Pathology Commons^™

Cryptococcus Neoformans And Streptococcus Pneumoniae Co-Infection In Post-Traumatic Meningitis In A Patient With Unknown Hiv Status, Faryal Saleem, Naima Fasih, Afia Zafar

Department of Pathology and Laboratory Medicine

Meningitis is a serious disease associated with considerable morbidity and mortality. Mixed meningeal infections due to bacteria and fungi are exceptionally rare. Here we report a case of meningeal co-infection with cryptococcus neoformans and streptococcus pneumoniae in a patient with unknown human immunodeficiency virus status. Because of the rarity of such cases, stringent screening of every cerebrospinal fluid specimen to exclude the presence of multiple pathogens is imperative. Assessment of patients for immunodeficiencies in case of isolation of an opportunistic organism like cryptococcus is also needed.

Hospital Preparedness In Community Measles Outbreaks-Challenges And Recommendations For Low-Resource Settings, Sadia Shakoor, Fatima Mir, Anita Zaidi, Afia Zafar

Department of Pathology and Laboratory Medicine

We have reviewed various strategies involved in containment of measles in healthcare facilities during community outbreaks. The strategies that are more applicable to resource-poor settings, such as natural ventilation, mechanical ventilation with heating and air-conditioning systems allowing unidirectional air-flow, and protection of un-infected patients and healthcare workers (HCWs), have been examined. Ventilation methods need innovative customization for resource-poor settings followed by validation and post-implementation analysis for impact. Mandatory vaccination of all HCWs with two doses of measles-containing vaccine, appropriate post-exposure prophylaxis of immunocompromised inpatients, and stringent admission criteria for measles cases can contribute toward reduction of nosocomial and secondary transmission …

Gastrointestinal Stromal Tumors: A Clinicopathologic And Risk Stratification Study Of 255 Cases From Pakistan And Review Of Literature, Nasir Ud Din, Zubair Ahmad, Huma Arshad, Romana Idrees, Naila Kayani

Department of Pathology and Laboratory Medicine

Purpose:
To describe the clinicopathological features of gastrointestinal stromal tumors (GIST) diagnosed in our section and to perform risk stratification of our cases by assigning them to specific risk categories and groups for disease progression based on proposals by Fletcher et al and Miettinen and Lasota.
Material and Results:
We retrieved 255 cases of GIST diagnosed between 2003 and 2014. Over 59% were male. The age range was 16 to 83 years with a mean of 51 years. Over 70% occurred between 40 and 70 years of age. Average diameter of tumors was 10 cms. The stomach was the most …

Hiv Prevalence In Blood Donors And Recipients In Pakistan: A Meta-Analysis And Analysis Of Blood-Bank Data, Bushra Moiz, Barkat Ali, Muhammad Hasnain Chatha, Ahmed Raheem, Hasan Abbas Zaheer

Department of Pathology and Laboratory Medicine

Background:
The first instances of HIV-antibody detection in donated blood in Pakistan were reported in 1988. Since then, documentation of HIV in blood donors and of rates of transmission via transfusion has been limited. Previously assumed to have a low prevalence, HIV is an increasing health concern in Pakistan. Since there is no national, centralized blood-banking system, there are no reliable data on which to base estimated risks of transfusion-associated HIV infection. This study was therefore conducted to estimate the prevalence of HIV in blood donors and recipients in Pakistan between 1988 and 2012.
Methods:
Meta-analyses were undertaken of reported …

Mammary-Type Myofibroblastoma Of The Right Thigh: A Case Report And Review Of The Literature, Jamshid Abdul-Ghafar, Nasir Ud Din, Zubair Ahmad, Steven D. Billings

Department of Pathology and Laboratory Medicine

Introduction:
Mammary-type myofibroblastoma of the soft tissue is a very rare, benign, mesenchymal neoplasm with myofibroblastic differentiation. To date, 20 cases of extra-mammary myofibroblastoma have been described in literature. To the best of our knowledge, this is the largest extra-mammary myofibroblastoma described in the literature, and the first case reported in this location.
Case Presentation:
A 50-year-old Pakistani man presented with a long history of a painless, huge lump on his right thigh. His clinical examination showed normal-looking skin and there was no inguinal lymphadenopathy. The mass was excised with a clinical impression of soft tissue sarcoma. Gross examination showed …

Labrad : Vol 40, Issue 2 - November 2014, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• Significance of HLA Typing in Transplant Medicine
• Role of Protocol Renal Biopsies in Transplant Patients
• Blood Product Utilization in Haematopoietic Stem Cell Transplant Recipients
• Use of Magic Marker “C4d” in the Diagnosis of Acute Antibody Mediated Rejection in Renal Transplant Patients
• Coagulopathy in Renal Transplantation
• Therapeutic Drug Monitoring of Cyclosporine
• Signifi cance of CMV antigenemia Assay In Renal Transplant Patients
• Pretransplant Serological Evaluation
• Importance of Monitoring Cytomegalovirus (CMV) and BKV (Polyomavirus) Infection in Renal Transplant Patients

Leishmania Donovani Bodies In Bone Marrow, Natasha Ali, Shabneez Hussain

Department of Pathology and Laboratory Medicine

We report a case of a 5-year-old female, resident of Afghanistan, who presented with fever and massive splenomegaly. Bone marrow revealed Leishmania donovani bodies (LD bodies) in macrophages characterized by a kinetoplast and characteristic double dot appearance. She was diagnosed as visceral leishmaniasis which is transmitted by sandflies (Phlebotomus).

Chromosomal Abnormalities In Primary Myelodysplastic Syndrome, Anila Rashid, Mohammad Khurshid, Usman Shaikh, Salman Adil

Department of Pathology and Laboratory Medicine

Objective: To determine the frequency of cytogenetic abnormalities in patients diagnosed as primary myelodysplastic syndrome (MDS) using conventional karyotyping. Study Design: Case series. Place and Duration of Study: The Clinical Laboratory, The Aga Khan University Hospital, Karachi, between January 2006 - June 2012. Methodology: Patients of all ages and either gender who fulfilled WHO criteria for MDS were included. Cytogenetic analysis was conducted at the time of diagnosis. Patients who had secondary MDS were excluded from analysis. Chromosome identification and karyotype description was done according to the International System for Chromosome Nomenclature (ISCN, 1995) and described as frequency percentage. Results: …

Shifting Of Vitamin D Deficiency To Hypervitaminosis And Toxicity, Aysha Habib, Hafsa Majid, Romaina Iqbal

Department of Pathology and Laboratory Medicine

No abstract provided.

Tyrosine Kinase Inhibitors In Cancer Therapeutics: Great Expectations From Small Molecules, Zeeshan A Ansar, Tariq Moatter

Department of Pathology and Laboratory Medicine

No abstract provided.

Quality Of Life In Patients With Thalassemia Major In A Developing Country., Sarah H. Siddiqui, Ruba Ishtiaq, Faiza Sajid, Raihan Sajid

Department of Medicine

Objective: To determine the problems faced by thalassemic patients in their personal, psychological and social life.

Study Design: A cross-sectional multi-centre survey.

Place and Duration of Study: Karachi, Lahore and Quetta Centres of Fatimid Foundation, from October 2009 to October 2010.

Methodology: An indigenously developed Qualifty of Life (QoL) questionnaire modified from SF-36 questionnaire was administered to 101 transfusion dependent subjects suffering from thalassemia major. Variables were analyzed using SPSS version 15 for descriptive statistics.

Results: The mean age of the subjects was 10.5 years ranging from 6 - 21 years. Less than one third of the patients felt that …

Drug Resistant Tuberculosis: Challenges Of Urbanization, Rumina Hasan

Department of Pathology and Laboratory Medicine

No abstract provided.

Mycobacterium Tuberculosis Central Asian Strain (Cas) Lineage Strains In Pakistan Reveal Lower Diversity Of Miru Loci Than Other Strains, Asho Ali, Zahra Hasan, Sana Jafri, Raunaq Inayat, Rumina Hasan

Department of Pathology and Laboratory Medicine

Mycobacterium tuberculosis (MTB) Central Asian Strain (CAS) lineage strains are predominant in South Asia. Mycobacterial interspersed repetitive units-variable number of tandem repeats (MIRU-VNTR) typing is an effective way of determining genetic diversity of strains. A maximum of 24 loci-based MIRU-VNTR typing can be used, however, it is important to investigate the relevance of specific MIRU loci for regional strains for more cost-effective MIRU typing. MIRU-VNTR typing was performed on MTB strains from Pakistan. Strains were comprised of CAS (n=113) and non-CAS lineages (n=87) - both multi-drug resistant (MDR) and drug susceptible. Hunter Gaston Discriminatory Index (HGDI) for each MIRU loci …

Promoter Hypermethylation Of Tumor Suppressor Genes Correlates With Tumor Grade And Invasiveness In Patients With Urothelial Bladder Cancer, Shumaila M. Bilgrami, Sohail A. Qureshi, Shahid Pervez, Farhat Abbas

Section of Urology

Purpose: To investigate the promoter methylation status at selected loci which encode for key proteins involved in apoptosis, DNA repair, cell cycle control and progression in urothelial cell carcinoma of bladder and compare the findings from tissue samples with that of plasma.
Methods: Total genomic DNA was isolated from 43 non-muscle invasive (low grade) and 33 muscle invasive (high grade) urothelial bladder cancer samples along with 10 control cases of normal bladder mucosa. Promoter methylation status was investigated for RASSF1A, APC, MGMT, CDKN2A and CDKN2B genes using real-time methylation-specific PCR with SYBR® green. Plasma samples from 16 patients with muscle …

Response To Imatinib Mesylate In Patients With Early Chronic Phase Chronic Myeloid Leukemia And Derivative Chromosome 9 Deletion Or Clonal Evolution, Mohammad Usman Shaikh, Tariq Moatter, Naveen Naz Syed, Natasha Bahadur Ali, Salman Adil

Department of Pathology and Laboratory Medicine

Objectives: The significance of clonal evolution and derivative chromosome 9 in Philadelphia-positive CML is not fully characterized and studies have yielded conflicting results. After working on emergence of clonal evolution from our region, we continued to find out the response of Imatinib Mesylate on such cases of CML treated in our center.
Materials and methods: We conducted a cross sectional, prospective analysis on response of Imatinib Mesylate on patients with Philadelphia positive chronic myeloid leukemia with clonal evolution treated from period of September 2007 till 2010. Patients were grouped on basis of cytogenetic analysis performed by conventional cytogenetic and fluorescence …

Labrad : Vol 40, Issue 1 - April 2014, 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
• Meeting Report: The 37th Annual Conference of the Pakistan Association of Pathologists

Refusal To Autopsy: A Societal Practice In Pakistan Context, Laila Akber Cassum

School of Nursing & Midwifery

Autopsies or post-mortem examinations have become a common practice in Western medicine for verifying the cause of death, and to obtain additional scientific information on certain diseases. In monotheistic religions autopsies present several ethical questions even though the advantages attributed to post-mortems in the West are well acknowledged by people living in this modern world. In Islamic Republic of Pakistan where Islam is the prevailing religion followed by the Muslims, Pakistani society have diverse perception, assumptions and hypothesis on the concept of autopsy. This presumption is due to presence of diverse objections raised in religious and sociocultural context. In our …

The Heart Weight–Body Weight Coefficient In Kenyans Aged 14 Years And Above, Mbayah Etabale

Master of Medicine in Anatomic Pathology

Background: The heart size has traditionally been assessed using absolute reference weights. But the heart weight (HW) has been shown to depend on one’s body size hence a better measure is the ratio of the HW to the body weight (BW) – the HW-BW coefficient. Initially noted to be 0.43% and 0.40% in males and females respectively, recent studies have shown an increase of up to 0.51%. Objective: To determine the HW-BW coefficient in Kenyans aged 14 years and above. Methods: One hundred and four deceased Kenyans aged 14 years and above, with no heart or chronic lung disease, were …

Residual Disease And Hpv Persistence After Cryotherapy For Cervical Intraepithelial Neoplasia Grade 2/3 In Hiv Positive Women In Kenya, Hugo De Vuyst, Nelly R. Mugo, Silvia Franceschi, Kevin Mckenzie, Vanessa Tenet, Julia Njoroge, Farzana S. Rana, Samah R. Sakr, Peter J.F. Snijders, Michael Chung

Pathology, East Africa

Objective: To assess residual cervical intraepithelial neoplasia (CIN) 2/3 disease and clearance of high-risk (hr) human papillomavirus (HPV) infections at 6 months after cryotherapy among HIV-positive women.

Design: Follow-up study.

Methods: 79 HIV-positive women received cryotherapy for CIN2/3 in Nairobi, Kenya, and underwent conventional cytology 6 months later. Biopsies were performed on high grade cytological lesions and hrHPV was assessed before (cervical cells and biopsy) and after cryotherapy (cells).

Results: At 6 months after cryotherapy CIN2/3 had been eliminated in 61 women (77.2%; 95% Confidence Interval, (CI):66.4–85.9). 18 women (22.8%) had residual CIN2/3, and all these women had hrHPV at …

Epidemiology Of Malaria In A Village In The Rufiji River Delta, Tanzania: Declining Transmission Over 25 Years Revealed By Different Parasitological Metrics, Anna Färnert, Victor Yman, Manijeh Vafa Homann, Grace Wandell, Leah Mhoja, Marita Johansson, Salome Jesaja, Johanna Sandlund, Kazuyuki Tanabe, Ulf Hammar, Matteo Bottai, Zul Premji, Anders Björkman, Ingegerd Rooth

Pathology, East Africa

Background: Assessments of the epidemiology of malaria over time are needed to understand changes in transmission and guide control and elimination strategies.

Methods: A longitudinal population study was established in 1985 in Nyamisati village in the Rufiji River Delta, Tanzania. A physician and research team lived in the village 1984–2000. Parasite prevalence by microscopy and two PCR methods, spleen rates and haemoglobin levels were measured in repeated cross-sectional surveys between 1985 and 2010. Passive surveillance of malaria cases was maintained until end 1999. Bed nets were distributed after the surveys 1993, 1999 and 2010.

Results: In 1985, overall parasite prevalence …

Androgen Receptor Expression And Associated Clinico-Pathologic Features In Primary Breast Cancer From Kenya, Joshua Kibera Chege

Master of Medicine in Anatomic Pathology

Introduction: Breast cancer is a heterogeneous group of diseases classified into various subtypes according to clinical, histological and molecular features as well as by the expression of prognostic and predictive biomarkers. New biomarkers are being studied which may be therapeutic targets in various breast cancer subtypes particularly triple-negative breast cancer. Recent studies show that androgen receptor (AR) expression can be used as a prognostic marker and there is evidence that anti-androgen therapy may be beneficial in oestrogen receptor negative breast cancer. Retrospective studies show that patients with breast cancers co-expressing androgen receptor and oestrogen receptor have a favourable prognosis and …

The Prevalence Of Malaria And Assessment Of The Uptake Of Malaria Prevention Measures In Blood Donors In Two Regional Blood Transfusion Centres In Kenya, Valerie Magutu

Master of Medicine in Clinical Pathology

Transfusion transmitted malaria is one of the most common transfusion transmissible infections and is a threat to blood safety and malaria control in Sub-Saharan African countries where malaria is endemic. The majority of healthy adults living in malaria endemic areas have some degree of immunity to the disease and an asymptomatic low-level parasitaemia is known to exist in a subset of this population. Blood donors recruited from the population are screened using a donor-selection criteria that includes age, weight, self-declared well-being and measurement of vital signs but not history of recent malaria infection or treatment. The Kenya National Blood Transfusion …

Environmental And Occupational Factors Associated With Chronic Myeloid Leukemia: A Case-Control Study, R. Kasmani, N.A. Othieno-Abinya, M.T. Singh Riyat, G.W. Kiarie, Peter Wanzala

Pathology, East Africa

Background: The relationship between chronic myeloid leukemia (CML) and a broad range of exposures to occupational and environmental factors known to cause leukemia in general is limited. CML is by and large incurable and treatment is just palliative and life prolonging, with high case fatality rate, even in the best centers. Furthermore treatment is very expensive. Identification of leukemogenic factors is therefore important if this can lead to simple public health interventions.

Objective: The objective was to determine key environmental and occupational exposure factors that may be associated with CML.

Methods: This was a case-control study involving CML …

Low Prevalence Of Methicillin Resistant As Determined By An Automated Identification System In Two Private Hospitals In Nairobi, Kenya: A Cross Sectional Study, Geoffrey Omuse, Beatrice Kabera, Gunturu Revathi

Pathology, East Africa

Background: Staphylococcus aureus (S.aureus) is a major cause of both healthcare and community acquired infections. In developing countries, manual phenotypic tests are the mainstay for the identification of staphylococci with the tube and slide coagulase tests being relied upon as confirmatory tests for S. aureus. The subjectivity associated with interpretation of these tests may result in misidentification of coagulase negative staphylococci as S.aureus. Given that antibiotic resistance is more prevalent in CONS, this may result in over estimation of methicillin resistant S.aureus (MRSA) prevalence.

Methods: A review of susceptibility data from all non-duplicate S.aureus isolates generated between March 2011 and …

Ovarian Sex Cord Stromal Tumours In Children And Young Girls - A More Than Two Decade Clinicopathological Experience In A Developing Country, Pakistan, Saroona Haroon, Romana Idrees, Aleena Zia, Aisha Memon, Saira Fatima, Naila Kayani

Department of Pathology and Laboratory Medicine

Background: Ovarian sex-cord stromal tumours (SCST) are rare, and relatively infrequent in children. These have to be distinguished from more common germ cell tumors in children and also from benign epithelial neoplasms.
Objectives: The purpose of our study was to report the clinical and pathological findings in young patients with these tumours in our population.
Material and Methods: The present observational cross-sectional study included all subjects SCST, in Aga Khan University Hospital Histopathology Laboratory, Karachi, Pakistan, from January 1992 till July 2013.
Results: Of the total of 513 SCSTs presented during the study period, 39 fulfilled inclusion criteria and were …

Pleomorphic Lobular Carcinoma Of The Male Breast With Axillary Lymph Node Involvement: A Case Report And Review Of Literature, Muhammad Nauman Zahir, Khurram Minhas, Munira Shabbir-Moosajee

Department of Pathology and Laboratory Medicine

Background: Carcinoma of the male breast is responsible for less than 1% of all malignancies in men but the incidence is rising. Invasive ductal carcinoma is the most common histological subtype while invasive lobular carcinoma is responsible for only 1.5% of the total cases of which pleomorpic lobular carcinoma is an extremely rare variant. We report the case of a gentleman with node positive, pleomorphic lobular carcinoma of the breast.
Case Presentation: An elderly gentleman with a past history of type 2 diabetes and long term ethanol use presented to us with a self-discovered palpable lump in the left breast. …

Aetiology Of Acute Febrile Episodes In Children Attending Korogwe District Hospital In North-Eastern Tanzania, C. Mahende, B. Ngasala, J. Lusingu, A. Butichi, P. Lushino, M. Lemnge, Zul Premji

Pathology, East Africa

Introduction: Although the burden of malaria in many parts of Tanzania has declined, the proportion of children with fever has not changed. This situation underscores the need to explore the possible causes of febrile episodes in patients presenting with symptoms at the Korogwe District Hospital (KDH).

Methods: A hospital based cross-sectional study was conducted at KDH, north-eastern Tanzania. Patients aged 2 to 59 months presenting at the outpatient department with an acute medical condition and fever (measured axillary temperature ≥37.5°C) were enrolled. Blood samples were examined for malaria parasites, human immunodeficiency virus (HIV) and bacterial infections. A urine culture was …

Using Verbal Autopsy To Measure Causes Of Death: The Comparative Performance Of Existing Methods, C.J.L. Mahende, R. Lozano, A.D. Flaxman, P. Serina, D. Phillips, A. Stewart, S.L. James, A. Vahdatpour, C. Atkinson, M.K. Freeman, S.L. Ohno, R. Black, S.M. Ali, A.H. Baqui, L. Dandona, E. Dantzer, G.L. Darmstadt, V. Das, U. Dhingra, A. Dutta, W. Fawzi, S. Gomez, B. Hernandez, R. Joshi, H.D. Kalter, A. Kumar, V. Kumar, M. Lucero, S. Mehta, Zul Premji, D. Ramirez-Villalobos, H. Remolador, I. Riley, M. Romero, M. Said, D. Sanvictores, S. Sazawal, V. Tallo, A. D. Lopez

Pathology, East Africa

Background: Monitoring progress with disease and injury reduction in many populations will require widespread use of verbal autopsy (VA). Multiple methods have been developed for assigning cause of death from a VA but their application is restricted by uncertainty about their reliability.

Methods: We investigated the validity of five automated VA methods for assigning cause of death: InterVA-4, Random Forest (RF), Simplified Symptom Pattern (SSP), Tariff method (Tariff), and King-Lu (KL), in addition to physician review of VA forms (PCVA), based on 12,535 cases from diverse populations for which the true cause of death had been reliably established. For adults, …

A Review Of 74 Patients With Newly Diagnosed Multiple Myeloma At A Tertiary Referral Hospital In Nairobi, Kenya, G. Kiraka, Mbayah Etabale, Riyat Malkit

Pathology, East Africa

Introduction: Multiple myeloma is a neoplastic disorder characterized by clonal proliferation of plasma cells. We aimed to carry out a retrospective audit to describe clinical and laboratory features of patients newly diagnosed with multiple myeloma.

Materials and Methods: Records of all patients initially diagnosed with multiple myeloma at the haematology clinic of Aga Khan University Hospital, Nairobi, from January 1, 1999 to December 31, 2011 were reviewed. Diagnosis of multiple myeloma was based on (1) increased numbers of abnormal, atypical or immature plasma cells in a bone marrow aspirate or trephine, (2) presence of monoclonal protein or free light chains …

Applying Consensus Criteria To The Evaluation Of Patients With Suspected Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma, E. Mulwa-Babu, Riyat Malkit, D. Parech

Pathology, East Africa

We describe a series of 5 patients in whom the application of consensus criteria for the diagnosis of chronic lymphocytic leukemia (CLL) led to a revised diagnosis. These patients had been recruited in a wider study describing the occurrence of CLL in Kenya. This case series highlights some of the pitfalls of making a diagnosis of CLL without incorporating all criteria.