Outcome of hairy cell leukemia patients treated with cladribine - a 10-year single-center experience in Pakistan

ABSTRACT Introduction and objective: Hairy cell leukemia is an uncommon, indolent B-cell lymphoproliferative disorder. Therapy with cladribine (2-chlorodeoxyadenosine) is able to induce complete remission (CR) in the majority of patients after a single course of treatment. We report the outcomes of patients treated at Aga Khan University Hospital, Karachi, Pakistan. Methods: This was a retrospective review. Medical records of patients were used to collect data. Results: A total of 21 patients with hairy cell leukemia were treated with cladribine. All patients achieved an initial CR. Four patients (19%) required hospitalization and therapy for neutropenic fever. Six patients (29%) relapsed at a median of 48 months. All 6 patients were treated for relapse, out of which 4 achieved CR, 1 had partial response and 1 had refractory disease. The overall survival rate was 90.5%, with a median follow-up of 35 months. Conclusion: A single course of cladribine is able to induce CR in a vast majority of patients. Unfortunately, relapse is not uncommon. Patients who relapse can be successfully retreated with cladribine. Cladribine has impressive efficacy and a favorable acute and long-term toxicity profile when administered to patients with HCL.

Acute poisoning and its medicolegal aspects in patients presenting at a tertiary care hospital of Sindh

Objective: To assess acute poisoning and its medicolegal aspects in patients presenting at a tertiary care hospitalofSindh

Study Design:Observational Study

Place and Duration of Study: This study was carried out at Liaquat University Hospital Jamshoro/Hyderabad from April 2014 to June 2015

Materials and Methods: 240 cases of acute poisoning were studied presenting at the outpatient departments and emergency wards of the Liaquat University Hospital Jamshoro/Hyderabad. Acute poisoning cases were selected according to inclusion and exclusion criteria. Tools used for gathering information were the; information obtained from attendants/relatives, history of patients him/herself, clinical presentation, clinical signs and symptoms, laboratory findings and moreover response to anti poisoning therapy. Data was analyzed on statix software 8.1 [USA]. Data was analyzed using student`s t-test and Chi-square test for continuous and categorical variables respectively. P-value

Results: Of 240 subjects, 147 [61.25%] were male and 93 [38.75%] were female. [p=0.01]. Most of study subjects belong to low social class in present study. Mean age of subjects was 45 +/- 7.7 years. Male outnumbered to female as regards the acute poisoning [p=0.001]. Acute poisoning for suicide purpose was noted in 54.1 % [n=130] of study subjects. Kachasharab, organophosphate and diazepam were the most commonly used agents for poisoning purpose

Conclusion: Acute poisoning is increasing due to commonly available poisons such as drugs and pesticides. The public sector authorities should take measures for the proper implementation of handling of drugs, poisons and pesticides

Multi nodular goiter; frequency of malignancy and its histopathological types. a tertiary care hospital experience

I. To determine the frequency of malignancy in multi nodular goiter. II. To determine the histopathological types. This is a prospective study. Surgical department of Foundation Hospital Rawalpindi and associated Teaching Hospital of Frontier Medical College Abbottabad. Aug. 2002 to Aug. 2007. One hundred patients with Multi nodular were included in this study. Patient with diffuse goiter, solitary nodules, patient operated somewhere else and suspected cases of malignancy were excluded from the study. Tissue were sent to Armed Force Institute for histopathological examination. Patients were followed for 2 weeks after surgery with histopathological report, all the preoperative and postoperative findings were recorded in detail. Data was analyzed byusing SPSS 14. Majority of patients studied, belonged to Azad Kashmir and Gilgit which are among the known endemic regions for goitre in Pakistan and other from Chakwal and Jhelum. Histopathology revealed 96 [96%] patients with multi nodular goiter, 3 [3%] papillary carcinoma and 1 [1%] Follicular carcinoma. Multinodularity of the goitre should not be considered as low risk of malignancy and delay for surgical intervention. Changes in the size of gland, the appearance of new and hard nodules or cervical lymphadenopathy may indicate malignant change and prompt indication for surgery

Lump breast; role of FNAC in diagnosis

Lump breast is a fairly common presenting complaint for which patient seeks medical advice and becomes anxious about the diagnosis. Fine needle aspiration cytology [FNAC] for the diagnosis of lump breast has been proved as a simple, rapid and economical procedure. The present study was done to evaluate the diagnostic accuracy of fine lump breast in our set-up compared with open biopsy. The study was conducted in surgical department of Nishtar hospital Multan and Frontier Medical College Abbottabad. One hundred female patients with lump breast were selected for the study and their medical history was recorded. The age range was 15-65 years. All of the patients under went FNAC of the lump breast followed by open biopsy for comparison. The results reveal that this study shows a sensitivity of 87.5% for FNAC to pick malignant lesions and specificity of 82.4% while over all diagnostic accuracy 84%. Fine needle aspiration cytology is safe, easy, cheap and accurate procedure. Its sensitivity and specificity is fairly high and is a good alternative to open biopsy. FNAC should be routinely used and open biopsy should be performed in doubtful cases only

Primary intrathoracic goiter - a rare mediastinal tumor

Primary intrathoracic goiter is a rare presentation of thyroid disease. Its removal usually necessitates thoracotomy or sternotomy. This patient having a primary intrathoracic goiter presented with posterior mediastinal mass that was removed through a right lateral thoracotomy