Clinical registry for rheumatoid arthritis; a preliminary analysis

Objective: To establish a clinical registry for Rheumatoid Arthritis and delineate the most common symptoms that rheumatoid arthritis [RA] patients experience in our set up

Study Design: Cross sectional study

Place and Duration of Study: Study was carried out at Military Hospital [MH] Rawalpindi at Rheumatology Department during the period of Jan 2013 to Jun 2015

Material and Methods: A clinical registry for Rheumatoid Arthritis was developed as per criteria jointly developed by American College of Rheumatology [ACR] along with European League against Rheumatism [EULAR] [2010]. Fifty-eight patients were registered after their informed consent and approval by Military Hospital [MH] Rawalpindi ethical committee. Age, gender and relevant clinical parameters of RA patients were recorded on case report forms and stored for analysis in the RA registry in Excel 2010. The figures were reported in frequencies and percentages

Results: Multiple joint pains [48.28%], fever [24.14%], morning stiffness of joints [22.41%] were the most common symptoms in RA patients. Other clinical manifestations included painful bilateral swollen joints [13.79%], pain in different parts of the body [10.34%], Raynaud's phenomenon [10.34%], malaise [8.62%], swollen body parts [8.62%], ulcers [8.62%], fatigue [6.90%], nodules on skin/elbow/interphalangeal joints [6.90%], deformities of fingers/ hand [3.45%], redness of eyes [3.45%], body rash [3.45%], inability to walk [3.45%], cervical lymphadenopathy [1.72%], stiffness of spine [1.72%] and myalgias [1.72%]

Conclusion: It is concluded that multiple joint pains, fever and morning stiffness of joints are the most common symptoms of RA patients

Microbial spectrum of cardiac implantable electronic device infections - a tertiary cardiac center experience

The objective of the study was to determine the microbiological spectrum of cardiac implantable electronic device [CIED] infections. Case series Armed Forces Institute of Cardiology / National Institute of Heart Diseases AFIC/NIHD from January 2011 to Nov 2013. A total of 15 pus samples from patients with possible CIED infection out of 814 patients with implantable CIEDs were processed. Thirteen patients with positive cultures out of fifteen were included in the study. Clinical evidence of CIED infection included signs of inflammation and purulent drainage. A CIED infection was microbiologically confirmed based on culture yield. Blood cultures were carried out in all patients with suspected CIED infection along with trans-oesophageal echocardiography [TOE], wherever clinically indicated to exclude bacteremia and lead endocarditis. Sixty nine percent of patients with culture proven CIED infection were females and 31% were males. The mean age of patients was 61 years [range 53-70 years]. Devices included 11 PPMs, 1 ICD and 1 CRT. The most frequent organisms were gram-positive [77% of isolates]; with Coagulase-negative Staphylococci [CoNS] predominating in particular Methicillin Resistant Staphylococcus epidermidis [MRSE] in 46.4% cases followed by Methicillin Sensitive Staphylococcus epidermidis [MSSE] in 15%. Non tuberculous Mycobacterium fortuitium was isolated from pus in two patients; with PPM and ICD implants respectively. MRSA was isolated in only 01 PPM infection with evidence of lead endocarditis on TOE. Pseudomonas species was isolated from pus in one patient with CRT implant. CIED infections are more often caused by Staphylococci predominantly CoNS, although atypical Mycobacteria can be implicated

Onest of adult varicella in relation to rural or urban origin and its complications

To determine area of origin of adult varicella patients, whether rural or urban, to compare the mean interval between leaving the area of origin and onset of varicella in adults of rural origin in comparison with those of urban origin and to observe its complications. A cross-sectional study. Combined Military Hospital, Abbottabad, from January to December 2006. All patients over the age of 18 years, presenting with acute illness clinically, suggestive of varicella were included in the study. A specially designed proforma was filled for each patient separately, which included demographic features as well as area of origin, whether rural or urban, and the age at which they left the area of origin. These patients were examined, treated and assessed clinically on regular basis for the progress of the disease as well as for its possible local or systemic complications. Data analysis was done by using statistical programme SPSS-10. Out of 9155 adult patients, 156 [1.70%] had varicella, including 128 [82.1%] males and 28 [17.9%] females. Origin was rural in 125 [80.1%] and urban in 31 [19.9%] patients. Mean interval between leaving area of origin and developing varicella in those of rural origin was 01.79+01.78 years and that in patients of urban origin was 03.37+05.72 years [p+0.009]. None of the patients developed any complication of the disease. Varicella in adults is generally a benign illness. It is more common among adult males of rural origin and the interval between leaving the area of origin and onset of varicella in these patients is significantly less as compared to that in adults of urban origin

Microflora and antibiograms of discharging ears in a cross - section of population in Quetta, Balochistan

To study the micro flora and the antibiograms of patients with discharging ears due to Otitis externa / Otitis media in Quetta, Balochistan and to analyse and compare the results with other domestic and international studies. Prospective, descriptive study. Department of ENT, Combined Military Hospital, FC Hospital, Saleem Medical Complex and Mideast Hospital Quetta, from January 2003 to June 2005. The ear swabs of 1105 patients with otorrhoea were prospectively analyzed. Antibiotic testing was done using modified Kirby Bauer disc diffusion method. In addition to the usual antibiotics, the two most common topically available antibiotics [gentamicin and Ofloxacin] were also tested. There were 1057 positive cultures for organisms from the 1105 patients with 1125 isolates. The most common causal organisms isolated were staphylococcus aureus [40%] with 10.29% Methicillin resistant staphylococcus aureus [MRSA] positive followed by pseudomonas aeruginosa [38.4%]. Fungi accounted for 3.7% of isolates. Out of the two antibiotics commonly available as topical eardrops, Ofloxacin has a very high overall susceptibility rate [97.3%] to all organisms cultured. Staphylococcus aureus is the commonest organism, replacing pseudomonas aeruginosa in discharging ears. All the isolates cultured were highly sensitive to Ofloxacin / Ciprofloxacin. Thus apart from fungal infection of the ear Ofloxacin eardrops should be the mainstay of treatment

Seropositivity of hepatitis delta virus in patients with chronic Hepatitis B virus infection

To determine the frequency of hepatitis delta virus [HDV] seropositivity in patients with chronic Hepatitis B Virus [HBV] infection at Armed Forces Institute of Pathology [AFIP], Rawalpindi. Study design: Cross-sectional study. The study was conducted at department of Virology, AFIP, Rawalpindi. A total of 227 serum samples were collected at AFIP, Rawalpindi, from patients with chronic hepatitis B virus [HBV] infection along with a short history regarding the age, sex and socioeconomic status. Enzyme Linked Immundsorbent Assay [ELISA] for detection of HDV Immunoglobulin G [IgG] and Immunoglobulin M [IgM] antibodies was performed on all the collected serum samples. A total of 30 [13.2%] patients out of 227, were found positive for IgG. The mean age of the patients was 35.8 +/- 10.7 years. Seropositivity of HDV-IgG was 12.8% [25/195] in males and 15.6% [5/32] in females. 11.8% [6/51] of patients from higher socioeconomic group and 13.6% [24/176] in lower socioeconomic group were positive for HDV-IgG [p=0.728%]. Our study shows that 13.2% of chronic hepatitis B virus infected patients at AFIP, Rawalpindi, were positive for HDV IgG. HDV seropositivity was not affected by demographic variables-such as age, gender and socioeconomic status of patients

Hepatitis B viral load in various categories of chronic hepatitis B carriers

To determine serum hepatitis B virus [HBV] DNA levels by Real-time Polymerase chain reaction [PCR] in different categories of treatment-naive patients with chronic HBV infection in context with Hepatitis B serology and serum Alanine aminotransferase [ALT] levels. Cross-sectional study. A total of 122 chronic hepatitis B carriers, including 79 low grade carriers [Anti-HBe positive HBeAg negative], 40 high grade carriers [HBeAg positive, Anti-HBe negative] and 3 intermediate grade carriers [Both HBeAg and Anti-HBe negative] were evaluated for HBV DNA levels and serum ALT levels. The serum HBV DNA levels of the low grade carriers with normal ALT levels [<40 IU/L] were significantly lower than the low-grade carriers with raised ALT levels [mean viral load 3x10[3] vs. 1.6x10[6] copies/mL; p=0.0003]. The HBV DNA levels of the high grade carriers were significantly higher than those of the low grade carriers with normal ALT levels [mean viral load 6.4x10[7]vs. 3x10[3] copies/mL; p=0.0007] and than those of low grade carriers with raised ALT levels [mean viral load 6.4x10[7] vs. 1.6x10[6] copies/ mL; p=0.03]. The results show that HBV DNA levels vary in different categories of chronic hepatitis B carriers and when evaluated by a sensitive quantitative PCR assay the HBV DNA levels can be used for differentiation between HBeAg-negative chronic hepatitis B and inactive hepatitis B surface antigen carrier state

Outbreak of dengue fever in Mangla and Mirpur area

Dengue virus infection has been endemic in Pakistan. An outbreak of febrile illness associated with thrombocytopenia was reported from Mangla and adjoining areas in vicinity of Mangla Dam during July-August 2003. We carried out a serological investigation of the outbreak by serosurveillance. Sera from 52 representative cases were received for viral studies at our institute. Aim of the study was to rule out dengue infection in these cases. Descriptive laboratory based. Department of Virology, Armed Forces Institute of Pathology, Rawalpindi. According to clinical history all the, patients had fever of 3-10 days duration associated with thrombocytopenia. Suspecting Dengue infection, their acute sera were tested for Dengue IgM, by the kit manufactured by Diagnostic Automation Inc., Dengue virus IgM ELISA USA. Among 52 single sera from these cases. Dengue IgM antibodies were detected in 38[73%] cases. Among the sero-positive cases, 7[18.4%] had Vivax malaria. 32[84%] were males with mean age of 34 years and 6[16%] were females with mean age of 27 years. Platelets were below 150,000/micro l in all the cases. Occurrence of Dengue fever in northern Pakistan has been documented and this should now be considered in the differential diagnosis of undiagnosed cases of fever, moreover concomitant malaria infection emphasizes the need for sustainable, community-based mosquito control

beta thalassaemia imported from the mediterranean to the subcontinent?

The study was conducted to determine the source of beta thalassaemia mutations in Pakistan with the help of tracing the HLA antigens and common mutations. A total of one hundred and fifty five subjects [n=155] were included in the study. It included fifty-four patients of thalassaemia major [n=54] and their one hundred and one [n=101] siblings. HLA typing by lymphocytotoxicity method was performed for HLA class I antigens. Retrospective analysis was carried out for common beta thalassaemia associated mutations. The most frequent HLA class I frequencies and beta thalassaemia mutations were compared with different populations of the world to establish genetic ancestry of our patients. Our analyses showed that HLA B35 was present in our thalassaemics in the highest frequency. The antigen frequency [af] of HLA-B35 was 0.37 in thalassaemics while it was 0.21 in normal population [p=0.004]. The af of HLA-B35 was 0.24 in siblings of thalassaemics [p=0.06] versus normal population. However, increased expression of HLA B35 has not been reported in a number of the thalassaemic populations studied for HLA antigen. The combined HLA class I frequencies for our population have the closest match with those found in Caucasian population of the Mediterranean region. The study of the mutations for beta thalassaemia shows the mutation Fr 8/9 [G+] to be present in the highest frequency in areas of northern Pakistan. The HLA and mutation analysis show a trend for this mutation to be Asian-Indian in origin. The other common beta thalassaemia mutation that is prevalent in Southern region of Pakistan is IVS-l-5 substantiated by HLA and mutation analysis studies. It is probably of Arabic decent, as it occurs along the seashore of old trade route extending from Yemen to Philippines. There is evidence that beta thalassaemia mutations arose denovo spontaneously in Pakistan and India and then spread within pedigrees. However there is a chance that IVI-l-5 mutation may have been imported from Arabic Peninsula. It will be interesting to study HLA frequencies / RFLPs of Sindhi and Baluch populations and compare them with seashore areas enroute