Mohannad Natheef AbuHaweeleh

Objective: To evaluate the safety, efficacy and feasibility of ambulatory bilateral same‐session retrograde intrarenal surgery (BSS‐RIRS) compared to unilateral RIRS, under a standardized clinical protocol. Patients and Methods: We conducted a retrospective multicentre cohort study including 202 adult patients who underwent ambulatory bilateral same‐session RIRS (BSS‐RIRS) or unilateral RIRS between January 1 and December 31, 2024 . All included patients had complete perioperative data and postoperative non‐contrast CT imaging at 4–6 weeks. Of these, 95 underwent BSS‐RIRS and 107 underwent unilateral RIRS. Demographic, clinical and operative variables were analysed. Stone‐free status (defined as residual fragments ≤4 mm) and complication rates (within 30 days) were assessed. Multivariable logistic regression was used to adjust for potential confounders. Results: BSS‐RIRS patients had significantly longer operative times compared to the unilateral group (106.9 vs. 87.3 minutes, p < 0.001) and were more likely to be treated with thulium lasers (73.4% vs. 54.2%, p = 0.003). Preoperative stenting was notably less common in the BSS‐RIRS group (39% vs. 65.4%, p < 0.001). Despite these differences, early complication rates remained low and statistically similar between groups (2.1% vs. 3.7%, p = 0.49), with adjusted regression analysis showing a possible non‐inferior BSS‐RIRS early complication rate (OR 0.36, p = 0.209). Overall stone‐free rates were comparable (85.3% vs. 82.3%, p = 0.56). In regression analysis, bilateral RIRS showed increased odds of stone‐free status, but this was not statistically supported (adjusted OR 1.62, 95% CI 0.64–4.10, p = 0.309). Grade A stone‐free status (0 mm residual) was significantly lower in the bilateral group (72.8% vs. 93.2%, p < 0.001). Conclusion: Ambulatory BSS‐RIRS is a safe and effective approach for managing bilateral renal stones, offering comparable overall stone‐free rates and complication profiles to unilateral RIRS. Additionally, it provides procedural efficiency and potential cost‐effectiveness when applied in appropriately selected cases. Further studies are warranted to refine patient selection criteria and validate long‐term outcomes.

Background: Childhood asthma, obesity, and vitamin D deficiency are all highly prevalent in Qatar, and children with concurrent asthma and obesity experience greater disease severity and poorer treatment response than those with asthma alone. Although vitamin D deficiency has been linked to asthma, the combined effect of co-existing asthma and overweight/obesity on vitamin D status has not been characterized in this population, warranting further investigation. Methods: This cross-sectional observational study assessed serum 25-hydroxyvitamin D levels in children aged 6– 17 years, residing in Qatar. A total of 364 children were divided into four groups: children with normal weight and asthma (NW-A), children with overweight/obesity and asthma (OO-A), children with overweight/obesity and no asthma (OO), and children with normal weight and no asthma (NW). Between-group differences were assessed using chi-square, Dunn (Bonferroni-corrected), and Spearman correlation tests, and a multivariable logistic regression model adjusted for age, sex, BMI, and atopy was used to examine the association between asthma and vitamin D status. Results: Children in all the four groups demonstrated a high prevalence of vitamin D deficiency (< 50 nmol/L), regardless of asthma or BMI. Vitamin D deficiency was present in 81.1% of OO, 73.9% OO-A, 68.3% of NW, and 66.3% of NW-A, with no statistically significant difference across groups. Vitamin D levels were similar between NW-A and OO-A, but OO group had significantly lower levels. A negative correlation between BMI and vitamin D levels was observed in OO-A (ρ=– 0.279, p=0.008) and OO (ρ=– 0.266, p=0.009), but not in normal-weight children. Multivariable logistic regression showed no significant association between vitamin D levels and asthma status. Conclusion: Higher BMI was associated with lower serum vitamin D levels in overweight/obese children, independent of asthma status, whereas asthma was not independently associated with vitamin D deficiency. Given the cross-sectional design, these findings indicate associations rather than causal relationships. The high prevalence of vitamin D deficiency across all study groups highlights a substantial public-health concern and supports the value of routine screening, nutritional and lifestyle measures, and where indicated, vitamin D supplementation, in pediatric health management in Qatar, pending confirmation from longitudinal and interventional studies.

Paratesticular leiomyomas are rare benign mesenchymal tumors arising from smooth muscle of paratesticular tissues, including vascular walls, dartos muscle, and spermatic cord. Angioleiomyoma represents a vascular-rich subtype. They usually present as slow-growing, painless extratesticular masses in middle-aged men. Imaging helps localization but is not diagnostic while histopathology with immunohistochemistry confirms diagnosis. A 49-year-old motocross athlete presented with progressive scrotal enlargement causing discomfort. Examination showed a large encapsulated mass displacing normal testes. Computed tomography revealed a large heterogeneous paratesticular lesion with neoangiogenesis. The mass was excised and scrotoplasty was performed. Histology showed benign spindle cells, low Ki-67 (~3%), and positivity for desmin and CD34. This case emphasizes recognition and testis-sparing management of paratesticular leiomyoma, ensuring excellent outcomes without need for long-term surveillance.

Brucellosis is a zoonotic infection transmitted through contact with infected animals or consumption of unpasteurized dairy products and remains endemic in regions such as the Mediterranean, Middle East, Asia, and Africa. Its variable clinical manifestations often mimic other diseases, complicating diagnosis. We report a case of unilateral Brucella epididymo-orchitis in a middle-aged animal handler to highlight diagnostic and therapeutic challenges. A 32-year-old Indian man working with camels and goats presented with fever, body aches, fatigue, poor appetite, and a lip ulcer. Initial examination was unremarkable. Laboratory tests showed hypochromic microcytic anemia, leukocytosis, and positive Brucella serology. Scrotal ultrasonography demonstrated testicular enlargement with increased vascularity, while blood cultures grew Brucella canis. Although treatment adherence was initially poor due to medication side effects, clinical and laboratory parameters improved after completing antibiotics. The patient was discharged on doxycycline and cefuroxime with close follow-up.

Background: Tubulocystic renal cell carcinoma (TC-RCC) is a rare and distinct subtype of renal cell carcinoma with characteristic histopathological and immunohistochemical features. Due to its rarity, limited data exist regarding its clinicopathological profile, biological behavior, and prognosis. This review aims to analyze reported TC-RCC cases to improve understanding of tumor characteristics, outcomes, and key diagnostic markers. Methods: Scoping review of 30 published TC-RCC cases was conducted. Data collected included tumor laterality, site, size, focality, stage, associated malignancies, local extension, metastatic spread, lymph node involvement, vascular invasion, and immunohistochemical findings relevant to diagnosis and prognosis. Results: TC-RCC demonstrated a left-sided predominance (63.3%) and was most often unifocal. The upper renal pole was the most commonly involved site (36.7%). Tumor size ranged from 0.8 to 37 cm. Concurrent malignancies were identified in 26.7% of cases, most frequently papillary renal cell carcinoma. Extra-renal extension and distant metastases occurred in 16.7% of cases, while lymphovascular invasion was uncommon. Immunohistochemistry showed frequent positivity for AMACR (66.7%), CD10 (46.7%), and Vimentin (43.3%). Conclusion: TC-RCC exhibits variable clinical behavior and a notable association with concurrent malignancies. Immunohistochemical markers, particularly AMACR and CD10, are diagnostically valuable. Further studies are needed to establish prognostic markers and standardized management strategies.

Renal angiomyolipomas (AMLs) are rare benign kidney tumors. Epithelioid angiomyolipoma (EAML) is a distinct variant with unique histopathological features and recognized malignant potential. This study highlights the diagnostic features and pitfalls of EAML. A 41-year-old woman was referred after an incidental left renal mass was detected on ultrasound. She was asymptomatic, with unremarkable examination and laboratory results, though her family history included several malignancies. Magnetic resonance imaging revealed a 3.5-cm partly exophytic, posterior lower-pole renal mass without pelvicalyceal invasion. The patient underwent robotic-assisted left partial nephrectomy. Histopathology showed a tumor composed predominantly of epithelioid cells with reduced vascularity, thick-walled vessels, and adipose tissue. Immunohistochemistry demonstrated positivity for smooth muscle actin (SMA) and Human Melanoma Black-45 (HMB-45) and negativity for Paired box 8 (PAX-8), confirming EAML. EAML poses diagnostic and management challenges due to uncertain malignant potential and lack of guidelines. Surgical resection remains primary treatment, with long-term surveillance recommended.

Immunotherapy represents a paradigm shift in oncology, rooted in a century of evolving scientific understanding and clinical application. From the pioneering use of Coley’s toxins in the late nineteenth century to the introduction of cytokine-based interventions, the trajectory of immunotherapeutic approaches has paralleled advancements in immunology and molecular biology. This review comprehensively examines the historical development and progressive refinement of immunotherapy for cancer, charting the transition from non-specific immune stimulation to targeted immune modulation. Central to this discussion are the sophisticated mechanisms by which tumour cells evade immune detection and destruction. These include downregulation of antigen presentation machinery, secretion of immunosuppressive cytokines, recruitment of regulatory T cells and myeloid-derived suppressor cells, and exploitation of immune checkpoint pathways, particularly CTLA-4 and PD-1/PD-L1 axes. The advent of immune checkpoint inhibitors has yielded durable clinical responses in diverse malignancies, substantiating their role as foundational agents in cancer therapy. Nonetheless, both primary and acquired resistance to immune checkpoint inhibition remain significant clinical obstacles. Resistance mechanisms are multifactorial, involving tumour-intrinsic genetic alterations, modulation of the tumour microenvironment, and adaptive changes in immune cell phenotypes. Contemporary research endeavors are directed at overcoming these barriers, including the optimization of combinatorial regimens, development of next-generation checkpoint modulators, tumour-specific vaccines, and the integration of adoptive cell therapies. Future directions in cancer immunotherapy are poised to leverage advances in systems biology, genomics, and single-cell technologies to individualize interventions and enhance therapeutic efficacy. Ultimately, a comprehensive delineation of tumour-immune interactions will underpin the next generation of rational, effective, and durable cancer immunotherapies.

Introduction: Small cell carcinoma of the bladder (SCCB) is a rare aggressive cancer, representing less than 1% of bladder cancers. Similar to small cell lung cancer (SCLC), it progresses rapidly, metastasizes early, and has a poor prognosis, complicating treatment. Unlike more common bladder cancers, SCCB often resists localized treatments and responds better to chemotherapy. However, its management generally relies on protocols for SCLC due to limited specific research. Case Presentation: A 47‐year‐old male from Bangladesh presented with intermittent painless hematuria, weak urinary stream, and incomplete voiding for 2 months. His medical history includes diabetes mellitus, chronic kidney disease, hypothyroidism, adrenal adenoma, and coronary artery disease. His physical examination was unremarkable. His blood work up showed hypochromic microcytic anemia and elevated creatinine. Urine cytology revealed atypical degenerated urothelial cells, polymorphonuclear leukocytes, and red blood cells. He underwent flexible cystoscopy, which showed a nodular tumor with a wide base at the left lateral bladder wall measuring less than 3 cm. He had a CT scan, which revealed irregular thickening in the left posterolateral bladder wall, suggesting muscle‐invasive carcinoma extending into the perivesical fat. He had an MRI scan which confirmed a 4 x 4.5 − cm mass with extravesical involvement. Histopathology examination from his transurethral resection of bladder tumor specimens showed mixed carcinoma, comprising both classic invasive urothelial carcinoma (UC) and SCCB. The small cell component exhibited scant cytoplasm, high nuclear‐to‐cytoplasmic ratio, hyperchromatic nuclei, and numerous mitotic figures, with synaptophysin and weak chromogranin positivity; UC cells were GATA‐3 positive. Surgical resection removed most of the tumor. The patient tolerated the procedure well, with no complications. After four chemotherapy cycles, he had a follow‐up PET CT, which showed significant tumor regression. Conclusion: This case highlights the unusual early coexistence of SCCB with classic UC in the bladder, emphasizing the importance of comprehensive histopathological and immunohistochemical evaluation for accurate diagnosis and treatment planning. Further research on SCCB could improve diagnosis, treatment strategies, and identification of molecular targets, potentially enhancing survival rates and patient quality of life.