Objectives: To determine the frequency of silent cardiac ischemia in type II diabetes mellitus patients presenting to tertiary care facility. Methodology: This cross-sectional study was conducted from 20th October 2017 to 20th April 2018 at Department of Medicine Jinnah Hospital Lahore. After a detailed history, measurement of height, blood pressure, weight, fasting blood sugar, body mass index of 237 patients were recorded, and electrocardiography (ECG) was done before and after exercise tolerance testing (ETT). Changes in ECG were assessed and person labeled as having silent cardiac ischemia or not depending on the outcome of the ECG. Results: Mean age was 54.9 ± 5.9 (range: 45 – 63) years. There were 144 male patients and 93 female patients The mean duration of type II diabetes mellitus in the study population was 10.0 ± 2.6 (range: 6 – 15) years. The frequency of silent cardiac ischemia was found to be 45.1%. Increasing age, prolonged duration of diabetes mellitus, history of smoking and hypertension, and increased body mass index were significantly related to silent cardiac ischemia (p-value< 0.05). Conclusion: Silent cardiac is quite prevalent in our population that demands urgent efforts to diagnose this condition earlier for better future outcomes.
Objective: To find out the frequency of hiatal hernia among patients with dyspepsia undergoing esophagogastroscopy. Study Design: Descriptive, Cross-sectional study. Setting: Departments of Medicine and Gastroenterology, Services Hospital Lahore. Period: December 2018 to June 2019. Material & Methods: A total of 195 patients with dyspepsia aged 20 to 60 years of both sexes were enrolled. Patients with history of gastric or duodenal ulcer, pregnant women, Chronic Renal Failure and Chronic Liver Disease were excluded. After taking informed consent, esophagogastroscopy was done in each patient and presence or absence of hiatal hernia was noted. Results: Out of 195 patients enrolled 104 (53.3%) were male. Mean age was 41.3±8.8 years and mean duration of disease 6.3±2.0 months. Mean BMI was 27.5±3.0 kg/m2 and 101 (51.7%) had BMI <27 kg/m2. Thirty-seven (19.8%) were smokers while sedentary lifestyle was reported in 93 (47.6%). Hiatal hernia among patients with dyspepsia undergoing esophagogastroscopy was found in 16 (8.21%) patients. Conclusion: We conclude that hiatal hernia was not uncommon in patients with dyspepsia undergoing esophagogastroscopy. Age and smoking status had a significant association with hiatal hernia while no association with sex, duration of disease, BMI, occupation or lifestyle.
A 72-year-old asthmatic gentleman with a history of recurrent sinusitis and chronic bronchitis presented with shortness of breath and progressively worsening hypoxemic respiratory failure. His CT chest demonstrated airspace disease bilaterally with ground-glass opacifications. He had peripheral eosinophilia with raised inflammatory markers but negative work up of infection. On further investigation, ANA was positive, titer 1:160, speckled pattern and both pANCA and cANCA were present. The patient was diagnosed with Eosinophilic Granulomatosis with Polyangiitis (EGPA) and started on intravenous steroids and cyclophosphamide. A rare multi-organ vasculitis, EGPA is hallmarked by asthma, sinusitis and eosinophilia. In initial stages vasculitic involvement is not usually seen thereby making EGPA a diagnostic challenge. doi: https://doi.org/10.12669/pjms.39.1.6436 How to cite this: Mahmood K, Butt NI, Ashfaq F, Aftab S. Eosinophilic Granulomatosis with Polyangiitis (EGPA): A case report with atypical presentation. Pak J Med Sci. 2023;39(1):---------. doi: https://doi.org/10.12669/pjms.39.1.6436 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
We present the case of a 27 year old woman who presented with paralysis of left-half of the body and inability to speak for 1 day. She was a diagnosed patient of Rheumatic heart disease since her childhood for which mitral valve replacement with metallic valves had been done 7 years ago. She had been taking warfarin regularly but INR had not been monitored. She had one child born through Cesarean section at 37 weeks of gestation 4 weeks prior to presentation. She had taken warfarin throughout her pregnancy, and discontinued it 2 days before her delivery. Her CT brain showed multiple bilateral asymmetrical hemorrhagic venous infarcts due to sinus thrombosis subsequently confirmed by Magnetic Resonance Venography. The final diagnosis was Rheumatic heart disease with hemorrhagic venous infarcts due to cortical venous thrombosis and a multidisciplinary management involving radiologist, cardiologist, neurologist and gynecologist was planned.
Anton's syndrome implies the situation when affected patient contradicts blindness in spite of objective documentation of loss of vision, and often confabulate to assert their bearing. It is an infrequent sequel of cortical blindness affecting both occipital cortex and other cortical centers, while patients genuinely act as if they are sighted. Our case report is of a lady, 55 years old, who presented to us with history of uncontrolled diabetes, hypertension and visual loss as a consequence of occipital lobe infarction bilaterally. In patients with evidence of occipital lobe injury and atypical visual loss, an assessment for cortical blindness and Anton's syndrome must be included. Anton's syndrome is most frequently caused by cerebrovascular disease. Any condition that causes cortical blindness may, however, lead to Anton's syndrome. Improvement in visual function after occipital lobe infarction due to cerebrovascular events is limited. Therefore, the management should be focused on rehabilitation and secondaryprevention. Keywords: Anton’s syndrome, Occipital lobe infarct, Diabetes mellitus, Hypertension.
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