Fludarabine induced autoimmune haemolytic anaemia in a patient with chronic lymphocytic leukaemia

Autoimmune haemolytic anaemia following fludarabine is an uncommon complication and previously treated patients are at higher risk. We describe a case of 57- year old lady with chronic lymphocytic leukaemia; she received intermittent courses of alkylating agents and purine analogue, fludarabine. Reintroduction of fludarabine for her relapsing disease induced autoimmune haemolytic anaemia. Numbers of cases have been reported regarding autoimmune haemolytic anaemia following fludarabine administration, but none have been published from our part of the world. Normally T-cell suppresses autoreactive lymphocytes that can produce autoantibodies. Suppression of T-cells by fludarabine, in addition to the underlying disease process appears to be a contributory factor for autoimmune haemolytic anaemia

Bi-Variate Causal Estimates of Dividend Yield, Earning Yield Ratios and Stock Index: A Case of Karachi Stock exchange

The study examines the relationships between Pakistan’s market stock returns, dividend yields and earning yield ratios. Specifically, it examines the existence of long-run and short-run relationships between and among stock market return, dividend yield and earnings earning yield ratios. Using the monthly data from 1997-2007, the study finds that all these fundamental variables have a strong long run relationships. As for the short run relationship, the results show significant predictive power from dividend yield to stock return and stock market return to earning yield ratio. In addition to applying vector error correction model, the results show that there is the significant long-term equilibrium between stock market index, dividend yield and earning yield ratios. Hence, fundamental variables are an important source of information in determining the stock market returns and useful to investors and other stakeholders in making their investment decisions. Keywords: Causal Relationship, Dividend Yield, Earning Yield and Stock Index

Familial homocystinuria

Two cases of siblings diagnosed as cases of familial homocystinuria are reported. Both the cases have classical presentation of familial homocystinuria including history of dislocation of lens of the right eye. Brother had history of psychomotor retardation while sister had a significant history of deep vein thrombosis. Levels of plasma homocysteine were elevated and urinary homocysteine was positive in both the cases

Efficacy of intravenous hydration versus amino acid infusion in idiopathic oligohydramnios

Objective: To compare the efficacy of intravenous hydration and amino acid infusion in cases of isolated oligohydramnios.Methodology: A single blind randomized clinical trial conducted in Dept of Obs/Gynae, Aziz Bhatti Shaheed Teaching Hospital, Gujrat, from 12-06-2019 to 11-12-2019. A total of 104 mothers having isolated oligohydramnios were randomized into two groups for administration of 6 drips of normal saline (group-A) or amino acid infusion (group- B). The AFI was measured before and after the infusions. The sum total of these four values was AFI in centimeter. The normal AFI in term gestation is taken as 12.9±4.6cm. The rise in AFI was studied and analyzed.Results: In group-A vs group-B, the mean maternal age was 32.1±4.4 vs 31.0±5.5 yrs, Mean Gestational age was 29.1±2.9 vs 29.0±3.1 wks, mean BMI was 34.6±9.7 vs29.1±5.7 Kg/m2. In both groups majority was multigravida. Mean AFI at first presentation was comparable in both groups (3.78±0.56 vs 3.73±0.36). Mean AFI after six drips was significantly higher in group-B. (4.79 ±0.65 vs 6.82±0.62; p<0.001). Similarly, change of AFI showed significant increase in group-B when compared with group-A (1.0±031 vs 3.09±0.70; p<0.001). Stratification for age, gestational age, BMI and parity was also carried out.Conclusion: Intravenous amino acid is an effective therapy for improving AFI and is beneficial in management of isolated oligohydramnios

Diagnostic importance of bone marrow examination in non-hematological disorders

Objective: To evaluate the frequency of involvement of bone marrow with non-haematologic disorders and to observe the significance of bone marrow examination in establishing primary diagnosis of the same. Methods: It was a descriptive study that extended from January 2003 to September 2005. A total of 4569 bone marrow aspirate and trephines were reported during this period. Only the non-haematological disorders were analyzed for their clinical and laboratory parameter. Results: During the study period, 63 patients (1.4%) were diagnosed to have non-haematological diseases detected primarily through bone marrow examination. The mean age of patients at time of procedure was 33 years (range 6 months to 89 years), with male to female ratio of 3.2:1. Anaemia was the most frequent clinical finding followed by splenomegaly and weight loss. In adults metastatic tumors were the commonest disorder, followed by chronic granulomatous disease/reaction. However in children, storage disorders were more prevalent followed by haemophagocytosis as the second commonest non-haaematological disease. Conclusion: Metastatic solid tumors were the frequent non-hematologic disorder involving bone marrow in adult patients while storage diseases were most common among children. Hence, bone marrow examination is a useful laboratory tool in asserting the diagnosis of various non-haematological malignancies and other miscellaneous disorders

Soft Tissue Changes Associated with First Premolar Extractions in Kashmir Female Population

Purpose: The purpose of study was to examine the effect of upper and lower incisor retraction on reduction of the profile and to record any correlation between dental and soft tissue parameters. Materials and methods: The study was a retrospective cephalometric study. A homogenized sample of 10 adult femaleorthodontic patients was selected from the local population. All patients were treated at a private practice using Pre Adjusted 0.022" slot edgewise appliance. Pretreatment and posttreatment lateral cephalograms were taken in natural head position with lips in relaxed position. Each lateral cephalogram was traced and a reference line was established (a constructed line perpendicular to Sella-Nasion minus 7° through Sella). Linear measurements were made with a from A’ point, upper incisor tip, mandibular incisor tip, most anterior point of upper lip, most anterior point of lower lip and B’ point. The angular measurements were the nasolabial angle, labiomental angle. Upper and lower lip thickness and interlabial gap parallel to the reference line were also measured. Results: All linear and angular measurements showed statistically significant (p < 0.05) changes except for changes in upper lip thickness, lower lip thickness, lower vermillion, B’ pointand lower lip anterior. The Pearson’s correlation test showed a significant positive correlation between upper incisor retraction and upper lip position statistically significant decrease in the interlabial gap by 3.4 ± 2.5 mm (p < 0.001). Conclusion: On the basis of the results obtained from this study, it can be concluded that extraction of the four first premolars followed by the retraction of anteriors can be successful in reducing dental and soft tissue procumbency in adult females with bimaxillary protrusion in the local population&nbsp

Clinico-pathologic features of chronic myeloid leukemia and risk stratification according to sokal score

To compile the clinical and haematological parameters of chronic myeloid leukemia (CML) and risk stratification according to Sokal score in our population. A descriptive analysis. The Aga Khan University Hospital, during the period from August 1997 to August 2005. All patients with diagnosis of chronic myeloid leukemia treated as outpatient in haematology clinic, or admitted in haem-oncology wards in The Aga Khan University Hospital were included. Records were retrospectively analyzed for clinicopathologic features. Risk groups were assigned as per Sokal scoring. During the 8 years study period, 245 patients with chronic myeloid leukemia were analyzed, the median age of presentation was 35 years (range 11-73); with male to female ratio 1.69:1. At the time of diagnosis, 178 patients (72.6%), 48 (19.7%) and 17 (7.8%) of patients were in chronic, accelerated and blast phase of the disease respectively. Abdominal fullness was the frequent clinical presentation followed by fever. Laboratory parameters revealed mean hemoglobin 10.0 g/dl (range 4.6-15), mean total leukocyte count 168 x 10(9)/L (35-959) and mean platelets 408 x 10(9)/L (range 30-2335). The mean size of spleen at the time of presentation was 9.2 cm below the left subcostal margin. A large number of patients (46.2%) were in high risk group according to Sokal score i.e. \u3e 1.2. CML occurred more commonly at younger age in this series. Most of these patients were in high risk group according to Sokal scor

Pregnancy outcome after first trimester vaginal bleeding

Background: First trimester vaginal bleeding is one of the most common complications in pregnancy threatening its proper development and successful outcome.Methods: A case-control study was conducted from October 2016 to April 2018 in the department of obstetrics and gynecology SKIMS.200 cases with vaginal bleeding in first trimester were taken for study. Out of the cases, number of patients who had abortion, ectopic, molar pregnancy or continued their pregnancy beyond 20 weeks was noted. Those who continued their pregnancy were compared with 130 controls for complications developing later in pregnancy.Results: There was significantly higher incidence of PIH (15.4% of cases, 6.9% of controls, p value = 0.005) and abruption (7.7% and 1.5% among cases and controls respectively with p-value of 0.034) among cases than controls. Mean gestational age at delivery in cases was 35.6±3.63 weeks while in controls it was 38.5±1.94 weeks (p value <0.001). Mean birth-weight of the neonates in cases was 2.16±0.78 kgs while in controls was 3.05±0.53 kgs (p value <0.001). IUGR occurred in 9.2% of cases and 3.1% of controls (p value 0.039). There was significantly higher neonatal ICU admission rate in cases than controls (p value 0.019).Conclusions: Patients with first trimester vaginal bleeding are at increased risk for spontaneous loss and adverse pregnancy outcome

Medical thoracoscopy- an experience

Background: Medical thoracoscopy is a minimally invasive procedure for diagnosing and treating pleural diseases especially undiagnosed exudative pleural effusion. It is cost effective and safe. The diagnostic yield in undiagnosed pleural effusion is excellent.Methods: This prospective observational study was done in Government Chest Disease hospital of Government Medical College, Srinagar during the period between December 2015 to Dec 2016.Thirty undiagnosed pleural effusion patients after thoracocentesis and who fulfilled inclusion and exclusion criteria’s were included in the study. Medical thoracoscopy using rigid thoracoscope was started for the first time in our hospital and was done in these enrolled patients. Clinical, Thoracoscopic findings and histopathological data of the patients were collected prospectively and analysed.Results: Maximum patients were in the age group of 41-50 years. Most common Thoracoscopic finding was multiple nodules (40%) followed by sago grain infiltration (33.4%). Malignancy was the most common HPE finding of pleural biopsy (46.6%) followed by TB (33.3%). All nodules (13) turned out to be malignant while all sago grain appearance pleura (10) turned out of to be TB. The overall diagnostic yield is 80% as a whole and 96% among patients who had thoracoscopic pleural findings.Conclusions: Medical Thoracoscopy is a safe and easy outpatient procedure and an excellent diagnostic tool for undiagnosed exudative pleural effusion. The diagnostic yield is quite high and complications of procedure are negligible