Brucellosis and dengue fever A co infection or cross reactivity?

Brucellosis and Dengue fever can present with acute febrile illness with other nonspecific symptoms and share common haematological and biochemical abnormalities making their clinical differentiation a diagnostic challenge. We present two cases admitted with acute febrile illness and other nonspecific symptoms. In both patients diagnosis of brucellosis was confirmed by positive blood culture and or positive serology by tube agglutination test method, in both patients Dengue virus 1gM and or IgG was also positive. This may represent co-infection or cross-reactivity between serological tests used for the diagnosis of brucellosis and dengue fever. To the best of our knowledge this has not been previously reported. Both these cases are presented here to share our experience with others

Primary non Hodgkin's lymphomas of gastriointestinal tract a clinico pathological study

This study aims to retrospectively review the pattern of patients with various gastro-intestinal lymphomas seen in King Abdul Aziz Hospital, Jeddah, Saudi Arabia from June 1990 to June 2002 with a view to determine and analyze various clinical and pathological aspects of this disease. All cases of Primary non-Hodgkin's lymphoma of gastro-intestinal tract received and diagnosed in Histopathology department of King Abdul Aziz Hospital, Jeddah, between June 1990 and June 2002 were retrospectively reviewed and the data was analyzed to determine age gender, ethnicity, clinical presentation, anatomical localization, histological type and Helicobacter pylori status. A total of 47 patients were retrieved for this study, with 85.10% being Saudi nationals. The male to female ratio was 1 : 0.74%. The mean age was 52.44 years. The peak age of onset was in the 6th decade. About 45% of our patients had gastric lymphoma, whereas 20.53% had small bowel lymphoma. Among the total number of patients, 46.81% men had MALT type lymphomas. Helicobacter pylori were positive in all patients with gastric lymphoma. Gastrointestinal lymphomas are frequently seen in patients in Saudi Arabia, with MALT gastric lymphoma being the commonest tumour. The strong association between H. Pylori and gastric lymphoma as an important aetiological factor is emphasized

Value of D-dimers assay in diagnosis of pulmonnary Embolism

To determine the value of D-Dimers assay in the diagnosis of Pulmonary Embolism [PE] at Armed Forces Institute of Pathology, Rawalpindi, Pakistan from January to November 2000. Forty three consecutive patients clinically suspected of suffering from pulmonary embolism and referred to Armed Forces Institute of Pathology for Ventilation-Perfusion scan of lungs were inducted in the study. A detailed history was taken and clinical examination was performed. All patients were then subjected to Perfusion and/or Ventilation scan, which was taken as the standard for the diagnosis of PE. Blood samples were collected from all patients in trisodium citrate. Platelet poor plasma obtained from the samples was tested for D-Dimers semi-quantitatively using latex agglutination method. Out of 43 patients 14[32.6%] had completely normal ventilation-perfusion scan hence the diagnosis of PE was excluded. In 6 [13.9%] patients the results were considered indeterminate. Abnormalities suggestive of pulmonary embolism were detected in 23 [53.5%] patients. D-Dimers were less than the cut off value of 500 ng/ml in 19 [44.2%] patients, whereas in 24 [55.8%] the levels were more than 500 ng/ml. When compared with the results of ventilation-perfusion scan the sensitivity of D-Dimers was 91.3% and specificity was 100%. Positive predictive value of the test was 100% whereas negative predictive value was 87.5%. D-Dimers assay combined with high clinical evidence is a cost effective, readily available test which can safely exclude the diagnosis of pulmonary embolism in majority of the cases

Hodgkin's disease: the disease pattern and treatment response

To study the disease pattern and treatment response of Hodgkin's Disease in our patients. Prospective study from Jan 1995 to June 1997. Armed Forces Institute of Pathology and Oncology Department of CMH, Rawalpindi. Patients with newly diagnosed Hodgkin's Disease. Disease pattern on presentation and response to various therapeutic protocols. Thirty patients were included in the study, 19 males and 11 females. Age of patients ranged from 3.5-90 years with a median of 32.5 years. Histologically mixed cellularity was the most common subtype [76.6%]. Most of the patients had advanced disease, 46.6% stage III and 16.6% were in stage IV at the time of initial presentation. Overall Complete Remission [CR] rate was 82%. There was no significant difference between the CR rate among the patients who received ABVD [10 out of 12 achieved CR] and MOPP variants [9 out of 12 achieved CR]. Complete response rate is 82% which is similar to the other centres of the world. Results of treatment with ChlVPP, C-MOPP and LOPP are almost equal to ABVD. These modifications of MOPP are very cheap as compared to ABVD, ChlVPP is almost ten times cheaper. These regimens can be safely recommended without compromising treatment benefits. This observation is very pertinent in developing countries like Pakistan, where resources allocated for health facilities are very limited

Intensive post remission chemotherapy in acute myeloid leukaemia

To establish the spectrum of toxicities and supportive care required during intensive post remission chemotherapy with high dose Ara-c in Acute Myeloid Leukaemia. A retrospective study. From Aug. 95 to Feb. 98. Department of Radiotherapy and Oncology CMH Rawalpindi and Armed Forces Institute of Pathology, Rawalpindi. Eleven patients of acute myeloid leukaemia achieving complete remission, received total of 36 courses of HidAC. Toxicities occurring and supportive care required during intensive post remission chemotherapy with HidAC. Most common toxicities included fever, bleeding and conjunctivitis. Two patients died due to cerebral bleeding and DIC. Patients were managed with antibiotics, platelet concentrates and topical steroids. No patient developed CNS toxicity