Background: Resistant hypertension is a BP that is not controlled by three or more anti-hypertensive medications of different classes, including diuretics. Refractory hypertension is an evolving term reflecting a BP that is not controlled with five agents or more of different anti-hypertensive classes, including diuretics. Patient with refractory HTn has to have secondary hypertension workup. Case: A 45-year-old lady with a known past medical history of obesity, HTN, and DM-II. She was admitted as she had generalized fatiguability and vague chest pain. The ECG, and the TTE showed hypertensive heart disease. She had normal cardiac enzymes. Initial BP was recorded to be 185/127 mmHg. Consequently, she was commenced on anti-HTN medications. Her BP was difficult to control with the maximum doses of six anti-HTH medications (amlodipine, valsartan, hydralazine, indapamide, labetalol, spironolactone)(Fig 1). Decision-making: All the secondary causes of HTN were excluded; normal renin-aldosterone ratio, normal US doppler for the renal arteries, normal sleep study, normal CT chest and abdomen looking for masses, normal dotatate scan, and negative pheochromocytoma work-up. Because she had social stress, she was commenced on anxiolytics (alprazolam). Subsequently, the BP reading improved by around 10-20 SBP; however, her average reading continued to be around 160/90 mmHg. Conclusion: Refractory hypertension is a management dilemma, especially when the causes of secondary hypertension are excluded. Benzodiazepines can be a reasonable option in certain situations where the refractory hypertension is believed to be stress-induced.

Diabetes mellitus is a well-recognized contributor to increased COVID-19 severity. Endothelial dysfunction has been implicated in the pathogenesis of COVID-19, while thrombocytopenia has been identified as a potential risk factor for severe COVID-19. In this study, we evaluated the combined effect of thrombocytopenia and other markers of endothelial dysfunction on disease outcomes in patients with type 2 diabetes and active COVID-19 infection. Our aim was to risk stratify patients with COVID-19 and type 2 diabetes mellitus, which can help identify patients with high-risk features who will benefit the most from hospital admission and a high level of care. This cross-sectional study was performed after reviewing secondary data of 932 patients with COVID-19 and type 2 diabetes mellitus in the outpatient and inpatient settings across Qatar between March 1, 2020 and May 7, 2020. Univariate and multivariate analyses, with adjustment for low platelet counts, were performed for the following variables: age, hemoglobin, white blood cells (WBC), lymphocytes, monocytes, eosinophils, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, ferritin, D-dimer, and interleukin 6. Increasing age was associated with an increased risk for death and/or intensive care unit admission in diabetic patients with COVID-19 who have low platelet counts. These findings support the evidence found in the literature and give special attention to COVID-19 patients with low platelet counts and diabetes mellites. These results can guide physicians in making clinical decisions regarding hospital admission and escalation of care during follow-up in this population of patients.

Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm, classically described as a triphasic disease. However, little is known about risk factors for developing CML. Currently, ionizing radiation is the only established risk factor. Here, we report on a 37-year-old man treated for tuberculosis; 2 years later, he developed CML in a chronic phase. We would like to shed light on tuberculosis as a possible risk factor for CML.

Periprocedural venous thromboembolisms (VTEs) area rare occurrence but a critical complication after catheter ablation of atrial fibrillation (AF) .here we report a 39 year old gentleman treated for paroxysmal atrial fibrillation with catheter cryoablation ,while was compliant to anticoagulation with DOAC dabigatran . one week later he developed acute PE