Cytogenetic abnormalities in patients with hematological malignancies in Lahore city, Pakistan / Anormalidades citogenéticas em pacientes com neoplasias hematológicas na cidade de Lahore, Paquistão

Hematological and hematopoietic cells malignancies of the genes and hematopoietic cells are associated with the genetic mutation, often at the chromosomal level. The standard cytogenetic study is widely accepted as one of the main diagnostics and prognostic determinants in patients. Therefore, the current descriptive and cross sectional study sought to determine the cytogenetic analysis of frequent hematological malignancies in Pakistan. A total of 202 peripheral bone marrow or blood samples from patients with benign and malignant hematological malignancy were taken using a conventional G-banding technique. Among enrolled patients, the mean age was 21.5 years ± 23.4, and gender-wise distribution showed a marked predominance of the male 147 (73%) population compared to the female 55 (27%). Patients in the age group (2-10 years) had the highest frequency, 48 (24%), of hematological neoplasms, followed by age (11-20 years) with 40 (20%). Normal karyotypes (46, XX/46, XY) was found in 51% (n=103) patients. Furthermore, the frequency of complex karyotype was 30 (15%), while normal was seen in 171 (85%) patients. Pre-B Acute Lymphoblastic Leukemia (Pre-B ALL) was the most prevalent malignancy of 66 (33%), followed by Chronic Myelogenous Leukemia (CML) of 41 (20%) and Acute Lymphocytic Leukemia of 29 (14%). Translocation was the most prevalent 50 (25%), followed by hypotriploidy 14 (7%) and monosomy 8 (4%) on chromosome aberration analysis. In addition, t(9:22) translocation was found to be 20 (10%) in CML, with the majority in the age group (31-40 years). This study recommends that karyotyping should be tested frequently in hematological conditions because it may provide insight into the relative chromosomal changes associated with particular malignancies.

As neoplasias hematológicas e de células hematopoiéticas dos genes e as células hematopoiéticas estão associadas à mutação genética, geralmente em nível cromossômico. O estudo citogenético padrão é amplamente aceito como um dos principais determinantes diagnósticos e prognósticos em pacientes. Portanto, o presente estudo descritivo e transversal buscou determinar a análise citogenética de neoplasias hematológicas frequentes no Paquistão. Um total de 202 amostras de medula óssea periférica ou sangue de pacientes com malignidade hematológica benigna e maligna foi coletado usando uma técnica convencional de banda G. Entre os pacientes inscritos, a média de idade foi de 21,5 anos ± 23,4, e a distribuição por gênero mostrou uma marcada predominância da população masculina de 147 (73%) em comparação com a feminina de 55 (27%). Pacientes na faixa etária (2-10 anos) tiveram a maior frequência, 48 (24%), de neoplasias hematológicas, seguida da idade (11-20 anos) com 40 (20%). Cariótipos normais (46, XX / 46, XY) foram encontrados em 51% (n = 103) dos pacientes. Além disso, a frequência de cariótipo complexo foi de 30 (15%), enquanto normal foi observada em 171 (85%) pacientes. Leucemia linfoblástica aguda pré-B (LLA Pré-B) foi a doença maligna mais prevalente de 66 (33%), seguida por leucemia mieloide crônica (LMC) de 41 (20%) e leucemia linfocítica aguda de 29 (14%). A translocação foi o 50 mais prevalente (25%), seguido por hipotriploidia 14 (7%) e monossomia 8 (4%) na análise de aberração cromossômica. Além disso, a translocação t (9:22) encontrada foi de 20 (10%) na LMC, com a maioria na faixa etária (31-40 anos). Este estudo recomenda que o cariótipo deve ser testado com frequência em condições hematológicas porque pode fornecer informações sobre as alterações cromossômicas relativas associadas a doenças malignas específicas.

Cytogenetic abnormalities in patients with hematological malignancies in Lahore city, Pakistan

Abstract Hematological and hematopoietic cells malignancies of the genes and hematopoietic cells are associated with the genetic mutation, often at the chromosomal level. The standard cytogenetic study is widely accepted as one of the main diagnostics and prognostic determinants in patients. Therefore, the current descriptive and cross-sectional study sought to determine the cytogenetic analysis of frequent hematological malignancies in Pakistan. A total of 202 peripheral bone marrow or blood samples from patients with benign and malignant hematological malignancy were taken using a conventional G-banding technique. Among enrolled patients, the mean age was 21.5 years ± 23.4, and gender-wise distribution showed a marked predominance of the male 147 (73%) population compared to the female 55 (27%). Patients in the age group (2-10 years) had the highest frequency, 48 (24%), of hematological neoplasms, followed by age (11-20 years) with 40 (20%). Normal karyotypes (46, XX/46, XY) was found in 51% (n=103) patients. Furthermore, the frequency of complex karyotype was 30 (15%), while normal was seen in 171 (85%) patients. Pre-B Acute Lymphoblastic Leukemia (Pre-B ALL) was the most prevalent malignancy of 66 (33%), followed by Chronic Myelogenous Leukemia (CML) of 41 (20%) and Acute Lymphocytic Leukemia of 29 (14%). Translocation was the most prevalent 50 (25%), followed by hypotriploidy 14 (7%) and monosomy 8 (4%) on chromosome aberration analysis. In addition, t(9:22) translocation was found to be 20 (10%) in CML, with the majority in the age group (31-40 years). This study recommends that karyotyping should be tested frequently in hematological conditions because it may provide insight into the relative chromosomal changes associated with particular malignancies.

Resumo As neoplasias hematológicas e de células hematopoiéticas dos genes e as células hematopoiéticas estão associadas à mutação genética, geralmente em nível cromossômico. O estudo citogenético padrão é amplamente aceito como um dos principais determinantes diagnósticos e prognósticos em pacientes. Portanto, o presente estudo descritivo e transversal buscou determinar a análise citogenética de neoplasias hematológicas frequentes no Paquistão. Um total de 202 amostras de medula óssea periférica ou sangue de pacientes com malignidade hematológica benigna e maligna foi coletado usando uma técnica convencional de banda G. Entre os pacientes inscritos, a média de idade foi de 21,5 anos ± 23,4, e a distribuição por gênero mostrou uma marcada predominância da população masculina de 147 (73%) em comparação com a feminina de 55 (27%). Pacientes na faixa etária (2-10 anos) tiveram a maior frequência, 48 (24%), de neoplasias hematológicas, seguida da idade (11-20 anos) com 40 (20%). Cariótipos normais (46, XX / 46, XY) foram encontrados em 51% (n = 103) dos pacientes. Além disso, a frequência de cariótipo complexo foi de 30 (15%), enquanto normal foi observada em 171 (85%) pacientes. Leucemia linfoblástica aguda pré-B (LLA Pré-B) foi a doença maligna mais prevalente de 66 (33%), seguida por leucemia mieloide crônica (LMC) de 41 (20%) e leucemia linfocítica aguda de 29 (14%). A translocação foi o 50 mais prevalente (25%), seguido por hipotriploidia 14 (7%) e monossomia 8 (4%) na análise de aberração cromossômica. Além disso, a translocação t (9:22) encontrada foi de 20 (10%) na LMC, com a maioria na faixa etária (31-40 anos). Este estudo recomenda que o cariótipo deve ser testado com frequência em condições hematológicas porque pode fornecer informações sobre as alterações cromossômicas relativas associadas a doenças malignas específicas.

Cytogenetic abnormalities in patients with hematological malignancies in Lahore city, Pakistan / Anormalidades citogenéticas em pacientes com neoplasias hematológicas na cidade de Lahore, Paquistão

Abstract Hematological and hematopoietic cells malignancies of the genes and hematopoietic cells are associated with the genetic mutation, often at the chromosomal level. The standard cytogenetic study is widely accepted as one of the main diagnostics and prognostic determinants in patients. Therefore, the current descriptive and cross-sectional study sought to determine the cytogenetic analysis of frequent hematological malignancies in Pakistan. A total of 202 peripheral bone marrow or blood samples from patients with benign and malignant hematological malignancy were taken using a conventional G-banding technique. Among enrolled patients, the mean age was 21.5 years ± 23.4, and gender-wise distribution showed a marked predominance of the male 147 (73%) population compared to the female 55 (27%). Patients in the age group (2-10 years) had the highest frequency, 48 (24%), of hematological neoplasms, followed by age (11-20 years) with 40 (20%). Normal karyotypes (46, XX/46, XY) was found in 51% (n=103) patients. Furthermore, the frequency of complex karyotype was 30 (15%), while normal was seen in 171 (85%) patients. Pre-B Acute Lymphoblastic Leukemia (Pre-B ALL) was the most prevalent malignancy of 66 (33%), followed by Chronic Myelogenous Leukemia (CML) of 41 (20%) and Acute Lymphocytic Leukemia of 29 (14%). Translocation was the most prevalent 50 (25%), followed by hypotriploidy 14 (7%) and monosomy 8 (4%) on chromosome aberration analysis. In addition, t(9:22) translocation was found to be 20 (10%) in CML, with the majority in the age group (31-40 years). This study recommends that karyotyping should be tested frequently in hematological conditions because it may provide insight into the relative chromosomal changes associated with particular malignancies.

Resumo As neoplasias hematológicas e de células hematopoiéticas dos genes e as células hematopoiéticas estão associadas à mutação genética, geralmente em nível cromossômico. O estudo citogenético padrão é amplamente aceito como um dos principais determinantes diagnósticos e prognósticos em pacientes. Portanto, o presente estudo descritivo e transversal buscou determinar a análise citogenética de neoplasias hematológicas frequentes no Paquistão. Um total de 202 amostras de medula óssea periférica ou sangue de pacientes com malignidade hematológica benigna e maligna foi coletado usando uma técnica convencional de banda G. Entre os pacientes inscritos, a média de idade foi de 21,5 anos ± 23,4, e a distribuição por gênero mostrou uma marcada predominância da população masculina de 147 (73%) em comparação com a feminina de 55 (27%). Pacientes na faixa etária (2-10 anos) tiveram a maior frequência, 48 (24%), de neoplasias hematológicas, seguida da idade (11-20 anos) com 40 (20%). Cariótipos normais (46, XX / 46, XY) foram encontrados em 51% (n = 103) dos pacientes. Além disso, a frequência de cariótipo complexo foi de 30 (15%), enquanto normal foi observada em 171 (85%) pacientes. Leucemia linfoblástica aguda pré-B (LLA Pré-B) foi a doença maligna mais prevalente de 66 (33%), seguida por leucemia mieloide crônica (LMC) de 41 (20%) e leucemia linfocítica aguda de 29 (14%). A translocação foi o 50 mais prevalente (25%), seguido por hipotriploidia 14 (7%) e monossomia 8 (4%) na análise de aberração cromossômica. Além disso, a translocação t (9:22) encontrada foi de 20 (10%) na LMC, com a maioria na faixa etária (31-40 anos). Este estudo recomenda que o cariótipo deve ser testado com frequência em condições hematológicas porque pode fornecer informações sobre as alterações cromossômicas relativas associadas a doenças malignas específicas.

Assessment of Qualitative and Quantitative Changes in 5 days stored Platelet Concentrates in Bangabandhu Sheikh Mujib Medical University

Background: The fast-growing demand for platelet concentrates (PC) necessitates the storage of these blood products before transfusion. Platelets are prepared as concentrates from the whole blood or by plateletpheresis. Qualitative and quantitative assessment of these PCs is an important issue in transfusion medicine. To assess the qualitative, quantitative changes and bacteriological safety of 5 days of stored platelet concentrates (PC).Material & Methods:This prospective study was conducted at the department of Clinical Pathology in collaboration with the Department of Transfusion Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from April 2008 to April 2009. A total of 65 healthy donors were included in the study as per the inclusion and exclusion criteria. Therefore, 65 platelet concentrates (bags/units) were prepared from the donors. Purposive sampling of the units was done. pH and platelet indices (PLT, MPV, PDW and P-LCR) were measured and Gram staining of PCs was performed on days 0 and 5. Statistical significant tests were done at a 95% confidence interval using the statistical package for social science (SPSS).Results:The mean (±SD) pH was 7.18±0.07 ranging from 7.0 to 7.3 during day 0. On day 5 the mean (±SD) pH was 6.77±0.11 and their range was from 6.5 to 7. The mean pH difference was statistically significant (p<0.05) between day 0 and day 5. The mean (±SD) PLT/unit was 70.56±15.56 x109/unit and it ranged from 38.01 to 110.6 x109/unit during day 0. On day 5 the mean (±SD) PLT/unit level was 68.46±15.52 x109/unit and it ranged from 36.82 to 107.2 x109/unit. The mean PLT/unit difference was statistically significant (p<0.05) between day 0 and day 5. The mean (±SD) MPV was 9.34±0.92 fl and it ranged from 7.5 to 11.5 fl during day 0. During day 5 the mean (±SD) MPV was 9.27±0.99 fl ranging from 7.0 to 11.2 fl. The mean (±SD) PDW was 10.07±1.61 fl and which ranged from 7.4 to 14.4 fl during day 0. During day 5 the mean (±SD) PDW was 10.72±1.71 fl ranging from 7.0 to 15.4 fl. The mean (±SD) PLCR was 18.28±5.67 % and it ranged from 8.0 to 32.5 % during day 0. During day 5 the mean (±SD) PLCR was 21.18±5.91 % and it ranged from 10.0 to 36.3 %. The mean PLT, PDW and PLCR differences were statistically significant (p<0.05) between day 0 and day 5 in the unpaired t-test, however, the mean MPV difference was not statistically significant (p<0.05) between day 0 and day 5. Gram staining of platelet concentrates on day 0 and day 5 found no bacteria.Conclusions:Storage-induced lesions take place in PCs when stored for 5 days in second-generation storage containers under the currently recommended conditions, but how far these changes are clinically relevant needs to be investigated.

Surgical Outcome of Decompressive Craniectomy in Traumatic Brain Injury: A study in a tertiary care hospital of Bangladesh

Background: Head injury is one of the most important causes of death caused by trauma. Decompressive craniectomy is said to be the best way to reduce otherwise intractable intracranial pressure and its complications in traumatic brain injury. But we have not enough information regarding the outcomes and effectiveness of decompressive craniectomy in traumatic brain injury. The aim of this study was to assess the outcomes and effectiveness of decompressive craniectomyin in traumatic brain injury.Material & Methods:This prospective observational study was conducted in Khwaja Yunus Ali Medical College and Hospital, Sirajganj and TMSS Medical College & Hospital, Bogura, Bangladesh in collaboration with the Department of Neurosurgery during the period from July 2018 to December 2021. In total 32 patients with severe traumatic brain injury diagnosed and treated in the above-mentioned hospitals were recruited as the samples for this study. The outcomes of the patients evaluated by the Glasgow Coma Scale (on which scores range from 3 to 15, with lower scores indicating reduced levels of consciousness). All patient data were collected, processed, analyzed as well as disseminated by using MS Office 2019 and SPSS version 23 programs as per the necessity.Results:In analyzing the duration of hospitalization we observed, the mean (±SD) days of mechanical ventilation, days of ICU staying and days of hospitalization were 8.88 ± 2.54, 10.21 ± 3.16 and 15.57 ± 4.51 days respectively. Finally, the mean (±SD) Extended Glasgow Outcome Scale score of all the patients was found as 9.1. On the other hand, the unfavorable Extended Glasgow Outcome Scale score (1 to 4) was found in 56% patients. In this study, finally death cases were found 22%.Conclusion:Decompressive craniectomy ensures better outcome in term of survival but the limitation is quality of life issues after survival especially among poor GCS (3-6) group. Prompt hospitalization, early diagnosis and proper ICU and ventilation facilities can ensure more satisfactory outcomes for the patients with traumatic brain injury.

Assessment of Qualitative and Quantitative Changes in 5 days stored Platelet Concentrates in a tertiary care Hospital of Bangladesh

Background: The fast growing demand for platelet concentrates (PC) necessitates the storage of these blood products prior to transfusion. Platelets are prepared as concentrates from the whole blood or by plateletpheresis. Qualitative and quantitative assessment of these PCs are an important issue in transfusion medicine. Aim of the study: To assess the qualitative, quantitative changes and bacteriological safety of 5 days stored platelet concentrates (PC).Material & Methods:This prospective study was conducted at the department of Clinical Pathology in collaboration with the department of Transfusion medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka during April 2008 to April 2009. A total of 65 healthy donors were included for the study as per the inclusion and exclusion criteria. Therefore, 65 platelet concentrates (bags/units) were prepared from the donors. Purposive sampling of the units was done. pH and platelet indices (PLT, MPV, PDW and P-LCR) were measured and Gram staining of PCs were performed on day 0 and 5. Statistical significant tests were done at 95% confidence interval using statistical package for social science (SPSS).Results:The mean (±SD) pH was 7.18±0.07 ranging from 7.0 to 7.3 during day 0. During day 5 the mean (±SD) pH was 6.77±0.11 and their range was from 6.5 to 7. The mean pH difference was statistically significant (p<0.05) between day 0 and day 5. The mean (±SD) PLT/unit was 70.56±15.56 x109/unit and it ranged from 38.01 to 110.6 x109/unit during day 0. During day 5 the mean (±SD) PLT/unit level was 68.46±15.52 x109/unit and it ranged from 36.82 to 107.2 x109/unit. The mean PLT/unit difference was statistically significant (p<0.05) between day 0 and day 5. The mean (±SD) MPV was 9.34±0.92 fl and it ranged from 7.5 to 11.5 fl during day 0. During day 5 the mean (±SD) MPV was 9.27±0.99 fl ranging from 7.0 to 11.2 fl. The mean (±SD) PDW was 10.07±1.61 fl and which ranged from 7.4 to 14.4 fl during day 0. During day 5 the mean (±SD) PDW was 10.72±1.71 fl ranging from 7.0 to 15.4 fl. The mean (±SD) PLCR was 18.28±5.67 % and it ranged from 8.0 to 32.5 % during day 0. During day 5 the mean (±SD) PLCR was 21.18±5.91 % and it ranged from 10.0 to 36.3 %. The mean PLT, PDW and PLCR difference were statistically significant (p<0.05) between day 0 and day 5 in unpaired t-test, however the mean MPV difference was not statistically significant (p<0.05) between day 0 and day 5. Gram staining of platelet concentrates on day 0 and day 5 found no bacteria.Conclusions:Storage-induced lesions take place in PCs, when stored for 5 days in second generation storage containers under the currently recommended conditions, but how far these change are clinically relevant need to be investigated

Use of Red Cell Distribution Width Index for Screening and Differentiation of Iron Deficiency Anemia and Beta Thalassemia Trait

Background: Iron deficiency anemia (IDA) is one of the common nutritional disorders in the world. In the subcontinent Microcytic hypochromic anemia is usually caused by beta thalassemia trait (BTT) and iron deficiency anemia (IDA). IDA may be confused with BTT. It is important to distinguish between the above conditions to avoid unnecessary iron therapy in thalassemia carriers. Red cell distribution width index (RDWI) are a simple, easy, and cost effective method to get a primary and valuable information regarding the diagnosis of IDA and BTT. Objective: To assess the predictive value of Red cell distribution width index (RDWI)) for differentiation of Iron Deficiency Anaemia and Beta Thalassaemia Trait.Material & Methods:The study was a cross-sectional descriptive study which was conducted in Department of Clinical Pathology, Bangladesh Shishu Hospital and Institute, Dhaka, Bangladesh. Over a period of April 2019 to September 2020. The newly clinically diagnosed cases of BTT and IDA were selected for this study. The sample size was 110. Among them 46 cases were identified as BTT and 64 were IDA. Data were analysed using a computer programme SPSS 25.0 version.Results:Total 110 respondents were included in the study. Among them 46.4% were female and 53.6% were male. About 72.72 % of respondents were aged 1 to 10 years old, while 10% were aged 11 to 20 years old and 10% were aged 21 to 30 years old. 4.54 % were between the ages of 31 to 40, as well as those over 40. The average age (SD) was 22.0 � 32.52. Mean (盨D) age was 22.0 � 32.52. RDWI had both sensitivity and specificity more than 80% in detection of BTT and IDA. Sensitivity, specificity of RDWI index for detection of BTT was found 81.0%, 83.8%. In case of IDA, sensitivity and specificity was found 83.8% and 81.0% respectively.Conclusions:The current study found that multiple discriminants can be used to differentiate between iron deficiency anemia and the Beta Thalassaemia Trait. RDWI could be a better way to tell the difference between BTT and IDA.

Pattern of Cytogenetic Abnormality by Fluorescence in Situ Hybridization (FISH) in Multiple Myeloma Patients in a Tertiary Hospital

Background: Multiple myeloma is a plasma cell neoplasm with acquired genetic abnormalities of clinical and prognostic importance, with survival duration ranging from a few months to more than 10 years. Cytogenetic abnormalities (CA) detected by fluorescence in situ hybridization (FISH) are of major prognostic significance since e.g. patients with del(17p), t(4;14) or gain 1q21 show dismal outcome. Objective: To evaluate the cytogenetic patterns by fluorescence in situ hybridization (FISH) of clinically diagnosed cases of multiple myeloma.Methods:This cross-sectional study was conducted in Department of Haematology, Dhaka Medical College Hospital, Dhaka, from January 2018 to December 2018. A total number of 30 patients with multiple myeloma were analyzed cytogenetically by interphase fluorescence in situ hybridization (iFISH). The collected data were analyzed by using the Statistical Package for Social Science (SPSS-24) for windows version 10.0.Results:Out of 30 diagnosed Multiple Myeloma cases the mean age was 56.37�.38 years and male to female ratio was almost 3:1. Sixteen (56.7%) of 30 patients. Among 30 cases of 8 cases were thyrogenicity positive of 7(23.3%) patients was detected del 13q positive. Isolated del 13q was found in 4 cases. 2 cases were found coexistence of del 13q and del 17p positive ;1 case was found coexistence of del 13q and t(4;14) positive and rest of 1 case had del 17 p positive. There was no detectable t (11; 14) and t(14;16) in any of 30 cases.Conclusion:FISH panel for Multiple Myeloma including del (13q); t(11;14); t(4;14), del(17p), t(14;16) is very important molecular test for the prognosis , risk stratification, treatment modality of the patient. On the basis of cytogenetic abnormality Multiple Myeloma risk stratification is modified now a day. This Revised International Staging system R-ISS is a simple and powerful prognostic staging system.

Impact of Low-Intensity Exercise on Liver Enzymes and Antioxidants Systems of the Body

Background: Liver is the most important organ performing more than 500 functions in the body. In addition, the human cell has a natural antioxidants system which maintains the production of antioxidants and reactive oxygen species (ROS) during the metabolic process of the cell. Objective: This particular research study is basically conducted for the purpose to assess the impact of low-intensity exercise on liver enzymes and antioxidants systems of the body. Methods and materials: Total 40 subjects (20 from low-intensity exercise as an experimental group and 20 subjects as a control group) were included as the participants of the study. For assessment of liver functions and redox state of the body, 5 ml blood was collected from all subjects. Liver functions tests (LFTs) were performed for the assessment of liver enzymes and ferric reducing assay protocols (FRAP) was performed for the assessment of the redox state of the body. The data obtained about liver functions and redox state were processed through statistical package for social sciences (SPSS) version 23 and thus different statistical tools i.e. mean, standard deviation and T-score were used for the analysis of data. Results: Data analysis reveals that; no significant effect was found on liver enzymes as well as on antioxidants system of the body. Conclusion: On the basis of findings the researcher concluded that low-intensity exercise has no significant effects on liver enzymes. In addition, it was also concluded that low-intensity exercise helps in the improvement of blood life quality by reducing various health problems related to oxidative damages of cells and muscles fatigue.

Exercise is more important than Medicines: A Clinical Approach

Promotion, as well as maintenance of health, is directly associated with exercise and good dietary habits. Lack of exercise and good dietary habits adversely affect health, therefore this study was conducted to assess the perception of patients regarding the effectiveness of exercise and medicine in the maintenance of health. Total of 30 patients of different diseases (heart diseases, hypertension, and obesity) was voluntarily taken as a sample of the study. For the collection of data, a questionnaire was developed; collected data were analyzed by applying Student’s t-test using SPSS version 21.0. Heart problems, hypertension, and obesity all are the chronic health problems and the majority of the respondents opined that the impact of performing various kinds of exercise along with medicine for reducing these chronic health problems was significant (p=0.004). On the basis of findings, the researcher concluded that exercise is the sister art of medicine which plays a significant role in preventing different health problems such as heart diseases, hypertension, and obesity.

Evaluation of ocular injuries associated with mid-facial trauma

The aim of this study was to evaluate frequency, etiology and association of ocular injuries with fractures in the middle third region of face. 129 patients with mid-face fracture were included in the study. An elaborated history was taken regarding trauma, followed by assessment of patients clinically and characteristics of fracture and associated ocular injuries noted. Out of 129 in total 52 patients [40.3%] sustained ocular injuries. Frequencies for gender involvement were 38[73.1%] male and 14 [26.9%] female patients. The most common etiology associated was Road Traffic Accident [RTA] 25 [48.1%] followed by Assault 11[21.2%], Fall 8 [15.4%], sports injury 5 [9.6%] and Firearm injury [FAI] 3[5.8%]. Subconjuctival Hemorrhage [71.15%] was the most common ocular injury found to be associated with mid facial fracture in this study. Other ocular complication found in these patients were Diploipa [19.23%], decreased visual acuity [17.3%], Enophthalmous [9.61%], Hyphema [5.76%] and blindness as 3.85%

Negative repercussions of caregiving burden: poor psychological well-being and depression

Objectives: To compare depression and psychological well-being between caregivers of schizophrenic patients and non-caregivers and to study the burden of caregiving as a relative risk for depression and psychological well-being

Methods: This cross sectional comparative study was conducted at International Islamic university Islamabad from January to September 2017. Fifty informal caregivers of schizophrenic patients from 19 to 55 years of age were included in the study. The control group consisted of age and socio-economic status matched healthy volunteers who did not have any psychological or medical patient at home needing care and assistance. For measurement of study variables i.e., burden of caregiving, depression and psychological well-being, instruments used were Zarit Burden Interview [ZBI], The Beck Depression Inventory [BDI] and Warwick-Edinburgh Mental Well-Being Scale [WEMWBS] respectively

Results: Results were analyzed using MANOVA followed by One-Way ANOVA. Findings indicated that informal caregivers of schizophrenia have greater depression and poor psychological well-being in comparison to the non-caregiver controls. Association of caregiving burden with psychological well-being and depression was calculated using Chi Square test and relative risk

Conclusion: Caregiving adversely affects informal caregivers' mental health and wellbeing. Informal caregiving is a burden for the caregivers; health status of family members involved in caregiving should be routinely assessed to enhance their health-related quality of life

Global and regional cancer epidemiology: according to world cancer report 2012 and others

The International Agency on Cancer [IARC] has initiated World Cancer Report 2012 in 2014. The report estimates the worldwide incidence and mortality for 27 major cancers and for all cancers combined for 2012 and is available in the

GLOBOCAN series of the International Agency for Research on Cancer. Overall, there were 14.1 million new cases and 8.2 million deaths in 2012. The most commonly diagnosed cancers were lung [1.82 million], breast [1.67 million], and

colorectal [1.36 million]; the most common causes of cancer death were lung cancer [1.6 million deaths], liver cancer [745,000 deaths], and stomach cancer [723,000 deaths]. In Pakistan, there are over 1.4 million cancer patients. Annually there are 139,200 new cancer cases and 101,600 deaths. Incidences of cancers are different in different parts of Pakistan as depicted by reports generated by two major cancer registries in the country

Study on tooth morphological variations among various ethnic groups of Pakistan

The aim of the study was to elucidate the prevalence of some accessory dental morphological traits variations in permanent teeth of population belonging to Swati, Gujar and Jadoon ethnic groups. The study sample was 300 subjects [100 of each group] volunteer students both male and females aged 12-21 taken in different schools of targeted areas having specifically Swati, Gujar and Jadoon residents. The study period was from July-January 2010. The prepared dental plaster casts were examined for morphological variations such as shoveling, bushman canine, distal accessory ridge and cusp of Carabelli. These traits were analyzed through Arizona state university tooth morphology system. The occurrence rate of each morphological trait was calculated as percentage of total sample size. In results the cusp of Carabelli exhibited maximum expression in Swati group while in Swati and Gujars more shoveling was observed as compared to Jadoons however the Bushmen canine was totally absent in these groups. The dentist should be aware of these dental morphological variations because in actual life the teeth morphology expresses more variations than in textbooks

Effects of twin-block appliance treatment on skeletal and dentoalveolar changes in class II division 1 malocclusion cases

Objective: To assess reduction of profile convexity, correction of molar and canine relationship and achievement of normal over jet using Clark's Twin Block appliance in growing subjects having skeletal class II patterns

Study Design: Descriptive case series

Place and Duration of Study: The study was conducted at KRL General Hospital Orthodontic department from Aug 2017 to Jan 2018

Material and Methods: Fifty patients between 11-14 years of age were recruited having cervical maturation [CVM] stage 3 as diagnosed by their lateral cephalogram. Only Skeletal class II patients as confirmed by ANB values of >4 and SNB values of <78 having low angle [SN-MP] are included in this study. Good quality radiographs and study models are obtained at start of treatment T and at the end of achievement of results T1. Data was recorded in specially made proforma and analyzed using SPSS 20.0. Analysis included frequencies, Mean +/- standard deviation [SD] and paired t test. A p-value<0.05 was considered significant

Results: Results have established positive impact of Twin-Block appliance therapy in patients with CVM stage 3 paired. I-test has revealed significant reduction in values of over jet and correction of class II molars and canines. Skeletal profile convexity has also been reduced by significant reduction in angle of convexity

Conclusion: This study has demonstrated that successful management of the first phase of treatment of a patient with Angle's Class II Division I malocclusion using the twin block appliance can be achieved with significant outcomes

Blood transfusion support in mass disaster and trauma situations an experience at a tertiary care center

Objectives: To assess the blood transfusion support requirements in mass disaster and trauma situations

Study Design: Cross-sectional observational study

Place and Duration of Study: This study was conducted at Combined Military Hospital Quetta from, Jan 2013 to Dec 2015

Material and Methods: Nature of injuries, triage details, details of surgical procedures and duration of hospital stay were noted. Data was analyzed with respect to cross match to transfusion ratio and the number of units of each component transfused. Patients requiring massive transfusion and any associated complications were also studied

Results: A total of 2228 casualties were received during the study period, of these, males were 18 [75 percent] and 6 [25 percent] were females. Mean age was29.7 years. 1636 [73.4 percent] casualties had sustained major injuries. Mean hospital stay was 6.31 days. Only 199 [12.2 percent] patients required blood transfusion with a mean of 2.9 units of RCC, 8.7 bags of FFP and 4.6 bags of platelets. Fifteen [7.5 percent] patients received massive transfusion. Following massive transfusion, one case of metabolic acidosis and two cases of coagulopathy were reported

Conclusion: Mass disasters and trauma casualties pose a serious challenge to any healthcare facility in general and the blood transfusion services in particular. Only a well-organized blood transfusion center and blood transfusion emergency preparedness can result in better patient care and outcome. Not all patients need transfusion and a delicate balance between demand and supply has to be maintained

Reduction of body and testicular weight of Albino rats in Arsenic toxicity

Abstract: The metals toxic for living being are led, mercury, arsenic, cadmium and cobalt. Arsenic is increasing day by day in underground water and is more toxic for the proliferating tissue in the body as intestine, ovaries, testes etc

Study design: Experimental study

Place and duration: National Institute for health, Islamabad from 2008 to 2014

Methodology: 20 Male albino rats were bought from National Health Institute, Islamabad weighing from 250-300 grams. They were divided in to two groups A and B each having 10 animals. Group A was taken as control and was given 10 ml of distilled water orally in the morning and evening with normal diet for 28 days. Group B was given 10 ml of water with sodium arsenite 5mg/kg of body weight for 28 days with normal diet

Results: The present study showed that there was reduction of body and testicular weight of albino rats given arsenic when compared with control

Conclusion: Arsenite and arsenate compounds are highly toxic to human beings as well as animals. Arsenic induced toxicity might be responsible for regression of testes and reduces the body and testicular weight of albino rats

Serum cystatin C as an early diagnostic biomarker of diabetic kidney disease in type 2 diabetic patients

Objective: To determine the diagnostic accuracy and cut-off values of serum cystatin C as early diagnostic biomarker of diabetic kidney disease. Study Design: Cross-sectional analytical study. Place and Duration of Study: Department of Pathology, Army Medical College, Rawalpindi in collaboration with Endocrinology Department, Military Hospital [MH], Rawalpindi from November 2015 to November 2016

Methodology: One hundred and nineteen diagnosed patients of type 2 diabetes mellitus were enrolled in the study from the outpatient Endocrinology Department of the MH Rawalpindi. Fifty disease-free controls were also included. Fasting blood samples of the patients and controls were analysed for creatinine by Jaffé's kinetic method and estimated GFR was calculated using MDRD-based equation for GFR. Serum cystatin C was estimated by quantitative turbidimetric method

Results: Serum cystatin C was higher in the diabetic group [mean = 1.022 +/-0.33 mg/dl] as compared to the control group [mean = 0.63 +/-0.14 mg/dl]. ROC curve analysis, keeping less than 60 ml/min/1.73 m2 GFR [CKD-MDRD based] as reference value of the stat variable/gold standard; revealed an area under the curve of 0.914 [95% CI 0.85-0.98] and at optimal sensitivity of 88.2% and specificity of 84.8% the established cut-off of serum cystatin C was 1.26 mg/L

Conclusion: Cystatin C is an accurate biomarker of diabetic kidney disease with good sensitivity and specificity

Neurological complications are avoidable during CABG

Objective: To review the incidence of stroke in patients undergoing CABG and the impact of a preventive strategy adopted at tertiary care unit of cardiac surgery

Methods: The data of all patients who underwent isolated CABG [N= 722] from July 2016 to August 2017 at Faisalabad Institute of Cardiology was retrieved for this retrospective study. All operations were done on cardiopulmonary bypass and cold blood cardioplegia. Numeric data was summarized as Mean +/- Standard Deviation while categoric variables were summarized into frequency and percentage

Results: Mean age of patients was 53.83 +/- 8.8 years. Mean Parsonnet and Logistic EuroScore were 4.3 +/- 3.2 and 3.3 +/- 0.9 respectively. Forty nine patients [6.78%] had significant carotid artery disease. Mean number of grafts was 2.8 +/- 0.82. Diabetes was present in 27.8% patients. Neurological complications were noticed in 14 patients [1.94%] who included 12 permanent paralyses. Further subgroup analysis revealed that 67 patients who were operated by single clamp technique remained free of neurological complications. This is clinically remarkable finding but due to small population size it is statistically non- significant

Conclusion: The incidence of neurological complications can be reduced significantly by adopting the appropriate preventing measures. Use of Single Clamp technique may be the reasons of such a low incidence of stroke in this study

Characteristics and outcomes in patients with anti N-Methyl-D-Aspartate receptor auto-immune encephalitis

Objective: To study characteristics and outcome in patients with anti-N-Methyl-D-Aspartic Receptor encephalitis. Study Design: Retrospective observational cohort. Place and Duration of Study: Neurology Department Military Hospital Rawalpindi, from Feb 2015 to Sep 2016

Material and Methods: Data of patients admitted with anti-n-methyl-D-aspartate receptor encephalitis was analyzed retrospectively. Patients were classified as having definite or probable anti-N-methyl-D-sspartate receptor encephalitis whether antibody testing in CSF was positive or negative respectively and fulfillment of other defined parameters. Patient characteristics, treatment protocols and outcomes were noted

Results: Eleven patients were included in this cohort. Six [54.5%] were males and 5 [45.5%] were female. Mean age was 31.18 years [SD 14.865]. Mean day to symptom onset was 18.51 days [SD 16.646]. Abnormal behavior was seen in 90.9%, Seizures and movement disorder in 81.8%, speech dysfunction in 72.7%, decreased level of consciousness in 63.6% and autonomic dysfunction in 54.5% anti-N-methyl-D-aspartate receptor antibodies were done in CSF in 3 patients only out of which 2 were positive. In remaining nine patients antibody testing was not done due non availability of facility and or affordability. Out of eleven patients 2 [18.25%] had definite encephalitis and 7 [81.8%] had probable encephalitis. CSF was abnormal in 63.6% with pleocytosis in 18.2% and oligoclonal bands in 45.5%. EEG was abnormal in 72.7% and MRI was annormal in 36.4%. Outcome was favorable in 63.6% and unfavorable in 36.4%

Conclusion: In this study we were able to determine that patients with anti-N-Methyl-D-Aspartate Receptor encephalitis have a favorable outcome if diagnosed and treated aggressively early in the course of disease