Let's read! We will often find out this sentence everywhere. When still being a kid, mom used to order us to always read, so did the teacher. Some books are fully read in a week and we need the obligation to support reading. What about now? Do you still love reading? Is reading only for you who have obligation? Absolutely not! We here offer you a new book enPDFd preventing chronic diseases a vital investment to read.

Preventing Chronic Diseases: A Vital Investment

Severe falciparum malaria: a case report.

Peripheral pancytopenia is not a disease by itself; rather it describes simultaneous presence of anemia, leucopenia and thrombocytopenia resulting from a number of disease processes. Only a few systematic studies have been published on the topic of pancytopenia, although extensive studies have been done for its different etiological factors like aplastic anemia, megaloblastic anemia, leukemia, etc. Thus, this study was carried out to investigate for and to identify the causes of pancytopenia, to find out the frequency of different causes, to determine the incidence of pancytopenia in relation to sex and age and to compare our findings with those of other similar studies from this part of the world. This was a prospective study conducted in the Department of Pathology of a teaching institute and a tertiary care hospital in southern Maharashtra, India, over a period of two years. All the patients referred to the central clinical laboratory for routine complete blood count (CBC) and peripheral smear (PS) examination, from both - the outpatient and the inpatient departments, were screened for pancytopenia. Of these, a total number of 250 cases that fulfilled the diagnostic criteria were selected. Detailed hematological investigations followed by bone marrow aspiration wherever indicated and possible were performed according to standard methods to ascertain the causes of pancytopenia. A definite male preponderance was observed, the male to female ratio being 2.6 : 1. The majority of cases were encountered in 3rd and 4th decades. Hypersplenism (29.2%), Infections (25.6%), Myelosuppressants (16.8%) and Megaloblastosis (13.2%) were the four most common causes in this large series on pancytopenia from a single centre in India. Detailed clinical history and meticulous physical examination along with baseline hematological investigations, provides invaluable information in the complete workup of pancytopenic patients, helping in systematic planning of further investigations to diagnose and ascertain the cause, avoiding a battery of unnecessary tests.

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An etiological reappraisal of pancytopenia - largest series reported to date from a single tertiary care teaching hospital

Infection of C57BL/6 mice with Plasmodium berghei ANKA induces a fatal neurological disease commonly referred to as experimental cerebral malaria. The onset of neurological symptoms and mortality depend on pathogenic CD8(+) T cells and elevated parasite burdens in the brain. Here we provide clear evidence of liver damage in this model, which precedes and is independent of the onset of neurological symptoms. Large numbers of parasite-specific CD8(+) T cells accumulated in the liver following P. berghei ANKA infection. However, systemic depletion of these cells at various times during infection, while preventing neurological symptoms, failed to protect against liver damage or ameliorate it once established. In contrast, rapid, drug-mediated removal of parasites prevented hepatic injury if administered early and quickly resolved liver damage if administered after the onset of clinical symptoms. These data indicate that CD8(+) T cell-mediated immune pathology occurs in the brain but not the liver, while parasite-dependent pathology occurs in both organs during P. berghei ANKA infection. Therefore, we show that P. berghei ANKA infection of C57BL/6 mice is a multiorgan disease driven by the accumulation of parasites, which is also characterized by organ-specific CD8(+) T cell-mediated pathology.

https://espace.library.uq.edu.au/view/UQ:377011/UQ377011_OA.pdf

High Parasite Burdens Cause Liver Damage in Mice following Plasmodium berghei ANKA Infection Independently of CD8+ T Cell-Mediated Immune Pathology

Objective:�Theobjectiveofthisstudywastodeterminethefrequencyofcommoncausesleadingto� Pancytopenia in patients presenting to tertiary care hospital at Karachi. Methods:�Atotalof�62�patientswiththediagnosisofPancytopeniaofmorethanoneweekdurationwere� enrolledinthestudy.�Allpatientsunderwentadetailedmedicalhistoryandfullphysicalexamination� followedbybloodsamplingfortheinvestigationsi.e.�completebloodcountwithperipheralfilm,�erythrocyte� sedimentation rate (ESR), Malarial parasites (MP), liver function test, Renal function tests, PT and viral profile� (HBsAg,�Anti-HCV),�Ultrasonographyofabdomen.�Allpatientsunderwentbonemarrowaspiration� andtrephinebiopsyforreportingandinterpretation.�Durationofstudywassixmonths,�fromMay�2010�to� November 2010. Results: The average age of the patients was 37.76 ± 16.38years. Out of 62 patients, 36 (58%) were male and 26 (42%) were female. Megaloblastic anemia was the commonest cause that was observed in 41.9% cases followed by acute myeloid leukemia 27.4%, aplastic anemia 19.4% and erythroid hyperplasia 11.3%. Conclusion: This study concluded that most common cause of pancytopenia is Megaloblastic anemia, followedbyacutemyeloidleukemiaandaplasticanemia.�Bonemarrowexaminationisasingleuseful� investigation which reveals the underlying cause in patients with pancytopenia.

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The common causes leading to pancytopenia in patients presenting to tertiary care hospital

Objectives: To find out the frequency of the different causes of Pancytopenia and also to specifically detect the percentage of vitamin B 12 deficieny amongst these patients. Methodology: It is a prospective study carried out in Medical Unit I (Ward 5) of Jinnah Postgraduate Medical Centre Karachi from March to August 2007. A total of 88 patients were included after a detailed history and examinations the information was recorded on Proforma. Findings of aspiration and trephine biopsies were interpreted in the light of history, clinical examination and peripheral blood findings. Results: Out of 88 patients suffering from Pancytopenia, a large number (40.90%) were diagnosed as Megaloblastic Anemia, out of which 77.77 % had vitamin B12 deficiency. Aplastic anemia was found in 28 (31.88%) patients followed by other less common causes. Conclusion: Megaloblastic anemia was found in largest number of patients who were found to have Pancytopenia on initial investigations and majority of such patients were found to be deficient in Vitamin B 12 .

Pancytopenia: megaloblastic anemia is still the commonest cause

Objective: To evaluate the clinical, biochemical and sonographic changes in patients with falciparum malaria and jaundice. Study Design: A case series. Place and Duration of Study: This study was conducted at Medical Unit-I (Ward 5), Jinnah Postgraduate Medical Centre, Karachi, from January 2006 to November 2007. Methodology: A total of 62 adult patients, regardless of age and gender, with peripheral blood film evidence of falciparum malaria, who had jaundice, were included. Any patient with evidence of infection with Plasmodium vivax or other causes of liver disease (e.g. viral hepatitis, cirrhosis, portal hypertension, amoebic liver abscess, unexplained hepatomegaly, ascites, history of alcoholism, taking hepatotoxic drugs, past history of jaundice) was excluded on the basis of history, relevant clinical examination and investigations. Results: Age of the patients ranged from 13-48 years (mean 26.04±8.33). All patients were febrile and icteric, with pallor in 67.7%, hepatomegaly in 30.6%, splenomegaly in 70.9% and impaired consciousness in 20%. Serum bilirubin levels ranged from 3 to 24 mg%. Thirty two (51.6%) had serum bilirubin 3-6 mg%, 20 (32.2%) had 6-10 mg% and 10 (16.1%) had >10 mg%. ALT levels ranged from 20-870 IU/L and AST levels 24-1210 IU/L respectively. INR ranged from 1-1.3. Twenty eight patients (45%) had predominantly conjugated or mixed hyperbilirubinemia and serum transaminases were more than three times normal. Ultrasonography revealed hepatomegaly with decreased echogenicity in 22 (35.4%), splenomegaly in 48 (77.4%) and both hepatomegaly and splenomegaly in 16 (25.8%). Gallbladder wall thickness was increased in 5 (8.06%) patients. There was no evidence of biliary dilatation. Conclusion: A significant percentage of patients having falciparum malaria with jaundice fulfill the criteria for malarial hepatopathy. It should be considered in patients presenting with acute febrile illness with jaundice so that specific treatment can be given.

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Malarial hepatopathy in falciparum malaria.

Objective To determine the etiologic patterns of ischaemic stroke in young adults. Study design A descriptive study. Place and duration of study Department of Neurology, Jinnah Postgraduate Medical Centre, Karachi, from January to December 2010. Methodology All ischaemic stroke patients aged 15 - 45 years were included. The etiologic patterns were classified using TOAST (Trial of ORG 10172 in acute ischaemic stroke) classification and comparisons were made between different stroke subtypes with reference to traditional risk factors like age, smoking, hypertension, diabetes mellitus and dyslipidemia. Results were described in percentages. Results There were 75 cases and higher proportion of patients had ischaemic stroke due to cardiac etiology below the age of 35 years. Nineteen patients had cardioembolic stroke [8 (42.1%) males and 11 (57.9%) females]; 15 patients had large artery atherosclerosis [males 9 (60%), females 6 (40%)]; 17 patients had stroke of determined etiology (SDE), [6 (35.2%) males and 11 (64.8%) females] among whom 47% were due to venous sinus thrombosis. Twelve patients had stroke of undetermined etiology (SUE), [5 (41.6%) males and 7 (58.4%) females] and 12 patients had stroke due to small vessel disease (SVD) [8 males (66.7%) and 4 (33.3%) females. Conclusion Cardioembolism, venous sinus thrombosis and premature atherosclerosis are common etiologies in young patients with acute ischaemic stroke.

Etiologic patterns of ischaemic stroke in young adults.

Migraine, a primary headache disorder, is usually recurrent with moderate to severe intensity. Migraine is the third most common cause of disability under the age of 50. There are various scoring systems for assessing this disability, one of which is MIDAS; the Migraine Disability Assessment Score. The objective of our study was to determine the extent of disability among migraine patients, patterns of prophylaxis, and their healthcare-seeking behaviors. This survey was done in 50 migraine patients at Jinnah postgraduate medical Centre from April to May 2018. The questionnaire inquired about the demographic information, management of migraine, and effect of this condition on their sleep, and the last part had assessment to know about their functional disability. The majority of the patients were females with a mean age of 31 ± 10 years. Acetaminophen was the most common medication used during a migraine attack, followed by nonsteroidal anti-inflammatory drugs. Only 54% of subjects admitted using prophylaxis, out of which 94% had stopped taking it after some time, with the most common reason being their side effects. β-blockers were the most common prophylaxis used. Only 32% had a regular follow-up visit with their doctors. Patients were graded according to the MIDAS score as: little or no disability, 22%; mild disability, 14%; moderate disability, 24%; and severe disability, 40%. The majority of migraine patients were found to have severe disability, which affected their daily work and social activities. Despite an increase in disability rate due to migraine, people do not seek regular medical care for this type of headache in Pakistan.

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Effect of Migraine Headache on Productivity of Patients According to Migraine Disability Assessment Score: A Cross-Sectional Study

Jinnah Postgraduate Medical Centre, Karachi, Pakistan Background: Acute cerebral events play an important role in generating autonomic imbalance especially cardiac rhythm disturbances. This forms the basis of significant lethal abnormalities of heart rate and rhythm like QTc prolongation, ventricular fibrillation, asystole, and ultimately death. This study was conducted to determine the frequency of QTc prolongation in patients presenting with acute haemorrhagic stroke at a tertiary care hospital. Methods: This descriptive case series was conducted at Medical Unit-I, ward-5, Jinnah Postgraduate Medical Centre (JPMC), Karachi, from 13 October, 2009 to 12 April, 2010. Patients of either gender and age >18 years who presented within 48 hours of onset of acute hemorrhagic stroke for the first time, confirmed by computerized tomography (CT) scan of brain were included. A 12 lead electrocardiogram (ECG) was performed. Lead III and VI were used for this due to their importance in this aspect. QTc was then calculated by using Bazetts formula. Data was analysed using SPSS-12. Results: Among 95 patients of acute haemorrhagic stroke, 48 (50.5%) had prolonged QTc in lead III, 47 (49.5%) had prolonged QTc in lead VI. The average QTc interval in lead III was 440.4±45.2 (Range=364–571). Proportion of prolonged QTc in lead III was higher in males than females. Frequency of QTc III prolongation was higher in comparatively younger age groups than older age groups. Conclusion: The frequency of prolonged QTc interval among patients of acute hemorrhagic stroke is alarmingly higher in our setup. Prolonged QTc is a useful predictor of impending clinical deterioration and provide an opportunity for early intervention to reduce severe loss like mortality. Keywords: Haemorrhagic stroke, QTc prolongation

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Shahnaz Shah

Papers

Pancytopenia: megaloblastic anemia is still the commonest cause

Malarial hepatopathy in falciparum malaria.

Etiologic patterns of ischaemic stroke in young adults.

Effect of Migraine Headache on Productivity of Patients According to Migraine Disability Assessment Score: A Cross-Sectional Study

Frequency of QTc prolongation in patients with hemorrhagic stroke.