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HYPOPITUITARISM

  Case scenario:                          We present a 15-year-old boy, the second of a set of twins, who presented with short stature and delayed puberty. A subtle difference in stature was noticed on review of their childhood pictures by 2 years of age through the disparity in stature became obvious to the parents at 6 years of age and it became embarrassing at 15 years of age when parents decided to seek medical attention. He was a product of term gestation with a birth weight of 3.2kg; there was no history suggestive of birth trauma. A developmental milestone in the first two years of life was essentially normal like his unaffected twin brother. At presentation both height and weight were below 3rd percentile for age, he had a low blood pressure of 80/50mmHg, infantile male external genitalia with the testicular volume of 2ml, bone age of 7 years, very low serum testosterone, growth hormone, adrenocorticotropic ho...

ACUTE VIRAL HEPATITIS A, E

Introduction:                     Hepatitis is inflammation of the liver. Acute viral hepatitis is a public health problem globally. The causative viruses may be Hepatitis A virus(HAV), Hepatitis B virus(HBV), Hepatitis E virus(HEV).and several other hepatic viruses that are not easy to test in most laboratories but have similar clinical presentations. Hepatitis C virus may be the cause of acute hepatitis.   HAV and HEV are transmitted by the fetal-oral route through the consumption of contaminated food and water. HBV is transmitted through contaminated blood or blood products, or maternal transmission. HCV is transmitted through contaminated blood or blood products. HAV is more common in children, is mild to moderate, and full recovery is expected. HAV may be anicteric and may only be recognized by the deranged liver enzyme. HEV is more common in adults and is more severe than HAV. HEV is especially unsafe in pregnant women with a...

ACUTE PULMONARY OEDEMA

 Case Scenario:                             The patient was a 64 years old woman, with a history of monoclonal gammopathy of undermined significance and hepatitis B, admitted to the hospital with Flash pulmonary edema. On observation, The patient has intense dyspnoea, diaphoresis, cyanosis, and peripheral vasoconstriction suggesting cardiogenic shock; the pulse pressure was normal, and the pulse was rapid and thread. Although at first cardiac auscultation was apparently non-revealing because of the pulmonary findings supremacy, a later detailed examination after patient improvement and ward admittance revealed an early diastolic murmur, respective of aortic regurgitation. Epidemiology:                                The prevalence of pulmonary edema was estimated to be 75,000 to 83,000 per 100,000 heart failure patients with redu...

PEPTIC ULCER

 Case scenario:                           A 23-year-old man visited a clinic with the complaint of upper abdominal pain, nausea, heartburn, and sometimes vomiting. He was in the usual state of health 5 days ago when he started having epigastric pain. Pain aggravated at night after having a large meal. He was fond of hot and spicy foods. He had a family history of peptic ulcers disease. He denied cigarette smoking. Epidemiology:                       In the United States, around 4 million people have active peptic ulcers and around 350,000 new cases are diagnosed every year. 4 times as many duodenal ulcers are diagnosed as related to gastric ulcers. Around 3,000 people die every year due to gastric and duodenal ulcers each. There has been a marked decrease in hospitalization and morbidity of ulcers in modern times. Hospitalization rates for duodenal ulcers decrease...

HIV/AIDS

Epidemiology: HIV continues to be a major global health issue, having claimed 36.3 million lives so far. There is no cure for HIV infection. However, with increasing access to HIV prevention, diagnosis treatment, and care, even for opportunistic infections, HIV has become a manageable chronic health condition, enabling people with HIV to live a long and healthy life. There was an estimated 37.7 million people living with HIV at the end of 2020, over 2/3rd of which are in the WHO African region.   In 2020, 680,000 people died from HIV-related causes and 1.5 million people acquired HIV. Symptoms:  Fever  Chills  Rash Night sweats Muscle aches  Sore Throat Fatigue Swollen Lymph nodes Complications:    Pneumocystis pneumonia Candidiasis  Tuberculosis Cytomegalovirus Cryptococcal meningitis Toxoplasmosis   Diagnosis:                   Blood tests are the only way to test for HIV. These blood tests ...

TUBERCULOSIS

 Case Scenario:                           The patient is a 30-year-old male who was admitted to the hospital from home after 1 week of cough, profuse nocturnal sweating, loss of appetite, and hyposomnia. He was seen by an emergency room physician who saw signs of depression. The patient has a history of intravenous drug abuse and hepatitis B. Epidemiology:                       It is estimated that around 2 billion people are infected by tuberculosis. Every year 10 million people get infected by it and 1.6 million people die from it. In fact, T.B is the leading cause of death out of all the infectious diseases. Causes:             Tuberculosis is caused by a type of bacterium called mycobacterium tuberculosis. It spreads when a person with active T.B sneezes or coughs and someone inhales the spelled particles which have the t.b bacter...

CHOLERA

Case Scenario:                         A patient is 27 years old. He was infected by Bacteria V. cholerae(Cholera using bacteria it is a gram-negative type). By eating contaminated food and water or water right after a watermelon, uncooked food, or fruits. After 24-48 hours, some symptoms started to begin with painless watery diarrhea which is very voluminous and vomiting happens with it sometimes too. He vomits when he eats something. After a day his skin takes the color of pale yellow and he becomes weak due to dehydration due to vomiting and diarrhea. In the first days of the infection, he drank some rehydration syrups but those weren't effective, He also felt severe pain in the stomach. He experienced accompanying abdominal cramps, probably from distension of loops of the small bowel as a result of the large volume of the intestinal secretions. Fever is typically absent. Epidemiology:           ...

DENGUE

 Introduction:                          Dengue is the world's most rapidly spreading viral mosquito-borne infection. Most cases of dengue are A-symptomatic or they have very mild symptoms which can be managed at home. The most important complication of dengue is not the low platelet count but the capillary leak syndrome. Capillary leak syndrome leads to loss of fluid from the plasma which results in hypotension and shock. Epidemiology:                         While dengue is seen throughout the year, it is most common during September and October right after the rainy season. Definitions: Febrile Phase: The initial phase of the infection is characterized by high fever for 2-7 days, often associated with facial flushing, skin erythema, generalized body ache, myalgia, arthralgia, and headache. Mild hemorrhagic manifestations such as petechiae and mucosal membra...

TYPES OF MALARIA: COMPLICATED FALCIPARUM MALARIA

Case definition: P. falciparum asexual parasitemia in the peripheral blood smear or by RDT. Symptomatic malaria without signs of severity or evidence of vital organ dysfunction.  Case scenario:                       A 45-year-old man is brought into your clinic with a sudden high fever, headache, vomiting, diarrhea, yellow sclera, and dark urine. He is drowsy but is able to answer your questions. On physical examination, his temperature is 103 Fahrenheit, pulse is 110/minute, respiratory rate is 36/min and he is jaundiced. There is some tenderness over the liver, but the abdomen is otherwise soft and non-tender. Lab tests accompanying him is as follows: Hb 9.8 gm/dl, W.B.C: 5,500/cm, platelets: 40,000/cm, total bilirubin: 5.8 mg/dl, ALT:65 I.U, Blood urea 65 mg/dl, S.creatinine: 4.5 mg/dl, MP shows trophozoites of P.falciparum. Warning signs: Hyperpyrexia Prostration Impaired consciousness Respiratory disease Multiple convulsio...

TYPES OF MALARIA: MALARIA RECRUDESCENCE

 Case scenario:                           A patient is treated for P.vivax with chloroquine. He felt well for the next 10 days, after which fever and shivering happened again. This time no parasites were seen on the smear. but you suspect malaria due to inadequate treatment. An episode of malaria within 14 days of the previous episode can be due to improper treatment of malaria from the underdosing, wrong or sub-standard drugs, poor absorption, inadequate timing of treatment, or drug resistance.  However, if a patient returns after 14 days then the first-line drug should be repeated since this represents possibly a new infection or relapse. Possibly, the drug concentration in blood was insufficient to suppress all parasites