Brucellosis is commonly transmitted by consumption of unpasteurized dairy products and most commonly presents as fever, arthralgia, fatigue, hepatosplenomegaly, and peripheral arthritis. Our patient presented with a history of three months of high-grade fever, undocumented significant weight loss, jaundice, and hepatosplenomegaly. On the seventh day of admission, he developed sudden onset of shortness of breath, and his jugular venous pressure was raised with fine crackles at the lung bases bilaterally and pedal edema up to the ankles bilaterally. Electrocardiography was done, which showed T wave inversions in 1 and augmented Vector Left (aVL). Troponin I was raised at that time, and echocardiography revealed an ejection fraction of 40%. A diagnosis of myocarditis secondary to brucellosis was made.
Antiphospholipid syndrome (APS) is an acquired prothrombic state with recurring thromboembolic and obstetric complications in the presence of antiphospholipid antibodies. Isolated skin manifestation especially symmetrical peripheral gangrene (SPG) in postpartum phase is reported rarely. To highlight this unusual presentation of APS with SPG we present a case of young female who developed SPG on her third postpartum day. Postpartum period runs a high risk of sepsis but development of such extensive and rapid ischemic changes in APS is seen uncommonly.
BackgroundDiagnosing intestinal (Luminal) tuberculosis is challenging due to limited yield of diagnostic modalities like CT scan, colonoscopy with blind ileal biopsies. GeneXpert MTB/RIF (Xpert) assays for diagnosing tuberculosis have been performed in the body secretions with excellent results. Its yield in stool is tested in this study.ObjectiveThe study aims to evaluate the yield of GeneXpert assay in stool of suspected cases of intestinal tuberculosis.MethodsHundred patients with suspected intestinal tuberculosis underwent routine biochemical tests, radiological investigations, colonoscopy with caecal and blind ileal biopsies for histopathology. Fresh stool samples were collected, processed for DNA extraction, tested using 2:1 ratio of GeneXpert reagent to sample to give positive or negative results for Mycobacterium tuberculosis and Rifampicin resistance.ResultsOut of hundred participants, 52% were female. Mean age was 28.21 ± 12.13. CT scan and colonoscopy findings suggestive of TB were present in 47% and 43% participants respectively. GeneXpert in stool was positive in 20% cases. Considering mucosal biopsy with histopathology of intestinal specimens as diagnostic of abdominal Tuberculosis, sensitivity and specificity of GeneXpert was 39.1% and 85.7% respectively.ConclusionStool GeneXpert assay offers an alternative approach to detect intestinal tuberculosis rapidly with good diagnostic accuracy. Although it cannot replace the AFB culture and histopathology but contribute for early diagnosis and management.
Background: Polycystic ovary syndrome (PCOS) is a heterogeneous metabolic disorder affecting women of the child-bearing age. Alteration in lipid profile is one of the troublesome features faced by PCOS patients that need to be treated. Aim: The purpose of this study was to compare the effects of Probiotics, Metformin and their Combination therapy on lipid profile in women suffering from PCOS. Study Design: Single-Centered Randomized Controlled Trial. Setting: Gynecological clinic of Karachi at Tertiary care Hospital from December 2018 to May 2019. Patients and Methods: Total 78 PCOS patients of age between 18 to 40 years were involved in this trial rendering to Rotterdam criteria. After taking written and informed consent they were randomly allocated to three groups and were received: Metformin 500 mg B.D (n = 26), Probiotic Capsule 180 mg B.D (n = 26) and Combination of Metformin 500 mg B.D / Probiotic Capsule 180 mg B.D for 12-weeks. Lipid profile was measured at baseline and after 12-weeks of intervention along with the body weight. In the end, pre versus post therapy and comparison of different group’s results were analyzed. Results: Metformin and Met/Pro Combination groups resulted in a significant reduction in Total Cholesterol (TC) as compared to Probiotic group. Fall in Low-Density Lipoprotein Cholesterol (LDL-C) levels were noteworthy after Probiotics and Met/Pro treatment. Serum TG concentrations were significantly reduced in all the groups. High-Density Lipoprotein Cholesterol (HDL-C) levels were slightly elevated after Probiotics treatment, which was not statistically significant but Metformin and Met/Pro group increases it to the significant value. No substantial change was found in the Very Low-Density Lipoprotein Cholesterol VLDL-C levels in any of the three groups. Conclusion: Overall, Probiotics treatment in PCOS women for 12 weeks exhibited noteworthy changes in TG, and LDL-C levels. Metformin markedly improve Cholesterol, TG and HDL-C. However, Met/Pro improved all the lipid changes to the significant value except for VLDL-C.
Behcet's disease (BD), also known as Behcet's syndrome, is a rare, chronic, autoimmune disorder of unknown origin. Its manifestations are thought to be caused by vasculitis, resulting in damage to blood vessels of all sizes throughout the body. We report a 25-year-old Pakistani male who is sexually active and presents with a one-year history of shortness of breath, cough, exertional dyspnea, and neck and facial swelling. On examination, he had severe anemia, mouth ulcers, distended neck and chest veins, prominent abdominal veins, and a scrotal ulcer. After going through mandatory investigations to evaluate the presenting signs and symptoms, thromboses were found in the major veins, including the superior vena cava (SVC) and external iliac vein, as well as a positive pathergy test. Accordingly, a diagnosis of Behcet's disease with cardiomyopathy and venous thrombosis was made. He was treated with anticoagulants, steroids, and azathioprine for six months and subsequently went into remission.
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