JCPSP
Danish Hasan Qaiser, Mohammad Perwaiz Sandila, Aamir Omair, Ghulam Moinuddin Ghori.
Correlation of routine haematological parameters between normal maternal blood and the cord blood of healthy newborns in selected hospitals of Karachi
J Coll Physicians Surg Pak Feb 2013;23(2):128-31.
King Saud Bin Abdulaziz University for Health Sciences, NGHA, Riyadh, KSA.
Objective: To determine any significant correlation between the routine haematological parameters of maternal blood and umbilical cord blood of their respective newborns. Study Design: Cross sectional study. Place and Duration of Study: The study was conducted at four public and private hospitals of Karachi including Sindh Government Qatar Hospital, Sindh Government Hospital, Liaquatabad, Ziauddin University Hospital and Chinniot Maternity and Child Hospital, respectively from July 2006 to April 2008. Methodology: Three milliliters venous blood was collected in EDTA containing tube for complete blood count of mothers before delivery. Five milliliters cord blood was collected from the umbilical cord of the babies immediately after delivery by clamping and cutting the babies' end of the cord. For haematological parameters a standard coultergram was done including haemoglobin, RBCs count, haematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC), white blood cell count, differential leukocyte count and platelet count. Pearson's correlation co-efficient was used to determine an association between the maternal and cord blood parameters. Results: A total of 404 maternal and umbilical cord blood samples were analyzed. All the blood parameters including haemoglobin, RBCs count, HCT, MCV, MCH, white blood cell count, differential leukocyte count and platelet count were found to be high in cord blood as compared to the maternal blood, but they showed a very weak to negligible correlation. Mean Corpuscular Haemoglobin Concentration (MCHC), showed a moderate correlation. Conclusion: Routine haematological parameters of newborns are independent of maternal routine haematological parameters.
Nabiha Farasat Khan, Mohammad Saeed, Saima Chaudhary, Farkhanda Ghafoor.
Haematological parameters and recurrent aphthous stomatitis
J Coll Physicians Surg Pak Feb 2013;23(2):124-7.
Shaikh Zayed Federal Postgraduate Medical Complex, Lahore.
Objective: To find out the relationship between recurrent aphthous stomatitis (RAS) with deficiencies of haemoglobin, haematocrit, serum vitamin B12, serum Ferritin and red blood cells (RBC) Folate level. Study Design: An analytical cross-sectional study. Place and Duration of Study: Department of Oral Health Sciences, Shaikh Zayed Federal Postgraduate Medical Complex, Lahore, from February to July 2008. Methodology: Sixty consecutive subjects with active RAS were taken as the aphthous group; 60 age and gender matched subjects without RAS were as the Non-Aphthous group. Five milliliter blood was taken from both groups to evaluate the levels of serum B12, and RBC Folate through radio immuno assay and serum ferritin with enzyme linked immuno-sorbent assay tests. Complete blood count was carried out to determine the level of haemoglobin and haematocrit in both groups. Proportion of subjects with lower values was compared using 2 text of proportions with significance at p < 0.05. Results: Serum Ferritin (p = 0.001), haematocrit (p < 0.001), RBC Folate (p < 0.001) and serum B12 (p < 0.001) were significantly lower in the RAS group. Combined deficiency state (haemoglobin, serum Ferritin, haematocrit, RBC Folate and serum B12) was identified in 13% (n = 8) RAS patients. Conclusion: Frequency of haematinic deficiencies was high in RAS patients. Serum B12 and RBC Folate were significantly low in aphthous group.
Ehtesham Haider, Wasim Wali, Samiullah Raja, Muhammad Tariq.
Creutzfeldt Jakob disease
J Coll Physicians Surg Pak Apr 2013;23(4):295-7.
Military Hospital, Rawalpindi.
A case of 50 years of age, male with sporadic Creutzfeldt Jakob Disease (sCJD) is reported. Patient had dementia, behavioural abnormalities, unsteady gait and myoclonic jerks. Magnetic resonance imaging (MRI) brain T2 weighted and Fluid Attenuated Inverse Recovery (FLAIR) images showed abnormally increased signal intensity in caudate nucleus and putamen. Scalp electroencephalogram (EEG) revealed periodic synchronous biphasic sharp wave complexes. On the basis of history, clinical findings, typical MRI brain and EEG changes, diagnosis of sporadic CJD was made.
Naeem Naqi, Shaharyar Ahmad, Ijaz Shah, Javaid Khattak.
A
multicentre phase-ii feasibility study evaluating gemcitabine/
vinorelbine / prednisolone combination chemotherapy in relapsed /
refractory hodgkin's lymphoma
J Coll Physicians Surg Pak Jun - Jun 2013;23(6):397-400.
Combined Military Hospital and Medical College, Lahore/Rawalpindi.
Objective: To determine the efficacy and toxicity of Gemcitabine,
Vinorelbine and Prednisolone (GVP) salvage chemotherapy in relapsed /
refractory Hodgkin’s Lymphoma (HL). Study Design:A phase-II
non-randomized single arm study. Place and Duration of Study: This study
was conducted at Combined Military Hospital and Medical College Lahore,
Mayo Hospital, King Edward Medical University, Lahore, Allied Hospital,
Punjab Medical College, Faisalabad and Combined Military Hospital,
Rawalpindi, from January 2007 to December 2007. Methodology: Fifty adult
patients with relapsed/refractory HL, adequate marrow reserve,
hepatorenal and pulmonary functions, with radiological measurable
disease and Karnofsky performance status of 0 – 2 non-candidates for
stem cell transplantation, were enrolled. Four 28 days cycles of GVP
(Gemcitabine 1000 mg/m2, Vinorelbine 30 mg/m2 on day 1 and 8
intravenously with oral Prednisolone 100 mg/day on day 1 – 5) were
given. Response evaluation done according to Cotswolds meeting
recommendations and toxicity was evaluated with NCI-CTC (National Cancer
Institute - Common Terminology Criteria for adverse events v 3.0).
Results: Forty patients completing 4 cycles of GVP, 14 refractory/early
relapse and 26 late relapsed (one year postprimary treatment with ABVD)
were available for evaluation. The overall response (CRu+PR) rate was
77.5% with better response 85% in late relapsed patients. Haematological
toxicity was most common and seen in 70% of cases. Conclusion: GVP is
well-tolerated regimen with high response rate and needs to be tested in
late relapsed HL.
Afshan Shahid, Ayesha Khan.
Tranexamic acid in decreasing blood loss during and after caesarean section
J Coll Physicians Surg Pak Jul 2013;23(7):459-62.
Dow University of Health Sciences, Karachi.
Objective: To determine the effectiveness of tranexamic acid (TXA) in reducing blood loss during and after caesarean section (CS), as well as its safety. Study Design:A randomized double-blind placebo controlled study. Place and Duration of Study: The Lyari General Hospital, Karachi, from March 2009 till April 2011. Methodology: Women undergoing lower segment caesarean section (LSCS) were enrolled. The patients were randomized to receive either injection TXA or distilled water just before the surgery. Blood loss was collected and measured. First from the time of placental delivery to the end of LSCS and later from the end of LSCS to two hours postpartum. Haemoglobin, urine analysis, liver and renal functions were tested in both the groups. Mean values blood loss were compared using t-test with significance at p < 0.05. Results: Tranexamic acid significantly reduced the quantity of blood loss from placental delivery to the end of LSCS which was 356.44 ± 143.2 ml in the TXA group versus 710.22 ± 216.72 ml in the placebo group (p < 0.001). It also reduced the quantity of blood loss from the end of LSCS to 2 hours postpartum which was 35.68 ± 23.29 ml in the TXA group versus 43.63 ± 28.04 ml in the placebo group (p = 0.188), was not significant. No complications or side effects were reported in either group. Conclusion: Tranexamic acid significantly reduced the amount of blood loss during the LSCS, but it did not reduce the blood loss significantly after the caesarean section. Its use was not associated with any side effects or complication like thrombosis. TXA can be used safely and effectively in women undergoing LSCS to reduce intraoperative blood loss.
Semra Kara, Hulya Uluozkan, Yavuz Yilmaz, Fatma Inci Arikan, Ugur Dilmen, Yildiz Dallar Bilge.
Necrotizing enterocolitis in a newborn following intravenous immunoglobulin treatment for haemolytic disease
J Coll Physicians Surg Pak Aug - Aug 2013;23(8):598-600.
Ankara Training and Research Hospital, Ankara, Turkey.
ABO iso-immunization is the most frequent haemolytic disease of the
newborn. Treatment depends on the total serum bilirubin level, which may
increase very rapidly in the first 48 hours of life in cases of
haemolytic disease of the newborn. Phototherapy and, in severe cases,
exchange transfusion are used to prevent hyperbilirubinaemic
encephalopathy. Intravenous immunoglobulins (IVIG) are used to reduce
exchange transfusion. Herein, we present a female newborn who was
admitted to the NICU because of ABO immune haemolytic disease. After two
courses of 1 g/kg of IVIG infusion, she developed necrotizing
enterocolitis (NEC). Administration of IVIG to newborns with significant
hyperbilirubinaemia due to ABO haemolytic disease should be cautiously
administered and followed for complications.
Mohammad Noman Khan, Taseer Ahmed Khan, Zulfiqar Ahmed.
Discrepancy in ABO blood grouping
J Coll Physicians Surg Pak Aug - Aug 2013;23(8):590-2.
University of Karachi, Karachi.
Discrepancies in blood typing is one of the major reasons in eliciting a
transfusion reaction. These discrepancies can be avoided through
detailed analysis for the blood typing. Here, we report a subgroup of
blood group type-B in the ABO system. Donor's blood was analyzed by
employing commercial antisera for blood grouping. The results of forward
(known antisera) and reverse (known antigen) reaction were not
complimentary. A detailed analysis using the standard protocols by
American Association of Blood Banking revealed the blood type as a
variant of blood group-B instead of blood group-O. This is suggestive of
the fact that blood group typing should be performed with extreme care
and any divergence, if identified, should be properly resolved to avoid
transfusion reactions. Moreover, a major study to determine the blood
group variants in Pakistani population is needed.
Manzar Bozdar, Suhaib Ahmed, Omar Jamy, Tamoor Bin Hanif, Nadir Ali, Saeed Akhtar Khan Khattak.
Role of genetic counselling in prenatal diagnosis of beta-thalassaemia in Pakistan
J Coll Physicians Surg Pak Aug - Aug 2013;23(8):553-7.
Armed Forces Institute of Pathology (AFIP), Rawalpindi.
Objective: To compare the response towards prenatal diagnosis (PND) of β-thalassaemia, in individuals who had not received genetic counselling and a genetically counselled population. Study Design: Cross-sectional survey. Place and Duration of Study: Department of Haematology, Armed Forces Institute of Pathology (AFIP), Rawalpindi, from March 2009 to December 2010. Methodology: Using non-probability consecutive sampling, a total of 176 individuals having thalassaemic children, were interviewed regarding PND of thalassaemia, by using a structured questionnaire. Forty two individuals were taken as controls as they had received genetic counselling for PND, whereas the remaining 134 were taken as cases. Responses towards PND were compared using chi-square test. Odds ratio was also calculated for subsequent PND utilization. Results: Seventy (52.2%) cases and 42 (100%) controls were aware of the availability of PND in Pakistan. This difference in awareness was statistically significant (p < 0.001). In the controls, 40 (95.3%) individuals were aware of the appropriate timing of the test, in contrast to 52 (39%) cases (p < 0.001). PND was used in subsequent pregnancies by 50 (37.3%) cases and 32 (80%) controls (p < 0.001). The calculated odds ratio for subsequent PND utilization was 5.37. Conclusion: The study reflects a very positive attitude of genetically counselled thalassaemia affected families towards PND. For better utilization of PND, genetic counselling services should be available at all health strata.
Nadeem Zia Abbasi, Mir Jalalud Din, Zainab Zahur, Amjad Aziz Khan, Abdul Samad Sheikh, Furqan Ali, Khalid Hussain Memon.
Diagnosis and treatment of hodgkin's lymphoma: at times a challenge
J Coll Physicians Surg Pak Oct - Oct 2013;23(10):752-3.
Institute of Nuclear Medicine, Oncology and Radiotherapy (INOR), Abbottabad.
Hodgkin\'s lymphoma has been traditionally defined as a hematopoietic
neoplasm composed of diagnostic Reed-Sternberg cells. More than 70% of
the cases involve cervical or supraclavicular lymph nodes. Isolated
sub-diaphragmatic lymphadenopathy or organ involvement is rare. We
present the case of Hodgkin\'s lymphoma in a 51 years old female, who
presented with obstructive jaundice and lymphadenopathy, empirically
treated previously as a case of tuberculosis. Chemotherapy with modified
ABVD protocol was given with dose modification according to LFT's. Her
liver functions returned to normal levels after the first cycle. The
main purpose of reporting the case is to stress definitive diagnosis of
the disease before initiating treatment and the modified chemotherapy
regimen used in this infrequent presentation of the disease.
Muhammad Usman Shah, Murtaza Ali Sundhu, Muhammad Zahid Hussain.
Postpartum aplastic anemia presenting as pancytopenia due to malarial infection
J Coll Physicians Surg Pak Nov - Nov 2013;23(11):809-10.
Department of Medicine, Military Hospital, Rawalpindi.
Pancytopenia is a condition with decreased numbers of all cell lines.
Aplastic anemia is a common cause although malarial infection causing
lysis of RBCs may also partly mimic this condition. The infection may
also damage the patient's bone marrow resulting in pancytopenia as well.
We present the case of a post-partum female patient who reported with
fever, body aches and shortness of breath one month after the delivery
of her baby. All blood cell counts were decreased and peripheral blood
smear showed malarial parasites. Anti-malarial treatment was initiated
following which the fever subsided but, despite regular transfusions,
the blood counts remained low. Bone marrow biopsy report revealed P.
falciparum pigments along with hypocellularity characteristic of severe
aplastic anemia. Consequently, bone marrow transplantation was advised
as a therapeutic measure. This case report highlights the increased
susceptibility of pregnant women to malaria in endemic areas and
subsequent aplastic anemia.
Saleem Ahmed Khan, Suhaib Ahmed, Nuzhat Mushahid, Masood Anwer, Shahzad Saeed, Farooq Ahmed Khan, Ghassan Umair Shamshad, Zulqarnain Joyia.
Comparison of real time polymerase chain reaction with microscopy and antigen detection assay for the diagnosis of malaria
J Coll Physicians Surg Pak Nov - Nov 2013;23(11):787-92.
Military Hospital, Armed Forces Institute of Transfusion and Armed Forces Institute of Pathology, Rawalpindi.
Objective: To determine the sensitivity of a real time polymerase chain reaction (PCR) for malaria diagnosis and to compare its accuracy with microscopy and an antigen based rapid diagnostic test (OptiMal). Study Design: Cross-sectional analytical study. Place and Duration of Study: Military Hospital, Armed Forces Institute of Transfusion and Armed Forces Institute of Pathology, Rawalpindi, from July to December 2011. Methodology: Venous blood samples of 300 clinically suspected patients of malaria were tested for malaria parasite by microscopy and OptiMal; and malaria parasite index was calculated for the positive samples. Plasmodium genus specific real time PCR was performed on all specimens, targeting small subunit rRNA gene. Diagnostic accuracy of three tests was compared and cost analysis was done. Results: Out of 300 patients, malaria parasite was detected in 110, 106 and 123 patients by microscopy, OptiMAL and PCR respectively. Real time PCR was 100% sensitive while microscopy and OptiMal had sensitivity of 89.4% and 86.2% respectively. All methods were 100% specific. The cost per test was calculated to be 0.2, 2.75 and 3.30 US$ by microscopy, OptiMal and PCR respectively, excluding the once capital cost on PCR equipment. Conclusion: Genus specific real time PCR for the diagnosis of malaria was successfully established as a highly sensitive and affordable technology that should be incorporated in the diagnostic algorithm in this country.
JPMA
Naureen Mushtaq, Zehra Fadoo, Ahmed Naqvi.
Objective: To evaluate the demographic features, outcome and prognostic
factors seen in children with acute lymphoplastic leukaemia at a
tertiary care hospital. Methods: The retrospective descriptive study was
conducted at Aga Khan University Hospital, Karachi, comprising data
related to children below 15 years of age and treated between January
1997 and December 2006. Kaplan Meir survival curves were used to
describe overall and event-free survival rates. Cox Proportional Hazards
model was used to describe factors associated with death and relapse.
SPSS 16 was the main statistical tool. Results: Of the total 121
children diagnosed with the condition, 79 (65.3%) were males; 86 (71.1%)
patients were between 1-9 years of age; Immunophenotyping was done in
99 (81.81%) patients: 86 (87%) cases had precursor B and 13 (13.13%) had
precursor T. Of the total, 106(87.6%) patients opted for treatment,
while 15 (11.6%) were lost to follow-up. Besides, 26(21.7%) patients had
at least one relapse; the most common site being bone marrow in 13
(50%) followed by central nervous system in 9 (36.6%). There were
20(16.5%) deaths in the sample. Infection was the most frequent cause of
death. The event-free survival and overall survival was 63% (n=76) and
65%(n=79) respectively. Conclusion: Through the clinical characteristics
of children with acute lymphoblastic leukamia were similar to those
reported in literature, the outcomes were inferior. The high rate of
infections and relapse warrant better supportive care and risk-based
approach.
Childhood acute lymphoblastic leukaemia: experience from a single tertiary care facility of pakistan
J Pak Med Assoc Nov - Nov 2013;63(11):1399-404.
Department of Paediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan.