Oxidative stress and total antioxidant status in acute leukemia at diagnosis and post remission induction phase

This study evaluated the activity of superoxide dismutase [SOD1], glutathione reductase [GR] and total antioxidant status [TAS] in the hemolysate and sera of patients with acute leukemia [AL] at diagnosis, post remission induction phase and in healthy controls. However, total antioxidant status and glutathione reductase activities normalized after remission induction phase in acute myeloid leukemia [AML] only whereas levels of SOD were reduced but not achieved the normal level in acute lymphoblastic leukemia [ALL]. TAS activity showed no difference in either sex among any subtype of acute leukemia but glutathione reductase level was significantly higher in female ALL patients. Activity of SOD was elevated in T-cell ALL and acute myelomonocytic leukemia however; no significant difference in the activity of GR and TAS was noted. Levels of antioxidant were reduced insignificantly in patients who achieved complete remission

Vitamin D levels in patients of acute leukemia before and after remission-induction therapy

To determine the levels of 25-hydroxyvitamin [25[OH]D3] in patients with acute leukemia and the effect of remission-induction chemotherapy. This study was case control, all newly diagnosed patients of acute leukemia between the age of one to sixty years and residents of Pakistan were enrolled and evaluated. Those who were unwilling or unable to provide written informed consent were excluded. All selected patients [n=86] were grouped in to acute myeloid leukemia [AML] and acute lymphoblastic leukemia [ALL]. AML was further categorized as A1 before remission-induction [n=17] and B1 after remission induction [n=13], ALL was further categorized as A2 before remission-induction [n=31] and B2 after remission induction [n=25]. The 25-hydroxyvitamin [25[OH]D3] levels were measured in the sera of all patients [before and after remission-induction] by one step delayed chemiluminescent micro particle immunoassay [CMIA].We compared 25[OH]D3 levels in all patients before and after the remission-induction chemotherapy. A total of 86 patients were analyzed, in which 60 patients were male. Mean age was 24.39 years [range, 1 to 60 years]; the mean levels of 25[OH]D in group A1 [n=17] was 17.70 +/- 3.2 ng/ml, in group B1 [n=13] 14.06 +/- 2.4 ng/ml, 19.07 +/- 7.08 ng/ml in group A2 [n=31], while 10.59 +/- 3.9 ng/ml found in group B2 [n=25]. 25[OH]D3 insufficiency was evident subnormal in majority of patients with acute leukemia and 25[OH]D3 were further reduced after remission-induction as compared to untreated group, difference was statistically significant when compared with each group

Seropositivity of hepatitis C, hepatitis B and HIV in chronically transfused beta -thalassaemia major patients

The purpose of this study was to determine the frequency and trend of transfusion transmitted infections [TTI] in chronically transfused beta-thalassaemia major [TM] patients with reference to the duration of transfusions. A cross-sectional study was done on 160 beta-TM patients and 5517 healthy blood donors to find out the prevalence of HCV, HBV and HIV infections. Out of 160 patients, 21 cases [13.1%] were anti-HCV positive, 2 [1.25%] were HBsAg positive. HIV antibodies were not detected in any sample. However, 109 [1.9%] and 104 [1.8%] of 5517 blood donors were positive for HCV and HBV respectively. No donor showed HIV antibodies. Anti-HCV was positive in 9/111[8.4%] thalassaemics [< 10 years of age] while 11/49 [22%] [> 10 years of age] showing significant difference [p = 0.005] among the two groups. For the past 10 - 12 years the screening of blood has reduced the magnitude of the disease significantly as shown by the trend in two age groups. Further improvements need to be done to implement uniform screening throughout the country

JAK2V617F mutation in chronic myeloid leukemia predicts early disease progression

To determine the association of JAK2V617F mutation along with BCR-ABL translocation or Philadelphia chromosome in chronic myeloid leukemia with early disease progression to advanced stages [accelerated phase or blast crisis] and poor outcome. Case series. National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, from February 2008 to August 2009. All the newly diagnosed cases of BCR-ABL or Philadelphia positive CML were tested for JAK2V617F mutation by Nested PCR. Demographic data, spleen size, hemoglobin levels, white blood cell and platelet counts were recorded. Independent sample t-test was used for age, haemoglobin level and spleen size. Fisher's exact test was applied to compare disease progression in JAK2V617F mutation positive and negative cases. Out of 45 newly diagnosed cases of CML, 40 were in chronic phase, 01 in accelerated phase and 04 in blast crisis. JAK2V617F mutation was detected in 12 [26.7%] patients; 09 [22.5%] in chronic phase, none in accelerated phase and 03 [75%] in blast crisis. During a mean follow-up of 8 months, 03 patients in chronic phase transformed in blast crisis and 02 into accelerated phase. Overall 08 out 0f 11 [73%] JAK2V617F positive patients either had advanced disease or showed disease progression. Only 2 of 20 [10%] available patients, negative for the mutation, showed disease progression by transforming into blast crisis [p < 0.001]. No statistically significant difference was seen in the age, spleen size, haemoglobin levels, white blood cells and platelets counts in JAK2V617F positive patients. JAK2V617F mutation was detected in 26.7% cases of chronic myeloid leukemia. A significant proportion of them showed early disease progression

Triglyceride profile in dyslipidemia of type 2 diabetes mellitus

To evaluate ratios of serum triglycerides and cholesterol levels which may indicate postprandial lipid handling and to assess their role as prospective markers of dyslipidaemia in type 2 diabetes mellitus. Comparative, observational study. Bismillah Taqee Hospital, Karachi from July 2002 till December 2003. The study comprised 160 subjects, including 83 known type 2 diabetics [45 males, 38 females] and 77 age-matched controls [45 males, 32 females]. Fasting blood samples were analysed for serum triglycerides and total cholesterol, using automated chemistry analyzer. HDL-C was determined by precipitation method and LDL-C and VLDL-C were estimated by Friedewalds formula. LDL/HDL ratio and TG/HDL ratios were also calculated. The mean values for male and female diabetics were compared with that for the male and female non-diabetics respectively and tested for significance by paired t-test. Serum triglycerides and VLDL were raised in both male and female diabetics. No significant differences were observed in levels of serum total cholesterol, LDL, HDL and the LDL/HDL ratio. The mean value of the TG/HDL ratio for male diabetics was higher than that for the male non-diabetics [p=0.39]. A statistically significant difference was found in the TG/HDL ratios for the female diabetics and non-diabetics [p < 0.05]. In this study, type 2 diabetics showed marked hypertriglyceridaemia and raised TG/HDL ratio. The dyslipidaemia of diabetes predisposes to development of coronary heart disease and, therefore, evaluation of the TG:HDL ratio may provide a good tool to monitor and manage the lipid abnormalities in diabetics

Arteriovenous thrombosis in chronic renal failure patients receiving renal replacement therapy

To determine the frequency of thrombotic complications and to identify factors associated with arteriovenous thrombosis in patients of chronic renal failure receiving renal replacement therapy. A descriptive study. The study was carried out at Sindh Institute of Urology and Transplantation [SIUT], Karachi, from May 2003 to December 2003. Of the 3000 patients evaluated, 61 End Stage Renal Disease [ESRD] patients on regular dialysis, having recent renal transplant, were selected for the study after informed consent. These patients had arteriovenous thrombosis with temporary central lines thrombosis and vascular access problems. Cases of congenital or acquired thrombotic disorders, e.g. with malignancy, DIG, liver disease, systemic lupus erythematosus or other immunologic diseases, pregnancy or women using oral contraceptives, were excluded. Similarly, patients taking any type of anticoagulant therapy during the preceding one week were not included in the study. Findings were recorded in a structured questionnaire. Laboratory analysis was done after clinical and radiological evaluation. Thrombophilia screening included antithrombin, protein C, protein S deficiencies and lupus anticoagulant. Forty-seven out of 61 patients selected were positive for thrombophilia screening with protein C deficiency in 26.2%, protein S deficiency in 16.3%, antithrombin in 5%, lupus anticoagulant in 13.1% and combined deficiency was observed in 16.3%. Of the 3000 patients, 61 with frequency of 2% were found to be deficient in one or had combined deficiency of these. Thus, the study of ESRD patients presenting with arteriovenous thromboembolism emphasizes the need to reconsider the perception that this clinical entity is rare and requires further studies

Application of fibrin glue in maintaining post operative haemostasis in a thrombocytopenic patient: a novel approach case report

Here we report a case of chronic refractory autoimmune thrombocytopenic purpura [ITP] who presented with severe persistent thrombocytopenia, 3 months history of incisional hernia with aggravating symptoms. Considering the potential danger of acute obstruction, with its disastrous consequences, surgery was performed under cover of fibrin glue and hernia was repaired without any excess post operative bleeding

Predictive value of MCV/RBC count ratio to discriminate between iron deficiency anaemia and beta thalassemia trait

Two forms of hypochromic microcytic anaemia i.e. iron deficiency and beta-thalassaemia trait are common in our society. This study reports the prevalence of iron deficiency anaemia and beta-thalassaemia trait and predictive value of MCV/RBC count ratio to discriminate between two. Venous blood was taken from 299 students of Karachi Medical and Dental College and Ziauddin Medical University in Na2 EDTA and analyzed by semi-automated Sysmex K-1000 haematology analyzer. MCV/RBC count ratio was used to discriminate between iron deficiency and beta-thalassaemia trait and > 14% was marked as iron deficiency. Hb electrophoresis was used as gold standard test for confirmation. Serum iron and TIBC was performed to confirm iron deficiency anaemia. Iron deficiency was found in 9% while beta-thalassaemia was seen in 3% students. MCV/RBC count ratio showed a positive predictive value of 91%. In areas where iron deficiency anaemia and beta-thalassaemia trait are common, MCV/RBC count ratio can be used to screen out beta-thalassaemia trait