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   2015| January-April  | Volume 5 | Issue 1  
    Online since January 13, 2015

 
 
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ORIGINAL ARTICLES
A comparative study of serum aminotransferases in chronic kidney disease with and without end-stage renal disease: Need for new reference ranges
Lopamudra Ray, Sunil Kumar Nanda, Anirban Chatterjee, Rajlaxmi Sarangi, Satyaki Ganguly
January-April 2015, 5(1):31-35
DOI:10.4103/2229-516X.149232  PMID:25664265
Background: Hepatic diseases are common among chronic kidney disease patients and liver function tests particularly serum liver enzymes play an important role in diagnosing and monitoring these patients. Serum aminotransferase levels commonly fall near the lower end of the range of the normal values in patients of chronic kidney disease (CKD). High-levels of serum alkaline phosphatase (ALP) can occur in these patients due to renal osteodystrophy. Thus, the recognition of liver damage in these patients is challenging. Aim: To compare the levels of serum aspartate aminotransferase (AST), alanine aminotransferase (ALT) and ALP among three groups - CKD patients without end stage renal disease (ESRD), patients with ESRD and healthy controls. Materials and Methods: A retrospective, hospital-based study was carried out from 100 patients' records from each group and serum AST, ALT and ALP values were noted. Results: Our study showed that serum AST and ALT levels were significantly lower in CKD patients both without and with ESRD compared to controls. Further, these two enzyme levels were also significantly lower in CKD patients with ESRD compared to CKD patients without the condition. Serum ALP levels were significantly higher in patients with and without ESRD as compared to the controls. However, the values did not differ significantly between patients with and without ESRD. Conclusion: Levels of serum aminotransferases were low in CKD with and without ESRD and the levels become lower as the severity of CKD increases. Thus, the study established the need for separate reference ranges of serum aminotransferase in different stages of CKD.
  5,220 536 11
CASE REPORTS
Unusual case of focal neck swelling: Phlebectasia of internal jugular vein with intracranial extension
Virender Malik, Abha Kumari, TVSP Murthy
January-April 2015, 5(1):58-60
DOI:10.4103/2229-516X.149247  PMID:25664271
Internal jugular vein (IJV) phlebectasia is rare in occurrence and is frequently misdiagnosed and managed inappropriately. It commonly presents as a unilateral neck swelling which typically increases in size with valsalva maneuver. Although, the most common cause of a focal neck swelling, which increases in size with valsalva maneuver is laryngocele, the possibility of phlebectasia of IJV should always be borne in mind, especially in child. Owing to the rarity of this condition, a high index of suspicion is required to recognize the same and managed appropriately. We present a case of phlebectasia of the right IJV with intracranial extension and discuss its management. The case is being reported in view of its clinical rarity (the intracranial extension being extremely rare) and to highlight the available management strategies.
  5,436 315 5
ORIGINAL ARTICLES
Prevalence of vitamin D deficiency in north-west Punjab population: A cross-sectional study
Rachna Bachhel, Navyug Raj Singh, Jagtesh Singh Sidhu
January-April 2015, 5(1):7-11
DOI:10.4103/2229-516X.149220  PMID:25664260
Background: Many studies show a high prevalence of vitamin D deficiency across various populations the world over. There is relative lack of prevalence data in Punjab, India. This cross-sectional study was carried out to assess the prevalence of vitamin D deficiency in the north-west Punjab population. Aim: To study the prevalence of vitamin D deficiency in the north-west Punjab population across various population characteristics such as gender, education, locality, occupation, and dietary habits. Materials and Methods: Healthy volunteers (N = 150) of either sex were enrolled and their fasting plasma samples tested for 25-hydroxy vitamin D [25(OH) D] levels. Data were compiled as percentages and means across different population characteristics. Statistical analysis was done using Chi-square test and Fisher's exact test. Results: A high overall prevalence (90%) of vitamin D deficiency was observed in the study subjects. There was a significant difference in the prevalence of vitamin D insufficiency between rural and urban subjects (P < 0.05) and among the subjects pursuing different occupations (P < 0.001). A significant gender-specific difference was also recorded at the cut-off level of 25 (OH) D, with women showing higher prevalence of deficiency compared to men (P < 0.05). Conclusions: There is a high prevalence of vitamin D deficiency in the population of Punjab. Lower prevalence is displayed by those subjects who have greater opportunities for sunlight exposure, such as like rural individuals, farmers, and housewives.
  3,400 621 6
Ferric carboxymaltose: A revolution in the treatment of postpartum anemia in Indian women
Setu Rathod, Sunil K Samal, Purna C Mahapatra, Sunita Samal
January-April 2015, 5(1):25-30
DOI:10.4103/2229-516X.149230  PMID:25664264
Objectives: The objective of the present study is to compare the safety and efficacy of ferric carboxymaltose (FCM), intravenous (IV) iron sucrose and oral iron in the treatment of post = partum anemia (PPA). Materials and Methods: A total of 366 women admitted to SCB Medical College, Cuttack between September 2010 and August 2012 suffering from PPA hemoglobin (Hb) <10 g/dL were randomly assigned to receive either oral iron or IV FCM or iron sucrose. FCM, IV iron sucrose, and oral iron were given as per the protocol. Changes in hemoglobin (Hb) and serum ferritin levels at 2 and 6 weeks after treatment were measured and analyzed using ANOVA. Adverse effects to drug administration were also recorded. Results: A statistically significant increase in Hb and serum ferritin level were observed in all three groups, but the increase in FCM group was significantly higher (P < 0.0001) than conventional iron sucrose and oral iron group. The mean increase in Hb after 2 weeks was 0.8, 2.4, and 3.2 g/dL and 2.1, 3.4, and 4.4 g/dL at 6 weeks in oral iron, iron sucrose and FCM groups, respectively. The mean increase in serum ferritin levels after 2 weeks was 2.5, 193.1, and 307.1 and 14.2, 64, and 106.7 ng/mL after 6 weeks in oral iron, iron sucrose and FCM groups, respectively. Adverse drug reactions were significantly less (P < 0.001) in FCM group when compared with other two groups. Conclusion: Ferric carboxymaltose elevates Hb level and restores iron stores faster than IV iron sucrose and oral iron, without any severe adverse reactions. There was better overall satisfaction reported by the patients who received FCM treatment.
  3,181 602 12
EDUCATIONAL FORUM
Relationship between periodontal diseases and preterm birth: Recent epidemiological and biological data
Moneet Walia, Navdeep Saini
January-April 2015, 5(1):2-6
DOI:10.4103/2229-516X.149217  PMID:25664259
Preterm infants are born prior to completion of 37 weeks of gestation. These patients are seen on the rise despite the efforts put in to control them. Global incidence of preterm birth is around 9.6% of all birth representing 12.9 million births with regional disparities: From 12% to 13% in USA, from 5% to 9% in Europe, and 18% in Africa. First reported by Offenbacher et al. in 1996 relationship exist between maternal periodontal disease and delivery of a preterm infant. This article reviews the recent epidemiological and biological data. The articles were searched on Google, PubMed recent articles were selected. Mainly, three hypotheses by which periodontal bacteria can affect the outcome of pregnancy. Biological hypothesis: (a) Bacterial spreading, (b) Inflammatory products dissemination, (c) Role of fetomaternal immune response against oral pathogens. The promotion of the early detection and treatments of periodontal disease in young women before and during pregnancy will be beneficial especially for women at risk.
  2,824 578 6
CASE REPORTS
Elder homicide by unique combination of different mechanisms of asphyxia
Parthasarathi Pramanik
January-April 2015, 5(1):61-64
DOI:10.4103/2229-516X.149249  PMID:25664272
Elder homicide is a fatal outcome of elder abuse and neglect. Multifactorial homicidal asphyxia in an elderly man by combination of three different mechanisms is an uncommon incident. This following case demonstrates a very unusual murder of 74-year-old man in his own residence. Crime scene visit and postmortem examination revealed that the victim was killed by combined effect of ligature strangulation, traumatic asphyxia and smothering by plastic bag.
  3,060 248 -
Leukemic gingival enlargement: Report of a rare case with review of literature
Shamimul Hasan, Nabeel Ishrat Khan, L Bhaskar Reddy
January-April 2015, 5(1):65-67
DOI:10.4103/2229-516X.149251  PMID:25664273
Oral cavity functions as an early indicator for a variety of systemic diseases. Early and accurate diagnosis of these underlying systemic disorders entails thorough examination of the oral mucosa, gingiva, teeth, tongue and other oral tissues. Although gingival changes may be related to local factors in the oral cavity, it can also be an expression of systemic conditions such as blood dyscrasias, endocrinal imbalance, and nutritional deficiencies. Leukemia, a malignancy of white blood cells is a dreadful disease, which, if not diagnosed properly and treated early may result in significant morbidity and mortality. Oral changes may be the first and only presenting signs in leukemic patients. This paper aims to throw light on an interesting case of acute leukemia diagnosed on the basis of oral signs and emphasizes the importance of thorough oral examination to identify the threatening condition.
  2,701 395 2
ORIGINAL ARTICLES
Laparohysteroscopy in female infertility: A diagnostic cum therapeutic tool in Indian setting
Suman Puri, Dinesh Jain, Sandeep Puri, Sandeep Kaushal, Satjeet Kaur Deol
January-April 2015, 5(1):46-48
DOI:10.4103/2229-516X.149240  PMID:25664268
Aims: To evaluate the role of laparohysteroscopy in female infertility andto study the effect of therapeutic procedures in achieving fertility. Settings and Design: Patients with female infertility presenting to outpatient Department of Obstetrics and Gynecology were evaluated over a period of 18 months. Materials and Methods: Fifty consenting subjects excluding male factor infertility with normal hormonal profile and no contraindication to laparoscopy were subject to diagnostic laparoscopy and hysteroscopy. Statistical Analysis Used: T-test. Results: We studied 50 patients comprising of 24 (48%) cases of primary infertility and 26 (52%) patients of secondary infertility. The average age of active married life for 50 patients was between 8 and 9 years. In our study, the most commonly found pathologies were PCOD, endometroisis and tubal blockage. 11 (28.2) patients conceived after laparohysteroscopy followed by artificial reproductive techniques. Conclusions: This study demonstrates the benefit of laparohysteroscopy for diagnosis and as a therapeutic tool in patients with primary and secondary infertility. We were able to achieve a higher conception rate of 28.2%.
  2,600 315 3
Gastroprotective effect of methanolic extract of Gomphrena celosioides on indomethacin induced gastric ulcer in Wistar albino rats
Ige Janet Oluwabunmi, Tijani Abiola
January-April 2015, 5(1):41-45
DOI:10.4103/2229-516X.149238  PMID:25664267
Context: Gastric ulcer is one of the most prevalent gastrointestinal disorders. A number of studies have been carried out to determine the efficacy of herbal medicines in the treatment of gastric ulcer. Objectives: The present study was undertaken to evaluate the anti-ulcerogenic activity of methanol extract of Gomphrena celosioides (GC) in male Wistar rats. Materials and Methods: The rats were divided into eight groups, methanol extract of GC was administered orally, for seven consecutive to five groups. On the 7 th day, indomethacin was administered to induce gastric ulceration. Gastric secretions were collected and analyzed. Results: Animals pretreated with GC extract showed a significant reduction in ulcer score, ulcer index, gastric volume, and gastric total acidity in indomethacin-induced ulcer models in a dose dependent manner when compared to the ulcerated control group. Conclusion: The study revealed gastroprotective activity of the extract in dose-dependent manner. Methanol extract of the leaves of GC was significantly effective in protecting the gastric mucosa against indomethacin-induced ulcers at all the dose level studied.
  2,198 323 6
Tibial cortical thickness: A dependable tool for assessing osteoporosis in the absence of dual energy X-ray absorptiopmetry
Mir Sadat-Ali, Ezzat Elshaboury, Abdallah S Al-Omran, Md. Quamar Azam, Anjum Syed, Abid Hussain Gullenpet
January-April 2015, 5(1):21-24
DOI:10.4103/2229-516X.149228  PMID:25664263
Background and Objective: Bone mineral density measurements with absorptiometry dual-energy X-ray absorptiometry (DXA) is the gold standard for diagnosing low bone mass and risk for fragility fractures. DXA is not available at every center, and physicians require an alternative method of diagnosis before referring patients. We conducted this study to assess and compare total cortical thickness (TCT) and its relation to the T score by DXA and its correlation-ship in the diagnosis of osteoporosis. Patients and Methods: Total cortical thickness was carried out in 50 Saudi Arabian females ≥ 45 years with DXA scans and 25 patients with age of ≤ 35 years whose radiographs of the upper tibia were available for analysis. Postero-medial cortical thickness of the tibia was measured 13 cm from the joint line and an average was calculated. The average T score of the spine and the hip was taken. A comparison was made between age, T score, and the TCT. Inter cortical distance (ICD) was measured and compared in both groups. Data were analyzed for predictive value for diagnosis of osteopenia and osteoporosis. Results: There was a significant association between the T score and the TCT and age. As the age advanced the T score and TCT was very low (<0.05, 95% confidence interval [CI] <0.2). Forty patients were osteopenic and 10 osteoporotic. The T score in the former was – 1.33 ± 0.71 and the later was – 3.22 ± 0.56 (P < 0.0001 95% CI: <–1.67) and the TCT was 0.655 ± 0.06 versus 0.51 ± 0.05 (P < 0.0001 95% CI: <–0.17). In women ≤35 years the average TCT was 0.804 ± 0.155 cm and IMD was 3.34 ± 0.45 cm. Conclusions: We conclude that if TCT is less than the threshold value of ≤ 0.5 cm, patients should be referred for further investigations with DXA. We believe that further studies are needed to confirm our findings and in areas where DXA is not available, based on the TCT measurement anti-osteoporotic therapy could be initiated when other risk factors for osteoporosis is present.
  2,193 280 4
CASE REPORTS
Bardet-Biedl syndrome: A rare cause of end stage renal disease
R Hemachandar
January-April 2015, 5(1):70-72
DOI:10.4103/2229-516X.149254  PMID:25664275
Bardet-Biedl syndrome is a rare autosomal recessive disorder, recently categorized as ciliopathy characterized by dysfunction of primary cilia which results in myriad manifestations in various organ systems. Though renal abnormalities can occur in this syndrome, renal failure is a rare presentation. The author reports a case of 18-year-old female who presented with polydactyly, obesity, retinitis pigmentosa, learning disability and renal failure.
  2,218 240 1
BRIEF COMMUNICATION
Obinutuzumab: A FDA approved monoclonal antibody in the treatment of untreated chronic lymphocytic leukemia
Mamta Sachdeva, Sameer Dhingra
January-April 2015, 5(1):54-57
DOI:10.4103/2229-516X.149245  PMID:25664270
Chronic lymphocytic leukemia (CLL) is an adult lymphoid malignancy with a variable clinical course. There is considerable interest in the identification of new treatments, as most current approaches are not curative. While most patients respond to initial chemotherapy, relapsed disease is often resistant to the drugs commonly used in CLL and patients are left with limited therapeutic options. Obinutuzumab is recently approved in combination with chlorambucil for people with previously untreated CLL and is additionally being investigated in a large clinical program, including multiple head-to-head phase III studies compared with Rituxan in indolent non-Hodgkin's lymphoma and diffuse large B-cell lymphoma. In this article, author has made an attempt to review the therapeutic profile of this newly approved monoclonal antibody in the treatment of CLL.
  2,045 367 6
ORIGINAL ARTICLES
Hepatitis B virus seroprevalence and its correlation with CD4 cells and liver enzymes among human immunodeficiency virus positive individuals at a tertiary care hospital in North-West India
Saroj Hooja, Anita Singhal, Rekha Bachhiwal, Rajiv Yadav, Nitya Vyas
January-April 2015, 5(1):36-40
DOI:10.4103/2229-516X.149235  PMID:25664266
Background: Human immunodeficiency virus (HIV) and hepatitis B virus (HBV) are global health concerns. Due to shared routes of transmission, co-infection is common. Their co-existence can cause severe liver complications and immunological impairment in infected individuals. Aim: To find the prevalence of HBV co-infection in HIV patients and to assess the pattern of liver enzymes and CD4 T-cell counts in HIV monoinfected and HIV/HBV co-infected patients. Materials and Methods: A total of 342 consecutive confirmed HIV positive treatment naοve patients were tested for hepatitis B surface antigen (HBsAg). Clinical staging was done according to Centers for Disease Control and Prevention classification guidelines. Liver function tests were performed by an autoanalyser. CD4 T-cells were estimated by FACS Calibur. Results: Hepatitis B virus co-infection was detected in 8.7% of HIV positive patients as compared to 1.42% in the HIV negative control group (P < 0.05). Majority of the HIV monoinfected and co-infected patients were below 38 years. HBsAg positivity was higher in males (9.4%) and the route of transmission was heterosexual. Categorical data revealed significantly higher proportion of alanine aminotransferase and aspartate aminotransferase (AST) in the co-infected patients compared to the monoinfected patients (P < 0.05). The HIV/HBV co-infected patients had significantly lower CD4 T-cell counts (P = 0.03) and significantly higher AST, alkaline phosphatase and serum bilirubin values (P = 0.023, P = 0.029, P = 0.009 respectively) than the monoinfected group. Males had 1.33 times higher risk than females for co-infection (odds ratio = 1.33; 95% confidence interval 0.57-3.10). Conclusion: The prevalence of co-infection was high. Raised levels of liver enzymes and lowered CD4 counts were seen in co-infected patients. These findings underscore the importance of HBV screening of all HIV positive individuals before initiating antiretroviral treatment.
  1,859 271 1
Improvement in nutrient handling in STZ induced diabetic rats treated with Ocimum gratissimum
Uduak Akpan Okon, Koofreh Godwin Davies, Titilope Helen Olubobokun
January-April 2015, 5(1):49-53
DOI:10.4103/2229-516X.149242  PMID:25664269
Objective: Alteration in digestive and absorptive enzymatic activities has been reported in diabetes mellitus (DM), but not with Ocimum gratissimum (OG) treatment. This study was, therefore, designed to indirectly assess the effect of DM and treatment with OG on nutrient digestion and absorption, through estimation of their fecal excretion. Materials and Methods: Animals were randomly assigned into three groups of six per group for control, DM and diabetic mellitus treated (DMT). Diabetes was induced by single intraperitoneal injection of 65 mg/kg streptozotocin in the test groups. OG was administered to the DMT group at dose of 1500 mg/kg once daily for 28 days. Fecal glucose, protein and cholesterol were determined. Results: Fecal glucose was significantly (P < 0.001) lower in the DM group compared to the control and DMT groups, with the DMT groups significantly (P < 0.001) lower than the control. Fecal protein was significantly (P < 0.001) lower in the DM group than the control whereas it was significantly lower in the DMT groups than the DM. Fecal cholesterol was significantly (P < 0.001) higher in the DM than the DMT and control groups with DMT significantly (P < 0.01) higher than the control. Conclusion: This result indicates the propensity of OG to reverse impairment of nutrient digestion and absorption in DM.
  1,863 252 -
Assessment of aerobic capacity in overweight young females: A cross-sectional study
Shaikh M Shazia, Khaled M Badaam, Deepmala N Deore
January-April 2015, 5(1):18-20
DOI:10.4103/2229-516X.149224  PMID:25664262
Context: Overweight / obese people are prone to develop cardiovascular, respiratory and other chronic diseases at young age because of abnormal weight. Aerobic capacity (VO 2 max) is an accepted index of cardio respiratory fitness. Decrease in VO 2 max can be an early marker for altered cardiovascular physiology. Objectives: The present study was carried out with the objective of evaluating aerobic capacity in overweight young females and comparing it with that of normal weight females. Materials and Methods: Twenty-three female subjects aged 18-20 years were enrolled in each group. Group 1 comprised overweight subjects and group 2 comprised normal weight subjects. Analysis to assess the difference in VO 2 max between the groups was done by unpaired t-test. Results: Mean age of group 1 and 2 was 18.91 ± 0.67 years and 18.83 ± 0.78 years, respectively. Mean BMI in group 1 and 2 was 26.18 ± 1.06 kg/m 2 and 20.65 ± 1.5 kg/m 2 respectively. VO 2 max in groups 1 and 2 was 34.52 ± 3.26 ml/min/kg and 37.51 ± 2.88 ml/min/kg respectively. The difference in VO 2 max found in overweight girls was statistically significant with P value of 0.002. Conclusion: Overweight girls had significantly reduced, cardio-respiratory fitness when compared to normal weight young females.
  1,778 332 2
Effect of aminoguanidine on cardiovascular responses and survival time during blood loss: A study in normotensive and deoxycorticosterone acetate-salt hypertensive rats
Babak Barmaki, Majid Khazaei
January-April 2015, 5(1):12-17
DOI:10.4103/2229-516X.149222  PMID:25664261
Introduction: Hemorrhagic shock causes more circulatory disturbances and mortality in hypertensive than normotensive subjects. In the late phase of hemorrhagic shock, nitric oxide (NO) overproduction leads to vascular decompensation. In this study, we evaluated the effect of inducible NO synthase (iNOS) inhibitor, aminoguanidine (AG), on hemodynamic parameters and serum nitrite concentration in decompensated hemorrhagic shock model in normotensive and hypertensive male rats. Materials and Methods: Twenty-four male rats were divided into hypertensive and normotensive groups (n = 12 each). Hypertension was induced by subcutaneous injection of deoxycorticoesterone acetate (DOCA), 30 mg/kg in uninephrectomized rats. Decompensated hemorrhagic shock was induced by withdrawing blood until the mean arterial pressure (MAP) reached 40 mmHg. After 120 min, each group was assigned to aminguanidine (100 mg/kg) and control group. Hemodynamic parameters were monitored for next 60 min. Blood samples were taken before and after shock period and 60 min after treatment. Survival rate was monitored for 72 h. Results: Infusion of AG in normotensive animals caused a transient increase in MAP and increase of heart rate, whereas it did not affect those parameters in hypertensive animals. Hemorrhagic shock caused a significant rise in serum nitrite concentration in normotensive and hypertensive rats and infusion of AG did not significantly change it in both groups. No significant differences observed in survival rate between AG-treated and not treated groups. Conclusion: It seems that inhibition of iNOS with AG does not have beneficial effects on hemodynamatic parameters and survival rate during decompensated hemorrhagic shock in normotensive and hypertensive animals.
  1,700 276 4
CASE REPORTS
Lichenoid drug eruption due to imatinib mesylate
Anuradha Bhatia, Bimal Kanish, Paulina Chaudhary
January-April 2015, 5(1):68-69
DOI:10.4103/2229-516X.149253  PMID:25664274
Imatinib mesylate is a selective tyrosinase kinase inhibitor which has revolutionized the treatment of chronic myeloid leukemia. It is also used in gastrointestinal stromal tumors and dermatofibrosarcoma protruberans. Cutaneous adverse reactions are the most common nonhematological side effects secondary to imatinib. Nonlichenoid reactions are common, while lichenoid reactions are rare. We report a case of lichenoid drug eruption due to imatinib. As the indications and use of imatinib are increasing, the incidences of adverse effects, including cutaneous ones, are likely to increase. Some of the reactions may be severe enough to warrant discontinuation of the drug. The physicians should be aware of this morphological entity, which is usually benign and does not warrant withdrawal of the drug.
  1,673 215 2
EDITORIAL
Blood test to help diagnose type 1 diabetes approved by Food and Drug Administration
Rajiv Mahajan
January-April 2015, 5(1):1-1
DOI:10.4103/2229-516X.149215  PMID:25664258
  1,563 317 1
CASE REPORTS
Paraneoplastic optic neuritis as the first manifestation of periampullary carcinoma
Rudrajit Paul, Asim K Ghosh, Avirup Sinha, Raja Bhattacharya
January-April 2015, 5(1):73-75
DOI:10.4103/2229-516X.149255  PMID:25664276
Paraneoplastic optic neuritis is a rare phenomenon that often presents as a diagnostic challenge. It has been mostly reported with small cell cancers or thymoma. Prompt treatment of the malignancy is the only effective therapy for the condition. Visual loss, once established usually becomes irreversible. We here report a case of paraneoplastic optic neuritis in a 40-year-old female with periampullary carcinoma. This is probably the first report of this association in the medical literature.
  1,584 197 1
The paradox of recurrent with rare: A rare case of bilateral proptosis and facial palsy in acute myeloid leukemia with recurrent cytogenetic translocation t(8:21)
Rohit Kapoor, Jitender Mohan Khunger, Atul Sharma, Soumya Sachdeva
January-April 2015, 5(1):76-78
DOI:10.4103/2229-516X.149256  PMID:25664277
A 13-year-old female child presented with bilateral proptosis and subconjuctival hemorrhage of 2 months duration. Subsequently, the biopsy and peripheral smears confirmed the diagnosis of acute myeloid leukemia (AML). Recurrent cytogenetic translocation t(8:21) in AML associated with extramedullary manifestation; was discovered which is a rare event. Furthermore, myeloperoxidase negative blasts and periodic acid Schiff negative blasts in AML with t(8:21) is a very rare combination to the best of our knowledge.
  1,553 180 -
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