Objective: To determine the prognostic value of red cell distribution width (RDW-CV%) in predicting the outcome in neonatal sepsis.Methodology: It was an observational study conducted at the Pakistan Institute of Medical Sciences, Islamabad, from December 2018 to April 2020. A total of 136 neonates at term with clinical suspicion of neonatal sepsis were equally divided based on RDW into two groups as normal and raised RDW. A complete blood count and C-reactive protein were done on the day of admission and repeated on Day 3. Outcomes were observed in terms of discharges, expiries and length of hospital stay.Results: The mean RDW of Group 1 (normal RDW) was 14.71±0.65 on Day 1 and 17.14±0.14 on Day 3 with a significant p-value of <0.001. In group 2 (Raised RDW) on Day 1 it was 17.14±1.46 and at day-3 was 17.8±1.90 with a p<0.001. Discharged neonates in group 1 were 57 (83.8%) and in group 2 were 46 (67.6%). (p=0.458). Expired neonates in Group-1 were 11(16.2%) and in group-2 were 22(32.4%) with significant p-value of 0.028. Neonates shifted to ventilator in group-1 were 10 (14.7%) and in group-2 were 24(35.3%) with p-value (0.006). Length of hospital stay in terms of days in group1 with mean 5.85± 4.03 and group-2 it was 7.63± 4.82 with a significant p-value of <0.001.Conclusion: Raised RDW in clinically septic neonates was associated with poor outcomes in terms of length of hospital stay, mechanical ventilation and deaths compared to neonates with normal RDW.Keywords: Red cell distribution width, Sepsis, Neonatal
Objective: This study aims to determine diagnostic accuracy of peripheral blood smear and automated haematology analyzer and to determine frequency of different types of anemia diagnosed by peripheral blood smear and automated hematology analyzer. Study Design: Cross Sectional study. Setting: Department of Pathology, Rawal Institute of Health Sciences, Islamabad. Period: November 2015 to April 2016. Material & Methods: Sample size of 149 suspected anemia patients was calculated using WHO calculator with 95% confidence interval. Research approval was taken from hospital ethical board. Patients were approached through non probability consecutive sampling method. Both peripheral blood smear examination and automated haematology analysis of each sample was performed. Diagnostic accuracy and frequency of anemia types was measured. Data analysis was done with the help of SPSS version 25. Chi-square and fissure exact test and ROC curve analysis was applied and significant (p<0.05) results were reported. Results: Total 149 patients were included in study. There were 42(28.2%) male and 107(71.8%) female. Mean age of patients was 35.1±2.1SD. Peripheral blood smear and automated haematology analyzer showed sensitivity (68% vs 92%), specificity (59% vs 88%), PPV (72% vs 92%), NPV (55% vs 88%) and diagnostic accuracy (64% vs 91) respectively. Most common type of anemia diagnosed with peripheral blood smear was microcytic hypochromic anemia with raised RDW 36.7% followed by normocytic normochromic anemia with raised RDW 13.3% and macrocytic anemia (p=0.001) while in automated haematology analyzer microc ytic hypochromic anemia with raised RDW54.4% followed by normochromic normocytic anemoia with normal RDW 11.1% (p=0.000). Conclusion: Automated haematyology analyzer had high diagnostic accuracy for diagnosis of anemia. Microcytic hypochromic anemia and normocytic normochromic are most common anemias diagnosed by peripheral blood smear and automated hematology analyzer and peripheral blood smear cannot be completely replaced by automated haemolytic analyzer. However, if both methods are used simultaneously, more accurate results can be obtained.
Objectives: To determine frequency of students’ perceptions (satisfaction) regarding teaching effectiveness, feedback of assessment mode and suggestions for improvement in pathology teaching technique in a medical college. Study Design: Cross-sectional Study. Setting: Medical & Dental College Islamabad. Period: January 2017 to June 2017. Material & Methods: A total of 224 students, who were going to appear for their professional examination were included in the study. Approval from the institutional ethical committee was taken. A set of questions on T/L practices and the suggested modifications were incorporated into the questionnaire. Descriptive statistics were used in the form of frequency distribution and data was analyzed by utilizing percentages. Results: Study demonstrated that female participants were more than male students. The subject of pathology was found to be interesting by majority of the students and it was consented that knowledge about pathology helps in clinical rotations. The subject of Pathology was expressed to be tough by about one third (27.84%) of the students. Clinical correlations, presentations and explanations used to simplify the subject during lectures were found to be satisfactory by the students. Majority of the learners acknowledged that they were motivated to put up queries and respond to questions during lectures. Readability, usefulness of lecture presentations and innovative methods were thought to be acceptable by the students. Majority of the students recommended changes in teaching learning methods. Conclusion: A moderately high satisfaction was found among medical students regarding teaching and learning methodology of pathology. Pathology teaching system could be improved by applying group discussion; case based studies and integrated teaching approaches in our teaching system.
Chronic myeloid leukemia is a myeloproliferative neoplasm. It is a common disease of elderly, rarely affecting pediatric, adolescent or young adults. The median age of presentation is 65 years. The incidence is 1‐2 cases per 100,000 adults. Tyrosine kinase inhibitors (TKIs) are highly successful and have good remission rates in the CML treatment; though multiple factors are associated with failure of treatment. We present a patient of 14 years old male who was diagnosed as CML. He was seven months into TKI therapy, transformed into B-Lineage acute lymphoblastic leukemia. Keywords: Chronic myeloid leukemia, Rare, Acute lymphoblastic leukemia, Pediatric, Transformation.
Acute Promyelocytic Leukemia (APL) is a very uncommon type of acute myeloid leukemiacomprising less than 10% of pediatric population. Acute Promyelocytic leukemia is a neoplastic proliferation of abnormal promyelocytes in bone marrow, caused by cytogenetic abnormality t(15;17). Majority of patients (80%) have long term survival, and death occurs in approximately 10% of patients in early course of the disease; mainly because of hemorrhage. Hemorrhagic complications can be reduced by appropriate therapy if started timely, which ultimately reduces the risk of death.We report a case of 7 years old boy with complaints of fever off and on for past 06 months, bruises and swelling on left leg for 1 week, blood containing vomiting for 1day. He was diagnosed as APL on bone marrow biopsy. Keywords: Acute promyelocytic leukemia, Paediatric, Retinoic acid syndrome, All-Trans retinoic acid, FAB AML-M3, Sudan Black-B.
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