Lymph node biopsies: Evaluation of disease pattern and role of surgery – Our experience from South Punjab, Pakistan

Objective: The objective of the study was to determine the frequency of different pathologies presenting with lymphadenopathy in patients from South Punjab and to evaluate the role of surgery in reaching the diagnosis. Materials and Methods: It was a cross-sectional study done at Recep Tayyip Erdogan Hospital, Muzaffargarh (managed by The Indus Health Network), from August 2014 to October 2017. Those being biopsied at some other hospital and the lymph node dissection biopsy done for a known primary cancer were excluded. Results: Lymph node biopsy was done on a total of 71 patients (56.3% n = 40 males, 43.7% n = 31 females). The mean (standard deviation) age of the patients was 27.30 ± 17.07 years. Open biopsy was performed on 70 cases (98.6%), whereas laparoscopic biopsy was performed on one case (1.4%). The most common pathology found on histopathology report was Tuberclosis (TB) lymphadenitis (49.3%, n = 35), followed by lymphoma (25.4% – Hodgkin's disease [HD] 15.5% and non-Hodgkin's lymphoma [NHL] 9.9%). Conclusion: TB is the most common pathology, followed by lymphoma. HD is more common than NHL. Surgical biopsy is the gold standard. Laparoscopy and other minimally invasive techniques are very safe and useful for excision biopsy of the central lymph nodes.

Nutritional assessment of general population of Faisalabad; Pakistan

Objective: The aim of this study is to assess the nutritional status of general population living in Faisalabad and to determine the association between dietary intake and iron deficiency anemia. Subjects and Methods: A cross-sectional survey was conducted in Faisalabad on 216 subjects (11–35 years of age) and subjects were selected using simple random sampling living in during the study. So far the methodology on the basis of the hypothesis of Z- test I have arrived at the conclusion at confidence interval 98% following results were found. Results: Nearly 38.43% of the participants had anemia, among them 21.76% of the participants had mild anemia, 15.74% of the participants had moderate anemia and 0.93% of the participants had severe anemia. The 34.25% of participants were underweight and 9.7% of participants were overweight. More than 55% of females were suffering from anemia. Conclusion: Most of the female participants had anemia. There was a significant association between the intake of meat and hemoglobin level. Hence, special measures should be taken to provide dietary education, especially to females to have healthier mothers in the future.

Expression of paired Box-2 gene product in renal tumors as a diagnostic immunomarker

Objective: This study was aimed at evaluating the usefulness of paired box-2 gene (PAX-2) in the diagnosis of renal tumors. Materials and Methods: This study included 60 renal tumors. The newly prepared hematoxylin and eosin stained slides of all cases were evaluated and the diagnoses were confirmed or revised for each tumor according to the 2004 World Health Organization classification of renal tumors. Representative and consecutive sections of each tumor were submitted for anti-PAX-2 antibody immunohistochemistry. The pattern of staining (nuclear or cytoplasmic) was also noted. PAX-2 expression in tumors was correlated with low- and high-nuclear grades (Fuhrman nuclear grades). Results: The 45/60 (75%) cases showed PAX-2 nuclear immunoexpression. The frequency of positivity in renal tumors was seen in 29/34 (85.5%) and 12/15 (80%) cases of clear cell RC, papillary RCC, respectively. The PAX-2 was positive in 20/45 cases for score 1+. The 16/45 cases were categorized into score 2+, and 9/45 cases were categorized into score 3+. Conclusion: PAX-2 is a diagnostically useful marker for primary renal tumors and is inversely proportion to the grades of the renal tumor.

study of Galactin-3 on fine needle aspiration as a diagnostic marker differentiating benign from malignant thyroid neoplasm

Background and Objective: Thyroid nodules are very common in our setup and their diagnosis on fine needle aspiration is not easy and is a taxing affair. It is a challenge to differentiate between follicular adenoma and follicular carcinoma without histology. Our objective was to investigate the role of Galectin-3 in fine needle aspirates of thyroid nodules as a prospective diagnostic marker and consequently its ability to differentiate benign from malignant neoplasms

Methods: The research was conducted at the department of Pathology, King Edward Medical University, in association with other teaching institutions of Lahore from June 2012 to July 2014. Sixty cases of solitary thyroid nodules were included in the study. Haematoxylin and eosin staining of the fixed smears and Galectin-3 immunohistochemical staining of the sections prepared from the cell block was performed

Results: There were 60 patients in our study with a mean age of 33.35 years. The Bethesda system for reporting thyroid cytopathology was used to classify the smears and only categories IV, V and VI were included. On histological examination of the resected nodules there were 38.3% [23/60] cases of follicular adenoma, 46.6% [28/60] were of papillary carcinoma and follicular carcinoma made up to 15% [9/60] of all cases. Galectin-3 was negative in 100% [23/23] cases of follicular adenomas. Out of 37 malignant cases 65% lesions showed positivity, while 35% showed negativity for this immunomarker. Considering the malignant lesions, 75% cases of papillary carcinomas showed a positive reaction while only 33% of follicular carcinomas were positive for the immunomarker. This showed that the positive expression was more common in papillary as compared to follicular carcinomas

Conclusion: Galectin-3immunomarker is considerably expressed in malignant tumors, but it is not expressed in benign follicular lesions

The Association of Relative Risk of High Risk HPV with Cervical Abnormalities in Bahrain.

Background: Th e study was conducted to see the association of cervical abnormalities in relation to high risk Human Papilloma Virus (HR-HPV) infection at King Hamad University Hospital, Bahrain. Materials and Methods: It was a retrospective cohort study completed in 3 years at King Hamad University Hospital, Department Pathology Lab and other private Hospitals of Bahrain. Patients of Obstetrics and Gynecology out patient’s clinic and other requesting private hospitals were included in this study.A non-probability purposive sampling technique was used for this retrospective review of 160pathology reports and HPV cervista reports. Data was collected from I-Seha and patients Al-care, and was transferred and assessed SPSS-version 22. Results: Th ere were 160 cases in total, who were examined for HPV–HR DNA using Cervista molecular testing. Th ere were 73 cases were Positive for HPV and 87 cases negative for HPV. Th e minimum age of patiesnt's was 20 years while the max was 70 years. Th e mean age was 42.5 years. HR-HPV was detected in (100%) all cervical HSIL cases and in 71% of LSIL cases. Cervical intraepithelial lesion CIN2/3+ was signifi cantly associated with HR-HPV positive cases. Compared to HPV positive cases, here was no cervical intraepithelial lesion (CIN) of any grade found in HR_HPV negative cases. Th ere were only four cases with LSIL found to be R-HPV positive, which may be associated with Low-risk HPV infection. Conclusion: Th ere was strongest association of cervical neoplastic lesions with high risk HPV to control.

Use of antibiotics within the integrated management of childhood illness [IMCI]: guidelines in pediatric outpatient settings

Background: The success of standardized measures for disease classification and treatment has led disease-specific approaches led WHO and UNICEF to incorporate them into a set of guidelines for the integrated management of childhood illness [IMCI], which includes modules or subsets of guidelines for the recognition and management of children with acute respiratory infections, diarrhea, measles, malaria and other febrile illness, and malnutrition

Objective: To assess the use of antibiotics within the IMCI Guidelines in Pediatric Outpatient Settings of Jinnah Hospital

Methodology: It was a cross-sectional study conducted at Pediatrics OPD Jinnah Hospital from May 1, 2014 - August 21, 2014. The 150 children and their parents / accompanying person fulfilling the inclusion criteria after consultation from pediatric consultation were interviewed regarding their disease status and prescription by the doctor regarding antibiotics and other conditions. All the information was entered in a structured questionnaire. The samples were collected by non-probability / purposive sampling technique

Results: Among 150 children included in study mean age of children was 36 months SD 20.42 months. 60% were male and 40% female. Presenting complaints among children were, 75.0% presented fever, 26.4% had loose motions, 22.3% has vomiting, 20.3% had cough. 12.8% presented with abdominal pain. Among those who received antibiotics, 10% received third generation cephalosporin [ceftriaxone, cefexime], 10.7% penicillin's [mostly amoxicillin and piperacillin], and 4% ciprofloxacin. 30% received combination of 2 or 3 antibiotics [14.7% combination of ceftriaxone and amikacin [aminoglycoside], According to IMCI guidelines 34% were not appropriately treated, 20.7% received antibiotics when they should not and 13.3% did not received antibiotics when they should have

Conclusion: Their low adherence to integrated management of childhood illness [IMCI] recommendations for prescription of antibiotics in routine outpatient settings the study shows highly prevalent use of third generation cephalosporins

Psychosocial determinants of hypertension

Abstract: Hypertension or high blood pressure is a condition in which blood pressure in the arteries is persistently elevated. It is a serious problem in the community leading to social stagnation

Objectives: To determine the association between various psycho-social factors and hypertension. Design: Population based Case-Control study. Place and Duration: Urban Lahore. From May 2012-September 2012

Subjects and Methods: A population based case-control study with 1:1 case to control ratio was conducted. A total of 100 persons [50 cases and 50 controls] were recruited in the study. The selection was made on laid down criteria from adult population living in Urban Lahore in the vicinity of Mayo Hospital Lahore after taking due consent. Data was collected through a pretested questionnaire by a 5 membered team of MBBS students of King Edward Medical University, Lahore under direct supervision of Department of Community Medicine, KEMU. Data was collected, compiled and analyzed through SPSS version 20

Results: Overall 47% were males and 53% were females. Hypertension was found more in females, in the age group 51-65 years, who were married and in graduates. In bivariate analysis, hypertension was found significantly associated with anxiety [OR: 3.167, 95%CI: 1.398-7.174], restlessness [OR: 5.060, 95%CI: 2.150-11.910], anger [OR: 3.083, 95%CI: 1.330-2.963], and income [OR: 3.019, 95%CI: 1.315-6.929]. Whereas diet [OR:0.667, 95%CI: 0.302-1.472], sedentary lifestyle [OR: 1.000, CI: 0.454-2.203], smoking [OR: 1.976, CI: 0.612-6.380], alcohol intake [OR: 2.042, CI: 0.719-23.266], intake of tea/coffee [OR:2.125, 95%CI:0.943-4.789] and unemployment [OR:0.583,95%CI:0.177-1.925] were not found to have any association with hypertension

Conclusion: Hypertension was found significantly associated with anxiety, restlessness, anger, and income

Ileocaecal schistosomiasis - a case report from King Hamad University Hospital Bahrain

Bilharziasis [schistosomiasis] is a chronic parasitic infection caused by the nematode family called Schistosoma species which include; S. mansoni which is common in southern and sub-Saharan Africa, South America and Caribbean and transmitted through contaminated fresh water. S. haematobium is distributed throughout Africa and is transmitted through contaminated water. S. japonicum, found in Southeast Asia. S. mekongi found in Cambodia and Laos. S. intercalatum, found in parts of Central and West Africa. A case of Schistosomiasis was reported of the ileo-cecal area and discuss the clinical and pathological features, and review the relevant literature

Incidence of beta-thalassemia carriers in Muzaffarabad, Azad Kashmir

Objective: To determine the frequency of beta-thalassemia carriers in healthy population from Muzaffarabad Azad Kashmir

Methods: In this cross sectional population based study, people from Muzaffarabad were motivated to get themselves tested for beta thalassemia trait. People found healthy on basis of a questionnaire and clinical examination were included in the study. Complete blood counts and peripheral smear review were performed on EDTA samples. Hemoglobin [Hb] electrophoresis was performed. Subjects with mean corpuscular volume [MCV], <76 fl, and/or mean corpuscular Hb [MCH], < 27 pg were subjected to hemoglobin A2 [HbA2] level estimation by elution method. Hemoglobin A2 of more than 3.5% was considered diagnostic for beta-thalassemia trait. Azad Kashmir is a territory with considerable ethnic heterogeneity. This is basically a tribal society with a high proposition of consanguineous marriages. We created awareness among the general population

Results: Found that gene is present in almost all tribes studied

Conclusion: Using strict criteria for healthy population, we conclude that incidence of thalassemia trait is 5.6 % in our study population. beta -thalassemia trait is present in almost all ethnic groups. To control thalassemia major, screening program for thalassemia carriers must be initiated in the area

Retroperitoneal schwannoma, incidental detection - case report King Hamad University Hospital Bahrain

Shwannomas are benign nerve sheath tumors that mostly occur in the head and neck, extremities, and mediastinum. These rarely present as retroperitoneal masses. A case was reported of an incidentally detected retroperitoneal shwannoma in a 32-year-old female. Schwannomas, the benign nerve sheath tumors, grow slowly but they may cause pain, weakness, numbness, or stay asymptomatic. Symptoms depend on the location and size of the tumor. Sometimes the patients, who present to the Accidents and Emergency with vague abdominal pain. Imaging incidentally may detect a pelvic lesion that is always diagnosed on histopathology after complete resection

Facts sheets of cartilage tumors. classifications and differential diagnosis - review article

Tumors, which differentiate to cartilage, share characteristic features for the production of chondroid matrix by these tumor cells. The cartilage tumors are ranged from completely benign lesions to highly malignant. These are subdivided by location into peripheral, surface, central and intramedullary lesions. Benign bone tumors are a group of neoplasms that are most frequent in children and young adults, although they may also present in later stages of life. The malignant cartilage tumors affect bones and joints but rarely as compared to osteogentic tumors. The Malignant tumors cannot be differentiated from benign simply by biopsy without radiographic evidence. However, CT and MRI imaging may be of some use in defining the extent of tumour spread locally

Detection of HPV and its Association with Different Known Risk Factors for Neoplastic Cervical Lesions.

Objective: Cervical carcinoma is one of the most common diseases in our setup studies show that it is preceded by precursor lesions. It has been suggested that persistent infections with human papillomavirus (HPV) is the major risk factor in the development of this invasive cervical neoplasia. The rationale of this study was, whether detection may contribute to the identification as a major risk factor in cervical neoplastic lesions. Study Design: Experimental study. Methods: 102 cases were selected after screening 1000 specimens through Papanicolaou stains of cervical cytology and histopathology for detection of HPV and its subtype PCR. Data for risk factors were collected by a questionnaire and association of HPV was seen with Positive PCR results. Patient demographics including their age, sexual partners, marital status, socioeconomic condition, contraceptive and screening history were evaluated to determine whether subsidiary risk factors are associated with HPV and the development of cervical lesions among Pakistani women. Major Outcome: 85% cases of cervical carcinoma were associated with high risk HPV infection. Results:46/102 (45%) cases were low grade squamous cell intraepithelial lesions(L-SILs),twenty two (21.5%) cases were high grade squamous cell intraepithelial lesions (H-SILs), 14(13.7%) cases were squamous cell carcinomas(SCC), 6 (5.8%) cases showed features of adenocarcinoma, 10(9.8%) cases showed cytology of atypical squamous cells of undetermined significance(ASCUS) and 4(3.9%) cases were of atypical glandular cells of undetermined significance(AGUS). Out of 102 cases, 88/102(86.27%) were positive for HPV and among them 32/88 (36%) cases were of HPV-16 and 56/88(64%) cases of HPV-18. There was strong association of HPV positivity with young age, early marriages, poor socioeconomic condition, abortions, multiparity and smoking but there was no association with multiple marriages. Conclusion: Frequency of HPV-18 was greater than HPV-16 in cervical neoplastic lesions and was strongly associated with certain known risk factors for cervical carcinoma.

Histopathological and Immunohistochemistry Observations Based Bukhari Grading for Squamous cell carcinoma.

Background: Increasing incidence of Squamous Cell Carcinoma (SCC) has emphasized the challenges of managing this condition. Traditional microscopic information often fails, especially when based on H & E methods. Immunohistochemistry (IHC) and molecular studies in combination with traditional histopathology may fill this gulf. Aims: The study was conducted to introduce new a grading system based on both histopathological and biological correlation of SCC. Settings and Design: A descriptive study included 180 cases of SCC of the skin (all regions of skin and oral mucosa). Cellular proliferation index (Ki‑67 and p53 expression) was studied in SCC by immunohistochemistry (IHC). This study was carried out in the Department of Pathology from January 2006 to December 2008. Methods and Material: The clinicopathological information regarding age, sex, primary tumor site, tumor size, local recurrence, distance metastasis and follow‑up status was collected for each case. Patient outcome was verified and updated through the medical records. Five micron thick (5μm) sections were cut from archival formalin fixed, paraffin embedded specimens. The first section was stained with haematoxylin and eosin (H&E) for histopathological analysis. Other sections were stained immunohistochemically with p53 and Ki‑67 and then independently scored for the expression of p53 proteins and Ki‑67 index. Results: SCC was designated low, intermediate, and high tirade grades based on the sum of point values assigned to each 4 scores of histological differentiation, staging, expression of p53 protein and Ki‑67 index. Expression of P53 was found to be related to the Ki‑67 and the scores of histology and stages of SCC. A significant correlation was found among the newly assigned grades, stages (Spearman correlation = 0.721, P value = 0.000). The grades were also significantly correlated with other prognostic factors like local invasion, lymph node and distance metastasis (Kendall’s Tau‑b = 0.394;p‑value = 0.00). Tumor recurrence was also significantly based on grades of SCC (Kendall’s Tau–b = 0.966, P value = 0.025). Conclusion: It was concluded that a new grading system is an important prognostic indicator of squamous cell carcinoma. This practical approach has potential to improve clinical evaluation of SCC in understanding the pathological as well as clinical behavior of SCC.

Oral squamous cell carcinoma; clinico-pathological parameters and AgNOR status in grading

The aim of this study was to evaluate clinico-pathological parameters and the status of argyrophilic nucleolar organizer regions stain in various histological grades of oral squamous cell carcinoma. A cross sectional study was conducted on fifty cases of oral squamous cell carcinoma. The specimen were collected from the department of Oral and Maxillofacial Surgery and processed for hematoxylin and eosin stain and AgNOR stain Pathology Laboratory, King Edward Medical University Lahore. Bidi smoking is associated with oral squamous cell carcinoma. The AgNOR [mAgNOR and pAgNOR] status was significantly low in well differentiated and moderately differentiated compared to poorly differentiated oral squamous cell carcinoma [p =0.001]. AgNOR size in poorly differentiated was significantly higher than the AgNOR size in well differentiated oral squamous cell carcinoma. Similarly the distribution of AgNOR in moderately and poorly differentiated oral squamous cell carcinoma was significantly high. The AgNORs index was significantly high in poorly differentiated squamous cell carcinoma as compared to well differentiated and moderately differentiated squamous cell carcinoma. The use of AgNORs stain is easy, valid and reliable method to assess the histological grading of oral squamous cell carcinoma and should be used to predict the prognosis of patients

Bone mineral density and diet of teachers of college of home economics at Lahore

To evaluate the Bone Mineral Density [BMD] and diet of teachers of a Govt. College of Home Economics in Lahore. It was survey research. Purposive sampling technique was adopted for the selection of 50 teachers from Govt. College of Home Economics of age group 30 - 60 years. About 46% of the subjects had BMD ratio in between -2.58 to -4.0 [Osteoporotic category]. The root cause of low BMD ratio was not really age related but in majority of the sample it was due to sedentary life style and lack of awareness about the importance of exercise in relation to bone health. The total mineral and vitamin intake required for bone health [calcium, magnesium, phosphorus and vitamin D] was below the recommended, among majority of the sample

Use of supravital toluidine blue staining to improve the efficiency of fine-needle aspiration cytology reporting in comparison to papanicolaou stain

To see the efficiency, adequacy and accuracy of toluidine blue stained smears of FNAC of Breast thyroid and salivary glands swelling with comparison to conventional stained FNAC smears witt Papanicolaou. A total of 114 aspirates from various sites were included in the study. The smears were stainec with toluidine blue and conventional Papanicolaou stain and the cytomorphology of both the smears were compared. The values were tabulated and statistical tests of significance was applied. Of the 114 aspirates included in our study the diagnostic accuracy by using papanicolaou wa 78%, while it was upto 100% with supravital toluidine blue stained smears. The percentage of inadequacy was reduced to just 25%. The observations were statistically significant. Breast 37/48 [77%] and Salivar glands 11748 [23%] respectively. The most commonly used categorization of a five-tier system was used for reporting of breast cytology, with categories ranging from insufficient materials [C1], benign [C2], atypics [C3], suspicious of malignancy [C4], or [C5] frankly malignant. Most of breast lesions were benign 2 [67.56%]. There were only 9 [24.32%] malignant cases followed by 2 cases of C-4 and one case of C-3. Benig thyroid lesion were more frequent comprising of 51 [72.27%] cases. One case [1.5%] of papillary carcinoma was found while 13 case were follicular lesions. There were 4 [36.4%] cases of pleomorphic adenoma an 3 [27.3] cases of non-specific sialadenitis. There was one case [9%] of each lesion for mucoepidermoi carcinoma, adenoidcytic carcinoma and benign cyst. Toluidine blue stained study of FNAC improves the diagnostic accuracy by minimizing the smearing and drying artifact, loss of cell sample during fixation and staining which influences the diagnost accuracy

Gestational diabetes; to compare the efficacy of metformin with insulin in diabetes mellitus in terms of fetomaternal outcome

Objectives: To compare the efficacy of Metformin with insulin in gestational diabetes mellitus in terms of fetomaternal outcome

Study Deign: Randomized clinical trial study

Setting: Lady Aitchison Hospital Lahore

Period: January 2014 to March 2015

Methodology: Total 500 pregnant females with GDM were included in the study through nonprobability, consecutive sampling. Patients were divided into 2 equal groups [A: B]. Patients in group A were given tablet metformin 500 mg by oral route and group B was administrated regular injection Insulin by subcutaneous route

Results: The mean age of females was 32.14 +/- 6.13 years. The mean gestational age was 31.07 +/- 3.8 weeks. There were 78 [15.6%] females who had 0 parity, 107 [21.4%] females had parity 1, 175 [35%] females had parity 2, 95 [19%] females had parity 3, 33 [6.6%] females had parity 4 and 12 [2.4%] females had parity 5.There were 54 [10.8%] cases had PTB, out of which 12 [4.8%] had PTB with metformin while 42 [16.8%] had PTB with insulin. There were 115 [23%] neonates required NICU admission, out of which 37 [14.8%] neonates with metforminand78 [31.2%] neonates with insulin. There were 87 [17%] neonates who had neonatal hypoglycemia, out of which 23 [9.2%] neonates with metformin and64 [25.6%] neonates with insulin. The difference was significant between both groups for all fetal outcomes [P<0.05]

Conclusion: The metformin is more effective in preventing adverse fetal and maternal outcome as compared to insulin

Anemic patients; relationship of frequency and severity of iron deficiency anemia with preterm labor and eventual perinatal outcome

Pregnant women are particularly considered to be the most vulnerable group because of the additional demands that are made on maternal stores during pregnancy. The iron deficiency anemia is the most common nutritional deficiency problems in females and is responsible of high maternal death rate in our society

Objectives: to determine the relationship of frequency and severity of iron deficiency anemia to preterm labor and eventual perinatal out come in anemic patients

Study Design: it was a case control study

Study Setting: in Obstetrics and Gynecology Unit-III, Sir Ganga Ram hospital, Lahore from July 2012 to June 2013

Methodology: the study was conducted on 200 patients [100 cases and 100 controls] were studied. Cases were patients admitted in labor room with preterm labor and Controls were females in labor at term at. Convenience sampling was done. On admission relevant history taking examination and investigation were done. The data was collected on a Performa

Results: there were 50 patients with anemia amongst the patients with preterm labor. In the control group, 40 patients were suffering from anemia. In the patients with preterm labor the mean hemoglobin was 9.83 grams/deciliter. In the control group the mean hemoglobin was 10.3gm/dl. [Pregnant women having hemoglobin <10 gm/dl are considered to be anemic]. The odds ratio was calculated to be 3.4 and P value was <0.05

Conclusions: iron deficiency anemia was associated with increased risk for low birth weight, preterm delivery, and perinatal mortality. The frequency of iron-deficiency anemia was seen in both groups of pregnant women

Frequency of placenta previa in previously scarred and non scarred uterus

To determine the frequency of placenta Previa in patients coming to a tertiary care unit with previously scarred and non-scarred uterus. A descriptive cross sectional study was carried on 114 cases who underwent caesarean sections [37 cases out of 645 cases with non scarred uterus and 77 cases from 721 cases with scarred uterus] in the department of obstetrics and gynecology Lady Willingdon Hospital from January 2008- December 2011. Most patients [47.36%] were between 26-30 years age group, presented with gestational age between 36-40 weeks [70.17%], were mostly G2-4, while frequency of placenta Previa in non-scarred uterus was 32.45% [37 cases], and frequency in previously scarred uterus was 67.54% [77 cases]. Major degree Previa was found in 88 cases [77.19%]. There were 5.70% cases of placenta Previa from non-scarred uteruses and 10.67% cases of placenta Previa [10.67%] from already scarred uteruses. Stratification revealed a higher trend of the morbidity with the increase in number of previous caesarean sections. A significantly higher frequency of placenta Previa was found among patients coming to a tertiary care hospital with previously scarred uterus

Antigen expression on blast cells and hematological parameters at presentation in acute lymphoblastic leukemia patients

To analyze the expression of various antigens on the leukemic blasts and to determine the hematological parameters, in Acute Lymphoblastic Leukemia [ALL] patients at presentation. Observational study. King Edward Medical University, Lahore and Hameed Latif Hospital, Lahore, from February 2013 to March 2014. A total of 50 newly diagnosed and untreated patients of ALL were selected from Mayo Hospital and Hameed Latif Hospital. These patients included both genders and all age groups. Hemoglobin, total leukocyte count and platelet count were determined on hematology analyser-Sysmex-Kx-2I. Blast cell percentage was estimated on Giemsa stained blood smears. Immunophenotyping was done on bone marrow samples by 5 colour flowcytometery on Beckman Coulter Navious Flowcytometer. An acute leukemia panel of 23 antibodies was used. The data was entered and analyzed in SPSS version 22. Of the 50 ALL patients, 36 [72%] were B-ALL and 14 [28%] T-ALL. There were 18 [36%] children and 32 [64%] adults. T-ALL included 22% of the childhood and 31% of the adult cases. Immunophenotypic analysis showed that CD19, CD79a and CD20 were B-lineage specific markers whereas cCD3, CD3 and CD5 were T-lineage specific. CD10 was the most sensitive marker for B-ALL and CD7 was the most sensitive marker of T-ALL. TdT was expressed in 92% B-ALL and 71% T-ALL cases, CD34 in 58% and 43% cases and CD45 in 83% and 100% respectively. High leukocyte count [> 50 x 10[9]/L] was present in 58% cases. Hemoglobin was < 10 g/dl in 74% patients and platelet count was below 20 x 10[9]/L in 12% patients. Leukocyte count, hemoglobin, platelet count and blast cell% did not show a significant difference in the two ALL immunotypes. The frequency of T-ALL is higher in childhood as well as adult ALL in our population compared to the Western literature. Antigenic expression of the blast cells also shows some interesting differences. A large number of our patients present with high leukocyte count which is a known factor associated with poor prognosis