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BackgroundChikungunya virus (CHIKV) is an alphavirus transmitted by mosquito vectors.1 Acute infection lasts for 1–10 days and is characterised by abrupt onset of fever and severe arthralgia. Painful polyarthralgia is the symptom causing serious economic and social impacts on individuals and the affected communities.2 In a study conducted by Schilte C et al, 60% of CHIKV-infected patients suffered from arthralgia, 36 months after acute infection[.3 Non-salicylate analgesics and non-steroidal anti-inflammatory drugs (NSAIDS) are most commonly used for symptomatic relief.4 There is lack of local data on CHIKV and it’s after effects. By determining the clinical and laboratory features associated with CHIKV and persistent arthralgia, it will help us in early diagnosis, and improved outcomes in our population.ObjectivesTo study clinical and laboratory features associated with persistent arthralgia in patients with chikungunya feverMethodsThis observational study was conducted at the Rheumatology Clinic of Liaquat National Hospital, Karachi. It comprised of collected data of patients who presented with arthralgias and positive chikungunya serology. Detailed history, examination and laboratory investigations were recorded in a pre-designed structured proforma and SPSS21 was used for statistical analysis.ResultsWe had 52 patients out of which 28.8% were males and 71.2% were female, mean age being 45±5 years. Mean duration of arthralgia was 2.6 months. Pre-existing rheumatologic conditions were RA in 1.9% while SLE in 1.9% of the patients. Out of the total 9.6% were hospitalised due to complications like encephalitis, septic arthritis. Symmetrical arthralgia and asymmetrical was described in 76.9% and 23.1% of cases respectively. Small joint involvement was in 21.2%, large joint in 20.8% while both small and large involvement was seen in 48.1% of patients. Morning stiffness of greater than ½ hour was described in 63.5% of cases. Elevated ESR, CRP was seen in 69.2% and 59.6% cases, respectively. Patients were either given NSAIDs (34.6%), steroids (57.7%), or both (7.7%). Steroid was usually given in the form of a single intra muscular methylprednisolone 120 mg dose. In total 85.7% of patients improved after receiving steroids. While in group receiving NSAIDS only, improvement was seen 7.1% of total cases, and persistent arthralgia was seen in 88.9% of same group.ConclusionsChikungunya viral arthralgia has constituted a major disease and socioeconomic burden in our society in a relatively short span of time. Studies including our show it to be a great mimicker of inflammatory arthritis, and stresses the need to differentiate it, as history, clinical examination and lab parameters show quite similarity. Prompt treatments through steroids have shown great response in symptoms.References[1] Singhand SK, Unni SK. “Chikungunyavirus:hostpathogen interaction,”Reviews in Medical Virology2011;21(2):78–88.[2] Juppand PG, McIntosh BM. “Chikungunyavirusdisease,” in The Arboviruses: Epidemiology and Ecology, T. P. Monath, Ed., pp.137–157...

Hyper eosinophilic syndrome (HES) is a rare condition with a potential for morbidity and mortality, if left untreated. Therefore, it is important to highlight it, as often these cases are misdiagnosed and mismanaged, specially when presenting with an atypical initial presentation. This case report describes an unusual initial clinical presentation of HES. Patient was a 75-year lady presenting to Rheumatology Clinic with short duration of fever and polyarthritis. Joint aspiration showed purulent fluid with a cell count of 61,000/mm 3 with predominant neutrophils and eosinophils. Her peripheral blood also showed a high white blood cell (WBC) count (80,700/mm 3 with 73% eosinophils). Her workup for eosinophilic leukemia was negative, so a diagnosis of HES was made. She was initiated on corticosteroids and hydroxycarbamide as first-line therapy. Unfortunately, the patient was unresponsive to steroids with her WBC count rising to 130,000/mm 3 and her clinical course was complicated by cardiac failure and peripheral neuropathy. Improvement in arthritis and peripheral eosinophilia was noted after she was given imatinib and stabilised clinically.

Objective: The purpose of this study was to determine whether or not individuals with iron deficiency anemia and an underlying inflammatory condition had a connection between serum ferritin as an acute phase reactant and C - reactive protein. Study Design: Cross-sectional/Prospective study Place and Duration: Liaquat university of Medical and health sciences jamshoro Hyderabad. January 2022 to December 2022 Methods: This research comprised 136 individuals who were suffering from iron deficiency anemia. After getting informed written consent detailed demographics of enrolled cases were recorded. Using an automated hematology analyzer (Mindray BC-5000), the parameters of the blood were analyzed. Serum ferritin levels were used to classify each patient into one of three categories. Serum ferritin levels were divided into three groups: Group I (serum ferritin <10 μg/L), Group II (11–150 μg/L), and Group III (>150 μg/L).SPSS version 23.0 was used to analyze the data. Statistical analysis was conducted using Pearson's correlation tests. Results: In current study patients mean age was 31.13±6.75 years and had mean BMI 24.6±3.52 kg/m2. There were majority 74 (54.4%) males and 62 (45.6%) females in this study. Majority of the patients 81 (59.6%) were had low ferritin <10 μg/L, followed by normal ferritin 11–150 μg/L in 45 (33.1%) cases and 10 (7.4%) cases had high ferritin >150 μg/L. We found strong co-relation of C reactive protein and high level of serum ferritin with p value <0.002. Serum ferritin levels were negatively correlated with hemoglobin. Conclusion: We concluded in this study that levels of serum ferritin was positively associated with C-reactive protein (CRP). In patients with underlying deficiency of iron, secondary inflammation may increase the level of ferritin in serum. Keywords: Ferritin, Haemoglobin, Iron Deficiency Anaemia, C-Reactive Protein

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