PRIMARY CNS LYMPHOMA MIMICKING TUBERCULOSIS INFECTION - A CASE REPORT

Primary central nervous system lymphoma (PCNSL) is a rare variety of extra nodal non-Hodgkin lymphoma that reportedly involves leptomeninges, the brain, spinal cord, eyes, or may involve other organs systemically. We present a case of 46-yearold woman with complaints of headache and fever for three weeks, associated with right-sided weakness & altered state of consciousness for one week. The most common presentation of primary central nervous lymphoma is diffuse or multifocal supratentorial masses causing cognitive deterioration and involvement of vitreous, retina, and optic nerve. Most cases ofPCNSL are left undiagnosed due to uncommon

Displacement of Gray Matter and Incidence of Seizures in Patients with Cerebral Cavernous Malformations

Seizures are the most common presentation in patients with cerebral cavernous malformations (CCMs). Based on the hypothesis that the volume or proportion of gray matter (GM) displaced by CCMs is associated with the risk of seizure, we developed an algorithm by which to quantify the volume and proportion of displaced GM and the risk of seizure. Image analysis was conducted on 111 patients with solitary CCMs (divided into seizure and nonseizure groups) from our gamma knife radiosurgery (GKRS) database from February 2005 and March 2020. The CCM algorithm proved effective in quantifying the GM and CCM using T1WI MRI images. In the seizure group, 11 of the 12 patients exhibited seizures at the initial presentation, and all CCMs in the seizure group were supratentorial. The location of the limbic lobe within the CCM was significantly associated with the risk of seizure (OR = 19.6, p = 0.02). The risk of seizure increased when the proportion of GM displaced by the CCM exceeded 31%. It was also strongly correlated with the volume of displaced GM. The volume and proportion of displaced GM were both positively correlated with the risk of seizure presentation/development and thus could be used to guide seizure prophylaxis in CCM patients.

Dilated cardiomyopathy associated with a mutation in the dispatched RND transporter family member 1 gene

Dilated cardiomyopathy is the most common presentation of cardiomyopathy in children with 20–35% of patients having an identified genetic component. There are more than 30 genes implicated in the pathogenesis of dilated cardiomyopathy. We present the first report of a female infant with dilated cardiomyopathy with a genetic variant in the dispatched RND transporter family member 1 gene.

P-EGS13 Risk Factors of Bleeding Gastroduodenal Ulcer Among Patient Undergo Emergency Upper Endoscopy in Hospital Melaka

Background Bleeding gastroduodenal ulcer has been one of the leading causes of admission in surgical or gastroenterology departments all over the world, requiring immediate intervention with high associated mortality exceeding 10%. We analyzed few important risk factors that lead to this potentially ill condition. Methods Data from a number of 548 patients who underwent emergency upper endoscopy were collected retrospectively from June 2020 till June 2021 in Hospital Melaka. Results From our data collection of emergency upper endoscopy performed, 111 patients had findings of high-risk ulcer (Forrest Ia, Ib, 2a and 2b). From these 111 patients, the most common presentation was low hemoglobin value (<10g/dL), with 43.6%. Presentation of melena encountered the second most common symptom (26.3%), while fresh per rectal bleeding counts the less common symptom (1%). Forrest Ib ulcer showed the commonest diagnosis found during endoscopy (45.5%), followed by Forrest IIa ulcer (34.5%), Forrest IIb ulcer (16.4%), and Forrest Ia ulcer (3.6%). There were 27 participants who undergo repetitive endoscopy. For Helicobacter Pylori infection, there were 367 patients (66.7%) underwent the test during endoscopy, which showed 187 patients detected (51%) with H.Pylori positive. We identify other risk factors which lead to this fatal condition such as, patient’s comorbidities including liver disease, renal disease and their medications, blood investigations including hemoglobin level, platelet count, total white cell count, total bilirubin, Alanine Transaminase (ALT), serum urea and creatinine. Conclusions It is a must to identify important risk factors for bleeding gastroduodenal ulcers to prevent morbidity and mortality, and to initiate emergency intervention medically and surgically. From this study, it was a great move for us to make further research on how these risk factors affecting our management of patients.

Evaluating the transitions in care for children presenting with acute asthma to emergency departments: a retrospective cohort study

Background Acute asthma is a common presentation to emergency departments (EDs) worldwide and, due to overcrowding, delays in treatment often occur. This study deconstructs the total ED length of stay into stages and estimates covariate effects on transition times for children presenting with asthma. Methods We extracted ED presentations in 2019 made by children in Alberta, Canada for acute asthma. We used multivariable Cox regressions in a multistate model to model transition times among the stages of start, physician initial assessment (PIA), disposition decision, and ED departure. Results Data from 6598 patients on 8270 ED presentations were extracted. The individual PIA time was longer (i.e., HR < 1) when time to the crowding metric (hourly PIA) was above 1 h (HR = 0.32; 95% CI:0.30,0.34), for tertiary (HR = 0.65; 95% CI:0.61,0.70) and urban EDs (HR = 0.77; 95% CI:0.70,0.84), for younger patients (HR = 0.99 per year; 95% CI:0.99,1.00), and for patients triaged less urgent/non-urgent (HR = 0.89; 95% CI:0.84,0.95). It was shorter for patients arriving by ambulance (HR = 1.22; 95% CI:1.04,1.42). Times from PIA to disposition decision were longer for tertiary (HR = 0.47; 95% CI:0.44,0.51) and urban (HR = 0.69; 95% CI:0.63,0.75) EDs, for patients triaged as resuscitation/emergent (HR = 0.51; 95% CI:0.48,0.54), and for patients arriving by ambulance (HR = 0.78; 95% CI:0.70,0.87). Times from disposition decision to ED departure were longer for patients who were admitted (HR = 0.16; 95% CI:0.13,0.20) or transferred (HR = 0.42; 95% CI:0.35,0.50), and for tertiary EDs (HR = 0.93; 95% CI:0.92,0.94). Conclusions All transition times were impacted by ED presentation characteristics. The sole key patient characteristic was age and it only impacted time to PIA. ED crowding demonstrated strong effects of time to PIA but not for the transition times involving disposition decision and ED departure stages.

Epidemiology, risk factors and monitoring of acute otitis externa

Estimates show that otitis externa is a common presentation in different settings and can be acute, chronic, or necrotizing. Eczema of the ear canal is usually associated with the condition. It has also been demonstrated that humid environments, swimming, and mechanical trauma, using hearing aid supplements, and absence or reduce air wax are all significant risk factors that can increase the risk of having otitis externa. The pathology of otitis externa is simply an inflammation of the external auditory canal, which can either be attributed to an infection or other non-infectious etiologies. In the present literature review, we have discussed the epidemiology, risk factors, and monitoring of patients with acute otitis externa. Our findings indicate the high prevalence of the condition, especially among developing countries and areas with high temperature and humidity levels. Swimmers are more commonly affected together with adults. However, children might also be affected in some cases. Male individuals also have a higher risk. Nevertheless, data is limited and further studies are needed. The condition can be easily treated and symptoms usually resolve within 1 day from initiating the treatment. However, some cases might persist, and in these events, consultation with an otolaryngologist is required together with culture for adequate identification of the etiology and management of the case.

COMPARISON OF SPIROMETRY DATA AND SYMPTOMS BETWEEN MALE AND FEMALE SMOKERS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

BACKGROUND & OBJECTIVE: Chronic Obstructive Pulmonary Disease (COPD) is a heterogeneous disease, showing the exaggerated response of airways to any injurious stimulus. It is no longer considered as the disease of men as it is becoming increasingly prevalent in females. Evidence suggests that gender affects the clinical presentation of the disease. The objectives of the study is to compare spirometry data between male and female smokers with COPD and to study the association of cough, sputum, and dyspnea with gender in smokers with COPD. METHODOLOGY: This descriptive study was conducted at the University of Health Sciences Lahore. The study sample included 41 COPD patients with a history of smoking. After taking written informed consent, patients were recruited from the outpatient departments of tertiary care hospitals of Lahore by convenience sampling technique. A complete history was taken, and spirometry was done on each subject. The subjects were divided into male and female groups, followed by the comparison of Spirometry data between the groups and association of symptoms with gender using appropriate statistical techniques. RESULTS: The results of this study demonstrated females were significantly younger and exhibited a greater decline of lung functions with similar pack-years history compared to male smokers with COPD. The most common presentation of females was breathlessness compared to male patients, who had sputum production as the most common presentation. CONCLUSION: Significant differences were seen in spirometry and clinical presentation of the disease in male and female COPD groups, showing the onset and symptomology of the disease.

Clinico-pathological changes in COVID-19 patients

Background: Novel Corona virus is associated with the respiratory disorder. Corona virus cases disease ranging from a common cold like illness severe acute respiratory syndrome. Biochemical parameters become altered in the patients, and this has been correlated with the severity of the disease. The present study was undertaken to analyse the effect of novel corona virus infection in organs other than lungs.Methods: The study is a retrospective studycarried out in RMCH and RC, Kanpur from July 2020 to June 2021. Haematological, biochemical and inflammatory biomarker study was conducted in 336 COVID-19 patients.Results: Out of 336 COVID-19 patients the maximum number of patients belonged to the age group of 61-70 years. There were 75% symptomatic and 25% asymptomatic cases of confirmed COVID-19. Sore throat was the most common presentation followed by cough and dyspnoea. Other manifestations include fever, myalgia, loss of taste, loss of smell and running nose. Serum CRP and PCT concentration were observed in more severe cases 22.2% and 17% respectively. Haematological findings include decrease in total RBC count (58.33%). Symptomatic COVID-19 patients have thrombocytopenia (30.95%), lymphopenia (25%), leucocytosis (11.90%) and leucopenia 8.33%. Hepatic dysfunction and renal dysfunction was observed in 71.42% and 14.28% symptomatic cases respectively.Conclusions: We concluded that novel corona virus is not only affecting respiratory system but also other vital organs. On the basis of haematological and biochemical findings we can predict the severity of COVID-19 infection which could be helpful for management of the disease.

Clinical characteristics of Demodex-associated recurrent hordeola: an observational, comparative study

Our study evaluated the association between Demodex infestation and recurrent hordeola and examined the clinical features associated with these eyelid lesions. This was an observational, comparative study. We reviewed 250 patients and divided them into the recurrent hordeolum (n = 153) and control (n = 97) groups. Demodex infestation was detected by epilating eyelashes around the lesion/s and viewing them under a light microscope. Patient medical records and photographs were retrospectively analyzed to identify the clinical characteristics of Demodex-associated recurrent hordeola. Demodex was detected in 91 (59.5%) and 17 (17.5%) patients in the recurrent hordeolum and control groups (p < 0.001), respectively. In the recurrent hordeolum group, Demodex mites were found in 74 (68.5%) and 17 (37.8%) of the adult and pediatric patients (p < 0.001), respectively. Among patients with recurrent hordeola, patients in their 20s were most likely to have concomitant Demodex infestation. Patients with Demodex infestations were also more likely to develop recurrent lesions within a shorter period of time from the primary incision and curettage. The most common presentation of Demodex-associated recurrent lesions was external hordeola (67%) (p = 0.002). Demodex infestation may cause recurrent hordeola in adults and children. These mites may play a greater role in the development of lesions in adult patients. The strongest association between Demodex infestation and recurrent lesions was seen in patients in their 20s. Our results suggest that if the hordeola recur within a short period of time with the clinical characteristics of external location of eyelid, multiple numbers of lesions, or anterior blepharitis, eyelash epilation should be performed to identify the presence of Demodex mites.