Clinical registry for rheumatoid arthritis; a preliminary analysis

Objective: To establish a clinical registry for Rheumatoid Arthritis and delineate the most common symptoms that rheumatoid arthritis [RA] patients experience in our set up

Study Design: Cross sectional study

Place and Duration of Study: Study was carried out at Military Hospital [MH] Rawalpindi at Rheumatology Department during the period of Jan 2013 to Jun 2015

Material and Methods: A clinical registry for Rheumatoid Arthritis was developed as per criteria jointly developed by American College of Rheumatology [ACR] along with European League against Rheumatism [EULAR] [2010]. Fifty-eight patients were registered after their informed consent and approval by Military Hospital [MH] Rawalpindi ethical committee. Age, gender and relevant clinical parameters of RA patients were recorded on case report forms and stored for analysis in the RA registry in Excel 2010. The figures were reported in frequencies and percentages

Results: Multiple joint pains [48.28%], fever [24.14%], morning stiffness of joints [22.41%] were the most common symptoms in RA patients. Other clinical manifestations included painful bilateral swollen joints [13.79%], pain in different parts of the body [10.34%], Raynaud's phenomenon [10.34%], malaise [8.62%], swollen body parts [8.62%], ulcers [8.62%], fatigue [6.90%], nodules on skin/elbow/interphalangeal joints [6.90%], deformities of fingers/ hand [3.45%], redness of eyes [3.45%], body rash [3.45%], inability to walk [3.45%], cervical lymphadenopathy [1.72%], stiffness of spine [1.72%] and myalgias [1.72%]

Conclusion: It is concluded that multiple joint pains, fever and morning stiffness of joints are the most common symptoms of RA patients

Microbial spectrum of cardiac implantable electronic device infections - a tertiary cardiac center experience

The objective of the study was to determine the microbiological spectrum of cardiac implantable electronic device [CIED] infections. Case series Armed Forces Institute of Cardiology / National Institute of Heart Diseases AFIC/NIHD from January 2011 to Nov 2013. A total of 15 pus samples from patients with possible CIED infection out of 814 patients with implantable CIEDs were processed. Thirteen patients with positive cultures out of fifteen were included in the study. Clinical evidence of CIED infection included signs of inflammation and purulent drainage. A CIED infection was microbiologically confirmed based on culture yield. Blood cultures were carried out in all patients with suspected CIED infection along with trans-oesophageal echocardiography [TOE], wherever clinically indicated to exclude bacteremia and lead endocarditis. Sixty nine percent of patients with culture proven CIED infection were females and 31% were males. The mean age of patients was 61 years [range 53-70 years]. Devices included 11 PPMs, 1 ICD and 1 CRT. The most frequent organisms were gram-positive [77% of isolates]; with Coagulase-negative Staphylococci [CoNS] predominating in particular Methicillin Resistant Staphylococcus epidermidis [MRSE] in 46.4% cases followed by Methicillin Sensitive Staphylococcus epidermidis [MSSE] in 15%. Non tuberculous Mycobacterium fortuitium was isolated from pus in two patients; with PPM and ICD implants respectively. MRSA was isolated in only 01 PPM infection with evidence of lead endocarditis on TOE. Pseudomonas species was isolated from pus in one patient with CRT implant. CIED infections are more often caused by Staphylococci predominantly CoNS, although atypical Mycobacteria can be implicated

Microflora and antibiograms of discharging ears in a cross - section of population in Quetta, Balochistan

To study the micro flora and the antibiograms of patients with discharging ears due to Otitis externa / Otitis media in Quetta, Balochistan and to analyse and compare the results with other domestic and international studies. Prospective, descriptive study. Department of ENT, Combined Military Hospital, FC Hospital, Saleem Medical Complex and Mideast Hospital Quetta, from January 2003 to June 2005. The ear swabs of 1105 patients with otorrhoea were prospectively analyzed. Antibiotic testing was done using modified Kirby Bauer disc diffusion method. In addition to the usual antibiotics, the two most common topically available antibiotics [gentamicin and Ofloxacin] were also tested. There were 1057 positive cultures for organisms from the 1105 patients with 1125 isolates. The most common causal organisms isolated were staphylococcus aureus [40%] with 10.29% Methicillin resistant staphylococcus aureus [MRSA] positive followed by pseudomonas aeruginosa [38.4%]. Fungi accounted for 3.7% of isolates. Out of the two antibiotics commonly available as topical eardrops, Ofloxacin has a very high overall susceptibility rate [97.3%] to all organisms cultured. Staphylococcus aureus is the commonest organism, replacing pseudomonas aeruginosa in discharging ears. All the isolates cultured were highly sensitive to Ofloxacin / Ciprofloxacin. Thus apart from fungal infection of the ear Ofloxacin eardrops should be the mainstay of treatment

Onest of adult varicella in relation to rural or urban origin and its complications

To determine area of origin of adult varicella patients, whether rural or urban, to compare the mean interval between leaving the area of origin and onset of varicella in adults of rural origin in comparison with those of urban origin and to observe its complications. A cross-sectional study. Combined Military Hospital, Abbottabad, from January to December 2006. All patients over the age of 18 years, presenting with acute illness clinically, suggestive of varicella were included in the study. A specially designed proforma was filled for each patient separately, which included demographic features as well as area of origin, whether rural or urban, and the age at which they left the area of origin. These patients were examined, treated and assessed clinically on regular basis for the progress of the disease as well as for its possible local or systemic complications. Data analysis was done by using statistical programme SPSS-10. Out of 9155 adult patients, 156 [1.70%] had varicella, including 128 [82.1%] males and 28 [17.9%] females. Origin was rural in 125 [80.1%] and urban in 31 [19.9%] patients. Mean interval between leaving area of origin and developing varicella in those of rural origin was 01.79+01.78 years and that in patients of urban origin was 03.37+05.72 years [p+0.009]. None of the patients developed any complication of the disease. Varicella in adults is generally a benign illness. It is more common among adult males of rural origin and the interval between leaving the area of origin and onset of varicella in these patients is significantly less as compared to that in adults of urban origin

Seropositivity of hepatitis delta virus in patients with chronic Hepatitis B virus infection

To determine the frequency of hepatitis delta virus [HDV] seropositivity in patients with chronic Hepatitis B Virus [HBV] infection at Armed Forces Institute of Pathology [AFIP], Rawalpindi. Study design: Cross-sectional study. The study was conducted at department of Virology, AFIP, Rawalpindi. A total of 227 serum samples were collected at AFIP, Rawalpindi, from patients with chronic hepatitis B virus [HBV] infection along with a short history regarding the age, sex and socioeconomic status. Enzyme Linked Immundsorbent Assay [ELISA] for detection of HDV Immunoglobulin G [IgG] and Immunoglobulin M [IgM] antibodies was performed on all the collected serum samples. A total of 30 [13.2%] patients out of 227, were found positive for IgG. The mean age of the patients was 35.8 +/- 10.7 years. Seropositivity of HDV-IgG was 12.8% [25/195] in males and 15.6% [5/32] in females. 11.8% [6/51] of patients from higher socioeconomic group and 13.6% [24/176] in lower socioeconomic group were positive for HDV-IgG [p=0.728%]. Our study shows that 13.2% of chronic hepatitis B virus infected patients at AFIP, Rawalpindi, were positive for HDV IgG. HDV seropositivity was not affected by demographic variables-such as age, gender and socioeconomic status of patients

Hepatitis B viral load in various categories of chronic hepatitis B carriers

To determine serum hepatitis B virus [HBV] DNA levels by Real-time Polymerase chain reaction [PCR] in different categories of treatment-naive patients with chronic HBV infection in context with Hepatitis B serology and serum Alanine aminotransferase [ALT] levels. Cross-sectional study. A total of 122 chronic hepatitis B carriers, including 79 low grade carriers [Anti-HBe positive HBeAg negative], 40 high grade carriers [HBeAg positive, Anti-HBe negative] and 3 intermediate grade carriers [Both HBeAg and Anti-HBe negative] were evaluated for HBV DNA levels and serum ALT levels. The serum HBV DNA levels of the low grade carriers with normal ALT levels [<40 IU/L] were significantly lower than the low-grade carriers with raised ALT levels [mean viral load 3x10[3] vs. 1.6x10[6] copies/mL; p=0.0003]. The HBV DNA levels of the high grade carriers were significantly higher than those of the low grade carriers with normal ALT levels [mean viral load 6.4x10[7]vs. 3x10[3] copies/mL; p=0.0007] and than those of low grade carriers with raised ALT levels [mean viral load 6.4x10[7] vs. 1.6x10[6] copies/ mL; p=0.03]. The results show that HBV DNA levels vary in different categories of chronic hepatitis B carriers and when evaluated by a sensitive quantitative PCR assay the HBV DNA levels can be used for differentiation between HBeAg-negative chronic hepatitis B and inactive hepatitis B surface antigen carrier state