National Journal of Health Sciences
Not a member yet
374 research outputs found
Sort by
High Fluorescence Lymphocyte Count and Immature Platelet Fraction; “Can these Two Parameters Reliably Distinguish between Dengue and ITP?”
No full textAbstract: Objective: Thrombocytopenia is a frequent finding in Dengue fever. Immune Thrombocytopenia (ITP) is a diagnosis of exclusion and is not associated with febrile illness. Ignoring fever, low platelet count and clinical signs may be similar in both conditions. Peripheral film finding in Dengue fever shows many reactive lymphocytes. Enumeration of these reactive lymphocytes as high fluorescence lymphocyte count (HFLC) and computing immature fraction of platelets (IPF) may be useful in differentiating these two disorders as soon as the blood sample is analyzed on XN-1000 hematology analyzer.Materials and Methods: A cross-sectional study was conducted at National Institute of Blood Disease and Bone Marrow transplantation from January to July 2019 during (Dengue season); blood samples from emergency room were analyzed on XN-1000 hematology analyzer for complete blood count and IPF. Samples with thrombocytopenia were checked for IPF count and HFLC from the extended research parameter data of the analyzer. Patients presenting with fever, had Dengue NS-1 tested. Detailed history & examination was recorded from the patients.Results: Out of the 124 patients, 62 (50%) patients of Dengue and ITP respectively. Male to female ratio was 2:1. Mean age in Dengue was 25.52±10.46 years while 34.44 + 20.82 years in ITP group. Mean platelet count was significantly higher in dengue than ITP patients (120.59 ± 80.28 x109/L versus 41.84 ±38.62 x109/L) (p<0.001). HFLC was 11.71± 7.17% in Dengue fever while 0.198±0.25% in ITP patients whereas IPF in ITP group was 21.91 ± 16.09% while 8.79± 4.39%in Dengue patients were found to be significant i.e. (p<0.001).Conclusion: Excluding fever, thrombocytopenia, presence of increased number of HFLC and low or normal IPF can reliably a predictor of a diagnosis in Dengue season
Severe Pancytopenia and Stomatitis Case due to the Treatment with High Dose Methotrexate
No full textAbstract: Objective: Methotrexate is used to suppress inflammation in many rheumatologic conditions. Here we present an elderly patient who developed serious side effects due to methotrexate. A 78 year old male admitted to emergency department with oral mucosal bleeding, skin rash, decrease in oral nutrition intake and weakness. He had been using 5 milligrams of methotrexate as 2 tablets twice a day for 10 days, after he was diagnosed with psoriatic arthritis 15 days ago. A diagnosis of methotrexate intoxication established with history, physical examination and laboratory analysis, which revealed pancytopenia. His signs and symptoms, as well as pancytopenia were recovered on 6th day of the hospitalization. He had been treated with folinic acid and filgrastim along with supportive care. Although methotrexate treatment and toxicity is well established it is still a clinical challenge that all clinicians must be aware of. In conclusion, methotrexate intoxication is a clinical entity that can lead to serious clinical consequences, and it is essential to diagnose and initiate appropriate treatment without delay to preventmorbidity and mortality
Frequency of Hypothyroidism in Patients with Hepatitis C on Standard Interferon Therapy
No full textAbstract: Introduction: Hepatitis C virus (HCV) infection is an emerging public health issue affecting young people in developing countries. It is the common cause of chronic liver disease which if untreated, leads to cirrhosis, hepatocellular carcinoma and ultimately liver transplantation. HCV infection is conventionally treated with Interferon-? (IFN-?) and anti-viral Ribavirin (RBV). Thyroid dysfunction is frequently encountered in patients having HCV and being treated with IFN-? and antiviral (RBV).Objective: To find out the incidence of thyroid dysfunction i.e., hypothyroidism in patients of HCV infection being treated with IFN-? and anti-viral (RBV). Material and Methods: 250 patients having HCV infection were enrolled for the study. All patients were treated with 3 million units subcontinually 3 times per week and antiviral (RBV). Thyroid function tests were performed at the start of the treatment to have a baseline thyroid status and at the end of the treatment. Patients were considered to have hypothyroidism when thyroid stimulating hormone (TSH) was more than 4.0 mIU/L. Results: 47 (18.8%) patients had thyroid dysfunction after 3 months of the therapy. Out of these 47 patients, 36 (76.59%) had hypothyroidism and 11 (23.4%) had hyperthyroidism. It is evident that patients on IFN-? and antiviral therapy for HCV infection developed thyroid dysfunction particularly hypothyroidism that is more in females
Iatrogenic Venous Compression Syndrome due to Surgical Lumbar Hardware
No full textAbstract: Background: The Iliac vein compression syndrome (IVCS) is most commonly due to May-Thurner variant, an anatomic variant where in the right common iliac artery overlies the left common iliac vein and compresses it against the lumbar spine. The compression of the common venous outflow tract of the left lower extremity may cause discomfort, swelling, or deep vein thrombosis in the iliofemoral veins. The role of the pelvic surgery particularly the lumbar hardware in the development of symptomatic Venous compression syndrome in patients with May-Thurner syndrome is not well understood. The incidence is presumably very low. Herein, we present six patients who developed IVCS after Lumbar hardware.
Method: The cases were diagnosed between Nov. 2016 to Oct. 2019 in the Outpatient Cath Lab of McKinney, TX. The patient’s medical records were retrospectively analyzed looking for risk factors, clinical features, venogram findings, and post venogram. The evaluation of each case was described, and common trends were later presented in a cross-case analysis
The Concept of Damage Control Laparotomy
No full textAbstract: Over the past 25 years, principles of damage control Laparotomy have saved many lives. Quick recognition of injuries and immediate transfer to operating room are essential. Patients with polytrauma have substantial haemorrhage and go into a vicious cycle of death (hypothermia, coaugulopathy and acidosis). Prior to surgery, adequate resuscitation helps to improve both intra and post-operative mortality. And the focus is on control of bowel contamination and haemorrhage. Once achieved, patient is resuscitated in ICU setup to optimize physiology. Adequate hydration, blood transfusion, re-warming of the patient and other supportive measures are taken to arrest the ongoing cycle of coagulation, hypothermia and metabolic acidosis. Later, patient is moved to theatre for definitive management of injuries. Improvement in patient outcome has been reported by an increased understanding of damage control and the anatomical and physiological steps taken to improve the outcomes
Prevalence of Hepatitis in Paediatric Oncologic Patients: A Single Centre Study
No full textABSTRACT: Background: Oncologic problems are increasing day by day very rapidly. It includes leukaemia, solid tumors, germ cell tumors and many others. Leukaemia is a growing reason of paediatric mortality. Children with leukaemia, usually have low blood count which requires blood transfusions. These transfusions can lead to transfusion associated viral infections particularly Hepatitis B and Hepatitis C. Objective: To identify the prevalence rate of HBV and HCV infections in paediatric oncology patients and to identify the probable relation of transfusion with that of the spread of the infection and its detection method. Methods: This cross-sectional study was carried out at molecular department of Child Aid Association Karachi from January 2013 to December 2015. A sample size of 200 paediatric oncology patients was taken. The samples were processed by Real Time Polymerase Chain Reaction (PCR) technique. Result: The results showed that out of 200 patients, 17 were HBV positive having a prevalence rate of 8.5% and 69 were HCV positive with prevalence rate of 34.5%. Among 17 HBV positive patients, no patient was infected before the start of treatment while 03 out of 69 HCV positive patients were previously infected. Conclusion: The incidence of HCV and HBV is raising in the paediatric oncology patients on treatment. This demonstrates that the management may be responsible for this predicament. These patients are exposed to cytotoxic and chemotherapeutic drug infusions and multipleblood transfusions. Therefore blood transfusion practices should meet the standard operating procedures which ensure the use of sterilized equipments and the donors should be screened for viral hepatitis through PCR
Effective Cancer Management can only be Possible via a Multidisciplinary Team Approach - Need for Establishment of Site Specific Tumor Boards
No full textIn Pakistan there is no proper National Cancer Registry. The age-standardized rates (ASR) for cancer (all sites), 1995 to 1997 in Karachi South (KS) were 139.11/100000 in males and 169.5/100000 in females
Pulmonary Hypertension in Sickle Cell Disease Patients: Correlation of TRV Jet with Serum NT-Pro BNP Concentration
No full textABSTRACT: Objectives: The aim of this study was to determine the prevalence of pulmonary hypertension [PH] and correlate it with the laboratory markers of hemolysis and serum NT-pro brain natriuretic peptide [BNP] concentrations in Sickle cell disease [SCD] patients from Oman. Methods: A cohort of 115 SCD patients was investigated with complete blood counts, blood chemistry, Serum NT-proBNP levels, imaging studies and cardiac evaluation with a 12-lead electrocardiogram and Doppler echocardiogram. They were prospectively screened for pulmonary hypertension [PH] with echocardiography, defined as a tricuspid regurgitation flow velocity of > or =2.5 m/sec. Results: Amongst the 73 evaluable patients, those with PH [n=7] had a median age of 32 years with an interquartile range (IQR) of 25.5-34 years, and a prevalence of 9.6%. No statistically significant differences were detected in the haematological parameters, serum blood chemistry and ECG parameters in patients with and without PH. However, in the PH patients, there was an increased plasma NT pro-BNP levels [p<0.006], and serum CRP levels [p<0.003][Mann Whitney U test]. Furthermore, the differences in the indirect bilirubin levels were statistically significant for one tailed comparison [p<0.04, Mann Whitney U test]. The serum NT-pro BNP levels were also significantly correlated with PH[r=0.368, p<0.025]. Conclusions: The median age of PH patients was decade higher with median serum NT-pro BNP levels being two-fold higher and significantly correlated with PH. The significant correlation between serum indirect bilirubin and PH may implicate haemolytic parameters in the pathogenesis of PH
LABs Responsible for Enhancing Antibiotic Susceptibility Pattern and Gene Transference
No full textABSTRACT: Probiotics are gram positive organisms considered beneficial for combating with various pathogens. Most ofthem are antibiotic resistant, giving an idea that they may be carrier of r-plasmids. Our aim of the study was to determine theproportion of LABs that associate with r-gene transference as well as in boosting up antibiotic susceptibility range. For that weisolated probiotic cultures of Streptococcus, Lactobacillus, and Leuconostoc from milk sample, and checked the susceptibilitypattern of isolated probiotics and pathogens (test organisms) against carbepenem. Results showed all LABs are resistant, whilemost of the pure test organisms were sensitive, after that these pathogens were treated with Labs coated disc that was preparedby the Kirby Bauer method. These LAB treated organisms were again checked with carbepenem to check the susceptibilitypattern, this whole protocol was carried out on Muller Hinton Agar (MHA) plate. According to our results test organismstreated with Streptococcus and Lactobacillus species occurred with a 20% and 1% of resistivity, while organisms treated withLeuconostoc species enhanced the sensitivity 66% and streptococcus 1%, whereas Lactobacillus did not show any change inantibiotic spectrum
Pediatric Chronic Myeloid Leukemia with Megakaryocytic Blast Crisis as Initial Presentation: Case Report and Review of Literature
No full textAbstract: Background: Pediatric Chronic Myeloid Leukemia (CML) is a rare entity accounting for 2-3% of pediatric malignancies. CML rarely presents as Blast Crisis (BC) at the time of diagnosis, and megakaryocytic blast crisis is even rarer.Case Presentation: We herein, report a case of a young female, 10-year-old who presented with anemia, leukocytosis and massivesplenomegaly. Clinical features, peripheral film and bone marrow findings were consistent with CML in megakaryocytic blast crisis. Bone marrow cytogenetic analysis revealed karyotype of 46, XX, t(9:22)(q34;q11.2) in 20 metaphases and BCR-ABL P210 by PCR was detected with transcript level of 83%, which further confirmed our diagnosis.Conclusion: De novo presentation of chronic myeloid leukemia with megakaryocytic blast crisis is rarely observed in pediatric population with very few cases published till now. We are presenting this case because of its rarity, likelihood of misdiagnosis as AML (M7) and poor prognosis, if not treated precisely