Efficacy of disposable spinal needle in diagnostic bone marrow aspiration

To see the efficacy of disposable spinal needle in diagnostic bone marrow aspiration. Observational study. Department of Haematology, Military Hospital and Army Medical College, Rawalpindi from 1st October 2008 to 31st September 2009. A total of 324 bone marrow aspirations were performed after obtaining informed consent. The study included both male and female subjects and was not restricted to a particular age group. After detailed clinical history and physical examination, blood counts were performed on Sysmex KX-21 hematology analyzer. Smears were examined to assess the indications for bone marrow aspiration. The procedure was conducted at posterior iliac spine in all cases except children under 2 years of age, for which tibia was the preferred site. A 16-gauge spinal needle was used, under sterile conditions using Lignocaine 2% as a local anesthetic. Leishman Stain was used to stain the slides. Pearls reaction and cytochemical stains were used where required. Once prepared, the slides were examined under light microscope and the diagnosis was made in light of both the clinical presentation and microscopic findings. The results were analyzed on SPSS version 17.0. Out of 324 bone marrow aspirations diagnosis was possible in 295 cases. The most frequently diagnosed conditions were anaemia [Megaloblastic, Iron deficiency, Anaemia of chronic disorder], Leukemias [Acute Leukemias and Chronic Leukaemias] and reactive changes in bone marrow secondary to infection. Disposable spinal needles are convenient, user-friendly, readily available [even in remote areas] and ensure sterilization in bone marrow aspiration

Sternum: a useful but forgotten site for bone marrow aspiration

This study was carried out to evaluate the usefulness of sternal puncture for bone marrow examination when posterior superior iliac spine was not approachable. Case series. The study was carried out from Sep 2008 till Feb 2009 at Haematology Department, Army Medical College /Military Hospital Rawalpindi. Sternal puncture was performed on 12 patients where PSIS/ASIS were not accessible due to patients condition/ disease. The diagnosis was possible in all the patients and the reports were intimated within a few hours of carrying out the procedure. Indications for sternal puncture were non accessibility of PSIS/ASIS due to obesity, bed sores, anasarca, skin lesions and patients on ventilators. No complications were seen. Sternum is as good as other sites of bone marrow examination especially in critically ill patients who cannot undergo conventional bone marrow aspiration

Bone marrow aspiration: the diagnostic tool in haematological and non-haematological disorders

This study was undertaken to ascertain various clinical conditions requiring bone marrow examination and to assess its advantages in our clinical setup. This study is case series, which was carried out at the Department of Pathology, Combined Military Hospital, Sialkot Cantt from 1[st] Jun 2005 to 31[st] Dec 2007. One hundred and six bone marrow examinations were performed from 1[st] June 2005 till 31[st] Dec 2007. Patients of all age groups and gender referred for bone marrow examination were included in the study. After history, clinical examination and blood complete counts, about 0.1 and 0.2 ml of bone marrow was aspirated from posterior superior iliac spine, sternum or tibia under local anesthesia or Ketamine as per age. Well spread films were made immediately and air dried. The smear was stained with Leishman stain and Peri's stain and assessed by examination under microscope. The patient's ages ranged from 06 months to 80 years with a mean age of 38 years. Twenty five patients were children under the age of 15 years and 81 were adults. Male to female ratio was 2:1. The clinical presentation of the patients was progressive pallor [50], fever of unknown origin [13] and bleeding [6]. The common clinical situations where bone marrow examination was requested were the presence of anaemia 37[34.9%], leukaemia 25 [23.5%], myelodysplastic syndrome 7 [6.6%], multiple myeloma 5 [4.7%], chronic disorders 10 [9.4%] and non-haematological conditions 8 [7.5%]. Diagnosis was established in >/= 90% cases. Bone marrow examination remains a simple, reliable and the most effective technique in the diagnosis of many important clinical conditions.It is an important and readily accessible tool for diagnosing various haematological and non-haematological conditions. The importance of bone marrow examination is further highlighted in cases where routine investigations fail to reach a conclusive diagnosis

Correlation between glycated haemoglobin and random plasma glucose levels for the screening of diabetes mellitus

To find out a correlation between Glycated hemoglobin [HbA1c] and random plasma glucose levels for the screening of diabetes mellitus. Analytical cross-sectional study. This study was conducted in the Department of Pathology, Army Medical College, National University of Sciences and Technology, Rawalpindi, from January 2010 to April 2010. Three hundred and fifteen patients were included in the study. HbA1c was estimated using Ion Exchange Resin separation kit of Globe Diagnostics, as per guidelines. The Plasma samples received were analyzed on fully automated chemical pathology analyzer Selectra E for random glucose estimation by Glucose Oxidase method. The gender distribution and the relationship of age with HbA1c and random plasma glucose levels were also determined. The results were interpreted using Statistical Package for The Social Sciences [SPSS] version 17. There was a direct correlation between glycated hemoglobin and random plasma glucose levels while there was no correlation between age of the patients and the HbA1c or the age and the random plasma glucose levels. We also found that for every 1% rise in HbA1c, plasma glucose level rose by 2.3mmol/L. Glycated haemoglobin can be used as a reliable, feasible and fairly accurate tool for screening of diabetes mellitus

Monitoring the biochemical effect of haemodialysis in the patients with end-stage renal disease using saliva as an alternative to serum

To compare the effect of haemodialysis on biochemical changes in saliva with changes in serum in patients with end- stage renal disease [ESRD]. This is a Quasi-experimental study, which was conducted in the Department of Pathology and Nephrology, Army Medical College, Rawalpindi, Pakistan from Sep 2008 to Dec 2008. Total thirty nine patients of ESRD consisting of 28 males and 11 females on maintenance haemodialysis were included by convenient sampling technique. Pre and post haemodialysis 3 ml blood samples and saliva were collected under sterile conditions. Biochemical analysis of urea, creatinine and uric acid were carried out on clinical chemistry autoanalyser Selectra E. Electrolytes were analyzed on ion selective electrode analyzer Easylyte. Serum and salivary nitrite were estimated by Griess reaction on ELISA reader. The results were analyzed on SPSS version 16.0. The patients' age ranged from 15 to 80 years. The causes of ESRD were hypertension 15 [38%], diabetes mellitus 7[18%], pyelonephritis 6[15%], glomerulonephritis 3[8%], nephrolithiasis 3[8%] miscellaneous 2[5%] and unknown 3[8%]. The post dialysis serum and saliva revealed a significant decrease in urea [35.48% vs 30.54%], creatinine [37.48% vs 29.65%], uric acid [44.33% vs 37.51%] and nitrites [67.47% vs 52.00%] [P<0.001]. The study demonstrated significant Pearson's correlation between serum and salivary [pre and post dialysis] urea [r=0.73;p<0.001; r=0.69;p<0.001], creatinine [r=0.83;p<0.001; r=0.72;p<0.001], uric acid [r=0.69;p<0.001; r=0.64;p<0.001] and nitrite [r=0.59;p<0.001; r=0.53;p<0.001] respectively. The study demonstrated significant parallel decrease in urea, creatinine, uric acid and nitrite in the post dialysis samples of serum and saliva. Saliva offers an alternative to serum as a biological fluid that can be analyzed in the laboratory for monitoring biochemical change in the patients of ESRD

Coronary heart disease risk factors in male-type androgenetic alopecia

Hyperandrogenaemia and androgenetic alopecia has some association with increased risk of coronary heart disease. Conflicting data has since been reported with regards to levels of biochemical markers of coronary heart disease risk factors in androgenetic alopecia. A case control study was planned to evaluate biochemical markers of coronary heart disease in hyperandrogenaemia of males and androgenetic alopecia. Patients of androgenetic alopecia [n=22] were men with fronto-occipital baldness, aged 20-30 years. Healthy controls [n=20] were age-matched males without alopecia. The individuals with clinical evidence of any systemic or localised scalp disease were excluded. Levels of fibrinogen, glucose, Insulin, uric acid, total cholesterol, LDL-cholesterol and HDL-cholesterol were measured. The levels of total cholesterol, LDL-cholesterol, insulin, glucose, and uric acid in patients of androgenetic alopecia when compared with normal controls were raised significantly. Fibrinogen levels were raised while HDL-Cholesterol was lower in patients than controls but the difference was not significant statistically. The results support the hypothesis that androgenetic alopecia in males is associated with increased risk of coronary heart disease