ABSTRACT
Background Clinically most apparent symptoms of COVID-19 include fever and cough, which in some patients show a worsening trend but are completely non-apparent in patients who present with an asymptomatic course of the disease. The aim of this study was to identify clinical and biochemical differences among polymerase chain reaction (PCR) positive patients who are either febrile or afebrile. Methods This study was conducted in Rawalpindi Medical University and Allied Hospitals between September and December 2020. All patients who tested positive for reverse transcription polymerase chain reaction (RT-PCR) COVID-19 were included in the study. After evaluation of 146 patients, 100 were selected, and with a response rate of 97%, a total of 97 patients were included in the final analysis. Depending on the presence of fever, the participants were divided into two groups. Both groups were then compared for baselines vitals and laboratory investigations. Data was entered and analyzed in SPSS v23.0 (IBM Inc., Armonk, New York). Results Among the 97 patients, 66 (68%) of the participants were male, and 31 (32%) were females. The mean age of the study participants was 45.23±18.08 years. Fever was present in 39 (40.2%) of the participants. When compared with patients with no fever, the patients with fever had greater severity of disease (p<0.001), higher heart rate (p<0.001), decreased oxygen saturation (p<0.001). Among the laboratory investigations, the fever group had a greater tendency of having deranged alanine aminotransferase (ALT) (70.82±29.23 vs. 32.83±16.22, p=0.010), Lymphocytes (1.56±0.54 vs. 2.12±0.94, p=0.003) and serum total bilirubin (1.06±0.36 vs. 0.55±0.21, p=0.009). Based on multiple regression analysis, the presence of fever is a predictor of derangement in ALT (OR=1.034, CI=1.001-1.068 p=0.025) and total bilirubin (OR=4.38, CI=2.14-6.78, p=0.021). Conclusion Fever may not be present among all patients presenting with COVID-19 infection, but those who have a fever have a greater risk of having deranged liver function tests. Hence, it is important to monitor liver function tests (LFTs) in COVID-19 patients presenting with fever.
ABSTRACT
OBJECTIVE: The objective of this case report is to emphasize the importance of considering uncommon conditions like Fahr's disease in the differential diagnosis of seizures and cognitive impairment, especially in patients with a history of thyroidectomy. MATERIAL AND METHODS: A 56-year-old woman who had undergone subtotal thyroidectomy 25 years previously presented with movement disorder and cognitive impairment secondary to hypoparathyroidism. A CT scan of the brain showed pathognomonic bilateral calcification in the basal ganglia, thalamus and cerebellar nuclei. RESULT: The patient was diagnosed with Fahr's disease caused by post-thyroidectomy hypoparathyroidism and successfully managed with oral calcium, carbidopa/levodopa and haloperidol. CONCLUSION: We recommend the routine use of CT scanning in the long-term follow-up of post-thyroidectomy patients. LEARNING POINTS: CT scans of the brain should be routinely carried out as part of long-term follow-up after thyroidectomy.Cognitive impairment and/or seizures should also be investigated using brain imaging.Taking a detailed history is a cornerstone of diagnosis in internal medicine.
ABSTRACT
Methemoglobinemia (MetHb) being a rare cause of cyanosis is generally not considered in its differential diagnosis. Methemoglobinemia is an abnormal Hb produced physiologically by auto-oxidation. If this process of auto oxidation is impaired either due to genetic defect or due to exogenous drugs/ toxins, its level starts rising. Once it is > 3%, tissue hypoxia ensues. Here is a case of dapsone induced MetHb and is reported in a young girl with central cyanosis, and was treated successfully with methylene blue. Methemoglobinemia should be considered in differential diagnoses of cyanosed patient with normal ABGs, PaO2 and cardio-respiratory status. If left untreated, the disease can be fatal.
ABSTRACT
To share our experience of managing acute DSP patients, a cross sectional, observational study was conducted for one year. Patients with acute DSP, defined as "ingestion of a poison or excessive dose of a medicine for self-harm" were included. Patient demographics (gender, age, educational, and marital status etc), intention, substance used, and outcome were noted. Eighty patients (47 female, and 33 male) were managed. Mean patient age was 24.35 +/- 7.69 years. Most of the patients were educated up to 10th grade, were unmarried, resident of urban area, occupation wise household related, and belonged to middle class. Majority (55%) of patients wanted to commit suicide. Benzodiazepines (31.3%) and organophosphate (OP) compounds (21.3%) were commonly used for DSP. 2.5% (n = 2) patients expired. DSP with OP compounds was significantly associated with suicidal intention.
