Mediclinic City Hospital

Sepsis is common in hospitalized pediatric patients, leading to increased morbidity, including multiple organ dysfunction and mortality. Fluid resuscitation and antibiotic administration are the primary protective mechanisms for sepsis. However, not all infections are bacterial, and unnecessary antibiotic use increases the risk of developing multidrug resistance; therefore, it is essential to distinguish bacterial from viral or other infections. Routine laboratory investigations cannot always identify the cause of diseases, but assessing different biomarker levels can help identify these infections and treat sepsis accordingly. This mini-review aims to critically analyze the available evidence supporting the use of biomarkers in pediatric sepsis. We have used the search engines PubMed, Cochrane Library, and Google Scholar to retrieve relevant information. We reviewed studies evaluating various biomarkers used for sepsis diagnoses, like C-reactive protein, ferritin, lactate, procalcitonin, tumor necrosis factor-alpha, etc. Apart from the diagnosis, trials are being conducted to assess the role of these biomarkers in monitoring and guiding antibiotic therapy to promote early recovery. The sensitivity of each biological marker varied in different studies, and no single biomarker can identify all types of infections. More robust studies are necessary to compare the roles of various biomarkers in diagnosing and guiding the appropriate therapy.

Severe Plasmodium falciparum malaria remains a major cause of morbidity in children, particularly among non-immune travelers. Intravenous artesunate is the treatment of choice for severe malaria due to its rapid parasite clearance and improved safety profile. However, post-artemisinin delayed hemolysis (PADH) is increasingly recognized as a delayed adverse effect, typically occurring seven to 30 days after treatment. Recognition of PADH is crucial to avoid misdiagnosis, guide monitoring, and ensure timely intervention.A previously healthy nine-year-old boy presented with severe P. falciparum malaria following travel to Tanzania. He developed multiorgan dysfunction, including thrombocytopenia, acute kidney injury, hepatic dysfunction, and hypoxemic pneumonia, and was treated in the pediatric intensive care unit with intravenous artesunate followed by oral artemether-lumefantrine. After clinical improvement and parasite clearance, he was discharged. Ten days after treatment initiation, he re-presented with pallor, jaundice, and dark urine. Laboratory evaluation demonstrated hemoglobin decline, indirect hyperbilirubinemia, elevated lactate dehydrogenase (LDH), reticulocytosis, low haptoglobin, and absence of parasitemia - confirming PADH. He required admission and transfusion of packed red blood cells, with subsequent full hematological recovery.This case highlights PADH as an important delayed complication of artesunate therapy in non-immune pediatric travelers. Early recognition, structured post-treatment monitoring, and clear differentiation from malaria recrudescence are essential to guide management. This case reinforces the need for follow-up hemolysis testing seven to 30 days after treatment, particularly in patients with high initial parasitemia.This case report describes a child with severe falciparum malaria successfully treated with intravenous artesunate who subsequently developed PADH. It illustrates the biphasic course of artemisinin therapy - initial parasite clearance followed by delayed hemolysis - underscoring the need for post-discharge monitoring.

Immune checkpoint inhibitor-induced encephalitis (ICIiE) is a rare but potentially life-threatening neurological immune-related adverse event associated with cancer immunotherapy. Pembrolizumab, a programmed cell death protein 1 (PD-1) inhibitor, has demonstrated significant efficacy across multiple malignancies; however, its use can lead to dysregulated immune activation affecting the central nervous system. Clinical presentation is highly variable and often mimics infectious or paraneoplastic encephalitis, making diagnosis challenging, particularly in immunocompromised patients. We report the case of a 63-year-old woman with grade III breast carcinoma, status post mastectomy, receiving adjuvant chemotherapy with paclitaxel and carboplatin in combination with pembrolizumab, who presented with persistent high-grade fever one week after immunotherapy administration. She was initially managed as a case of neutropenic sepsis and treated with broad-spectrum antibacterial and antifungal therapy; however, she developed progressive neurocognitive deterioration characterized by confusion, disorientation, irritability, and intermittent dystonic posturing, prompting intensive care unit admission. Extensive infectious evaluation, including repeated cultures, viral studies, and imaging, was unrevealing. Cerebrospinal fluid (CSF) analysis demonstrated marked lymphocytic pleocytosis and significantly elevated protein levels, while bacterial and viral polymerase chain reaction panels were negative. Brain MRI showed no definitive acute abnormalities. Given the temporal relationship with pembrolizumab exposure and exclusion of alternative etiologies, a diagnosis of immune checkpoint inhibitor (ICI)-related encephalitis was made. High-dose intravenous methylprednisolone was initiated, resulting in rapid defervescence and complete neurological recovery, normalization of inflammatory markers, and a return to baseline mentation. This case highlights the importance of maintaining a high index of suspicion for immune checkpoint inhibitor-related encephalitis in patients receiving immunotherapy who present with unexplained fever and subacute neurological decline. Early multidisciplinary evaluation and prompt initiation of immunosuppressive therapy are critical to preventing morbidity and achieving favorable neurological outcomes.

Gastrointestinal basidiobolomycosis (GIB) is a rare, emerging fungal infection caused by Basidiobolus ranarum. It primarily affects immunocompetent individuals and often presents as a mass lesion mimicking colorectal malignancy or inflammatory bowel disease. Due to its non-specific presentation and rarity, GIB is frequently misdiagnosed, leading to delayed or inappropriate management. In this article, we present a case of GIB in a young male in his 20s who presented with a four-month history of intermittent and recurrent severe abdominal pain associated with significant weight loss. Based on the information at hand, he was being treated for a suspected inflammatory bowel disease. Subsequently, he underwent a gastroscopy and colonoscopy. His colonoscopy initially reported him to have acute severe destructive colitis with a wide differential diagnosis, including inflammatory bowel disease, Bechet’s disease, ischemic or pseudomembranous colitis. Based on initial suspicion, the patient was started on therapy for Crohn's disease, with which he showed mild improvement. However, he again got worse with exacerbating symptoms. His histopathology was sent to a tertiary care hospital in the United States, and he was found to have GIB. After initiation of antifungal therapy, including a combination of itraconazole and intravenous liposomal amphotericin (later changed to voriconazole), his symptoms showed remarkable improvement. This case report highlights the importance of recognizing the rare presentation of GIB in an immunocompetent adult who was initially misdiagnosed as a case of inflammatory bowel disease, emphasizing the importance of histopathological evaluation in diagnosing fungal infections. It also indicated that GIB, despite being a highly destructive colitis, can be successfully treated with antifungals without the need for invasive surgical procedures.

Glaucoma is a leading cause of blindness worldwide, with its impact expected to increase substantially in the coming years. It results from structural and functional damage to the optic nerve and can be classified into primary open-angle glaucoma (POAG), primary angle-closure glaucoma (PACG), and secondary glaucoma. This retrospective cross-sectional study is among the first to examine the prevalence and extent of glaucoma in a tertiary care center in the United Arab Emirates (UAE). Adults over the age of 18 who presented to the ophthalmology outpatient clinic between January 2017 and December 2021 with a confirmed diagnosis of glaucoma were analyzed. Data collected included demographic variables such as age, gender, and nationality, as well as comorbidities including diabetes, hypertension, and family history of glaucoma. Data collection resulted in 553 glaucomatous eyes, where the mean age was 53.3 ± 14.0 years (range 20-98 years), and the majority of participants were male (60%, n = 332) compared to 40% of females (n = 221). Looking at the proportion of glaucoma by year, it was evident that 38.1% of eyes were severely affected in 2017, and this proportion increased to 53.9% by 2021. UAE nationals had the highest rate of severe glaucoma (60.7%), in contrast to patients from India (38.6%), the United Kingdom (26.2%), and other nationalities (46.4%) (p < 0.001). There was a significant association between age and severe glaucoma, with prevalence lowest in the youngest group (≤28 years, 25.0%) and highest in the oldest group (≥69 years, 68.6%; p < 0.001). Male gender was also significantly associated with severe disease, whereas diabetes, hypertension, and family history showed no significant associations. To our knowledge, this study is the first of its kind in the UAE that looks into the risk factors and epidemiology of glaucoma. The data from this study will aid in filling the gap with regard to prevalence data in the UAE, which can further guide screening and prevention measures.

Behçet's Disease (BD) is a chronic, systemic vasculitis of unknown etiology that affects multiple organ systems. It is characterized by recurrent oral and genital ulcers, ocular involvement, affecting arteries and veins of all sizes. It is more prevalent in countries along the ancient Silk Road. Diagnosis is primarily clinical, as there are no specific laboratory tests. The International Criteria for BD (ICBD) was developed to improve diagnostic accuracy. Management requires a multidisciplinary approach, with treatment strategies depending on disease severity. Despite BD's significant morbidity and diverse clinical manifestations, its prevalence and characteristics remain to be described in Palestine. This research provides critical insights into disease patterns and contributes to improved diagnosis and management in Palestine. A retrospective cohort study was conducted in the period from Aug 2024 until March 2025 in rheumatology clinics across the West Bank and Jerusalem. 60 Patients diagnosed with BD based on ICBD (score ≥ 4) were included. Exclusion criteria were cognitive impairment, incomplete records, or non-residence in Palestine. Sixty patients were enrolled. Data was collected via chart review and patient interviews. Disease-related complications were assessed using the Behçet's Overall Damage Index (BODI) to ensure standardized evaluation. The male to female ratio was 1.14:1. In addition, the most common initial clinical presentations were oral aphthous ulcers (96.7%), genital aphthous (86.7%), ocular lesions (66.7%), skin lesions noted (46.7%), while vascular lesions occurred in (30%). Neurological manifestations and positive Pathergy test were (25%) and (18.3%), respectively. Regarding complications, the most common were vascular events (36.7%), skin ulcerations (33.3%), mucocutaneous scars (20%), avascular necrosis (13.3%), osteoporotic fractures (10%). Regarding complications in the eye, anterior segment changes presented (15%), posterior segment changes (8.3%), visual impairment in one eye (33.3%), and (13.3%) in both. Neurological complications were less frequent and there was no difference in characteristics between the genders. The most common manifestations were oral aphthous ulcers, followed by genital ulcers, neurological manifestations, and pathergy was the least frequent. The most frequently reported complications were vascular events, skin ulceration, and visual impairment, while neuropsychiatric complications were the least frequent, and there was no gender difference in BD characteristics. No trial registry number.

Background and aimsCoronary artery calcium (CAC) scoring is an increasingly adopted, non-invasive modality for assessing coronary artery disease (CAD). However, its diagnostic reliability in comparison to invasive coronary angiography (ICA) remains controversial. This study evaluated the diagnostic performance of CAC scoring in predicting CAD using ICA as the reference.MethodsAdults who underwent both coronary computed tomography angiography (CCTA) with CAC scoring and ICA within a three-month interval were retrospectively analyzed between 2018 and 2024. Obstructive CAD was defined as ≥ 50% stenosis on ICA. Patients were stratified by CAC scores: 0 (group 1), 1–399 (group 2), and ≥400 (group 3). Chi-square analysis was utilized to assess the differences in CAC scores compared to ICA. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CAC against ICA were all calculated using R version 4.4.0.ResultsAmong 110 patients (mean age 53 ± 10; 86.4% males), obstructive CAD was found in 25% of patients in group 1, 56% of patients in group 2, and 79% of patients in group 3 (χ2 = 14.21, p < 0.001). CAC demonstrated a sensitivity of 91.2%, specificity of 63.2%, a PPV of 92.2%, and an NPV of 60%.ConclusionWhile a CAC score of 400 or higher strongly predicts significant CAD, scores of zero or intermediate values fail to exclude obstructive disease reliably. These findings reaffirm that CAC scoring is a useful stratification tool but should be interpreted with caution, particularly in high-risk patients, and confirmed with ICA when appropriate.

Major congenital anomalies (MCAs) are significant contributors to perinatal morbidity and mortality, especially in preterm and low birth weight neonates. The association between MCAs, preterm birth, and low birth weight remains poorly defined, necessitating further research to refine management strategies. This study aimed to investigate the impact of MCAs on preterm and low birth weight births in a sample of the Emirati population. The analysis was based on a cohort of singleton live births from the Mutaba’ah study (2017–2023). Regression models assessed the association between MCAs and both preterm birth and low birth weight, adjusting for maternal and neonatal characteristics. Neonates with any MCAs had two-times higher odds of preterm birth (adjusted odds ratio (AOR): 2.0, 95% confidence interval (CI) 1.3–2.9) and low birth weight (AOR: 2.2, 95% CI 1.4–3.3), compared with MCAs-free neonates. Moreover, neonates with multiple MCAs had significantly increased odds of being born preterm (AOR: 5.3, 95% CI 2.6–10.7) or with low birth weight (AOR: 3.5, 95% CI 1.5–8.6). This study provides evidence of a strong association between MCAs and increased risks of preterm birth and low birth weight, highlighting the need for a proactive, multidisciplinary approach to improve health outcomes for this vulnerable population.