Frequency of syphilis among antenatal clinic attendee in combined military hospital Abbottabad

Frequency of syphilis among pregnant women attending Combined Military Hospital Abbottabad Descriptive study. A screening for syphilis of 500 married pregnant women presenting to antenatal clinics was carried out using the qualitative Rapid Plasma Regent [RPR] test/ Venereal Disease Research Laboratory [VDRL] test. The Treponema Palladium Haem-Agglutination Assay [TPHA] test was used as confirmatory test for all Venereal Disease Research Laboratory [VDRL] test positive cases. A total of 8 women [1.6%] were positive for Venereal Disease Research Laboratory [VDRL] test. Out of these 4 [0.8%] were positive for Treponema Palladium Haem-Agglutination Assay [TPHA] test. All of these cases have bad obstetrical history. The sero-positivity of Venereal Disease Research Laboratory [VDRL] test is [1.6%], considered high among pregnant women reporting in obstetrics clinics of Combined Military Hospital Abbottabad. Similarly sero-positivity of Treponema Palladium Haem-Agglutination Assay [TPHA] test is [0.8%] considered high among the Venereal Disease Research Laboratory [VDRL] test population. Therefore Screening of syphilis in pregnancy especially in patients having bad obstetrical history [BOH] should be incorporated into the study

Efficacy of disposable spinal needle in diagnostic bone marrow aspiration

To see the efficacy of disposable spinal needle in diagnostic bone marrow aspiration. Observational study. Department of Haematology, Military Hospital and Army Medical College, Rawalpindi from 1st October 2008 to 31st September 2009. A total of 324 bone marrow aspirations were performed after obtaining informed consent. The study included both male and female subjects and was not restricted to a particular age group. After detailed clinical history and physical examination, blood counts were performed on Sysmex KX-21 hematology analyzer. Smears were examined to assess the indications for bone marrow aspiration. The procedure was conducted at posterior iliac spine in all cases except children under 2 years of age, for which tibia was the preferred site. A 16-gauge spinal needle was used, under sterile conditions using Lignocaine 2% as a local anesthetic. Leishman Stain was used to stain the slides. Pearls reaction and cytochemical stains were used where required. Once prepared, the slides were examined under light microscope and the diagnosis was made in light of both the clinical presentation and microscopic findings. The results were analyzed on SPSS version 17.0. Out of 324 bone marrow aspirations diagnosis was possible in 295 cases. The most frequently diagnosed conditions were anaemia [Megaloblastic, Iron deficiency, Anaemia of chronic disorder], Leukemias [Acute Leukemias and Chronic Leukaemias] and reactive changes in bone marrow secondary to infection. Disposable spinal needles are convenient, user-friendly, readily available [even in remote areas] and ensure sterilization in bone marrow aspiration

Sternum: a useful but forgotten site for bone marrow aspiration

This study was carried out to evaluate the usefulness of sternal puncture for bone marrow examination when posterior superior iliac spine was not approachable. Case series. The study was carried out from Sep 2008 till Feb 2009 at Haematology Department, Army Medical College /Military Hospital Rawalpindi. Sternal puncture was performed on 12 patients where PSIS/ASIS were not accessible due to patients condition/ disease. The diagnosis was possible in all the patients and the reports were intimated within a few hours of carrying out the procedure. Indications for sternal puncture were non accessibility of PSIS/ASIS due to obesity, bed sores, anasarca, skin lesions and patients on ventilators. No complications were seen. Sternum is as good as other sites of bone marrow examination especially in critically ill patients who cannot undergo conventional bone marrow aspiration

Biochemical pattern of liver function tests in hepatitis E epidemic

To evaluate the biochemical pattern of liver function tests in acute hepatitis E epidemic. Cross sectional descriptive study. Department of Pathology Army Medical College, Rawalpindi from June '09 to Dec '09. A total of 81 patients of acute hepatitis of all age groups, both male and female were included in the study. Patients who reported with symptoms of acute hepatitis and tested positive for hepatitis E IgM antibody were included. Detailed history, clinical examination and serial liver function tests [LFTs] were carried out. Weekly data of LFTs was arranged serially up to 4 weeks. The results were analyzed on SPSS version 17. The patients' age ranged from 17-59 years. Serum Alanine Transaminase [ALT] values were highest in the first 2 weeks reaching 100 times the upper limit of normal [ULN]. Similarly serum total bilirubin [TBil] reached up to 8 times ULN in the 1st week. The increase in serum alkaline phosphatase [ALP] was 2 times ULN and then returned to within the reference range in the 3rd and 4th weeks before other variables. Serum albumin levels remained unchanged. Prothrombin time [PT] was found to be prolonged. Two cases ended up fatally. Rest recovered fully and became symptom free. Hepatitis E is a serious clinical condition. LFTs play an important role in its diagnosis. There is marked derangement of LFTs. Sharp rise in serum ALT up to 100 times ULN is a significant feature and should raise the suspicion of acute Hepatitis E

Correlation between glycated haemoglobin and random plasma glucose levels for the screening of diabetes mellitus

To find out a correlation between Glycated hemoglobin [HbA1c] and random plasma glucose levels for the screening of diabetes mellitus. Analytical cross-sectional study. This study was conducted in the Department of Pathology, Army Medical College, National University of Sciences and Technology, Rawalpindi, from January 2010 to April 2010. Three hundred and fifteen patients were included in the study. HbA1c was estimated using Ion Exchange Resin separation kit of Globe Diagnostics, as per guidelines. The Plasma samples received were analyzed on fully automated chemical pathology analyzer Selectra E for random glucose estimation by Glucose Oxidase method. The gender distribution and the relationship of age with HbA1c and random plasma glucose levels were also determined. The results were interpreted using Statistical Package for The Social Sciences [SPSS] version 17. There was a direct correlation between glycated hemoglobin and random plasma glucose levels while there was no correlation between age of the patients and the HbA1c or the age and the random plasma glucose levels. We also found that for every 1% rise in HbA1c, plasma glucose level rose by 2.3mmol/L. Glycated haemoglobin can be used as a reliable, feasible and fairly accurate tool for screening of diabetes mellitus

Bone marrow aspiration: the diagnostic tool in haematological and non-haematological disorders

This study was undertaken to ascertain various clinical conditions requiring bone marrow examination and to assess its advantages in our clinical setup. This study is case series, which was carried out at the Department of Pathology, Combined Military Hospital, Sialkot Cantt from 1[st] Jun 2005 to 31[st] Dec 2007. One hundred and six bone marrow examinations were performed from 1[st] June 2005 till 31[st] Dec 2007. Patients of all age groups and gender referred for bone marrow examination were included in the study. After history, clinical examination and blood complete counts, about 0.1 and 0.2 ml of bone marrow was aspirated from posterior superior iliac spine, sternum or tibia under local anesthesia or Ketamine as per age. Well spread films were made immediately and air dried. The smear was stained with Leishman stain and Peri's stain and assessed by examination under microscope. The patient's ages ranged from 06 months to 80 years with a mean age of 38 years. Twenty five patients were children under the age of 15 years and 81 were adults. Male to female ratio was 2:1. The clinical presentation of the patients was progressive pallor [50], fever of unknown origin [13] and bleeding [6]. The common clinical situations where bone marrow examination was requested were the presence of anaemia 37[34.9%], leukaemia 25 [23.5%], myelodysplastic syndrome 7 [6.6%], multiple myeloma 5 [4.7%], chronic disorders 10 [9.4%] and non-haematological conditions 8 [7.5%]. Diagnosis was established in >/= 90% cases. Bone marrow examination remains a simple, reliable and the most effective technique in the diagnosis of many important clinical conditions.It is an important and readily accessible tool for diagnosing various haematological and non-haematological conditions. The importance of bone marrow examination is further highlighted in cases where routine investigations fail to reach a conclusive diagnosis

Clinical presentation in an outbreak of hepatitis E

In many cases of acute hepatitis, hepatitis E virus [HEV] is a common cause. Hepatitis E is a self limiting disease which shares many epidemiological, clinical and morphological similarities with hepatitis A. Both are enterically transmitted. The purpose of this study was to evaluate the clinical presentation of hepatitis E during an epidemic and correlate the clinical features with liver function tests [LFTs]. It is a cross sectional retrospective study. The study was conducted at Army Medical College [National University of Sciences and Technology] and Military hospitals Rawalpindi from July to December 2009. One hundred patients admitted to the hospital with clinical features of acute hepatitis including anorexia, nausea, vomiting, pain epigastrium, jaundice, raised serum total bilirubin [TBil] and serum aminotransferase [ALT] were included in the study. Hepatitis E in these patients was confirmed by detecting the presence of anti HEV IgM. The patients were monitored during their stay in the hospital and changes in their clinical condition were correlated with liver function tests [LFTs]. The most prominent symptoms in all patients were fatigue, nausea, anorexia, jaundice and dark urine, followed by pain epigastrium [50%], low grade fever [48%] and hiccups [2-3%]. Jaundice developed when mean total bilirubin was 127micromol/L, mean ALT was 1527 U/L and mean ALP 127 U/L. Serum bilirubin correlates with the development of jaundice. Hepatitis E presents with varying clinical features. The presentation is acute with marked anorexia, nausea and fatigue coupled with sharp rise in LFTs. Any adult presenting with acute onset of these symptoms should be investigated for LFTs and anti HEV IgM