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Dubai, United Arab Emirates

We report the first case of native aortic and mitral valve endocarditis due to Gemella bergeriae from the Middle East in a young patient with rheumatic heart disease. Our case illustrates a fulminant course of infection with G. bergeriae endocarditis that was complicated by embolic stroke, as well as intracerebral and subarachnoid haemorrhage secondary to rupture of a mycotic aneurysm in the right middle cerebral artery. This case highlights the dire, unreported neurological complications of infective endocarditis due to a rare causative organism-G. bergeriae. 2014 BMJ Publishing Group Ltd. Source

Abdullgaffar B.,Rashid Hospital
International journal of surgical pathology

Intramammary lymph nodes (IntraMLNs) are frequent mostly benign incidental findings. However, they are clinically important because they can be the primary sites of metastasis and sentinel lymph nodes. Literature data regarding the clinical significance of IntraMLNs metastasis, however, remains controversial. This study aimed to perform a systematic review and meta-analysis to better define the prognostic value of positive IntraMLNs in patients with breast cancer. A systematic review of the literature without date restrictions was conducted. Five electronic medical databases were searched, and a hand-search of the reference lists of the collected articles was also performed. Studies with sufficient and relevant pathologic and clinical survival data were included. Other studies with insufficient data or normal findings were excluded. This study found 18 studies eligible for systematic review, 3 of which were eligible for outcome meta-analysis. IntraMLNs metastases were strongly correlated with axillary lymph nodes involvement. Positive IntraMLNs are reliable predictors of axillary lymph node involvement and therefore a guide for further surgical management of the axillary nodes. Even though it could be concluded that IntraMLNs metastasis is an independent predictor of outcome, this meta-analysis was limited because of the scarcity of data and the inconsistencies and heterogeneity of the outcome studies. Source

Agarwal S.K.,Rashid Hospital
BMJ case reports

A young man presented with a 2-month history of fever and malaise. Cardiac auscultation revealed the presence of a diastolic murmur. Subsequently, a cardiac echocardiogram was done, which showed a large vegetation adherent to an anterior mitral leaflet. The blood culture was positive for Brucella species. The patient was given antibiotic therapy for brucellosis and referred for surgery. Brucella endocarditis is one of the rarest, yet most notorious complications of this infection. This condition requires a high degree of clinical suspicion in order to facilitate prompt diagnosis and treatment. Source

We describe the case of a young man who presented with abdominal pain, vomiting and acute symmetric peripheral polyneuropathy. He was noted to have high anion gap metabolic acidosis with high lactate levels and persistently high arterial and venous pO2 values. The cerebrospinal fluid was acellular with a high protein and the nerve conduction study was consistent with axonal sensorimotor neuropathy. His clinical condition deteriorated rapidly despite full supportive care and he subsequently died of multiorgan failure. An extensive workup for various infectious, autoimmune and other possible aetiologies was carried out to identify the underlying cause for his fulminant illness. All diagnostic workup was non-conclusive except for a significantly elevated serum aluminium level. We have discussed the possibility of aluminium phosphide poisoning in view of the clinical presentation. 2014 BMJ Publishing Group Ltd. Source

Aldabal L.,Rashid Hospital | Bahammam A.S.,King Saud University

Cheyne-Stokes respiration (CSR) is a form of central sleep-disordered breathing (SDB) in which there are cyclical fluctuations in breathing that lead to periods of central apneas/hypopnea, which alternate with periods of hyperpnea. The crescendo-decrescendo pattern of respiration in CSR is a compensation for the changing levels of blood oxygen and carbon dioxide. Severe congestive heart failure seems to be the most important risk factor for the development of CSR. A number of pathophysiologic changes, such as sleep disruption, arousals, hypoxemia-reoxygenation, hypercapnia/hypocapnia, and changes in intrathoracic pressure have harmful effects on the cardiovascular system, and the presence of CSR is associated with increased mortality and morbidity in subjects with variable degrees of heart failure. The management of CSR involves optimal control of underlying heart failure, oxygen therapy, and positive airway pressure support. In this review, we initially define and describe the epidemiology of central sleep apnea (CSA) and CSR, its pathogenesis, clinical presentation, diagnostic methods, and then discuss the recent developments in the management in patients with heart failure. © 2009 Springer Science+Business Media, LLC. Source

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