Dengue Virus Serotypes Circulating in Khyber Pakhtunkhwa Province, Pakistan, 2013-2015

From 2013 to 2015, the National Institute of Health, Pakistan, received 1,270 blood samples of suspected dengue cases reported from inpatient and outpatient departments of various hospitals in Khyber Pakhtunkhwa (KPK) province. In this study, we determined the circulating dengue virus (DENV) serotypes using real-time reverse transcriptase (RT)-PCR to understand the serotype-based epidemiology of DENV. All four serotypes (DENV-1 [6%], DENV-2 [33%], DENV-3 [47%], and DENV-4 [0.1%]) were found circulating during the study period. Our findings suggest the need for an active surveillance system coupled with the laboratory diagnosis, especially in the chronic endemic areas of the country. Public awareness programs are needed for effective control and prevention of outbreaks in the future.

prospective, split-face, randomized, open-label study comparing efficacy of trichloroacetic acid [100%] and cryotherapy in xanthelasma palpebrarum

Objective To compare the clinical efficacy of trichloroacetic acid [TCA] 100% and cryotherapy in xanthelasma palpebrarum [XP]

Methods 40 patients fulfilling the inclusion criteria were treated with cryotherapy on right eye [group A] and TCA on left eye [group B]. Patients were followed up for 6 weeks and final outcome variable of efficacy i.e. complete resolution of xanthelasma was assessed at 6 weeks. Adverse side effects of therapy were also recorded as secondary outcome variables. Data were analyzed by SPSS 19.0

Results Mean age of patients was 43.75 +/- 5.90 years and age ranged from 34 to 56 years. Out of 40 patients 9 [22.5%] were male and 40 [77.5%] were female. Complete resolution of xanthelasma was seen in only 7 [17.5%] in group A, while complete resolution of lesions was seen in 30 [75%] of patients in group B [p = 0.000]

Conclusion A single session of 100% TCA is highly effective than cryotherapy in the treatment of Xanthelasma palpebrarum

Dengue outbreak in Swat and Mansehra, Pakistan 2013: An epidemiological and diagnostic perspective

Objective: To high light some epidemiological, clinical and diagnostic features of dengue fever during an outbreak and the role of different diagnostic techniques to achieve the highest level of accuracy in results. Methods: Blood samples (n = 323) were collected along with epidemiological and clinical data from suspected dengue patients who visited different hospitals in Swat and Mansehra district of Pakistan between May-November 2013 during a dengue outbreak. Samples were tested for the detection of viral nucleic acid by real-time PCR, non structural protein-1 (NS1) antigen and IgM antibodies by ELISA. Results: Out of 323 cases with clinical dengue infection, 304 were positive by one or more diagnostic parameter; 201 samples were positive by real-time PCR, 209 were positive by NS1 ELISA and 190 were positive by IgM antibodies. Sensitivities of real-time PCR and NS1 ELISA were comparable for early diagnosis of dengue virus infection, IgM antibody detection assay was found useful for the diagnosis in the samples collected later than day 5 of onset. Conclusions: The use of real-time PCR or detection of non structural protein NS1 by ELISA followed by IgM antibodies detection can be recommended for early diagnosis of dengue virus infection with a high level of accuracy.

NS1 antigen: A new beam of light in the early diagnosis of dengue infection

Objective To evaluate NS1 antigen detection ELISA for the early laboratory diagnosis of dengue virus infection. Methods The present study was conducted to evaluate the overall positivity of NS1 antigen detection ELISA and its comparison with viral RNA detection via real time PCR and IgM antibodies detection by ELISA. Results A total of 1270 serum samples were tested 86% (1097/1270) were detected positive by one or more than one diagnostic test. Out of 1 270, 64% (807/1270) were positive by NS1 ELISA and 52% (662/1270), 51% (646/1270) were positive by real-time RT-PCR and IgM ELISA respectively. Conclusions NS1 antigen detection ELISA is highly suitable diagnostic tools and it also has great value for use in outbreak and epidemic situation.

Dengue outbreak in Swat and Mansehra, Pakistan 2013: An epidemiological and diagnostic perspective

OBJECTIVE@#To high light some epidemiological, clinical and diagnostic features of dengue fever during an outbreak and the role of different diagnostic techniques to achieve the highest level of accuracy in results.@*METHODS@#Blood samples (n = 323) were collected along with epidemiological and clinical data from suspected dengue patients who visited different hospitals in Swat and Mansehra district of Pakistan between May-November 2013 during a dengue outbreak. Samples were tested for the detection of viral nucleic acid by real-time PCR, non structural protein-1 (NS1) antigen and IgM antibodies by ELISA.@*RESULTS@#Out of 323 cases with clinical dengue infection, 304 were positive by one or more diagnostic parameter; 201 samples were positive by real-time PCR, 209 were positive by NS1 ELISA and 190 were positive by IgM antibodies. Sensitivities of real-time PCR and NS1 ELISA were comparable for early diagnosis of dengue virus infection, IgM antibody detection assay was found useful for the diagnosis in the samples collected later than day 5 of onset.@*CONCLUSIONS@#The use of real-time PCR or detection of non structural protein NS1 by ELISA followed by IgM antibodies detection can be recommended for early diagnosis of dengue virus infection with a high level of accuracy.

NS1 antigen: A new beam of light in the early diagnosis of dengue infection

OBJECTIVE@#To evaluate NS1 antigen detection ELISA for the early laboratory diagnosis of dengue virus infection.@*METHODS@#The present study was conducted to evaluate the overall positivity of NS1 antigen detection ELISA and its comparison with viral RNA detection via real time PCR and IgM antibodies detection by ELISA.@*RESULTS@#A total of 1270 serum samples were tested 86% (1097/1270) were detected positive by one or more than one diagnostic test. Out of 1 270, 64% (807/1270) were positive by NS1 ELISA and 52% (662/1270), 51% (646/1270) were positive by real-time RT-PCR and IgM ELISA respectively.@*CONCLUSIONS@#NS1 antigen detection ELISA is highly suitable diagnostic tools and it also has great value for use in outbreak and epidemic situation.

Nature of oral biopsies; Liaquat university hospital hyperabad

Biopsy is the removal of a tissue sample from a living body with the objective of providing the pathologist with a representative, viable specimen for histopathologic interpretation and diagnosis. Objectives: To find out frequency and nature of oral biopsies reported at liaquat university hospital Hyderabad. Design: Descriptive/Cross sectional. Period: 1st February 2012 to 31st January 2014 Setting: Oral and Maxillofacial Surgery Department, Liaquat University Hospital Hyderabad. Material and Methods: A total of 180 patients were reported at OPD and Oral and Maxillofacial Surgery ward of Liaquat University Hospital for oral incisional, excisional and punch biopsy purpose. Study design was descriptive/cross sectional study. All patients were treated both under general anesthesia as well as local anesthesiaandsedation. All the biopsies were sent to histopathology department for confirmation of diagnosis. Results:119 patients [66.1%] were males and 61 patients [33.8%] were females with age range from 10-80 years. Malignancy was diagnosed in 80 patients [44.4%] while odontogenic cysts were diagnosed as second common category with 38 patients [21.1%]. Conclusions: Squamous cell carcinoma was diagnosed as the most common malignant lesion which is rising danger to the society specially as the age advances.

Postherpetic pseudohernia of abdominal wall: a case report

Herpes zoster is a common disease of the dorsal root ganglia and sensory nerve fibers, clinically characterized by unilateral painful vesicular eruption of the skin in a dermatomal distribution. Segmental motor weakness is a rare complication that occurs in 0-5 percent of patients and is associated with an excellent prognosis for recovery. We herein, present a case of herpes zoster complicated by segmental motor paresis of abdominal musculature resulting in pseudohernia. This rare complication of herpes zoster, with an excellent prognosis for recovery, should be recognized by dermatologists and surgeons as it can save costly consultations and evaluations

Efficacy of clarithromycin in pityriasis rosea

To determine the efficacy of clarithromycin in the treatment of Pityriasis Rosea [PR]. Double blind randomized controlled trial. Dermatology OPD, Military Hospital, Rawalpindi, from July 2008 to July 2009. Patients aged above 10 years, diagnosed with PR, were randomly assigned to two groups of 30 each to receive either clarithromycin or similar-looking placebo for one week. Neither the patient nor the treating physician knew to which group the patient belonged. Patients were assessed at 1, 2, 4 and 6 weeks after presentation and compared for complete, partial or no response. Among the 60 patients, no significant difference was found between the two groups at 2 weeks after presentation [p = 0.598]. In the placebo group, complete response was seen in 20 [66.7%], partial response in 3 [10.0%] while no response was seen in 7 [23.3%]. In clarithromycin group, there was complete response in 23 [76.7%], partial response in 3 [10.0%] and no response in 4 [13.3%] patients. Clarithromycin is not effective in treatment of pityriasis rosea

Effect of relining methods on dimensional accuracy and stability of conventional complete dentures - a literature review

To review the literature in order to evaluate the effect of relining methods on dimension accuracy and stability of conventional complete denture. Review of literature. The literature search was mainly performed through internet. Abstracts and full text of articles published in journals indexed by index Medicus were searched Pubmed. A Google search was also performed to obtain material available at websites of different dental associations. The comparison was made among original research studies, cross sectional surveys, meta analysis, review articles and guidelines in context to the purpose of study. The laboratory reline method has relatively good dimensional stability and strength, but presents a major drawback i.e patient has to be without denture for a certain period of time, on the other hand chairside reline method seems to be convenient and easy and require short working time. Autopolymerising acrylic resins have the potential of causing chemical or thermal burns of the oral mucosa. Autopolymerising direct chairside relining materials have been used widely in clinical setting. The Direct chairside method is advisable as it presents the least gap at posterior palatal seal area. However chairside relines are technique sensitive and require experience

Needle stick injuries among dental students, house officers and paradental staff working at Liaquat Medical University Hospital, Hyderabad

The objectives of the study were to find out the risks of needle stick injury and to identify who sustained such injuries and under what circumstances and what actions were taken to minimize the risks of needle stick injuries among dental students, house officers and para dental staff working at Liaquat Medical University Hospital. It was carried out from Aug 2011 to Sept 2012. Information was obtained through Questionare. Study design was descriptive. 513 students, house officers andparaden-tal staff participated in this study. House officers 23[4%] were male and 57 [11%] were female. Male students were 102 [20%] and female were 223[44%]. Among Paradental staff male were 92[18%] and female 16 [3%], and they suffered 79[10%] injuries. Self inflicted injuries were 455 [58%] and through other persons 315 [41%]. Department-wise injuries were Operativel 140 [18%], Prosthodontic 25[3%]. Orthodontic 28 [3%]. periodontology. 27[3%], Oral Maxillofacial Surgery 97[12%]. Through block anesthesia 428 [55%] and through infiltration needle 345 [44%]. Students were at high risk

Frequency of pigmented birthmarks in newborns of various ethnic groups of Pakistan

To determine the frequency of various types of pigmented birthmarks in neonates of different ethnic background born at PNS Shifa, with in 48 hours of birth. Descriptive Cross sectional study Department of Dermatology and Department of Obstetrics, PNS Shifa, Karachi. The study was conducted for six months, from 1st March 2008 till 31st September 2008. Patients and Two hundred newborn children of both sexes, born by any mode of delivery and belonging to different social classes and ethnic groups, in their first 48 hours of life were recruited. Each baby was physically examined, after taking consent from the mother, so as to assess the type, colour and distribution of the pigmented birthmark. All demographic features were recorded in a proforma and a digital photograph of each baby with a pigmented birthmark was also taken. Pigmented birthmarks observed included Mongolian blue spot, caf‚-au-lait macules and congenital melanocytic nevi. Among the ethnic groups these nevi were more prevalent among groups with darker skin colour and black hair. Mongolian blue spot are the commonest pigmented birthmarks observed followed by caf‚-au-lait macules and congenital melanocytic nevi

Risk factors in patients presenting with acute coronary syndrome to a tertiary care facility

Care facility our study evaluates the most commonly implicated risk factors associated with Acute Coronary Syndrome [ACS] in Pakistani patients presenting to a tertiary care facility. All patients presenting with Syndrome ACS to Shifa International Hospital over the six month period extending from May 2004 to December 2004 were included in this descriptive study. Patients were questioned for the presence or absence of conventional risk factors for coronary artery disease [CAD]. Body Mass Index [MBI] and lipid profiles were also documented. Data was entered into SPSS version 10.0 to obtain descriptive statistics. Over six months, 110 patients conforming to the inclusion / exclusion criteria were included in this study. 72.8% of the patients were from the Rawalpindi/Islamabad area. The male to female ratio was roughly 3:1. 22.7% of the patients were below the age of 50 years, and smoking was substantially more implicated in this population subset as compared to the rest of the study patients. Considering the term "Dyslipidemia" to encompass any one or more individual lipoprotein abnormalities and not merely elevation in total serum cholesterol, 96.5% of the patients were found to be dyslipidemic, most commonly on account of HDL less than 40 mg/dl [74.4%] or LDL more than 100mg/dI [72.1%] and elevated triglycerides [64.9%]. BMI>25kg/m2 was present in 41% of the patients, and 22. 1% were obese with BMI> 30kg/m2. Males were more likely to be smokers and females were more likely to be diabetic and hypertensive. Three simultaneous risk factors [hypertension, diabetes mellitus and dyslipidemia] were present in 4 1% of the cases. Traditional and validated risk factors were present in all patients. Hypertension, dyslipidemia and elevated BMI were seen more frequently in this patient population. In addition, more than a third of the patients had more than three risk factors for CAD, an observation which has significant preventive management implications

Is amnioinfusion effective enough to reduce perinatal mortality?

To assess the effects of amnioinfusion for meconium stained liquor on reducing perinatal death. This case control study was conducted in Kalsoom Maternity hospital, Peshawar on singleton pregnancies with cephalic presentation, >37 weeks gestation and meconium stained liquor at admission or during labor, randomized in two groups. Group 1 [study group] received amnioinfusion [normal saline 500mls at room temperature] over a period of 30 minutes at a rate of 10-20 mls/min. Group 2 [control group] did not receive such treatment. Fetal heart monitoring at every 10-15 minutes along with progress of labour plotted on a partogram was recorded. Out of 82 cases, 1 breech and 2 premature were excluded so 79 were left for the study. All were with cephalic presentation and gestation >37 weeks in 73.41% cases and postdates in 26.5% cases. In Group 1 [n=52], 36 [69.2%] had normal vaginal delivery [NVD], 4[7.7%] had outlet forceps delivery, 12[23.1%] had vacuum vaginal delivery and cesarean section rate was 0%. Two [3.8%] newborns were referred to nursery with 1 [1.9%] early neonatal death. In Group 2 [n=27], 6 [22.2%] had NVD, 11[40.7%] delivered with outlet forceps, 10[37.1%] had vacuum vaginal delivery and no cesarean section. Twelve [44.4%] babies were referred to nursery with 2 [7.4%] early neonatal deaths. Amnioinfusion is associated with improvements in perinatal outcome, particularly in settings where facilities for fetal surveillance are limited. The technique appears to be safe, simple and economical

Rheumatic mitral stenosis presenting as acute abdominal aortic occlusion and foot drop

Systemic thromboembolism in not an infrequent complication of rheumatic mitral stenosis. We report a case of acute abdominal aortic occlusion due to rheumatic mitral stenosis, in the absence of atrial fibrillation, mimicking spinal cord compression. Systemic streptokinase given 48 hours after symptom's onset lead to rapid and dramatic recovery with limb salvage