Acute liver failure secondary to chronic lymphocytic leukemia

Chronic lymphocytic leukemia is an indolent malignancy of lymphocytes commonly seen in elderly. Dissemination of malignancy is a rare cause of acute liver failure and has rarely been reported. Here we describe the case of a sixty five year old male presenting with acute liver failure. He is a diabetic with no known history of seropositive hepatitis, drug intake or any addictions. Bone marrow and liver biopsy suggestive of chronic lymphocytic leukemia. He eventually succumbed to his illness.

Prolonged dengue outbreak at a high-rise apartment in Petaling Jaya, Selangor, Malaysia: A case study

@#There was an increasing trend in dengue infection in Malaysia with many outbreaks that occurred in Petaling District, Selangor in 2013 – 2014. A high rise apartment in Petaling Jaya reported ten episodes of dengue outbreaks from June 2013 to June 2014. We studied the prolonged dengue hotspot at this residential complex in Petaling Jaya, Selangor and made recommendations to prevent future prolonged dengue outbreaks. This was a retrospective exploratory study by analysing secondary data on dengue outbreaks from years 2013 to 2014. Small group discussions, interview sessions with staff and site visits were carried out to obtain necessary information. Two hundred and ninety-one cases were notified during the dengue outbreaks from Epid week (EW) 25 in 2013 to EW 26 in 2014 with no mortality reported. Information entered into dengue databases might be incomplete or mixed up. Active case detection and environmental risks assessment based on cases were not carry out due to the massive outbreak. Basic information on the population in the outbreak locality was unavailable. Various control activities were carried out with varying outcomes. Community participation was poor with little cooperation from residents during health education and community-based mosquito breeding prevention activities. To ensure better management of dengue outbreaks and to prevent prolonged dengue outbreaks in the future, integrated case findings, effective control activities, extensive environmental assessment on the outbreak locality and adopting innovative community outreach initiative with sufficient staff are required to curb dengue vector.

The Prevalence of JAK2-V617F Mutation in Sudanese Patients with Chronic Myeloproliferative Neoplasms.

Myeloproliferative neoplasms (MPNs) are clonal malignant diseases that represent a group of conditions including polycythemia vera (PV), essential thrombocythemia (ET), and myelofibrosis (MF). The JAK2-V617F mutation has been described as a frequent genetic event in majority of patients with MPNs. The aim of this study was to determine the frequency of JAK2-V617Fmutation in Sudanese patients with myeloproliferative disorders referred to Isotope Center, and to investigate the differences of laboratory parameters between patients with JAK2-V617F positive myeloproliferative neoplasms (MPNs) and JAK2 wild type MPNs. A total of 259 patients with MPNs; 159 with polycythemia vera (PV), 55 with essential thrombocytosis (ET) and 45 with primary myelofibrosis (PMF), and11 healthy adult individuals were enrolled in this study from March 2013 to November 2015. DNA was isolated from peripheral blood leukocytes by innuPREP kit, and JAK2-V617F mutation gene detected by allele specific PCR. The JAK2-V617F mutation was detected in 71% (184/259) patients with MPNs. The prevalence of the mutation was 81.7% in PV, 56.4% inET, and 51.1% in PMF. Mutation was not detected in 11 healthy adult people. The presence of JAK2-V617F was not associated with Hb level, Hct, or the platelet count for PV and ET, whoever the mutation positively correlated with high Hb (P=.039), Hct (P=.04) in PMF patients, and with high erythrocytes count in PV. The JAK2-V617F mutation can be frequently detected in the Sudanese patients with MPNs.

Obesity and asthma severity among adults presenting to the out patient clinic

Recent studies have suggested a relationship between asthma and obesity. The risk for developing asthma increases with increasing obesity among individuals. Yet little is known about how obesity influences asthma. To determine whether a relation of Obesity to asthma exists among adults presenting to the out patient respiratory clinic, and the correlation between Obesity and spirometric changes in patients with asthma. A cross-sectional study was done for one hundred patients aged 17 to 70 years patients with asthma diagnosed by clinical and pulmonary function test, in the respiratory outpatient's clinic in AL Kadhmia Teaching Hospital. Collected from May to December 2010. The following parameters were assessed: Weight, height, body mass index, gender, spirometric parameters which includes of forced expiratory volume in 1 second [FEVI], forced vital capacity[FVC],FEV 1/FVC ratio, and forced expiratory flow 50% [FEF50%]. There were 100 asthmatic patients,32 male and 68 female. There age between 17-70 year, classified into four groups according to BMI. There was significant relation between obesity and asthma [p=0.03],this relation was statistically significant in female[p=0.003] but not in male. Spiromety in male showed no statistically significant [p-value > 0.05] for FEVI, FVC FEVI/FVC ratio, FEF50% in both non obese and obese, but in female statistically significant for FEVI/FVC[p 0.05], FEF50% [p 0.036], while no statistically significant for FEVI, FVC in both groups, for both male and female according to BMI there is statistically significant for FEF50% [p 0.015],while no statistically significant for FEVI/FVC, FVC, FEVI in both groups. There was a significant relation between asthma and obesity, in female, but not in male. There is statistically significant difference for FEF50%, and FEVI/FVC in obese female. Also there is statistically significant difference for FEF50% in both male and female according to BMI

effect of age on clinical and radiological presentation in patients with pulmonary tuberculosis in Baghdad

Mycobacterium tuberculosis causes the most common type of human tuberculosis worldwide The most common mode of transmission is by inhalation of droplet nuclei from expectorated respiratory secretions. Active infection is diagnosed by documenting the presence of Al tuberculosis in respiratory secretions or other body fluids or tissues. Age is an important determinant of the risk for the disease The risk may increase in the elderly To compare the effect of age between elderly and younger on clinical and radiological presentation in patients with pulmonary tuberculosis in Iraq. A prospective study was done for 251 patients with smear positive pulmonary tuberculosis in outpatient's clinic in the Chest and Respiratory Disease Specialized Center in Baghdad. Collected from January to May 2009.The following parameters were assessed: Age, gender, symptoms, risk factors, radiological findings, and incidence of recurrent The relation of these parameters between elderly and younger was evaluated There were 174 young adult patients and 77 elderly patients The elderly group age was between 60-80 years, and younger adult age was between 17-59 years. There was no significant difference in the symptoms between the two groups Family history of pulmonary tuberculosis [p=0.009] was more common in young adult, while DM [p=0.001] was more common in elderly Comparison of radiological findings in young adults vs. elderly patients shown a typical findings [p=0.036] which is more in elderly There was no significant difference in the incidence of recurrence between the two groups. There was no significant difference in the symptoms between elderly and younger age groups. Family history of PTB was more common in young adults, while DM was more common in elderly. A typical radiological findings were more in elderly. There was no significant difference in the incidence of recurrence between the two groups

Outcomes of surgical management of tracheobronchial injuries---a case series from a developing country / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>Tracheobronchial injuries are defined as injuries involving the trachea and/or bronchi from the level of the cricoid cartilage extending up to the division of the bronchi. We present a case series with most of the tracheobronchial injuries found to be sustained after penetrating trauma.</p><p><b>METHODS</b>A retrospective review was performed at the Aga Khan University, Karachi, Pakistan. From January 2004 to December 2009, 168 patients with thoracic trauma were treated, of whom 15 were recognized to have major tracheobronchial and pulmonary injuries.</p><p><b>RESULTS</b>The average age was 31 years with most of the patients being male (14:1). Among them,11 patients had penetrating trauma as the main cause of injury, 3 patients had blunt trauma from road traffic accidents, only 1 patient had combined trauma (blunt and penetrating trauma). Eight patients were diagnosed based on radiological findings. All the patients were treated surgically. Lobectomy was the most common intervention performed in 7 patients. The mortality rate was 7% (1 patient). Most patients survived with no sequelae (10 patients) while 5 survived with disability. We found that penetrating trauma was the leading cause of injury in our series. The severity of injury depends upon the weapon causing the trauma. Patients in our series had multiple injuries and required surgical management.</p><p><b>CONCLUSIONS</b>Tracheobronchial injuries are rare but potentially life threatening. They require quick diagnosis and management. Diagnosis tends to be difficult since there are no specialised diagnostic modalities available at present.</p>

Acute traumatic subclavian artery thrombosis and its successful repair via resection and end-to-end anastomosis / 中华创伤杂志(英文版)

Subclavian artery thrombosis is a rare complication of clavicle fractures. We reported a 20-year-old man who was admitted to the emergency room after a road traffic accident. He was a pedestrian who was initially hit by a bus and after he fell down on the road, he was run over by a car. On evaluation, he was found to have multiple facial and rib fractures, distal right humerus and right clavicle fracture. Significantly, right radial pulse was absent. After further evaluation including Doppler studies and an angiography which revealed complete obstruction of right subclavian artery just distal to its 1st portion, the patient was urgently taken to the operation room. A midclavicular fracture was adjacent to the injured vessel. We established proximal and distal control, removed damaged part. After mobilizing the subclavian artery, an end-to-end anastomosis was made. Then open reduction and internal fixation of right distal humerus was performed. The rest of the postoperative course was unremarkable. To prevent complications of subclavian artery thrombosis, different treatment modalities can be used, including anticoagulation therapy, angioplasty, stenting and bypass procedures.

Dilemma in the diagnosis of mediastinal adenopathy in the south Asian population-role of CT guided biopsy, mediastinoscopy and video-assisted thoracoscopy [VATS]

The diagnosis of mediastinal adenopathy is a dilemma amongst treating physicians especially in South Asia. This is because although tuberculosis is endemic in this region, many a times lymphoma and sarcoidosis cannot be excluded. Often patients are being treated with medications without a confirmed diagnosis. The Video-assisted thoracoscopy [VATS] has revolutionized the way mediastinal adenopathy is diagnosed and managed in this part of the world

Beta-carotene, glycemic control and dyslipidemia in type 2 diabetes mellitus

Diabetes mellitus is a stressful condition in which the increased production of free radicals impairs the generation of naturally occurring antioxidants like vitamins and carotenoids. The present study deals with the changes in serum fl'-carotene in type 2 diabetes mellitus, as modulated by glycemic control and oxidative stress. Multiple biochemical parameters were obtained from plasma of 57 patients with type 2 diabetes mellitus [25 males and 32 females], on oral hypoglycemic with a disease duration of 1- 15 years and 37 healthy normal subject s of matching age and sex to serve as controls. The biochemical parameters measured in the present study included the glycated Hb [HbAlc], serum lipids [total cholesterol TC, triglycerides TG, high and low density lipoprotein cholesterols, HDL-C and LDL-C], lipid peroxides and serum beta-carotene. Results revealed a marked reduction of beta-carotene in the diabetics in a pattern proportional to that of the glycemic control, dyslipidemia and oxidative stress. Possible causes, mechanisms and suggestions underlining these changes are discussed

Evaluation of multiple transrectal ultrasound guided biopsies of the prostate for the detection of prostate cancer

To evaluate different regimens used in transrectal [TRUS] guided biopsy and to identify the optimal [TRUS] biopsy regimen, a prospective study included 80 consequent men undergoing biopsy either because of an elevated PSA> 4 ng/ml and/or abnormal digital rectal examination. Biopsies yielded 34 patients with prostate cancer giving a positive biopsy rate of 42.5%. Traditional sextant biopsy diagnosed 30 patients [88.2%]out of 34 patients with prostate cancer, while laterally directed biopsies detected 32patients [94%]. Positive transitional biopsy was positive in only two patients. No single case of prostate cancer was diagnosed only by transitional zone biopsies. The highest detection rate among traditional sextant biopsy sites were at the apex [88%] while the lowest were at the base [67.4%]. None of patients developed major complications. A sextant biopsy, far laterally oriented, regimen is the optimum transrectal biopsy regimen for detection of prostate cancer

Prevalence of neuropathy in patients with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease is a disease that reduces the expiratory flow, thus resulting in hypoxemia in variable severity. Twenty-one chronic obstructive pulmonary disease patients and 43 age-matched control subjects were included in the study. Nerve conduction study, pulmonary function tests and oxygen saturation were evaluated. The sensory conduction velocities of all the examined nerves were reduced significantly in the patient's group. The motor conduction velocity is reduced but not to a significant level. All the parameters of pulmonary function tests and oxygen saturation were reduced in the chronic obstructive pulmonary disease patients. A clear relationship between the degree of airway obstruction and posterior tibial sensory neuropathy was noticed. The abnormality in the nerve conduction velocity is predominantly of sensory type. Low oxygen concentration appears to be the causative agent

Renal stones in Kelantan, Malaysia--has the pattern changed?

Records of 183 patients with renal stones managed at Hospital Universiti Sains Malaysia between 1985 and 1995 were retrospectively evaluated. The commonest symptom was lumbar pain which may be associated with either frequency, blood stained urine or dysuria. One hundred and sixty-one patients (88%) had upper tract stones while the remainder had lower tract stones. Positive urine cultures were seen in 33 patients. The commonest organism isolated was Escherichia coli followed by Klebsiella aeruginosa and Staphylococcus aureus. Almost all of our patients had renal impairment at presentation and 70% of them progressed to chronic renal failure. In contrast to previous findings, the pattern of renal stone in this region is similar to that described in Western society. Its effect on renal function is serious and hence warrant special attention.

Adult asthma in northern Iraq

217 patients attended the out patient department between July 1986-1989 diagnosed to have bronchial asthma depending on clinical history, physical examination and peak flow meter measurement [PEFR]. They included 98 men [45.2%] and 119 women [54.8%]. The age of onset of their first symptoms varied between 13-40 years. The duration of their symptoms ranged between few days to over 20 years. Family history was present in 64 patients [29.5%] and nasal symptoms was present in 60 patients [27.6%%]. The main presenting symptoms were day time and nocturnal dyspnea both indicating moderate to severe air way obstruction with PEFR of 300L/minute or less. The triggering factors precipitating acute attacks in their order of frequency were cigarette smoke, dust, cold weather, respiratory infection and exercise. 106 patients [48.84%] were on no regular medications and only 25 patients [11.5%] were on different types of steroids. Inhalers are underused by our patients. B2 stimulant and steroid inhalers were used in [31.5%] and [3.2%] of our patients respectively

Disribution of ABO and RH blood group systems among Arbil population

Blood group determination was done for 23247 individuals in Arbil city ranging in age from 6 years to 65 years, 11234 of them were males and 12013 females. The distribution of their blood groups was: A32.4%, B23.5%, Ab 6.4% and O 37.7% and group Rh positive 93.39%. The findings were compared to studies in other parts of Iraq and the world

Acute myocardial infarction in patients admitted to c.c.u Arbil teaching hospital comparative study on risk factors and complications

A prospective study on patients admitted to ccu in Arbil teaching hospital was carried out over one year period from June 1988-June 1989, out of [246] patients admitted to the unit, 165 were found to have acute myocardial infarction. 105 [63%] were males, 60 [37%] were females, 102 [61%] had ventricular premature beat, 105 [63%] were smoker or had history of smoking, other risk factors observed less frequently. 76.8% of our patients were admitted after 4th from onset of their symptoms. 10 patients had primary ventricular fibrillation, [5] five were successfully resuscitated. 17 out of 21 patients with asystole died. Total mortality rate 25 of 165 patients was [15.15%]. Our results compared to other studies in other studies in other parts of our country

effect of single dialytic procedure on the level of serum zinc, copper and iron in patients on chronic hemodialysis program

The effect of single dialytic procedure on the level of serum zine, copper and iron was evaluated in 91 patients on chronic haemodialysis. The level was compared to the results in 27 health subjects. Serum zine level was significantly low [P< 0.005] and was affected by dialysis. Serum copper was significantly increased after single dialysis [P<0.005], but was not significantly different compared to the control. serum iron increased after single dialysis but the change was not significant [P< 0.005]. Aetiologies and probable mechanisms were discussed with its clinical and biochemical importance

Prescribing rates of various antihypertensive drugs in Erbil, 1991-1992

The rate of prescribing various antihypertensives was evaluated.of 325 prescriptions. 183 contained single drug therapy while 142 containe combined therapy. The most ccmmonly presented drugs when used as monotherapy are atenolol [30.05%], propranolol [10.92%]. methyl dopa [30%], amiloride +hydrochlorthiazide [16.39%], benz thiazide + triamtren [4.39%], nifedepine [7.1%] and captopril [1.09%]. The most frequently used drugs as monotherapy or in combination are diureties [51.6], B-Blocker [42%], C N S-acting drugs [37.8%]. while diuretics are the most frequently combined drug with C-N.S-acting drug in [38%], with B-blockers in 26.76%, and with calcium channel blocker in [11.26%]. Our result shows that drug availability influences treatment of our hypertensive patients, although our study was conducted during drug embargo on our country in 1991-1992

Accidental poisoning of children in Erbil province

This Is a retrospective study of 541 children with accidental poisoning admitted to Erbil Children Hospital in 1986, 448 children [82.8%] were between 1 and 5 years of age. Kerosine poisoning was the commonest [296 cases, 54.7%] followed by food poisoning [123 cases, 22.7%] and drugs and chemicals poisoning [122 cases, 22.6%] The male to female ratio was 1.5. The period of hospitalization was longer in cases of kerosine poisoning than in the others. The mortality rate was 2/541 [0.3%]. 364 cases [67.3%] were discharged with no complications and 175 [32.3%] took their own discharge. No seasonal variation was observed In kerosine poisoning, but 61% of food Poisoning and 34.5% of drug poisoning occurred in the summer

Kala-Azar in Iraq: treatment of relapsing cases by splenectomy

Kala-azar is an endemic disease in Iraq, caused by the parasite Leishmania donovani, It was found to be of mediterranean varient which affects children only. The patients are usually responding to the treatment with triantimony sodium gluconate. In some of the treated cases the disease relapses within few months of therapy and a second course of therapy is needed. In this paper we report two cases of relapsing kala-azar despite repeated medical treatment, managed successfully by splenectomy