Furqan Ul Haq

Infectious Causes of Acute Meningoencephalitis Syndrome in Children: Insights from a Tertiary Care Hospital in Pakistan

Unraveling Thrombocytopenia, A Study of Platelets Indices in Varied Etiologies

Living in Isolation: A Thematic Analysis of COVID-19 Patient Experiences, Perceptions and its Literature Review

Background: Thoracic outlet syndrome is a rare condition secondary to compression of neurovascular bundle in. Being physically active led to better prognosis. Literature shows a strong link between the thoracic and the thoracic area. Introduction: TOS can present with arm pain and swelling, arm fatigue, paresthesia, weakness, and discoloration of the hand. TOS can be classified as neurogenic, arterial, or venous based on the compressed structure(s). Methodology: This is a case presentation of our patient presented to us and was diagnosed with TOS, and then we have written its literature review article on the presentation and management of TOS discussed in PubMed indexed articles. Results and Conclusion: Our patient was timely diagnosed and after managing the acute complication of TOS, such as pain and thrombosis, it was treated with surgical excision of extra rib, since then the patient is asymptomatic. Muscle hypertrophy is recognized as can induce vascular or neurogenic compression outlet syndrome and certain sports. Neurogenic manifestation is most common, presenting with Pain, numbness, tingling, weakness, and vasomotor changes of upper limb. Vascular complications of thoracic outlet syndrome are uncommon including thromboembolic phenomena and swelling. Both surgical and non-surgical Treatment whereas some non-surgical Treatment appears to be effective in some patients. Despite advances, substantial controversy regarding the diagnosis remains. This is evidenced by the lack of objective findings surrounding TOS, the most common and widely disputed form of TOS. The challenges associated with diagnosis complicate the selection of the appropriate treatment option. In some cases, e.g., acute vascular insufficiency or progressive neurologic dysfunction, surgical decompression is clearly indicated. Prompt recognition and treatment of TOS provide the greatest opportunity for optimal recovery. Unfortunately, the multitude of nonspecific symptoms and challenges in diagnosis can delay treatment and increase the risk of complications. Surgical intervention for TOS syndrome is reserved for patients who have failed conservative management. Conservative treatment including physical therapy need be trialed for at least 4–6 months prior to consideration of surgical intervention.

Background: Haemophagocytic lymphohistiocytosis (HLH) is a rare and life-threatening syndrome characterized by an excessive inflammatory response. Limited data exist on adult HLH. Introduction: Hemophagocytic lymphohistiocytosis (HLH) is a condition in which immune hyperactivation and deregulation causes hemophagocytosis and organ disorder due to activated histiocytes and macrophages. Symptoms include fever, splenomegaly, abdominal distension and hepatomegaly. Case Report: We report the case of a forty year old man who presented to our Hospital with fever and loose stools and upon investigation had a pancytopenia with hypertriglyceridemia, hepatosplenomegaly, these clinical and laboratory findings raised suspicion of HLH secondary to typhoid fever. The patient was treated with immunosuppression (dexamethasone) and antibiotics and showed remarkable recovery. Hemophagocytic lymphohistiocytosis should be suspected in patients with tropical infections like enteric fever, tuberculosis, malaria, dengue, etc. that worsen despite appropriate treatment, as late diagnosis is associated with greater mortality. In this national, retrospective cohort study, we analysed data from the Pub Med database collected between October 1, 2006 and December 31, 2023 in making of this literature review. Results and Conclusion: Typhoid fever caused by the bacterium salmonella typhi and paratyphi is a serious febrile illness and is more common in the developing countries As a first line intervention, treating the etiology of HLH would be an efficient way to restrict the disease's progression. We report a rare and unique case of secondary HLH due to typhoid fever, this complication is often missed and a prompt diagnosis is essential for the treatment of this fatal disease. It can be primary (familial) or secondary (acquired). Clinically diagnoses can be difficult because of similarities in signs and symptoms with other illnesses as it generally presents with fever, loose stools, and decreased appetite and on Investigation one can expect pan or bi cytopenias, hepatosplenomegaly, hypertriglyceridemia, hypofibrinogenemia. Timely diagnosis of HLH makes it very treatable in majority of cases.

Background: Chronic pain is a persistent and among most prevalence issue in childhood the bio psychosocial model of pain which is a complex interplay contributes to pain symptoms. Disability has guided our understanding and treatment of pediatric pain. The exact cause of chronic pain is sometimes infectious. Introduction: The inclusion of chronic pain and rehabilitation terms resulted in a search to treat pediatric pain, treatment requires a comprehension and multi-disciplinary approaches mostly relieved by psychological intervention. Currently it is unclear how accurate diagnosis is made by general practitioners and specialists and how evaluation is made by pain specialists can affect patient’s outcomes. Case: A young adult female whose chronic hip and knee pain from several months was treated for pain, and osteoporosis, and osteomalacia, with calcium supplements, once Magnetic resonance imaging was done, it revealed that the patient is having fluid filled space in left hip when biopsied revealed chronic osteomyelitis. Conclusion: Chronic pain in pediatrics may be associated to osteomalacia, or osteopenia, it may be infectious, may be due to malignancy or fracture, but it shall be investigated with MRI na biopsy if the pain persists and not reliving with analgesics and supplements. Ignorance of chronic osteomyelitis can have poor outcomes.

Crimean-Congo hemorrhagic fever (CCHF) is a widespread tick-borne zoonotic disease. Sporadic outbreaks of CCHF occur in endemic regions, including Pakistan. The clinical spectrum of the illness varies from asymptomatic seroconversion to severe disease which may end in death. The treatment is supportive, including blood and blood products. There is multi-organ involvement in CCHF including acute hepatitis, thrombocytopenia, coagulopathy, acute kidney injury (AKI), and encephalopathy. Hematological and biochemical parameters may identify patients at substantial risk of worse outcomes. Early detection of the disease and forecasting the clinical course may be helpful. This case series aims to evaluate the trends of hematological and biochemical parameters among the survivors and non-survivors of CCHF. All consecutive patients aged 16 years and above admitted to the isolation unit of Hayatabad Medical Complex, Peshawar, Pakistan between 1^st July and 30^th July 2022 with the diagnosis of CCHF were included in this case series. The diagnosis of CCHF was made by detecting viral ribonucleic acid by a polymerase chain reaction. For all patients, age, gender, address, occupation, clinical presentation, history of contact with animals, and travel history were recorded. All the vitals were taken regularly. The hematological (complete blood count) and biochemical parameters (serum creatinine, alanine aminotransferase (ALT), and C-reactive protein (CRP)) were documented daily. The blood group was determined for all the cases. Out of 17 cases, the majority (16 cases, 94.1%) were male and butchers (eight cases, 47.1%) by profession. All cases had significant contact with animals. Four patients (23.5%) died. Three out of the four non-survivors (75%) had ALT < 5 times the upper limit of normal with a static pattern of liver enzymes without much decline in ALT till death. One non-survivor (25%) had marked elevation of ALT at presentation, which had a declining trend till death. Seven out of 13 survivors (53.8%) had moderate to marked elevation in the level of ALT at presentation. The ALT showed a downward trend during the course of illness in all these patients. The remaining survivors (six out of 13, 46.2%) had a mild elevation of ALT and 50% of them showed improvement in the ALT level during hospitalization. All patients had thrombocytopenia at presentation. None of the non-survivors showed a persistent increase in the platelet count, and three cases remained severely thrombocytopenic at the time of death. However, the trend in platelet count among all the survivors was increasing. The CRP level in the majority (three out of four cases, 75%) of the non-survivors remained elevated till death, while all survivors showed a progressive decline in CRP level. A majority (11 out of 17 cases) had blood group B. Half of the non-survivors (two out of four cases) and the majority of the survivors (nine out of 13 cases) had blood group B. AKI was found in all non-survivors, while all the survivors had normal renal function throughout the course. A persistently raised ALT and CRP level, a persistently low or decreasing platelet count, and AKI were associated with mortality. Blood group B was the commonest blood group among patients of CCHF, which is not reflective of the blood group distribution of the general population from which this case series has been reported.

Cutaneous chromoblastomycosis is a chronic subcutaneous fungal disease of the skin caused by Blastomyces dermatitidis, especially by Fonsecaea, Phialophora, and Cladophialophora species affecting the skin, lungs, intestines, stomach, and central nervous system. It is treated using itraconazole in mild cases and amphotericin B in severe cases. A six-year-old female child presented to the Dermatology Outpatient Department with pigmented brown to blackish tanned plaques and verrucous lesions on the face and extremities. These lesions were present for the past two and a half years and were slowly enlarging and involving other areas like the trunk. The lesions were proven on biopsy to be cutaneous blastomycosis. The patient was put on infusions of amphotericin B in a calculated pediatric dose. Her blood pressure and renal function tests were checked daily to avoid any electrolyte derangements, nephrotoxicity, and systemic infusion reactions caused by amphotericin B. Amphotericin B reduced the size of the cutaneous lesions, and treatment response was assessed on regular follow-ups. Chromoblastomycosis should be considered in the differential diagnosis to enable timely treatment and to prevent its lethal complications such as epidermoid carcinoma. Treatment should continue for two to three months until histopathology is negative to ensure complete eradication.

Brugada syndrome (BrS) is an autosomal-dominant condition mainly caused by defects in sodium channels causing ST-segment elevation in electrocardiograms (ECGs) in the V1 and V2 precordial leads, with ventricular tachyarrhythmias due to premature ventricular contractions, which increases the risk of sudden cardiac death. BrS usually presents in adulthood, with an average age of presentation of 41 years. In this article, we describe a case of BrS diagnosed in a 36-year-old male having sudden cardiac arrest with no comorbidities such as hypertension, diabetes mellitus, smoking, or any valvular disease history. We then explain the ECG-based diagnosis, signs and symptoms, presentation at the emergency department, and treatment options.

Primary hepatic lymphoma (PHL) is a rare subtype of diffuse large B-cell lymphoma (DLBCL). A 55-year-old male patient presented to us with jaundice and right upper quadrant pain. Investigations showed elevated alkaline phosphatase, lactate dehydrogenase, total bilirubin, normal alanine transaminase, and negative viral profile. Sonographic and computed tomographic scans show hepatosplenomegaly with hypodense lesion in liver associated with lymph nodes enlargement in the region of porta hepatis celiac axis, mediastinal and axillary lymphadenopathy. On immunohistochemistry, cells were positive for cluster of differentiation (CD)-19, CD-20, CD-21, c-myelocytomatosis oncogene (c-MYC), B-cell lymphoma 2 (Bcl-2), multiple myeloma oncogene-1 (MUM-1), same as B cell markers so it is diagnosed as PHL. DLBCL especially PHL shall be considered among the differentials of space-occupying lesions of liver. Early diagnosis of primary hepatic lymphoma is not a difficult task if excisional lymph node biopsy is taken following detection on ultrasound or CT scan which will lead to improved treatment, improvement in survival, and cost-effectiveness with good prognostic outcomes.