Pulmonary renal syndrome in a patient with vasculitis: case report and review of literature

Granulomatosis with polyangiitis [GPA] previously known as Wegner's granulomatosis, is a small vessel vasculitis that preferentially involves capillaries, arterioles and venules, presenting as multisystemic disease classically with alveolar haemorrhage and renal insufficiency. We report a case of GPA diagnosed on history, clinical findings and supported by imaging and very high levels of C-ANCA. Renal biopsy confirmed the typical histopathological findings. We discuss herein the management of the case and review of literature

Juvenile rheumatoid arthritis

To determine the spectrum of clinical presentation, laboratory parameters and drug therapy in patients with Juvenile Rheumatoid Arthritis [JRA]. Case series. The Children's Hospital and The Institute of Child Health, Lahore, from October 2008 to October 2011. All patients who fulfilled the American College of Rheumatology criteria for JRA were enrolled. Their clinical features, investigations done and treatment received for JRA were noted. Statistical analysis of data was done on SPSS version 16.0 for obtaining descriptive statistics. Out of 185 patients, 50.3% [n = 93] were females; 54% [n = 100] were between 10 - 15 years of age. Polyarthritis was found in 71.9% [n = 133] followed by oligoarthritis [22.7%, n = 42] and systemic onset disease [5.4%, n = 10]. Morning stiffness [78%] and fever [68%] were the most common clinical presentations. All patients with systemic onset disease had fever [n = 10] followed by skin rash, hepatosplenomegaly and lymphadenopathy. Uveitis was found in 2 patients, and both belonged to the oligoarticular group. Rheumatoid factor was found in 10.27% [n = 19] of all patients. All patients were given non-steroidal anti-inflammatory drugs [NSAIDs]. Disease modifying agents [methotrexate] were given to 43.8% [n = 81]. Steroids were used in 61% [n = 113] of patients either with NSAIDs alone or NSAIDs plus methotrexate. Disease profile of JRA at the study centre showed that polyarthritis is the commonest type. Recognition of subtypes will help in planning the management of these patients

Post-anaesthetic sore throat in patients with endotracheal tube

It has been noticed in the past that some patients who had undergone surgeries under general anaesthesia regained conscience and complained of sore throat. This study is to determine the ratio of patients under general anaesthesia who will present with post-operative sore throat; and to attempt to reduce that ratio in order to provide a more comfortable recovery to the patients. Sixty four patients eligible to be considered for analysis had follow ups for the next three days and were asked to describe any sore throat feature they might be experiencing after they recovered from anaesthesia. The incidence of sore throat in the patients was 37.5%. An alternative to ETT has to be employed [e.g. LMA]

Preoperative anxiety before elective surgery

To ascertain the preoperative anxiety level and different factors responsible in patients admitted for an elective surgical procedure in a tertiary care public hospital. Anxiety levels were measured in admitted patients of the Civil Hospital, Karachi, Pakistan awaiting elective surgery from October to January 2006. In the afternoon preceding surgery, patients were asked to complete 2 visual analogue scales [VAS] regarding anxiety about the proposed surgery and anesthesia [range, 0 = 'not anxious at all' to 100 = 'extremely anxious']. They were then asked to select different factors responsible for their anxiety from a list. Mean anxiety score for surgery was 57.65 +/- 25.1 and for anesthesia was 38.14 +/- 26.05. There was a statistically significant high level of pre-operative anxiety in females as compared to males [p<0.01]. The most common factors contributing to anxiety were concern about family in 173 [89.6%] patients, fear of complications in 168 [87%], results of operation in 159 [82.4%], and postoperative pain in 152 [78.8%]. Fifty-six percent of patients thought that their anxiety would be lessened by a detailed explanation regarding the operation and anesthesia. Our patients experience very high levels of preoperative anxiety. This can be easily measured in the preoperative period and allows detection of patients with high anxiety, encouraging appropriate steps to ameliorate this. Establishment of preoperative counseling clinics and properly informed consent taken before surgery will help in reducing preoperative anxiety