Altered Coagulation Pattern in Different Histological Grades of Squamous Cell Carcinoma

Background: The incidence of squamous cell carcinoma has doubled in the last three decades associated with a high rate of morbidity and mortality. The incidence of bleeding and/or thrombosis in advanced stage cancer necessitates a need for research in blood coagulation abnormalities in malignancy. The objective of the present study was to determine the alteration in coagulation pattern among patients diagnosed with squamous cell carcinoma (SCC). Material and Methods: This cross-sectional study was conducted in Pathology department of Isra University Hospital, Hyderabad over a period of 06 months. A total of 126 samples were selected through non-probability convenient sampling. Both male and female patients of all age groups having SCC of skin, gastrointestinal and genital tract were included. The coagulation profile was analyzed by Sysmax CA 50 and Nycocard reader II. Data was entered into SPSS version 22.0 and results were analyzed. Results: The mean age of the patients with SCC in the present study was 55.5 ± 12 years with more male patients (n=81; 64.3%) as compared to females (n=45; 35.7%). Oral SCC was found to be the most common site of squamous cell carcinoma (43.7%). Majority of the patients had well differentiated SCC (42.1%) followed by moderately differentiated (40.5%) and poorly differentiated SCC (17.4%). The comparison of severity of SCC with coagulation profile revealed that PT (P=0.01), APTT (P=0.001), D-dimers (P=0.01 and TT (P=0.01) were significantly increased, whereas fibrinogen was significantly decreased (P=0.001). Conclusions: The histological differentiation of SCC (from well differentiated to poorly differentiated tumors) showed a highly significant association with different coagulation profile parameters like PT, APTT, BT, CT, D-dimer, TT, and fibrinogen levels

Effectiveness of Haemophilus influenzae type b conjugate vaccine on radiologically-confirmed pneumonia in young children in Pakistan.

OBJECTIVE: The effectiveness of Haemophilus influenzae type b (Hib) vaccine in preventing severe pneumonia in Asian children has been questioned, and many large Asian countries yet to introduce Hib conjugate vaccine in immunization programs. The primary objective of this study was to assess Hib conjugate vaccine effectiveness (VE) on radiologically-confirmed pneumonia in children born after introduction of Hib conjugate vaccine in Pakistan. STUDY DESIGN: A matched case-control study enrolled cases of radiologically-confirmed pneumonia in several hospitals serving low-income populations during 2009-2011. Cases were matched by age and season with 3 hospital and 5 neighborhood controls. Pneumonia was diagnosed using standardized World Health Organization criteria for chest radiograph interpretation. Matched OR were estimated for VE. RESULTS: A total of 1027 children with radiologically-confirmed pneumonia were enrolled; 975 cases, 2925 hospital controls, and 4875 neighborhood controls were analyzed. The coverage for 3 doses of diphtheria-tetanus-pertussis-hepatitis B-Hib conjugate vaccine was 13.7%, 18%, and 22.7% in cases, hospital controls and neighborhood controls, respectively. Estimated Hib VE for radiologically-confirmed pneumonia was 62% with 3 doses of vaccine using hospital controls and 70% using neighborhood controls. CONCLUSIONS: Hib conjugate vaccine prevented a significant fraction of radiologically-confirmed pneumonia in children in Pakistan. Maximizing impact on child survival needs improved immunization coverage