Etiology of pleural effusion among adults in the State of Qatar: a 1-year hospital-based study

There have been no systematic studies of diseases causing pleural effusion in Qatar. This prospective, hospital-based study involved all adult patients [> 15 years] with pleural effusions who were admitted to referral hospitals over a 1-year period. A total of 200 cases of pleural effusion were identified [152 males and 48 females]; mean age 45.1 [SD 18.5] years. A majority of patients [73.5%] were non-Qataris, mostly from the Asian subcontinent. The most frequent cause of pleural effusions was tuberculosis [32.5%], followed by pneumonia [19%], cancer [15.5%] and cardiac failure [13%]. The most frequent cause of malignant effusion was bronchogenic carcinoma [38.7%], whereas Gram-positive organisms were the most frequent isolates from empyema fluid [62.5%]. Histological examination and culture of pleural biopsy were the most useful diagnostic workup for tuberculosis effusions, whereas repeated cytological examination of pleural fluid and pleural biopsy were most useful for malignant effusions

Audit of the management of patients admitted to Hamad general hospital with community-acquired pneumonia

To enhance the quality of patient care, Hamad Medical Corporation [HMC] has previously adopted guidelines for the management of community-acquired pneumonia [CAP] based upon the PSI model. We audited retrospectively the management of CAP inpatients admitted to Hamad General Hospital from 1 January until 31 June, 2008 with the objective of establishing whether these HMC guidelines were being implemented appropriately. Sixty-nine patients with CAP were admitted during the study period. Guidelines for the assessment of disease severity at presentation were not followed in all patients. Appropriate antibiotic therapy was instituted in 52 [75.4%] cases. Ten patients died [14.5%]. The rate of use of a severity assessment score to stratify patients with CAP based on recognized guidelines was zero and the death rate of 1 4.5% might reflect that noncompliance

Cystic hygroma as a rare cause of obstructive sleep apnea

A 16-year-old female presented with a seven-month history of episodic cessation of breath during sleep, associated with loud snoring and bluish discoloration of lips. She was a known case of cystic hygroma since birth with many surgical interventions and multiple relapses, the last having been laser therapy of a laryngeal cyst seven months previously. She had obvious throat scarring and a small cyst in soft palate. On the right side of the neck there was a non-tender soft tissue mass 6 x 4 cm in diameter and decreased breath sounds on auscultation of the right upper zone of the chest. MRI of the neck and chest showed a mass involving the right side of neck to the upper part of the chest and severe narrowing of the upper airway at the base of the tongue. A sleep study confirmed obstructive sleep apnea. She was referred to the UK for further surgery and treatment and died suddenly while there. The rare association of cystic hygroma and sleep apnea is reviewed

Tuberculous tenosynovitis: a rare presentation of miliary TB

We present, as a rare manifestation of miliary TB, a case of tuberculous tenosynovitis, preceding by two weeks onset of tuberculous meningitis. A gradual progressive onset of a painless swelling of the right forearm was followed by high-grade fever, headache and neck pain. A suspected diagnosis of tuberculous meningitis based upon analysis of cerebrospinal fluid [CSF] was confirmed later by positive CSF polymerase chain reaction [PCR] for mycobacterium tuberculosis. Although the patient had a positive Mantoux test of 20 mm, there was no evidence of pulmonary TB and a negative CSF smear for acid fast bacilli but a positive smear from a fine needle aspirate of the swelling of the right forearm. The antituberculous therapy led to a successful outcome

Malaria cases presenting at Hamad general hospital in Doha-Qatar 2000-2002

Imported malaria is increasing in nonendemic countries, including the State of Qatar, mainly as a result of the influx of immigrant workers. A retrospective chart review of 153 malaria cases identified at Hamad General Hospital during 2000-2002 is used to emphasise the scale of the problem especially the need to create greater public awareness that travellers to malarious areas must take suitable precautions including appropriate chemopro-phylaxis

IgA kappa chain myeloma with cast nephropathy in a man with type 2 diabetes mellitus and retinopathy

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 k urine. Skull X-ray showed multiple lytic lesions. Serum frotein electrophoresis showed a monoclonal band of 33g/l 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

Frozen eye what could it be?

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

Good pasture's syndrome: case report and discussion

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 anti-glomerular 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

Study of patients with heat stroke admitted to the intensive care unit of Hamad general hospital, Doha, Qatar during summer 2004

Summer shade temperatures in the State of Qatar are commonly above 40 °C making heat stroke a big problem in unacclimatized outside immigrant workers. Seven males were admitted with heatstroke to the ICU, Hamad General Hospital between 4th July and 24th August 2004. Presenting signs varied but included coma, abnormal behavior, aggression, mental confusion, fits, hypovolemic shock and respiratory failure, metabolic acidosis, hypokalemia, hy-ponatremia, elevated serum enzymes and sinus tachycardia. All developed renal insufficiency but none died and there appeared to be no residual brain or organ damage. This has been taken as a measure of the effectiveness of the treatment and management in the ICU. It is emphasized that heat stroke is a medical emergency that can result in major organ failure and death and that early recognition and correct treatment are crucial