ABSTRACT
Autoimmune pancreatitis is a rare fibroinflamatory disorder of the pancreas with immunoglobulin G 4[IgG4] associated systemic disease which is steroid responsive.1,2 It has a variable clinical presentation ranging from obstructive jaundice, abdominal pain, steatorrhea and diabetes mellitus. In general presentation of autoimmune pancreatitis as acute pancreatitis is considered to be uncommon. The article presents a case of a 30 years old female newly diagnosed as diabetes mellitus presented with obstructive jaundice with raised lipase and amylase treated as acute pancreatitis. Due to persistent elevation of amylase and lipase and deranged liver function test she was further evaluated her CT findings were typical of autoimmune pancreatitis with raised serum IgG4 levels diagnosed as autoimmune pancreatitis. She was treated with steroids and responded well and after few months presented with relapse
ABSTRACT
Background: Dengue fever and malaria both can present with thrombocytopenia and is regarded as a strong predictor of dengue fever. Thrombocytopenia is also considered criterion of disease severity, bad prognostic factor and its presence is associated with increase probability of malaria
Objective: To determine frequency of co-existence of dengue fever and malaria in thrombocytopenic patients presented with acute febrile illness in tertiary care hospital
Methods: Cross-sectional, observational study conducted at the department of Emergency Medicine, Ziauddin University Hospital, Karachi from April 2013 to January 2014. A total of 159 patients meeting inclusion criteria were included in this study. 5ml of blood by venupuncture in EDTA anti-coagulant for platelet count and preparing thick and thin films and 2 ml of blood in plain bottle for detection of dengue specific IgM was collected from all patients. Thick films are used to identify malarial parasites and thin films to identify specie. Dengue fever was diagnosed on positive dengue IgM. Co-existence was labeled as positive if malarial parasites and dengue IgM found to be present at the same time. This diffusion susceptibility test was use to determine susceptibility of bacterial agents to antibiotics. Data was analyzed by descriptive statistics using SPSS software version 19
Results: Overall mean [+/- SD] age was 38.3 [+/- 7.9] years, with Male to female ratio was 1.1: 1. Coinfections [Dengue and Malaria] were diagnosed in 5 [5.6%] of cases. From 5 cases, 3 [60%] were male and 2 [40%] were female. Mean [+/- SD] age of 5 positive cases of co-infection was 37.8 [+/- 8.3] years
Conclusion: Concurrent infections were found 5.6% in this study, however, this percentage is slightly low; and special consideration should be given to the likelihood of co-infection with dengue and malaria Co-existence of dengue fever and malaria in thrombocytopenic patients presented with acute febrile illness
ABSTRACT
To know the frequency of right ventricular infarction in patients with acute inferior wall myocardial infarction. Retrospective study. This study was carried out in Department of Medicine at Civil Hospital Karachi from 1[st] November 2011 to 30[th] April 2012. In this study 65 adult patients of either sex with ECG evidence of inferior wall infarction were enrolled who were admitted in medical department at Civil Hospital Karachi. The duration of the study was 6 months. Inclusion criteria were age > 12 years of either sex or acute inferior wall myocardial infarction on electrocardiography [ST- segment elevation of more than or equal to 1 mm in at least two or three leads i.e. II, III, and aVF]. Exclusions criteria were age less than 12 years and evidence of either right or left bundle branch block on ECG. Data was analyzed through SPSS software. Out of these 65 patients, 45 [69%] were male and 20 [31 %] were female. All patients with acute inferior wall myocardial infarction were divided into three age groups i.e. 3[4%]cases were < 40 years, 44[58.66%] cases between 40-60years , and 18[24%] cases in > 60 years. From a total of 65 patients presented with acute inferior wall myocardial infarction, 40 [62%] were not associated with right ventricular infarction [Group-I], whereas 25 [38%] were associated with right ventricular infarction [Group-II], On ECG, ST-segment elevation in leads V 3R and V 4R was present in 1 out of 40 [2.5%] patients in Group-I, and 23 out of 25 [92%] in Group-II [p=<0.001]. The sensitivity, specificity, positive and negative predictive value of raised JVP was 72%, 82.5%, 78.2% and 82.5% respectively. The sensitivity, specificity, positive and negative predictive value of clear lung fields in the presence of raised JVP was 84%, 87.5%, 80.7% and 89.7% respectively. ST-segment elevation in leads V3R and V4R was 92% sensitive, 97.5% specific, having 95.8% positive and 95.12% negative predictive value. On echocardiography right ventricular dilatation was 96% sensitive, 97.5% specific, having 96% positive and 97.5% negative predictive value. In conclusion, frequency of right ventricular infarction is 38.46% in association with inferior infarction in our clinical settings