Classical Arabic (CA) poses several challenges in Natural Language Processing (NLP). The pre-trained transformers-based models that pertain to Arabic have been performing very well in downstream tasks. This year's Quran QA 2023 have presented with two shared tasks, which are: Passage Retrieval (PR) Task and Machine Reading Comprehension (MRC) Task. We used Arabic pre-trained models for our proposed systems and we found that they perform very well with their respective tasks. 


LKAU23 at Qur’an QA 2023: Using Transformer Models for Retrieving Passages and Finding Answers to Questions from the Qur’an

**Scoring is only possible in the semifinals hall**

**Abstract:**



Aching Adipose: Shedding Light on Dercum’s Disease

Introduction 
Accurate diagnosis and interpretation of signs and symptoms are crucial for effective patient management. However, there are instances when medical findings can be deceiving, indicating a particular condition or outcome when the situation is more complex or unexpected. 

This distinctive case illustrates such an example of a deceptive, almost benign finding which led to a more portentous diagnosis. Such instances remind us of the ever-evolving nature of medicine and the importance of maintaining a critical mindset when interpreting clinical data. 

Case Presentation 
A 31-year-old, apparently healthy male visited his doctor with concerns about a seemingly innocent rash on his shoulder that had been present for a year. What started as a small, 1x2 cm rash had recently become an elevated 5x7 cm rash and had also started appearing in multiple other parts of his body, like his groin, back, postauricular, scalp, and axillary regions. 

Due to the lesion's persistence, a biopsy was conducted revealing Kaposi Sarcoma (KS). Further evaluation led to the diagnosis of full-blown HIV AIDs with a CD4 count of 12. After ruling out opportunistic infections, he was started on Highly Active Antiretroviral Therapy (HAART) and chemoprophylaxis for Mycobacterium Avium Complex and Toxoplasmosis. 

However, the patient developed odynophagia, oral thrush, cough, and shortness of breath despite being on prophylaxis and was therefore admitted with esophageal candidiasis and Pneumocystis carinii pneumonia, for which he underwent a prolonged course of therapy. 

Discussion 
KS, a multicentric angioproliferative neoplasm, with its distinctive skin lesion gained public attention as an AIDS defining malignancy. Although common during the height of the AIDS epidemic, with the advent of effective HAART therapy, KS has become an uncommon differential. 

A metanalysis of studies between 1967 to 2013 revealed that KS was highest in people affected by HIV (481.54 per 100 000 person-years). 

Studies also report an annual decrease of 3.6% in KS incidence after the introduction of HAART world-wide. 

At the time of presentation, our patient had extensive diffuse KS which served as the tip of the iceberg, which led to his diagnosis and prompt initiation of HAART. 

In conclusion, the significance of possessing a broad clinical knowledge base and exercising the highest level of suspicion cannot be overstated. By embracing a comprehensive approach to patient care and maintaining a healthy skepticism towards clinical presentations, practitioners can enhance diagnostic accuracy, optimize treatment outcomes, and ultimately improve patient safety and well-being. As we navigate the challenges of modern medicine, fostering a culture of continuous learning, critical thinking, and unwavering suspicion will undoubtedly contribute to the advancement of healthcare and the provision of exemplary patient care.

From Innocence to Diagnosis - The Hidden Impact of a Disregarded Rash​

Lymphomatoid papulosis (LyP) is a chronic cutaneous CD30-positive lymphoproliferative disorder that is characterized by red-to-violaceous crops of papulonodular skin lesions. Although LyP carries a positive prognosis, there is consensus that LyP is associated with a history of or subsequent development of lymphoma. Herein, we present a case of LyP in a patient with a history of cutaneous B-cell lymphoma. The patient is a 67-year-old male with a history of treated cutaneous B-cell lymphoma two years prior to presentation, currently in remission, presenting with a two week history of painful hemorrhagic papules on his hands. Biopsy revealed a dense lymphomatoid infiltrate with admixed histiocytes and dermal hemorrhage. Tumor cells expressed CD3 and CD4, with marked loss of CD7. Small clusters of CD30+ cells were noted. There was no significant expression of CD20, CD56, or myeloperoxidase. At subsequent follow up, his original lesions were healing, but he had developed a new crop of lesions on the foot and both hands. Given the patient’s clinical course and histopathologic findings, a diagnosis of LyP subtype C was favored. The patient’s presentation was notable due to antecedent history of cutaneous B cell lymphoma, in addition to confinement to acral sites.

Lymphomatoid Papulosis Type C in Patient with History of Cutaneous B-Cell Lymphoma

Background
Most of the available COVID-19 outcome data in Solid Organ Transplant (SOT) recipients does not suggest a higher mortality rate in the SOT population. Though theoretically immunosuppressive medications might be associated with worse outcome, its immunomodulatory effect might be beneficial.

Methods
We retrospectively analyzed the effect of dose-reduction of mycophenolate, tacrolimus, and prednisone on the severity of COVID-19 in SOT recipients diagnosed with COVID-19 at the Center for Transplantation of the University of Kansas Medical Center between January 1, 2020 and December 31, 2022. Severe COVID-19 was defined as development of hypoxia while the patient is on room air during a 21-day period following COVID-19 diagnosis. To evaluate the effect of dose changes after the diagnosis of COVID-19 on the odds of severe COVID-19, we subset our data based on whether patients were taking mycophenolate (n = 449), tacrolimus (n = 537) or prednisone (n = 386) at the time of diagnosis. Within each subgroup, we fit a logistic regression model with severe COVID-19 as the response variable and adjusted for the relevant immunosuppressant and a set of covariates.

Results
In our SOT population, 570 patients were diagnosed with COVID-19 (458 kidney, 73 liver, 54 heart, 43 pancreas, and 8 lung recipients). The median patient age was 54 years, 59% were male, and 70% were white. After adjusting for other covariates, a mycophenolate dose-reduction of < 50% was associated with an odds ratio of 1.89 (95% CI: 0.96-3.70; p=0.06) for developing severe COVID-19. Similarly, decreasing the dose of mycophenolate by  50% was associated with an odds ratio of 2.44 (95% CI: 1.02-5.85, p=0.05) for developing severe disease. Tacrolimus dose reduction did not increase the risk of severe COVID-19. An increase or a decrease of prednisone dose was not associated with severe COVID-19. 

Conclusion
The reduction of mycophenolate dose when a SOT patient is diagnosed with COVID-19 should be discouraged, especially if the patient has mild disease. 


Reducing the dose of Mycophenolate in Solid Organ Transplant Recipients Diagnosed with SARS-CoV-2 Infection Increases the Risk of Severe COVID-19

Background: Acinetobacter baumannii is one of the world’s most multi-drug resistant (MDR) pathogens. Traditionally responsible for causing nosocomial pneumonia, bacteremia, and soft tissue infections in critically ill and immunocompromised patients, A. baumannii has evolved to propagate a growing number of atypical infections, including fatal cases of necrotizing fasciitis (NF; i.e., flesh-eating disease), over the past decade. Concerningly, these NF A. baumannii (NFAb) isolates display enhanced virulence and antibiotic resistance uncharacteristic of type strains, resulting in limited efficacy of current therapeutics. As such, understanding of mechanisms by which these strains evade host defenses, environmental stress, and previously effective antibiotics is imperative, yet remains scant. Our lab has obtained two MDR NFAb isolates from a case of NF that led to sepsis and death over 36-hours. The present study sought to elucidate resistance mechanisms of these isolates for the identification of new drug targets to treat MDR A. baumannii infections.

Methods: To determine if NFAb resistance and propagation of infection involves the mechanism of host immune cell entry, NFAb isolates (i.e., NFAb-1 collected pre-mortem from blood and NFAb-2 collected post-mortem from tissue) were co-incubated with human-derived THP-1 macrophages with or without pre-treatment with Cytochalasin D, an inhibitor of phagocytosis. A colistin-protection assay was performed to isolate viable intracellular bacteria, which were quantified by colony forming units (CFUs) after 24 hours. To assess resistance to desiccation, dried NFAb isolates and type strains were resuspended, and surviving cells were quantified by CFUs at 1, 5, and 7 day intervals. Lastly, transformation efficiency was assessed using selective media and fluorescence via flow cytometry, then reported as transformant CFU:total CFU.

Results: Similar to type strains, NFAb isolates were found to primarily enter macrophages via macrophage-mediated phagocytosis; however, both NFAb isolates displayed greater intracellular entry and survival in the host immune cells than type strains. Interestingly, NFAb-1 demonstrated greater resistance to desiccation than NFAb-2 over the course of 7 days. Although previous studies highlighted genomic differences between NFAb-1 and NFAb-2, no differences were observed in transformation efficiency between NFAb isolates and type strains.

Conclusion: Collectively, these results suggest NFAb isolates utilize a variety of resistance strategies to survive, and possess a profound ability to rapidly adapt, even within the context of a single infection. Moving forward, we aim to identify the genes propagating the intracellular survival and infection demonstrated by these isolates to serve as potential targets for novel therapeutics.

Utilizing Atypical Isolates of Acinetobacter baumannii to Uncover Novel Mechanisms of Resistance

Dermatofibromas are benign cutaneous soft-tissue tumors characterized by solitary or multiple, firm red-brown to black dermal nodules found on the trunk or extremities. Dermatofibromas most frequently affect middle-aged adults and have a slight preponderance in females. Variants of dermatofibroma include hemosiderotic, aneurysmal, epithelioid and deep fibrous histiocytomas, cellular, lipidized, lichenoid, keloidal, atrophic, and atypical. 

Diagnosis of the classical type of dermatofibroma is made clinically and based on dermoscopic patterns; however, the clinical and histologic heterogeneity observed in dermatofibroma variants can pose a diagnostic challenge and may be difficult to distinguish from potentially aggressive malignancies. Notably, hemosiderotic dermatofibroma has been reported to clinically simulate melanoma, while atypical dermatofibroma, is often mistaken histologically for sarcoma. 

Herein, we report a unique presentation of a patient with a recurrent atypical melanocytic nevus and multiple benign dermatofibromas masquerading as potentially malignant counterparts.

Dermatological Deception: Massive Dermatofibroma and Atypical Melanocytic Nevus Mimicking Malignancy

Background
Drug-induced hypersensitivity syndrome (DIHS) is a severe, potentially life-threatening drug reaction with cutaneous and internal organ involvement. DIHS can lead to various autoimmune conditions, occurring in about 10% of patients, including thyroiditis. This case highlights the need for post-DIHS thyroiditis screening.

Case Presentation
A 32-year-old woman presented to the emergency department with fever, morbilliform eruption, facial swelling, lymphadenopathy, and laboratory studies notable for atypical lymphocytes (4%), eosinophilia (1400), and aminotransferase abnormalities (AST 61, ALT 265). Two weeks prior, she initiated a course of oral trimethoprim-sulfamethoxazole. History, clinical exam, and laboratory findings were consistent with DIHS. She was treated with high-dose corticosteroids with a resolution of the eruption and stabilization of hepatic enzymes. At follow-up in an outpatient dermatology clinic four weeks after discharge, she was noted to have clinically painful thyromegaly, fever, tachycardia, and palpitations. She was referred to the ED to expedite workup for suspected symptomatic hyperthyroidism. Workup revealed TSH of 0.01 (L), FT4 >7.7 (H), TSI <0.10, TRAb negative, and TPO Ab 202 (H). Thyroid ultrasound showed enlarged thyroid with heterogenous echotexture. Endocrinology diagnosed her with thyroiditis and prescribed atenolol for symptom management. She continued to have heat intolerance, palpitations, and faint pink macules on her lower legs. She initiated low-dose methimazole with a resolution of symptoms.

Discussion

One of the most common drug classes to cause post-DIHS autoimmune thyroiditis are sulfa drugs and antiepileptics. The most commonly seen issues that arise in the thyroid post-DIHS are Hashimoto’s thyroiditis and Graves’ disease, which have been observed to occur between 2 months and 3 years after the diagnosis of DIHS. As seen in this case, the patient experienced debilitating symptoms of thyroiditis within 1 month, which could have been minimized with early screening and recognition. This case emphasizes the importance of dermatologic follow-up for patients diagnosed with DIHS and the role of post-DIHS screening for autoimmune thyroid disease, as missed diagnosis of delayed sequelae can lead to significant morbidity.

Importance of Post-Drug Induced Hypersensitivity Syndrome Thyroiditis Screening

Pott Puffy Tumor is a rare disorder commonly seen in adolescent populations and typically arises as a complication of severe sinusitis, leading to osteomyelitis of the frontal bone and presenting as swelling of the forehead. Herein, we report a case of a 46-year-old male with no significant known medical history presenting with seven months of headache. This case highlights the importance of considering Pott Puffy Tumor as a differential diagnosis in adult patients presenting with chronic headache and frontal swelling.

Pott Puffy Tumor in Newly Diagnosed Human Immunodeficiency Virus

Background
Malaria in the United States is a rare disease with a reported number of cases typically 2,000 each year. In 2022, the State of Ohio had 32 malaria cases: 10 females and 22 males. This mosquito born illness poses a major threat to American travelers, military personnel, and US citizens living abroad in endemic areas. In returning travelers from high-risk countries, Malaria is the most common cause of febrile illness. Plasmodium ovale can remain dormant in the liver and presentation will be delayed. Chronic infection and relapsing disease will persist if the infection is not treated in the initial stages. Relapse episodes may occur months or years later. 

Case Presentation
We present a case of a 39-year-old male with a past medical history of chronic pancreatitis, depression, type 2 diabetes mellitus, gastroesophageal reflux disease, recent Epstein- Barr virus infection, who presents with fever, nausea, and vomiting beginning 10 days prior to admission. The patient has an extensive travel history abroad and returned from Angola six months ago. Prior to admission, he underwent treatment at a different hospital for sepsis, encephalopathy, fever, Epstein-Barr virus and babesia. His condition worsened and he left against medical advice and opted to seek treatment at our facility. With concern for malaria, immediate testing included: Giemsa-stained peripheral blood smear and malaria polymerase chain reaction. His anti-malarial treatment regimen included artemether-lumefantrine tablets for 3 days. Plasmodium species PCR was positive for Plasmodium ovale. The patient responded well to therapy, and continued follow-up at the infectious disease clinic. Likely, the progression and severity of his malaria infection progressively worsened due to delays in treatment and testing. Given his travel history, a concern for malaria should have been on the differential diagnosis at his previous hospital admission.

Discussion
Plasmodium ovale and Plasmodium vivax infection can remain dormant for months and will cause relapses despite anti-malarial prophylaxis treatment. An immunocompromised patient with infection can trigger nonspecific host defense mechanisms. The patient’s symptoms were initially attributed to Epstein-Barr virus infection; unfortunately, there was a missed malaria diagnosis. New research suggests climate change is increasing the mosquito population worldwide and likely causing higher malaria cases. Anti-malarial prophylaxis should be initiated and completed in patients traveling to endemic regions. Returning travelers with flu-like symptoms should be evaluated for malaria as soon as possible.


A Case of Plasmodium Ovale Malaria Presentation

Background
Schistosomiasis, also known as Bilharzia, is a disease caused by schistosomes, a type of trematode or fluke parasite. Transmission occurs through contact with parasite-infested water. There are three major schistosome species that cause severe infection in humans, each with a preference for a specific organ system. The disease is predominantly found in rural areas with inadequate sanitation of freshwater sources and is endemic in Africa, Asia, and South America. Infected individuals excrete schistosome eggs, which hatch and infect freshwater snails, serving as intermediate hosts. The cercariae that develop within the snails can penetrate human skin and enter the bloodstream. Adult schistosomes migrate to various organ systems via the venous system, most commonly affecting the gastrointestinal and genitourinary tracts. Clinical manifestations and chronic inflammation are associated with the presence of schistosome eggs. Schistosomiasis can involve multiple organ systems, with symptoms varying depending on the affected system. Genitourinary schistosomiasis can lead to hematuria, dysuria, and pelvic pain. Diagnosis involves antigen detection, imaging, and tissue sampling. Chronic infection can result in bladder fibrosis and calcification, as well as an increased risk of bladder cancer, particularly squamous cell carcinoma. Early detection and treatment with Praziquantel are crucial in reducing the risk of cancer development.

Case Presentation
A 26-year-old man with a history of intermittent gross hematuria presented to his primary care physician. Previous evaluation at a local hospital revealed a possible clot or mass in the bladder, but further investigation was not pursued. The recent presentation showed gross hematuria with small clots, and urinalysis confirmed the presence of red blood cells. Urine culture, cytology, and STI panel were negative. CT Urogram with contrast revealed plaque-like and nodular wall thickening of the bladder. Cystoscopy showed diffuse white-yellow deposits, and pathology confirmed the diagnosis of schistosomiasis. CT of the abdomen and pelvis was valuable in assessing the extent of involvement. The patient was referred to infectious disease for treatment.

Discussion
As global travel increases, physicians are more likely to encounter uncommon conditions such as schistosomiasis, which may not be endemic to their population or location. Awareness, early detection, and immediate treatment are crucial to prevent long-term complications and improve patient outcomes. This case emphasizes the importance of staying informed about rare conditions and utilizing imaging techniques to provide timely and appropriate care to patients.

Underline digital video library

LKAU23 at Qur’an QA 2023: Using Transformer Models for Retrieving Passages and Finding Answers to Questions from the Qur’an

Aching Adipose: Shedding Light on Dercum’s Disease

From Innocence to Diagnosis - The Hidden Impact of a Disregarded Rash

Lymphomatoid Papulosis Type C in Patient with History of Cutaneous B-Cell Lymphoma

Reducing the dose of Mycophenolate in Solid Organ Transplant Recipients Diagnosed with SARS-CoV-2 Infection Increases the Risk of Severe COVID-19

Utilizing Atypical Isolates of Acinetobacter baumannii to Uncover Novel Mechanisms of Resistance

Dermatological Deception: Massive Dermatofibroma and Atypical Melanocytic Nevus Mimicking Malignancy

Importance of Post-Drug Induced Hypersensitivity Syndrome Thyroiditis Screening

Pott Puffy Tumor in Newly Diagnosed Human Immunodeficiency Virus

A Case of Plasmodium Ovale Malaria Presentation

A Case Report on Chronic Schistosomiasis

Risk of Lupus Death According to Rural Urban Residence

Stay up to date with the latest Underline news!

PRESENTATIONS

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Underline digital video library

LKAU23 at Qur’an QA 2023: Using Transformer Models for Retrieving Passages and Finding Answers to Questions from the Qur’an

Aching Adipose: Shedding Light on Dercum’s Disease

From Innocence to Diagnosis - The Hidden Impact of a Disregarded Rash​

Lymphomatoid Papulosis Type C in Patient with History of Cutaneous B-Cell Lymphoma

Reducing the dose of Mycophenolate in Solid Organ Transplant Recipients Diagnosed with SARS-CoV-2 Infection Increases the Risk of Severe COVID-19

Utilizing Atypical Isolates of Acinetobacter baumannii to Uncover Novel Mechanisms of Resistance

Dermatological Deception: Massive Dermatofibroma and Atypical Melanocytic Nevus Mimicking Malignancy

Importance of Post-Drug Induced Hypersensitivity Syndrome Thyroiditis Screening

Pott Puffy Tumor in Newly Diagnosed Human Immunodeficiency Virus

A Case of Plasmodium Ovale Malaria Presentation

A Case Report on Chronic Schistosomiasis

Risk of Lupus Death According to Rural Urban Residence

Stay up to date with the latest Underline news!

PRESENTATIONS

CONFERENCES

COMPANY

RESOURCES

From Innocence to Diagnosis - The Hidden Impact of a Disregarded Rash