VOL. 4, NO. 4, 2019 by Nida Anwar
Research Article, Dec 2019
Medical errors (MEs) are flaws in implementation of act and failure of planning associated with p... more Medical errors (MEs) are flaws in implementation of act and failure of planning associated with patients. To avoid errors healthcare units are trying to make safer strategies that decrease morbidity and mortality due to MEs. The aim of this study was to evaluate errors and make strategies to avoid such errors in future.
Methods: A cross sectional study conducted at NIBD-PECHS campus Karachi, Pakistan. Approval was taken from institutional review board.
Data was collected from February 2018 to January 2019. Reporting form included variables like reporting month, location, department, classification, root cause, risk, action taken, financial burden and status. Analysis was done by using SPSS 23.0.
Results: A total of 42 MEs were reported at our hospital which were divided into four categories: patient care events 19 (45.2%), management events17 (40.5%), criminal events 3 (7.1%) and equipment error errors 3 (7.1%). Most of errors occurred in inpatient department 27 (64.2%) and nurses were responsible for 17 (40.5%) errors. In most of cases 23 (54.8%) root cause was staff negligence and to resolve this 22 (52.4%) verbal warnings were given. About 367.62USD (52,000PKR) were consumed to resolve the errors.
Conclusion: We concluded that reporting MEs is practical approach to give quality services to patients and facilitates in making new policies to reduce errors in future.
Papers by Nida Anwar
Cureus
Introduction The objective of the study was to assess the impact of coagulopathy in risk-stratifi... more Introduction The objective of the study was to assess the impact of coagulopathy in risk-stratified acute promyelocytic leukemia (APML) patients irrespective of bleeding manifestation. Patients and methods This was a cross-sectional study design conducted at the National Institute of Blood Diseases and Bone Marrow Transplantation (NIBD & BMT) from November 2019 to December 2021. A total of 62 patients between three years to 74 years of age of either gender and treatment-naive cases of APML were included in the study. Morphological diagnosis was made on bone marrow samples, and confirmation was done by karyotyping/fluorescence in situ hybridization (FISH) and/or polymerase chain reaction (PCR). Complete blood count (CBC), prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimer, and fibrinogen levels were done for bleeding risk assessment. Cases other than APML and cases on treatment were excluded from the study. Results A total of 85 APML patients were registered at our institute. Among them, 62 (73%) were included in the analysis as per the inclusion criteria of the study. The median age was 32 (3-74) years, with a male predominance of 34 (55%). According to the Sanz score, 18 (29%) patients were noted to have low risk; however, 22 (35.4%) patients were found to have an intermediate-risk disease and 22 (35.4%) patients had high-risk disease. There was positive bleeding history among 44 (71%) patients, followed by fever in 28 (45%) patients. Raised PT, APTT, and D-dimer were found in 46 (74%), 38 (61%), and 52(83.8%) patients, respectively. Low fibrinogen levels were observed among 16 (26%) patients. The association of risk stratification and bleeding history with CBC and coagulation parameters was observed. Platelet count and total leucocyte count were noted to be significantly associated with risk stratification. However, there was no association observed between the rest of the parameters with risk stratification and bleeding. Conclusion The results of our study suggest that regardless of bleeding symptoms, coagulation parameters must be investigated at the time of diagnosis in patients with suspected APML, and in addition to all-trans-retinoic acid (ATRA), transfusion of fresh frozen plasma should be done. It has clinical value, and adding it to the algorithm of treatment would be beneficial to the patients in the developing world, where resources are already meager.
Introduction
The objective of the study was to assess the impact of coagulopathy in risk-stratif... more Introduction
The objective of the study was to assess the impact of coagulopathy in risk-stratified acute promyelocytic leukemia (APML) patients irrespective of bleeding manifestation.
Patients and methods
This was a cross-sectional study design conducted at the National Institute of Blood Diseases and Bone Marrow Transplantation (NIBD & BMT) from November 2019 to December 2021. A total of 62 patients between three years to 74 years of age of either gender and treatment-naive cases of APML were included in the study. Morphological diagnosis was made on bone marrow samples, and confirmation was done by karyotyping/fluorescence in situ hybridization (FISH) and/or polymerase chain reaction (PCR). Complete blood count (CBC), prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimer, and fibrinogen levels were done for bleeding risk assessment. Cases other than APML and cases on treatment were excluded from the study.
Results
A total of 85 APML patients were registered at our institute. Among them, 62 (73%) were included in the analysis as per the inclusion criteria of the study. The median age was 32 (3-74) years, with a male predominance of 34 (55%). According to the Sanz score, 18 (29%) patients were noted to have low risk; however, 22 (35.4%) patients were found to have an intermediate-risk disease and 22 (35.4%) patients had high-risk disease. There was positive bleeding history among 44 (71%) patients, followed by fever in 28 (45%) patients. Raised PT, APTT, and D-dimer were found in 46 (74%), 38 (61%), and 52(83.8%) patients, respectively. Low fibrinogen levels were observed among 16 (26%) patients. The association of risk stratification and bleeding history with CBC and coagulation parameters was observed. Platelet count and total leucocyte count were noted to be significantly associated with risk stratification. However, there was no association observed between the rest of the parameters with risk stratification and bleeding.
Conclusion
The results of our study suggest that regardless of bleeding symptoms, coagulation parameters must be investigated at the time of diagnosis in patients with suspected APML, and in addition to all-trans-retinoic acid (ATRA), transfusion of fresh frozen plasma should be done. It has clinical value, and adding it to the algorithm of treatment would be beneficial to the patients in the developing world, where resources are already meager.
Case Report, Dec 1, 2019
Extensive fibrosis in myelodysplastic syndromes (MDS) is relatively infrequent and associated wit... more Extensive fibrosis in myelodysplastic syndromes (MDS) is relatively infrequent and associated with worst prognosis. It hasbeen classified as a specific entity by WHO. Moreover, the incidence and prevalence of Myelodyplastic Syndromes in children and adolescents is very low. Herein, we report a case of a 17 years old boy diagnosed as myelodysplastic syndrome with fibrosis along with ofmonosomy 7. Data pertaining relationship between myelodysplastic syndrome with fibrosis and karyotype abnormalities is relatively sparse. This case report will assist in considering better risk adapted therapies.
Chronic Myeloid Leukemia (CML) is a myeloproliferative neoplasm in which the major proliferative ... more Chronic Myeloid Leukemia (CML) is a myeloproliferative neoplasm in which the major proliferative component is comprised of granulocytes and is characterized by translocation of BCR-ABL and formation of Philadelphia (Ph) chromosome. Extreme thrombocytosis in chronic myeloid leukemia is rare and mimic essential thrombocythemia. Thus, chronic myeloid leukemia should be ruled out in patients who present with extreme thromobocytosis. A 28 years old female presented to us with abdominal discomfort, bleeding gums and hematuria. Her past medical history was unremarkable and there wasn’t any family history of bleeding disorder. On examination she had pallor and splenomegaly. Laboratory studies showed thrombocytosis with platelet count of 6420 x 10^9/L , moderate leucocytosis of 22.8 x 10^9/L along with low hemoglobin of 7.9 g/dL. Workup for acquired von willebrand disease was done which showed vWF: Ag 94%, vWF: Ricof 30%, FVIII 75%. Her cyto reduction with hydroxycarbamide 3g/day was started...
BMC Genomics
Background Myelodysplastic syndromes (MDS) are clonal disorders of hematopoietic stem cells exhib... more Background Myelodysplastic syndromes (MDS) are clonal disorders of hematopoietic stem cells exhibiting ineffective hematopoiesis and tendency for transformation into acute myeloid leukemia (AML). The available karyotyping and fluorescent in situ hybridization provide limited information on molecular abnormalities for diagnosis/prognosis of MDS. Next generation DNA sequencing (NGS), providing deep insights into molecular mechanisms being involved in pathophysiology, was employed to study MDS in Pakistani cohort. Patients and methods It was a descriptive cross-sectional study carried out at National institute of blood diseases and bone marrow transplant from 2016 to 2019. Total of 22 cases of MDS were included. Complete blood counts, bone marrow assessment and cytogenetic analysis was done. Patients were classified according to revised WHO classification 2016 and IPSS score was applied for risk stratification. Baseline blood samples were subjected to analysis by NGS using a panel of 5...
National Journal of Health Sciences, 2021
Abstract: Objective: Aplastic anemia (AA) is characterized by pancytopenia and hypocellular bone ... more Abstract: Objective: Aplastic anemia (AA) is characterized by pancytopenia and hypocellular bone marrow. Several factors like infections, toxins, chemotherapeutics and radiations are known causes for the suppression of hematopoietic cells which results in bone marrow failure but the exact etiology is unknown. The current study was conducted to assess the baseline demographics, laboratory and clinical characteristics of patients presenting with aplastic anemia and evaluate their cytogenetic profile. Materials and Methods: A retrospective cohort study conducted at National Institute of Blood Diseases and Bone Marrow Transplantation after approval by Institutional Ethics Committee. In this study, AA patients were enrolled from January 2010 to December 2018. Data collection included demographic, laboratory and clinical characteristics including age, gender, symptoms, treatment, and blood counts. Cytogenetic analysis was performed on bone marrow samples. Data analysis was done by using S...
Therapy related Acute Lymphoblastic Leukemia (t-ALL) is a rare secondary malignancy. It occurs in... more Therapy related Acute Lymphoblastic Leukemia (t-ALL) is a rare secondary malignancy. It occurs in patients who are exposed to chemotherapy and/or radiotherapy for primary malignancy. We are reporting here a case of a thirty five years old female patient who was referred to us for fever, malaise and bleeding from gums. She had a history of ovarian carcinoma for which she took carboplatin and other chemotherapeutic agents. Extensive workup was done which was consistent with the diagnosis of Precursor-B cell Acute Lymphoblastic Leukemia. In the context of previous history of exposure to carboplatin, she was diagnosed as a case of therapy related Acute Lymphoblastic Leukemia secondary to carboplatin.
JPMA. The Journal of the Pakistan Medical Association, 2021
The study was designed to investigate the quantity and reasons of wastage of blood products. This... more The study was designed to investigate the quantity and reasons of wastage of blood products. This was an observational study conducted from February 2018 to February 2019 at the National Institute of Blood Disease and Bone Marrow Transplantation (NIBD and BMT), PECHS campus. The study was approved by the institutional review board. Wastage and reasons of wastage for all the blood products were evaluated. Frequencies were calculated by using SPSS version 23.0. A total of 2,880 bags of blood products were available, including 960 each of platelets, packed red cells and fresh frozen plasma. The overall wastage rate was 3.5%. Packed red cells and platelets were fully consumed, yet shortage of supply was observed. However, highest wastage was observed in fresh frozen plasma i.e. 102 bags. Expiry of unused products 60 (59%) followed by broken bags 30 (29%) were two common modes of wastage. Wastage of blood products is a genuine issue in a hospital setup, strategies and plan of action shou...
International Journal of Laboratory Hematology, 2020
To assess the seasonal variations in hematological disorders among patients diagnosed on the basi... more To assess the seasonal variations in hematological disorders among patients diagnosed on the basis of bone marrow biopsy, who attended National Institute of Blood Diseases (NIBD) clinics during 2006 to 2015.
Background: Myelodysplastic syndromes (MDS) are clonal disorders of hematopoietic stem cells exhi... more Background: Myelodysplastic syndromes (MDS) are clonal disorders of hematopoietic stem cells exhibiting ineffective hematopoiesis and tendency for transformation into acute myeloid leukemia (AML). The available karyotyping and fluorescent in situ hybridization provide limited information on molecular abnormalities for diagnosis/prognosis of MDS. Next generation DNA sequencing (NGS), providing deep insights into molecular mechanisms being involved in pathophysiology, was employed to study MDS in Pakistani cohort.Patients and Methods: It was a descriptive cross-sectional study carried out at National institute of blood diseases and bone marrow transplant from 2016 to 2019. Total of 22 cases of MDS were included. Complete blood counts, bone marrow assessment and cytogenetic analysis was done. Patients were classified according to WHO classification 2016 and IPSS score was also calculated. Baseline blood samples were subjected to analysis by NGS using a panel of 54 genes associated with...
European Journal of Medical Research
Forensic Odontology or Forensic Dentistry is an important and well established Dental Specialty i... more Forensic Odontology or Forensic Dentistry is an important and well established Dental Specialty in the Advanced World and its formal teaching has existed for more than a century. Time has come for this to be introduced in Pakistan for all its Academic, Research and Practical reasons pertaining to Justice System & Crime. Its significance in terms of reporting, sharing scientific evidence, handling Crime is influenced by the people who are properly Qualified and trained as Forensic Odontologists and unfortunately we have none. As our society is rapidly changing, becoming more commercial & losing its cultural, ethical & human touch, therefore we feel it is high time for this neglected Dental Specialty to be given birth-introduced as we aim for National Paradigm Shift and share this Presentation.
Journal of the Pakistan Medical Association
Objectives: To evaluate the presence and characteristics of additional karyotype abnormalities in... more Objectives: To evaluate the presence and characteristics of additional karyotype abnormalities in chronic myeloid leukaemia cases. Method: The cross-sectional study was conducted at the Department of Cytogenetics and Molecular Pathology, National Institute of Blood Diseases and Bone Marrow Transplant, Karachi, from May 2010 to September 2016 and comprised diagnosed chronic myeloid leukaemiapatients regardless of age and gender.Baseline cytogenetic evaluation was done on overnight, 24-hrs un-stimulated and 72-hrs stimulated bone marrow cultures, and karyotypes were defined according to the International System for Human Cytogenetic Nomenclature2013. Data was analysed using SPSS 23. Results: There were 222 cases with a median age of 38 years (range: 12-84 years). The male-to-female ratio was 1.8:1. Chronic myeloid leukaemiawas detected in 18(8.1%) patients havingadditional cytogenetic abnormalities. Among the patients found positive, cytogenetic type was minor in 10(55.55%), major 3(1...
Pakistan Journal of Medical Sciences
Objective: We performed a prospective analysis at our center to find out the most common organism... more Objective: We performed a prospective analysis at our center to find out the most common organisms causing bacterial infections to establish pattern of antibiotic resistance, in order to combat febrile neutropenia effectively in the terms of outcome as well as cost. Methods: A hospital based observational study was conducted at National Institute of Blood Diseases and bone marrow transplantation from January 2017 to December 2017. Patients presented with absolute neutrophil count (ANC) of less than 500/ml were enrolled. Data were analyzed by SPSS version 21.0. P value of <0.05 was considered statistically significant. Results: In this study, a total of 242 patients from various hematological disorders were enrolled and 403 bacterial isolates were obtained. The most frequent isolated gram-negative organisms were Escherichia coli, followed by Klebsiella pneumoniae and the most prevalent gram-positive organisms were staphylococcus aureus and Enterococcus species. The antimicrobial s...
National Journal of Health Sciences
Extensive fibrosis in myelodysplastic syndromes (MDS) is relatively infrequent and associated wit... more Extensive fibrosis in myelodysplastic syndromes (MDS) is relatively infrequent and associated with worst prognosis. It hasbeen classified as a specific entity by WHO. Moreover, the incidence and prevalence of Myelodyplastic Syndromes in children and adolescents is very low. Herein, we report a case of a 17 years old boy diagnosed as myelodysplastic syndrome with fibrosis along with ofmonosomy 7. Data pertaining relationship between myelodysplastic syndrome with fibrosis and karyotype abnormalities is relatively sparse. This case report will assist in considering better risk adapted therapies.
National Journal of Health Sciences
Hemoglobin Q is one of the alpha chain variants resulting from structural changes in alpha 1 glob... more Hemoglobin Q is one of the alpha chain variants resulting from structural changes in alpha 1 globin gene. It is often heterozygous in form and clinically silent even in the presence of beta thalassemia trait in compound heterozygous form. We identified two Sindhi Hindu families with hemoglobin Q India, one is compound heterozygous for Hb Q India and thalassemia trait, while other has heterozygous Hb Q India variant. These samples were booked for routine hemoglobinopathy screening and the variant was suspected after finding an unknown peak at a retention time of 4.68 seconds, performed on high performance liquid chromatography(HPLC). For confirmation, these samples were sent for DNA analysis for the presence of suspected Hb Q India mutation, using amplification refractory mutation system (ARMS).
Case Report, Dec 1, 2019
Hemoglobin Q is one of the alpha chain variants resulting from structural changes in alpha 1 glob... more Hemoglobin Q is one of the alpha chain variants resulting from structural changes in alpha 1 globin gene. It is often heterozygous in form and clinically silent even in the presence of beta thalassemia trait in compound heterozygous form. We identified two Sindhi Hindu families with hemoglobin Q India, one is compound heterozygous for Hb Q India and thalassemia trait, while other has heterozygous Hb Q India variant. These samples were booked for routine hemoglobinopathy screening and the variant was suspected after finding an unknown peak at a retention time of 4.68 seconds, performed on high performance liquid chromatography(HPLC). For confirmation, these samples were sent for DNA analysis for the presence of suspected Hb Q India mutation, using amplification refractory mutation system (ARMS)
Case Report, Dec 1, 2019
Extensive fibrosis in myelodysplastic syndromes (MDS) is relatively infrequent and associated wit... more Extensive fibrosis in myelodysplastic syndromes (MDS) is relatively infrequent and associated with worst prognosis. It hasbeen classified as a specific entity by WHO. Moreover, the incidence and prevalence of Myelodyplastic Syndromes in children and adolescents is very low. Herein, we report a case of a 17 years old boy diagnosed as myelodysplastic syndrome with fibrosis along with ofmonosomy 7. Data pertaining relationship between myelodysplastic syndrome with fibrosis and karyotype abnormalities is relatively sparse. This case report will assist in considering better risk adapted therapies.
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VOL. 4, NO. 4, 2019 by Nida Anwar
Methods: A cross sectional study conducted at NIBD-PECHS campus Karachi, Pakistan. Approval was taken from institutional review board.
Data was collected from February 2018 to January 2019. Reporting form included variables like reporting month, location, department, classification, root cause, risk, action taken, financial burden and status. Analysis was done by using SPSS 23.0.
Results: A total of 42 MEs were reported at our hospital which were divided into four categories: patient care events 19 (45.2%), management events17 (40.5%), criminal events 3 (7.1%) and equipment error errors 3 (7.1%). Most of errors occurred in inpatient department 27 (64.2%) and nurses were responsible for 17 (40.5%) errors. In most of cases 23 (54.8%) root cause was staff negligence and to resolve this 22 (52.4%) verbal warnings were given. About 367.62USD (52,000PKR) were consumed to resolve the errors.
Conclusion: We concluded that reporting MEs is practical approach to give quality services to patients and facilitates in making new policies to reduce errors in future.
Papers by Nida Anwar
The objective of the study was to assess the impact of coagulopathy in risk-stratified acute promyelocytic leukemia (APML) patients irrespective of bleeding manifestation.
Patients and methods
This was a cross-sectional study design conducted at the National Institute of Blood Diseases and Bone Marrow Transplantation (NIBD & BMT) from November 2019 to December 2021. A total of 62 patients between three years to 74 years of age of either gender and treatment-naive cases of APML were included in the study. Morphological diagnosis was made on bone marrow samples, and confirmation was done by karyotyping/fluorescence in situ hybridization (FISH) and/or polymerase chain reaction (PCR). Complete blood count (CBC), prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimer, and fibrinogen levels were done for bleeding risk assessment. Cases other than APML and cases on treatment were excluded from the study.
Results
A total of 85 APML patients were registered at our institute. Among them, 62 (73%) were included in the analysis as per the inclusion criteria of the study. The median age was 32 (3-74) years, with a male predominance of 34 (55%). According to the Sanz score, 18 (29%) patients were noted to have low risk; however, 22 (35.4%) patients were found to have an intermediate-risk disease and 22 (35.4%) patients had high-risk disease. There was positive bleeding history among 44 (71%) patients, followed by fever in 28 (45%) patients. Raised PT, APTT, and D-dimer were found in 46 (74%), 38 (61%), and 52(83.8%) patients, respectively. Low fibrinogen levels were observed among 16 (26%) patients. The association of risk stratification and bleeding history with CBC and coagulation parameters was observed. Platelet count and total leucocyte count were noted to be significantly associated with risk stratification. However, there was no association observed between the rest of the parameters with risk stratification and bleeding.
Conclusion
The results of our study suggest that regardless of bleeding symptoms, coagulation parameters must be investigated at the time of diagnosis in patients with suspected APML, and in addition to all-trans-retinoic acid (ATRA), transfusion of fresh frozen plasma should be done. It has clinical value, and adding it to the algorithm of treatment would be beneficial to the patients in the developing world, where resources are already meager.
Methods: A cross sectional study conducted at NIBD-PECHS campus Karachi, Pakistan. Approval was taken from institutional review board.
Data was collected from February 2018 to January 2019. Reporting form included variables like reporting month, location, department, classification, root cause, risk, action taken, financial burden and status. Analysis was done by using SPSS 23.0.
Results: A total of 42 MEs were reported at our hospital which were divided into four categories: patient care events 19 (45.2%), management events17 (40.5%), criminal events 3 (7.1%) and equipment error errors 3 (7.1%). Most of errors occurred in inpatient department 27 (64.2%) and nurses were responsible for 17 (40.5%) errors. In most of cases 23 (54.8%) root cause was staff negligence and to resolve this 22 (52.4%) verbal warnings were given. About 367.62USD (52,000PKR) were consumed to resolve the errors.
Conclusion: We concluded that reporting MEs is practical approach to give quality services to patients and facilitates in making new policies to reduce errors in future.
The objective of the study was to assess the impact of coagulopathy in risk-stratified acute promyelocytic leukemia (APML) patients irrespective of bleeding manifestation.
Patients and methods
This was a cross-sectional study design conducted at the National Institute of Blood Diseases and Bone Marrow Transplantation (NIBD & BMT) from November 2019 to December 2021. A total of 62 patients between three years to 74 years of age of either gender and treatment-naive cases of APML were included in the study. Morphological diagnosis was made on bone marrow samples, and confirmation was done by karyotyping/fluorescence in situ hybridization (FISH) and/or polymerase chain reaction (PCR). Complete blood count (CBC), prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimer, and fibrinogen levels were done for bleeding risk assessment. Cases other than APML and cases on treatment were excluded from the study.
Results
A total of 85 APML patients were registered at our institute. Among them, 62 (73%) were included in the analysis as per the inclusion criteria of the study. The median age was 32 (3-74) years, with a male predominance of 34 (55%). According to the Sanz score, 18 (29%) patients were noted to have low risk; however, 22 (35.4%) patients were found to have an intermediate-risk disease and 22 (35.4%) patients had high-risk disease. There was positive bleeding history among 44 (71%) patients, followed by fever in 28 (45%) patients. Raised PT, APTT, and D-dimer were found in 46 (74%), 38 (61%), and 52(83.8%) patients, respectively. Low fibrinogen levels were observed among 16 (26%) patients. The association of risk stratification and bleeding history with CBC and coagulation parameters was observed. Platelet count and total leucocyte count were noted to be significantly associated with risk stratification. However, there was no association observed between the rest of the parameters with risk stratification and bleeding.
Conclusion
The results of our study suggest that regardless of bleeding symptoms, coagulation parameters must be investigated at the time of diagnosis in patients with suspected APML, and in addition to all-trans-retinoic acid (ATRA), transfusion of fresh frozen plasma should be done. It has clinical value, and adding it to the algorithm of treatment would be beneficial to the patients in the developing world, where resources are already meager.