Pre-Press Paper

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

ABSTRACT

Objective:

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.

Methodology:

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.

Results:

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.

Conclusions:

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

DELETION 7q ABNORMALITY IN A CHILDHOOD PRE B ALL: A CASE REPORT AND REVIEW OF LITERATURE

ABSTRACT

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.

BEDSORES INCIDENCE IN ICU PATIENTS: A TERTIARY CARE EXPERIENCE

Abstract: Introduction:The aim of this study was to see the incidence of bedsores in our hospital and determine relating factors.

Material and Methods: This cross sectional study was performed on 71 consecutive ICU admissions at Ziauddin hospital ICU from March to May 2015. Data was analyzed on SPSS version 16 by independent sample t-test and chi square test. In 71 patients, 12 developed bedsores, of which seven were males and five were females. Available data in Performa included :demographics, functional class, comorbidities, category(surgical, medical or trauma patient), primary cause of ICU admission, total day of ICU stay, total period of mechanical ventilation, requirement of dialysis, albumen level and if bedsore developed than its details and grade.

Result: In this study, 71 patients were admitted in ICU; 40 patients, which is 56.33%, were male and 31 patients, which is 43.66%, were female. Twelve patients that is 16.90% were affected with bedsores of which seven were males and five were females and this was found to be statistically significant.

The mean age of patients with bedsores was 66.75 years +18.29 as compared to 52.42 years +18.20 in group with no bedsore development.

Total mechanical ventilation required in the group that developed bedsore was 4 days+1.67 to group with no bedsore development, which was 2.36 days + 1.21.

The patients who developed bedsore had serum albumen levels 2.54 +0.26 and group that did not develop bedsore had albumen levels 3.14 + 0.77 and the result was found to be statistically significant.

Conclusion: Development of bedsore was found to be statistically significant to the poor functional class, high mean age, total hospital stay, mean mechanical ventilation and low level of albumin.

Keywords: Bedsores, Pressure Ulcers, Hospital, Admitted patients, Intensive care unit, Incidence.

FREQUENCY AND PATTERN OF ELECTRIC CURRENT INJURY IN CHILDREN

ABSTRACT

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.

ROLE OF DISCRIMINATION INDICES IN SCREENING OF BETA THALASSEMIA TRAIT IN LOW-RESOURCED AREAS OF PAKISTAN

Abstract

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.

DE NOVO DELETION 17P (DEL17P) IN AN ADULT T-CELL PROLYMPHOCYTICLEUKAEMIA AS A RARE PRESENTATION

ABSTRACT:

T-Cell Prolymphocytic leukemia is a rare and an aggressivelymphoproliferative disease which is unresponsive to conventional chemotherapy.We present a case of 72 years old female hospitalized in July 2018 in National Institute of Blood diseases and BMT, Karachi, Pakistan, having lymphadenopathy, splenomegaly, leucocytosis with lymphocytosis, thrombocytopenia and peripheral smear showed predominant population of mature looking lymphocytes. Immunophenotyping shows CD45 (+), CD3(+), CD4(+), CD5(+), ZAP70(+), CD38(+)*, CD25(+)* and negative CD19, CD20, CD10, CD11c, CD8, FMC, Kappa & Lambda and cytogenetics by FISH showed del17 p53 in 35% of interphase nuclei. In patients of T-PLL, del 17 p53 has never been reported previously.

KEYWORD

del17p, T-cell, Prolymphocytic, Leukemia, Lymphoproliferative, CLL.

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