HIV prevalence in blood donors and recipients in Pakistan: a meta-analysis and analysis of blood-bank data.

Background: The first instances of HIV-antibody detection in donated blood in Pakistan were reported in 1988. Since then, documentation of HIV in blood donors and of rates of transmission via transfusion has been limited. Previously assumed to have a low prevalence, HIV is an increasing health concern in Pakistan. Since there is no national, centralized blood-banking system, there are no reliable data on which to base estimated risks of transfusion-associated HIV infection. This study was therefore conducted to estimate the prevalence of HIV in blood donors and recipients in Pakistan between 1988 and 2012. Methods: Meta-analyses were undertaken of reported prevalences of HIV in blood donors and recipients published during 1988–2012. Papers were identified by searching PubMed, Google, CINAHL and PakMediNet and the websites of the World Health Organization, the national HIV/AIDS Surveillance Project and the National AIDS Control Programme of Pakistan. In addition, the 1998–2012 records of the Aga Khan University blood bank were analysed. Results: The 254 abstracts identified at the preliminary search were reviewed and, after removal of duplications, case-reports, editorials and reviews, 32 papers were selected that met the inclusion criteria. All studies that reported on HIV antibodies in blood donors/recipients were included, irrespective of the methodology used. Since seroconversion had only been confirmed through supplemental testing in a few papers, the results were analysed separately for reports based on screening only and confirmed cases. A total of 142 of 2 023 379 blood donors and 4 of 3632 blood recipients were HIV positive, giving an overall pooled seroprevalence of 0.00111% in blood donors and 0.00325% in blood recipients. The annual prevalences of HIV in donors at the Aga Khan University blood banks were similar, ranging from 0.013% to 0.116%. Conclusion: Very few reports on HIV in blood donors in Pakistan could be retrieved, and the overall pooled prevalence is low. However, the limited data and confounding factors mean that that these results may significantly underestimate the true situation. It is recommended that a complete survey of blood banks should be conducted throughout the country, in order to provide a more reliable estimate of the risk of transfusion-associated HIV infection in Pakistan.

Treatment of fractures in 15 cases of osteitis fibrosa cystica - hyperparathyroidism: a case series

To study retrospectively the results of treatment of cases of pathological fractures presenting with osteitis fibrosa cystica due to hyperparathyroidism. Records of cases of hyperparathyroidism treated for pathological fractures in the past seven years were reviewed to assess success of treatment by various modalities. All patients had been investigated for vitamin D deficiency, parathyroid levels, serum calcium and phosphate levels along with renal function tests. All X-rays were restudied for evidence of osteitis fibrosa cystica. Thirteen cases healed uneventfully, one died of unrelated reasons and one failure led to non union. All patients had received oral calcium supplements and injectable vitamin D for three months at least. There were no complications of this treatment regimen. Pathological fractures due to bone weakness caused by hyperparathyroidism can be treated by various treatment modalities supplemented by oral calcium and injectable vitamin D

Outcome of strangulated inguinal hernia

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Clinical features and hematological investigations pattern in Acute Promyelocytic Leukaemia patients

Acute Promyelocytic Leukemia [AML-M3] patients, though amenable to treatment, present with early and sometimes severe bleeding manifestations. In our setup, for various reasons, patients are diagnosed rather late and therefore these bleeding manifestations are a limiting factor in the early and effective treatment of leukemia in such cases. To look into the clinical, peripheral blood and bone marrow features of AML-M3 patients in our setup. A total of 40 consecutive cases of AML-M3 diagnosed on bone marrow biopsy over a period of 10 years were analyzed for clinico-morphological features. Majority of patients [75%] were <30 years of age. The male: female ratio was 3:2. The mean duration of symptoms was 4.2 weeks [Range 1-10 weeks]. Commonest clinical features were fever, pallor and bleeding manifestations. The spleen and liver were variably enlarged in 25% and 45.5% of cases, respectively. The hemoglobin levels ranged from 3.1 to 12.8 g/dl with a mean of 6.6 g/dl. The WBC count ranged from 0.5 to 142 x 10[9]/l with a mean of 28.3 x 10[9]/l. Platelet counts ranged from 5-150 x 10[9]/l with a mean of 28.8 x 10[9]/l. Morphologically 36 patients had hypergranular and 4 had hypogranular promyelocytic leukemia. The features identified in our study can help in early diagnosis of APL, which is known to be extremely important in effective management of patients