Journal of Islamabad Medical & Dental College
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Peripheral Blood Parameters in Patients of NonHodgkin’s Lymphomas Showing Bone Marrow Infiltration
No full textBackground: Non-Hodgkin’s lymphomas are frequently characterized by bone marrow infiltration. Peripheral blood counts and examination of blood smears are essentially performed along with bone marrow biopsy in the pretreatment investigations. Variations in peripheral blood counts are believed to have prognostic implication. Objectives: To look into various types of cytopenias and presence of atypical lymphoid cells in the peripheral blood of patients of non-Hodgkin’s lymphoma showing bone marrow infiltration. Materials and Methods: This descriptive study was performed in the department of Pathology, Pakistan Institute of Medical Sciences from January 2,004 to December, 2,004. A total of 50 consecutive patients of non-Hodgkin’s lymphoma belonging to all age groups and both sexes, and showing bone marrow infiltration on aspiration and trephine biopsies were included. Peripheral blood counts were performed on an automated haematology analyzer. Blood smears stained by Wright stained were scanned for atypical lymphoid cells. In the differential leucocyte count, 500 cells were counted. Results: Cytopenias of all types were frequently observed. Anaemia was the commonest finding (94%), followed by thrombocytopenia (62%) and neutropenia (34%). Bicytopenia was noted in 38% and thrombocytopenia in 30% of cases. Atypical cells were observed in the blood smears of 64% of patients. Conclusions: Anaemia alone or as a part of bicytopenia or pancytopenia is common finding in patients of non-Hodgkin’s lymphoma showing bone marrow infiltration. A detailed examination of stained blood smears shows atypical lymphoid cells in 64% of patients. Ke
Clinical Pattern and Management of Typhoid Ileal Perforation
Get PDFObjective: To determine the clinical presentation of typhoid ileal perforation and its outcome after treatment at tertiary care Hospital.Material and Methods: This cross-sectional study was carried out in the Department of General Surgery, LUMHS/Jamshoro from October 2010 to September 2011. All the cases presented with typhoid perforation on clinical basis and having X-ray demonstration of air-fluid and gas under the diaphragm were included. In the study all the cases underwent surgical emergency with coverage of broad spectrum antibiotic, nasogastric suction, and correction of fluid. Electrolyte imbalance was occurred and blood transfusion was done before the surgery. All the data regarding clinical presentation, postoperative complications and mortality was recorded in the proforma. Data was analyzed by SPSS version 16.Results: Total 40 patients were studied. Mean age of the patients was 27.08+22.0 years with the range of 10 to 60 years. Most common 82.5% were male and 17.5% was female. Abdominal pain and tenderness were found in all the cases. Regarding signs and symptoms, abdominal distension (97.5%) and fever (95%) were the most common presented. Primary closure in two layers was done in 40.0% cases, segmentation resection end to end anastomosis procedure was done in 10.0% cases and primary repair with proximal ileostomy was done in 50.0% cases. Wound infection was developed in 62.5% patients followed by wound adhesion in 30.0% cases. Mortality rate was 10.0%.Conclusion: We observed wound infection and wound adhesion were the commonest complications with mortality rate was 10%
Diagnostic Accuracy of Aetiology Score for Predicting Variceal Bleed in Patients of Upper Gastrointestinal Bleeding
Get PDFObjective: To assess the diagnostic accuracy of aetiology scoring system for diagnosing variceal bleeding in patients presenting with upper gastrointestinal bleeding using endoscopy as gold standard.Material and Methods: This cross sectional study was conducted at Department of Medicine Unit, Jinnah hospital Lahore (JHL) from 19th December 2015 to 20th May 2016. In total 230 subjects, fulfilling the inclusion criteria were selected by non-probability consecutive sampling technique and informed consent were obtained. Patients were evaluated for variceal bleeding on the basis of aetiology scoring system and then confirmed with endoscopy. Data was analyzed by using SPSS 21.0 and sensitivity, specificity, positive and negative predictive value of aetiology score was calculated taking endoscopy as gold standard.Results: Out of 230 patients presenting with upper gastrointestinal bleeding, males and females were 48.3% and 51.7% respectively. The mean age was 41.64 + 10.53 years, the mean Upper gastrointestinal bleeding Ateiology score system was 3.23+ 1.55. The sensitivity, specificity, positive predicted value and negative predicted value at a cutoff value of etiological score > 3.1 for variceal bleeding were 90.70%, 82.18%, 86.67% and 87.37% respectively. it was observed that there was statistically significant association between etiological score > 3.1 and endoscopy.Conclusion: The UGIB Aetiology Score, composed of 3 parameters, using a cut-off ≥ 3.1 accurately predicted variceal bleeding and may help to guide the choice of initial therapy for UGIB before endoscopy
Dengue Fever
Get PDFDengue fever (DF) is the most common viral disease transmitted by the arthropods.1 Dengue fever manifests as flu like illness affecting all age groups including infants, children and adults. Dengue hemorrhagic fever (DHF) is a life threatening complication of dengue characterized by high fever, hemorrhagic phenomena, thrombocytopenia and sometimes circulatory failure.2 Early diagnosis is essential, based mainly on history, physical examination and laboratory investigations. There is mortality rate of 1-5% in untreated cases and in less than 1% with treatment. However with severe disease the mortality rate reaches to 26%.3
Dengue and DHF are fast emerging as a global health problems. 4 Dengue is endemic in more than 110 countries. It affects 50 to 100 million people worldwide a year with half a million hospitalizations and almost 12,500-25,000 deaths.5 The incidence of dengue has increased 30 folds between 1960 and 2010. Factors responsible for dengue’s spread include explosive population growth, unplanned urban overpopulation with inadequate public health systems and poor vector control
Marchiafava-Bignami Disease: A Rare Disease with MRI Findings and Literature Review
Get PDFMarchiafava bignami disease (MBD) is an unusual complication of chronic alcoholism that typically results in demylination of corpus callosum, but sometimes it can involve the adjacent white matter and even the subcortical and cortical regions. The pathophysiology of MBD is still unknown but thought to be due to vitamin B complex deficiency. Magnetic Resonance Imaging (MRI) is crucial for its diagnosis that shows the characteristic lesions in corpus callosum which may also extend into deep white matter, subcortical and cortical regions. We present a case of Marchiafava bignami disease in 55-year chronic alcoholic referred to us for MRI brain by Medical unit. This case is presented here for its rarity along with its clinical and radiological findings as well as literature review to generate awareness regarding this uncommon toxic complication of chronic alcoholism
Frequency of Helicobacter Pylori Infection in Immune Thrombocytopenia
Get PDFObjective: To accomplish the comparative analysis of clinical features and laboratory findings in Helicobacter Pylori positive and negative patients with Immune thrombocytopenia. Patients and Methods: This cross sectional study was conducted from May 2013 to Nov 2014 at Hematology Unit, Liaquat National Hospital, Karachi. During the study duration, 59 adult patients, diagnosed as chronic immune thrombocytopenia were enrolled in the study. Helicobacter Pylori infection was documented by Helicobacter pylori stool antigen (HpSA) enzyme immunoassay method (EIA). Frequencies were calculated. Chi-square test and independent sample t test were used for comparison. P-value of less than 0.05 was considered statistically significant. Results: Helicobacter Pylori infection was detected in 25 out of 59 cases of chronic immune thrombocytopenia. No statistically significant differences were seen in H-Pylori positive and negative patients with respect to clinical features and laboratory findings except mean platelet count, which was lower (57.95±15.1) in Helicobacter Pylori negative as compared to positive patients (71.44±18.8). Conclusion: We found no significant difference between the clinical and laboratory attributes in H Pylori positive and negative cases. Significant finding of high platelet count in Helicobacter Pylori positive patients, may perhaps narrate the possible association. 
A Rare Variant of Acute Open Fracture Dislocation of Knee Joint
Get PDFAcute knee dislocation usually results from high-energy trauma like motor vehicle accidents, fall from significant height and sports related injuries. Early intervention to reduce joint and recognize any limb threatening vascular injury and repair is mandatory. Knee dislocations are usually closed and very rarely associated with proximal tibia or patella fractures. We presented a very unique case of open posterior dislocation of knee joint with medial Hoffa fracture and avulsion of ligamentum patellae without any neurovascular injury. We reduced the knee joint, fixed the fracture and stabilized the patellar tendon. The fracture achieved union and patient had full range of knee motion and full weight bearing without any support or pain. To our knowledge this is the first case in the literature which does not fit into any classification system and not yet reported. 
The changing Role of a Teacher: A Paradigm Shift
Get PDFRecent advances and refinements are continuously changing the face of medical education with the paradigm shift in the role of teacher. The use of information technology and research has opened a big window through which the teaching and learning can be modified. The shifting of onus of learning from teachers to students and replacement of compartmentalized and discipline-based curriculum by integrated one require change in curriculum content, design and delivery. As Albert Einstein once said “the measure of intelligence is the ability to change”; the changes in the field of medical education can be implemented in true spirit only if the teachers adapt to change.
The fact cannot be denied that the successful implementation of curriculum depends upon the quality of teaching. Nowadays teacher centered learning is being replaced by student centered approach with focus on student collaboration and team work instead of creating competitive environment for individual student. Small group discussions, simulation and e-learning along with community-based learning has been added to lectures and bed-side teaching. Early exposure to clinical sciences has provided relevance to the basic sciences curriculum. The skills and attitudes have gained importance in assessment with more focus on evidence-based practice. These global changes in the world of medical education led to the changing role of a teacher. Ronald Harden, a renowned Medical Educationist summarized the qualities of a good teacher in following formula encompassing the three main areas
Spectrum of Bone Lesions at Pakistan Institute of Medical Sciences
Get PDFObjective: To study demographic details of bone lesions diagnosed at Pakistan Institute of Medical Sciences (PIMS), Islamabad Patients and Methods: A retrospective analysis of histopathology reports of 222 patients diagnosed to have various types of bone lesion, in the department of pathology at Pakistan Institute of Medical Sciences, Islamabad during a period of five years (July 2005- June 2010) was conducted. These biopsies were evaluated on hematoxylin and eosin (H&E) stained sections from paraffin embedded tissue blocks. Special stains performed whenever required. Results: Pyogenic osteomyelitis comprised 43.6% of all bone pathologies, followed by granulomatous most probably tuberculous osteomyelitis in 7.6%. Chronic osteomyelitis was more commonly observed in 20-30 years of age group and males were affected more as compared to females. The commonest age group for benign lesion was 11-20 years. Primary malignant tumors were noted in 4.9% cases and metastatic tumors were seen in 14.4%. The commonest age group for metastatic tumors was more than 50 years of age. Males were affected more as compared to females in overall bone lesions. Femur was the commonest site in primary bone lesions. Jaw bones and scalp were more commonly involved metastatic tumors. Conclusions: Metastatic tumors were more common than primary malignancies. Scalp and mandible involvement was seen in metastatic tumors and bones of lower limbs were more commonly involved in primary bone lesions. Males were more commonly affected than females in this study
Role of Molecular Biology in Histopathology
Get PDFPathology has evolved significantly in the past 50 years. Even I can feel lot of changes in last 10 years of my histopathology practice starting from my residency days till the present day and things are now developing even at a greater pace. It is very difficult to keep up the pace with these ever-changing and developing diagnostic modalities. Light microscopy was the sole examination technique at first and pathology was comparatively simple. However, with increasing tumor diagnosis and tumor burden across the globe, a strong need was felt to strengthen the classification systems so that diseases could be put into specific categories and hence treated in a more specified and accurate manner. This need gave birth to the technique of immunohistochemistry, which was based on the principle of antigen retrieval and binding of specific antibodies designed for a particular antigen. Nowadays well-developed histopathology departments use hundreds of antibodies in order to diagnose different kinds of diseases particularly several kinds of neoplastic diseases including benign and malignant tumors. We can very confidently classify tumors broadly into categories of carcinoma, lymphoma, sarcoma, neuroendocrine tumor, melanoma, perivascular epithelioid cell tumor, metastatic tumor etc. Each of these broad groups can be further classified into specific categories based on histological and immunohistochemical features. This has revolutionized the treatment options for patients. However, every technique has a limitation. After immense and colossal research in the field of immunohistochemistry, it is now very much known that immunohistochemistry has got its own limitations