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Background: Malaria is a fatal infectious disease which  is associated with numerous complications and has a profound effects on the blood indices. Thrombocytopenia is frequently reported among the patients with malaria though it is not an indication of the severity of the disease.   Objective: The aim of the current study is to observe the hematological changes particularly the incidence of thrombocytopenia among the patients with malaria presented to the Khyber Teaching Hospital, Peshawar. Methodology: A descriptive cross-sectional study was conducted at the Medicine Department of Khyber Teaching Hospital, Peshawar from August 2018 to February 2019. A total of 95 malaria parasite (MP) positive cases were included in the study. The patients’ demographic details and the hematological variables were recorded. Data was analyzed using SPSS Version 20.0. Results: Among 95 MP positive patients, 88 had Plasmodium vivax infection while 7 patients were suffering from Plasmodium falciparum malaria. Moreover, 89 (93.6%) were found to have thrombocytopenia with majority having grade 1 thrombocytopenia (52.6%). while leukopenia was seen among 29.5% of the cases and only 5.3% presented with leukocytosis. The level of Hb was normal in majority of the cases and only 27.4% had Hb<11.5g/dl.   Conclusion: Thrombocytopenia is a common hematological finding among the patients suffering from malaria. Our study findings favor the diagnostic implications of thrombocytopenia as an indicator of acute malaria.

Hydatid disease is a parasitic infestation by Echinococcus granulosus, which involves the liver and lungs primarily. The authors report a case of disseminated hydatid disease involving multiple organs simultaneously in a 7-year-old child from Kabul, Afghanistan. The patient under examination had been having a complaint of cough and low-grade fever for the last one year. Computed tomography (CT) and ultrasonography (USG) demonstrated cystic lesions in his liver, lungs, spleen, and suprarenal region. The literature review showed that it was very rare for hydatid disease to involve multiple organs simultaneously, even in endemic areas, and the management of disseminated disease was very challenging, especially in the pediatric population.

Existing electricity supply systems face several challenges, including increasing energy prices with greenhouse gas (GHG) emissions and fossil fuel depletion.  These issues have a significant impact on all power system stakeholders, including customers/prosumers, utilities, and microgrid operators. Renewable energy incorporation and different energy managing strategies such as demand-side management (DSM), demand response (DR), and others may help to overcome these limitations. Campus microgrids are among the largest energy consumers in the United States, with high energy expenditures. This article presents a new energy management (EMS) system for a university campus microgrid with onsite solar PV and ESS that operates in a grid exchange scenario. The suggested EMS not only lowers power consumption costs by prolonging storage life; however, it also guarantees grid stability through limiting and shifting loads using price-based and incentive-based demand response methods. ESS is utilized as a stand-by energy reserve to maintain the microgrid system stability and to assist the utility network in the event of a power outage. In MATLAB, a quadratic approach is used to solve the proposed framework. According to the findings, the suggested EMS decreases the prosumer's operating cost and increasing self-consumption, minimizes peak load from the national grid, and encourages campus stakeholders and energy controllers to engage in large-scale ESS installations and distributed generation (DG).

Introduction Disease monitoring in management of acute leukemia is essentially important in terms of risk stratification and assessing response to chemotherapy throughout the disease course for which minimal residual disease (MRD) testing is the most reliable tool. Measurement of MRD by flow cytometry is based on the principle of studying difference in antigenic expression of the leukemic cells, hematogones and residual normal B cells. Modulation of antigen expression is an established fact that occurs on leukemic blasts during treatment under the influence of chemotherapeutic drugs, which may cause difficulty in analysis and detection of MRD [H.Burnusuzov et al. Folia Medica 2016;58(1):28-35]. Literature has reported antigen expression modulation, particularly during the glucocorticoid phase of induction therapy [Dworzak et al. Cytometry Part B 2010; 78B: 147-153]. For MRD assessment, such phenotypic shifts pose a particular challenge since they can cause misinterpretations and false results. However to our knowledge there hasn't been a large cohort studied to map antigenic modulation and analyze similar antigenic trends in comparison between leukemic blasts and non-leukemic B cells which may coexist during different phases of chemotherapy. Key words: B-lymphoblastic leukemia, Flowcytometry, Antigen modulation, Minimal residual disease, Immunophenotype Methods: The study is conducted at the Hematology department of The Indus Hospital from April 2018 to March 2020. Among 445 pediatric B-lymphoblastic leukemia patients (1 month-18 years); we studied 121 patients who were MRD positive in bone marrow throughout the evaluation period. All patients received Berlin-Frankfurt-Munster (BFM) chemotherapy protocol as per National Cancer Institute (NCI) risk stratification criteria. To observe immunophenotypic modulation (IM) in antigen expression of Tdt, CD34, CD10, CD20, CD45, CD13, CD33 and CD66, compared from the time of diagnosis (day 0), post induction chemotherapy (day 35), post consolidation chemotherapy (day 52) and during maintenance chemotherapy (day78). Using eight color Flowcytometry (BD FACS CANTO-II; DIVA software version 8.0.2), the IM was assessed by comparative analyses of the changes in the mean flourescence intensity (MFI) of leukemic and non-leukemic B cells. The Wilcoxon signed rank test is used to compare median of MFI values at diagnosis and subsequent time points of MRD. Independent sample T-test/Mann-Whitney U test was applied as appropriate to determine significant differences in expression of antigens. A p-value of &lt; 0.05 was considered as significant. Box and whisker plots and run charts will be used for descriptive purposes. Results: Mean age of the patients was 5.7years ±3.7 with male to female 1.7:1.We analyzed forward scatter and side scatter properties and antigen expression of the leukemic and normal residual B-cells. We observed statistically significant differences in MFI levels of CD10, CD20, CD19, CD45, CD66 and Tdt of leukemic cells showing trends at different phases. Down modulation of CD10 was noticed from day 0-day 35 however up modulation was observed in subsequent phases. CD20 and TdT both showed significant and stable up modulation from day 0-day78. A steep down modulation was observed in CD45 and CD19 from day 0 to day 52 and thereafter remained stable. CD34 expression was variable and showed up modulation at day 35 followed by down modulation and then again a reincrease at day 78. CD66, CD33 and CD13 showed similar varying trends exhibiting up modulation at day 35 and then down modulation at day 52 and day 78. Residual normal B cells showed substantial decrease in antigenic expression for CD19, CD20 and CD45 till day 52 followed by an ascent at day 78. Conclusion: Immunophenotypic modulation occurred to different extents in all analyzed samples. Our results confirm the presence of transient immunophenotypic changes for CD10, CD34, CD13, CD33 and CD66 at induction phase of chemotherapy whereas CD20 and TdT showed irreversible gain in expression that is exploitable for MRD detection. The MFI of the different antigens expressed by the leukemic blasts should be taken into consideration and cautiously analyzed for MRD detection. Figure 1 Disclosures No relevant conflicts of interest to declare.