Correlation of Vitamin D deficiency with chest X-rays severity scores and different inflammatory markers in severe and critical COVID-19 patients

Objective: To determine the relationship between Vitamin D deficiency with Chest X-Rays severity score and Different Inflammatory Markers in Severe and Critical COVID-19 Patients. Design: A cross-sectional study Setting: The study was conducted in COVID-19 isolation units at Mardan Medical Complex Teaching Hospital (MMCTH) and Bacha Khan Medical College, Pakistan Participants: 206 patients who tested positive for COVID-19 by PCR were included in the final analysis.Data Collection/Intervention: We collected demographic, comorbidity, laboratory, and clinical outcome data from the electronic records of admitted, deceased, or discharged patients.Main outcome measure: Frequency of symptoms, comorbidities, mortality and morbidity, chest x-ray severity scores, different inflammatory markers in Vitamin D deficient Covid-19 patients Results: 128(62.14%) were severe and 78(37.5%) were critical COVID-19 patients. The whole cohort had 82(39.80%) males and 124(60.20%) females, with a median age of 55 IQR (50-73). Study participants' median Vitamin D level was 14.01ng/ml, with a minimum of 7.5ng/ml and a maximum of 70.8ng/ml. 67/206 patients died, with a fatality ratio of 32.5%. 54/67(80.59%) suffered from one or more comorbid conditions. Conclusion: Low Vitamin D levels were linked to a higher risk of death, higher x-ray severity scores, and different inflammatory markers. Vitamin D levels greater than 30ng/ml for older patients and greater than 40ng/ml in older patients with comorbidities were associated with reduced severity and mortality in patients with COVID-19

Is There Any Benefit of Drain Placement on Postoperative Complications in Patients Undergoing the Sistrunk Procedure?

Introduction Same-day, outpatient Sistrunk procedure is commonly performed to manage thyroglossal duct cyst anomalies and may lead to postoperative complications. Surgical drains are placed to prevent complications, but recent observations show no advantage and rather increased health care costs and patient discomfort. Objective The study evaluated if drain placement in the Sistrunk procedure offers any benefit on postoperative complications. Methods A retrospective analysis of patient records having undergone same-day, outpatient Sistrunk procedure from 2004 to 2014 was done. Of 58 (38 male and 20 female) patients included, 38 did not have drains placed and the remaining 20 had drains placed. Mean and median age of patients was 18.1 and 13.5 years, respectively. Postoperative complications of patients with drains versus those without drains were statistically analyzed. Results Overall, about 10% of patients had hematoma/seroma (H-S), with 6.9% of patients needing aspiration for H-S; 3.4% had wound infections; and 1.7% had pus formation. No statistically significant differences in Sistrunk-related complications between patient groups (with drain or without drain) were seen using Fisher exact (two-sided) test: H-S (p = 0.08); need for aspiration (p = 0.29); wound infection (p > 0.05); and pus formation (p = 0.35). Chi-square test also did not show any significant difference in the groups in terms of number of follow-ups. Conclusion Surgical placement of a drain in the Sistrunk procedure does not seem to offer any advantage in terms of reducing common postoperative complications. Sameday Sistrunk procedure without any drain placement may be a safer alternative without necessitating hospitalization. More studies with larger sample size are needed for further substantiation.(AU)

Computed tomography [CT] scan; ring enhancing lesions on brain

Ring enhancing lesions are a common neurological problem seen in either gender and in all age groups. Objectives: To determine the clinical presentations and etiological factors in patients with ring enhancing lesion on CT scan brain. Design: Case series study. Period: One year. Setting: Department of medicine, Liaquat University Hospital, Hyderabad. Patients and methods: Subjects of either sex =12 years of age, presented with seizures, fever, focal neurological signs and deficit, headache, weight loss and vomiting and had single or multiple ring enhancing lesions on computed tomography [contrast CT brain film] were enrolled and entered in the study. CT scan brain was advised to evaluate any identified lesion and then certain specific biochemical tests were also advised to detect the particular existence etiological factor. The data was analyzed in SPSS 16 and the frequency and percentage was calculated. Results: During one year study period, total 50 subjects were detected as ring enhancing lesion on CT scan. The mean age +/-SD of the over all population was 28.87+/-4.84 whereas the mean age +/-SD of male and female population was 27.76+/-6.53 and 30.76+/-5.83 respectively. Ring enhancing lesions were right sided in 30 patients [60%], on the left side in 15 [30%] and bilateral lesions were identified in 6 subjects [10%] on brain imaging. Majority of the ring enhancing lesions were single 45 [90%] and the parietal lobe was observed as the commonest site. The headache, seizures, fever, pyramidal signs and papilledema was identified the common clinical features whereas the common etiological factors responsible for ring enhancing impression on brain CT scan were tuberculoma 17[34%], brain tumor 12[24%], metastasis 05[10%] and brain abscess 04[08%]. Conclusions: The male population was predominant while the seizure was observed as common clinical feature whereas the tuberculoma, brain tumour and metastasis are the common etiological factors responsible for ring enhancing lesion on brain imaging.

Axial length variability in cataract surgery

To determine the mean axial length and biometric measures in patients undergoing cataract surgery and further compare the variability of axial length between the gender and with age. Cross-sectional observational study. Eye Unit I, Department of Ophthalmology, Liaquat University of Medical and Health Sciences, Hyderabad, Pakistan from January 2010 to December 2012. All patients referred for cataract surgery were assessed. The study included 886 eyes which were straightforward cataract cases with no other ocular problem. The data was collected for axial length, keratometric values and Intra-Ocular Lens [IOL] power prior to cataract surgery. The collected data was then analyzed using SPSS version 19 for windows software. Gender based comparison showed significant difference in age, axial length, keratometric values and IOL power between the two groups [p=0.000]. 86% of the eyes had an axial length between 21.00 mm and 23.99 mm. In univariate analysis there was significant [p=0.000] relation between overall age and axial length. The keratometric values ranged between 36.75 D and 52.50 D. Majority of the IOL powers ranged between 20.00 D and 23.00 D. The mean axial length of patients undergoing cataract surgery was 22.96 +/- 1.04 mm, was comparable to Indian and Chinese population but shorter than the Western population. Females had shorter axial lengths, similar to other studies. Axial length was positively associated with age among the females, the cause of which is yet to be determined

Clinical features, role of mobile plasmapharesis unit and outcome in patients with acute inflammatory demyelinating polyradiculoneuropathy [Guillain-Barr‚ syndrome]

To study the clinical features, role of mobile plasmapharesis unit and outcome in patients with acute inflammatory demyelinating polyradiculoneuropathy [AIDP]. Retrospective Cross Sectional Study. This study was conducted at Neurology Department, KEMU, Lahore from July 2008 till June 2012. Patients from various hospitals [both public and private] fulfilling the Ashbury and Cornblath's Clinical Diagnostic Criteria for GBS and requiring plasmapharesis were included in the study. For this purpose a special proforma was designed to be filled by the primary physician at the time of request for mobile plasmapharesis service. This service was provided by a donor organization namely Pakistan Myasthenia Gravis Welfare Organization [PMWO] based at a public hospital in Lahore. Plasmapharesis was started according to the guidelines, as soon as possible after admission, if patient had history of progressive weakness. The protocol of this treatment was to exchange 200 to 250 ml of plasma per kilogram of body weight in five sessions within 7 to 10 days. The replacement fluids most often consist of 0.9% normal saline, haemaccel and/or albumin. Recovery was assessed by modified Hughes Guillain-Barr‚ syndrome disability scale. A total of 152 patients were included in the study with 94 [61.8%] males and 58 [38.2%] females and M: F ratio of 1.62:1. The mean age was 32.66 [SD 15.89] with range from 7-80 years. One hundred and nine [72%] cases presented between 11-40 years of age. All patients were treated with five sessions of plasmapharesis. Drop out rate for plasmapharesis was 1.5% implying its good tolerability. Out of the total of 152 cases, 149 [98%] cases presented with progressive areflexic weakness and 3 [2%] patients with bilateral external Ophthalmoplegia, areflexia and ataxia [Miller-Fisher variant]. Sensory symptoms were present in 31[20.4%], bulbar weakness in 29[19.1%], and bilateral facial weakness in 25[16.4%] cases. Severe respiratory distress requiring ventilatory support occurred in 36[23.7%] cases. Pearson's correlation revealed that gender and age were not risk factors for the development of ventilatory failure [p=0.354; 0.803], bilateral facial weakness [p = 0.121; 0.473] or bulbar weakness [p= 0.383; 0.745] respectively. Overall mortality was 5% and all these cases developed severe respiratory distress and needed ventilatory support. Complete recovery occurred in 90% cases and 5% had residual deficit [Hughes disability scale severity 1 and 2] at mean follow up of six months. Our study showed that GBS is statistically more frequent in males than females in our local population with maximum frequency between 11-40 years of age range. However, the two factors i.e. gender and age has no significant association with the development of ventilatory failure, bilateral facial weakness and bulbar weakness. Areflexic motor weakness was the commonest presenting feature. Plasmapharesis remained very effective therapeutic option which is cheaper and affordable in our poor socio-economic setting. Mobile unit service provided an excellent opportunity to treat most of these patients at their native hospitals. We recommend that government and donor organizations should develop more mobile plasmapharesis services in all major cities which can cover nearby district and tehsil hospitals

The study of gene GJB2/DFNB1 causing deafness in humans by linkage analysis from district Peshawar.

Families with at least 2 or more individuals having hereditary hearing loss were enrolled from different areas of Khyber Pakhtoonkhwa, mainly from district Peshawar. Detailed history was taken from each family to minimize the presence of other abnormalities and environmental causes for deafness. Families were questioned about skin pigmentation, hair pigmentation, and problems relating to balance, vision, night blindness, thyroid, kidneys, heart, and infectious diseases like meningitis, antibiotic usage, injury, and typhoid. The pedigree structures were based upon interviews with multiple family members, and pedigrees of the enrolled families were drawn using Cyrillic program (version 2.1). All families showed recessive mode of inheritance. I studied 8 families of these 10. For linkage analyses, studies for DFNB1 locus, 3 STR markers (D13S175, D13S292, and D13S787) were genotyped using polyacrylamide gel electrophoresis (PAGE) and haplotypes were constructed to determined, linkage with DFNB1 locus. From a total of 8 families, a single family-10 showed linkage to DFNB1 locus.

Molecular investigation of mental retardation locus gene PRSS12 by linkage analysis.

The present study was carried out to determine the prevalence of families having mental retardation in Pakistani population. We enrolled seven mentally retarded (MR) families with two or more affected individuals. Family history was taken to minimize the chances of other abnormalities. Pedigrees were drawn using the Cyrillic software (version 2.1). The structure of pedigrees shows that all the marriages are consanguineous and the families have recessive mode of inheritance. All the families were studied by linkage analysis to mental retardation locus (MRT1)/gene PRSS12. Three STR markers (D4S191, D4S2392, and D4S3024) in vicinity of mental retardation (MR) locus (MRT1)/gene PRSS12 were amplified on all the sample of each family by PCR. The PCR products were then genotyped on non denaturing polyacrylamide gel electrophoresis (PAGE). The Haplotype were constructed to determine the pattern of inheritance and also to determine that a family was linked or unlinked to gene PRSS12. One out of the seven families was potentially linked to gene PRSS12, while the other six families remain unlinked.

Frequency of depression in chronic Hepatitis C naive patients

To determine frequency of depression in chronic hepatitis C na‹ve patients before interferon therapy using CES-D questionnaire. Patients testing positive antibodies to HCV by EIA of more than 6 months duration and who have not taken interferon therapy previously were included after taking informed consent. Patients who had co-infections such as hepatitis B and D virus or human immunodeficiency virus, or patients with other coexisting chronic liver disease like primary biliary cirrhosis, chronic autoimmune hepatitis and Wilson disease were excluded from study. Urdu version of CES-D a self-reporting questionnaire in public domain was administered. A score of >/= 10 was taken consistent with depression. Ninety-six patients were included and 59.4% were depressed. These included 57.9% males and 42.1% females. Highest frequency was seen in under-graduates and positive correlation was seen with duration of hepatitis C infection. This study showed that 59.4% of patients with hepatitis C have depression before initiation of therapy and this should be evaluated and treated if necessary before starting interferon therapy

Frequency of acute hepatitis C after needle stick injury and its treatment outcome

To determine the frequency of acute HCV infection after needle stick injury and its treatment outcome. Patients with HCV positive needle stick injury and reporting within 72 hours of incident were selected. Co-infections with HBV, HDV, HIV, hematological disorders and depression were excluded. Anti-HCV was done at presentation and those testing positive were excluded. HCV RNA was done after two weeks or anti-HCV after six weeks of incident. Those testing positive were kept under observation for 16 weeks for spontaneous resolution. After this period HCV RNA and Genotype were done and therapy with Peg-interferon was started. Rapid, early and sustained virological responses were checked. Two hundred eight patients with HCV positive needle stick injury were selected, 10 [4.8%] developed acute HCV infection out of them one [10%] had spontaneous recovery during the observation period of 16 weeks. seven [77.8%] achieved rapid virological response and eight [88.9%] achieved sustained virological response. Acute HCV is an uncommon disease to diagnose; it has favorable response to therapy if initiated early after a strict surveillance of patients for 8-16 weeks

frequency of hepatitis B and C among volunteer blood donors in Balochistan

In this cross-sectional study, the frequency of hepatitis B and C among volunteer blood donors in blood banks of Sandeman Provincial and Lady Duffren Hospitals, Quetta, Pakistan was estimated. 1474 blood donors were selected by convenient sampling. After obtaining informed consent, brief history and examination were done. They were tested for HBsAg and anti-HCV antibodies in laboratory. The collected data analyzed by SPSS 12.0 and results shown in frequencies and percentages. Out of 1474 blood donors, 1284 [87.1%] were males and 190 [12.9%] were females. The mean age was 25 [range: 16-49] years. 71 [4.8%] were positive for HBsAg [63 males and 8 females], 26 [1.8%] for anti-HCV [21 males and 5 females] and 4 [0.27%] were positive for both [3 males and 1 female]. Most of them belonged to ages 21-40 years. The frequency of hepatitis B is same as that of other part of the country contrary to the belief that Balochistan is a high prevalent region for hepatitis B as compare to the rest of the country, while the frequency of hepatitis C is less than expected. Health education and vaccination for hepatitis B should be encouraged and more vigilant efforts should be done

Predictors pf ischemic versus hemorrhagic strokes in hypertensive patients

To identify the factors that predispose to ischemic versus hemorrhagic stroke in hypertensive patients. Cohort study. The study was conducted at the Aga Khan University Hospital [AKUH], Karachi, from August 1999 to May 2001. All the hypertensive patients, who were registered in AKUH acute stroke outcome data base, over a period of 22 months, were identified and from this cohort the patients with first ever stroke were selected. The data regarding demographics, stroke type [ischemic vs. hemorrhagic], pre-existing medical problems, laboratory and radiological investigations was recorded and analyzed. Five hundred and nineteen patients with either ischemic stroke or parenchymal hemorrhage were registered over a period of 22 months. Three hundred and forty-eight patients [67%] had hypertension and of these, 250 had first ever stroke at the time of admission. Presence of diabetes mellitus [OR: 3.76; CI: 1.67-8.46] and ischemic heart disease [OR: 6.97; CI: 1.57-30.98] were found to be independent predictors of ischemic strokes. Presence of diabetes mellitus and ischemic heart disease predict ischemic stroke in a patient with hypertension

Kleine Levin syndrome

Kleine-Levin Syndrome [KLS] is a rare disorder of uncertain etiology, characterized by recurring episodes of undue sleepiness lasting for days. We report a case of young female presenting with episodes of undue sleep along with hypersexuality and excessive food intake, who improved significantly on lithium and valproate. KLS should be considered in young patients, who present with episodes of undue somnolence

Rapidly developing Optic Neuritis secondary to Ethambutol: possible mechanism of injury

Optic neuritis has been described among the toxic effects of Ethambutol. This side effect is dose related. The mean duration of Ethambutol induced optic neuritis [EON] is three months. We report a case of EON after few days of exposure to Ethambutol and the symptoms resolved after discontinuation of Ethambutol. This most likely represents an idiosyncratic reaction which is different as compared to dose related optic neuritis

Chronic infections and risk of stroke: possible explanation for cryptogenic stroke

The association of certain infections as a potential cause of stroke has been known for some time. The complications of bacterial or fungal endocarditis resulting in emboli, mycotic aneurysm and subarachnoid hemorrhage; meningeal infiltration by spirochetes and inflammatory cells seen in neurosyphilis; strokes by direct invasion of cerebral blood vessels in tuberculous meningitis as well as other basilar meningitides; and cerebral vasculitis in association with varicella zoster infection are the few examples. More recent interest has been focused on chronic infections by common organisms such as Helicobacter Pylori and Chlamydia Pneumonie and their role in atherosclerosis processes. This article reviews the current literature highlighting the association of these infections to atherosclerotic processes which ultimately result in strokes. The pathophysiology of stroke is variable. Large artery atherosclerosis accounts for the main pathogenesis in myocardial infarction, whereas thrombo-embolism, lipohyalinosis, hypercoagulable states and arterial dissection are some of the pathogenetic-mechanisms involved in stroke. Still 30-40% of strokes have no apparent etiology [cryptogenic strokes]. This shows the diversity and variability of the cerebral vasculature when compared with the coronary vasculature. The risk factors for stroke therefore need to be investigated independently of those for atherosclerosis and MI. It would be also imperative to consider the temporal profile of the associated infective process. Acute infections, may cause or contribute to acute stroke by promoting a pro-inflammatory or pro-coagulant effect at the time of the infection for example acute bronchitis could alter inflammatory and coagulation parameters, leading to sudden atherosclerotic plaque rupture or thrombosis, precipitating a clinical event. Alternatively, chronic, subclinical infection with certain organisms may be one of several potential underlying causes of the chronic inflammatory process of atherosclerosis. Both acute and chronic processes could occur together in any one individual, as well. Similarly, it should be taken into consideration if the infective process is localized or systemic. The presence of a chronic infection anywhere in the body, for example, could promote systemic pro-inflammatory changes, including monocyte and macrophage activation, cytokine release, hypercoagulability, or systemic changes in other mechanisms of atherogenesis, such as lipid metabolism. Direct vessel invasion and infection, alternatively, may contribute to local changes in the vessel wall that lead to atherogenesis, progression of plaque growth, or plaque rupture. Thus, if infections were shown to play an important role in the initiation or progression of atherosclerosis, the implications for clinical practice and stroke prevention would be significant. Although much of the data on the role of infection in atherosclerosis is based on association of organisms with atherosclerosis, and thus does not clearly provide proof of causality, more experimental data is becoming available from in vitro work, animal studies, and even clinical trials