UNUSUAL PRESENTATION OF REACTIVE ARTHRITIS AFTER SALMONELLA ENTERITIS IN A 6-YEAR-OLD BOY

ABSTRACT: Reactive arthritis, formerly called Reiter’s syndrome is extra-articular oligoarthropathy, which can be due to bacterial infection or genetic predisposition. The infections are either urogenital (chlamydia being most notorious) or gastrointestinal (e.g. salmonella, yersinia, etc.). The human leukocyte antigen (HLA-B27) antigen has been implicated as the most common predisposing factor. Reactive arthritis often involves the joints of the lower limb. Bacterial enteric infections are a potential threat in a Pediatric population that can be due to an acute illness or its sequelae. Reactive arthritis following outbreaks of enteric infections with Salmonella is uncommon in the pediatric population. We report a rare case of a 6 years old boy who came to ER with high-grade fever and severe pain in the right iliac fossa. Clinical diagnosis of appendicitis was made by the physicians on physical exam but after radio-pathological investigation like CBC, ESR, CRP, Blood culture, USG abdomen, CT abdomen, and MRI, diagnosis of reactive arthritis secondary to salmonella enteritis was made and the patient underwent right hip arthrotomy after which he was discharged. Thus, imaging played a pivotal role in the right diagnosis of a patient with proper management guidelines. This also showed that salmonella enteritis can present atypically mimicking septic arthritis or acute appendicitis. Reactive arthritis after salmonella infection is a very rare and one of its kind case reported in Pakistan.

COMPARATIVE STUDY OF ANTIBIOTICS, TOOTHPASTE AND PLANT EXTRACTS AGAINST BACTERIAL PATHOGENS ISOLATED FROM HUMAN GUMS

This study was conducted to find out the effectiveness of some antibiotics, toothpastes, and medicinal plant extracts against the bacterial species isolated from human gums. A total of 125 samples were collected. The male and female patients were with the age from 15-60 years. A total of 27 species were isolated and identified. Among those bacterial species, Streptococcus mutans was most prevalent 29.62%, followed by Lactobacillus acidophilus 22.22%, Streptococcus sobrinus 18.51% and S aureus 14.81% respectively. While Micrococcus spp. 3.7%, Streptococcus sanguinis 3.7%, Actinomyces viscosus 3.7% and Aeromonas were least prevalent. To observe the most effective treatment for gum infections, the isolated strains were subjected to the sensitivity tests against antibiotics, toothpastes and plant extracts. The maximum zone of inhibition formed by Sulfamethoxazole was found against Staph aurus 33mm, while the minimum zone by Amoxicillin was observed against Streptococcus sobrinus (6mm). The maximum zone of inhibition by Toothpaste 1 (Fluoride and salt) was against Micrococcus spp. 34mm. The maximum zone of inhibition by Curcuma longa against S. mutans was 22mm, while the minimum zone by Ajuga bracteosa against S. mutans was 11mm. The data obtained through this study revealed that antibiotics were more effective for the treatment of oral bacterial pathogens as compared to toothpaste and plant extracts with moderate and low activity, respectively. Therefore, it is strongly suggested that use of antibiotics during infection and toothpaste with fluoride and salt contents in daily routine could help in the elimination of bacterial pathogens to maintain oral health.

ASSESSMENT OF VARIATIONS IN SPHENOID SINUS PNEUMATIZATION IN PAKISTANI POPULATION AT TERTIARY CARE HOSPITAL. A RETROSPECTIVE MULTIDETECTOR COMPUTED TOMOGRAPHY STUDY

Aim: The aim of the study is to evaluate the role of computed tomography in identifying the various pattern of pneumatization in the sphenoid sinuses.Knowledge of pattern of pneumatization is essential for various trans-sphenoidal surgical procedures. Methodology: This is a retrospective study conducted at tertiary care hospital Lahore General Hospital Department of Diagnostic Radiology from the period of June 2020 to December 2020.The study consisted of a total of 80 patients from age group of 20 years to 70 years who were referred to the Department of Diagnostic Radiology for CT scan(PNS) .Patients of age less than 20 years , previous facial surgeries , trauma of skull base and having tumor of sphenoid sinuses were excluded. Sphenoid sinuses images were evaluated for pneumatization by posterior and anterior extensions. RESULTS: The patients included were in the age range of 20-70 year with an average age of 43.5 year in which 44 (55%) were male and 36(45) were female The pneumatization pattern observed in the sphenoid sinuses in descending order was as follows , post sellar prevalence was 75%, prevalence of sellar was 10% and 2.5% was presellar. Conchal prevelance was observed to be 0%. Conclusion: Sphenoid sinus anatomy review before trans-sphenoidal surgery is vital for safer endoscopic instrumentation of the patients . Keyword: Sphenoid sinus, pneumatization, cerebral fluid leak, endoscopy

SERUM VISFATIN, INSULIN RESISTANCE AND BETA CELL FUNCTION IN TYPE II DIABETIC PATIENTS AND NON-DIABETIC ADULT OFFSPRING WITH POSITIVE PARENTAL HISTORY OF TYPE II DIABETES MELLITUS

Introduction: Non-diabetic individuals with type II diabetic parents are more susceptible to develop Diabetes. Visfatin; an adipocytokine and an enzyme is linked with glucose metabolism and affected by obesity. It works like insulin in the human body. It serves as a key enzyme in nicotinamide adenine dinucleotide biosynthesis and plays a pivotal role in glucose mediated insulin secretion. Aims and Objectives: In this study we aimed to determine and compare serum visfatin levels, insulin resistance (HOMA-IR) and beta cell function (HOMA-%B) of type II diabetic patients and non-diabetic adult offspring of type II diabetic parents with that of non-diabetic adult offspring of non-diabetic parents. Material and methods It was a cross-sectional comparative study conducted at Diabetes clinic of Lahore General Hospital (LGH) and department of Physiology, Post Graduate Medical Institute (PGMI), Lahore in 2018. The study groups included thirty type II diabetic subjects (group III) and forty non-diabetic adult offspring of type II diabetic parents (group II). Forty non-diabetic adult offspring of non-diabetic parents served as controls (group I). The subjects were of thirty to fifty years of age. Blood pressure, BMI and waist circumference of every subject was measured. Fasting blood samples of the subjects were analyzed for serum insulin, glucose and visfatin. Insulin resistance (HOMA-IR), insulin sensitivity (HOMA-%S) and beta cell function (HOMA-%β) were also calculated. Results Type II diabetics (group III) had significantly higher serum visfatin, HOMA-IR, and lower HOMA-%S as compared to the controls (group I). No significant difference was found between HOMA-%B of group III and controls. On the contrary, non-diabetic adult offspring of type II diabetic parents (group II) had significantly lower serum visfatin and HOMA-%S while HOMA-%β, HOMA-IR was significantly higher in comparison to the control group (group I). Conclusion Visfatin production seems suppressed in non-diabetic individuals with type II diabetic parents probably due to hyperinsulinemia. Moreover, it has a little role in insulin secretion in these individuals as reflected by their higher HOMA-%B index. However, visfatin’s upregulation in chronic hyperglycemia is indicative of its restorative role in the declined beta-cell function in type II diabetics.

CORRELATION OF THROMBOCYTOPENIA WITH GRADING OF ESOPHAGEAL VARICES IN PATIENTS WITH CIRRHOSIS

Objective: To determine the relationship of severity of thrombocytopenia with various grades of esophageal varices in patients with cirrhosis. Study design: A cross sectional observational study. Place and duration of study: Medicine department of Pakistan Railway General Hospital from 1st September, 2018 to 31st August, 2020. Material and Methods: The record of 100 patients with cirrhosis having concomitant thrombocytopenia and esophageal varices was retrospectively analyzed. The information about clinical, hematological, biochemical, ultrasound and endoscopic findings was retrieved from medical record. On the basis of platelet count, four groups were made. Group I consisted of patients with a platelet count ≤ 20,000/ µl, group II 21,000-49,000/ µl, group III 50,000-99,000/ µl, and group IV 100,000- 149,000/ µl. Esophageal varices were reclassified as small and large varices group depending on the size. Correlation of thrombocytopenia with grading of esophageal varices was calculated using spearman’s correlation. Results: Out of 100 patients, 76% had large varices and 24% had small varices. Thrombocytopenia was more severe in patients with large varices group when compared with small varices group. There was significant negative correlation between thrombocytopenia and grading of esophageal varices (r= -.691; P < 0.001). Conclusion: The severity of thrombocytopenia increased with increase in the size of esophageal varices. Low platelet count can strongly predict large varices in patients with cirrhosis.

FREQUENCY OF ADRENAL INSUFFICIENCY AMONG PATIENTS OF HUMAN IMMUNODEFICIENCY VIRUS

Background: Human immunodeficiency virus (HIV) has emerged as a major public health problem worldwide over the last two decades. Many complications and problems are associated with HIV like lipodystrophy, retarded growth in young patients, impaired endocrine and renal functioning and cardiovascular diseases. Objective: To determine the frequency of adrenal insufficiency among patients of human immunodeficiency virus presenting to HIV clinic in a tertiary care hospital. Study Design: Cross Sectional Study. Setting: HIV clinic, Jinnah Hospital Lahore. Study Duration: August, 2019 to February, 2020. Material and Methods: A total of 180 patients of HIV presenting to HIV clinic of Jinnah hospital Lahore and fulfilling the selection criteria were approached after approval from ethical review board an informed consent was taken from the subject and an ACTH stimulation test was performed and adrenal Insufficiency was diagnosed. Intramuscular injection of 0.25 mg of synthetic ACTH was administered to all patients; and after 60 minutes serum cortisol was measured. A peak stimulated cortisol of less than 20 mcg/dl was labeled as adrenal insufficiency. Results: Mean and standard deviation of the age was 42.16 ± 17.31 years. Male patients were 56.1% while female patients were 43.9%. Adrenal insufficiency was present in 38.3% patients while it was absent in 61.7% patients. No significant association found between age and presence of adrenal insufficiency (p=0.280). Also no significant association found between duration of disease and adrenal insufficiency (p=.557). There was a significant association found between intake of antiretroviral therapy and presence of adrenal insufficiency having (p<0.005) Conclusion: Adrenal insufficiency was found in significant number of HIV patients but effect modifiers like age, duration of disease did not show significant association except intake of antiretroviral therapy.

FACTORS ASSOCIATED WITH HAEMATURIA IN CHILDREN IN AGE GROUP OF 1 TO 14 YEARS

BACKGROUND: Haematuria is the most common urinary finding that bring children to the attention of the paediatric nephrologists. It can be caused by glomerular & non-glomerular diseases. The main causes of Haematuria are urinary tract infections, trauma to abdomen, acute post streptococcal glomerulonephritis and congenital hydronephrosis. OBJECTIVE: The objective of this study was to identify the distribution of factors in children with haematuria in age group of 1 to 14 years METHODS: A total of 84 admitted patients of haematuria, who fulfill the inclusive criteria,were enrolled in this study after consent from their parents. Each patient was evaluated through history, examination and investigated. Urine sample of each patient was analyzed for a microscopic examination. Investigations / imaging were performed in clinical laboratory of LGH / PGMI, Lahore. The collected information was entered into SPSS version 20, and analyzed. RESULTS: There were 47(44.05%) male and 37(55.95%) female patients in this study. The mean age of patients was 8.69 ± 3.63 years.We found 14 patients (16.66%) has urological anomalies,6 boys have posterior urethral valves.2 girls and one boy has vesicoureteral reflux.One boy and one girl has ureterovesical junction obstruction,one boy has hypospadias and 2 girls , ureteropelvic junction obstruction.History of recent bladder catheterization was seen in 5(5.59%), urinary tract infection 17(20.23%) and 14 patients has urological anomalies(16.66%). CONCLUSION: According to this study ,most common factors causing haematuria was urinary tract infection 17(20.23%) , acute poststreptococcal glomerulonephritis 16(19.04%) and congenital urological anomalies 14(16.66%).Renal stones were found in 10(11.90%).

DIAGNOSTIC ACCURACY OF COLOR ANDPULSED DOPPLER IN THE EVALUATION OF PAROTID GLAND TUMORS

Background: The parotid glands are the largest salivary glands in humans and are frequently involved in various primary & systemic disease processes. The most common benign parotid gland tumor is pleomorphic adenoma. Around 20% of parotid tumors are malignant with most common parotid tumors being mucoepidermoid carcinoma and adenoid cystic carcinoma. Objective: To determine the diagnostic accuracy of pulsed and color Doppler for the evaluation of parotid gland cancer. Methods: It was a cross sectional study by design carried out in Department of Radiology and Department of Maxillofacial Surgery, Mayo Hospital – Lahore in a duration of three year. All the patients were examined with mind-ray 7.5 MHz linear transducer. There are three methods used collectively; Grey Scale, color Doppler and Pulsed Doppler in sonographic examination. Color Doppler and pulsed Doppler demonstrate number of blood vessels within the tumor, their Peak Systolic Velocity and Resistive Index respectively. Histo-pathological results were correlated post operatively with the data obtained from Doppler ultrasound. Data was analyzed using SPSS 23.0 Results: In this study, 192 patients were included .The mean age was 39.42 ± 11.93 years. 58.85% (112) were male patients and 41.15 %( 80) patients were females. The solid masses with regular margins were evaluated and the diagnostic accuracy of pulsed Doppler was found to be 87.5% taking histopathology as gold standard. Conclusion: This study shows pulsed Doppler to be more accurate tool for diagnosis of parotid gland tumor as compared to color Doppler taking histopathology as gold standard.

PROTECTIVE EFFECT OF SEA BUCKTHORN SEED OIL EXTRACT ON ACETAMINOPHEN INDUCED HISTOLOGICAL CHANGES OF HEPATOCYTES IN ADULT ALBINO RATS.

Objective: to reveal the effects of sea buckthorn seed oil on acetaminophen induced variations (Diameter of hepatocytes and vacuolization) in liver of rats. Methods: it was experimental study, conducted at Post Graduate Medical Institute. This study was performed on 24 adult rats, which were then randomly separated into 4 groups A,B,C and D. the experiment lasted for 13 days. Group A was control received normal saline and distilled water. Group B, received acetaminophen750mg/kg as single dose on day 10. Group C and D received acetaminophen at dose of 750mg/kg along with sea buckthorn seed oil extract 2.6mg/kg and 5.2mg/kg. Liver was removed and fixed in 10% formalin. To observe the effect of acetaminophen and sea buckthorn seed oil , slides were prepared for histological examination. The diameter of hepatocytes and vacuolization was observed. The evaluation of results was done by using SPSS 21. Results: In Group B, vacuolization was seen in all animals and significant increase in mean diameter (11.9± 1.5 μm) of hepatocytes was seen. However in Group C, vacuolization was absent in all animals and mean hepatocyte diameter was (6 ± 0.6 μm). In Group D, no vacuolization was seen in all animals and mean hepatocyte diameter decreased to (5.2± 1.5 μm) after administration of SBT seed oil. Conclusion: Administration of SBT( 2.6mg/kg and 5.2mg/kg) exerts a protective effect against damaging effects of ACM ( 750 mg/kg) on hepatocytes in albino rats. This hepatoprotective role becomes greater with increasing dose of SBT.