Abstract Introduction Febrile neutropenia is a medical emergency in patients with hematological malignancies. The severity of neutropenia and the duration of infection have an important implication on primary treatment outcome. Previously assessed institutional review revealed gram negative bacteria to be the most common microorganisms, and leading cause of febrile neutropenia. However, the predominance of gram positive bacteria had also increased in later past years [1]. In high risk patients, infections caused by multidrug resistant bacteria worsen treatment complications and thus at times empirical use of antibiotics like colomycin is required; otherwise the prognosis may be jeopardized [2]. Regular surveillance of local flora and susceptibility pattern of antimicrobial is must to elude the antimicrobial resistance. Objective The study was conducted to evaluate the prevalence of microorganisms and to observe the sensitivity pattern of antimicrobials as an institutional protocol to establish antimicrobial policies. Material and methods A cross sectional study was conducted at National Institute of blood diseases and bone marrow transplantation, PECHS campus from August 2021 - January 2022. Ethical approval was taken from research committee prior to the study and informed consent was taken from the patients. Febrile neutropenia was defined as a single reading of oral temperature of ≥38 °C on two or more occasions in 12 h in the presence of absolute neutrophil count of less than 1000cells/mm. Blood cultures were performed using the BACTEC blood culture system. Organisms were identified according to routine bacteriological procedures and disc diffusion method was used for interpreting antibiotic susceptibility. Data was analyzed by SPSS version 23.0. Frequencies and percentages were calculated for categorical variable and mean (standard deviation) was computed for quantitative variables. Association between categorical variables was observed using the chi-square test or Fisher’s exact test. P value of <0.05 was considered statistically significant. Results A total of 310 cultures taken from blood (37.4%), peripheral line (4.2%), hickman line (8.1%), red line (2.6%), pus (7.1%), sputum (9.7%) and urine (31%) samples were observed. Out of total 213 (69%) were found to be gram negative and 97 (31%) were gram positive. Gram negative were mostly reported in blood cultures 61 (20%) while gram positive was found in urine cultures 80 (26%). E.coli (40.8%) was the most prevalent among the gram negative microorganisms followed Klebsiella pneumonae (16.9%), Pseudomonas species (11.7%), Pseudomonas aeruginosa (11.3%), Burkholderia cepacia (7%), Enterobacter species (3.3%), Moraxella species (3.3%), Proteus mirabilis (2.8%), Salmonella typhi (1.4%), Acinetobacter species (0.9%) and Citrobacter species (0.5%). In gram negative organisms, Acinetobacter species, Burkholderia cepacia, Citrobacter species and Moraxella species were identified substantially which were not previously prevalent. In gram positive microorganisms Staphylococcus epidermidis (55.3%) was more prevalent, followed by Enterococcus species (19%), Micrococcus species (16%), Streptococcus species (6%), Staphylococcus aureus (3.7%), from which Micrococcus species was reported for first time. Sensitivity of meropenem, amikacin and colistin was higher in gram negative while the sensitivity of fosfomycin, and linezolid was found in gram positive isolates The association of sensitivity and resistance with gram negative and positive isolates was found statistically significant with amikacin, vancomycin, fosfomycin and ciprofloxacin (p=<0.05). Conclusion Gram negative isolates were found prevalent in our study. The sensitivity of meropenem, amikacin and colistin was high than other regimens in gram negative while the sensitivity of fosfomycin, and linezolid was found in gram positive isolates. Few emerging isolates were observed in the study as well. The regular review of microbial pattern and susceptibility evaluation is imminent for prevention of microbial resistance and assessment of institutional practices. References 1. Martinez-Nadal G, Puerta-Alcalde P, Gudiol C, Cardozo C, Albasanz-Puig A, Marco F, Laporte-Amargós J, Moreno-García E, Domingo-Doménech E, Chumbita M, Martínez JA. Inappropriate empirical antibiotic treatment in high-risk neutropenic patients with bacteremia in the era of multidrug resistance. Clinical Infectious Diseases. 2020 Mar 3;70(6):1068-74. 2. Kanadan A, Bhagwath AA, Sebastian BT, Rudrapathy P, Manickam S. Study on oral microbial flora and antibiotic sensitivity pattern among oral cancer patients in a tertiary cancer care center. Journal of Orofacial Sciences. 2019 Jul 1;11(2):93.
Abstract: The World Health Organization (WHO) has categorized acute undifferentiated leukemia (AUL) as a rare subtype of acute leukemia of ambiguous lineage (ALAL). The prognosis of AUL is considered poor and it expresses no known lineage-specific markers. In majority of the cases, AUL has been associated with karyotypic abnormalities, most commonly deletion 5q and complex karyotype. Deletion 17p correlation with acute myeloid leukemia and myelodysplastic syndome has been previously established and is associated with poorer outcomes. Herein we are reporting a case of forty years old male who was referred to National institute of blood diseases and bone marrow transplantation with complains of fever, multiple neck swellings, and early satiety and was diagnosed as Acute Undifferentiated Leukemia along with deletion 17p. This is a rare entity and can aid in further diagnostic and therapeutic approaches. Keywords: Acute undifferentiated leukemia, Deletion 17p, Flourescnece in situ hybridization, Allogeneic haematopoetic stem cell transplantation, Flow cytometry.
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Background : Diabetes insipidus is a rare disease which can be considered as a part of broad
spectrum of preeclampsia manifestations. Case
presentation : A
39-year old primigravid woman, with an unremarkable past medical
history, was admitted in the 33rd week of gestation
for elevated blood pressure. On admission, her blood pressure was 140/90
mmHg and the only abnormal laboratory findings
were trace proteinuria and elevated liver enzymes. During the following days
her blood pressure rose to 150/100 mmHg
with deterioration of clinical and paraclinical status of the patient characterized
by excessive thirst, polydipsia and excretion of large amounts of diluted
urine. Having considered the patient's aggravating status, termination of
pregnancy was planned. Fortunately, all the clinical and paraclinical presentations,
including those related to the probable diabetes insipidus disappeared on the
second day of postpartum period. Conclusion: Sign
and symptoms of diabetes insipidus should be considered in all cases admitted
for preeclampsia.
Abstract Background All-trans retinoic acid (ATRA) is an indispensable part of the treatment of acute promyelocytic leukemia (APL). Although, mild cutaneous toxicities like mucocutaneous xerosis, rash, and pruritus are well reported, ATRA associated severe dermatological toxicities are extremely rare. ATRA is primary metabolized by cytochrome P450 (CYP450) enzyme system, and triazole antifungals are notorious for their strong inhibitory effect on CYP450. Case presentation Three Asian APL patients experienced rare ATRA-induced severe dermatological toxicities: exfoliative dermatitis (ED) in cases 1 and 2, and necrotic scrotal ulceration in case 3. Both case 1 (33-year-old female), and case 2 (28-year-old male) landed in emergency department with dehydration, generalized skin erythema and xerosis during their induction chemotherapy. Both of these patients also developed invasive aspergillosis and required concomitant triazole antifungals during their chemotherapy. For ED, intravenous fluids and broad-spectrum antibiotics were started along with application of local emollients to prevent transdermal water loss. Although their general condition improved but skin exfoliation continued with complete desquamation of palms and soles. Dermatology was consulted, and clinical diagnosis of ED was established. Discontinuation of ATRA resulted in complete resolution of ED. Case 3 (15-year-old boy) reported two blackish mildly tender scrotal lesions during induction chemotherapy. He also had mucocutaneous candidiasis at presentation and was kept on triazole antifungal. Local bacterial & fungal cultures, and serological testing for herpes simplex virus were reported negative. Despite adequate local care and optimal antibiotic support, his lesions persisted, and improved only after temporary discontinuation of ATRA. After a thorough literature review and considering the temporal association of cutaneous toxicities with triazole antifungals, we speculate that the concomitant use of triazole antifungals inhibited the hepatic metabolism of ATRA, resulting in higher serum ATRA concentration, and markedly accentuated cutaneous toxicities in our patients. Conclusion By highlighting this crucial pharmacokinetic interaction, we want to caution the fellow oncologists to be mindful of the inhibitory effect of triazole antifungals on CYP450. We propose using a non-myelosuppressive combination of ATRA and arsenic trioxide for management of APL hence, obliterating the need of prophylactic antifungals. However, in the event of invasive fungal infection (IFI), we suggest using alternative class of antifungals.
Introduction It has been discovered that low levels of thiamine reserves in the body are related to diabetes mellitus (DM) because thiamine directly influences carbohydrate metabolism. Therefore, the purpose of this study was to assess several metabolic variables and blood thiamine levels in patients with type 1 and type 2 DM and compare them with those in a control group of healthy individuals. Methods This case-control study was conducted at multiple diabetic outpatient centers in Karachi. A total of 90 participants, who were divided into three groups, each containing 30 individuals, were chosen using a convenient non-probability sampling technique. Group A served as the control group and consisted of healthy, non-diabetic individuals. Groups B and C contained subjects with type 1 and type 2 DM, respectively. Descriptive analysis was reported as mean standard deviation, whereas gender and comorbidities were expressed as frequencies and percentages. The chi-square test and Pearson's correlation coefficient were used to determine the associations of the variables with type 1 DM, type 2 DM, and controls. Results The study results revealed statistically significant differences between controls, type 1 and type 2 DM, in the means of blood glucose levels and all lipid profiles, such as glycated hemoglobin (HbA1c), fasting blood sugar (FBS), random blood sugar (RBS), serum thiamine, triglycerides (p < 0.001), high-density lipoprotein (HDL) (p = 0.014), and total cholesterol (p = 0.013). Furthermore, it was shown that among the control group, type 1 and type 2 DM, HbA1c, and FBS were insignificantly correlated with thiamine levels, whereas the HbA1c and FBS of the combined diabetic groups were significantly correlated with the thiamine level (r = 0.465, p < 0.001) and (r = 0.360, p = 0.005), respectively, where 'r' is the Pearson correlation coefficient. Additionally, HbA1c and FBS in the combined three groups were significantly correlated with the thiamine level (r = -0.626, p < 0.001) and (r = -0.561, p < 0.001), respectively. Conclusion This study concluded that patients with type 1 and type 2 DM had significantly higher levels of FBS, RBS, HbA1c, triglycerides, and total cholesterol than controls. Furthermore, both type 1 and type 2 DM patients' serum thiamine and HDL levels were observed to be considerably lower than those of controls. Additionally, among both types of DM and controls, there was a strong correlation between FBS and HbA1c. Therefore, we recommend that serum thiamine levels be routinely monitored in diabetic patients, and thiamine supplementation should be considered to avoid complications, especially vascular complications of DM.
Background: One of the main downside of a hospital is healthcare related infections which impose great challenge to health systems despite many advances.These infections affect morbidity/mortality and also increase the economic burden.Our study was designed to compare the difference in infection control at our hospital before and after taking measures at our newly established centre. Methods:A cross-sectional study was conducted after ethical approval from February, 2018 to January2019.The study was divided into two phases.First phase comprised of initial 6 months and second phase for later 06 months of hospital establishment.Data were collected from the laboratory in form of cultures reports.Descriptive and inferential statistic was done by using SPSS version 23.0.Results: A total of 1151 cultures were sent, out of which 681 (59%) were sent in initial phase and 470 (41%) were sent in later phase.It was found out that in initial and later phase there was increased rate of fungal growth in environment cultures.In majority of the patients no bacterial growth was reported in initial and later phase.Overall, absence of any organisms was found to be statistically same in both phases.However, bacterial and fungal growth reduced in later than the initial phase and the reduction in fungal growth was statistically significant.The growth of organism from the environment, accessories inside the patient's room, nursing counter, and patients was found statistically non-significant. Conclusions:Our study revealed that the number of organisms isolated in initial phase was greater than the later phase but the reduction was not satisfactory.Implementation of policies and protocols are needed in this regard.
OBJECTIVE: We assessed the predictive potential of XN-HPC for CD34+ cell count as obtained through Sysmex automated hematology analyzers (XN-1000). METHODS: This study was conducted at the National Institute of Blood Diseases and Bone Marrow Transplantation in 84 donors between December 2012 and December 2017 in the first phase and later validated in 112 donors between December 2017 and December 2018. Sysmex XN-1000 and BD FACS Calibur estimated XN-HPC and CD34+ cells of peripheral blood apheresis product, respectively. Spearman's correlation was assessed between XN-HPC and CD34+ cell count followed by receiver operating characteristic curve calculation to determine the XN-HPC cutoff for a CD34+ count of ≥2 million cells/kg of recipient's body weight RESULTS: There is a moderately positive correlation (P value = .003) between XN-HPC and CD34+ count. Receiver operating characteristic curve analyses demonstrated that a cutoff value for XN-HPC of ≥1·845×106cells/kg of recipient's body weight has a specificity and sensitivity of 100% and 78·2%, respectively, for predicting the CD34+ count of ≥2 million cells/kg of recipient's body weight. This cutoff value of XN-HPC was prospectively validated in 112 donors. The positive predictive value was found to be 100%, while negative predictive value was 17%. CONCLUSION: XN-HPC has a highly promising potential to serve as a cost-effective and time-saving surrogate for CD34+ cell count.
To establish a reliable XN-HPC cutoff, for an effective CD34 + cell count of ≥2 × 106cells/kg of the recipient’s body weight, in harvested bone marrow products in allogenic transplantation. The study was carried out in two phases. In retrospective Phase 1, data from 47 donors were analyzed. Sysmex analyzer XN-20 and BD FACS Calibur were employed to process XN-HPC and CD34 + cell enumeration, respectively. To make the two variables comparable, both XN-HPC and CD34 + cell counts were reported as the number of cells/kg of the recipient’s body weight. Spearman’s rank correlation coefficient was calculated for CD34 + cells and XN-HPC, followed by the calculation of the receiver operating characteristic (ROC) curve to identify the XN-HPC value which could effectively predict the cutoff of ≥2 × 106 CD34 + cells/kg of the recipient’s body weight. In Phase 2, the computed XN-HPC cutoff was validated in a prospective set of 53 donors by obtaining the positive and negative predictive values. Statistically significant correlation was obtained between XN-HPC and CD34 + cell count with Spearman’s rho of 0.54 (p-value <0.001). The optimal XN-HPC cutoff, for the required CD34 + ve cell count of ≥2 × 106 cells/kg of the recipient’s body weight, was calculated to be ≥2.80×106 cells/kg of the recipient’s body weight with the specificity and sensitivity of 100% and 31%, respectively. The ROC curve demonstrated the area under the curve to be 0.74. Phase 2 validation revealed 100% PPV. For harvested bone marrow products with XN-HPC of ≥2.80×106 cell/kg of the recipient’s body weight, CD34 + cell enumeration by flow cytometry can safely be disposed of.
Objectives To establish a reliable XN-HPC cutoff, for an effective CD34 + cell count of ≥2 × 106cells/kg of the recipient's body weight, in harvested bone marrow products in allogenic transplantation.Methods The study was carried out in two phases. In retrospective Phase 1, data from 47 donors were analyzed. Sysmex analyzer XN-20 and BD FACS Calibur were employed to process XN-HPC and CD34 + cell enumeration, respectively. To make the two variables comparable, both XN-HPC and CD34 + cell counts were reported as the number of cells/kg of the recipient's body weight. Spearman's rank correlation coefficient was calculated for CD34 + cells and XN-HPC, followed by the calculation of the receiver operating characteristic (ROC) curve to identify the XN-HPC value which could effectively predict the cutoff of ≥2 × 106 CD34 + cells/kg of the recipient's body weight. In Phase 2, the computed XN-HPC cutoff was validated in a prospective set of 53 donors by obtaining the positive and negative predictive values.Results Statistically significant correlation was obtained between XN-HPC and CD34 + cell count with Spearman's rho of 0.54 (p-value <0.001). The optimal XN-HPC cutoff, for the required CD34 + ve cell count of ≥2 × 106 cells/kg of the recipient's body weight, was calculated to be ≥2.80×106 cells/kg of the recipient's body weight with the specificity and sensitivity of 100% and 31%, respectively. The ROC curve demonstrated the area under the curve to be 0.74. Phase 2 validation revealed 100% PPV.Conclusions For harvested bone marrow products with XN-HPC of ≥2.80×106 cell/kg of the recipient's body weight, CD34 + cell enumeration by flow cytometry can safely be disposed of.
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