Tumour cell characteristics and microenvironment composition correspond to clinical presentation in newly diagnosed nodular lymphocyte-predominant Hodgkin lymphoma.

Different studies have characterized the microenvironment and its prognostic impact in classic Hodgkin lymphoma whereas such analyses are pending for nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL). We thus investigated characteristics of tumour cells and microenvironment in NLPHL and evaluated possible correlations with the clinical presentation. Lymph node samples from 152 NLPHL patients who had first-line treatment within the randomized German Hodgkin Study Group HD16-HD18 trials were available and analysed with regard to IgD status and nuclear size of the tumour cells as well as presence of PD1-positive follicular T helper cells and CD163-positive macrophages in the microenvironment. While large tumour cell nuclei and high numbers of PD1-positive follicular T helper cells in the microenvironment were more common in patients presenting with early/intermediate stages than in patients with advanced-stage disease (p < 0.0001, unpaired t-test; p = 0.0022, Mann-Whitney test), no differences between risk groups were observed in terms of the IgD status of the tumour cells and the content of CD163-positive macrophages in the microenvironment. PD1-positive follicular T helper cells were present in both cases with typical and variant growth patterns and rosetting around the tumour cells was observed in 96% of patients, indicating an important role of PD1-positive follicular T helper cells in NLPHL.

Comparison between different methods of calculating Kt/V as the marker of adequacy of dialysis.

OBJECTIVES: To compare different methods of calculating adequacy of hemodialysis in terms of Kt/V. METHODS: This was an observational, quantitative study undertaken after the approval of Internal Review Board at the Hemodialysis Unit of Nephrology department, Mayo Hospital, Lahore from 1st December 2018 to 30th June 2019. Sixty hemodynamically stable patients of end stage renal disease undergoing hemodialysis for more than three months with age 18 to 70 years were included in the study by convenience non probability sampling. Critically ill patients with multiple co-morbidities like sepsis (i.e. total leukocyte count >11000 or <4000 x 109/L), ischemic heart disease, pace- makers, malignancies, cirrhosis etc. were excluded. Patients who were not adherent to dialysis prescription or hemodynamically unstable were also excluded. One way ANOVA and Pearson's correlation were used to find correlation between three methods of measuring Kt/V. RESULTS: Mean ultrafiltration was 2.1+ 0.76 liter/session. Pre dialysis weight was 64.7 +14.7 kgs, mean post dialysis weight was 62.5 + 14.7 kgs. For every patient blood flow rate was 300 ml/m and dialysis flow rate was 500 ml/min. The mean values of Kt/V measured by Daugirdas formula was 1.35 ± 0.33, mean online clearance monitoring (OCM) value was 1.17 ± 0.29 and by normogram was 1.36 ± 0.33. There was positive significant correlation between values of Daugirdas formula, Normogram and online clearance monitoring (OCM) i.e. r = 0.897 (p-value < 0.001) measured by Pearson's correlation and one way-ANOVA. CONCLUSION: Online clearance monitoring can be used for measuring adequacy of hemodialysis, but OCM slightly underestimates Kt/V as compared to Daugirdas formula and Normogram.

Factors Associated with Seroconversion of Hepatitis C Virus in End Stage Renal Disease Patients.

OBJECTIVE: To determine patient and dialysis services-related factors associated with seroconversion of hepatitis C virus (HCV) in hemodialysis (HD) patients. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Department of Nephrology, Mayo Hospital, King Edward Medical University (KEMU), Lahore, from January to December, 2018. METHODOLOGY: All patients on regular HD for more than three months were enrolled. All patients who seroconverted from HCV-negative to positive status three months after starting HD, were included. Patient-related factors (age, gender, blood transfusion, duration and frequency of dialysis, history of dental treatment and surgical intervention) and dialysis services-related parameters (dedicated staff, isolated room, hemodialysis machine, reverse osmosis plant, compliance of universal infection control measure) were noted. RESULTS: Out of 990 patients, 492 (49.7%) were reported as seroconverted for HCV during HD. Factors determined statistically significant for seroconversion were surgical intervention (p<0.001), history of dental procedure (p <0.001), blood transfusions (p <0.001), multiple sexual partner (p <0.001), age (p=0.035) and duration of hemodialysis (p <0.001). Factors not affecting seroconversion included frequency of dialysis (p=0.062), history of renal transplant (p =0.097) and family history of hepatitis (p=0.941). A significant negative correlation was observed between the rate of seroconversion of HCV and the score of universal infection control measures (r=-0.665, p=0.018). CONCLUSION: There was a high rate of seroconversion of HCV in HD patients. Factors responsible for seroconversion were history of surgical intervention, dental treatment, blood transfusion, multiple sexual partners, age and duration of dialysis. The dialysis centres non-compliant with universal infection control measures were having high rate of seroconversion. Key Words: Hemodialysis, Seroconversion, HCV, Blood transfusion, Dental treatment, Surgical intervention, Infection, Isolation.

Rhabdomyolysis Leading to Acute Kidney Injury.

Rhabdomyolysis constitutes an uncommon cause of acute kidney injury (AKI). A large variety of causes with different pathogenic mechanisms may involve skeletal muscles resulting in rhabdomyolysis with or without acute kidney injury. Crush syndrome and unaccustomed physical exertion are the most common causes of rhabdomyolysis. This study reports local cases of AKI secondary to rhabdomyolysis that presented to a tertiary care centre over a period of four years. Most of them were males and belonged to younger age group. Muscle enzyme creatine phosphokinase level was raised in all patients, while myoglobinuria was detected only in one patient. Most of the patients (10/16) were managed conservatively with fluid replacement; and some of them (6/16) needed dialysis. AKI was resolved in all the patients after a variable period of time. Key Words: Rhabdomyolysis, Acute kidney injury, Myoglobinuria, Creatine phosphokinase, Trauma.

Granulomatous Interstitial Nephritis: A Rare Cause of Acute Kidney Injury.

Acute granulomatous interstitial nephritis (GIN) is a rare cause of acute kidney injury (AKI) but treatable. It is present in 0.5 to 0.9% of native renal biopsies. Treatment with moderate dosage of steroids is associated with good prognosis. We herein review a case of a 48-year lady having AKI following drug-induced damage [non-steroidal anti-inflammatory drugs (NSAIDs) and antibiotics]. Her renal functions did not improve after one month of drug withdrawal, so renal biopsy was done that showed acute GIN. She was treated with intravenous then oral steroids that completely resolved AKI.

Perception Of Health Professionals Towards The Scope Of Family Medicine In The Healthcare System Of Pakistan.

BACKGROUND: Background: Primary health care is the backbone of comprehensive healthcare systems, and family physicians complement horizontal health coverage. In the developed world family medicine is integral to new doctors' training but, in the developing world, there are hurdles, e.g., poorly targeted financing, lack of skills and resources, and little health professionals' interest in the specialty. METHODS: This study determined perceptions of undergraduate and postgraduate medical trainees and healthcare professionals in Pakistan about family medicine. Participants' perceptions were examined via a selfadministered pre-structured questionnaire about family medicine in developing countries before and after a targeted seminar. Epi Info software (v.7) was used for statistical analysis. The p-value <0.05 was considered statistically significant. RESULTS: One hundred & eight questionnaires were returned postseminar demonstrating raised participant awareness of family medicine, with the majority (postgraduate 90.00% and undergraduate 90.91%) believing that health departments should create family medicine specialist posts to encourage students and post-graduate trainees. Similarly, 89.77% undergraduates and 95.00% postgraduates believed that comprehensive family medicine in primary health could be a solution to improve health care in Pakistan. Of note, when asked pre-seminar "do you feel you would consider family medicine as career speciality?", 42% undergraduates replied yes; when asked the same question post-seminar 63% of undergraduates and 90% of postgraduates replied yes. CONCLUSIONS: Introducing family medicine as a subject in medical colleges will create awareness and interest towards this speciality; until then, awareness lectures and seminars by trained family physicians will help bridge the gap towards encouraging students about its benefits.