Journal of Islamabad Medical & Dental College
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New Onset Pancytopenia in Adults: Clinico-etiological Profile at a Tertiary Care Hospital
Get PDFObjective: To evaluate and compare common disorders leading to new onset pancytopenia among both genders.
Methods: It was a cross-sectional study conducted at the Department of Pathology at Watim Medical College and Watim General Hospital, Rawat, from November 2020 to November 2021.A total of 98 adult patients with persistent pancytopenia for one week who gave consent for bone marrow aspiration and a trephine biopsy were selected. A blood-complete picture with peripheral smears along with bone marrow aspiration biopsy were done. Trephine needle biopsy and cytochemical staining were performed when required.
Results: There were 44 males and 54 female patients. The mean age was 43.49 ±19 years. Common presenting complaints were pallor (82.6%), weakness (63.2%), petechial haemorrhages (45.9%) and fever (23.5%). The hemoglobin value, white blood cell count and platelet count were 6.5± 1.65 g/dl, 3.20 ±1.43 x 109/L and 55.21 ±28.01 x 109/L respectively. Major causes were megaloblastic anemia with female predominance (S.D: 0.003) in 43.8% patients, aplastic anemia with male predominance (S.D:0.001) in 17.3%, portal hypertension induced splenomegaly in 13.2%, infectious diseases in 7%, leukemias in 5.1% and Myelodysplastic syndromes in 3.1%.
Conclusion: Megaloblastic anaemia is the major cause of pancytopenia in females and aplastic anemia in male pancytopenic patients
Frequency and Clinical Implications of Atrial Fibrillation in Patients with Accessory Pathways
Get PDFAbstract:
Atrial fibrillation (AF) is a common arrhythmia associated with various cardiac conditions. This study investigates the frequency of AF in patients with accessory pathways, anomalous electrical connections that can lead to supraventricular tachycardia.
Objective:
The primary objectives are to determine the prevalence of AF in patients with accessory pathways, identify associated factors, and assess the impact on clinical outcomes. A comprehensive dataset of 400 patients undergoing supraventricular tachycardia ablation at Hayatabad Medical Complex from 2020 to 2022 was analyzed.
Method:
A retrospective study design was employed, utilizing patient records with documented accessory pathway(s) and complete clinical-electrophysiological data. Demographic information, clinical presentation, electrocardiographic and electrophysiological data, ablation procedures, and clinical outcomes were systematically collected. Analytical approaches included frequency calculation, comparative analysis, regression analysis, and outcome assessment.
Result:
Out of 400 patients, 3.5% presented with AF at the time of accessory pathway ablation. Age was identified as a significant predictor of AF occurrence, with a mean age of 63.2 years in AF cases compared to 55.8 years in non-AF cases. Recurrence of arrhythmias was observed in 57.1% of patients with AF, emphasizing the need for ongoing monitoring and management.
Conclusion:
This study contributes valuable insights into the relatively low prevalence of AF in patients with accessory pathways. While certain factors, including age, may be associated with AF, they do not serve as definitive predictors. Tailored management and adherence to guidelines are crucial for optimizing outcomes in this unique patient population. Future research may explore genetic factors and refine risk stratification models for a deeper understanding of AF in patients with accessory pathways
Accuracy of Haematology Analyzer in the Diagnosis of Malaria in Comparison with Gold Standard Microscopy
Get PDFObjective: To assess the accuracy of Haematology analyzer in the diagnosis of malaria in comparison with gold standard microscopy.
Methodology: A cross-sectional study was conducted at the Pakistan Institute of Medical Sciences and the Pakistan Atomic Energy Commission in Islamabad, Pakistan. The study was conducted for around six months, from May 2023 to October 2023. The Mindray BC-6200 haematology analyzer was utilised to evaluate a total of 191 samples, comprising 127 samples from that were infected with malaria and 64 samples from healthy controls. When the presence of malaria parasites, identified as Plasmodium vivax and Plasmodium falciparum, was detected in dyed thick blood film, a microscopy examination was carried out as a reference. Analyse-it v4.92.3 was used to create the receiver operating characteristic (ROC) curve analysis. The agreement between BC-6200 and light microscopy was assessed using the Kappa value.
Results: The InR by BC-6200's sensitivity and specificity for P. falciparum and P. vivax infections. The sensitivity of the InR by BC-600 for P. falciparum and P. vivax was 27.9% and 85.5%, respectively. The specificity of the InR by BC-6200 for P. vivax and P. falciparum was 82.7% and 86.5%, respectively. The infection densities in microscopy varied statistically significantly between the various InR groups (χ2 = 14.50, P < 0.005).An analysis was conducted on the correlation between the cell blood count and the count of InR in both the P. vivax and P. falciparum-infected patient groups. The results showed a clear correlation between InR (P. vivax group R2 = 0.87) and ΔWBC (WBCDIFF–WBCBASO). In the Mindray BC-6200 haematology analyzer, WBCBASO represents the number of WBC counting in the BASO channel with severe membrane degradation, while WBCDIFF represents the number of WBC counting in the DIFF channel with mild lyse. The volume distribution widths of RBC, HGB, and red blood cells did not differ substantially. The reticulocyte characteristics of the P. vivax/P. falciparum patient group and control group differed significantly (P<0.02), although RBC, HGB, and red blood cell volume distribution width (RDW) did not differ significantly (P > 0.05). There was a significant difference (P<0.02) in the PLT count between the P. vivax/P. falciparum patient groups and the control group.
Conclusion: The results imply that malaria might be screened for in a clinical setting using the BC-6200 haematology analyzer's "InR" flag and "InR#/InR‰" parameters
Expression of JAK2 V617F Mutation in BCR - ABL Negative Myeloproliferative Neoplasms
Get PDFOBJECTIVE: To detect the presence of JAK2V617F mutation in BCR - ABL negative myeloproliferative neoplasms and to stratify high risk patients for targeted therapy.PLACE AND DURATION OF STUDY: Department of Haematology, Armed forces institute of Pathology (AFIP), Rawalpindi, from Dec 2023 to Oct 2023.STUDY DESIGN: Descriptive cross sectional studyMETHODOLOGY: A total of 40 consecutive patients of BCR - ABL 1 negative myeloproliferative disorders were included in the study after being diagnosed according to WHO defined haematological criteria for each disorder and performing bone marrow examination under aseptic measures. Informed consent and ethical approval were obtained from each individual. All patients had their blood samples examined for the G-T point mutation (V617F) in the JAK2 gene located on chromosome 9, utilizing allele-specific real-time qualitative polymerase chain reaction (RT-qPCR). Results were analyzed by using SPSS version 22.RESULTS: Out of total 40 patients included in our study 21(52.5%) had Polycythemia Vera (PV), 15 (37.5%) had Primary myelofibrosis (PMF) and 4 (10%) had Essential thrombocythemia (ET). JAK2 mutation was found in 20 (95.2%) patients of PV, 9 (60%) patients of PMF and 2 (50%) patients of ET with a significant p-value of ˂ 0.001.CONCLUSIONS: JAK2 V617F is a useful clinical marker for establishing diagnosis and separating high risk patients for specific targeted therapy
Role of Formoterol on Myogenic Regulatory Factor to Ameliorate Statin-induced Myopathy
Get PDFObjective: To investigate the effects of β2-adrenergic agonist formoterol on expression of myogenic regulatory factor myogenin in statin-induced myopathies in rats
Methods: Adult male Sprague-Dawley rats were randomized into control (A), statin-only (B), and statin + formoterol groups (C) (n=30 per group). The control group A received no treatment. B group received simvastatin at 60 mg/kg/day by oral gavage for 12 weeks to induce myotoxicity. C group received simvastatin at 60 mg/kg/day plus formoterol at 3 μg/kg/day by oral gavage for 12 weeks. After 12 weeks, extensor digitorum longus muscles were dissected and 5 μm transverse sections were immunostained for myogenin expression. One cross section was selected from each of the specimen for study. Myogenin-positive nuclei were quantified in 8 random 40x magnification fields per muscle section by a blinded investigator. Data was analyzed using IBM SPSS.
Results: Myogenin-positive nuclei were minimal in the control (A) group and statin-only (B) groups. In contrast, the statin + formoterol (C) group exhibited a significant increase in myogenin-positive nuclei compared to both control and statin-only groups (p<0.001), indicating enhanced muscle regeneration.
Conclusion: Formoterol treatment augmented skeletal muscle repair pathways in a rat model of statin-induced myopathy, potentially via activation of quiescent muscle satellite cells and upregulation of myogenic regulatory factor myogenin in group C
Prevalence of Interstitial Lung Disease in Patients with Chronic Cough Taking Chest X-rays and CT Chest as Diagnostic Tools
Get PDFIntroduction: With well over 200 types of pulmonary disorders, ILD is a growing global health burden with chronic cough being the most frequent symptom. As it hampers the basic respiratory mechanism, it eventually deteriorates the overall quality of life. The diagnosis of ILD is quite challenging and the accuracy rates with conventional tests are quite low.
Material and methods: A cross-sectional study on 200 patients was performed in Sir Ganga Ram Hospital, Lahore, Pakistan. The study took place from the period of 15th April to 15th July 2023. Chest X-ray (CXR) and Computed Tomography (CT) Chest were used as diagnostic tools.
Results: The chest x-ray detected ILD in 114 (57%) while the chest CT identified in 178 (89%) of the patients. CXR and CT had a sensitivity of 65.05 and 95.65 and a specificity of 45.1 and 85.2 respectively. CXR and CT detected reticular opacity, nodular opacity, and ground glass opacity in 66% vs 81%, 41% vs 78%, and 33% vs 55% of the ILD patients. Dyspnoea (85%), fever (30%), arthralgia (24%), and weight loss (9%) were found as clinical indications.
Conclusion: CXR can be used to perform initial preliminary tests to filter out the presence of other diseases in patients with ILD. However, it cannot be solely relied on as a diagnostic tool. CT Chest can be the choice of imaging modality in diagnosing ILD as it outperformed CXR in many aspects of our study, with better precision, accuracy, sensitivity, and specificity
Incidence of Pocket Infection after Implantation of Permanent Pacemaker
Get PDFObjective: The research aimed to enhance clinical awareness and optimise preventive strategies in permanent pacemaker (PPM) implantation
Methodology: We followed the patient on 2nd and 4th weeks after implantation of PPM. A total of 500 patients were followed over a 1-year period of time. We defined pocket PPM infection as the presence of local oedema and redness or swelling with and without systemic signs of infection that required antibiotic therapy and/or device removal.
Results: The mean age of the patients was 55.4 ± 14.2 years, and 58% were male. The most common indications for PPM implantation were atrioventricular block (42%), sick sinus syndrome (32%), and atrial fibrillation with slow ventricular response (18%). The median follow-up time was 12 months. The overall incidence of PPM infection was 2.4% (12 cases).
Conclusion: PPM pocket infection is a rare but serious complication that occurs mainly within the 2 weeks after implantation. Diabetes mellitus, renal failure, and the use of temporary pacing wires are significant risk factors for PPM infection. Prevention strategies and close follow-up are essential to reduce the morbidity and mortality associated with this complication
Health Determinants of Methylmercury Exposure in Coastal Pakistani Women: Fish Consumption and Environmental Influences
Get PDFBackground: Mercury pollution from industries poses health risks through bioaccumulation in fish. Women in coastal communities with high fish intakes are particularly vulnerable. However, methylmercury (MeHg) exposure has not been quantified in Pakistan.
Objective: To estimate MeHg levels in the scalp hair of women from a coastal community in Sindh province and examine the relationship with fish consumption and other risk factors.
Methods: A cross-sectional study was conducted among 100 women aged 15–49 years in Rehri Goth, Sindh. Detailed dietary histories were obtained through interviews. Scalp hair samples were analysed for total mercury using cold-vapour Vapor Atomic Absorption Spectrophotometry.
Results: The median hair MeHg level was 7.15 μg/g, exceeding international guidelines. Higher levels were associated with fish from polluted waters (3.5 μg/g), skin whitening product use (6.5 μg/g), and traditional medicine intake (9.0 μg/g). A weak positive correlation was found between MeHg and age. Fish consumption averaged 4 times/week.
Conclusion: Women in coastal Sindh have high MeHg exposure from frequent fish intake, likely exacerbated by industrial pollution. Risk mitigation is needed to protect vulnerable populations, especially during critical windows of neurodevelopment.
 
C-Reactive Protein as a Prognostic Indicator: Navigating the Challenge of Predicting Severity and Mortality in Acute Pancreatitis
Get PDFObjective: The main goal was to evaluate the effectiveness of C-reactive protein (CRP) in assessing acute pancreatitis severity 48 hours after onset by contrasting its results with CT scans.
Methodology: This cross-sectional study, which lasted six months from May to December 2019 at the Department of General Surgery, Pakistan Institute of Medical Sciences, comprised 150 suspected cases. CT scans and serum samples were taken 48 hours after the onset of symptoms. A postgraduate trainee created reports using a standard proforma to record CT scan results and CRP levels.
Results: The average age of the patients was 45.03±10.86 years, with severe acute pancreatitis confirmed in 28.7% of cases by CT scans. CRP demonstrated notable diagnostic values: sensitivity 81.4%, specificity 92.52%, PPV 81.4%, NPV 92.52%, and an overall accuracy of 89.33%.
Conclusion: C-reactive protein (CRP), a product of interleukin-1 and interleukin-6 responses by the liver, emerges as a valuable and cost-effective biomarker. Its consistent elevation in correlation with pancreatitis severity, especially within the critical 48-hour window, suggests its potential as a reliable predictor. This study underscores CRP's diagnostic utility and accessibility, emphasizing its role in assessing acute pancreatitis severity.
Key Words: C-reactive protein, CT scan, Acute pancreatiti
Clinical Application of Reticulocyte Maturity Indices in Early Diagnosis of Iron Deficiency Anemia in the First Trimester of Pregnancy
Get PDFBackground: Iron deficiency anemia (IDA) is a prevalent global health issue, particularly affecting pregnant females due to increased iron demands during pregnancy. In Pakistan, IDA remains a significant concern, posing challenges to maternal and child health. Early detection and management of iron deficiency are crucial for improving pregnancy outcomes.
Objective: This study aims to investigate the iron status and associated hematological parameters among pregnant females during the first trimester in Islamabad, Pakistan.
Methodology : This cross-sectional study, conducted in collaboration with the Pakistan Atomic Energy Commission (PAEC) and the Pakistan Institute of Medical Sciences (PIMS), aimed to investigate the iron status among first-trimester pregnant females in Islamabad, Pakistan.Laboratory investigations encompassed hemoglobin and serum ferritin assays, reticulocyte counts, and other red blood cell parameters. Participants were categorized into distinct iron status groups based on these evaluations. Utilizing SPSS version 25, statistical analysis followed ethical protocols, striving to uncover discrepancies in hematological parameters across the various iron status groups.
Results : Among 340 first-trimester pregnant women, three iron status groups were identified. Group 1 (n = 102) had low ferritin despite normal Hb, with elevated immature reticulocytes. Group 2 (n = 150) showed normal iron parameters, while Group 3 (n = 88) had high reticulocyte counts. Group 2 exhibited superior erythrocyte indices and higher ferritin levels than Groups 1 and 3. Group 3 displayed the poorest indices and elevated immature reticulocytes. These findings highlight variations in iron status and reticulocyte maturation among pregnant women.
Conclusion: This study underscores the high prevalence of iron deficiency anemia among first-trimester pregnant females in Islamabad, Pakistan. Variations in red blood cell parameters and serum ferritin levels highlight the importance of early iron status assessment for optimizing maternal and foetal health outcomes