High prevalence of mild hyperhomocysteinemia and folate, B12 and B6 deficiencies in an urban population in Karachi, Pakistan

To find out the prevalence of hyperhomocysteinemia, and deficiencies of folate, vitamin B6 and vitamin B12 in an urban population in Karachi, Pakistan. In a pre and post experimental study, eight hundred and seventy-two apparently healthy adults [aged 18-60 years; 355 males and 517 females] were recruited from a low-income urban locality in East of Karachi from February 2006 to March 2007. Fasting venous blood was obtained. Serum was analyzed for folate and vitamin B12. Plasma was analyzed for pyridoxal phosphate [PLP, coenzymic form of B6] and total homocysteine. A group of vitamin-deficient individuals [n=194] was given 3-week supplementation with folic acid [5mg/day], methycobalamin [0.5mg/day] and pyridoxine hydrochloride [vitamin B6, 50 mg/day]. After supplementation, serum/plasma levels of folate, vitamin B12, PLP and homocysteine were again determined. Prevalence of hyperhomocysteinemia [>15micromol/l] was 32%. Similarly percent values of folate deficiency [<3.5ng/ml], vitamin B6 deficiency [PLP<20 nmol/l] and vitamin B12 deficiency [<200pg/ml] in the study population were 27.5%, 33.7% and 9.74%, respectively. Hyperhomocysteinemia was associated with male sex, folate deficiency, vitamin B12 deficiency [OR [95%CI], 8.3[5.7-12.1]; 2.5[1.76-3.58]; 2.6[1.5-4.5], respectively]. A 3-week supplementation with folic acid, methycobalamin and pyridoxine hydrochloride in vitamin-deficient subjects decreased plasma homocysteine levels by 37%. High prevalence estimates of folate, vitamin B12, and vitamin B6 deficiencies appear to be the major determinants of hyperhomocysteinemia in a low income general population in Karachi

Gastrointestinal abnormalities in vitamin B[12] deficient patients with megaloblastic anemia

In a retrospective cohort study, hospital records of 220 patients [119 males and 101 females, age 1 year-80 years] with megaloblastic anemia were examined to find out any relationship of gastrointestinal abnormalities with vitamin B[12] and folate deficiencies in these patients. Forty three percent of the patients were folate-deficient [serum folate levels

Significance of cytogenetic abnormalities in acute myeloid leukaemia

To evaluate the role of karyotype in acute myeloid leukaemia [AML] as a predictor of response to induction chemotherapy. A cross-sectional study was carried out at the department of Pathology and Oncology, Aga Khan University Karachi from January 2003 to January 2005. Newly diagnosed patients with denovo AML admitted to the hospital were included in the study. Diagnosis of AML was based on FAB criteria, immunophenotyping and cytogenetic studies. They were treated according to standard protocols [combination of anthracycline and cytarabine -3+7] and those who had acute promyelocytic leukaemia additionally received all- trans retinoic acid [ATRA]. A total of 56 patients were enrolled, 4 were excluded due to inadequate cytogenetic analysis and the remaining patients entered the study protocol. There were 32 males and 20 females with mean age of 31.3 years [range 9 months to 73 years]. Thirty-five [67.3%] patients had normal karyotype while 17 [32.7%] were found to have cytogenetic abnormalities. Eleven patients did not receive treatment at our hospital. Half of the [51.2%] patients out of remaining 41 achieved complete remission on bone marrow examination after receiving induction chemotherapy. In favourable risk group 3/3 [100%] achieved complete remission [CR] while 15/32 [46.9%] in intermediate risk group and 3/6 [50%] in unfavourable risk group. There was low CR rate in patients with high white cell counts. The frequency of cytogenetic abnormalities in AML and response to induction chemotherapy was low when compared with international data possibly due to the small sample size. However, there was a clear difference in CR rates between favourable and unfavourable risk groups

Role of ICT malaria immunochromatographic test for rapid diagnosis of malaria

To evaluate the sensitivity and specificity of immunochromatographic test [ICT] malaria p.f/p.v using microscopy as the gold standard diagnosis. Five hundred and sixty patients of both sexes and all age groups with clinical suspicion of malaria were studied. Venous blood was collected for microscopy and ICT. Thick and thin films prepared and stained with Leishman's stain were examined. ICT malaria test was performed and interpreted according to manufacturer's instructions. Data was analyzed using Epi-6. A total of 560 cases were studied, 339 males and 221 females with age ranges between 2 to 73 years. Seventy two [12.85%] cases had parasitaemia [with or without sexual forms]. On microscopy 65 [11.6%] cases had asexual-stage parasitaemia and 7 [1.25%] cases had P. falciparum gametocytes only. Thirty two cases were infected with P. falciparum, 29 with P. vivax and 4 had mixed infection. For P. falciparum the ICT was 97.0% sensitive, 98.3% specific, with positive predictive value [PPV] of 78.0% and a negative predictive value [NPV] of 99.8%. For P. vivax the sensitivity was only 89.7%, specificity 97.9%, PPV was 70.3% and NPV 99.4%. Our results are in concordance with previous studies. Rapid tests though expensive are simple to perform and effective diagnostic tools of malaria. They can be used selectively, though microscopy remains the gold standard diagnosis, economical and accurate if performed by skilled technologists

Frequency of irregular red cell alloantibodies in patients with thalassemia major: a bicenter study

To provide frequency and distribution pattern of various types of irregular red cell alloantibodies in patients with thalassemia major. This is a descriptive study conducted at two centers from January to December 2001. Purposive sampling was done and all patients diagnosed to have thalassemia major were included in the study. Antibody identification was carried out on serum employing commercial two-cell panel using standardized blood bank methods. If patients were found to have an irregular red cell alloantibody then the antibody identification was performed using 16 panel cells. A total of ninety-seven patients were included in the study. Fifty-three patients were males and 44 females. Mean age was 10.6 years. Irregular red cell alloantibodies were found in 9 [9.2%]. Mean age of patients who developed red cell alloantibody was 11.9 years. Three [33.3%] patients developed anti-K while two [22.2%] had non-specific antibody. One patient each developed anti-D [11.1%] and anti-E [11.1%]. Two had anti-D [11.1%] and anti-C while the other one [11.1%] developed anti-E and anti-K. We concluded that there is relatively high rate of alloimmunization in our set of patients when compared to data from our region. We also suggest that red cell alloimmunization should not be overlooked in patients receiving regular blood transfusions

Freequency of FAB subtypes i acute myeloid leukemia patients at Aga Khan University Hospital Karachi

Acute myeloid leukemia [AML] is a heterogeneous disease. Therefore, various parameters are needed to classify this disease into subtypes, so that specific treatment approaches can be utilized effectively. The commonly used method for diagnosis and classification is based on FAB criteria using morphology and cytochemical stains. For sonic of the categories, imnninophenotyping is necessary. The aim of present study is to determine the frequency of various sub types in acute myeloid leukemia using FAB criteria in our population. This will aid in the correct diagnosis of acute leukemia and hence proper management of the patients. Materials and This is descriptive case control study conducted at Aga Khan University Hospital from January 1999 to December 2000. The total number of subjects was 116 that included both adults and children. The patients were diagnosed on the basis of bone marrow morphology using FAB classification. Cytochemistry was done in all cases, while immunophenotyping was considered only in those cases that were found to be problematic. Among 116 patients, 70 were males and 46 were females with male to female ratio 1.5:1. The age ranged between 6 months to 85 years with a mean age of 32 years. AML-M4 was the predominant French American-British [FAB] subtype [36.2%] followed by M2 [30.25%], M3 [10.4%], M1 [7.7%]. M5a [3.5%], M5b [2.5%] and M6 [0.8%]. Conclusions: The most common FAB subtype observed in our study was Acute myclomonocytic leukemia [M4] which is in accordance with studies reported from Saudia Arabia and a previous study reported from our institution. However, other national and international studies have reported Myeloblastic Leukemia with maturation [M2] as the predominant subtype of AML