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Objectives: This study aims to assess the impact of the 2022 floods in Pakistan on the incidence of vaccine-preventable diseases (VPDs) in flood-affected regions, specifically focusing on areas with traditionally low vaccination coverage. Design: Weekly incidence data of VPDs from September to November 2021 and 2022 were collected and analyzed for the provinces of Sindh, Khyber Pakhtunkhwa, and Baluchistan. The study compared year-on-year changes in disease incidence to evaluate the effect of the floods on disease burden. Results: The analysis revealed significant increases in the incidence of various VPDs in the flood-affected regions compared to the previous year. Diseases such as pertussis showed a 171% increase, while mumps exhibited nearly a 1000% increase in reported cases. Other diseases including polio, diphtheria, neonatal tetanus, measles, chickenpox, and rubella also experienced substantial rises in case numbers. Concurrently, cases of lower respiratory tract illnesses and diarrheal diseases in children under five years old surged notably. Conclusions: The findings underscored the failure of relief and healthcare efforts in managing vaccine-preventable diseases in flood-affected areas of Pakistan. The study highlights an urgent need for targeted intervention strategies, including enhanced immunization drives and healthcare infrastructure improvements in vulnerable regions. The post-flood scenario presents a critical opportunity to address existing challenges in vaccination coverage and to mitigate future disease outbreaks through comprehensive public health initiatives.
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Lipoprotein(a), or Lp(a), is a distinctive lipoprotein particle linked to various cardiovascular diseases, notably atherosclerosis and aortic stenosis. Much like plasminogen, Lp(a) hinders normal fibrinolysis, leading to increased thrombosis and slower clearance of fibrin debris. It also causes inflammation, oxidative stress, and endothelial dysfunction, contributing to the formation of atherosclerotic lesions. Epidemiological studies have consistently shown that even slight increases in Lp(a) levels correlate with a heightened risk of cardiovascular events. Furthermore, Lp(a) plays a role in aortic stenosis by binding to leaflet valves, accumulating within them, and triggering calcium deposition and nodule formation. These calcium deposits gradually narrow the arteries, impeding blood flow. By raising inflammation and oxidative stress in the valve, Lp(a) accelerates tissue damage and calcium deposition. Traditional lipid-lowering therapies have limited efficacy in reducing Lp(a) levels. However, new treatments using RNA interference and antisense oligonucleotides to decrease Lp(a) production in the liver offer promising prospects for mitigating the risks and managing atherosclerosis and aortic stenosis associated with high Lp(a) levels. As Lp(a) screening becomes more common in healthcare, physicians will be better equipped to assess patients' risk levels and provide tailored treatments. This review aims to examine the role of Lp(a) in the development of aortic stenosis and atherosclerosis.
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Myxomas are rare tumors arising from the uncontrolled proliferation of mesenchymal cells. Among cardiac conditions, cardiac myxomas account for less than 0.1% of cases, with the majority found in the left atrium and only 8% in the right atrium. Atrial myxomas present with various clinical manifestations, including constitutional symptoms, symptoms caused by blood flow obstruction, and tumor embolism. This case report describes a 50-year-old male patient presenting with syncope, fatigue, and dyspnea, who had a history of well-controlled hypertension and atrial fibrillation. Physical examination, further diagnostic workup, and echocardiography led to a provisional diagnosis of right atrial myxoma. The patient underwent a median sternotomy, and the tumor was surgically excised, resulting in both diagnostic and curative outcomes. Histological analysis confirmed the diagnosis of myxoma. This case report contributes valuable insights into the presentation, diagnostic challenges, and treatment of atrial myxoma.
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Myxomas are tumors that occur due to uncontrolled proliferation of mesenchymal cells. Cardiac myxomas although very rare, are still the most common primary tumor of heart. Cardiac myxomas have a prevalence of 0.03% in the general population. They can have a variety of clinical presentations with obstructive cardiac symptoms, constitutional symptoms and symptoms due to embolism to other body parts chief among them. CNS embolism with stroke is among the rarest clinical presentation of cardiac myxomas. Our article portrays a case of cardiac myxomas that initially resulted in episodes of dyspnea and syncope and eventually led to recurrent episodes of transient ischemic attack and stroke. Case was confirmed by transesophageal echocardiography and managed surgically by medial sternotomy. Myxoma, a benign primary cardiac tumor is itself a rare occurrence, embolization of myxoma leading to multiple strokes is an atypical clinical presentation. Our report would be a valuable addition to the already existing literature.
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Background: The objective of this short communication is to summarize the current situation in Pakistan regarding the rising cases of diphtheria and to emphasize the need for public health interventions to control the spread of the disease. Study design: This study is a short communication. Methods: Data on diphtheria cases were collected from various sources including the Pakistan Ministry of Health, the World Health Organization (WHO), and media reports. Descriptive statistics were used to summarize the data on the number of cases and trends over time. Results: As of 2023, the number of reported diphtheria cases in Pakistan has increased by 50% compared to the previous year. The majority of cases are being reported from the Sindh and Punjab provinces. The incidence of diphtheria is highest among children under the age of 10. Conclusions: The rising cases of diphtheria in Pakistan are a cause for concern and indicate the need for effective public health interventions to control the spread of the disease. This includes increasing vaccine coverage, improving hygiene practices, and enhancing surveillance and reporting systems. The public health community should also work towards educating communities on the importance of vaccination and preventative measures to reduce the burden of diphtheria in Pakistan.
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The article describes a rare case of bullous scabies in a 30-year-old female. Scabies is a skin condition caused by the mite Sarcoptes scabiei and is typically transmitted through skin-to-skin contact. Bullous scabies is a rare presentation of scabies and is characterized by tense bullae and blisters that resemble bullous pemphigoid. The patient presented with pruritus, bullae on the hands and feet, and papules on various body parts. After a provisional diagnosis of scabies was made, microscopic examination confirmed the presence of mites and eggs. The patient was treated with Permethrin cream and antihistamines, and her symptoms regressed over the next two months. The husband and two other family members also reported improvement after treatment. While bullous scabies is an uncommon presentation of scabies, it is important to consider it in the differential diagnosis for patients presenting with bullae and pruritus. The exact pathophysiology of bullous scabies is yet to be determined, but theories include a staph aureus superinfection or production of autoantibodies in response to scabies lytic enzymes. Early recognition and appropriate treatment can lead to good outcomes in patients with bullous scabies.
