Incidence of beta-thalassemia carriers in Muzaffarabad, Azad Kashmir

Objective: To determine the frequency of beta-thalassemia carriers in healthy population from Muzaffarabad Azad Kashmir

Methods: In this cross sectional population based study, people from Muzaffarabad were motivated to get themselves tested for beta thalassemia trait. People found healthy on basis of a questionnaire and clinical examination were included in the study. Complete blood counts and peripheral smear review were performed on EDTA samples. Hemoglobin [Hb] electrophoresis was performed. Subjects with mean corpuscular volume [MCV], <76 fl, and/or mean corpuscular Hb [MCH], < 27 pg were subjected to hemoglobin A2 [HbA2] level estimation by elution method. Hemoglobin A2 of more than 3.5% was considered diagnostic for beta-thalassemia trait. Azad Kashmir is a territory with considerable ethnic heterogeneity. This is basically a tribal society with a high proposition of consanguineous marriages. We created awareness among the general population

Results: Found that gene is present in almost all tribes studied

Conclusion: Using strict criteria for healthy population, we conclude that incidence of thalassemia trait is 5.6 % in our study population. beta -thalassemia trait is present in almost all ethnic groups. To control thalassemia major, screening program for thalassemia carriers must be initiated in the area

Etiological pattern of splenomegaly in adults at tertiary care hospital Jamshoro Sindh

Background: Splenomegaly is usually the result of an underlying disorder; causes ranging from infections to blood cancers. Primary diseases of spleen are uncommon. Etiology of splenomegaly varies according to the geographical areas studied and depends upon the endemic, genetic and hematological diseases in the particular region. Purpose of this study was to find out the causes of splenomegaly in a tertiary care hospital representing almost entire interior of Sindh

Material and methods: This descriptive case series study was carried out at Department of Medicine Liaquat University Hospital Jamshoro from 1[st] March 2007 to 31[st] August 2007, over a period of six months. 100 Male and Female patients older than 13 years of age and admitted in ward with clinically enlarged spleen were selected for this study. Sampling technique was Non Probability convenient sampling. After getting informed consent from patients proforma was filled, elaborating history, important clinical findings and investigations like abdominal ultrasonography, CBC, LFT, HBsAg, Anti HCV etc were performed. Data analysis was carried out by SPSS 16 statistical software

Results: Among 100 patients with splenomegaly there was majority of male patients i.e.60%.The most common cause of splenomegaly found in our study was chronic liver disease i.e. 64% followed by malaria 16%, and hematological malignancies 14%. There were 2% patients found with enlarged spleen due to tuberculosis, remaining 4% comprised 1% each of enteric fever, infective endocarditis, CCF and SLE. Among the patients of hematological malignancies there were 9% patients of leukemia, 4% of lymphoma and 1% of myelofibrosis. As to the 9% leukemic patients, 4% suffered from Chronic Myeloid Leukemia, 3% from Acute Myeloid Leukemia and 2% from Chronic Lymphocytic Leukemia. Most common associated clinical sign was anemia demonstrated in 77% of patients

Conclusions: Chronic liver disease is the most common that leads to splenomegaly in population studied. Malaria and hematological malignancies appear to be the major contributors for splenomegaly. Finding of enlarge spleen needs clinical work up to reach the correct diagnosis

Bone metastasis: a comparison between bone scan and bone marrow aspiration biopsy

Background: all cancer involves the production of abnormal cells are capable of irregular and independent growth that invades health body tissues. Metastases are a characteristic feature of all malignant tumors, which spread to distant areas of body via lymphatic system and blood stream

Material and Methods: this cross-sectional study included 50 patients with different Malignancies. The diagnosis of these patients had been established on the basis of Histopathology. These patients were taken from Oncology Department of lnmol Jinnah, Shaikh Zayed and Mayo Hospitals. Lahore. These patients underwent bone scan which was performed with technetium 99m methldipbosphonate. [99.m Tc-:-MDP]. Twenty five patients with positive bone scan findings were taken as group A and the other 25 patients with negative bone scan were marked as group-B. The metastatic involvement of these patients was found by performing bone marrow aspiration and trephine biopsy

Results: in our study, 9 out of 50 cases were positive for bone marrow infiltration. Out of these 5 cases [20%] were positive for bone marrow metastases in positive bone scan patients. Whereas 4 patients [16%] were positive for bone marrow metastases in negative bone scan patients

Conclusion: the study hence reveals that bone scan is a superior method for detection of bone marrow infiltration in patients with · malignant metastatic disease but bone marrow aspiration /trephine biopsy is also mandatory as it picked 4 patients [16%] out of 25 patients with negative bone scan

Infiltration of bone marrow in solid tumours

In this study a total of 51 patients were selected with established malignant disorders. The frequency of metastatic involvement of the bone marrow was determined by obtaining concurrent bilateral aspiration and biopsy from posterior iliac spine. Routine investigations [hemoglobin, total and differential leucocyte count platelets and ESR] were performed in all cases. Specific investigations included bilateral bone marrow biopsies and trephines. In these tumors, breast, prostate and lung most commonly metastasized to marrow in adults, whereas neuroblastoma was most common in pediatric age group. It is suggested that the aspirate and biopsy were found complementary in the diagnosis of bone marrow metastases

comparison of clinical diagnosis and serological diagnosis in an epidemic of Crimean-Congo haemorrhagic fever

Crimean Congo Haemorrhagic Fever [CCHF] is life-threatening disease caused by Nairovirus of genus Bunyavirus caused by tick bite of Hayalomma species or by direct contact of the blood/sera of the patient and animals suffering from this disease. Epidemics have been occurring in Balochistan province of Pakistan and neighbouring Afghanistan and Iran from time to time with high mortality. Aim: In the absence of facilities for detection of serological markers of CCHF [IgM and IgG antibodies and PCR for viral RNA], a study was designed to diagnose and treat cases of CCHF reporting to a specialist unit hospital situated at Quetta, Pakistan. The aim was to compare the clinical features, complications and outcome of both groups of patients; one detecting the disease clinically only and the other depending upon serological tests for the diagnosis. Thirty-four patients having fever of less than two weeks of duration with features of bleeding from the skin and various orifices were included in this study from June 2001 to September 2001 after hospitalization. Index case and some of the consecutive cases were subjected to detection of serological markers. Rest of the cases were diagnosed on clinical grounds and baseline laboratory investigations only. Difference in both the groups was noted carefully. All the patients were given Ribavirin and blood products as and when required. Statistically there was no obvious difference in clinical manifestations [fever, body aches, purpuric spots, ecchymosis, epistaxis, gum bleed etc.] and laboratory findings [blood picture, serum ALT, serum urea and electrolytes, PT, APTT, etc]. There was also no difference in mortality of the two groups studied. In an on ongoing outbreak of CCHF, history, clinical findings and supportive baseline laboratory investigations may be sufficient for early detection and treatment of CCHF cases. However for documentation of start of epidemic, serological markers should be done. Therefore facilities for detection of viral markers of CCHF should be available at centers like Quetta

Prevalence of ABO blood groups and subgroups in a population of Lahore

ABO blood groups and sub-groups of A, A1, A2, A1B and A2B were determined in 3000 individuals from various parts of Lahore. Almost half of the subjects were females and half were males, mostly adults with a wide age range, belonging to various casts. Grouping was done by both tube and slide methods of Dacie and Lewis. A1 and A2 subgroups were determined by using anti-A, lectin [Dolichus Biflorus]. Blood group B had the highest prevalence [35.8%] in both males and females followed by O [29.6%] A [23.6%] and then AB [10.9%]. Sub-group A1 in our study was 21.2% and A2 2.43% [relative ratio 89.74 / 10.26] While A1 B was 8.72% and A2B 2.2% [relative ratio 79.75 / 20.25]

Acute lymphoblastic leukaemia: a study of immunophenotypes

Immunological characteristics of leukaemic blast cells from 55 patients of acute lymphoblastic leukaemia were analysed using a panel of monoclonal antibodies and immunoperoxidase technique. Among 36 children the percentage of Common-ALL was found to be low [39%] as compared to western reports, whereas that of T-ALL was high [36%]. Out of 19 adults, 52.6% were Common-ALL, 21.1% Early-B-ALL and 16% T-ALL; the findings being consistent with western studies. The T-ALL cases [13] were subclassified according to the stage of thymic maturation depending upon the expression of CD8 and CD4 antigens. Six were identified as early, 3 as common and 4 as late thymocyte stage