Pulmonary embolism and intraperitoneal bleeding in a patient with severe ovarian hyper stimulation syndrome (OHSS): A management dilemma

Ovarian hyper stimulation syndrome (OHSS) and venous thromboembolic are known complications of ovarian stimulation therapy. Pulmonary embolism accounts for 7.9% of the episodes of thromboembolic diseases reported in OHSS. We describe a case of 33-year-old Bahraini woman who presented to the Bahrain Defense Force Hospital (Banoon Center) with a history of 13 years primary infertility, and previous unsuccessful intrauterine insemination. Through the In-vitro fertilization (IVF) treatment cycle she had Ovarian hyperstimulation which was further complicated with ovarian bleeding and pulmonary embolism.Our case addresses this rare complication and its management challenges related to the event of thromboembolic disease with anticoagulants in the presence of bleeding. Keywords: OHSS, Pulmonary embolis

A case of relapsing polychondritis mimicking Ludwig’s angina

Relapsing polychondritis (RP) is a severe progressive inflammatory condition involving cartilaginous structures and caused by an autoimmune process, for which there is no confirmatory serological biomarker and which still is diagnosed on a mainly clinical basis. RP has been associated with many diseases like Sweet’s syndrome, Behcet’s disease, rheumatoid arthritis, and other autoimmune disorders. We attempt to describe here a unique case of a 38-year-old female with a high-grade fever, sore throat, difficulty in swallowing, hoarseness of the voice, and found to have signs of tongue swelling and inflammation of the oral cavity that mimicked Ludwig’s angina, necessitating antibiotic use. On careful re-evaluation the patient was diagnosed to have relapsing polychondritis based on auricular and respiratory tract chondritis and response to steroids. The purpose of this report is to emphasize the fact that careful clinical assessment is needed to diagnose RP, which may be misdiagnosed as Ludwig’s angina

CHARACTERISTICS OF PATIENTS HOSPITALIZED WITH 2009 H1N1 INFLUENZA IN A TERTIARY CARE HOSPITAL IN SOUTHERN SAUDI ARABIA

<p><strong>Background</strong></p> <p>Pandemic influenza A (H1N1) virus emerged and spread globally in the spring of 2009.  We describe the clinical features of the patients who were hospitalized with 2009 H1N1 influenza July 2009 to June 2010 in a tertiary care hospital in Khamis Mushyt, Saudi Arabia.  We analyzed the clinical and laboratory variables in order to determine predictors of poor outcome</p> <p><strong>Methods</strong></p> <p>We performed a prospective study in all patients who were hospitalized for at least 48 hours  and with a positive test for 2009 H1N1 virus through RT-PCR(real time polymerase chain reaction).  Their epidemiological, clinical, biochemical characteristics were collected and the hospital course of the patients with eventual outcome (discharge or death) was observed. We applied a logistic regression analysis to determine the best predictor of death.</p&gt

Use of the platelet count/spleen diameter ratio for the noninvasive diagnosis of esophageal varices in patients with schistosomiasis

Background/Aim: In patients with liver cirrhosis, the platelet count/spleen diameter ratio has been validated as a parameter for the noninvasive diagnosis of esophageal varices. Schistosoma infection is a frequent cause of portal hypertension in Middle Eastern countries, and is associated with the development of esophageal varices. In this study we aimed to evaluate the platelet count/spleen diameter ratio as a noninvasive tool for the prediction of the presence of esophageal varices in patients with schistosoma-related chronic liver disease. Patients and Methods: Forty-three patients with hepatosplenic schistosomiasis underwent upper digestive endoscopy to check for the presence of esophageal varices. Furthermore, all patients underwent abdominal ultrasonography, and maximum spleen diameter (in mm) was measured. The platelet count/spleen diameter ratio was calculated in all patients. Results: Esophageal varices were found in 31 patients (72%). Age and gender were not significantly different between patients with and without varices. In patients with varices, median platelet count (82,000/μL versus 172,000/μL, P < 0.0001) and platelet count/spleen diameter ratio (571 versus 1651, P < 0.0001) were significantly lower, while spleen diameter (147 mm versus 109 mm, P = 0.0006) was significantly larger. In multivariate analysis, the platelet count/spleen diameter ratio was the only parameter independently associated with the presence of varices (P < 0.0001). Conclusions: In this study we have validated the use of the platelet count/spleen diameter ratio for the noninvasive diagnosis of esophageal varices in patients with portal hypertension caused by schistosoma infection. In these patients, the platelet count/spleen diameter ratio might be used to allow better rationalization of medical resources and use of endoscopy