Evaluation of hematological causes in cases of nasal bleeding

To find the causes of hematological disorder in patients of epistaxis attending ENT department, Abbasi Shaheed Hospital. This cross sectional study was carried out in ear, nose and throat and hematology departments of Abbasi Shaheed Hospital from Jan 2006 to Dec 2008. Patients of epistaxis attending ENT out patient deptartment and emergency were included. A questionnaire was filled including brief clinical history, general and local examination. Based on history, patients were stratified into two groups. Group 1 included patients with single episode of epistaxis while in group 2 patients with a history of recurrent epistaxis were enrolled. For hematology workup complete blood count with peripheral film examination, bleeding time, prothrombin time and activated partial thromboplastin time were done. Specialized test like platelet aggregation test, VonWillibrand factor Ag, Ristocetin cofactor and factor VIII assay were carried out in selected cases. Bone marrow aspiration and trephine biopsy were done for the workup of cytopenia. The causes of bleeding assayed and recurrent epistaxis were compared with single episode. 10% patients were having various hematological disorders. In majority of cases no cause was found. Recurrent epistaxis or epistaxes with mucocutaneous bleeding were found to be more associated with hematological disorder and in the absence of local pathology it should be thoroughly investigated

Micropathogens in chronic suppurative otitis media an experience of 208 pus cultures at Abbasi Shaheed Hospital

To determine the causative pathogens of chronic suppurative otitis media and their antimicrobial sensitivity. Prospective analytic study. Two hundreds patients were enrolled for the study attending the ENT out patient department of Karachi Medical and Dental College and Abbasi Shaheed Hospital. Majority of the patients were children and young adult, with male predilection. 208 Pus cultures were taken from the ears of the 175 selected patients and Gram staining and antibiotic sensitivity was done on all of them. Staphlococcus aureus and Pseudomonas aeruginosa were responsible for most of infections in this study about 68%. Proteus spp., Klebsiella spp. and E.coli were also found in the cultures but in very low figure. Quinolones and aminoglycosides were found extremely effective against the two major pathogens, i.e., Staph.aureus and Pseudomonas aeruginosa with sensitivity index of 91% and 98% respectively. Macrolides and cephalosporins were also highly effective with 80-88% sensitivity whereas both Staph.aureue and Pseudomonas were quite resistant to Ampicillin and Amoxicillin. Chronic suppurative otitis media is primarily the disease of children and young adults, and incidence in adult and old population being very less. Staphylococcus aureus and Pseudomonas aeruginosa are most frequent causative organism and extremely sensitive to quinolones and aminoglycosides

Megaloblastic anaemia, seen in 48 cases of pancytopenia

To assess megaloblastic anaemia in patients presenting with pancytopenia. Descriptive study. Hospitalized patients referred for bone marrow examination for the work up of pancytopenia were selected. Complete blood count was done on haematology auto analyzer. Bone marrow aspiration was done for cytology. Perl's iron staining was done in patients showing low blood indices. Forty eight [48] patients underwent bone marrow aspiration for cytology for the work up of pancytopenia. Nineteen [19] patients [39%] showed megaloblastic anaemia. Macrocytosis and hypersegmented neutrophils were the most common finding on peripheral blood smear. Fregmented red cells were seen in 13 patients showing classical finding of megaloblastic anaemia. Megaloblastic anaemia was found to be the most common cause of pancytopenia. Diagnosis of megaloblastic anaemia requires only complete blood count, peripheral blood smear and bone marrow cytology, which is cost effective. Nutritional factors and recurrent infection seem to be associated strongly with megaloblastic anemia

Comparative efficacy and safety and efficacy of systemic 13-cis retinoic acid 20 mg/day vs. 40 mg/day in acne vulgaris

Early and effective treatment in acne vulgaris is essential to prevent facial scarring and psychological distress. To evaluate the safety and efficacy of two different doses of 13-cisretinoic acid in the treatment of acne vulgaris. Sixty patients of moderate to severe acne vulgaris were selected from the dermatology out patient clinics of Abbassi Shaheed hospital, Aga Khan Hospital, Burhani Hospital and Taj Medical Complex, Karachi. They were randomly divided into two groups. Group I was given 20mg systemic 13-cis retinoic acid daily and group II, 40mg daily for 24 weeks. Assessment of the severity of acne was done using Global Acne Grading System [GAGS]. Clinical improvement was measured on physician acceptance scale, every two months till 24 weeks. Safety was evaluated on the basis of side effects and lab abnormalities at the baseline and end of therapy. Marked dose related decrease in acne lesions was noted within 8 weeks of the onset of therapy in all patients. In group I, out of 30 patients 24 showed 70% clearance in 8 weeks, 90% clearance in 16 weeks and 100% in 24 weeks, with residual pits in four patients. Six female patients were prescribed Diane 35' at 24 weeks, who still had premenstrual flare of acne. In group II, 26 patients out of 30 showed 90% clearance in 8 weeks and 100% clearance from 16-24 weeks. Mild scarring was noted in six patients at 24 weeks of treatment. Three female patients still had new eruption and were given Diane 35' after 24 weeks and in one male patient the dosage was increased to 60mg/day, which cleared the acne in 32 weeks. The results of two groups were insignificant [p>0.5]. Side effects noted were cheilitis, dryness pruritus and desquamation of skin, more in group II. A mild mood change with irritability was noted in 3 female patients. 13-cis retinoic acid is safe and efficacious in the treatment of acne vulgaris. A dose-dependent faster response is seen, although 20 mg/day works equally well than 40mg/day till 24 weeks

Peripheral blood film - an important tool for diagnosing Anaemia, its types and causes

To emphasize the importance of peripheral film and pathologist's comments in diagnosing different types of anaemia and its possible causes in hospitalized patients at Abbasi Shaheed Hospital. It is a descriptive study. The study populations comprised of hospitalized patients in various wards at Abbasi Shaheed Hospital. A month of year is randomly selected for the study. The records of complete blood picture report of the patients were revised for anaemia, its morphologic type and possible cause of anaemia on the basis of blood indices and peripheral blood film. One thousand and eight blood reports of complete blood picture were reviewed. Among the total. 605 were female and 403 were male and 563 patients were found anaemic. Based on blood indices and haemoglobin, 151 showed hypochromic micro-cytic picture. Seven films showed hypochromic microcytic picture, target cells and high red cell count suggestive of thalassemia minor, or iron deficiency anaemia plus thalassemia minor. 87 cases showed dimorphic picture. Normocytic normochromic picture was seen in 134 patients. 59 slides showed target cells. Macrocytes with right shifted neutrophils were seen in 07 patients. Burr cell were seen in 7 patients. Trophozoites and schizonts of Plasmodium vivax were found in 9, while trophozoites of p.falciparam were seen in 2 peripheral slides. Fragmented cells were observed in 2 blood smears. Peripheral film is an old but very important diagnostic tool to reach to final diagnosis. So whenever blood is sent for complete blood picture. one should pay attention on the comments given on peripheral film