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RENAL DISEASE IN SYSTEMIC LUPUS ERYTHEMATOUS: ALL THAT GLITTERS IS NOT GOLD 系统性红斑狼疮肾病:闪光的未必都是金子
Pub Date : 2022-01-01 DOI: 10.51253/pafmj.v71i6.3311
Hafiz Waleed Khan, A. Arshad, Abdul Wahab Mir
Patients with systemic lupus erythematosus may occasionally develop renal pathology from causes unrelated to the underlying disease. We describe one such case. This 22-year-old lady, with past history of arthritis, presented with dyspnea and fever. She had clinical signs consistent with systemic lupus erythematosus. Echocardiogram revealed valvular regurgitation. Antibiotics were started for probable infective endocarditis. She developed acute kidney injury. This was initially attributed to lupus nephritis, but subsequently renal histopathology revealed acute interstitial nephritis. Renal functions normalized with oral prednisolone. This case highlights the fact that a broader differential diagnosis must always be considered even if the diagnosis is clear.
系统性红斑狼疮患者可能偶尔会因与基础疾病无关的原因而发展肾脏病理。我们描述一个这样的例子。22岁女性,既往有关节炎病史,表现为呼吸困难和发烧。她的临床症状符合系统性红斑狼疮。超声心动图显示瓣膜反流。对可能的感染性心内膜炎给予抗生素治疗。她患上了急性肾损伤。这最初归因于狼疮肾炎,但随后肾脏组织病理学显示急性间质性肾炎。口服强的松龙使肾功能恢复正常。这个病例强调了一个事实,即即使诊断是明确的,也必须考虑更广泛的鉴别诊断。
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引用次数: 0
SEMEN ANALYSIS; CORNER STONE IN EVALUATING INFERTILITY 精液分析;评估不孕症的基石
Pub Date : 2022-01-01 DOI: 10.51253/pafmj.v71i6.6150
Aysha Khan, Zunera Shahbaz, S. Yousaf, Abeera Ahmed, F. Sana, F. Sana
Objective: To study the patterns and distribution of various abnormal semen parameters in infertile males. Study Design: Cross sectional study. Place and Duration of Study: Department of Pathology, Combined Military Hospital, Karachi, from Nov 2019 to Oct 2020. Methodology: The study included 364 patients who presented with primary and secondary infertility. Consecutive convenient sampling was done. Semen analysis was performed using World Health Organization latest guidelines. Samples were categorized as normospermia, azoospermia, oligospermia, asthenozoospermia and necrospermia. Results: The study comprised of 364 samples of infertile males. Normal sperm count was observed in 317 (87%) males, azoospermia in 28 (7.6%) and oligospermia in 19 (5.2%) males. Low ejaculated volume and higher non-motile sperms were noted in oligospermia samples in comparison with normospermia samples. Asthenozoospermia was observed in 102 (28%) and oligoasthenospermia was noted in 15 (4.1%) samples. Conclusion: Good quality semen analysis is a corner stone to diagnose the cause of male infertility.Sperm concentration and motility are the important markers of normal male reproductive system and are related to each other.
目的:探讨不育男性精液各项异常参数的形态及分布。研究设计:横断面研究。学习地点和时间:2019年11月至2020年10月,卡拉奇联合军队医院病理科。方法:该研究包括364例原发性和继发性不孕症患者。连续方便取样。精液分析采用世界卫生组织最新指南。样本分为正常精子症、无精子症、少精子症、弱精子症和无精子症。结果:该研究包括364个不育男性样本。正常精子317例(87%),无精子28例(7.6%),少精子19例(5.2%)。与正常精子症相比,少精子症样本的射精量低,无运动精子较多。102例(28%)出现弱精子症,15例(4.1%)出现少弱精子症。结论:高质量的精液分析是诊断男性不育症病因的基石。精子浓度和活力是男性生殖系统正常的重要标志,两者之间存在一定的相关性。
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引用次数: 0
A CASE REPORT OF JUVENILE FORM OF METACHROMATIC LEUKODYSTROPHY 少年型异色性脑白质营养不良1例报告
Pub Date : 2022-01-01 DOI: 10.51253/pafmj.v71i6.4362
Muhammad Mohsin Sajjad, Sidra Yousaf
Metachromatic Leukodystrophy is a lysosomal storage autosomal recessive disease characterized by arylsulphatase enzyme deficiency, with central and peripheral demyelination. We report a case of a 15-year-old girl with 6 months history of progressive muscular weakness, poor school performance, gradual memory loss and gait disturbance. Neurological examination was grossly normal, except mild muscle wastage in both upper and lower limbs and slight reduction of power globally in all limbs. Routine bloods including a lumbar puncture was normal and the diagnosis of metachromatic leukodystrophy was made on the findings of magnetic resonance imaging (MRI) brain.
异色性脑白质营养不良症是一种溶酶体贮积常染色体隐性遗传病,以芳基硫酸酶缺乏为特征,伴有中央和外周脱髓鞘。我们报告一个15岁的女孩,她有6个月进行性肌肉无力、学习成绩差、逐渐记忆丧失和步态障碍的病史。神经学检查大体正常,除了上肢和下肢轻度肌肉萎缩和四肢整体力量轻微下降。常规血包括腰椎穿刺正常,并根据脑磁共振成像(MRI)的结果诊断为异色性脑白质营养不良。
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引用次数: 0
THE IDEAL PROFILE (INCREASE IN B-LINES/DELTA B-LINES) ON LUNG ULTRASOUND FOR DIAGNOSING WEANING INDUCED PULMONARY EDEMA IN VENTILATED PATIENTS 肺超声诊断通气患者脱机所致肺水肿的理想轮廓(b线/ δ b线增加)
Pub Date : 2022-01-01 DOI: 10.51253/pafmj.v71i6.5691
Ghulam Rasheed, Zahid Siddique Shad, Tooba Mehreen, Nusrat Kharadi, Moazma Ramzan, Azmat Abdullah, K. Abbas
Objective: To ascertain the ideal number of B-lines on lung ultrasound for the diagnosis of weaning induced pulmonary edema in ventilated patients. Study Design: Prospective observational study. Place and Duration of Study: Department of Medicine, Shifa International Hospital, Islamabad, from Jan to Aug 2020. Methodology: All the patients over the age of 18 years who were on mechanical ventilation in a medical intensive care unit were included in the study. The patients were given spontaneous breathing trials as a protocol for weaning from mechanical ventilation. Lung ultrasound was performed on 4 points of anterior chest wall before and after spontaneous breathing trials. Before and after spontaneous breathing trials counting of B lines was done on ultrasound of lung and comparison of increase in B lines (Delta-B-lines) was done with reference diagnosis of weaning induced pulmonary edema diagnosed by intensivist who was blinded to the results of lung ultrasound. Results: The study included 42 patients including 23 (54.8%) men and 19 (45.2%) women. 14 cases failed spontaneous breathing trials. Seven cases (16.7%) had weaning induced pulmonary edema. Delta-B-lines ≥6 diagnosed weaning induced pulmonary edema with 100% accuracy. Out of the remaining seven patients with weaning failure but without weaning induced pulmonary edema, 6 (28.6%) had Delta-B-lines ≥6. The ultrasound lung technique had a 100% sensitivity profile to detect weaning induced pulmonary edema and a specificity of 77.78%. Conclusion: The study indicates that Delta-B-lines ≥6 diagnosed the weaning induced pulmonary edema with the best accuracy.
目的:探讨肺超声诊断通气患者脱机肺水肿的理想b线数。研究设计:前瞻性观察性研究。学习地点和时间:2020年1月至8月伊斯兰堡Shifa国际医院医学部。方法:所有在重症监护病房使用机械通气的18岁以上患者纳入研究。患者进行自主呼吸试验,作为脱离机械通气的方案。在自主呼吸试验前后分别对前胸壁4个点进行肺超声检查。在自主呼吸试验前后对肺超声进行B线计数,并与对肺超声结果不知情的重症监护医师诊断的脱机肺水肿的参考诊断进行B线(δ B线)的增加比较。结果:纳入42例患者,其中男性23例(54.8%),女性19例(45.2%)。自主呼吸试验失败14例。7例(16.7%)发生脱机所致肺水肿。δ b线≥6线诊断脱机性肺水肿的准确率为100%。在其余7例脱机失败但未脱机引起肺水肿的患者中,6例(28.6%)的δ - b线≥6。超声肺技术检测脱机肺水肿的敏感性为100%,特异性为77.78%。结论:δ b线≥6线诊断脱机肺水肿准确率最高。
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引用次数: 1
EVALUATION OF CHONDROPROTECTIVE EFFECTS OF HYALURONIC ACID IN A RAT MODEL OF OSTEOARTHRITIS 透明质酸对骨关节炎大鼠模型软骨保护作用的评价
Pub Date : 2022-01-01 DOI: 10.51253/pafmj.v71i6.3984
Noaman Ishaq, S. Ali, Muhammad Waqar Aslam Khan, Kulsoom Farhat, Nausheen Ata, Quratulain Mehdi
Objective: To evaluate the chondroprotective effects of hyaluronic acid in a rat model of osteoarthritis. Study Design: Laboratory based experimental study. Place and Duration of Study: Department of Pharmacology, Army Medical College, Rawalpindi, in alliance with National Institute of health, Islamabad and Department of Pathology, Army Medical College Rawalpindi, from Apr to Jun 2019. Methodology: Sixteen (16) rats of Sprague Dawley breed were procured in this study. Osteoarthritis was induced in right knee joint of rats by surgical resection of medial meniscus and anterior cruciate ligament. They were allocated into two (02) groups with eight (08) rats in both groups. Group-I was control group that was treated with 0.2 ml intra articular saline once weekly for four weeks. While group-II was treatment group that was intra particularly administered with 0.2ml hyaluronic acid once weekly for four weeks. One week after the last dosage, gait pattern of the animals was scored. Then animals were sacrificed and a part of proximal tibia was obtained for histopathologic analysis. Results: Mean gait score of control group and treatment group was 3.25 ± 0.707 and 1.00 ± 0.756 respectively with a statistically significant p-value of <0.001, while mean histopathological Modified Mankin score of control and treatment group was 11.5 ± 1.195 and 5.50 ± 1.195 respectively with a significant p-value of <0.001. Conclusion: Intra articular viscosupplementation of hyaluronic acid in rat model of osteoarthritis resulted in improved gait pattern and histopathology.
目的:探讨透明质酸对骨关节炎大鼠模型的软骨保护作用。研究设计:基于实验室的实验研究。学习地点和时间:2019年4月至6月,拉瓦尔品第陆军医学院药学系与伊斯兰堡国家卫生研究所和拉瓦尔品第陆军医学院病理学系合作。方法:本研究选用Sprague Dawley品种大鼠16只。采用手术切除大鼠右膝关节内侧半月板和前交叉韧带的方法诱导骨关节炎。随机分为2组(02),每组8只(08)。ⅰ组为对照组,给予关节内生理盐水0.2 ml,每周一次,连用4周。ii组为治疗组,给予透明质酸0.2ml,每周1次,连用4周。末次给药后1周,对动物的步态模式进行评分。然后处死动物,取胫骨近端部分进行组织病理学分析。结果:对照组和治疗组的平均步态评分分别为3.25±0.707和1.00±0.756,p值均有统计学意义<0.001;对照组和治疗组的组织病理学改良曼金评分分别为11.5±1.195和5.50±1.195,p值均有统计学意义<0.001。结论:骨关节炎模型大鼠关节内补充透明质酸可改善其步态模式和组织病理学。
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引用次数: 0
Salivary Diagnosis of COVID-19 COVID-19唾液诊断
Pub Date : 2022-01-01 DOI: 10.51253/pafmj.v71i6.5498
Seema Shafiq, Asim Riaz
Dear Editor, It is indeed an honour for us to contribute towards the ongoing research regarding the latest contagion, Coronavirus disease (COVID-19) as caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) leading to global pandemic with variable clinical outcomes. COVID-19 positive individuals present with a variety of signs and symptoms as sore throat, cough, fever, dyspnoea, headache, myalgia, nausea, and vomiting whereas, some develop severe acute respiratory distress syndrome with a fatality rate of about 10%.1 Possible oral findings include xerostomia, hypogeusia, and chemosensory alterations. Common routes of transmission being person-to-person via direct sneeze, cough, and droplet inhalation or by contact through mucosa of eyes, nose and saliva.
尊敬的编辑:我们很荣幸能够为正在进行的关于最新传染病的研究做出贡献,冠状病毒病(COVID-19)是由严重急性呼吸综合征冠状病毒2 (SARS-CoV-2)引起的,导致全球大流行,临床结果不一。COVID-19阳性个体表现出各种体征和症状,如喉咙痛、咳嗽、发烧、呼吸困难、头痛、肌痛、恶心和呕吐,而一些人则出现严重的急性呼吸窘迫综合征,死亡率约为10% 1可能的口腔表现包括口干、嗅觉减退和化学感觉改变。常见的传播途径是人与人之间通过直接打喷嚏、咳嗽和飞沫吸入或通过眼、鼻黏膜和唾液接触传播。
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引用次数: 0
ENDOSCOPIC ENDONASAL DACRYOCYSTORHINOSTOMY: EXPERIENCE OF HUNDRED CASES 鼻内窥镜泪囊鼻腔造瘘术一百例体会
Pub Date : 2021-12-31 DOI: 10.51253/pafmj.v71i6.4251
M. Shahid, Muhammad Awais, Amjad Akram, Syed Abid hassan Naqvi, Omar Zafar, T. Malik
Objective: To determine the success rate of Endonasal Endoscopic Dacryocystorhinostomy (Endo-DCR) in cases of chronic dacryocystitis secondary to primary acquired nasolacrimal duct obstruction (NLDO). Study Design: Quasi-experimental study. Place and Duration of Study: Department of Oculoplastic Surgery, Armed Forces Institute of Ophthalmology Rawalpindi, from Sep 2018 to Nov 2019. Methodology: Endo-DCR under General Anaesthesia was performed on 100 patients of primary acquired nasolacrimal duct obstruction causing chronic dacryocystitis. Post-operatively these patients were checked on first post-op day, then on one week and finally four months after surgery. We removed silicone tubes of all the patients four months after surgery. To ensure patency of lacrimal passage, we did syringing and irrigation of lacrimal system of all cases, at conclusion of the study. We chose absence of epiphora and patent lacrimal system on syringing as indicators of successful procedure. Results: Hundred patients (males 37; females 63) were recruited for this study. Mean age of our sample population was 51.1 ± 29 years. Right nasolacrimal duct obstruction cases were 56 whereas left nasolacrimal duct obstruction cases were 44. Subjective improvement i.e., absence of epiphora was found in 90% patients. We got successful irrigation of lacrimal passages (objective improvement) in 94% of patients. Conclusion: Endo-DCR yields comparable results to external Dacryocystorhinostomy (Ex DCR). It offers additional benefits of esthetically better outcome, lesser complication rate and short surgery and patient recovery time.
目的:探讨鼻内窥镜下泪囊鼻腔造瘘术(endon - dcr)治疗继发于原发性获得性鼻泪管阻塞(NLDO)的慢性泪囊炎的成功率。研究设计:准实验研究。学习地点和时间:2018年9月至2019年11月,拉瓦尔品第军队眼科研究所眼整形外科。方法:对100例原发性获得性鼻泪管梗阻致慢性泪囊炎患者在全身麻醉下行内腔dcr。术后,这些患者在术后第一天接受检查,然后在术后一周和四个月接受检查。术后4个月,我们将所有患者的硅胶管全部切除。为保证泪道通畅,我们在研究结束时对所有病例进行了泪道系统的冲洗和冲洗。我们选择无泪和泪道系统通畅作为手术成功的指标。结果:100例患者(男性37例;本研究招募了女性(63)。样本人群的平均年龄为51.1±29岁。右侧鼻泪管梗阻56例,左侧鼻泪管梗阻44例。主观改善,即90%的患者没有显色。94%的患者泪道冲洗成功(客观改善)。结论:内泪囊鼻腔吻合术与外泪囊鼻腔吻合术的效果相当。它提供了美观更好的结果,更少的并发症率和更短的手术和患者恢复时间的额外好处。
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引用次数: 0
CYTOGENETIC ANALYSIS OF PATIENTS WITH AMBIGUOUS GENITALIA 阴部不清患者的细胞遗传学分析
Pub Date : 2021-12-31 DOI: 10.51253/pafmj.v71i6.5007
S. Zaidi, A. Mahmood, Rafia Mahmood, A. Latif, H. Robert, Sarah Fatimah
Objective: To determine the magnitude and classification of cases of ambiguous genitalia presenting to our setup. Study Design: Cross-sectional study. Place and Duration of Study: Department of Haematology, Armed Forces Institute of Pathology, Rawalpindi Pakistan, from Aug 2018 to Feb 2019. Methodology: All the patients with ambiguous genitalia referred for cytogenetic analysis, were included in the study. The patients were subjected to a detailed history and physical examination. The record of radiological investigations was were obtained. Cytogenetic analysis was performed using the conventional G-banding technique. Hormonal testing included 17- hydroxyprogesterone (17-OHP) levels was also performed. Results: Fifty-one cases of ambiguous genitalia were studied. The median age was 15 months. Thirty-three patients (64.7%) had a 46XY karyotype, 17 (33.3%) had a 46XX karyotype while 1 (1.9%) had 45X/46, XY mosaic karyotype. Thirty patients (58.8%) were products of consanguineous marriage. Congenital adrenal hyperplasia was diagnosed in 12 cases (70.5%) of 46 XX karyotype and in 3 cases (9%) of 46XY karyotype. Conclusion: Ambiguous genitalia, currently categorized as disorders of sex development, are not uncommon in our populartion. Increased awareness and early diagnosis are crucial to prevent life threatening complications of congenital adrenal hyperplasia, to determine sex of rearing, and to counsel the parents or patients.
目的:确定出现在本装置的生殖器模糊病例的数量和分类。研究设计:横断面研究。学习地点和时间:2018年8月至2019年2月,巴基斯坦拉瓦尔品第武装部队病理研究所血液科。方法:本研究纳入所有接受细胞遗传学分析的生殖器模糊患者。对患者进行详细的病史和体格检查。获得了放射学调查记录。细胞遗传学分析采用常规g带技术。激素检测包括17-羟孕酮(17- ohp)水平。结果:对51例生殖器模糊患者进行了分析。中位年龄为15个月。46XY核型33例(64.7%),46XX核型17例(33.3%),45X/ 46XY镶嵌核型1例(1.9%)。近亲婚姻产物30例(58.8%)。46xx核型12例(70.5%),46XY核型3例(9%)诊断为先天性肾上腺增生。结论:阴唇模糊,目前被归类为性发育障碍,在我国人群中并不少见。提高认识和早期诊断对于预防危及生命的先天性肾上腺增生并发症,确定饲养性别,并向父母或患者提供咨询至关重要。
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引用次数: 0
MATERNAL OUTCOMES OF PREGNANCY-RELATED ACUTE KIDNEY INJURY 妊娠相关性急性肾损伤的产妇结局
Pub Date : 2021-12-31 DOI: 10.51253/pafmj.v6i6.5813
I. Khattak, S. Khattak, Ayesha Imran, K. Kamal, Umair Yaqoob
Objective: To determine the frequency of Pregnancy-related acute kidney injury in the Pakistani population and its effect on maternal health. Study Design: Cross-sectional study. Place and Duration of the Study: Department of Nephrology and Obstetrics and Gynecology, Combined Military Hospital Kharian, from Jan 2018 to Dec 2020. Methodology: All pregnant women with normal renal functions at the time of enrolment in the study and no previous history of any kidney disease or renal procedure in the recent past (at least 3 months) before conception were included in our study at Combined Military Hospital Kharian. All participants had serum creatinine tested at enrolment and were inquired specifically about any history of renal disease or any renal procedure in the recent past (at least 3 months old). Results: Mean maternal age in the study was 29 ± 7.67 years however it ranged from 16-41 years. Around a quarter of acute kidney injury cases occurred in the first and second trimesters combined, with 26 (12%) and 24 (11%) cases in the first and second trimesters, respectively. Thirty percent of acute kidney injury cases were diagnosed in the third trimester. A substantial number 58 (27%) of cases developed azotemia which persisted beyond three months and developed chronic kidney disease of various stages. Regarding maternal outcomes, 166 (77%) mothers recovered completely. However, 43 (20%) patients had some degree pf azotemia, a few cases required permanent renal replacement therapy. Conclusion: Acute kidney injury is a common problem in our community leading to suboptimal maternal outcomes..............
目的:了解巴基斯坦人群中妊娠相关性急性肾损伤的发生率及其对孕产妇健康的影响。研究设计:横断面研究。研究地点及时间:2018年1月至2020年12月,哈里安军队联合医院肾内科及妇产科。方法:所有在研究入组时肾功能正常且在受孕前最近(至少3个月)没有任何肾脏疾病或肾脏手术史的孕妇被纳入我们在哈里安联合军事医院的研究。所有参与者在入组时都进行了血清肌酐检测,并特别询问了近期(至少3个月)的任何肾脏疾病史或任何肾脏手术。结果:本组产妇平均年龄为29±7.67岁,年龄范围为16 ~ 41岁。大约四分之一的急性肾损伤病例发生在妊娠早期和中期,分别有26例(12%)和24例(11%)发生在妊娠早期和中期。30%的急性肾损伤病例在妊娠晚期被诊断出来。大量58例(27%)的病例发展为氮血症,持续时间超过3个月,并发展为不同阶段的慢性肾脏疾病。在产妇结局方面,166名(77%)母亲完全康复。然而,43例(20%)患者有不同程度的氮血症,少数病例需要永久性肾脏替代治疗。结论:急性肾损伤是我们社区常见的问题,导致产妇预后不佳..............
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引用次数: 0
EXPERIENCE OF SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS-2 (SARS-COV-2) - COVID-19 AT A TERTIARY CARE HOSPITAL IN QUETTA, BALUCHISTAN 在俾路支省奎达的一家三级保健医院治疗严重急性呼吸综合征冠状病毒-2 (sars-cov-2) - COVID-19的经验
Pub Date : 2021-12-31 DOI: 10.51253/pafmj.v71i6.6422
Naveed Asif, S. Satti, A. Younas, Mehwish Gilani, W. Shaikh, Q. Ain
Objective: To share the experience of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2)-COVID-19 at a tertiary care hospital in Quetta, Baluchistan. Study Design: Cross-sectional study. Place and Duration of Study: Department of Pathology, Combined Military Hospital Quetta, from Mar to Dec 2020. Methodology: This study included 14,741 study participants presenting to CMH Quetta with signs and symptoms of Coronavirus Disease-19 (COVID-19) and others undergoing COVID-19 PCR for screening purpose. Nasopharyngeal swab collected from these study participants were tested for COVID-19 viral RNA by real-time Reverse Transcription Polymerase Chain reaction (RT-PCR) assay. Results: Out of these 14,741 study participants, 1886 (12.7%) were found to be SARS-CoV-2 PCR positive. Among 1886 study participants, 1503 (80%) were males while 383 (20%) were females. Mean age of the study participants was 36 ± 14 years. Most frequent clinical presentations were body aches (96.5%), fever (94.1%), cough (66.8%) and loss of appetite (68.2%). Around 67 (3.5%) positive study participants were asymptomatic. Conclusion: In this study, we observed male predominance but severity of signs and symptoms among female study participants. SARS-COVID-19 caused disease with wide range of clinical spectrum and disease can be fatal as well.
目的:分享俾路支省奎达市某三级医院应对SARS-CoV-2的经验。研究设计:横断面研究。学习地点和时间:奎达联合军队医院病理科,2020年3月至12月。方法:本研究纳入了14,741名在CMH奎达就诊时出现冠状病毒病-19 (COVID-19)体征和症状的研究参与者,以及其他接受COVID-19 PCR筛查的参与者。通过实时逆转录聚合酶链反应(RT-PCR)法检测从这些研究参与者收集的鼻咽拭子是否含有COVID-19病毒RNA。结果:在这14741名研究参与者中,1886人(12.7%)被发现为SARS-CoV-2 PCR阳性。在1886名研究参与者中,1503名(80%)是男性,383名(20%)是女性。研究参与者平均年龄为36±14岁。最常见的临床表现为身体疼痛(96.5%)、发烧(94.1%)、咳嗽(66.8%)和食欲不振(68.2%)。约67名(3.5%)阳性研究参与者无症状。结论:在这项研究中,我们观察到男性的优势,但在女性研究参与者的症状和体征的严重程度。SARS-COVID-19引起的疾病具有广泛的临床谱,疾病也可能是致命的。
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引用次数: 2
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