Pathology of high altitude pulmonary oedema

To describe autopsy findings in fatal cases of high altitude pulmonary oedema. Descriptive study. The study was carried out between 1999 and 2002 at an army field medical unit in Baltistan, Armed Forces Institute of Pathology, Rawalpindi and Army Medical College, Rawalpindi, Pakistan. Autopsies were performed in 17 fatal cases of High Altitude Pulmonary Edema [HAPE] occurring among soldiers serving in Siachen. All cases were males with a mean age of 26.8 years [19-35]. The mean altitude at which HAPE occurred was 5192 meters [2895-6492], and the mean duration of stay at these altitudes was 15.3 days [1-30]. Eleven individuals had undergone proper acclimatization. The commonest clinical findings were cough [70%] dyspnoea [53%], nausea [47%], headache [41%], vomiting [35%], chest pain [35%] and tightness in chest [24%]. Cyanosis and frothy secretions in the nostrils and mouth were present in all but one case. Mean combined weight of lungs was 1470 grams [1070-1810]. There was marked congestion of outer and cut surfaces. Interstitial oedema was present in all cases. RBCs and leukocyte infiltrates were seen in 13 and alveolar hyaline membranes in 9 cases. Thrombi were seen in 2 cases. Cerebral oedema was present in 9 cases. HAPE can occur after more than two weeks of stay at high altitudes despite proper acclimatization. Concomitant cerebral oedema is frequently present. Our autopsy findings are consistent with what has been reported previously

End of treatment response in chronic hepatitis C patients treated with interferon alpha and ribavirin

We conducted a study at Combined Military Hospital [CMH], Sialkot, from August 2010 to February 2011 with the objective to determine the frequency of early and end of treatment virological response in patients with chronic hepatitis C infection treated with IFN-alpha / ribavirin therapy. HCV RNA PCR positive adult patients of either gender were included in the study. A total of 123 patients [56 males and 67 females] were given alpha-interferon ribavirin for 24 weeks. At 12 weeks post-treatment, 82 patients out of 123 [EVR 66.6%] had negative HCV RNA PCR while 85 patients out of 123 were HCV PCR negative at 24 weeks [ETR 69.1%]. Conventional alpha-interferon ribavirin therapy should discontinued in patients who are non responders at 12 weeks of treatment and be offered pegylated interferon to save time, money and minimize the side effects

Brucella melitensis presenting as erythema nodosum-like lesions

Brucellosis is a chronic granulomatous zoonosis with protean manifestations. Cutaneous involvement in Brucellosis is a relatively rare phenomenon. We describe a case of Brucella melitensis infection presenting with erythema nodosum like skin lesions involving palms and soles in a 70 years old lady

Pattern of systemic fungal infections and antimicrobial susceptibility of isolates in cancer patients

Fungal pathogens are implicated as an important cause of morbidity and mortality in cancer patients. In Pakistan the pattern of systemic fungal infections in cancer patients is not known. The present study was done to determine the pattern of systemic fungal infections and antimicrobial susceptibility of fungal isolates in cancer patients in Rawalpindi. It is a non-interventional descriptive study carried out from May to October 2003 at the Armed Forces Institute of Pathology, Rawalpindi. Blood, urine, stool and sputum specimens were collected for culture isolation of fungi from 73 febrile cancer patients. Antifungal susceptibility of the isolates to amphotericin B, fluconazole and itraconazole was determined by Etest and broth macrodilution technique. Forty-five fungi were isolated from 28 patients. Twenty isolates were Candida albicans, 21 were non-Candida albicans yeasts: C. tropicalis [n=13], C. glabrata [n=5], C. kefyr [n=3], Rhodotorula rubra [n=1] and three were Aspergillus fumigatus. All the isolates of C. albicans were susceptible to itraconazole; one was resistant to fluconazole while 3 isolates showed intermediate resistance to amphotericin B. The non-Candida albicans were generally more resistant: all the isolates of C. kefyr were resistant to amphotericin B, two isolates of C. tropicalis were resistant to fluconazole and three isolates of C. glabrata were resistant to itraconazole. Isolates of A. fumigatus were susceptible to amphotericin B but resistant to fluconazole. Systemic fungal infections in cancer patients by non-Candida albicans are on the rise and they are generally more resistant than C. albicans. Antifungal susceptibility testing must be performed in these cases in order to improve survival and decrease morbidity. Itraconazole can be used for prophylaxis of fungal infections in these patients

update on the diagnosis of tuberculosis

Tuberculosis [TB] continues to be the bane of mankind. Early diagnosis is the cornerstone of tuberculosis control strategies. Recent years have seen major advances in the fields of biotechnology and molecular biology with introduction of several new diagnostic techniques for tuberculosis and improvement in the existing ones. The new automated culture techniques have appreciably reduced the time required for detection and antimicrobial susceptibility testing. The molecular amplification techniques like the Polymerase Chain Reaction [PCR] have made the same-day diagnosis a reality. Improvements in serology and introduction of novel new techniques like the bacteriophage assays have also shown a lot of promise. However, most of these new techniques are too expensive and sophisticated to be of any practical benefit to the vast majority of TB patients living in underdeveloped countries like Pakistan for whom an early and inexpensive diagnosis remains as elusive as ever. In this article various existing modalities as well as the new advances in TB diagnostics are reviewed