Zoster Sine Herpete: two unusual cases of varicella-zoster reactivation with atypical complaints of acute chest pain and severe headache.

In this case report, we describe two unusual presentations of varicella-zoster virus (VZV) reactivation without rash, a condition known as Zoster Sine Herpete (ZSH). In Case 1, a 58-year-old woman presented with severe right-sided chest pain under her breast that radiated to the ipsilateral back. After the initial workup ruled out cardiac and musculoskeletal etiologies, the characteristic dermatomal distribution of pain made us suspect VZV reactivation. A diagnosis of ZSH was made with positive VZV IgG and IgM serologies and symptomatic relief after famciclovir treatment. In Case 2, a 43-year-old woman presented with a severe headache and resolved sharp right flank pain. She was diagnosed with varicella meningitis after cerebrospinal fluid showed positive VZV DNA. Intravenous acyclovir treatment resulted in symptom resolution. The most common presentation of VZV reactivation is Herpes Zoster, or shingles, making ZSH a frequently missed diagnosis. High clinical suspicion is warranted to prevent life-threatening complications of ZSH.

Corneal Complications And Visual Impairment In Vernal Keratoconjunctivitis Patients.

BACKGROUND: Vernal kerato-conjunctivitis (VKC) is an infrequent but serious form of allergic conjunctivitis common in warm and humid areas where air is rich in allergens. It affects both eyes asymmetrically. Although VKC is a self-limiting disease but visions affecting corneal complications influence the quality of life in school children. The aim of this study was to list the corneal complications due to this condition and to find out the extent of visual impairment among VKC patients. METHODS: This cross-sectional study was conducted in the department of Ophthalmology, Benazir Bhutto Shaheed Hospital on 290 eyes of diagnosed cases of VKC. The diagnosis of VKC was made on the basis of history and examination. Visual acuity was recorded using Snellen's notation and visual impairment was classified according to World Health Organization classification for visual disabilities. RESULTS: The mean age of presentation was 10.83±6.13 years. There were 207 (71.4%) males and 83 (28.6%) females. Corneal scarring was observed in 59 (20.3%) eyes. Keratoconus was found to be in 17 (5.9%) eyes. Shield ulcer was detected in 09 (3.1%) eyes while 07 (2.4%) eyes had corneal neovascularization. Majority of the patients with visual loss had corneal scarring and the complication that led to severe visual loss in most of the eyes was Keratoconus. CONCLUSIONS: Vernal kerato-conjunctivitis in the presence of corneal complications is a sight threatening disease and can lead to severe visual impairment.

Burden And Spectrum Of Respiratory Ailments In Paediatric Tertiary Care Setting.

BACKGROUND: Respiratory tract infections are a significant cause of mortality and morbidity in paediatric age group all over the world and especially in under developed regions. The present study was conducted with an aim to assess the burden and the types of respiratory illnesses in our region. METHODS: The study was a cross sectional study conducted at Paediatric A unit of Ayub teaching hospital from 1st October, 2018 to 31st March, 2019. All patients aged 1 month and above who required admission for various respiratory ailments were included in the study. RESULTS: A total of 2255 patients were admitted in Paediatric A unit over a six months period. Of these, 603 (26.74%) patients were admitted with various respiratory problems and were included in the study. Among these, 389 (64.5%) patients were male and 214 (35.5%) were female. Mean age of the participants was 18.77±30.87 months. The major disease categories were bronchopneumonia in 189 (31.3%), bronchiolitis in 176 (29.2%), measles pneumonia in 60 (10%), lobar pneumonia in 52 (8.6%) and upper RTI in 32 (5.3%). Mean duration of stay was 3.13±2.08 days. Majority of the patients 482 (79.9%) were up to 24 months of age, followed by 77 (12.8%) patients in 25-60 months age and 44 (7.3%) patients more than 60 months of age. A total 295 (48.92%) patients were vaccinated while 308 (51.07%) patients were either partially vaccinated 116 (19.2%) or unvaccinated 192 (31.8%). A total of 576 (95.5%) patients were discharged, 17 (2.8%) patients expired and 5 (0.8%) were referred to higher specialty. Bronchopneumonia was the leading cause of mortality in this study. CONCLUSIONS: Respiratory tract infections constitute a major threat to the health of paediatric patients especially in the first two years of life. Improvement in vaccination coverage is essential in reducing the burden of a majority of respiratory ailments along with health education.

Obesity And Diabetes As Determinants Of Vitamin D Deficiency.

BACKGROUND: Vitamin D has been the focus of attention in the recent past owing to its multitude of effects on various organ systems including immune system, endocrine, cardiovascular etc. Diabetes mellitus and obesity are widely prevalent in our region. The present study was designed with an objective to determine the vitamin D status in relation to diabetes mellitus and obesity in our area. METHODS: This cross-sectional study was conducted at the Medical C Unit of Department of Medicine, Ayub Teaching Hospital from January to December 2017. Approval of ethical committee was taken. A total of 117 patients were enrolled in this study of which 109 were finalized for analysis owing to incomplete data in 8 cases. Patients' characteristics were recorded on a structured proforma. Type 2 diabetes was confirmed using HbA1C Levels. Using ADA 2016 criteria. Vitamin D status was assessed using 25-OH-Vit D levels from the same laboratory. Height and weight of the patients were recorded to obtain BMI. Data was entered and analysed using SPSS version 20. RESULTS: Of the total sample, 69 (63.3%) were females and 40 (36.7%) were males. Mean age of the participants was 44.13±15.777. Mean vitamin D levels were 26.35±18.72. A total of 83 (76.14%) patients were either vitamin D deficient 66 (60.6%) or insufficient 17 (15.6%) while 26 (23.9%) were sufficient in vitamin D. There was statistically significant difference in vitamin D status in diabetic versus non diabetic patients (p=0.015). As regards BMI and vitamin D status, the difference was also statistically significant (p=0.018). CONCLUSIONS: Vitamin D deficiency is widely prevalent in our region. There is also a high prevalence of obesity and diabetes mellitus and they are inversely related to low vitamin D levels.

Spironolactone-induced degradation of the TFIIH core complex XPB subunit suppresses NF-κB and AP-1 signalling.

Aims: Spironolactone (SPL) improves endothelial dysfunction and survival in heart failure. Immune modulation, including poorly understood mineralocorticoid receptor (MR)-independent effects of SPL might contribute to these benefits and possibly be useful in other inflammatory cardiovascular diseases such as pulmonary arterial hypertension. Methods and results: Using human embryonic kidney cells (HEK 293) expressing specific nuclear receptors, SPL suppressed NF-κB and AP-1 reporter activity independent of MR and other recognized nuclear receptor partners. NF-κB and AP-1 DNA binding were not affected by SPL and protein synthesis blockade did not interfere with SPL-induced suppression of inflammatory signalling. In contrast, proteasome blockade to inhibit degradation of xeroderma pigmentosum group B complementing protein (XPB), a subunit of the general transcription factor TFIIH, or XPB overexpression both prevented SPL-mediated suppression of inflammation. Similar to HEK 293 cells, a proteasome inhibitor blocked XPB loss and SPL suppression of AP-1 induced target genes in human pulmonary artery endothelial cells (PAECs). Unlike SPL, eplerenone (EPL) did not cause XPB degradation and failed to similarly suppress inflammatory signalling. SPL combined with siRNA XPB knockdown further reduced XPB protein levels and had the greatest effect on PAEC inflammatory gene transcription. Using chromatin-immunoprecipitation, PAEC target gene susceptibility to SPL was associated with low basal RNA polymerase II (RNAPII) occupancy and TNFα-induced RNAPII and XPB recruitment. XP patient-derived fibroblasts carrying an N-terminal but not C-terminal XPB mutations were insensitive to both SPL-mediated XPB degradation and TNFα-induced target gene suppression. Importantly, SPL treatment decreased whole lung XPB protein levels in a monocrotaline rat model of pulmonary hypertension and reduced inflammatory markers in an observational cohort of PAH patients. Conclusion: SPL has important anti-inflammatory effects independent of aldosterone and MR, not shared with EPL. Drug-induced, proteasome-dependent XPB degradation may be a useful therapeutic approach in cardiovascular diseases driven by inflammation.