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Peripartum cardiomyopathy (PPCM) is a rare cause of heart failure that occurs during the final month of pregnancy through about five months after delivery, without any other known cause, and it increases the risk of thromboembolic events by many folds. A 38-year-old female with a history of peripartum dilated cardiomyopathy was admitted to our hospital, one month after a cesarean section, for severe breathlessness. Examination revealed signs of global heart failure and right deep vein thrombosis. Pulmonary CT angiography revealed pulmonary embolism of the right pulmonary artery. The patient was treated by oral anticoagulation with acenocoumarol with all international normalized ratio (INR) values within the target range (2-3). One month later, she was admitted to the emergency department with acute dyspnea and superior vena cava syndrome. Thoracic CT angiogram showed bilateral pulmonary emboli associated with an extensive deep vein thrombosis of both internal jugular veins, sigmoid sinuses, subclavian veins, innominate venous trunks, and the origin of the superior vena cava without any lesion suspected of malignancy. The thrombophilia screen performed six weeks after the suspension of vitamin K antagonists (VKAs) revealed severe deficiencies of protein C and protein S. In this report, we present the first case of recurrence of fatal thromboembolic events under well-conducted oral anticoagulation in a patient with PPCM associated with severe protein C and protein S deficiencies.Introduction Tuberculosis (TB) remains one of the top 10 causes of death globally. Around 1.7 billion people are infected with mycobacterium TB worldwide, and almost 90% of cases each year are found in 30 high TB burden countries. Due to the influx of a large expatriate population mainly from the high TB burden countries, there is an increased number of pulmonary TB as well as tuberculous pleural effusion cases reported in Qatar. Objectives The demographic, clinical, laboratory, and histopathological parameters of patients with tuberculous pleural effusion were assessed. Methods A single-center study was conducted at Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar. CC-122 mouse Adults diagnosed to have tuberculous pleural effusion were included, and those with clinical suspicion of tuberculous pleural effusion with positive sputum acid-fast bacillus (AFB) but negative AFB in pleural samples were excluded. Results A total of 106 patients were reviewed, of whom 100 were included for the final analysis, with 8her samples. The number of positive Light's criteria did not have any association with positive AFB yield.Malignant eccrine spiradenoma (MES) is an exceedingly rare skin adnexal tumor that arises from pre-existing benign eccrine spiradenoma (BES). MES tumors show a wide spectrum of morphological features, posing a diagnostic challenge to the pathologist. Sarcomatous (heterologous) elements are seen in a few of these tumors, further complicating the morphological picture. We herein describe a case of a 66-year-old male who presented with a recently enlarging, ulcerated, nodular skin lesion over the right leg that had been present for the last 25 years. The patient underwent wide local excision of the tumor. Microscopic examination revealed a neoplastic lesion comprising benign and malignant components. The carcinomatous component showed features of infiltrating adenocarcinoma, not otherwise specified, whereas the sarcomatous component showed predominant osteosarcomatous and focal chondrosarcomatous differentiation. The benign component showed morphological and immunohistochemical features of BES. No adjuvant treatment was administered. The patient was alive and disease-free for 14 months, after which he was lost to follow-up. Careful identification and knowledge related to histological diversity are keys to the correct diagnosis of this rare tumor. MESs are potentially aggressive tumors, and therefore, close long-term follow-up should be maintained.Introduction Multiple sclerosis (MS) is often associated with depression and anxiety, with no clear prevalence, and the relationship between them is not fully understood. Methods In a cross-sectional study of 365 multiple sclerosis patients selected through a random sampling method from the MS society of Riyadh, Saudi Arabia, we collected data by self-administered questionnaires - the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder (GAD-7) questionnaire - and analyzed by descriptive and analytical statistics. Results Approximately 51.1% of participants had moderate or severe anxiety and 64% of them had depression among community-based multiple sclerosis patients according to Generalized Anxiety Disorder (GAD-7) questionnaire, and according to the PHQ-9 Arabic version about 28.85% showed mild to moderate depression. The MS patients aged 53 to over 60 years showed higher levels of mild anxiety (76.32%) and higher levels of depression ranging from mild to moderate (53.61%) (P = 0.001). While the MS patients younger than 53 years showed moderate to severe anxiety (60.71%) and depression levels (62.32%). In different age group bad health status (37.6%) was associated with a higher prevalence of depression levels (P = less then 0.001) and people who were widowed (22.38%), divorced (26%), and separated (37.82%) had significant depression levels (P = 0.017). In terms of anxiety, 54.58% of females had anxiety (P = 0.005), more older people showed anxiety (43.17%) (P = 0.026), and people with a bad general health state (26.38%) had anxiety (P = less then 0.001). Conclusion Among different types of MS patients, anxiety is more prevalent in the elder group (76%) of people and depression is more prevalent in young patients (62%).Takayasu's arteritis is a rare systemic vasculitis affecting the aorta and its primary branches. In developing countries, it is often associated with late diagnosis and high morbidity and mortality. We report a case of Takayasu's arteritis diagnosed in the postpartum period and discuss the challenges faced for optimal outcomes during the ongoing coronavirus disease 2019 pandemic.
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