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Introduction: HIV is the systemic illness known as acquired immune deficiency syndrome (AIDS). According to the report of World Health Organization, 33.2 million people has infected by Human Immunodeficiency Virus. Objective: To determine the frequency of neutropenia in HIV patients in tertiary care hospital. Material and method: The current study was Descriptive, cross sectional study. It was carried out in Hematology department, Hayatabad Medical Complex, Peshawa from 30/10/2018 to 30/4/2019. The demographic and clinical data of all patients including age, gender, occupation, residence, neutrophil count and HIV status were recorded on predesigned proforma. The study data was analyzed using SPSS version 17. Results: In our study, totally 114 patients were included. There were 71(62%) male patients and 43(38%) female patients in our study. Based on neutropenia status 17(15%) patients were observed with neutropenia whereas 97(85%) patients were not observed with neutropenia Conclusion: Our study concludes that the frequency of neutropenia was 15% in HIV patients in tertiary care hospital. Keywords: neutropenia, HIV, AIDS, Prevalence

Objectives: To assess the impact of lymphopenia on the COVID-19 disease outcome. Study Design: Retrospective study. Setting: ICU and Isolation Ward of Hayatabad Medical Complex, Peshawar. Period: July 2020 to Dec 2020. Material & Methods: Different parameters of CBC were performed using the five parts Sysmex differential hematology analyzer BS-1800. A total of 274 patients were included via non probability sampling. Relevant information’s were recorded on a pre-designed performa prepared in accordance with the objectives of the study. Results: The absolute lymphocyte count was lower in patients who were admitted in ICU as compared to those in isolation ward (p-value 0.07). Likewise patients with severe lymphocytopenia (lymphocyte count less than 0.5) had a greater rate of mortality (p value 0.01). No significant difference in term of TLC and ANC was noted in survivor’s vs non survivors groups in present study. Conclusion: Our study concludes that lymphopenia serves as a reliable and early prognostic factor in determining disease severity and mortality COVID-19.

Background: Anemia influences approximately 20 million people around the world mostly women and children. Megaloblastic anemia, a common cause of anemia caused by ineffective erythropoiesis, commonly manifested by peripheral blood cytopenia. Objective: To find out the frequency of megaloblastic anemia in pediatric patients presenting with peripheral cytopenia Methodology: This descriptive cross sectional study was carried out at the Department of Hematology, Hayatabad Medical Complex, Peshawar from 19 Feb, 2019 to 19 Aug, 2019. All the participants were selected based on inclusion criteria. Hematological profile was recorded for the entire participant. Automated hematology analyzer was used for all the blood counts. Data analysis was carried out by using IBM SPSS version 23. Results: Totally 175 patients were enrolled in our study. There were 117 (66.85%) males patients whereas female patients were 58 (33.14%). Based on age distribution, 65 (37.14%) patients were recorded in 5-10 years age group, 110 (62.85%) patients were recorded in 11-15 years age group. Mean and SDs for age was recorded as 12.3+3.19. Megaloblastic anemia was observed in 23 (13.14%) patients. Conclusion: Our study concludes that megaloblastic anemia is highly prevalent in pediatric patients presenting with peripheral cytopenia. Pancytopenia is a common condition in our pediatric patients caused by failure of bone marrow and leukemia. Keywords: Anemia, Bone Marrow, Megaloblastic, Pancytopenia

Introduction: Globally, the most prevalent hereditary hemoglobinopathy is thalassemia. Diabetes mellitus is a prevalent endocrine consequence in patients with thalassemia major, affecting 20-30% of patients Objective: To determine the frequency of diabetes mellitus in thalassemia major patients presenting at tertiary care hospital Methodology: Study design was descriptive cross sectional, conducted at Department of Hematology, Hayatabad Medical Complex, Peshawar for duration of six months from 13 January 2020 to 13 July 2020. In the current study a total of 193 patients presenting with thalassemia major were observed. Blood samples were taken and sent to hospital laboratory for the diagnosis of diabetes mellitus. All the collected information were entered and analyzed in statistical software SPSS version 22. Results: Among 193 participants, 133(69%) patients were in age group 5-11 years, 60(31%) patients were in age group 12-18 years with mean age of 7 years and SD of ± 4.86. Gender distribution was analyzed as 108(56%) patients were male while 85(44%) patients were female. Based on frequency of diabetes mellitus, 10(5%) patients were observed as diabetic while diabetes mellitus was not observed in 183(95%) patients of thalassemia. Conclusion: Our study concludes that the frequency of diabetes mellitus was high in thalassemia major patients in our population. In order to minimize endocrine disorders in Pakistan, there is a need of new policies and management strategies. Key words: Diabetes mellitus; Thalassemia major; Morbidity

Background & Objectives: COVID-19 has spread around the globe, and our country is no exception. We have been actively observing and managing these patients and have recorded the salient features including risk factors, the presenting complaints and also the trends of mortality.

Background and study aims: COVID-19 has spread around the globe in short span of time. We have been working as team to ‎observe the pandemic since it hits our country and have been observing the different demographic, ‎hematologic and inflammatory mediators that affect the outcome of the disease. To facilitate the ‎clinicians working in isolation‏ ‏units and COVID-ICU, we tried to determine the clinical sensitivity ‎of different hematological indices to predict the severity and mortality in COVID-19‎. Patients and Method: We did a cross sectional study covering 182 patients, 112(61.53%) males and 70(38.46%) females, ‎who were tested COVID-19 positive in two tertiary care hospitals of Khyber Pukhtunkhwa (Qazi ‎Hussain Ahmed Medical Complex Nowshera & Hayatabad Medical Complex Peshawar). Hematological markers were assessed for their diagnostic and prognostic values. ‎Independent t-test was used in groups with different outcome (discharged satisfactorily vs expired) ‎regarding hemoglobin concentration, neutrophil to lymphocyte ratio (NLR), absolute neutrophilic ‎count (ANC) and platelet count.‎ Receiver operating characteristics (ROC) curve was used as statistical tool to determine the ‎relationship of clinical sensitivity and specificity of different hematological indicators to predict the ‎worst outcome in COVID-19‎‎. Results: A statistically significant difference (p 7.2k (75.9%), ‎ANC >3.9% (86.2%), ALC 1.8 (93.1%) and PLT

Objectives: To determine the variation of d-dimers in COVID-19. To determine the contribution of demographic factors (age and gender) toward an elevated d-dimers values. To determine the probability of surviving in different age groups in COVID-19, with d-dimer > 0.5 µg/ml. Methodology: A total of 193 patients were enrolled from COVID-19 isolation units, Hayatabad medical complex Peshawar, whose d-dimer levels were performed as per instructions of the treating physician and were followed. Relevant information’s were recorded on a pre-designed performa prepared in accordance with the objectives of the study. Results: Out of total 193 patients 152(78.8%) were males and 41(21.2%) females. 94(48.7%) patients were in the age range 35-55 y while 76(39.4%) patients had age more than 55 y. Regarding d-dimer readings, 162(83.9%) had d-dimer levels more than 0.5 µg/ml. The mean with standard deviation of age of the patients was 52 ± 13 y. The mean with standard deviation of d-dimer values of the patients was 4.9 ± 13.3 µg/ml. It was observed that, the relative risk of deranged values of d-dimers was 1.18 (rr = 1.18) in patients with age > 55 y. Similarly in female gender the relative risk of higher values of d-dimers above normal was 1.26 (rr = 1.26) without reaching a statistically significant p-value (p = 0.48). The probability of worse outcome in term of death was 2.06 times more in patients with d dimers > 0.5 µg/ml (OR = 2.06). Furthermore the probability of surviving was 90-100% by age < 50 y, 80% in age range 51-60 y, 45% in age range 61-70 y and 30% at age > 80 y. Conclusion: The deranged d-dimer levels were noted in 84% of the COVID-19 patients. Age > 55 y and female gender are at higher risk of deranged d-dimers and further consequences. Survival rate of patients with deranged d-dimers drops to 30% in patients with age > 80 y, 45% at age < 70 y. Key word: COVID-19, D-dimers, survival rate, prognostic values Anaesth. pain intensive care 2020;24(5): Received: 20 June 2020, Reviewed: 24, 28 June 2020, Accepted: 1 July 2020

Corona Virus disease termed as COVID-19, is an emerging highly contagious respiratory disease that is caused by novel corona virus. Its main clinical symptoms are fever, dry cough, fatigue, myalgia and dyspnea. In Pakistan, the literature so far covering the prevalence and incidence is deficient. By24thJuly 2020, reported data from government sources declares 270,400 confirmed cases with 5763 deaths. 219783 cases are recovered and 1316 cases are under treatment in high dependency units countrywide. Sindh is the province with highest number of corona cases crossing 115883. Gender and age matters when there is talk about the prognosis and outcome of the disease. A study reported that corona virus is striking and felling more Italian males as compared to females in extreme of age because of their weak immunity status. They further elaborated that Italian model of mortality is a trend mirror of what they observed in China with more causality in male gender and at extreme age. Using the Kaplan Meir test we analyzed the 32 deceased data from our hospital named Qazi Hussain Ahmed Medical Complex Nowshera and district line list for a number of variables including the impact of gender and comparing the survival capabilities of both genders simultaneously infected with COVID-19. We observed that male gender that have contracted COVID-19 in their extreme ages offering less resistance to the virus with poor survival rate as compared to the female’s gender where the surviving capabilities for unknown reasons are stronger than those in male gender (Figure 1). Many factors can contribute including low viral load because of less exposure as compared to the male gender in our religious society. Similarly, there could be some un-discovered immune predominance in female gender that confers more imm

Background: Hepatitis B infection has an intimate relationship with lipids. The role of lipid-related variants remains unknown in the risk of hepatitis B infection persistence and steatosis in the Pakistani population. Recently, three GWAS-based polymorphisms in the TM6SF2, PNPLA3, and MBOAT7 genes have suggested being associated with steatosis and/or liver injury. However, the role of these variants is unknown in Hepatitis B virus (HBV) persistence and steatosis in the Pakistani population. Objectives: We determined whether TM6SF2, PNPLA3, and MBOAT7 genetic variations are associated with HBV chronicity and hepatic steatosis in the Pakistani population. Methods: A total of 297 patients visiting the Hayat Abad Medical Complex in Peshawar were included in this study. Clinical analysis, along with genotyping of SNPs in the PNPLA3, TM6SF2, and MBOAT genes, was performed using the TaqMan genotyping assay. Logistic regression analysis, along with other tests as appropriate, was used to determine the association of the analyzed SNPs with HBV persistence, chronicity, and hepatic steatosis in the analyzed set of patients. Results: In 297 subjects (240 HBV patients and 57 healthy controls), PNPLA3 rs738409 (OR: 0.43, 95% CI: 0.23 - 0.81, P = 0.009) and TM6SF2 rs58542926 (P = 0.018) genotypes were independently associated with the risk of chronic HBV infection, but not MBOAT rs641738 (OR: 1.3, 95% CI: 0.64 - 2.62, P = 0.454). We also observed that the PNPLA3 rs738409 GG genotype was associated with 2.97-fold and TM6SF2 rs58542926 genotype T allele with 1.54-fold increased risk of steatosis. Conclusions: PNPLA3 rs738409 and TM6SF2 rs58542926, but not MBOAT rs641738, were the risk variants for HBV persistence and steatosis in the Pakistani population.

To identify the co-existence of iron deficiency and iron overload in individuals with beta thalassaemia trait.The cross-sectional study was conducted at Rehman Medical Institute and Khyber Medical University, Peshawar, Pakistan, September 1, 2015, to December 31, 2017, and comprised individuals with hypochromic microcytic blood picture. Haemoglobin electrophoresis was performed on their blood samples. Serum ferritin levels of subjects with Haemoglobin Subunit Alpha 2 levels between 3.5% and 7% were checked. Data were analysed using analysed using GraphPad Prism v6.Of the 292 subjects, 159(54.5%) were males and 133(45.5%) were females. Of these, 240 (82.2%) were anaemic and 52 (17.8%) had haemoglobin within the normal range. Serum ferritin level of 55(18.8%) subjects was low and 207(70.9%) were iron-replete. Notably, 30(10.3%) subjects had serum ferritin levels higher than the reference range, and this was more common among adults (p0.001).Ferritin levels in beta thalassaemia trait can be low, normal or higher than the normal values..

Background and study aims Host genetic modifiers of the risk and persistence of hepatitis B virus (HBV) infection in the Pakistani population have not been clearly elucidated. Recently, two genome-wide association studies described that STAT4 and IFNL3 variants are associated with different aspects of the course of HBV infection. However, the roles of these variants in the persistence of HBV infection have not been investigated in the HBV-infected population of Pakistan. Therefore, we examined the roles of the STAT4 and IFNL3 variants in a chronic HBV-infected population from the Khyber Pakhtunkhwa (KPK) region of Pakistan. Patients and methods STAT4 rs7574865 and IFNL3 rs12979860 genotyping were performed in 297 subjects (240 infected with HBV and 57 controls). Statistical analyses were performed using the chi-squared test, Student’s t-test, Hardy–Weinberg equilibrium tests and logistic regression models. Results Among the 297 subjects, compared with the IFNL3 rs12979860 genotype [odds ratio (OR) = 0.7, 95% confidence interval (CI) = 0.39–1.29, p = 0.2), the STAT4 rs7574865 genotype was independently associated with the risk of developing chronic HBV infection [OR = 1.9, 95% CI = 1.09–3.50, p = 0.02]. Conclusion The STAT4 rs7574865 and not the IFNL3 rs12979860 variant is associated with persistence of HBV infection in a Pakistani population from the KPK region.

Background: Khyber Pakhtoonkhwa and Afghanistan located in South Central Asia which is most prevalent area for childhood leukemia. In this region, no previous data or study was available on estimated cases per year of different types of childhood leukemia. The aim of the present study is to evaluate the frequency of different types of childhood leukemia in the children from different districts of Khyber Pakhtoonkhwa (KP) and Afghanistan presenting to Hayat Abad Medical Complex Hospital, Peshawar. Methods: This descriptive cross-sectional study was conducted in pathology department Hayat Abad Medical Complex hospital, Peshawar, Pakistan. Duration of the present study was, from January 2014 to December 2016. A total number of 605 children were enrolled up to 15 years of age, who were suspected to have leukemia, went through bone marrow examination. 3 ml blood was collected in EDTA tube (purple top) and complete blood count was prepared by hematology analyzer (Ruby cell dyne, Abbott, USA). By aseptic techniques bone marrow aspiration and bone marrow trephine biopsy samples were collected from all patients. Slides were papered from Bone marrow aspirates, fixed with methanol and stained with Giemsa, myeloperoxidase and periodic acid Schiff stain. Trephine biopsy slides were stained by Hematoxylene and Eosin and Reticulin stain. Immunohistochemistry was done after initially examining bone marrow aspirate slides. All data was documented and statistical analysis was performed by SPSS-20 software. Findings: Among 605 children suspected to have leukemia, 281 (46.5%) children were diagnosed with different types of childhood leukemia. Out of 281 diagnosed patients, 231(82.2%) were Pakistani children and rest of the 50 (17.8%) were Afghani children. The studied population consist of 173(61.6%) males and 108(38.4) females. Their age ranged from 3 months to 15 years with median age of 9.8 years. Out of 281 cases, 210 (74.73%) were diagnosed to have acute lymphoblastic leukemia and rest of the children were 62 (22.06%) acute myeloid leukemia, 7 (2.44%) chronic myeloid leukemia, 2 (0.71%) had Juvenile Chronic Myelomonocytic Leukemia (JMML) and 1 (0.35%) child was report with Chronic Myelomonocytic leukemia (CMML). There was no significant differences seen in prevalence among Afghan children and Pakistani children except ALL, which is more frequent in Afghan children compared to Pakistani children and no single case of CMML, were diagnosed in Afghan children. Conclusion: In the present study, acute lymphoblastic leukemia is most frequent leukemia in the children of Khyber Pakhtoonkhwa and Afghanistan. Juvenile chronic Myelomonocytic leukemia is found the less common leukemia in the present study.

Beta-Thalassaemia syndromes are a group of hereditary disorders characterised by a genetic deficiency in the synthesis of beta-globin chains due to a defect in beta-globin genes. The objective of this study was to determine the haematological features of beta-thalassaemia trait (BTT). and to determine the sensitivity of Mean Corpuscular Volume (MCV), Mean Corpuscular Haemoglobin (MCH) and Mentzer Index (ML) as a screening tool for beta-thalassaemia trait.A descriptive study was conducted in Hayatabad Medical Complex, Peshawar from May 2009 to May 2010 with 203 subjects having BTT. Blood samples were collected in EDTA anti-coagulated tubes. RBC indices were taken as part of complete blood count (CBC) by haematology analyser, and Haemoglobin (Hb) electrophoresis was done to determine the HbA2 percentage. The data was collected and analysed on statistical software for demographic details, RBC indices and HbA2 levels.Out of 203 patients, 92 (45%) were males and 111 (55%) were females. Most patients tested were in the 15-45 year age group. One-hundred-sixty (79%) patients had anaemia. MCV was lower than 76 fl in all the cases. Mean MCV was 59.1 fl. MCH was low, the mean MCH being 19.3 g/dl. MCH26 gave sensitivity of 99% in detecting BTT. We calculated MI for these cases and found out that it was12 in 75% of cases and15 in 197 (97%).Beta-thalassaemia traits present with a microcytic hypochromic blood picture, detected on simple haematology analysers as low MCV and MCH and MI which provide a useful screening tool for beta-thalassaemia trait.