Nusrat Bashir

Role of low dose cytarabine in elderly patients with acute myeloid leukemia: An experience.

Purpose: To highlight the acceptable results seen after use of low dose cytarabine in elderly patients of acute myeloid leukemia (AML) with comorbidities. Materials and Methods: This was a prospective study carried on 30 newly diagnosed patients of AML over 60 years of age who were unfit for standard treatment regimens. We did not use azacytidine and decitabine in our patients because these therapeutic modalities being extremely costly and our patient affordability being poor. After taking patient consent and institutional ethical clearance these patients were treated with 20 mg/m 2 cytarabine subcutaneously in two divided doses 12 h apart for 4 days every week for 4 weeks which constituted a cycle before disease, re-assessment was done. A repeat cycle was administered where ever needed and after attainment of remission, we continued low dose cytarabine for 2 days/week as maintenance after complete or partial response was documented. Results: In our study, we found that around 20% of patients achieved complete remission and 30% partial remission. The remission rates were definitely influenced by counts at presentation, performance at presentation, comorbidities, underlying myelodysplastic syndrome and baseline cytogenetics. Conclusion: Low dose cytarabine is effective treatment option for elderly patients with AML when standard treatment options are not warranted.

Hereditary stomatocytosis: First case report from Valley of Kashmir

Stomatocytes are erythrocytes with a central slit or mouth-shaped (stoma) area of central pallor when examined on dried smears. In wet preparations, they are uniconcave rather than biconcave, giving them a bowllike appearance. In vitro, stomatocytes are produced by drugs that intercalate into the inner half of the lipid bilayer, thereby expanding the inner lipid surface area relative to that of the outer half of the bilayer. Hereditary stomatocytosis (also known as hereditary hydrocytosis, or overhydrated stomatocytosis) refers to a heterogeneous group of autosomal dominant hemolytic anemias caused by altered sodium permeability of the red cell membrane. We present the first case report of hereditary stomatocytosis in a 10-year-old male from the valley of Kashmir. Only eight families with this condition have been described worldwide.

PLASMAPHERESIS: AN EXPERIENCE AT A TERTIARY CARE HOSPITAL.

Nusrat Bashir. Objectives:To analyze our experience with 105 cases who underwent plasmapheresis for various disorders. Materials and Methods:-Retrospective review of Plasmapheresis(PE) was done over a period of 13 years, from july 2015 to August 2002 in a tertiary care centre. Results:The main indication for PE was GuillainBarresyndrome( GBS) ( 31%) . Age of patients ranged from 18-62 years. The most common complications were paraesthesias and/or cramps (36.1%) and hypocalcemia (7%).There was no mortality related to the procedure. Conclusion:-The analysis of 105 cases of plasmapheresis in our department showed that the procedure is safe, with only minimal procedure related complications and no mortality.

MODIFIED TECHNIQUE OF TRANS-NASAL TRANS-SPHENOIDAL MICRO-DECOMPRESSION FOR PITUITARY ADENOMAS-AN EXPERIENCE.

Mohammad Akbar Shah. Background:Weighing 0.6 grams the pituitary has unassuming regulatory functions on human body and the tumors of pituitary explain the pervasive might of this tiny structure. Patients and methods:we carried out a prospective comparative study on two patient groups of thirty patients each. One of the groups underwent conventional technique for tumor decompression with xylocaine-adrenaline nasal mucosa infiltration and the other one underwent a modified technique of tumor decompression with normal saline infiltration. In addition we used gelatin foam in empty sella in modified technique in place of fat as is done in conventional surgical procedure.The results of two groups were compared. The patients with tumor infiltration into the sinuses and major vessels were excluded from the study. Results and conclusion:Modified surgical technique is safe and very effective in terms of in perioperative hemodynamics, blood loss, surgical field and post-operative MRI interpretation.

Cured case of relapsed acute myeloid leukemia with giant central nervous system chloroma

Myeloid leukemias are a heterogenous group of disease characterized by infiltration of blood, bone marrow and other tissues by neoplastic cells of hematopoietic origin. Rarely, patients may present with symptoms from a mass lesion located in soft tissues. The mass lesion represents a tumor of leukemic cells and is called granulocytic sarcoma or chloroma. This is more commonly seen in monocytic subtype with abnormalities of chromosome 11. In general, they are felt to augur a poorer prognosis, with a poorer response to treatment and worse survival. There have been few case reports of orbital and central nervous system (CNS) chloroma in pediatric age group who have done better than only a medullary disease. Here, we present a case of acute myelogenous leukemia M2 who had two relapses one medullary and one extramedullary (CNS relapse with giant CNS chloroma). Patient was reinduced with same drugs and was advised to go for allogenic stem cell transplantation, which he could not. Subsequently presented with features of raised  Intracranial tension (ICT) and was diagnosed to have extramedullary relapse in the form of giant CNS chloroma. He was treated with surgical debulking of the tumor, fludarabine, AraC, idarubicin, and G-CSF chemotherapy protocol (FLAG-IDA) chemo, and local intraspinal triple therapy 5 years back and stands cured at present.

Hemolysis caused by accidental exposure to dichlorovos: a rare manifestation

Dichlorovos, an organophosphate, is an insecticide used on crops, animals, and in pest-strips. Acute (short-term) and chronic (long-term) exposures of humans to dichlorvos results in the inhibition of an enzyme, acetylcholinesterase, with neurotoxic effects including perspiration, vomiting, diarrhea, drowsiness, fatigue, headache, and at high concentrations, convulsions, and coma. Dichlovoros should therefore be added to the list of toxins known to cause acute hemolysis. We present a rare case of a 45 year old male patient of Dichlorovos poisoning presenting as acute hemolysis.

Role of oral clonidine in preventing postsubarachnoid block shivering in patients undergoing elective urological surgeries: an experience

Purpose The aim of this study was to investigate the effectiveness of oral clonidine in preventing postsubarachnoid block shivering in urological surgeries. Patients and methods It was a prospective double-blind study carried out on 120 elective patients after ethical clearance and after written informed consent was obtained from the patients who underwent urological surgeries. Patients were divided into two groups of 60 each: the study group and the placebo group. Patients in the study group received an oral clonidine tablet of 150 mg 90 min before block. The severity of shivering and other hemodynamic parameters were noted and compared between the two groups. Results We found a statistically significant decrease in postblock shivering incidence as well as severity in the clonidine-treated group, with no significant changes in hemodynamic and other parameters between the two groups and thus recommend its use. Conclusion As a prophylaxis, clonidine given orally at a dose of 150 mg seems to be a cheap, effective, and easily available drug for preventing postsubarachnoid block shivering in patients undergoing elective urological surgeries.

Dapsone as a cheap and safe second-line drug for chronic immune thrombocytopenia in developing countries: A prospective cohort study

Objective: The aim was to evaluate the efficacy and safety profile of dapsone as a cheap second-line treatment for chronic immune thrombocytopenia (ITP) in developing countries. Materials and Methods: A prospective study on 100 chronic ITP patients. These patients were put on dapsone after ruling out glucose 6 phosphate dehydrogenase deficiency and secondary causes of ITP. Results: The basic work up for secondary causes of ITP was negative. All these patients had been treated with steroids in the past. Anti-D had been given acutely in 20 patients, and intravenous immunoglobulin G had been given in 10 patients. Vincristine had been given to 20 of these patients. Dapsone was started in these patients, and 44% patients showed a response to treatment. The mean time to onset of response was 21 days. Out of these 44 patients, 21 (47.7%) went into remission and had platelet count >100,000/μl at 2 years post tapering of the treatment. Remaining 23 patients were kept on low dose dapsone and maintained their platelet counts. Adverse drug reactions included mild skin eruptions in 5% of patients, pruritus in 10% of patients, dose-related hemolysis in 1% of patients, methemoglobinemia in 1% of patients and Stevens Johnson syndrome in 1% of patients. 56 patients were nonresponders to the available, affordable conventional medical treatment and were referred to the surgical department for splenectomy, with a cure rate of 86% postsurgery. Conclusions: Dapsone is a safe, cheap and effective treatment option for patients with chronic ITP, who cannot afford the usual costlier second-line drugs.