Rafal Ali | College of Science University of Baghdad (original) (raw)
Papers by Rafal Ali
Journal of Cardiac Failure, Apr 1, 2023
Journal of the Endocrine Society, Nov 1, 2022
Cureus, Oct 31, 2022
Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening syndrome involving excessive immun... more Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening syndrome involving excessive immune activation. It can be primary (familial) or secondary (triggered by infection, malignancy, or rheumatological disease). This is a case of a previously healthy 43-year-old African American woman who presented with fever and confusion. The patient was eventually diagnosed with pulmonary aspergillosis and responded well to antifungal therapy. She met the diagnostic criteria of HLH-2004 trial for hemophagocytic lymphohistiocytosis. She also fulfilled the 2019 classification criteria for systemic lupus erythematosus (SLE) without the classical signs and symptoms of SLE. HLH management includes supportive management, treatment of underlying condition, and immunosuppressive treatment. Etoposide and dexamethasone are commonly used treatments for HLH; however, underlying active infection can limit the treatment options. In our case, the patient was treated with steroids and hydroxychloroquine. Her condition gradually improved and she recovered without complications. Based on our literature review, we encountered six cases of HLH secondary to Aspergillosis with a mean age of approximately 47 years. The diagnosis of HLH is often delayed because of nonspecific presentation. Early identification and treatment are crucial to improve the survival rate.
Cureus, Jun 17, 2022
Hypophosphatemic rickets can cause a variety of bone and joint symptoms, one of its rare presenta... more Hypophosphatemic rickets can cause a variety of bone and joint symptoms, one of its rare presentations is sacroiliac joint involvement, which may be mistaken for inflammatory spondylitis. Here, we report the case of a 31-year-old African American woman who presented with a two-year history of lower back pain and morning stiffness, initially suspected to be due to inflammatory spondyloarthritis. Laboratory tests revealed negative inflammatory markers, normal serum calcium, vitamin D3, and parathyroid hormone levels; however, the alkaline phosphatase levels were elevated and serum phosphorus level was low. Magnetic resonance imaging (MRI) of the lumbosacral spine revealed mild widening of the sacroiliac joint with periarticular sclerosis with no signs of osteitis or bone marrow edema. Her condition was attributed to a known diagnosis of X-linked hypophosphatemic rickets affecting her sacroiliac joints. Her symptoms gradually improved after conservative treatment with physical therapy, nonsteroidal antiinflammatory drugs, phosphate, and vitamin D supplementations. Based on our literature review, we have come across only five rickets cases with similar presentations. Two patients had previously undiagnosed hypophosphatemic rickets at 15 and 35 years of age. One case was related to vitamin D-deficient rickets, and the final two cases were adult-onset vitamin D-resistant rickets misdiagnosed as ankylosing spondylitis. Radiological signs of sacroiliac joint involvement in these cases include narrowing of the sacroiliac joints, fusion of the sacroiliac joints, subchondral hypointense signal changes, and chondral surface irregularities. Vitamin D supplementation has significantly reduced the incidence of rickets; however, there are still cases of familial rickets that can present with a variety of symptoms, including signs and symptoms consistent with inflammatory spondylitis, which can be easily misdiagnosed or mistreated if this presentation is not recognized.
Circulation
Introduction: Cardiac tamponade is often evaluated through echocardiography. However, not all pat... more Introduction: Cardiac tamponade is often evaluated through echocardiography. However, not all patients with tamponade physiology develop clinical tamponade. Thus, we evaluated various echocardiographic and clinical factors as predictors of the need for intervention. Methods: A total of 264 patients with tamponade physiology were extracted from the echocardiographic database. We compared clinical and demographic factors among those who underwent intervention vs. conservative care. Factors with p value of <0.2 were included in a multivariable logistic regression model. Results: 76% of these patients had moderate to large pericardial effusions, and their mean MAP was 92 mmHg. Half of these patients (n=134) had either pericardiocentesis or a pericardial window. Only 7 patients (3%) required a repeat pericardiocentesis.Intervention patients had more positive echocardiographic parameters (2 (1-3) vs 1.5 (1-2) p<0.001) and moderate to large pericardial effusions (90% vs 62% p<0.00...
Archives of Clinical and Medical Case Reports
Colorectal cancer [CRC] is the third most diagnosed but preventable cancer worldwide. The guideli... more Colorectal cancer [CRC] is the third most diagnosed but preventable cancer worldwide. The guidelines for CRC screening were first introduced formally in the 1990s, and over the past three decades, the screening rate slowly increased. As per the American Cancer Society [ACS], in the year 2020, about 69.7% of adults between 50 and 75 had colorectal cancer screening, with the lowest screening rate in adults between 50 and 64 years of age. The incidence of colorectal cancer is also rising in the younger population worldwide. According to recent American College of Gastroenterology guidelines, the starting age for screening is 45 years instead of 50. The rising incidence and low compliance with screening in the younger population make it hard to improve CRC-related mortality. As per ACS, there is almost 30% of the eligible unscreened population in 2020, so we believe there is a need for effective screening programs worldwide. We understand that there are modifiable and non-modifiable factors for non-compliance. Some of them are lack of awareness, fear about screening, their previous experience with screenings, and overprescription of Colonoscopies in open or direct access systems. Overprescription of Colonoscopies in open or direct access systems [OAC] can lead to longer wait times due to fewer appointments for people who need them. Implementing patient navigation or tracking systems with reminders can help recruit people for cancer screening, overcome the barriers to accessing clinical services, and provide appropriate counseling. Executing clinical care pathways can help reduce the risks of overprescription. Monitoring practice progress by establishing a baseline screening rate and a future goal is also essential. Developing quality improvement projects around these goals can help discover system deficits and ideas to overcome them. The primary purpose of this review, even though it is not new, is to increase awareness among physicians regarding the rising incidence of CRC in the younger population and the need to increase screening rates. We also believe there is a need for more effective CRC screening tests that are easy to administer, with minimal discomfort to the participant.
Journal of Cardiac Failure
Journal of the Endocrine Society
Background In ambulatory settings, primary hyperparathyroidism is the most prevalent cause of hyp... more Background In ambulatory settings, primary hyperparathyroidism is the most prevalent cause of hypercalcemia. Approximately 85% of primary hyperparathyroidism cases are caused by a solitary parathyroid adenoma; other causes include diffuse parathyroid hyperplasia, multiple parathyroid adenomas, and parathyroid cancer. Chief cell adenomas are the most prevalent; adenomas can also consist of oxyphil cell adenomas, lipoadenomas, or mixed cell adenomas. Water clear cell adenoma (WCCA) is a rare tumor formed of large clear cells with foamy pink cytoplasm. Fewer than 30 cases have been recorded in the literature. Case A 52-year-old male with polyuria and polydipsia, diagnosed with hypercalcemia was referred to an endocrinologist. His calcium was 10.9 mg/dl, corresponding parathyroid hormone (PTH) 74 pg/ml, 24-hour urine calcium 818 mg/24hr, vitamin D 25–hydroxy 24.2 ng/ml. He was referred to an endocrine surgeon. A 4-dimensional CT scan revealed soft tissue masses posterior to the thyroid ...
Cureus
Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening syndrome involving excessive immun... more Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening syndrome involving excessive immune activation. It can be primary (familial) or secondary (triggered by infection, malignancy, or rheumatological disease). This is a case of a previously healthy 43-year-old African American woman who presented with fever and confusion. The patient was eventually diagnosed with pulmonary aspergillosis and responded well to antifungal therapy. She met the diagnostic criteria of HLH-2004 trial for hemophagocytic lymphohistiocytosis. She also fulfilled the 2019 classification criteria for systemic lupus erythematosus (SLE) without the classical signs and symptoms of SLE. HLH management includes supportive management, treatment of underlying condition, and immunosuppressive treatment. Etoposide and dexamethasone are commonly used treatments for HLH; however, underlying active infection can limit the treatment options. In our case, the patient was treated with steroids and hydroxychloroquine. Her condition gradually improved and she recovered without complications. Based on our literature review, we encountered six cases of HLH secondary to Aspergillosis with a mean age of approximately 47 years. The diagnosis of HLH is often delayed because of nonspecific presentation. Early identification and treatment are crucial to improve the survival rate.
Journal of Clinical Oncology
360 Background: Aromatase inhibitors (AI) are an essential treatment for postmenopausal women wit... more 360 Background: Aromatase inhibitors (AI) are an essential treatment for postmenopausal women with hormone receptor-positive breast cancer in the adjuvant setting. Estrogen deficiency caused by AIs has adverse effects on bone health. Studies reveal that 5 years of treatment with anastrozole led to 6.1% of bone loss at the lumbar spine and 7.2% at the hip. The aim of the project is to identify the current degree of attention to bone health and skeletal-related complications in women with early-stage breast cancer stages I-III that are on AIs at a community cancer center at Einstein Medical Center Montgomery. Methods: This is a retrospective chart review of 63 patients ages 50-85 diagnosed with early-stage I-III breast cancer on an AI in the adjuvant setting. Patients who started on an AI between January 2013 through December 2017 were included. Data on Dual-energy X-ray absorptiometry scans (DEXA) and treatment at baseline, 2-years, and 4-years were analyzed. We followed to see if th...
Cureus
Hypophosphatemic rickets can cause a variety of bone and joint symptoms, one of its rare presenta... more Hypophosphatemic rickets can cause a variety of bone and joint symptoms, one of its rare presentations is sacroiliac joint involvement, which may be mistaken for inflammatory spondylitis. Here, we report the case of a 31-year-old African American woman who presented with a two-year history of lower back pain and morning stiffness, initially suspected to be due to inflammatory spondyloarthritis. Laboratory tests revealed negative inflammatory markers, normal serum calcium, vitamin D3, and parathyroid hormone levels; however, the alkaline phosphatase levels were elevated and serum phosphorus level was low. Magnetic resonance imaging (MRI) of the lumbosacral spine revealed mild widening of the sacroiliac joint with periarticular sclerosis with no signs of osteitis or bone marrow edema. Her condition was attributed to a known diagnosis of X-linked hypophosphatemic rickets affecting her sacroiliac joints. Her symptoms gradually improved after conservative treatment with physical therapy, nonsteroidal antiinflammatory drugs, phosphate, and vitamin D supplementations. Based on our literature review, we have come across only five rickets cases with similar presentations. Two patients had previously undiagnosed hypophosphatemic rickets at 15 and 35 years of age. One case was related to vitamin D-deficient rickets, and the final two cases were adult-onset vitamin D-resistant rickets misdiagnosed as ankylosing spondylitis. Radiological signs of sacroiliac joint involvement in these cases include narrowing of the sacroiliac joints, fusion of the sacroiliac joints, subchondral hypointense signal changes, and chondral surface irregularities. Vitamin D supplementation has significantly reduced the incidence of rickets; however, there are still cases of familial rickets that can present with a variety of symptoms, including signs and symptoms consistent with inflammatory spondylitis, which can be easily misdiagnosed or mistreated if this presentation is not recognized.
Journal of the American College of Cardiology, 2022
Cureus, 2022
Corticosteroid therapy is a known risk factor for osteonecrosis, more commonly with chronic use a... more Corticosteroid therapy is a known risk factor for osteonecrosis, more commonly with chronic use and high cumulative dose. Osteonecrosis (avascular necrosis) has been described in pregnancy involving primarily the femoral head. To our knowledge, only rare cases of femoral meta diaphysis or knee osteonecrosis in pregnancy have been documented in the literature. We report a 28-year-old woman with sickle cell trait and beta-thalassemia trait who developed severe bilateral knee pain shortly after corticosteroid therapy. She was 34-weeks pregnant when she presented with the signs of preterm labor and was found to have oligohydramnios and preeclampsia. She was given two intramuscular injections of betamethasone 12 mg one day apart to enhance the fetal lung maturity. Within hours of the second injection, she developed acute and severe bilateral knee pain affecting her mobility and ambulation. Bilateral knee x-rays were unremarkable. Given the severity and persistence of her pain, magnetic resonance imaging (MRI) of bilateral lower extremities was done few days later and showed signs of early osteonecrosis involving bilateral distal femoral meta diaphysis and right lateral femoral condyle. Other than the steroid therapy she had received, no additional extrinsic risk factors for osteonecrosis were identified. Potential intrinsic risk factors were thought to include her combined sickle-beta-thalassemia traits and pregnancy. She was diagnosed with steroid-induced osteonecrosis, given the temporal relationship. Her presentation was unique, because osteonecrosis affected unreported sites during pregnancy, and it started shortly after a brief course of antenatal steroid. She was treated conservatively with analgesics, and outpatient orthopedic follow-up was recommended. She was advised to avoid prolonged weight-bearing and strenuous activities. On a follow-up appointment two months later, she was still complaining of bilateral knee pain with ambulation though it was less severe. She did not return for follow-up thereafter. We suggest the possibility of osteonecrosis in pregnancy involving uncommon sites, such as distal femur and femoral condyle in this case, following one or two doses of systemic steroid. Obstetricians need to consider osteonecrosis when evaluating an unexplained musculoskeletal pain after betamethasone that is used for preterm labors. More studies, including reporting more cases with unusual presentation and prospective studies following pregnant patients receiving steroid therapy, are needed to better understand the causes, associations, management, and clinical course of osteonecrosis in pregnancy.
International Journal of Health Sciences (IJHS), Sep 3, 2022
Microfacies analysis of the Cretaceous Mishrif Formation was studied in Nasiriyah oil field in Na... more Microfacies analysis of the Cretaceous Mishrif Formation was studied in Nasiriyah oil field in Nasiriyah Governorate, southern of Iraq using integrated borehole data set that included, core samples and well logs in newly drilled well to analyze the microfacies and the Diagenesis Process of the formation, 100 thin sections for selected well. The results show that the formation composed of: (top to base) a fine-grained, limonitic fresh water limestone containing Charophytae. Four facies' associations were distinguished in the Mishrif Formation. These include:-These include:-Restricted shallow Open Marin environment is represented by Wackstone and Mudstone to Wackstone. The shallow open marine environment is represented by bioclastic wackestone and packestone, as well as rudistid floastone in rare situations. Shoal Environmentis represented by bioclastic packstone to grainstone, as well as rudstone. Deep Marine environment is represented by mudstone to packstone. six diagenetic processes affected on Mishrif Formation:
Journal of Cardiac Failure, Apr 1, 2023
Journal of the Endocrine Society, Nov 1, 2022
Cureus, Oct 31, 2022
Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening syndrome involving excessive immun... more Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening syndrome involving excessive immune activation. It can be primary (familial) or secondary (triggered by infection, malignancy, or rheumatological disease). This is a case of a previously healthy 43-year-old African American woman who presented with fever and confusion. The patient was eventually diagnosed with pulmonary aspergillosis and responded well to antifungal therapy. She met the diagnostic criteria of HLH-2004 trial for hemophagocytic lymphohistiocytosis. She also fulfilled the 2019 classification criteria for systemic lupus erythematosus (SLE) without the classical signs and symptoms of SLE. HLH management includes supportive management, treatment of underlying condition, and immunosuppressive treatment. Etoposide and dexamethasone are commonly used treatments for HLH; however, underlying active infection can limit the treatment options. In our case, the patient was treated with steroids and hydroxychloroquine. Her condition gradually improved and she recovered without complications. Based on our literature review, we encountered six cases of HLH secondary to Aspergillosis with a mean age of approximately 47 years. The diagnosis of HLH is often delayed because of nonspecific presentation. Early identification and treatment are crucial to improve the survival rate.
Cureus, Jun 17, 2022
Hypophosphatemic rickets can cause a variety of bone and joint symptoms, one of its rare presenta... more Hypophosphatemic rickets can cause a variety of bone and joint symptoms, one of its rare presentations is sacroiliac joint involvement, which may be mistaken for inflammatory spondylitis. Here, we report the case of a 31-year-old African American woman who presented with a two-year history of lower back pain and morning stiffness, initially suspected to be due to inflammatory spondyloarthritis. Laboratory tests revealed negative inflammatory markers, normal serum calcium, vitamin D3, and parathyroid hormone levels; however, the alkaline phosphatase levels were elevated and serum phosphorus level was low. Magnetic resonance imaging (MRI) of the lumbosacral spine revealed mild widening of the sacroiliac joint with periarticular sclerosis with no signs of osteitis or bone marrow edema. Her condition was attributed to a known diagnosis of X-linked hypophosphatemic rickets affecting her sacroiliac joints. Her symptoms gradually improved after conservative treatment with physical therapy, nonsteroidal antiinflammatory drugs, phosphate, and vitamin D supplementations. Based on our literature review, we have come across only five rickets cases with similar presentations. Two patients had previously undiagnosed hypophosphatemic rickets at 15 and 35 years of age. One case was related to vitamin D-deficient rickets, and the final two cases were adult-onset vitamin D-resistant rickets misdiagnosed as ankylosing spondylitis. Radiological signs of sacroiliac joint involvement in these cases include narrowing of the sacroiliac joints, fusion of the sacroiliac joints, subchondral hypointense signal changes, and chondral surface irregularities. Vitamin D supplementation has significantly reduced the incidence of rickets; however, there are still cases of familial rickets that can present with a variety of symptoms, including signs and symptoms consistent with inflammatory spondylitis, which can be easily misdiagnosed or mistreated if this presentation is not recognized.
Circulation
Introduction: Cardiac tamponade is often evaluated through echocardiography. However, not all pat... more Introduction: Cardiac tamponade is often evaluated through echocardiography. However, not all patients with tamponade physiology develop clinical tamponade. Thus, we evaluated various echocardiographic and clinical factors as predictors of the need for intervention. Methods: A total of 264 patients with tamponade physiology were extracted from the echocardiographic database. We compared clinical and demographic factors among those who underwent intervention vs. conservative care. Factors with p value of <0.2 were included in a multivariable logistic regression model. Results: 76% of these patients had moderate to large pericardial effusions, and their mean MAP was 92 mmHg. Half of these patients (n=134) had either pericardiocentesis or a pericardial window. Only 7 patients (3%) required a repeat pericardiocentesis.Intervention patients had more positive echocardiographic parameters (2 (1-3) vs 1.5 (1-2) p<0.001) and moderate to large pericardial effusions (90% vs 62% p<0.00...
Archives of Clinical and Medical Case Reports
Colorectal cancer [CRC] is the third most diagnosed but preventable cancer worldwide. The guideli... more Colorectal cancer [CRC] is the third most diagnosed but preventable cancer worldwide. The guidelines for CRC screening were first introduced formally in the 1990s, and over the past three decades, the screening rate slowly increased. As per the American Cancer Society [ACS], in the year 2020, about 69.7% of adults between 50 and 75 had colorectal cancer screening, with the lowest screening rate in adults between 50 and 64 years of age. The incidence of colorectal cancer is also rising in the younger population worldwide. According to recent American College of Gastroenterology guidelines, the starting age for screening is 45 years instead of 50. The rising incidence and low compliance with screening in the younger population make it hard to improve CRC-related mortality. As per ACS, there is almost 30% of the eligible unscreened population in 2020, so we believe there is a need for effective screening programs worldwide. We understand that there are modifiable and non-modifiable factors for non-compliance. Some of them are lack of awareness, fear about screening, their previous experience with screenings, and overprescription of Colonoscopies in open or direct access systems. Overprescription of Colonoscopies in open or direct access systems [OAC] can lead to longer wait times due to fewer appointments for people who need them. Implementing patient navigation or tracking systems with reminders can help recruit people for cancer screening, overcome the barriers to accessing clinical services, and provide appropriate counseling. Executing clinical care pathways can help reduce the risks of overprescription. Monitoring practice progress by establishing a baseline screening rate and a future goal is also essential. Developing quality improvement projects around these goals can help discover system deficits and ideas to overcome them. The primary purpose of this review, even though it is not new, is to increase awareness among physicians regarding the rising incidence of CRC in the younger population and the need to increase screening rates. We also believe there is a need for more effective CRC screening tests that are easy to administer, with minimal discomfort to the participant.
Journal of Cardiac Failure
Journal of the Endocrine Society
Background In ambulatory settings, primary hyperparathyroidism is the most prevalent cause of hyp... more Background In ambulatory settings, primary hyperparathyroidism is the most prevalent cause of hypercalcemia. Approximately 85% of primary hyperparathyroidism cases are caused by a solitary parathyroid adenoma; other causes include diffuse parathyroid hyperplasia, multiple parathyroid adenomas, and parathyroid cancer. Chief cell adenomas are the most prevalent; adenomas can also consist of oxyphil cell adenomas, lipoadenomas, or mixed cell adenomas. Water clear cell adenoma (WCCA) is a rare tumor formed of large clear cells with foamy pink cytoplasm. Fewer than 30 cases have been recorded in the literature. Case A 52-year-old male with polyuria and polydipsia, diagnosed with hypercalcemia was referred to an endocrinologist. His calcium was 10.9 mg/dl, corresponding parathyroid hormone (PTH) 74 pg/ml, 24-hour urine calcium 818 mg/24hr, vitamin D 25–hydroxy 24.2 ng/ml. He was referred to an endocrine surgeon. A 4-dimensional CT scan revealed soft tissue masses posterior to the thyroid ...
Cureus
Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening syndrome involving excessive immun... more Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening syndrome involving excessive immune activation. It can be primary (familial) or secondary (triggered by infection, malignancy, or rheumatological disease). This is a case of a previously healthy 43-year-old African American woman who presented with fever and confusion. The patient was eventually diagnosed with pulmonary aspergillosis and responded well to antifungal therapy. She met the diagnostic criteria of HLH-2004 trial for hemophagocytic lymphohistiocytosis. She also fulfilled the 2019 classification criteria for systemic lupus erythematosus (SLE) without the classical signs and symptoms of SLE. HLH management includes supportive management, treatment of underlying condition, and immunosuppressive treatment. Etoposide and dexamethasone are commonly used treatments for HLH; however, underlying active infection can limit the treatment options. In our case, the patient was treated with steroids and hydroxychloroquine. Her condition gradually improved and she recovered without complications. Based on our literature review, we encountered six cases of HLH secondary to Aspergillosis with a mean age of approximately 47 years. The diagnosis of HLH is often delayed because of nonspecific presentation. Early identification and treatment are crucial to improve the survival rate.
Journal of Clinical Oncology
360 Background: Aromatase inhibitors (AI) are an essential treatment for postmenopausal women wit... more 360 Background: Aromatase inhibitors (AI) are an essential treatment for postmenopausal women with hormone receptor-positive breast cancer in the adjuvant setting. Estrogen deficiency caused by AIs has adverse effects on bone health. Studies reveal that 5 years of treatment with anastrozole led to 6.1% of bone loss at the lumbar spine and 7.2% at the hip. The aim of the project is to identify the current degree of attention to bone health and skeletal-related complications in women with early-stage breast cancer stages I-III that are on AIs at a community cancer center at Einstein Medical Center Montgomery. Methods: This is a retrospective chart review of 63 patients ages 50-85 diagnosed with early-stage I-III breast cancer on an AI in the adjuvant setting. Patients who started on an AI between January 2013 through December 2017 were included. Data on Dual-energy X-ray absorptiometry scans (DEXA) and treatment at baseline, 2-years, and 4-years were analyzed. We followed to see if th...
Cureus
Hypophosphatemic rickets can cause a variety of bone and joint symptoms, one of its rare presenta... more Hypophosphatemic rickets can cause a variety of bone and joint symptoms, one of its rare presentations is sacroiliac joint involvement, which may be mistaken for inflammatory spondylitis. Here, we report the case of a 31-year-old African American woman who presented with a two-year history of lower back pain and morning stiffness, initially suspected to be due to inflammatory spondyloarthritis. Laboratory tests revealed negative inflammatory markers, normal serum calcium, vitamin D3, and parathyroid hormone levels; however, the alkaline phosphatase levels were elevated and serum phosphorus level was low. Magnetic resonance imaging (MRI) of the lumbosacral spine revealed mild widening of the sacroiliac joint with periarticular sclerosis with no signs of osteitis or bone marrow edema. Her condition was attributed to a known diagnosis of X-linked hypophosphatemic rickets affecting her sacroiliac joints. Her symptoms gradually improved after conservative treatment with physical therapy, nonsteroidal antiinflammatory drugs, phosphate, and vitamin D supplementations. Based on our literature review, we have come across only five rickets cases with similar presentations. Two patients had previously undiagnosed hypophosphatemic rickets at 15 and 35 years of age. One case was related to vitamin D-deficient rickets, and the final two cases were adult-onset vitamin D-resistant rickets misdiagnosed as ankylosing spondylitis. Radiological signs of sacroiliac joint involvement in these cases include narrowing of the sacroiliac joints, fusion of the sacroiliac joints, subchondral hypointense signal changes, and chondral surface irregularities. Vitamin D supplementation has significantly reduced the incidence of rickets; however, there are still cases of familial rickets that can present with a variety of symptoms, including signs and symptoms consistent with inflammatory spondylitis, which can be easily misdiagnosed or mistreated if this presentation is not recognized.
Journal of the American College of Cardiology, 2022
Cureus, 2022
Corticosteroid therapy is a known risk factor for osteonecrosis, more commonly with chronic use a... more Corticosteroid therapy is a known risk factor for osteonecrosis, more commonly with chronic use and high cumulative dose. Osteonecrosis (avascular necrosis) has been described in pregnancy involving primarily the femoral head. To our knowledge, only rare cases of femoral meta diaphysis or knee osteonecrosis in pregnancy have been documented in the literature. We report a 28-year-old woman with sickle cell trait and beta-thalassemia trait who developed severe bilateral knee pain shortly after corticosteroid therapy. She was 34-weeks pregnant when she presented with the signs of preterm labor and was found to have oligohydramnios and preeclampsia. She was given two intramuscular injections of betamethasone 12 mg one day apart to enhance the fetal lung maturity. Within hours of the second injection, she developed acute and severe bilateral knee pain affecting her mobility and ambulation. Bilateral knee x-rays were unremarkable. Given the severity and persistence of her pain, magnetic resonance imaging (MRI) of bilateral lower extremities was done few days later and showed signs of early osteonecrosis involving bilateral distal femoral meta diaphysis and right lateral femoral condyle. Other than the steroid therapy she had received, no additional extrinsic risk factors for osteonecrosis were identified. Potential intrinsic risk factors were thought to include her combined sickle-beta-thalassemia traits and pregnancy. She was diagnosed with steroid-induced osteonecrosis, given the temporal relationship. Her presentation was unique, because osteonecrosis affected unreported sites during pregnancy, and it started shortly after a brief course of antenatal steroid. She was treated conservatively with analgesics, and outpatient orthopedic follow-up was recommended. She was advised to avoid prolonged weight-bearing and strenuous activities. On a follow-up appointment two months later, she was still complaining of bilateral knee pain with ambulation though it was less severe. She did not return for follow-up thereafter. We suggest the possibility of osteonecrosis in pregnancy involving uncommon sites, such as distal femur and femoral condyle in this case, following one or two doses of systemic steroid. Obstetricians need to consider osteonecrosis when evaluating an unexplained musculoskeletal pain after betamethasone that is used for preterm labors. More studies, including reporting more cases with unusual presentation and prospective studies following pregnant patients receiving steroid therapy, are needed to better understand the causes, associations, management, and clinical course of osteonecrosis in pregnancy.
International Journal of Health Sciences (IJHS), Sep 3, 2022
Microfacies analysis of the Cretaceous Mishrif Formation was studied in Nasiriyah oil field in Na... more Microfacies analysis of the Cretaceous Mishrif Formation was studied in Nasiriyah oil field in Nasiriyah Governorate, southern of Iraq using integrated borehole data set that included, core samples and well logs in newly drilled well to analyze the microfacies and the Diagenesis Process of the formation, 100 thin sections for selected well. The results show that the formation composed of: (top to base) a fine-grained, limonitic fresh water limestone containing Charophytae. Four facies' associations were distinguished in the Mishrif Formation. These include:-These include:-Restricted shallow Open Marin environment is represented by Wackstone and Mudstone to Wackstone. The shallow open marine environment is represented by bioclastic wackestone and packestone, as well as rudistid floastone in rare situations. Shoal Environmentis represented by bioclastic packstone to grainstone, as well as rudstone. Deep Marine environment is represented by mudstone to packstone. six diagenetic processes affected on Mishrif Formation: