Role of clinical skill centre in undergraduate medical education: Initial experience at Rehman Medical College Peshawar.

OBJECTIVE: To assess the performance of students on clinical skill factors and to measure the satisfaction level of students related to the training. METHODS: The descriptive study was conducted at Rehman Medical College, Peshawar, Pakistan, from August 1 to September 15, 2013, and comprised all third-year medical students who had undergone clinical skill training. Their performance was evaluated through end-of-module objective structured clinical examination. Students' feedback measuring satisfaction on a five-point Likert scale was obtained on a designed validated tool. Monitoring of the clinical skills centre training programme was done by the quality enhancement cell at the college. SPSS 16 was used for statistical analysis. RESULTS: Of the 98 students who took the examinations, 94(96%) cleared generic stations and 70(72%) to 96(98%) discipline-based stations. Overall, 94(96%) cleared the first objective structured clinical examination, ranging from 83(84.6%) for Persian language conversation training to 98(100%) for general physical examination. In the second examination, 90(92%) students passed; ranging from 72(73%) for Gynaecology to 97(98.7%) each for Surgery and Ear, Nose and Throat. There was no significant difference between mean results of the two exams (p>0.05). CONCLUSIONS: Clinical skills training achieved the desired objectives and outcomes. However, continuing studies need to be done to establish reliability of the programme.

EXPRESSION OF PEROXISOME-PROLIFERATOR ACTIVATED RECEPTORS-γ IN DIABETICS, OBESE AND NORMAL SUBJECTS.

BACKGROUND: Current researcn in type 2 diabetes mellitus focuses on the role of Peroxisome- Proliferator Activated Receptors (PPARs) in the pathogenesis of the Insulin Resistance Syndrome (IRS), which are pre-diabetic lesion and the hallmark of fully developed type 2 diabetes mellitus. This study aims at identifying the abnormal status of the PPAR-γ in adipose tissues of type 2 diabetes mellitus patients, when compared with matched normal controls. METHODS: This cross-sectional study was conducted in Ayub Medical College, Abbottabad, from 2012 to 2014. Sample included three equal groups of patients. Group-1 with diagnosed type 2 diabetes mellitus, aged 40-65 years, acting as the test group, Group-2 included non-diabetic obese, and Group-3 with normal subjects. Transcription Factor Assay for Peroxisome Proliferator Activated Receptor Gamma (gamma PPAR) was done on ELISA Technique from Nuclear Extract procured from Adipose Tissue of the subjects. RESULTS: Mean age of enrolled participants was 48.93 SD ± 6.52 years. Patients ranged between ages of 40 years to 67 years. The mean values of PPAR in normal, obese and diabetic group were 1.72 SD ± 0.28, 1.282 SE ± 0.18 and 1.283 SE ± 0.18 respectively. The difference in mean values of PPAR was significant p < 0.05: CONCLUSION: The levels of PPAR-γ in patients with type 2 Diabetes Mellitus and Obese cases are significantly lower than normal controls.

Changes Of Intraocular Pressure In Vitrectomised Eyes After Removal Of Silicone Oil.

BACKGROUND: Patients with Rhegmatogenous retinal detachment develop raised intraocular pressure (IOP) when they undergo pars plana vitrectomy with silicone oil. The present study was done to document changes in IOP with silicone oil and after its removal. METHODS: The interventional study was conducted at Eye department of Lady Reading Hospital Peshawar, from August 2012 to July 2014 on 30 patients with Rhegmatogenous retinal detachment in whom pars plana vitrectomy with silicone oil injection was indicated. IOP readings were obtained on 1st postoperative day, at one month and at 6 months; the silicone oil was removed after the third reading and the IOP readings obtained after 2 weeks. RESULTS: Of the 30 patients selected for the study, there were 25 (83.3%) males and 5 (16.7%) females with ages ranging from 12-80 years (mean age 41.83±21.43 years). The mean of three pre silicone oil removal IOP readings was 27.35±9.20 mmHgwhich was reduced to a mean of 16.10±6.14mmHg following the removal of silicone oil at 6 months (p<0.001). Postoperative raised IOP values were highly predictive of persistently elevated IOP readings in patients after six months. CONCLUSIONS: Vitrectomised eyes with silicone oil raised intraocular pressure which was reduced after silicone oil removal.

Complementing theory with practice to enhance Students' learning.

BACKGROUND: Combining cognitive skills teaching related to the techniques leads to better understanding in a skill training course; but still there a substantial disagreement in curriculum on such combinations. This study aims to help guide the designers in making the outline of instructional plan for a Clinical Skills Module (CSM) for the undergraduates. Objectives were to assess performance of students on a clinical skill after training by two different models of (hands-on only or with cognitive skills) instructions and explore their perception on the employment of educational strategies through Focus Group Discussions (FGD) through a Sequential mixed method study design: (1) Quantitative (Pre- and post-assessments and comparing their results (2) Qualitative (Exploration of perspectives through constructivist approach using qualitative phenomenological design) The study was conducted during the month of September, 2015 at Rabigh Medical College, King Abdul Aziz University, Jeddah. METHODS: Students entering fourth year were randomized to two groups to participate in pre-post OSCE using global rating scale and their scores were compared. The examiners were kept blinded to the randomization of students undergoing two separate training methods. The test group (group A) was trained for both procedural as well as cognitive skills whereas the control group (Group-B) was trained only with hands-on practice. Later their perception about the addition of cognitive skills to improve of procedural skills was explored through focus group discussions. The recorded audio tapes of FGDs were transcribed and analysed thematically. Triangulation of themes and trends was achieved by relating the content analysis to the relevant frequency of quotes. Auditing of the data verification was done by all the authors separately.. RESULTS: A total of 42 students completed both pre- and post-tests. As a result, student performance in OSCE significantly increased from pre- to post-test (p<0.001) in both the groups; on the other hand no statistically significant difference was found in the pre- and posttest scores between groups A and B (p=0.108). Five themes (1) advantages, (2) disadvantages of combining theory with practice, (3) time balance in teaching a skill, (4) training on skills, (5) skillsassessment, were found prevalent on thematic analysis of the FGDs. CONCLUSIONS: Students' ability to grasp the procedural skills was not significantly different when they acquire the cognitive skills in addition to the practical sessions. Students were more convinced to adopt combination of the two in the learning of procedural skills.

Premarital genetic screening for beta thalassemia carrier status of indexed families using HbA2 electrophoresis.

OBJECTIVE: To devise a strategy for prevention of beta thalassemia in newborns through reliable screening of indexed families. METHODS: The cross-sectional study was conducted over six months in 2011 and comprised blood samples collected from subjects belonging to different ethnic groups from families of beta thalassemia major children registered with the Abbottonian Medical Association Blood Care Centre, Abbottabad, in Pakistan's Khyber Pakhtunkhwa province. Electrophoretic separation of human haemoglobin like A, F, S and C was done and then haemoglobin in the gel was immobilised in a fixative solution and the gel was dried to a film. Haemoglobin pattern was visualised by staining the film with a protein-specific stain. The pattern was quantified by densitometry. RESULTS: Of the 98 samples, 57(58.2%) had b-thalassemia trait with elevated haemoglobin alpha 2 level, and 41(41.8%) had normal level. Out of the 57 carriers, 33(57.89%) were males and 24(42.10%) were females. Mean age of carriers was 11.65±6.25 years compared to 10.93±7.75 in normal patients. Mean haemoglobin alpha 2 level of carriers was 5.2±0.56% compared to 2.34±0.57% in normal subjects. CONCLUSIONS: Carrying out mass screening programmes throughout Pakistan for the detection of thalassemia carriers and providing them the benefit of marriage counselling may decrease the incidence of thalassemia Major.

EVALUATION OF TOXIC HEAVY METALS IN AYURVEDIC SYRUPS SOLD IN LOCAL MARKETS OF HAZARA, PAKISTAN.

BACKGROUND: Herbal and Ayurvedic preparations, widely used in Pakistan and the developing world, present serious risk of heavy metal toxicity related to their medicinal content and prolonged use by patients. The objective of this study was to find out the concentration of heavy metals in Herbal & Ayurvedic liquid preparations commonly used for treatment of different diseases, from local markets of Hazara. METHODS: The cross sectional survey of traditional herbal & Ayurvedic medicine shops included ten liquid preparations selected from local shops of Mansehra and Abbottabad after interviewing the shopkeepers; so as to select the most commonly sold preparations along with their indications. All samples were analysed on standard Atomic Absorption Spectroscopy for qualitative and quantitative study of toxic heavy metals (Mercury, Iron, Zinc, Lead, Manganese and Arsenic). RESULTS: Toxic levels of Mercury were present in seven syrups, i.e., (Kashneeze, Akseer e Pachas, Tankar, Sharbat e folad, Urosinal, Akseer e Jigar and Amrat dhara) while Arsenic was present only in Urosinal. Iron, Zinc, Manganese and Lead were present in permissible limits in all syrups. CONCLUSION: Mercury and Arsenic are present in local Herbal & Ayurvedic liquid preparations far beyond the permissible limits as proposed by the International Regulatory Authorities for health drugs while the rest of metals, i.e., Zinc, Manganese, and Iron are within the therapeutic limits.

EFFECT OF INTRAOPERATIVE MITOMYCIN-C APPLICATION IN OUTCOME OF EXTERNAL DACRYOCYSTORHINOSTOMY.

BACKGROUND: Patients develop postoperative fibrosis at the site of operation after dacryocystorhinostomy (DCR) which results in impairment of the osteum patency. This quasi-experimental study was undertaken to determine the role of intraoperative Mitomycin C (MMC) application in maintaining postoperative patency of the osteum. METHODOLOGY: The present study was conducted at the Eye department of Ayub Medical College, Abbottabad on patients in whom routine DCR was indicated. Subjects were divided into mitomycin C (Test) and non mitomycin C (Control) groups. In test group, Mitomycin C was applied to the anastomosed flaps and osteotomy site for 30 minutes. Postoperative patients were followed for up to 6 months and outcome of patency was documented. RESULTS: A.total of 73 patients were included, divided into test (30) and control (43) groups. An overall success rate of 86.3% was obtained for patent ostia; this was based on 96.67% success in test group compared to 79.1% in the control group (p=0.031). CONCLUSION: Intraoperative application of Mitomycin-C significantly improves the success rate in external dacryocystorhinostomy.

Rehman Medical College admission criteria as an indicator of students' performance in university professional examinations. .

BACKGROUND: Although admission criteria are standardized by Pakistan Medical & Dental Council (PM&DC), medical colleges can conduct aptitude tests as admission criteria. The present study aimed to determine the correlation of Rehman Medical College's (RMC) admission criteria with students' academic performance in the Khyber Medical University (KMU) First Professional Part-1 examinations. METHODS: A descriptive study was done at RMC from December 2012 to March 2013 based on computerized records of first and second year MBBS students (years 2010 and 2011; 100 students per year). Students who dropped out or were stricken off from RMC before the university exam were excluded. Pearson's correlation coefficient was calculated by using SPSS-15. RESULTS: For 2010, highest correlation was observed between combined marks of all admission criteria components and KMU professional examination (r=0.466, p<0.001) followed by RMC aptitude test (r=0.424, p<0.001). For females, combined marks of admission criteria showed highest correlation (r=0.629, p<0.001) while RMC aptitude test showed highest correlation for male students (r=0.361, p=0.004). For 2011, combined marks of admission criteria (r=0.359, 7=0.001) showed the highest correlation with KMU professional examination marks followed by Educational Testing & Evaluation Agency (ETEA) marks (r=0.327, p=0.002). ETEA marks showed highest correlation for females (r=0.491, p=0.001) followed by combined marks of admission criteria (r=0.432, p=0.005); for males, combined marks of admission criteria (r=0.385, p=0.006) showed highest correlation followed by ETEA marks (r=0.383, p=0.007). CONCLUSION: Combined marks of admission criteria correlate with students' academic Derformances in university professional examination result.

Medical education and social environment.

BACKGROUND: A positive learning environment and quality of course content have an imperative role in academic achievement of students. This study aims to assess students' point of view about the quality of education and social environment of a public sector medical college in Pakistan. Relative scarcity of data from students' perspective merited this study. METHODS: A cross-sectional survey was undertaken at Ayub Medical College, Abbottabad, Pakistan, including 300 medical students from all five years of the MBBS course. Systematic random sampling was used with a kth interval of 4 for each class. Self-administered questionnaire was used and contained items related to academics, learning environment, learning resources, teaching methodologies and student-friendly activities. The data were analysed using SPSS-16. RESULTS: There were 265 respondents (88.3%) to the questionnaire with males accounting for 58.9% (n=156). In general students showed satisfaction with quality of content being taught; however there was discontent towards various academic and non- academic facilities provided to the students. Only 44.10% and 31.50% students reported provision of academic related facilities and interactive sessions as up to mark respectively; 83% students reported that undergraduate medical research was in need of improvement; 55.5% and 60.2% reported that facilities in hostel and recreational facilities needed improvement respectively; and 52.8% students stated presence of a healthy, student friendly, encouraging environment was not up to mark. CONCLUSION: Although course content and teaching methodologies are generally satisfactory, a healthy, student friendly, encouraging environment is vet to be created to help students foster their abilities completely.

Growth centile charts (anthropometric measurement) of Pakistani pediatric population.

OBJECTIVE: To measure Anthropometric data (Height and Weight) of Pakistani school children (of different socioeconomic and cultural background) 3-16 year, to develop growth centile charts, based on the above measurement and to document obesity and stunting in Pakistani Paediatric population, based on the above measurement. METHODS: A Cross-sectional study with multistage stratified sampling was done in a Nationwide project of Higher Education Commission (HEC, Ref no: 20-441/R&D/2008) to develop growth centile charts of Pakistani paediatric population. Study was conducted from 2006-2009. Children studying in private and government schools of the four provinces of Pakistan were included. Prior to starting the study permission from the principal of the respective school and parents was taken. A total of 12837 children with normal birth weight, complete immunization, no history of chronic infection from 36-192 months (3-16 year) were included. Heights (cms), weight (kg), for Body Mass Index (BMI) (kg/m2), 24 hour diet recall was obtained. All socioeconomic groups were included. Food records of the children were subjected to USDA food exchange list. RESULTS: The average height (cms) of children was 139.11 +/- 18.44, average weight (kg) was 33.21 +/- 11.25 and average BMI was 16.76 +/- 3.22 kg/m2 (range from 11.3-41.98). The 95th centile according to CDC charts for the age groups 3-16 years were calculated. A total of 664 (5.1%) children were found to be obese. In the age group 3-5 years, > 5-10 year and > 10-16 year; 29 (8.1%), 272 (5.1%) and 363 (5.1%) were found to be obese, respectively. CDC height and weight in the three groups of Pakistani children > 3-5 year, > 5-10 year, > 10-16 year were at the 10-25 centile. CONCLUSION: Overall, the prevalence of stunting was 14%. Height and weight was 10-25 centile of the CDC charts. Obesity was 5%. Pakistani centile charts of healthy children from Pakistan have been made.

Death in the home: domestic violence against women in Khyber Pakhtunkhwa.

BACKGROUND: Domestic or Interpersonal Violence (IPV) remains a major global problem often resulting in morbidity and mortality. The present study was conducted to determine the scope of deaths related to domestic violence in the Khyber Pakhunkhwa province, Pakistan. METHODS: Data were collected on all reported female fatalities due to domestic violence for the years 2009-2011 from the records of the department of Forensic Medicine, Khyber Medical College Peshawar for analysis. RESULTS: A total of 305 deaths were reported, showing an increasing trend of 115 deaths for 2009-10 and 190 deaths for 2010-2014. The majority, 182 (59.7%) belonged to the rural areas and 123 (40.3%) to urban areas of the province. Victims were generally of the younger age groups (17% below age 16 and 42.3% between 17-32 years). Homicide was the manner of death in 293 (96.1%) while the most common causative agent was firearm injury (235, 77.1%). Head and neck injuries were most common (52.6%) followed by the chest and abdomen (31.6%) while multiple sites and extremities accounted for 15.8% of injuries. CONCLUSION: Young and adult females of KPK province of Pakistan are susceptible to homicidal deaths due to domestic violence, perpetrated through firearm injuries to the head and neck regions.

Prevalence of cutaneous manifestations of diabetes mellitus.

BACKGROUND: Diabetes mellitus (DM) is a clinical syndrome characterized by hyperglycaemia due to absolute or relative insulin deficiency. The aim of this study was to evaluate the frequency of skin manifestations in patients with diabetes mellitus of this area. This descriptive study was conducted in medical out patient door of District Headquarter Hospital Battgram from January 2008 to July 2008. METHODS: A total of 350 diabetic (types 1 and 2) patients over 15 years of age attending the medical OPD of DHQ Hospital were examined in detail for skin manifestations of the disease. RESULTS: Three hundred and fifty diabetic (type-1 and type-2) patients (193 females and 157 males) enrolled in this study. Mean age of the patients was 54 +/- 8.53 years. Duration of diabetes was between 1-12 years; 320 patients had type-2 and 30 patients had type-1 diabetes mellitus. Patients with uncontrolled disease were 327 and 23 patients showed adequate glycaemic control. Seventy-six percent of patients had cutaneous manifestations. The skin manifestations observed were: skin infections 30.9%, foot gangrene and ulcers 12.9%, pruritus 7.1%, vitiligo 5.7%, yellow skin 4.2%, diabetic dermopathy 4.2%, skin tags 3.7%, acanthosis nigricans 2.9%, eruptive xanthomas 2.6%, necrobiosis lipoidica diabeticorum 1.4%, diabetic bullae 0.6%, and pigmented purpuras in 0.3% patients. CONCLUSIONS: Cutaneous manifestations were quite common in the diabetics of this area.

Dna methyltransferase 1 (DNMT1) gene activity in human lymphomas correlates with aberrant p53 gene expression.

BACKGROUND: The DNA Methyltransferase 1 (DNMT1) gene has been implicated as a mutagen for tumor suppressor genes by causing hypermethylation and subsequent TA mutations of CpG islands located in the promoter regions of these genes. The present study was undertaken to determine if increased DNMT1 gene activity correlated with increased aberrant p53 gene expression in human lymphomas. METHODS: The study was undertaken on randomly selected archival human lymph nodes comprising 50 normal or reactive lymph nodes and 50 lymphoma lymph nodes. These were subjected to Fluorescent In Situ Hybridization (FISH) using oligonucleotide Antisense probes for the DNMT1 and the p53 mRNA according to standard FISH protocols. Percent cells stained, mean 'dots' stained per cell and staining signal intensity were taken as the criteria for comparing control and lymphoma lymph nodes. Quantitation of probe signals was done both by manual visualization of fluorescent signals and computer based image analysis. Correlation analysis was performed by calculation of Pearson's correlation coefficient. RESULTS: Data indicated significantly increased expression of the DNMT1 and the p53 mRNA in lymphoma cases as compared to controls (p < 0.001). Moreover significant correlation was obtained for the expressions of these two genes in lymphomas (p < 0.001), but not in control lymph nodes. CONCLUSION: Increased DNMT1 gene activity may contribute to increased p53 gene expression in human lymphomas, supporting a mutagenic role for the DNMT1 gene.

Clinical diagnostic criteria for suspected ileocaecal tuberculosis.

BACKGROUND: Ileocecal Tuberculosis (TB) is difficult to diagnose clinically as getting histological specimens means resorting to surgery, which is often hazardous and complicated in sick, anemic and emaciated patients with malabsortion syndrome. The present study was undertaken as an attempt to devise clinical criteria for diagnosis of ileocecal TB without resorting to invasive surgery. METHODS: 52 patients with suspected ileocecal TB were assigned pre-determined criteria based on clinical signs, symptoms and simple laboratory investigations. Criteria for exclusion were also devised; patients were followed up for an average of 1.1 years. Clinical response was assessed by complete resolution of symptoms and signs within 3 months. RESULTS: All 52 patients completed the study and all became symptom free within 3 months of treatment. All patients gained a minimal of 2 kg over 6 weeks and 32 patients gained more than 10% of body weight within 3 months; the difference in mean weights before and after 3 months treatment was highly significant (p < 0.001). CONCLUSIONS: In patients with suspected ileocecal tuberculosis, predetermined clinical criteria can be readily applied for early diagnosis, without resorting to surgery and with excellent clinical response.

Release of vasopressin during suppression of oestrous cycle in rat by zoladex and hypovolemic challenge.

BACKGROUND: The vasopressin (AVP) response to hypovolemia has been compared in intact and chemically castrated rats. This functional ovariectomy was done to confirm the findings in surgical ovariectomy of how gonadal steroids modulate the release of AVP under hypo-volemic challenge. METHODS: Twenty female Sprague Dawley rats were checked for oestrous over two consecutive cycles. The ten control rats were given sub-cutaneous puncture only whereas the experimental were given Zoladex implant. On the fifteenth day all the rats were given intra-peitoneal injection of poly-ehylene glycol. All the rats were de-capitated after an hour. RESULTS: The uterine weight was significantly decreased in experimental group. The plasma AVP level was also significantly decreased in the experimental group. The pituitary AVP level was significantly increased in the experimental group. CONCLUSION: The chemical castration effected the AVP secretion, this proves that the sex steroids modulate the release of AVP secretion inspite of hypo-volemic challenge.

Increased DNA methyltransferase 1 (DNMT1) gene expression in human lymphomas by fluorescent in situ hybridization.

BACKGROUND: The DNA Methyltransferase 1 (DNMTI) gene is among the better known 'epigenetic' systems that can regulate normal and abnormal gene expression as well as create 'hot spots' for DNA mutations. Its role has been studied in a number of malignancies with important implications for involvement in early events of malignant transformation. The present study describes the findings with respect to expression of this gene in human lymphomas studied by Fluorescent In Situ Hybridization (FISH). METHOD: The study was undertaken on randomly selected archival human lymph nodes comprising 50 specimens of normal or reactive lymph nodes and 50 specimens of lymphoma lymph nodes. These were subjected to FISH using oligonucleotide Antisense probes for the DNMT1 mRNA according to standard FISH protocols. Percent cells stained, mean 'dots' stained per cell and staining signal intensity were taken as the criteria for comparing control and lymphoma lymph nodes. Quantitation of probe signals was done both by manual visualisation of the fluorescent signals and computer based image analysis. RESULTS: Data indicated a significantly increased expression of the DNMT1 mRNA in lymphoma cases as compared to controls (p<0.001). CONCLUSION: This implies a possible role of the DNMT1 gene in transformation / oncogenesis in human lymphomas.

Partial hydatidiform mole along with term gestation and alive baby.

Gestational trophoblastic disease consists of a broad spectrum of conditions ranging from an uncomplicated partial hydatidiform molar pregnancy to stage-IV choriocarinoma with cerebral metastases. We describe a partial molar change in the placenta that was associated with a normal female fetus that was delivered at term and is alive and healthy.

Presentation of pulmonary tuberculosis at Ayub Teaching Hospital Abbottabad.

BACKGROUND: Pulmonary tuberculosis (PTB) may be easily confused with other chest diseases during its initial presentation. This study was carried out to identify presenting clinical and laboratory features that differentiate PTB from other diseases and to correlate clinical features and laboratory findings. METHODS: This study was carried out at the Department of Pulmonology, Ayub Teaching Hospital Abbottabad, from September 1999 to December 2000. A total of 46 patients were included in the study after being clinically diagnosed as pulmonary tuberculosis. These patients were subjected to detailed history taking recording age, sex, weight, socioeconomic status and smoking habits. They were clinically evaluated and laboratory tests including Hemoglobin, ESR, TLC, DLC and sputum for AFB were done. They were put on standard antituberculous therapy and followed from 2 to 5 months to monitor treatment effect. Statistical analysis was performed by SPSS 8 computer program. RESULTS: A bimodal presentation (below age 30 years and above age 50 years), fever, productive cough, weight loss, night sweats and raised ESR were the most common findings in PTB patients. Sputum AFB smears were positive in 50% of diagnosed cases. No correlation was found between clinical and laboratory parameters in establishing a confident diagnosis of the disease. CONCLUSIONS: The study highlights the importance of further research to pinpoint stronger and more reliable criteria for diagnosis.

Randomized clinical trial of human interleukin-11 in Dengue fever-associated thrombocytopenia.

OBJECTIVE: To assess the effectiveness of recombinant human (rh) IL-11 to increase platelets count in patients suffering from Dengue fever (DF). STUDY DESIGN: Randomized double blind placebo control study. PLACE AND DURATION OF STUDY: Farooq Hospital, Lahore, from July to October 2011. METHODOLOGY: Forty hospitalized patients suffering from Dengue fever having platelets count ² 30000 per micro liter were randomly categorized into two groups, rhIL-11 (test) and distilled water (placebo) groups. The efficacy outcomes (as indicated by step up in platelets count at 48 hours) for the treatment group were compared with the outcomes for the placebo group. RESULTS: The data revealed that the increase in platelet response with recombinant human interleukin 11, 1.5 mg subcutaneously is significantly more brisk than the placebo group. The platelets response in patients with severe thrombocytopenia was greater in the treatment group (50%) at 48 hours as compared to the placebo group (20%) (p=0.047). Response rate was slightly greater among males (6/10, 60%) than females (8/16, 50%); moreover, three-fourth (75%) female responders were in the placebo group, compared to half (50%) male responders in the treatment group. CONCLUSION: Results of the study suggest that treatment of severe thrombocytopenia accompanying DF with recombinant human interleukin11 may be a useful therapeutic option.