Case presentation: A fifty four year old African American female with history of rheumatoid arthritis (RA) presented to the emergency room with signs and symptoms of community acquired pneumonia. Patient was diagnosed with RA 30 years ago and was treated initially with non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids and gold injections for 3 months since then she didn't receive any disease modifying anti rheumatic drugs (DMARD) or corticosteroids. On examination, she was wheelchair bound with multiple joint deformities: ulnar deviation, swan neck deformities, without any signs of active synovitis. Rheumatoid nodules were absent. She had severe limitation of passive and active movement of the hip joints bilaterally. Images of the pelvis showed resporption of the femoral (1). Marked subchondral sclerosis was noted in the acetabulum. CT scan of the pelvis was done to rule out subcapital femoral neck fracture. It demonstrated advanced degenerative changes in both hip joints with partial resorption of both femoral heads worse on the left, no fracture was noted. Conclusion: Osteolysis is a complication of long term untreated RA that is rarely seen in adults with RA and is more common in JRA. Abbreviations: Rheumatoid Arthritis (RA), DMARD (disease modifying anti rheumatic drugs), NSAID (Non-Steroidal anti-inflammatory drugs), Full Range of Motion (FROM), Tempomandibular Joint (TMJ)

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In 2008, the “Central Hospital” of Abu Dhabi closed, bringing to an end a long period of service to that community. The site was completely demolished, allowing room for further developments of Sheikh Khalifa Medical City. For 40 years, Abu Dhabi “Central Hospital” had been the main health center for the multi-ethnic community of Abu Dhabi. It was the seed for the local health care system, and its staff made significant health care and academic contributions, particularly in the field of nephrology, infectious disease, and emergency medicine. Its academic contributions were remarkable, relative to its modest facilities. This history note aims to commemorate the life and contributions of this small, yet pioneering, institution to the health services, medical education, and research in the capital of this new nation. It gives an opportunity to pay tribute to all those who served in it at any stage of their career.

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Background: About half of cirrhotic patients develop ascites. Large volume paracentesis or trans internal jugular portosystemic shunt are alternatives in patients with refractory ascites. Intravenous (IV) loop diuretics are not routinely recommended for the treatment of cirrhotic ascites. We audited our experience with the use of IV furosemide and IV human albumin for the treatment of cirrhotic ascites that did not respond to oral diuretics and salt restriction. We also assessed the treatment side effects and patient's outcomes. Patients and Methods: Study subjects were selected from patients who were admitted for management of moderate or massive cirrhotic ascites refractory to oral diuretics and salt restriction. Patients' characteristics were documented. Renal function and electrolytes were measured on admission and daily thereafter. All patients were treated with IV furo-semide at 40-60 mg TID, human albumin at 100ml of 20% (20gm) per day and spironolactone at 150-400 mg daily. We recorded complications and mortality during these admissions. Results: Fifty admission episodes for 28 patients were evaluated. The mean age was 58 ± 5 years. In 32 admissions, the ascites responded to the treatment regimen and Large volume paracentesis (LVP) was not required. The mean serum creatinine was 132 ± 17 μmol/l. High urine sodium was an indicator of response, with a mean of 71±14 mmol/l. Mild renal impairment was the most common complication (53.3%). The mean duration of hospital stay was 9.2 ± 2.3 days. Seven patients died from sepsis and hepatorenal syndrome type 1. Conclusions: Closely monitored use of IV furosemide with human albumin for treatment of cirrhotic ascites is effective and superior to oral diuretics, and it may reduce the need for LVP.

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Lateral medullary syndrome, also known also as Wallenberg syndrome, remains an interesting clinical entity with varied presentations of cerebrovascular accidents. The area of the brain stem involved is the posterolateral part of the medulla oblongata receiving arterial blood supply from the posterior inferior cerebellar artery. We present a 60-year-old man presenting with unilateral vocal cord palsy due to an unusual central cause, being part of lateral medullary syndrome. We reviewed the neuroanatomy and clinical aspects of this condition.

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Background: Oxidative stress has been implicated in the pathophysiology of cerebral ischemia. Pentraxin-3 plays an important role in innate immune responses and in inflammatory diseases. Our aim was to evaluate pentraxin-3 serum level on focal transient cerebral ischemia and reperfusion model in rabbits and to assess the anti-inflammatory and anti-oxidant effects of vagus nerve stimulation. Materials and methods: Focal transient cerebral ischemia and reperfusion was induced by occlusion of the right common carotid artery for 2 hours followed by reperfusion for one hour. Stimulating electrodes were implanted on the cervical part of the right vagus nerve. Vagus nerve stimulation was started 30 min following right common carotid artery ligation for a period of one hour. The stimulation signals were delivered every five minutes for 30 seconds. All the procedures were duplicated but no stimulus was delivered in the control group. Serum level of pentraxin-3, lipid peroxide and total thiols were determined at baseline, at end of ischemia and at end of reperfusion and the animal decapitated and neuronal damage was evaluated. Results: We found that vagus nerve stimulation caused reduction of the ischemic features with revival of the cell shape and size. It also resulted in decreased serum levels of pentraxin-3 and lipid peroxide whereas the level of total thiols was increased. Conclusion: We concluded that the observed diversity in pentraxin-3, lipid peroxide and total thiols serum levels in cerebral ischemia and reperfusion may reflect relative roles in the biology. Anti-inflammatory and anti-oxidant role of vagus nerve stimulation in cerebral ischemia and reperfusion may represent a marker of altered cerebral function, and may provide potential therapeutic applications.

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Background: Abdominal obesity, insulin resistance and hyperinsulinemia play a central role in the pathogenesis of polycystic ovarian syndrome (PCOS). Abdominal adipose tissue is a source of adiponectin. Metformin has been widely used in the treatment of PCOS and has been shown to improve the metabolic and hormonal disturbances of PCOS. Objective: The current study aimed to investigate the relationships between serum adiponectin and adiponec-tin receptor-1 (AdipoR1) with insulin resistance, hormonal variables, and anthropometric measures in patients with polycystic ovarian syndrome (PCOS), and to find the shortterm effect of metformin treatment on adiponectin and Adi-poR-1 levels in these patients. Patients and Methods: 38 PCOS patients and 14 age- and body mass index (BMI)-matched healthy controls were recruited. In all participants, BMI, waist circumference, serum levels of fasting glucose, insulin, adiponectin, AdipoR1, total testosterone, luteiniz-ing hormone (LH), and follicle stimulating hormone (FSH) were assessed. PCOS patients received metformin treatment (1500 mg/daily) for two menstrual cycles followed by measurement of all previous parameters. All subjects gave informed consent. Results: PCOS patients had higher waist circumference, fasting glucose, insulin, homeostasis model assessment of insulin resistance (HOMA-IR), testosterone, LH and LH/FSH ratio than did controls. In PCOS patients, adiponectin and AdipoR1 were lower than in controls, and both correlated negatively with waist circumference, insulin, and HOMA-IR (P=0.048, P=0.0003, P=0.0003, respectively for adiponectin and P=0.039, P=0.023, P=0.025, respectively for AdipoR-1). HOMA-IR followed by testosterone were independent predictors of adiponectin while HOMA-IR was an independent predictor of AdipoR1. Metformin decreased fasting glucose (P=0.003), insulin (P=0.042), HOMA-IR (P=0.006), testosterone (P=0.001), LH (P=0.0001) and LH/ FSH ratio (P=0.003) and increased adiponectin (P=0.014) and AdipoR1 (P=0.001) levels in PCOS patients. Conclusion: Reduced adiponectin and Ad-sipoR1 in PCOS patients is independently associated with insulin resistance and the improvement of insulin sensitivity by short-term metformin treatment results in increased adiponectin and AdipoR-l.

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Backgrounds: We studied the changes in blood-brain barrier (BBB) permeability and brain trace elements concentration in acute hypo-osmolality and pentylenetetrazol (PTZ)-induced seizures model in rats. Furthermore, the effect of acute hypo-osmolality on seizure activity (patterns) in the PTZ model, the correlation between seizure severity score (SS score) and changes of both of BBB permeability and brain trace elements concentration in rats were also studied. Materials and Methods: Four groups (18 animals /group) of adult male albino rats were included. The animal groups are: (1) Control group: received only a vehicle. (2) Hypo-osmolar group: received warm distilled water (DW). (3) Seizure group: injected with PTZ i.p. (4) Hypo-osmolar + seizure group: first injected with DW and then PTZ. During the next 30 minutes, the animals were observed for seizure activity. For evaluation of BBB permeability changes, serum S100B protein and Evan Blue (EB) dye content of brain tissue were evaluated. Additionally macroscopic and microscopic examinations of brain tissue were completed. Trace elements, magnesium (Mg), zinc (Zn), copper (Cu) and iron (Fe), concentration in brain tissue were estimated. Results: There were significant increase of EB content of brain tissue, and serum S100ß in hypo-osmolar, seizure and hypo-osmolar + seizure groups, as compared with control animals. These parameters were significantly increased in the hypo-osmolar + seizure group when compared with either hypo-osmolar or seizure groups. These results were confirmed by macroscopic examination of brain tissue. Trace elements concentration of brain tissue, Mg, Zn, Cu and Fe, were significantly decreased in hypo-osmolar, seizure and hypo-osmolar + seizure groups in comparison with control animals. Histological examination of sections from the hilar region of dentate gyrus of the hippocampus revealed degenerative changes in the three groups of animals in comparison with control animals. Morphometric analysis showed a significant decrease in the number of cells in the hilar region of dentate gyrus in the three groups of animals in comparison with controls. Seizure activity significantly increased in hypo-osmolar + seizure as compared to seizure group. The correlation analysis revealed that significant −ve correlations were found between SS score and trace elements concentration, while significant +ve correlations were observed between SS score, and each of EB content and serum S100ß protein in seizure and hypo-osmolar + seizure groups. Conclusion: Our study demonstrated that, hypo-osmolality and PTZ-induced seizures could result in increased BBB permeability with a decrease of brain trace elements concentration. This could play a vital role in the pathophysiology of epileptic seizures. In addition, hypo-osmolality can enhance neuronal excitability and severity of seizures in the PTZ-induced model in rats.

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In this article, the author presents a personal first hand experiences of having spent over 20 years practicing surgery in Abu Dhabi. He recalls being recruited amongst the first few doctors to start the services in Abu Dhabi. He practiced general surgery with its widest possible sence to include orthopedics, urology and even newurosurgery. Of course trauma surgery was central theme including camel's bites. Memories of the early days of the postgraduate education and holding the primary examination of the syrgical Fellowship examinations. Many anecdotes of professional,and social encounters with colleagues, VIP's, and patients were recalled with great love and affection. These give an value added insight into the first two decades of life the Gulf reagion at the dawn of its development.

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