Etiological Spectrum and Clinical Profile of Patients Admitted with Pancytopenia

Aims:The etiological spectrum and clinical profile of admitted patients presenting with pancytopeniawere studied. Study Design:This was a prospective study conducted on 200 patients presenting to the Department of Medicine, Department of Oncology and the Allied Specialities of Medicine, Dayanand Medical College and Hospital, Ludhiana and were found to have pancytopenia during hospital stay.Results:Mean age of the patients was 45.69 ± 17.05 years with maximum number of patients (23%) in the age group of 51-60 yearsand 119 patients were males and 81 patients were females.Most common physical finding was pallor (95%), followed by splenomegaly (22%) and hepatomegaly (17%). Total of107 patients were vegetarians (53.5%) and 93 patients (46.5%) were non-vegetarians. Mean hemoglobin was 7.16 ± 2.04 g/dl, mean total leucocyte count was 2.51 ± 1.02 x 103/cu.mm, mean platelet count was 54885.37 x 103/ul ± 40320.96 and mean the absolute neutrophil count was 1.59 x 103 /cu.mm ± 0.84. Ten patients of pancytopenia were because of tropical fever which included 4 cases of dengue, 3 cases of malaria, 2 cases of enteric fever and 1case of mixed infection (malaria + scrub typhus).Viral markers were positive in 14 out of the 63 patients tested. Out of these 14 patients, 4 were HBsAg reactive, 7 were HCV +ve and 3 were HIV +ve. Most common red blood cell picture on peripheral blood film was normocytic normochromic (34.5%), followed by mixed morphology (33.5%). Macrocytic and microcytic morphology was seen in 19.5% and 12.5% of the patients respectively. Hypercellular marrow was seen in 82 patients (42.9%), normocellular marrow was seen in 58 patients (30.3%) and hypocellular marrow was seen in 51 patients (26.7%). The most common cause of pancytopenia in this study was megaloblastic anemia in 59 patients (29.5%), the 2nd common cause was leukemias in 28 patients (14%) and the 3rdcause was aplastic anemia in 22 patients (11%). Drug induced pancytopeniawas seen in 21 patients (10.5%) and hypersplenism in 9 cases (4.5%).Conclusion:This study has helped us in knowing the various etiologies of pancytopeniain this hospital. Megaloblastic anemia was the most common etiology in this study followed by leukemiasand aplastic anemia. The study helped us in understanding of the age and gender distribution, the hematological parameters, the peripheral blood film in pancytopenia and the bone marrow picture in these patients.

Incidence and Risk Factors for Hypertension During Childhood Acute Lymphoblastic Leukemia Therap

Objective: To determine the incidence of hypertension among children during the inductionand re-induction phases of acute lymphoblastic leukemia (ALL) therapy and association withpossible risk factors. Methods: A retrospective analysis of 208 consecutive pediatric (age<18 y) ALL patients, treated per BFM-95 protocol between January 2009 and December2013. Data were analyzed to determine the incidence of hypertension and risk factors for itsdevelopment. Results: Incidence of hypertension requiring antihypertensive medication,was 29% (61/208) during induction and 17% (33/198) during re-induction (P=0.003). Median(range) age of patients developing hypertension was 4 y (4 mo to 8 y). Age <10 y andpresence of constipation were independently predictive of hypertension by multivariateanalysis. Conclusion: The present study reports a high incidence of hypertension amongchildren undergoing ALL induction therapy.

Topical treatment in vitiligo and the potential uses of new drug delivery systems.

Vitiligo is a psychologically devastating condition. Topical therapy is employed as first-line treatment in localized vitiligo. Currently, several topical agents are available in many forms viz. methoxsalen (solution and cream), trioxsalen (solution), corticosteroids (gel, cream, ointment and solution) and calcineurin inhibitors (ointment and cream). Although topical therapy has an important position in vitiligo treatment, side-effects or poor efficacy affect their utility and patient compliance. Novel drug delivery strategies can play a pivotal role in improving the topical delivery of various drugs by enhancing their epidermal localization with a concomitant reduction in their side-effects and improving their effectiveness. The current review emphasizes the potential of various phospholipid based carriers viz. liposomes, transferosomes, ethosomes, lipid emulsions, solid lipid nanoparticles and organogels in optimizing and enhancing the topical delivery of anti-vitiligo agents, whilst reducing the side effects of drugs commonly used in its topical treatment.