Factor XII (Hageman Factor) Deficiency: a rare harbinger of life threatening complications.

Hageman factor (factor XII) has a key role in activation of intrinsic coagulation system gauged by activated partial thromboplastin time (aPPT). Hageman factor deficiency is more often an autosomal recessive condition, but an autosomal dominant inheritance is also reported. This condition in its own is not known to cause bleeding complications rather is associated with paradoxical fatal thromboembolic complications.

Acute disseminated encephalomyelitis: a call to the clinicians for keeping this rare condition on clinical radar.

Acute disseminated encephalomyelitis is a rare disease of central nervous system, which can present with a variety of clinical manifestations. That is why first attack of ADEM, in particular remains a diagnostic puzzle. Early anticipation and diagnosis is important for better outcomes.

Antimicrobial susceptibility patterns: a three-year surveillance study in a rehabilitation setting.

Introduction: To analyze the susceptibility patterns in a rehabilitation center.

Methods: This retrospective observational study was conducted between January 2011 and to January 2013 at Sultan Bin Abdulaziz Humanitarian City (SBAHC), Riyadh, Kingdom of Saudi Arabia. Number of the patients, specimen type, pathogen detected and antibiogram were entered in database for analysis using Inter System Track care software.

Antithyroid drug induced a granulocytosis: what still we need to learn?

Antithyroid drugs (ATDs) induced agranulocytosis is a rare but life threatening condition. We report a 29 years Filipino female diagnosed as having hyperthyroidism with normal base line blood counts, liver and renal profile. She was started on maximum 60 mg (20mg TID) oral dose of carbimazole since one month by her treating physician.

Low rate of non-compliance to antituberculous therapy under the banner of directly observed treatment short course (DOTS) strategy and well organized retrieval system: a call for implementation of this strategy at all DOTS centers in Saudi Arabia.

Introduction: The objective of this study was to show the effectiveness of revised retrieval system on non-compliance.

Methods: We retrospectively evaluated the effectiveness of a revised retrieval system on non-compliance during continuous phase of antituberculous treatment (Jan-2005 to Dec-2010) compared to baseline non-compliance (Jan-2002 to Dec-2004).

Results: In the baseline period, 141 of 501 (28%) patients did not attend their first appointment.

Contemporary empyema thoracis necessitans in an adult male caused by Staphylococcus aureus: decortication is superior to traditional under water seal intercostal tube in chronic empyema.

Empyema thoracis necessitans is a rare clinical finding nowadays. We report 55 years old Saudi male with past history of road traffic accident, poly trauma, chest surgery and paraplegia admitted for rehabilitation in Sultan Bin Abduaziz Humanitarian City (SBAHC), Riyadh, Saudi Arabia and diagnosed with empyema thoracis necessitans due to Staphylococcus aureus, treated initially with traditional thoracostomy under water seal intercostal intubation and antibiotics but subsequently required decortication.

Adult male with non-resolving opacity in the right hemithorax.

Pulmonary agenesis is a well-known but rare congenital anomaly of the respiratory system. It represents failure of development of the primitive lung bud. We are reporting bilobar agenesis of the right lung associated with multisystem involvement in an adult patient.

A 35-year-old immuno-competent male with open pulmonary tuberculosis associated with extra-ordinary extensive extra-pulmonary tuberculosis.

Multifocal tuberculosis is characterized by the presence of large multifocal tuberculosis areas in the same or different adjacent or distant organs. Primary lesions are usually in the lungs in the majority of patients. Difficulty in confirming multifocal tuberculosis and consideration of other diseases may lead to a delay in diagnosis and thus in initiating treatment.

Multifocal tuberculosis: Many faces of an old menace.

Unlabelled: Tuberculosis continues to be a major health problem, and is among the leading causes of morbidity and mortality worldwide. Pulmonary tuberculosis is the commonest and epidemiologically the most important type of tuberculosis as the source of spread in the community. Some patients presenting with pulmonary tuberculosis also have associated multifocal extra-pulmonary tuberculosis and vice versa.

Paraplegia is not a diagnosis: Spinal tuberculosis deserves a place on the clinical radar screen: Awakening call to clinicians.

Disseminated Tuberculosis(TB) occurs through lymphohaematogenous dissemination of M. tuberculosis. Although it is more common in young children and those who are having risk factors like having acquired or innate immunodeficiency, weak immune system being on immunosuppressive treatments; it can also occur in immunocompetent indviduals with heavy load of infection.

Prevalence of diabetes type-2 & pulmonary tuberculosis among Filipino and treatment outcomes: A surveillance study in the Eastern Saudi Arabia.

Objective: To study prevalence of diabetes type-2 and pulmonary tuberculosis among Filipino patients and treatment out comes. Tuberculosis centre of Dammam medical complex (MOH) is a referral centre for the Eastern Saudi Arabia where patients from all government and private hospitals having open pulmonary tuberculosis are admitted for isolation till they are rendered noninfectious. All patients are treated for 6 months under DOTS strategy with 4 drugs (2HRZE) for 2 months as initial intensive phase and 2 drugs (HR) for 4 months as continuation phase.

Clinical consequences of non-compliance with directly observed therapy short course (DOTS): Story of a recurrent defaulter.

In 1993, the World Health Organization (WHO) declared tuberculosis (TB) a global emergency, and subsequently introduced the directly observed therapy short course (DOTS) strategy, a technical and management package, based on the earlier work of the International Union Against Tuberculosis and Lung Disease (IUATLD) and international experience with DOTS, which strategy beyond a doubt has played a great role in the initial success of this program, especially in hospitalized patients under the initial intensive phase of 4-drug, anti-TB treatment with Isoniazid, Rifampicin, Pyrazinamide and Ethambutol. This results in rapid clinical well-being and early sputum conversion. This is indeed epidemiologically very important to break the chain of infection.

Patterns of antituberculous drug resistance in Eastern Saudi Arabia: a 7-year surveillance study from 1/2003 to 6/2010.

Objective: To examine the patterns of antituberculous drug resistance of Mycobacterium tuberculosis in patients with pulmonary and extra-pulmonary tuberculosis in the Eastern province of the Kingdom of Saudi Arabia.

Methods: This is a retrospective study of antibiotic susceptibility of 1681 non-repetitive M. tuberculosis isolates from 1/2003 to 6/2010.

Milliary tuberculosis with unusual paradoxical response at 3 weeks of antituberculous treatment.

Milliary Tuberculosis (TB) occurs through lymphohaematogenous dissemination of M. tuberculosis and paradoxical response (PR) is a recognized feature. Respiratory failure, choroid tubercles and brain tuberculomas are some of the complications.