Triple valve endocarditis by mycobacterium tuberculosis: a case report.

BACKGROUND: Granulomas caused by Mycobacterium Tuberculosis have been observed at autopsy in the heart, pre-dominantly in the myocardium and endocardium, but rarely involving the coronary vessels and valvular structures. Mycobacterium tuberculosis valvular endocarditis is extremely rare, with most reports coming from autopsy series. CASE PRESENTATION: We report the case of a 17 year old immunocompetent girl who presented with history of fever, malaise, foot gangrene and a left sided hemiparesis. On investigation she was found to have infective endocarditis involving the aortic, mitral and tricuspid valves. She had developed a right middle cerebral artery stroke. She underwent dual valve replacement and tricuspid repair. The vegetations showed granulomatous inflammation but blood cultures and other biological specimen cultures were negative for any organisms. She was started on antituberculous treatment and anticoagulation. CONCLUSION: This is the first reported case of triple valve endocarditis by Mycobacterium Tuberculosis in an immunocompetent host. Especially important is the fact that the right heart is involved which has been historically described in the setting of intravenous drug abuse.This implies that Tuberculosis should be considered in cases of culture negative endocarditis in endemic areas like Pakistan even in immunocompetent hosts

Vivax malaria and chloroquine resistance: a neglected disease as an emerging threat

In Pakistan, Plasmodium vivax contributes to major malaria burden. In this case, a pregnant woman presented with P. vivax infection and which was not cleared by chloroquine, despite adequate treatment. This is probably the first confirmed case of chloroquine-resistant vivax from Pakistan, where severe malaria due to P. vivax is already an emerging problem

Hypermucoviscous Klebsiella syndrome it\u27s in the community!

Hypermucoviscous Klebsiella syndrome is a unique syndrome caused by a new variant of Klebsiella pneumoniae (KP), characterized by abscess formation at distant body sites. This emerging KP strain is different from the usual classic strains in having the rmp gene which increases capsule formation making this strain resistant to phagocytosis and helping in its dissemination to distant organs. A 50 years old diabetic man presented with facial swelling after dental procedure which progressively increased despite being on antibiotics. On examination he was febrile, had neck swelling with signs of inflammation and tender hepatomegaly. Ultrasonography showed submental and liver abscesses which were subsequently drained and both cultures isolated KP with hypermucoid colonies on agar plate and a positive string test indicating the presence of this new hypervirulent strain of KP. Therefore, a diagnosis of Hypermucoviscous Klebsiella syndrome should be considered in all patients who present with KP infection with multiple organ abscesses.

Problems of Orphan Children in State-Sponsored Orphanages of Khyber Pakhtunkhwa, Pakistan

The present study is conducted in two sweet homes of Khyber Pakhtunkhwa, Pakistan i.e. Sweet Home of Peshawar and Sweet Home of Abbottabad. The nature of the study was quantitative and a close-ended questionnaire was used as a tool of data collection for collecting information from the sample size of 134 respondents selected through the proportional allocation method. The association was tabulated through the application of Chi-Square test statistics to ascertain the association between the dependent and independent variables. Study findings revealed a significant association (P?0.05) of an index of various socio-economic problems of orphans with the statements such as children at sweet home is routinely harassed; adult children physically abuse younger children in the sweet home, etc. with the dependent variable i.e. protection aspects of orphanages. The government and staff should provide an environment free of harassment, abuse, stress, and anxiety, foster mother at sweet home should be advised to treat children like her biological one, the staff should understand children’s method of learning, organize exercises were some of the recommendations forwarded in the light of study findings

Hair dye poisoning and rhabdomyolysis.

Hair dye ingestion is a rare cause of toxicity in Pakistan. We are presenting the case report of a 55 year old male who presented with accidental hair dye ingestion and developed laryngeal oedema requiring emergent tracheostomy. He had also developed aspiration pneumonitis and chemical oesophagitis. However, the most alarming manifestation was rhabdomyolysis. Hair dye toxicity can be fatal if not recognized early. There is no antidote available. Rhabdomyolysis is a complication and needs to be managed aggressively in order to prevent long term morbidity

Fulminant invasive aspergillosis of the mediastinum in an immunocompetent host: a case report.

Introduction: Invasive aspergillosis is a serious complication in immunocompromised patients. It is an opportunistic disease, which predominantly occurs in the lungs, although dissemination to virtually any organ is possible. Invasive aspergillosis in an immunocompetent patient with extension to the mediastinum has rarely been reported. Here, we present the case of a patient with no apparent immunodeficiency state, who presented with Aspergillus endocarditis and fulminant invasive aspergillosis with extensive involvement of the mediastinal structures, which ultimately was responsible for her death. To the best of our knowledge, this is the first reported case in the literature on fulminant invasive mediastinal aspergillosis with extension to the pulmonary vasculature and concomitant Aspergillus endocarditis in an apparently immunocompetent patient without pre-existing lung disease. Case presentation: Our patient was a previously healthy 47-year-old Asian woman, who presented to our emergency room with severe progressive shortness of breath of one month’s duration, associated with orthopnea and unstable vital signs. Conclusion: Invasive aspergillosis has been described in the presence of pulmonary disease, such as chronic obstructive pulmonary disorder, and one case has been reported in a patient without preexistent disease, but none of these have been fatal. Our case is therefore the first reported case of its kind. Our case shows that fulminant aspergillosis can occur in an immunocompetent host and can be fatal. We conclude that invasive aspergillosis should not be excluded from the differential diagnosis on the basis of immunocompetency

Risk factors for mortality of patients with ceftriaxone resistant E. coli bacteremia receiving carbapenem versus beta lactam/beta lactamase inhibitor therapy

Objective: Extended spectrum β-lactamases (ESBL) producing Enterobacteriaceae predominantly E. coli and K. pneumoniae bacteremia have limited treatment options and high mortality. The objective was to determine the risk factors for in-hospital mortality particularly treatment with carbapenem versus beta lactam/beta lactamase combination (BL/BLI) in patients with ceftriaxone resistant E. coli bacteremia. A retrospective cohort study was conducted at the Aga Khan University, Karachi, Pakistan. Adult patients with sepsis and monomicrobial ceftriaxone resistant E. coli bacteremia were enrolled. Factors associated with mortality in patients were determined using logistic regression analysis. Results: Mortality rate was 37% in those empirically treated with carbapenem compared to 20% treated with BL/BLI combination therapy (p-value: 0.012) and was 21% in those treated with a carbapenem compared to 13% in patients definitively treated with BL/BLI combination therapy (p-value: 0.152). In multivariable logistic regression analysis, only Pitt bacteremia score of ≥ four was significantly associated with mortality (OR: 7.7 CI 2.6-22.8) while a urinary source of bacteremia was protective (OR: 0.26 CI 0.11-0.58). In-hospital mortality in patients with Ceftriaxone resistant E. coli bacteremia did not differ in patients treated with either a carbapenem or BL/BLI combination. However, Pitt bacteremia score of ≥ 4 was strongly associated with mortality

From Responsibility to Profitability: The Indirect Link of Perceived CSR And Financial Performance

Present research aims to examine indispensable research questions of what the indirect effect of perceived CSR on banks’ financial performance with the mediation of customer satisfaction and firm reputation by underpinning stakeholder theory is. Philosophically, the present research come under the post-positivist paradigm, with a deductive approach as the casual relationship among study variables are examined by collecting primary data through survey strategy by employing time-lagged design in the banking sector of Pakistan. The sample of this research is collected form purposefully selected 50 branches of different banks operating in three larger metropolitan cities of Punjab, Pakistan. This study employed contemporary data collection and analysis techniques. Data analysis is conducted by using Smart PLS. This study concluded that corporate social responsibility enhanced the company's financial performance with the mediation of customer satisfaction and firm reputation. The relationship between corporate social responsibility and company financial performance is also investigated. When contemplating the practical implications, managers and policymakers need to take into account the foundational structure to enhance their financial results