Frequency of chemotherapy induced neutropenia in patients of non hodgkin's lymphoma

The aim of the study is to see the frequency and severity of neutropenia after first or subsequent cycles of chemotherapy in patients of Non Hodgkin's lymphoma [NHL]. Descriptive cross sectional study. This study was carried in the Radiotherpay and Oncology Department, Bolan Medical Complex Hospital, Quetta, from March 2010 to February 2012, Forty two patients of different types of NHL diagnosed on lymph node biopsy presenting for the first time at Radiotherapy and Oncology Department in collaboration with Haematology Section [Pathology Deptt:], Bolan Medical Complex Hospital. Quetta, were included. They were admitted in the ward and evaluated with history, physical examination and for staging investigations. Patients were then planned for chemotherapy comprising cyclophosphamide, doxorubicin, and vincristine with prednisolon [CHOP] and with rituximab [R CHOP]. After the first cycle of chemotherapy they were monitored for expected neutropenia in the ward. The neutrophil counts were repeated on days 7 and 10 following chemotherapy. Neutropenia was graded as defined in the operational definition and all the data were entered on a designed data sheet. Forty two patients of NHL were included in this study, of which 34 patients received CHOP, and 08 patients R-CHOP, from March, 2010 to February, 2012. According to WHO classification, 24[57.1%] patients were of Diffuse large B-cell lymphoma [DLBCL], 08[19.0%] were follicular lymphoma [FL] and 04[9.5%] patients were Mantle cell lymphoma [MCL] and remaining 06[1430] are other types of NHL's. 2[4.7%] of patients suffered from grage IV neutropenia [absolute neutrophil count of <0.5 x 10[9]7L], 3[7.1%] had grade III Neutropenia [absolute: Neutrophil count of 0.5 x 10[9]L-0.9 x 10[9]/L], 3[71%] had Grade II neutropenia [absolute netrophil count 1.5 x 10[9] /L-1.4 x 10[9]/L] and 5[11.9%] had Grad I neutropenia [absolute netrophil count 1.5 x 10[9]/L-1.900/L]. Other risk factors noted, i.e., cardiac, Liver and Renal comorbidities in 3[7.1%], 5[11.9%] and 4[9.5%] of patients respectively. Overall 30.8% of patients of NHL's suffered from neutropenia of all grades post first cycle of chemotherapy comprising CHOP and R-CHOP

Incidence of malignant lymphomas in balochistan

Traditionally lymphomas are classified into Hodgkin's disease [HD] and Non Hodgkin's lymphoma [NHL] depending upon histo-pathological evidence on biopsy taken from an enlarged lymph node. Delayed diagnosis in lymphoma deteriorates the health eminence resulting in poor outcome. The aim of the study is to estimate the incidence and clinical presentation of malignant lymphomas in Balochistan. Prospective Study. This study was carried in the Department of Radiotherapy and Oncology, Bolan Medical Complex Hospital, Quetta from June, 2006 to May, 2012. A total of 263 newly diagnosed patients of both types of lymphoma from different parts of Balochistan were registered in Bolan Medical Complex Hospital in Department of Radiotherapy and Oncology. Followed by histopathology, WHO classification and Ann Arbor staging was done to assign subtype and extent of disease. It was found that the incidence of Non Hodgkin's lymphoma a [64.7%] was greater than Hodgkin's disease [35.2%] and both present bimodal distribution in age. Male patients dominate female patients in both cases [2.5:1]. Lymph-adenopathy of cervical region was primary site in 44 % of cases while 27.6 % were extra nodal. Histopathology shows 57.4 % mixed cellularity variant in Hodgkin's lymphoma and 25.5% diffuse B cell pattern in Non Hodgkin's lymphoma. Ann Arbor staging reveals that 3.4% cases present with stage I and 64.5% show stage IV. To conclude Non Hodgkin's lymphoma is two times more frequent than Hodgkin's lymphoma with greater male contribution. Due to delayed diagnosis resulted in late stage presentation ,health awareness is needed for physicians and general population for availability of patients at a due time for management

Increasing trend of homicidal drone attacks in Pakistan

To study the increasing trend of Homicidal Attacks in Pakistan. Retrospective study. This study was carried out at 1. Benazir Civil Hospital Rawalpindi, 2. Forensic Medicine Deptt. General Hospital PGMI Lahore, 3. Civil Hospital Sialkot, 4. DHQ Benazir Hospital Abbottabad 5. DHQ Hospital Gujrat from 01.01.2012 to 31.05.2013. The data of Homicidal drone attacks and mortality was collected from news papers, internet and medical journals of Forensic Medicine. The Bureau of Investigative Journalism estimates the following cumulative statistics about US drone strikes: [As of March 2013]. Total strikes: 366. Total reported killed: 2,537 - 3,581. Civilians reported killed: 2000 - 3000. Children reported killed: 368 - 997. Total reported injured: 1,174-1,465 . Strikes under the Bush Administration: 52. Strikes under the Obama Administration: 314. The trend of Homicidal drone attack was increased in Pakistan in President Pervaiz Musharaf time in favour of Americans by giving our National Airports. The people of Waziristan are also responsible for these attacks as they give information about Taliban to their centers by giving signals in a cost of dollars

Air disasters and mortality in Pakistan

To study the mortality in air disasters in Pakistan. Original study. This study was conducted in the Department of Forensic Medicine, Frontier Medical and Dental College, Abbottabad and Fountain University Medical College, Rawalpindi from January 2009 to November 2012. The mortality data was collected from Internet, Civil Aviation Authority, Newspapers and research journals. The results are shown in tables and graphs. The air disasters are one of the significant cause of mortality. The factors responsible for air disasters should be minimized to reduce mortality

Outcomes of surgical management of tracheobronchial injuries---a case series from a developing country / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>Tracheobronchial injuries are defined as injuries involving the trachea and/or bronchi from the level of the cricoid cartilage extending up to the division of the bronchi. We present a case series with most of the tracheobronchial injuries found to be sustained after penetrating trauma.</p><p><b>METHODS</b>A retrospective review was performed at the Aga Khan University, Karachi, Pakistan. From January 2004 to December 2009, 168 patients with thoracic trauma were treated, of whom 15 were recognized to have major tracheobronchial and pulmonary injuries.</p><p><b>RESULTS</b>The average age was 31 years with most of the patients being male (14:1). Among them,11 patients had penetrating trauma as the main cause of injury, 3 patients had blunt trauma from road traffic accidents, only 1 patient had combined trauma (blunt and penetrating trauma). Eight patients were diagnosed based on radiological findings. All the patients were treated surgically. Lobectomy was the most common intervention performed in 7 patients. The mortality rate was 7% (1 patient). Most patients survived with no sequelae (10 patients) while 5 survived with disability. We found that penetrating trauma was the leading cause of injury in our series. The severity of injury depends upon the weapon causing the trauma. Patients in our series had multiple injuries and required surgical management.</p><p><b>CONCLUSIONS</b>Tracheobronchial injuries are rare but potentially life threatening. They require quick diagnosis and management. Diagnosis tends to be difficult since there are no specialised diagnostic modalities available at present.</p>

Acute traumatic subclavian artery thrombosis and its successful repair via resection and end-to-end anastomosis / 中华创伤杂志(英文版)

Subclavian artery thrombosis is a rare complication of clavicle fractures. We reported a 20-year-old man who was admitted to the emergency room after a road traffic accident. He was a pedestrian who was initially hit by a bus and after he fell down on the road, he was run over by a car. On evaluation, he was found to have multiple facial and rib fractures, distal right humerus and right clavicle fracture. Significantly, right radial pulse was absent. After further evaluation including Doppler studies and an angiography which revealed complete obstruction of right subclavian artery just distal to its 1st portion, the patient was urgently taken to the operation room. A midclavicular fracture was adjacent to the injured vessel. We established proximal and distal control, removed damaged part. After mobilizing the subclavian artery, an end-to-end anastomosis was made. Then open reduction and internal fixation of right distal humerus was performed. The rest of the postoperative course was unremarkable. To prevent complications of subclavian artery thrombosis, different treatment modalities can be used, including anticoagulation therapy, angioplasty, stenting and bypass procedures.

XDR tuberculosis: a report from the New Delhi Tuberculosis centre, India

During the 6 years from 2001 to 2006, a total of 18,443 M. tuberculosis isolates were processed for drug sensitivity testing. Of those, 9614 [52.12%] were found to be multidrug resistant. A total of 86 [0.89%] cases met the criteria of XDR among the MDR-TB cases. Year-wise detection of these XDR cases is given in Table I. A consistent decline was observed in the incidence of reported cases of XDR over the years right from the year 2001. These 86 cases were reported from 7 states with the largest number from Delhi [49] followed by neighbouring Rajasthan [10], Haryana [9], Uttar Pradesh [8], Uttaranchal [5], Punjab [4] and Madhya Pradesh [1]. Of those 86 cases, only 5 patients were females and rest were males. A total of 53 out of 86 [61.6%] of the isolated resistant strains were resistant to more than 4 classes of drugs indicating severity of resistance

Damage control surgery: a safe approach for exsanguinating trauma patients

To analyze the role of damage control in surgery in severely injured and polytrauma patients. Descriptive study. Surgical unit of District Headquarter [teaching] Hospital, Rawalpindi. January 2000 to December 2007. This study included 28 severely injured patients who presented in the accident and emergency department of District Headquarters [teaching] Hospital, Rawalpindi. These patients were unstable because of life threatening hemorrhage following some blunt or penetrating trauma. After immediate shifting to operation theater, resuscitation and operative intervention was done simultaneously. Different procedures of damage control surgery like abdominal packing for hepatic and pelvic trauma, major vascular ligation for vascular injuries of neck and extremities were adopted in phase I. In phase II patients were managed in ITC for coagulopathy and hypothermia. Definitive treatment was done in Phase III after 24-72 hours once patients got stable. Total 28 patients included in the study. In 18 patients abdominal packing for hepatic injury [n=11] and pelvic fractures [n=7] was done. Major vascular ligations in n=11 and temporary intestinal clamping in n=1 patient. Planned re-exploration after 24-72 hours in n=16 and unplanned re-exploration within 24 hours in n=5 patients was done. Complications included ongoing hemorrhage [n=5], coagulopathy [n=2], controlled biliary fistula [n=1], abdominal compartment syndrome [n=1], cerebral ischemia [n=1] and gangrene of abdominal wall [n=1]. Two patients died

Dilemma in the diagnosis of mediastinal adenopathy in the south Asian population-role of CT guided biopsy, mediastinoscopy and video-assisted thoracoscopy [VATS]

The diagnosis of mediastinal adenopathy is a dilemma amongst treating physicians especially in South Asia. This is because although tuberculosis is endemic in this region, many a times lymphoma and sarcoidosis cannot be excluded. Often patients are being treated with medications without a confirmed diagnosis. The Video-assisted thoracoscopy [VATS] has revolutionized the way mediastinal adenopathy is diagnosed and managed in this part of the world

Magnesium sulphate therapy in edampsia: an experience at Chanilka medical college Larkana

To evaluate the role of magnesium sulphate [MgSo4] in the management of eclamptic patients in terms of efficacy, safety, recurrence of convulsion and fetomaternal out come. This descriptive case series study was conducted over a period of one year from 1[st] October 2007 to 30[th] September 2008 at Gynae and Obs Unit-1 Sheikh Zayed Hospital for women CMC Larkana. All the patients admitted with eclampsia during the study period were included in the study. All patients were managed accordingly to the protocol. MgSO4 was given to eclamptic patients according to protocol who had no contra indications to this drug. Recurrence of convulsions, side effects of MgSO4, maternal and fetal outcome were noted. During the study period total no: of obstetrical admissions were 4051 and total deliveries were 3200. Sixty seven patients presented with eclamptic fits which accounts for 1.6% of total deliveries. Only 13 patients [19.4%] were booked and the rest were un-booked. Majority was primigravida and common age group was 21-30 years. In the antepartum period eclampsia were accounted for 29.6%, intrapartum 43.6% while 26.8% were postpartum eclampsia. Fits occurred in the 3[rd] trimester after 32 weeks in 32 cases [58%]. All patients received MgSO4. 94% had no side effects, 2.9% developed diminished reflexes, 1.4% developed hypotension, 1.4% developed renal failure, recurrence of fits was observed in 4 cases [5.9%]. 3 patients were expired due to cardiopulmonary failure with in 24 hours after arrival at Hospital. Fetal out come was analyzed 48 retuses born alive, 4 were IUL 9.were FSB, and 4 were NND. In conclusion MgSO4 was found to be were effective and cheap for control of fits and has lower risk of recurrent convulsions. The occurrences of drug complications were very low with standard protocol. Maternal mortality was also 12w 2nd fetal outcome was found to be good. Clinical monitoring seems to be sufficient in this study

incidence of weapons used in autopsy cases

The different types of weapons are used in Autopsy cases. To determine the weapon pattern in Autopsy cases. DHQ Hospital Rawalpindi. From January 2007 to December 2007. 170 cases were taken from the record of autopsy cases conducted at DHQ Hospital Rawalpindi. The 170 cases were taken from DHQ Hospital Rawalpindi. The weapons used is significant in Autopsy cases

Whole blood assays to identify Th1 cell antigens and peptides encoded by mycobacterium tuberculosis-specific RD1 genes

To identify Th1 cell-stimulating antigens/peptides encoded by the genes predicted in the Mycobacterium tuberculosis-specific genomic region of difference [RD]1, deleted in Mycobacterium bovis Bacille Calmette-Guerin[BCG], by using synthetic peptides and whole blood from tuberculosis [TB] patients. Heparinized peripheral blood was obtained from culture-proven pulmonary TB patients [n = 16] attending the Chest Disease Hospital, Kuwait. Whole blood was diluted with tissue culture medium RPMI-1640 and tested for Th1 cell stimulation using antigen-induced proliferation and interferon- [IFN-] secretion assays. The antigens included a peptide pool of 220 peptides covering the sequence of 12 open reading frames [ORFs] of RD1 [RD1mix], peptide pools of RD1 ORF5 [ORF5mix], ORF6 [ORF6mix] and ORF7 [ORF7mix], and individual peptides of ORF6 [P6.1-P6.6] and ORF7 [P7.1-P7.6]. M. tuberculosis culture filtrate, cell walls and whole-cell M. bovis BCG were used as complex mycobacterial antigens. The results obtained with different antigens and peptides were statistically analyzed for significant differences using Z test. The complex mycobacterial antigens [culture filtrate, cell walls and M.bovis BCG] and RD1mix induced comparable [p > 0.05] positive antigen-induced proliferation and IFN- responses with whole blood from TB patients. However, the positive IFN- responses induced by ORF6mix and ORF7mix were higher than ORF5mix. Among the individual peptides, P6.4 and P7.1 of ORF6 and ORF7, respectively, induced the highest IFN- responses, suggesting that these peptides represented the immunodominant Th1 cell epitopes of RD1 ORF6 and ORF7 in the patients tested. The whole blood assays with synthetic peptides are useful to identify Th1 cell antigens/peptides encoded by genes located in M. tuberculosis-specific genomic regions

Primary non-hodgkin's lymphoma of vagina associated with pregnancy

We report a case of non-Hodgkin's lymphoma [NHL] in 23 years old, 36 weeks pregnant female, who presented with a swelling in the vagina. Biopsy of the lesion led to profuse haemorrhage and emergency caesarean-section along with bilateral ligation of internal iliac arteries were required. Recovery was smooth and she was discharged from the hospital on the 5th postoperative day. Histopathology revealed non-Hodgkin's lymphoma, diffuse large B cell type [DLBCL]. Further treatment by medical oncologist led to complete resolution of the tumour at three months

Etiology of chronic liver disease in children

To review the clinical spectrum and etiology of chronic liver disease in children at National Institute of Child Health, Karachi. Prospective study in children aged 1 to 14 years with suspected chronic liver disease. Complete blood count, LFT's, prothrombin time, serum albumin and ultrasound of abdomen were done in all patients. Liver biopsy was done in majority of the cases. Viral markers included HBsAg, anti HCV and ANA to determine etiology. Those who were negative for hepatitis B, C and autoimmune disease, were subjected to slit lamp examination of eyes and 24 hours urinary copper estimation for Wilson's disease. Alpha-1-antitrypsin levels were done in selected patients. A total of 55 cases were studied. The common presenting features were edema, ascites [44 patients], jaundice [27], variceal bleeding [23] and fever [22]. On examination anemia was present in 52 patients, edema in 46, jaundice in 37, splenomegaly in 42 and hepatomegaly in 35 patients. Fortynine patients had hypoalbuminemia [<2.5 gm%], 45 raised ALT [>80 IU/L] and 49 prolonged PT [>4 sec of control]. Ultrasonography showed a dilated portal vein in 34 patients and esophageal varices were seen in 46 patients on endoscopy. Thirteen [24%] had chronic hepatitis B, 9[16%] autoimmune disease, 9 [16%] Wilson's disease and all were anti HCV negative. Etiology remained uncertain in 24 [44%] cases. Hepatitis B was the leading cause of chronic liver disease in children followed by Wilson's disease and autoimmune liver disease. None of the patients had hepatitis C in this study

Trend of cigarette smoking among the college students, medical students and doctors

Smoking trend is increasing in both developed as well as under-developed countries. The students of high school, colleges, even medical colleges, disease healers and teachers of preventive/community medicine were also found to be engaged in smoking. Therefore this survey was designed for students and doctors of Abbotabad and Rawalpindi. 700 students and 100 doctors were randomly selected from high schools, colleges, Medical Colleges of Abbottabad and Rawalpindi. A smoking survey questionnaire was designed and filled on individual interview. The percentage of students of schools and colleges engaged in smoking was high as compared to medical students and doctors. There was no girl student found to be engaged in smoking. The trend of cigarette smoking is much higher in students of schools and colleges as compared to medical students and doctors which is an alarming situation for health, life and economy of the nations. Therefore the campaign should be moved to prevent this trend especially in the young generation and literate population

Genitourinary tuberculosis; experience in a teaching hospital of southern Punjab

Genitourinary tuberculosis is a common accompaniment of pulmonary tuberculosis. If diagnosis and treatment are delayed, irreversible damage can result. Twenty three patients of genitourinary tuberculosis were treated at Nishtar Medical College Multan from 1992 to 1997. Mean age was 37 years. There was no typical symptom or sign. Radiological evidence of pulmonary tuberculosis was present in 11 [47%] patients. Five patients had renal failure at the time of presentation. Four patient had unilateral non functioning kidney, one patient had pyonephrosis and renal stone, six patients had unilateral stricture of ureter [2 upper, 4 lower] and one patient had bilateral stricture of ureter [lower], two patients had bladder mass, two patients had enlarged prostate, three patients had scrotal abscess, one patient had infertility and one patient had early changes. Ablative surgery was required in 5 patients while conservative and reconstructive surgery was done in 18 patients. Diagnosis of genitourinary tuberculosis requires high index of suspicion as there is no typical clinical feature. Early diagnosis is essential to avoid irreversible damage

Epidemiological aspects and cost of managing hypertension in Saudi Arabian primary health care centres

The main epidemiological features and the direct cost of management of hypertension for a sample of registered patients in primary health care centres in Al-Khobar, Saudi Arabia were examined. Epidemiological features were gathered through patient interviews and from medical records, while direct cost of management was obtained using a standard formula. Consultation accounted for the highest direct cost of disease management [67%]; investigations and drugs were responsible for 16% and 17%, respectively. Number of visits, frequency of follow-up and use of additional drugs were significantly associated with higher total direct cost and higher cost of consultation. Medical education for physicians regarding cost containment and the complete documentation of medical treatment is advised