Clinicopathological spectrum of Diffuse Large B Cell lymphoma: a study targeting population yet unexplored in Pakistan.

OBJECTIVE: Diffuse Large B Cell Lymphoma (DLBCL) is the most common type of Non-Hodgkin Lymphoma (NHL). The aim of this study was to assess the clinico pathological characteristics of DLBCL specifically, among the affected individuals residing in Northern areas of Pakistan who had not been previously included in major lymphoma studies due to their remote location. RESULTS: Mean age of the patients was 49.7 years. Male: female ratio was 1.5:1. Primary site was lymph node in 99 (71.74%) patients, out of which, 36 (26.09%) patients had B symptoms and 19 (13.77%) patients had stage IV disease. 39 (28.26%) patients had primary extra nodal involvement, 4 (2.90%) patients had B symptoms and 3 (2.17%) had stage IV disease. Extra nodal sites involved in primary extra nodal DLBCL were gastrointestinal tract (GIT) 19 (48.72%), tonsils 6 (15.38%), spine 4 (10.26%), soft tissue swelling 3 (7.69%), parotid gland 2 (5.13%), thyroid 2 (5.13%) central nervous system (CNS) 1 (2.56), breast 1 (2.56%) and bone marrow 1 (2.56%). Our study revealed increased percentage of patients with nodal DLBCL in stage IV and with B symptoms. Few patients with primary extra nodal DLBCL had B symptoms and stage IV disease at presentation. GIT was the most common site of involvement in primary extra nodal DLBCL.

An unusual case of gross myoglobinuria in a child following Russell's viper (Daboia russelii) envenomation.

Overt myoglobinuria associated with myotoxicity is a classic feature of sea snake envenomation. Russell's viper bites usually result in coagulopathy, neurotoxicity and nephrotoxicity but rarely myotoxicity has been reported, especially in the Sri Lankan variety (Daboia russelii). All those studies have demonstrated mild degree myotoxicity with microscopic level myoglobinuria. We report what is probably the first case of gross myoglobinuria in a child following a Russell's viper bite with biochemical evidence of significant myotoxicity well beyond the levels that have been previously reported.

Systematic case finding for tuberculosis in HIV-infected people who inject drugs: experience from Pakistan.

SETTING: Pakistan is a high tuberculosis (TB) burden country, moving from low human immunodeficiency virus (HIV) prevalence to a concentrated epidemic driven primarily by people who inject drugs (PWID). The Antiretroviral Treatment Adherence Unit (AAU) in Islamabad, Pakistan, is a residential facility that offers combined treatment for opioid dependence and HIV. OBJECTIVE AND DESIGN: This retrospective study was conducted to assess TB prevalence among HIV-infected PWID referred to the AAU and to evaluate the diagnostic value of cough as a screening symptom. A single sputum sample was collected regardless of symptoms, and examined using smear, Xpert® MTB/RIF and culture. RESULTS: Of 888 PWID, 71.5% submitted a sputum sample. More TB cases were detected using Xpert (n = 25) than with smear (n = 10) or culture (n = 20). A TB prevalence of 6141 per 100 000 was estimated based on seven cases already identified as being on anti-tuberculosis treatment and 32 newly diagnosed bacteriologically confirmed TB cases. Both cough and smoking (10 pack-years) were associated with increased TB prevalence. Only half of the TB cases reported cough. Rifampicin resistance was reported among 10% (3/29) of newly identified cases. CONCLUSION: TB prevalence in HIV-infected PWID was 15 times higher than in the general adult population. As a screening symptom, cough has low diagnostic value.

Gastric specimens for diagnosing tuberculosis in adults unable to expectorate in Rawalpindi, Pakistan.

Setting: Adult pulmonary tuberculosis (TB) patients unable to expectorate quality sputum represent a diagnostic challenge. A private hospital in Pakistan routinely performs gastric aspiration in adults with difficulties expectorating. Objective: To assess the usefulness of gastric specimens (GS) in diagnosing pulmonary TB (PTB) and drug-resistant TB in adult presumptive TB patients unable to expectorate, and to compare the diagnostic yield and sensitivity of smear, culture and the Xpert® MTB/RIF assay. Design: This was a comparative cross-sectional study based on retrospective record review. Results: Of 900, 885 and 877 GS tested by smear, Xpert and culture, respectively, interpretable results were obtained for respectively 900 (100%), 859 (97.1%) and 754 (86.0%), with a diagnostic yield of respectively 23.6%, 30.3% and 24.9%. The yield was significantly higher for Xpert in previously treated patients. There were 313 patients with definite TB, defined as positive on Xpert and/or culture. The 82.8% sensitivity of Xpert was significantly higher than that of smear (61.0%) and culture (67.8%). Conclusion: GS obtained by aspiration under routine programme conditions is useful for detecting TB and drug-resistant TB in adult patients unable to expectorate. Xpert, with its rapid testing, high proportion of interpretable results and better sensitivity, can substantially improve the diagnosis of bacteriologically confirmed TB and rifampicin resistance.

Contexte: Les patients adultes atteints de tuberculose pulmonaire (TB) incapables d'expectorer des crachats de qualité posent un problème en matière de diagnostic. Un hôpital privé du Pakistan réalise en routine l'aspiration gastrique chez les adultes qui ont du mal à expectorer.Objectif: Evaluer l'utilité des échantillons gastriques (GS) chez des patients adultes présumés atteints de TB incapables d'expectorer, pour le diagnostic de la TB pulmonaire et pharmacorésistante et pour comparer le rendement diagnostique et la sensibilité du frottis, de la culture et du test Xpert® MTB/RIF.Schéma: Etude comparative transversale basée sur une revue rétrospective des dossiers.Résultats: Un total de 900, 885 et 877 GA ont été testés respectivement par frottis, Xpert et culture et des résultats interprétables ont été obtenus chez 900 (100%), 859 (97,1%) et 754 (86,0%) patients avec un rendement diagnostique respectivement de 23,6%, 30,3% et 24,9%. Le rendement a été significativement plus élevé pour l'Xpert chez les patients déjà traités. Il y avait 313 patients avec une TB, définie comme la positivité de l'Xpert et/ou de la culture. La sensibilité de l'Xpert de 82,8% a été significativement plus élevée que le frottis (61,0%) et la culture (67,8%).Conclusion: Le GS aspiré sous des conditions de routine de programme est utile pour détecter la TB et la TB pharmacorésistante chez des patients adultes incapables d'expectorer. L'Xpert avec un test rapide, la proportion élevée de résultats interprétables et une meilleure sensibilité, peuvent substantiellement améliorer le diagnostic de la TB confirmée par bactériologie et la résistance à la rifampicine.

Marco de referencia: El diagnóstico de la tuberculosis (TB) pulmonar se dificulta en los pacientes adultos que no pueden suministrar muestras de esputo de buena calidad. En un hospital privado del Pakistán se practica de manera sistemática la aspiración gástrica en los adultos con dificultad para expectorar.Objetivo: Evaluar la utilidad del aspirado gástrico (GS) para el diagnóstico de la TB pulmonar farmacorresistente, en los pacientes con presunción de TB que tienen dificultad para expectorar y comparar el rendimiento diagnóstico y la sensibilidad de la baciloscopia, el cultivo y la prueba Xpert® MTB/RIF.Método: Un estudio transversal comparativo a partir del examen retrospectivo de las historias clínicas.Resultados: Se examinaron 900 muestras de GS mediante baciloscopia, 885 con la prueba Xpert y 877 por cultivo; se obtuvieron resultados interpretables en 900 (100%), 859 (97,1%) y 754 muestras (86,0%), con un rendimiento diagnóstico de 23,6%, 30,3% y 24,9%, respectivamente. El rendimiento fue significativamente superior con la prueba Xpert en los pacientes con antecedente de tratamiento. El diagnóstico definitivo de TB, definido como un resultado positivo de la prueba Xpert, el cultivo o ambos, se estableció en 313 pacientes. La prueba Xpert exhibió una sensibilidad de 82,8%, que fue significativamente más alta que la sensibilidad de la baciloscopia (61,0%) y la del cultivo (67,8%).Conclusión: El examen de las muestras de GS en el marco del programa corriente es útil para detectar la TB y la TB farmacorresistente en los pacientes adultos que no pueden expectorar. La prueba Xpert que ofrece un diagnóstico rápido, alta proporción de resultados interpretables y mejor sensibilidad puede mejorar notablemente el diagnóstico con confirmación bacteriológica de la TB y la resistencia a rifampicina.