Large Ascites in a Cirrhotic Patient Reveal an Isolated and Late Metastasis of Ductal Breast Cancer: A Case Study.

Breast cancer is the most prevalent cancer in women worldwide, and its prevalence has increased since the introduction of screening programs. Most cases are discovered at an early stage; however, despite effective treatment, some cases progress to metastasis. The most common breast cancer metastatic locations are the bone, liver, and lungs. Ascites malignant due to peritoneal involvement is a rare manifestation of metastatic breast cancer. After 8 years of well-controlled breast cancer, we report a 54-year-old woman who presents with malignant ascites and is known to have cirrhosis of the liver.

Massive pulmonary embolism led to cardiac arrest two days after thoracoscopy in a young male with pleural tuberculosis.

TB itself is considered an independent risk factor for VTE; however, developing pulmonary embolism after medical thoracoscopy is extremely rare. Herein, we describe a 30-year-old previously healthy male with pleural tuberculosis developed a massive pulmonary embolism with subsequent cardiac arrest after a diagnostic medical thoracoscopy. Computed tomography pulmonary angiogram (CTPA) showed major right pulmonary embolism (PE). Unfortunately, the patient passed away despite resuscitation and extensive organ support in the intensive care unit (ICU). This case highlights the thrombotic risk in this population group in order to avoid such devastating complications.

Enigma of categorizing COVID-19-related lung parenchymal diseases and management experience with follow-up outcomes in Qatar: a case series.

Coronavirus disease 2019 (COVID-19) has become one of the worst global pandemics in recent history. Post-COVID-19 interstitial lung disease is a significant concern in COVID-19 survivors. It is a disabling clinical condition for patients and a burden on the healthcare system. With time and subsequent waves of COVID-19 globally, the post-COVID-19 sequelae of lung diseases can be debilitating. We report cases of three patients with persistent hypoxia post-COVID-19, raising concerns for interstitial lung disease in Qatar. In this report, we shared our experience of the patient's clinical course, complications, and outcomes with post-COVID-19 sequelae of lung parenchymal disease. Patients were followed up during and after treatment until recovery or discharge from the hospital.

Post-COVID-19 vaccine acute hyperactive encephalopathy with dramatic response to methylprednisolone: A case report.

BACKGROUND: Since introducing the SARS-CoV-2 vaccination, different adverse effects and complications have been linked to the vaccine. Variable neurological complications have been reported after receiving the COVID-19 vaccine, such as acute encephalopathy. CASE PRESENTATION: In this report, we describe a 32-year-old previously healthy man who developed acute confusion, memory disturbances, and auditory hallucination within 24 hours from getting his first dose of the COVID-19 Moderna vaccine.EEG showed features of encephalopathy, CSF investigations were nonspecific, and MRI head did not depict any abnormality. He received five days of ceftriaxone and acyclovir without any benefit. DISCUSSION: Extensive workup for different causes of acute encephalopathy, including autoimmune encephalitis, was negative. Also, Our patient improved dramatically after receiving methylprednisolone, supporting an immune-mediated mechanism behind his acute presentation. Accordingly, we think the COVID-19 vaccine is the only possible cause of our patient presentation, giving the temporal relationship and the absence of other risk factors for encephalopathy. CONCLUSION: the clinician should be aware of the possible neurological complications of the different COVID-19 vaccines. Further research is needed to clarify the pathophysiology of such complications.

The diagnostic dilemma of bilateral optic neuritis and idiopathic intracranial hypertension coexistence in a patient with recent COVID-19 infection.

Owing to autoantibody production and thrombophilic disorders in COVID-19, physicians must have low threshold to investigate secondary IIH and demyelinating disorders in patients with headache and decreased vision following recent COVID-19 infection.

Hepatitis E Viral Association with Autoimmune Hepatitis: A Viral Trigger or Cross-Reactivity.

Autoimmune hepatitis (AIH) is a chronic disease characterized by hepatocellular inflammation and destruction. Its pathogenesis remains unclear. Current evidence suggests that environmental factors, including viral infections, are implicated as possible triggers. We present a case of a 36-year-old lady with systemic lupus erythematosus who presented with abdominal pain, nausea, vomiting, and jaundice. She was initially diagnosed as acute hepatitis E virus (HEV) infection based on positive serology, but she did not improve with conservative management. Subsequently, she underwent liver biopsy that showed features characteristic of AIH. We discuss the role of HEV as a possible trigger of AIH. We also highlight the possibility of cross-reactivity between liver antigens and HEV as an explanation for the positive HEV serology in AIH. We explore the management options of cases in which both acute HEV infection and AIH coexist, which might be challenging as there is no current consensus whether to start immunosuppressive therapy or to manage such cases conservatively. Moreover, we discuss previous similar cases in which different lines of management were chosen.

Cardiac Tamponade: An Unusual Cause of a Severe Headache with Normal Blood Pressure.

Cardiac tamponade is a life-threatening condition characterized by slow or rapid compression of the heart due to the accumulation of fluid in the pericardial space and rarely presents mainly as a headache. We report an unusual presentation of cardiac tamponade associated mainly with severe headache over three days and mild shortness of breath in a 60-year-old male not known to have any previous heart disease. Immediate computed tomography (CT) scan of the head ruled out intracranial hemorrhage. A chest x-ray showed cardiomegaly, and further echocardiography revealed a large pericardial effusion on a transthoracic echocardiogram compromising the right ventricular output. Urgent pericardiocentesis was performed and removed 800 ml of hemorrhagic fluid that led to a complete resolution of his severe headache.

Paroxysmal Nocturnal Hemoglobinuria with Glucose-6-Phosphate Dehydrogenase Deficiency: A Case Report and Review of the Literature.

In this study, we are describing a female patient with paroxysmal nocturnal hemoglobinuria (PNH) and glucose-6-phosphate dehydrogenase (G6PD) deficiency. Both diseases are known to cause hemolytic anemia that mediates the hemolysis of RBCs through several mechanisms. In PNH the hemolysis is mediated through complement activation and oxidative stress. G6PD enzyme is crucial in preventing damage to cellular structures caused by oxygen-free radicles. In G6PD deficiency the hemolysis is mediated through the oxidative stress created by oxygen-free radicles. Since both diseases mediate hemolysis through the oxidative stress, we hypothesize that both conditions have facilitated an effect on each other and this will reflect on the response to treatment, and this response to treatment could vary based on whether the two mutations occurred in the same gene or in two different X chromosomes. Having diagnosed PNH, the management is very expensive and not all the patients can afford it, especially our patient who is a maid by occupation. So, the real challenge in our case is to monitor her in subsequent visits and to plan the treatment keeping in mind her financial status.

Impact of multi-approach strategy on acid suppressive medication use in a teaching hospital in Qatar.

OBJECTIVE: To evaluate the impact of a multi-approach strategy to improve the appropriate usage of acid suppressive medication (ASM) in medical inpatients and compare it with the baseline data from 2007. SETTING: Five general medicine wards in a 600-bed teaching hospital in Doha, Qatar. METHOD: A prospective evaluation of the usage of ASM 1 year after a multi-approach strategy. This consisted of four main interventions: audit and feedback method (including awareness lectures to all medical and pharmacy staff), implementation of a usage guideline for medical inpatients, circulating a logarithmic chart on the proper usage of ASM for medical inpatients from admission through to discharge and participation of clinical pharmacists in the multidisciplinary rounds. All medical patients admitted from May through June 2009 were evaluated. Data about the usage of ASM were collected upon and during admission, at discharge and at the next follow-up visit. Justified indications for its usage were based on the approved product information and on evidence-based literature recommendations. Data were compared with the findings of the baseline clinical audit done 2 years earlier. MAIN OUTCOME MEASURE: The usage of ASM in justified and non-justified indications upon and during admission, at discharge and at the next follow up visit. RESULTS: A total of 414 patients were admitted during the study period, 208 patients (50%) received ASM compared to 53% in 2007 (206 patients out of 389). Seventy-four patients (36%) were using ASM upon admission compared to 48 patients (23%) in the 2007 clinical audit. Inappropriate ASM use decreased with 51% during admission (66 to 32%, P < 0.0001), 62% at discharge (34 to 13%, P < 0.0001) and 67% at the next follow up visit (15 to 5%, P = 0.0008). CONCLUSION: Despite the higher number of patients receiving ASM upon admission, the multi-approach strategy used in our institution resulted in a significant improvement in the appropriate usage of ASM in medical inpatients.

Prescribing pattern of acid suppressive medications for medical inpatients in a teaching hospital in Qatar.

OBJECTIVE: To assess the prescribing pattern of acid suppressive medications (ASMs) in medical inpatients in a teaching hospital in Qatar, and compare this with the American Food and Drug Administration approved indications, and published data. METHODS: This study is based on a review of the patient's medical records for the usage of ASMs, namely, histamine-2 receptor antagonists (H2RAs), and proton pump inhibitors (PPIs) in patients admitted consecutively to the medical wards of Hamad General Hospital, Doha, Qatar from May through June 2007. The review included the type of ASM used, timing of prescription (before, or during admission), risk factors for ulcer development, and indication for use. Records for patients using ASMs after discharge without justified indication were assessed 2 months later. RESULTS: A total of 389 patients were admitted, 206 (53%) received ASMs during their hospital stay, 48 (12%) of them were taking ASMs before admission. One hundred and eighty-four patients (89%) received PPI, and 22 (11%) received H2RA. During admission, the usage of ASMs was justified in 70 (34%) patients. One hundred and twenty-nine (63%) received ASMs after discharge, the usage of which was justified in only 59 (46%) patients. From the 70 patients receiving ASMs after discharge for unjustified indications, 30 (43%) patients were re-prescribed with ASMs, 2 months or more after discharge. CONCLUSION: Acid suppressive medications are prescribed in the majority of these patients without justified indication. Moreover, many of them continued their ASMs for at least 2 months after discharge.