ABSTRACT
Objective: to determine the clinico-haematological profile and etiological factors of aplastic anaemia in patients under study
Material and Methods: this cross sectional study was conducted on 34 aplastic anaemic patients in the department of Department of Haematology and Blood Transfusion, Sheikh Zayed Medical College/Hospital, Rahim Yar Khan with cases referred from medicine, pediatric and out patients departments over a period of 22 months from October 2008 to July 2010. Patients of all ages and sex were included in the study. Data was entered into SPSS version 15 and analyzed descriptively
Results: results depict that most of the patients were in the age range 5-35 years with mean+/-SD [22.18+/-9.107 years]. 82.35% patients were males and 17.65% were females. Out of 34 cases diagnosed as aplastic anaemia, 30 cases [88.2%] were suffering from acquired aplastic anemia while 4 [11.7%] cases were found to have inherited aplastic anaemia [Fanconi Anaemia]. Out of 34 patients with acquired aplastic anemia, 23 [67.6%] patients had drug induced marrow hypoplasia with major marrow suppressant effect produced by chloramphenicol and sulfa formulated drugs in 14 [60.87%]. 9 [39.13%] patients used non-steroidal anti-inflammatory drugs particularly lndomethacin and heavy metals incorporated in herbal medicines. Only 4 cases [11.8%] were diagnosed as inherited aplastic anaemia with major clinical manifestations in the form of hyperpigmentation of skin, short stature and hypoplastic thenar eminences. Interestingly there was not a single patient with positive viral serological profile [e.g. HCV, HBsAg, HIV etc]
Conclusion: majority of the studied patients had acquired aplastic anaemia. Antibiotics particularly Sulfonamides and Chloramphenicol, non steroidal anti-inflammatory drugs, gold salts and non-specified heavy metals are important causes of bone marrow suppression
ABSTRACT
Objective: to evaluate the modifiable risk factors associated with obesity in adolescents belonging to different socioeconomic groups
Material and Methods: this comparative study was carried out in urban district of Lahore. A total of 270 adolescents 13-15 years of age were recruited, 90 each from upper, middle and lower socioeconomic groups [based on the school fee]. Calorie intake, physical activity and hours of television viewing and computer usage was determined by a self-administered questionnaire
Results: there was statistically significant difference regarding daily calorie intake of the upper middle and lower socioeconomic groups [F=4.588, df =2, p<0.05]. There was no significant difference in hours of physical activity per day in the upper, middle and lower socioeconomic groups [F=1.997, dF = 2, p>0.05]. There was a statistically significant difference in the hours of television watching and computer use per day in the upper, middle and lower socioeconomic groups [F=9.491, df=2, p<0.05]
Conclusion: calorie intake was influenced by socioeconomic status being highest in upper socioeconomic group followed by the lower socioeconomic group and was lowest in the middle socioeconomic group. There was no difference in the hours of physical activity per day in the upper, middle and lower socioeconomic groups. Hours of television watching and computer use per day was influenced by socioeconomic status being highest in the upper socioeconomic group followed by middle and then lowest in the lower socioeconomic group
ABSTRACT
Objectives: To evaluate the relative frequency of hereditary spherocytosis and hereditary elliptocytosis with particular reference to clinical and hematological parameters
Material and Methods: This retrospective study was conducted from Feb 1999 to Dec 2007 [08 years and 10 months]. A total of 25 patients, in the age range from 10 years to 30 years, presenting with weakness, anaemia, jaundice and splenomegaly were included in the study. Out of these, 16 patients were studied from Feb 1999 to Sep 2002 in Jinnah Hospital Lahore, 04 patients from Oct 2002 to Sep 2004 in King Abdul Aziz Specialist Hospital, Taif, KSA, and 05 patients from Dec 2005 to Dec 2007 in Ghurki Trust Teaching Hospital Lahore. Blood complete picture including peripheral blood film, osmotic fragility test, Coombs' test and auto-haemolysis tests were performed on clotted blood samples, EDTA anticoagulated blood samples and defibrinated/heparinized peripheral blood samples
Results: Anaemia was seen in 19 patients [76%], jaundice in 13 patients [52%]and splenomegaly in 22 patients [88%]. Laboratory parameters showed spherocytes in 15 patients [60%], ovalocytes/elliptocytes in 10 patients [40%], positive osmotic fragility test in 18 patients [72%], positive autohaemolysis test in 21 patients [84%], raised serum bilirubin level in 15 patients [60%]. In addition, positive direct Coombs' test was also seen in 02 cases [8%]. After determining the specificity and sensitivity of each test sample, results were compared with clinical presentation. These findings were found to be consistent with international studies carried out in different parts of the world
Conclusions: The application of proper clinical and hematological approach has revealed an unexpected proportion of cases with hereditary spherocytosis and hereditary elliptocytosis who present with mild jaundice and minimal to moderate splenomegaly. These cases if not investigated properly may be misinterpreted as suffering from immune hemolytic anaemia. Injudicious use of steroids in such cases can jeopardize the individual's immune status
ABSTRACT
The purpose of this study was to evaluate the frequency of osteolytic lesions and their pathogenesis in plasma cell myeloma [PCN]. The study was conducted in Ghurki Trust Teaching Hospital [GTTH], Combined Military Hospital, Jinnah Hospital and a Private Clinic at Lahore from January 2002 to November 2007. A total of 26 indoor male and female patients from Orthopaedic, ICU and Medical wards were included in the study. Among these patients, 18 cases reported to GTTH, 2 each from CMH Lahore and JHL respectively and 4 cases reported to a Private Clinic. Clinical parameters were further differentiated into Male n=15; 57.6%, Female; n = 11; 42.3% and mean age was 63 year. Lymphadenopathy was seen in 5 patients [n=5, 19.2%], hepatomegaly in 8 patients [n=8, 30.7%], splenomegaly in 7 [n=7, 26.9%] and bone pain in 20 patients [n=20; 76.9%]. Osteolytic bone lesions as revealed by conventional X-ray skeleton was seen in majority of patients [n=17; 65.3%]. After fulfilling the criteria for the diagnosis of Plasma cell myeloma, frequency/ prevalence of osteolytic lesions were assessed and compared with clinical and laboratory parameters. Multiple osteolytic lesions revealed, by conventional radiography, were most commonly seen in the skull, verterbrae, ribs, pelvis and proximal long bones. However, use of MRI indicates that skeletal abnormalities exist in nearly all patients with myeloma. These osteolytic lesions evolve from imbalance between osteoblasts and asteoclasts interplay with primary derangement originating in bone marrow microenvironment. The basic stimulus is interaction of malignant plasma cells with bone marrow stromal cells and the production of different cytokines and growth factors. These inflammatory factors produce proliferation and differentiation of osteoclasts, inhibition of osteoblasts and formation of osteolytic lesions. The resultant demineralisation is manifested as raised serum calcium level
Subject(s)
Humans , Male , Female , Osteolysis , Lymphatic Diseases , Hepatomegaly , Splenomegaly , OsteoclastsABSTRACT
This was a retrospective study designed to evaluate the frequency and clinical significance of Philadelphia [Ph] chromosome in acute leukaemia. The place and duration of this work was Armed forces Institute of Pathology Rawalpindi from April 1988 to January 1990 and a private medical center from June 1999 to July 2002. A total of 50 cases of acute leukaemia were included in the study. Thirteen cases presenting de-novo ALL and thirty two cases as denovo ANLL [AML and AMML]. Two patients were diagnosed as blast transformation phase of CGL with ALL phenotype whereas 03 cases presented with acute leukaemia transformation from MDS with AML/ AMML phenotype. The samples received were either peripheral blood or bone marrow aspirate. Chromosomal analysis was performed using culture, banding and staining technique. Morphology, clinical findings, therapeutic response and survival were compared in patients with and without the Ph chromosome. Ph chromosome was found to be +ve in 02 newly diagnosed patients presenting with ALL. Ph chromosome in association with additional chromosomal abnormalities persisted in 02 cases transformed into ALL from CGL, and it was found in 05 cases of de novo AML. The study failed to reveal any consistent chromosomal translocation involving chromosome 9 and 22 in 03 AML cases transformed from MDS. Patients with Ph+ ALL differed from those with Ph-ALL in being older, in having more frequent lymphadeno-pathy and splenomegaly and in demonstrating higher initial leucocyte count and more peripheral blasts. Complete remission was obtained in 09 patients with Ph -ve ALL but in only 2 of 4 with Ph +ve ALL. Adults with Ph -ve ALL also survived significantly longer. Five adults with ANLL [AML/AMML] who were Ph +ve did not respond to treatment and survived significantly shorter than adults with Ph -ve AML. No clinical or morphological features indicated which patients with acute leukemia would have Ph chromosome. The Philadelphia chromosome has been considered relatively specific for chronic granulocytic leukaemia. However patients with acute leukaemia [ALL and AML] can also present with positive Philadelphia chromosome. In our study, we have described 09 cases with positive Philadelphia chromosome. Comparison was made with the remaining 41 cases who were Ph negative. Thus it can be concluded that the presence of Ph chromosome in adult acute leukaemia may have biological and clinical significance