IntroductionStroke has become one of the most severe causes of long-term neurological impairment and disability and is considered one of the leading causes of mortality worldwide. This study aimed to determine time delays in stroke patients from symptoms onset to treatment with tissue plasminogen activator (tPA) initiation in King
WHIM (Warts, Hypogammaglobulinemia, Infections, and Myelokathexis) syndrome is a rare primary immunodeficiency disorder characterized by susceptibility to human papillomavirus (HPV) infections, neutropenia, and hypogammaglobulinemia. WHIM syndrome is caused by a gain-of-function mutation CXCR4, leading to increased responsiveness of neutrophils and lymphocytes to CXCL12. This results in an accumulation of atypical hypersegmented mature neutrophils in the bone marrow and peripheral blood neutropenia. This case report discusses a 10-year-old girl who was diagnosed with WHIM syndrome at the age of four years following Haemophilus influenzae meningitis. She was found to have Tetralogy of Fallot at birth, which was surgically repaired when she was one year old. She was also found to have significant neutropenia during surgery and received multiple doses of G-CSF with a good response. She presented to the hospital at the age of four years with fever, neck stiffness, lethargy, and headache and was diagnosed with H. influenzae meningitis. Her immunology workup revealed significant neutropenia and hypogammaglobulinemia, as well as low antibody levels to H. influenza type B, tetanus toxoid, and Streptococcus pneumonia, despite up-to-date vaccination. Furthermore, decreased levels of T cells and B cells were detected. The patient was started on IgG replacement therapy and Bactrim prophylaxis. Bone marrow biopsy revealed granulocytic hyperplasia and occasional hypersegmented neutrophils, suggesting myelokathexis. Genetic testing revealed a heterozygous CXCR4 mutation with a premature stop codon (p.Ser338Ter), confirming the diagnosis of WHIM syndrome. This case report highlights the association of WHIM syndrome with congenital heart defects, such as Tetralogy of Fallot. A literature review revealed three other cases of congenital heart defects in patients with WHIM syndrome, indicating a potential role for CXCR4 and CXCL12 in septum formation. The rarity of the disorder and the lack of a universal screening tool makes the diagnosis of WHIM syndrome difficult. Therefore, physicians should consider WHIM syndrome in patients with congenital heart defects, particularly if they have recurrent HPV infections, neutropenia, and hypogammaglobulinemia.
Aim: Public awareness of type 2 diabetes is a requirement for individuals and communities to help prevent the disease. Therefore, this study aimed to assess the level of knowledge and awareness of type 2 diabetes among diabetic and non-diabetic persons in Jeddah region, Kingdom of Saudi Arabia (KSA). Materials and Methods: A structured questionnaire was established and a total of 325 respondents (male = 180 and female = 145) have joined this study and descriptive analysis was used to evaluate the knowledge and attitude of the respondents. Results: There was 44.0% of respondents who did not know the difference between diabetes type 1 and 2. The level of awareness about type 2 diabetes in Saudi Arabia ranged between good and very good with 37.8% and 28.9% respectively. More than 50% of respondents did know the important combination of drugs, diet, and physical activity in type 2 diabetes treatment. The respondents have below-average knowledge regarding risk factors, symptoms, and prevention of type 2 diabetes. Furthermore, the respondents (39.4%) have the misconception that diabetes can be cured. However, they were awarded that modification of lifestyles could control type 2 diabetes. Conclusion: Diabetes education should be taken into consideration to increase awareness regarding the risk factors of type 2 diabetes in Saudi Arabia.
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