Azurophilic inclusions in plasma cells

We report a 45-year-old man with complaints of chest pain and weight loss who was referred for a bone marrow/trephine procedure to the Aga Khan University Hospital. Bone marrow examination showed plasmacytosis of 95% with plasma cells containing coarse Auer rod-like azurophilic inclusions, which failed to stain positively with Sudan Black B or periodic acid Schiff stain. These inclusions have rarely been previously reported as they are more significant morphologically rather than having a prognostic value

Fulminant hemolysis in glucose-6-phosphate dehydrogenase deficiency

Key Clinical MessageGlucose-6-phosphate dehydrogenase (G6PD) deficiency is an X-linked disorder affecting some 400 million people worldwide. Though clinically silent, it may result in hemolysis on oxidative stress induced by drugs or infections. Viral hepatitis A with coexisting G6PD deficiencycan be devastating associated with severe hemolysis, anemia, renal failure, and hepatic encephalopathy

Evaluation of elevated alanine aminotransferase and hepatitis B virus DNA in healthy seronegative blood donors

Background: Serum alanine transaminase (ALT) has been used as a surrogate marker for detection of hepatitis B and C in blood donors in Pakistan since 1985. Since the introduction of more sensitive assays the value of ALT became questionable but it was still used with subsequent wastage of blood units with raised ALT. Finding: We conducted a study for a period of one year to evaluate the usefulness of ALT. During the study period, 25117 subjects donated blood. Eight hundred and seventy two donors (3.4%) were positive for one or more serological tests. ALT of all donors ranged from 0-1501 U/L (Mean±SD; 33.4±25.45U/L). The donors seronegative for all disease markers were 24245 (96.6%). Of these, 21164 (84.2%) donors had their ALT within reference range while 2874 (11.4%) and 207 (0.8%) of donors had minimal and markedly elevated results respectively. Six hundred and twenty one blood units (including red cells, platelets and plasma) were discarded based on elevated ALT results alone at a cost of $39,123. Two hundred seronegative blood donors with normal ALT, minimally and markedly elevated ALT levels, were selected randomly and evaluated for hepatitis B deoxynucleic acid by individual PCR. None of the donors was found to be reactive. Conclusion: This work did not support a positive association between hepatitis B virus nucleic acid and elevated ALT in healthy serologically negative blood donors

Is manual reticulocyte count a reliable option for under resourced countries

OBJECTIVES: To establish the credibility of manual reticulocyte counts without compromising the quality of care, and to evaluate the degree of acceptability of manual reticulocyte counts in terms of accuracy and cost effectiveness in comparison with two automated haematology analyzers. METHODS: Visual reticulocyte enumeration was evaluated for comparability, within-batch precision and costing with respect to Coulter STKS and Gen S haematology analyzers. RESULTS: The results of reticulocyte estimation for 80 samples as obtained by 3 modes were correlated using Pearson\u27s correlation coefficient (r) which were computed as 0.884, 0.875, and 0.793 for manual-Gen.S, Gen.SSTKS and manual-STKS respectively thus showing positive association of these results. STKS had the CV of 10.4% and was more precise compared to Coulter Gen.S (CV = 11.6%) while manual counts showed the least precision with a CV of 19.8%. The cost per test was calculated to be $0.11 for manual technique in contrast to$0.45 for Gen S and $1.09 for STKS. CONCLUSION: Visual counting of reticulocytes can be used as a reliable tool for estimating reticulocytes in resource strained countries as it is not only cost effective but can also efficiently discriminate between high and low reticulocyte ranges which are required for sound clinical judgment

Attitude of overseas Pakistani students towards modular examination.

oai:mmcedupk_jmmcfinal.jmmc.mmc.edu.pk:article/8Introduction: Modularization an innovative initiative taken by educational institutes around the globe to increase the student’s productivity and efficiency.   Objective: The objective of this study was to determine the knowledge and attitude regarding modularization in overseas Pakistani students. Methodology: A cross sectional survey was conducted at the International Medical College of one of the public sector university during December 2012 till February 2014. A total of 425 undergraduate students were approached through non-probability convenience sampling technique and requested to fill a semi structured questionnaire after taking written consent. Result: According to the outset of this paper a total of 425 students were questioned. Among the total 189 students were male (44.47%) and 236 were female (55.52%) out of which the majority belonged from North America/Canada (79.06%). A vast percentage (48.94) invested of about 2 hours of study daily. 63.06% of students believed modular examination to be a fair system and 32.94% of students thought it to be a failure to affect any educational standards. 36% of students blame stress/load for their poor result and 31.06% agrees with the lengthy syllabus being responsible for their down showing GPA’s. 43.06% of students face hardships because of irregular attendance. The major complaint of students (39%) was their teaching style. 46.12% of students prefer to study from lecture notes. Thus, this study completely clears all the aspects of student’s performance in modular system of examinations and its flow and shortcomings. It is important that more effort should be put into cater to student’s stress, loads and make it an effective system to improve a student’s capability and efficiency.  Conclusion: The findings of this study can guide us to revise and reshape the assessment system practiced at various medical colleges in Karachi

Acute Generalized Exanthematous Pustulosis Induced by Erlotinib (Tarceva) with Superimposed Staphylococcus aureus Skin Infection in a Pancreatic Cancer Patient: A Case Report

Acute generalized exanthematous pustulosis (AGEP) is a rare acute reaction that is drug induced in 90% of the cases and characterized by a widespread, sterile pustular rash. Erlotinib, a small-molecule EGFR tyrosine kinase inhibitor, has been approved by the FDA for patients with pancreatic cancer and non-small cell lung cancer. Skin rash is a well-known side effect related with all EGFR blocking agents. It has been suggested that rash could be used as a surrogate marker for response and possibly be associated with prolonged survival. We report a case of rare presentation of AGEP involving an adverse effect of erlotinib. The commonly reported adverse effects of erlotinib are mild skin eruptions. However, our case describes the rare presentation of AGEP induced by erlotinib. The estimated incidence rate of AGEP is approximately 1–5 cases per million/year

The frequency of heparin induced thrombocytopenia in patients undergoing elective cardiac bypass surgeries

OBJECTIVE: To determine the frequency of Heparin Induced Thrombocytopenia (HIT) in patients undergoing elective cardiac bypass surgeries and to observe the platelets evolution post surgically in these patients. METHOD: A prospective study was designed and 100 unselected consecutive patients undergoing elective cardiac bypass surgery were enrolled and evaluated. The clinical and laboratory details were noted before and after surgery. Their platelet counts were observed from day 0 (prior to surgery) to day 5 post operatively. Particle gel immunoassay was used to demonstrate the presence of antibodies against heparin-platelet factor 4 complexes. RESULTS: There were 86 males and 14 females with median age of 59 and 53.5 years respectively. Marked platelet count variation was detected during post operative period in all patients (n=100) ranging from 23 +/- SD 186.73 to 389 +/- 84.12 X 109/L. However, 20 patients showed \u3e50% drop on day 5 and seven of these also showed seroconversion. The clinical scoring for HIT was found to have a good negative predictive value. Thromboembolic complications were not observed in any of our patients. CONCLUSIONS: HIT is prevalent to a significant extent in patients after cardiac surgery in our clinical setting though it mostly remains undetected and is an under-diagnosed entity

Two incision mini open carpal tunnel release- a minimally invasive alternative to endoscopic release

Abstract Surgical techniques for carpal tunnel release are constantly evolving to reduce complications. This retrospective study was planned to identify the outcome and complications associated with a new operating technique for release of carpal tunnel using two incisions. It was conducted at the Aga Khan University Hospital, Karachi, and comprised patients undergoing surgical release of carpal tunnel syndrome (CTS) between January 2011 and December 2014. Of the 54 patients,38(70.4%) cases were of right-sided CTS. The mean operating time was 12.5±4.9 minutes. Complete relief from symptoms was observed in all the patients and the only complication noted was superficial infection in 2(3.7%) patients.The outcomes and complications associated with this technique were comparable with other standard techniques. No major complication (e.g. neurovascular injury) was reported, which showed that this technique was safe and had no additional risks. Therefore, it can be used as an alternative to endoscopic release which is expensive and requires special training and equipment

Population study of 1311 C/T polymorphism of Glucose 6 Phosphate Dehydrogenase gene in Pakistan – an analysis of 715 X-chromosomes

<p>Abstract</p> <p>Background</p> <p>Nucleotide 1311 polymorphism at exon 11 of G6PD gene is widely prevalent in various populations of the world. The aim of the study was to evaluate 1311 polymorphism in subjects carrying G6PD Mediterranean gene and in general population living in Pakistan.</p> <p>Results</p> <p>Patients already known to be G6PD deficient were tested for 563C-T (G6PD Mediterranean) and 1311 C-T mutation through RFLP based PCR and gene sequencing. A control group not known to be G6PD deficient was tested for 1311C/T only.</p> <p>C-T transition at nt 1311 was detected in 60/234 X-chromosomes with 563 C-T mutation (gene frequency of 0.26) while in 130 of normal 402 X-chromosomes (gene frequency of 0.32).</p> <p>Conclusion</p> <p>We conclude that 1311 T is a frequent polymorphism both in general populations and in subjects with G6PD Mediterranean gene in Pakistan. The prevalence is higher compared to most of the populations of the world. The present study will help in understanding genetic basis of G6PD deficiency in Pakistani population and in developing ancestral links of its various ethnic groups.</p

Improvement in quality of lifesix months after primary total hip arthroplasty in a Pakistani population.

Abstract This prospective, cohort study was carried out to assess the improvement in quality of life of patients undergoing elective primary total hip arthroplasty (THA). It was conducted at the orthopaedic department of the Aga Khan University Hospital, Karachi, from June 2014 to May 2015, and comprised patients who had undergone THA. A total of 89 patients having a mean age of 41.5±12.0 years with a baseline core outcomes measure index (COMI)-hip score of \u3e 3.5 were included. A decrease in COMI-hip score by \u3e3 points six months post-operatively was considered improvement in quality of life. Patient satisfaction with restriction to squatting was assessed separately. The mean reduction in COMI-hip was 4.9±1.3 with 83(93%) patients experiencing significant improvement in quality of life. Age \u3e50 years and American Society of Anaesthesiologists (ASA) level \u3eIII was significantly associated with no improvement in quality of life. Most patients were satisfied with their disability to squat irrespective of COMI-hip score. THA was found to be associated with significant improvement in quality of life and COMI-hip score was applicable in our population despite its inability to assess disability with restriction in squatting