Rare bleeding disorders: spectrum of disease and clinical manifestations in the Pakistani population

Background@#Rare inherited coagulation factor deficiencies constitute an important group of bleeding disorders. A higher frequency of these disorders is seen in areas of high consanguinity.Our aim was to study the prevalence and spectrum of rare inherited bleeding disorders, characterize the severity of the deficiencies, identify different clinical manifestations, and evaluate different treatments provided. @*Methods@#This cross-sectional study was conducted in the Department of Haematology, Armed Forces Institute of Pathology Rawalpindi, between January 2014 and December 2018.A detailed history was taken, and an examination was performed. The signs and symptoms were noted, and the patients were diagnosed on the basis of a coagulation profile. The disease severity was assessed using factor assays. @*Results@#Among 2,516 patients with suspected coagulation disorders, 774 (30.8%) had an inherited bleeding disorder. Of the 774 patients, 165 (21.3%) had a rare bleeding disorder;91 (55.2%) of them were males, and 74 (44.9%) were females, with a male-to-female ratio of 1.2:1. The median patient age was 9 years 3 months. The most common disorder was factor VII deficiency (46 patients, 27.9%). The most common clinical presentation was bruising in 102 (61.8%) and gum bleeding in 91 (55.2%) patients. @*Conclusion@#The most common rare bleeding disorder in our population is factor VII deficiency. The prevalence of these bleeding disorders is high in our population due to a high number of consanguineous marriages.

Comparison between metformin and insulin in treatment of gestational diabetes mellitus and effect on neonatal hypoglycaemia

To compare the efficacy of metformin in the treatment of gestational diabetes mellitus [GDM] with insulin and to compare the frequency of hypoglycaemia in neonates of the mothers treated with metformin and insulin. Randomized control trial to compare the efficacy of metformin with insulin in the treatment of GDM. Outpatient department and labour ward of Obstetric and Gynaecology department of Benazir Bhutto Hospital Rawalpindi from August 2012 to January 2013. A total of 110 pregnant ladies with GDM diagnosed after 20 weeks of gestation were included and divided into group A and group B with 55 patients in each group. Group A patients were treated with insulin and group B with metformin. Plasma fasting glucose and two hours postprandial glucose levels were determined on weekly basis for four weeks after starting the treatment to determine the efficacy of insulin and metformin. At birth plasma glucose levels of all the neonates were carried out two hourly, and more frequently depending upon the requirement, during first 24 hours in both the groups to determine neonatal hypoglycaemia. Fasting plasma glucose in group A and B were calculated as 5.96 +/- 0.58 and 5.76 +/- 0.46 mmol/L respectively [p=0.280], while two hours post-prandial plasma glucose levels were 7.34 +/- 0.48 and 7.28 +/- 0.58 mmol/L respectively [p=0.650]. Efficacy in group A was 78.18% and in group B was 70.91% [p=0.381] while frequency of neonatal hypoglycaemia was calculated as 61.54% in group A and 41% in group B [p=0.113]. The efficacy of metformin in treatment of gestational diabetes mellitus is similar as with insulin and the frequency of hypoglycemia in neonates of the mother treated with metformin and insulin is also similar

Various modes of fatalities and pattern of fatal injuries in the field

To determine various modes of fatalities and pattern of fatal injuries in the field. Descriptive study. The study was carried out at the Combined Military Hospital Bannu, the base hospital of Waziristan FATA from January 2005 to October 2009. All the soldiers brought in dead from operational area to CMH Bannu were included in the study. After entry of their personal data in admission and discharge book the detailed examination was carried out. Only percentages are presented for confidentiality purpose. However details may be provided by the author on requests routed through the authorities concerned. Gunshot wounds [33.51%], bomb blast [30.16%], mine blast [18.99%] and rocket blast [7.82%] were the common modes of fatality. Multiple injuries [two or more than two] were found on 63%, head injuries on 18%, chest injuries on 13% and abdominal injuries on 6% of all the fatal cases. Maximum numbers of fatal cases were received in the year 2005 [37.65%].Most common mode of fatal injuries was gunshot wound followed by bomb blast and mine blast. Multiple injuries were the most common fatal injuries followed by head and chest injuries. There is a need for preparedness at all levels to reduce the mortality.