Malignant and non-malignant causes of hypercalcemia: A retrospective study at a tertiary care hospital in Pakistan

Background: Hypercalcemia is a common electrolyte abnormality presenting with a variety of symptoms. The common causes are primary hyperparathyroidism and malignancy associated with hypercalcemia. However, iatrogenic hypercalcemia with the overzealous use of vitamin D has now emerged as another important cause of hypercalcemia over the past decade.Objective: This study aims to evaluate the causes of hypercalcemia, management strategies, and outcomes in patients admitted with hypercalcemia in a tertiary care hospital. Method: It is a retrospective study done at Aga Khan University Hospital (AKUH), Karachi after taking approval from the ethical review committee (ERC). Data were gathered about all patients admitted from 1st January 2008 to 31st December 2018. A total of 1142 patients were included in the study and their calcium levels were noted. Along with demographic details, data pertaining to their diagnosis and all investigations done to evaluate the causes of hypercalcemia were noted in a pre-defined questionnaire.Results: A total of 814 patients having hypercalcemia were included in the final analysis and their mean age was 60.8 ± 14.1 years. Male and female patients were 45.4% and 54.6%, respectively, and their mean hospital stay was 6.2 ± 5.8 days. The most common cause of hypercalcemia was malignant solid tumors (49.1%), followed by hematological malignancy (16.5%), hyperparathyroidism (10.9%), definite vitamin D toxicity (8%), chronic kidney disease (4.9%), chronic granulomatous diseases (4.7%), and probable vitamin D toxicity (3.5%). The oral cavity carcinoma (17.7%) was the most common solid tumor associated with hypercalcemia. Amongst hematological malignancy, multiple myeloma (14.4%) was the most common one. Out of 814 patients admitted with hypercalcemia, 601 (74%) patients recovered from hypercalcemia, while mortality was observed in 129 (16%) patients. Of those who expired, 110 (85.3%) had malignancy either solid tumor or hematological.Conclusion: Malignancy is the most common cause of hypercalcemia in admitted patients. The knowledge of hypercalcemia\u27s causes is of great importance so that targeted investigations can be done. Not only will it minimize the cost burden and shorten the hospitalization of patients; it will also help the physicians to decide the appropriate management accordingly. Moreover, vitamin D toxicity was also observed in a significant number of patients which highlights the common practice of using higher doses of vitamin D by physicians

The Role of Ownership Concentration and Dividend Policy on Firm Performance: Evidence from an Emerging Market of Pakistan

Purpose- The main aim of this study is to determine the role of ownership concentration and dividend policy on the firm performance of chemical sector firms of Pakistan. Design/Methodology- This research used the secondary data collected from the annual reports of the companies listed at the Karachi Stock Exchange (KSE). However, inclusion criteria are the 26 listed firms from 2012 to 2017, giving a total of 156 observations. This study used the Generalized Least Squares Model. Findings- The findings reveal that ownership concentration has a significant positive association with firm financial performance. This stated that larger shareholders could attribute to the alignment of managerial incentives with shareholder interests. They also monitor the team very effectively and efficiently. The dividend policy has a significant positive relationship with ROA. Leverage and tangibility have a significant negative relationship with firm performance. Practical Implications- These results potentially can be relevant for policymakers and academic research as well as also helpful for managers and policymakers

BCR-ABL1 Gene Mutation in Acute Lymphoblastic Leukemia

Objective:  Determination of frequency of BCR-ABL1 gene mutation in Acute Lymphoblastic Leukemia. Methodology: This cross sectional study was carried out at the Department of Molecular Haematology, Armed Forces Institute of Pathology between January 2018 to March 2021. All newly diagnosed patients of Acute Lymphoblastic Leukemia were included in the study while patients already on treatment and with secondary leukemia were excluded from the study. Blood counts were done and various parameters such as total leukocyte count, hemoglobin, and platelet count were calculated. Results: 623 patients were included in the study. BCR-ABL gene was positive in 105 (16.8%) patients. A total of 96 (92%) were positive for BCR ABL p190 rearrangement and 9 (8%) were positive for BCR ABL p210 rearrangement.  Mean age of patients was 21 years. The frequency of BCR ABL gene was positive in 72% males and 28% females. BCR-ABL positive ALL was associated with higher TLC count. CNS involvement was more common in Acute Lymphoblastic Leukemia with BCR-ABL. The likelihood of post-induction remission decreased with age. Conclusion: In our study population, a frequency of 16.8% patients were BCR ABL1 positive in acute lymphoblastic leukemia. BCR- ABL gene mutation in ALL is more prevalent in young adults. The frequency of p190 rearrangement is more common than p210 BCR-ABL rearrangement. BCR-ABL positive ALL is more prevalent in males than in females

Serum Phosphate Level in Patients with Severe Acute Malnutrition at Nutrition Stabilization Centre, Children Hospital, and Institute of Child Health Multan

Objective: To evaluate the serum phosphate level of children with severe acute malnutrition and effect of therapeutic feeds (F75 and F100) on serum phosphate levels. Study Design: Prospective Observational Study. Place and Duration of Study : The study was conducted at Stabilization center of Children's Hospital and Institute of Child Health Multan from 1 March 2018 to 30 March 2019. Materials and Methods: The total 270 children with severe acute malnutrition, who were under 5 years of age and admitted to the stabilization center for complicated SAM during study duration were included in the study. Initial management of the patients were started by following WHO protocols for Severe Acute Malnutrition management and the baseline labs along with serum phosphate levels were sent for evaluation. Patients were admitted at Stabilization Centre for the management plan as per guidelines. Once the patients were stabilized in one week approximately the transition towards rehabilitation phase of severe acute management started. Serum phosphate levels were assessed at admission, at stabilization (day 7 of admission) and at the time of discharge. Data was analyzed using SPSS version 21. Results: The mean age of our patients was 22 ± 2 months. The male to female ratio were 1:2. Hypophosphatemia was documented in 180 (66%) patients with mean 0.96 ± 0.40 mmol/ltr < (1.45 –1.78mmol/ltr) serum phosphate levels at the time of admission. During transition phase the phosphate levels were 1.1± 0.45 mmol/l and after rehabilitation phase 1.45 ± 0.45 mmol/l on average of 15 days of management. After using F75 and F100 therapeutic feeds in stabilization, transition, and rehabilitation phase 178 (98.9%) children were treated and had normal serum phosphate level at the time of discharge. Conclusion: Hypophosphatemia is commonly present in SAM children. Introduction of therapeutic feeds F75 and F-100 during stabilization phase and rehabilitation phase significantly improves phosphate levels in SAM children with low phosphate levels

Anthesis and Booting: Two Critical Stages Vulnerable to Water Stress in Wheat (Triticum aestivum L.) With Respect to Yield Production

Six spring bread wheat varieties (AAS-11, BARS-09, Dharabi-11, Faisalabad-08, Chakwal-50 and Fatehjang-2016) and 4 elite lines of wheat (10FJ01, 12FJ26, 12FJ01 and 11FJS309) were analyzed with respect to water stress by providing them two types of treatments i.e., control (no stress) and strained treatment (20 days of stoppage of irrigation at booting and further 20 days of drought after anthesis) at Barani Agricultural Research Station, Fatehjang during 2017-18. Results of this study exhibited highly significant variations prevailed in all the wheat genotypes by viewing their mean performance with respect of all physiological and yield traits. AAS-11, Fatehjang-2016 and Dharabi-11 exhibited their best performance and pointed out elevated mean productivity (MP), stress tolerance index (STI), relative water content (RWC) and geometric mean productivity (GMP). Moreover, stress susceptibility index (SSI) and tolerance (TOL) was anticipated at lowest among the above-mentioned wheat varieties and lines. Based multivariate analysis (biplot) and dendrogram studies; AAS-11, Fatehjang-2016 and Dharabi-11 are most suitable wheat cultivars for drought tolerance at booting and anthesis stage. MP, STI, RWC, GMP, SSI and TOL are renowned to be favourable gauges for identification of drought tolerance wheat ideotype. Likewise, same wheat varieties also exhibited higher grain yield per plant that put them in higher ranked genotypes for making selections and recombination while improving wheat through breeding for drought resistant

Treatment Outcome of Kwashiorkor in Children as Per World Health Organization Guideline at Nutrition Stabilization Center Multan, Pakistan

Objective: To assess the treatment outcomes and associated factors among children with kwashiorkor (Edematous Severe Acute Malnutrition) at Nutrition Rehabilitation Centre the Children Hospital and The Institute of Child Health, Multan. Study Design: Retrospective Descriptive research. Place and Duration of Study: This study was planned at the nutritional rehabilitation center of The Children Hospital and The Institute of Child Health, Multan from 01 January 2012 till 30 December 2020. Materials and Methods: The record register of stabilization center was utilized to gather the required information for the study. Baseline statistics and medical signs and symptoms of kwashiorkor, complications and treatment outcome of children were recorded. Patients of age 1 month to 60 months with kwashiorkor (weight/height less than -3SD with edema) were included who were treated according to WHO guidelines for Severe Acute Malnutrition (SAM). Results: during the year 2012-2020, a total of 2393 children were admitted with severe acute malnutrition out of which 222 (9.4%) were edematous SAM (Kwashiorkor). 222 kwashiorkor patients 25 (11.2%) were less than 6 months while 197(88.7%) were more than 6 months old. 120 (54%) were males and 102 (46%) were females. Out of total kwashiorkor patients, 40% presented with diarrhea, about 30% had pneumonia, hypoglycemia was recorded in 10% children, Urinary Tract Infection 15% and other diseases like celiac disease nephrotic syndrome and complication included the 5% of total. Almost 90% of patients recovered and got discharged and 8% passed away, only (2%) patients left against medical advice (LAMA). Conclusions: Kwashiorkor is the second most prevalent form of severe acute malnutrition in south Punjab and usually difficult to diagnose due to masking effects of edema. Kwashiorkor can be successfully managed by using the WHO guidelines for sever acute malnutrition. WHO guidelines also show treated patients discharged mostly with a lower percentage of mortality and comorbidities

Caudal duplication syndrome: a rare entity

The rare caudal duplication syndrome is a spectrum of anomalies primarily involving partial or complete duplication of organs comprising the gastrointestinal, genitourinary and distal neural tube systems. These findings are considered to be a result of aberrant embryogenesis. We hereby report a case of an adult female with complete duplication of the genital and urinary systems (urethra and bladder), hindgut and lower end of vertebral column with no functional impairment. She presented in her first pregnancy at 36 weeks gestation, in labour. To the author's knowledge this is the first case of caudal duplication syndrome with pregnancy from Pakistan. Key Words: Caudal duplication, Genitourinary, Gestation, Hindgut