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OBJECTIVE: To determine the effects of granulocyte colony-stimulating factor in improving platelet count in patients with dengue fever. METHODS: The retrospective, cross-sectional study was conducted at Northwest General Hospital and Research Centre, Peshawar, Pakistan, between January 2021 and October 2022, and comprised dengue fever inpatients regardless of age and gender who received granulocyte colony-stimulating factor subcutaneously. The impact of colony-stimulating factor on platelet and white blood cell counts as well as any unfavourable consequences was assessed. Convenient sampling was used and a structured format was used for data collection. Data was analysed using SPSS 21. RESULTS: Of the 100 patients, 67(67%) were males and 33(33%) were females. The largest age group was that of >55 years 31(31%), fever was present in all the 100(100%) cases, bleeding in 18(18%) and platelet count <30,000 in 83(83%) cases. Dengue fever was confirmed by rapid dengue nonstructural protein 1 antigen in 76(76%) cases, dengue immunoglobulin G antibody test 28(28%), and immunoglobulin M antibody test in 31(31%) cases. Overall, 72(72%) patients received only one dose of granulocyte colony-stimulating factor. Post-administration, a substantial rise in the median platelet and white blood cell counts was seen compared to the baseline (p<0.05) on day 2. CONCLUSIONS: Granulocyte colony-stimulating factor helped increase platelet and white blood cell counts quickly in dengue fever patients.

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OBJECTIVE: To determine and compare the performance of TUBEX®TF, Widal test and blood culture in the diagnosis of enteric fever. METHODS: The retrospective study was conducted at the Northwest General Hospital and Research Centre, Hayatabad, Peshawar, Pakistan, and comprised medical record from January to December 2018 related to patients who presented with fever. Typhidot, Widal test and blood culture had been performed as part of evaluation. Data was analysed using SPSS 16. RESULTS: Of the 241 patients, 68(28.21%) tested positive for salmonella in blood culture. Among them, TUBEX®TF was positive in 29(42.64%) and Widal was positive in 25(36.76%). TUBEX®TF had positive predictive value 33.33%, negative predictive value 71.77%, sensitivity 42.65% and specificity 62.34%. The corresponding values for Widal were 24.51%, 69.06%, 36.76% and 55.49%. CONCLUSIONS: Sensitivity, specificity, positive predictive value and negative predictive value of TUBEX®TF and Widal test were very low compared to blood culture.

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Nonbacterial thrombotic endocarditis (NBTE) refers to noninfectious vegetations of the heart valves. It is commonly associated with malignancy and autoimmune diseases like systemic lupus erythematosus, Rheumatoid arthritis. Herein, we present Non-bacterial thrombotic endocarditis and Disseminated intravascular coagulation as the initial manifestations of prostate cancer. A 50-yearold gentleman, known case of hypertension and diabetes, presented with a history of recurrent ischaemic strokes, STEMI and a recent diagnosis of infective endocarditis. He had been taking antibiotics for the past 20 days without any improvement. Negative blood cultures in the presence of vegetations on repeat echocardiography led to a suspicion of NBTE. Laboratory investigations were suggestive of Disseminated intravascular coagulation. CT abdomen and pelvis demonstrated enlarged prostate with enlarged pelvic lymph nodes. Prostate specific antigen was raised at more than 100ng/ml. A bone scan showed extensive metastasis. The patient was started on GnRH analogue and bicalutamide. His Disseminated intravascular coagulation resolved and he was subsequently started on anticoagulants. The valvular lesions diminished without any residual dysfunction.

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Dengue is a mosquito-borne viral disease that has rapidly spread in the recent years, particularly in South Asia. While haematologic complications, such as cytopenia and bleeding, may occur in severe dengue infection, reports of haemolytic anaemia in dengue fever are scant. We report a patient who developed haemolytic anaemia following dengue fever. A 45 years old gentleman presented with five-day history of fever and was recently diagnosed with dengue fever. He developed jaundice and started vomiting on the third day of his clinical course. His laboratory investigations revealed deranged liver profile, Coombs negative haemolytic anaemia and G6PD deficiency. He was treated conservatively with fluids and blood transfusions. His liver functions and haemolytic anaemia gradually resolved. This case highlights the importance of recognising dengue fever-induced haemolytic anaemia in a G6PD deficient patient by physicians and pathologists, enabling better diagnosis and improved management of this life-threatening condition.

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Primary hyperparathyroidism (PHPT) is common among adults. However, its incidence is rare among children associated invariably with delay in diagnosis. In children, it is caused by hyperplasia, adenoma or related hereditary disorders. Herein, a 17-year male with PHPT presented with rare skeletal manifestations of genu valgum and bilateral epiphyseal displacement of femur. Investigations done three years ago reported hypocalcemia and vitamin-D deficiency. He was diagnosed with rickets and received plenty of calcium and vitamin D supplements. Due to lack of clinical improvement following the supplementation, re-evaluation revealed hypercalcemia, elevated vitamin D levels and elevated parathyroid hormone (PTH). A 99mTc-sestamibi scan reported increased uptake in the left inferior lobe of the thyroid gland. Surgical removal of the parathyroid gland was done and histopathology revealed parathyroid adenoma. Rickets in the setting of PHPT can masquerade as PHPT. In a patient with rickets, hypercalcemia at presentation or following the calcium and vitamin supplementations, should warn the physicians to rule out PHPT.

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