White blood cell differential fluorescence abnormal scattergram: A useful indicator for early detection of malarial parasite.

Background & Objective: Undiagnosed malarial infectionis associated with significant mortality and morbidity. Laboratory investigations leading to rapid, accurate and timely diagnosis of malaria is still a challenge. This study was done to assess the utility of abnormal White blood cell differential fluorescence (WDF) scattergram for diagnosis of malaria. Our aim was to study the utility of WDF scattergram for early detection of malarial parasite. Methods: All EDTA anti-coagulated blood samples received in laboratory during a period from Dec 2019 to May 2020 were analyzed on anautomated hematology analyzer, Sysmex XN 1000. All abnormal WDF scattergrams pertaining to plasmodium specie were critically evaluated and recorded. Review of Leishman-stained peripheral smears as well as immune-chromatographic assay by rapid test devices (RTD) was done. Accordingly, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for detection of malaria by abnormal scattergram were calculated. Results: Out of total 1, 26,000of samples analyzed, abnormal WDF scattergrams were detected in 96 cases. Amongst these, 95.8% (92) were positive for MP on Leishman-stained peripheral smear as well as on ICT with a p-value of 0.05. WDF scattergram abnormalities typical of malaria showed a sensitivity of 80% and specificity of 93.26%. Positive predictive value of 95.8% whereas negative predictive value of 99.9% was detected. Significant findings of hemolysis, platelet clumps, nucleated RBCS (NRBCs) and RBC agglutination were noted in cases (n=4) with abnormal WDF scattergram negative for malaria on peripheral smear. Conclusion: Interpretation of abnormal WDF scattergram not only increases the early detection rate for malarial parasite but isa strong indicator for presence of hemolysis, RBC agglutination, platelet clumps and leucoerythroblastic blood picture as well.

"Cognitive Peer Coaching"- A workplace-based faculty development approach for problem- based learning facilitators: A qualitative study.

OBJECTIVE: To explore the factors affecting the learning process of novice problem-based learning facilitators trained through Cognitive Peer Coaching. METHODS: The qualitative study with phenomenological design was conducted at the Islamic International Medical College, Riphah International University, Islamabad, Pakistan, from March to August 2018, and comprised problem-based learning facilitators, experts and novices who were given orientation about cognitive peer coaching through workshops. Novice facilitators were trained by experts through cognitive peer coaching cycle comprising pre-observation, observation and post-observation phases following socio-cognitive apprenticeship theory based on modelling, coaching, scaffolding, articulation, reflection and exploration. Data was collected through an observation checklist and semi-structured interviews which were audio-recorded, transcribed and subjected to thematic analysis manually. RESULTS: Of the 15 subjects, 10(66.6%) were novice facilitators and 5(33.3%) were experts. Six themes generated and they were mental growth spurred from within, conscientisation, experiential learning, intrinsic motivation, effective body language, and impediment to success. Learning by observation, learning by doing, increased motivation, autonomy, constructive feedback and reflection augmented the facilitation skills, while unawareness about reflective practices and peer coaching were identified as major obstacles in personal and professional growth of faculty. CONCLUSIONS: Cognitive peer coaching was found to be a dynamic, innovative and feasible faculty development approach that contributed to the learning of facilitation skills from psychological, emotional and social perspective.

Frequency And Pattern Of Bone Marrow Involvement Among Patients With Non Hodgkin Lymphoma.

BACKGROUND: Non-Hodgkin lymphoma (NHLs) are a heterogeneous group of lymphoid neoplasms, characterized by an irregular pattern of spread and may present with extranodal involvement This study was conducted to determine the frequency and pattern of Bone marrow involvement on trephine biopsy in cases of Non-Hodgkin lymphoma (NHL). METHODS: This cross sectional study was conducted in Pathology department of Fauji Foundation Hospital (FFH)/Foundation University medical college (FUMC) Rawalpindi, from14th December 2010 to 14th December 2011. One hundred and six patients with histopathologically confirmed Non-Hodgkin lymphoma on lymph node (LN) biopsy, who had not received any chemotherapy were selected and Bone Marrow (BM) trephine biopsies for staging were performed on them. RESULTS: Out of one hundred and six patients, forty five (42.5%) were diagnosed to have Bone Marrow involvement on staging. The most common pattern was diffuse, i.e., 44.44%, followed by the interstitial infiltrate in 28.89%, focal and mixed constituted 11.11% each, and paratrabecular pattern was found in 4.44%. CONCLUSIONS: This study highlights the high incidence of involvement and diffuse pattern in the Bone marrow biopsies of newly diagnosed Non-Hodgkin lymphoma, both of which indicate poor prognosis..

Chediak-Higashi syndrome presenting in accelerated phase.

Chediak-Higashi Syndrome (CHS) is a rare autosomal recessive disorder, characterized by silver hair, recurrent infections, partial oculo-cutaneous albinism, mild coagulation defect and progressive neuropathy. The characteristic feature of CHS is the presence of huge lysosomes and cytoplasmic inclusions within different body cells like the white blood cells. The disease has an early onset but usually presents in an accelerated phase. We present a case of a 2 years old boy with high grade fever, bilateral cervical lymphadenopathy, hepatosplenomegaly, abdominal distention of 28 days duration. He was diagnosed with Chediak-Higashi syndrome in accelerated phase on the basis of clinical presentation, morphological findings on peripheral blood film and bone marrow aspirate.