The diagnostic challenge of pulmonary Kaposi's sarcoma with pulmonary tuberculosis in a renal transplant recipient: a case report.

We report a case of a 39-year-old, HIV-negative, post renal transplant patient who developed mucocutaneous Kaposi's sarcoma with lung parenchymal involvement and concurrently culture proven pulmonary tuberculosis. To the best of our knowledge, this is the first case report of this combination, which presented with cavitating lung nodules and responded well to withdrawal of immunosuppressive drugs beside antituberculous treatment.

Chronic eosinophilic pneumonia presenting with recurrent massive bilateral pleural effusion : case report.

We describe a rare case of a 29-year-old woman with chronic eosinophilic pneumonia (CEP) presenting with massive bilateral pleural effusion leading to respiratory failure, a complication that was not reported before with CEP. The patient was successfully managed with ventilatory support and steroid therapy. On long-term follow-up, she remained well, receiving a low maintenance dose of prednisone without evidence of relapse of the disease.

The diagnostic challenge and management of pulmonary Kaposi's sarcoma in renal transplant recipients.

Kaposi's sarcoma is a multicentric low grade tumor that usually begins with the development of violaceous skin lesions and is associated with the presence of human herpes virus 8. Kaposi's sarcoma has been described in immunocompromised patients, particularly following renal transplantation, with cutaneous involvement being the most salient finding. Infectious and non-infectious pulmonary disorders in immunocompromised patients can simulate the radiological manifestations of pulmonary Kaposi's sarcoma. This report highlights the dilemma in reaching an accurate diagnosis of pulmonary Kaposi's sarcoma as a complication of immunosuppression post-renal transplant and reviews the management of immunosuppression related Kaposi's sarcoma.

Sleep disorders in Saudi health care workers.

BACKGROUND: The objective of the study was to screen for sleep habits and various sleep disorders, using a standard questionnaire. PATIENTS AND METHODS: The questionnaire was designed to assess sleep habits, the degree of daytime sleepiness using the Epworth Sleepiness Scale (ESS), and specific sleep problems. A random sample of Saudi employees working as medical or paramedical personnel was selected. RESULTS: There were 163 respondents (65%) comprising 33 females and 130 males. The mean ESS score was 9.4. Sixty-four respondents (39.3%) had an ESS score of more than 10, i.e., excessive daytime sleepiness (EDS). When subjects with poor sleep habits and/or sleep problems were excluded, there were 65 ânormalâ sleepers, with a mean ESS score of 8.9+/-3.6. This did not differ from the rest of the sample population, who had a score of 9.8+/-3.7 (P=0.15). Subjects with inadequate sleep or insomnia consisted of 17 females (51.5%) and 45 males (34.6%). There were seven subjects, all males (5.4%), with habitual snoring. Ten males (7.7%) and two females (6.1%) reported having breathing pauses while asleep. Symptoms of restless leg syndrome, sleep paralysis, and cataplexy were reported by 21 (12.9%), 26 (16.0%) and two (1.2%) subjects, respectively. CONCLUSION: The prevalence of EDS in the Saudi population is higher compared to that reported from other populations when a Western ESS normal range is used. Nevertheless, the range of normal score of ESS is probably broader for Saudis compared to other populations. In general, sleep disorders are common but unrecognized in our community.

Susceptibility of LDL to oxidative stress in obstructive sleep apnea.

Cardiovascular diseases are more common in patients with obstructive sleep apnea (OSA) than in the general population. We hypothesized that severe hypoxemia during sleep in these patients may cause an imbalance between reactive oxygen species and the antioxidant reserve that is important for the detoxification of these molecules. We tested the hypothesis that low-density lipoproteins (LDL) in hypoxic OSA patients may be more susceptible to oxidative stress than LDL of nonhypoxic OSA patients and normal controls. Fifteen OSA patients were included in this study, six with severe hypoxia (hypoxic group) who spent more than 10 minutes during sleep with SaO2 < 85% (mean 96 minutes), and nine OSA patients (nonhypoxic group) who spent less than 10 minutes during sleep with SaO2 < 85% (mean 1.1 minutes). Six healthy nonsmoking males of the same age group were included as a control group. The susceptibility of each individual's LDL to oxidative stress was examined after free-radical challenge in vitro by assessing changes in levels of conjugated dienes. The LDL in OSA patients with severe hypoxia was not more susceptible to oxidative stress compared to the LDL of nonhypoxic OSA patients and normal controls. After 6 hours of exposure to an oxidative agent, the changes in the mean conjugated diene were not different among the three groups (p = 0.75). The time required to reach 50% of maximal absorbance was also not different, p = 0.199. Glutathione peroxidase and catalase activities in red blood cells in the hypoxic and nonhypoxic patient groups were not significantly different. One night of CPAP therapy in each patient group did not significantly change the level of the antioxidant enzymes. Our results did not show any difference in the susceptibility to oxidative stress between hypoxic and nonhypoxic OSA patients and normal controls.

Long-term compliance with continous positive airway pressure in patients with obstructive sleep apnea syndrome.

A ten-year retrospective analysis of the clinical features and survival of 60 Saudi children with systemic lupus erythematosus (SLE) was made. All the patients fulfilled the 1982 American College of Rheumatologyâs revised criteria for SLE and had had the disease at or before the age of 16 years. The female to male ratio was 5:1, the mean age of onset was 12.1 years (range 1.6-16 years), and the mean duration of follow-up was 4.7 years (range 2.2-11). Thirty-eight patients (63%) were diagnosed correctly before referral to KFSH&RC or KKUH. The mode of presentation was as follows: 55 patients had musculoskeletal involvement (91.6%), 49 patients had skin involvement (81.6%), 40 patients had hematological abnormalities (66.6%), 39 patients had renal disease (65%), 10 patients had pulmonary involvement (16%), 23 patients had cardiovascular disease (38%) and 18 patients had central nervous system involvement. During the study period four patients died (6.6%)âtwo of renal failure, one from meningitis and one from severe sepsis. This is the largest collection of childhood systemic lupus erythematosus from the Middle East and it shows that SLE is more common in Saudis than was hitherto believed, and that it has a high rate of organ involvement.

Medical treatment of sleep apnea.

Obstructive sleep apnea is a common disorder. Since 1981 the treatment of choice has shifted from tracheostomy or weight loss to uvulopalatopharyngoplasty and then to continuous positive airway pressure. This review encompasses the most recent literature, focusing mainly on current treatment options and other potential and experimental modes of therapy. We review in detail continuous positive airway pressure therapy, including unwanted effects; compliance and possible ways to improve it; and ways to deal with the difficult patient. We also review dental appliances, electrical stimulation, and potential hormonal and nicotine treatment.