Medical Specialties Commons^™

Spot Urine Protein: Creatinine Ratio Versus 24 Hour Urine Protein At Various Levels Of Gfr Patients Referred To A Tertiary Care Hospital Of Pakistan, Absar Ali, Naila Asif, Sonia Yaqub, Waqar Kashif, Diamond Merchant, Iffat Yazdant

Department of Pathology and Laboratory Medicine

OBJECTIVE: To determine the correlation of "random single voided urine protein: creatinine ratio" to "twenty four hour urine protein" at different levels of glomerular filtration rate (GFR) in Pakistani population.

METHODS: A total of 107 patients were included in this cross section study. Patients were divided into five groups according to the GFR. Spot urine protein: creatinine ratio and 24 hour urine protein was measured by the standard methods. The correlation coefficient ( r) between the two was calculated in each group separately.

RESULTS: The GFR in groups 1 to 5 was > or =90, 60-89, 30-59, 15-29, and /minute/1.73 m2 …

A Case Of Histoplasmosis Mimicking Tuberculosis, Asim Qureshi

Department of Pathology and Laboratory Medicine

Drug resistance to Tuberculosis is an emerging problem but proper exhaustive workup needs to be done before confirming the diagnosis. The case of a 5 year old male child who presented with low grade fever and lymphadenopathy and was being treated with anti TB drugs with no satisfactory response is presented. A detail workup including a biopsy gave the diagnosis of histoplasmosis.

Frequency And Clinical Spectrum Of Rare Inherited Coagulopathies--A Tricenter Study, Safoorah Khalid, Fareena Bilwani, Salman Naseem Adil, Mohammad Khurshid

Department of Pathology and Laboratory Medicine

OBJECTIVE: To determine the frequency of rare inherited coagulopathies at three centers of haematology in Karachi and to study the clinical spectrum and laboratory data of these coagulopathies.

METHODS: This was a descriptive study conducted from September 2003 to December 2004 on subjects from Aga Khan University Hospital, Husaini Blood Bank and Fatimid Blood Transfusion Centre. All the subjects with bleeding tendency without any acquired causes of bleeding were selected for further investigation, and were asked relevant questions as present in the questionnaire. Screening tests including platelet count, PT, APTT and bleeding time were performed on all patients and subsequently, …

Time Trends In The Incidence Of Cancer Cervix In Karachi South, 1995-2002, Yasmin Bhurgri, Shahid Pervez, Naila Kayani, Muneeza Afif, Imran Tahir, Kauser Nazir, Ahmed Usman, Naveen Faridi, Hadi Bhurgri, Jawaid Malik, Imtiaz Bashir, Asif Bhurgri, Rashida Ahmed, Sheema H Hasan, Mohammad Khurshid, S. M. H. Zaidi

Department of Pathology and Laboratory Medicine

Introduction:The objective of the study was to determine the trends of cancer cervix in Karachi South during an eight (1995-2002) year period. Methododology: Cancer cervix cases recorded at Karachi Cancer Registry during 1st January 1995 to 31st December 2002 were analyzed. Trends were studied by analyzing the age standardized incidence rates (ASR)s in 2 time periods, 1995-97 and 1998-2002.

Results:

Cancer cervix ranked sixth in the 1995-97 period the age standardized incidence rate (ASR) world and crude incidence rate (CIR) per 100,000 were 6.81 and 3.22. It reached the fifth ranking in the 1998-2002 period with an ASR and …

Emergence Of Carbapenem Resistant Gram Negative And Vancomycin Resistant Gram Positive Organisms In Bacteremic Isolates Of Febrile Neutropenic Patients: A Descriptive Study., Seema Irfan, Faiza Idrees, Vikram Mehraj, Faizah Habib, Salman Adil, Rumina Hasan

Department of Pathology and Laboratory Medicine

Background:This study was conducted to evaluate drug resistance amongst bacteremic isolates of febrile neutropenic Patients with particular emphasis on emergence of carbapenem resistant Gram negative bacteria and vancomycin resistant Enterococcus species.

Methods:

A descriptive study was performed by reviewing the blood culture reports from febrile neutropenic Patients during the two study periods i.e., 1999-00 and 2001-06. Blood cultures were performed using BACTEC 9240 automated system. Isolates were identified and antibiotic sensitivities were done using standard microbiological procedures.

Results:

Seven twenty six febrile neutropenic Patients were admitted during the study period. A total of 5840 blood cultures were received, off …

Rhinosporidiosis Presenting As An Urethral Polyp, Najamul Sahar Azad, Zubairali Ahmad, Naila Kayani

Department of Pathology and Laboratory Medicine

Rhinosporidiosis is an inflammatory disease caused by Rhinosporidium seeberi, a protoctistan mesomycetozoa, member of a group of novel aquatic parasites, characterized by hyperplastic polypoid lesions of the nasal cavity and rarely other mucous membranes. We report an unusual presentation of rhinosporidiosis as an urethral polyp, which is only the second case of rhinosporidiosis reported from Pakistan.

Clear Cell Papillary Cystadenoma Of Epididymis, A Mimic Of Metastatic Renal Cell Carcinoma, Nausheen Yaqoob, Aamir Ahsan, Zubair Ahmad, Ambreen Nasir Khan

Department of Pathology and Laboratory Medicine

We discuss a case of 25 year old male who was evaluated for primary infertility following marriage. He had no previous history of urogenital complaints or abnormalities. In fact, his past medical history was unremarkable. On examination epididymal masses were found. Semen analysis showed azoospermia. Right epididymal mass was surgically excised. Histopathology showed an epididymal neoplasm composed of simple and complex papillary processes lining and filling the ducts. The tumor cells were clear and positive for cytoplasmic glycogen. Immunohistochemistry was also supportive. Diagnosis of clear cell papillary cystedenoma was made based on histopathological and immunohistochemical features.

Dubin-Johnson Syndrome, Aziz-Un Nisa, Zubair Ahmad

Department of Pathology and Laboratory Medicine

A young man presented with recurrent episodes of mild jaundice. Apart from conjugated hyperbilirubinemia, other liver function tests were always normal. Clinical suspicion of Dubin-Johnson syndrome was raised. Liver biopsy showed diffuse deposition of coarse granular dark brown pigment in hepatocytes. Dubin-Johnson syndrome is a benign condition, which results from a hereditary defect in biliary secretion of bilirubin pigments, and manifests as recurrent jaundice with conjugated hyperbilirubinemia. The defect is due to the absence of the canalicular protein MRP2 located on chromosomes 10q 24, which is responsible for the transport of biliary glucuronides and related organic anions into bile. No …

Diagnostic Tool For Glanzmann's Thrombasthenia Clinicopathologic Spectrum, Natasha Bahadur Ali, Bushra Moiz, Mohammad Usman Shaikh, Salman Adil, Bushra Rizvi, Yasmeen Rahman

Department of Pathology and Laboratory Medicine

Objective: To platelet aggregometry and describe the clinical spectrum of Glanzmann's thrombasthenia diagnosed by platelet aggregometry.
Study design: A case-series.
Place and duration of study: This study was carried out at the clinical laboratories at the Aga Khan University Hospital, Karachi from January 2003 to January 2006.
Patients and methods: All patients irrespective of age and gender presenting with bleeding symptoms and having normal platelet count were evaluated. Demographic details, relevant clinical history along with results of complete blood count, bleeding time and platelet aggregation studies were retrieved through computerized data base and evaluated for the diagnosis of Glanzmann's thrombasthenia. …

Metachronous Primary Cancers Of Colon And Stomac, Zubair Ahmad, Ayesha Memon, Khurram Minhas

Department of Pathology and Laboratory Medicine

Synchronous or metachronous occurrence of esophageal, gastric and colonic cancers is a very rare occurrence, although there are several case reports in literature. A case of a 41 years old man with metachronous cancers of colon and stomach is reported.

Knowledge, Attitudes And Practices Of Health Care Workers Regarding Needle Stick Injuries At A Tertiary Care Hospital In Pakistan, Afia Zafar, Naveen Aslam, Nosheen Nasir, Riffat Meraj, Vikram Mehraj

Department of Pathology and Laboratory Medicine

OBJECTIVE: To assess the knowledge, attitude and practices of HCWs regarding needle stick injuries at the Aga Khan University Hospital.

METHODS: A cross-sectional study was conducted on medical personnel. A structured pre-tested questionnaire was administered during June-July 2003. The data was analysed by SPSS 13.0. Percentages of the categorical variables were computed and compared by Chi square test at a 5% level of significance. Odds ratios and their 95% CIs were also computed.

RESULTS: Of 80 participants, 29 were doctors and 51 were registered nurses. About 45% reported having a needle stick injury in the past. Frequency of injury was …

A Fatal Case Of Gram Negative Bacterial Sepsis Associated With Disseminated Strongyloidiasis In An Immunocompromised Patient, Naima Fasih, Seema Irfan, Usman Sheikh, M. Sim Beg

Department of Pathology and Laboratory Medicine

We report a fatal case of disseminated strongyloidiasis in a patient with multiple myeloma receiving chemrotherapy. A fifty-seven years old man presented with severe diarrhoea and vomiting, fever, weight loss and dysphagia,due to mouth ulcers. Despite broad-spectrum intravenous antibiotics, albendazole (anti protozoal) and supportive treatment, the patient died of Gram-negative sepsis.

Primary Drug Resistance To Antituberculous Drugs In Nwfp Pakistan, Arshad Javaid, Abdul Ghafoor, Abdul Rab, Anila Basit, Zia Ullah, Shaukat Ali, Afia Zafar, Rumina Hasan

Department of Pathology and Laboratory Medicine

Objective: To assess the prevalence of Primary drug resistance to Antituberculous drugs in NWFP
Method: A cross-sectional prevalence study was undertaken to evaluate the prevalence of drug resistance among new TB patients, using a non-probability convenience sampling methodology. Sample size was calculated according to the population and WHO's estimated incidence of smear positive tuberculosis in the province/country. Sputum samples were obtained from 122 newly diagnosed patients of pulmonary tuberculosis from centres in Peshawar and Abbotabad in NWFP.
Results: Sensitivities were performed by proportion method which showed the following resistance values in 118 eligible patients: 15 (12.7 %) …

Hepatic Angiosarcoma With Metastasis To Small Intestine, Zubair Ahmad, Azizun Nisa, Romana Idrees, Khurram Minhas, Shahid Pervez, Khalid Mumtaz

Department of Pathology and Laboratory Medicine

Hepatic angiosarcomas are rare tumours with poor prognosis, with patients usually dying within 6 months. Metastases mainly occur in lymph nodes, spleen, lungs, bones and adrenals. Metastasis to small intestine is even rarer. Similarly, primary or metastatic angiosarcomas in small intestine are extremely rare, often present with recurrent gastrointestinal bleeding and anemia, and have an extremely poor prognosis. Both primary or metastatic intestinal angiosarcomas may exhibit epithelioid morphology. It may be very difficult to differentiate between primary and secondary cases in intestine and especially when the tumour exhibits epithelioid morphology.

Antibiotic Susceptibility Of Pathogens Isolated From Patients With Community-Acquired Respiratory Tract Infections In Pakistan--The Active Study, Afia Zafar, Zahid Hussain, Eale Lomama, Sophie Sibille, Seema Irfan, Erum Khan

Department of Pathology and Laboratory Medicine

BACKGROUND: Respiratory tract infections (RTIs) are amongst the most wide spread and serious infections, accounting for over 50 million deaths globally each year. In developing countries, infants under 4 years of age are at greatest risk of lower RTIs, whereas in developed countries the severity of infection and rate of mortality are greater in elderly. The objective of the survey was to determine the in vitro susceptibility of antibiotics commonly prescribed RTIs against Streptococcus pneumoniae (SP), Haemophilus influenzae (HI) and Streptococcus pyogenes, isolated from patients with community-acquired RTIs globally. This survey involved 9 countries. In this study we present the …

Primary Drug Resistance To Anti-Tuberculous Drugs In Karachi, Arshad Javaid, Nadim Rizvi, Mosavir Ansari, Ashraf Sadiq, Iqbal Sher Burki, Nadeem Ur Rehman, Rumina Hasan, Afia Zafar

Department of Pathology and Laboratory Medicine

Objective: To assess the frequency of primary drug resistance among newly diagnosed tuberculosis cases in Karachi.
Study Design: Cross-sectional study.
Place and Duration of Study: Multicentric study involving various TB clinics and treatment centres of Karachi between April to December 2005.
Methodology: The frequency of drug resistance among new TB patients was evaluated using a non-probability convenient sampling methodology. Sputum sample was obtained from 140 newly diagnosed sputum smear-positive patients of pulmonary tuberculosis from various centres of Karachi. Sensitivities were performed by proportion method.
Results: Fifteen (11.5%) samples in 130 eligible patients showed primary resistance to one …

Glucose-6-Phosphate Dehydrogenase (G6pd) Screening In Pakistani Neonates: To Be Or Not To Be, Bushra Moiz

Department of Pathology and Laboratory Medicine

No abstract provided.

Longitudinal Tracking Of Cytokines After Acute Exposure To Tuberculosis: Association Of Distinct Cytokine Patterns With Protection And Disease Development, Rabia Hussain, Najeeha Talat, Firdaus Shahid, Ghaffar Dawood

Department of Pathology and Laboratory Medicine

Household contacts (HCs) of patients with tuberculosis (TB) are at higher risk of infection as well as the development of active disease. Longitudinal tracking of antigen-specific cytokines after acute exposure may significantly advance our understanding of the dynamic changes in cytokine patterns associated with disease establishment. To achieve this objective, we carried out a prospective cohort study with healthy HCs after exposure to TB. The patterns of cytokines (gamma interferon [IFN-gamma] and interleukin 10 [IL-10]) in response to mycobacterial antigens (culture filtrate [CF] proteins) and nonspecific mitogens (phytohemagglutinin [PHA] and lipopolysaccharide [LPS]) were assessed at 0, 6, 12, and 24 …

Infiltrating Ductal Carcinoma Breast With Central Necrosis Closely Mimicking Ductal Carcinoma In Situ (Comedo Type): A Case Series, Shahid Pervez, Hassan Khan

Department of Pathology and Laboratory Medicine

Here we present a series of infiltrative ductal carcinoma breast cases (infiltrative ductal carcinoma with central necrosis) so closely mimicking 'DCIS with central comedo necrosis' that on initial morphological analysis these foci of tumors were labeled as DCIS (high grade, comedo). However on further histological work up and by using immunohistochemistry (IHC) for myoepithelial markers it was later confirmed that these were foci of infiltrative ductal carcinoma breast with central necrosis. This case series gives the realization that a breast carcinoma may be partly or entirely DCIS like yet invasive. In such a dilemma IHC especially for assessment of myoepithelial …

Clear Cell Carcinoma Of Ovary With Associated Mucinous Cystadenoma And Endometriosis, Zeeshan Uddin, Nausheen Yaqoob, Naila Kayani, Sheema H. Hasan

Department of Pathology and Laboratory Medicine

A 45 year old woman presented with right sided ovarian mass with multiple omental deposits and liver metastases. The right ovary was enlarged and showed a partly cystic partly solid cut surface. Histological picture showed clear cell carcinoma with areas of mucinous cystadenoma and endometriosis. Clear cell carcinoma is known to be associated with endometriosis. To the best of author's knowledge, it's association with mucinous cystadenoma has been described only once in the literature, where clear cell carcinoma was shown to be associated with mucinous cystadenoma without any evidence of endometriosis.

Clinical Presentation And Genotype Of Hepatitis Delta In Karachi, Tariq Moatter, Zaigham Abbas, Sabhita Shabir, Wasim Jafri

Department of Pathology and Laboratory Medicine

Aim:
To assess the clinical presentation and genotypes of delta hepatitis in local population.
Methods:
In this prospective study, 39 consecutive patients who were positive for HBsAg and hepatitis D virus (HDV) antibody were included. The patients were divided in two groups on the basis of presence or absence of HDV RNA and a comparative study was done. Genotype of HDV was determined in PCR positive patients.
Results:
Overall there is male dominance, in which 34 patients out of 39 (87.2%) were male. Twenty (51%) patients were from the adjacent areas of three provinces; Sindh, Punjab and Balochistan indicating the …

Epidermoid Cyst Of The Ovary, Romana Idress, Zubair Ahmad, Khurrum Minhas, Naila Kayani

Department of Pathology and Laboratory Medicine

Epidermoid cysts of the ovary are rare lesions and are uniformly incidental findings in hysterectomy specimens. They must be differentiated from mature cystic teratomas of the ovary, and some authors believe them to be monodermal teratomas. The histogenesis is still uncertain. We report an epidermoid cyst of the ovary which was an incidental finding.

Analysis Of Amniotic Fluid Specimens For Common Chromosome Disorders Using Interphase Fluorescence In Situ Hybridization, Tariq Moatter, Zahida Khilji, Farzana Murad, Shama Munim

Department of Pathology and Laboratory Medicine

Objective: The aim of the study was to examine the usage of multi colour FISH technology as an adjunct to conventional cytogenetics for the prenatal diagnosis of aneuploidy in interphase nuclei from high risk pregnancies.
Methods: Amniotic fluid samples were collected for interphase FISH analysis using DNA probes for chromosomes 13, 18, 21, X and Y. All the probes were directly labeled with fluorescent molecules. Fluorescent signals were observed under a microscope. A minimum of 100 nuclei with defined hybridization signals were counted for each probe.
Results: Seventy-eight amniotic fluid samples were received for FISH analysis. The average age of …

Collecting Duct Carcinoma: An Incidental Finding In A Non Functional Kidney Secondary To Nephrolithiasis, Asim Qureshi

Department of Pathology and Laboratory Medicine

A nephrectomy specimen was sent to the laboratory for end stage renal disease secondary to nephrolithiasis. Initial sections incidentally revealed a tumor infiltrating the normal renal tissue. Further workup including cytochemical and immuno-histochemical stains confirmed it to be collecting duct carcinoma.

Chronic Itp: Analysis Of Various Factors At Presentation Which Predict Failure To First Line Treatment And Their Response To Second Line Therapy, Naveen Naz Syed, Salman Adil, Muhamed Raihan Sajid, Mohammad Usman, Bushra Moiz, G N Kakepoto, Mohammad Khurshid

Department of Pathology and Laboratory Medicine

OBJECTIVE: To observe the significance of various factors in chronic idiopathic thrombocytopenic purpura (ITP) which predict the response of first line (corticosteroids) and second line therapy (splenectomy) and to evaluate their response to second line therapy.
METHODS: This was a descriptive, prospective study conducted from August 2004 till January 2006. Patients of all age groups and both genders with diagnosis of chronic ITP were included. Treatment protocol and criteria for response assessment was explained.
RESULTS: During 17 months period, 86 patients with chronic ITP were analyzed. Non-responders to first line therapy were 74 patients who ultimately required splenectomy. …

Diagnostic Importance Of Bone Marrow Examination In Non-Hematological Disorders, Naveen Naz Syed, Bushra Moiz, Salman Adil, Mohammad Khurshid

Department of Pathology and Laboratory Medicine

Objective: To evaluate the frequency of involvement of bone marrow with non-haematologic disorders and to observe the significance of bone marrow examination in establishing primary diagnosis of the same.
Methods: It was a descriptive study that extended from January 2003 to September 2005. A total of 4569 bone marrow aspirate and trephines were reported during this period. Only the non-haematological disorders were analyzed for their clinical and laboratory parameter.
Results: During the study period, 63 patients (1.4%) were diagnosed to have non-haematological diseases detected primarily through bone marrow examination. The mean age of patients at time of …

Comparison Of Different Phenotypic Methods Of Detection Of Methicillin Resistance In Staphylococcus Aureus With The Molecular Detection Of Mec-A Gene, M Zeeshan, K Jabeen, E Khan, S Irfan, S Ibrahim, Z Parween, Afia Zafar

Department of Pathology and Laboratory Medicine

OBJECTIVE: To evaluate accuracy, cost-effectiveness and ease to perform different phenotypic methods i.e. Cefoxitin 30 microg disc, Oxacillin 1microg disc and Oxacillin agar screening plate (6microg/ml ) for early and accurate identification of MRSA by comparing with the detection of mec-A gene in our clinical isolates.
DESIGN: A comparative study.
PLACE AND DURATION OF STUDY: Clinical samples submitted in the Clinical Microbiology Laboratory at Aga Khan University Hospital, Karachi, from 1st August to 31st October 2006.
MATERIAL AND METHODS: Out of 200 clinical samples, conventional Polymerase chain reaction (PCR) was done on 62 pure biochemically identified S. aureus …

Evaluation Of Immune Response To Hepatitis B Vaccine In Health Care Workers At A Tertiary Care Hospital In Pakistan: An Observational Prospective Study, Mohammad Zeeshan, Kauser Jabeen, Anita Nausheen Akbar Ali, Ailia Wilayat Ali, Saadia Z Farooqui, Vikram Mehraj, Afia Zafar

Department of Pathology and Laboratory Medicine

Background: Seroconversion rates reported after Hepatitis B virus (HBV) vaccination globally ranges from 85–90%. Health care workers (HCWs) are at high risk of acquiring HBV and non responders' rates after HBV vaccination were not reported previously in Pakistani HCWs. Therefore we evaluated immune response to HBV vaccine in HCWs at a tertiary care hospital in Karachi, Pakistan.
Methods: Descriptive observational study conducted at Aga Khan University from April 2003 to July 2004. Newly HBV vaccinated HCWs were evaluated for immune response by measuring serum Hepatitis B surface antibody (HBsAb) levels, 6 weeks post vaccination.
Results: Initially 666 employees were included …

Antimicrobial Resistance In Neisseria Gonorrhoeae And Limited Treatment Options, Afia Zafar, Kauser Jabeen

Department of Pathology and Laboratory Medicine

No abstract provided.

Nosocomial Buffalopoxvirus Infection, Karachi, Pakistan, Afia Zafar, Robert Swanepoel, Roger Hewson, Mazhar Nizam, Altaf Ahmed, Akhtar Husain, Antoinette Grobbelaar, Kevin Bewley, Valerie Mioulet, Barry Dowsett, Linda Easterbrook, Rumina Hasan

Department of Pathology and Laboratory Medicine

During 5 months in 2004–2005, buffalopoxvirus infection, confirmed by virus isolation and limited nucleic acid sequencing, spread between 5 burns units in Karachi, Pakistan. The outbreak was related to movement of patients between units. Control measures reduced transmission, but sporadic cases continued due to the admission of new patients with community-acquired infections.