Statins everyday versus alternate days: Is there a difference in myalgia rates?

Objective Statins are widely used drugs, known to cause myalgia, leading to high discontinuation rates. The objective of our study was to determine the frequency of myalgia in patients on everyday-dose (EDD) regimen with those on alternate-day dose (ADD) regimen. Methods This cross sectional study was conducted in a tertiary care hospital of Pakistan. A sample size of 400 patients between the age of 40–70 years, taking simvastatin 40 mg for at least 6 months or more were selected. Patients with prior musculoskeletal or neuromuscular complains, and family history of muscular disorders were excluded. Subjects were evaluated for myalgia via a self-administered questionnaire, and those complaining of myalgia were then evaluated for serum vitamin D levels. Data was analyzed through SPSS 16.0 and compared using chi square test. Results The overall prevalence of myalgia was 7% (28/400). Frequency of myalgia in patients taking simvastatin everyday (n = 20, 10%) was significantly higher compared to those taking it every alternate day (n = 8, 4%) (p = 0.02). There was no significant difference between the time of onset, nature, severity, type, or location of myalgia between the 2 groups. The most common cited triggering factor for pain was physical exercise. Of the patients experiencing myalgia, 13 (6.5%) from the EDD group and 6 (3%) from the ADD group had low levels of vitamin D. Conclusions ADD regime was better tolerated by the patients than EDD regime. Alternate day therapy, with or without vitamin D supplementation, may be used by the physicians for troublesome muscular complains.

Bone marrow infiltration and patterns in previously diagnosed patients of non hodgkin lymphoma [a single centre study]

Objective: The objective of this study was to determine the frequency of bone marrow infiltration along with various histological patterns of bone marrow infiltration in previously diagnosed patients of Non Hodgkin Lymphoma

Study Design: Cross sectional study

Place and Duration of Study: Department of Haematology, Armed Forces Institute of Pathology Rawalpindi. Six months, from Nov 2013 to May 2014

Material and Methods: This study involved 70 patients diagnosed of Non-Hodgkin Lymphoma

Results: The mean age of the patients was 51.40 +/- 16.50 years and 78.6% of the patients were males and 21.4% were females. Diffuse Large B-Cell lymphoma was the most frequently observed variant [DLBCL, 60%], followed by Follicular [22.9%] and small lymphocytic lymphoma [SLL, 14.3%]. Most of the patients were suffering from Stage-IV disease [51.4%], followed by Stage-III [25.7%] and Stage-II disease [22.9%]. Bone marrow infiltration was observed in 51.4% patients. The most common pattern of infiltration was recorded as diffuse, observed in 33.3% of patients. The second most common pattern was interstitial which was recorded in 25% cases followed by mix [22.2%] and focal [16.7%] patterns. The frequency of bone marrow infiltration was unaffected by age [p=0.497], gender [p=0.868] and type of the disease [p=0.486]

Conclusion: The most common pattern of diffuse large B-cell Non Hodgkin lymphoma infiltration was bone marrow followed by interstitial tissue

Mental foramen morphometry in a population from Khyber Pakhtunkhwa (KP) Pakistan / Morfometría del foramen mental en una población de Khyber Pakhtunkhwa (KP) Pakistán

Knowledge of variations in MF location, size and shape is important when anesthetizing nerves of the mandibular region in dental procedures. The location, shape and position of the MF were determined in 119 human mandibles of unknown age and sex from different KP medical institutions. Parameters determined were: MF length and width; accessory mental foramen (AMF) width; MF and AMF to midline (MF-ML) (AMF-ML), upper (MF-UM) (AMF-UM) and lower mandibular margins (MF-LM) (AMF-LM) and posterior border of the mandibular ramus (MF-PRM) (AMF-PRM). AMF position in relation to the MF was also noted. MF were mainly oval and situated below the second premolar. MF mean length and width were: 2.4 ± 0.89 (right) and 2.4 ± 0.727 mm (left), and 3.0 ± 0.80 (right) and 2.9 ± 0.94 mm (left) respectively. MF-ML, MF-UM, MF-LM and MF-PRM distances on the right and left sides were: 29.1 ± 2.19 mm and 28.1 ± 2.12 mm; 11.0 ± 3.99 mm and 11.2 ± 3.98 mm; 13.1 ± 1.83 mm and 12.8 ± 1.74 mm; and 69.3 ± 5.52 mm and 68.7 ± 5.02 mm, respectively. Double mental foramen (DMF) were observed on both sides (10.9 % right, 12.6 % left) with length and width 0.7 ± 0.42 mm and 0.9 ± 0.34 mm (right) and 0.8 ± 0.32 mm and 1.0 ± 0.47 mm (left): they were mainly oval (5.8 % right, 7.56 % left). DMF-MF distance was 8.9 ± 4.58 mm on the right and 6.6 ± 4.11 mm on the left. An oval accessory mental foramen was observed in one mandible. There was no difference between right and left MF; however differences in the parameters measured were observed in relation to other populations indicating the need to be aware of such differences when undertaking surgical procedures around the MF.

El conocimiento de las variaciones del foramen mental (FM), su ubicación, tamaño y forma es importante al momento de anestesiar los nervios de la región mandibular en procedimientos dentales. La ubicación, forma y posición del FM se determinó en 119 mandíbulas humanas, de edad y sexo desconocidos, de diferentes instituciones médicas de Pakistan. Los parámetros determinados fueron: longitud y ancho; ancho del foramen mental accesorio (FMA); MF y AMF a la línea mediana (FM-LM) (FMA-LM), margen superior (FM-MS) (FMA-MU) y margen inferior (FM-MI) (FMA-MI) y el margen posterior de la rama mandibular (FM-RMP) (FMA-RMP). También se observó la posición del FMA en relación con el FM. La forma del FM fue principalmente ovalada y situado por debajo del segundo premolar. Los datos de longitud y anchura del FM fueron: 2,4 ± 0,89 (derecha) y 2,4 ± 0,727 mm (izquierda), y 3,0 ± 0,80 (derecha) y 2,9 ± 0,94 mm (izquierda), respectivamente. Las distancias FM-LM, FM-MS, FM-MI y FM-MRP en el lado derecho e izquierdo fueron: 29,1 ± 2,19 mm y 28,1 ± 2,12 mm; 11.0 ± 3.99 mm y 11,2 ± 3,98 mm; 13,1 ± 1,83 mm y 12,8 ± 1,74 mm; y 69,3 ± 5,52 mm y 68,7 ± 5,02 mm, respectivamente. Se observaron foramenes mentales dobles (FMD) en ambos lados (10,9 % derecho, 12,6 % a la izquierda) con una longitud y ancho de 0,7 ± 0,42 mm y 0,9 ± 0,34 mm (derecha) y 0,8 ± 0,32 mm y 1,0 ± 0,47 mm (izquierda): fueron principalmente ovalados (5,8 % derecha, izquierda 7,56 %). La distancia FMD-FM fue de 8,9 ± 4,58 mm a la derecha y 6,6 ± 4,11 mm en el izquierdo. Se observó un foramen mental accesorio ovalado en una mandíbula. Hubo diferencia entre FM derecho e izquierdo. Sin embargo, las diferencias en los parámetros medidos fueron observados en relación con otras poblaciones que indican la necesidad de ser conscientes de estas diferencias al realizar procedimientos quirúrgicos en todo el MF.

Assessment of status of thyroid functions in patients of beta thalassemia major, reporting to OPD of military hospital, Rawalpindi

Objective: To determine the status of thyroid functions in patients of beta Thalassemia Major, reporting to OPD of Military Hospital, Rawalpindi

Study Design: Descriptive cross sectional study

Place and Duration of Study: Paediatric Outpatients Department of Military Hospital, Rawalpindi from 1st Jan to 30th Jun 2012

Material and Methods: After taking informed consent from the parents of all the children fulfilling the inclusion criteria, detailed history was taken and blood samples were drawn by strict aseptic means. Samples taken from these patients included complete blood and thyroid profile [serum thyroxine T4, triiodothyronine T3 and thyroid stimulating hormone TSH]. These blood samples were labeled and sent to Armed Forces Institute of Pathology [AFIP], Rawalpindi for analysis by enzyme-linked immunosorbent assay [ELISA]. Primary hypothyroidism was defined by TSH levels >4IU/ml. Statistical analysis was done at the end of study using SPSS version 10. Significance for association was calculated using student t-test

Results: Sixty patients fulfilled the inclusion criteria out of these sixty four patients lost the follow up while 56 patients completed the study. Out of 56 patients, 21 [37.5%] had biochemical evidence of hypothyroidism. Mean Ferritin level was 3924 +/- 1247ng/ml in hypothyroid and 3136 +/- 1387ng/ml in euthyroid patients indicating a significant difference in mean serum ferritin levels between hypothyroid patients and others

Conclusion: The study demonstrates hypothyroidism in a significant number of hyper transfused beta- thalassemic patients, emphasizing the importance of monitoring thyroid functions in thalassemic patients, particularly in those receiving suboptimal chelation

Methylmalonic acidemia

Methylmalonic Acidemia [MMA] is an inborn error of metabolism that results in accumulation of methylmalonic acid in blood and increased excretion in urine. The effects of MMA vary from mild to life threatening and it usually presents in early infancy. Affected infants can have vomiting, dehydration, hypotonia, developmental delay and failure to thrive. The emergency treatment of the newborn with MMA mainly comprises rehydration and promotion of anabolism, followed by long-term dietary management by both the restriction of precursor amino acids using a low protein diet and avoidance of prolonged fasting. Prognosis depends on the type of MMA and whether the condition is well controlled in general and during episodes of metabolic decompensation. We report here the presentation and management of a 2-year boy with MMA who failed to achieve expected milestones for age. To the best of our knowledge, only one case of MMA has been reported from Pakistan

Frequency of cardiomyopathy in beta thalassemic children

Objective: To determine the frequency of cardiomyopathy in beta thalassemic children

Study Design: Cross-sectional descriptive study

Place and Duration of Study: This study was carried out in the Pediatric department of Postgraduate Medical institute Lady Reading Hospital Peshawar from 1.1.2013 to 31.12.2013

Materials and Methods: Total 334 Cases were collected by Consecutive [non probability] sampling technique using WHO sample size calculation software. Patients collected according to fulfilling the inclusion/exclusion criteria. Beta thalassemic children with 10 or more blood transfusions, aged 2 to 15 years and both male and female children

Results: In this study, 334 patients suffering from beta thalassemia were included. Male to female ratio was 1.62:1 and age ranged from 2 to 15 years. Average age was 7.57 years + 3.79SD. Dilated cardiomyopathy in beta thalassemic was observed in 13[3.9%], while restrictive cardiomyopathy was in 9[2.7%]patients

Conclusion: The majority of patients with beta-thalassaemia demonstrated a unique hemodynamic patternindicatingcardiomyopathy

Optimal and efficient management of mandibular fractures

The aim of the study was to find out whether eliminating intraoperative intermaxillary fixation from the management of mandibular fractures has any bearing on treatment outcomes. A retrospective study was carried out on 53 mandibular fractures treated at Margalla Institute of Health Sciences and its affiliated hospitals from June 2010 to December 2014. Successful bone healing, occlusion and complications were assessed in mandibular fractures treated with open reduction and internal fixation and without the use of intraoperative intermaxillary fixation. Minor wound dehiscence was seen in 7 patients. 3 patients required hardware removal due to subsequent hardware failure; however no case of nonunion was seen. Clinically significant malocclusion [Moderate: Grade 2] was seen in only one patient after 3 months. There were negligible and comparable number of postoperative complications. It was concluded 'hand holding' of the mandibular fractures as an alternative to the more traditional IMF/MMF through various means, a reliable and predictable way of fixation of mandibular fractures

Gastrointestinal and hepatotoxic side effects of coamoxiclav in adults

Background: Co-amoxiclav which is a combination of Amoxicillin and Calvulanic acid is one of the most commonly prescribed antibiotics so there was need to study the side effects of this drug

Objectives: This study was done to enlist the adverse reactions especially the gastroinstestinal and hepatotoxic adverse reactions in patients who were prescribed co-amoxiclav

Patients and Methods: This cross-sectional study was conducted on 200 patients, both indoors and out-doors in the Department of Medicine of Khyber Teaching Hospital [KTH], Lady Reading Hospital [LRH] and Hayatabad Medical Complex Peshawar, in months of August-October of 2013. The individuals included in the study were those treated as inpatient or outpatient with the diagnoses of uncomplicated UTIs, RTIs including Sinusitis and Pneumonia and the Skin infection. Those who were below the age of 18 years, requiring more than one antibiotic, having previously known chronic disease especially the liver disease or on any long-term medications, alcoholics and pregnant ladies were excluded from the study. A detailed questionnaire mentioning the age, sex and ethnicity of the patients, indications for the use of co-amoxiclav, duration of the treatment, base line LFTs including Bilirubin, SGPT and Alkaline Phosphatase and use of any concomitant drugs was devised. The patients were asked for follow up at weekly intervals for eight weeks after the course of treatment and assessed clinically and biochemically and LFTs recorded. This study which was approved by the Ethics Committee of our hospital was self-funded by the authors and informed consent was taken from every patient. The data was processed using SPSS version 16

Results: Amoxicillin- Calvulanate combination was seen to be well tolerated by most of the patients in our study subjects and adverse reaction were noted only in 36 [18%] of the patients. The commonest side effect was diarrhea seen in 24 [12%] of the patients which was more severe in patients getting higher doses and for more than a week. Side effects were commonly seen in old patients 16 [8%] and in chronic smokers. Hepatotoxic side effects were seen in 6 [3%] of the participants mainly cholestatic type of derangement on LFTs was seen and the toxicity was Mild i.e. Grade 1 in five of them as per National Institute of Cancer's, "Common Toxicity Criteria for Adverse Events, version 4.0 [CTCAEv4]" while one developed Grade 2 Hepatocellular type of Liver injury secondary to Co-Amoxiclav. Only 2% of the patients were discontinued with the drug when they developed signs and symptoms of allergy on the 1[st] day of treatment while Oral candidiasis was seen in only 1% of the study subjects

Conclusion: Gastrointestinal and hepatic side effects are uncommon with Co-Amoxiclav and the commonest adverse reaction is diarrhea. Clinically obvious jaundice along with biochemically deranged LFTs is pretty remote possibility and can be reverted on stopping the drug and commencing the supportive treatment

Laboratory confirmed health care-associated bloodstream infections: a Jordanian study

Few studies have been conducted in Jordan related to health care associated bloodstream infections [HCABSIs]. This study aims to examine epidemiology of HCABSIs among hospitalized adult patients in Jordan. A cohort study [N = 570; 445 confirmed HCABSIs, 125 uninfected patients] with a nested 1:1 matched case-control design [n = 125 in each group] was used based on data from one large referral hospital in Jordan over a period of 5 years. HCABSI cases were determined based on confirmed positive blood culture after 48 h of admission. The case-control analyses [n = 250 per group] matched on gender, age, same admission month and unit. The overall incidence and mortality rates were 8.1 and 5.8 per 1000 admissions, respectively. Four-variable and three-variable multivariate models were proposed to explain the risk of HCABSIs in the matched analyses .The four-variable model consists of blood product [OR = 24.5], invasive procedures [OR = 4.3], renal failure [OR = 9.2], and presence of other infections [OR = 21.6]. The three-variable model consists of recipient of blood product [OR = 19.7], invasive procedures [OR = 4.5], and renal failure [OR = 9.4]. This study is a pioneer study that examined risk factors, the associated HCABSIs in Jordan. Results from this study can be used to influence infection control plans in Jordan

Primary alveolar proteinosis

A 35 years old man presented with primary pulmonary alveolar proteinosis who was admitted to chest unit of ATH through casualty department. Before he came to our ward he was treated with different antibiotics including anti-tuberculosis drugs for a month at least. But his symptoms did not improve rather his dyspnoea got worse. He was misdiagnosed till histopathology revealed that he has pulmonary alveolar proteinosis. With this background we briefly review clinical features, diagnosis and treatment of this rare disease.

High altitude headache - an etiological based study

To determine the various causes of headache in patients evacuated from high altitude. Descriptive study An observational hospital based study carried out on 50 soldiers evacuated from Northern Areas to Military Hospital Rawalpindi between Sep 2009 to Mar 2010 for evaluation of headache as their major complaint. Necessary investigations including neuroimaging were carried out in coordination with Department of Neurology, Military Hospital and an appropriate diagnosis was made in each case. The data was analyzed accordingly. A total of 50 patients were analyzed .They were all males and the mean age was 25 years. 52% patients had Acute Mountain Sickness, 12% hypertension, 10% High altitude cerebral edema, 8% Tension type headaches, 6% Dural venous sinus thrombosis, 6% migraine, 2% encephalitis, 2% were of Subarachnoid hemorrhage and 2% patients Hydrocephalus. Acute mountain sickness and high altitude cerebral edema accounts for a significant number of patients with high altitude headache

Strangulated obturator hernia - an unusual presentation of intestinal obstruction

An 81-year-old Caucasian emaciated female presented with 3 days history of colicky abdominal pain nausea, projectile vomiting and abdominal distension. A pre-operative diagnosis of mechanical bowel obstruction was made. The absence of characteristic clinical signs in this thin elderly woman with a small bowel obstruction failed to provide a pre-operative diagnosis. She underwent a midline laparotomy and resection and anastomosis of small bowel and repair of the strangulated right obturator hernia. The high mortality rate associated with this type of abdominal hernias requires a high index of suspicion to facilitate rapid diagnosis and prompt surgical intervention if the survival rate is to be improved

Correlation of the ERPF with the extraction fraction values of technetium-99m mercaptoacetyltriglycine.

OBJECTIVE: The objective of this study was to determine if a correlation exists between the effective renal plasma flow (ERPF) and the extraction fraction (EF) using 99mTc MAG3 in children. This EF has been previously described with 9mTc DTPA. However, the renal imaging agent of choice has become 9mTc MAG3. MATERIAL AND METHOD: The study was approved by The Children's Hospital of Philadelphia's institutional review board. Informed consent was also obtained A retrospective study of 29 children (16 males, 13 females) of ages 1 month to 19.5 years who underwent 99mTc MAG3 renal scintigraphy from September 2001 to December 2001 was analysed. EF values were calculated with and without attenuation correction in each kidney by determining the counts in a region of interest, correcting for background and comparing the counts with the injected dose. The EF was compared to the ERPF calculated using the Schlegel's method. The correlation between the EF and the ERPF corrected and non-corrected for soft tissue attenuation, were determined and were identified by using linear regression analysis. RESULTS: There was significant correlation between the ERPF and the EF with (r = 0.62, p < 0.05 on the left, r = 0.51, p = 0.005 on the right) than without attenuation correction (r = 0.54, p = 0.003 on the left, r = 0.42, p = 0.022 on the right). CONCLUSION: These results indicate a correlation of the ERPF calculated using the Schlegel's method with EF obtained from a 99mTc MAG3 renal scintigraphy. The EF may be the good alternative parameter for calculation of renal function, potentially more practical in pediatric patient and the ERPF for 99mTc MAG3 using the established software program based on Schlegel's formula.

Stress hyperglycemia and mortality in patients with acute ischemic stroke

The objective of the study was to compare mortality and morbidity in patients of acute ischemic stroke presenting with and without stress hyperglycemia. A high proportion of patients suffering an acute stress such as stroke or myocardial infarction may develop hyperglycemia, even in the absence of a preexisting diagnosis of diabetes. This study was carried out in neurology units of Military Hospital Rawalpindi, and in Combined Military Hospital Rawalpindi, both are tertiary referral hospitals. The duration of study was from 1st March to 25th August, 2004. In the hyperglycemic group, out of 50 patients, 22 [44%] died within 04 weeks of stroke. In the control group, 10 [20%] out of 50 patients expired. The study showed a statistically significant relative risk of 2.2 in case of hyperglycemics as compared to normoglycemics. In the study group, mortality rate was higher in males, 14 [63%] out of 22 as compared to females of 8 [36.36%]. Even in survivors, functional outcome at 01 month was worse in the hyperglycemic group. Patients with stress hyperglycemia were 0.4 times less likely to improve as compared to normoglycemics. In non-diabetic patients suffering from an ischemic stroke, moderately elevated glucose levels were associated with a more than 2-fold higher risk of short-term mortality compared with lower glucose levels. Even in survivors, stress hyperglycemia was associated with a poor functional outcome after acute ischemic strokes

Morphological changes induced by cottonseed flour in rat testes

Gossypol, a component of the cottonseed, has anti-fertility effects. The present study was planned to determine whether diets containing whole cottonseed flour could produce morphological changes in the rat testes similar to pure gossypol. Sixteen animals were randomly divided into two groups, Control [C] and Test [T] groups. Each group comprised of 08 animals. Control group received standard diet, while test group received 70% standard diet and 30% cottonseed flour. A significant decrease in body weight, testicular weight and diet consumption was seen in the test group. Histological sections were stained in serial order by three different stains, H and E, PAS and Masson's Trichrome. Microscopic examination revealed significant increase in luminal diameter [P<0.0001] and decrease in wall thickness of seminiferous tubules [P<0.0007] of test group. Cell count per tubule was significantly decreased in test group [P<0.002]. Degenerative changes in the epithelium were seen in 78.8% and degenerative cells in the lumen of the seminiferous tubules in 41.23% of tubules were observed in test group. Sertoli and leydig cell counts were not different from those of control. No disruption of basement membrane was observed. Pigment laden cells in the interstitial tissue were observed in the test group. The observed morphological changes induced by cottonseed flour suggest that cottonseed flour, by virtue of its contents of the compound gossypol is equally toxic to rat testes like pure extract of gossypol

Heterozygous beta thalassemia in parents of children with beta thalassemia major

Beta thalassemia is the most common single gene disorder causing a major genetic health problem in the world. Beta thalassemia is common in Pakistan. This study was conducted to find out the pattern of transmission of beta thalassemia in the affected families. One hundred families having children with beta thalassemia major were analyzed at Postgraduate Medical Institute, Lady Reading Hospital Peshawar, Pakistan, for detection of beta thalassaemia trait. Screening was performed in both maternal and paternal parents and grandparents. Four hundred and fifteen [69.2%] cases of heterozygous beta thalassaemia were detected in the survey of 100 families [600 subjects], having beta thalassaemia major children. Altered red cell morphology such as hypochromia, microcytosis and aniso-poikilocytosis were seen in all these cases. Haemoglobin A2 level ranged 4.0-6.9%, MCV of less than 77 fl and MCH of less than 26.4 pg were found in all the subjects with beta thalassaemia trait. The frequency of consanguineous marriages in parents was first cousin 72%, second cousin 5%, distant cousin 4% and un-related 19%. Consanguinity was found to be present in most of the parents of patients with beta thalassaemia major. This can be minimized by health education, nation-wide screening and provision of genetic counseling to the affected families

Histological changes in parts of forgut of rat after indomethacin administration

Indomethacin, a non-steriodalanti-inflammatory drug, is used mainly for the treatment of painful joints such as rehumatoid arthritis, osteo'arhtritis, gout, ankylosing spondylitis etc. It relieves pain, reduces swelling and tenderness of the joints. It also induces ulceration of stomach and small intestine both in experimental animals and humans. In this study indomethacin was given intrapertioneally in maximum therapeutic dose [4 mg/Kg body weight] to three experimental groups B, C and D for one, two and three weeks respectively. Group A was the control group. Effects were observed in stomach pylorus and proximal duodenum. In the stomach pylorus, well defined superficial ulcers were identified during initial two weeks of drug administration. The ulcer penetrated as for as muscularis mucosae and ulcer bed had coagulative necrosis and inflammatory cells. During third week, stomach pylorus showed minor damage in the form of focal necrosis. Duodenum was affected less than stomach and showed villi with lost tips, tilted and distorted villi. Morphometric analysis showed changes in stomach pylorus and in duodenum. The number of mitotic figure was significantly increased in stomach pylorus. Duodenum showed insignificant to significant decrease in the height of villi. Increase in the number of goblet cells, columnar cells, and mitotic figure was also noted; which was undoubtedly part of the tissue response to an injury. These observations suggested that indomethacin given in a ma ximum therapeutic dose, initially induces lesions in stomach pylorus and proximal duodenum but almost no effects were noted when duration of the drug administration was prolonged

Remission and survival rates of acute myeloid leukemia patients in Peshawar

Thirty four patients were diagnosed as having acute myeloid leukemia [AML] between July 1994 and June 1996 at Lady Reading Hospital, Peshawar. Aim of the study was to determine the remission rate, leukemia-free survival and overall survival of patients suffering from AML in the center. 20 [58%] patients were male while 14 [42%] patients were female. Median age was 30 years [range 5-59 years]. Twenty one [62%] of our patients were between the age of 17 and 36 years, thus more than half of our patients belonged to the younger age group. M1 and M2 sub-types were the most commonly encountered sub-types of AML in our patients. Minimum follow-up was for 12 months. All 34 evaluable patients received Cytarabine 100mg/m2 for 7 days and Daunorubicin 45 mg/m2 for 3 days [standard 7+3 regime]. Patients achieving a complete remission received four cycles of monthly Cytarabine 100mg/m2 for 5 days and Daunorubicin 45mg/m2 for 2 days [5+2 regime] as maintenance chemotherapy. Daunorubicin was replaced with 6-Thioguanine after 4 months of maintenance therapy. An overall response rate of 62% was achieved [complete remission in 50% patients and partial response in 12% patients]. Leukemia-free survival at 6 months and twelve months was 50% and 30% respectively. Our treatment strategies, results and difficulties involved in the treatment of acute myeloid leukemia patients in developing countries are discussed