Pathology Commons^™

Demographic And Clinical Features Of Dengue Fever In Pakistan From 2003-2007: A Retrospective Cross-Sectional Study., Erum Khan, Mehreen Kisat, Nabil Khan, Amna Nasir, Salma Ayub, Rumina Hasan

Department of Pathology and Laboratory Medicine

Background: Demographic features of dengue fever have changed tremendously in Pakistan over the past two decades. Small scale studies from all over the country have reported different aspects of individual outbreaks during this time. However, there is scarcity of data looking at the overall trend of dengue virus infection in the country. In this study, we examined annual trends, seasonality, and clinical features of dengue fever in the Pakistani population.
Methods: Demographic information and dengue IgM status of all patients tested for dengue IgM antibody at Aga Khan University Hospital from January 2003 to December 2007 were analyzed to look …

Pattern Of Drugs Of Abuse Identified In Chemical Samples, Farhan Javed Dar, Aysha Habib Khan, Imran Siddiqui, Farooq Ghani

Department of Pathology and Laboratory Medicine

OBJECTIVE: To determine the pattern of drugs of abuse in urine and blood samples processed at referral laboratory in Pakistan so that information on the type of drugs used can be identified and used for ready reference for future strategy. Study Design: Observational study.

PLACE AND DURATION OF STUDY: Clinical Laboratory of The Aga Khan University Hospital, Karachi, from July 2006 to March 2008. Methodology: Retrospective review of records were done for the common drugs that are used for screening at the Clinical Laboratory include alcohol, amphetamine, barbiturates, benzodiazepines, cannabinoids, cocaine and opiates. Alcohol was tested in blood and others …

Inducible Clindamycin Resistance Due To Expression Of Erm Genes In Staphylococcus Aureus: Report From A Tertiary Care Hospital Karachi, Pakistan, Naima Fasih, Seema Irfan, Afia Zafar, Erum Khan, Rumina Hasan

Department of Pathology and Laboratory Medicine

OBJECTIVE: To assess the frequency of phenotypic expression of inducible resistance of clindamycin due to expression of erm genes, in clinical isolates of Staphylococcus aureus (S. aureus), by double disk diffusion test (D-test).

METHOD: This was a cross sectional study conducted in the clinical laboratory of Aga Khan University Hospital, Karachi. A total of 2432, non duplicate clinical isolates of S. aureus, consisting of 1562 methicillin sensitive S. aureus (MSSA) and 870 methicillin resistant S. aureus (MRSA), were selected from February 2007 to January 2008. One hundred and thirty eight isolates of S. aureus were selected based on discordant resistance …

One Year Survival With Poorly Differentiated Metastatic Pancreatic Carcinoma Following Chemoembolization With Gemcitabine And Cisplatin., Daniel B Brown, Carin F Gonsalves, Charles J Yeo, Agnes K Witkiewicz, Brian I Carr

Department of Radiology Faculty Papers

While hepatic arterial chemoembolization is efficacious for a number of malignancies, there is scant data regarding treatment of pancreatic adenocarcinoma. We report a complete radiographic response at one year from diagnosis of metastatic pancreatic carcinoma. Gemcitabine/cisplatin based chemoembolization may be of potential benefit for patients with liver-dominant metastases from pancreatic carcinoma. Given the typical survival of 6 months or less in this patient group with standard therapies, further research is warranted.

Quebec Platelet Disorder, Anwar Hussain Abbasi, Quratulain Shaikh, Syed Ather Hussain

Department of Pathology and Laboratory Medicine

A case of Quebec platelet disorder is hereby reported. A 33 years old woman presented with history of epistaxis and gum bleeding since childhood and menorrhagia and bleeding per vaginum after puberty, also had history of excessive blood loss after birth of child. Her coagulation profile was normal but platelet function testing by platelet aggregation assay showed abnormal aggregation of platelet with epinephrine. This type of response is seen in "Quebec platelet disorder" which is a rare autosomal dominant disorder of platelet function characterized by increased bleeding after any injury or trauma.

Trends In Undergraduate Teaching Of Parasitology In Medical Schools Of Pakistan, Vikram Mehraj, Taimur Saleem, Saima Lalani, Nadia Sani, Imran Khan, Fatima Afridi, Hina Irfan, Mohammad Asim Beg

Department of Pathology and Laboratory Medicine

OBJECTIVE: Parasitic diseases are a major public health problem in the tropical and sub tropical countries including the subcontinent region. We aimed to assess methods of Parasitology education in medical schools of Karachi Pakistan.

METHODS: Ten medical schools in Karachi, Pakistan were sent a structured questionnaire collecting information on different aspects of Parasitology education. The collected data was analyzed using SPSS version 14.0.

RESULTS: The response rate of this study was 90%. Majority of the schools in Karachi, Pakistan (78%) taught Parasitology concurrently with Microbiology, Pathology, Pharmacology and Forensic medicine in third and fourth year of undergraduate training. More than …

Immunophenotypic Profile Of Acute Leukemias At Agakhan University Hospital, Nairobi, Beatrice M. Kabera

Master of Medicine in Clinical Pathology

Background: Reliable distinction between AML and ALL is important for the selection of appropriate therapy. The final diagnosis of acute leukemia should be based on clinico-pathological, morphological, cytochemical and molecular cytogenetics data, together with immunophenotypic information. Flow cytometry has become the preferred method for the lineage assignment and maturational analysis of malignant cells in acute leukemias. Immunophenotyping has also allowed the detection of aberrant antigen co expression and the analysis of heterogeneity and clonality of malignant cells in acute leukemias. It is insufficient to merely make a diagnosis of acute leukemia, or even AML or ALL. Further classification is essential …

Detection Of Extended Spectrum Beta Lactamases Genotypes And Their Association With Cephalosporin Susceptibility In Community Acquired Enterobacteriaceae Infections, Daniel W. Maina

Master of Medicine in Clinical Pathology

Background: Infections caused by Extended Spectrum Beta-Lactamases (ESBLs) producing enterobacteriaceae have become a global problem. Initially confined to the hospital set-up, they are increasingly being reported in the community. These infections are often resistant to a wide variety of B- lactams including extended spectrum cephalosporins, with clinical and epidemiological implications for healthcare systems and necessitate surveillance measures based on local data. Local information on the genotypes of ESBLs and their association with cephalosporin resistance in community acquired ESBL-producing Enterobacteriaceae isolates is scanty, hence the need for this study. Aim: To detect ESBLs genotypes and correlate these with susceptibility to cephalosporins …

Nipple Adenoma Of Breast: A Masquerader Of Malignancy, Kanwal Aftab, Romana Idress

Department of Pathology and Laboratory Medicine

Nipple adenoma is a benign condition simulating malignancy such as breast carcinoma and/or Paget’s disease clinically. In this study 19 cases diagnosed as nipple adenoma over a period of 14 years are described. The diagnosis was confirmed by histology alone. All patients were females with age ranging from 23 to 63 years. Most of the cases presented clinically with in duration and ulceration accompanied by pain and itching. The diagnosis was clinically suspected in only 3 cases. This highlights the importance of histological diagnosis in all suspicious breast lesions. In one case, the clinical and histological diagnosis was incorrect leading …

Patterns Of Fatal Gunshot Injuries In Nairobi: A Prospective Forensic Study, Ancent K. Nzioka

Master of Medicine in Anatomic Pathology

Introduction: Gunshot injuries are one of the leading causes of fatal and non fatal injury in many countries (1) .All over the world, injury studies show an increasing preference for the gun as the weapon of choice for homicides and suicides (2).Firearms are more lethal compared to other portable and concealable weapons (2). Gunshot injuries impact severely on the criminal justice as well as health care systems (3, 4). There is no available published statistics on fatal gunshot injuries inKenya. Some basic statistics are important in understanding the magnitude and severity of the socio-economic burden caused by gunshot injuries. Objective: …

Expression Patterns Of Β–Catenin, Cox-2 And P27 In Colorectal Carcinomas At Aga Khan University Hospital, Nairobi, Patricia Okiro

Master of Medicine in Anatomic Pathology

Introduction: Colorectal cancer is the third most common cancer worldwide, as indicated by WHO. Local published and unpublished data indicate that patients in the developing world with colorectal cancer tend to present at an early age, and possibly at a more advanced stage than described in the developed world. The reason for this difference is unclear, and as yet undefined. The Wnt/APC pathway, Microsatellite instability pathway and the Epigenetic pathway are three pathogenetically distinct pathways that have been implicated in the development of colorectal cancer. Exploration of these patterns may allow us to elucidate possible reasons for these differences. Objectives: …

High-Throughput Experimental Studies To Identify Mirna Targets Directly, With Special Focus On The Mammalian Brain, Peter T. Nelson, Marianthi Kiriakidou, Zissimos Mourelatos, Grace S. Tan, Mary H. Jennings, Kevin Xie, Wang-Xia Wang

Pathology and Laboratory Medicine Faculty Publications

We review the pertinent literature on methods used in high-throughput experimental identification of microRNA (miRNA) "targets" with emphasis on neurochemical studies. miRNAs are short regulatory noncoding RNAs that play important roles in the mammalian brain. The functions of miRNAs are related to their binding of RNAs including mRNAs. Since mammalian miRNAs tend to bind to target mRNAs via imperfect complementarity, understanding exactly which target mRNAs are recognized by which specific miRNAs is a challenge. Based on early experimental evidence, a set of "binding rules" for miRNAs has been described. These have focused on the 5' "seed" region of miRNAs binding …

Labrad : Vol 35, Issue 2 - June 2010, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• The Atypical Lymphocytes
• High Performance Liquid Chromatography (HPLC): An Effective Tool for the Diagnosis of Various Hemoglobinopathies
• Platelet Transfusions: What We Need to Know
• Measuring Homocysteine Levels
• Parathyroid Hormone: A Marker of Vitamin D Deficiency and Insufficiency
• Surrogate Measures of Insulin Sensitivity
• Foetal Autopsy
• Laboratory Diagnosis of Vaginitis due to Trichomonas Vaginalis
• AKU Clinical Laboratory Continuing Medical Education Seminars

Epistatic Relationships Between Sara And Agr In Staphylococcus Aureus Biofilm Formation., Karen E. Beenken, Lara N. Mrak, Linda M. Griffin, Agnieszka K. Zielinska, Lindsey N. Shaw, Kelly C. Rice, Alexander R. Horswill, Kenneth W. Bayles, Mark S. Smeltzer

Journal Articles: Pathology and Microbiology

BACKGROUND: The accessory gene regulator (agr) and staphylococcal accessory regulator (sarA) play opposing roles in Staphylococcus aureus biofilm formation. There is mounting evidence to suggest that these opposing roles are therapeutically relevant in that mutation of agr results in increased biofilm formation and decreased antibiotic susceptibility while mutation of sarA has the opposite effect. To the extent that induction of agr or inhibition of sarA could potentially be used to limit biofilm formation, this makes it important to understand the epistatic relationships between these two loci.

METHODOLOGY/PRINCIPAL FINDINGS: We generated isogenic sarA and agr mutants in clinical isolates of S. …

Individual Micrornas (Mirnas) Display Distinct Mrna Targeting "Rules", Wang-Xia Wang, Bernard R. Wilfred, Kevin Xie, Mary H. Jennings, Yanling Hu, Arnold J. Stromberg, Peter T. Nelson

Pathology and Laboratory Medicine Faculty Publications

MicroRNAs (miRNAs) guide Argonaute (AGO)-containing microribonucleoprotein (miRNP) complexes to target mRNAs.It has been assumed that miRNAs behave similarly to each other with regard to mRNA target recognition. The usual assumptions, which are based on prior studies, are that miRNAs target preferentially sequences in the 3'UTR of mRNAs,guided by the 5' "seed" portion of the miRNAs. Here we isolated AGO- and miRNA-containing miRNPs from human H4 tumor cells by co-immunoprecipitation (co-IP) with anti-AGO antibody. Cells were transfected with miR-107, miR-124,miR-128, miR-320, or a negative control miRNA. Co-IPed RNAs were subjected to downstream high-density Affymetrix Human Gene 1.0 ST microarray analyses using …

Osteopontin And Cadherin 11 Are Novel Mediators And Drug Targets For Chronic Lung Diseases, Daniel J. Schneider

Dissertations and Theses (Open Access)

Chronic lung diseases (CLDs) are a considerable source of morbidity and mortality and are thought to arise from dysregulation of normal wound healing processes. An aggressive, feature of many CLDs is pulmonary fibrosis (PF) and is characterized by excess deposition of extracellular matrix (ECM) proteins from myofibroblasts in airways. However, factors regulating myofibroblast biology are incompletely understood. Proteins in the cadherin family contribute epithelial to mesenchymal transition (EMT), a suggested source of myofibroblasts. Cadherin 11 (CDH11) contributes to developmental and pathologic processes that parallel those seen in PF and EMT. Utilizing Cdh11 knockout (Cdh11 -/-) mice, the goal of this …

Loss Of Stromal Caveolin-1 Independently Predicts Poor Disease-Free Survival And Time To Recurrence In Patients With Prostate Cancer, M. Wagner, A. Dasgupta, F. Sotgia, R. B. West, M. P. Lisanti, A. K. Witkiewicz

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Results:

Of the 167 patients originally included in the study, 43 were either lost to follow up or had insufficient clinical data for comparison. Of the remaining 124 cases, 32 showed loss of stromal Cav-1. Statistical analysis revealed no significant association between stromal Cav-1 loss and the usual markers of disease severity including Gleason grade, stage and presence of metastases. Kaplan-Meier curves showed a significant association between stromal Cav-1 loss and poor disease-free survival and time to recurrence (p<0.05), but no significant association with cancer-specific survival.

Increase In Isolation Of Extended Spectrum Beta Lactamase Producing Multidrug Resistant Non Typhoidal Salmonellae In Pakistan., Kauser Jabeen, Afia Zafar, Seema Irfan, Erum Khan, Vikram Mehraj, Rumina Hasan

Department of Pathology and Laboratory Medicine

Background:Increasing resistance to quinolones and ceftriaxone in non typhoidal Salmonellae is a global concern. Resistance to quinolone and 3rd generation cephalosporin amongst non typhoidal Salmonellae (NTS) from Pakistan has been reported in this study.

Methods:

Retrospective analysis of laboratory data was conducted (1990-2006). NTS were isolated and identified from clinical samples using standard microbiological techniques. Antimicrobial susceptibility testing was performed by Kirby Bauer. Extended spectrum beta lactamase production (ESBL) was detected using combined disc method. Ciprofloxacin sensitivity was detected by nalidixic acid screening method. Minimum inhibitory concentration (MIC) of ciprofloxacin was determined by agar dilution method. Statistical analysis was …

Trends In Salmonella Enteric Serovar Typhi In Nairobi, Kenya From 2004 To 2006, Doris M. Mengo1, Sam Kariuki, Ann W. T. Muigai, Gunturu Revathi

Pathology, East Africa

Background: Typhoid fever is a global health problem. The World Health Organization (WHO) estimates that the current annual global burden of typhoid is approximately 22 million new cases, 5% of which are fatal.

Methodology: To assess the trends in antibiotic resistance in 100 Salmonella enterica serovar Typhi strains were isolated from the blood of patients in Nairobi, Kenya, from 2004 to 2006. All isolates were tested against ampicilin, chloramphenic, nalidixic acid, ciprofloxacin, cotrimoxazole, cefuroxime, cefriaxone, amoxycillin/clavulanic acid, tetracycline and gentamycin. Susceptibility and resistance were determined using MIC and disk diffusion tests.

Results: From 2004 to 2006 a total of 100 …

Increased Isolation Of Esbl Producing Klebsiella Pneumoniae With Emergence Of Carbapenem Resistant Isolates In Pakistan: Report From A Tertiary Care Hospital, Erum Khan, Muslima Ejaz, Afia Zafar, Kauser Jabeen, Sadia Shakoor, Raunaq Inayat, Rumina Hasan

Department of Pathology and Laboratory Medicine

OBJECTIVE: To report trends of extended spectrum beta lactamase (ESBL), multidrug resistant (MDR) ESBL and emergence of carbapenem resistant ESBL producing isolates of K. pneumoniae from Pakistan.

METHODS: Retrospective analysis of laboratory data was conducted (2002-2007). K. pneumoniae were isolated and identified from clinical samples using standard microbiological techniques. Antimicrobial susceptibility testing was performed by Kirby Bauer. ESBL was detected using combined disc method. Statistical analysis was performed using SPSS version 13.

RESULTS: 15914 K. pneumoniae isolates (2002-2007) were analyzed. Significant increase in ESBL and MDR ESBL producing K. pneumoniae (p = or < 0.0001) was observed. We found significant association of ESBL positive K. pneumoniae with age less than 10 years, males and blood isolates (p = 0.001). 0.4% (n=23) of ESBL positive isolates were carbapenem resistant.

CONCLUSIONS: Increase in ESBL and carbapenem resistant …