Clinico-haematologic association and prognostic relevance of NPM1 and FLT3-ITD mutations in acute myeloid leukaemia

Background and Objectives: Molecular genetic abnormalities have a significant role not only in diagnosis but also in determining the clinical course and prognosis. Nucleophosmin-1 [NPM-1] is associated with good prognosis while internal tandem duplication of the fms-like tyrosine kinase-3 gene [FLT3-ITD] confers a poor prognosis. Knowledge of the status of these mutations in AML patients not only guides treatment decisions but also helps in predicting response to frontline induction and consolidation chemotherapy as well as the risk of relapse and overall survival. Our objectives were to determine the prevalence, clinico-haematological features and immunophenotypic characteristics of AML patients with FLT3-ITD and NPM1 mutation and to evaluate the response to induction therapy [CR] and disease free survival [DFS] in this cohort of patients

Methods: Patients diagnosed as AML from March 2015 to March 2017 at Armed Forces Institute of Pathology Rawalpindi were included in the study. Clinico-haematologic and immunophenotypic parameters were noted and molecular analysis for FLT3-ITD and NPM1 mutation was performed. Any correlation with cytogenetics or other molecular markers was also studied. Response to standard induction chemotherapy and disease-free survival were assessed

Results: A total of 108 cases of AML were analyzed. Median age was 35 years and 64.8% were males. The median age of the study group was 35 years. Of these, 70 [64.8%] were males while 38 [35.2%] were females. Twenty-nine [26.9%] patients were NPM1 positive, twelve [11.1%] were FLT3-ITD positive while eight [7.4%] were positive for both mutations. Patients with NPM1 mutations were associated with female gender, higher haemoglobin level and platelet counts while those with FLT3-ITD mutations were predominantly seen in male patients and had significantly higher WBC counts, bone marrow blasts, biopsy cellularity and LDH levels. CR rates of NPM1 positive, FLT3-ITD positive and both mutation positive groups were 72%, 60% and 71%, respectively. The median disease-free survival was significantly lower in the FLT3-ITD positive group [7.1 months] as compared to the NPM1 positive group [16.1 months]. The median disease-free survival was 12 months and 11.9 months in the NPM1 positive/FLT3-ITD positive and the NPM1 negative/FLT3-ITD negative groups, respectively

Conclusion: AML patients harbouring NPM1 and FLT3-ITD mutations have distinct clinical and haematological characteristics. NPM1 mutations have a better CR and DFS as compared to FLT3-ITD group.

Supplementation of garlic and coriander seed powder: Impact on body mass index, lipid profile and blood pressure of hyperlipidemic patients

Garlic and coriander play an obligatory role in the metabolism of lipids leading to the reduction of CVD development. We hypothesized that garlic, coriander and their mixture improves the lipid profile, BMI and blood pressure of CVD patients. Eighty patients were partitioned into 4 groups, each group consisting of twenty patients. The groups were randomly assigned to three supplements i.e. garlic powder [GP], coriander seed powder [CSP] and mixture [1:1 dry weight basis] of GP and CSP at a dose rate of 2 g/day. The fourth group was kept as placebo. The patients were examined for serum lipid profile, BMI and blood pressure at the start [0 day], 20, 40 and 60th day of supplementation. The initial 40 days were the intervention period whereas the last 20 days were the follow up period. The results indicated that all the supplements significantly [p<0.05] influenced the BMI, HDL, total cholesterol, triglycerides, LDL and systolic blood pressure of the patients. Among the supplements, GP had the highest influenced on BMI, TC, LDL and HDL whereas the impact of GP-CSP and CSP was more pronounced on TGL and blood pressure of the patients, respectively. All the parameters decreased with supplementation except HDL, which increased with the consumption of supplements. It was concluded that consumption of garlic, coriander and their mixture at a dose rate of 2 g/day is improving the lipid parameters of the patients

Expression analysis of matrix metalloproteinase-9gene in rheumatoid arthritis patients on disease modifying anti-rheumatic drugs

Objective: to evaluate matrix metalloproteinase-9gene expression in rheumatoid arthritis patients on disease modifying anti-rheumatic agents with the objective to further modify the current treatment regimen if indicated in order to prevent progression to deforming rheumatoid arthritis

Study Design: cross-sectional comparative study

Place and Duration of Study: cream Lab [Centre for Research in Experimental and Applied Medicine] and Department of Biochemistry and Molecular Biology, Army Medical College, in collaboration with Rheumatology Department at Military Hospital Rawalpindi from November 2015 to November 2016

Methodology: a total of 60 patients of both genders were taken, among which 30 were patients and 30 were controls. Non-probability purposive sampling technique was used. RNA was extracted from respective blood sample and cDNA was synthesised and after optimisation, expression analysis of matrix metalloproteinase-9gene was seen on real time PCR

Results: mean age of rheumatoid arthritis patients and healthy controls was 49.27 +/- 12.11and 42.10 +/- 9.02 years, respectively. Among controls, 50% were males [15] and 50% were females [15]; whereas, among patients, 30% [9] were males and 70% [21] were females. The mean cycle threshold [Ct] value of MMP-9expressions in patients was 27.9147 +/- 2.953; whereas, mean Ct of controls was 23.84 +/- 2.845. Down regulation of this gene was found in patients in comparison to controls

Conclusion: downregulation of matrix metalloproteinase-9was observed in patients as compared to controls indicating that current treatment regimen did not require further modification

3 Isoforms of PML RAR [Alpha] in acute Promyelocytic Leukaemia

Objective: To determine the frequencies of three isoforms of PML RAR[alpha] fusion gene in APL

Study Design: Descriptive cross sectional study

Place and Duration of Study: Department of Hematology, Armed Forces Institute of Pathology [AFIP], Rawalpindi Pakistan, from Apr 2015 to Oct 2015

Material and Methods: This study involved 97 newly diagnosed cases of APL, aged between 15-70 years from both genders. Double nested PCR was carried out by Applied Biosystems 2720 Thermal Cycler in every patient to determine the isoform of PML RAR[alpha] fusion gene. A written informed consent was obtained from every patient

Results: The age of the patients ranged from 17 years to 69 years with a mean of 37.87 +/- 12.89 years. There were 68 [70.1 percent] male and 29 [29.9 percent] female patients in the study group. The bcr1 isoform was found in 9 [9.3 percent] patients. There was no significant difference in the frequency of bcr1 isoform across age groups; 17-34 years vs. 35-52 years vs. 53-69 years [14.6 percent vs. 7.0 percent vs. 0.0 percent; p=0.223] and genders; male vs. female [7.4 percent vs. 13.8 percent; p=0.317]. The bcr2 isoform was found in 26 [26.8 percent] patients. There was no significant difference in the frequency of bcr2 isoform across age groups; 17-34 years vs. 35-52 years vs. 53-69 years [19.5 percent vs. 27.9 percent vs. 46.2 percent; p=0.164] and genders; male vs. female [25.0 percent vs. 31.0 percent; p=0.539] while the bcr3 isoform was found in 62 [63.9 percent] patients. There was no significant difference in the frequency of bcr3 isoform across age groups; 17-34 years vs. 35-52 years vs. 53-69 years [65.9 percent vs. 65.1 percent vs. 53.8 percent; p=0.717] and genders; male vs. female [67.6 percent vs. 55.2 percent; p=0.242]

Conclusion: The most frequent isoform of PML-RAR[alpha] fusion gene was bcr3 which was observed in 62 [63.9 percent] cases followed by bcr2 [26.8 percent] and bcr1 [9.3 percent]. There was no significant difference in the frequency of isoforms with patient's age and gender

Expression analysis of glyoxalase I gene among patients of diabetic retinopathy

Objectives: To study expression of glyoxalase I in patients of diabetic retinopathy

Methods: This cross-sectional comparative study was conducted at Centre for Research in Experimental and Applied Medicine [CREAM], Department of Biochemistry and Molecular Biology, Army Medical College, Rawalpindi in collaboration with Armed Forces Institute of Ophthalmology [AFIO] from January 2015 to November 2015. Sampling technique was non- probability purposive sampling. Total 60 subjects were enrolled in two groups. Group-I comprised 30 patients of diabetic retinopathy and Group-II of 30 normal healthy controls. Clinical and demographic data was collected and fasting venous blood samples [2 ml] were drawn. RNA was extracted and subjected to cDNA synthesis. Expression analysis for glyoxalase I was carried out and relative quantification done by double delta Ct method

Results: Mean age of the patients was 61.30 +/- 7.06 years and mean age of controls was 59.60 +/- 6.43 years. There were 17 [56.7%] males and 13 [43.3%] females in Group-I while Group-II comprised 14 [46.7%] males and 16 [53.3%] females. There was down regulation of glyoxalase I among patients of diabetic retinopathy in comparison with controls when relative gene expression was calculated

Conclusion: Down regulation of glyoxalase I in patients of diabetic retinopathy suggests it to be a contributory factor in the development of disease

Expression of Estrogen Receptors [ER], Progesterone Receptors [PR] and HER-2/neu receptors in endometrial carcinoma and their associations with histological types, grades and stages of the tumor

Objective: To study and detect immunohistochemical expression of Estrogen Receptors, Progestrone Receptors and HER-2/neu Receptors in Endometrial Carcinoma [EC] and to find their associations with histological types, grades and stages of the tumor

Methods: A cross sectional study of one year duration from January 2016 to January 2017 was conducted at Histopathology department of Army Medical College, Rawalpindi. A non-probability purposive sampling technique was used to include 56 cases of EC. The specimens were tested for ER, PR and HER-2/neu expression using immunohistochemical analysis. Data was analyzed in SPSS and the significance of association of expression of the receptors with histological types, grades and stages of the tumor was assessed

Results: Significant association of Her-2/neu overexpression with histological types and grades of EC was seen, whereas the association of ER and PR expression with histological types, grades and stage of EC was statistically insignificant

Conclusion: It is suggested that EC showing over expression of HER2/neu with immunohistochemistry may be treated with anti HER-2/neu treatment with better chances of survival and decreased post-treatment morbidity

Spectrum of bone marrow changes in patients of chronic kidney disease [stage III, IV and V]

Objective: To see the various hematological changes in the bone marrow of patients with chronic kidney disease [CKD] stage III, IV and V. Study Design: Cross sectional observational study. Place and Duration of Study: Study was conducted in the department of haematology [Pathology], Army Medical College, Rawalpindi and duration was one year, from Mar 2015 to Feb 2016

Material and Methods: Patients of both sexes and all age groups with CKD stage III, IV and V were included in this study. Patients' histories were recorded. Complete blood counts, bone marrow aspiration and trephine biopsy were done and evaluated microscopically. Mean blood counts of the patients in three groups of CKD were compared. Frequencies of various bone marrow [BM] findings in patients of CKD were calculated

Results: Out of 57 patients, 41 [71.9%] were males while 16 [28%] were females. Mean age was 60 years. There was no statistically significant difference between the mean hemoglobin, mean white cell count and mean platelets count of the patients in three groups of CKD. Reactive changes due to underlying CKD and inflammation were the most frequent findings in the BM of the patients

Conclusion: Anaemia of mild to moderate severity and reactive changes in the BM are the most frequent haematological findings encountered in patients suffering from advanced stage CKD. Since CKD is predominantly a disease of the elderly so it is not rare to find the co-morbidities including plasmacytosis, malignancies and their effects on the BM in patients of CKD

Immunophenotyping pattern in mixed phenotype acute leukaemias

Objective: To evaluate Immunophenotyping patterns in Mixed-Phenotype Acute Leukemias [MPAL]

Study Design: Descriptive study

Place and Duration of Study: This study was carried out in the department of Hematology, Armed Forces Institute of Pathology Rawalpindi, from 1st Jan 2013 to 31st Jan 2017

Material and Methods: After taking informed consent from the patients fulfilling the inclusion criteria, detailed history was taken and blood samples were drawn for blood complete picture. The patients suspected to have acute leukemia were subjected to bone marrow examination [aspiration and trephine biopsy] for further cytochemical staining [SBB] and Immunophenotyping

Results: Total 680 new cases of acute leukemias on initial workup of either gender age were included. Patients of other haematological disorders were excluded from the study. Among 680 new cases of acute leukaemia, 23[3.4%] cases were of MPAL immunophenotyping using scoring system proposed by EGIL [European Group for the Immunological Characterization of Leukemias] classification. Among MPAL, 19[83%] cases were Biphenotypic [13[57%] cases of My/B-ALL, 5[22%] cases of My/T-ALL, and 1[4%] case of T/B-ALL]. 4[17%] cases were Bilineage [My/B-ALL]. Most of the cases were diagnosed at less than 10 years of age

Conclusion: My/B-ALL is the most common immunophenotype followed by My/T-ALL. Therefore immunophenotyping is indispensable for diagnosis and for therapy decisions of MPAL]

Comparative analysis of fluorescence in situ hybridization and real time polymerase chain reaction in diagnosis of chronic myeloid leukemia

Objective: To compare the sensitivity and specificity of fluorescence in situ hybridization [FISH] with real time polymerase chain reaction [RT-PCR] in the diagnosis of Chronic Myeloid Leukemia [CML]

Study Design: A cross-sectional, analytical study

Place and Duration of Study: Haematology Department, Armed Forces Institute of Pathology, Rawalpindi, from January 2012 to February 2014

Methodology: A total number of 87 patients of CML were studied. The diagnosis was made on the basis of clinical history, peripheral blood and bone marrow aspiration. These patients were tested for the presence of BCR-ABL1 fusion gene by RT-PCR and FISH. About 5 ml of venous blood was collected, half was taken in heparin for FISH and half in ethylenediamine tetra-acetic acid [EDTA] for CBC and PCR. For FISH, cells were cultured for 24 hours in RPMI 1640 medium and evaluated using BX51 fluorescence microscope for dual fusion signal of yellow colour. Samples having 20 or more interphases positive for dual fusion signals were taken as positive. For PCR, RNA extraction was done by Tri-Reagent LS [MRC, USA] and cDNA was synthesized using reverse transcriptase and gene specific primer. RT-PCR was done on ABI-7500. The positive samples were identified when fluorescence exceeded threshold limit. Results of RT-PCR and FISH were compared

Results: Out of the 87 patients, 85 [97.7%] were PCR positive and 2 [2.3%] were PCR negative, whereas in FISH 83 [95.4%] were positive and 4 [4.5%] were negative. Sensitivity and specificity of FISH was 97.6% and 100%, respectively

Conclusion: FISH is a reliable supplementary method to PCR for detection of BCR-ABL1 fusion gene in the diagnosis of CML

Detection of temporal bone cholesteatoma by multidetector computed tomography

Objective: To determine the CT patterns of temporal bone cholesteatoma in patients presenting with chronic discharge from ear

Methodology: This was a cross-sectional study conducted at Department of Radiology, Rehman Medical Institute Peshawar from January 2013 to June 2014. 78 patients with chronic discharging ear, who were referred from E.N.T outpatient department, were included in the study. All scans were performed on 128 slice Multidetector Computed tomography [MDCT] scanner.O.Smm reconstructed images in bone window and 3mm images in soft tissue window were viewed on 5.1 vitrea workstation in axial, coronal and sagittal planes. The CT studies were correlated with clinical examination findings, surgical and histopathology. Basic radiologic patterns of cholesteatoma described on CT scan were assessed. The data was processed using Microsoft excel 2007

Results: Cholesteatoma was present in 48 [61%] cases. The disease was bilateral in 7 cases [14 %], 39 [81 %] were unilateral. 25 [52%] were left sided and 14 [29%] right-sided. 24 [30 %] patients were characterized as having otomas-toiditis whereas 7[8%] patients were radiologically difficult to characterize if they were cholesteatoma or not

Conclusion: Cholesteatomas can cause bone erosions and should be detected early. The important role of MDCT lies in the early detection of cholesteatoma, and more conservative surgical procedures can be used to eradicate the disease

Frequency of Gc-globin promoter 158 [C>T] XmnI polymorphism in patients with homozygous/compound heterozygous beta thalassaemia

BACKGROUND: Response to hydroxyurea therapy in homozygous or compound heterozygous beta thalassaemia [BT] has been reported as more favourable in the presence of XmnI polymorphism. The prevalence of XmnI polymorphism may vary with BT phenotypes and genotypes, and differs geographically in distribution. Prevalence of XmnI polymorphism is not known in northern Pakistan. Objective: To determine the frequency of Gc-globin promoter 158 [C>T] XmnI polymorphism [XmnI polymorphism] in patients with homozygous or compound heterozygous beta thalassaemia. MATERIALS: Polymerase chain reaction [PCR] for common beta thalassaemia mutations and Gc-globin promoter 158 [C>T] XmnI polymorphism was performed on 107 blood samples of transfusion dependent beta thalassaemia [BT] patients in Pakistan. One hundred samples of unrelated BT traits and 94 samples of healthy subjects as controls were also analysed for BT mutations and XmnI polymorphism. Results: Out of 301 DNA samples, XmnI polymorphism was detected in 71[24%]; in normal controls, XmnI polymorphism was detected in 34/94 [36%] subjects; while in homozygous/compound heterozygous BT, it was detected in 14/107[13%] patients [Fisher's exact test, p =. 0002]. In heterozygous BT group, XmnI polymorphism was detected in 23/100 subjects [Fisher's exact test, p =. 03 with normal controls, and p =. 049 with homozygous/compound heterozygous BT]. The most common BT genotype was Frame Shift [Fr] 8–9/Fr 8–9, and none of the patients with this genotype had XmnI polymorphism. The second most common genotype was IVSI-5/IVSI-5; 4/26 [15%]. Cases with this genotype had XmnI polymorphism. Conclusion: XmnI polymorphism in homozygous/compound heterozygous BT group is 13%. The most common genotype associated with XmnI polymorphism was IVSI-5/IVSI-5

Efficacy and biochemical evaluation of pharmaceutical optimized felodipine 10 mg [F-7] with essential hypertension

The objective of this double-blind, comparative study evaluating efficacy and biochemical effects of optimized felodipine 10mg [F-7] as monotherapy with comparison to placebo in adult patient with essential hypertension. Double-blind, comparative study. This study was conducted at the Department of Biochemistry, University of Karachi from March 2011 to October 2011. This was multicenter randomized, double-blind, comparative study. Patients were randomized to receive once Felodipine [F-7] daily for 8 weeks and at the end of study efficacy and biochemical evaluation was done. The patients treated with optimized Felodipine 10mg [F-7] alone, blood pressure reduction was lower, although significant; reaching values of 140.2 +/- 11.3 /87.9 +/- 5.5 mmHg [p < 0.05 versus Placebo] by the end of eight weeks of treatment. No significant variation of blood glucose was observed and different parameters of lipid profile were also observed during the eight weeks of treatment with antihypertensive regimen used. Thus, the drug regimens used may be considered neutral as regards glucose and plasma lipid metabolism profile because drug used at low doses. We can suggest that the high antihypertensive efficacy, good tolerability and no biochemical effects of the optimized Felodipine 10mg [F-7] it is an excellent option for the treatment of hypertension in a wide range of hypertensive patients, with a high potential to reduce cardiovascular risks

Reconstruction of hind foot defects; a simplified workable solution

Reconstruction of traumatic as well as non-traumatic hind foot defects is always a challenging task. We share here a simple and practical protocol [working solution] to select the most suitable method for soft tissue coverage of hind foot defects, customizable for every patient. We carried out this study, in our department on 75 cases from March 2009 to May 2012. All cases with wound/defect in hind foot area were included. Majority of cases were traumatic rest included cases of malignancy, Trophic ulcers, infection. Patient's data including age, sex, site of injury, mode of injury, extent of injury [isolated or combined], if combined structures involved, type of wound, management of wound, wound healing time and complications were noted. Once optimal wound conditions were achieved the best possible reconstructive option was selected. The various reconstructive options include VAC therapy, Skin graft, local transposition flap, perforator based flapspedicled faciocutaneous/ muscle flaps, intrinsic foot muscles, Medial plantar artery flap and distant flaps like cross leg flap and micro vascular free flaps. All patients had satisfactory and stable reconstruction. They were ambulating freely by 4-6 weeks post operatively. There were few complications like patchy graft loss, peripheral flap necrosis, flap congestion, but none was serious and did not require repeat surgery. The simplified protocol followed by us is a practical customizable solution for difficult task of hind foot reconstruction. The choice of one or multiple techniques will vary from time to time from one surgeon to another depending upon his or her experience and liking

Analysis of risk factors and demographic pattern of carcinoma breast in Pakistani women and literature review

OBJECTIVE: To analyze the risk factors and demographic pattern of carcinoma breast with literature review among patients reporting in surgical department

STUDY DESIGN: A prospective descriptive study

PLACE AND DURATION: This study was conducted in the Department of surgery PESSI Hospital Islamabad from February 2009 to March 2011

SUBJECTS AND METHODS: Sixty two female patients of all ages presenting with the clinical features of carcinoma breast were included. A questionnaire was filled with information gained in OPD and in wards

RESULTS: Majority of patients [n=26, 41.94%] were from 5 decade. Age varies from 35 years to 80 with mean age of 53.22 +10.23. Age of menarche was 12 to 18 years. Most of women [61.30%, n=38] were postmenopausal with mean postmenopausal period 9.61+7.77 years. Mean age at first pregnancy was 21.24+3.32 years and majority of patients were married [n=61, 98.39%], multiparous [n=60, 96.77%], lactated [n=59, 95.16%], had no family history [n=60, 96.77%] or use of oral contraceptives [n=58, 93.54%]

Duration of symptoms ranged from two months to three years [Mean duration 07.67 + 02.91 months]

Painless lump [n=48, 77.41%], lump with ulceration [n=16, 25.80%], nipple discharge [n=12, 19.35%] and weight loss [n=8, 12.90%] are the commonest presentations among patients

CONCLUSION: Low risk factors are commonly observed in contrast to high risk factors which are rarely observed among our patients in this study and after national literature review. It is concluded that different demographic factors responsible for low or high risk in breast cancer mentioned in literature should be re evaluated in our country

Clinical spectrum of autosomal dominant polycystic kidney disease [ADPKD]

To evaluate the clinical spectrum of autosomal dominant polycystic kidney disease [ADPKD]. Hospital base perspective and retrospective study. This study was conducted in Department of Nephrology Sandeman, Provincial Hospital Quetta, from Nov. 2008 to Dec. 2010. In this study, 50 patients were taken with autosomal dominant polycystic kidney disease diagnosed by abdominal ultrasonography which were evaluated for their clinical spectrum by symptoms, clinical examination, ultrasonography, urine detailed report, urea, creatinine, 24 hours urinary creatinine and also evaluate for the extra-renal manifestation by abdominal utrasonography, gastrointestinal endoscopy and computed tomography [C.T Scan] of brain

Management of 30 cases of malignent skin lesions at the lower eyelid and cheek with cervicofacial flaps

To assess suitability of this flap with respect to defects in this area. Observation study. Department of Plastic Surgery and Burns Bolan Medical College and Complex Hospital Quetta, from January 2003 to December 2009. 30 cases were operated with reconstruction using cervicofacial flaps. Patients were selected through Out Patient Department. Follow up 3 and 6 months. Flaps survival was 100% with partial flaps necrosis a tip of the flaps in 4 cases, with large defects recurrence was observed in five cases. Procedure was found to be suitable with regards to large defect i.e. [4 cm to 6 cm]

Comparison of shoulder function, radial nerve palsy and infection after nailing versus plating in humeral shaft fractures

To compare shoulder function, radial nerve palsy and infection after interlocking nailing with plating of fractures of shaft of humerus during 30 weeks of follow-up. Experimental study. Orthopaedic Wards of Combined Military Hospital, Rawalpindi, from November 2006 to November 2008. Two groups of 30 patients each were inducted. Group A [n=30] was treated with intramedullary interlocking nailing while Group B [n=30] underwent plating with dynamic compression plate [DCP]. Shoulder function using ASES score, radial nerve palsy and infection were observed for 30 weeks. In group A, 11 patients had severe or moderate shoulder dysfunction [ASES score below 39], out of whom 8 [72%] were above 50 years. This age related disability was significant [p=0.003]. Transient palsy was observed in 3 patients [10%] and mild wound infection in 2 [6%], which was not associated with age or open fracture. In group B, only 1 patient had severe shoulder dysfunction, the difference was statistically significant between the two groups [p=0.001], especially in patients above 50 years of age. There was no statistical difference in infection and palsy rates between the two groups. Although nailing and plating are effective treatments for fractures of shaft of humerus, ante-grade nailing may not be suitable in elderly patients, as it can cause significant shoulder dysfunction

Frequency of anti-tuberculous therapy-induced hepatotoxicity in patients and their outcome

Tuberculosis [TB] is a very common droplet infection especially in the northern areas. If untreated, the disease may be fatal within 5 years in more than half of cases. To study the frequency of anti-tuberculous therapy [ATT] induced hepato-toxicity was the subject of the present hospital based descriptive study. The study was conducted in Medical Unit, Ayub Teaching Hospital and patients with diagnosed Tuberculosis in whom ATT was initiated were included in the study. The subsequent development of elevated liver enzyme levels and hepatitis, amongst some members of the study group; was diagnosed, with the help of clinical findings and Liver Function Tests [LFT's] and were dealt with according to severity. Out of the 500 patients studied 277 [55.4%] were male and 223 [44.6%] were female, 203 [40.5%] were in age group 21-35 years, 136 [27.1%] in age group 36-50 years, 141 [28.1%] in age group 51-65 years while 20 [4%] were above 65 years of age. Out of them 40 [8%] developed hepatotoxicity, 21 [4.2%] patients amongst the study group developed overt hepatitis, 20 [4%] of them made an uneventful recovery while 1 [0.2%] died of Fulminant Hepatic Failure [FHF]. ATT-induced hepato-toxicity, was frequently encountered in patients put on ATT