Importance of immature platelet fraction as predictor of immune thrombocytopenic purpura

Background and Objective: Immune thrombocytopenic purpura [ITP] is a clinical syndrome in which a decreased number of circulating platelets [thrombocytopenia] manifests as a bleeding tendency, easy bruising [purpura] or extravasation of blood from capillaries into skin and mucous membranes [petechiae]. The diagnosis of ITP can be made clinically on the basis of symptoms, we need to see if ITP can be confirmed in patients by quantification of residual RNA containing immature platelets [megakaryocytic mass] or immature platelets fraction [IPF] using automated hematology analyzers [Sysmex XE-2100]

Methods: In order to check the efficacy of IPF% parameter of Sysmex XE-2100 a total of 231 patients of thrombocytopenia were included in this study. Complete blood count [CBC] was estimated. The data was statistically analyzed by SPSS version 17

Results: About 62 patients were diagnosed as ITP and 169 patients were diagnosed as non ITP on the basis of clinical history. The mean IPF % value of ITP patients was 16.39% and the IPF % value of Non ITP patients was 7.69% respectively. There was no significant difference in IPF% values with respect to time between sampling and acquisition of complete blood count. The diagnostic sensitivity of IPF% as biomarker for ITP and non-ITP was 85.71% [95% CI: 84.04% to 85.96%] and 41.76% [95% CI: 39.87% to 43.65%]

Conclusion: The mean IPF % value by Sysmex XE-2100 can be used to predict ITP

Vaginal breech delivery; still a safe mode of delivery to reduce the rate of cesarean section

To determine the obstetric and perinatal outcome of pregnancies with singleton breech presentation, and to scrutinize the causes of increasing incidence of cesarean section in breech presentation. Analytical Observational study. Department of obstetrics and gynecology Fatima hospital Baqai university campus from Jan 2010 to Oct 2011. This study includes 135 patients with singleton breech presentation >/= 34 weeks of gestation, were analyzed in detail with help of designed Performa. Patients were categorized in three groups. Groups a, who had elective C-section, group b. who underwent emergency caesarean section or had C-section after failed trial of vaginal delivery and group c. who had vaginal breech delivery. Elective caesarean section was done in those cases that had some other indications for carrying out this procedure apart from breech presentation. Trial of vaginal breech delivery was planned for all multiparous women except those falling in group A. All antepartum fetal demise, twin pregnancies and placenta previa of major degree were excluded. Of 135 women, 7[5%] underwent prelabour cesarean, and 128[95%], had trial of vaginal delivery, of whom 117[91.5%] delivered vaginally. Significantly more infants weighing> 3.5kg were selected for prelabour and intrapartum cesarean than vaginal delivery. Two neonates had Apgar score< 7 at 5 minutes but both were normal neurologically. There were no nonanomalous perinatal death and no case of significant trauma or neurological dysfunction. Two infants died due to lethal anomalies. Trial of vaginal breech delivery in well counselled patients, still taken as an appropriate option without compromising prenatal and maternal outcome. It also decreases the rate of cesarean section

Facial abuse of topical steroids and fairness creams: a clinical study of 200 patients

To estimate the magnitude of problem with reference to social demography, motivation and to record adverse effects of topical steroids [TCs] and fairness creams abuse on face. This study was conducted at Dermatology Department of Nawaz Sharif Social Security Teaching Hospital affiliated with University of Lahore. Patients with steroidal rosacea reporting to the investigator were asked about their current use of topical steroids and fairness creams and observations recorded. Out of 200 patients studied 152 [76%] were females and 48 [24%] males, the majority belonging to low income group from urban area. Sixty six [33%] patients used potent TCs, 100 [50%] patients used TCs in combination with various fairness creams and 34 [17%] patients used fairness creams exclusively. The main indications for these creams, in order of preference were acne, improving dark complexion and melasma. Patients were ignorant of the ingredients and the adverse effects of TCs versus fairness creams among abusers were comparable. Unwarranted cosmetic use of TCs with or without fairness creams is quite common in facial dermatoses resulting in steroidal dermatitis resembling rosacea.

Diagnostic yield of D-dimer in pulmonary embolism

To determine the diagnostic yield of D-dimer in combination with multi-detector computed tomography [MDCT] in patients with clinical symptoms and signs of acute pulmonary embolism. Cross sectional observational study. This study was carried out in Radiology Department Rashid Hospital Dubai UAE, from October 2011 to September 2012. In patients with clinical symptoms and signs of acute pulmonary embolism, D-dimer and MDCT were performed. Pulmonary angiography was performed to compare the results. For descriptive purpose the patients were divided into four groups. The sensitivity, specificity, false positive rate, false negative rate, positive predictive value and negative predictive value were calculated. There were total of 151 patients of whom 97 [64.2%] were males and 54 [35.8%] females. The mean age of the patients was 47.26 +/- 16.16 year. Shortness of breath was noted in 104 [68.9%, p = 0.000], chest pain in 88 [58.3%, p = 0.042] and cyanosis in 57 [37.7%, p= 0.061] patients. The D-dimer test was positive in 80 [53.0%] patients while CT angiogram in 56 [37.1%] patients. In 52 patients both D-dimer and MDCT angiogram were positive, while 65 patients had normal D-dimer and CT angiogram. The sensitivity of D-dimer in combination with CT angiogram was 92.85%, specificity 68.42%, false positive rate 31.57%, false negative rate 7.14%, positive predictive value 63.41%, negative predictive value 94.20% and accuracy 77.48%. D-dimer is an easy, non-invasive, safe, efficient and cost effective method of diagnosis in clinically suspected cases of pulmonary embolism

Evaluation of efficacy of various immunochromatographic rapid tests for dengue diagnosis

The immunochromatographic rapid tests facilitate the early diagnosis of dengue by providing evidence of the presence of virus specific proteins [antigens/ antibody] in human blood. Many products for rapid dengue diagnosis are available in the market; the performance of few selected products was evaluated and compared with enzyme linked immuno sorbent assays [ELISA]. Sera from a large number of patients [n=184] admitted to National Institute of Blood Diseases and Bone Marrow Transplantation [NIBD] were used to determine the efficiency of non-structural [NS] 1, IgA, IgG and IgM based rapid test devices for dengue diagnosis. The dengue NS1 antigen based device was least efficient while among the antibody based devices the dengue IgA rapid test [RDT] was comparatively better [specificity: 80.95%; sensitivity: 85.21%]. This device could detect both primary and secondary dengue infection and was found to be the most sensitive device at all point of sample collection. The dengue IgA RDT could be a cost effective and efficient rapid test device for timely dengue diagnosis at all levels of healthcare settings

functional ectopic vaginal anus: a rare clinical entity

A case of functional ectopic vaginal anus is presented in a 20 years old girl. Patient complained of passage of stool through her vagina. She was continent and had no complaint of constipation. Her examination revealed imperforated anus with functional ectopic vaginal anus. Her surgery was performed in two stages. In first stage, anoplasty was performed at midpoint between the vulval and anal opening. The posterior vaginal wall was repaired in two layers and protective loop colostomy was made. In the second stage, after a period of 3 months loop colostomy was closed. Patient's recovery was smooth, she is not constipated and continent with Wexner score of 3. She was advised pelvic floor rehabilitation exercises. She improved within a month with Wexner score of zero

Missed intrauterine contraceptive device presenting as urinary bladder stone

Presence of foreign body in urinary bladder is an uncommon condition. It often causes difficulty in diagnosis. A multiparous woman with history of intrauterine contraceptive device [copper T loop] placed two year back presented with urinary frequency, urgency, dysuria and suprapubic pain on frequent occasions. Investigation revealed a urinary bladder calculus encrusted upon displaced copper T loop. Cutaneous cystolithotomy was performed along with tubal ligation. Postoperative recovery was uneventful.

Herpes zoster: seasonal variations and morphological patterns in Pakistan

To determine the relevance of seasonal variations and pattern of herpes zoster among the labor community in Lahore. This observational, cross sectional study was conducted at Nawaz Sharif Social Security Teaching Hospital from June, 2009 to May, 2010. Entitled patients that included the industrial labour and their dependents who were clinically diagnosed to be suffering from Herpes zoster during the above mentioned period were included in the study. All the findings were recorded on a pre-designed pro forma. Fifty two enrolled patients constituted 0.46 per cent of overall OPD patients, with male to female ratio of 2:1 and the mean age at presentation was 47 years. Average duration of symptoms at presentation in Herpes zoster ophthalmicus [HZO] was 4.5 days while in remaining cases it was 5.6 days. The surge of the cases was noted with onset of summer and most common dermatomes involved were thoracic followed by ophthalmic division of trigeminal nerve. There is a relationship between Herpes zoster and seasonal variations which seems to be different from temperate climate of western countries

Huge ovarian cyst

A 24 year old female presented with complaint of abdominal distension, difficulty in breathing and restlessness. Ultra-sonographic examination revealed that there was a huge cystic collection with internal debris, multiple septation involving whole abdomen and pelvis, originating from left ovary. Her laparotomy was done; a huge ovarian cyst of about 25x30 cm was removed. Post-operative recovery was smooth. Histopathological examination revealed that it was mucinous cyst adenoma. The purpose of this case presentation to report one of the huge ovarian cysts from our Centre and to highlight the diagnostic finding

Comparison of unfractionated heparin vs low molecular weight heparin in the treatment of acute deep vein thrombosis

To compare the results of unfractionated heparin [UFH] with low molecular weight heparin in the treatment of acute deep vein thrombosis of lower limb. Randomized control trial. Bolan Medical Complex Hospital, Quetta from January 2002 to July 2003. Thirty patients who presented with acute deep vein thrombosis of lower limb, confirmed by either Doppler ultrasonography or venography, were selected for the study. Patients were divided randomly into two groups for treatment. Group 1 was started with unfractionated heparin while group 2 with low molecular weight heparin. Comparison of two treatments to determine the efficacy was done by certain criteria like pain improvement, reduction in swelling, alteration in bleeding profile, complications of therapy, recurrence, morbidity and mortality. The age of the patients ranged from 16-82 years. There were 15 females [50.00%] and 15 males [50.00%]. Pain and swelling were present in all patients [100%], while temperature and superficial vein dilation in 43.3% and 30% respectively. The distribution of DVT in left lower limb was in 13 patients [43.33%], right lower limb involvement in 12 patients [40.00%] and both limbs involvement in 5 patients [16.67%]. In group 1 improvement in pain occurred after 4th day in 13 patients, while in group 2 before 4th day in 8 patients [p-value=0.068]. Improvement in swelling was observed after 6th day in 11 patients [group 1], while before 6th day in 8 patients [group 2] [p-value=0.171]. Bleeding time was prolonged in 5 patients in group1and statistically found significant [p-value=0.014], while in group 2 it was normal. Thromboembolism in 3 patients and major bleeding was observed in 2 patients in group 1, while in group 2 it was normal. Recurrence was reported in 2 patients in group 1 and 1 patient in group 2 [p-value 0.0815]. The hospital stay was more than 10 days in group1 [12 patients], and less than 10 days in group 2 [13 patients]. It was found statistically significant [p-value=0.001]. Three patients died in group 1, while no mortality was observed in group 2. Treatment with low melecular weight heparin [LMWH] has good patient compliance and is easy to administer. LMWH has an advantage over UFH due to its normal bleeding profile and significantly less hospital stay

Diagnostic yield of color doppler ultrasonography in deep vein thrombosis

To see the diagnostic yield of color Doppler ultrasonography in patients who presented with clinical symptoms and signs of acute deep vein thrombosis of lower limb. Descriptive study. The study was carried out in Bolan Medical Complex Hospital, Quetta from January 2002 to December 2002. Twenty five patients, who presented with clinical symptoms and signs of acute deep venous thrombosis of lower limb, were selected. In all patients color Doppler ultrasound and venography was performed to compare the results. The age of the patients ranged from 16-82 +/- 20.33 years. The mean was 49.16, median 50.00 and mode 60.00 There were 15 females [60.00%] and 10 males [40.00%]. Left lower limb involvement was seen in 12 patients [48.00% +/- 0.51], right lower limb involvement in 10 patients [40.00% +/- 0.50] and both limbs involvement in 3.0 patients [12.00% +/- 0.33]. Color Doppler ultrasound was positive in 16 patients [64.00% +/- 0.48] while venography was positive in 21 patients [84.00% +/- 0.37%]. Doppler ultrasonography and venography showed that 11 patients [52.38%] had distal DVT, while 10 patients [47.62%] had distal as well as proximal DVT. Ten patients [100.00%] of proximal as well as distal DVT were diagnosed by CDU and later confirmed by venography. Eleven patients [100.00%] of distal DVT only in whom 6 patients [54.54%] were diagnosed by CDU, while 5 patients [45.46%] had inconclusive findings, which were confirmed by venography. Doppler ultrasonography compared venography showed sensitivity 76.1%, specificity 100%, positive predictive value 100%, negative predictive value 44.45% and accuracy 80.00%. Color Doppler ultrasonography is a non-invasive, safe, efficient and cost-effective method in diagnosing acute deep venous thrombosis of lower limb but still it has not 100% accuracy. It is better for diagnosing proximal DVT than distal DVT. 7