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Background: The most prevalent and significant arboviral disease affecting humans is dengue. It is spread by the Aedes genus of mosquitoes, which are common in tropical and subtropical regions of the world. Thrombocytopenia occurs commonly among patients suffering from dengue fever, making them more prone to hemorrhagic complications. The predisposing factors leading to thrombocytopenia and bleeding manifestations after dengue infection are not well-known Objective: We attempted to determine the frequency of thrombocytopenia and its co-relation with serum vitamin B12 levels among dengue patients. Methods: This cross-sectional study after taking approval from the hospital ethical committee was carried out at the Department of Medicine PNS Rahat Hospital from June, 2022 to November, 2022. A total of 145 diagnosed patients suffering from dengue fever fulfilling the inclusion criteria were enrolled. Patients with concomitant sepsis, malignancy, autoimmune disorder, hematological disorder, and drugs causing thrombocytopenia were not included in the study. Precise history and biodata were entered in the Pro forma. Patients were investigated for CBC, VIT B12 LEVEL, and other routine investigations. SPSS version 27 was used for data analysis. P-value≤0.05 was considered as statistically significant. Results: Out of a total of 145 patients, 78 (53.8%) were males and 64 (46.2%) were females With a mean age of 38.22±15.93 years.139 patients (95%) had thrombocytopenia. we found a significant positive correlation of thrombocytopenia with Vitamin B12 deficiency (r=0.731, p

Even though methicillin-resistant Staphylococcus aureus (MRSA) is considered a source of nosocomial pneumonia, a few cases have likewise depicted instances of community-acquired pneumonia (CAP) among healthy individuals that were caused by MRSA. Mostly CA-MRSA causes skin and soft tissue infection but can be responsible for severe invasive infection with higher morbidity. Invasive CA-MRSA requires aggressive management to prevent complications. CA-MRSA strains are now recognized as distinct clonal entities that differ from traditional hospital-acquired MRSA (HA-MRSA) strains. The increasing prevalence of MRSA in the community is an important public health problem, which needs increased vigilance in the diagnosis and management of suspected and confirmed staphylococcal infections. We present an intense case of CAP brought about by MRSA with impending respiratory failure in a 19-year-old male, who presented with acute febrile illness with swelling over lips with no co-morbid and insignificant past medical history. Through this case, we intend to increase awareness among physicians about the growing role of CA-MRSA in the population; they should be meticulous in treating patients with CA-MRSA, and be aware of the complications of this disease and the appropriate empiric and target antibiotics regimen for such infections, whenever it is suspected, to enhance better clinical outcomes

Euglycemic diabetic ketoacidosis (EuDKA), is an uncommon but potentially fatal medical emergency characterized by metabolic acidosis, ketosis, and either normal or near normal blood glucose level. The Diagnosis is delayed due to a lack of hyperglycemia leading to adverse consequences. It’s not a routine diagnosis but patients with both types of diabetes mellitus may suffer from it. Since august 2014, after the inclusion of sodium-glucose cotransporter-2 inhibitors (SGLT2i) for the management of diabetes mellitus, the incidence of euglycemia DKA has raised. The other conditions that may contribute to this metabolic disorder include fasting, chronic liver disease, pregnancy, gastroparesis, bariatric surgery, glycogen storage disease, cocaine intoxication, and insulin pump failure. Euglycemic DKA, a diagnosis of exclusion, should be considered in any unexplained metabolic acidosis among diabetic patients, who report to the hospital with nonspecific symptoms not suggesting DKA and have been taking sodium-glucose cotransporter-2 inhibitors. Here we are describing a case of ketoacidosis with normoglycemia caused by empagliflozin in a female suffering from type 2 diabetes mellitus to raise awareness of physicians to minimize the delays in the identification of this life-threatening metabolic disorder.

Adrenal myelolipoma is a rare benign neoplastic lesion, mostly asymptomatic and unilateral. It originates from the adrenal gland and is made up of mature adipose tissues with the hematopoietic series. Adrenal lipomas are extremely rare and always benign and non-secreting. We describe a case of a hypertensive female patient who presented with abdominal pain. Physical examination and investigations were unremarkable. Ultrasound abdomen showed a hyperechoic mass on the left side of the abdomen. Contrastenhanced abdomen illustrated a large heterogeneous mix density lesion in the left suprarenal gland showing enhancing soft tissue and macroscopic fat components suggesting adrenal myelolipoma. Although the patient did not have any related complications but owing to the large size of the tumor, surgical resection was planned which was later done successfully

Background: Diabetes Mellitus is a chronic illness that is characterized by high blood sugar levels and is associated with high mortality and morbidity due to its long-term complications. Glycosylated hemoglobin (HbA1c) is the gold standard test to assess glycemic control for a duration of three months. Therefore, awareness of diabetic patients regarding HbA1c is important for their appropriate management. Objective: To evaluate the pattern and knowledge regarding HbA1c testing among diabetic patients. Methods: Descriptive, cross-sectional study was conducted at the Department of Internal Medicine, The Indus Hospital (TIH), Karachi, From October 21, 2018, to April 20, 2019. After taking informed consent, a total of 380 diabetic patients fulfilling the inclusion criteria were interviewed by a resident in Internal Medicine. Besides demographic data, the recent value of HbA1c and knowledge of HbA1c were recorded on a predesigned questionnaire. The lab results of HbA1c were taken through the Health management informatics system (HMIS). SPSS software version 20 was used for data analysis. Results: Out of a total of 380 patients, 131 (34.5%) were males and 249 (65.5%) were females. The mean age was 51.6±10.4 years. The majority of patients (64.5%) had no formal education. The mean BMI was 27.9kg/m2 . The mean duration of diabetes was 6.6+7.4 years. As far as knowledge about the HbA1c test was concerned, 14 patients (3.7%) had knowledge about the HbA1c test. 10 patients (2.6%) knew what the target HbA1c should be, 48 patients (12.6%) knew about the frequency of testing of HbA1c while 10 patients (2.6%) remembered their last HbA1c results. The patients who had knowledge about HbA1c were comparatively younger (mean age: 43.57 vs 51.98, p=0.003) Conclusion: The results of the current study indicate the lack of awareness and knowledge of HbA1c testing among diabetic patients. It is also concluded that there is a need to create awareness among diabetic patients regarding the HbA1c test for their appropriate management.