Cardiac tamponade as a presenting manifestation of Sheehan syndrome.

We report a 38-year-old Syrian woman who presented with progressive breathlessness, hypotension and circulatory collapse. Echocardiogram revealed a large pericardial effusion with evidence of cardiac tamponade. There was a history of secondary amenorrhoea, loss of axillary and pubic hair following childbirth at 28 years of age. Investigations revealed low levels of gonadotrophins, oestrogen, prolactin and thyrotrophin but normal levels of basal and post-synacthen (ACTH) cortisol. An MRI of the sella showed atrophic changes of the pituitary. She was treated with intravenous fluids, dopamine infusion, intravenous hydrocortisone and thyroxine replacement. The clinical suspicion of Sheehan syndrome facilitated early administration of corticosteroids, adequate thyroxine replacement and rapid resolution of pericardial effusion.

Factors associated with severity of knee osteoarthritis in elderly Kuwaiti population

Osteoarthritis [OA] of the knee is a leading cause of functional disability. It is characterized by progressive cartilage loss. Many factors are associated with the progression of the disease severity. The study aimed at exploring factors that could be associated with the severity of knee osteoarthritis [OA] in elderly Kuwaiti population. The study design was a cross sectional one, in which 110 patients with idiopathic symptomatic knee OA were classified according to radiological findings into tow groups: mild/moderate [48 patients] and severe [62 cases]. A pre-designed questionnaire included personal data, anthropometric measurements and results of clinical and radiological examination. Basic univariate analyses were followed by multiple logistic regression analysis. Of the risk factors examined, obesity was the only significant determinant of progression of knee OA [OR = 38.6, 95% CI: 2.4 - 72.3], while female gender, presence of Heberden's nodes and squatting showed border line statistical significance [OR = 1.5, 95% CI: 1.0 - 2.]; [OR = 1.5, 95% CI: 0.9 - 2.5] and [OR = 1.5, 95% CI: 1.0 - 2.4] respectively. Obesity is the strongest modifiable risk factor for the severity of osteoarthritis. Weight loss may reduce the risk of progression of OA of the knee