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Objective: To investigate and compare the frequency of MRSA carriers among medical and surgical Intensive Care Unit staff in Tertiary Care Hospitals. Study Design: Cross-sectional comparative study. Place and Duration of Study: Department of Medicine, Two Tertiary Care Hospitals, Rawalpindi Pakistan, from Mar to May 2022. Methodology: A total of 134 ICU staff in different working shifts, including consultants, residents, nurses, paramedics, ward attendants, and sanitary workers, were subjected to nasal swabs, which were sent for culture and sensitivity. The nasal swab culture was found to be positive and negative for MRSA. Results: Out of 70 individuals from the surgical ICU, 12(17.14%) tested positive for MRSA, while 8(11.4%) out of 64 individuals from the medical ICU tested positive for MRSA (p=0.568). The overall MRSA carriage among ICU staff was found to be 14.9%. Out of these 20(14.9%) individuals, 3 were doctors, 4 nurses, 10 paramedical staff, 1 ward attendant, and 2 sanitary workers. Only 7(35%) had confirmed contact with MRSA patients within the last 2 months, and 15(11.2%) had received prior decolonization. A total of 44(32.8%) out of 134 individuals had contact with a MRSA-carrier patient in the last 2 months. 27(20.1%) individuals had received prior decolonization for MRSA carriage, with a mean duration of 5.37±4.404 months. Conclusion MRSA is an important superbug in our ICUs. With the use of prophylactic and gunshot therapies in intensive care units, these bacteria tend to acquire resistance to the anti-microbial agents, rendering our most expensive and last line of defence ineffective.

Objective: To compare the results of High-Performance Liquid Chromatography and Capillary Electrophoresis in the screening of haemoglobinopathies. Study Design: Cross-sectional study. Place and Duration of Study: Department of Haematology, Armed Forces Institute of Pathology, Rawalpindi Pakistan, from May 2020 to Nov 2020. Methodology: Ninety(90) newly diagnosed patients with haemoglobinopathies were included. Patients with a history of recent blood transfusion (

Objective: To determine the syphilis trends by using the reverse algorithm in healthy/asymptomatic blood donors from Northern Pakistan. Study Design: Perspective longitudinal study. Place and Duration of Study: Department of Microbiology, Armed Forces Institute of Transfusion (AFIT), Rawalpindi Pakistan, from Jan to Sep 2022. Methodology: After taking a complete history from potential donors, an appointed blood bank doctor performed a general physical examination. Potential donors’ blood samples were tested for syphilis by the Chemiluminescent Microparticle Immunoassay (CMIA) method followed by reflexively testing of CMIA reactive blood samples with Rapid Plasma Reagin (RPR), and results were interpreted as positive or negative. Results: A total of 56122 donors donated blood over nine months, including 55742(99.3%) males and 380(0.7%) females. Blood donors ranging from 18-65 years with a mean age of 28.82±7.1 were included in the study. Out of 56122 blood donor samples submitted, 487(0.87%) turned out to be syphilis positive by CMIA method, comprising 485(99.59%) males and 02(0.41%) females. Of 487 CMIA-positive serum samples, 216(44.3%) were RPR-positive, all male donors. Conclusion: A higher latent syphilis trend was observed in replacement non-voluntary young male donors between 18 and 40 years of age. The majority of the syphilis positives donors were male, while females made up a negligible percentage.

Objective: To assess the frequency of erythrocytosis and compare the clinical features and haematological parameters in patients presenting with primary and secondary erythrocytosis in the Pakistani population. Study Design: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Pathology, Rawalpindi Pakistan, from May 2020 to May 2021. Methodology: Eighty-three subjects presenting with marked erythrocytosis (Hb-17 g/dl or more, HCT – 50% or more) were included in the study, while those admitted with conditions leading to spurious polycythaemia or patients on diuretics were excluded. Polycythaemia vera was diagnosed as per revised WHO criteria 2016. Results: Only 23 subjects (27.71%) fulfilled the diagnostic criteria for Polycythaemia vera, while 60 subjects (72.29%) had secondary erythrocytosis. Significant differences were observed in haematological patterns between Polycythaemia vera and Secondary erythrocytosis patients. Of the 23 Polycythaemia vera subjects, 20(86.9%) were males and only 3(13.1%) were females, whereas 35(58.3%) out of 60 subjects with secondary erythrocytosis were males and 25(41.6%) were females (p=0.01). Males showed a higher frequency of Polycythaemia vera and, hence, of Janus Kinase2 positivity than females (Odds ratio=0.23, p=0.02). Conclusion: Polycythemia vera is less common than secondary erythrocytosis in the local population. Males showed a higher frequency of Polycythemia vera and, hence, of Janus Kinase2 positivity than females.

Objective: To find the changing radiological pattern of COVID-19 on HRCT chest in vaccinated patients. Study Design: Observational, cross-sectional study. Place and Duration of Study: Combined Military Hospital, Sialkot Pakistan, from Jan to Feb 2022. Methodology: All patients referred for High-resolution computed tomography (HRCT) chest were included. All participants underwent HRCT chest after recording the demographic data. Computed tomography (CT) images were reviewed by an experienced radiologist for pulmonary involvement and determining the computed tomography severity score, which ranged from 0-40 points. Results: A total of 90 patients were included in the study. The mean age was 35.8±13.2 years. The number of partially vaccinated, fully vaccinated patients, and those with booster doses were 10(11.1%), 62(68.9%) and 18(20%), respectively. Patients with normal or non-specific findings on HRCT were 74(82.2%), and those with findings suggestive of COVID-19 pneumonitis were 16 (17.8%). The mean CT severity score among positive cases was 4.69±8.01, while the most frequent pulmonary finding was ground glass opacities found in 11(68.8%) cases. Conclusion: Vaccination reduces the frequency and severity of pulmonary involvement in cases with breakthrough COVID-19 though the presentation of the disease and pattern of the pulmonary involvement does not show much change.

Objective: To examine the clinical severity and infarct volume of acute ischemic stroke (AIS) compared to control subjects by comparing the mean platelet volume/platelet count (MPV/PC) ratio. Study Design: Cross-sectional (validation) study. Place and Duration of Study: Acute Stroke Unit, Pak Emirates Military Hospital (PEMH), Rawalpindi, from Jul and Dec 2020. Methodology: This study included 50 consecutive AIS patients (Group-1) and 50 healthy subjects (Group-2). An automated haemanalyser determined MPV and MPV/PC ratios. In addition, a modified Rankin Scale for the severity of AIS and ABC/2 method for infarct volume was used. Results: This study comprised 69 males and 31 females. Statistical analysis showed that MPV and MPV/PC have significantly different mean values between Group-1 and Group-2 at a p-value of 0.001. In addition, according to the Rankin scale, a significant difference of means (p-value

Objective: To determine the frequency and patterns of bone marrow infiltration in non-Hodgkin lymphoma patients. Method: The cross-sectional study was conducted at the Armed Forces Institute of Pathology, Rawalpindi, Pakistan, from April to October 2021, and comprised patients of either gender aged 20-80 years who had been diagnosed with non-Hodgkin lymphoma. Following assessment and as per standard protocol, bone marrow aspirate and trephine biopsy were done on all patients from the posterior superior iliac spine, and slides were prepared and assessed. Data was analysed using SPSS 25. Results: Of the 100 patients, 67(67%) were males and 33(33%) were females. The overall mean age was 54.99+12 years, and mean duration of symptoms was 11.7±1.5 months. Diffuse large B-cell lymphoma was the commonest type 43(43%). Infiltration of marrow occurred in 38(38%) patients, with 12(12%) of them being cases of mantle cell lymphoma. The commonest infiltration pattern was diffuse in 17(17%) cases, followed by focal/nodular in 10(10%). Conclusion: Diffuse large B-cell lymphoma was found to be the commonest type of non-Hodgkin lymphoma, and marrow infiltration occurred most frequently in cases of mantle cell lymphoma. Key Words: Bone marrow, Infiltration, Non-Hodgkin lymphoma.

Objective: To determine the association of haematological parameters with disease complications in patients with type 2 Diabetes Mellitus. Study Design: Cross-sectional analytical study. Place and Duration of Study: Department of Hematology, Armed Forces Institute of Pathology, Rawalpindi Pakistan from Feb to Aug 2019. Methodology: In this study, 200 Patients were selected and divided into four groups, 1) Anaemia without Diabetes 2) Diabetes with Anaemia 3) Diabetes without Anaemia 4) Healthy Control Group. All the patients were assessed because of their clinical history and laboratory evidence. The patients' clinical details, type of anaemia, laboratory investigations and complications related to diabetes were recorded on a specially designed proforma. Results: Diabetes-related complications were highest in diabetes with anaemia Group. It was recorded that diabetes with anaemia Group, 36 patients (50.0%) had microvascular complications and 32 patients (47.8%) had macrovascular complications. In the healthy control group, 8 patients (11.1%) had microvascular complications, and nine patients (13.4 %) had macrovascular complications. Conclusion: Patients with type 2 Diabetes Mellitus should be evaluated and treated for anaemia routinely to prevent complications

Objective: To compare the marginal integrity of Class-I amalgam and bonded amalgam restorations in maxillary and mandibular molars at seven days, three, six and twelve-months intervals. Study Design: Comparative prospective study. Place and Duration of Study: Department of Operative Dentistry, Armed Forces Institute of Dentistry, Rawalpindi Pakistan,from Jul 2017 to Jul 2018. Methodology: A total number of 114 patients of either gender with an age range of 14-45 years having Class-I cavities in first and second maxillary and mandibular molars on both sides were equally distributed in two groups. Group-A received conventional Amalgam, and Group-B received bonded amalgam restorations. All the fillings were placed and carved using routine instruments used for amalgam restorations, and the restorations were polished after 24 hours. The patients were initially evaluated for marginal ditching around restorations with the help of a dental mirror and explorer at seven days,followed by inspection at 3, 6 and 12 months. Results: Of the 114 participants, all showed excellent marginal integrity at seven-days intervals regardless of the restorative material used. However, marginal integrity deteriorated swiftly with time among those 57(50%) participants who acquired conventional Amalgam. Marginal integrity at 3, 6 and 12-months period was 51(89.5%), 35(61.4%) and 17(29.8%), respectively.Bonded amalgam restorations performed superiorly with 100%, 56(98.2%) and 43(75.4%) successful marginal integrity at 3, 6 and 12-months, respectively. Conclusion: Bonded amalgams can be a better substitute than non-bonded amalgam restorations with superior longevity in marginal integrity. Keywords: Amalgam, Bonded amalgam, Marginal integrity, Micro-leakage, Marginal deterioration, Restoration longevity.

Objective: To evaluate the diagnostic significance of reticulocyte maturity indices in iron deficiency anaemia. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Hematology, Armed Forces Institute of Pathology, Rawalpindi, from Sep 2019 to Jun 2020. Methodology: A total of 340 children, ages between 1 and 5 years of either gender, were divided into two groups based on haemoglobin and ferritin level. Group A comprised of 203 children with haemoglobin >11 g/dL andferritin level >7 ng/ mL. Group B comprised of 137 children with haemoglobin 0.05) and significant differences were noted in terms of low, medium & high fluorescence ratios in both groups (p

Objective: To determine the magnitude and classification of cases of ambiguous genitalia presenting to our setup. Study Design: Cross-sectional study. Place and Duration of Study: Department of Haematology, Armed Forces Institute of Pathology, Rawalpindi Pakistan, from Aug 2018 to Feb 2019. Methodology: All the patients with ambiguous genitalia referred for cytogenetic analysis, were included in the study. The patients were subjected to a detailed history and physical examination. The record of radiological investigations was were obtained. Cytogenetic analysis was performed using the conventional G-banding technique. Hormonal testing included 17- hydroxyprogesterone (17-OHP) levels was also performed. Results: Fifty-one cases of ambiguous genitalia were studied. The median age was 15 months. Thirty-three patients (64.7%) had a 46XY karyotype, 17 (33.3%) had a 46XX karyotype while 1 (1.9%) had 45X/46, XY mosaic karyotype. Thirty patients (58.8%) were products of consanguineous marriage. Congenital adrenal hyperplasia was diagnosed in 12 cases (70.5%) of 46 XX karyotype and in 3 cases (9%) of 46XY karyotype. Conclusion: Ambiguous genitalia, currently categorized as disorders of sex development, are not uncommon in our populartion. Increased awareness and early diagnosis are crucial to prevent life threatening complications of congenital adrenal hyperplasia, to determine sex of rearing, and to counsel the parents or patients.

Objectives: To determine the prevalence, clinical manifestations and laboratory findings of Pakistani Glanzmann Thrombasthenia patients and to assess the treatment received by these patients. Materials and Method: This cross-sectional study examined 2542 patients over a period of 10 years who were referred with a suspicion of a platelet function disorder. Clinical details, laboratory parameters and treatment received were noted. Results: Glanzmann thrombasthenia constituted 80.15% of the platelet function disorders. Of these, males were 112 (34.25%) while females were 215 (65.75%). Median age at diagnosis was 9 yrs 2 months (range of 8 months to 26 years) and at first presentation was 4 years 3 months (range of 3 months to 12 years). Consanguinity was observed in 85.32% of the patients. Common clinical features were easy bruisability (85%), epistaxis (78.6%) and gum bleed (56.3%). Mean haemoglobin was 8.6+2.46 g/dl and mean bleeding time was > 15 min. All patients showed no aggregation with collagen, ADP and epinephrine and a normal response to ristocetin on light transmission aggregometry. Conclusion: We have reported a large number of patients of Glanzmann thrombasthenia, a disorder which is not so rare in our population, emphasizing the importance of early diagnosis and appropriate management.

Objective: To look for patients of sepsis with a qSOFA score of more than two and an association of a high qSOFA score with mortality and other socio-demographic factors. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Medicine, Combined Military Hospital, Sialkot Pakistan, from Nov 2021 to May 2022. Methodology: All baseline and relevant investigations were carried out at the time of initial clinical assessment, and the qSOFA score was calculated by a consultant medical specialist for all the patients diagnosed with the septic condition. Patients were followed up for two weeks to look for mortality. Results: A total of 500 patients, managed for sepsis during the study period were included in the study. Of them, 298(59.6) were males, while 202(40.4) were females. Out of all the patients in the study, 379(75.8) had a qSOFA score of two or less than two, while 121(24.2) had a qSOFA score of more than two. Increased mortality, patients with more than 50 years and comorbid illnesses were found statistically significantly more in the group having a qSOFA score of more than two (p-value

Objective: To study the diagnostic utility of lactate dehydrogenase levels in differentiating megaloblastic anemia from myelodysplastic anemia in Pakistan. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Hematology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan from Feb, 2019 to Aug, 2019. Methodology: In this study, total 240 patients (18-75 years of age) males and females were selected by consecutive sampling technique and were equally divided into 3 groups; patients with megaloblastic anemia, patients with myelodysplastic syndromes and healthy control group. The clinical history and duration of anemia were recorded on special designed proforma. The laboratory investigations including lactate dehydrogenase levels were also noted. Both types of anemia were compared on basis of Lactate Dehydrogenase Levels. Results: The lactate dehydrogenase levels in megaloblastic group were more than 3000 IU/L in 58 out of 80 patients (72.5%). On other hand, myelodysplastic group had 79 out of 80 patients with lactic acid dehydrogenase levels below 450 IU/L (98.75%). The difference in lactic acid dehydrogenase levels between both groups was found to be statistically significant. Conclusion: Serum lactate dehydrogenase levels can be used to differentiate megaloblastic anemia from other anemia especially myelodysplastic syndromes before doing a bone marrow examination. High lactate dehydrogenase levels above 3000 IU/L in megaloblastic anemia can differentiate it from other anemia.

Objective: To evaluate the performance of Nucleated RBC (NRBC) Count using a fully automated haematology analyzer versus manual counting. Study Design: Cross-Sectional Study. Place and Duration of Study: Department of Hematology, Armed Forces Institute of Pathology, from Sep 2019-Jun 2020. Methodology: Routine fresh whole blood samples were run on Sysmex XN-3000 automated haematology analyzer and 384 samples with results of ≥0.1% Nucleated red blood cells were included in this study. Manual NRBC counting was carried out twice on Leishman-stained peripheral blood smears from all 384 samples. Comparison between manual and automated nucleated red blood cell counting methods was statistically analyzed through linear regression analysis & coefficient correlation. The degree of agreement between two methods was analyzed through Bland-Altman plot. Finally, concordance between the two methods was also analyzed at 5 different ranges of nucleated red blood cells. Results: Linear regression analysis revealed a (r2) value of 0.97. Regression equation was calculated as XN = 0.76MC ± 1.28, with 95% limits of agreement between ± 40.42% and -24.47%. A mean bias of 7.97% was demonstrated through Bland-Altman plot. Concordance analysis revealed a concordance rate of 93.74% (360/384). Nucleated red blood cell counting between two methods were more concordant when nucleated red blood cell counts were

Objective: To analyze internal quality control of blood components, including red cell concentrates, fresh frozen plasma, cryoprecipitate and random donor platelets, to measure our blood bank performance. Study Design: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Transfusion (AFIT), Rawalpindi Pakistan from Jul to Dec 2021. Methodology: Whole blood units were separated into red cell concentrates, fresh frozen plasma and random platelets by the platelet-rich plasma method. Cryoprecipitates were prepared from FFPs. Quality control was done on representative components. For red cell concentrates, hematocrit was measured. For platelet concentrates, pH and platelet yield were measured. For fresh frozen plasma, Factor-VIII assay and for cryoprecipitate, Factor VIII and fibrinogen assays were done. The blood components were also tested for bacterial cultures. Results: A total of 1130 units were analyzed for quality control, including 360 red cell concentrates, fresh frozen plasma, random donor platelets each and 50 cryoprecipitates. Red cell concentrates had a mean hematocrit of 68.5±3.7%. Random donor platelets had a yield of 10.1±1.4× 1010 / unit and a mean pH of 6.7±0.2. Fresh frozen plasma had a Factor VIII level of 2.2±0.98 IU/ml. Cryoprecipitate had a mean fibrinogen level of 202.8±27.8 mg/unit and Factor VIII132.5±54.1IU/unit. All blood components met internal quality control standards. Blood cultures were negative in 99.2% of random donor platelets tested. Conclusion: The internal quality control of blood products was in concordance with the national and international standards for quality control in blood banks.

Objective: Determination of significance of immature platelet fraction (IPF%) in diagnosed patients of Immune thrombocytopenic purpura (ITP). Study Design: It was a cross-sectional study. Place and Study Duration: Haematology department, Armed forces Institute of Pathology (AFIP), Rawalpindi Pakistan June 2021 to December 2021. Methodology: Patients of all ages and genders diagnosed with ITP and platelets less than 100 x 109/L after a review of peripheral blood film were included in the study. Detailed history and examination were made, complete blood count (CBC) test was done on Sysmex XN-3000 automated haematology analyzer. Peripheral blood was stained with Leishman stain and examined under a microscope to rule out pseudo thrombocytopenia and the presence of abnormal cells and dysplasia. After adequate quality and control, the immature platelet fraction was performed on Sysmex XN 3000. Results: Seventy-two diagnosed cases of immune thrombocytopenic purpura were part of the study. The mean age of the patients was 21.00±14.50 years. 34 (48%) patients were males, and 38 (52%) were females. The mean platelet count was 49.40±24.60. Mean IPF was 17.90±9.50 per microliter. Immature platelet fraction (IPF%) was raised in all the patients with immune thrombocytopenic purpura, confirming our hypothesis that IPF% was an independent predictor for the detection of ITP. Conclusion: Immature platelet fraction is a unique parameter that can pick patients having thrombocytopenia due to peripheral destruction, including immune thrombocytopenic purpura.

Objective: To assess the outcome and complications of plasmapharesis in treatment of myasthenia gravis and factors linked to poor outcome at hematology unit of a tertiary care teaching hospital of Pakistan Study Design: Prospective comparative study. Place and Duration of Study: Pak Emirates Military Hospital/Armed Forces Institute of Pathology, Rawalpindi, from Jan 2018 to Jul 2019. Methodology: A prospective study was conducted on patients of myasthenia gravis presented at our neurology department. All the complications of the procedure were recorded. Outcomes included recovery, shifting to intensive care unit and death. Pearson chi-square was applied to relate the factors with presence of complications or poor outcome. Results: Hypotension 3 (6%) was the commonest complication faced by the patients followed by chest discomfort 2 (4%) during or after the plasmapharesis. Out of 50 patients, 47 (94%) recovered, 8 (16%) had minor complications, 2 (4%) were shifted to the intensive care unit and 1 (2%) died. Long duration of time between onset of symptoms and first session of plasmapharesis had a significant relationship (p-value

Objective: To determine the frequency of clinical features and cytogenetic abnormalities in patients of down syndrome and correlation of cytogenetic abnormalities with clinical features. Study Design: Cross sectional study. Place and Duration of Study: Department of Haematology, Armed Forces Institute of Pathology, Rawalpindi, from Feb 2017 to Feb 2018. Methodology: Total 163 patients with clinical suspicion of Down syndrome were selected by non-probability convenient sampling and diagnosis was confirmed by conventional cytogenetic analysis using Giemsa trypsin banding technique. Clinical features were assessed and frequency of different cytogenetic abnormalities were noted. Results: Out of total 163 patients, 96 (59%) were male and 67 (41%) were female. Median age of the patients was 11 months. Trisomy 21 was detected in 158 (96.9%), Robertsonian translocation in 4 (2.4%) and mosaicism in 01 (0.6%) patient. The predominant clinical features observed were slaunted with eyes, epicanthic folds, depressed nasal bridge and protruding tongue. Conclusion: Trisomy 21 is the most common cytogenetic abnormality observed in patients of down syndrome.

Introduction: Hospital-Acquired Infection (HAI) is a serious health hazard across the world, being a major contributor to the rate of morbidity and mortality. Inadequate evidence is available on the magnitude of hospital-acquired infections in tertiary care hospitals of Pakistan, thus resulting in a poor focus on this aspect of quality of care. Aims & Objectives: The study aims to measure the frequency of post-op culture-positivity, sensitivity, and its associated attributes in a tertiary care hospital in Lahore, Pakistan. Place and duration of study: Tertiary care teaching hospital in Lahore, Punjab from April to July, 2016. Material & Methods: A cross-sectional study was conducted in a public sector, tertiary care, teaching hospital in Lahore using secondary data. All discharged patients’ files from surgical and allied specialties, operated from 1st Oct, 2015 to 31st Dec 2015, having ages between 18 to 60 years and of both gender, were included consecutively in the study. Data was collected on a structured, self-constructed form and analyzed through SPSS version 21. Results: Out of the total 420 patient files, 47 (11.2%) had culture positive reports, out of which 74.5% had UTIs, 17% tissue/wound infection, 4.3% fluid infections and 4.3% had other site infections. 46% of the females and 32% of the males were found to be culture positive out of the suspects of HAI. The highest infection rate was found among patients of urology (71%), while there was no positive culture found for neurosurgery patients. The most frequently found organisms in cultures were Coliform species (38%), Pseudomonas Aeruginosa (13%), followed by Escherichia coli, Staphylococcus Aureus and Candida Albican. Mixed growth was found in 26% of the cultures. The antibiotic sensitivity of the cultures was to Amikacin (38.3%), Imipenem (29.8%), Tazocin (21.3%) and Gentamycin (14.9%). The antibiotic resistance among the cultures was to; Ciproxin (44.7%), Amoxicillin (34.0%), Cefotaxime (31.9%) and Ampicillin (23.4%). Conclusion: The infection rate among suspects of HAI, was found to be high in this study which calls for an urgent need of robust infection control policy and strategies.

Objective: To determine the association of various haematological parameters with different species of malarial parasites. Study Design: Cross sectional study. Place and Duration of Study: Department of Haematology, Armed Forces Institute of Pathology (AFIP) Rawalpindi, from Sep 2018 to Sep 2019. Methodology: Thick and thin blood smears stained with Leishman stain were examined for the presence of malarial parasites under light microscopy. After the organism was detected by examination of thick blood films, identification of malarial parasite species was carried out using thin blood smears. Basic haematological parameters were evaluated using automated analyzer (Sysmex KX-21). Results: Plasmodium falciparum was identified as the causative organism in 100 (38%) of the malaria cases whereas 100 (62%) of the cases had Plasmodium vivax. A trend towards decreased Hemoglobin, Red Blood Cells, platelet, lymphocyte and eosinophil count was observed in Plasmodium falciparum group as compared to Plasmodium vivax group (p=0.001), whereas, the former showed an increase count of white blood cell, neutrophil and monocyte (p=0.001). Conclusion: Hematological parameters like Hemoglobin, RBC count, WBC count and Platelet count vary significantly with the type of plasmodium species causing malarial infection.

Objective: To determine diagnostic importance of immature granulocyte percentage in patients with infection in early stages in hospital settings. Study Design: Cross sectional study. Place and Duration of Study: Department of Haematology, Armed Forces Institute of Pathology (AFIP) Rawalpindi, from Oct 2017 to Oct 2018. Methodology: One hundred patients were inducted who fulfilled the criteria of systemic inflammatory response syndrome (SIRS) and sepsis. Four ml blood from the patients was taken via venepuncture or indwelling catheter in an EDTA tube, White blood cell count (WBC) and immature granulocyte (IG) percentage was analyzed by using Sysmex XN3000 haematology analyzer. Results: The diagnostic accuracy of immature granulocyte percentage in patients with sepsis as compared to white blood cell count was recorded as 67.40%, 82.35%, 94%, 70% and 87.14% for sensitivity, specificity, positive predictive value, negative predictive value and accuracy rate respectively. Conclusion: Immature granulocyte count at 1.0% is a reliable and effective predictor of infection, validating its addition into the diagnostic protocols in the intensive care unit settings

Objective: Detection of MPL and JAK2 exon12 gene mutation in myeloproliferative neoplasms (MPN) in JAK2V617F negative Myeloproliferative Neoplasms. Study Design: Cross sectional study. Place and Duration of Study: Department of Haematology, Armed Forces Institute of Pathology, from Jun 2017 to Jun 2018. Methodology: Total of 90 newly diagnosed JAK2V617F negative myeloproliferative neoplasms patients were enrolled in the study. Clinico-haematologic features were noted. DNA was extracted from bone marrow samples. Molecular analysis was performed for MPL and JAk2 exon 12 gene by Sanger Sequencing. Results were analyzed by using Genetic Analyzer HITACHI 3130. Results: Out of these 106 patients 86 were males and 20 were females. On mutation analysis of 16 (15%) patients were found positive for JAK2V617F while 90 (84.9%) were JAK2V617F negative. We then studied these 90 JAK2V617F negative myeloproliferative neoplasms patients for other mutations such as MPL gene and JAK2 exon12. On the basis of clinical features, physical examination, Blood complete picture, bone marrow aspiration and trephine biopsy findings 48 (53.3%) were diagnosed as PV, 22 (24.4%) as ET, 20 (22.2%) as PMF. JAK2 exon12 mutation analysis was screened in 48 (54%) patients and remaining 42 (46%) patients, out of which 22 (24.4%) ET patients and 20 (22.2%) were diagnosed as PMF analyzed for MPL gene mutations. Conclusion: We have found that none of these patients carry JAK2 exon12 and MPL gene mutation.

Objective: To detect the calreticulin gene mutation in myeloproliferative neoplasms and its clinicohaematological correlation. Study Design: Cross sectional study. Place and Duration of Study: Armed Forces Institute of Pathology, from Jun 2017 to Jun 2018. Methodology: A cross sectional study was conducted at Department of Haematology, Armed Forces Institute of Pathology from June 2017 to June 2018. A total of 48 newly diagnosed JAK2V617F patients with negative myeloproliferative neoplasma were enrolled in the study. Clinico-haematologic features were noted. DNA was extracted from bone marrow samples. Molecular analysis was performed for Calreticulin gene by Sanger Sequencing. Results were analysed by using Genetic Analyser HITACHI 3130. Results: Of 48 newly diagnosed JAK2V617F negative myeloproliferative neoplasms patients, 38 were male and 10 were females with M:F ratio of 3.8:1. Mean age was 43.5 years (standard deviation ± 15). 9 (18.8%) were diagnosed as polycythemia vera, 21 (43.8%) as Essential thrombocythemia and 18 (37.5%) as having Primary myelofibrosis. CALR mutation was detected in four (8%) of myeloproliferative neoplasms cases. Out of four CALR positive cases, three were diagnosed to have Primary myelofibrosis while only one had a diagnosis of Essential thrombocythemia. Conclusion: We conclude that CALR mutation was an important molecular marker in JAK2V617F negative patients. Primary myelofibrosis shares a high rate of CALR mutation as compared to polycythemia vera and essential thrombocythemia.

Objective: To determine the frequency of NRAS and KRAS mutations in newly diagnosed acute myeloid leukemia patients and correlation with their clinicopathological parameters along with prognostic impact. Study Design: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Haematology, Rawalpindi, from Mar 2017 to Aug 2017. Methodology: A total of 70 acute myeloid leukemia patients were recruited in this study. Each patient was assessed by blood complete picture, bone marrow examination (aspiration and trephine biopsy) and cytochemical staining by sudan black. Flow cytometry was done for immunophenotyping of each patient. Mutation analysis of NRAS and KRAS of exon 1 and exon 2 were performed on Peripheral /bone marrow sample by PCR followed by purification and analysis of gene mutations by Sanger sequencing. Results: Of the seventy patients, five percent were positive for NRAS mutation while no KRAS Mutation was detected in our study. Mean age of our patients was 31.5 with a SD of ± 18.9. Patients presented very high levels of WBC with an average of 83.7 ± 107 years. Regarding clinicopathological parameters all NRAS mutation positive patients and NRAS mutation negative patients there was prominent splenomegaly as well as bleeding from gums but the percentage of splenomegaly and bleeding gums was much greater in NRAS mutation patients as compared to NRAS negative patients. Conclusion: There were limited studies regarding NRAS and KRAS mutations in Pakistan so larger sample size is required to determine frequency along with its prognostic impact.

Objective: To determine the frequency and clinical features of inherited platelet function disorders diagnosed at Armed Forces Institute of Pathology. Study Design: Cross sectional study. Place and Duration of Study: Department of Haematology, Armed Forces Institute of Pathology, Rawalpindi, from Feb 2017 to Aug 2017. Methodology: All patients with history of bleeding from multiple sites or requiring transfusion were selected. Initial tests performed included complete blood counts, peripheral film and bleeding time. When bleeding time was prolonged, prothrombin time and activated partial thromboplastin time were done to rule out Von Willebrand disease and Fibrinogen deficiency. Results: A total of 172 patients were analyzed during study period.Inherited platelet function disorders were diagnosed in 24 (13.9%) patients, 111 (64.5%) patients had inherited coagulopathies. 3 (1.8%) patients showed inconclusive results while no inherited bleeding disorder was detected in 34 (19.8%) patients. Among platelet function disorders, Glanzmann thrombasthenia was diagnosed in 12 (50%) patients, Bernard soulier syndrome (BSS) in 11 (45.8%) patients and Storage pool disorder in 1 (4.1%) patient. Conclusion: Glanzmann thrombasthenia was the most commonest inherited platelet function disorders. Diagnosis requires platelet aggregation studies.

In the next generation wireless communication paradigm, the number of devices are expected to increase exponentially after the concept of Internet of Things (IoT). These devices are power constrained, with limited processing capability. Therefore, in order to get the maximum advantage from these low power IoT sensing devices, it is of utmost need to empower them. Similarly, the devices are not able to process the computationally intensive applications. In this work, Wireless Power Mobile Edge Cloud (WPMEC) is considered, which is an integration of Wireless Power Transfer (WPT) and Mobile Edge Cloud (MEC) to address low power devices' battery and computational capabilities. The WPMEC is charging the devices in the first phase using the WPT and in the second phase, the devices are offloading their computational intensive data to the MEC. Partial offloading scheme is first time introduced and analyzed with WPMEC. Performance of proposed solution is evaluated in terms of overall network computational energy efficiency. Extensive simulations have been carried out to validate the proposed solution. It is shown that the proposed partial offloading scheme with WPMEC outperforms the binary and local computational schemes.

Introduction: The optimal approach to screening and risk stratification for non-alcoholic fatty liver disease is challenging given disease burden and variable progression. The aim of this study was to assess primary care physician and referring physician practice patterns regarding non-alcoholic fatty liver disease. Methods: An anonymous nationwide survey was administered to primary care physicians, endocrinologists, and cardiologists in a: (1) tertiary academic hospital, (2) community hospital, and (3) the American College of Physicians Insider Panel. Survey domains assessed non-alcoholic fatty liver disease knowledge, recommendations for screening, risk stratification, treatment, and referral patterns. Results: A total of 440 providers completed the survey (35.2% completion rate; N = 82 academic hospital, N = 21 community hospital, N = 337 American College of Physicians). Half were male (51.7%), 78% from internal medicine, with 5% subspecialists. Providers were knowledgeable regarding prevalence and risk factors for non-alcoholic fatty liver disease. 58% would support screening for non-alcoholic fatty liver disease and used liver enzymes to do so. Only 22.5% used serum biomarkers and 23% used transient elastography for risk stratification. Primary reason for referral was advanced fibrosis/cirrhosis. 80% reported barriers to treating non-alcoholic fatty liver disease. There was no consistent diet recommended. Conclusion: In this nationwide survey, we demonstrated that while overall disease knowledge was good, there was an important disconnect between current guidelines and real-world clinical practice. There is also significant heterogeneity in practice patterns for first-line therapy of non-alcoholic fatty liver disease and the majority of provider’s report barriers to treating non-alcoholic fatty liver disease. These findings highlight the potential role for reevaluating screening and risk stratification recommendations in primary care to better align with needs in that setting.

The recent combination of ambient backscatter communication (ABC) with non-orthogonal multiple access (NOMA) has shown great potential for connecting large-scale Internet of Things (IoT) in future unmanned aerial vehicle (UAV) networks. The basic idea of ABC is to provide battery-free transmission by harvesting the energy of existing RF signals of WiFi, TV towers, and cellular base stations/UAV. ABC uses smart sensor tags to modulate and reflect data among wireless devices. On the other side, NOMA makes possible the communication of more than one IoT on the same frequency. In this work, we provide an energy efficient transmission design ABC-aided UAV network using NOMA. This work aims to optimize the power consumption of a UAV system while ensuring the minimum data rate of IoT. Specifically, the transmit power of UAVs and the reflection coefficient of the ABC system are simultaneously optimized under the assumption of imperfect channel state information (CSI). Due to co-channel interference among UAVs, imperfect CSI, and NOMA interference, the joint optimization problem is formulated as non-convex, which involves high complexity and makes it hard to obtain the optimal solution. Thus, it is first transformed and then solved by a sub-gradient method with low complexity. In addition, a conventional NOMA UAV framework is also studied for comparison without involving ABC. Numerical results demonstrate the benefits of using ABC in a NOMA UAV network compared to the conventional UAV framework.

Background: Suicide by poisoning is the second most common cause of death by suicide (27.9%) as per The National Crime Records Bureau (NCRB) India in 2015. Aluminum phosphide (ALP) is the leading agricultural poison used to commit suicide as where its availability is not properly regulated. ALP is a highly toxic solid fumigant pesticide, rodenticide and insecticide. Case presentation: A 40-year-old woman was brought by the police to the emergency section. Her extremities were cold and hypotonic, and her skin was pale. Patient’s vitals were unstable with pulse rate 112/minute irregularities, blood pressure 68/54 mm of Hg, respiratory rate 22/minute shallow and body temperature 30.1 ºC and characteristicly strong garlicky odor on her breath. During the suction of gastric contents, spontaneous ignition of gas with flames and white fumes with sound like a blast was observed by resident doctors and para-clinical staff. Gastric aspirate along with Ryle’s tube were immediately sent to the forensic department where the Silver Nitrate test was performed and it was found strongly positive for phosphine gas. Discussion: Aluminum phosphide readily reacts with water and hydrochloric acid in the stomach to produce phosphine (hydrogen phosphide, PH3) and a small amount of diphosphine. Conclusion: The present case report stresses on the need that the emergency physicians need to be highly alert and adequately prepared while handling such patients. Spontaneous ignition with the release of phosphine from ALP poisoned patients can not only affect the patient, but also pose a health hazard to emergency physicians and medical staff.

This research looks at the effectiveness of microinsurance services during and after a disaster and at disaster management as an effective tool for community betterment. A detailed review has been done on available research and case studies. Unfortunately, underdeveloped countries suffer due to a lack of finances during and after a disaster. Developed countries are usually not ready for any disaster at government and public levels. A disaster affected country will also be keen for financial help from donor agencies and other counties. Microinsurance would be very helpful during any disaster to overcome the financial needs at the community level. Microinsurance is a practice that can share the financial liability with the affected population during a disaster. There is no trend in Pakistan for community based microinsurance for certain reasons, although there are very good examples available for review in the region. These include microinsurance services based on community microinsurance models such as SEWA (Gujarat), Weather-Index-based insurance (Ethiopia) and Crop insurance against typhoons (Philippine). These have played a vital role in disaster risk transfer during and after disasters. This study will identify the implementation and outcome of microinsurance in Pakistan during a disaster and understand how much beneficial microinsurance would be for the betterment and recovery of affective community on an urgent basis.

Down’s syndrome is a genetic disorder that is associated with multiple congenital anomalies having great impact on anaesthetic management. Apart from this, it also predisposes the patient to the atlantoaxial dislocation making the management of airway a difficult task. In our case, the child already had traumatic atlantoaxial dislocation that further makes the successful airway management without progression of any neurological injury a challenge. Hereby, we report the successful management of an 8-year-old child with Down’s syndrome and traumatic atlantoaxial dislocation using Airtraq® optical laryngoscope.

A case of severe eosinophilia is reported in a child with giardiasis