A young patient with Graves' disease presenting with a triad of heart failure, pancytopenia, and jaundice: A case report.

Key Clinical Message: Graves's disease must be treated promptly to avoid serious sequelae such as cardiomyopathy, liver injury, and pancytopenia. Early initiation of antithyroid medications and beta blockers could not be overrated even in the presence of these complications. Abstract: Graves' disease causes a large spectrum of clinical manifestations. Delayed diagnosis and management of Graves' disease could lead to serious systemic sequelae. We describe a case of a young man who presented with progressive cough, increased abdominal girth and ankle swelling for a few months. On examination, he had jaundice, bilateral exophthalmos, diffuse goiter, ascites, and significant lower limb edema. Laboratory investigations showed increased Thyroxin level with a suppressed thyroid stimulating hormone and positive anti-thyrotropin receptor antibodies. Also, the patient had pancytopenia, coagulopathy and cholestatic pattern of elevated liver enzymes. Echocardiography demonstrated mildly reduced left ventricular function with diastolic dysfunction, but electrocardiogram did not show atrial fibrillation. Despite the concerns about using antithyroid medications in patients with impaired liver function tests and pancytopenia, the patient improved dramatically without worsening of his hematological or biochemical parameters. Early initiation of antithyroid medications and beta blockers is essential for patients who are newly diagnosed with hyperthyroidism.

Seizures provoked by over-the-counter cough and cold medications in an elderly patient: a case report.

BACKGROUND: Seizures are common neurological emergencies in the elderly that are frequently provoked. Geriatrics have higher rates of neurological disorders and other comorbidities that could affect seizure threshold. CASE PRESENTATION: An 83-year-old male Arabic patient presented to the emergency department with an acute confusional state and urinary incontinence followed by a witnessed tonic-clonic seizure in the hospital. Thorough investigations and imaging were positive only for nonspecific magnetic resonant imaging findings with a negative electroencephalogram. The patient was diagnosed with provoked seizure due to over-the-counter cold medications that included pseudoephedrine and caffeine. He was not prescribed antiepileptic medications at discharge and did not develop subsequent seizures up to this date. CONCLUSION: Over-the-counter cough and cold medications with sympathomimetic ingredients can be associated with provoked seizures in the elderly. Physicians should be aware of the potentially serious adverse events associated with commonly used nonprescription sympathomimetics such as pseudoephedrine and caffeine in elderly patients.

Comparison of demographic, clinical and laboratory characteristics between first and second COVID-19 waves in a secondary care hospital in Qatar: a retrospective study.

OBJECTIVE: To compare the patient profile and outcomes in Qatar during the first and second waves of the COVID-19 pandemic. SETTING: A retrospective observational study was conducted comparing the demographic, clinical and laboratory characteristics of patients with COVID-19 infection admitted to a secondary care hospital, during the first and second waves of the pandemic. PARTICIPANTS: 1039 patients from the first wave and 991 from the second wave who had pneumonia on chest X-ray and had a confirmed SARS-CoV-2 infection by a real-time PCR test of a nasopharyngeal swab were included. Patients with a normal chest X-ray and those who had a negative PCR test despite a positive COVID-19 antigen test were excluded. OUTCOME: Length of stay, need for mechanical ventilation, final disposition and mortality were the key outcomes studied RESULTS: Influenza like symptoms (18.5% in the first wave vs 36.1% in the second wave, p 0.001), cough (79.2% vs 87%, p<0.001) and dyspnoea (27.5% vs 38% p<0.001) were more common in the second wave. Second wave patients had significantly higher respiratory rate, lower peripheral oxygen saturation, needed more supplemental oxygen and had higher incidence of pulmonary embolism. More patients received hydroxychloroquine and antibiotics during the first wave and more received steroids, antivirals and interleukin-1 antagonist during the second wave. The second wave had a shorter length of stay (14.58±7.75 vs 12.61±6.16, p<0.001) and more patients were discharged home (22% vs 10%, p<0.001). CONCLUSIONS: Patients who presented during the second wave of COVID-19 pandemic appeared to be more ill clinically and based on their laboratory parameters. They required shorter hospitalisation and were more likely to be discharged home. This could represent greater expertise in handling such patients that was acquired during the first wave as well as use of more appropriate and combination therapies during the second wave.

Thrombosis post-mRNA-based SARS-CoV-2 vaccination (BNT162b2) - Time to think beyond thrombosis with thrombocytopenia syndrome (TTS).

The COVID-19 pandemic has affected the global socioeconomic and healthcare infrastructure. Vaccines have been the cornerstone in limiting the global spread of the pandemic. However, the mass scale vaccination has resulted in some unanticipated adverse events. Arguably the most serious of these has been the development of widespread thrombosis with viral-vectored vaccines. We present a case of extensive thrombosis associated with the messenger RNA (m-RNA) vaccine.

Transient spontaneous chylothorax presented with neck pain and swelling in a patient with latent TB: Case report.

The aim of this case report is to raise awareness about self-limited spontaneous chylothorax. Extensive workup for small nontraumatic chylothorax may not be justified.

Pleural Effusion Revealing a Diagnosis of Ewing Sarcoma.

Pleural effusion can rarely present as an initial manifestation of Ewing sarcoma. We illustrate a case of a young male adult who was admitted with pleural effusion that led to the diagnosis of Ewing sarcoma.

Neurogenic Pulmonary Edema Following a Seizure: A Case Report and Literature Review.

Acute pulmonary edema is one of the frequent causes of dyspnea encountered in everyday practice. It is broadly attributed to be either cardiogenic or noncardiogenic. It is usually treated with diuretics in addition to other medications depending on the underlying pathology. Here, we report a case of a female patient who presented with shortness of breath after developing a seizure. Further investigations excluded cardiogenic etiology and showed critically low phenytoin level. It improved within 48 h of supportive care without giving diuretics favoring the diagnosis of neurogenic pulmonary edema as the primary pathology. The goal of our case report is to keep neurogenic pulmonary edema in mind, and hence provide the appropriate management, when dealing with similar cases.

Sclerotic Bone Metastasis in Pulmonary Adenocarcinoma.

Pulmonary adenocarcinoma is one of the major types of lung cancers in which metastasis is very common and it accounts approximately to one-third of all primary pulmonary cancers. Although a minority of patients with lung cancer are asymptomatic, which gets usually detected in routine chest radiography, most of the patients present with some symptoms. Lung cancer metastasis may occur virtually in every organ system. Patients with non-small-cell lung cancer commonly have extrathoracic metastases to the adrenal glands, liver, brain, bones, and lymph nodes at presentation. Approximately one-third of patients with lung cancer will present with symptoms related to extrathoracic spread. Metastasis to the bone is not uncommon in lung cancer; however, osteoblastic bone metastasis is very rare. Here we present a 30-year-old female diagnosed to have pulmonary adenocarcinoma with multiple sclerotic bony lesions in the vertebra.