Pathology Commons^™

Knowledge And Awareness Regarding Cervical Cancer And Uptake Of Pap Smear Among Women In Karachi, Pakistan, Shama Razzaq, Sayeeda Amber Sayed Amber Sayeeda Amber Sayed, Sumera Aziz Ali

Community Health Sciences

Objective: To determine the knowledge regarding cervical cancer, its symptoms and risk factors among women of 18 years and above attending the gynecology OPD in two public hospitals Karachi, Pakistan.
Methodology: A cross-sectional survey was held from February to June 2013 in Karachi, Pakistan. 384 females aged 18 years and above attending gynecology clinics in two public sector hospitals were taken through non-probability sampling method. The knowledge was assessed using a point scale method which had binary response i.e. correct and incorrect. A score of 50% (≥ 11 correct responses) was considered as optimum knowledge.
Results: Overall knowledge of cervical …

Eliminating Wrong Blood Transfusions - Recent Advances, Farheen Karim, Salman Naseem Adil

Department of Pathology and Laboratory Medicine

No abstract provided.

Perception Of Pathology As A Future Career Choice Among Medical Students From Karachi, Pakistan: Experience From A Private Medical School, Najia Bano Ghanchi, Raabia Nizamuddin Nizamuddin, Amna Qasim, Zahra Nur Khaled, Ahmed Buksh Raheem, Natasha Bahadur Ali, Naila Kayani, Mohammad Asim Beg

Medical College Documents

To determine the perception of pathology as a future career choice among medical students of a private medical school from Karachi, Pakistan. A descriptive cross-sectional study was conducted at the Aga Khan University, Karachi, Pakistan. A total of 201 students participated in this study. All Students were approached randomly to participate. A total of 201 students participant survey forms were evaluated in this study. The overall satisfaction level with pathology was observed in 61.8% ofthe students. Majority of the students understood subspecialties which were a part of clinical medicine. Over half of the students thought pathology as a specialty should …

Enterobius Vermicularis In Tubo-Ovarian Abscess: A Rare And Interesting Incidental Finding - A Case Report, Faryal Saleem, Faizan Malik, Saira Fatima

Department of Pathology and Laboratory Medicine

Enterobius vermicularis is a common intestinal nematode; however, rare extraintestinal Enterobius infections have been reported from different parts of the world. Here, we present a case of tubo-ovarian abscess in an otherwise healthy young sexually active female with no known comorbids with history of on and off lower abdominal pain for one year and high grade fever for one month. On the basis of further workup and radiological evaluation, a preoperative diagnosis of right sided tubo-ovarian abscess was made and salpingo-oophorectomy was performed laproscopically in July 2015. Histopathology of the resected tissue revealed necrosis and in one area Enterobius vermicularis …

Selective Screening For Organic Acidurias And Amino Acidopathies In Pakistani Children, Noreen Abbas Sherazi, Aysha Habib Khan, Lena Jafri, Azeema Jamil, Nasir Ali Khan, Bushra Afroze

Department of Pathology and Laboratory Medicine

Objective: To determine the frequency of organic acidurais (OA) and amino acidopathies (AA) in selected high-risk patients screened in two years.
Study Design: Retrospective Observational study.
Place and Duration of Study: The Aga Khan University Hospital (AKUH), Karachi, from January 2013 to December 2014.
Methodology: Patients with OA and AA were included in the study and patients with IMDs other than OA and AA were excluded. Amino acids and organic acids were analyzed on high performance liquid chromatography and gas chromatography-mass spectrometry respectively. Clinical data and chromatograms of patients screened for IMDs were reviewed by chemical pathologist and metabolic physician. …

Increasing Usage Of Rapid Diagnostics For Dengue Virus Detection In Pakistan, Zahra Hasan, Saher Razzak, Muhammad Farhan, Maryam Rahim, Nazneen Islam, Azra Samreen, E. Khan

Department of Pathology and Laboratory Medicine

No abstract provided.

Atypical Teratoid/ Rhabdoid Tumor Of Brain: A Clinicopathologic Study Of Eleven Patients And Review Of Literature, Nasir Ud Din, Abrar Barakzai, Aisha Memon, Sheema Hasan, Zubair Ahmad

Department of Pathology and Laboratory Medicine

Creative Commons Attribution LicenseBackground: Atypical teratoid/ rhabdoid tumor (AT/RT) is a rare aggressive embryonal central nervous system(CNS) tumor of infancy and early childhood. Majority of the cases arise in the posterior fossa, and remaining in thecerebrum. Aims: To analyze the clinicopathologic features of AT/RT on a cohort of cases. Materials and methods:All reported cases of AT/RT at the Department of Pathology and Laboratory Medicine, Aga Khan University Hospital(AKUH) from 2007 to 2016 were reviewed for clinical and pathological features. Immunohistochemical stain for INI-1was performed in all 11 cases. Follow up was obtained. Results: A total of 11 cases were identified. …

Labrad : Vol 43, Issue 1 - March 2017, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• Chikungunya
• Rapid Molecular Diagnosis of Chlamydia Trachomatis (CT) and Neisseria Gonorrhoeae (NG) Urethritis
• Overview of Rubella Testing
• Most Common Bone and Soft Tissue Infections Seen in our Practice
• Diagnosis of Helicobacter Pylori Infection in Developing Countries- Pros & Cons
• Screening for Neonatal Infections with TORCH Profile
• Blood and Bone Marrow Changes in Viral Infections
• Malaria
• World Rare Disease Day
• Radiology Pathology Correlation

Evaluation Of The Parasight Platform For Malaria Diagnosis, Yochay Eshel, Arnon Houri-Yafin, Hagai Benkuzari, Natalie Lezmy, Mamta Soni, Malini Charles, Jayanthi Swaminathan, Hilda Solomon, Pavithra Sampathkumar, Zul Premji, Caroline Mbithi, Zaitun Nneka, Simon Onsongo, Daniel Maina, Sarah Levy-Schreier, Caitlin Lee Cohen, Dan Gluck, Joseph Joel Pollak, Seth J. Salpeter

Pathology, East Africa

The World Health Organization estimates that nearly 500 million malaria tests are performed annually. While microscopy and rapid diagnostic tests (RDTs) are the main diagnostic approaches, no single method is inexpensive, rapid, and highly accurate. Two recent studies from our group have demonstrated a prototype computer vision platform that meets those needs. Here we present the results from two clinical studies on the commercially available version of this technology, the Sight Diagnostics Parasight platform, which provides malaria diagnosis, species identification, and parasite quantification. We conducted a multisite trial in Chennai, India (Apollo Hospital [n = 205]), and Nairobi, Kenya …

Homocysteine As A Biomarker For Thrombosis: What Is The Learning Curve?, Bushra Moiz

Department of Pathology and Laboratory Medicine

No abstract provided.

Tailored Metabolic Workup For Urolithiasis – The Debate Continues, Hammad Ather, Imran Siddiqui, Tahmeena Siddiqui, M Nasir Sulaiman

Department of Surgery Docs

Abstract

Urolithiasis is one of the commonest afflictions of the urinary tract. Stones are of various chemical compositions, some share some common etiology; but most are specific to the structure and composition of stone. In view of highly recurrent nature of this condition, it is logical to have strategies for prevention. However, due to multiple factors most patients receive no or fragmented information on prevention. The current controversy is to the extent of metabolic workup in adult first time stone former. This requires longitudinal studies to show benefit in prevention strategies. Patients at high risk can have recurrence in weeks …

Coinfection With Lichtheimia Corymbifera And Aspergillus Flavus In An Immune-Competent Patient Mimicking As Pulmonary-Renal Syndrome, Ali Bin Sarwar Zubairi, Farah Idress, Kauser Jabeen, Saima Kamal, Afia Zafar

Department of Medicine

Lichtheimia corymbifera and Aspergillus flavus pulmonary coinfection has been rarely reported in immune-competent patients. We report case of a young male who presented with clinical features of pulmonary-renal syndrome and was later diagnosed to have bilateral polymicrobial fungal lung infection.

The 17th International Congress On Infectious Diseases Workshop On Developing Infection Prevention And Control Resources For Low- And Middle-Income Countries, Sangeeta Sastry, Nadia Masroor, Gonzalo Bearman, Rana Hajjeh, Alison Holmes, Ziad Memish, Britta Lassmann, Didier Pittet, Fiona Macnab, Rachel Kamau, Evelyn Wesangula, Paras Pokharel, Paul Brown, Frances Daily, Fatma Amer, Jaime Torres, Miguel O’Ryan, Gunturu Revathi, Andre Bulabula, Shaheen Mehtar

Pathology, East Africa

Hospital-acquired infections (HAIs) are a major concern to healthcare systems around the world. They are associated with significant morbidity and mortality, in addition to increased hospitalization costs. Recent outbreaks, including those caused by the Middle East respiratory syndrome coronavirus and Ebola virus, have highlighted the importance of infection control. Moreover, HAIs, especially those caused by multidrug-resistant Gram-negative rods, have become a top global priority. Although adequate approaches and guidelines have been in existence for many years and have often proven effective in some countries, the implementation of such approaches in low- and middle-income countries (LMICs) is often restricted due to …

Practical Guide And Atlas For The Diagnosis Of Fungal Infections, Afia Zafar, Kauser Jabeen, Joveria Farooqi

Books

Laboratory diagnosis of fungal infections remains challenging in South East Asia as it is a neglected field in most diagnostic centres in the developing world. Initial microscopic examination of clinical specimens for the presence of fungal elements followed by growth and eventual identification of isolates up to genus and species levels are very basic and important services that must be provided by any clinical microbiology laboratory. These services have considerable impact on selection of appropriate antifungal therapy and ultimate reduction in morbidity and mortality. With the realisation of scarcity of this service and expertise in Pakistan, our group decided to …

Readiness For Antimicrobial Resistance (Amr) Surveillance In Pakistan; A Model For Laboratory Strengthening, Dania Khalid Saeed, Rumina Hasan, Mahwish Naim, Afia Zafar, Erum Khan, Kauser Jabeen, Seema Irfan, Imran Ahmed Haq, Mohammad Zeeshan, Zabin Wajidali, Joveria Farooqi, Sadia Shakoor, Abdul Chagla, Jason Roy

Department of Pathology and Laboratory Medicine

Background: Limited capacity of laboratories for antimicrobial susceptibility testing (AST) presents a critical diagnostic bottleneck in resource limited countries. This paper aims to identify such gaps and to explore whether laboratory networks could contribute towards improving AST in low resource settings.
Methods: A self-assessment tool to assess antimicrobial susceptibility testing capacity was administered as a pre-workshop activity to participants from 30 microbiology laboratories in 3 cities in Pakistan. Data from public and private laboratories was analyzed and capacity of each scored in percentage terms. Laboratories from Karachi were invited to join a support network. A cohort of five laboratories that …

Phenotypic Low-Level Isoniazid Resistance As A Marker To Predict Ethionamide Resistance In Mycobacterium Tuberculosis, Salima Qamar, Joveria Q. Farooqi, Kausar Jabeen, Rumina Hasan

Department of Pathology and Laboratory Medicine

Background: Tuberculosis is one of the most prevalent diseases in Pakistan. Pakistan has the highest burden of MDR-TB in the Eastern Mediterranean region. Ethionamide is an anti-tuberculous drug frequently used to treat MDR-TB. Its drug susceptibility testing is not easily available in resource limited settings. Since it acts on the same target protein as isoniazid (inhA protein encoded by inhA gene), we sought to find out if phenotypic isoniazid resistance can be a marker of ethionamide resistance.
Materials and Methods: This was a retrospective observational study conducted at the Aga Khan University hospital section of microbiology. Data was retrieved between …

Utility Of Peripheral Film Findings And Its Correlation With Automated Analyzer - An Audit From Tertiary Care Hospital, Sidra Asad, Imran Ahmed, Natasha Ali

Department of Pathology and Laboratory Medicine

Background and Objective: With the advent of automated hematology analyzer, the use of traditional microscopy of blood film has become limited. The objective of our study was to determine the percentage of peripheral blood smear review in our institution in the era of automation and to identify reasons of manual review.
Materials and Methods: This was a prospective audit from January 1, 2015, to January 15, 2015. Consecutive complete blood count (CBC) samples and peripheral smear requests made up the sample size. All age groups and genders were included. CBCs were performed on Sysmex XE-5000. The variables to be analyzed …

Papillary Craniopharyngioma: A Clinicopathologic Study Of A Rare Entity From A Major Tertiary Care Center In Pakistan, Muhammad Usman Tariq, Nasir Ud Din, Zubair Ahmad, Wasim Memon

Department of Pathology and Laboratory Medicine

Background: 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.
Objective: 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.
Materials and Methods: …

Rapid Detection Of In Vitro Antituberculous Drug Resistance Among Smear-Positive Respiratory Samples Using Microcolony Detection-Based Direct Drug Susceptibility Testing Method, Irim Iftikhar, Seema Irfan, Joveria Farooqi, Zahida Azizullah, Rumina Hasan

Department of Pathology and Laboratory Medicine

Background: With the rise in multidrug-resistant tuberculosis, there is a search for newer techniques that will rapidly detect drug-resistant Mycobacterium tuberculosis. Although molecular techniques can detect resistance, culture is still considered gold standard, especially in resource-limited settings where quick, cheap, and easy techniques are needed. The aim of the study was to evaluate microcolony method thin layer agar (TLA) for quick detection of resistance against the first- and second-line antituberculous drugs in clinical isolates. This was a cross-sectional study performed at Aga Khan University Hospital.
Material and Methods: A total of 87 Z-N stain smear-positive pulmonary samples were received and …

High Resolution Melting: A Useful Field-Deployable Method To Measure Dhfr And Dhps Drug Resistance In Both Highly And Lowly Endemic Plasmodium Populations, Yaye Dié Ndiaye, Cyrille K. Diédhiou, Amy K. Bei, Baba Dieye, Aminata Mbaye, Nasserdine Papa Mze, Rachel F. Daniels, Ibrahima M. Ndiaye, Awa B. Déme, Amy Gaye, Mouhamad Sy, Tolla Ndiaye, Aida S. Badiane, Mouhamadou Ndiaye, Zul Premji, Dyann F. Wirth, Souleymane Mboup, Donald Krogstad, Sarah K. Volkman, Ambroise D. Ahouidi, Daouda Ndiaye

Pathology, East Africa

Background: Emergence and spread of drug resistance to every anti-malarial used to date, creates an urgent need for development of sensitive, specifc and feld-deployable molecular tools for detection and surveillance of validated drug resistance markers. Such tools would allow early detection of mutations in resistance loci. The aim of this study was to compare common population signatures and drug resistance marker frequencies between two populations with diferent levels of malaria endemicity and history of anti-malarial drug use: Tanzania and Sénégal. This was accomplished by implementing a high resolution melting assay to study molecular markers of drug resistance as compared to …

Reference Intervals For Thyroid Stimulating Hormone And Free Thyroxine Derived From Neonates Undergoing Routine Screening For Congenital Hypothyroidism At A University Teaching Hospital In Nairobi, Kenya: A Cross Sectional Study, Geoffrey Omuse, Ali Kassim, Francis Kiigu, Ra'ana Hussain, Mary Limbe

Pathology, East Africa

Background: In order to accurately interpret neonatal thyroid function tests (TFTs), it is necessary to have population specific reference intervals (RIs) as there is significant variation across different populations possibly due to genetic, environmental or analytical issues. Despite the importance of RIs, globally there are very few publications on RIs for neonatal TFTs primarily due to ethical and technical issues surrounding recruitment of neonates for a prospective study. To the best of our knowledge, this is the first report from Africa on neonatal RIs for TFTs.

Methods: We used hospital based data largely derived from neonates attending the wellness clinic …

Urolithiasis Analysis In A Multiethnic Population At A Tertiary Hospital In Nairobi, Kenya, Francis Kiigu, Alfred Hayombe, Daniel Maina

Pathology, East Africa

Background: Urolithiasis is a global problem whose incidence is reported to be on the rise across the world. Previously, urolithiasis was reported as being rare among the indigenous African population but recent data suggest otherwise. This study reviewed the demographic and clinical characteristics of patients with urolithiasis seen at the Aga Khan University hospital Nairobi (AKUHN) as well as the chemical composition of the stones and the modalities of therapy used.

Methods: This was a retrospective study which utilized patients’ clinical and laboratory records from 2013 to 2014. Sixty-seven symptomatic patients with confrmed urolithiasis formed the study. This study aimed …

Simplified Antibiotic Regimens For Treatment Of Clinical Severe Infection In The Outpatient Setting When Referral Is Not Possible For Young Infants In Pakistan (Simplified Antibiotic Therapy Trial [Satt]): A Randomised, Open-Label, Equivalence Trial, Fatima Mir, Imran Nisar, Shiyam S. Tikmani, Benazir Baloch, Sadia Shakoor, Fyezah Jehan, Imran Ahmed, Simon Cousens, Anita K M Zaidi

Department of Paediatrics and Child Health

Background: Parenteral antibiotic therapy for young infants (aged 0–59 days) with suspected sepsis is sometimes not available or feasible in countries with high neonatal mortality. Outpatient treatment could save lives in such settings. We aimed to assess the equivalence of two simplified antibiotic regimens, comprising fewer injections and oral rather than parenteral administration, compared with a reference treatment for young infants with clinical severe infection.
Methods: We undertook the Simplified Antibiotic Therapy Trial (SATT), a three-arm, randomised, open-label, equivalence trial in five communities in Karachi, Pakistan. We enrolled young infants (aged 0–59 days) who either presented at a primary health-care …

Erratum To: Neonatal Hyperbilirubinemia In Infants With G6pd C.563c>T Variant, Bushra Moiz, Amna Nasir, Sarosh Ahmed Khan, Saleema Amin Kherani, Maqbool Qadir

Department of Pathology and Laboratory Medicine

No abstract provided.

Labrad : Vol 42, Issue 3 - December 2016, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• Provocative Testing for Growth Hormone Disorders
• Serum Procalcitonin for Early Sepsis Diagnosis
• Monoclonal Gammopathy of Undetermined Significance (MGUS)
• Understanding Six Sigma Methodology
• Blood Collection for Culture
• Molecular Analysis of Alpha Thalassaemia by Multiple Ligation Probe Assay
• Prognostification of Acute Myeloid Leukemia with FLT 3 Mutation
• Interferon Gamma Release Assay (IGRA) for Detection of Mycobacterium Tuberculosis Infection in the Host
• An Analysis of Needle Stick Injury in the Department of Radiology

Effect Of Time Duration Of Digestion/Decontamination Technique On Yield Of Mycobacteria And Contamination Rates From Sterile Body Fluids (Pleural And Ascitic Fluid) And Pus Specimens, Samreen Shafiq, Faryal Saleem, Kauser Jabeen, Joveria Farooqi, Warda Alam, Sadia Hanif, Shazia Ali, Sadia Shakoor, Rumina Hasan

Department of Pathology and Laboratory Medicine

Background:
Duration of digestion/decontamination has a considerable impact on yield of mycobacteria especially from sterile body fluids and pus specimens. Additionally, duration of digestion/decontamination affects the contamination rates. This study evaluates the effect of digestion/decontamination protocol for 15 and 20min versus inoculation of media directly from the sample on contamination rates as well as the yield of mycobacteria from pus and sterile fluids other than cerebrospinal fluids.
Methods:
Pleural fluid (n=60), pus (n=48) and ascitic fluid (n=12) specimens were cultured for mycobacteria and evaluated for contamination and mycobacterial yield using three different processing methodologies: without digestion/decontamination with 5% NaOH-NALC (D/D), …

Mycobacterial Contamination Of Bronchoscopes: Challenges And Possible Solutions In Low Resource Settings, Dania Khalid Saeed, Sadia Shakoor, Seema Irfan, Rumina Hasan

Department of Pathology and Laboratory Medicine

The use of bronchoscopes has increased in tuberculosis (TB) diagnostics to circumvent the diagnostic challenges that are associated with low sputum volume and smear-negative TB. In healthcare facilities situated in low income countries that have a high burden of TB, adequate decontamination of bronchoscopes is a challenge and often overlooked to save on time and costs. This amplifies the risk of outbreaks and pseudo-outbreaks due to Mycobacterium tuberculosis and nontuberculosis mycobacteria. In this minireview, we review published literature of contaminated bronchoscopes causing pseudo-outbreaks of M. tuberculosis and nontuberculosis mycobacteria in an effort to determine common sources, and possible mitigation strategies …

Pulmonary Infections After Tuberculosis, Kauser Jabeen

Department of Pathology and Laboratory Medicine

Aims and Objective: Despite effective treatment of pulmonary tuberculosis (TB) patients, destruction of lung parenchyma may lead to complications including repeated infections. These infections are often misdiagnosed or wrongly identified as TB recurrence, and hence are not treated effectively. The frequency and severity of these infections vary with the extent of damage, and are much more prominent in patients with post-TB bronchiectasis and fibrocavitary diseases. This presentation will focus on the epidemiology, treatment, and management of post-TB infections and challenges, and the impact of these infections on public health in high-TB-burden countries.
Methods: Published literature and review articles were evaluated …

Tuberculosis In Vulnerable Populations In Eastern Mediterranean Region-Implications For Control, Sadia Shakoor, Rumina Hasan

Department of Pathology and Laboratory Medicine

Objectives: Socially and economically disadvantaged or "vulnerable" people are at high risk of tuberculosis (TB) and also contribute to active chains of TB transmission. Included in such vulnerable populations are children, women, prisoners, people living with human immunodeficiency virus, the homeless, and displaced people. The ongoing active transmission of TB among such populations is made more difficult to assess and control by difficult access, health inequities, poverty, and other chronic and debilitating health conditions at individual, domestic, and community levels.
Methods: The 22 Eastern Mediterranean Region member states encompass diverse sociopolitical and socioeconomic situations with far-reaching effects on vulnerable populations …

Massive Pulmonary Embolism Presenting As Seizures, Shahrukh Hashmani, Fateh Ali Tipoo Sultan, Murtaza Kazmi, Amammarah Yasmeen

Department of Pathology and Laboratory Medicine

Pulmonary embolism can present in various ways, though seizure activity has been rarely reported. We report a 38 years old male who had met a road traffic accident, underwent surgery, presented a month later with seizures, chest pain, shortness of breath and low blood pressure. Massive pulmonary embolism was diagnosed on CTPA, with classical features on ECG and echocardiogram and the patient was successfully managed with thrombolysis. Massive pulmonary embolism (MPE) should be kept in mind in patients who present with seizures, chest pain and haemodynamic instability.