Exploring Transthyretin Amyloid Cardiomyopathy: A Comprehensive Review of the Disease and Upcoming Treatments

Transthyretin amyloid cardiomyopathy (ATTR-CM) is a mutation-based genetic disorder due to the accumulation of unstable transthyretin protein and presents with symptoms of congestive heart failure (CHF) and numerous extracardiac symptoms like carpal tunnel syndrome and neuropathy. Two subtypes of ATTR-CM are hereditary and wild-type, both of which have different risk factors, gender prevalence and major clinical symptoms. Timely usage of imaging modalities like echocardiography, cardiac magnetic imaging resonance, and cardiac scintigraphy has made it possible to suspect ATTR-CM in patients presenting with CHF. Management of ATTR-CM includes appropriate treatment for heart failure for symptomatic relief, prevention of arrhythmias and heart transplantation for nonresponders. With the recent approval of tafamidis in the successful management of ATTR-CM, numerous potential therapeutic points have been identified to stop or delay the progression of ATTR-CM. This article aims to provide a comprehensive review of ATTR-CM and insights into its novel therapeutics and upcoming treatments.

Neurofibromatosis to neoplasia transition: a rare case report of spindle cell malignant peripheral nerve sheath tumor with literature review

Introduction and importance

Malignant peripheral nerve sheath tumor (MPNST) is a rare and aggressive soft tissue malignant tumor. MPNST in the spinal canal is rarely seen except in cases of neurofibromatosis type 1. However, a long-segment extradural spinal malignant spindle cell neoplasm has not been reported in the current literature.

Case presentation

We present the first reported case of spinal malignant spindle cell neoplasm extended along the spine. The detected lesion is responsible for compressing various segments of the spinal cord, causing thinning of the cord and secondary stenosis of the spinal canal, leading to a condition known as multisegment compression myelopathy.

Clinical discussion

MPNSTs are typically detected late due to nonspecific symptoms, with a higher incidence in extremities and a notable occurrence in unusual locations. Diagnosis relies on MRI and histopathology, with S_100 positivity as a neural marker. MPNSTs can arise from neurofibromas or Schwann cells, with a significant portion resulting from TP53 mutations or secondary to radiation exposure.

Conclusion

This case stands out due to its unique presentation, characterized by a predominantly spindle cell morphology with certain epithelioid features. It is imperative to recognize this condition for an accurate diagnosis, emphasizing the spindle cell-type MPNST and highlighting its exceptionally poor prognosis.

Oral and topical spironolactone in acne treatment: A meta-analysis of effectiveness and safety

Acne vulgaris (AV) is a common chronic inflammatory skin disorder that commonly lasts from adolescence to adulthood and has serious social and psychological consequences. Current treatments typically use antibacterial drugs, which contributes to the rise in antibacterial drug resistance. Spironolactone, a potassium-sparing diuretic with anti-androgen effects, has been used off-label to treat acne by lowering sebum production. This systematic review and meta-analysis aims to assess the safety and efficacy of oral and topical spironolactone in acne treatment. Following PRISMA guidelines, a complete search of five databases yielded seven eligible studies (643 individuals) that compared spironolactone to placebo in randomized controlled trials. The total lesion count (TLC), comedones and papule counts, acne severity index (ASI), and adverse events (AEs) were all measured. RevMan was used for statistical analysis, and effect estimates were presented as mean differences (MD) and relative risk (RR), as appropriate. The study found that spironolactone significantly reduced ASI (MD =  - 6.53, 95% CI: [- 10.83 to - 2.22], p = 0.003) and had a satisfactory safety profile, particularly in terms of menstruation symptoms. There were no statistically significant variations in TLC, comedone, or papule counts between the 4, 8, and 12-week intervals. Adverse events, including menstrual abnormalities, were similar across groups. Spironolactone, both oral and topical, demonstrated promise in lowering acne severity, particularly in female patients. While larger, long-term trials are required to demonstrate its efficacy and safety, spironolactone is a beneficial option to antibacterial drug therapies for dermatological and cardiovascular issues.

Epidemiology, biosafety, and biosecurity of Avian Influenza: Insights from the East Mediterranean region

The World Organization for Animal Health defines Avian Influenza Virus as a highly infectious disease caused by diverse subtypes that continue to evolve rapidly, impacting poultry species, pet birds, wild birds, non-human mammals, and occasionally humans. The effects of Avian influenza viruses have been recognised as a precursor for serious health concerns among affected birds, poultry, and human populations in the Middle East. Furthermore, low and high pathogenic avian influenza viruses lead to respiratory illness with varying severity, depending on the virus subtype (e.g., H5, H7, H9, etc.). Possible future outbreaks and endemics of newly emerging subtypes are expected to occur, as many studies have reported the emergence of novel mutations and viral subtypes. However, proper surveillance programs and biosecurity applications should be developed, and countries with incapacitated defences against such outbreaks should be encouraged to undergo complete reinstation and reinforcement in their health and research sectors. Public education regarding biosafety and virus prevention is necessary to ensure minimal spread of avian influenza endemic.

Emergence of Artificial Intelligence and Machine Learning Models in Sudden Cardiac Arrest: A Comprehensive Review of Predictive Performance and Clinical Decision Support

Sudden cardiac death/sudden cardiac arrest (SCD/SCA) is an increasingly prevalent cause of mortality globally, particularly in individuals with preexisting cardiac conditions. The ambiguous premortem warnings and the restricted interventional window related to SCD account for the complexity of the condition. Current reports suggest SCD to be accountable for 20% of all deaths hence accurately predicting SCD risk is an imminent concern. Traditional approaches for predicting SCA, particularly "track-and-trigger" warning systems have demonstrated considerable inadequacies, including low sensitivity, false alarms, decreased diagnostic liability, reliance on clinician involvement, and human errors. Artificial intelligence (AI) and machine learning (ML) models have demonstrated near-perfect accuracy in predicting SCA risk, allowing clinicians to intervene timely. Given the constraints of current diagnostics, exploring the benefits of AI and ML models in enhancing outcomes for SCA/SCD is imperative. This review article aims to investigate the efficacy of AI and ML models in predicting and managing SCD, particularly targeting accuracy in prediction.