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Objective: To determine the frequency of Hyperhomocysteinemia in patients of essential hypertension presenting with acute ischemic stroke. Study Design: Cross-sectional analytical study. Place and Duration of Study: Department of Internal Medicine, Combined Military Hospital, Quetta Pakistan, from Feb 2018 to Jan 2019. Methodology: The patients of essential hypertension presenting with acute ischemic stroke between 20-70 years of age of either gender were evaluated for the serum homocysteine level. Results: A total 195 patients of essential hypertension presenting with acute ischemic stroke for ≥24 hours duration, of age between 20-70 years, of both genders were included in the study by non-probability consecutive sampling. Majority of patients were between 50-59 year of age (34.3%) with majority of them were male (66.4%). Out of 195, 70.3% were smokers, 56.4% were diabetics, 60.5% were obese and 71.7% had hyperhomocysteinemia respectively. The statistical significance was also observed for hyperhomocysteinemia in accordance with age (p=0.04), gender (p=0.02), obesity (p=0.03) smoking (p=0.01) and diabetes mellitus (p=0.03). Conclusion: Hyperhomocysteinemia is more prevalent in patients of essential hypertension with acute ischemic stroke. [ABSTRACT FROM AUTHOR]

Objective: To find the association of Child-Pugh's Class with oesophagal varices and portal hypertensive gastropathy in cirrhotic patients at CMH Lahore. Study Design: Cross sectional study Place and Duration of Study: Department of Gastroenterology and Department of Pathology, Combined Military Hospital Lahore Pakistan, from Feb to May 2021. Methodology: All patients with cirrhosis of the liver, irrespective of aetiology, who underwent upper gastrointestinal endoscopy, were included in the study. Lab data was retrieved from the Pathology Department to calculate Child Pugh's score. Endoscopic findings of oesophagal varices and portal gastropathy were recorded and their correlation/association with Child-Pugh's Class was calculated separately by using Pearson's coefficient. Results: A total of 148 patients were included in the study. Male patients were 90(60.8%) and female were 58(39.2%). The age range was 27-85 years, with the mean of patients being 55.93±13.19 years. Association of Child Pugh's Class with oesophagal varices and portal hypertensive gastropathy revealed that higher grades of oesophagal varices (Grade-lll) and severe portal hypertensive gastropathy were found in Child Pugh's Class-B (13.51%, 14.18%) and C (15.54%, 16.2%) as compared to Class- A (4.72 %, 1.35%). Child-Pugh's Class positively correlates with both oesophagal varices and portal hypertensive gastropathy by Pearson's coefficient r=0.594 and 0.035, respectively; both have significant p values (p <0.05). Conclusion: Child-Pugh's Class has a positive correlation with both oesophagal varices and portal hypertensive gastropathy in patients with cirrhosis [ABSTRACT FROM AUTHOR]

Objective: To assess the working knowledge of health care workers (HCW) regarding the appropriate use of disinfectants against Coronavirus in hospital care settings using a questionnaire. Study Design: Cross-sectional study. Place and Duration of Study: Combined Military Hospital Lahore, Pakistan, from Apr 2020. Methodology: Two hundred health care workers were consecutively selected and divided into two groups, irrespective of gender. Each participant had to fill a structured proforma containing twenty-five close-ended questions. Result: Group-1 participants were 126 (63%) and group 2 participants were 74 (37%). 117 (92.8%) group-1 participants were 20-30 years of age and degree holders while 40 (54%) group-2 participants were 31-40 years old and diploma holders. Significant awareness (p<0.001) regarding disinfectants was observed in group-1 (102 81%); all the degree holders were well aware of disinfectants and required less training. In contrast, in group-2, 44 (59%) were fully aware of disinfectants; the rest did not qualify and needed proper training. Participants with a good educational status and work experience of >10 years were the high achievers in both groups. Conclusion: This study revealed that majority of the participants knew about the correct usage of disinfectants and they were fully prepared to handle the ongoing pandemic. Another finding was that awareness was directly related to relevant education, prolonged work experience and age. [ABSTRACT FROM AUTHOR]

Objective: To assess the frequency of stress hyperglycemia and mortality in patients with hyperglycemia admitted in medical Intensive Care Unit. Study Design: Cross-sectional study. Place and Duration of Study: Medical Intensive Care Unit, Combined Military Hospital Quetta, from Nov 2018 to Jun 2019. Methodology: A total of 150 adult patients of age between 18-80 years, of both genders, with Intensive Care Unit stay >24 hours, who were treated in medical Intensive Care Unit during study period, were included in the study. Those patients with duration of stay <24 hours, paediatric patients, surgical and pregnant patients and those who were on chronic steroid therapy and those who were given TPN and dextrose infusions were excluded. The blood sugar fasting was measured daily and blood sugar random was measured on admission and twice daily. The patients were segregated into three groups: Normoglycemia, Diabetes mellitus and Stress hyperglycaemia. The frequency of patients and outcome of patients in terms of death was observed in all groups. Results: The mean age of study population was 55.02 ± 18.14 years, with 99 (66%) were males while 51 (34%) were females. Among study population 77 (51.3%) had normoglycemia, 46 (30.7%) had Diabetes Mellitus while 27 (18%) had stress hyperglycaemia. Out of 77 patients with normoglycemia 10 (12.9%) died, while number of deaths in patients with diabetes mellitus and stress hyperglycaemia was 21 (45.6%) and 15 (55.5%) respectively. The mean maximum blood glucose in those who survived and died was 214.39 ± 100.69 mg/dl and 295.26 ± 122.60 mg/dl respectively, which was significant with a p-value <0.01. Conclusion: This study showed that 18% patients had stress hyperglycemia with higher mean maximum blood glucose levels in those who died, as compared to who survived. [ABSTRACT FROM AUTHOR]

Objective: To assess the notion that milk can cause or aggravate asthma and break this myth. Study Design: A cross sectional study. Place and Duration of Study: Medicine department, Combined Military Hospital Lahore, from Jan 2019 to Dec 2020. Methodology: A survey was conducted whereby known asthmatics were questioned about their opinion weather milk aggravates their asthma. Those who confirmed their positive response were exposed to milk and some liquid resembling milk, and their Lung functions were tested after each drink. The 42 patients who considered milk as the primary aggravator were called for the study for spirometry Results: A total of 600 people from the general population were surveyed. Two hundred and six (34.3%) of them were illiterate, 394 (65.6%) were educated from middle to graduates. In the first milk/milk encounter, the combined dyspnea scale showed increase of 50.3% and improvement of 0.008% in FEVI/FVC. In the second substitute /milk encounter, the dyspnea score showed an increase of 61.8% and an increase of 0.90% in FEVI/FVC. In the third milk/substitute encounter the dyspnea score showed a decrease of 22.9% and the FEVI/FVC decreases by 5.5%. In the 4th substitute/substitute encounter, dyspnea scores decreased by 8.4% while the pre and postencounter FEVI/ FVC scores were 2726 and 2711 with 0.55% decrease with insignificant p-value >0.05. Conclusion: Drinking milk or milk substitute has negligible effect on the spirometric parameters. [ABSTRACT FROM AUTHOR]

Objective: To establish the correlation between glycated hemoglobin (HbA1c) and lipid profile in patients with type 2 diabetes mellitus (T2DM). Study Design: Correlation study. Place and Duration of Study: Pak Emirates Military Hospital Rawalpindi (PEMH), Medical Outpatient department (OPD), from Nov 2017 to May 2018. Methodology: A total of 160 patients with type 2 diabetes mellitus of both genders, 30-70 years of age presenting in OPD were included in study, while those with T1DM, CKD stage 3 and above, infection or diabetic foot, any endocrine disease and female patients with pregnancy were excluded from the study. The blood samples were taken for blood sugar random (BSR), blood sugar fasting (BSF), haemoglobin A1c (HbA1c), lipid profile and results were collected next day. The Pearson correlation test was used to analyze correlations. Results: Among 160 patients the mean age was 57.28 ± 10.13 years, 81 (50.6%) were males while 79 (49.4%) were females. The 34 (21.20%) patients had good, while 125 (78.80%) had poor glycaemic control using haemoglobin A1c of 7% as a cut off. A positive and statistically significant correlation was observed between haemoglobin A1c and total cholesterol (r=0.233, p<0.01), triglycerides (r=0.172, p<0.05), and a correlation which was positive but statistically not significant was observed between haemoglobin A1c and LDL-C (r=0.105, p=0.260) while a statistically insignificant negative correlation was observed between haemoglobin A1c and HDL-C (r=-0.041, p=0.652). Conclusion: A significant positive correlation was found between haemoglobin A1c and total cholesterol and triglycerides. Haemoglobin A1c can also be used as a biomarker to predict dyslipidemias in patients with type 2 diabetes mellitus. [ABSTRACT FROM AUTHOR]

Objective: To compare the usefulness of Grocco’s sign with an alternative method, Khalid’s maneuver, which does not require any change in patient’s position to elicit Grocco’s sign. Study Design: A comparative prospective study. Place and Duration of Study: Combined Military Hospital Lahore, from Jan 2019 to Jul 2019. Methodology: A total of 200 patients who were divided into two groups (group A and group B) with 100 patients in each group. Group A was a control group. Group B was subdivided into group B1 containing patients with serous pleural effusion and group B2 containing patients with empyema. Two independent operators were asked to do chest percussion in all patients to elicit Grocco’s sign. Furthermore Positional method and Inspiratory method (Khalid’s maneuver) to elicit disappearance of dullness in Grocco’s triangle were compared in patients with positive Grocco’s sign Statistical significance & 95% confidence interval was calculated using nonparametric unpaired t test (Mann-Whitney U-Test). Results: Grocco’s sign was negative in all patients in group A while it was positive in all patients in group B. In group B1 patients, the percussion dullness disappeared in Grocco’s triangle in 48 (96%) (95% CI 93.2-98.1) patients by the positional method and 46 (92%) (95% CI 90.1-95.6) patients by Khalid’s maneuver with statistically insignificant p-value i.e. 0.44. In group B2 patients, the percussion dullness failed to disappear by both methods. Conclusion: Grocco’s sign helps in assessment of the patients with simple and complex pleural effusion and thus guiding further management decisions early in time. Khalid’s maneuver which has the ability to elicit Grocco’s sign with near similar accuracy provides handy alternative for such patients with comparable p-value to the standard procedure. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of neurological manifestations and complications of SARS-COV-2. We were especially concerned with the cases where the primary presentation was neurological indicating the neuroinvasive potential of the virus. Study Design: Prospective observational study. Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi, from Apr to May 2020. Methodology: A total of 405 confirmed COVID patients were enrolled for the study. Demographic features and initial clinical manifestations were noted and patients were followed during the hospital stay for the development of any new neurological signs and symptoms. For analytical purposes, neurological presentations were grouped into the central nervous system, peripheral nervous system, and musculoskeletal system manifestations. Appropriate laboratory testing was employed as required on case to case basis. Results: In this study, the mean age was 46.6 ± 15.5 years. Two hundred and seventy one (66.9%) patients were male while one hundred and thirty four (33.1%) were female. The neurological illness was a primary manifesttation in twenty four (6%) cases. These included encephalopathy (n=15), ischemic stroke in young (n=2), GuillainBarre syndrome, (n=1), facial nerve palsy (n=2), and encephalitis (n=1). The most common neurological symptoms were headache 142 (35%), and hyposmia 39 (9.6%) followed by encephalopathy 34 (8.3%). More serious complications like seizures 7 (0.7%) and stroke 9 (2.2%) were also seen. Conclusion: Severe Acute Respiratory Syndrome-Coronavirus 2 can present with a neurological illness like its predecessors. We should remain vigilant to the possibility of neurological presentation of COVID-19 that can be thromboembolic, inflammatory or immune-mediated. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy of Rosuvastatin 5mg and Simvastatin 20mg in reducing low-density lipoprotein cholesterol in newly diagnosed patients with type 2 diabetes. Study Design: Quasi-experimental study. Place and Duration of Study: Department of General Medicine, Pak Emirates Military Hospital (PEMH), Rawalpindi, from Jul 2017 to Jan 2018. Methodology: Patients of type 2 diabetes with hypercholesterolemia (mean LDL-C levels >100 mg/dl) were included in the study. In a sample of 100 patients, half of the patients were in the Rosuvastatin 5mg group (group A) while half patients were in the Simvastatin 20mg group (group B). Non-probability consecutive sampling was done. We followed up the patients for 6 weeks. All the laboratory investigations were performed from the laboratory of the same hospital. Investigator himself recorded all the information including name, age, gender, weight, LDL-C levels, Renal function test reports and CK-MB levels in a self-designed, self-administered proforma. Data were analyzed with statistical analysis program SPSS V 23. Results: Age range in this study was from 35 to 60 years with a mean age of 46.980 ± 6.31 years in group A vs 48.520 ± 5.61 years in group B. Mean LDL-C Levels were 149.460 ± 25.76 mg/dl in group A vs 146.960 ± 22.92 mg/dl in group B. Mean weight was 82.880 ± 9.17 kg in group A vs 88.660 ± 10.33kg in group B. Male gender was dominant in both group (70% and 72%). In group A, efficacy was seen in 40 (80%) patients as compared to 24 (48%) patients in group B (p<0.001). Conclusion: Rosuvastatin 5mg tablet was more effective than Simvastatin 20mg in reducing low-density lipoprotein cholesterol in newly diagnosed type 2 diabetes patients. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of hyponatremia in acute cerebrovascular accidents and explore the relationship of hyponatremia with age, gender, type, and duration of cerebrovascular accidents. Study Design: Cross-sectional analytical study. Place and Duration of Study: Department of Internal Medicine, Combined Military Hospital Peshawar, from Dec 2016 to Jun 2017. Methodology: In this study, a total of 127 patients with acute cerebrovascular accidents i.e. within 12 hours of onset were enrolled. Serum sodium levels were evaluated at the initial presentation of the patient at the emergency department after confirmation of cerebrovascular accidents following clinical evaluation and computed tomography scan of brain without contrast. Results: In this study, the mean age was 46 ± 8.7 years. Seventy-four (58%) patients were males while 53 (42%) patients were females. Eighty-six (68%) patients had ischemic cerebrovascular accidents while 41 (32%) patients had hemorrhagic cerebrovascular accidents. Thirty-eight (30%) patients had hyponatremia. Stratification of hyponatremia with age, gender, duration of cerebrovascular accidents, and the type of cerebrovascular accidents showed statistically insignificant correlation with p-value >0.05. Conclusion: The frequency of hyponatremia in our cohort of acute cerebrovascular accidents patients was 30%. There was no association between hyponatremia and age, gender, type, or duration of cerebrovascular accidents. Monitoring of serum sodium levels must be done in all patients who are admitted with a cerebrovascular accidents. [ABSTRACT FROM AUTHOR]

Objectives: To compare the clinical cure rate for doxycycline and levofloxacin in treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and explore the response in relation to gender. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Medicine, Pak Emirates Military Hospital Rawalpindi, from Nov 2015 to Jun 2016. Methodology: In this study, indoor patients diagnosed with acute exacerbation of chronic obstructive pulmonary disease were enrolled through consecutive sampling and randomized into two groups through lottery method. Patients were randomly assigned to oral doxycycline 100 mg twice daily or oral levofloxacin 500 mg once daily for five days. The clinical and laboratory assessments of the patients were done on the 7th day to note response as clinical cure or clinical failure. Results: Mean age of the sample was 52 ± 5.5 years. Clinical cure was observed in 156 (84.8%) patients. Cure rate was found to be significantly higher in levofloxacin group as compared to the doxycycline group (91.3% vs. 78.3% respectively) (p=0.014). Significantly higher cure rate was observed for levofloxacin than doxycycline in males (p=0.026). No significant difference in the cure rate was noticed among the two treatment groups in females (p=0.289). Conclusion: Clinical cure rate for acute exacerbation of chronic obstructive pulmonary disease with levofloxacin was significantly higher in the sample as compared to doxycycline. The males from the sample showed similar difference in cure rate for the two drugs. [ABSTRACT FROM AUTHOR]

Objective: To determine the demographic variance in location and histopathological findings of esophageal carcinoma in Punjab-Pakistan. Study Design: Observational cross sectional study. Place and Duration of Study: This study was conducted in Multicentre Tertiary Care Hospitals of Combined Military Hospital/Pak Emirates Military Hospital/Army Medical College Rawalpindi, Combined Military Hospital Kharian and Combined Military Hospital Multan from 2010 to 2017. Methodology: Patients with dysphagia and histopathology proven malignancy were included in this study. All patients had undergone flexible upper gastrointestinal endoscopy. Patients with lesions other than carcinoma, causing dysphagia and those with inconclusive histopathology were excluded from our study. The morphological site of the carcinoma were divided into upper, middle, lower and at gastro-esophageal junction. Histo pathologically proven carcinoma of esophagus was reviewed for subtype of grading differentiation. Statistical analysis was done using IBM version SPSS 22. Results: Out of 150 patients, 85 (57%) were males and 65 (43%) were females. Their age ranged between 30 to 85 ± 12.33. Among one hundred and fifty patients 107 (71.33%) had Squamous Cell Carcinoma, 42 (28%), Adenocarcinoma and metastasis in two cases. Frequency of distribution of esophageal carcinoma in North, East and South Districts of Punjab was 73%, 18% and 9% respectively. Esophageal Carcinoma in upper, middle, lower and Gastroesophageal junction was 22.5%, 35%, 15% and 27.5% respectively. Frequency of well differentiated SCC was 46 (30.6%) and well differentiated AC 31 (20.7%) respectively. Conclusion: SCC with male preponderance is more common in North of Punjab. Lower 1/3rd and GE junction esophageal tumor are the commonest sites in all North, East and South Punjab. Histopathological differentiation revealed Well Differentiated SCC along with significant rise in Adeno-carcinomas compared to previous national studies. [ABSTRACT FROM AUTHOR]

Objective: To compare the frequency of post-stroke seizure between acute ischemic and haemorrhagic stroke patients. Study Design: Comparative, prospective study. Place and Duration of Study: Combined Military Hospital, Rawalpindi Pakistan, from Oct 2021 to Oct 2022. Methodology: A total of 180 patients with acute stroke, were included in the study. CT brain and/or MRI brain were performed to diagnose all patients. Patients were divided into haemorrhagic and ischemic stroke groups. Patients were followed for four weeks. Results: The mean age of the patients was 48.92±7.80 years. The majority were males 127(70.5%),125(69.4%) patients had an ischemic stroke, while 55(30.6%) had haemorrhagic. Post-stroke seizures were seen in 12(7.07%). In haemorrhagic stroke patients, the frequency was 5/55(9.09%), while 7/125(5.6%) in ischemic ones. The difference in frequencies was 4.03%. There was no significant difference in seizure frequencies between the two groups (p=0.298). Conclusion: This study concluded that there is no significant statistical difference in frequencies of post-stroke seizure in haemorrhagic stroke compared to ischemic stroke patients. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of asymptomatic spontaneous bacterial peritonitis in patients of liver cirrhosis with ascites. Study Design: Descriptive study. Place and Duration of Study: The study was conducted at indoor and outpatient departments of Medicine, Military Hospital, Rawalpindi, Pakistan from 29th February 2008 to 28th August 2008. Subject and Methods: One hundred and ninety five patients of liver cirrhosis with ascites were selected. To standardize the study; patients of both genders over 18 years of age, diagnosed with liver cirrhosis and ascites were included in the study after obtaining their informed consent. Patients with abdominal tenderness and fever, hepatic encephalopathy, intra-abdominal surgically treatable cause, with any co-morbid disease (hypertension and diabetes mellitus) or refusing to give consent were excluded from the study. Strict inclusion/exclusion criteria were observed to control the confounding variables. Diagnosis of spontaneous bacterial peritonitis was based on increased ascitic fluid absolute polymorphonuclear leukocyte (PMN) count (≥ 250 cells / mm³) and/or positive bacterial culture. Results: Out of 195 patients, 10 patients (5%) had neutrocytic ascites (absolute neutrophil count ≥ 250 cell/mm³). Out of these 195 patients, three patients (1.5%) were found to have positive ascitic fluid culture. Conclusion: In our study the frequency of asymptomatic spontaneous bacterial peritonitis in patients of liver cirrhosis with ascites turned out to be 5% which is low. Therefore, analysis of ascitic fluid through diagnostic paracentesis should be reserved for inpatient or outpatient with clinically apparent new onset ascities or in cirrhotic patients with ascities whose general condition deteriorates. [ABSTRACT FROM AUTHOR]

Objective To evaluate the in vitro activity of nitrofurantoin against various isolates yielded from urine specimens. Place and duration Department of Microbiology, Armed Forces Institute of Pathology Rawalpindi, from January 2009 through January 2010. Materials and methods A total of 919 urinary isolates (Escherichia coli 690, Klebsiella pneumoniae 62, Klebsiella oxytoca 26, Enterococcus faecalis 54, Enterococcus faecium 18, Enterobacter agglomerans 16, Enterobacter cloacae 4, Acinetobacter baumannii 20, Citrobacter spp 15, Serretia marcesens 14) were cultured from urine specimens during the study period. All the isolates were tested against nitrofurantoin along with other routine antibiotics used for urinary pathogens. Results Out of total 919 urinary isolates, percentages of sensitivities of nitrofurantoin against Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca, Enterococcus faecalis, Enterococcus faecium, Enterobacter agglomerans, Enterobacter cloacae, Acinetobacter baumannii, Citrobacter spp, Serretia marcesens were 89.4, 32.3, 15.4, 81.5, 39.0, 43.8, 50, 25, 26.7 and 28.6% respectively. Conclusion Nitrofurantoin is very effective against urinary isolates in-vitro and can be used empirically for uncomplicated urinary tract infections. [ABSTRACT FROM AUTHOR]

Background: Normal values of complete blood counts show variation from region to region and between different ethnic groups. It is important to establish reference range for these values in our population for clinical use by our physicians. This descriptive cross sectional study aimed at establishing the normal reference values of complete blood counts in physically normal full term new-borns of Panu Aqil, Rural Sind, Pakistan., Methods: The study was conducted at Combined Military Hospital, Panu Aqil Cantonment, from January 2010 to March 2011, on 316 term normal neonates selected on the basis of gestational age of 37 weeks or more with uneventful antenatal period. During the initial 12 hours of delivery, 2 ml Cord blood was collected in bottle containing tripotassium ethylene diamine tetra acetic acid (K3EDTA) as the anticoagulant and Complete blood counts were performed by Sysmex KX-21 automated haematology analyser. Blood films were prepared and stained by Leishman stain., Results: The haemoglobin was mean +/- SD 15.4 +/- 1.9 g/dL. The Mean Corpuscular Volume (MCV) was 103.4 +/- 4.6 fL, while Mean Corpuscular haemoglobin (MCH) was 33.8 +/- 1.6 pg. The Red cell Distribution Width-CV (RDW-CV) was 18.5 +/- 1.8%. The total leukocyte count (TLC) was mean +/- SD 13.7 +/- 4.0 x 10(9) /L. The Absolute Neutrophil count (ANC) was mean +/- SD 7.7 +/- 3.0 x 109 /L. The Absolute Lymphocyte count (ALC) was mean +/- SD 5.1 +/- 1.8 x 10(9)/L. Platelet count was mean +/- SD 285 +/- 62 x 10(9) /L., Conclusion: Our values provide reference range for haematological values in healthy newborns of Panu Aqil, Rural Sindh, for clinical use by our physicians.

In polyglandular autoimmune (PGA) syndromes, there is immune dysfunction of two or more endocrine glands. Immunity mediated disorders of non-endocrine organs may also be seen. These syndromes are of two main types: type I and type II. We are reporting this case of a 32 years old lady who presented initially with hypothyroidism for many years and received thyroid replacement therapy. After that she was married and had children. After an interval of about seven years of the initial diagnosis of hypothyroidism, she was hospitalized in first trimester of pregnancy for severe vertigo, syncopal episodes and hypotension. She responded well to intravenous fluids and steroids. Further endocrine related, investigations revealed Addison's disease and the above episode were retrospectively diagnosed as Addisonian crisis. Thus the patient was diagnosed as Schmidt's Syndrome (Autoimmune polyendocrine syndrome type 2) since 2009.

Background: Thrombocytopenia is often seen in the patients of malaria infected with Plasmodium vivax. We studied patients admitted in hospital having coexisting thrombocytopenia and malaria, and recorded the response to anti-malarial therapy., Methods: In this cross-sectional descriptive study, a total of 120 patients admitted in medical ward with Plasmodium vivax malaria and co-existing thrombocytopenia were studied., Results: Out of total 120 slide positive Malaria patients who had low platelet count (<150x10(9) /L), platelet count increased to ≥150x10(9) /L in 73 (60.8%) patients after five days of anti-malarial therapy while in 47 (39.2%) patients thrombocytopenia persisted. After ten days of anti-malarial therapy, platelet count in all the patients recovered to ≥ 150x10(9) L. None of the patients required platelet transfusion., Conclusion: In majority of the patients of Plasmodium vivax malaria having thrombocytopenia, platelet count returns to normal within five to ten days of start of anti-malarial treatment and nlatelet transfusion is not required.

Despite recent advancements in diagnostic and treatment modalities, malaria is still one of the most prevalent human diseases with high mortality and morbidity. We described a case of 45 years old man with Plasmodium falciparum malaria primarily presenting with myocarditis. The possibility of malaria was Subsequently considered when he developed fever followed by signs of cerebral involvement. This happens to be a distinctly unusual presentation and we highlighted various features of this case. Thus in hyperendemic areas complicated Plasomdium falciparum malaria may present initially With atypical features and high index of suspicion may lead to prompt early aggressive antimalarial therapy and reduce the complications.