Outcome of adult patients with acute lymphoblastic leukaemia receiving the MRC UKALL XII protocol: a tertiary care centre experience

Introduction:Acute lymphoblastic leukaemia (ALL) is a heterogeneous group of lymphoid neoplasm resulting from the proliferation of malignant lymphoid cells. We aimed to study the outcome of adult Patients with ALL receiving the Medical Research Council UKALL XII protocol. Methods: This was a retrospective study conducted at Aga Khan University Hospital from January 2001 to December 2008. The medical records of all adult Patients were reviewed and analysed for clinical, morphological and immunological features at presentation and impact on treatment outcomes. Multivariate analysis and survival studies were performed using Kaplan-Meier statistics. Results: The total number of Patients was 54, with a male to female ratio of 3.4:1 and a median age of 28 years. Common presenting symptoms were fever (n is 49) and bleeding (n is 14). 38 Patients had haemoglobin less than 10 gms/dl, 21 had white blood cell (WBC) count of 50 x 10E9/L or more, and 35 had lactate dehyrogenase more than 1,000 IU. Morphologically, FAB-L2 was the commonest subtype, with 38 Patients with B-ALL and eight with T-ALL. Multivariate analysis showed that age above 30 years, male gender, WBC count above 50 x 10E9/L and T-ALL subtype were independent risk factors for poor survival. 46 (85 percent) Patients achieved complete remission. The median survival was 12.3 months. At the end of five years, 16 Patients were alive, two were alive with disease and 14 were in complete remission. Conclusion: Overall survival and relapse rates in our study were comparable to those reported internationally

Cyclosporin induced fatal rhabdomyolysis in a young patient with acquired aplastic anemia: a case report

Cyclosporin is used as an immunosuppressive agent in the management of a variety of autoimmune disorders1 and in patients of organ transplant to suppress host immunity and prevent rejection.2 It is now well established that acquired aplastic anemia is secondary to immune mediated destruction of stem cells in the bone marrow3 and hence Cyclosporin is used as a first line immunosuppressive drug alone or in combination with anti lymphocyte globulin in the management of aplastic anemia.1 Rhabdomyolysis is a rare side effect of Cyclosporin.4 Here we describe a case of fatal rhabdomyolysis in a young patient who received cyclosporin for treatment of aplastic anemia

Flow cytometric and demographic analysis of t cell acute lymphoblastic leukemia in Pakistani population.

Background: This study was carried out to analyze the proportion of T cell acute lymphoblastic leukemia (TALL) among all acute lymphoblastic leukemia (ALL) in Pakistani population and its correlation with the demographic features. Accuracy of cell surface markers used in flow cytometric analysis of the leukemic cells was also determined. Methods: Data of 209 consecutive cases of acute lymphoblastic leukemia (ALL) presenting between July 1995 and July 2003 was analyzed. Flow cytometry was performed on all ALL cases using the standard protocols. TALL markers included CD3, CD5 and CD7. Results: Proportion of TALL among known ALL Pakistani patients was 17.22%. Mean age of the TALL patients was 17.2 years. Proportion of TALL was higher in adults than in children (21.95% vs. 14.17%). Overall in this study there were more male patients affected by TALL (25/36 or 69.40%) than females (11/36 or 30.60%). The female to male ratio among TALL patients was 1:2.27. However, the proportion (%) of TALL in females was higher than males (18.96% vs. 15.82 %) i, e, 1.2:1. CD7 was found to be the most sensitive among both adults & children. It was positive in 94.4% of the TALL cases. Conclusion: Proportion of TALL among ALL in Pakistan is similar to that reported in this region, indicating a candidate association with geographical location and socioeconomic status. The reactivity of markers with TALL cells was similar to what we expected based upon literature. However, due to some aberrant and cross reactivity displayed by each marker, we strongly recommend a panel approach including B and myeloid markers to ensure a correct diagnosis of TALL

Long-term outcomes of acute myeloid leukemia in adults in Pakistan

Objective: To describe the long-term outcomes of Acute Myeloid Leukemia (AML) and to study clinico­pathological features at presentation, morphological subtypesand remission rates. Methods: Demographic information, response to therapy and survival of patients (\u3e14 years of age) admitted between January 1988 to August 1996 with acute myeloid leukaemia was retrieved and analysed. Results: Seventy-four patients were admitted with a diagnosis of AML during the study period. There were 43 males and 31 females. Age ranged between 15 and 70 years with a mean age of 38 years. The most common presenting feature was fever (67.5%) and the morphological subtype according to French-American-British Group (FAB) criteria was M4. Fifty-five patients received treatment and were evaluable for response and outcomes. Thirty-six (65.4%) patients had complete remission. Sixteen (29.1%) died during the first 28 days after starting induction chemotherapy. The median survival was 11 months. Six (11%) patients (4 females, 2 males) are surviving beyond 4 years (long-term survivors).Conclusion: Our study suggests that the long-term outcomes of adults with AML are comparable to what has been reported in the literature for patients who do not receive bone marrow transplants (JPMA 52:482;2002)

Design of RF Frontend Unit to Avoid Intermodulation Using Arduino Uno

Designing a Radio Frequency (RF) front end is vastly realized for determining the level of integration that is required in the signal chain inside the receivers to be idealistic. The receivers is susceptible to harmful intermodulation due to nonlinear RF front ends. In this paper, intermodulation distortion is avoided by a selective prototype hardware design of RF fort end which is connected with the Arduino Uno for controlling the power levels. The measurements are tested out as a result of injecting a signals within x-band frequencies and chosen different power levels are assumed. These measurements is revealed an accepted results for the intermodulation avoidance

Energy Loss of a Heavy Quark Produced in a Finite Size Medium

We study the medium-induced energy loss $-\Delta E_0(L_p)$ suffered by a heavy quark produced at initial time in a quark-gluon plasma, and escaping the plasma after travelling the distance $L_p$. The heavy quark is treated classically, and within the same framework $-\Delta E_0(L_p)$ consistently includes: the loss from standard collisional processes, initial bremsstrahlung due to the sudden acceleration of the quark, and transition radiation. The radiative loss {\it induced by rescatterings} $-\Delta E_{rad}(L_p)$ is not included in our study. For a ultrarelativistic heavy quark with momentum p \gsim 10 {\rm GeV}, and for a finite plasma with L_p \lsim 5 {\rm fm}, the loss $-\Delta E_0(L_p)$ is strongly suppressed compared to the stationary collisional contribution $-\Delta E_{coll}(L_p) \propto L_p$. Our results support that $-\Delta E_{rad}$ is the dominant contribution to the heavy quark energy loss (at least for L_p \lsim 5 {\rm fm}), as indeed assumed in most of jet-quenching analyses. However they might raise some question concerning the RHIC data on large $p_{\perp}$ electron spectra.Comment: 18 pages, 3 figures. New version clarified and simplified. A critical discussion added in section 2, and previous sections 3 and 4 have been merged together. Main results are unchange

Paraendocrine behaviour of tumours of the gastrointestinal tract with reference to human placental lactogen.

This article does not have an abstract

Hematologic and cytogenetic findings in eleven chronic myelogenous leukemia patients treated with imatinib mesylate at a tertiary care hospital

Objective: To evaluate the response of Imatinib mesylate in patients with myeloid leukemia in chronic ,accelerated and blast phase. Methods:Eleven patients with established diagnosis of chronic myeloid leukemia were treatedwith Imatinib mesylate. Adverse events were documented with regular follow ups. Hematological and cytogeneticresponses were assessed according to established criteria. Patients with zero percent Philadelphia positivemetaphases were labeled as complete cytogenetic response while patients with 1% to 35% Philadelphia positive metaphases were termed as partial responders. Results: Of 11 cases there were 7 males and 4 females with a mean age of 39.5 years and median age 51 years(range 21-69). Male to female ratio was 7:4. Median follow-up was 34 weeks (range 8-78). Four patients werein blast crisis, 1 in accelerated phase and remaining six patients were in chronic phase. All patients achieved hematological response. Cytogenetic response was present in six patients, 3 were responders and the remainingwere non responders. Two patients achieved complete cytogenetic response and one patient had partial cytogenetic response. Both patients with complete cytogenetic response relapsed in twelve weeks time. Conclusion: Imatinib mesylate is a drug with curative potential and can be used as a first line drug in the management of CML, however at present the cure rate is unknow

Boundary condition at the junction

The quantum graph plays the role of a solvable model for a two-dimensional network. Here fitting parameters of the quantum graph for modelling the junction is discussed, using previous results of the second author.Comment: Replaces unpublished draft on related researc