Essential rhythmic palatal myoclonus in a 51-year-old man.

Essential palatal myoclonus is a rare movement disorder consisting of continuous rhythmic jerks of the soft palate; it usually develops secondary to brainstem or cerebellar disease called symptomatic rhythmic palatal myoclonus. Diagnosis is usually clinical, and some patients, however, fail to show evidence of a structural lesion like our patient called essential rhythmic palatal myoclonus. We report a 51-year-old man who has suffered from the condition and showed improvements on treatments.

Burden of typhoid fever in Sulaimania, Iraqi Kurdistan.

BACKGROUND: Typhoid fever imposes a high disease burden worldwide, but resource limitations mean that the burden of typhoid fever in many countries is poorly understood. METHODS: The authors conducted a prospective surveillance study at the adult and pediatric teaching hospitals in Sulaimania, Iraqi Kurdistan. All patients presenting with an undifferentiated febrile illness consistent with typhoid were eligible for enrollment. Enrolled patients had blood cultures and Brucella serologies performed. Incidence was calculated with reference to census data. RESULTS: Both typhoid fever and brucellosis were common, and the incidence of typhoid fever was 21 cases/100 000 patient-years. Classic disease symptoms were uncommonly observed. DISCUSSION: Cost-effective surveillance projects to calculate disease burden of typhoid fever are practical and replicable. Typhoid has successfully adapted to the healthcare environment in Sulaimania. Additional work in the region should focus on antibiotic resistance and other enteric pathogens such as Brucella spp.

A 55 years old man with pulmonary alveolar microlithiasis.

Pulmonary alveolar microlithiasis (PAM) is a very rare diffuse chronic lung disease characterized by deposition of small spherules of calcium phosphate within the alveolar cavity. The disease is usually seen from birth up to 40 years of age and is usually diagnosed incidentally during radiography of the chest for other reasons. Most of patients are asymptomatic or having very mild symptoms and the majority of patients either have normal or restrictive pulmonary function test. Clinically, the course of the disease is different; it remains static in few patients or it may progress to pulmonary fibrosis, respiratory failure and cor pulmonale in others. In this case report, we present a 55-year-old man who presented with moderate shortness of breath which has progressed from mild symptoms with in the previous years. His chest high-resolution CT scan showed diffusely scattered, ill-defined little shadowy micronodules which involve the left lung; lingula and left lower lobe in particular. A lung biopsy confirmed the diagnosis of PAM. He was followed up for 1 year with treatment by steroid and alendronate, and no progression was noticed in fact improvement in pulmonary function test noticed. This is the first case report of PAM in Kurdistan.

A 24 year-old male with yellow nail syndrome having bronchiactasis without pleural effusion as a pulmonary manifestation.

Yellow nail syndrome is a rare entity of unknown etiology. Classically, it consists of a triad of slow-growing yellow nails of fingers and toes, lymphedema, and pulmonary manifestations mainly pleural effusion. Other pulmonary manifestations also have been described in the literature such as bronchiectasis, recurrent pneumonias, bronchitis, and sinusitis. This paper describes a case of yellow nail syndrome which did not have the classic triad of the condition; he presented with progressive yellow hand and toe nails intermittent lymphedema, bronchctasis, and sinusitis without pleural effusion.