WAPDA Hospital

Objective: To find out the frequency of typhoid in patients presetting with high grade fever and to find the multiple drug resistance (MDR) and extensively drug resistance (XDR) in a diagnosed case of typhoid. Methods: This cross sectional study was conducted at Pediatrics department Naseer Teaching Hospital, Peshawar. All the participants were enrolled using non-probability sampling, their symptoms, clinical signs, blood culture and culture sensitivities were recorded. Data was analyzed using the statistical package for social science (SPSS) version 21. Results: A total of 166 participants were included in the study. Out of these 71 patients significantly had a positive blood culture. ( p value = <0.001) Sensitivity for generations of antibiotics was also studied which showed Trimethoprim, Ceftriaxone, Chloramphenicol and Ampicillin to be least sensitive. Azithromycin, Meropenem and Imipenem were more sensitive. Most of patients were XDR 35 (49.3%). Conclusion: Since in pediatric population fever is a very common complaint, typhoid disease should be suspected and ruled out as a differential especially in patients presenting with fever without localizing signs (FWLS). Also, in order to counter extensive drug resistance the importance of planned appropriate dosing of antibiotics must be emphasized at all levels of healthcare. Key Words: Typhoid, Fever without localizing signs (FWLS), Fever, Pediatric, MDR, XDR

Objective: To determine the etiological pattern, clinical presentation and outcome of patients with proptosis in a tertiary care hospital. Study Design: Cross-sectional study. Place and Duration of Study: Ophthalmology Department, Khyber Teaching Hospital, Peshawar Pakistan, from Jan 2019 to Jun 2020. Methodology: This study was conducted on 60 patients having proptosis. Patients were treated either medically, surgically or both. The demographic profile included age, gender and type of proptosis. The outcome included recovery, re-treatment,referral to the relevant speciality and loss to follow-up, were measured. Results: Out of 60 patients with proptosis, 39 were males, and 21 were female. Fifty-two patients had unilateral, and 8 had bilateral proptosis, with the majority suffering from non-axial proptosis. On aetiology exhibited tumours (45%), infectious (25%), inflammatory (16.6%), vascular (6.66%) and injury (6.66%). The surgical procedure was indicated in 27(45%) patients,while medical treatment was given in 28(46.6%) patients. Five patients (8.4%) received both surgical and medical treatment. Out of 60 patients, 26 patients (46.33%) fully recovered and 11 patients (18.33%) did not recover, 17(28.33%) patients were referred to other specialities for management, and 5(8.3%) patients lost to follow-up. Conclusion: In our study, tumours were the main cause of proptosis, followed by infective and inflammatory causes, with the paediatric age group (<18 years) at more risk.

Introduction: Left ventricular hypertrophy (LVH) is related to increased risk of stroke. However, very few studies analyzed association of LVH assessed by Echocardiography (Echo) in ischemic and hemorrhagic stroke separately. Aims & Objectives: To determine the association of left ventricular hypertrophy on echocardiography with hemorrhagic or non-hemorrhagic stroke. Place & Duration of Study: Study was done in Department of Cardiology Shaikh Zayed Hospital Lahore for six months from 01-01-2019 to 30-06-2019. Material & Methods: Total 190 patients, fulfilling inclusion and exclusion criteria were selected. All patients underwent for echo and LVH was noted. Left ventricular posterior wall (PW) and inter ventricular septum (IVS) thickness>11mm in males and >10mm in females labeled as LVH. Results: Results of this study showed that risk of LVH was 1.66 times higher among patients who presented with Hemorrhagic: 57.9% vs Non-hemorrhagic stroke: 34.7%. Elderly age group patients (RR: 1.85), female patients (RR:2.53), overweight patients (RR:2.38), longer duration of stroke (RR:2.42) and diabetic patients had higher association with LVH in hemorrhagic stroke. Conclusion: It was observed in this study that patients having hemorrhagic stroke had higher association of left ventricular hypertrophy (LVH) as compared to Non- Hemorrhagic stroke. Further studies are needed in this domain to address the association between LVH and hemorrhagic stroke.

Aim: To determine the association of left main stem disease with diabetes and hypertension in STEMI patients underwent coronary angiography Methodology: This study was conducted at Department of Cardiology, Sheikh Zayed Hospital, Lahore during January to June 2019 where 220 patients with age ranging from 40-70 years whether male or female, presenting with STEMI, In Exposed Group: Patients presenting with STEMI having diabetes and hypertension and Unexposed Group: Patients of STEMI without diabetes and hypertension. We excluded all cases with recurrent MI or undergoing recurrent PCI (on medical record), valvular heart disease, and cardiogenic shock. Then two groups were formed i.e. exposed group with diabetes and hypertension and unexposed group without diabetes and hypertension. All patients underwent angiography by a senior consultant cardiologist with assistance of researcher. On angiography, presence of LMS disease was ≥50% occlusion (stenosis) in LMS artery. Angiography reports were assessed and LMS disease was noted labeled. Patients with LMS disease was managed as per hospital protocol. Results: In this study risk of LMS was higher among exposed group as compared to un exposed group. i.e. exposed: 19.1% & Unexposed: 5.5%, RR=3.50 The risk of LMS among exposed group was higher for patients in the age group 51-60 years (RR=8.00), for male patients (RR=5.76) risk for LMS was higher as compared to female patients in exposed group, patients with normal BMI (RR:2.20) and patients with shorter duration of STEMI in exposed group had higher risk for LMS (1-4 weeks: RR=7.54). Conclusion: Results of this study showed that hypertensive and diabetic patients presenting with STEMI had higher risk for LMS disease. Keywords: Left main stem, Diabetes, Hypertension, Coronary, Angiography

Today the world is facing one of the deadliest pandemics caused by COVID-19. This highly transmissible virus has an incubation period of 2 to 14 days. It acts by attaching to the angiotensin-converting enzyme (ACE2) with the help of glycoprotein spikes, which it uses as a receptor. Real-time polymerase chain reaction (PCR; rt-PCR) is the gold standard diagnostic test, and chest X-ray and computed tomography (CT) scan are the other main investigations. Several medications and passive immunization are in use to treat the condition. We searched using PubMed and Google Scholar using keywords such as COVID-19, coronavirus, and their combination with pathological findings, clinical features, management, and treatment to search for relevant published literature. After the removal of duplications and the selection of only published English literature from the past five years, we had a total of 31 papers to review. Most of the COVID-19 affected patients have mild pneumonia symptoms, and those with severe disease have comorbidities. Patients with COVID-19 had pathological findings, like ground-glass opacities, consolidations, pleural effusion, lymphadenopathy, and interstitial infiltration of inflammatory cells. Radiological changes show lung changes such as consolidations and opacities, and the pathological findings were infiltration of inflammatory cells and hyalinization. Patients with mild symptoms should self-quarantine, whereas those with severe acute respiratory distress syndrome (ARDS) are treated in the hospital. Medications under trial include antivirals, antibacterials, antimalarials, and passive immunization. Supportive treatment such as oxygen therapy, extracorporeal membrane oxygenation, and ventilator support can also be used. The symptoms shown by patients are very mild and self-limiting. There is no definitive treatment, although a combination of hydroxychloroquine and azithromycin have shown good results, and passive immunization also shows promising results, their safety profile is yet to be studied in detail.