Tuberculous granuloma on bone marrow trephine

Bone marrow examination is a useful tool for diagnosis of many diseases. The utility of bone marrow examination in workup of pyrexia of unknown origin cannot be undermined. Bone trephine of patients presenting with pyrexia of unknown origin must be carefully looked upon for granulomas for evaluation of tuberculosis. In this case, bone marrow trephine aided in timely diagnosis of tuberculosis in a patient

Cerebral venous sinus thrombosis in a patient with undiagnosed factor VII deficiency

Factor VII (FVII) deficiency is one of the rare inherited bleeding disorders. Thrombosis has been occasionally described in inherited FVII deficiency. Here, we report a young female with undiagnosed FVII deficiency who presented with cerebral venous sinus thrombosis (CVST). Oral contraceptive pill was found to be prothrombotic risk factor. The CVSToccurred in spite of the congenital FVII deficiency indicating that no definitive antithrombotic protection is assured by this defect. Low molecular weight heparin and anti-Xa assay were found to be safe choice of anticoagulation and monitoring, respectively, in this patien

Precursor lymphoblastic lymphoma in the extramedullary tissue: A rare manifestation of chronic myeloid leukemia in blast crisis

Chronic myeloid leukemia (CML) is a myeloproliferative disorder characterized by immature granulocytes in peripheral blood and bone marrow. In 95% of cases, it is always due to the presence of Philadelphia chromosome characterized by the presence of reciprocal translocation between chromosome 9 and 22. However, in 7% -17% of individuals, extramedullary proliferation also occurs, either in skin, lymph nodes, bone or central nervous system (CNS), which could be either myeloid, lymphoid or mixed progenitor in origin. The present case is of a 23-year-old male who presented with lower limb weakness, bowel and urinary incontinence. His complete blood count (CBC) findings showed a raised white blood count (WBC) of 408 X 10E9/L. Peripheral film, bone marrow biopsy and immunohistochemistry showed findings consistent with CML in chronic phase. Bone marrow cytogenetic revealed the presence of Philadelphia chromosome. Simultaneously, magnetic resonance imaging (MRI) was done which revealed extradural mass at L1-L3 level; histopathological and immunohistochemistry findings showed features compatible with precursor B cell lymphoblastic lymphoma. His cerebrospinal fluid (CSF) cytology revealed similar blast cells. This extramedullary presence of lymphoid blast cells in the CNS put the patient in the rare entity of CML in blast crisis. He was started on tablet nilotinib and also received multiple cycles of intrathecal chemotherapy with cytosar, methotrexate and hydrocortisone. He also underwent radiotherapy of extradural mass. His lower limb weakness improved dramatically. However, after receiving the fourth cycle of intrathecal therapy, the patient died consequent to neutropenic sepsis. Extramedullary blast crisis in CML has a poor prognosis. Any patient with CML, presenting with CNS symptoms or lymph node enlargement should be thoroughly investigated for extramedullary blast crisis, as there is a considerable change in management and prognosis from the prototype CML in chronic phase

Knowledge attitude and practices among urban women of Karachi, Pakistan, regarding breast cancer

Objective: To determine the knowledge,attitudes and practices of urban women regarding breast cancer and its available screening modalities.Methods: The cross-sectional, questionnaire-based, descriptive study was conducted in the urban population of Karachi in November 2010. Female attendants (n=373) visiting a tertiary care centre and four of its urban outreach centres during the study period were administered a questionnaire. The answers were then scored with regard to their knowledge. Frequencies and percentages were computed through SPSS 17, and analysis of variance was used to confirm significance.Results: Of the 373 participants with a mean age of 32.4+/-10.9 years, 293 (78.6%) were married, and 257 (69%) were housewives. The education level was considerably high; with 214 (57.4%) graduates. The mean score for knowledge of risk factors was 2.84 out of a total of 13; which was significantly associated with marital status and income. Age \u3e 40 years, education level, income and employment status were also significantly associated with higher mean screening awareness scores. Nearly 182 (48.8%) had heard about Breast Self Examination and 142 (38%) knew how to perform one. However, only 97 (25.9%) regularly performed such an exam. Almost all 3621 (97%) women wanted more media awareness campaigns regarding the issue.CONCLUSION: There is a real need for comprehensive health education programmes focusing on breast cancer awareness in Pakistan

Trends in antibiotic susceptibility and incidence of late-onset Klebsiella pneumoniae neonatal sepsis over a six-year period in a neonatal intensive care unit in Karachi, Pakistan

Introduction: The incidence, change in antibiotic susceptibility,a n risk factors associated with mortality of late-onset Klebsiella pneumoniae sepsis during 2006–2011, in a neonatal intensive care unit (NICU) of a developing country, were analyzed. Methods: The medical records of neonates with a discharge diagnosis of sepsis due to late-onset K. pneumoiae were retrieved. Demographic features, gestational age, date and year of admission, antibiotic susceptibility of isolates, and discharge status were recorded.The late-onset K. pneumoniae incidence per 1000 NICU admissions and risk factors for mortality due to late-onset K. pneumoniae sepsis are reported. Results: During the period 2006-2011, 104 of 2768 neonates developed late-onset K. pneumoniae sepsis. The overall incidence of late-onset K.pneumoniae sepsis was 3.7% (37/1000 NICU admissions), with the highest annual incidence being 53/1000 in 2010. Most cases were males (n = 64; 62%) and most were premature and very low birth weight (n = 68; 65%). More than 80% of isolates were resistant to ampicillin + clavulanic acid, gentamicin, aztreonam, and cephalosporins. An increasing trend of resistance to amikacin, fluoroquinolones, piperacillin/tazobactam, and imipenem was observed. In 2011, three-quarters (72%;n = 13) of late-onset K. pneumoniae were CR K. pneumoniae. Seventeen (16%) neonates died. Being male (p= 0.06, adjusted odds ratio (AOR) 9.2, 95% confidence interval (CI) 1.3–66.9), having an extremely low birth weight (p = 0.01, AOR 6.1, 95% CI 0.8–44.4), having severe thrombocytopenia (p = 0.07, AOR 3.9, 95% CI 1.2–13.0), and failure to achieve microbiological clearance (p \u3c 0.001, AOR 19.6, 95% CI 4.0–98.0) were significantly associated with mortality due to late-onset K. pneumoniae sepsis. Conclusion: There has been a rise in carbapenem-resistant strains of late-onset K. pneumoniae, associated with an increased mortality and limited antibacterial choices. Antimicrobial stewardship and rigorous infection control measures seem to be the only way to limit the spread of these strains

Additional file 1 of Human health and ecology at risk: a case study of metal pollution in Lahore, Pakistan

Additional file 1: Table S1. Detail of sampling locations with respect to water resource, site ID, sampling date and coordinates. Table S2. Physicochemical properties of the water samples collected from groundwater, canals, river Ravi, drains, and respective National Environmental Quality Standards. Table S3. Parameters used for the calculation of Chronic Daily Intake (CDI) through oral and dermal exposures are enlisted in the table. Values are presented with units and references. Table S4. Reference values of EC50/LC50 (μg/L) for algae, fish and crustaceans used for the calculation of Toxic Units (TU). Table S5. Descriptive summary of the metal concentration (μg/L) in water bodies. Table S6. Hazard quotients and Health Risk Index: Oral Hazard Quotients (HQoral) and Oral Health Index (HRIoral) are presented only for groundwater samples, as other water resources are not commonly used for drinking. Dermal Hazard Quotient (HQdermal) and Dermal Health Index (HRIdermal) are presented for all water samples collected from grounderwater, canals, river and drains. Data is presented in the form of minimum (Min.), maximum (Max.), average (Mean) and standard deviation. Table S7. Ecological risk of metal contamination based on the toxic unit (TU) is presented for three trophic levels: algae, fish and crustaceans. Toxic Units (TU) are given for each metal, and for the total toxicity of all metals detected at each site (TUsum). For illustration purposes, log-transformation was performed. Table S8. Risk Quotients: Risk Quotients (RQ) and sum of the Risk Quotients (RQsum) are presented for all water samples collected from grounder water, canals, river and drains. Data is presented in the form of minimum (Min.), maximum (Max.), average (Mean) and standard deviation. Figure S1. Principal component analysis of heavy metals: Each vector in the plot represents a variable, and the direction and length of the vector indicate the contribution and correlation of each variable to the top two principal components

Bioaccumulation of Heavy Metals in Water, Sediments, and Tissues and Their Histopathological Effects on Anodonta cygnea (Linea, 1876) in Kabul River, Khyber Pakhtunkhwa, Pakistan

The present investigation aimed to assess the concentrations of selected heavy metals in water and sediments and their bioaccumulation in tissues of freshwater mussels and their histopathological effects on the digestive gland, gills, and gonads of Anodonta cygnea. Water, sediments, and freshwater mussel samples were collected at four sites, that is, reference and polluted sites, along the Kabul River, Khyber Pakhtunkhwa. The polluted sites were receiving effluents from the industrial, agricultural, municipal, and domestic sources. The order of metals in the water was Zn>Pb>Ni>Cu>Mn>Fe>Cr>Cd, in sediments the order was Fe>Zn>Cr>Ni>Mn>Pb>Cu>Cd, and in the soft tissues the order was Fe>Zn>Mn>Pb>Cu>Cr>Ni>Cd. Histopathological alterations observed in polluted sites of Kabul River were inflammation, hydropic vacuolation, and lipofuscin pigments (in digestive gland), gill lamellar fusion, dilated hemolymphatic sinus, clumping, and generation of cilia and hemocytic infiltration (in gills), and atresia, necrosis, granulocytoma, hemocytic infiltration, and lipofuscin pigments (in gonads). The histopathological alterations in the organs of Anodonta cygnea can be considered as reliable biomarkers in biomonitoring of heavy metal pollution in aquatic ecosystems