Dengue Hemorrhagic fever complicated by intercostal artery hemorrhage.

Hemorrhagic manifestations are fairly common in Dengue hemorrhagic fever and are associated with increased mortality. During last few decades there have been increasing reports of Dengue infection with unusual manifestations. Here we present a case of dengue hemorrhagic fever complicated by spontaneous rupture of an intercostal artery leading to a large hematoma which was treated successfully with angio-embolization. To the authors\u27 knowledge this is a first case of dengue hemorrhagic fever complicated by spontaneous intercostal artery hemorrhage

Dengue fever with hepatitis E and hepatitis A infection

Infection with dengue viruses produces a spectrum of clinical illness ranging from a nonspecific viral syndrome to severe and fatal haemorrhagic disease. Important risk factors include the strain and serotype of the infecting virus, as well as the age, immune status, and genetic predisposition of the patient. The teaching point in this case study was Dengue fever which occurred concomitantly with Hepatitis A and Hepatitis E virus infection

HYBRID BONE SCINTIGRAPHY IN GASTROINTESTINAL MALIGNANCIES – INSTITUTIONAL EXPERIENCE

Objective: Bone metastases in gastrointestinal (GI) malignancies are uncommon and known to be predominantly lytic thus rendering a limited role for conventional bone scintigraphy. The aim of the study is to review Tc99m MDP bone scans performed in patients with known GI malignancy and the utility of Single-photon emission computed tomography (SPECT)/CT in characterization of bone lesions.Methods: Retrospective review of bone scans was done from June 2014 to December 2016 in patients with known GI malignancy, using electronic Hospital Information System.Results: A total of 110 patients (60 males, 50 females; Age range: 22–84 years, Mean Age 51.4 years with SD of 14.8) had bone scan over a period of 30 months. The commonest indications for referral were suspected bone metastasis on other imaging modalities including [CT (n = 56), Magnetic resonance imaging (n = 10), Positron emission tomography/CT (n = 6)], musculoskeletal pain (n = 37), pathological fracture (n = 1), neurological symptoms (n = 1), hypercalcemia (n = 1) and others (n =14) including restaging workup etc. Metastatic lesions were identified in 32 (29%) patients whereas 78 (71%) patients had benign non-aggressive lesions leading to normal bone scans. Among 32 patients with osseous metastasis, 8 (25%) patients had unifocal lesion; axial skeleton (n = 2) appendicular skeleton (n = 6), 24 (75%) patients had multifocal lesions; axial skeleton (n = 6), appendicular skeleton (n = 6) and both axial + appendicular (n = 12). Four (12%) patients had concurrent visceral metastases. In our cohort, based on the location of primary tumour, the frequencies of osseous metastasis were; esophagus = 15 out of 43 (35%), gastric = 7 out of 18 (39 %), gastro-esophageal junction = 1 out of 8 (1.5%) and colorectal = 9 out of 40 (22.5). SPECT/CT was acquired in 29 out of 110 patients, which characterized metastatic lesions (n = 12) and benign looking non-aggressive entities (n =17). Overall, bone scan upstaged disease in 31% and down staged 15% patients.Conclusion: Bone metastases in GI malignancies, though uncommon, show an aggressive pattern, with axial and appendicular involvement, and can be readily identified with hybrid bone scintigraphy in symptomatic patients. Key words: Hybrid imaging, Tc99m MDP, bone metastases, gastrointestinal malignancie

Cutaneous Ulcers as Initial Presentation of Localized Granulomatosis with Polyangiitis: A Case Report and Review of the Literature

Background. Granulomatosis with polyangiitis (GPA) is an ANCA associated small vessel vasculitis characterized by necrotizing granulomatous inflammation involving the upper and the lower respiratory tract and the kidneys. The disease has a broad clinical spectrum that ranges from limited/localized involvement of a single organ system to a generalized systemic vasculitis that affects several organs with evidence of end organ damage. Atypical forms of the disease have been recognized with or without respiratory tract involvement with a long protracted course before manifesting as generalized disease. Case Presentation. We describe a 57-year-old woman who presented with recurrent fever and cutaneous ulcers on her legs who was diagnosed to have granulomatosis with polyangiitis (GPA) after an extensive evaluation which excluded infectious, other vasculitides, connective tissue disease and malignant etiologies. Conclusion. In the absence of typical manifestations, granulomatosis with polyangiitis (GPA) is indeed a diagnostic challenge to the physician. Atypical manifestations like unexplained recurrent fever and cutaneous ulcers nevertheless call for keeping a low threshold for the diagnosis of GPA as the disease can initially present in localized form before heralding into a generalized disease

Attitude of Medical Students Towards Psychiatry in a Tertiary Care Hospital

Background: Dearth of psychiatrist specialists is evident worldwide. Awareness of undergraduate students towards mental illness has an important role in affecting the quality of care the patient receives and in choosing  psychiatry as a career . Decision to specialize in psychiatry based on many factors, however attitude of undergraduates towards career choice play most important role in this aspect. Objective: This study aims to explore attitude and towards psychiatry among medical undergraduates in tertiary care hospital and factors influencing this decision. Methodology: It was Descriptive cross sectional study done at Nishtar medical University, tertiary care hospital of Multan Pakistan from July to December 2019. The total 384 students from first to final year were enrolled by non probability convenient sampling technique. Participation was voluntary and ensured that response would be kept anonymous. ATP-30 (Attitude towards Psychiatry)   a 30 item self- administered questionnaire was used to measure the attitude of medical students. Data collected on a pre defined questionnaire was analyzed using SPSS version 23. Results pertaining to rates were reported as frequencies and percentages. Result: 47.4% of study respondents were male and 52.6 % were female. 52.3% of our study respondents strongly agree that psychiatry was respected branch of medicine and 56.7% strongly agree that psychiatry should be an important part of medical curriculum. 19.4% of study respondents consider it in the list of the carrier choice while majority didn’t think that it should be in their career list options. Conclusion: Majority of students shows positive attitude. Mostly found it as respected and essential field of medicine. However insufficient knowledge and awareness can also be observed in responses pertaining to available treatment and advancement in the field. There is a need to revise the curriculum and clinical rotation schedule to raise interest of students  regarding  mental health issues of their community and ease their decision in choosing it as a career. Keywords: Attitude, Undergraduate medical students, Psychiatry, Multan, Pakistan DOI: 10.7176/JMPB/63-06 Publication date: January 31st 202

MicroRNA: A Signature for Cancer Diagnostics

Various tools and techniques are being used for the diagnosis of cancer, but not a sole technique provides powerful result at the very early stages of cancer. This provides the need for type of tools which could detect cancer at early stages so that survival rate could be augmented. There are various diagnostic ways to identify cancer, but in each case, there are always circumstances to compromise on the sensitivity. In this framework, a new and more advanced approach of diagnosis for cancer is microRNA (miRNA). miRNAs are conserved regions among humans and animals, and their synthesis takes place in the nucleus and cytoplasm. There are several types of microRNAs that could be upregulated and downregulated in various cancers. A cancer cell could be identified by measurement of the expression pattern of miRNA. By examining the expression level for different types of cancers, miRNA can be used as biomarker for early detection of cancer in human beings

The learners\u27 perspective on internal medicine ward rounds: a cross-sectional study

Background: Ward rounds form an integral part of Internal Medicine teaching. This study aimed to determine the trainees\u27 opinions regarding various aspects of their ward rounds, including how well they cover their learning needs, how they would like the rounds to be conducted, and differences of opinion between medical students and postgraduates. Methods: A cross-sectional study was conducted on a total of 134 trainees in Internal Medicine, comprising medical students, interns, residents and fellows, who were asked to fill in a structured, self-designed questionnaire. Most of the responses required a rating on a scale of 1-5 (1 being highly unsatisfactory and 5 being highly satisfactory). Results: Teaching of clinical skills and bedside teaching received the lowest overall mean score (Mean +/- SD 2.48 +/- 1.02 and 2.49 +/- 1.12 respectively). They were rated much lower by postgraduates as compared to students (p \u3c 0.001). All respondents felt that management of Patients was the aspect best covered by the current ward rounds (Mean +/- SD 3.71 +/- 0.72). For their desired ward rounds, management of Patients received the highest score (Mean +/- SD 4.64 +/- 0.55), followed by bedside examinations (Mean +/- SD 4.60 +/- 0.61) and clinical skills teaching (Mean +/- SD 4.50 +/- 0.68). The postgraduates desired a lot more focus on communication skills, counselling and medical ethics as compared to students, whose primary focus was teaching of bedside examination and management. A majority of the respondents (87%) preferred bedside rounds over conference room rounds. Even though the duration of rounds was found to be adequate, a majority of the trainees (68%) felt there was a lack of individual attention during ward rounds. Conclusions: This study highlights important areas where ward rounds need improvement in order to maximize their benefit to the learners. There is a need to modify the current state of ward rounds in order to address the needs and expectations of trainees