Eleven-year-old-girl with membranous sore throat

Diphtheria is caused by Corynebacterium diphtheriae primarily affecting mucous membrane of upper airways. Global incidence of diphtheria has reduced due to worldwide immunization programs. Yet cases of diphtheria are reported across the world because of poor vaccine coverage, large population and low socio economic status. We report here a case of diphtheria in an 11-year-old girl who presented with fever, sore throat, difficulty in swallowing and hoarseness of voice for 3 days. Hematological analysis showed neutrophit leukocytosis with normal lymphocytes, CRP was raised, cardiac profile, renal function test, hepatic functions and chest x-ray were normal. Microscopy of throat swab revealed rods containing metachromatic granules .on Albert stain. Intramuscular penicillin was started and diphtheria antioxin was administered. The child recovered uneventfully and was kept on follow up

Niacin is a major drug for lowering LDL-Cholesterol

Objective: Study was planned to examine the effects of Niacin [Vitamin B-3] on serum LDL Cholesterol levels

Patients and Methods: Study was conducted at department of Pharmacology, Basic Medical Sciences Institute [BMSI], Jinnah Postgraduate Medical Centre [JPMC], Karachi, from January 2002 to July 2002. Forty hyperlipidemic patients were included, among which 20 patients were on placebo as control group and 20 were on tablet Niacin, 2 gram daily, in divided doses for a period of three months. Patients with diabetes mellitus, peptic ulcer, renal disease, hepatic disease, hypothyroidism and alcoholism were excluded from the study. Serum LDL-cholesterol was calculated by Friedwald formula [LDL-Cholesterol Total Cholesterol-[Triglycerides/5 +HDL-Cholesterol] described by Delong et al [1986] and Beamount et al [1970]. Data were expressed as the mean +/- SD and "t" test was applied to determine statistical significance of the difference. A probability value of <0.05 was the limit of significance

Results: Three patients were dropped from the study due to side effects of Niacin. Niacin decreased the levels of LDL-Cholesterol froml82.58+/-8.74 mg/dl to 119.29+/-4.08 mg/dl, which was highly significant [p<0.001], when compared statistically by paired "t" test. Overall percentage [%] changes from day-0 to day-90 were -34.66

Conclusion: Niacin decreases the risk of CHD by decreasing LDL-Cholesterol

Right vertebral artery: anomalous prevertebral course and distribution

Vertebral artery [VA] is the largest branch of the first part of the subclavian artery and the chief source of blood supply to brainstem, cerebellum, occipital lobe of cerebrum and posterior cranial fossa. Anomalous origin, course and / or branching pattern of VA may lead to disturbance in vertebro-basilar hemodynamics, risking cerebro-vascular insufficiency. A unique case of right VA having usual origin, but anomalous course and branching pattern in its prevertebral segment is described. Moreover the right thyrocervical trunk was absent in present case and inferior thyroid artery branched off the variant VA. The ligation of such vertebral artery may cause a compromise to thyroid in addition to posterior cranial fossa blood supply. The information about its course is crucial during diagnostic investigations and surgical procedures in the head and neck region