Dubin-Johnson syndrome

A young man presented with recurrent episodes of mild jaundice. Apart from conjugated hyperbilirubinemia, other liver function tests were always normal. Clinical suspicion of Dubin-Johnson syndrome was raised. Liver biopsy showed diffuse deposition of coarse granular dark brown pigment in hepatocytes. Dubin-Johnson syndrome is a benign condition, which results from a hereditary defect in biliary secretion of bilirubin pigments, and manifests as recurrent jaundice with conjugated hyperbilirubinemia. The defect is due to the absence of the canalicular protein MRP2 located on chromosomes 10q 24, which is responsible for the transport of biliary glucuronides and related organic anions into bile. No treatment is necessary and patients have a normal life expectancy

Recurrent phyllodes tumour of the breast transforming to a fibrosarcoma

Phyllodes tumours of the breast are characterized by having both an epithelial as well as stromal component and these usually comprise almost 3% of all fibroepithelial tumours. They are exceptional in this aspect to convert into a stromal sarcoma of the breast after multiple recurrences. To the best of our knowledge, there are only three case reports regarding this in the available literature as it is an exceptional change. In this case report, we present a case of recurrent phyllodes transforming into a breast fibrosarcoma in a middle age postmenopausal woman. Histopathological examination and immunohistochemistry of the lesion were performed to confirm the diagnosis of breast fibrosarcoma

Severity Index and Outcome of Hospitalized COVID-19 Patients in Capital Hospital, CDA, Islamabad

Objective: To assess clinical characteristics and outcome of patients with Covid-19 infection. Study design: Descriptive cross-sectional study.Place and duration of study: Department of Medicine, Capital Hospital Islamabad from February 01, 2021 to April 25, 2021.Methodology: A manual medical record of total of 221 patients was conducted, more than 18 years of age, both genders, who presented with features suggestive of Covid-19 infection were included. Patients were tested for COVID-19 PCR, blood complete picture and inflammatory markers. The data was analyzed by using SPSS version 42.Results: Among 221 patients, there were 125(56.6%) males and 96(43.4%) females. Mean age was 57.20+13.17 years. Total 155(70%) cases were Covid PCR +ve and 66(30%) –ve. 86(38.9%) cases had mild, 91(41.2%) had moderate and 44(19.9%) had severe covid-19 infection. Lymphopenia was observed in 154(69.7%) cases. C-reactive protein was positive in 178(80.5%) cases. Serum ferritin was raised in 114(51.5%) cases, D-dimers in 139(66.9%), lactic dehydrogenase in 167(75.5%) cases with significant association with disease severity. Serum interleukin, performed in moderate and severe cases only, had mean value of 54.1+105.94pg/ml. Diabetes mellitus was found significantly associated with mortality (p=0.007) as well as hypertension (p<0.0001). 207 cases were managed and discharged, 14 cases expired (6.33%). Mortality was significantly associated with disease severity (p<0.001). Remdesivir was given to symptomatic patients and 94.4 % patients were discharged vs 5.6 % expired. Remdesivir and tocilizumab was given in combination in severe/critical patients and 76.5% patients were discharged vs 23.5% expired.Conclusion: Covid-19 is a disease with variable presentations. Severity of Covid-19 infection is directly related to lymphopenia as well as inflammatory markers. IL-6 levels, raised in more severe cases, signify immune response to Covid-19. Disease is more severe in patients with comorbids. In moderate to severe disease remdesivir and in severe covid disease with high IL-6 levels combination of antiviral and tocilizumab may help to improve outcome

Accuracy Of Serum Ferritin, C-Reactive Protein, Lactate Dehydrogenase And D. Dimers In Assessing Severity And Outcome Of COVID-19 Infection

ABSTRACT: Introduction: Covid-19 emerged as pandemic. In the beginning, due to the rapid spread of virus it was difficult to understand fully its pathogenesis but various inflammatory markers were found to be raised. Along with the detection of virus by polymerase reaction (PCR), studies of these markers not only help in diagnosis but also in assessing the prognosis of covid-19 infection. Material and methods: This cross sectional study was conducted in the Capital Hospital, CDA Islamabad from December to June 2022. After taking consent various inflammatory markers were recorded on a proforma. Patients were followed and outcome was also recorded. The data collected was analyzed by percentage/ frequency distribution. T-test was applied and p-values were calculated (significant p-value=<0.05).  Sensitivity, specificity, positive and negative predictive values, area under curve (AUC) and accuracy were calculated by using SPSS, version 23. Results: A total of 185 covid-19 PCR positive patients were included in the study. 112(60.5%) were men and 73 (39.5%) were women. 165(89.2%) patients were > 40 years of age. 117 (63.2%) patients had mild /moderate disease and 68(36.8%) had severe disease.  162 (87.5%) patients were discharged and 23 (23.4%) expired. AUC in relation to severity of disease was 0.603 for C- reactive protein (CRP), 0.543 for lactate dehydrogenase (LDH), 0.525 for D. dimers and 0.619 for ferritin. Accuracy in relation to disease severity was as following: CRP 57.4%, D. dimers 52.4 %, ferritin 57.9% and LDH 55.7%.  AUC in relation to outcome of covid-19 was 0.699 for CRP, 0.668 for LDH, 0.742 for D. dimers and 0.677 for ferritin. Accuracy of inflammatory markers in relation to outcome was as following: CRP 45.9%, D. dimers 61.2%, LDH 48.1% and ferritin 46.9%. Conclusion: Serum ferritin showed the highest accuracy (57.9%) in assessing the covid-19 severity and D. dimer came up with highest accuracy (61.2%) in assessing disease outcome

In vitro biological assessment of 1,3,4-oxadiazole sandwiched by azinane and acetamides supported by molecular docking and BSA binding studies

The 1,3,4-Oxadiazole is an aromatic heterocyclic moiety recognized in drug research for its low lipophilicity. The multiple functionalities, heterocyclic azinane, sulfonamide, 1,3,4-oxadiazole and acetamide, are combined collectively to enhance the bioactivity potential of synthesized molecules. All the compounds were acquired by following microwave assisted and conventional techniques in a comparative way. The synthesized derivatives were screened for their antibacterial and enzyme inhibition potential. Furthermore, BSA binding analysis was executed to infer about the interaction with serum albumin. The spectral data of IR, EI-MS, 1H-NMR and 13C-NMR were used to elucidate the final structures of compounds. The synthesized compounds had a modest antibacterial potential. Compound 8f bearing 2-methyl-4,5-dinitrophenyl group was the most active one against all the bacterial strains taken into account and α-glucosidase enzyme. Compound 8d bearing 4-nitrophenyl group was the best acetyl cholinesterase inhibitor and 8i bearing phenylethyl group was the best urease inhibitor

Sector Sustainability Check: Rural Open Defecation Free (ODF) & Rural (Drinking) Water Supply Schemes (RWSS) Punjab & Sindh Provinces

This study focused on the behavioral sustainability of latrine use and continued functionality of rural water supply systems in ODF certified villages in the Sindh and Punjab provinces of Pakistan. Our chief role was to develop, integrate and analyze social norms measures as part of the larger sustainability check. This report presents those methods, measures and findings. PennSONG served as an associate partner in the report, working with lead partner AAN Associates (www.aanassociates.com) and associate partner Institute of Environmental Sciences and Engineering (iese.nuse.edu.pk). The study was substantially supported by the Ministry of Climate Change (MOCC), the Government of Pakistan, and UNICEF Pakistan

Unusual metastases of hepatocellular carcinoma (hcc) to bone and soft tissues of lower limb

Hepatocellular carcinoma metastasizing to bones and soft tissues of extremities is an unusual occurrence. The present report describes two such cases, where this unusual happening was the presenting feature. Role of immunohistochemistry for diagnosis is emphasized

Outcomes of COVID-19 infection in patients with hematological malignancies- A multicenter analysis from Pakistan

Purpose: COVID-19 infection resulting from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began to spread across the globe in early 2020. Patients with hematologic malignancies are supposed to have an increased risk of mortality from coronavirus disease of 2019 (COVID-19) infection. From Pakistan, we report the analysis of the outcome and interaction between patient demographics and tumor subtype and COVID-19 infection and hematological malignancy. Patients and methods: This multicenter, retrospective study included adult patients with a history of histologically proven hematological malignancies who were tested positive for COVID-19 via PCR presented at the oncology department of 5 tertiary care hospitals in Pakistan from February to August 2020. A patient with any known hematological malignancy who was positive for COVID-19 on RT-PCR, was included in the study. Chi-square test and Cox-regression hazard regression model was applied considering p ≤ 0.05 significant. Results: A total of 107 patients with hematological malignancies were diagnosed with COVID-19, out of which 82 (76.64%) were alive, and 25 (23.36%) were dead. The significant hematological malignancy was B-cell Lymphoma in dead 4 (16.00%) and alive group 21 (25.61%), respectively. The majority of the patients in both the dead and alive group were on active treatment for hematological malignancy while they came positive for COVID-19 [21 (84.00%) & 48 (58.54%) p 0.020]. All patients in the dead group were admitted to the hospital 25 (100.00%), and among these, 14 (56.00%) were admitted in ICU with a median 11 (6-16.5) number of days. Among those who had contact exposure, the hazard of survival or death in patients with hematological malignancies and COVID-19 positive was 2.18 (CI: 1.90-4.44) times and 3.10 (CI: 2.73-4.60) times in patients with travel history compared to no exposure history (p 0.001). Conclusion: Taken together, this data supports the emerging consensus that patients with hematologic malignancies experience significant morbidity and mortality resulting from COVID-19 infection

Sector Sustainability Check: Rural Open Defecation Free (ODF) & Rural (Drinking) Water Supply Schemes (RWSS) Punjab & Sindh Provinces

This study focused on the behavioral sustainability of latrine use and continued functionality of rural water supply systems in ODF certified villages in the Sindh and Punjab provinces of Pakistan. Our chief role was to develop, integrate and analyze social norms measures as part of the larger sustainability check. This report presents those methods, measures and findings. PennSONG served as an associate partner in the report, working with lead partner AAN Associates (www.aanassociates.com) and associate partner Institute of Environmental Sciences and Engineering (iese.nuse.edu.pk). The study was substantially supported by the Ministry of Climate Change (MOCC), the Government of Pakistan, and UNICEF Pakistan