Patient: Male, 60-year-old Final Diagnosis: Lung cancer Symptoms: Shoulder pain Medication:— Clinical Procedure: — Specialty: Oncology • Pulmonology Objective: Mistake in diagnosis Background: Shoulder pain is a common complaint in general practice and typically has an orthopedic or rheumatological etiology. However, it may be the presenting symptom of a serious underlying condition, such as lung cancer. Case Report: A 60-year-old man with a 30 pack-year history of smoking presented with worsening right shoulder pain over the last 6 months. He had no respiratory symptoms or weight change. He was seen at several general practice clinics and treated for a rotator cuff injury. However, his pain became severe, to the point that it affected his activities of daily living. A shoulder X-ray revealed opacity in the right apical zone. After a thorough investigation, the patient was found to have lung cancer with local invasion and intracranial metastases. However, in light of the advanced stage of the disease, a palliative approach was taken. The patient remained on multiple oral analgesics for the control of his pain. Conclusions: The present case shows that common symptoms such as shoulder pain can be indicative of serious underlying pathology. Physicians should remain alert and maintain a high index of suspicion for Pancoast tumor in patients who are heavy smokers. Furthermore, a chest X-ray needs to be performed in elderly patients and smokers with shoulder pain.

Vitamin D (VD) deficiency and insufficiency have been linked to poor quality of life (QoL); general weakness, fatigue, and nonspecific pain. Despite abundance of sun light, there is a wide spread VD deficiency in the Arabian Gulf countries. However, the impact of VD deficiency on the quality of life has not been well documented in the Arabian Gulf countries, including the Kingdom of Saudi Arabia (KSA). This study aims to analyze the effect of crude vitamin D levels on quality of life in none pregnant Arab women in the Kingdom of Saudi Arabia (KSA). The study was a prospective cross sectional study, using a sample of 152 subjects of patients aged 13 years and above attending the outpatients' clinic at King Faisal Hospital, Kingdom of Saudi Arabia (KSA). The study collected anthropometric and demographic variables, in addition to a small plasma sample from all subjects to measure VD levels, calcium (Ca), phosphorus (P), parathyroid hormone (PTH) and lipid profile by standard methods. Subjects were categorized according to VD levels as normal (>30 ng/ml), insufficiency (21 to 29 ng/ml), or deficient (≤ 20 ng/ml). The RAND Short Form -36 (SF-36), which consists of 36 questionnaire items was used to measure (QoL) across eight domains for both physically and emotional wellbeing: physical functioning; role limitations due to physical health; role limitations due to emotional problems; energy/fatigue; emotional well-being; social functioning; pain and general health. Logistic regression analysis was used to investigate the associations between VD levels and QoL. The mean scores in the total sample were 65.5 (SD ±14.6) for the physical component summary (PCS) score and 58.2 (SD ±15.2) for the mental component summary score (MCS). Vitamin D deficiency was overwhelmingly high among subjects across age and sex. The PCS and MCS QoL scores were also lower than the average. However, the study found no association between VD levels and QoL, presumably due to sample size and con-founders. Further studies are needed to identify the impact of VD levels on perceived QoL.