Pre-Press Paper

Secondhand Water-pipe Smoking and its Correlation with Systemic Inflammation among Cafés Employees in Karachi, Pakistan



The study was designed to determine the correlation of exposure to secondhand smoking (SHS) of Water pipe (WP) with Neutrophils to Lymphocytes ratio and Platelets to Lymphocytes ratio.


A cross sectional survey was conducted among employees at cafés and restaurants of Karachi, where WP smoking facility is offered to consumers. A total of 200 participants were selected through convenience sampling, out of which 181 consented to participate. Participants were divided into exposed (to SHS) and unexposed groups. Data were collected by using structured questionnaire, and blood samples were drawn to measure systemic inflammatory markers (Neutrophil to Lymphocyte ratio NLR, Platelet to Lymphocyte ratio PLR). Data was analyzed by using SPSS software.


Among the included 181 participants, 48.1% (n=87) were unexposed to SHS, 31.5% (n=57) were exposed to SHS of WP and 20.4% (n=37) were exposed to SHS of cigarette & WP. Mean NLR (P = 0.779) and mean PLR (P = 0.205) did not vary significantly according to exposure to SHS among participants. After adjusting for socio-demographic covariates, associated of NLR and PLR with exposure to SHS was also not found to have a statistical significance.


The study found no correlation between exposure to SHS of WP and systemic inflammation using different markers. However, the cross-sectional nature of data and uncontrolled confounding and relatively lower level of exposure in the study sites may potentially explain the overall findings of the study.

Key words:

Secondhand smoking, waterpipe smoking, cigarette, systemic inflammation, Neutrophil to Lymphocyte ratio, Platelet to Lymphocyte ratio



Aim: In childhood and adult Acute myeloid leukemia and Myelodysplastic syndrome chromosome 7 aberrations are not an uncommon.But in childhood ALL it is rarely seen.In this case we identified a rare cytogenetic aberration in a girl with Precursor B cell acute lymphoblastic leukemia.

Method: Ten and a half year old girl presented with complaints of fever for two weeks and generalized body swelling for ten days.She was anaemic,tachycardia with mild hepatosplenomegaly.She had raised TLC-67×109/L with 52% blasts.MLL gene and bcr-abl were negative.

Result: Our patient cytogenetic analysis showed deletion 7q22-34.

Conclusion: Studies have shown that the long arm of 7q from 7q22-q36 has many important tumor suppressor genes located on it.Thus its deletion results in increased leukemogenesis propensity.It will be interesting to find any interconnection between myeloid and lymphoid clones and chromosome 7 abnormalities.

Keywords: Pre B ALL, Chromosome 7, Deletion 7q22-34, Tumor suppressor gene, Leukemogenesis, Cytogenetic.



Aims and objectives: To analyze the data regarding etiological and predisposing factors in pediatric burns and make conclusion for prevention of pediatric burns.

Study design: Retrospective hospital based observational study.

Setting: Department of Pediatric Surgery King Edward Medical University/ Mayo Hospital Lahore.

Duration of study: From June 2017 to June 2018.

Methodology: Children with electric current injuries were admitted in Pediatric surgery department King Edward Medical University/ Mayo Hospital Lahore. As it was a retrospective study so the main source of information was the hospital admission files. A detailed research proforma was made having all variables and data was collected. Data regarding total number of patients, age, gender, mechanism of burn injury, operating findings, treatment and outcome were noted and statistical analysis was done by using SPSS version 20.

Results: One hundred and thirty (n=130) patients with burn injuries caused by electric current in age ranging from 2 to 12 years were treated during one year period. There were 72(55%) males and 58(45%) females. Areas involved were mainly the limbs and face. High voltage electric current was responsible for 90(69%) burn cases and low voltage in 40(31%) cases. Electric current injury caused by direct contact occurred in 100(77%) cases whereas electric flash burn was responsible in 30(23%) cases. Fasciotomy was performed in 78(60%) cases amputations at different levels in 24(18%) and disarticulations of shoulder joint were performed in 6(4.5%) cases. Split thickness skin grafting was done in 80(61.5%) cases whereas 12(9%) cases having minor injury were treated conservatively. 92(71%) cases were discharged home, 23 (17.5%) cases expired and in 15(11.5%) cases parents refused for treatment.

Conclusion: Burns are caused by human errors and are therefore preventable. Disability due to severe burn adversely affects the life of a growing child and is a huge social issue. Public awareness through print and electronic media as well as education at school level is to be stressed in order to prevent electric current burn injury resulting in high morbidity and mortality. There is a need to establish more state of the art pediatric burn units according to population consensus in our country.

Keywords: electric current, burn injuries, predisposing factors, etiology, management, epidemiology, outcome.



Introduction: Thalassemia is a common inherited hemoglobinopathy in Pakistan. Despite various preventive measures taken, each year around 5000 new cases are diagnosed. The problem occurs due to undiagnosed beta Thalassemia carriers. This is because of lack of massive screening programs and unavailability of hemoglobin electrophoresis in different cities of Pakistan. The aim of this study is to assess the sensitivity of different discriminating indices in screening of beta Thalassemia trait.

Method: The study was conducted at Pakistan Institute of Medical Sciences from Jan 2018-July 2018. All patients who were diagnosed as beta thalassemia trait through hemoglobin electrophoresis were included in the study. Seven discriminating indices were applied and sensitivity of each index was calculated.

Result: The male to female ratio was 1:1. 88% of the cases had a positive family history of Thalassemia. Among the various indices used, Shine and Lal showed a sensitivity of 100%, followed by Ricerca (96.6%) and Ehsani (92.58%). The sensitivities of Mentzer, Srivasta, RDWI and MCHD were 92.56%, 91.70%,79% and 70.9% respectively. The results of our study showed that Shine and Lal is the most sensitive index for screening beta Thalassemia trait.

Conclusion: Shine and Lal index is useful to the clinicians as an initial screening tool of beta thalassemia trait. Such cases can then be referred to laboratories where hemoglobin electrophoresis facility is available.

Keywords: Beta Thalassemia, Thalassemia trait, Discriminating Indices, Iron deficiency Anemia, microcytic hypochromic Anemia, Hemoglobin electrophoresis.



Introduction: Amongst all chronic lymphoproliferative disorders B-CLL is the most common. Clinical behavior of CLL is very variable and in order to identify the clinical spectrum there is a need for risk adaptive prognostic markers which will further facilitate in management strategy. Currently available molecular biomarkers ZAP-70 & CD-38 have gain much interest in providing useful prognostic information in patients diagnosed as B- CLL.

Objective:Toassess ZAP-70 and CD 38 positivity in patients diagnosed with B-CLL.

Material & Methods: This was a cross sectional study conducted between Jan 2014 to July 2018 at NIBD, Karachi. Patients with B-CLL meeting the inclusion criteria were enrolled in the study. All patients gave informed consent. Immunophenotyping data analysis was done on FASCCaliburflowcytometryand Cell Quest software. We defined ZAP-70 and CD38 positivity as the presence of this marker on at least 20% and 30% of the B-CLL cells respectively. All required information was collected on pre designed Performa.

Results:Total of 101 patients diagnosed as B-cell CLL were included in the study. Median age of enrolled patients was 64 years (range 43-85 years). Majority of the patients i.e.; 69 out of 101 (68.32%) were males and the rest 32 (31.68%) were female. ZAP-70 was positive in 2.97% of patients (03/101), while CD 38 positivity was detected in 33.66% (34/101).

Conclusion:ZAP-70 & CD-38 positivity was present in 2.97% & 33.66% of newly diagnosed B-CLL patients respectively.Screening for these biological markers in all newly diagnosed CLL patients will result in more dependable identification of disease clinical behavior.

Keywords: ZAP-70, CD-38, Chronic lymphocytic leukemia, Flowcytometry, Immunophenotyping, Prognosis.


Abstract: Background: The nursing school undergraduates’ performance influences the quality production of graduates. These in turn will be the future leaders and workforce for the country in improving the health care system. Thus it is imperative that the students do achieve good performance standards. Academic achievement or performance is the degree in which a learner, instructor or organization have accomplished their short term or long term learning objectives.

Objective: The main purpose of this studywas to explore the factors (e.g., student related, school related, home related, teacher related) that may affect the academic performance of Undergraduate Nursing Students (UNSs).

Material and Methods: In this descriptive research study, a cross-sectional survey design was used to conduct this research study. Through simple random sampling technique, a sample of 129 Undergraduate Nursing Students was selected from the BSN (Bachelor of Science in Nursing) and Post RN BScN (Registered Nurse Bachelor of Science in Nursing)  Studentsof the Lahore School of Nursing, The University of Lahore, Pakistan. A modified version [1] of the research scale was used to collect the relevant data from the research subjects.

Results: One hundred and twenty-nine student nurses participated in this research study; the majority of the participants were females 110 (85.3%). Four types of factors such as teacher-related with an overall mean (3.90), school-related (3.88), student-related (3.83), and home-related factors (3.48) were studied to explore their effect on the academic performance of student nurses. It was found that teacher related factors were at the top with overall mean score of 3.90 and family-related factors were at the lowest level with an overall mean score of 3.48

Conclusion: The result shows that identified factors have influence on academic performance of student nurses. Finding can be used by administrators, educators and evaluators in designing and implementing an educational programs geared to developed academic performance among student nurses.

Keywords: Undergraduate nurses, Learners, Academic performance, Teacher-related factors, School-related factors, Student-related factors, and Home-related factors.



Introduction: Acute leukemia is characterized by the presence of 20% or more blasts in peripheral blood and/or bone marrow biopsy. It includes both AML & Acute ALL. However the diagnosis of AML can also be made when the blast percentage in peripheral blood or bone marrow is < 20 % if there is an associated t(8;21), inv(16), or t (16;16) chromosomal abnormality or PML-RAR fusion gene [1-3]. Tumor lysis syndrome is the most common disease related emergency in patients with leukemia & requires immediate management.

Objective: To ascertain the Frequency of TLS in Acute Leukemia.

Study design: Cross sectional study.

Setting:  NIBD & BMT, Karachi.

Duration of study: The duration of study was 6 months i.e. from May 2016 to November 2016.

Results: 111 patients were enrolled in this study. 41 (36.9%) patients were female & 70 (63.1%) were male, with mean age of 42.8±15.5 years. 66 (59.4%) patients were found to have AML & ALL was seen in 45 (40.6%) patients. Tumor lysis in AML was seen in 21 patients (18.9%) of which 15 patients (13.5%) had LTLS & 06 patients (5.4%) had CTLS. Tumor lysis in ALL was seen in 23 patients (20.7%) of which 16 patients (14.4%) had LTLS & 07 patients (6.3%) had CTLS.

Conclusion: TLS is a frequently common disease related complication in patients with acute leukemia. LTLS is found to be more common than CTLS both in AML & ALL.

Keywords: Tumor lysis (TLS), LTLS, CLTLS, Acute leukemia, AML, ALL.



Soft drinks are those drinks which do not contain alcohol. These soft drinks are either carbonated or non-carbonated soft drinks. Carbonated soft drinks are consumed widely across the globe. Today, when people are becoming more health conscious, concerns are being raised regarding the impact of carbonated soft drinks on health. When discussing the effects of carbonated soft drinks on health carbon dioxide, phosphoric acid and sugar are of main concern. Most carbonated beverages have acidic pH which results in gastroesophageal reflux disease (GERD) like symptoms. The phosphoric solution in these beverages is powerful enough to cause human teeth to become soft. The caffeine present in colas is known to be a hazardous factor for osteoporosis. When taken after a period of dehydration, the sugar in these beverages is known to cause more renal injury then plain water. The sugar content in these beverages may lead to lipids production in the body and result in obesity, hypertension, non-alcoholic fatty liver disease (NAFLD), and pancreatic cancer. Hence, it is necessary to monitor diet and focus on natural and healthy beverages.

Keywords: Soft Drinks, Side-Effects, Diseases, Obesity, Tooth Erosion, Hypertension.



Therapy related Acute Lymphoblastic Leukemia (t-ALL) is a rare secondary malignancy. It occurs in patients who are exposed to chemotherapy and/or radiotherapy for primary malignancy. We are reporting here a case of a thirty five years old female patient who was referred to us for fever, malaise and bleeding from gums. She had a history of ovarian carcinoma for which she took carboplatin and other chemotherapeutic agents. Extensive workup was done which was consistent with the diagnosis of Precursor-B cell Acute Lymphoblastic Leukemia. In the context of previous history of exposure to carboplatin, she was diagnosed as a case of therapy related Acute Lymphoblastic Leukemia secondary to carboplatin.

Keywords: Carboplatin, Therapy related ALL, Ovarian cancer, Secondary malignancy, Platinum based chemotherapy.