Effects of beetroot (Beta vulgaris) supplements on selective enzymatic and non-enzymatic antioxidants in iron deficiency anemia.

Iron deficiency anemia (IDA) is not only associated with iron deficiency but has shown strong association with the over production of free radicles and deficiency of antioxidant enzymes. The result of this imbalance is oxidative stress (OS) which is now considered as an important associated factor with various diseases. Treating IDA in most of cases with oral iron supplements results in more OS as iron is a transition metal. A more suitable alternate for iron supplementation is Beta vulgaris supplement, which being herbal in origin is far less associated with side effects. We studied effects of beta vulgaris supplements on enzymatic and non-enzymatic antioxidants in IDA patients. A significant increase in all study parameters were observed after treatment (p <0.05). When pre-supplemental values of super oxide dismutase (SOD) and reduced glutathione (GSH-PX) of IDA were compared with post-supplemental values, they were significantly low (p <0.05). A positive correlation was noted between the two antioxidants and hemoglobin (Hb) values suggesting a direct relationship between antioxidant status and Hb levels. Non enzymatic antioxidants included vitamin A,C and E. We also found a significant improvement (p <0.05) of these vitamins when compared with their initial values and the control group. Our study shows improvement of antioxidant status of anemic patients with 12 week supplementation of Beta vulgaris.

Oxidative stress associated with altered activity of glutathione peroxidase and superoxide dismutase enzymes with IDA during pregnancy.

Iron deficiency anemia (IDA) during pregnancy, although associated with disturbances of hematological parameters, is now also considered as a source of oxidative stress (OS). Present study aims to detect any alteration in superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) enzymes activity in pregnant women with IDA. Levels of GSH-Px and SOD were measured in 156 anemic, pregnant women and compared with similar levels in 20 non anemic, pregnant women. Activity of SOD was found to be reduced in the anemic group when compared with the control group. We found a non- significant increase in GSH-Px activities in the anemic group. These findings could be explained in terms of OS under hypoxic condition which preserves the activity of GSH-Px with a decrease activity of SOD. A positive association was seen between IDA during pregnancy and OS with results suggesting that, apart from the deficiency of iron, some other factors are also associated for the increased OS seen during pregnancy.

Preclinical meritorious anticancer effects of Metformin against breast cancer: An In vivo trial.

OBJECTIVE: This research aims to evaluate the preclinical meritorious and anticancer effects of Metformin in a Xenograft model of breast cancer. METHODS: This interventional trial was conducted during a defined period of 5 months (August 2016 January 2017). We used a Xenograft model of nude BALB/c mice. A sample size of 50 mice, allocated into two groups and designated as Group A and Group B for Metformin and negative control groups, respectively. The anticancer activity of Metformin has been evaluated by comparing the tumour volume, tumour weight, tumour regression ratio, percentage regression, and survival rate. RESULTS: Compared with the control group, Metformin can significantly reduce the progression of tumour in the Xenograft model of breast cancer induced by MCF-7. This is reflected by significant differences in tumour volume at the final follow-up (p = <0.001). Our findings are further supported by a significant reduction of the tumour growth rate (p = <0.001) and tumour weight (p = <0.001) in the Metformin group than in the control group. Similarly, the total survival rate and tumour regression are more significantly correlated in the Metformin group. CONCLUSION: This study demonstrates that Metformin can significantly reduce the tumour growth and can increase the survival rate in a Xenograft model of breast cancer.

Phase behavior of ketoprofen-poly(lactic acid) drug particles formed by rapid expansion of supercritical solutions.

The present contribution investigates whether it is possible to form stable amorphous particles of ketoprofen-poly(lactic acid), naproxen-poly(lactic acid), and indomethacin-poly(lactic acid). Amorphization and micronization of these poorly water-soluble drugs offer a combined way to improve the solubility and enhance the dissolution rate. The particles were formed by pulsed rapid expansion of supercritical CO(2) solutions and characterized in the aerosol phase with rapid-scan infrared spectroscopy and after collection with scanning electron microscopy and X-ray diffraction. None of the three drug-poly(lactic acid) mixtures showed long-term stability on the order of weeks against the reversion from the amorphous to the crystalline state. Ketoprofen was the only drug that formed mixed amorphous particles with at least short-term stability. The long-term products turned out to be submicrometer- to micrometer-sized particles with a crystalline drug core and an amorphous poly(lactic acid) shell. Moreover, we found that the poly(lactic acid) coating stabilizes the particles against agglomeration.

In vivo efficacy, toxicity and biodistribution of ultra-long circulating desferrioxamine based polymeric iron chelator.

Desferrioxamine (DFO) is currently in clinical use to remove iron from transfusion-dependent patients with ß-thalassemia major, sickle-cell anemia and the myelodysplastic syndromes. However, its short half-life, burdensome, subcutaneous mode of administration and propensity to cause neurotoxicity at high doses greatly hinder its use. Thus, developing an optimized version of DFO with extended half-life, and reduced toxicity is a major goal. Using high molecular weight (MW), non-toxic, hyperbranched polyglycerol with high functionality, we demonstrate that the efficacy of DFO can be tuned with considerable reduction in toxicity. Using zebrafish embryos and mice, we tested toxicity, iron removal efficacy with low dosing and the biodistribution of ultra-long circulating DFO (ULC-DFO) conjugates. There was no significant difference in the mortality and development of zebrafish embryos upon exposure to ULC-DFO. Similarly, body weights and serum lactate dehydrogenase levels in mice treated with ULC-DFO remained within the normal range throughout the tolerance study. Moreover, ULC-DFO is significantly more effective than low MW DFO in promoting iron removal both from organs and via urine in iron overloaded mice despite using a moderate, once-weekly dosing schedule. This is probably due to the extended circulation half-life of ULC-DFO. The MW of ULC-DFO influences the accumulation and biodistribution, with highest MW (637 KDa) associated with up to 12% accumulation in the liver. In contrast, ULC-DFO with MWs of 75 KDa and lower were associated with relatively low organ accumulation, indicating that biodistribution of ULC-DFO can be tuned. Since ULC-DFO has improved iron removal properties, longer plasma retention time and possesses excellent biocompatibility, it represents a polymer conjugate with high clinical utility in comparison to DFO for the treatment of transfusion dependent iron overload. More importantly, ULC-DFO is anticipated to reduce the requirement for prolonged subcutaneous infusion of DFO.

Hybrid polyglycerols with long blood circulation: synthesis, biocompatibility, and biodistribution.

Multifunctional polymers with defined structure and biocompatibility are critical to the development of drug delivery systems and bioconjugates. In this article, the synthesis, in vitro blood compatibility, cell viability, in vivo circulation, biodistribution, and clearance of hybrid copolymers based on linear and branched polyglycerol are reported. Hybrid polyglycerols (M(n) ≈ 100 kDa) are synthesized with different compositions (15-80 mol% linear polyglycerol). Relatively small hydrodynamic size and radius of gyration of the hybrid polyglycerols suggest that they are highly compact functional nanostructures. The hybrid polyglycerols show excellent blood compatibility as determined by measuring their effects on blood coagulation, red blood cell aggregation, hemolysis, platelet, and complement activation. The cell viability in presence of hybrid polyglycerols is excellent up to 10 mg mL(-1) concentration and is similar to both dextran and polyvinyl alcohol. Furthermore, tritium labeled hybrid polyglycerol shows long blood circulation (t(1/2ß)= 34 h) with minimal organ accumulation in mice. Multifunctionality, compact nature, biocompatibility, and the long blood circulation make these polymers attractive for the development of bioconjugates and drug delivery systems.

Clinically approved iron chelators influence zebrafish mortality, hatching morphology and cardiac function.

Iron chelation therapy using iron (III) specific chelators such as desferrioxamine (DFO, Desferal), deferasirox (Exjade or ICL-670), and deferiprone (Ferriprox or L1) are the current standard of care for the treatment of iron overload. Although each chelator is capable of promoting some degree of iron excretion, these chelators are also associated with a wide range of well documented toxicities. However, there is currently very limited data available on their effects in developing embryos. In this study, we took advantage of the rapid development and transparency of the zebrafish embryo, Danio rerio to assess and compare the toxicity of iron chelators. All three iron chelators described above were delivered to zebrafish embryos by direct soaking and their effects on mortality, hatching and developmental morphology were monitored for 96 hpf. To determine whether toxicity was specific to embryos, we examined the effects of chelator exposure via intra peritoneal injection on the cardiac function and gene expression in adult zebrafish. Chelators varied significantly in their effects on embryo mortality, hatching and morphology. While none of the embryos or adults exposed to DFO were negatively affected, ICL -treated embryos and adults differed significantly from controls, and L1 exerted toxic effects in embryos alone. ICL-670 significantly increased the mortality of embryos treated with doses of 0.25 mM or higher and also affected embryo morphology, causing curvature of larvae treated with concentrations above 0.5 mM. ICL-670 exposure (10 µL of 0.1 mM injection) also significantly increased the heart rate and cardiac output of adult zebrafish. While L1 exposure did not cause toxicity in adults, it did cause morphological defects in embryos at 0.5 mM. This study provides first evidence on iron chelator toxicity in early development and will help to guide our approach on better understanding the mechanism of iron chelator toxicity.

Biodegradable polyglycerols with randomly distributed ketal groups as multi-functional drug delivery systems.

Biodegradable multi-functional polymeric nanostructures that undergo controlled degradation in response to physiological cues are important in numerous biomedical applications including drug delivery, bio-conjugation and tissue engineering. In this paper, we report the development of a new class of water soluble multi-functional branched biodegradable polymer with high molecular weight and biocompatibility which demonstrates good correlation of in vivo biodegradation and in vitro hydrolysis. Main chain degradable hyperbranched polyglycerols (HPG) (20-100 kDa) were synthesized by the introduction of acid labile groups within the polymer structure by an anionic ring opening copolymerization of glycidol with ketal-containing epoxide monomers with different ketal structures. The water soluble biodegradable HPGs with randomly distributed ketal groups (RBHPGs) showed controlled degradation profiles in vitro depending on the pH of solution, temperature and the structure of incorporated ketal groups, and resulted in non-toxic degradation products. NMR studies demonstrated the branched nature of RBHPGs which is correlating with their smaller hydrodynamic radii. The RBHPGs and their degradation products exhibited excellent blood compatibility and tissue compatibility based on various analyses methods, independent of their molecular weight and ketal group structure. When administered intravenously in mice, tritium labeled RBHPG of molecular weight 100 kDa with dimethyl ketal group showed a circulation half life of 2.7 ± 0.3 h, correlating well with the in vitro polymer degradation half life (4.3 h) and changes in the molecular weight profile during the degradation (as measured by gel permeation chromatography) in buffer conditions at 37 °C. The RBHPG degraded into low molecular weight fragments that were cleared from circulation rapidly. The biodistribution and excretion studies demonstrated that RBHPG exhibited significantly lower tissue accumulation and enhanced urinary and fecal excretion when compared to non-degradable HPG of similar molecular weight. Excellent biocompatibility together with in vivo degradability and clearance of RBHPGs make them attractive for the development of multi-functional drug delivery systems.

Design of long circulating nontoxic dendritic polymers for the removal of iron in vivo.

Patients requiring chronic red blood cell (RBC) transfusions for inherited or acquired anemias are at risk of developing transfusional iron overload, which may impact negatively on organ function and survival. Current iron chelators are suboptimal due to the inconvenient mode of administration and/or side effects. Herein, we report a strategy to engineer low molecular weight iron chelators with long circulation lifetime for the removal of excess iron in vivo using a multifunctional dendritic nanopolymer scaffold. Desferoxamine (DFO) was conjugated to hyperbranched polyglycerol (HPG) and the plasma half-life (t1/2) in mice is defined by the structural features of the scaffold. There was a 484 fold increase in t1/2 between the DFO (5 min) versus the HPG-DFO (44 h). In an iron overloaded mouse model, efficient iron excretion by HPG-DFO in the urine and feces was demonstrated (p = 0.0002 and 0.003, respectively) as was a reduction in liver, heart, kidney, and pancreas iron content, and plasma ferritin level (p = 0.003, 0.001, 0.001, 0.001, and 0.003, respectively) compared to DFO. Conjugates showed no apparent toxicity in several analyses including body weight, serum lactate dehydrogenase level, necropsy analysis, and by histopathological examination of organs. These findings were supported by in vitro biocompatibility analyses, including blood coagulation, platelet activation, complement activation, red blood cell aggregation, hemolysis, and cell viability. This nanopolymer-based chelating system would potentially benefit patients suffering from transfusional iron overload.

Influence of architecture of high molecular weight linear and branched polyglycerols on their biocompatibility and biodistribution.

The availability of long circulating, multifunctional polymers is critical to the development of drug delivery systems and bioconjugates. The ease of synthesis and functionalization make linear polymers attractive but their rapid clearance from circulation compared to their branched or cyclic counterparts, and their high solution viscosities restrict their applications in certain settings. Herein, we report the unusual compact nature of high molecular weight (HMW) linear polyglycerols (LPGs) (LPG - 100; M(n) - 104 kg mol(-1), M(w)/M(n) - 1.15) in aqueous solutions and its impact on its solution properties, blood compatibility, cell compatibility, in vivo circulation, biodistribution and renal clearance. The properties of LPG have been compared with hyperbranched polyglycerol (HPG) (HPG-100), linear polyethylene glycol (PEG) with similar MWs. The hydrodynamic size and the intrinsic viscosity of LPG-100 in water were considerably lower compared to PEG. The Mark-Houwink parameter of LPG was almost 10-fold lower than that of PEG. LPG and HPG demonstrated excellent blood and cell compatibilities. Unlike LPG and HPG, HMW PEG showed dose dependent activation of blood coagulation, platelets and complement system, severe red blood cell aggregation and hemolysis, and cell toxicity. The long blood circulation of LPG-100 (t(1/2ß,) 31.8 ± 4 h) was demonstrated in mice; however, it was shorter compared to HPG-100 (t(1/2ß,) 39.2 ± 8 h). The shorter circulation half life of LPG-100 was correlated with its higher renal clearance and deformability. Relatively lower organ accumulation was observed for LPG-100 and HPG-100 with some influence of on the architecture of the polymers. Since LPG showed better biocompatibility profiles, longer in vivo circulation time compared to PEG and other linear drug carrier polymers, and has multiple functionalities for conjugation, makes it a potential candidate for developing long circulating multifunctional drug delivery systems similar to HPG.

Efficient synthesis of isobenzofuran-1(3H)-ones (phthalides) and selected biological evaluations.

The studies presented here deal with the convenient and efficient one-step conversion of o-alkylbenzoic acids into their corresponding isobenzofuran-1 (3H)-ones (phthalides) using NaBrO3/NaHSO3 in a two-phase system. A range of o-alkylbenzoic acids was used with the object of getting a variety of phthalide derivatives as multipurpose biologically active compounds. Seventeen phthalides have been synthesized and tested for cytotoxicity, antibacterial and antifungal activities. Some of these compounds showed promising cytotoxic effects against Artemia salina. Compounds 4j-4p were highly active against Gram-negative and Gram-positive bacteria among all tested compounds. In the fungicidal assay, the compounds showed a broad spectrum of activity against six fungi. All compounds were characterized via elemental analysis, UV, IR, mass and-NMR spectroscopy.

Oxidative stress associated with altered activity of glutathione peroxidase and superoxide dismutase enzymes with IDA during pregnancy

Iron deficiency anemia [IDA] during pregnancy, although associated with disturbances of hematological parameters, is now also considered as a source of oxidative stress [OS]. Present study aims to detect any alteration in superoxide dismutase [SOD] and glutathione peroxidase [GSH-Px] enzymes activity in pregnant women with IDA. Levels of GSH-Px and SOD were measured in 156 anemic, pregnant women and compared with similar levels in 20 non anemic, pregnant women. Activity of SOD was found to be reduced in the anemic group when compared with the control group. We found a non- significant increase in GSH-Px activities in the anemic group. These findings could be explained in terms of OS under hypoxic condition which preserves the activity of GSH-Px with a decrease activity of SOD. A positive association was seen between IDA during pregnancy and OS with results suggesting that, apart from the deficiency of iron, some other factors are also associated for the increased OS seen during pregnancy

Advantages of carotid endarterectomy under local anaesthesia with minimal cerebral monitoring: an experience of 45 cases

To evaluate the benefits, efficacy and safety of local cervical plexus block in the performance of carotid endarterectomy, in the absence of sophisticated cerebral perfusion monitoring. This study was carried out at Combined Military Hospital [CMH] Lahore, Pakistan from January 2012 to May 2013. Quasi-experimental study. A total of 45 cases of ASA II and ASA III physical status were operated for carotid endarterectomy under local block of cervical plexus. After thorough preanaesthetic assessment, the patients physical conditions were optimized before surgery. Premedication was given with midazolam and sedated during operation with small doses of propofol. Local anaesthesia [LA] was completed by injecting bupivacaine in cervical plexuses C2, C3 and C4 areas. During operation vital signs and adequacy of cerebral perfusion were monitored by keeping the patient awake and making clinical neurological observations. Verbal contact was maintained with the patient. Breathing patterns and motor power were assessed in contralateral upper and lower limbs. Postoperatively patients were interviewed and analgesia during operation was assessed with visual analogue scale. Surgeon's satisfaction regarding intraoperative analgesia was also noted. Patients who required added sedation or local anesthetic agent were also noted. Average duration of surgery time was two hours and average stay of the patients in hospital was five days. Out of 45 patients, 37 patients [82%] had smooth and comfortable anaesthesia and analgesia. In only 1 patient [2.2%] LA had to be converted into general anaesthesia [GA]. In 3 cases [7%] LA was supplemented. One patient [2.2%] developed hoarseness and difficulty in breathing and 1 patient [2.2%] developed hemiparesis intra-operatively; while 1 patient [2.2%] developed hypotension in the immediate postoperative period. One patient [2.2%] developed haematoma at infiltration site. Surgeon satisfaction was excellent in 40 [89%] cases. Surgery of carotid endarterectomy can be performed adequately and comfortably under LA. In centers where sophisticated facilities for intraoperative cerebral blood flow measurements are not available, clinical intraoperative assessment of cerebral functions is of immense benefit, which is only possible under LA

Effect of general anaesthesia versus spinal anaesthesia on apgar score in elective caesarean section

To compare the effects of general versus spinal anaesthesia on Apgar score of neonates in elective Caesarean section. Randomized control trial. The Department of Anaesthesia and Intensive care CMH Lahore over duration of six month from 20-02-07 to 19-08-07. A total of 100 pregnant patients undergoing elective Caesarean section were divided into two groups: Group-A [General anaesthesia], Group-B [spinal anaesthesia]. In both the groups the patients were randomly divided using random number table and were blind to the technique of anaesthesia used. Mean Apgar score at one minute in group-A was 6.4 +/- 1.1 and in group-B was 8.4 +/- 1.1. The difference between two groups was statistically significant [p< 0.001]. Mean Apgar score at 5 minute was observed 9.4 +/- 0.7 in group-A and 9.5 +/- 0.6 in group-B. The difference between these two groups was not statistically significant [p=0.202]. Apgar score of neonates whose mothers received spinal anaesthesia was better at 1 minute than neonates whose mothers received general anaesthesia but there was no significant difference in Apgar score after 5 minutes in both techniques

Comparison of effectiveness of thoracic epidural and paravertebral block for post thoracotomy pain relief

To compare the effects of thoracic epidural and thoracic paravertebral block in post thoracotomy pain relief and early ambulation. Randomized control trial [RCT]. Combined Military Hospital Rawalpindi a tertiary care health facility, from Jan 2007 to Dec 2007. Thoracic epidural block was given in group-A while thoracic paravertebral block was given in group-B patients post operatively. Pain scores were assessed at 30 min intervals after the dose of 0.25% Bupivacaine using visual analogue scale [VAS]. There was no significant difference for pain scores in first 24 hours after surgery between paravertebral block [PVB] and thoracic epidural group measured at 30 min interval. But complication like hypotension occurred less with PVB. Paravertebral block is a safe and effective technique and can to be used more widely for unilateral post thoracotomy pain relief

Congenital fibre type disproportion: an unusual presentation of respiratory failure

A 38-year-old lady, with a weeklong history of flu-like illness, presented acutely with type-2 respiratory failure needing mechanical ventilation. She had a known history of a rare subtype of congenital myopathy called congenital fibre type disproportion myopathy [CFTDM]. This condition most commonly presents as hypotonia in neonates and is characteristically non-progressive. It may present in children as generalised weakness, delayed milestones and skeletal deformities such as scoliosis and myopathic facies. To the best of our knowledge this is the first reported case of CFTDM contributing to respiratory failure in an adult patient. She made good recovery in four weeks and was discharged home on intermittent non-invasive ventilatory support

Comparison of median and paramedian techniques of spinal anaesthesia

To compare median and paramedian technique of spinal anaesthesia in terms of success rate, number of attempts, paresthesia, bloody tap and length of needle. Comparative cross-sectional study. Department of Anaesthesia and Intensive care PNS Shifa Karachi over duration of one year from March 2007 to Feb 2008. This was a comparative cross-sectional study and 100 patients undergoing spinal anaesthesia for lower abdominal and lower limb surgeries were included. Hundred patients were divided into two separate groups. Group I was given spinal anaesthesia with median approach and Group II was given spinal anaesthesia with paramedian approach. In both the groups the patients were divided using non probability convenience sampling and patients were blind to the choice of technique of spinal anaesthesia used, however consent was obtained from every patient to be included in study. The success rate of median approach was found to be 84%, with the first attempt success rate of 48%. Paresthesia was felt by 38% of patients and incidence of bloody tap was 6%. Length of needle required most of the time was between 4-6 cms. The success rate of paramedian approach was found to be 96%, with first attempt success rate of 70%. Paresthesia was felt by 20% of patients and incidence of bloody tap was 12%. Most of the time length of needle required was between 6-8 cms. Paramedian approach is associated with higher success rate with lesser number of attempts and decreased incidence of paresthesia

Bilateral lung collapse due to aspirated nasal packing

An aspirated foreign body continues to present serious challenge of airway management to anesthesiologists perioperatively. These patients usually present with respiratory distress and require a high index of suspicion; need prompt assessment and recognition of the potential cause, and emergency management to obtain the best possible outcome. Nasal packing after ENT surgery has been previously reported to result in complications. A nasal pack obstructing left bronchus completely and right bronchus partially, resulting in post obstructive pulmonary edema is reported. This patient had aspirated the nasal pack in recovery room after tracheal extubation. The case highlights the need for close postoperative monitoring in patients with nasal packs, the diagnostic role of fibroptic bronchoscope and therapeutic role of rigid bronchoscope in airway obstruction

Acute organophosphorus poisoning - an experience

To determine various modes of acute poisoning due to pesticides with respect to gender, age, time period, mechanical ventilation, hospital stay and outcome. Prospective observational study. Department of medicine, Combined Military Hospital Pano Aqil Sindh, from April 2003 to November 2004. All indoor patients poisoned by pesticides, of either sex, age more than 12 years were included in the study. Data collected on proforma, contained categories of age, gender, mode of poisoning, time duration, clinical presentation, mechanical ventilation, hospital stay and final outcome. Out of 24 poisoned patients, 18 were males [75%] and 6 were females [25%]. Mean age was 23 years [range 13 years to 47 years]. About 79% of the victims were in the age range of 16-25 years. Suicidal, occupational and accidental incidences were 70.83%, 20.83% and 8.33% respectively. Only 10 patients [42%] needed mechanical ventilation due to acute respiratory failure and other 14 patients [58%] managed conservatively. Mean hospital stay was 4.5 days [range 01 to 15 days]. A total of 3 deaths with death rate of 12.5% were observed and all the deaths were among the suicidal victims. Pesticides are the major chemical agents which pose a health threat, particularly to young people, depressed females and farm workers, in rural set up. Since respiratory failure is the major reason for mortality, its early recognition, prompt endotracheal intubation and mechanical ventilation are life saving measures in severe organophosphorus [OP] poisoning

Pre - operative hematological profile: current practice

The use of pre-operative laboratory tests became a part of clinical practice in the later half of the 20th century as the clinicians acknowledged identification of pre-operative assessment of prospective postoperative morbidity and mortality. It was, however, argued that routine pre-operative hematological investigations were not cost-effective. Less than 3% of the abnormalities noted were previously unknown, and the number of patients whose surgery was delayed or altered as a result of the abnormal hematological tests ranged from none to 0.5%. In fact, overuse of the laboratory has a detrimental effect on the quality of care because clinicians were over-loaded with irrelevant information. Reference ranges are defined as the central 95% distribution of healthy subjects, and therefore, the probability [p] of an abnormal value occurring in a perfectly healthy patient increases with the number of tests [n] performed [p=1-[.95] n]. Thus, if 12 tests are performed, the probability of at least one test being abnormal is 46% and if 20 tests are performed, at least one will be abnormal in 65% of healthy subjects. Additionally, an abnormal value in an asymptomatic patient is far more likely to be false-positive than in a symptomatic patient, which may result in further unnecessary workup and delay in surgery. The objective of this communication was to analyze current practice in pre-operative hematologic profile evaluation