Differentiation of beta thalassemia trait from iron deficiency anemia by hematological indices

Objective: We aimed at finding out reliable parameter in the differentiation of iron deficiency anemia [IDA] and beta-thalassemia trait [beta -TT] in the adult population subjected to Saudi Arabian Premarital Screening Program

Methods: A total of 620 adults [age range 21-36 years] reported during February 2012 to November 2012. Tests for serum iron and ferritin were carried out in individuals showing low hemoglobin [Hb]. All the selected subjects' samples were subjected to blood morphology, comparison of MCV, RBC count. Red Cell Distribution Width [RDW] was noted from the Coulter Report whereas Red Cell Distribution Width Index [RDWI] value was calculated for all the samples

Results: A total of one hundred and thirty-five individuals with hypochromic microcytic anemia having normal hemoglobin F and hemoglobin A2 < 3.2% were inducted in the study. Ninety-three were diagnosed having IDA, whereas thirty-two were having beta TT. Ten individuals revealed other causes of anemia. The RBC count was higher, and MCV was much lower in beta TT as compared to IDA. Both groups were subjected to RDW and RDWI, however, RDWI which showed better sensitivity and specificity for beta TT

Conclusion: RDWI is a reliable and useful index for differentiation among IDA and beta TT, as compared to RDW

Utilization of smart phones related medical applications among medical students at King Abdulaziz University, Jeddah: a cross-sectional study

Introduction: The present study explored the utility, attitude, and trends regarding Smart phone related Medical Applications [Apps] among medical students of King Abdulaziz University [KAU] Jeddah, Saudi Arabia [SA] and their perceptions of the impact of Medical Apps in their training activities

Subjects and methods: This survey was conducted at the Faculty of Medicine, Jeddah, and Rabigh campuses, KAU, Jeddah, SA. All participants were medical students of 2nd to 6th year. The data was collected by using an anonymous questionnaire regarding the perception of medical students about Medical Apps on the smart devices and the purpose of installation of the Apps. Additionally examined was the use of different Medical Apps by the students to investigate the impact of Medical Apps on the clinical training/practice. Data was analyzed on SPSS 21

Results: The opinion of 330/460 medical students from all academic years was included in the study with a response rate of 72%. There were 170 [51.5%] males and 160 [48.5%] females with a mean age of 21.26 +/- 1.86 years. Almost all participating students 320 [97%] were well aware of Medical Apps for smart devices and89.1% had installed different applications on their smart devices. The main usage was for either revision of courses [62.4%] or for looking up of medical information [67.3%], followed by preparing for a presentation [34.5%] and getting the medical news [32.1%]. Regarding the impact of Medical Apps, most of the students considered these helpful in clinical decision-making, assisting in differential diagnosis, allowing faster access to Evidence-Based Medical practice, saving time and others. The practical use of these Apps was found to be minimal in medical students. Around 73% were occasional users of Medical Apps, and only 27% were using Medical Apps at least once a day

Conclusion: The regular use of Medical Apps on mobile devices is not common among medical students of KAU

Changing haematological parameters in dengue viral infections

Dengue Fever is the most common arboviral disease in the world, and presents cyclically in tropical and subtropical regions of the world. The four serotypes of dengue virus, 1, 2, 3, and 4, form an antigenic subgroup of the flaviviruses [Group B arboviruses]. Transmission to humans of any of these serotypes initiates a spectrum of host responses, from in apparent to severe and sometimes lethal infections. Complete Blood count [CBC] is an important part of the diagnostic workup of patients. Comparison of various finding in CBC including peripheral smear can help the physician in better management of the patient. This cross sectional study was carried out on a series of suspected patients of Dengue viral infection reporting in Ittefaq Hospital [Trust]. All were investigated for serological markers of acute infection. Out of 341 acute cases 166 [48.7%] were confirmed by IgM against Dengue virus. IgG anti-dengue was used on 200 suspected re-infected patients. Seventy-one [39.5%] were positive and 118 [59%] were negative. Among 245 confirmed dengue fever patients 43 [17.6%] were considered having dengue hemorrhagic fever on the basis of lab and clinical findings. Raised haematocrit, Leukopenia with relative Lymphocytosis and presence atypical lymphocytes along with plasmacytoid cells was consistent finding at presentation in both the patterns of disease, i.e., Dengue Haemorrhagic fever [DHF] and Dengue fever [DF]. Changes in relative percentage of cells appear with improvement in the symptoms and recovery from the disease. These findings indicate that in the course of the disease, there are major shifts within cellular component of blood.

Swine flu experience in local population of Lahore

The Swine "flu pandemic" of 2009 was a global out break of a new strain of influenza A virus [H1N1], threatening human lives across the sphere and created a great panic in people around the world. In Pakistan, first case of swine flu was reported in August 2009. According to WHO, 12,220 deaths have been reported world wide. The current new reassorted strain has acquired two new capabilities, human to human spread and enhanced virulence. According to the center for disease control and prevention [CDC] recommendations, patients were included in the study who fulfilled the criteria of suspected, probable or confirmed case of swine flu. Eighty females and 32 males [total 112] suspected of swine flu cases included in this study. Among these 112 cases 92 patients were between the ages of 21-60 years. All the 100% patients presented with cough, fever and sore throat. Only 15% had vomiting and diarrhea in addition to common symptoms. Complication developed in 8 patients, out of which 6 cases were confirmed by Real Time - Polymerase Chain Reaction [RT-PCR] suffering from H1N1 influenza with 50% mortality rate. Clinician should include swine flu influenza A in the differential diagnosis of the patients presented with febrile respiratory illness who have been in contact, or visit the community having positive cases of influenza. Patients having flu like symptoms must stay at home for 7-10 days, avoid contact to the others, should cover nose and mouth with tissue while coughing or sneezing

Incidence of dengue haemorrhagic fever in local population of Lahore, Pakistan

Dengue virus infection is the most common mosquito born viral disease and is a major public health problem [globally]. More than 2.5 billion people in over 112 countries of the world are at risk from dengue virus. According to WHO, more than 100 million new cases of dengue fever occur world wide including dengue haemorrhagic fever [500,000] cases and Dengue Shock Syndrome [DSS] along with 2.5% mortality rate. In Pakistan incidence of dengue is increasing since 1994 and is becoming an important public health problem. Among the 341 acute cases, 166 [48.7%] were confirmed by IgM dengue specific kit, 27 [7.9%] in gray zone and 148 [43.4%] were negative. IgG was used on 200 suspected re-infected patients. Among them 79 [39.5%] were positive, 3 [1.5%] in gray zone and 118 [59%] were negative. Male to female ration was 1.25:1. Most patients presented typical sign and symptoms of fever, headache, myalgia, anorexia, malaise, skin rash and retroorbital pain in 98, 81, 75, 63, 47 and 41% respectively in descending order. Among 245 confirmed dengue fever patients 43 [17.6%] were considered dengue haemorrhagic fever cases on the basis of lab and clinical findings. More prevalence has been observed in old age [37.8%] as compared to children [7.1%] in age group 1-15 years. Continuous surveillance and education of the clinician is essential for the recognition of the risk factors of dengue haemorrhagic fever for early diagnosis and management

Priapism - an unusual presentation in chronic myeloid leukaemia: case report and review of the literature

Chronic Myeloid Leukaemia [CML] counts for around 15% of haematological malignancies. We are reporting two cases in which initial presentation of the disease was with priapism. After initial investigative profile, the priapism was relieved by aspiration and decompression. Later investigations revealed hyperleukocytosis due to CML in both the cases. These cases demonstrate the importance of identifying the underlying cause of priapism, as it directly influences both initial and ongoing management

Aplastic manifestations of myelodysplastic syndrome as evidenced by cytogenetic studies

To detect chromosomal aberrations characteristic of myelodysplastic syndrome [MDS] in cases presenting as aplastic anaemia. A prospective study of all newly diagnosed cases of aplastic anaemia for the detection of chromosomal abnormalities over a period of two years. Twenty cases of aplastic anaemia and 8 cases of Myelodysplastic Syndrome [control] were analyzed cytogenetically. The suspected cases of congenital aplastic anaemia and those already on some treatment [other than supportive] were not included in the study. Cytogenetic analysis was done by Giemsa-Trypsin banding technique. Both direct and stimulated cultures were set up. Out of 20 patients studied, in 4 there was culture failure. Number of available patients was thus 1 6. Only 2 out of 16 patients diagnosed as aplastic anaemia showed chromosomal abnormalities. One had Robertsonian translocation t [13:15] of no clinical significance. However, 1 out of 16 patients [6.25%] had clonal change characteristic of MDS i.e. 46, XY/45.XY, del [5q],-6. In the control group of 8 patients of MDS, 5 showed chromosomal aberrations. In 2 out of 5 monosomy 7 was detected, in 1 del [5q] and in other del [7q] was detected. One patient showed Robertsonian translocation t [13:15]. Clonal changes in cases of aplastic anaemia although low in frequency at the time of presentation may be seen in upto 6.25% of cases. These cases may very well be of Hypoplastic MDS. If serial cytogenetic analysis and monitoring of blood counts are carried out more patients may be found to develop cytogenetic abnormalities and finally MDS

Down's syndrome: prospects for prevention by antenatal diagnosis

The results of a prospective study on cytogenetic analysis of Chorionic Villus Samples [CVS] taken in early pregnancy [after 10 weeks] from pregnant ladies aged between 22 and 50 years are being presented. OBJECTIVE: To find out the prevalence of chromosomal defects with advancing age of the mother. SETTING: Department of Medical Genetics, Armed Forces Institute of Pathology, Rawalpindi. METHODS: A total of 48 samples have been studied. Ten patients were above the age of 35 years and 38 were below the age of 35 years. Chorionic villus samples were obtained after 10th week of pregnancy through transabdominal approach. Cytogenetic cultures were set up both by the direct and routine methods. Three out of the seven samples taken from expecting mothers aged above 35 and one culture from a patient aged less than 35, showed trisomy 21. This study highlights the fact that incidence of chromosomal aberrations and the Down's syndrome in particular, increases with the advancing maternal age. Prenatal studies can therefore be utilized to decrease the incidence of various chromosomal abnormalities