Regional variation and clinical manifestations of acute dengue infection observed at a tertiary care hospital of district Rawalpindi

Objectives: To assess the regional variation and clinical manifestations of acute dengue infection amongst the patients who presented to a tertiary care hospital of Rawalpindi

Study design: A Descriptive study

Place and duration: Study was carried out at Microbiology Department of Holy Family Hospital, Rawalpindi Medical College, Rawalpindi, from 1st August 2010 to 30th March 2011

Methodology: A simple random sampling technique was adopted for all the suspected cases of acute dengue, admitted in the dengue ward of Holy Family Hospital, Rawalpindi. Their blood samples were taken and analyzed by ELISA test for the detection of antidengue antibodies [IgM]

Results: A total of 30.2% [n=104] patients were diagnosed positive by ELISA test. The frequency of dengue fever [DF] in males was 68.2% [n=71] and in females it was 31.7% [n=33]. The incidence of dengue fever was high in Rawalpindi [30.2%] and Chakwaal [30.1%]. The most common clinical manifestations were high grade continuous fever [>10[degree]F] seen in 88.4% [n=92], followed by retro-orbital headache 65.3% [n=68], epigastric pain 65.3% [n=68], arthralgias 63.4% [n=66] and myalgias 50% [n=52]

Conclusion: The incidence of Dengue fever is high in Rawalpindi and Chakwaal. The most common clinical manifestations of acute DF include high grade continuous fever along with retro-orbital headache, epigastric pain, myalgias and arthralgias

Giant goiter: not uncommon in endemic areas of Pakistan. a 10 years experience

Objectives: To determine the prevalence of giant goiter and morbidity after surgery and to compare the data with the national and international literature

Study Design: A prospective, observational study

Place And Duration: Department of Surgery, Fauji Foundation Hospital, Rawalpindi from May 1999 to April 2008

Methodology: All patients with giant multinodular goiter [Grade IV] were operated and prevalence of compilations was recorded meticulously, and data compared with national and international literature

Results: A total of 744 patients operated and majority were female 94.89% [n=706] from 5[th] decade of life i.e. 35.75% [n=266]. Giant multinodular goiter [Grade IV] found in 26.08% [n=194]. Among them, 96.90% [n=188] were euthyroid. Near total thyroidectomy was done in 59.79% [n=116] patients, total thyroidectomy in 28.86% [n=56] and subtotal thyroidectomy in 11.35% [n=22] patients. Transient hypocalcaemia was the commonest complication observed, in 8.24% [n=16] patients followed by seroma formation- 7.21%, [n=14]. Permanent hopoparathyroidism-2.66%, [n=4], Permanent recurrent laryngeal nerve injury-1.03%, [n=2], transient recurrent laryngeal nerve palsy-4.63%, [n=9], postoperative bleeding-1.03%, [n=2] and wound infection noticed in 2.57% [n=5] patients

Conclusion: Giant goiter is not uncommon in our setup, with expected high postoperative complications so surgery should be done by experienced hands in the centers where all facilities are available. Public awareness should be created by health authorities and organizations regarding prevention and early treatment

diagnostic and management options of naegleria fowleri amebic infection

The source of Naegleria fowleri [N. fowleri] Infection is via direct contact with poorly chlorinated or contaminated water. It can easily be acquired during swimming or face wash with contaminated water through inhalation of Naegleria cysts. The mortality rate with N. fowleri or 'brain-eating amoeba1 has been estimated to be as high as 98%

The exact prevalence of N. fowleri infection in Pakistan cannot be assessed because of limited National data. The clinical manifestations usually mimic meningitis and hydrocephalous, thus, remained the main reason for under reporting of these cases

Therefore, there is a dire need to adopt proper diagnostic approaches through cerebrospinal fluid [CSF] microscopic examination and molecular detection by polymerization chain reaction [PCR] studies in all the suspected cases. Moreover an aggressive combination therapy with Amphotericin B, rifampicin and miconazole can be helpful to reduce the high mortality rate form the said infection

Risk profile in young patients with acute myocardial infarction

The objective of this study was to determine the frequency of risk factors in young patients with acute myocardial infarction and thus with ischemic heart disease [IHD], aged 20 to 40 years, in our population. A descriptive study. This study was carried out at Combined Military Hospital, Kharian Cantonment Pakistan from January 2007 to December 2008. All patients who fulfilled the inclusion criteria who presented to emergency reception of the hospital with a diagnosis of Acute MI were included. The patients were admitted to coronary care unit [CCU] and were managed for Acute myocardial infarction [MI]. Their detailed history was then taken including symptoms at presentation and their risk factors were assessed with the help of history and laboratory investigations. A total of 137 patients were included during the study period. Mean age was 36 years [SD=3.67]. Majority of patients were males. Smoking was the major risk factor [64.2%] followed by family history of IHD [30.7%]. Most frequent risk factor for Acute myocardial infarction [MI] at young age is smoking followed by family history

Frequencies and patterns of arrythmias in anterior and inferior myocardial infarction

The objective of this study was to identify the frequency and clinical patterns of arrhythmias in anterior and inferior myocardial infarction [MI]. A descriptive study. This study was conducted at critical care unit of Combined Military Hospital Kharian cantonment from January 2006 to December 2006. Hundred patients were included in the study that fulfilled the required criteria. They underwent detailed history taking and systemic examination. Patients were monitored through cardiac monitors and serial ECG recordings were taken especially if any rhythm disturbances were observed or if the patient suffered any symptom, till the time of discharge from the hospital. The relevant information was entered into a specially designed pro forma. All the data collected through the pro forma was analyzed through SPSS version 11 in terms of frequency, percentages and proportions. Premature ventricular contractions [PVCs] were the most common rhythm disturbance followed by ventricular tachycardia [VT]. Both were more common in anterior myocardial infarction [MI] than inferior MI. Bradyarrhythmias were more common with inferior MI. PVCs usually manifested with chest pain, VT was accompanied by palpitations and dyspnoea. Atrioventricular [AV] blocks clinically presented as syncope. PVCs are the most common rhythm disturbance after anterior and inferior MI. VT and ventricular fibrillation [VF] are frequent in anterior while bradyarrhythmias are common with inferior MI

Basal cell carcinoma involoving the skin of breast a rare site

Basal cell carcinoma [BCC] is the most common and least lethal form of all cancers. The estimated lifetime risk of BCC in the white population is 33-39% in men and 23-28% in women. It occurs most frequently in people over 50 years of age and almost twice as often in men as in women. Up to 85% of BCCs are found in the head and neck region, but the lesions occasionally occur in unusual and routinely photoprotected locations. These include breast, vulva, scrotum, earlobe and middle ear. With such an atypical presentation of BCC, a keen and skeptical eye for diagnosis is required. No population-based epidemiologic studies to assess the incidence of BCC have been done in Pakistan. However, some scattered data can be found in local medical literature, which shows the highest frequency in 51-60 years age group with a male preponderance. We report a case of non healing ulcerated lesion over breast that was being treated for 5 years unsuccessfully. On skin biopsy, it came out to be BCC. As far as we have searched, it is the first report of such a case in Pakistani literature

Cutis marmorata telangiectatica congenita

A case of cutis marmorata telangiectatica congenita [CMTC] is reported. A young girl had an unusual presentation with sclerosis in the skin lesions, senile features, hypoplasia of the mandible, transverse nail dystrophy, and transverse toe defects resembling Adams-Oliver syndrome. These associated abnormalities are very rare and some have not been documented before with CMTC. The possible relationship of CMTC with Adams-Oliver syndrome is also discussed