Bone marrow infiltration and patterns in previously diagnosed patients of non hodgkin lymphoma [a single centre study]

Objective: The objective of this study was to determine the frequency of bone marrow infiltration along with various histological patterns of bone marrow infiltration in previously diagnosed patients of Non Hodgkin Lymphoma

Study Design: Cross sectional study

Place and Duration of Study: Department of Haematology, Armed Forces Institute of Pathology Rawalpindi. Six months, from Nov 2013 to May 2014

Material and Methods: This study involved 70 patients diagnosed of Non-Hodgkin Lymphoma

Results: The mean age of the patients was 51.40 +/- 16.50 years and 78.6% of the patients were males and 21.4% were females. Diffuse Large B-Cell lymphoma was the most frequently observed variant [DLBCL, 60%], followed by Follicular [22.9%] and small lymphocytic lymphoma [SLL, 14.3%]. Most of the patients were suffering from Stage-IV disease [51.4%], followed by Stage-III [25.7%] and Stage-II disease [22.9%]. Bone marrow infiltration was observed in 51.4% patients. The most common pattern of infiltration was recorded as diffuse, observed in 33.3% of patients. The second most common pattern was interstitial which was recorded in 25% cases followed by mix [22.2%] and focal [16.7%] patterns. The frequency of bone marrow infiltration was unaffected by age [p=0.497], gender [p=0.868] and type of the disease [p=0.486]

Conclusion: The most common pattern of diffuse large B-cell Non Hodgkin lymphoma infiltration was bone marrow followed by interstitial tissue

Seroprevalence of transfusion transmissible infections in blood donors: a three year experience

Objective: To determine seroprevalence of transfusion transmissible infections [TTIs] in blood donors and to compare the present results with the data from studies conducted in past

Study Design: Descriptive study

Place and Duration of Study: Armed Forces Institute of Transfusion [AFIT], Rawalpindi from January 2010 to December 2012

Material and Methods: All the blood donors who had donated blood at AFIT during the three year study period were included. Prior to blood donation at the institute, all the donors were subjected to a preset, structured questionnaire to determine their eligibility for donation as per the criteria set by the institute. Donors7 serum samples were screened for hepatitis B virus [HBV], hepatitis C virus [HCV], human immunodeficiency virus [HIV] and syphilis by using HBsAg, anti-HCV, HIV antigen-antibody combination assay and syphilis antibody test, respectively. The repeatedly reactive samples were considered as true reactive

Results: A total 160552 blood donors were screened during the study period. The mean age of the donors was 29 ++/- 10.2 years [Range: 18 - 60 years]. Out of these, 158144 [98.5%] were male donors and 2408 [1.5%] were female donors. 7385 [4.6%] donors were volunteer and 153167 [95.4%] donors the replacement donors. The seroprevalence of TTIs in the donors for HBV, HCV, HIV and syphilis was 2385 [1.48%], 4194 [2.61%] 26 [0.02%] and 1520 [0.95%], respectively. The seroprevalence of HBV was higher and statistically significant [p value<0.05] in Gp-II [31-45 years] and the seroprevalence of both HCV and Syphilis was higher and statistically significant [p value <0.05] in both GP-II [31-45 years] and GP-III [46 years and above] when compared with overall seroprevalence of the respective infections in all age groups

Conclusion: This study highlights that the seroprevalence of HBV and HCV is decreasing in our blood donors, but still it is an important risk factor for spread of these infections. The seroprevalence of HIV is rising gradually in the blood donors

Pulmonary tuberculosis; frequency of smear positive in private laboratories of Sargodha outside the TB-DOTS programme

To assess the frequency of smear positive pulmonary tuberculosis patients diagnosed at private laboratories of Sargodha not included in the national DOTS [Direct Observational Therapy Short Course] programme. A retrospective study. Private laboratories of Sargodha from January 2007 to December 2012. Data analysis of 3952 patients who reported to private laboratories of Sargodha for staining of sputum for AFB was carried out. They were all self reporting and were either suspects of pulmonary tuberculosis or had a history of contact with a smear positive case of TB. Staining was done by Ziehl-Neelson method. The smear results were reported as positive or negative. Out of total 3952 specimens 373 [9.21%] were found to be positive for the presence of acid fast bacilli. From these 373 positive cases 164 [44%] were female and 209 [56%] were males. The age group most frequently associated with the smear positive result was aged > 55 years [13.89%] followed by age < 15 years [10%]. A large number of smear positive patients are diagnosed in private sector. These patients are not registered in DOTS programme of World Health Organization. Their number is not included in the calculating the prevalence TB in our country. It is recommended that TB case notification should be made mandatory by law by private sector health care providers

Frequency of hepatitis B surface antigen and anti-hapatitis C antibodies in remote villages of district Skardu

To determine the frequency of hepatitis B surface antigen and anti-hepatitis C virus antibodies in the remote villages of district Skardu. A prospective study in a field setting. 123 Medical Battalion [Civil Hospital Tolti] Oct 2010 to Oct 2011. The study was carried out during establishment of free medical camps at five villages of district Skardu; all above 2600 meters of sea level. They were tested for HBsAg and volunteer an anti HCV with rapid, one step immunochromatic essay. All positive samples were confirmed by a third generation ELISA. Of 3145 volunteers were tested for both viruses; 54 [1.71%] were found positive for HBsAg and 34[1.08%] for anti HCV. This 54[1.71%] were positive for HBsAg and 34[1.08%] for anti HCV. The frequency of HBsAg and anti HCV in these remote villages of Skardu is lesser than more developed areas of Pakistan.

Evaluation of absence of clinical pallor in recruits

Clinical findings such as pallor of the conjunctivae, nail beds, lips, oral mucosa and palmar creases have been used by physicians in the diagnosis of anaemia. This study was carried out to determine the value of absence of clinical pallor in ruling out anaemia in recruits by measuring blood haemoglobin concentration as a true standard. A cross-sectional descriptive study. Pathology department of Combined Military Hospital Sargodha from Jan 2009 to Jun 2009. Young adults selected for recruitment in army after medical examination by general duty medical officers were included in the study. Haemoglobin estimation was done on Sysmex KX-21 semi automated haematology analyzer. Out of total 1760 individuals who were not having conjunctival pallor as per assessment of the doctors, 109 [6.19%] were found anaemic [haemoglobin<13.5g/dL] by haemoglobin estimation. Among the anaemic recruits, 88 [80.73%] were having haemoglobin 13.49 to 10.00 g/dL. The absence of clinical pallor is not likely to rule out mild anaemia in all selected recruits

Seroepidemilogical survey of hepatitis b virus infection amongst Barbars in Faislabad

Barbers who have occupational hazard of accidental exposure to blood are at increased risk for acquiring blood borne infections. There are many blood borne infections but hepatitis due to hepatitis B and C viruses is leading cause of morbidity and mortality worldwide including Pakistan. The objective of this study was to find the frequency of HBsAg in barbers and to assess their knowledge of this occupational risk. This is a cross-sectional epidemiologic survey, that was conducted at Faisalabad between Jan 2007 to March 2007. A total of 139 barbers working in Faisalabad city were included in the study. A closed structured questionnaire was filled to asses the knowledge and attitude of the barbers. HBsAg test was carried out by rapid test method for each barber. Mean age of barbers was 37.3 years and they had worked in the trade for an average of 15.9 years. Only 37 [26.62%] regarded hepatitis B as occupational hazard for barbers. HBsAg was positive in 4.63% of barbers working at hair dresser shops and 6.45% of roadside barbers. Awareness about the occupational hazard of hepatitis B among barbers is poor. All means of prevention must be used to protect the health of these workers and of the general population

Needle stick injuries to denta health care personnel

The risk of acquiring blood-borne pathogens through needle sticks during dental care procedures is undisputed; many workers in hospital settings have contracted diseases in this manner. These injuries can be avoided by eliminating the unnecessary use of needles, using devices with safety features, and promoting education and safe work practices for handling needles and sharps. The aim of this article is to create awareness of these risks and measures that dental healthcare personnel can use to prevent percutaneous exposures in oral health settings. This narrative update is based on the overview of the medical literature on the needle stick injuries among dental health care personnel. Awareness of the potential consequences associated with needle stick injuries is must for dental health care personnel. Greater collaborative efforts by all concerned persons are needed to prevent needle stick injuries and the tragic consequences that can result

Anemia and intestinal parasitic infestations in school children in Skardu

Anemia and intestinal parasitic infestations are major medical and public health problems in Pakistan. This study was carried out to determine the frequency of anemia, intestinal parasitic infestations and possible correlation between two in Skardu district of Northern Areas. This study included 978 school children in the villages of Alchori, Kharmang, Hamzigound and Dassu of district Skardu under school health care program 2004. Stool smears were prepared with normal saline and each sample was studied under light microscope using 10x and 40x objectives. Free flowing 20 ul capillary bloods by prick method was taken from each student and hemoglobin estimation was done by Cyanmethemoglobin method. Out of 978 specimens, 537 [54.91%] revealed the presence of either cysts or ova of the intestinal parasites. Out of 543 parasites isolated, the most common parasite isolated was Ascaris lumbricoides 193 [35.54%] followed by Giardia lamblia 168 [30.94%], Entamoeba histolytica 59 [10.87%], Trichuris trichura 46 [8.47%], Ankylostoma duodenale 32 [5.89%], Hymenolepsis nana 31 [5.71%], Entrobius vermicularis 11 [2.02%] and Taenia species 3 [0.55%]. Three hundred and sixty two students [37.01%] had anaemia out of 978 students. Out of the 362 children with anemia, 283 [78.18%] were positive for intestinal parasites. Out of these 978, 623 [63.70%] were males and 355 [36.30%] were females. They were further subdivided on the basis of age into two groups. Six hundred and thirty three [64.72%] students were in 5-10 years age group and 345 [35.28%] in 11-15 years age group. The present study revealed the high percentage of intestinal parasitic infestation associated with anemia in school children of district Skardu

Perceptions about blood donation among army personnel

There is little literature on the public attitudes towards blood safety and blood donation in Pakistan. The purpose of study was to identify the misconceptions, beliefs and fears about blood donation among army personnel so that appropriate strategies can be adopted for the recruitment of voluntary non-remunerated blood donors in future. This cross sectional descriptive study was carried out at 123 [I] Fd Amb from July 2004 to Dec 2004. A self-administered questionnaire and face-to-face interview on the various aspect of blood donation were used for data collection from each individual. A total of 200 army personnel participated in the study. Out of 200 individuals, 41 [20.5%] were donors and 159 [79.5%] were non-donors. One hundred and eighty nine [94.5%] including donors and non-donors replied that a person more than 45 years of age could not donate blood. Out of 159 non-donors, 137 [86.16%] were of the opinion that blood donor should be of >60 Kg of weight. One hundred and seven [67.30%] of the non-donors answered that one can donate blood once a year. One hundred and forty five [91.20%] non-donors did not know amount of blood extracted during each donation. Out of 159 non-donors, 78 [49.06%] replied that they were not approached by anybody for blood donation. Out of 200 donors and non-donors, 105 [52.5%] revealed that extra leave could be the major incentive for blood donation. This study revealed the misconceptions regarding blood donation among army personnel. This needs education and motivation through dissemination of information regarding blood donation particularly by medical staff

Abo and rhesus blood groups in potential blood donors at skardu [northern areas]

Blood groups are genetically determined and incidence of ABO and Rh groups varies very markedly in different parts of the world and in different races. This study was conducted to document the frequency of ABO and Rhesus blood groups in potential male blood donors belonging to Skardu district of Northern Areas. It was cross sectional, prospective and observational study. It was carried out at Skardu district in 2004. The study group included a total of 1045 volunteer males from 20 to 40 years of age during blood donation campaign in different areas of the district Skardu in 2004. Blood was extracted and ABO and Rh blood grouping was carried out by tube method using commercially prepared antisera. The frequency of each type was calculated separately. The most common blood group was A [30.62%] followed by B, O and AB [26.80%, 26.60%, 15.98%] respectively. Out of 1045, Rhesus positive blood group comprised 991 [94.83%] and Rhesus negative was 54 [5.17%]. The most frequent ABO phenotypes linked with Rhesus was A+[29.38%] followed by B+ [25.55%], O + [24.79%], AB + [15.12%], O - [1.86%], A- [1.24%], B - [1.24%] and AB - [0.86%]. Our results show that the most common blood group is A positive in Skardu in contrast to other studies from Pakistan. Knowledge of the distribution of ABO and Rh blood groups is important for blood bank and transfusion services in particular area

Evidence based medicine: medical practice in the third millennium

Evidence-based medicine [EBM] is a growing international movement in health care that aims to bring the best evidence from medical research to the bedside, clinic and community. Evidence-based medicine de-emphasizes intuition, unsystematic clinical experience and pathophysiologic rationale as sufficient grounds for clinical decisionmaking and stresses the examination of evidence from clinical research. The aim of this paper is to familiarize the readers with the basic concept, methodology, resources of evidence-based medicine and its applicability in Pakistan

Management of painful sickle cell crisis in pregnancy

A 24-year old Saudi woman with homozygous SS sickle cell disease was admitted with a 2-day history of a typical painful episode involving her legs and back. There was no recent febrile illness. She was 28 weeks pregnant and had two children, the youngest being two years old. Past medical history revealed regular hospital admissions for pain crises and red cell transfusions. On examination, she looked ill, pale and icterus. Her vital signs were remarkable for a pulse of 126/minute and temperature of 38.50C. Systemic examination was unremarkable. Pain was localized to lower limbs and back and was deep in nature, the severity being 9 on Visual Analogue Scale [VAS]. Laboratory data revealed haemoglobin 7.5 g/dL, corrected reticulocyte count 13%, total leukocyte count 9.7x10e9/L with 73% neutrophils and platelet count 435x10e9/L. Total bilirubin was 57 mmol/L with 46 mmol/L of unconjugated bilirubin. Abdominal ultrasound revealed normal 28-week gestation. She was admitted and immediately started on intravenous dextrose 5% and oxygen supplementation. Morphine was started with a bolus 3 mg I/V and then infusion was given at the rate of 2 mg per hour [0.04 mg/kg/hour] with an infusion pump. Severity of pain was assessed every hour. Two units of red cell packs were transfused. Broad-spectrum antibiotics empirically administered. There was good response to this and dose of morphine was reduced to 1 mg/hour [0.02 mg/kg/hour] after 24 hours. She was pain-free after 3 days of treatment. She was given tablet diclofenac sodium, 50 mg eight hourly, for two days and then discharged from the hospital

Knowledge, attitudes and practices regrarding blood donation among the Saudi population

To assess the knowledge, attitude and practice regarding blood donation among the Saudi population. Based on this study, an effective strategy can be made regarding motivation and recruitment of voluntary non-remunerated blood donors in future. This cross sectional study was carried out at the Armed Forces Hospital, Sharourah, Kingdom of Saudi Arabia, during January 2003. A total of 500 adult males were interviewed. Each individual completed a questionnaire in Arabic language containing epidemiological data and knowledge regarding blood donation and reasons of blood donation or non donation. Out of 500 individuals, 291 [58.2%] were donors and 209 [41.8%] were non donors. Four hundred and seventy-one [94.2%] replied that a person more than 45-years of age could not donate blood. Fifty-one point two% [107 out of 209] of the non-donors answered that one can donate blood once a year. Out of 291 donors, 186 [63.9%] donated blood for their family members or friends and 105 [36.1%] were volunteer blood donors. Eighty-nine non donors [42.6%] replied that they were 'not approached by anybody' for blood donation and 80 [38.3%] considered themselves unfit for donation due to weakness. There are misconceptions regarding blood donation among the Saudi population. This needs education and motivation through dissemination of information regarding blood donation particularly on electronic media

Cerebro vascular accident in sickle cell disease

An 11-year-old Saudi female reported in pediatric outpatient department with complaint of weakness of left side of the body for last two days. The child was a known case of sickle cell disease and was diagnosed at an age of 6 months. Two other siblings were also sicklers. She had an episode of left sided hemiparesis 2 years back and on CT scan, diagnosis of cerebral infarct was made [Figure 1]. Exchange transfusion was done at that time. Patient recovered completely. She was receiving blood transfusion every 6-8 weeks. During summer vacations, she went to her native town and did not receive blood transfusion for about 13 weeks. She developed weakness on left side of the body. On examination, she was fully conscious and well oriented in time, place and person. She was pale and her vital signs were stable. On central nervous system examination, her speech was normal. No cranial nerve deficit was noted. Power in left upper limb was grade IV/V with normal reflexes. Power in left lower limb around hip and knee was grade IV/V and power around left ankle was grade II. Plantar extensor and plantar clonus was present in the left side. No signs of cerebeller lesion or meningial irritation were noted. Rest of the systemic examination did not reveal any abnormality. Her blood counts revealed hemoglobin 7.2 g/dl, platelets 203 x 109/l and total leukocyte count 13.5 x 109/l with differential showing neutrophils 51%, lymphocytes 45%, monocytes 2% and eosinophils 2%. Reticulocyte counts were 13%. Biochemistry profile revealed glucose, urea, creatinine, electrolytes, calcium, aspartate transaminase and alanin transaminase within normal range. Total bilirubin was 46.7 umol/l [normal range 0.0-24 umol/l]; out of this unconjugated bilirubin was 41 umol/l. Lactate dehydrogenase [LDH] levels were 1543 U/l [normal value 297-537 U/l]. CT scan of the brain revealed right temporo-parietal infarct. Her hemoglobin S was 83% on hemoglobin electrophoresis. Exchange transfusion was done as per protocol of this hospital and child was maintained on adequate hydration. Child was discharged from hospital after two weeks. She was advised physiotherapy for weakness of left lower limb and hyper-transfusion protocol in outpatient department regularly