Mohammad Usman

Haemorrhagic manifestations and utility of haematological parameters in dengue fever: a tertiary care centre experience at Karachi.

A retrospective observational study of dengue fever was performed, including 210 patients (male:female ratio 1.6:1, ages 6–74 y, mean 29.7 y) attending the Aga Khan University Hospital, Karachi from January 2001 to December 2006. All included patients proved dengue IgM antibody positive. Of these, 19 (9%) showed increased haemoglobin/haematocrit levels on admission which remained elevated in 4 (2.1%) at the time of discharge. 56 patients (26.6%) had leucopenia and neutropenia and 77.1% (161) had thrombocytopenia at the time of admission; 2.5% (5) and 16.7% (35) had deranged PT and APTT, respectively. Atypical lymphocytes were seen in 109 patients (52%). Platelet transfusion was given in 45 (22.1%) cases. The majority of patients were discharged without any adverse sequelae. The fatality rate was 3.3% (n =7) and these patients died of dengue shock syndrome, while 196 (93.3%) recovered completely. Haematological parameters are an important clue and should be tested when a patient presents with symptoms suggestive of dengue fever.

Additional chromosomal abnormalities in Philadelphia-positive chronic myeloid leukemia.

BACKGROUND AND OBJECTIVE The emergence of non-random chromosomal abnormalities is a well-recognized occurrence in chronic myeloid leukemia (CML) and detection of these abnormalities is important in prognostic stratification. The frequency and types of additional chromosomal abnormalities in CML patients has not been determined in our region. PATIENTS AND METHODS We conducted a descriptive, prospective study of additional chromosomal abnormalities in patients with an established diagnosis of Philadelphia-positive CML from May 2001 to June 2007. Cytogenetic studies were repeated every three months with the conventional G-banding technique and described according to the international system for Human Cytogenetic Nomenclature. All patients received imatinib mesylate. RESULTS In 219 patients with Philadelphia-positive CML, 34 (15.5%) (median age, 38 years) developed 51 additional chromosomal abnormalities. Five cases had variant translocations prior to starting imatinib; the remaining 29 cases acquired chromosomal abnormalities after starting imatinib, including 8 cases that received prior interferon-alfa. Twenty-one patients were in chronic phase, 10 in accelerated phase and 3 were in blast crisis. Trisomy 8 was the most frequent abnormality followed by random chromosomal abnormalities and variants of the Philadelphia chromosome. CONCLUSIONS The overall frequency of additional chromosomal abnormalities was similar to that in previous reports. Early identification of these abnormalities may help in adapting to a more appropriate therapeutic approach.

Hematological and nonhematological toxicities of imatinib mesylate in patients with chronic myeloid leukemia and gastrointestinal stromal tumor

Objectives : To determine the hematological and nonhematological toxicities of imatinib mesylate in patients with chronic myeloid leukemia (CML) and gastrointestinal stromal tumors (GIST) and to review the literature to compile a list of the etiologic agents responsible for these events. Materials and Methods : This was a prospective study conducted from May 2001 to February, 2007. Two hundred and thirty-two patients with CML and GIST treated with imatinib mesylate at the Aga Khan University Hospital were included in the study. Side effects were graded according to the common toxicity criteria of the National Cancer Institute version 3.0. Results : Ninety-seven patients experienced various side effects which, in decreasing order of frequency, were: generalized hypopigmentation, periorbital edema, nausea, and weight gain. Hematological toxicities included mainly grade I/II anemia and thrombocytopenia. Grade III/ IV hematological adverse events were rare in our group. The frequency of all events is equally distributed in all phases of CML and GIST. The side effects rarely lead to permanent discontinuation of therapy. Conclusion : Imatinib mesylate is a well-tolerated drug with some adverse events that are only rarely a permanent barrier to therapy.

Retrospective review of 25 cases of thrombotic thrombocytopenic purpura in Pakistan.

Thrombotic thrombocytopenic purpura (TTP) is a disorder characterized by thrombocytopenia, microangiopathic hemolytic anemia, fever, neurological abnormalities, and renal dysfunction. Because of the rarity of TTP, no comprehensive data is available in the Pakistani population. The present study aimed to review the therapeutic interventions, relapses and mortality rate in patients with TTP treated at a tertiary care hospital in Pakistan. This was a retrospective review of patients treated over a period of more than nine years (2001–2010). Medical charts were retrieved using the ICD coding system version 9 and each file was reviewed by the principal author for clinical and laboratory details, along with the therapy utilized and the outcome. Twenty‐five patients were diagnosed with TTP, including nine males (36%) and 16 females (64%) with a median age of 30 ± 18.4 years for all patients. Idiopathic TTP was seen in 17 patients (68%) and secondary causes were identified in eight (32%). Patients were treated with plasma exchange once the diagnosis of TTP was established. Only neurological and renal involvement at the time of presentation emerged as important indicators in determining the outcome and response to treatment. Most of our patients tolerated plasmapheresis very well; however, delay in starting plasmapheresis due to late presentation was a major hurdle in our set up.