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Professor, Consultant Pathologist, American Board Certified Pathologist, Fellow College of American Pathologists. Areas of interest Fine Needle Aspiration Cytology, Cytology, Cancer, Ethics, Islam, Humanity

Editorial: Thalidomide in Thalassemia: A Fortune in Making

Muhammad Tariq Masood Khan

Assistant Professor of Haematology, Northwest School of Medicine, Peshawar
Thalidomide is the unfortunate drug which got entangled in the greatest iatrogenic catastrophe in human history(1). In 1950s, deemed safe and “miraculous”, the drug was prescribed to pregnant women with nausea and insomnia. By that time nobody knew about its teratogenic potential. This culminated in around 10000 births with severe morbidities. In the aftermath, thalidomide was banned immediately all over the world(1).

The drug however, never seized to loose attention. The first rational indication was identified for Leprosy by Dr Jacob Sheskin in 1964(2). In 1990s, Dr Judah Folkman demonstrated utility of thalidomide in treating Multiple Myeloma(3). These indications portray the anti-inflammatory, immunomodulatory and anti-cancer properties of the drug, which have been pursued in other similar diseases as well. At current, literature reports efficacy of thalidomide in several dermatological, rheumatological, gastrointestinal, cardiac and malignant diseases(4). Of particular significance is the role in thalassemia, a well-known haematological disease.

Original Article: Correlation of Modified Marsch Grades with Serum Anti Tissue Transglutaminase Antibody Levels in Celiac Disease

Anum Usman*, Mudassira*, Khalida Moeed**, Noor Khan Lakhanna* and Humaira Zafar*
*Department of Pathology, Al Nafees Medical College & Hospital, Islamabad, **Department of Anatomy, Loralai Medical College, Loralai

Objective: To correlate the histopathological grades of celiac disease using Modified Marsch grading system with serum IgA anti-tissue transglutaminase antibody levels.
Study Design Prospective Cross-sectional study
Study Place Department of Pathology, Al Nafees Medical College& Hospital
Duration of Study May 7, 2015 To December 10,2015
Methodology: Informed consent was taken from all the enrolled patients in written form depending upon inclusion and exclusion criteria. Endoscopic biopsy from all patients was processed routinely for histopathological analysis. Modified Marsch grading system was used for grading the morphological findings. Anti-Tissue transglutaminase (tTG) IgA antibodies were measured by the ELISA (Enzyme-Linked Immunosorbent Assay) technique. Both serological marker and biopsy data were correlated using Regression analysis test and Spearman rho test in SPSS version 20.
Results: In this study 77 patients were included, out of which 55 were labeled as celiac disease patients. There were38.9%males and 61.1% females. By the Modified Marsch Grading System, there were 9.1% cases in Marsch 1 and 13% in Marsch 2 whereas Marsch-3a, Marsch-3b and Marsch-3c included 15.6%, 19.5% and 14.3% cases respectively. After correlation with tTG IgA Ab titers, 27.2% patients had negative serology. Total22% patients in both Marsch 1& 2 were serologically positive and had IgA tTG Ab titers > 11 units/ml whereas majority of patients with Marsch 3a had tTG IgA Ab titers between 11 to 100 units/ml. Marsch grades 3b and 3c strongly correlated with increasing values of serology as IgA tTG Ab titers > 100 units/ml.
Conclusion: Celiac disease grades obtained by using Modified Marsch System significantly correlates with tTG IgA Ab titers
Key Words: Anti Tissue Transglutaminase, Celiac disease, Serology, Marsch, Histopathology.

Original Article: Bacterial Spectrum and Antibiotic Susceptibility Patterns in Nosocomial Pneumonia in the Intensive Care Unit

Mumtaz Ahmad Khan*, Mumtaz Ali khan**and Khawaja Ashfaq Ahmed***
* Pathology Department, Abbas Institute of Medical Sciences, Muzaffarabd, Pakistan**National Institute of Health Islamabad, *** Abbas Institute of Medical Sciences, Muzaffarabad, Pakistan

Abstract Background: Nosocomial pneumonia is the most common infection acquired in the hospital with the highest prevalence in intensive care units (ICUs). Antimicrobial resistance is an important factor in predicting outcomes and resources used in ICUs. Globally ICUs are facing the emergence and spread of antibiotic-resistant pathogens, and for some pathogens there are few therapeutic options available. Objective: To evaluate the bacterial spectrum from patients with nosocomial pneumonia in the intensive care unit of a secondary care hospital in Saudi Arabia, and their antibiotic susceptibility patterns
Methods: This prospective, descriptive study was carried out at the Department of Microbiology, King Abdullah Hospital in Bisha from June 2011 to May 2012. Lower respiratory tract samples were obtained from suspected cases of nosocomial pneumonia in the ICU. The specimens were cultured on appropriate media. The identification of bacteria and susceptibility testing were done by using BD PhoenixTM Automated Microbiology system. In vitro antibiotic susceptibility patterns were analyzed using WHONET software.
Results: A total of 301 clinical isolates were analyzed. The frequencies of Gram-positive and Gram-negative bacteria were 16% and 84% respectively. Among Gram-positive bacteria, Methicillin-sensitive Staphylococcus aureus (MSSA) and Methicillin-resistant Staphaureus (MRSA) were the leading pathogens, while, Acinetobacter, Klebsiella and Pseudomonas species were the most common Gram-negative isolates. 79% isolates of Acinetobacter species were resistant to carbapenem, while 3 were resistant to all the antibiotics tested including colistin and were declared as pan-drug resistant Acinetobacter. Extended-spectrum beta-lactamase-producing K. pneumoniae accounted for 28% of all Klebsiella species isolated and
24% of Pseudomonas species were resistant to ceftazidime.
Conclusion: The Gram-negative bacteria remained more prevalent in ICU patients with nosocomial pneumonia. The reduced antibiotic susceptibility among Gram-negative bacteria alerts us that more effective strategies are needed to control the spread of antibiotic resistant organisms in critical patient areas.
Keywords: Nosocomial pneumonia, Antimicrobial resistance, Enterobacteriaceae, K. pneumoniae, Escherichia coli, Serratia marcescens

Original Article: Effectiveness of Training Session in Improvement of Insulin Administration Technique in Diabetic Patients

Abdul Khalid, Rubina Rafique, Ali Arshed, Munazza Nazir and Ashfaq Ahmed
Department of medicine, Abbas Institute of Medical Sciences Muzaffarabad
Azad Jammu and Kashmir Medical College Muzaffarabad

Objective: To evaluate the effectiveness of training session in improvement of insulin administration technique in diabetic patients.
Methods: The cross- sectional analytical study was conducted in Department of medicine Abbas Institute of Medical Sciences Muzaffarabad from April 2017 to August 2017.100 patients were recruited for studyinterviewed regarding their knowledge and practices of insulin injection. Patients with incorrect injection technique were observed during administration of insulin injection. Education session was conducted and patients were given feedback about their mistakes. The injection technique was re-observed after the education session and follow up with same set of questions was made in same session.
Results: The injection technique was incorrect in 26%, partially correct in 54% and correct in 18% of patients before education session. After the education session injection technique was correct in 92% of patients. It was partially correct in 8% while no patient had incorrect technique. These results were statistically significant (p< 0.001) when compared with one sample t-test.
Conclusion: Few minutes of teaching and guidance by health care professionals brings remarkable change regarding patient’s awareness for correct application of insulin injection technique.
Keywords: Diabetes Mellitus, Insulin injection technique.

Original Article: Effectiveness of Iron Chelation Therapy Using Serum Ferritin Levels in Thalassemia Major Patients

Irum Anwar*, Samina Amanat** and Ahmareen Khalid**
*Rawalpindi Medical College (RMC), **Shaheed Zulfiquar Ali Bhutto Medical University,
Pakistan Institute of Medical Sciences, Islamabad
Objective: Is to evaluate the effectiveness of iron chelation therapy in thalassemia patients using serum ferritin level at children hospital, Shaheed Zulfiquar Ali Bhutto Medical University, Pakistan Institute of Medical Sciences Islamabad
Background: -Thalassemia major is caused by defect in the synthesis of 1 or more the goblin subunits of hemoglobin, resulting in valuable phenol types lifelong RBC transfusion remain the main treatment for BETA thalassemia major patients’ transfusion dependent patients in the absence of chelation therapy, develop progressive accumulation of iron, which is responsible for tissue damage. Prevalence of iron Induce organ damage ultimately resulting in iron toxicity. This iron toxicity produces myocardial siderosis and heart failure, liver cirrhosis and liver fibrosis and liver cancer osteoporosis and endocrine dysfunction and thromboembolism.
Materials & Methods: -The study was carried out at thalassemia center, children hospital, Pakistan Institute of Medical Sciences Islamabad January 2015-April 2016. All the patients that are enrolled in the thalassemia center were examined the Inclusion criteria of my study is those patients that are receiving iron chelation therapy. The exclusion criteria of my study are patients that are not undergoing iron chelation therapy.
Results:-Out of total 105 patients, 70 (67%) were receiving iron chelation therapy. in these 65(62%) and 40(38%) were males and females respectively. Majority of the patients showed very high ferritin level. The mean serum ferritin level was found to be 3650.14 ng/ml. 65% of the patients have mean serum ferritin level less than 3000ng/ml, 27% of the patients have serum ferritin level between 3000-6000ng/ml, while 8% have ferritin level above 6000ng/ml. The observed highest average ferritin level is 7651ng/ml, while lowest is 1866ng/dl.
Conclusion:-A high percentage of the patients are receiving iron chelation therapy in PIMS but iron chelation therapy is not very effective. The study showed high levels of serum ferritin .There is a dire need to rationalize the iron chelation therapy.
Key Words: -Thalassemia, transfusion, iron chelation therapy, ferritin level

Original Article: Adverse Reactions in Whole Blood Donors

Veenaa Venkatesh and Karthikeyan T.M
Karpagam Faculty of Medical Science and Research, Othakkalmandapam,
Coimbatore, Tamil Nadu, India
Background: Human blood is the most precious and essential element of human life. Safe and adequate blood supply is a big challenge in developing countries like India. Voluntary blood donors tolerate blood donation very well.
Objective: The aim of the study is to estimate and possibly avoid the cause of donor adverse reactions.
Materials & Methods: The study was conducted over a period of one year from January 2017 to December 2017. The donor population consisted of 2455 donors of which 1823 were males and 632 were females. Donor adverse reactions were analyzed.
Results: Only 16 (0.007%) donors had adverse reactions like sweating, giddiness, pain, itching and pallor. None suffered severe adverse reactions in the study.
Conclusion: Although number of donors who had adverse reactions were low, it is desirable to further reduce the rate of adverse reactions so that repeat blood donations by the population can be promoted.
Keywords: Blood Donation, Whole blood donors, Adverse Reactions.

Original Article: Incidence of Accidental Poisoning by Common Household Substances

Muhammad Yousaf*, Rizwan Zafar Ansari**, Anwar Ahmed*** and Zahid Hussain Khalil****
* Department of Forensic Medicine, Khyber Medical College, Peshawar, ** Department of Forensic Medicine, Northwest School of Medicine, Peshawar, *** Department of Forensic Medicine, Fazaia Medical College, Islamabad, **** Department of Forensic Medicine, Kabir Medical College, Peshawar

Objective: To determine common household poisonous substances and trend of poisoning in terms of nature of poisoning, clinical manifestation and victims age group.
Methods: A retrospective study was conducted at major tertiary care hospitals of Rawalpindi including Holy Family Hospital, Civil Hospital and Benazir Hospital (former RGH). Data was collected from the medico-legal clinics and record room of hospital emergency and autopsy centers. The data was collected from January 2008 to December 2017. All cases of poisoning were collected; socioeconomic status, age, sex and other demographic details were analyzed along with frequency of commonly used substances and their clinical presentation by using SPSS 19. Mean and standard deviation was calculated for quantitative variables, like age, time passed since exposure to poison. Frequency and percentages were calculated for qualitative data including factors leading to accidental poisoning.
Results: During the period of 10 years, 2627 were cases of poisoning reported in causality department of tertiary care hospitals of district Rawalpindi. Of them, medical records of 2303(87.6%) cases were reviewed; 542(23.5%) adult due to accidental intake and 1761(76.4%) pediatric cases below 16 years of age most common cause was accidental intake of chemicals placed in incanting colored rapper bottles placed in approachable areas. In 324(12.3%) cases, the poisoning occurred due to animal bite. Psychiatric drug over dose was found in 667(29%) cases, followed by prescription drugs 561(24.4%), pesticides 35.2(15.3%), hydrocarbons 23.0(10%), analgesics 20.0(8.7%), household toxins 20.0(8.7%), alcohol, drug abuse 68(2.97%) and others 153(6.67%). Exclusion criteria was poisoning outside home and animal bite.
Conclusion: Poisoning was a serious cause of morbidity in children and young adults. Easy accesses to medications were the leading cause and home was the most common place of incident.
Keywords: Poisons, Accidental poisoning, Household substances