Lupus catatonia in a young girl who presented with fever and altered sensorium

We report a case of 20 Years old girl who presented with catatonia resulting from cerebral lupus. There are few cases of catatonia being described in Systemic Lupus Erythmatoses [SLE]. The patient presented to us with fever and altered sensorium. She was initially treated on lines of Acute Bacterial Meningitis/encephalitis but lumbar puncture examination and CT scan showed no evidence of these conditions. Patient's behavior was also not improved after this treatment and she further deteriorated in the sense that she exhibited mutism, negativism and psychosocial withdrawal. Psychiatric analysis was done and she was found to be having catatonia and on further investigation came out to be a case of SLE. Keeping in mind her previous history of joint pains, oral ulcers and alopecia her autoimmune profile such as ANA and dsDNA was done that came out to be positive. Patient responded to treatment with steroids, Hyroxychloroquine and azathioprine in addition to clonazepam and fluoxetine for her catatonic behavior. Thus this case history illustrates the importance of considering organic disease in patients presenting with catatonia

Correlation between microalbuminuria and hypertension in Type 2 diabetic patients

Hypertension is commonly found in patients with Diabetic Kidney Disease [DKD]. Microalbuminuria is the first clinical sign of involvement of kidneys in patients with type 2 diabetes. Uncontrolled hypertension induces a higher risk of cardiovascular events, including death, increasing proteinuria and progression to kidney disease. To determine the correlation between microalbuminuria and hypertension and their association with other risk factors in type 2 diabetic patients. One hundred and thirteen type 2 diabetic patients attending the diabetic clinic of Shaikh Zayed Postgraduate Medical Institute, Lahore, Pakistan were screened for microalbuminuria and raised blood pressure. The study was conducted from November 2012 to June 2013. Patients were divided into two groups. Group 1, those with normoalbuminuria [n=63] and Group 2, those having microalbuminuria [n=50]. Group 2 patients showed higher blood pressure values as compared to Group 1. The results were statistically significant and showed poor glycemic control as a contributing risk factor. The study concluded that there is high frequency of hypertension among type 2 diabetics but still much higher among those having microalbuminuria. So, early recognition of renal dysfunction through detection of microalbuminuria and to start treatment without any delay will confer future protection from end stage renal disease as well as hypertension and its complications in type 2 diabetic patients

Prevalence of microvascular complications in newly diagnosed patients with type 2 diabetes

Microvascular complications are the major outcome of type 2 Diabetes Mellitus progression, which reduce the quality of life, incur heavy economic burdens to the health care system and increase diabetic mortality. The aims of this study were to assess the prevalence of microvascular complications among newly diagnosed type 2 diabetic patients and to analyze the association between these complications and poor glycemic control. This cross sectional hospital based study was carried out in Diabetic Clinic of Shaikh Zayed Postgraduate Medical Institute, Lahore Pakistan. The study was conducted from November 2011 to November 2012 among newly diagnosed type 2 diabetic patients. Relevant information of all patients was recorded with the help of a proforma. They were investigated for retinopathy, nephropathy and neuropathy. We have divided the patients into two groups: Group I with good glycemic control [HbA1c < 6.5] and group II with poor glycemic control [HbA1c > 6.5]. In group II microvascular complications were 89.8%. Neuropathy, nephropathy and retinopathy were present in 68.5%, 56.2% and 31.4% respectively. These similar percentages in Group I were 50%, 0% and 31% respectively and are significantly lower. The study showed that even in newly diagnosed type 2 diabetic patients who had poor glycemic control, frequency of microvascular complications is much higher as compared to those who had average glycemic control. Thus tight glycemic control does count even in newly diagnosed type 2 diabetics to prevent and minimize the occurrence of complications

Dermatological manifestations of dengue fever

Each year dengue related infections are rising in tropical countries. There is not enough data available on dermatological manifestations of dengue fever. This study was conducted to investigate prevalence and type of dermatological manifestations of dengue fever [DF], Dngue Haemorrhagic Fever [DHF], and Dengue Shock Syndrome [DSS]. A Prospective study was contacted in Department of Medicine, Shaikh Zayed Hospital, Lahore, from 3[rd] Oct to 20[th] Nov 2010. Specific serological tests for DF were done in all 60 patients admitted with suspected diagnosis of DF, DHF or DSS. Forty-eight confirmed cases were evaluated for age, gender, mucocutaneous features and outcome of the disease. Forty-eight out of 60 patients had positive serology for dengue fever. Male to female ratio was 1.09:1. Their ages ranged 5-68 years with a mean of 31.5 +/- 15.2. DF, DHF and DSS were found in 71%, 19% and 10% respectively. Common dermatological presentations were oral mucous membrane congestion [66.67%], generalised morbiliform rash [64.58%] and eye congestion [64.58%]. Purpuric spots along with mucous membrane congestion, generalised morbiliform rash and eyes congestion was observed in 20.83%, 12.5% and 6.25% patients respectively. All except one patient improved clinically. One patient died of respiratory distress and haemorrhage on second day of admission. Dermatological features are significantly noticeable in dengue fever patients. These may help us in early diagnosis and better management of patients.

Clinical characteristics of patients with dengue fever: report of 48 patients in 2010

Dengue fever is a mosquito born viral disease. It occurs in tropical and sub-tropical areas of the world. Symptoms appear 3-14 days after the infective bite. Mortality can occur in dengue hemorrhagic fever and dengue shock syndrome unless prompt and adequate management is provided. To determine the clinical and epidemiological characteristics along with outcome of patients with dengue fever [DF] dengue hemorrhagic fever [DHF] and dengue shock syndrome [DSS]. Prospective, follow-up study. Department of Medicine, Shaikh Zayed Federal Postgraduate Medical Institute, Lahore from 3rd Oct 2010 to 20th Nov 2010. Specific serological tests for dengue fever were done in all 60 patients admitted with suspected diagnosis of DF, DHF and DSS. Forty-eight confirmed cases were evaluated for age, gender, clinical features and outcome of the disease. Forty-eight out of 60 patients had positive serology for dengue fever. Male to female ratio was 1.09:1. Their ages ranged from 5 years to 68 years with the mean of 31.5 +/- 15.2 years. DF, DHF and DSS were found in 71%, 19% and 10% cases respectively. Common presentations were fever [100%], skin rash [83.33%], myalgia [69.75%], restlessness [66.67%] and rigors and chills [66.67%]. All, except one patient improved clinically. One patient died on second day of admission. Dengue fever, a viral infection is re-emerging as a serious public health problem. Fever, rash, myalgia with rigors and chills were common presenting features

Interferon alfa and ribavirin induced hair changes

Combination therapy of lnterferon alfa and ribavirin in chronic hepatitis C has well documented cutaneous adverse effects. Most interesting of these has been reported on hair physiology. This study was conducted to determine the frequency and pattern of adverse effects involving hair in patients receiving combination of interferon alfa 2a and ribavirin for chronic hepatitis C. The study was conducted in Department of Dermatology, Division of Medicine Shaikh Zayed Hospital. Thirty Eight patients who completed treatment with interferon alfa 3 MIU subcutaneously thrice weekly] and 1200 mg ribavirin daily for 24 weeks were enrolled in this single-center study. The patient's response and examination finding particularly regarding involvement of hair was noted on a Pro forma. Thirty Two out of thirty eight [84%] patients noted adverse effects involving hair. The most frequent was diffuse hair loss and occurred in 27 patients [71 %]. Hypertrichosis of eyelashes [trichomegaly] and eyebrows [synophyrs] was observed in 18 [47%] and 16 [42%] patients respectively. Graying of hair was noted in 4 patients [11 %], while discoloration of moustache hair was seen in 2 patients [5%]. Epilation at the site of subcutaneous injection was noted in 10 patients [26%]. Alopecia areata was reported in 2 patients [5%]. It is concluded that adverse effects involving hair are frequent and varied [hair loss to excess hair growth] during combination therapy with Interferon alfa-2a and Ribavirin for chronic hepatitis C

Extra intestinal manifestations of irritable bowel syndrome

Objectives: This study was done to assess the frequency of extra intestinal features present in patients with irritable bowel syndrome

Design and place of study: It was an observational study conducted in out-patient Department of Medicine, Shaikh Zayed Hospital, Lahore affiliated with Federal Postgraduate Medical Institute, over a period of two years from January 2005 to December 2006

Subject and methods: The patients fulfilling the Rome II criteria of IBS were included in the study. A check list of extra intestinal symptoms was administered to all the patients

Results: A total of 63 patients were included in the study. There were 41 men and 22 women [male to female ratio of 1.86: I] with the age range from 18 to 61 years [mean of 33 .09 +/- 8.5 SD]. The mean duration of disease was 2.78 years. Urinary symptoms like frequency and urgency were present in almost one third of patients. These symptoms were more frequent in men [47%] than in women [33%]. The most common non-specific pain was chronic headache [62%] followed by fibromyalgia [43%] and non-specific chest pain [37%] of all cases. All of these non-specific pain symptoms were more common in women. Dysmenorrhoea [45%] was the commonest genitourinary symptom in women while impotence and premature ejaculation each were seen in 7% of men. As a group sexual and genital symptoms were more common in women than men

Conclusion: Majority of the IBS patients along with intestinal symptoms also suffers from extra intestinal complaints. Therefore, these patients should be actively screened for the presence of these extra intestinal complaints so that a timely multidisciplinary intervention may prevent further prolongation of their misery

Frequency of posttraumatic stress disorder symptoms in earthquake survivors

Objectives: This study was done to assess the frequency of symptoms of Posttraumatic Stress Disorder in earthquake survivors

Design and place of study: It was an observational study conducted on in-patient survivors of Oct 8. 2005 earthquake, admitted in different departments of Shaikh Zayed Hospital, Lahore affiliated with Federal Postgraduate Medical Institute

Subject and methods: The patients who had received different physical injuries and their surviving attendants were administered with a check-list of symptoms of Posttraumatic Stress Disorder [PTSD] diagnostic criteria of DSM-IV

Results: A total of 124 survivors [85 patients and 39 attendants] were identified and administered with the check-list. In all 52 [41.94%] of the survivors, 38 [44.77%] of patients and 14 [35.90%] of the attendants fulfilled the entire DSM-IV symptom criteria for PTSD. Among the patients more females i.e. 27 [52.94%] as compared to males i.e. 11 [32.32%] fulfilled the symptom criteria for PTSD

Conclusion: Posttraumatic Stress Disorder symptoms are very common in the survivors of an earthquake, an evidence to sensitize health care providers to organize and implement timely psychosocial assessment and interventions