Naveen Naz Syed

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.

Response to Imatinib Mesylate in Patients with Early Chronic Phase Chronic Myeloid Leukemia and Derivative Chromosome 9 Deletion or Clonal Evolution

Objectives: The significance of clonal evolution and derivative chromosome 9 in Philadelphia-positive CML is not fully characterized and studies have yielded conflicting results. After working on emergence of clonal evolution from our region, we continued to find out the response of Imatinib Mesylate on such cases of CML treated in our center. Materials and methods: We conducted a cross sectional, prospective analysis on response of Imatinib Mesylate on patients with Philadelphia positive chronic myeloid leukemia with clonal evolution treated from period of September 2007 till 2010. Patients were grouped on basis of cytogenetic analysis performed by conventional cytogenetic and fluorescence in situ hybridization (FISH) techniques and followed for three years to see the response rate of imatinib mesylate. Results: We reported here the response rate in one hundred and two previously untreated cases of chronic myeloid leukemia (Philadelphia positive). Twelve patients (11.7%) exhibit derivative chromosome 9, three had trisomy 8, one with addition 15 and one had deletion 16. At follow-up of 30 months 78 cases were evaluable and 45% and 61% showed complete and major cytogenetic response respectively. There is no significant association of derivative chromosome 9 with the response of imatinib mesylate in our group. Conclusion: Imatinib mesylate is the first line therapy in chronic phase of CML but the role in patients with clonal evolution need to be established by larger group of patients.

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.