Primary sternal osteomyelitis: a case report and review of the literature

Primary sternal osteomyelitis is a rare clinical entity generally caused by Staphylococcus aureus or Pseudomonas aeruginosa. Although rare it carries significant morbidity including spread to mediastinal structures and even mortality. Diagnosis is generally made on clinical suspicion in a patient with and anterior chest pain and swelling, fever and raised inflammatory markers. Management is generally aggressive surgical debridement and intravenous antibiotics. Hyperbaric oxygen can be used where available and reconstructive options need to be considered in those with extensive dissection. Herein we report the case of a 55 year old male with no previous chest surgery or trauma who presented with primary sternal osteomyelitis

Anti-HCV antibody positivity of various sections of Pakistani patients

To determine the anti-HCV antibody status of various sections of the Pakistani population and patients as reported in various Pakistani studies. A meta-analysis. Department of Medicine, Rawalpindi Medical College and Allied Hospitals, Rawalpindi, from July 2007 to July 2008. Data pertaining to anti-HCV antibody status of various sections of the Pakistani population and patients was collected from studies published till July 2008. To note anti-HCV antibody status, 15 groups of subjects like liver disease patients, general blood donors, adult screening, and community prevalence etc. were identified. The frequency of total and anti-HCV antibody positive subjects of each group was noted. Chi[2] was used as test of significance for comparison wherever appropriate. Data from 183 studies was collected; 1004391 subjects anti-HCV antibody status was retrieved. 4.27% [n=42982] of these were anti-HCV antibody positive. Major bulk of patients with liver disease [56.9%], 2.71% of general and 10.39% of professional blood donors groups were positive, [p < 0.05]. Positivity in community and adult screening was 11.52 and 6.29% respectively. According to the studies in consideration; 2.71% of Pakistani general blood donors and major bulk of liver disease patients are anti-HCV positive. Community based anti-HCV positivity is 11.52%

Bouveret's syndrome

Gastric Outlet Obstruction [GOO] due to impaction of a gallstone in the duodenum after migration through a bilioduodenal fistula is known as Bouveret's syndrome. Its clinical symptoms are entirely vague and nonspecific. Because of its rarity, insidiousness and unpredictable symptomatology, Bouveret's syndrome is never thought of in the differential diagnosis as aetiology of gastric outlet obstruction. Recent advances in fiberoptics technology, advent of modern imaging modalities and minimally-invasive techniques like endoscopy and laparoscopy has brought a great revolution in the management of Bouveret's syndrome and have tremendously decreased morbidity and mortality associated with this rare clinical entity

Combined persistent Mullerian duct syndrome, transverse testicular ectopia and mosaic Klinefelter's syndrome

Persistent Mullerian Duct Syndrome [PMDS], a rare form of male pseudohermaphroditism, is characterized by the persistence of Mullerian duct structures [uterus, fallopian tubes and upper two-thirds of vagina] in otherwise normally-virilized males [Karyotype 46XY]. Patients suffering from PMDS present with cryptorchidism, inguinal hernia and infertility. Diagnosis is established when Mullerian duct structures are discovered either during ultrasonography for localization of undescended testis[s], during surgical exploration for cryptorchidism or herniorrhaphy [hernii uteri inguinalis]. Presence of both testes on one side of the scrotum is known as Transverse Testicular Ectopia [TTE]. Co-existence of PMDS and transverse testicular ectopia in a patient of mosaic Klinefelter's syndrome [Karyotype 46XY/47XXY] is a unique genetic association

Obesity related compications in 100 obese subjects and their age matched controls

To note obesity related complications in subjects of age range 50-59 years. A case control study was conducted at Medical Unit of District Headquarters Hospital, Rawalpindi for 6 months. Hundred obese subjects in the age range 50-59 years and their age matched non-obese 100 controls were included consecutively from general population. Obese subjects had body mass index [BMI] >30Kg/m2. Controls had BMI of 18.5-22.9Kg/m2 and normal waist hip ratio. Obesity related complications i.e., hypertension, diabetes mellitus, ischemic heart disease, stroke, hyperlipidemia, gall stones, varicose veins, psychological problems, sleep related problems, and degenerative arthritis, were sought in all subjects. Waist hip ratio was noted as measure of central distribution of body fat in obese subjects. Of the 200 subjects, 59% [n=118] were female and 41% [n=82] male. Of the obese subjects 74% and 44% of non-obese controls were female. Mean age of obese subjects and their controls was 54.4'3.22 and 54.57'3.54 years respectively. Central obesity was noted in 84% of obese subjects. Hyperlipidemia [87%], hypertension [71%], diabetes mellitus [65%], gallstones [57%], ischaemic heart disease [49%], osteoarthritis [46%], and sleep disorders [35%] were significant [p<0.05] obesity related complications. Hyperlipidemia, hypertension, diabetes mellitus, gallstones, ischaemic heart disease, osteoarthritis and sleep disorders are common obesity related complications in subjects of age range 50-59 years

Extracorporeal shock wave lithotripsy

To determine the outcome of patients undergoing extracorporeal shock wave lithotripsy [ESWL] for treatment of upper urinary tract calculi [renal and ureteric], and to note role of double-J [DJ] stents in these patients. A cross-sectional analytical study. Department of Urology, Rawalpindi General Hospital, Rawalpindi, from February 1999 to July 2001. Record of patients who underwent ESWL for renal and ureteric stones was retrieved and analyzed using statistical program, SPSS version-10 and Epi-Info 2000. In some patients pre-ESWL DJ stents were placed because of various reasons like solitary kidney, large stone volume etc. Patients were divided in two groups, Group I, in whom DJ stents were not placed, and Group II, in whom DJ stents were placed. ESWL was performed in each subject in standard way employing piezoelectric lithotripter E.D.A.P. LT 02X. Patients were evaluated for stone clearance fortnightly with X-ray or ultrasound. Four hundred and thirty-two patients, 68.8% male and 31.2% female, underwent ESWL. Mean age of patients was 37.7 ' 13.1 years. Majority of patients [78.47%, n=339] had renal, while rest had ureteric stones. Group I and II included 408 [94.4%] and 24 [5.6%] patients respectively. Renal stones were present in 78% [n=318] of Group I and 87.5% [n=21] of Group II patients. Mean size of stones in Group I and II patients was 10.91 ' 4.6, and 10.4 ' 4.7mm. Stone clearance was 96.3% and 100% in Group I and Group II patients respectively. Significantly more ESWL sessions were required for stone clearance in Group II [p-value 0.03]; in addition Group II patients had significantly more complications [p-value 0.01]. ESWL is an effective procedure. Pre-ESWL stenting is associated with increased numbers of ESWL sessions and more complications

Characteristic features of 50 NAFLD patients

Objective: To note characteristic features of patients with nonalcoholic fatty liver disease [NAFLD] diagnosed on ultrasound basis

Design: Descriptive

Place and duration of study DHQ Teaching Hospital, Rawalpindi, from January to June 2003

Materials and Methods: Fifty NAFLD patients diagnosed on ultrasonographic findings were inducted consecutively. Patients with conditions associated with secondary NAFLD were excluded. Clinical and laboratory evaluation of each patient was done to note presence or absence of obesity, hepatomegaly, cholesterol and triglyceride levels, and diabetes mellitus. Obtained data was analyzed using statistical program, SPSS version 10

Results: Of the 50, 54% were female and 46% male. Mean patient age was 42.78 +/- 12.29 years. 66% patients were obese, 56% had hepatomegaly, 28% had elevated cholesterol, 72% had hypertriglycedemia, and 44% were diabetic. All of these features except for hypercholesterolemia were common in females

Conclusion: Obesity, hepatomegaly, diabetes, and hypertriglycedemia are characteristic features of our NAFLD patients that are more common in females