Care Center In Pakistan Research Articles

Hypopituitarism other than sellar and parasellar tumors or traumatic brain injury assessed in a tertiary hospital.

Objective:Data regarding the etiology, clinical and biochemical patterns in hypopituitarism is scant for Pakistan. We describe the characteristics of patients with hypopituitarism other than sellar and parasellar tumors or traumatic brain injury from a tertiary care center in Pakistan.Methods:We conducted a retrospective descriptive study in the Aga Khan University Hospital, Karachi, Pakistan. We studied all patients presenting with hypopituitarism, between January 2004 and December 2013. Clinical, hormonal and imaging data pertinent to the study was collected according to inclusion criteria.Results:Forty-two patients presented to the endocrinology clinics at the Aga Khan University Hospital during the study period. Thirty-seven patients (88.1%) were females. Mean age ± standard deviation of the participants was 53.8 ± 14.7 years. Sixteen patients had secondary infertility and all were females; a majority of patients in this group had Sheehan’s syndrome (n=8) followed by empty sella syndrome (n=3), partial empty sella syndrome (n=2), idiopathic cause (n=2) and tuberculoma (n=1). Eighteen females (48.6%) reported inability to lactate.Conclusions:Non-traumatic hypopituitarism was more common in women, with Sheehan syndrome being the most common cause of hypopituitarism in our study (35.7%). Secondary hypothyroidism was the most common hormonal deficiency. The most commonly reported symptom was weakness.

First 100 hepatic resections: short-term outcomes from a low volume centre in a developing country.

Background: Although well established as a therapeutic option in the developed world,hepatic resection has been slow to progress in some developing countries.The objective of our study was to review the early outcomes of hepatic resection from a low volume tertiary care center in Pakistan. Methods: All patients who underwent elective hepatic resection from January 2008 to December 2016 were reviewed. Data was collected regarding indication for surgery,type of hepatic resection,estimated blood loss(EBL),early morbidity and mortality. Results: Out of total of 100 patients, there were 53 males and 47 females. Indications for surgery included primary hepatic cancer in 56, metastatic tumors in 24 and benign lesion in 20 patients.Mean duration of surgery was 289 minutes while mean estimated blood loss(EBL) was 629 mls.Overall morbidity rate was 41% and 90-day mortality rate was 6%. Morbidity rates were higher in patients with associated co-morbid conditions(p=0.026) and duration of surgery longer than 300 minutes(p=0.69). Ninety-day mortality was higher in patients with primary hepatic cancers but the results were not statistically significant(p <0.225).EBL was significantly higher in patients with HCC(p<0.008) and in resections performed for primary hepatic cancers(p<0.000). Conclusion: Morbidity and mortality related to hepatic resection in our center was comparable to the rates reported in the literature.There is a need to focus on optimizing co-morbid conditions,and reducing blood loss by improvising surgical technique.

Frequency of Ischemic Stroke Subtypes Based on Toast Classification at a Tertiary Care Center in Pakistan.

Background:The purpose of this study was to determine the frequency of ischemic stroke subtypes based on Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification at a tertiary care center in Pakistan.Materials and Methods:A cross-sectional study was conducted in Stroke Unit of Shifa International Hospital, Islamabad. We included 145 patients who presented to us from November 2015 to February 2016 with radiological confirmed neurological deficits consistent with ischemic stroke. The causes of ischemic stroke were classified according to TOAST criteria. Regression analysis and Chi-square test were used to compute P value.Results:Among the 145 patients diagnosed with ischemic stroke, there were 54.1% males and 45.9% females with a mean age of 65 ± 14 years. Nearly 62.7% patients had hypertension (HTN) as the most common risk factor, followed by 38.6% diabetes mellitus (DM), 27.5% heart failure, 19.3% valvular disease, 18.6% previous stroke, 16.4% smoking, 15.1% dyslipidemia, 13.7% ischemic heart disease, and 13.1% atrial fibrillation. HTN was significantly associated with large vessel disease (P = 0.028). DM was significantly associated with small vessel disease (P = 0.001). Smoking and atrial fibrillation both were associated with unknown etiology of stroke (P = 0.001 and P = 0.039, respectively). Most common etiology of stroke was cardioembolism (40%), and atrial fibrillation is found to be the most common cause of cardioembolic stroke with 30.6% incidence.Conclusion:Our study concludes that cardioembolic stroke is the most common cause of acute ischemic stroke in our stroke unit. Atrial fibrillation is found to be the most common cause of cardioembolic stroke.

Adequacy of Completion of Computed Tomography Scan Request Forms at a Tertiary Care Center in Pakistan: A Clinical Audit.

IntroductionA lot of radiation exposure to a population comes from medical sources. Clinicians must justify the need for radiology procedures on a request form to prevent unnecessary scans and radiation exposure. Moreover, the properly-filled form will help to identify the patient correctly and provide clinical details to make a radiological diagnosis.ObjectiveThe purpose of the study was to audit the computed tomography (CT) scan request forms and find out the adequacy of completion of the request forms at Bahawal Victoria Hospital, Bahawalpur, Pakistan.Materials and methodsWe scrutinized 300 CT scan request forms received at the tertiary care center, Bahawal Victoria Hospital. We checked the adequacy of filling of different fields in the request forms like name, address, clinical and surgical history, and the name of required examination. We also looked for the missing subjects in the CT request form currently used in our hospital like the contact numbers of the patient and the doctor, the identity of the requesting doctor, renal function tests (RFTs), last menstrual period (LMP), and history of allergy. The results were analyzed using Statistical Package for the Social Sciences 20 (SPSS 20) (IBM, NY, USA) and Microsoft Office Excel Worksheet (Microsoft Corporation, NM, USA).ResultsThe name of the patient was present in 100% of the request forms, surname in 27.66%, age in 73.33%, gender in 64.33%, date in 91.66%, bed number in 37.90%, address in 1% and the name of required examination in 99.6%. Information about diagnosis included clinical history in 50.66%, past surgical history in 1%, laboratory investigations in 1%, and clinical examination in 8.66% of the forms. All the forms had the name and signature of the referring consultant, but only 10.33% forms contained the identity of the requesting junior doctor. More than half of the request forms for CT scan provided RFTs. We found no record of the allergy, LMP, and the contact number of the doctor and the patient.ConclusionThe information provided in the CT scan request forms was inadequate. The practice of filling these forms needs to be improved to protect the patients from unnecessary radiation exposure.

Acute porphyrias: clinical spectrum of hospitalized patients.

To determine characteristics, clinical features and triggers of acute porphyria in hospitalized patients presenting to a tertiary care center in Pakistan. Case series. The Aga Khan University Hospital, Karachi, from 1988 to 2003. Case records of 26 patients hospitalized with diagnosis were identified through computerized hospital patients' data. The diagnosis of acute porphyria was based on pertinent clinical features and laboratory investigations after exclusion of other alternative diagnosis and patients previously diagnosed as porphyric. The data was analyzed through SPSS software version 11.0. Twelve patients (46.2%) were males. Mean age was 21 years. Most common manifestation were gastrointestinal (n=22; 88.5%) followed by neurological symptoms (n=14; 54%). Neurological manifestations included seizures (n=9; 34.6%) and neuropathy (n=6; 23%). One patient presented with depression and insomnia. Family history was positive in (n=8; 30.8%). Eighteen (69%) had history of previous attacks at their presentation to the hospital. Most common precipitating factor was 'eating outside' (n=18; 69%). Porphyrias are uncommon and cryptic group of diseases. This study shows a slightly different gender distribution, earlier onset of symptoms, higher number of neuropsychiatric symptoms (especially seizures), more distal neuropathies and different precipitant in the studied subset of patients than described previously in the western studies.

Frequency of non-motor symptoms in Parkinson’s disease presenting to tertiary care centre in Pakistan: an observational, cross-sectional study

ObjectiveTo determine the frequency of non-motor symptoms (NMS) in patients of Parkinson’s disease (PD) presenting to a movement disorder clinic at a tertiary care centre in Pakistan, and how frequency...

Adoption of Robson's Ten Group Classification System (RTGCS) to Analyse Caesarean Section Rates at a Tertiary Care Centre in Pakistan

Objective: To assess the utility of Robson's ten group classification system (RTGCS) as an auditing tool for cae- sarean section rates.&#x0D; Methods: The present study was conducted by collecting data retrospectively from hospital records of Gynaecology and Obstetrics Unit 3, Abbasi Shaheed Hospital for the years 2013 and 2016. The rates of both years were com- pared in terms of RTGCS. After the initial audit in 2013, a three point strategy was implemented and the audit cycle repeated.&#x0D; Results: During the year 2013, 1986 women delivered in the hospital, 610 underwent caesarean section. The cae- sarean rate for the year was 30.7%. In the year 2016, 1560 women delivered at the unit, out of which, 412 births were by caesarean section. After the implementation of the three point strategy, which was formulated in the light of RTGCS, the caesarean rate was 26.4% in the year 2016.&#x0D; Conclusion: The adoption of RTGCS is the first step to analyse the obstetric practice in a standardised manner.

Clinical characteristics and factors associated with mortality in idiopathic pulmonary fibrosis: An experience from a tertiary care center in Pakistan.

Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive interstitial lung disease (ILD) that predominantly affects older adults. IPF has the highest mortality burden of all ILDs. Data on mortality in patients with IPF is limited in developing countries. To identify factors associated with mortality in patients with IPF at a tertiary care center in Pakistan. A retrospective chart review was conducted at the Aga Khan University Hospital (AKUH) in Karachi, Pakistan from January 2005 to December 2015. Patients were assessed for smoking status, clinical onset of disease, pulmonary hypertension, disease severity based on spirometry and hypoxemia. A total of 239 cases were reviewed, of which 103 were non-survivors. A total of 45 (18%) were current smokers and 71 (29.7%) were ex-smokers. Smoking was more common in non-survivors (56.3% P ≤ .01). Pulmonary hypertension was present in 18.8% of patients. 95.4% of patients who had received pirfenidone treatment were alive at the time of study. On multivariate analysis, pirfenidone treatment (OR 0.03; 95% CI 0.01-0.08), current smoking (OR 2.60; 95% CI 1.04-6.58), age older than 60 years (OR 2.63; 95% CI 1.04-6.58) and hypoxemia (OR 3.29; 95% CI 1.58-6.84) were the factors associated with mortality. Smoking, age greater than 60 years and hypoxemia were identified as factors that increased the odds of mortality in IPF patients, whereas pirfenidone was found to lower the odds of mortality.

Comparison of Two Protocols for Management of Placenta Accreta at a Tertiary Care Center in Pakistan

ABSTRACT Objectives To evaluate the morbidity of placenta accreta when managed by two different protocols. Materials and methods All women with placenta accreta coming to Abbasi Shaheed Hospital were included and divided in two groups. Group I included all women with accreta who were managed by lower segment transverse incision in the year 2013. Group II included all women whose accreta was dealt with classical incision in the year 2014. Morbidity from placenta accreta in all these cases was assessed. Results A total of 4220 deliveries took place during study. Placenta accrete was diagnosed in 24 cases (incidence = 0.0056%). Mean age of patients in group II was 28.58 ± 3.28 years and in group I was 29.75 ± 2.18 years. Blood products were received by 9(75%) patients in group I, and by 1(8.33%) in group II (p = 0.002). Intensive care unit admissions in group I were 75% and 25% in group II (p = 0.014). Renal sequelae occurred in 7 women in group I (58.3%) whereas none were observed in group II (p = 0.002). The mean duration of hospital stay was 9.83 ± 2.95 days in group I and 2.75 ± 1.215 days in group II. Conclusion Prevention of massive hemorrhage is the key factor in reducing maternal morbidity in placenta accreta cases. Clinical significance Dealing with accreta via midline incision in low resource settings leads to reduced morbidity. How to cite this article Izhar R, Husain S, Tahir S, Husain S. Comparison of Two Protocols for Management of Placenta Accreta at a Tertiary Care Center in Pakistan. J South Asian Feder Obst Gynae 2017;9(1):18-24.

Low cost quality initiatives for management of neurosurgical patients in developing nations: Perspective from a tertiary care centre in Pakistan.

Background:Targeting resources on cost-effective care strategies is pertinent for developing nations, specifically for already burdened specialties such as neurosurgery, where without state support and insurance companies, expenses are borne by the patient themselves.Methods:This was a descriptive review of literary work published by the section of neurosurgery at Aga Khan University Hospital, Pakistan. We searched PubMed and CiNAHL databases to identify articles, which were then critically analyzed and discussed from a perspective of low-cost quality care.Results:We demonstrate the cost effectiveness of three initiatives, namely, blood ordering protocol for elective spine arthrodesis, nonoperative management being superior to surgical stabilization in spine injury patients with complete neurological deficits, and early tracheostomy in patients with isolated severe traumatic brain injury.Conclusion:Initiation and implementation of such cost-effective strategies without compromising quality health standards must be emphasized by neurosurgical centers throughout the developing world for smart allocation and utilization of funds.

Clinical and laboratory profile of children with Cystic Fibrosis: Experience of a tertiary care center in Pakistan.

Objective:To determine the clinical presentation, diagnostic investigations and laboratory workup done in admitted children with cystic fibrosis at Aga Khan University Hospital Karachi, Pakistan.Methods:This is athree years retrospective study from January 2013 to December 2015 conducted at The Aga Khan University Hospital Karachi Pakistan, enrolling admitted patient from birth to 15 years of either gender, diagnosed with CF on the basis of clinical features and positive sweat chloride test. Different clinical presentations were noted including initial presentations. Sweat chloride values more than 60mmol/L were labeled as positive and consistent with diagnosis of CF. Available Delta F-508 mutation analyses were noted. Relevant laboratory and radiological investigations including sputum culture and HR-CT chest findings were documented. Results were analyzed using SPSS version 20.Results:Total 43 children were selected according to the inclusion criteria. Chronic cough (69.76%) was the most common initial clinical presentation. Mean age at onset of symptoms was 14.41± 26.18 months and mean age at diagnosis was 47.20 ± 45.80 months Respiratory features were most common in our cohort including chronic productive cough (90.71%), recurrent bronchopneumonia (72.09%) and asthma like presentation (44.19%) with wheezing and cough. 86% patients presented with failure to thrive. Gastroenterological features including steatorrhea were seen in 55.81% patients and 44.19% patients had abdominal distension. Mean sweat chloride value in our population was 82.70± 22.74. Gene analysis for Delta F-508 was identified in 12 (27.90%) patients. Bronchiectatic pulmonary changes on HRCT were seen in 18 patients (41.86%). Pseudomonas grew in 12 patients (27.90%) in sputum cultures at the time of diagnosis.Conclusion:Respiratory presentations predominate in CF children followed by gastrointestinal features. Nearly half of our patient had bronchiectatic changes on CT scan chest and more than quarter had pseudomonas colonization in the airways at the time of diagnosis. Delta F-508 mutation was found to be uncommon in our study population. There is significant delay in diagnosing patients with CF.

Frequency of color blindness in pre-employment screening in a tertiary health care center in Pakistan.

Objective:To describe the frequency of color vision deficiency among Pakistani adults presenting for pre-employment health screening in a tertiary care hospital.Methods:The cross-sectional study was carried out at the Aga Khan University Hospital, Karachi, and the data was collected for color vision deficiency, age, gender, and job applied for from pre-employment examination during 2013-2014. IBM SPSS 20 was used for statistical analysis.Results:Three thousand four hundred and thirty seven persons underwent pre-employment screening during 2013 and 2014; 1837 (53.44%) were males and 1600 (46.65%) females. The mean age was 29.01 (±6.53) years. A total of 0.9% (32/3437) persons had color vision deficiency with male being 1.4% and female 0.4%.Conclusion:Color vision deficiency was observed in 0.9% of candidates screened for pre-employment health check up in a tertiary care hospital. The color vision deficiency was predominantly present in male individuals.

The prevalence of coronary artery anomalies on CT scan; Experience from a tertiary care center in Pakistan (RCD code: I-1C.1)

Objectives This study is an effort to bridge the gap regarding the data of prevalence of coronary anomalies in South Asian countries by utilizing coronary CT angiography. Methods This is a cross sectional, descriptive study done at Aga Khan University Hospital Karachi, Pakistan. All adult patients who underwent coronary CT angiography from 1-1-2005 to 1-11-2016 were included in the study. Results Among 897 patients undergoing CCTA, 36(4.01%)patients were identified as having coronary artery anomalies(CAA). The mean age of patients was 48.3±11.9 years. Male to female ratio was 3:1. Among patients with coronary anomalies, the most common indication for CCTA was screening for coronary artery disease(58.3%). 33 patients(3.67%) showed coronary origin and course anomalies, whereas coronary artery fistula were identified in 3 patients(0.3% of cases). The most common anomaly identified was the anomalous origin of coronary artery from opposite coronary sinus with anomalous course(1.4%) with anomalous origin of RCA from the left coronary sinus with an inter-arterial course seen in 9 patients. Single coronary artery was seen in three cases(0.3%), in all these cases the single coronary artery originated from the right coronary cusp. In one patient (0.1%) dual LAD system was identified. Coronary artery fistulas were seen in 3 patients (0.3%).In two cases(0.2%) fistulous connection of LAD with pulmonary artery was seen, while fistula from LAD to coronary sinus was identified in one patient. Conclusions This study highlights the fact that the prevalence of coronary anomalies on CCTA in this region is similar to the reported data from rest of the world.

Papillary craniopharyngioma: A clinicopathologic study of a rare entity from a major tertiary care center in Pakistan.

Papillary craniopharyngioma (PCP) are uncommon variants of craniopharyngiomas (CP), which are benign epithelial neoplasms of the sellar and suprasellar region. Histologically, PCPs are typically composed of well-differentiated stratified squamous epithelium; however, focal variations are not uncommon. A distinction from other lesions of the region, despite being difficult to achieve due to the overlapping radiological and clinical features, is important for adequate treatment to be administered. Our aim was to study the clinical and histological features of PCP with emphasis on features that are helpful in its distinction from other lesions that are similar in appearance. We reviewed 13 cases of PCP diagnosed in our institution between January 2010 and December 2015. The mean age at presentation was 30.76 years. Two of the patients belonged to the pediatric age group. Male-to-female ratio was 2.25:1. Suprasellar location (either alone or in combination with sellar region) was the most common tumor site. Microscopically, all of the cases showed stratified squamous epithelium with frequent pseudopapillae formation. Focal adamantinomatous epithelium and columnar epithelium with variable cilia and goblet cells were seen in 4 (30.7%) cases. Brain invasion was observed in 3 (23%) cases. Four patients died of their disease; 2 of the 7 patients with an available follow up, developed recurrences; and, 5 experienced severe postoperative morbidity. Majority of the PCPs exhibited typical features with minor variations. Knowledge of the variations in histologic features helps in reaching the correct diagnosis. These tumors can behave aggressively with a high recurrence rate and decreased overall survival.

Frequency of color blindness in pre-employment screening in a tertiary health care center in Pakistan

Frequency of color blindness in pre-employment screening in a tertiary health care center in Pakistan

Synchronous and Metachronous Malignant Epithelial and Lymphoid Tumors: a Clinicopathologic Study of 10 Patients from a Major Tertiary Care Center in Pakistan

Case reports and case series documenting unfortunate patients with more than one malignant neoplasm are rare but well established. While majority of such patients have two malignancies, cases with three or even four malignant neoplasms in the same patient have been published in literature. A number of factors influencing carcinogenesis have been implicated in such cases including exposure to large amounts of radiation, chemotherapy for the original malignancy; prolonged history of heavy smoking and exposure to other environmental carcinogens; aging; and underlying genetic alterations. Concomitant multiple malignant neoplasms may be synchronous-two or more malignant neoplasms histologically distinct from each other, arising in the same site and detected simultaneously (for example during the same hospital admission) or detected one after the other in sequence in a period less than 6 months; or metachronous-two or more malignant neoplasms of similar or distinct histologic type detected at different times (after an interval of greater than 6 months) in different anatomic sites. Any combination of malignant tumors can occur in the same patient for example carcinomas with other carcinomas, carcinomas with Non-Hodgkin or Hodgkin lymphomas, carcinomas with mesotheliomas, carcinomas with sarcomas etc. We have reported several cases with multiple malignancies during our practice, and these cases were composed of the different combinations described above. The aim of the present study is to document 10 such cases of combined carcinoma and Non Hodgkin lymphoma in the same patient which were diagnosed in our section.

Carotid intima-media thickness and cardiometabolic risk factors in Pakistani type 2 diabetics

Context: Carotid intima-media thickness (CIMT) is a surrogate measure of atherosclerosis. In patients with type 2 diabetes mellitus, coexistent cardiometabolic risk factors contribute to atherosclerosis. Aims: The aim of this study is to explore the relationship between known cardiometabolic risk factors and CIMT in patients with type 2 diabetes mellitus. Settings and Design: A cross-sectional comparative study was conducted from June 2015 to May 2016 in a tertiary care center in Pakistan. Subjects and Methods: We recruited 237 participants among whom 119 had type 2 diabetes mellitus while 118 were controls. After complete history and examination, investigations including fasting and random blood glucose, glycated hemoglobin, and fasting lipid profile were obtained. All participants underwent Doppler ultrasound scanning of the carotid arteries for measurement of CIMT. Statistical Analysis Used: The data were analyzed through SPSS version 20.0 using Pearson's correlation coefficient. P < 0.05 was considered significant. Results: The target population constituted 44.3% males and 55.7% females. Among the participating males, 49.6% were diabetic while 50.4% of the female population was diabetic. There was a strong positive correlation of CIMT with duration of diabetes mellitus, systolic blood pressure, and total cholesterol. This correlation was moderately positive with age, diastolic blood pressure, and low-density lipoprotein levels in patients with type 2 diabetes mellitus. Conclusions: Different cardiometabolic risk factors have a varying impact on CIMT in patients with type 2 diabetes mellitus. The major contribution to CIMT is by the blood pressure, cholesterol, and duration of diabetes mellitus.

Presentation and outcome of young and old age rectal cancers at a tertiary care center in Pakistan – A six years' experience

Presentation and outcome of young and old age rectal cancers at a tertiary care center in Pakistan – A six years' experience

Comparison of awareness about precautions for needle stick injuries: a survey among health care workers at a tertiary care center in Pakistan.

BackgroundNeedle stick injuries (NSIs) have the potential of causing Hepatitis B and Hepatitis C, which is constantly adding to the burden of chronic liver disease in our country. It poses a risk to Health Care Workers (HCWs) and the patients they deal with. In order to limit the spread of these viruses, it is imperative that these HCWs be fully equipped with knowledge regarding prevention of NSIs and dealing with one, regardless of their designation. We therefore aimed to assess and compare the level of awareness about precautions for needle stick injuries amongst all those greatest at risk.MethodsThis was a cross- sectional study carried out at Liaquat National Hospital, Karachi, Pakistan. A 23 itemed self-administered questionnaire was given to hospital staff including doctors, lab technicians and nurses via convenience sampling, in various departments. Data was analyzed via SPSS 18 software and a p-value of <0.05 was considered significant.ResultsA total of 198 responses were taken for this study, out of which 70 (35.4 %) were doctors, 70 (35.4 %) nursing staff and 58 (29.3 %) laboratory technicians. Of all HCWs, 101 (51 %) knew that the standard method of discarding needles is without recapping. 159 (80.3 %) were still recapping needles. 180 (90.9 %) HCWs were vaccinated against Hepatitis B. 36 (18.2 %) were aware that blood should be allowed to flow after an NSI and site of prick should be washed with an antiseptic.ConclusionThe awareness was found to be very low amongst all HCWs. It should therefore be made compulsory for all HCWs to attend proper preparatory classes by the infection control department at the time of employment in order to improve the level of awareness and ensure safe practices.Electronic supplementary materialThe online version of this article (doi:10.1186/s13037-016-0108-7) contains supplementary material, which is available to authorized users.

Acute Lymphoblastic Leukemia in Adults - an Analysis of 51 Cases from a Tertiary Care Center in Pakistan.

Acute lymphoblastic leukemia (ALL) is a malignant disease in which early lymphoid precursors proliferate and replace the normal hematopoiesis. It has distinctive clinical and biological features. In respect to adult ALL, available data from Pakistan are limited. Therefore we reviewed the demographical and clinico- hematological profiles along with FAB stratification of adult patients with ALL presented at our hospital. In this cross sectional study, 51 adults (≥15 years) patients with ALL were enrolled from January 2010 to December 2014. The mean age was 23.8±12.9 years with the median age of 18.0 years. The male to female ratio was 2:1. The major complaints were fever (60.7%), generalized weakness (47.0%), overt bleeding (19.6%) and weight loss (13.7%). Physical examination revealed lymphodenopathy as a predominant finding detected in 43.1% followed by splenomegaly and hepatomegaly in 23.5% and 21.5%, respectively. The mean hemoglobin level was 9.0±2.75g/dl with a mean MCV of 82.2±15.4 fl, a mean total leukocyte count of 31.1±64.0x109/l, a mean ANC of 2.1±3.0 x109/l and a mean platelet count of 71.7±85.7x109/l. According to FAB classification, 47.1% were L1 type, 45.1% L2 and 7.8% L3 variant. Clinico-pathological features appeared comparable to published data. Febrile illness associated with lymphodenopathy was the commonest presentation. FAB classification revealed a predominance of ALL-L1 variant in Pakistani adult patients with ALL.