Paragonimus infection: Rare manifestation with pericardial effusion: A Case report and Literature review.

BACKGROUND: Paragonimus, is a globally distributed trematode, with human disease limited to endemic regions. It can be transmitted to humans through ingestion of intermediate hosts that are crustaceans. Most symptomatic infections consist of pulmonary disease, and in aberrant migration of immature flukes, extrapulmonary manifestations may occur. These presentations are relatively uncommon and may affect various organs with atypical Clinico-radiological pathologies that are often challenging to diagnose. Pericardial involvement has scarcely been reported before. Furthermore, the management, clinical outcomes and potential complications of this involvement remain unclear. CASE REPORT: Our patient is a 31-year-old Nepalese male who presented with abdominal distension and lower limb oedema. Initial work up revealed pericardial effusion, and analysis was suggestive of exudative lymphocytic effusion. Supported by positive QuantiFERON result along with his demographic data, the patient was treated presumptively as a case of tuberculous pericarditis, despite the negative initial Mycobacterial Tuberculosis work up. During follow up, the patient lacked clinical response and repeated echocardiography showed signs of tamponade with concomitant pleural effusion. subsequently video-assisted-thoracoscopy pericardial window along with pericardial and pleural biopsy were performed. Histopathological examination of the biopsied tissue revealed non-necrotizing granulomas containing a parasitic egg suggestive of Paragonimus. Fortunately, the patient received treatment with praziquantel and subsequently made good clinical recovery. CONCLUSION: Diagnosis of extrapulmonary Paragonimus infection can be challenging given its rarity and clinical picture mimicking other infectious aetiologies. Pericardial involvement is seldom reported in the literature and clinical suspicion should be raised particularly when dealing with atypical presentations and relevant demographic data.

Gender Differences and Prevalence of Mental Health Problems in Students of Healthcare Units.

The aim of the present was to assess and compare the mental health of male and female healthcare students in a Health University of Karachi, Pakistan. A cross-sectional study was conducted for which questionnaire was designed along the standard scoring scales of depression (PHQ-9), anxiety (GAD-7) and phobia (IAPT) completed by 300 enrolled students. Females (52%) of the medical institute suffered from mild to moderately-severe depression in contrast to the males (33%). Females were found to be affected by mild anxiety and phobia (42.7 and 26% respectively) exceeding the male population (27.3 and 15.3% respectively). However, severe depression or anxiety was not observed in either gender groups significantly, suggesting a healthy mental picture of these medical students. It can be concluded that health care students in modern upgraded education systems, in contrast to evidence from literature, have been able to adopt better coping mechanisms for maintaining their mental health.

Correction to: Gender Differences and Prevalence of Mental Health Problems in Students of Healthcare Units.

The original version of this article unfortunately contained a typo in the author name. The co-author name should be Ahsan Ehtesham instead it was published as Ahsan Ehtisham.

Cervical mediastinoscopy in the diagnosis of lymphadenopathy in South Asia.

We planned to determine the clinical utility and safety of mediastinoscopy in the pathologic diagnosis of mediastinal lymphadenopathy and to determine disease patterns in a tertiary care setting in Karachi. The retrospective review comprised record of patients who underwent mediastinoscopy over 25 years between July, 1990 and August, 2015. Of the 122 patients, records were complete for 88(72%). Mean age was 42.5±12.9 years and 55(62.5%) were male. Overall, 60(68.2%) patients had benign inflammatory diseases; 25 (28.4%) had lymphoma or lung cancer which was accurately staged; 26(29.5%) had tuberculosis; 13(14.8%) sarcoidosis; and 11 (12.5%) had concomitant tuberculosis and sarcoidosis. No mortality or significant morbidity was recorded. Mediastinoscopy was useful in staging bronchogenic carcinoma and influenced the management in this series. It was found to be accurate in the diagnosis of other malignant as well as benign mediastinal pathologies, all of which were treatable.