1 diabetes; Immune modulation; C-peptide preservation; Randomized controlled trials; Meta-analysis; Beta-cell function

Abstract

Background

Immune modulators are emerging as therapies to preserve beta-cell function in individuals newly diagnosed with type 1 diabetes (T1D). Because the early post-diagnosis period (within 100 days) is a critical window when residual beta-cell activity remains, timely intervention may influence long-term outcomes. With C-peptide as the gold-standard marker of beta-cell function, we evaluated whether immune modulators preserve stimulated C-peptide after at least 18 months and assessed their effects on HbA1c, insulin dose, hypoglycemia, and serious adverse events across randomized trials.

Materials and Methods

We systematically searched PubMed, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL) for randomized controlled trials assessing immune modulators in individuals with newly diagnosed type 1 diabetes (within 100 days of diagnosis). The search covered December 2024 to March 2025, with the final update performed in March 2025. Eligible studies reported outcomes for (1) stimulated C-peptide response; (2) HbA1c levels; (3) daily insulin dose; (4) frequency of hypoglycemia; and (5) serious adverse events. Heterogeneity was assessed using the I2 statistic, and a random-effects model was applied for outcomes with significant heterogeneity. This review was prospectively registered with PROSPERO (CRD42025646431).

Results

We included 7 RCTs comprising 1023 participants. Follow-up durations ranged from 18 months to 24 months. Immune modulator therapy was associated with improved preservation of C-peptide response (standardized mean difference [SMD] = 0.11; 95% CI 0.07–0.15.07.15; p < 0.01. HbA1c levels were modestly lower in the treatment group compared to placebo (mean difference = −0.01%; 95% CI −0.18–0.16; p = 0.91; while daily insulin requirements were reduced (mean difference = −0.02 units/day; 95% CI −0.05–0.00; p = 0.10). The incidence of hypoglycemia did not significantly differ between groups (risk ratio = 0.55; 95% CI 0.30–1.01; p = 0.06). Rates of serious adverse events were comparable across groups (risk ratio = 1.06; 95% CI 0.68–1.65; p = 0.79).

Conclusions and Recommendations

Immune modulators confer modest preservation of stimulated C-peptide up to 18–24 months in newly diagnosed type 1 diabetes, but without consistent improvements in HbA1c or insulin use. These therapies do not appear to increase risk of hypoglycemia or serious adverse events. Larger, head-to-head trials with standardized outcomes are needed to clarify which agents, populations, and regimens may provide clinically meaningful benefit.

EP35 In Vivo Efficacy of LL-37 and Derivative Peptides Against MRSA: Systematic Review and Meta-analysis of Animal Models.

Emmanel Ndezure 1,8 (endezure20@gmail.com), Daniel Eyiah 1,8 , Evans Akwaboah 1,8 , Atika Esmat Mohammed 2,8 (atikaesmat7@gmail.com), Shahd Mohamed Hussein 3,8 (shahd.m.hussein2003@gmail.com), Mandy Elewa 4,8 (mandymoien@yahoo.com), Wael Hafez 5,6 , Ismail A. Ibrahim 7,8 (ismailaiaibrahim@gmail.com)

1 Department of Theoretical and Applied Biology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; 2 Faculty of Science, University of Khartoum, Sudan; 3 Biotechnology program, Faculty of Agriculture, Ain Shams university, Egypt; 4 Department of Pharmacology and Therapeutics, Faculty of Pharmacy, Kuwait University, Kuwait; 5 Emirates society of Internal Medicine, EMA, Dubai and NMC Healthcare, UAE; 6 Medical Research and Clinical Studies Institute, The National Research Centre, Cairo, Egypt; 7 Faculty of Health Sciences, Fenerbahçe University, Istanbul, Türkiye; 8 Global Alliance of Young Researchers, Istanbul, Türkiye

Correspondence: Wael Hafez (wael.hafez@nmc.ae)

BMC Proceedings 2025, 19(32): EP35

Keywords: Cathelicidin LL-37; Methicillin-Resistant Staphylococcus aureus (MRSA); Antimicrobial Peptides; In Vivo Animal Models; Wound Healing; Systematic Review and Meta-analysis

Abstract

Background

Methicillin-resistant Staphylococcus aureus (MRSA) is a major global pathogen associated with high morbidity and increased mortality, and often exhibits resistance to conventional antibiotics. Human cathelicidin LL-37 and shorter derivatives show anti-MRSA and wound-healing activity, but in vivo efficacy and consistency across models remain unclear given peptide stability/toxicity constraints. The objective of this study was to evaluate whether LL-37 and its derivative peptides improve bacterial clearance, wound healing, and survival compared with controls in animal models of methicillin-resistant Staphylococcus aureus infection.

Materials and Methods

On April 22, 2025, a systematic search of PubMed, Scopus, and Embase was performed to identify preclinical studies that assessed the antibacterial activity of LL-37 and its derivatives in methicillin-resistant Staphylococcus aureus (MRSA) animal infection models. Guided by PRISMA, 1,014 unique records were screened after removing 368 duplicates; 23 met the inclusion criteria and 16 were included in the qualitative synthesis. Four studies (one with three independent experiments) provided sufficient data for the meta-analysis. The extracted variables included sample size, bacterial counts (mean ± SD), and intervention/control details. Standardized mean differences (Hedges’ g) were calculated using a random effects model. Study quality was assessed using the SYRCLE risk-of-bias tool.

Results

The meta-analysis of bacterial clearance pooled data from six independent experimental results (n = 44 animals) revealed that LL-37 and its derivatives significantly reduced bacterial burden compared with controls, yielding a pooled standardized mean difference (SMD) of −7.86 (95% CI: −9.40 to −6.33, p < 0.001). All studies favored LL-37, with no confidence intervals crossing zero. Heterogeneity was negligible (I2 = 0%, τ2 < 0.0001, p = 0.645), and the prediction interval (−9.74 to −5.99) indicated consistently large effects across similar experimental contexts. For wound healing (binary outcome), pooled analysis showed LL-37 significantly increased complete wound closure rates compared with controls, with a pooled risk ratio (RR) of 1.25 (95% CI: 1.16–1.36). The pooled proportion of healed wounds was 89.3% in the LL-37 groups versus 70.0% in controls, indicating a clinically relevant improvement.

Conclusion and Recommendations

LL-37 and its derivatives showed robust antibacterial activity and significantly enhanced wound healing in an MRSA-infected animal model. The large, consistent effects across studies support their advancement toward translational research and early phase clinical trials for potential human therapeutic use.

EP36 Untreated Hypothyroidism in Pregnancy: Maternal–Fetal Risks, Diagnostic Gaps, and Management (2010–2025)

Ismail A. Ibrahim 1,8 , Yasmine M. Osman 2,8 , Wajahat Ullah 3,8 , Leela krishna 4,8 , Kundan kumar 5,8 , Devika Krishnan 6 , Wael Hafez 6,7,9 , Ayesha Mirza Ayub 5,8

1 Faculty of Health Sciences, Fenerbahce University, Istanbul, Turkey; 2 Faculty of Nursing, Zagazig University, Egypt; 3 Saidu Medical College, Swat, Pakistan; 4 Andijan State Medical University, Andijan, Uzbekistan; 5 Dow University of Health Sciences, Karachi, Karachi, Pakistan; 6 NMC Royal Hospital, Khalifa City, Abu Dhabi, UAE; 7 Medical Research and Clinical Studies Institute, The National Research Centre, Cairo, Egypt; 8 Global Alliance of Young Researchers, Istanbul, Turkey; 9 Emirates society of Internal Medicine, EMA, Dubai, United Arab Emirates.

Correspondence: Devika Krishnan (Devika.krishnan@nmc.ae)

BMC Proceedings 2025, 19(32): EP36

Keywords: hypothyroidism in pregnancy; subclinical hypothyroidism (SCH); thyroid-stimulating hormone (TSH); levothyroxine therapy; iodine deficiency/prophylaxis; maternal–fetal outcomes.

Abstract

Background

Hypothyroidism affects 2–3% of pregnancies globally, while subclinical hypothyroidism (SCH) occurs in 3–15% of cases. In low- and middle-income countries, the prevalence increases to 5–31.6%, primarily due to iodine deficiency; posing significant maternal and fetal risks, and untreated hypothyroidism during pregnancy can impair neurodevelopment, increase obstetric complications, and reduce fetal survival.

Materials and Methods

This narrative review synthesized literature from 2010 to 2025, including clinical guidelines from the American Thyroid Association (ATA) and the Endocrine Society, as well as observational studies. The analysis focused on the epidemiology, pathophysiology, diagnostic strategies, and evidence-based management approaches for hypothyroidism in pregnancy.

Results

Maternal risks included a threefold higher incidence of preeclampsia, 1.8-fold increased miscarriage risk, 2.2-fold higher risk of preterm birth, and elevated rates of postpartum hemorrhage. Fetal and neonatal risks included neurodevelopmental deficits (7–10-point IQ reduction), congenital hypothyroidism (odds ratio 3.1), low birth weight (25% prevalence), and stillbirth (relative risk 2.3). Trimester-specific TSH thresholds (≤2.5 mIU/L in the first trimester and ≤3.0 mIU/L thereafter) were critical for timely diagnosis. Universal screening identified 40% more cases compared to risk-based screening. Levothyroxine titration reduced adverse outcomes by 65%, while iodine supplementation decreased SCH incidence by 50% in iodine-deficient regions.

Conclusions and Recommendations

Early LT4 for overt hypothyroidism should be prioritized, trimester-specific TSH monitoring, and consideration of universal screening where feasible. Implement iodine sufficiency policies (dietary 220–250 µg/day; 150 µg/day supplementation in deficient regions). High-quality trials should refine SCH thresholds and long-term neurodevelopmental outcomes.

EP37 Kinesio Taping for Breast Cancer-Related Lymphedema: Efficacy, Mechanisms, and Future Directions

Wesam Ibrahim Aboelenien 1,7 , Ibrahim Omar Dalabeh 2,7 , Salma Medhat Hammad 3,7 , Nouran Wael Bakir 4,7 , Obada Adnan Daqdouq 5,7 , Zyad Mady 6 , Ismail A. Ibrahim 7,8

1 Faculty of Pharmacy, Alexandria University, Alexandria, Egypt; 2 Faculty of Medicine, Yarmouk University, Irbid, Jordan; 3 Faculty of pharmacy, Pharos university, Alexandria, Egypt; 4 Faculty of Medicine, Menoufia University, Menoufia, Egypt; 5 Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; 6 NMC Royal Hospital, Khalifa City, Abu Dhabi, UAE; 7 Global Alliance of Young Researchers, Istanbul, Turkey; 8 Faculty of Health Sciences, Fenerbahce University, Istanbul, Turkey

Correspondence: Zyad Mady (Zyadmady41@gmail.com)

BMC Proceedings 2025, 19(32): EP37

Keywords: Kinesio taping; breast cancer–related lymphedema; lymphatic drainage; truncal lymphedema; complete decongestive therapy; bioimpedance spectroscopy.

Abstract

Background

Breast cancer-related lymphedema (BCRL) affects approximately one-third of breast cancer survivors, primarily because of surgical, radiological, or chemotherapeutic damage to the lymphatic pathways. While Complete Decongestive Therapy (CDT) remains the standard of care, factors such as patient intolerance and contraindications have prompted interest in alternative non-invasive modalities like Kinesio Taping (KT). This review synthesizes evidence on the efficacy, proposed mechanisms, and limitations of Kinesio Taping (KT) for BCRL, including its underexplored application in truncal lymphedema.

Methodology

In view that a meta-analysis was not possible as the heterogeneity is too high and limited by small sample sizes, short follow-up periods, inconsistent application techniques, and a lack of standardized outcome measures; a narrative review was conducted following a structured internal protocol. Databases including PubMed, Embase, Scopus, Web of Science, CINAHL, and the Cochrane Library were searched for English-language, peer-reviewed articles published between January 2015 and April 2025. Eligible studies enrolled adults (≥18 years) with limb or truncal BCRL, applied KT as a clearly defined adjunct, and reported quantitative outcomes (e.g., limb volume, bioimpedance, ultrasound) and/or patient-reported outcomes (e.g., pain, heaviness, quality of life). Studies were included if they used prospective controlled or quasi-experimental designs. Exclusion criteria comprised non-human research, primary/pediatric lymphedema, poorly defined interventions, or lack of outcome data.

Results

KT demonstrated the potential to improve lymphatic flow and alleviate symptoms, such as pain and heaviness, possibly via skin-lift effects that promote subcutaneous drainage. Most RCTs showed no statistically significant limb-volume change vs. compression/CDT; pooled mean differences ranged from −1% to +2%, CI crossing zero”. Truncal lymphedema remains especially under-researched, largely because of anatomical challenges and the absence of diagnostic criteria. Placebo effects cannot be ruled out in most of the studies.

Conclusions and Recommendations

KT shows promise as an adjunctive therapy in BCRL, particularly for patients unable to tolerate compression garments. However, established modalities such as CDT should not be replaced. KT may be considered as an adjunct in patients intolerant of compression, with shared decision-making and objective monitoring. Priority research includes sham-controlled RCTs with standardized KT protocols, objective biomarkers (BIS/MRI), and ≥3–6-month outcomes, especially for truncal disease.

EP38 Pediatric Recurrent Hypokalemic Paralysis with Nephrocalcinosis in a Consanguineous Family: Hereditary Renal Tubulopathy

Dalia Atef Abouda 1 , Sara Hosny 2 , Nihal Mohammad Sallam 3 , Sherin Tarek Fayez Ali 3 , Mohamed Abd Elfattah Mohamed 3 , Wael Hafez 4 , Ismail A. Ibrahim 5

1 Faculty of medicine, Alexandria university, Alexandria, Egypt; 2 Faculty of medicine, Benha university; 3 Pediatric department Cairo University, Cairo, Egypt; 4 Emirates society of Internal Medicine, EMA, Dubai and NMC Healthcare, UAE. & Medical Research and Clinical Studies Institute, The National Research Centre, Cairo, Egypt; 5 Faculty of Health Sciences, Fenerbahce University, Istanbul, Turkey

Correspondence: Wael Hafez (Wael.hafez@nmc.ae)

BMC Proceedings 2025, 19(32): EP38

Keywords: Hypokalemic paralysis - renal tubular acidosis – consanguinity – nephromegaly - metabolic acidosis - pediatric neurology

Abstracts

Background

Consanguinity remains a common cultural practice in many regions worldwide, particularly in the Middle East and North Africa, with rates exceeding 20–50% in some populations. Although often socially accepted, Consanguinity increases autosomal-recessive renal tubulopathies that may present in childhood with electrolyte derangements. In children with acute flaccid paralysis, severe hypokalemia from renal tubular acidosis (RTA) is a critical, treatable mimic of neuromuscular disease. We report a consanguineous pediatric case with recurrent paralysis and nephrocalcinosis.

Case Presentation

Here, we present a compelling case of a 7-year-old girl born to consanguineous parents who presented with acute-onset flaccid paralysis progressing from the lower to the upper limbs, without sensory or autonomic dysfunction. She had a history of a milder episode at age 3, leg bowing, short stature (calcium/vitamin D), and sibling with similar symptoms. Examination revealed hypotonia (upper limbs 3/5, lower limbs, 2/5), sunken eyes, and irritability. Laboratory tests showed severe hypokalemia (2.1 mEq/L) and metabolic acidosis (pH 7.2, HCO3 12 mEq/L), necessitating ICU admission for intravenous potassium and phosphorus. Renal ultrasonography demonstrated bilateral nephromegaly (right: 11 cm with echogenic calyces; left: 11.5 cm) and lifelong polyuria/polydipsia. These findings suggested RTA; urine studies supported distal vs proximal subtype. For a certain diagnosis, genetic mutation testing is normally advised, but it was unavailable. Treatment included electrolyte correction and phosphorus administration with clinical improvement.

Conclusion and Recommendations

This case underscores renal tubular acidosis as a differential diagnosis in recurrent pediatric paralysis, highlighting the need of metabolic assessment and family history in consanguineous families. Timely diagnosis can save life-threatening complications.

Written informed consent for publication in an open-access journal was obtained from the patient’s guardian.

EP39 Role of TAPSE as an Early Prognostic Factor After Pediatric Cardiac Surgery: A Cohort Study

Mohamed Abd Elfattah Mohamed 1 , Dalia Atef Abouda 2 , Amal Mahmoud Elsisi 1 , Hanan Zekry Khaled 1 , Mohamed Samir Eid 1 , Ismail A. Ibrahim 3 , Wael Hafez 4,5

1 Department of pediatrics, Kasr Al Aini faculty of medicine, Cairo University, Cairo, Egypt; 2 Faculty of medicine, Alexandria university, Alexandria, Egypt; 3 Faculty of Health Sciences, Fenerbahce University, Istanbul, Turkey; 4 Emirates society of Internal Medicine, EMA, Dubai and NMC Healthcare, UAE; 5 Medical Research and Clinical Studies Institute, The National Research Centre, Cairo, Egypt

Correspondence: Wael Hafez (Wael.hafez@nmc.ae)

BMC Proceedings 2025, 19(32): EP39

Keywords : Right ventricular function; TAPSE; pediatric cardiac surgery; prognostication; mechanical ventilation; PICU length of stay.

Abstract

Background

Right ventricular dysfunction is a well-known complication of cardiac surgery that may have negative effects. Echocardiography is a suitable, non-invasive, and accessible method for post-operative monitoring. TAPSE is an overall measure of RV function and a useful prognostic factor in many PICU cases because it requires a limited window compared with other approaches. The main objective of this study is to investigate the correlation between TAPSE & the Morbidity and Mortality outcomes in hospitalized pediatric patients undergoing cardiac surgeries including in-PICU mortality as a primary objective; as well as MV duration, vasoactive use, PICU Length of stay as a secondary objective.

Patients & Methods

A cohort study was conducted on 250 patients aged 1 month to 13 years who were admitted to the pediatric postoperative cardiac intensive care unit after cardiac surgery. Data obtained included age and sex, type of operation, and morbidity parameters, such as mechanical ventilation duration, nasal oxygen, inotropes, PICU stay, and mortality. On days 0, 3, and 5 following the operative procedure, all candidates underwent echocardiographic examination to assess TAPSE. Statistical analysis was performed using the independent t-test, ANOVA variance, chi-square test, and Spearman correlation to determine the correlation between variables.

Results

TAPSE performed on days 0, 3, and 5 resulted in 250, 231, and 165 cases, respectively. There was a significant negative correlation between TAPSE measurements and morbidity parameters, particularly on days 0 and 3 (duration of ventilation “test value −0.318”, nasal oxygen “test value −0.151”, inotropes “test value −0.338”, and PICU stay “test value −0.233”) (P<0.05). In addition, there was a strong correlation between the TAPSE results on days 0, 3, and 5 on one side and mortality (mortality was 23% with TAPSE SD 5.77 ± 1.195 on day 0, 23% with TAPSE 6.04 ± 1.098 on day 3, and 30% with TPASE 6.29 ± 1.137 on day 5), P < 0.05. There was a significant negative correlation between TAPSE measurements and morbidity parameters on days 0 and 3 in patients who underwent VSD surgery: duration of ventilation “test value −0.372”, nasal oxygen “test value −0.277”, inotropes “test value −0.418”, and PICU stay “test value −0.21” (P<0.05). Moreover, there was a significant negative correlation between TAPSE measurements and morbidity parameters on days 0 and 3 in patients with Fallot surgeries, inotropes “test value −0.33”, and PICU stay “test value −0.27” (P<0.05).

Conclusion and Recommendations

TAPSE correlates significantly with morbidity and mortality after pediatric cardiac surgery; after adjustment, TAPSE remained an independent predictor. TAPSE can be used as an early prognostic factor for morbidity and mortality in post-operative cardiac surgery in PICU.

EP40 Rosacea and Gastrointestinal Disorders: A Systematic Review and Meta-analysis of the Gut–Skin Axis

Wael Hafez 1,3,6 , Mahmad A. Ibrahim 2 , Dina Khair 3 , Rahmathullah Mohammad 3 , Amira Roshdy 3 , Rowida.ahmed 3 , Tarek F. Ismail 4 , Omar Al Dulaimi 5

1 The Emirates Society of Internal Medicine (ESIM), Emirates Medical Association, Dubai; United Arab Emirates; 2 Mediclinic Hospital, Abu Dhabi, UAE; 3 NMC Royal hospital, Khalifa City, Abu Dhabi, UAE; 4 Sheikh Khalifa Hospital, ALFujairah, UAE; 5 University Hospital of Wales, UK; 6 Medical Research and Clinical Studies, The National Research Centre, Cairo, Egypt

Correspondence: Rowida Ahmed (Rowida.ahmed@nmc.ae)

BMC Proceedings 2025, 19(32): EP40

Keywords: rosacea; gut–skin axis; irritable bowel syndrome; small intestinal bacterial overgrowth; inflammatory bowel disease; gastroesophageal reflux disease; celiac disease; meta-analysis

Abstract

Background

Rosacea has been linked to gastrointestinal disorders in multiple prior studies, with the postulated underlying relationship of this Interplay of Gut-Skin Axis owing to microbiota, and/or neurovascular/innate immunity. Various studies have examined the association between rosacea and gastrointestinal diseases with conflicting results. This relationship, and the rationale behind it, remain unclear. The aim of this study is to quantify associations between rosacea and predefined GI disorders (GERD, gastritis, esophagitis, IBS, celiac disease, SIBO, ulcerative colitis, Crohn disease, diverticulitis, microscopic colitis; deeply looking to this potential gut-skin interactions.

Materials and Methods

PubMed, Web of Science, and Scopus databases were searched until January 24, 2024, for case-control, cohort, or cross-sectional studies that reported an association between rosacea and gastrointestinal diseases; gastroesophageal reflux Disease/Gastritis, esophagitis, irritable bowel syndrome, celiac disease, Small Intestinal Bacterial Overgrowth, Ulcerative Colitis, Crohn's Disease, Diverticulitis, and Microscopic Colitis. The RevMan software (version 5.4) was used to perform the meta-analysis.

Results

Twelve studies with 5244709 participants were included. The pooled analysis showed a statistically significant association between rosacea group and increased incidence of GERD/Gastritis (OR = 1.72, 95% CI = 1.19 to 2.49, p-value = 0.004), celiac disease (OR = 1.63, 95% CI = 1.18 to 2.27, p-value = 0.003), IBS (OR = 1.77, 95% CI = 1.01 to 3.09, p-value = 0.04), SIBO (OR = 1.55, 95% CI = 1.05 to 2.30, p-value = 0.03), Crohn’s Disease (OR = 1.42, 95% CI = 1.27 to 1.59, p-value < 0.00001), esophagitis group (OR = 1.30, 95% CI = 1.07 to 1.57, p-value < 0.01), and diverticulitis (OR = 1.16, 95% CI = 1.05 to 1.28, p-value < 0.01) compared with the control group.

Conclusion and Recommendations

Rosacea is associated with several GI disorders in observational data; causality is unproven. Clinicians may consider targeted GI review (e.g., IBS/SIBO, reflux) in symptomatic rosacea, while mechanistic and prospective studies are needed. Additional research is needed to understand the processes of this gut-skin axis interaction.

EP41 Prolonged High–Anion Gap Metabolic Acidosis After Off-Label Intramuscular Tirzepatide: A Social-Media–Driven Case Report

Wael Hafez 1,4,5 , Surra Hassan 1 , Lougeen Z. Mohammad 1 , Sharika Subramani 1 , Rahmathullah Mohammad 2 , Hossam ElshekhAli 2 , Ali Nawaz 3

1 Department of Internal Medicine, NMC Royal Hospital, Khalifa City, Abu Dhabi, UAE; 2 Department of Critical Care Unit, NMC Royal Hospital, Khalifa City, Abu Dhabi, UAE; 3 Department of Emergency Medicine, NMC Royal Hospital, Khalifa City, Abu Dhabi, UAE; 4 Emirates society of Internal Medicine, EMA, Dubai, UAE; 5 Medical Research and Clinical Studies Institute, The National Research Centre, Cairo, Egypt

Correspondence: Lougeen Z. Mohammad (lougeen.mohammad@nmc.ae)

BMC Proceedings 2025, 19(32): EP41

Keywords: Tirzepatide; intramuscular injection; off-label use; metabolic acidosis; starvation ketosis; health misinformation.

Abstract

Background

Tirzepatide is a dual GIP and GLP-1 receptor agonist approved only for subcutaneous administration to patients with type 2 diabetes and obesity. Intramuscular (IM) injection may create a depot with prolonged, unpredictable absorption, potentially amplifying GLP-1–related anorexia and delayed gastric emptying.

Case Report

We report a 31-year-old woman who presented with a two-week history of dizziness, fatigue, headache, and gastrointestinal symptoms unrelieved by prior treatments. On admission, she was dehydrated with metabolic acidosis (pH 7.28), low bicarbonate, and hypoglycemia, while imaging was unremarkable. The patient disclosed off-label intramuscular self-administration of tirzepatide, guided by social media, in an attempt to prolong drug effect and reduce cost.

Results

The patient received intravenous fluids, proton pump inhibitors, and supportive care. Symptoms and laboratory abnormalities persisted through day 3. Continued conservative management let to full clinical and biochemical recovery by day 5, with stability maintained on follow-up.

Conclusions and Recommendations

Off-label intramuscular tirzepatide may unpredictably alter absorption and, in this case, coincided with prolonged high–anion gap metabolic acidosis plausibly driven by starvation ketosis. Clinicians should probe injection technique when adverse effects persist and proactively counsel patients about social-media misinformation.

Written informed consent for publication in an open-access journal was obtained from the patient.

EP42 MICA rs1051792 and Type 1 Diabetes in Egyptians: Association with Susceptibility and Microvascular Complications

Amal A. Mohamed 1 , Nour H. El Essawy 2 , Rawan Elsayed 2 , Mostafa M. ElGharbawy 2 , Wael Hafez 3,4,5 , Mai Alketbi 4 , Eman ALYahyaee 4 , Heba A. ElRamly 2

1 Biochemistry Department, National Hepatology Tropical Medicine Research Institute, GOTHI, Egypt; 2 Clinical Pharmacy Department, School of Pharmacy, Newgiza University, Giza, Egypt; 3 National Research Centre, Medical Research and Clinical Studies Institute, Cairo, Egypt; 4 NMC Royal Hospital, Khalifa City, Abu Dhabi, UAE; 5 Emirates society of internal Medicine, EMA, Dubai, UAE

Correspondence: Mai Alketbi (mai.alketbi@nmc.ae)

BMC Proceedings 2025, 19(32): EP42

Keywords : Type 1 diabetes; MICA rs1051792; genetic association; microvascular complications; Egyptians; NKG2D pathway

Abstract

Background

Type 1 Diabetes Mellitus (T1DM) is an autoimmune disorder that has a strong genetic basis. MHC class I chain-related gene A (MICA) may influence susceptibility to T1DM and its complications via immune-mediated pathways. This study aimed to investigate the association between the MICA rs1051792 polymorphism and T1DM risk prediction and clinical complications in the Egyptian population.

Materials and Methods

This case-control study was conducted to assess the association between MICA rs1051792 polymorphism and T1DM susceptibility and complications in an Egyptian cohort. Participants were recruited from the National Diabetes Institute, Cairo, Egypt between February to May 2025. The study included 114 unrelated patients diagnosed with Type 1 Diabetes Mellitus (T1DM) according to the American Diabetes Association (ADA) criteria and 99 age- and sex-matched healthy controls with no personal or family history of autoimmune or metabolic disorders. The sample size was estimated to detect an odds ratio of 2.0, with 80% power and a 5% significance level, assuming a 1:1 ratio of cases to controls. and a minor allele frequency of 0.25 based on standard sample size formulas for genetic association studies.

Results

The TT genotype was significantly associated with increased T1DM risk (OR = 4.56; p = 0.0008), higher fasting glucose and insulin levels, and prevalence of nephropathy, retinopathy, and neuropathy. No significant association with osteoarticular complications was observed. The TT genotype was also linked to poorer glycaemic control, whereas the CC genotype appeared protective.

Conclusion and Recommendations

MICA rs1051792 TT genotype may serve as a genetic marker for susceptibility to T1DM and its major complications in Egyptians. These findings support the role of MICA polymorphisms in T1DM pathogenesis and highlight the potential of genotype-based screening and personalized management strategies.

EP43 Biomarkers in Hemophilia: Diagnostic, Prognostic, and Treatment-Selection Utility—A Narrative Review

Dalia Atef Abouda 1 , Malak A. Hassan 1 , Buseyna Dahik 2 , Elsayed S. Moubarak 3 , Mohamed Mohsen Helal 4 , Lougeen Z. Mohammad 5 , Mohamad Humam Majed 5 , Ismail A. Ibrahim 6

1 Faculty of medicine, Alexandria university, Alexandria, Egypt; 2 Faculty of Medicine, Ankara Yilidirim Beyazit University, Ankara, Turkey; 3 Faculty of Medicine, Cairo University,Cairo,Egypt; 4 Faculty of Medicine, Zagazig University, Zagazig, Egypt; 5 Department of Internal Medicine, NMC Royal Hospital, Khalifa A, Abu Dhabi, UAE; 6 Faculty of Health Sciences, Fenerbahce University, Istanbul, Turkey

Correspondence: Mohamad Humam Majed (Mohamad.hasseyan@nmc.ae)

BMC Proceedings 2025, 19(32): EP43

Keywords: Hemophilia biomarkers - Factor VIII deficiency- Factor IX deficiency - Treatment response biomarkers - Inhibitor development prediction - miRNA-150 in hemophilia - IL-4 and IL-13 in hemophilia

Abstract

Background

Hemophilia is a hereditary bleeding disorder caused by deficiency of coagulation factor VIII (hemophilia A) or factor IX (hemophilia B). Despite effective factor replacement therapy, clinical challenges remain, including inhibitor development, inter-individual variability in pharmacokinetics, and progressive joint disease. With the advent of extended half-life (EHL) factors, emicizumab, and gene therapy, the need for reliable biomarkers has become increasingly important to optimize diagnosis, risk stratification, treatment monitoring, and long-term outcomes. Recent hemophilia evidence is dispersed and heterogeneous as diagnostic or prognostic tools. Instead, focusing on interventional and radiological assessment. To narratively synthesize diagnostic, prognostic, and predictive biomarkers in hemophilia A/B—including inhibitor risk, PK-guided dosing, joint disease activity, and monitoring of non-factor therapies—and to outline validation gaps.

Materials and Methods

This is a narrative review. We searched PubMed and Scopus for literature provided between 2000 and 2025, focusing on studies of diagnostic, prognostic, and predictive biomarkers in hemophilia. Evidence was prioritized from randomized controlled trials, large registries, and key assay validation studies.

Results

Multiple biomarker categories have been evaluated. Genetic variants in F8/F9 inform diagnosis and inhibitor risk. Immunologic profiles, including anti-FVIII IgG4 and cytokines (IL-4, IL-13), show predictive potential for inhibitor development. Global hemostasis assays (e.g., thrombin generation, thromboelastography) and PK/PD modeling enhance individualized dosing strategies. Joint biomarkers such as miRNA-150, cartilage degradation markers, and imaging correlations hold promise for early detection of subclinical arthropathy. Biomarkers are also being explored for monitoring emicizumab and other non-factor therapies. However, most findings remain preliminary and require multicenter validation.

Conclusions and Recommendations

Biomarkers across genetics (F8/F9), immunologic profiles (anti-FVIII IgG4; Bethesda), global hemostasis, and PK/PD show promise for individualized care in hemophilia; however, standardized assays, multicenter validation, and integration with clinical and imaging data are prerequisites for routine adoption. Further priorities multicenter validation, reference ranges, assay harmonization, and integration with clinical and genetic data.

EP44 Efficacy and Safety of Nerandomilast in Progressive Fibrosing Interstitial Lung Diseases: A Systematic Review and Meta-Analysis of Randomized Trials

Waleed M. Rasheed 1,7 , Mohammed Saad Sayed 2,7 , Yumna Mohammad Khasawneh 3,7 , Zaid Al-Farra 4,7 , Tala K. Abu-Alam 5,7 Yasser Batota 6 , Ismail A. Ibrahim 6,7

1 Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan; 2 Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt; 3 Faculty of Medicine, University of Jordan, Amman, Jordan; 4 Faculty of Medicine, Hashemite University, Zarqa, Jordan; 5 Faculty of Health Sciences, Fenerbahce University, Istanbul, Turkey; 6 Department of Internal Medicine, Nmc Royal Hospital, Khalifa City, Abu Dhabi, UAE; 7 Global Alliance of Young Researchers, Istanbul, Turkey

Correspondence: Yasser Batota (Yasserics@gmail.com)

BMC Proceedings 2025, 19(32): EP44

Keywords: Nerandomilast; BI 1015550; Idiopathic pulmonary fibrosis; Progressive pulmonary fibrosis; Forced vital capacity; Randomized trials; Safety; PDE4B inhibitor

Abstract

Background

Idiopathic pulmonary fibrosis (IPF) and other ILDs with a progressive fibrosing phenotype carry high morbidity and mortality. Nerandomilast (BI 1015550), a selective PDE4B inhibitor, has shown antifibrotic and immunomodulatory activity. We synthesized randomized trial evidence on its efficacy and safety in IPF/PPF.”

Materials and Methods

This systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. A comprehensive search of PubMed, Cochrane Library, Scopus, and Web of Science was performed up to July 2025 to identify randomized controlled trials (RCTs) evaluating the efficacy and safety of nerandomilast (BI 1015550) in patients with idiopathic pulmonary fibrosis (IPF) or progressive pulmonary fibrosis (PPF). Eligible studies included adult patients with FVC ≥45% predicted and DLCO ≥25%, comparing oral nerandomilast 18 mg twice daily to placebo. The primary outcomes were change in forced vital capacity (FVC) and incidence of drug-related adverse events. Study selection, data extraction, and risk of bias assessment (using the Cochrane RoB 2 tool) were performed independently by multiple reviewers. Data were pooled using a random-effects model. Mean difference (MD) and relative risk (RR) were calculated for continuous and dichotomous outcomes, respectively, with 95% confidence intervals (CI). Heterogeneity was assessed using the I2 statistic.

Results

This study included four RCTs that enrolled 2515 patients. Nerandomilast was associated with a significant improvement in FVC at Week 2 (mean difference, 31.71 mL; 95% confidence interval [CI], 9.55 to 53.87; I2=58%; P=0.005), week 12 (mean difference, 53.91 mL; 95% CI, 20.02 to 87.80; I2=74%; P=0.002), and week 52 (mean difference, 67.72 mL; 95% CI, 43.65 to 91.78; I2=0%; P<0.00001). The overall analysis confirmed a significant improvement in FVC (mean difference, 48.07 mL; 95% CI, 30.50 to 65.64; I2=68%; P<0.00001). Nerandomilast was associated with a significantly lower risk of all-cause mortality (risk ratio, 0.34; 95% confidence interval [CI], 0.14 to 0.83; I2=19%; P=0.02) and a higher risk of diarrhea (risk ratio, 1.92; 95% CI, 1.39 to 2.64; I2=4%; P<0.0001) than placebo.

Conclusion and Recommendations

Nerandomilast modestly attenuates FVC decline over 52 weeks in IPF/PPF with an acceptable safety profile characterized mainly by increased diarrhea; mortality signals are encouraging but imprecise. Larger, longer trials should clarify survival impact, refine patient selection, and define add-on benefits over standard antifibrotics.

EP45 Intramuscular Myxoma of the Thigh Mimicking a Vascular Malformation: Case Report and Brief Review

Hayssam Gibbaoui 1 , Ahmed Kaabneh 2 , Yasser Batota 3 , Noor Aldaosary 3 , Saikrishna Dinesh 3 , Sharika Subramani 3 , Wael Hafez 3,4,5

1 Department of Vascular Surgery, NMC Royal Hospital, Khalifa City, Abu Dhabi, UAE; 2 Department of Interventional Radiology, NMC Royal Hospital, Khalifa City, Abu Dhabi, UAE; 3 Department of Internal Medicine, NMC Royal Hospital, Khalifa City, Abu Dhabi, UAE; 4 Medical Research and Clinical Studies Institute, The National Research Centre, Cairo, Egypt; 5 The Emirates Society of Internal Medicine (ESIM), Emirates Medical Association, United Arab Emirates

Correspondence: Yasser Batota (Yasserics@gmail.com)

BMC Proceedings 2025, 19(32): EP45

Keywords: Intramuscular myxoma; Thigh mass; Vascular malformation mimic; MRI; Mazabraud syndrome; Case report; Soft-tissue tumor

Abstract

Background

Intramuscular myxoma is a rare benign mesenchymal tumor, most often in the thigh, shoulder, or buttock. It may mimic vascular malformations or myxoid sarcomas on imaging. Associations include Mazabraud syndrome (with fibrous dysplasia); cardiac myxoma belongs to Carney complex.

Case presentation

We describe the case of a 45-year-old man with no past medical history and who had a one-year history of a painless, slowly enlarging thigh mass. Initial work up -ultrasonography, CT angiography, then MRI- showed hypervascular lesion raising the likelihood arteriovenous malformation. Embolization was recommended to treat the case completely and reduce the risk of bleeding in the event that further surgical intervention is required, as the bleeding risk was considerable. The patient had a successful arterial embolization for this swelling with serial following up the size and appearance. Serial follow-up ultrasonography indicated that the mass size decreased for a short period of time before remaining constant. Surgical excision was performed because of ongoing pain and aesthetic concerns. Histopathological analysis identified an intramuscular myxoma as a lesion.

Conclusion and Recommendations

Intramuscular myxoma can closely mimic vascular malformations on imaging. In deep soft-tissue masses with equivocal radiology, tissue diagnosis remains definitive. Detailed MRI characterization and timely marginal excision, supported by histopathology and immunohistochemistry, prevent misclassification and unnecessary endovascular interventions.

Written informed consent for publication in an open-access journal was obtained from the patient.

EP46 Pediatric Hemophagocytic Lymphohistiocytosis: A Systematic Review of Case Reports

Mohamed El-Mezayen 1 , Marwa Farouk 1 , Bothaina Farouk 1 , Dalia Atef Abouda 1,3 , Yassin Abdelwahab 1 , Surra Hassan 4 , Ismail A. Ibrahim 2,3

1 Faculty of Medicine, Alexandria university, Alexandria, Egypt; 2 Faculty of Health Sciences, Fenerbahce University, Istanbul, Turkey; 3 Global Alliance of Young Researchers, Istanbul, Turkey; 4 NMC Royal Hospital, Khalifa City, Abu Dhabi, UAE

Correspondence: Surra Hassan (Surra.hassan@nmc.ae)

BMC Proceedings 2025, 19(32): EP46

Keywords : Pediatric HLH; case reports; diagnostic delay; sepsis mimic; HLH-2004 criteria; outcomes; etoposide–dexamethasone

Abstract

Background

Hemophagocytic Lymphohistiocytosis (HLH) is a rare, life-threatening hyperinflammatory syndrome in children that often mimics sepsis or malignancy, leading to delayed diagnosis and high mortality. Because randomized evidence is scarce, systematically synthesized case reports can inform recognition and early management. The main objective of this study is to systematically review published case reports and small case series describing pediatric HLH, focusing on clinical presentations, diagnostic delays, etiologies, management approaches, and outcomes.

Materials and Methods

A systematic search of PubMed, Embase, Scopus, and Web of Science identified case reports and small series (≤5 patients) involving children (0–18 years) diagnosed with HLH, published from 2010 to 2025 were done. Studies were screened and selected based on PRISMA guidelines. Data extraction used a structured form, and quality was assessed using the CARE checklist. Two reviewers independently screened titles/abstracts and full texts; discrepancies were resolved by a third reviewer. We included pediatric cases meeting ≥5 HLH-2004 criteria or high HScore; Duplicates and non-English abstracts without data Were excluded. Diagnostic delay was defined as days from first presentation to meeting HLH criteria.”

Results

A total of 150 case reports (involving 250 patients) met inclusion criteria. Ages ranged from neonates to adolescents. Common presenting symptoms were fever (95%), hepatosplenomegaly (80%), and cytopenias (75%). Delayed diagnosis was noted in 40% of cases, with initial misdiagnoses including sepsis, leukemia, and autoimmune conditions. Etiologies included familial HLH (30%), infection-associated (25%), malignancy-associated (20%), autoimmune (10%), and idiopathic (15%). Treatment regimens varied, with most receiving HLH-94/2004 protocols; outcomes ranged from full recovery (60%) to relapse (10%) and mortality (30%).

Conclusion and Recommendations

Published pediatric HLH cases show heterogeneous presentations with frequent diagnostic delay. Standardized reporting and rapid, criteria-based evaluation may shorten time-to-therapy. Future work should prospectively capture time metrics and etiology-specific outcomes to refine pathways for earlier treatment initiation.

EP47 Papillary Urothelial Neoplasm of Low Malignant Potential (Ta) in a Young Female: A Case Report

Alaa Salah Farag 1 , Amr Adel Awad 2 , Mahmoud Salah Zaki 2 , Omar Hammam Salloum 1,3,4 Malak Hroub 5,8 , Lateefa Al Ali 7 , Omer Aldulaimi 9 , Ismail A. Ibrahim 6,8

1 Department of Urosurgery, Damanhour Medical National Institute, Egypt; 2 Faculty of Medicine, Mansoura University, Egypt; 3 Palestinian Clinical Research Center, Bethlehem, Palestine; 4 Research Insights Arab Network, Cairo, Egypt; 5 Faculty of Medicine, Al-Quds University, Jerusalem, PalestineFaculty of Health Sciences, 6 Fenerbahce University, Istanbul, Turkey; 7 NMC Royal Hospital, Khalifa City, Abu Dhabi, UAE; 8 Global Alliance of Young Researchers, Istanbul, Turkey; 9 University Hospital of Wales, Cardiff, United Kingdom

Correspondence: Lateefa Alali (lateefa.alali@nmc.ae)

BMC Proceedings 2025, 19(32): EP47

Keywords: PUNLMP; non-muscle-invasive bladder cancer; TURBT; intravesical therapy; young adult; cystoscopic surveillance.

Abstract

Background

Papillary urothelial neoplasm of low malignant potential (PUNLMP) is a rare urothelial tumor that is typically observed in elderly patients and is characterized by low atypia and a low risk of progression.

Materials and Methods

We present the case of a 22-year-old female with no significant medical or surgical history, who developed symptoms consistent with lower urinary tract dysfunction. Transabdominal ultrasonography revealed a single 1 cm lesion in the posterior basal wall of the bladder. Histopathological examination confirmed a diagnosis of PUNLMP with endophytic growth. Following transurethral resection of the bladder tumor (TURBT), the patient received six consecutive weekly intravesical Bacillus Calmette-Guérin (BCG) injections. Follow-up cystoscopy conducted three months post-treatment showed no signs of recurrence.

Conclusion and Recommendations

This rare, young-onset PUNLMP was successfully treated with complete TURBT and remains recurrence-free at 3 months. Given the low-risk profile of solitary, small PUNLMP, standard management is TURBT with risk-adapted surveillance; intravesical BCG is generally not indicated unless additional risk factors or recurrences emerge. We recommend guideline-based cystoscopic follow-up (3 months, then 9–12 months, then annually) with consideration of urine cytology as clinically appropriate.

Written informed consent for publication in an open-access journal was obtained from the patient.

EP48 Giant Cell Arteritis Associated Posterior Circulation Stroke: A Diagnostic Case Report for Internal Medicine

Beegum Tasneem

Department of Acute Medicine, Aintree University Hospital, Liverpool, Merseyside, United Kingdom

Correspondence: Beegum Tasneem (Beegumtasneem@gmail.com)

BMC Proceedings 2025, 19(32): EP48

Keywords: Giant Cell Arteritis, Posterior Circulation Stroke, Anterior Ischaemic Optic Neuropathy, Atrial Fibrillation, Temporal Artery Biopsy

Abstract

Background

Giant Cell Arteritis (GCA) is the most common systemic vasculitis in adults over 50 and carries a high risk of irreversible visual loss and cerebrovascular complications. While stroke is an uncommon manifestation, it is often under-recognized, particularly when presenting without classic cranial symptoms, leading to diagnostic delays. This case aims to highlight posterior circulation stroke as an atypical presentation of GCA and emphasize the importance of early recognition and maintaining diagnostic consideration in older patients with acute neurological symptoms.

Materials and Methods

This is a single patient case report collected from a single hospital trust. A 69-year-old male with no significant past medical history presenting with headache, right facial droop, and diplopia. Ophthalmologic evaluation confirmed anterior ischaemic optic neuropathy with suspected central retinal artery occlusion. Temporal artery ultrasound demonstrated bilateral intimal thickening with positive compression sign, and subsequent biopsy confirmed bilateral GCA. Neuroimaging included CT angiography showing distal right vertebral artery occlusion and MRI revealing multiple acute infarcts in the cerebellum, occipital lobe, and thalamus. Relevant laboratory investigations included inflammatory markers, autoimmune panel, and routine biochemistry.

Results

The patient was treated with high-dose intravenous methylprednisolone followed by oral prednisolone, dual antiplatelet therapy, and statins. During admission, he developed new-onset atrial fibrillation, complicating stroke attribution. Rheumatology input guided ongoing immunosuppression. Despite initial unremarkable CT findings, MRI confirmed multifocal posterior circulation infarcts.

Conclusions and Recommendations

Giant cell arteritis (GCA) is a medical emergency and can present with ischemic ocular events and vertebrobasilar stroke, sometimes before classic cranial symptoms. Co-occurring atrial fibrillation (AF) complicates causality and antithrombotic choices. Posterior-circulation, multifocal infarcts accompanied by acute ocular ischemia (AION/CRAO) should trigger urgent evaluation for GCA even if the initial non-contrast CT is normal. A Color Doppler temporal-artery “halo sign” supports the diagnosis and warrants immediate high-dose corticosteroids; fast-track GCA pathways shorten time to treatment and improve outcomes. This case highlights the importance of maintaining high clinical suspicion for GCA in atypical stroke presentations and supports wider implementation of rapid-access diagnostic pathways to reduce morbidity. Further research into stroke mechanisms in GCA may help refine future management strategies.

Written informed consent for publication in an open-access journal was obtained from the patient.

Footnotes

The original version of this article was revised: The spelling of author Rayan Ahmed has been amended in abstract EP15

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Change history

2/16/2026

A Correction to this paper has been published: 10.1186/s12919-026-00361-9