Case OneMrs. GC was a 49 years old Nigerian trader presenting with two weeks history of breathlessness, one week history of pedal swelling and four day history of cough. Her breathlessness started on exertion and was relieved by rest, there was associated poorly radiating dull central chest pain with no aggravating or relieving factor, there is associated orthopnea, paroxysmal nocturnal dyspnea and palpitation. Bilateral pedal swelling started a week prior to presentation it has been recurrent with polyuria and bilateral loin pain no dysuria, no nocturia, no frothiness of urine, no facial swelling that regresses as day goes by. Dry cough started four day prior to presentation with associated low grade fever, occasional polydipsia no polyphagia. She has been having chronic diarrhoea and weight loss for one year with human immunodeficiency virus test that is negative repeatedly.Diagnosed to have peptic ulcer disease two years ago, not a known hypertensive, diabetic or thyrotoxic patient. She is married to a 55 year old Nigerian clergyman with four children. She doesn't smoke or take alcohol.On examination she was cachectic, afebrile ,pale, slightly icteric, not cyanosed, no asterixis, bilateral pitting pedal oedema up to the knee, fine tremor present, World Health Organisation (WHO) stage ll goitre, measures 8cm x 4cm x1cm no eye signs. Cardiovascular examination showed pulse rate 120 beats/min, arterial wall thickened, irregularly irregular, locomotor brachialis,

No abstract

No abstract

No abstract

No abstract