Dengue fever; a clinical experience

Dengue is the most prevalent mosquito-born viral illness in the world. Clinically dengue ranges from asymptomatic, non-febrile illness, classic dengue to dengue hemorrhagic fever/dengue shock syndrome. This study was included 79 patients conducted at Nawaz Sharif Social Sevurity Hospital, Lahore during the epidemic of dengue in Lahore from September 2011 to Dec 2011. Twenty out of 79 patients suspected of dengue fever were dengue IgM positive. Male to female ratio was 1.19: 1. Our study included 79 patients suspected of having dengue fever. Fever was the most common symptom in these patients. Early identification of dengue with risk of developing hemorrhage is an important clinical objective. The morbidity and mortality can be reduced by appropriate and judicious treatment of dengue patients

Brain abscess in cyanotic congenital heart disease: a preventable complication with heavy financial burden and poor outcome

To evaluate the financial burden and outcome of the children with brain abscess and underlying congenital cyanotic heart disease. To emphasize the need of early diagnosis and surgery of congenital cyanotic heart disease. Cross Sectional Descriptive Study. This study was conducted at the department of paediatric cardiology The Children's Hospital and The Institute of Child Health, Multan from February 2010 to January 2012. All the patients presenting with brain abscess and having underlying congenital heart disease were included in the study. All the patients underwent transthoracic echocardiography and computed tomography [CT] scan of the brain. Data was taken on a written proforma after proper consent. A total of 58 patients with cyanotic congenital heart disease presented with CNS manifestations including headache, fever, focal neurological signs, fits or altered sensorium during the study period. Out of these 24 turned out to have brain abscess. Multiple brain abscesses were found in 7 patients. All the patients were given broad spectrum IV antibiotics. 19 of the patients required surgical intervention. Repeat CT scan was performed in all the patients. Only 5 patients recovered without any neurological sequalae. 7 patients expired during hospital stay. All of the remaining 12 patients survived but with some permanent neurological deficit. IV antibiotics, supportive treatment, CT scan, other laboratory investigations and surgery, all have a lot of cost. Around 1500 to 2000 US [dollar sign], on an average, were spent by the government on one patient during hospital stay. The only way to avoid CNS complications of CCHD is early diagnosis and early surgical treatment. But unfortunately, in this country because of lake of paediatric cardiology services and deficiency of paediatric cardiac surgery centers, corrective surgery of congenital cyanotic heart disease is delayed. It increases the risk of brain abscess formation which in turn leads to excessive financial burden on government resources and also increases the risk of long term neurological sequalae. Establishment of more and more paediatric cardiac surgery centers in this country is urgently required

Type and severity of valvular involvement in pediatric rheumatic heart disease patients

To assess frequency and severity of type of valvular involvement in pediatric patients with Rheumatic Heart Disease. This descriptive study was conducted in the Department of Pediatric Cardiology Children Hospital Complex, Multan from April 2008 to April 2010. The data of all pediatric patients below 15 years of age undergoing detailed cardiac evaluation including ECG, X-Ray and Echocardiography were reviewed. Only new cases of Rheumatic Heart Disease were studied for type and severity of valvular involvement. The data was analyzed using SPSS version 13. A total of 2381 echocardiograms were performed during the study period. 190 [08%] patients were diagnosed as having Rheumatic Heart Disease. Mitral regurgitation was the commonest lesion: In 148 [77.9%] patients mitral regurgitation was found either alone [104, 54.7%] or in combination [44, 23.2%] with other lesions. In 50 [26.3%] patients aortic regurgitation was found either alone [06, 3.2%] or in combination [44, 23.2%] with other lesions. Mitral stenosis was found in only 14 [7.4%] patients. No patient had Rheumatic tricuspid or pulmonary valve. Amongst mitral regurgitation patients 54 [28.4%] had severe MR, 76 [40%] had moderate MR and 18 [9.5%] had mild MR. Amongst aortic regurgitation patients 06 [3.2%] had severe AR, 18 [9.5%] had moderate AR and 26 [13.7%] had mild AR. The commonest combination lesion was MR + AR which was found in 44 [23.2%] patients. The commonest valve involved in patients with Rheumatic Heart Disease was mitral valve followed by aortic valve. Regurgitant lesions are much more common in our younger age group patients as compared to the adult Rheumatic patients in whom mitral stenosis is usually the common lesion