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Background Behçet’s syndrome is a type of systemic chronic vasculitis of unknown etiology, frequently characterized by recurrent oral and genital ulcers and uveitis. It is less commonly characterized by arthritis and skin, vascular, and gastrointestinal involvements. Behçet’s syndrome affects various sizes of vessels by perivascular infiltration and vasculitis. Unlike other classic types of vasculitis, Behçet’s syndrome patients can present with both arterial and venous involvement. Although vascular Behçet’s syndrome is found in only around 15% of Behçet’s syndrome patients, it is the major cause of morbidity and mortality among them. Furthermore, although deep venous thrombosis has high incidence in Behçet’s syndrome patients, pulmonary artery thrombosis is an uncommon complication. Combining the findings of this and previous case reports of pulmonary artery thrombosis in Behçet’s syndrome patients, we sought to determine the best treatment options for pulmonary artery thrombosis in Behçet’s syndrome patients. Case presentation We present the case of a 22-year-old Arabian male who was admitted to an emergency department with acute chest pain, dyspnea, and hemoptysis for 2 weeks. He gave a long history of recurrent oral and genital ulcers for the last 4 months but without seeking medical advice. Spiral computed tomography showed arterial filling defects with a pulmonary nodule for which the presence of a pulmonary artery aneurysm ruled out. The lung perfusion scan showed multiple pulmonary perfusion defects. After excluding common infectious diseases such as tuberculosis and brucellosis, a diagnosis of Behçet’s syndrome with pulmonary artery thrombosis was made. Steroids with enoxaparin were initiated. The patient was discharged later on prednisolone (tapering dose) with adalimumab and apixaban. He was on regular follow-up for the next 9 months. Conclusions Vascular involvement in Behçet’s syndrome is a major contributor to morbidity and mortality of Behçet’s syndrome patients. Consequently, early detection of vascular involvement has a major impact on the prognosis of patients with Behçet’s syndrome.

Abdulrahman AlQahtani,1 Ziyad Alakkas,1 Fayez Althobaiti,1 Mohammed Alosaimi,1 Baraa Abuzinadah,1 Elshazly Abdulkhalik,2,3 Khaled Alswat4 1Internal Medicine Department, King Abdul Aziz Specialist Hospital, Taif, Makkah, Saudi Arabia; 2Consultant Cardiology, Cardiology Department, Al Azhar University, Cairo, Egypt; 3Cardiology Department, King Abdul Aziz Specialist Hospital, Taif, Makkah, Saudi Arabia; 4Department of Medicine, College of Medicine, Taif University, Taif, 21944, Saudi ArabiaCorrespondence: Abdulrahman AlQahtaniDepartment of Medicine, College of Medicine, Taif University, P.O. Box 11099, Taif, 21944, Saudi ArabiaTel +966 531901817Email a.s.alqahtni@gmail.comIntroduction: Cardiovascular disease is one of the main causes of hospital admission and mortality, and thyroid dysfunction increases the risk of developing acute or exacerbation of chronic cardiac conditions. The aim of this study is to investigate the prevalence of thyroid hormone abnormality among patients in the cardiac care unit (CCU) patients and its relation to admission diagnosis, clinical, biochemical data, and hospital-related outcomes.Methods: We conducted a retrospective cohort observational that included adult patients who were admitted to the CCU. We excluded those with known thyroid dysfunction and those who received amiodarone or IV contrast.Results: A total of 374 patients with a mean age of 62.7+14.7 years old were included. Ischemic changes were observed in 70.6% of the patients based on the admission diagnosis. In comparison to the non-ischemic group, the ischemic group was more likely to be male (P=0.010), to be active/former smokers (P=0.011), to have diabetes (P=0.009), to have diastolic dysfunction (P=< 0.001), to have undergone thrombolysis (P=< 0.001), and to have been referred to a tertiary center (P=< 0.001). Euthyroidism was observed in 57.8% of the patients based on the thyroid function test at admission. Compared to patients with thyroid dysfunction, those with Euthyroidism were more likely to be active/former smokers (P=0.002), to have lower heart rates (P=0.018), to not have chronic kidney disease (P=0.016), to not have heart failure (P=0.006), to have lower thyroid-stimulating hormone (TSH) levels (P=< 0.001), and to have lower tricuspid regurgitation (P=0.042).Conclusion: Thyroid dysfunction is common among patients admitted to the CCU. Non-significant positive correlations between TSH and hospitalization length, tertiary center referral, 30-day readmission, and in-hospital mortality when adjusting for potential confounders.Keywords: thyroid disease, sick euthyroid, acute coronary syndrome, heart failure, ischemic heart disease, nonthyroidal illness syndrome, NTIS

Patient: Female, 53-year-old Final Diagnosis: Diabetic KetoAcidosis (DKA) Symptoms: Gum bleeding Medication: Steroids Clinical Procedure: — Specialty: Metabolic Disorders and Diabetics Objective: Unusual clinical course Background: Steroids are used as anti-inflammatory agents, administered for a variety of medical conditions, either as short-or long-term treatment. Steroid use is associated with many adverse effects, including hyperglycemia, but ketoacidosis is rare. Case Report: We present the case of a 53-year-old woman who developed diabetic ketoacidosis after administration of methylprednisolone during treatment of immune thrombocytopenic purpura. She did not have diabetes or a family history of diabetes. Steroid-induced hyperglycemia with insulin resistance, lipolysis, and ketogenesis occurred and were likely to have precipitated the ketoacidosis. Blood glucose, blood gases, and urine test results were diagnostic for ketoacidosis. Conclusions: The risk of ketoacidosis and hyperglycemia should be considered in the course of steroid therapy, even without a diagnosis of diabetes, especially in patients who have risk factors for diabetes mellitus including obesity and long-term use of steroids, so that early identification of diabetic ketoacidosis can prevent further morbidity and mortality in chronic patients.

Objectives: Metabolic syndrome (MetS) is a group of multiple cardiovascular risk factors, including dysglycemia, central obesity, high cholesterol, and hypertension. Cardiovascular disease is one of the most common complications of MetS. Recent studies showed that prevalence of MetS among patients admitted with acute coronary syndrome was as high as 46%. Design: We conducted a cross-sectional study of 203 patients at the two main hospitals in Ta’if, Saudi Arabia. Patients older than 18 years who were admitted to the Cardiac Care Unit (CCU) between the months of August 2013 and June 2014 were asked to participate. MetS diagnosis was made based on the International Diabetes Federation definition. Results: A total of 203 patients participated, with 59.1% male and 40.9% were female. The mean age was 60.9 years with a mean body mass index of 28.97 kg/m2 and a mean waist circumference of 95.45 cm. The prevalence of MetS was 47.8%, primarily among obese female patients who reported sedentary lifestyles. Additionally, MetS patients were more likely to be admitted with heart failure (p

Methods: A cross-sectional study, collected from the Pilgrimages with diabetes during the Hajj season. Baseline characteristics were collected by a formal interview and the measurements were self-reported. The primary outcome was to evaluate the patients' Hajj readiness and the association of the previous Hajj performance on this outcome. Results: Of the 262 patients with diabetes participated, 72.9% have type 2, mean age of 53.1 years; mean duration of diabetes is 9.23 years.