Search

Objective: Oral submucous fibrosis (OSF) is a chronic condition of the oral cavity which results in permanent disability. A number of studies have proven that the management of premalignant diseases should include antioxidants. Therefore, a study was carried out to evaluate the efficacy of spirulina in the management of 40 oral submucous fibrosis in uttar Pradesh. Materials and Method: An study was conducted on 40 oral submucous fibrosis cases, 40 patients given spirulina capsules systemetically 500 mg twice daily for period of 6 months .The results were analyzed with tukey test and ANNOVA test. Result: The result showed statistically significant improvement in burning sensation whereas it was clinically significant in mouth opening and tongue protrusion. Conclusion: Spirulina can bring about clinical improvements in OSF patients. The observed effects suggest that spirulina can be used in management of OSF patients. However, studies involving larger samples and longer period of treatment follow up are suggested in the future.

Immunity is the ability of the body to defend itself against infectious diseases. The immune system has developed to protect the host from a continually evolving universe of dangerous bacteria. In addition, the immune system aids the host in the elimination of hazardous substances or allergenic chemicals that enter the body through the mucosal membranes. Autoimmunity is characterised by disruptions in the immune system's control at multiple levels. To avoid the onset of autoimmunity, self-tolerance and discrimination between self and non- self work together. Tolerance is produced and maintained via a combination between negative selection in the thymus, the transcription factor AIRE, CD4+CD25+ regulatory T cells, and dendritic cells. Autoimmune disease occurs when the adaptive immune system pedestals an attack counter to healthy tissue. When the adaptive immune system attacks healthy tissue, autoimmune disease develops.

The term “pigmentation of oral mucosa” is applied to a wide range of lesions or conditions featuring a change of color of oral tissues. Common causes of mucosal coloration including petechiae, purpura, ecchymoses, hematomas, vascular tumors and exogenous substances are not true pigmented lesions. In contrast, melanin which is synthesized by melanocytes, is a true pigment and usually imparts a brown, blue or black appearance of the mucosa. Oral pigmentation affects about 3% of the total population and most likely in those with dark skin, more prevalent in females than males during the 3rd or 4th decade of life. In this review, we are describing the oral manifestation and dental considerations associated with common pigmented disorders which will allow the practitioner to have a holistic approach in diagnosis and management of these patients.

Aims: To visualize the surface irregularities and changes after heat treatment on the prosthesis. This was done by Scanning Electron Microscopy. Material and Methods: Eight prosthesis were prepared with modification on the fitting surfaces. The occlusal surface of the tooth to receive the prosthesis was modified and engraved with the initials in the form of identification features. These were heat treated under furnace at temperatures of 500°C, 1000°C and 1500°C after which the scanning was done under Electron Microscope. Results: After heat treatment it was observed that the inner surface of the prosthesis was merely distorted and the details were intact. Analysis of the surface irregularities shows that there are slit surface changes on the occlusal surface at 1000°C and the fitting surface details are well protected. Conclusion: It was identified that after heat treatment at temperatures 1000°C and above some changes started occurring on the fitting surface and the identification features. At these temperatures the whole human body is charred and even the bones start to get destroyed. SEM images give the detailed pictures of the same and that if this method is incorporated in day today dentistry it will be a boom in the forensic identification.

There are various plant originated active chemical constituents which are toxicologically significant includes proteins, phenolic compounds, alkaloids, glycosides, and resins, etc. Out of these huge numbers of plants in the environment, few cause acute toxicity, severe illness if it is consumed. The diversity of active chemical constituent in plants is quite amazing. Natural poisons are those chemicals that kill without violence, mysteriously, secretly destroy life. Some of the common plant families and its toxic constituent are easily available like Euphorbiaceae (cleistanthin, toxalbumin, curcin), Solanaceae (capsicin, atropine, dutarin), Apocyanacae (uscharin, odolotoxin, neriodorin), Leguminosae (cytisine sparteine), Fabaceae (abrasine, diaminopropionic acid), Papaveraceae (narcotine, dihydrosangunarine). The natural poisons are also used by criminals for stupefying people that facilitate robbery, murder and other cases. These natural poisons are readily accessible and very cheap, so skilful poisoners prefer this toxic plant for a crime. In this work author revised literature related to the classification of plant’s chemical constituents, its lethal dose and metabolic effects on the body. It has been thoroughly received and collected from journals and textbooks to make this review useful to all specialists of different discipline and it also has significant forensic importance.

Objective Cell Saver system is the method of choice for red blood cell salvage from the surgical field; however, cost is a limiting factor. We at our institute have devised a cost-effective version of dialyser-based autotransfusion system. We performed pretransfusion comparison of our autotransfusion system with conventional cell saver system. Methods A prospective randomized observational study was performed in 104 consecutive patients with coronary artery disease undergoing by off-pump coronary artery bypass grafting. Patients were divided into two groups. In the dialyser group (53 patients), blood from surgical field was salvaged by our dialyser-based system. In the cell saver group (51 patients), blood was salvaged by cell saver. In both groups, 20-mL sample from the salvaged blood was analyzed for hemoglobin, platelets, protein, albumin, free hemoglobin, osmotic fragility, and peripheral blood smear examination. Results Total hemoglobin salvaged was comparable in both groups (85% vs 76%). On peripheral smear, red blood cells were swollen, but morphology was preserved. Moreover, normal osmotic fragility suggested absence of any lethal damage to red blood cells in either group. Dialyser-based system was more efficient in salvaging platelets (42.9% vs 6%), proteins (79.2% vs 0%), and albumin (65% vs 0%). Total free hemoglobin was three times more in dialyser group but was well below recommended limits. Conclusions Dialyser-based system is economical, is equally efficacious in salvaging red blood cells, is more effective in salvaging platelets and proteins, and does not contain significant amount of free hemoglobin. Therefore, this salvaged blood can be safely transfused.

Aims: Management of vertically fractured mandibular first molar by intra coronal splinting applying the finite centre of rotation effect of Pythagorus theorem. Case Presentations: A 28 year old male patient presented at the Department of Conservative Dentistry and Endodontics with the chief complaint of pain in the lower right back region of the mouth since last the 10 days. Past dental history revealed that affected tooth had root canal treatment done two years ago. History of present illness was that pain was elicited on chewing, and applying pressure on that area, with occasional bleeding from the same region. Intraoral examination revealed that tooth 46 was tender on percussion with vertically fractured crown in Case Study Tripathi et al.; BJMMR, 7(7): 623-629, 2015; Article no.BJMMR.2015.369 624 mesiodistal direction. Periapical Radiograph revealed that tooth was endodontically treated, with radiolucencies at apical and furcal area, and visible fracture line in mesiodistal direction at CEJ level. Technique Used in the Study: The tooth was endodontically retreated and Pythagorus theorem was used to locate the centres of rotation on both buccal and lingual sides of tooth 46 coronally. The technique was followed by drilling a vent at the same position approximating a fibre post (3M, Relyxfibre post). The centres were different both for buccal and lingual aspects which when approximated will provide antirotation. The post was placed in the buccolingual direction and the tooth was restored with posterior composites after which the restoration was checked for any high points. Follow up of the case was done for the period of one year. Discussion: The concept of the estimation of the finite centre of rotation is like the primary objective in tightening a screw joint to generate an optimum preload that will maximize the fatigue life of the screw while offering a reasonable degree of protection against loosening. The major advantage of this approach is that the fragment was stabilized properly and there was healthy development of periodontium over the year. Conclusion: Usually the vertically fractured tooth have poor prognosis and may likely be referred for extraction if not stabilized properly. This case report emphasizes the basic concept of stabilization and preventing rotation around an axis which will give the fractured tooth a better longevity and avoid the vibrations during crown preparation. The combined effect will restore the patient’s own natural tooth back and minimizes the chances of periodontal complication.

Bilateral inverted impacted third molar is a very rare incidence. Dearth of dental arch length and space are also considered as the chief cause for tooth impaction. Reviewing the literatures, mandibular third molar was the most frequently impacted tooth, followed by the maxillary third molars, the maxillary canines and the mandibular premolars.

Plasma is the fourth state of matter and other states of matter are liquid, gas, and solid 4 . Plasma occurs as a natural phenomenon in the universe in the form of fire, in the polar aurora borealis and in the nuclear fusion reactions of the sun and also can be created artificially which has gained importance in the fields of plasma screens or light sources 1 . There are two types of plasma: thermal and non-thermal or cold atmospheric plasma. Thermal plasma has electrons and heavy particles (neutral and ions) at the same temperature. Cold Atmospheric Plasma (CAP) is said to be non-thermal because it has electron at a hotter temperature than the heavy particles that are at room temperature. . Cold Atmospheric Plasma is a specific type of plasma that is less than 104°F at the point of application 4 . So the bright future of dentistry with help of cold plasma. Key word:- cold plasma, non thermal atmospheric plasma

The mandibular first molars ( primary and permanent) usually have 2 roots located mesially and distally, but occasionally they have an additional root located distolingually requiring special attention when root canal treatment is being considered . The additional root is regarded as a normal racial and morphological variation rather than as an abnormality. It appears to be more common in races of Mongoloid origin, including Malay, Chinese, Japanese, Eskimo, and American and Canadian Indian populations. 1 To study about the rarest root and root canal anatomy using spiral ct and r.v.g. Computed tomography and radio visiography has long been used as a diagnostic aid in dentistry .With the advent of new diagnostic aids like spiral computed tomography it has become very easy for the dentist to diagnose different root and root canal anatomy and accordingly plan the treatment.

Background: Myofascial pain dysfunction syndrome (MPDS) has been recognized as the most common, nontooth-related chronic orofacial pain condition that confronts dentists. A variety of therapies have been described in literature for its management. Objectives: This study is a prospective study carried out to evaluate the efficacy of occlusal splint therapy and compare it with transcutaneous electrical nerve stimulation (TENS) in the management of MPDS. Materials and Methods: Sixty patients who reported to the Department of Oral Medicine and Radiology, Pacific Dental College, Udaipur, since September 2009, in the age range of 17–55 years were included in the study and were randomly assigned to two equally sized groups, A and B. Group A patients received TENS therapy, whereas Group B patients received soft occlusal splint therapy. All the patients were evaluated for pain using visual analog scale (VAS), maximum comfortable mouth opening, temporomandibular joint (TMJ) clicking, and tenderness during rest and movement, as well as for the number of tender muscles at the time of diagnosis, after the first week of initiation of therapy, and every month for 3 months of follow-up. Results: There was a progressive decrease in VAS, number of tender muscles, TMJ clicking, and tenderness with various jaw movements, and there was a significant improvement in mouth opening in patients on occlusal splint therapy during the follow-up period when compared with TENS therapy group. Conclusion: Occlusal splint therapy has better long-term results in reducing the symptoms of MPDS. It has better patient compliance, has fewer side effects, and is more cost-effective than TENS therapy; hence, it can be chosen for the treatment of patients with MPDS.

Aim: The aim of this study was to compare the efficiency of conventional and digital radiography in assessing alveolar bone loss. Materials and Methods: The study group comprised 50 participants (25 males and 25 females) between 25 and 45 years of age. The participants were screened for all clinical features of periodontitis. A series of conventional bitewing radiographs of right and left of both maxillary and mandibular posterior region (15,16,17,25,26,27,35,36,37,45,46,47) were taken for each of 50 patients by examiner 1. Similarly, a series of digital bitewing radiographs were taken by examiner 2 for each 50 patients by using RVG of Planmeca Dixi 2 B Series. In digital bitewing radiographs, the measurement was done by examiner 2, using Planmeca Dixi 2 B Digital Software, by dragging the cursor to make a line by joining the linear points. Bone level less than 2 mm from the cementoenamel junction (CEJ) was considered normal while above that was considered bone loss. In case of conventional bitewing radiographs, alveolar bone loss was measured by the same examiner by measuring the distance from the CEJ to the most apical level of crestal bone using a divider and transparent ruler. The above collected data of examiners 1 and 2 were handed over to examiner 3 for statistical evaluation. Results: Comparison of conventional and digital radiographic techniques in left maxilla, left and right mandible, and between maxilla and mandible in the total sample and in females aged 25–35 and 36–45 years yielded a significant correlation while comparison of the two techniques in the right maxilla and between maxilla and mandible in males yielded a nonsignificant correlation. Conclusion: Direct digital radiography provides an edge over conventional radiography in assessing the periodontal bone destruction.

Chronic myeloid leukemia is a myeloproliferative disorder with a unique rearrangement, the Philadelphia chromosome. Oxidative stress, a pervasive condition of an increased number of reactive oxygen species, is now recognized to be prominent feature of various diseases and their progression. Thus antioxidants, which control the oxidative stress state, represent a major line of defense regulating overall true state of health. The relationship between antioxidants status and levels of well-known markers of oxidative stress that are measured as lipid peroxides and oxidized proteins reflect better health indices and postures. The aim of this study was to evaluate the role of oxidative stress in pathophysiology of Chronic myeloid leukemia by measuring the circulating plasma lipid peroxide levels in terms of malonyldialdehyde, total lipid hydroperoxide and oxidized proteins as protein carbonyl whereas antioxidant status were estimated in terms of reduced glutathione and total thiol in plasma of Chronic myeloid leukemia patients. The present study included 47 Chronic myeloid leukemia patients and 20 age-and sex-matched healthy subjects. Out of 47 Chronic myeloid leukemia patients, 31 were in chronic phase (CML-CP) and 16 in accelerated phase (CML-AP). The median age of Chronic myeloid leukemia patients was 33 years and that of controls was 32 years. Oxidative stress and antioxidant status in plasma were evaluated by spectrophotometric procedures. There was a significant increase (p

Objective. We aimed to establish age and sex specific percentile reference data for cardiovascular risk factors such as lipids, sugar, blood pressure, and BMI in apparently healthy and disease-free Gujarati population.Methods.In this cross-sectional study, we enrolled 3265 apparently healthy and disease-free individuals of both genders residing in Gujarat state. Fasting samples of blood were used for biochemical estimations of lipids and sugar. The measurement of BMI and blood pressure was also done according to the standard guidelines. Age and gender specific 5th, 25th, 50th, 75th, 90th, and 95th percentiles were obtained.Results. The mean values of lipids, sugar, blood pressure, and BMI were significantly (p<0.001) higher in males as compared to female population. Age-wise distribution trends showed increase in the risk factors from the 2nd decade until the 5th to 6th decade in most of the cases, where loss of premenopausal protection in females was also observed. Specific trends according to gender and age were observed in percentile values of various parameters.Conclusion.The outcome of current study will contribute significantly to proposing clinically important reference values of various lipids, sugar, blood pressure, and BMI that could be used to screen the asymptomatic Gujarati Indian population with a propensity of developing dyslipidemia, diabetes, blood pressure, and obesity.

Prognostic factors which can predict response to imatinib in patients with chronic myeloid leukemia (CML) have been of much interest. Identification of patients who are likely to fail to imatinib t...

BACKGROUND: Chronic myeloid leukemia (CML) is a myeloproliferative disorder with a unique genetic rearrangement, the Philadelphia chromosome. High reactive oxygen species (ROS) levels favor oxidative stress, which could play a vital role in normal processes and various pathophysiologies including neoplasm. Biomarkers of oxidative stress are measured as products of oxidized proteins and lipids. Plasma levels of protein carbonyl (PC), thiobarbituric acid reactive substances (TBARS) and total lipid hydroperoxide (LOOH) were used as biomarkers of oxidative stress in the past. The aim of this study was to evaluate the products of protein oxidation and lipid peroxidation in plasma as biomarkers of oxidative stress in CML patients. PATIENTS AND METHODS: The study included 40 CML patients and 20 age- and sex-matched healthy volunteers. Of 40 CML patients, 28 were in chronic phase (CML-CP) and 12 in accelerated phase (CML-AP). Plasma levels of PC, TBARS and LOOH as biomarkers of oxidative stress were evaluated by spectrophotometric methods. RESULTS: There were significant differences (P

BACKGROUND The functional definition of aplastic anemia (AA) is the failure of hematopoietic stem cells to proliferate. The aim of the present study was to analyze the S-phase fraction (SPF) (proliferative activity) in patients with AA at diagnosis to explore its relationship with disease characteristics and its value in discriminating among patients with different prognoses. We also investigated whether the SPF value influenced the response to immunosuppressive therapy in AA patients. PATIENTS AND METHODS The analysis of SPF at the time of diagnosis was carried out by flow cytometry on peripheral blood samples from 53 consecutive patients with AA and 30 age- and sex-matched controls. All patients were given cyclosporine and followed up periodically to determine response to therapy. RESULTS Based on the median SPF, AA patients were divided into two groups: patients with SPF ≤ 0.59% (n = 27) and patients with SPF > 0.59% (n = 26). An SPF > 0.59% was associated with advanced age (P = .02) and elevated serum LDH level (P = .01). Patients with an SPF > 0.59% also had a higher incidence of paroxysmal nocturnal hemoglobinuria and cytogenetic abnormalities. During a median follow-up of 18 months, 3.7% of patients with SPF ≤ 0.59 and 11.5% of patients with SPF > 0.59% developed dysplasia and one patient with SPF > 0.59% converted into AML. A significantly higher (P = .018) overall response rate of 53.9% was found in patients with SPF > 0.59% versus 22.2% of patients with SPF ≤ 0.59% at 6 months. CONCLUSIONS Independently of the peripheral blood count, the SPF at diagnosis may provide information on the expected response to immunosuppressive therapy and the propensity for disease to evolve into MDS/AML. Hence, SPF may serve as an early indicator for the evolution of MDS/AML in patients with AA and thus contribute to therapeutic decisions.

Adenoid cystic carcinoma (ACC) accounts for approximately 10% of all salivary gland tumors. It is the most common malignant tumor of submandibular and minor salivary glands. The most common location is the palate, generally in the area of the greater foramen. ACC is generally characterized by a slow growth rate, & it is often present for several years before the patient seeks treatment (Jindal and Joshi, 2007). A 28 year old man reported with a swelling on the left side of palate since one and a half years which was diagnosed histopathologically as ACC. A detailed description of the case along with review of literature is presented here with an aim to focus on the importance of detailed or advanced investigations as in the present case.

Undetected aneuploidy exists in a large percentage of patients with aplastic anemia at the time of diagnosis, which may not be identified by conventional cytogenetics. The presence of aneuploidy at any time in the clinical course implies poor prognosis in such patients. This warrants a need for the early detection of chromosomal abnormalities for prognosis and delineation of therapeutic modalities.Fifty patients with aplastic anemia and 30 controls were studied with an aim to determine the role of aneuploidy as an indicator of chromosomal abnormalities. DNA aneuploidy analysis was carried out by flow cytometry using Mod Fit-LT V3.0 software, whereas chromosomal analysis was performed by conventional cytogenetics.DNA aneuploidy was present in 14% of cases and chromosomal abnormalities were found in 4% of cases of aplastic anemia at the time of diagnosis before therapy. Overall, DNA aneuploidy was detected in 36% of cases by flow cytometry, whereas the cytogenetic method revealed chromosomal abnormalities in 14% of cases of aplastic anemia. Flow cytometric analysis showed hypodiploidy in one patient at the time of diagnosis who developed monosomy 7 during follow-up. All patients with hypodiploidy had short survival and they did not respond to therapy.The present study demonstrates the role of flow cytometry in the early detection of chromosomal abnormalities in patients at a time when they remain undetected by conventional cytogenetics. The presence of DNA aneuploidy in patients with aplastic anemia may be an early indicator of subsequent overt cytogenetic abnormality, associated with poor response to immunosuppressive therapy and a lower survival.

It is often difficult and challenging task to differentiate aplastic anemia (AA) from hypoplastic myelodysplastic syndrome (HMDS) among the patients with bone marrow aplasia. This is possibly because of the considerable clinical, cytological and histological similarities between these two disorders. As prognostic and therapeutic approach to AA and HMDS are different, it is imperative to differentiate them at the time of initial diagnosis. Various attempts have been made in the past to differentiate AA from HMDS. In the present study, we explored the value of certain new parameters i.e. S-phase fraction (SPF) and aneuploidy that could be used for this purpose.The study included 46 consecutive patients with aplastic anemia, 15 patients with HMDS along with 32 age and sex-matched control subjects. S-phase fraction and aneuploidy analysis was carried out by flow cytometry using Mod Fit-LT V3.0 software.The mean SPF value was significantly lower (p=0.02) in patients with AA and higher (p=0.01) in HMDS as compared to that of the control. Aneuploidy was present in 15.2% patients with AA and in 33.3% HMDS cases. During follow-up, 4 patients with AA developed MDS, out of these, three patients had aneuploidy as well as high SPF value at the time of diagnosis. Two patients with HMDS who had aneuploidy and high SPF, converted into AML. Eleven patients died during the study, in whom 8 had aneuploidy and high SPF value.We conclude that high SPF value and presence of aneuploidy favour the diagnosis of HMDS rather than AA. SPF and aneuploidy may be important parameters in patients with AA to predict their propensity to evolve into myelodysplastic syndrome and acute myeloid leukemia. SPF value may also be useful in the early diagnosis of HMDS before morphologically evidence of dysplasia is apparent.

Oxidative stress, a pervasive condition of an increased amount of free radicals, is now recognized to be prominent feature of various diseases and their progression. However, evidence for this association has often been lacking because of a lack of specific biomarkers and methods available to evaluate oxidative stress status in humans with disease conditions. Emphasis is now being placed on biomarkers of oxidative stress, which can be objectively measured and evaluated as indicators of normal biological and pathogenic processes. The aim of this study was to investigate the plasma levels of malondialdehyde (MDA) and protein carbonyl (PC) as biomarkers for oxidative stress and disease progression in patients with chronic myeloid leukemia (CML).The study included 20 CML patients and 10 age-and sex-matched healthy control volunteers. The mean age of CML patients was 37.11+/-11.36 years and that of controls was 31.07+/-7.60 years.There was a significant increase (p0.05) in plasma MDA and PC levels in CML patients as compared to healthy volunteers. Our results also showed that plasma MDA and PC levels were significantly higher (p0.001) in both chronic phase (CML-CP) and accelerated phase (CML-AP) as compared to healthy volunteers. During the follow-up of 12 months, two patients of CML-CP progressed to the accelerated phase. The mean plasma levels of MDA and PC in patients with CML-CP who progressed to CML-AP were found to be higher than in patients with CML-CP who did not progress to the accelerated phase.Plasma MDA and PC appears to reflect the oxidative stress status and disease progression in CML and can be used as biomarkers for oxidative stress and disease progression.

Introduction: Fractal analysis (FA) quantifies complex geometric structures by generating a fractal dimension (FD), which can measure the complexity of mucosa. FA is a quantitative tool used to measure the complexity of self-similar or semi-self-similar structures. Aim and Objective: The study was done to perform the FA of oral mucosa with keratotic changes, as it is also made up of self-similar tissues, and thus, its FD can be calculated. Results: In oral leukoplakia, keratinization increases the complexity of mucosa, which denotes fractal geometry. We evaluated and compared pretreated and post-treated oral leukoplakia in 50 patients with clinically proven oral leukoplakia and analyzed the normal oral mucosa and lesional or keratinized mucosa in oral leukoplakia patients through FA using box counting method. Conclusion: FA using the fractal geometry is an efficient, noninvasive prediction tool for early detection of oral leukoplakia and other premalignant conditions in patients.

Among the patients with bone marrow hypoplasia, differentiating aplastic anemia (AA) from hypoplastic myelodysplastic syndrome (HMDS) can be a difficult and challenging task because of the considerable clinical, cytological and histological similarities between these two disorders. The distinction between AA and HMDS is important because the clinical course and management of these two entities differ. There is a higher risk of progression to acute leukemia in patients with HMDS compared with AA. Various attempts have been made in the past to differentiate these entities. Different patterns of proliferation of bone marrow cells in AA and HMDS have been reported in past using proliferating cell nuclear antigens (PCNA). S-Phase Fraction (SPF) reflects the cellular proliferation and has been proven to be a useful diagnostic and prognostic marker in various hematological malignancies and solid tumors. In the present study, we examined whether flow cytometric analysis of SPF could be used as a tool to differentiate AA from HMDS. The study group comprised of 25 consecutive patients with AA, 18 patients with HMDS diagnosed on the basis of peripheral blood and bone marrow findings along with 30 age and sex matched healthy controls. The mean age of AA patients and HMDS patients was 27.1 ± 12.7 years (range 13–65 years with median age of 23 years) and 38.8 ± 20.6 years (range 15–75 years with median age of 32.5 years) respectively. The most common clinical presentation in patients with AA and HMDS was anemia. Other manifestations were bleeding and pyrexia. No etiological association could be made in any of these cases. Peripheral blood leucocytes were stained with propidium iodide and analyzed for SPF through flow cytometry using Modfit-LT V 3.0 software. The mean SPF value in the patients with AA and HMDS was 0.49 ± 0.33% and 0.79 ± 0.28% respectively. The mean SPF value in control subjects was 0.67 ± 0.22%. The SPF value in patients with AA was significantly lower than that of control (p=0.01) whereas there was no significant difference in SPF values in patients with HMDS and control subjects. The SPF value was statistically significant higher in HMDS patients as compared to AA (p=0.003). During follow-up, 3 patients (12%) with AA have revealed the evidence of dysplasia on repeat bone marrow examination. These patients had high SPF values as compared to the median SPF value in AA patients. We conclude that SPF value may be an important parameter in patients with AA to predict their propensity to evolve into HMDS. SPF value may also be useful in the early diagnosis of HMDS before morphologically evidence of dysplasia is apparent.

Aplastic anemia (AA) has variable course and may transform in some patients into paraxysmal nocturnal hemoglobinuria (PNH), myelodysplasia (MDS), or acute myeloid leukemia (AML). Attempts are made to find out indicators that might suggest its future course in order to make prognostic and therapeutic decisions.A proportion of patients with AA may develop cytogenetic abnormalities in due course which may herald the conversion into MDS or AML. The objective of this study was to assess the role of S phase fraction (SPF) and aneuploidy in the early detection of clonal abnormalities in hemopoietic cells. The study group comprised of 30 patients with AA diagnosed on the basis of peripheral blood and bone marrow findings and 15 healthy controls. All patients were put on cyclosporin (3–5 mg/kg/d) as no one was able to afford either anti-thymocyte globulin or bone marrow transplantation. The patients were followed up periodically for the response to treatment, side effects, and the development of cytogenetic abnormalities. The SPF, aneuploidy, and cytogenetic studies were performed at the start of the study and after 6 months. Peripheral blood cells were stained with propidium iodide and analyzed for SPF and aneuploidy through flow cytometry using Modfit-LT software. Cytogenetic study was performed by conventional method using peripheral blood/bone marrow cells. The mean age of the patients was 26.8±12.4 years (range 13–58 yrs) and male to female ratio was 4 to 1. The most common clinical presentation was anemia. Other manifestations were bleeding and pyrexia. No etiological association could be made in any of these cases. Seven patients (23 %) had aneuploidy at the time of diagnosis whereas 3 patients (10%) developed aneuploidy at six months of follow up. The mean SPF value in the controls was 0.47±0.35%. No control subject had aneuploidy. The mean SPF in patients who did not show aneuploidy (n=20) was 0.53 ±0.01% and it was not significantly different from that of controls. The mean SPF value in patients (n=7) who had shown aneuploidy at the time of diagnosis was 3.91 ±0.24% and in patients (n=3) who later on developed aneuploidy was 7.17± 0.38%. The SPF values in both these groups were significantly higher (p= We suggest that the measurement of SPF and aneuploidy in patients with AA can be helpful in the prognostic assessment in terms of their propensity to develop dysplasia, cytogenetic abnormalities, or malignancy. Therefore patients with high SPF or aneuploidy may not be advised to undergo immunosuppressive therapy as they may more commonl;y develop into malignancy.