Preseptal Cellulitis Due To Impetigo - A Case Report Of Uncommon Presentation In Pakistan.

We present the case of a 30-year-old woman who presented with 8-month history of intermittent fever, joint pains with morning stiffness, recurrent oral ulcers, photosensitivity, weight loss and hair fall. For the last 2 months, she had developed a dry cough with progressive shortening of breath. On examination, a cachexic lady with malar hyperpigmentation, alopecia, pallor, nail dystrophy and erythema over her hands and feet were noted. There were multiple punched-out skin ulcers of variable size over legs, arms and abdomen usually round in shape with well-defined even wound margins and scant serous discharge. Musculoskeletal examination revealed synovitis of both elbows and a few metacarpophalangeal and proximal interphalangeal joints. Chest X-ray and HRCT showed bilateral ground-glass opacification. Anti-Nuclear Antibody (ANA) was positive, 1:320, homogenous nuclear pattern. Anti-Ro antibody was highly positive and serum complement (C3, C4) levels were reduced. She was diagnosed with Lupus Vasculitis and started on steroids, mycophenolate mofetil and hydroxychloroquine.

Frequency of different lifestyle modification measures among patients with GERD based on monthly income.

A cross-sectional study was carried out at Shifa International Hospital Islamabad over a period of 6 months, to determine the frequency and compare the different lifestyle modifications among patients with Gastroesophageal Reflux Disease (GERD) of different monthly income groups. Two hundred patients of GERD were enrolled in the study and divided into two groups based on monthly income less than and more than Rs. 30,000 respectively. Data was analyzed using SPSS 21. Descriptive statistics were calculated. Chi-square test was applied keeping p-value <0.05. Mean age was 40±13 years, 82 (41%) males and 118 (59%) females. Walking was undertaken by 32% after meals and 87.5% consumed tea. Significant difference was seen between income groups and higher intake of fried and spicy foods respectively. Thus, effort needs to be made in creating awareness and counseling patients to practice lifestyle modifications to reduce GERD symptoms and stop sole reliance on medications.