The risk and predictors of gallbladder cancer in patients with gallbladder polyps: A retrospective cohort study with an insight into confounding by indication.

BACKGROUND AND AIM: We aimed to determine the risk and predictors of gallbladder cancer in all individuals with gallbladder polyps (GP) including those who did not have cholecystectomy. METHODS: The STROCSS guideline was followed to conduct a retrospective cohort study. All individuals with GP between 2010 and 2019 were followed up to determine the risk and predictors of gallbladder cancer. The primary outcomes were gallbladder cancer and gallbladder dysplasia, and the secondary outcomes included polyp growth rate and polyp disappearance rate. Binary logistic regression analysis and receiver operating characteristic curve analysis were conducted to evaluate the outcomes. RESULTS: Analysis of 438 patients showed risk of gallbladder cancer was 0.7% in all polyps (0% in polyps < 10 mm; 5.9% in polyps ≥ 10 mm). The risk of gallbladder dysplasia or cancer was 1.1% in all polyps (0% in polyps < 10 mm; 10% in polyps ≥ 10 mm). The polyp size (P = 0.0001) was predictor of cancer; however, patient's age (P = 0.1085), number of polyps (P = 0.9983), symptomatic polyps (P = 0.3267), and change in size (P = 0.9012) were not. Size of 21 mm was cut-off for risk of cancer (area under the curve [AUC]: 0.995, P < 0.001) and 11.8 mm for risk of dysplasia or cancer (AUC: 0.986, P < 0.001). The mean polyp growth rate was 0.3 mm/year and polyp disappearance rate was 16%. CONCLUSIONS: The GP size remains the only predictor of malignant changes regardless of patient's age, patient's symptoms and number of polyps. The polyp growth rate is unremarkable, and a significant proportion disappears during follow-up. We changed our follow-up protocol with reduced number of scans and early discharge policy.

Serum fasting lipid profile in children and adolescents with ß-thalassaemia major in southern Pakistan.

OBJECTIVE: Serum fasting lipid profile has been studied in various clinical spectrum of Beta (ß)-thalassaemia syndrome. Premature cardiac impairment in thalassaemia major appears primarily due to iron accumulation and oxidative injury; however it might be a sequel of abnormal lipoprotein concentrations. The rational of this study is to analyse the serum fasting lipid profile in cardiovascular disease free ß-thalassaemia major (ß-TM) patients. Relationships with age, gender, haematological parameters, liver enzymes and serum ferritin were observed. METHOD: Fasting serum lipid levels, liver function test (LFT), complete blood count (CBC) and serum ferritin were measured in 36 patients with homozygous ß-TM from March 2012 to March 2014. Patients were stratified into two groups, age≤15 and >15 years, to determine the possible lipid profile distinction in relation to age. RESULTS: 17 were males and 19 were females, with median age of 12.0 years. The mean total cholesterol (TC) and triglyceride (TG) were 5.01±1.32 and 8.36±5.28 mmol/L respectively. High TG was detected in 36.1%, while high density lipoprotein cholesterol (HDL) and low density lipoprotein cholesterol (LDL) were markedly low, 0.98±0.51 and 2.35±1.22 mmol/L respectively. No statistically significant difference was noted between the two age groups. The median TC to HDL ratio (TC:HDL) was elevated, 5.7 (4.0). We established significant correlation of total bilirubin with TC (r=-0.4), HDL (r=-0.5) and LDL (r=-0.4) (P<0.05). CONCLUSION: Dyslipidaemia in ß-TM patients is irrespective of age and gender including low HDL and high TC:HDL, whilst high TC:HDL may contribute as a significant risk marker for future cardiac events in these patients.

Pattern of Karyotypic Aberrations in Pakistani Patients with De Novo Acute Myeloid Leukemia.

BACKGROUND: Acute myeloid leukemia (AML) is a malignant disease of the bone marrow in which karyotypic analysis is the most important diagnostic and prognostic tool for predicting remission rate, relapse and overall survival. This study was carried out to determine the frequency and type of cytogenetic aberrations in de novo acute myeloid leukemia in adults at a tertiary care hospital. MATERIALS AND METHODS: This descriptive cross-sectional study was carried out in the Hematology Department, Liaquat National Hospital from November 2014 to April 2016.A total of 51cases were diagnosed with AML during the study period. Cytogenetic analysis was carried out by banding technique on bone marrow aspirate samples. RESULTS: The mean age of the study subject was 42.03±17.70 years. Frequency of karyotyping abnormalities was observed in 47% of cases, in which most frequently occurring cytogenetic abnormalities were those of good cytogenetics including t(15;17) and t(8;21), seen in 23.5% and 9.8% of cases respectively. Intermediate risk cytogenetics including Del 9q was seen in 1.96% of cases. However, poor risk cytogenetics including complex cytogenetics, t(11;q23) and del (13) were seen in 7.8%, 1.96% and 1.96% of cases respectively. Normal cytogenetics was seen in 27 (52.9%) patients. CONCLUSION: Karyotyping is one of the most important diagnostic and prognostic tools and a maximum benefit could be attained through cytogenetic analysis. Cytogenetic aberrations in our series are more or less similar as reported at national level with preponderance of good risk cytogenetics in our setting.

Demographic and Clinical Characteristics of Adult Acute Myeloid Leukemia--Tertiary Care Experience.

BACKGROUND: Acute myeloid leukemia (AML) is an acquired clonal frequent malignant disorder of myeloid progenitor cells. Our aim was to study demographical and clinicopathological features of adult Pakistani AML patients at presentation. MATERIALS AND METHODS: In this single centre study extending from January 2010 to December 2014, data were retrieved from the patient records with a predetermined performa and analyzed with SPSS version 22. RESULTS: Overall 125 patients were diagnosed at our institution with de novo AML during the study period. There were 76 males and 49 females (ratio 1.5:1), with an age range between 15 and 85 years and a mean age of 38.8±20.1 years. The major complaints were fever (72.8%), generalized weakness (60%), bleeding (37.6%) and dyspnea (12%). Physical examination revealed pallor in 56.8%, splenomegaly and hepatomegaly in 16% and 12.8%, respectively, and lymphodenopathy in 10.4%. The mean hemoglobin was 8.19±2.12g/dl with a mean MCV of 86.0±9.83 fl, a mean total leukocyte count of 43.1±68.5x109/l, an ANC of 3.09±6.66x109/l and a mean platelet count of 62.3±78.6x109/l. CONCLUSIONS: AML in Pakistani patients is seen in a relatively very young population with male preponderance, compared with the west. However, clinico-pathological features appear comparable to published data.

Acute Myeloid Leukemia: Clinical Spectrum of 125 Patients.

BACKGROUND: Acute myeloid leukemia is an acquired clonal heterogeneous stem cell disorder. Hence, various parameters are sought out to categorize this disease into subtypes, so that as a consequence specific treatment modalities can be offered. Conventionally, the practically used method for classification utilizes French American British (FAB) criteria based on morphology and cytochemistry. The aim of present study was to determine the current spectrum of AML sub types in patients in Karachi. MATERIALS AND METHODS: This single centre cross sectional study was conducted at Liaquat National Hospital, Karachi, extending from January 2010 to December 2014. Data were retrieved from archives were analyzed with SPSS version 22. RESULTS: A total of 125 patients were diagnosed at our institution with de novo AML during five years period, 76 males and 49 females. Median age was 34.5 years. AML-M1 was the predominant FAB subtype (23.2%) followed by M2 (18.4%), M3 and M4 (16% each), M0 (14.4%), M5 (7.2%), M6 (3.2%) and M7 (1.6%). CONCLUSIONS: AML in Pakistani patients is seen in a relatively young population. The most common FAB subtype observed in our study was acute myeloblastic leukemia, without maturation (M1).

Acute Promyelocytic Leukemia: a Single Center Study from Southern Pakistan.

BACKGROUND: Acute promyelocytic leukemia (APL) is a distinctive clinical, biological and molecular subtype of acute myeloid leukemia. However, data from Pakistan are scarce. Therefore we reviewed the demographic and clinical profile along with risk stratification of APL patients at our center. MATERIALS AND METHODS: In this descriptive cross sectional study, 26 patients with acute promyelocytic leukemia were enrolled from January 2011 to June 2015. Data were analyzed with SPSS version 22. RESULTS: The mean age was 31.8 ± 1.68 years with a median of 32 years. The female to male ratio was 2:1.2. The majority of our patients had hypergranular variant (65.4%) rather than the microgranular type. The major complaints were bleeding (80.7%), fever (76.9%), generalized weakness (30.7%) and dyspnea (15.38%). Physical examination revealed petechial rashes as a predominant finding detected in 61.5% followed by pallor in 30.8%. The mean hemoglobin was 8.04 ± 2.29 g/dl with the mean MCV of 84.7 ± 7.72 fl. The mean total leukocyte count of 5.44 ± 7.62 x 10(9)/l; ANC of 1.08 ± 2.98 x 10(9)/l and mean platelets count were 38.84 ± 5.38 x 10(9)/l. According to risk stratification, 15.3% were in high, 65.4% in intermediate and 19.2% in low risk groups. CONCLUSIONS: Clinico-epidemiological features of APL in Pakistani patients appear comparable to published data. Haemorrhagic diathesis is the commonest presentation. Risk stratification revealed predominance of intermediate risk disease.