Frequency and Severity of Thrombocytopenia in Neonatal Sepsis.

Background Neonatal sepsis includes numerous systemic illnesses such as septicemia, meningitis, urinary tract infections, and pneumonia. In developing countries, the major reason for neonatal mortality is septicemia, which accounts for almost 50% of overall deaths. Thrombocytopenia is one of the most common hematological problems during the neonatal period, affecting the majority of sufferers admitted to the neonatal intensive care unit (NICU). The aim of our study was to find the frequency of thrombocytopenia and its severity in neonates with sepsis. Methods The study was conducted at the Department of Hematology at Khyber Medical University, Peshawar, Pakistan. A total of 170 neonates with an age of fewer than 28 days, both genders, and positive blood cultures were included in the study using a non-probability consecutive sampling technique. Data was recorded in predesigned questionnaires after taking informed consent. Data were recorded and analyzed using SPSS version 26 (IBM Corporation, Armonk, NY, USA). Results Of the 170 neonates, 104 (61.2%) were males, with a mean age of 12.12±8.88 days. The majority of the babies 73 (42.9%) were in the age group of 0-7 days. Most of the neonates 72 (42.4%) were born via normal vaginal delivery (NVD). Of the neonates, 117 (68.82%) presented with fever, and 105 (61.76%) were reluctant to feed. Furthermore, 65.29% of the neonates had thrombocytopenia, of which 34 (20%) had mild, 43 (25.3%) had moderate, and 34 (20%) had severe thrombocytopenia. In neonates with positive blood culture, the platelet level was low (p<0.001). In the case of gram-negative organisms, the level of platelets was lower as compared to gram-positive organisms (p<0.001). Conclusion Sepsis is still a common cause of newborn thrombocytopenia. The fact that it is present in more than half of all culture-positive sepsis episodes indicates the severity of the condition. This condition is further defined by higher percentages of early-onset gram-negative septicemia compared to gram-positive sepsis.

Isovaleric Acidemia: A Rare Case of an Inborn Error of Metabolism.

Isovaleric acidemia (IVA) is an autosomal recessive disease of the leucine metabolism due to a deficiency of isovaleryl-CoA dehydrogenase (IVD). We report the case of a six-month-old girl admitted with a seven-day history of fever, cough, stridor, vomiting, and respiratory distress. Second-degree consanguinity was documented between the parents. Urine organic acid analysis by gas chromatography-mass spectrometry showed marked excretion of 3-hydroxybutyric acid along with moderate excretion of 3- hydroxy-isovaleric acid. Isovaleric acidemia was diagnosed based on history, examination, and laboratory evaluation. The patient managed with fluid resuscitation, correction of her metabolic acidosis, antibiotics, and supportive care.

Evaluation of Immunization Coverage in the Rural Area of Peshawar, Khyber Pakhtunkhwa.

BACKGROUND: In children, the leading cause of morbidity and mortality is infectious disease. Immunization is one of the most cost-effective methods for child survival. The purpose of the survey is to assess access and coverage of immunizations in the rural areas of the District Peshawar, Khyber Pakhtunkhwa. METHODS: A cross­sectional study was conducted in a rural population area of District Peshawar from February 2016 to April 2016 using the WHO's 30 cluster sampling method for evaluation of immunization coverage. RESULTS: A total of 390 children aged 12-23 months were included in the study. It was found that 67.94% of the children were fully immunized against vaccine-preventable diseases. Thirty percent of the children were partially immunized; the percentage of unimmunized children was 2.06%. Immunization cards were issued to and available with 58.8% of the subjects. The most common cause of partial immunization was a lack of information regarding vaccinations (27%). Immunization against measles was found to be low (67%). Those using private facilities were more likely to be completely immunized as compared to government facilities. CONCLUSIONS: Immunization coverage in our survey was 68%. Sustained efforts are required to achieve universal coverage of immunization. Significant interventions are required, especially in areas that are more rural and less educated.

Chronic myeloid leukaemia presenting as priapism: A case report from Khyber Pakhtunkhwa.

Priapism is known as a very rare complication of leukaemia. We report a 16-years boy who presented with the persistent painful erection of the penis for eleven days. He had aspiration without achieving sustained detumescence. The patient underwent an emergency irrigation and decompression of priapism by a consultant urologist. During the hospital stay blood morphology, bone marrow aspiration and BCR-ABL were done to confirm the diagnosis of chronic myeloid leukaemia. Our report thus explains the relevance of all physicians in the diagnosis and management of patients with priapism.

Primary Gastric Burkitt's lymphoma.

The primary gastrointestinal non-Hodgkin's lymphoma is a rare entity. Burkitt's lymphoma (BL) is an aggressive form of B-cell lymphoma which is endemic in Africa, while in rest of the world non-endemic cases has been reported. Primary gastric BL is extremely rare and only around 53 cases have been reported till now. Here we present the case of a middle-aged male, immunocompetent who presented with anorexia weight loss and diarrhea. His upper gastrointestinal endoscopy and biopsy revealed a large primary gastric Burkitt lymphoma. After chemotherapy, he remains in remission.

Frequency of acute kidney injury and its short-term effects after acute myocardial infarction.

OBJECTIVE: To find out the frequency of acute kidney injury and its short-term effects after acute myocardial infarction. METHODS: This descriptive, cross-sectional study was conducted at the cardiology department of Lady Reading Hospital's Postgraduate Medical Institute, Peshawar, Pakistan, from January to June 2016, and comprised acute myocardial infarction patients. Non-probability consecutive sampling technique was used. SPSS 20 was used for data analysis. RESULTS: Of the 207 patients, 154(74.7%) were male and 53(25.6%) were female. The overall mean age was 59.09±8.6 years. At admission, the mean baseline creatinine was 0.97±0.23, the mean glomerular filtration rate was 83.30±25.4 mL/min, and 30(14.4%) patients had an estimated glomerular filtration rate<60 mL/min. Moreover, 43(20.7%) patients developed acute kidney injury. Post-myocardial infarction in-hospital complications were higher in patients with acute kidney injury (p<0.05). CONCLUSIONS: In-hospital, short-term effects including acute heart failure, cardiogenic shock and arrhythmias were higher in acute kidney injury patients after acute myocardial infarction.

Serum Uric Acid level in the severity of Congestive Heart Failure (CHF).

BACKGROUND AND OBJECTIVE: It has been observed that in a clinical condition like hypoxemia there is an increase in the serum Uric acid level. The objective of our study was to find out the relationship between serum uric acid levels in the severity of Heart failure. METHODS: We analyze 285 patients with a diagnosis of Congestive heart failure admitted in Lady Reading Hospital Peshawar from March 1st to August 2016. Age group of patients was 17- 67 years. New York Health Association (NYHA) scoring were used to access the severity of Congestive Heart Failure. Serum UA level >7.0 mg/dl was considered high. RESULTS: Total 285 patients with CHF were analyzed with a mean age of 54±2.8 years in which males were 65.96% and 34.03% were female. 40% were in class II of New York Health Association (NYHA), 32.63% in class III and 25.61% in class IV and 1.75% were in class I. Out of 285, 59.29% met the definition of hyperuricemia. In which 83.43% were male and 16.57% were female. Most of the Hyperuricemic patients 62.13% were in age group of 51- 60 years, with a mean age of 57±4.5 years. We found a significant correlation between uric acid level and BNP (p= <0.001), and use of diuretics (p=<0.001). 34.93% of the Hyperuricemic CHF patients were in NYHA III and NYHA IV whose SUA was above 8 mg/dl as compared to 31.57% Hyperuricemic CHF patients whose SUA was below 8 mg/dl. CONCLUSION: High serum Uric acid was observed in 59.29% of patients with CHF. The observed significant correlation between UA level and some established prognostic markers in these patients may indicate that serum UA could provide additional prognostic information in this population. SUA as a marker can be measured anywhere at a low cost to help identify high-risk patients with CHF. Lowing uric acid is expected to be a new approach for prevention and therapy of HF.