Background . Most of the hematological disorders are heterogenous with regard to morphology, immunophenotype, and genetic rearrangements. Multiple recurrent chromosomal aberrations have been identified by conventional cytogenetic analysis, which is now widely recognized as one of the most important diagnostic and prognostic determinants in these patients. Though rarer, complex karyotype has been associated with worst prognosis. Materials and Methods . A total of 1185 bone marrow or peripheral blood cytogenetics samples were taken with different hematological diseases. They included both benign and malignant disease entities. In each case, cells were cultured and conventional cytogenetic analysis was performed. Results . Among 1185 subjects, 41 (3.4%) patients possessed complex cytogenetic abnormalities. Out of these 41, 33 (80%) were males. The mean age was 37 years (median age 39 years). Myelodysplastic syndromes had the most numbers of complex karyotypes (8%), followed by acute myeloid leukemia (7%) and acute lymphoblastic leukemia (4%). Also we found few patients with acute promyelocytic leukemia, aplastic anemia , chronic myeloid leukemia, and diffuse large B cell Lymphoma possessing complex karyotype. Frequencies of different cytogenetic abnormalities were assessed with respect to disease as well as independently. Trisomy 21 was the most common chromosomal abnormality found in 28% of patients. Conclusion . Complex karyotype was most frequently associated with myelodysplastic syndromes and acute myeloid leukemia. Trisomy 21 and deletion 5q were the commonest cytogenetic abnormalities found. We also assessed complex karyotype in benign diseases and detected one patient of aplastic anemia with complex karyotype. This is the first study highlighting the presence of complex karyotypes in hematological disorders in our region.
Objective: Sepsis occurs in hematological disorders due to neutropenia, clinical signs and symptoms are not specific for its diagnosis.Early biomarkers are potentially helpful for the diagnosis in these patients.This study was done to assess the utility of Procalcitonin (ProCT) as a marker of sepsis in patients with hematological disorders.Methods: A cross sectional study was conducted in the section of clinical chemistry, department of laboratory, National institute of Blood disease and Bone marrow transplantation (NIBD) Hospital in Karachi Pakistan.Total 366 patients with age groups of 15 to 60 years with suspected sepsis undergone ProCT test were enrolled in the study, their blood cultures results and biomarkers including; White blood cell (WBC) count, C-reactive protein (CRP) and Absolute Neutrophil count (ANC) were also recorded.Sepsis was labeled as per surviving sepsis campaign (SSG) international guidelines for management of severe sepsis and Septic Shock 2012 criteria.Results: Biomarkers of culture positive patients were compared with culture negative patients.The statistically significant difference was noted in ProCT (p value < 0.001) and CRP (p value < 0.003).However, no significant differences were noted in WBC count (p value > 0.05) and ANC count (p value > 0.05).ProCT had outstanding diagnostic accuracy with area under receiver operator characteristic curve (AUC) was 0.95 ; ( 95%CI0.89-1.00), that for CRP was modest (AUC 0.74; 95%CI 0.61-0.87),while that for WBC and ANC were poor with AUC 0.43; (95%CI0.311-0.58),AUC 0.44(95%CI 0.28-0.54)respectively. Conclusion:ProCT alone showed the excellent diagnostic power on ROC analysis which proves it as a stronger diagnostic biomarker for sepsis in hematological disorders.
This is a cross sectional record based study that included all registered cancer cases in Basrah Oncology Center for 6 years period (1997-2002). The number of deaths due to cancer and the total population of Basrah for these years were obtained from Basrah Health Office, and Central Statistical Bureau, respectively. The study showed that the incidence of cancer in Basrah steadily increased in the years (1997-2002). It increased from 17.9/100,000 population in 1997 to 25.4/ 100,000 population in 2002. The increase in the incidence was more marked for males where the incidence increased from 13.4/100,000 in 1997 to 24.5 /100,000 in 2002.Despite this increase the incidence and mortality rates of cancer in Basrah were less than that reported in Western societies by more than 10 times. These rates were also less than that registered in Baghdad or Nineveh. The rates in Western Basrah were less than that in the center or the East of the city. This may reduce the significance of the carcinogenic effect of industrial pollution or the use of depleted uranium in this part of Basrah. The deficient screening programs and recording system for cancer can be explanations for the low incidence of cancer in Basrah.
Cancer can be controlled by at least five synchronized strategies: population-based registration, prevention using both high risk and population approaches, adequate services for early detection and treatment, palliative care and research In this paper, we present a view on how to adopt such multi-approach strategy to contain cancer in Basrah and in Iraq. The assumptions behind our view are: 1. Cancer is an important public health problem 2. Cancer is a growing public health problem 3. Many cancers are preventable, many others can be cured and only small proportions lie outside the domains of prevention and cure. 4. The strategy encompasses all necessary partners (academic, health, environmental, NGOs …etc) We believe that the first correct step in the strategy is adequate population-based cancer registration. The authors are prepared to discuss their views with open constructive mind.
Introduction: Comparative outcomes of hospitalizations for Atrial Fibrillation (AF) with and without coexisting ischemic heart disease (IHD) have limited large scale data. Coexistence of AF and IHD is common and exposed patients are at high risk for ischemic/hemorrhagic events. We assess baseline characteristics and outcomes in these hospitalized patients using National Inpatient Sample (NIS). Hypothesis: Ischemic heart disease worsens the inpatient clinical outcomes of atrial fibrillation. Methods: We conducted a retrospective analysis of hospitalizations for AF using data from NIS between 2013 and 2014. International classification of diseases, 9th revision was used to identify the target population. The primary outcome was inpatient mortality, hospital length of stay and cost. Results: A total of 1531704 hospitalizations for AF were identified, of these, 863, 352 hospitalizations were without IHD and 668, 342 hospitalizations were with secondary diagnosis of IHD. AF with IHD cohort was older (mean age, 76.4 vs 74.4, p <0.001), had low proportion of females (41% vs 55%, p <0.001), higher proportion of whites (83.4% vs 81.6%, p <0.001) and high comorbidities such as hypertension, diabetes mellitus, chronic kidney disease and congestive heart failure. AF with IHD had significant higher inpatient mortality (OR 1.02, CI 1.01-1.04), increased length of hospital stay (6 vs 5.8 days, mean difference 0.05, p <0.001) and higher cost of hospital stay (mean difference, 7122 USD, p <0.001). There was higher prevalence of cardiogenic shock (OR 2.97, CI 2.86-3.09), cardiac arrest (OR 1.58, CI 1.53-1.62), complete heart block (OR 1.46 (CI 1.40-1.53) and acute kidney injury (OR 1.10, CI 1.09-1.11) in AF with IHD cohort. Conclusion: AF with coexisting IHD is associated with higher inpatient mortality, increased cost of hospital stays, and prolonged length of hospital stay as well as higher comorbidity burden.
To find frequency ofalpha Thalsaemia nhomozygous beta Thalsaemia patients, and to se any difernce infrequency and age ofirst ransfusion and mean haemoglobin concentration.The single-centred, escriptive cros-sectional study was conducted athe National Instiute of Blod Disease and Bone Marow Transplantaion, Karchi, from June 1,2012, to May 31, 2013. Patients of homozygous beta halsaemia, diagnosed by polymerase chain reaction, wer tested for coinheritance of alpha Thalsaemia nd foetal haemoglobin XMN1 polymorphism using polymerase chain reaction. SPS 17 was used for dat anlysi.Of the 286 patients, 19(41.6%) wer males, and 9(34.6%) showed coinheritance ofalpha thalsaemia. In the coinheritance group, 50(50%) and 1(1%) patients recived 1-20 and 21-40 times transfusions per year espectively, while inthe non-coinheritance group, the coresponding numbers wer 125(67%) and 27(14.%). Overal, 73(25.%) patients had nevr ben transfused, including 38(13.%) patients inthe alpha Thalsaemia group. XMN1 polymorphism was found in 86(41%) ofthe 208 patients who wer tested and anlysed on this count.Alpha thalsemia was presnt inmore than one-third homozygous beta halsemia patients.
Current COVID-19 pandemic has affected the entire globe. While there was no vaccine neither any specific treatment, investigational use of convalescent plasma has been explored in clinical trials. A prospective multicenter study of convalescent plasma was conducted. Donors were tested for total Anti-SARS-CoV-2 antibodies by electrochemiluminescence (ECLIA) and RT-PCR for COVID-19. Enzyme Linked Immunosorbent Assay (ELISA) was used to detect semi-quantitative and quantitative IgG anti-SARS-COV-2 antibodies. IgG Immunofluorescence-based lateral flow immunoassay (LFIA) was used to recheck seronegative donors. A total of 400 donors were enrolled. Twelve donors were SARS-CoV-2 positive by RT-PCR. Nine of 12 donors had developed SARS-CoV-2 IgG antibodies, while in 3 donors antibodies were not developed. A total of 70 donors (17.5%) were deferred due to seronegative status; 64 (16%) of them did not develop antibodies when plasma collection was planned. The IgG semiquantitative ELISA was positive in 282 and quantitative in 284 of 330 donors with a mean value of >1:160 and 44.10±39.22 IU/ml respectively. A total of 116 (29%) donors did not show IgG humoral response to COVID-19 even 28 days from the onset of illness. Subsequently, LFIA method was able to detect IgG antibodies in 20 of 48 (41.6%) seronegative donors and in 20 of 34 (58.8%) ECLIA positive ELISA negative donors. Viral RNA detection in recovered asymptomatic patients with concomitant IgG antibodies indicates recovery. Inability to detect antibodies by different testing kits may be due to their different antigenic targets or sensitivity. Significance of a positive COVID-19 RT-PCR in asymptomatic recovered patients is yet to be determined.
Introduction: Comparative outcomes of hospitalizations for Cardiac Resynchronization Therapy (CRT) implantation procedures with and without coexisting Ischemic Heart Diseases (IHD) have not been studied at national level databases. We attempted to assess outcomes and baseline characteristics in these hospitalizations based on the National Inpatient Sample (NIS). Hypothesis: Ischemic heart disease worsens inpatient outcomes in patients undergoing CRT implantation. Methods: We conducted a retrospective analysis of hospitalizations for CRT implantation from the National Inpatient Sample (NIS) between 2013 and 2014. ICD-9 Billing codes were used to identify the target population. The primary outcomes were inpatient mortality, and hospital length and cost of stay. Results: A total of 11057 cases were identified. IHD was listed as any diagnosis in 66% of these hospitalizations. The mean age was 72.5 and 66.9 years for CRT implantation with and without IHD, respectively. Hospitalizations without IHD were more likely to be female (44% vs. 25%; p=0.01). Patients in the CRT with IHD group had a higher comorbidity burden with a higher proportion of hypertension, chronic kidney disease, anemia, peripheral artery disease, and congestive heart failure (Table 1). Inpatient mortality was similar between both groups (OR 1.17, CI 0.75-1.81). The IHD cohort had higher rates of cardiac arrest (OR 1.30, CI 1.05-1.62), acute kidney injury (OR 1.21, CI 1.08-1.35), longer length and a higher cost of stay (Table 1). Conclusions: IHD is associated with higher costs, longer length of stay, and higher rates of cardiac arrest. However, the in-hospital mortality was not different between the two groups. Higher incidence of cardiac arrest in patients with CRT and IHD underlines the importance of ICD with CRT. The clinical implication is that the threshold of selecting a CRT-D device in patients eligible for CRT therapy should be lower in patients with IHD vis-à-vis patients without IHD.
Abstract: Background: Pediatric Chronic Myeloid Leukemia (CML) is a rare entity accounting for 2-3% of pediatric malignancies. CML rarely presents as Blast Crisis (BC) at the time of diagnosis, and megakaryocytic blast crisis is even rarer. Case Presentation: We herein, report a case of a young female, 10-year-old who presented with anemia, leukocytosis and massive splenomegaly. Clinical features, peripheral film and bone marrow findings were consistent with CML in megakaryocytic blast crisis. Bone marrow cytogenetic analysis revealed karyotype of 46, XX, t(9:22)(q34;q11.2) in 20 metaphases and BCR-ABL P210 by PCR was detected with transcript level of 83%, which further confirmed our diagnosis. Conclusion: De novo presentation of chronic myeloid leukemia with megakaryocytic blast crisis is rarely observed in pediatric population with very few cases published till now. We are presenting this case because of its rarity, likelihood of misdiagnosis as AML (M7) and poor prognosis, if not treated precisely. Keywords: Chronic Myeloid Leukemia (CML), Acute Myeloid Leukemia (AML), Blast Crisis (BC), Acute Megakaryocytic Leukemia (AMKL), Chronic Phase (CP), Accelerated Phase (AP), Tyrosine Kinase Inhibitor (TKI).
Summary Objective The aim of this study was to assess abnormality of coagulation and anticoagulation parameters in dengue fever patients and the impact of these tests on the management of patients. Background Dengue fever is endemic in Pakistan with seasonal rise in cases. Morbidities and mortalities are proportionately reported to be increasing and associated with disseminated intravascular coagulation resulting in haemorrhagic or thrombotic manifestations in patients having deranged coagulation profiles. Methods/Materials This observational and descriptive study was conducted on confirmed Dengue patients at the National Institute of Blood Diseases during the years 2013 to 2016. Patients of all age groups were included in this study. Results were analysed by SPSS version 23. Results A total of 200 patients were selected with the mean age being 28.68 years (±13.28) and male predominance (147/200). The mean platelet count, haemoglobin and haematocrit at base line for bleeders and non‐bleeders showed significant results, where platelet count at baseline for bleeders was 24 000, whereas for non‐bleeders it was 29 000 and it showed significant correlation with bleeding ( P ‐value .027). Platelets were transfused to 76 (38%) patients. However, none of the specialised haemostasis parameters beside the platelet count correlated with bleeding, requiring platelet transfusions. Conclusion Our study showed a significant association of platelet counts, haemoglobin and haematocrit with bleeding. It can be concluded that coagulation and anticoagulation profiles will not benefit the management of dengue patients and in countries like Pakistan, it will only add to the economic burden on the patients.
'/%3e%3cpath fill='%23fff' d='m8.751-17.959 10.11 11.373L3.997-9.844l13.94-6.1-7.692 13.129z'/%3e%3c/svg%3e)
'%3e%3ccircle r='20' fill='%23008'/%3e%3ccircle r='17.5' fill='%23fff'/%3e%3ccircle r='3.5' fill='%23008'/%3e%3cg id='d'%3e%3cg id='c'%3e%3cg id='b'%3e%3cg id='a' fill='%23008'%3e%3ccircle r='.875' transform='rotate(7.5 -8.75 133.5)'/%3e%3cpath d='M0 17.5.6 7 0 2l-.6 5L0 17.5z'/%3e%3c/g%3e%3cuse xlink:href='%23a' transform='rotate(15)'/%3e%3c/g%3e%3cuse xlink:href='%23b' transform='rotate(30)'/%3e%3c/g%3e%3cuse xlink:href='%23c' transform='rotate(60)'/%3e%3c/g%3e%3cuse xlink:href='%23d' transform='rotate(120)'/%3e%3cuse xlink:href='%23d' transform='rotate(-120)'/%3e%3c/g%3e%3c/svg%3e)