Minimal intervention dentistry: conceptual integration in the dental curriculum in cariology

The aim of this study was to evaluate the knowledge and practices of minimal intervention den-tistry [MID] in the teaching hospitals of Lahore. The target population for this cross-sectional study consisted of fresh graduates, house surgeons and demonstrators of Restorative Dentistry in the dental schools of Lahore. The questionnaire was prepared to assess the teaching and concepts of minimal intervention dentistry being taught at the undergraduate level. The results showed that 83% of the respondents believed that MID should replace the age old principles of GV Black. The respondents [90-95%] had sound knowledge about the caries risk assessment. However their concepts about clinical management using these techniques of MID were inadequate. In light of this study it is impervious that, a comprehensive practical training guided by the current principles of MID should be designed and implemented to improve present caries management educational program

Acute lupus haemophagocytic syndrome

A 25 year old female who had been on treatment for Systemic Lupus Erythematosus for the last 12 years presented with high grade non-remitting fever and pleural effusion. She had delivered a full term baby girl and soon developed pancytopenia, markedly raised fibrinogen degradation products, deranged coagulation profile, low serum fibrinogen level, raised liver enzymes and grossly raised serum ferritin. Bone marrow examination revealed reactive haemophagocytosis and megaloblastosis. Autoimmune disorders can lead to reactive haemophagocytic syndrome which is a treatable entity even if it presents with life threatening complications

Autoimmune complications in chronic lymphocytic leukemia: a single center experience

Chronic lymphocytic leukemia [CLL] is characterized by the progressive accumulation of B cells with mature appearance and a distinctive immunophenotype in peripheral blood, bone marrow, lymph nodes and other lymphoid tissues. Autoimmune complications are common in CLL and by far the most common manifestation is autoimmune hemolytic anemia [AIHA], followed by immune thrombocytopenia [ITP] and pure red cell aplasia [PRCA]. The study was carried was carried out to see the spectrum of autoimmune complications in patients diagnosed with CLL. This cross sectional study was carried out to describe the clinical presentation, haematological parameters and complications of CLL in patients coming to Shaikh Zayed Hospital [SZH], Lahore over a period of 6 years from June 2002 to July 2008. CLL cases were diagnosed according to the National Cancer Institute [NCI] criteria. The collected data was entered into SPSS version 13 for analysis. Thirty one patients were diagnosed with CLL and in 6 [19.4%] patients the disease was complicated by AIHA and in 1 [3.2%] patient by ITP at presentation. Autoimmune cytopenias were observed in 22% of 31 patients. Autoimmune hemolytic anaemia was more common than ITP, no patients of PRCA were recognized

Epidemiology of acquired aplastic Anaemia in Pakistan

Acquired aplastic anaemia is a rare disease which results in morbidity and mortality at a young age. This study was carried out to determine the clinical presentation, haematological parameters and association factors of acquired aplastic anaemia in a cohort of Pakistani patients. This was a cross-sectional study conducted at Haematology Department, Shaikh Zayed Hospital, Lahore over 7 years from June 2000 to July 2007. Eighty-two patients of acquired aplastic anaemia were enrolled in the study by non-probability purposive sampling. Their diagnosis was confirmed by complete blood count, bone marrow aspirate and trephine biopsy. The cohort was classified on the basis of severity and the epidemiological, clinical and haematological parameters were analysed. Of the 82 enrolled patients of acquired aplastic anaemia, 49 [59.8%] were males and 33 [40.2%] were females. Mean age of the patients was 27.93 +/- 18.7 years with a range of 1-80 years. The male to female ratio was 1.48:1. Bone marrow cellularity was less than 25% in 31 [38.0%] cases and between 25-30% in 51 [62%] of patients. Most of the cases were clinically severe aplastic anaemia [68%]. In 62 [76%] of the cases no association factors predisposing to aplastic anaemia could be identified. Acquired Aplastic anaemia is a disease of all ages. In the second decade and the elderly predominantly severe clinical stages were seen. Males presented at a younger age while females presented at all ages with a somewhat similar incidence. No association factors of Aplastic Anaemia could be identified in majority of the patients

Clinicopathological analysis of myelodysplastic syndrome according to French-American-British classification

To evaluate the age of onset, gender ratio, clinical presentation of Myelodysplastic syndrome patients, and to classify these patients according to French-American-British classification on the basis of morphological features in blood and bone marrow. Case series. The department of Haematolgoy, Shaikh Zayed Hospital, Lahore, from April 2007 to March, 2007. Fifty patients of primary Myelodysplastic syndrome [MDS] were studied. The patients were classified according to French-American-British [FAB] criteria and the epidemiological, clinical and haematological features of MDS patients were evaluated. Descriptive statistics were used to describe data. There were 31 males and 19 females. The mean age was 41 years. According to FAB classification, 39 cases of retractory anaemia, 1 case of retractory anaemia with ring sideroblast, 6 cases of retractory anaemia with excess of blasts and 4 cases of refractory anaemia with excess of blasts in transformation were identified. The commonest complaint was easy fatiguablity affecting 41 cases [82%]. Anaemia was the most common finding seen in 47 patients [94%]. Pancytopenia was seen in 33 cases [66%]. Dyserythropoeisis was present in 42 [84%], dysmyelopoeisis was seen in 21 [42%] and morphologically abnormal megakaryocytes were identified in 29 [58%] of the bone marrow aspirates. Grade-III reticulosis was seen in 9 bone marrow trephine biopsies. Abnormla localization of immature precursors [ALIP] were present in 18 cases. MDS was more frequent in young males, Refractory anaemia constituted a major chunk of the disease entity

Clinico-haematological characteristics in Pakistani patients of primary myelodysplastic syndrome according to world health organization classification

To assess the applicability of WHO classification on a cohort of Pakistani myelodysplastic syndrome [MDS] patients, and determine their epidemiological and clinico-pathological features. Case series. Haematology Department, Shaikh Zayed Hospital, Lahore, from April 2004 to March 2006. Forty six patients of primary MDS diagnosed by World Health Organization [WHO] criteria were included in the study by nonprobability purposive sampling. The cohort was classified accordingly and the epidemiological, clinical and haematological parametres were assessed. Descriptive statistics were used to describe the data. Forty six patients [28 males and 18 females] of primary MDS were included in the study. The mean age was 46.21 years. According to the WHO classification, 12 cases of refractory anaemia, 24 cases of refractory cytopenia with multi lineage dysplasia, 1 case of refractory cytopenia with multi lineage dysplasia and ring sideroblasts, 3 cases of MDS unclassified and 3 cases each of refractory anaemia with excess of blasts I and II were diagnosed. Symptomatic anaemia was seen in 37 cases and pancytopenia was documented in 33 cases. Dyserythropoiesis affected 41 cases. Grade III reticulosis was seen in 7 cases. ALIP was present in 13 cases. MDS presented at a young age. Refractory cytopenia with multi lineage dysplasia was the dominant disease category. Further studies are suggested for identifying the cytogenetic abnormalities and del 5q- category