RESUMO
Cardiac devices with intra-ventricular leads are associated with a risk of perforation. This can be a diagnostic challenge given that there is a whole spectrum of clinical presentation from incidental discovery on imaging to large effusions and tamponade. Here we present a case where a patient with permanent pacemaker for complete heart block presented with worsening fatigue that deteriorated to syncopal episodes. Electrocardiogram revealed bradycardia with junctional escape and imaging revealed the tip of the right ventricular lead beyond the ventricular wall. The lead was replaced under fluoroscopic guidance without the need for surgical intervention and the patient was ready for discharge on post-procedure day one. Replacement under fluoroscopic guidance is not only safe, but also enables early discharge, which reduces the burden on health care facilities as well as minimizes the patient's number of days lost in the hospital.
RESUMO
Most patients with autoimmune encephalitis do not present with well-described symptoms. Demographic data and information regarding co-morbidities could help in diagnosing the underlying disorder, but a definitive diagnosis is made by the result of autoimmune antibodies. Limbic encephalitis (LE), a variant of autoimmune encephalitis, is the inflammation of the limbic system of the brain. The disorder presents with the rapid development of confusion, working memory impairment, mood changes, and often seizures. LE could have paraneoplastic or non-paraneoplastic etiology. We present the case of a 15-year-old girl with seronegative LE, who presented with cognitive decline and seizures. This condition is rare, and therefore poses a great challenge in diagnosis at an early stage.
RESUMO
Background Along with reducing the global burden of diphtheria, pertussis and tetanus, the DPT3 (diphtheria-pertussis-tetanus) vaccine protects health care professionals (HCPs) as well as vulnerable patients in their care. This study evaluates awareness, knowledge and coverage of DPT3 vaccine and boosters among medical students of public university in Karachi, Pakistan. Methods A cross-sectional study consisting of 281 participants selected through convenience sampling was conducted from July 2017 to July 2018 using a self-administered questionnaire. Results While 93% participants received childhood doses of DPT3, only 39.2% received adult boosters. Students with positive immunization history in childhood and family vaccination routines were more likely to get adult boosters. Eighty-six percent of the students were unaware that their university had a recommended vaccination program as a part of the admission process. The assessment of awareness and knowledge revealed that only 10.5% individuals could be regarded as well-aware, 20.3% (n = 58) students as unaware, and 69.2% (n = 198) participants as moderately aware. Conclusion The level of awareness, knowledge and coverage of DPT3 vaccine is insufficient among medical students of a public university of Karachi; universities are recommended to take measures to enhance knowledge and ensure strict adherence of students to appropriate vaccination programs.