Unusual Presentation of Nocardiosis With Pleural Effusion in an Immunocompetent Host.

Nocardiosis is a disease caused by gram-positive, catalase-positive, rod-shaped bacteria that stain weakly on a Gram stain. It usually affects the lungs and skin but can cause disseminated infections. Nocardia has 85 species, ranging from nonpathogenic to pathogenic. Nocardia is an opportunistic organism that causes infections in the immunocompromised; however, 7% of the immunocompetent population has suffered from Nocardia infection. This case report highlights an unusual occurrence of pulmonary nocardiosis in a 31-year-old woman with a normal immune system. She was initially treated as an outpatient for what appeared to be community-acquired pneumonia. However, her condition deteriorated, ultimately revealing a substantial right pleural effusion with loculation and adjacent compressive atelectasis affecting a significant portion of her right middle and lower lung lobes, as detected by a CT scan followed by pleural fluid analysis which confirmed the infection. By sharing this experience, we aim to contribute to the collective knowledge of medical professionals and improve the accuracy of diagnosis and treatment.

Gitelman Syndrome and Hypertension: A Case Report.

In a patient with persistent hypokalemia, it is important to consider Gitelman syndrome, a rare, salt-wasting tubulopathy inherited in an autosomal recessive pattern. Gitelman syndrome leads to electrolyte abnormalities like hypokalemia, hypomagnesemia, and metabolic alkalosis. Typical clinical features include muscle cramps, fatigue, polydipsia, and salt cravings. Our case involves a female patient in her early 40s who visited the endocrinology clinic with symptoms of polyuria, constipation, muscle weakness, and fatigue. Electrolyte abnormalities included hypokalemia, hypomagnesemia, hypochloremia, and hyperreninemia. Initial tests, such as renal function tests, renal ultrasound, and CT scan, yielded normal results. Differential diagnosis of Gitelman syndrome and Bartter syndrome was considered due to the mutual electrolyte abnormalities of hypokalemia and metabolic alkalosis. Bartter syndrome was ruled out in our patient due to the presence of hypomagnesemia, which indicates a different defective receptor. Ultimately, genetic testing would be necessary to confirm the diagnosis of Gitelman syndrome considering the characteristic electrolyte disturbances and classic clinical presentation of fatigue, weakness, and salt craving.

Association Between Coronary Artery Disease and Plasma Omentin-1 Levels.

INTRODUCTION: Omentin-1 is secreted from visceral adipose tissue that contributes to chronic inflammatory diseases' pathogenesis, including cardiovascular events. In this case-control study, we will determine the association between plasma omentin and coronary artery disease (CAD). METHODS: This is a case-control study, conducted from June 2020 to April 2021 in the cardiology unit of a tertiary care hospital in Pakistan. Patients diagnosed with CAD (n = 300) within the last six months were included in the study. Another 300 participants without CAD and with similar demographic profiles were included in the control group. A blood sample of 5 ml was drawn from participants of both groups and sent to the laboratory to test for plasma omentin level. RESULTS: Plasma omentin level was significantly lower in patients with CAD compared to the patients without CAD (61.21 ± 10.21 ng/dL vs. 95.22 ± 12.21 ug/L; p-value: <0.0001). In both genders, the plasma omentin-1 was lower in patients with CAD compared to patients without CAD (p-value: <0.0001). CONCLUSION:  The present study revealed a negative association between omentin-1 and CAD. We speculate that low levels of omentin-1 might play a role in the pathogenesis of atherosclerosis. Therefore, plasma omentin-1 can be a potential biomarker to predict the development and progression of CAD.

Lumbar Disc Herniation: Comparing Pain Relief After Medical and Surgical Intervention.

Introduction The most common degenerative abnormality of the lumbar spine is lumbar disc herniation. There are two options of treatment, i.e. medical and surgical. Due to the scarcity of literature, it is a need of the hour to further study and evaluate the benefits and efficacy of early surgical intervention versus conservative management of lumbar disc herniation. Methods This study was conducted in the neurology unit of a tertiary care hospital in Pakistan from April 2019 to March 2021. After obtaining informed consent, 250 patients with a lumbar disc herniation, between the ages of 20 and 50 years, were enrolled in the study. Out of them, 81 participants chose surgical intervention while 169 participants chose medical intervention. Before the intervention, the patient's pain score was noted on the visual analog scale (VAS). The pain was assessed again 14 days after surgical intervention and 90 days after the start of medical intervention. Results There was a significant difference in the pain score in the post-intervention period in both the medical (7.01 ± 1.05 vs. 3.54 ± 0.51; p-value: <0.0001) and surgical intervention groups (6.92 ± 0.95 vs. 2.41 ± 0.42; p-value: <0.0001). Post-intervention, the VAS pain score was significantly lower in the surgical group as compared to the medical group (2.41 ± 0.42 vs. 3.54 ± 0.51; p-value: <0.0001). Conclusion In this study, there was a significant decline in pain in both groups; however, the reduction was more significant in the surgical group. Patients should be given both options for management of lumbar disc herniation and should be explained the pros and cons of each treatment option.

The Role of Vitamin C in Reducing Pain Associated With Diabetic Neuropathy.

INTRODUCTION: Neuropathic pain is a painful condition that arises after a lesion or an insult to the somatosensory nervous system, either in a central or peripheral location. The most common cause of neuropathic pain is diabetes. Controlled trials have been conducted on recent advancements in medicine to investigate the effect of vitamin C in the treatment of neuropathic pain. In this study, we aim to investigate the role of vitamin C in reducing pain associated with diabetic neuropathy. METHODS: This open-label, parallel-arm, interventional study was conducted in a public tertiary care hospital in Pakistan from April 2019 to March 2021. A total of 300 type II diabetic patients with newly diagnosed painful peripheral diabetic neuropathy, of either gender, were enrolled in the study. The intervention group received 60 mg duloxetine along with 200 mg oral vitamin C. The control group received 60 mg duloxetine without any additional intervention. Patients were asked to return for follow-up after 12 weeks. RESULTS: The mean visual analog score (VAS) was significantly lower in both, the intervention (5.54 ± 0.81 vs. 6.72 ± 0.90; p-value: <0.0001) and the control group (5.91 ± 0.80 vs. 6.79 ± 0.94; p-value: <0.0001), at week 12 compared to day 0. However, in comparison, VAS score in intervention at week 12 was significantly lower as compared to the control group (5.54 ± 0.81 vs. 5.91 ± 0.80; p-value: 0.0002). CONCLUSION: The use of vitamin C could be cost-effective and would be a safe and useful adjunctive therapy for pain associated with diabetic peripheral neuropathy.