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BACKGROUND Cubital tunnel syndrome results from pressure or stretching of the ulnar nerve, and carpal tunnel syndrome involves the median nerve. Elastofibroma is a rare, benign, slow-growing soft-tissue tumor that commonly occurs as a bilateral infrascapular tumor in elderly women. This report is of a 60-year-old woman who presented with combined carpal tunnel syndrome and cubital tunnel syndrome due to an elastofibroma causing compression of the median and ulnar nerves. CASE REPORT We report the case of a 66-year-old woman with left-hand numbness, tingling along the fingers, sleep disturbance, and weakness in pinching or holding objects for an extended period. The clinical examination and nerve conduction studies established the diagnosis of combined carpal tunnel syndrome (CTS) and cubital tunnel syndrome (CuTs) complicated by intrinsic muscle wasting. The patient underwent left carpal and cubital tunnels release surgery and end-to-side anterior interosseous nerve transfer to the motor component of the ulnar nerve. Pathologic evaluation of the entire specimen showed collagen bundles alternating with refractive cylinders stained with Verfoeff-van Gieson elastic stain. CONCLUSIONS This report is of a rare case of a histologically-confirmed single, peripheral, benign elastofibroma involving compression of the ulnar and median nerves. This case highlights the importance of histopathology in diagnosing rare soft-tissue tumors arising at an uncommon site and presenting with rare symptoms.

Extrapulmonary tuberculosis frequently eludes assessment through atypical presentations and constitute diagnostic challenges. High degree of suspicion with aids of GeneXpert MTB/RIF can clinch the diagnosis and avoid unnecessary consequences.

Well-differentiated liposarcoma (WDL) is one of the most common soft tissue sarcomas in adults. It has a predilection for middle-aged males and arises in deep-seated locations such as retroperitoneum, mediastinum, and spermatic cord. Its occurrence in young individuals at the hypopharyngeal region is an exceedingly rare event. Myxoid liposarcoma (ML)-like changes can seldom occur in some cases of WDL, which makes the diagnosis of WDL more challenging. Amplification of DDIT3 gene in a subset of cases of WDL has shown to be associated with such unique morphology. Herein, we present a case of a 36-year-old gentleman who presented with difficulty in breathing and swallowing for 3 months duration. CT scan of the neck revealed a lesion along the posterior wall of the hypopharynx measuring 3.5 cm. Histopathologic examination revealed a tumor composed of lobules of oval to spindle cells in a prominent myxoid stroma with delicate chicken-wire vasculature. In the vicinity, there were lobules composed of variably sized adipocytes separated by thick fibrous septa that contains atypical hyperchromatic spindle cells. By immunohistochemistry, the tumor cells in both components were immunoreactive for CDK4, but negative for MDM2. Fluorescence in-situ hybridization (FISH) confirmed the presence of MDM2 gene amplification. There was no evidence of FUS-DDIT3 gene rearrangement, however, DDIT3 gene was also amplified. The diagnosis of well-differentiated liposarcoma with prominent myxoid stroma was rendered. This is the first documentation of WDL with ML-like morphology harboring co-amplification of MDM2 and DDIT3 in the hypopharynx.

Background Appendicular neoplasms are rare, most commonly as carcinoids followed by appendicular mucinous neoplasms (AMN). To date, there remains controversy regarding the best treatment of AMN and factors affecting its prognosis. Method Retrospective chart review of patients operated for appendicular pathology (January 2011–December 2018, follow up to December 2020) at our institution. For all AMN patients, data included pre-operative clinical presentation, and operative/post-operative findings. Results 12454 patients underwent appendectomy, of whom 50 (0.4%) had AMN histopathologically (mean age = 47.2). Most patients had laparoscopic appendectomy as primary surgery. Low grade AMN was the most common subtype (n = 41, 82%), and pseudomyxoma peritonei (PMP) was found in 8 (16%) patients. Based on histopathology and margin involvement, the 50 patients were categorized into 3 prognostic categories of recurrence risk (no risk, 24 patients; low risk, 8; high recurrence risk, 18 patients). Disease-free survival (DFS) was lowest for high recurrence risk group (P, Highlights • Laparoscopic approach may be feasible for appendiceal mucinous neoplasms (AMN). • AMN can be categorized into 3 risk recurrence groups (No risk, low, and high). • AMN with acellular mucin at the margin may not require secondary surgery. • Higher tumor markers may indicate high risk of AMN recurrence.

This article examines the reliability of rainwater harvesting (RWH) systems in subcatchment area. Using water balance simulation and two definitions of this value (time-based and volumetric ones), the reliability of rainwater harvesting systems for 25 locations in Medenine’s dryland agricultural areas in south-eastern Tunisia is assessed. Extensive computer software was created using modelling idea for daily water balance, and three meteorological extremes, i.e. wet, average and dry years, were selected by analysing historical 20-year daily rainfall data to assess RWH system performance. Results stated that for wet climatic conditions, volumetric reliability of around 30–70% can be attained, whereas for these circumstances, only 10–24% time-based reliability can be accomplished. The method described in this article can also be applied to other arid and semi-arid areas by using daily rainfall data to predict water savings and the reliability of RWH systems.

Background Long-term inflammation in IBD is mediated by several immune cells, including T lymphocytes and natural killer (NK) cells, through the engagement of NK group 2D (NKG2D) receptors. Allelic variations of NKG2D ligands (NKG2Dls, MICA/B, ULBP1-3) influence differential levels and localization of protein expression or the release of soluble isoforms. The affinity of interaction with NKG2D can be also affected, modulating the cytotoxic activity of the target cell. Evaluation of these molecular pathways and soluble ligands presents the potential use a clinical biomarker for patient outcomes. Methods Gut tissue biopsies (left and right sides) and peripheral blood were collected from patients. 10 pediatric and 11 adult patients with IBD, 10 patients with gut malignancies and history of IBD were included in the study. Plasma form IBD patients and 10 healthy donors as controls, was used to quantify soluble NKG2DLs (sNKG2DLs) by ELISA (R&D Systems Duo Set). Nucleic acids were extracted from gut biopsies using the BioMasher II (Kimble) and All Prep DNA/RNA universal kit (Qiagen). Single nucleotide polymorphisms (SNPs, N=26) and relative gene expression of NKG2DL genes were conducted by qPCR using Taqman assays. Results 9/11 adult patients had diagnosis of ulcerative colitis, compared to 3/10 pediatrics. 5/10 pediatrics had Crohn’s disease and 2/10 unclassified IBD. A trend of prevalence of some allelic variants was detected for most of NKGD2Ls.In addition, mRNA encoding for NKG2DLs was detected commonly, although with heterogeneous quantifications, in all the tissues, including the retrospectively collected malignancies with history of IBD. Interestingly, the levels of sNKG2DLs were higher in pediatric (p Conclusions These results, although preliminary and further investigations are ongoing, suggest the relevance of NKG2D/NKG2DL pathway in the development and evolution of IBD. sNKG2DLs could be detected in most of patients, with different levels and highest concentrations in pediatric patients. In some cases, the presence of sNKG2DLs in the plasma could be associated with defined polymorphisms in genes encoding for these proteins. Ethics Approval This study was approved by Sidra Medicine and Hamad Medical Corporation Ethics Boards; approval number 180402817 and MRC-02-18-096, respectively.

Background Patients with inflammatory bowel disease (IBD) have increased risk of developing colorectal cancer (CRC), depending on the duration and severity of the disease. The evolutionary process in IBD is driven by chronic inflammation leading to epithelial-to-mesenchymal transition (EMT) events in colonic fibrotic areas. EMT plays a determinant role in tumor formation and progression, through the acquisition of ‘stemness’ properties and the generation of neoplastic cells. The aim of this study is to monitor EMT/cancer initiating tracts in IBD in association with the deep characterization of inflammation in order to assess the mechanisms of IBD severity and progression towards malignancy. Methods 10 pediatric and 20 adult IBD patients, admitted at Sidra Medicine (SM) and Hamad Medical Corporation (HMC) respectively, have been enrolled in this study, from whom gut tissue biopsies (from both left and right side) were collected. Retrospectively collected tissues (N=10) from patients with malignancy and history of IBD were included in the study. DNA and RNA were extracted from fresh small size (2–4 mm in diameter) gut tissues using the BioMasher II (Kimble) and All Prep DNA/RNA kits (Qiagen). MicroRNA (miRNA; N=700) and gene expression (N=800) profiling have been performed (cCounter platform; Nanostring) as well as the methylation profiling microarray (Infinium Methylation Epic Bead Chip kit, Illumina) to interrogate up to 850,000 methylation sites across the genome. Results Differential miRNA profile (N=27 miRNA; p Conclusions Although the results warrant further investigation, differential genomic profiling suggestive of altered pathways involved in oxidative stress, EMT, and of the possible stemness signature was found. The integration of data from multiple platforms will provide insights of the overall molecular determinants in IBD patients along with the evolution of the disease. Ethics Approval This study was approved by Sidra Medicine and Hamad Medical Corporation Ethics Boards; approval number 180402817 and MRC-02-18-096, respectively.

Background Oral cancer (OC) is a neoplastic process of the oral cavity that has high mortality and significant effects on patients’ aesthetics. The majority of OC is oral squamous cell carcinoma (OSCC) and resection remains the most frequent treatment. Recurrence is the main cause of tumor-related mortality. Material and methods A retrospective review of patients’ charts at Hamad Medical Corporation examined 154 adults who were diagnosed as OSCC and referred to the national head and neck cancer multi-disciplinary team meetings between 2012 and 2018. The data extracted was demographic, pathologic and clinical. All patients with oral cavity tumors other than squamous cell carcinoma were excluded. Results Males comprised the majority of the sample, mean age was 46.93 years. Tongue was the most common location. The majority of the patients were diagnosed at early stages, and a small subset of patients had histologically-proven local recurrence. Conclusion The young male predominance of OSCC patients in Qatar is unprecedented worldwide. Most patients were non-Qataris, mainly from South Asia. Loss of follow-up was a challenge in assessing the long-term outcomes of OSCC. Our findings suggest the need for a more vigilant surveillance approach to oral lesions particularly in male South-Asian patients, as well as improving the follow-up strategies., Highlights • Oral squamous cell carcinoma (OSCC) is the most common type of oral cancer. • There is no published data about OSCC in Qatar, despite its ethnically diverse population. • We reviewed the charts of all OSCC adult patients in Qatar between 2012- 2018 and studied multiple parameters. • Results showed unprecedented young male predominance, mainly South Asian expats. Loss of follow-up was a major limitation. • Our findings suggest the need for more vigilant surveillance to oral lesions particularly in male South-Asians.

Background: Oral cancer (OC) is a neoplastic process of the oral cavity that has high mortality and significant effects on patients’ aesthetics. Majority of OC is oral squamous cell carcinoma (OSCC) and resection remains the most frequent therapy. Recurrence is the main cause of tumor-related mortality.Material and methods: A retrospective review of patients’ charts in Hamad Medical Corporation studied of 154 adults who were diagnosed as OSCC in between 2006- 2018 . The data extracted was demographic, pathologic and clinical. All patients with oral cavity tumors other than squamous cell carcinoma were excluded.Results: Males comprised the majority of the sample, mean age was 46.93 years. Tongue was the most common location. Majority of the patients were diagnosed at early stages and a small subset of patients had histologically-proven local recurrence.Conclusion: Demographics of OSCC patients in Qatar revealed an unprecedented male predominance with a significant younger portion. Most patients were non-nationals, mainly from South Asia. No significant association was found between age groups and local recurrence against multiple parameters. Improving of follow-up system is suggested.Conclusion: The young male predominance of OSCC patients in Qatar is unprecedented worldwide. Most patients were non-Qataris, mainly from South Asia. Loss of follow-up was a challenge in assessing the long term outcomes of OSCC. Our findings suggest the need for a more vigilant surveillance approach to oral lesions particularly in male South-Asian patients, as well as improving the follow-up strategies.

Immunocompromised status is associated with invasive fungal infections including mucormycosis. These infections are challenging to treat and associated with high overall mortality.Here we report a fatal case of invasive mucormycosis in a cirrhotic, diabetic patient. Despite the swift diagnosis and management; the fungal invasion of the right internal carotid artery lead to massive ischemic stroke.Timely diagnosis and management is crucial for management but it seems not always enough and new approaches for treatment must be sought. Keywords: Mucormycosis, Rhinocerebral, Liver, Cirrhosis, Stroke

First described in 1995 by Meis-Kindbloom et al. as a variant of fibrosarcoma simulating carcinoma, sclerosing epithelioid fibrosarcoma (SEF) is a malignant soft tissue sarcoma characterized by epithelioid cells in dense sclerotic stroma, frequent immunoreactivity for MUC4 and heterogeneous genetic profile with recurrent EWSR1 gene rearrangement. It typically affects middle-age adults with a predilection for the lower extremity. It is believed that SEF is closely related to low-grade fibromyxoid sarcoma (LGFMS), both tumors show overlapping features in morphology, immunophenotype, and molecular profile. In this review, we discuss the clinical, morphologic, and immunohistochemical features of SEF with particular emphasis on its molecular diversity and relation to LGFMS.

Extranodal lymphoma (ENL) occurs in approximately 30%–40% of all patients with non-Hodgkin lymphoma and has been described in almost all organs and tissues. However, diffuse large B-cell lymphoma is the most common histological subtype of non-Hodgkin lymphoma, primarily arising in the retroperitoneal region. In this article, we report a rare case of an adult male diagnosed with primary diffuse large B-cell lymphoma of the gluteal and adductor muscles with aggressive bone involvement. All appropriate radiological and histopathological studies were done for diagnosis and staging. After discussion with the lymphoma multidisciplinary team, it was agreed to start on R-CHOP protocol (rituximab, cyclophosphamide, doxorubicin (Adriamycin), vincristine (Oncovin®), and prednisone) as the standard of care, which was later changed to R-CODOX-M/R-IVAC protocol (rituximab, cyclophosphamide, vincristine (Oncovin®), doxorubicin, and high-dose methotrexate alternating with rituximab, ifosfamide, etoposide, and high-dose cytarabine) due to inadequate response. Due to the refractory aggressive nature of the disease, subsequent decision of the multidisciplinary team was salvage chemotherapy and autologous stem cell transplant. The aim of this case report was to describe and evaluate the clinical presentation and important radiological features of extranodal lymphoma affecting the musculoskeletal system.

Harvested rainwater is an alternative source of water in arid and semi-arid regions (ASARs) around the world. Many researchers have developed and applied various methodologies and criteria to identify suitable sites and techniques for rainwater harvesting (RWH). Determining the best method or guidelines for site selection, however, is difficult. The main objective of this study was to define a general method for selecting suitable RWH sites in ASARs by assembling an inventory of the main methods and criteria developed during the last three decades. We categorised and compared four main methodologies of site selection from 48 studies published in scientific journals, reports of international organisations, or sources of information obtained from practitioners. We then identified three main sets of criteria for selecting RWH locations and the main characteristics of the most common RWH techniques used in ASARs. The methods were diverse, ranging from those based only on biophysical criteria to more integrated approaches including socio-economic criteria, especially after 2000. The most important criteria for the selection of suitable sites for RWH were slope, land use/cover, soil type, rainfall, distance to settlements/streams, and cost. The success rate of RWH projects tended to increase when these criteria were considered, but an objective evaluation of these selection methods is still lacking. Most studies now select RHW sites using geographic information systems in combination with hydrological models and multi-criteria analysis.

Nasopharyngeal papillary adenocarcinoma variety is extremely rare type of nasopharyngeal carcinoma. Limited number of cases reported in the literature, with most cases being reported from west and south Asia. We report the first case in English literature from the middle east and south Africa. A young gentleman diagnosed with low-grade nasopharyngeal papillary adenocarcinoma with positive cervical lymph node. He received a combined approach with endoscopic resection of the lesion and concomitant Left neck dissection followed by planned chemoradiotherapy. Through this case report, we would like to share our treatment approach and explore the optimum therapeutic strategies for primary nasopharyngeal papillary adenocarcinomas.

Death certificates, mortuary registries, hospital and police records are known to be data sources on injury fatalities. However, underreporting, misreporting and a lack of well-trained registers are some of the challenges faced by these systems. This study will describe the injury deaths reported in Qatar national vital statistics annual reports [NVSAR] and compare them with the national mortuary of the Hamad Medical Corporation [NMHMC] in Doha,Qatar. This retrospective study extracted all injury deaths recorded in the NHMC and compared them with those in NVSAR, from 1 January 2007 to 31 December 2015. Characteristics of injury deaths included: age, sex, mechanism of injury and the proportionate contribution to all injury deaths. The study extracted 20 870 deaths, from all causes, from NMHMC, from 1 Jan, 2007 to 31 Dec 2015. There was an annual average of 279 more deaths, from all causes; this trend was consistent throughout the study period. Of these deaths, 3391 (16.2%) were due to injuries in NMHMC, this differed significantly from NVSAR, with 4054 reported injury deaths [22.1%]. The difference between the reported injury deaths from the Mortuary and the NSVAR followed a sigmoidal curve, from 2007–2015 with a nadir in 2012 and a peak in 2015. Comparisons by mechanism of injury did not reveal a consistent pattern of difference. The average proportionate mortality [PM] from Mortuary pre-hospital injury deaths was 44.1% [range 21.5%–54.0%] while that for in-hospital deaths was 53.3% [range 46.2%–68.1%]. The differential reporting pattern of deaths between the NSVAR and NMHMC was unique for injury deaths, with more deaths reported in the NSVAR and opposite was for all-cause deaths. No relationship was noted when analyzed by mechanism of injury. Further analysis must be done to better elucidate the cause/s of these differences.

Background Suicide is a complex phenomenon involving several risk factors. We aimed to describe the frequency, pattern, and outcomes of patients with traumatic injuries following suicide attempts admitted to a level 1 trauma center. Methods We conducted a retrospective analysis of data obtained from Qatar National Trauma Registry and mortuary database. The study included all patients with traumatic injuries following suicide attempts, admitted to the Hamad Trauma Center (HTC) from April 2008 to March 2018. Results During this 10-year period, 206 patients were admitted to the HTC for injuries associated with suicide attempts. The majority were males (76%), young age (mean age 31 years), and expatriates specifically from South Asia (55%). The most common injury was due to self-inflicted cutting and piercing (51%) followed by jumping from height (30%). Females chose jumping from high place more often as a method of suicide attempt (59% vs. 20%), while males chose self-stabbing or cutting their throat (59% vs. 25%) (P = 0.001). Most of the patients had head injuries (30%) that was severe in terms of abbreviated injury scale score (3.6 ± 0.9). More than half (54%) of the patients required psychiatric consultations. The in-hospital mortality was 8% which was comparable in both genders. Conclusions The present study revealed that 1.8% of trauma admissions at HTC were related to suicidal attempts. Better understanding of risk factors is important in devising preventive strategies.

Hamartoma of the bladder is an unusual entity described in only eleven patients to date. It may present as painless hematuria, irritative urinary tract symptoms, or inability to void or it may be diagnosed incidentally. Hamartoma of the bladder may be isolated or occur as part of a syndrome. No isolated bladder hamartoma to date has shown malignant potential. We describe here a bladder hamartoma in a 15-year-old boy.