Baseline leukocyte count and acute coronary syndrome: predictor of adverse cardiac events, long and short term mortality and association with traditional risk factors, cardiac biomarkers and C-reactive protein

The elevated WBC count has been accepted as part of healing response following myocardial infarction as well as a predictor of adverse cardiovascular events. The study was designed to find out correlation between WBC count and coronary risk factors, cardiac biomarkers, C-reactive protein [CRP], incidence of adverse cardiac events and mortality in patients of ACS in Pakistan. One hundred and thirty- three patients of ACS were stratified according to WBC categories, WBC1 [<700/mm[3]], WBC2 [7100-10, 000/mm[3]] and WBC [>10, 000/mm[3]]. The WBCs were counted on admission by Sysmex cell counter, CRP by immunoturbidimetric method, and CK-MB and Trop-I by enzyme immunoassay. Adverse cardiac events and mortality were recorded for 12 months of follow up period. Long term mortality in patients with ACS was 6.4% in WBC1, 18.2% in WBC2 and 40.9% in WBC3 categories, while short term mortality was 2.6%, 3.0% and 18.2% in WBC2 and 40.9% in WBC3 categories respectively. Relative to patients in lower 2 WBC categories, patients in the highest category were 7 times more likely to die during 30 days [HR 7.83, p=0.017] and more than 9 times during the total follow up period [HR 9.42, p<0.001]. Cox regression analysis showed WBC3 a strong independent predictor of mortality [HR 6.36, p=0.016]. WBC count showed a positive correlation with coronary risk factors, cardiac biomarkers and CRP. WBC count is a strong independent predictor of mortality in patients with ACS and has positive correlation with coronary risk factors, cardiac biomarkers and CRP

Epidemic of cutaneous leishmaniasis: 109 cases in a population of 500

In February 2004, 4 patients aged 10-15 years presented at the Pakistan Institute of Medical Sciences with non-healing multiple ulcers on exposed parts. On the basis of history, clinical assessment and fine needle aspiration cytology, they were diagnosed as having cutaneous leishmaniasis. We were informed that several similar cases were present in their village. A team of doctors and technicians visited the area. A survey was conducted and another 105 cases with various morphological presentations were identified. The area was visited several times to find the vector, reservoirs and source of infection and to advise on controlling the epidemic

Treatment modality and prognosis as a function of topography and clinical staging in laryngeal carcinoma

Treatment modality and prognosis in laryngeal cancer depends on topography and clinical staging. While conservation surgery is indicated in early supraglottic and glottic cases, total removal of larynx is the choice in subglottic and late supraglottic and glottic tumours. Total laryngectomy is also indicated in failures after conservation operations and D.X.R. We use deep X-ray therapy as a post-operative supplement in advanced cases where we remove larynx as well as some adjoining infiltrated area such as pharynx, tongue base, etc. D.X.R. is also indicated for palliation. As regards prognosis, it is best in early clinical stage-1 and clinical stage-2 tumours, specially in glottic area. Advanced cases where one has to remove extensively do not fare so well. Same is true for cases who require neck dissection