Qatar Medical Journal - Volume 2006, Issue 2

A 68-year-old gentleman with a long history of type 2 diabetes mellitus and recurrent multidrug resistant urinary tract infection and a recent history of a carbuncle, presented with a one week history of fever and dysuria. Laboratory results included erythrocyte rouleaux formation, ESR 121 mm/h, creatinine 217umol/l, total protein 83 g/l, albumin 32g/l, and Bence-Jones protein in the urine. Skull X-ray showed multiple lytic lesions. Serum protein electrophoresis showed a monoclonal band of33g/ I of IgA kappa, IgG 665 mg/dl, and IgM 26.9 mg/dl. Bone marrow aspirate showed an infiltration of plasma cells. Renal biopsy showed a mild cast nephropathy with mild diabetic glomerular disease. The patient was assessed as stage IIIB multiple myeloma IgA kappa type and was started on chemotherapy MP protocol (oral Melphalan 5 mg/sq m body surface area plus oral prednisolone 60mg/sq m body surface area for four days every four weeks) after which he became stable.

Thyroid associated opthalmopathy (TAO) may precede, coincide, or follow the systemic complications of dysthyroidism it can present gradually as dry eyes, puffy eyelids, ocular pressure or pain, field loss, diplopia with 3rd, 4th, 6th nerve palsies we report a 22 year old Filipina female who presented with sudden onset of diplopia, pain, headache, with no sign or symptom of dysthyroidism and clinically sounds to have 3rd, 4th, and 6th, nerve palsies (left eye) the case represents diagnostic dilemma that's why found it worth to be reported

A 39-year old lady, admitted with a 15-day history of generalized fatigability, 7-day history of progressive shortness of breath associated with intermittent coughing up streaks of blood. Examination revealed a healthy looking female, she was pale, and mildly distressed. Chest examination showed bilateral lower crackles. CBC showed microcytic hypo chromic anemia with high erythrocyte sedimentation rate (ESR) 105 mm/hr. The initial chest X-ray showed bilateral lower infiltrates sparing the costophrenic angles. Although her initial serum creatinine was normal, she developed mild renal impairment during her hospital course. Renal biopsy was consistent with antiglomerular basement membrane antibody-mediated disease(Goodpasture syndrome). The hospital course was complicated by severe hypoxia, intensive care unit admission and intubation. The patient received the treatment of choice for Good pasture's syndrome i.e. plsmapharesis combined with prednisolone and cyclophsphamide,with excellent response. She was discharged home with a clear chest X-ray and a normal serum creatinine.

Aortic Valve Endocarditis Leading to Rupture of Sinus of Valsalva in the right-sided heart chambers is an unusual complication. Here we have presented a case where infective Endocarditis of Aortic Valve lead to Rupture of Sinus of Valsalva into the right atrium. Prolapsing vegetation also lead to a satellite lesion on tricuspid valve probably by direct implantation. Echocardiography with color flow mapping helped us to diagnose this case early and accurately so that timely surgery could save patient's life.

A 50 year old female with history of bronchogenic carcinoma completed her first cycle of chemotherapy, presents with 8 day history of diplopia when looking to the left. When asked to look at left, the right eye shows impaired adduction while the left abducting eye shows jerk nystagmus with the quick phase towards the opposite side.

This article presents a brief overview of digitalis toxicity, class of medication that is notoriously know for its toxicity, but which still has significant use in clinical practice. We hereby briefly outline on the use of digoxin specific Fab fragment in the treatment of digitalis toxicity

Carpal tunnel syndrome occurs when the median nerve, which runs from the forearm into the hand, becomes pressed or squeezed at the wrist. The median nerve controls sensations to the palm side of the thumb and fingers (although not the little finger), as well as impulses to some small muscles in the hand that allow the fingers and thumb to move. The carpal tunnel - a narrow, rigid passageway of ligament and bones at the base of the hand 3/4 houses the median nerve and tendons. Sometimes, thickening from irritated tendons or other swelling narrows the tunnel and causes the median nerve to be compressed. The result may be pain, weakness, or numbness in the hand and wrist, radiating up the arm. Although painful sensations may indicate other conditions, carpal tunnel syndrome is the most common and widely known of the entrapment neuropathies in which the body's peripheral nerves are compressed or traumatized.

Objectives: to estimate the prevalence and determinants of lower urinary tract symptoms (LUTS), in male expatriate workers in Qatar and to assess the impact of LUTS on the quality of life (Qol).

Context: A history of depression may increase risk for developing Alzheimer disease (AD) later in life. Clarifying this relation might improve understanding of risk factors for and disease mechanisms in AD.