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   Table of Contents - Current issue
July-December 2018
Volume 7 | Issue 2
Page Nos. 49-98

Online since Wednesday, August 22, 2018

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Knowledge of the caregivers of thalassemic children regarding thalassemia: A cross-sectional study in a tertiary care health facility of eastern India p. 49
Bijit Biswas, Narendra Nath Naskar, Rivu Basu, Aparajita Dasgupta, Bobby Paul, Keya Basu
Background: Caregivers knowledge regarding thalassemia is one of the vital areas in the prevention of the disease. Studies related to caregivers knowledge and its sociodemographic predictors are very few in number which is helpful in designing interventions across different study settings. Objectives: the study aimed to find out the knowledge level of caregivers of thalassemic children and its sociodemographic determinants. Materials and Methods: It was a cross-sectional observational study conducted in a thalassemia day care unit of Eastern India. The study included 328 caregivers of thalassemic children attending thalassemia day care unit during May 2015–April 2016. Data were analyzed using Statistical Package for the Social Sciences (SPSS) (version 16). Results: Out of 328 caregivers only 47.6% knew about genetic etiology of the disease, while only 52.4% and 50.9% knew about premarital counseling and antenatal screening, respectively. Regarding treatment of the disease, 75.9% knew that both blood transfusion and iron chelation are the treatment of thalassemia, while only 19.2% and 2.7% of them had knowledge regarding splenectomy and bone marrow transplantation, respectively. Only 52.7% had satisfactory knowledge regarding the disease. In multivariable model, caregivers educational level (adjusted odds ratio, AOR-3.13 [1.87–5.25]), working status (AOR-2.18 [1.23–3.86]), place of residence (AOR-2.05 [1.19–3.52]), and socioeconomic class (AOR-2.11 [1.25–3.58]) were significant predictors of their knowledge. Conclusion: Caregivers' knowledge regarding thalassemia was not at all satisfactory. Regular counseling of caregivers should be done addressing the knowledge lacunae's among them.
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Demographics and outcome of diffuse large B-cell lymphoma patients in Hiwa Hospital - Iraq-Kurdistan-Sulaimani p. 55
Nawshirwan Gafoor Rashid, Basil K Abdallah, Mouroge H Al Ani, Ahmed Kh Yassin
Background: Diffuse large B-cell lymphoma (DLBCL) is a heterogeneous form of hematological malignancy which comprises about 30% of lymphomas with variable outcome. Onset is usually in the sixth decade of life with male predominance. Morphological, clinical, and biological variation of DLBCL confirms the coexistence of several subtypes of the disease with distinct behavior of each type. Objective: The aims of this study were to determine the demographics and outcome of patients with DLBCL and compare these parameters with regional and international data. Patients and Methods: A retrospective study was conducted on 61 patients with confirmed diagnosis of DLBCL. The diagnosis was based on histopathological and immunohistochemistry which was done in the Department of Pathology, Shorsh General Hospital in Sulaimani. The cases were randomly selected according to the availability of data since March 2013–March 2017. Results: Median age at diagnosis was about 51 years with peak age of incidence between 50 and 64 years, with female predominance. The most common site of the primary tumor was nodal in which cervical lymph node is the most common site, and majority of the patients were in Stage III with predominance of B-symptoms. Vast majority of the patients have normal chest X-ray, and majority of the patients were in remission over a period of 19 months of follow-up. Conclusion: We found that there is a significant relationship between age, stage, and performance of the patients, while no significant relation between other parameters and the outcome of the patients is near to their Peers internationally.
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Demographic features of neuroblastoma in Iraq-Kurdistan Region- Sulaimani p. 62
Basil K Abdallah, Nawshirwan Gafoor Rashid, Shwan Ali Tawfiq
Background: Neuroblastoma is the third most common cancer in pediatric age group; it is the most common malignancy in the 1st year of life. The majority of the patients (50%–65%) have advanced disease at diagnosis. Diagnoses, staging investigations, and risk categorization have a great success in neuroblastoma, trying to classify the patient into risk groups according to the age, stage, and molecular study and this in turn has important value in the treatment strategies. Despite of this improvement in the early diagnosis and treatment protocol, neuroblastoma stills is one of the malignant diseases that are associated with high morbidity and mortality. Objectives: The aims of this study were to evaluate the pattern of presentation, studying the correlation between age, sex, and site of primary tumor with disease staging in patients with neuroblastoma. Patients and Methods: This study was done prospectively over a period of 6 years from February 2008 to February 2014. Sixty-two patients with newly diagnosed pediatric neuroblastoma admitted to Hiwa Hematology/Oncology hospital were included in this study. Age, sex, clinical patterns, staging, and important laboratory findings were assessed. The patients staged according to the International Neuroblastoma Staging System. We divided our patients into three groups according to the risk categories. Results: Data analyzed using SPSS- 13 and P value obtained by Chi-square test, a median age at diagnosis was about 24 months with male predominance. Most common site of the primary tumor was the abdomen; approximately 69% of our patients with neuroblastoma studied were Stage 4. Conclusion: The stage in our study was age dependent, but it was neither depending on the sex nor the site of the primary tumor.
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Treatment outcome of 100 chronic myeloid leukemia patients using nilotinib as the 2nd line therapy p. 67
Yaseen M Taher, Ali M Almothaffar, Bassam Francis Matti, Alaa Fadhil Alwan
Background: Nilotinib is a potent and selective BCR-ABL inhibitor approved for use in patients with newly diagnosed chronic myeloid leukemia (CML) in chronic phase (CML-CP) and in patients with CML-CP and accelerated phase (CML-AP) who are resistant to or intolerant of imatinib. Patients with imatinib-resistant CML, nilotinib treatment resulted in a significant proportion of patients achieving hematologic and cytogenetic responses in all phases of CML. Objectives: The aim of the present study was to assess the treatment outcomes in term of the molecular response rate of CML patients using Nilotinib as the second-line therapy after failure of imatinib therapy. Patients and Methods: A prospective study conducted between December 2014 and December 2016 in Baghdad Teaching Hospital and National Centre of hematology. A total of 100 patients, who were on nilotinib therapy as the second-line therapy, were enrolled in this study. The molecular response was assessed using real-time quantitative polymerase chain reaction (RQ-PCR). Major molecular response (MMR) was defined as the BCR-ABL1 of <0.1% by RQ-PCR. Results: The median age was 39 years, 59 were female and 41 were male. Fifty-three patients were classified as high-risk group, and 47 patients were as low risk. The BCR-ABL transcription level had a significant reduction from baseline at 3 months (P = 0.035) and the reduction from 3 months to 6 months was also statistically significant (P < 0.001). Comparing the patients who achieved MMR versus NO MMR, there was a significant association between low European Treatment and Outcome Study score and achieving MMR. An estimated 24 months overall survival (OS) is 95%. Conclusion: This study concluded that nilotinib is an effective therapeutic option for patients with CML-CP-resistant to imatinib therapy. Nilotinib treatment resulted in a high-OS rate and was well tolerated.
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Platelet parameters: Can they serve as biomarkers of glycemic control or development of complications in evaluation of type 2 diabetes mellitus? p. 72
Mukta Pujani, Himani Gahlawat, Charu Agarwal, Varsha Chauhan, Kanika Singh, Shveta Lukhmana
Background: Platelet function plays a crucial pathophysiological role in the development of atherothrombosis in patients with type 2 diabetes mellitus (DM). Platelet count (PC) and mean platelet volume (MPV) are simple, effective, and cheap tests that may be used to predict angiopathy in type 2 DM. Objectives: The aims of this study were to analyze various platelet parameters including PC, plateletcrit (total mass of platelets) (PCT), and mean platelet indices that are MPV, platelet distribution width (PDW), and platelet-large cell ratio (PLCR) in the type 2 DM patients, to compare various platelet indices between DM patients (with and without complications) and controls. Materials and Methods: This was a cross-sectional study conducted over a period of 3 months. Complete blood count along with blood glucose and HbA1c was estimated. The study population was divided into three groups: Group 1: Normal controls (n = 30); Group 2: DM patients without complications (n = 30); and Group 3: DM patients with complications (n = 30). Based on HbA1c levels among the diabetic patients, the diabetic groups were also classified as DM with HbA1c <7% and DM with HbA1c >7%. Results: All the platelet parameters were found to be higher among DM with complication as compared to DM without complication, and this was found to be statistically significant. Among the platelet parameters, MPV, PCT, and PDW were found to be higher among DM with HbA1c >7% as compared to DM with HbA1c <7%, and this was found to be statistically significant while there was no significant differences in PC and PLCR between the two groups. Conclusion: Monitoring of DM to prevent the occurrence of vascular complications is the need of the hour. The results of the study suggest a role of various platelet indices as a simple and cost-effective tool to monitor the progression and control of DM.
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Optical laser trapping for studying the deformability of sickle red blood cells in response to hydroxyurea p. 79
Anmar A Hussein, Haitham L Saadon, Asaad A Khalaf, Muzahim M Abdulah
Background: Sickle cell disease (SCD) is prevalent in Basrah city and affects the red blood cell (RBC) deformability and thereby causes disease symptoms. Hydroxyurea (HU) is effective in reducing morbidity and mortality in SCD patients by different mechanisms. Objectives: The aim of the study was to investigate the effect of HU on RBC deformability among SCD patients by direct laser optical trapping (OT) technique. Materials and Methods: Blood samples from SCD patients and control groups were prepared in the medical laboratory of Basrah Center for Hereditary Blood Diseases and transferred into physics laboratory wherein the laser system was presented and built-in. RBCs from each sample were exposed to three different powers of laser 5, 15, and 20 mW for 15 s and then were released and followed for 2 min. The images for each trapped RBC were obtained and at relaxation sequential times. The percentage changes in the diameters of trapped RBCs were measured for control and patient groups. Results: SCD patients were divided into two groups depending on whether they were receiving HU (39 patients) or not (43 patients). They were matched with 50 healthy individuals (control) regarding age and gender. We found that all the trapped RBCs were affected during the trapping time and then returned toward near normal with some differences between the groups and according to the power used. The deformability of HU group was better and closure to the control. Conclusion: The presented laser system and OT technique with optimal power are effective to study the RBC characteristics and deformability. HU is effective in improving RBC deformability among SCD patients.
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Variations in activated partial thromboplastin time and prothrombin time in individuals of A, B, AB, and O blood groups p. 85
Chizoba Okechukwu Okeke, Uru Star Okoro, Abiodun Babatunde
Background: Differences in blood group have been associated with predisposition to some diseases. Activated partial thromboplastin time (APTT) measures the efficiency of the intrinsic and common coagulation pathways, whereas prothrombin time (PT) test assesses the extrinsic and common coagulation pathways. Objective: The aim of this study was to assess the variations in PT and APTT among individuals of different ABO blood groups. Materials and Methods: A research was conducted at College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, and a total of 200 students were recruited, consisting of 106 females and 94 males. Six milliliters of blood was withdrawn from each individual, after obtaining ethical clearance and informed consent. ABO blood grouping was done by the tile method while APTT, and PT were analyzed using the standard manual methods. Statistical analysis was carried out using Statistical Package for the Social Sciences version 21. Results: The result shows that blood group O was predominant among the test individuals (45%) followed by blood groups A (31%) and B (15%), while blood group AB has the least percentage (9%). Blood group O showed a significantly higher APTT value (44.24 ± 15.10 s) compared to blood groups A (39.35 ± 12.12 s), B (35.93 ± 9.78 s), and AB (37.22 ± 8.15 s) (P < 0.05). Similarly, blood group A showed a significantly higher PT value (16.70 ± 2.53 s) compared to blood groups O (14.32 ± 2.37 s), B (13.53 ± 2.16 s), and AB (15.38 ± 1.79 s) (P = 0.05). Blood groups B and AB male individuals had a significantly higher PT and APTT levels, respectively, when compared with females (P < 0.05). Conclusion: This study showed that APTT and PT levels differ among different ABO blood groups; therefore, variations in blood group of individuals may affect their intrinsic and extrinsic coagulation mechanisms.
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Primary splenic follicular lymphoma treated with splenectomy and adjuvant chemotherapy; a case report p. 90
Anju A Abraham, Sreejith G Nair, Rony Benson, Jayasudha A Vasudevan
Primary splenic lymphoma is a rare low-grade non-Hodgkin's lymphoma. This is a case of a 52-year-old woman who had an incidental detection of a lesion in the spleen during evaluation for fever which was found to be a case of primary grade III follicular lymphoma of the spleen. The patient was started on rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy postsplenectomy. Rituximab was not added initially as the patient had a high viral load of hepatitis B virus (HBV). The patient completed six cycles of chemotherapy and rituximab added after four cycles when HBV DNA titer became negative. The outcome in patients with primary follicular lymphoma is good with splenectomy followed by multi-agent chemotherapy.
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A case of cutaneous T-cell lymphoma (CD − 8+) with multiple lesions treated with definitive radiotherapy p. 93
Sankalp Singh, Sharad Bhatnagar, Arti Sarin, Priyanka Borde, Niharika Bisht
Cutaneous T-cell lymphoma (CTCL) is the most common primary cutaneous lymphoma but rarely encountered. It is often misdiagnosed with allergic or infectious dermatological conditions and is usually a diagnosis of exclusion. The subsets of CTCL primarily consist of CD4 + and CD30 + lymphoproliferative disorders including mycoses fungoides. Herein, we report a case of CD 8 + ve CTCL stage IA that was previously misdiagnosed with cutaneous tuberculosis with no response to antitubercular therapy. After a confirmatory diagnosis of CTCL with multiple sites involved, he was treated with definitive local radiotherapy alone and had a complete response to treatment with no recurrence at 5 year's follow-up.
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Human genetic factors associated with protection against malaria p. 97
Bashir Abdrhman Bashir Mohammed, Mohammed Omer Gibreel
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