Sarcoidosis presenting as fatigue and weakness

Sarcoidosis is a systemic granulomatous disorder of unknown cause that occurs in both men and women of all races. It typically presents in patients after 20 years of age. Sarcoidosis most frequently involves the lung, but up to 30 percent of patients present with extra-thoracic manifestations. It can involve multiple organs to a variable extent and degree. In areas, where tuberculosis is endemic, the diagnosis of sarcoidosis may be overlooked and misdiagnosed because of clinical and radiographic resemblance. Herein, we present a case of a middle-aged man who visited multiple physicians with constitutional symptoms and was treated symptomatically but did not improve. He later developed skin lesions which were biopsied and led to correct diagnosis of sarcoidosis. Hence, a clinician should be aware of all the spectrums of presentations of rare diseases like sarcoidosis and always keep it as a differential when treating common diseases like tuberculosis. Key Words: Sarcoidosis, Skin lesions, Fatigue

Morbidity of colostomy reversal

Abstract OBJECTIVE: To determine morbidity after colostomy reversal at a tertiary care hospital. METHODS: The retrospective case series was conducted at the Aga Khan University Hospital, Karachi, and comprised records of patients aged 15 years or more who underwent colostomy reversal from January 2003 to December 2011. Data was collected regarding demographics, procedure dates, indication, as well as type and location of colostomy. Details of colostomy reversal, including pre-operative, intra-operative and post-operative variables were recorded. RESULTS: The mean age of the 96 patients was 40±16 years; 72(75%) of them being males. The most frequent indications for fashioning of colostomy were bowel perforation in 53 (55.2%) and malignancy in 9(9.3%) patients. Intra-operative complications occurred in 5(5.2%) with bowel perforation in 3(3.1%) and bleeding in 2(2%) patients. Overall, 40(41.6%) patients had post-operative local complications; the most common being wound infection in 19(19.8%) followed by incisional hernia 15(15.6%). Patients who experienced post-operative complications had significantly longer hospital stay compared to those without complications (9±2.8 vs. 7±2.4days; p=0.038). CONCLUSIONS: Colostomy reversal was associated with non-negligible morbidity. The most common complications were wound infection and incisional hernia

Outcome of percutaneous screw fixation of posterior pelvic ring injuries

Objective: To evaluate the clinical outcome of percutaneous fixation for unstable pelvic ring injury.Methods: This retrospective study was conducted at orthopaedics section of Aga Khan University Hospital Karachi, Pakistan from July 2015 to December 2018. Data was retrieved from trauma registry from July 2015 till December 2018, including all patients who underwent percutaneous fixation for pelvic ring injury. Majeed pelvic score was used to determine the functional outcome.Results: A total number of 30 patients were included, 27(90.0%) adults, and 3(10.0%) paediatrics patients. There were 21(70.0%) males and 9(30.0%)females. . Mean age of patients was 37.1±16.1 years. Post op mean Majeed functional pelvic Score was 85.8. Of the 30 patients, 18 (60.0%) had Excellent, 10 (33.3%) good and 02(6.7%) fair scoring.Conclusions: Percutaneous fixation of posterior ring injuries has excellent functional outcome, with minimal blood loss and no soft tissue striping.

Case series of rare Interstitial Lung Disease (ILD).

Pulmonary alveolar proteinosis (PAP) is a rare lung disease where periodic acid Schiff (PAS)-positive eosinophilic material accumulates in the alveoli of the lungs. Here we describe two cases of young males who presented with dynpnoea and weight loss. The HRCT scan of the chest in both cases showed the typical crazy-paving pattern and lung biopsies confirmed the diagnosis of PAP. They showed remarkable symptomatic improvement with therapeutic whole lung lavage

Two incision mini open carpal tunnel release- a minimally invasive alternative to endoscopic release

Abstract Surgical techniques for carpal tunnel release are constantly evolving to reduce complications. This retrospective study was planned to identify the outcome and complications associated with a new operating technique for release of carpal tunnel using two incisions. It was conducted at the Aga Khan University Hospital, Karachi, and comprised patients undergoing surgical release of carpal tunnel syndrome (CTS) between January 2011 and December 2014. Of the 54 patients,38(70.4%) cases were of right-sided CTS. The mean operating time was 12.5±4.9 minutes. Complete relief from symptoms was observed in all the patients and the only complication noted was superficial infection in 2(3.7%) patients.The outcomes and complications associated with this technique were comparable with other standard techniques. No major complication (e.g. neurovascular injury) was reported, which showed that this technique was safe and had no additional risks. Therefore, it can be used as an alternative to endoscopic release which is expensive and requires special training and equipment

Effect of continuous passive motion on knee flexion range of motion after total knee arthroplasty

Abstract OBJECTIVE: To compare mean knee flexion in patients on continuous passive motion and those without it after total knee arthroplasty. METHODS: The randomised controlled study was conducted at Aga Khan University Hospital, from July 2013 to June 2014, and comprised patients who underwent total knee arthroplasty. Patients were randomly assigned to either group, with Group A receiving standardised physiotherapy from 1st postoperative day, and Group B receiving physiotherapy and one hour of continuous passive motion twice a day from 1st postoperative day until discharge. Outcome assessment was done on the day of discharge. RESULTS: Of the 76 patients, there were 38(50%) in each group. There were 61(80%) women and 15(20%) men, with a mean age of 65.5±7.9 years in Group A and 61.6±9.1 years in Group B. The mean preoperative knee flexion in Group A was 90.3±13.2° and in Group B it was 96.9±11.5°. Mean maximum flexion at the time of discharge was 96.3±5.7° in Group A and 94.3±8.4° in Group B (p=0.22). The mean length of stay in Group A was 6.1±1.4 days and in Group B it was 8.6±2.4 days (p=0.01). CONCLUSIONS: Continuous passive motion had no influence on knee range of motion after total knee arthroplasty at the time of discharge

Evaluation of serum ferritin for prediction of severity and mortality in COVID-19- A cross sectional study

Background: Ferritin even though widely recognized as a representative of total body iron stores, its prognostic utility is linked with COVID-19. This study was aimed at evaluation of the association of ferritin with severity in Coronavirus disease 2019 (COVID-19), hospitalized patients and to test the hypothesis that it is an independent predictor of mortality.Material and methods: This study was conducted at Chemical Pathology, Department of Pathology and Laboratory Medicine, Aga Khan University (AKU), Karachi. Medical records of all in-patients including both genders, and all age groups with documented COVID-19 from 1st March to 10th August 2020 were reviewed. The subjects were divided into two categories severe and non-severe COVID-19; and survivors and non-survivors. The details were recorded on a pre-structured performa. Between-group differences were tested using the Mann-Whitney\u27s U-test. The receiver operating characteristic curve was plotted for ferritin with severity and mortality. A binary logistic regression was used to identify variables independently associated with mortality. The data was analyzed using Statistical Package for the Social Sciences (SPSS).Results: A total of 336 in patients were reviewed as declared COVID-19 positive during the study duration, and 157 were included in the final analysis including 108 males and 49 females. Statistically significant difference in ferritin was found in the two categories based on severity and mortality. Binary logistic regression showed ferritin to be an independent predictor of all-cause mortality supplemented with an AUC of 0.69 on ROC analysis.Conclusions: Serum ferritin concentration is a promising predictor of mortality in COVID-19 cases

Efficacy of Inferior Mandibular Nerve Block (IANB) with Articaine Infiltration Versus Lidocaine Infiltration Administered inTeeth with Irreversible Pulpitis

OBJECTIVES To compare the efficacy of (Inferior mandibular nerve block) IANB with Lidocaine infiltration versus with articaine infiltration in patients with irreversible pulpitis. METHODOLOGY An observational cross-sectional study was conducted in the Department of Operative Dentistry and Endodontics at Altamash Institute of Dental Medicine, Karachi. The study was initiated in January-April 2022. A total of 150 patients’ positive history of irreversible pulpitis, confirmed with cold pulp testing, were randomly allocated into two groups: 75 cases were treated with standard Inferior mandibular nerve block with Lidocaine buccal infiltration, and 75 were treated with buccal infiltration of 1.8 ml of 4% articaine. Before administering the anaesthetic injection, each subject was shown the visual analogue scale (VAS). After 15 minutes of administration, subjects were asked to rate the pain. The data was recorded on a designed proforma. RESULTS The average age of the patients was 35.52±10.09 years. Efficacy of the inferior alveolar nerve block with buccal infiltration of 1.8 ml of 4% articaine was significantly high as compared to Inferior mandibular nerve block with Lidocaine buccal infiltration [73.3% vs 50.67% p=0.004]. CONCLUSION Buccal infiltration of 4% Articaine for mandibular teeth during IANB can have a high success rate and is considered a good alternative

Measuring routine childhood vaccination coverage in 204 countries and territories, 1980-2019 : a systematic analysis for the Global Burden of Disease Study 2020, Release 1

Background Measuring routine childhood vaccination is crucial to inform global vaccine policies and programme implementation, and to track progress towards targets set by the Global Vaccine Action Plan (GVAP) and Immunization Agenda 2030. Robust estimates of routine vaccine coverage are needed to identify past successes and persistent vulnerabilities. Drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020, Release 1, we did a systematic analysis of global, regional, and national vaccine coverage trends using a statistical framework, by vaccine and over time. Methods For this analysis we collated 55 326 country-specific, cohort-specific, year-specific, vaccine-specific, and dosespecific observations of routine childhood vaccination coverage between 1980 and 2019. Using spatiotemporal Gaussian process regression, we produced location-specific and year-specific estimates of 11 routine childhood vaccine coverage indicators for 204 countries and territories from 1980 to 2019, adjusting for biases in countryreported data and reflecting reported stockouts and supply disruptions. We analysed global and regional trends in coverage and numbers of zero-dose children (defined as those who never received a diphtheria-tetanus-pertussis [DTP] vaccine dose), progress towards GVAP targets, and the relationship between vaccine coverage and sociodemographic development. Findings By 2019, global coverage of third-dose DTP (DTP3; 81.6% [95% uncertainty interval 80.4-82 .7]) more than doubled from levels estimated in 1980 (39.9% [37.5-42.1]), as did global coverage of the first-dose measles-containing vaccine (MCV1; from 38.5% [35.4-41.3] in 1980 to 83.6% [82.3-84.8] in 2019). Third- dose polio vaccine (Pol3) coverage also increased, from 42.6% (41.4-44.1) in 1980 to 79.8% (78.4-81.1) in 2019, and global coverage of newer vaccines increased rapidly between 2000 and 2019. The global number of zero-dose children fell by nearly 75% between 1980 and 2019, from 56.8 million (52.6-60. 9) to 14.5 million (13.4-15.9). However, over the past decade, global vaccine coverage broadly plateaued; 94 countries and territories recorded decreasing DTP3 coverage since 2010. Only 11 countries and territories were estimated to have reached the national GVAP target of at least 90% coverage for all assessed vaccines in 2019. Interpretation After achieving large gains in childhood vaccine coverage worldwide, in much of the world this progress was stalled or reversed from 2010 to 2019. These findings underscore the importance of revisiting routine immunisation strategies and programmatic approaches, recentring service delivery around equity and underserved populations. Strengthening vaccine data and monitoring systems is crucial to these pursuits, now and through to 2030, to ensure that all children have access to, and can benefit from, lifesaving vaccines. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe