A Case of Tick Bite Induced Babesiosis With Lyme Disease.

The Ixodes tick may transmit multiple pathogens, Lyme disease being the most common. Early detection of tick bites and using prophylaxis measures is the key to prevent tick bite-associated diseases like babesiosis, anaplasmosis, and Lyme disease. It is recommended to follow preventive measures like using diethyltoluamide (DEET) on the skin, applying permethrin on clothes while visiting the tick-infested areas. Co-infection is an uncommon occurrence but still representative in endemic areas. If there is delayed initiation of therapy in these kinds of patients, there may be dire consequences that may require aggressive therapy. Clinicians should consider co-infection when suspecting tick-borne disease which can prove to be fatal if not addressed promptly. Here, we present the case of a 72-year-old female with atypical symptoms, who was found to have coinfection with Lyme disease and Babesiosis on serology testing and peripheral smear and was diagnosed and treated promptly.

Estimation of Alpha-Synuclein Monomer and Oligomer Levels in the Saliva of the Children With Autism Spectrum Disorder: A Possibility for an Early Diagnosis.

Background In degenerative brain diseases like Parkinson's disease (PD), alpha-synuclein (a-syn) can be in its monomeric (a-syn-mono) or toxic oligomeric (a-syn-oligo) or as a total (a-syn-total) forms in the biological body fluids including saliva. Past research has observed major a-syn plasma variations in children with autism spectrum disorder (ASD) pointing toward brain degenerative components in their pathophysiology. No prior study has shown a-syn levels in ASD patients' saliva. Objective  This study estimates the levels of alpha-synuclein monomer (a-syn-mono) and alpha-synuclein oligomer (a-syn-oligo) in the saliva of ASD affected children so that saliva can be a method for detecting disorder. Materials and methods This cross-sectional, multi-center study was conducted in Islamic International Medical College, Autism Resource Centre (ARC), and Step-to-learn Rehabilitation center for the slow learner in Rawalpindi. The research was performed for one year from August 2018 to August 2019. Saliva samples from 80 children (40 ASD affected children, and 40 age- and sex-comparable healthy controls) were collected. Specific anti-alpha-synuclein monomers (anti-a-syn-mono) and anti-alpha-synuclein oligomers (anti-a-syn-oligo) enzyme-linked immunosorbent assay (ELISA) kits analyzed the salivary samples. Mean ± SD were reported for quantitative data. The data between the two groups were compared using an independent t-test. The p-value of ≤ 0.05 was considered statistically significant. Results A total of 80 children were included in the study (n=40 ASD affected, n=40 healthy controls). The age of participating children was between four and eight years. The mean alpha-synuclein monomer level in the saliva of ASD children was 92.03 ± 117.09 pg/ml (p≤0.05), and in healthy subjects was 186.78 ± 239.31 ρg/ml. The levels of alpha-synuclein oligomer in the saliva of patients with ASD children were 0.13 ± 0.05 ng/ml (p<0.001), and in the healthy subjects was 0.33 ± 0.26 ng/ml. Both alpha-synuclein monomer and alpha-synuclein oligomer levels were low in the saliva of ASD children. Conclusion Children with ASD had low levels of alpha-synuclein monomer and oligomer than healthy children which are unique than that of levels found in other degenerative brain diseases.

Serum Neopterin Is Not Influenced by Age and Blood Group of Transfusion-Transmitted Infection Negative Blood Donors.

Objectives To measure serum neopterin levels in blood donors of the local population and to study its relationship with age and blood group of transfusion-transmitted infection (TTI) negative blood donors. Methodology This cross-sectional study was carried out in the Department of Physiology at Liaquat National Hospital and Medical College (LNMC), Karachi, Pakistan, in collaboration with the Basic Medical Sciences Institute and Jinnah Post Graduate Medical Centre (JPMC). Data were collected from January 2018 to July 2018. A total of 174 blood donors participated in the study, who were selected by using a random sampling technique. They were screened through the standard procedures used for screening at the JPMC blood bank for TTIs as per the World Health Organization recommendations. Serum neopterin was estimated using enzyme-linked immunosorbent assay (ELISA) kits. Data analysis was performed using Statistical Package for Social Sciences (SPSS) version 23 (IBM Corp., Armonk, NY, USA). Chi-square and ANOVA (analysis of variance) were applied, and tests of significance were kept as P < 0.05. Results Neopterin level in the serum of TTI-positive blood donors was 15.1 ± 4.59 nmol/L, which was above the normal range and cutoff value of 10 nmol/L, whereas the neopterin level in the serum of TTI-negative blood donors was 6.1 ± 1.82 nmol/L (P = 0.001). In TTI-negative blood donors, the neopterin levels were within normal limits and were not influenced by age and blood groups (P > 0.05). Conclusions Serum neopterin levels did not report any significant difference in terms of age and blood group of TTI-negative blood donors and were seen to be within normal limits.

The Frequency and Risk Factors Identified for HBsAg and Anti-HCV in a Preoperative Screening of Patients Admitted in the Surgical Department at Al-Tibri Medical College Hospital.

Objective The aim of this study is to determine the frequency and risk factors for hepatitis B surface antigen (HBsAg) and anti-hepatitis C virus (Anti-HCV) in a preoperative screening of patients admitted at the surgical unit of Al-Tibri Medical College and Hospital and Lyari General Hospital, Karachi. Materials and methods This study was conducted at the surgical units of Al-Tibri Medical College Hospital and Lyari General Hospital, Karachi. This study was conducted for six months from 30th June 2017 to 31st December 2017. This observational study was performed using a non-probability convenient sampling technique. All patients who were undergoing elective and emergency surgical procedure were selected for the study and screened for HBsAg and anti-HCV by immunochromatographic test (ICT) method at the hospital laboratory. The risk factors identified as parenteral injections, past surgical procedure, blood transfusion, etc. along with demographic data as age, gender, and district residential status were recorded on a specially designed proforma. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 23. Descriptive statistics were applied, and the qualitative data were expressed as the mean and standard deviation. Results Among a total of 360 patients included in the study, 63 (21.38%) were found with anti-HCV positive, and 14 (3.88%) were HBsAg positive with none of the patients found to have co-infection. The male-to-female ratio was 2.3:1. The mean age of patients was 32.34±4.3 years. The age range affected commonly in the study population was 21-30 years, 24(31%). The commonest risk factor for transmission of viral infection was parenteral injection abuser 31(40.2%), followed by surgical procedure 13(18.1%), blood transfusion 10(12.9%), and barber shave 7(9.1%). Conclusion It was predicted in our study that hepatitis C was more common in patients screened preoperatively for surgery. However, the most frequent risk factor in these patients was parenteral abuse history. The preoperative screening is an important investigative tool for the identification of silent cases in the community for preventive measures adoption and treatment for silent carriers.

Frequency of Low Birth Weight and its Relationship With Maternal Nutritional and Dietary Factors: A Cross-Sectional Study.

BACKGROUND:  Low birth weight (LBW) is linked with fetal and neonatal mortality and morbidity; also it can slow down growth and cognitive development. Several factors contribute to pregnancy outcomes, including LBW deliveries, maternal nutrition, and additional dietary intake. Our study was aimed to identify the frequency and factors associated with LBW mothers in Karachi, Pakistan.  Methods: A cross-sectional survey was carried out at the Obstetrics and Gynaecological Department of Hamdard Hospital, Karachi. A total of 195 healthy pregnant females were enrolled. All the relevant data were collected from March 1st, 2019 to August 31st, 2019 with the help of a structured questionnaire designed specifically for the study where mothers were also asked about consumption of iron, vitamin, and extra meals since they became pregnant. Written, informed consent was taken from all of the participants before data collection. Data analysis was performed using a statistical package for the social sciences (SPSS) version 20.0. A Chi-square test was used for checking associations between the studied maternal factors and the weight of the children.  Results: There was a total of 195 pregnant females selected for the study. The frequency of LBW infants was found to be 57 (29.2%) in these women. The mean age of the females was 29.29 ± 5.22 years, 142 (72.8%) of them had a body mass index (BMI) of 25.0 kg/m2 or more, 102 (52.3%) of them had hemoglobin (Hb) between 10 and 11 mg/dL. The study results further showed that maternal Hb (p=0.02), vitamin C intake (p=0.037), iron intake (p=0.01), and consumption of extra meals during pregnancy (p=0.021) were significantly associated with a LBW of the children. Mothers whose Hb <10 mg/dL, no intake of vitamin C, or iron, and extra meals during pregnancy were more likely to have a child with LBW than others. CONCLUSION:  It can be concluded that maternal nutritional and dietary factors are very important during fetal development, and they have a significant relationship with the birth weight.

Features of Rhabdomyolysis Secondary to Immobility and Statin-Induced Myopathy in a 70-Year-Old Female.

Treatment with statins requires close monitoring of serum creatine kinase levels to prevent myopathy, which is a rare but potentially serious dose-dependent adverse effect of these drugs. Statins are cholesterol-lowering drugs that are among the most prescribed drugs worldwide and are considered effective in reducing the risk of major cardiovascular events. Although statins are generally well-tolerated, myopathies are a rare but known adverse event, ranging from muscle pain to very rare cases of life-threatening rhabdomyolysis. In this report, we aim to highlight the features of rhabdomyolysis secondary to immobility and statin-induced myopathy.

Thiamine Level in Type I and Type II Diabetes Mellitus Patients: A Comparative Study Focusing on Hematological and Biochemical Evaluations.

Objective Diabetes has been found to be associated with low levels of thiamine stores in the body, as thiamine directly affects carbohydrate metabolism. Amplified renal clearance of thiamine has been found in both type I and type II diabetic patients. It has been shown that high-dose thiamine therapy may have a therapeutic effect on early-stage diabetic nephropathy. The aim of this study was to evaluate various biochemical parameters and serum thiamine levels in type I and type II diabetic patients and compare them with a healthy control group. Methods A case-control study was carried out in the diabetic out-patient multi-centers in Karachi. A total of 90 participants were selected by using a non-probability convenient sampling technique and divided into three groups, each with 30 subjects. Group A included healthy non-diabetic subjects, while group B included subjects with type I diabetes mellitus (DM), and group C included subjects with type II DM. After receiving informed consent, blood samples were collected from all the participants for hematological and biochemical evaluation. The duration of the study was eight months. Results The study results revealed that the patients with type II DM had significantly higher mean fasting blood sugar (FBS), random blood sugar (RBS), and hemoglobin A1c (HbA1c) levels than those with type I DM or the control group (p<0.001 for all). Furthermore, the patients with type I or II DM had significantly higher mean levels of triglyceride (p<0.001) and total cholesterol (0.013) while significantly lower mean levels of high-density lipoprotein (HDL) (p=0.014) than controls. The study results further revealed that the patients with type I or II DM had significantly lower serum thiamine levels than controls (14.89±4.82 and 7.35±1.90 vs. 69.56±12.75, p<0.001). Conclusion The study results revealed that FBS, RBS, HbA1c, triglyceride, and total cholesterol levels were significantly higher in both type I and type II diabetes patients compared to controls. Furthermore, HDL and serum thiamine levels were found to be significantly lower in both type I and type II diabetic patients than in controls.

Safety and Efficacy of Procedural Sedation and Analgesia in Pediatric Oncology Patients.

Objective Procedural sedation and analgesia are the standard of care for painful procedures in children that require immobility. The aim is to assess the safety and efficacy of procedural sedation and analgesia in pediatric oncological patients in a large tertiary care hospital. Method An observational study performed to review medical records of children who received procedural sedation and analgesia (PSA) for pediatric oncological procedures from July 2018 to September 2018. Patients undergoing oncology procedures (lumbar puncture, intrathecal chemotherapy, bone marrow aspiration +/- trephine) were included, and non-anesthesiologist (intensive care physician/emergency physician certified in pediatric advanced life support) provided PSA. Patients were assessed according to PSA protocol guidelines by the American Society of Anesthesiology (ASA). Low-dose ketamine (0.5 mg/kg) and propofol (2 mg/kg) were administered. Results A total of 565 children underwent 1216 procedures in whom the median age was 7.4 years, and the majority (65.1%) were males. The most common procedure was the lumbar puncture (n = 956; 78.6%) followed by bone marrow aspirate only (n = 137, 11.3%) and both (n = 123, 10.1%). Eight (0.7%) patients developed transient oxygen desaturation only as an adverse effect of ketamine-propofol drug combination with 50% procedures utilizing propofol 1 mg/kg for sedation. Conclusion According to the results of our study, the majority of the pediatric patients responded and reported no adverse events during the procedure with ketamine and propofol. Therefore, we conclude that ketamine and propofol are safe and effective as both sedative and an analgesic in procedures on pediatric oncology patients.

Association of Clinical and Radiological Features in Various Repetitive Stress Injuries.

Objectives  To assess the clinical and radiological features of repetitive stress injuries (RSIs), specifically de Quervain's (DQ) disease, tennis elbow (TE), and plantar fasciitis (PF). Methods This was an observational study conducted for eight months (March 2019 to September 2019) at the Orthopedic Department in collaboration with the Radiology Department. Clinically diagnosed RSI patients from both genders, aged between 30 and 50 years, were included in the study. Clinical features that were considered include pain, swelling, and site of injury. Radiological findings from ultrasound, X-ray, and magnetic resonance imaging (MRI) were identified in all participants of the study. Data were analyzed using SPSS Version 21 (IBM Corp., Armonk, NY, USA). Data were represented as frequency and percentages. Results There were a total of 82 patients (40 males,42 females) with repetitive stress injury (RSI), with a mean age of 42.63±8.53 years. Of the 82 patients, 34 (41.4%) had DQ disease, 28 (34.1%) had TE, and 20 (24.4%) had PF. Pain and swelling were observed in all patients. In TE, the most affected site was the right lateral epicondyle process. The common radiological findings were hypoechoic fascia, increased fluid within the first extensor tendon compartment, cortical erosion, sclerosis in soft tissues, and calcification in soft tissues. Cozen's test was positive in most patients. In DQ, the most affected sites were left and right radial styloid processes. The common radiological findings were hypoechoic fascia, increased fluid within the first extensor, cortical erosion, and periosteal reaction. Finkelstein's test was also positive in most patients. In PT, the most affected site was the left heal plantar surface. The common radiological findings were hypoechoic fascia, increased thickness of fascia (>4.5 mm), increased fluid within the first extensor tendon compartment, cortical erosion, sclerosis in soft tissues, calcaneal spur, periosteal reaction, and calcification in soft tissues. Cozen's and Finkelstein's tests were also positive in most patients. Conclusions History, physical examination, laboratory findings, and imaging modalities all are important tools for the differential diagnosis of RSI. Our study results showed that if some clinical findings fail to diagnose any RSI, then ultrasound, X-ray, and magnetic resonance imaging (MRI) are the best and useful options before treatment.

Landau-Kleffner Syndrome: A Diagnostic Challenge.

The Landau-Kleffner syndrome (LKS), formerly known as acquired epileptic aphasia, is a rare syndrome that typically presents in early childhood with language regression and seizures. We report a case of LKS in an 7-year-old boy who presented with aggressive behavior, difficulty in maintaining posture, and language regression. Systemic examination, including neurological evaluation, was normal. Cerebrospinal fluid (CSF) analysis and magnetic resonance imaging (MRI) were normal. Electroencephalogram (EEG) showed abnormal findings associated with generalized seizure discharge during sleep with more spikes being noted in bilateral frontal and temporal regions. LKS was diagnosed and was treated with anticonvulsants and steroids. On follow-up, the child showed improvement in maintaining posture, was able to walk independently and had improved linguistic functions. This case adds another variant of LKS to the existing literature.

The adequate breast cancer knowledge assessment: A cross-sectional study done among nonmedical women of Karachi.

BACKGROUND: Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death in females' worldwide. Pakistan has higher incidence of the disease than the neighboring countries and one in every nine Pakistani women suffers from breast cancer which is one of the highest incidence rate in Asia. Numerous risk factors such as nulliparity, family history, genetic mutations, increasing age, early menarche, and late menopause are associated with the development of breast cancer. Lack of awareness and the preexisting myths regarding this disease have led to the detection of breast cancer at a later stage. OBJECTIVE: The main objective of this study is to determine the frequency of adequate breast cancer knowledge and its level among nonmedical women of Karachi coming to attend general surgery outpatient clinics. METHODS: A cross-sectional Study was conducted in Outpatient Clinics, Department of General Surgery, Civil Hospital, Karachi. The sample of 250 females with nonmedical background was gathered from December 27, 2016 to June 26, 2017. Adequate breast cancer knowledge was divided into three criteria such as poor, fair, and good knowledge. Chi-square test was applied. P ≤ 0.05 was considered as statistically significant. RESULTS: The mean age was 35.63 ± 9.56 years. Mean knowledge score was 5.24 ± 2.92. Overall, 42% of participants were found with adequate breast cancer knowledge whereas 58% of the participants had inadequate knowledge. Based on the study questionnaire, 38% had poor knowledge, 40.4% had fair knowledge, and 21.6% had good knowledge. Significant association was observed with age, monthly family income, education status, and occupation. CONCLUSION: The results showed lack of adequate knowledge. A high proportion (58%) of nonmedical females had inadequate knowledge about breast cancer.