eMedicine创建于1996年，由近万名临床医师作为作者或编辑参与此临床医学知识库的建设，其中编辑均是来自美国哈佛、耶鲁、斯坦福、芝加哥、德克萨斯、加州大学等各分校医学院的教授或副教授。

eMedicine

https://link.springer.com/content/pdf/10.1186%2Fs40413-016-0110-7.pdf

Particularities of allergy in the Tropics.

Severe falciparum malaria: a case report.

Peripheral pancytopenia is not a disease by itself; rather it describes simultaneous presence of anemia, leucopenia and thrombocytopenia resulting from a number of disease processes. Only a few systematic studies have been published on the topic of pancytopenia, although extensive studies have been done for its different etiological factors like aplastic anemia, megaloblastic anemia, leukemia, etc. Thus, this study was carried out to investigate for and to identify the causes of pancytopenia, to find out the frequency of different causes, to determine the incidence of pancytopenia in relation to sex and age and to compare our findings with those of other similar studies from this part of the world. This was a prospective study conducted in the Department of Pathology of a teaching institute and a tertiary care hospital in southern Maharashtra, India, over a period of two years. All the patients referred to the central clinical laboratory for routine complete blood count (CBC) and peripheral smear (PS) examination, from both - the outpatient and the inpatient departments, were screened for pancytopenia. Of these, a total number of 250 cases that fulfilled the diagnostic criteria were selected. Detailed hematological investigations followed by bone marrow aspiration wherever indicated and possible were performed according to standard methods to ascertain the causes of pancytopenia. A definite male preponderance was observed, the male to female ratio being 2.6 : 1. The majority of cases were encountered in 3rd and 4th decades. Hypersplenism (29.2%), Infections (25.6%), Myelosuppressants (16.8%) and Megaloblastosis (13.2%) were the four most common causes in this large series on pancytopenia from a single centre in India. Detailed clinical history and meticulous physical examination along with baseline hematological investigations, provides invaluable information in the complete workup of pancytopenic patients, helping in systematic planning of further investigations to diagnose and ascertain the cause, avoiding a battery of unnecessary tests.

/pdf/an-etiological-reappraisal-of-pancytopenia-largest-series-20p3e8c6zs.pdf

An etiological reappraisal of pancytopenia - largest series reported to date from a single tertiary care teaching hospital

Infection of C57BL/6 mice with Plasmodium berghei ANKA induces a fatal neurological disease commonly referred to as experimental cerebral malaria. The onset of neurological symptoms and mortality depend on pathogenic CD8(+) T cells and elevated parasite burdens in the brain. Here we provide clear evidence of liver damage in this model, which precedes and is independent of the onset of neurological symptoms. Large numbers of parasite-specific CD8(+) T cells accumulated in the liver following P. berghei ANKA infection. However, systemic depletion of these cells at various times during infection, while preventing neurological symptoms, failed to protect against liver damage or ameliorate it once established. In contrast, rapid, drug-mediated removal of parasites prevented hepatic injury if administered early and quickly resolved liver damage if administered after the onset of clinical symptoms. These data indicate that CD8(+) T cell-mediated immune pathology occurs in the brain but not the liver, while parasite-dependent pathology occurs in both organs during P. berghei ANKA infection. Therefore, we show that P. berghei ANKA infection of C57BL/6 mice is a multiorgan disease driven by the accumulation of parasites, which is also characterized by organ-specific CD8(+) T cell-mediated pathology.

https://espace.library.uq.edu.au/view/UQ:377011/UQ377011_OA.pdf

High Parasite Burdens Cause Liver Damage in Mice following Plasmodium berghei ANKA Infection Independently of CD8+ T Cell-Mediated Immune Pathology

Objectives: To find out the frequency of the different causes of Pancytopenia and also to specifically detect the percentage of vitamin B 12 deficieny amongst these patients. Methodology: It is a prospective study carried out in Medical Unit I (Ward 5) of Jinnah Postgraduate Medical Centre Karachi from March to August 2007. A total of 88 patients were included after a detailed history and examinations the information was recorded on Proforma. Findings of aspiration and trephine biopsies were interpreted in the light of history, clinical examination and peripheral blood findings. Results: Out of 88 patients suffering from Pancytopenia, a large number (40.90%) were diagnosed as Megaloblastic Anemia, out of which 77.77 % had vitamin B12 deficiency. Aplastic anemia was found in 28 (31.88%) patients followed by other less common causes. Conclusion: Megaloblastic anemia was found in largest number of patients who were found to have Pancytopenia on initial investigations and majority of such patients were found to be deficient in Vitamin B 12 .

Pancytopenia: megaloblastic anemia is still the commonest cause

Objective: To evaluate the clinical, biochemical and sonographic changes in patients with falciparum malaria and jaundice. Study Design: A case series. Place and Duration of Study: This study was conducted at Medical Unit-I (Ward 5), Jinnah Postgraduate Medical Centre, Karachi, from January 2006 to November 2007. Methodology: A total of 62 adult patients, regardless of age and gender, with peripheral blood film evidence of falciparum malaria, who had jaundice, were included. Any patient with evidence of infection with Plasmodium vivax or other causes of liver disease (e.g. viral hepatitis, cirrhosis, portal hypertension, amoebic liver abscess, unexplained hepatomegaly, ascites, history of alcoholism, taking hepatotoxic drugs, past history of jaundice) was excluded on the basis of history, relevant clinical examination and investigations. Results: Age of the patients ranged from 13-48 years (mean 26.04±8.33). All patients were febrile and icteric, with pallor in 67.7%, hepatomegaly in 30.6%, splenomegaly in 70.9% and impaired consciousness in 20%. Serum bilirubin levels ranged from 3 to 24 mg%. Thirty two (51.6%) had serum bilirubin 3-6 mg%, 20 (32.2%) had 6-10 mg% and 10 (16.1%) had >10 mg%. ALT levels ranged from 20-870 IU/L and AST levels 24-1210 IU/L respectively. INR ranged from 1-1.3. Twenty eight patients (45%) had predominantly conjugated or mixed hyperbilirubinemia and serum transaminases were more than three times normal. Ultrasonography revealed hepatomegaly with decreased echogenicity in 22 (35.4%), splenomegaly in 48 (77.4%) and both hepatomegaly and splenomegaly in 16 (25.8%). Gallbladder wall thickness was increased in 5 (8.06%) patients. There was no evidence of biliary dilatation. Conclusion: A significant percentage of patients having falciparum malaria with jaundice fulfill the criteria for malarial hepatopathy. It should be considered in patients presenting with acute febrile illness with jaundice so that specific treatment can be given.

/pdf/malarial-hepatopathy-in-falciparum-malaria-59hh68d9b1.pdf

Malarial hepatopathy in falciparum malaria.

Objective: To determine the clinical features and demographic profile of the patients having papular urticaria. Study Design: A case-series.

/pdf/clinical-study-of-papular-urticaria-3ucp08x19b.pdf

Clinical study of papular urticaria.

Background: Iron deficiency is the most common aetiology of anaemia worldwide and has several risk factors. Although iron deficiency anaemia (IDA) can occur at any age, women from reproductive age group are particularly vulnerable to develop IDA due to increased nutritional demand during pregnancy. Objective was to determine the frequency and nutritional risk factor of iron deficiency anaemia in women of child bearing age. This descriptive, cross sectional study was conducted from October 2005 to March 2006 at the Department of Medicine, Ward-5, and out-patients department of Jinnah Postgraduate Medical Centre, Karachi. Method: Two hundred non-pregnant females of child bearing age were included in the study; 100 with no previous pregnancy and remaining 100 with at least one prior history of pregnancy. All the relevant information, i.e., demographic and socioeconomic was collected through a questionnaire. Results: Two hundred patients with signs and symptoms of anaemia were recruited. Out of them 89 patients were found to be having iron deficiency anaemia in various age groups. Results also showed that dietary habit of patients was one of the causative factors leading to iron deficiency anaemia. Conclusion: To overcome iron deficiency anaemia a thorough and comprehensive strategy is required, i.e., educating the subjects to consume food rich in iron, community based program, monitoring severely anaemic cases and their treatment. Keywords: Nutrition, Iron deficiency anaemia, Child bearing age

/pdf/nutritional-iron-deficiency-in-women-of-child-bearing-age-4s8l89cjd7.pdf

Nutritional iron deficiency in women of child bearing age - what to do?

Pericardial cyst is an uncommon congenital abnormality that can occur in the middle mediastinum. The clinical presentation is variable and can range from asymptomatic patients in whom the diagnosis is incidental to those cases with complaints such as pain or heaviness in chest, difficulty in breathing or cough. These cysts can lead to cardio-pulmonary complications such right main stem bronchus obstruction, ventricular outflow obstruction, pulmonary artery stenosis, arrhythmias or cardiac temponade which can prove fatal. Due to the variable nature of patients’ complaints and grave complications associated with pericardial cyst, a detailed work-up is necessary to reach a diagnosis. We present this case in a middle-aged man who presented with feeling of heaviness in chest. He underwent thorough work-up in order to detect a pericardial cyst.

Liaquat Ali

Papers

Pancytopenia: megaloblastic anemia is still the commonest cause

Malarial hepatopathy in falciparum malaria.

Clinical study of papular urticaria.

Nutritional iron deficiency in women of child bearing age - what to do?

Pericardial cyst: a rare congenital anomaly