The serum-ascites albumin gradient (SAAG) is a proven diagnostic tool for categorizing ascitic fluid, especially portal hypertension. Cases of low SAAG in the setting of portal hypertension are extremely rare. We present a case of a 60-year-old male with heart failure and liver cirrhosis who had a recurrently low SAAG despite having portal hypertension. Comprehensive workup for ascites should be performed when encountering ascites of unclear origin. Additionally, clinicians should consider other clinical clues beyond the SAAG when the diagnosis is unclear to reach the most plausible diagnosis. JEL classification numbers: I10, Y5. Keywords: Ascites, Cirrhosis, Heart failure, Portal hypertension, Albumin.
The outbreak in Wuhan, China causes the coronavirus disease 2019 (COVID-19) which was named by World Health Organization (WHO). The infection is acquired through infected droplets by inhalation and/or contact. The incubation period varies from 2 to 14 days. The most common symptoms may include fever, sore throat, dry cough, shortness of breath, fatigue and malaise. During the outbreak, healthcare workers (HCWs) have the highest risk of getting infected as they are exposed to patients more often. This study is conducted to assess the impact of stress among HCWs, and to make a comparison of the different levels of stress experienced by HCWs during and before the outbreak. This study was conducted among HCWs in UAE who played a role during the outbreak and took a stance in treating COVID-19 patients. Keywords: COVID-19, Common symptoms, Healthcare providers.
Abstract High blood levels of vitamin B12 are often attributed to over-supplementation; however, elevated B12 levels can occur without supplementation, raising concerns about underlying serious conditions. This case report presents a 30-year-old female referred due to high serum cobalamin levels initially discovered during an evaluation for joint pain. Despite no vitamin B12 supplementation, her B12 levels rose from 2000 pg/mL to 7000 pg/mL over three months. Comprehensive testing, including liver and renal function tests, CBC, LDH, peripheral smear, thyroid function tests, homocysteine, methylmalonic acid levels, and imaging studies, revealed no abnormalities. Active holotranscobalamin was elevated, but there were no signs of malignancy or other serious conditions. The patient remained clinically stable throughout a six- month follow-up. This case highlights the importance of a structured approach in evaluating elevated serum cobalamin levels and considering macro-vitamin B12 in the differential diagnosis. Further research is needed to understand the clinical significance of macro-vitamin B12 and its impact on B12 level interpretation. Keywords: Macro-vitamin B12, Transcobalamins, Elevated serum cobalamin.
Abstract The goal of this study was to assess association between social demographic characteristic including Age and gender, patients past medical history, and outcome of Covid 19 admitted cases. Data was collected from the electronic data base of Thumbay hospital Ajman UAE. All registered cases of Covid19 from January 2020 to August 2021 were included in the research. The study identified that individuals above 40 years were more susceptible to Covid-19, with a higher prevalence in males than females. Diabetes mellitus emerged as the most common non-communicable disease among patients. The majority of cases were categorized as mild, followed by moderate, with a smaller proportion classified as severe. Notably, a significant percentage of cases showed improvement, while a minority experienced complication, and a small percentage resulted in mortality. Overall, this study provides valuable insights into the demographics and outcomes of Covid-19 patients in the specified healthcare setting. Capturing and understanding the information is important to state preventive measures that can help in reducing the number of cases in the country. Keywords: COVID-19 outcomes, Risk Factors.
Abstract Hairy cell leukemia (HCL) is a distinct subset of chronic lymphoid leukemia, presents with unique features, including the characteristic "hairy" projections seen in neoplastic B cells. We reported a case on hairy cell leukemia (HCL), emphasizing the challenges posed by this rare hematological malignancy, especially in the context of concurrent health crises such as the COVID-19 pandemic. This malignancy, though uncommon, necessitates comprehensive diagnostic methodologies, such as peripheral blood studies, flow cytometry, and bone marrow biopsy. Treatment strategies for HCL involve tailored approaches based on symptomatic presentations. Purine analogs, cladribine and pentostatin, stand as first-line interventions, showcasing efficacy in inducing and sustaining remission. However, the prolonged immunosuppression resulting from these treatments warrants vigilant monitoring for potential infectious complications. Emerging therapies, such as the BRAF inhibitor vemurafenib, provide additional options for refractory or progressive cases. The post-treatment phase demands meticulous follow-up, with an emphasis on regular blood work assessments by an oncology nurse and primary care physician. Our case further highlights the need for heightened awareness among healthcare professionals, particularly in the post-COVID-19 phase, where persistent symptoms led to the discovery of an underlying hematological disorder. Keywords: Hairy cell leukemia, Evan syndrome, Covid-19.
