Mediastinitis as a complication of Epstein-Barr virus infection: a rare entity

Epstein-Barr virus (EBV) is a member of the herpes virus family that can infect humans. Common manifestations of Epstein-Barr virus infection include fever, lymphadenopathy and pharyngitis with some rare complications including mediastinitis, myocarditis, pancreatitis, acute kidney failure and neurological disorders. Clinical findings along with serological evidences are needed to diagnose the infection. Early investigation for EBV in febrile patients can expedite both diagnosis and treatment

Coronavirus 2019: a review of virology, clinical features, diagnosis, and treatment

Coronavirus 2019 (COVID-19) is an enveloped ribonucleic acid (RNA) virus that is diversely found in humans and wildlife. A total of six species have been identified to cause disease in humans. The most recent outbreak initially presented as pneumonia of unknown etiology in a cluster of patients in Wuhan, China. The epicenter of infection was linked to seafood and exotic animal wholesale markets in the city. SARS-CoV-2 is highly contagious and is a declared global pandemic. This review will introduce a general overview of virology and describe the clinical features, diagnostic testing, and management of COVID-19 patients. There are multiple drug trials going on with some positive results. However, since no vaccine is available, the best way to combat the virus is by preventive methods. Our review will also provide a means to raise awareness among primary and secondary healthcare providers during the current pandemic

The spectrum of Evans syndrome: a literature review

Evans syndrome (ES) is an autoimmune disorder characterized by the simultaneous or sequential development of autoimmune hemolytic anemia (AIHA) and immune thrombocytopenia (ITP) and/or immune neutropenia in the absence of any underlying cause. Evans syndrome is a rare disorder although the exact frequency is unknown. No sex predilection is known and Evans syndrome has been described in all ethnic groups and at all ages. Classification of ES includes primary, with this being an exclusion diagnosis with no underlying condition, and secondary in the presence of an underlying disease. Clinical features are associated with anemia and thrombocytopenia including pallor, weakness, fatigue, jaundice, petechiae, ecchymosis, gingivorrhagia and epistaxis. First, a detailed history must be taken from the patient to determine the risk factors for developing ES then a family history of immune disorders along with a thorough physical examination. The management of Evans syndrome remains a challenge. Steroids with and without IVIG are recommended as front-line therapy. Red blood cell/platelet transfusion is indicated only in severe symptomatic patients due to the risk of exacerbations. Splenectomy may also be considered a second-line treatment

Association of chronic viral hepatitis with ABO blood groups and rhesus (Rh) factor

Background: Chronic viral hepatitis includes hepatitis B and hepatitis C and is responsible for causing the deaths of millions of people all across the world each year. Although there are small studies in literature about association between ABO blood groups and chronic viral hepatitis, only few studies found relation between them. The objective of this case control study is to establish a relation between the host factors and these viral infections.Methods: This is a case control study on patients diagnosed with CVHB and CVHC. The study was conducted on 508 patients reported to Nishtar Hospital, Multan and Sheikh Zayd Hospital, Rahim Yar Khan, Pakistan.709 healthy blood donors were selected as a control group from Nishtar Hospital blood bank during December 2016 and December 2017.The results were subjected to SPSS v.20 for analysis using the chi square test. The patients and blood donors were also asked about certain demographic factors like age, sex and blood transfusions.Results: Among CVHB patients,173(100%), the distribution of blood groups was following: Group A, 38 (21.96%), B, 57 (32.94%), AB, 11 (6.35%), O, 67 (38.72%). 158 (91.32%) were Rh positive and 15 (8.67%) Rh negative. In CVHC patients, 335 (100%), the distribution was following: Group A, 69 (20.59%), B, 123 (36.71%), AB, 24 (7.16%), O, 119 (35.52%). 303 (90.44%) were Rh positive while 32 (9.55%) were Rh negative. In healthy blood donors, 167 (23.55%) were group A, 225 (31.73%) group B, 41(5.78%) group AB, 276 (38.92%) group O.632 (89.13%) were Rh positive and 77 (10.86%) Rh negative.Conclusions: There was no significant difference between blood groups(p>0.5) and Rh(p>0.5) with chronic viral hepatitis. However, it was also observed that the infections of HCV increase among (26-45) years old patients while the HBV infections increase with progression of age. Association of chronic viral hepatitis infection with blood group types needs more studies to get more knowledge about this aspect

Chronic tension-type headache as a risk factor of myofascial trigger points in upper trapezius muscle fibers in neck pain patients

Chronic tension type headache (CTTH) is one of the very common neurological conditions which have striking impact on daily functional activities. In tension type headaches the myofascial TrP\u27s are frequently examined .It is observed that myofascial pain syndrome is frequent determinant of chronic nonspecific neck pain

The prevalence of bipolar spectrum disorder in medical students of Pakistan

Background: Bipolar affective disorder is cyclic swinging of mood between mania or hypo-mania and depression. Bipolar disorder is the sixth leading cause of disability worldwide and has a lifetime prevalence of about 1 to 3% in the general population. Despite a growing body of knowledge on bipolar spectrum disorder (BSD), relatively little is known about the clinical characteristics of BSD in medical students. This study evaluates the prevalence and severity of BSD in medical students in relation to certain socio-demographic factors like age, sex and class of education.Methods: A questionnaire based study was done on 298 medical students of Nishtar Medical University, Multan and Shaikh Zayed Medical College, Rahim Yar Khan chosen on basis of random sampling to test the prevalence of bipolar spectrum disorders using Mood Disorder questionnaire (MDQ). Out of these students 161 were males and 137 were females. Students were interviewed to obtain information about age, sex and academic year of education.Results: According to mood disorder questionnaire scoring, of the total 298 students 80 (26.84%) screened positive for bipolar spectrum disorder (BSD). Among 80 students who screened positive for BSD 43 (53.75%) are males while 37 (46.25%) are females. Class-wise distribution of BSD is as follows: Out of 80 students screened positive 15 (18.75%) are from 2nd year, 22 (27.5%) from 3rd year and 43 (53.75) from 4th year. Age-wise distribution of BSD is as following: Students of age 19, 20, 21, 22 and 23 years suffering from BSD were 5 (6.25%), 17 (21.25%), 23(28.75),22 (27.5%) and 13 (16.25%) respectively.Conclusions: In our study, the estimated rate of prevalence for bipolar spectrum disorder among medical students of Pakistan is 26.84%. There was no significant difference in prevalence on the basis of gender. Prevalence was increasing with both age and class wise distribution

The descriptive study of anxiety levels among diabetics: insulin users versus non-insulin users

Background: Anxiety is an emotion characterized by an unpleasant state of turmoil often accompanied by nervous behaviours such as pacing back and forth, somatic complaints and rumination. Diabetes is the most metabolically active disease which can influence the psychological state. This study evaluates the anxiety levels among diabetics (Insulin users versus non-insulin users) along with its relation to certain demographic factors like age, sex, education, type of medication and medication compliance.Methods: Hamilton anxiety rating scale (HAM-A) was used to test the anxiety levels in 187 diabetic patients visiting the diabetic clinic and research centre, Nishtar Hospital, Multan and other diabetic clinics in the area. 97 (51.87%) patients of the total sample are males and 90 (48.12%) patients are females.Results: In this study, 170 (91%) had type 2 diabetes while 17 (9%) suffered from Type 1 Diabetes. 66.66% of the patients in the sample were insulin users while 34.34% were non-insulin users. The overall mean anxiety level in insulin users is 24.55 and in non-insulin users is 23.92.Conclusions: Our study showed a high prevalence of anxiety levels in insulin users as compared to non-insulin users. Certain symptoms like anxious mood, tension, fears, depressed mood, cardiovascular and gastrointestinal symptoms appeared with mild anxiety levels while other symptoms like insomnia, somatic symptoms, autonomic symptoms, respiratory and genitourinary symptoms appeared with high severity levels. The presence of risk factors for anxiety among patients of diabetes predicts a causal relationship and deserves attention from clinicians

Clinical Efficacy and Safety Profile of Prucalopride in Chronic Idiopathic Constipation

Chronic idiopathic constipation (CIC) can be defined as bowel movements that are difficult to pass, are not occurring frequently, or have incomplete evacuation during defecation. A high-fiber diet and laxatives are the commonly used treatments, but in many cases, they do not produce satisfactory results. The first line of treatment is osmotic laxatives. If there is no improvement, the second line is guanylate cyclase-C (GCC) agonists like linaclotide or prokinetic agents such as prucalopride. On December 14, 2018, the United States Food and Drug Administration (US FDA) approved prucalopride for treating chronic idiopathic constipation. Prucalopride is a prokinetic agent which works at the 5-hydroxytryptamine receptor 4 (5-HT4) as an agonist with greater receptor selectivity. Patients on prucalopride reported improved symptoms, quality of life and satisfaction. The most frequent adverse events were headaches and problems related to the gastrointestinal tract. Caution should be taken when using prucalopride in patients with impaired liver and renal function. In Canada, prucalopride has been approved for treatment of female patients with chronic idiopathic constipation who have failed therapy with at least two laxatives from different classes over a six-month period.Open access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Anaemia in acute coronary syndrome: a cross-sectional study

Background: Acute coronary syndromes (ACS) are an imbalance between myocardial oxygen supply and demand, and the presence of anaemia further potentiates this imbalance. The burden of anaemia in patients presenting with acute coronary syndromes (ACS) is significant. Anaemia has the potential to worsen myocardial ischemic insult by decreasing the oxygen content of the blood supplied to the jeopardized myocardium. Present study investigates the prevalence of anaemia in ACS patients attending a tertiary health care institute.Methods: A total of 148 patients with ACS were recruited in the study from July 2018 to October 2018 in Multan institute of cardiology, Pakistan. All patients were subjected to a detailed history and thorough clinical examination and investigations after obtaining informed consent. Patient having any other diseases known to cause anaemia were excluded.Results: Mean age of patients was 49 years. Out of 148, 114 (77%) were males and 34(23%) were females. Prevalence of anaemia was 38% in Male and 58.8% in Female. Among Male, 18.8% were microcytic, 4.54% were macrocytic and 77.27% were normocytic. Among Female, 50% were microcytic and 50%% were normocytic. Prevalence of ACS was higher is patients with diabetes and hypertension combined (31%) than in patient with diabetes alone (17.56%) or hypertension alone (21.62%). 13.51% were pure vegetarians  while 78.37% were on mixed diet consisting of vegetables+meat+pulses.Conclusions: Higher incidence of anaemia was reported in subjects having acute coronary syndrome. Incidence of anaemia in STEMI patients was greater than NSTEMI and unstable angina patients. Severe form of acute coronary syndrome i.e. STEMI was associated with higher incidence of anaemia

The descriptive study of imposter syndrome in medical students

Background: Imposter syndrome is characterized by chronic feelings of self-doubt and fear of being discovered as an intellectual fraud. Despite evidence of abilities, those suffering from imposter syndrome are unable to internalize a sense of accomplishment, competence, or skill. Overall, they believe themselves to be less intelligent and competent than others perceive them to be. IS has several potential implications for medical education. The current study was designed to find out the frequency of imposter syndrome among medical students college so that certain measures must be taken to improve the teaching and learning methodologies as well as the curriculum.Methods: A cross-sectional, psycho-social analysis was conducted from March to July, 2018 at Nishtar Medical College, Multan after taking informed consent from the students. Clance Imposter Phenomenon Sclae (CIPS) was used to assess the prevalence and degree of severity of Imposter syndrome among medical chosen on basis of random sampling. The data collected was entered and analysed on SPSS v.20.Results: Two hundred (200) students were selected for the study and were asked to return the completed 20 items questionnaire. One hundred and eighty-nine (189) students returned the questionnaires, so the response rate was 94.5%. Out of 189 students, 121(64.36%) were males and 68(35.97%) were females. According to Clance imposter phenomenon scoring, of the total 189 students the severity of imposter syndrome is as follows: mild, 5(2.64%), moderate,72(38.09%), severe,103(54.49%) and very severe, 09(4.76%). Moreover, third year students were found to have high prevalence and degree of severity of imposter syndrome.Conclusions: Imposter phenomenon exists in a significant percentage of medical students and appears to peak in the third year of medical school. Both genders are at equal risk of having imposter syndrome. It is associated with various psychological illnesses. Further discussion regarding medical education paradigms in light of high levels of imposter phenomenon is needed