Clinicopathological spectrum of synovial sarcoma at armed forces institute of pathology, Rawalpindi, Pakistan

Objective: To analyse the clinicopathological spectrum of synovial sarcoma cases presenting in our institution. Study Design: Descriptive case series. Place and Duration of study: Armed Forces Institute of Pathology [AFIP] Rawalpindi, from Jan 2010 to Jan 2015

Material and Methods: All cases of synovial sarcoma diagnosed on histopathological examination were recovered from the Armed Forces Institute of Pathology [AFIP] laboratory information management system. The inclusion criteria consisted of optimally processed Haematoxylin and Eosin stained slides. Positive immunohistochemistry for epithelial membrane antigen/cytokeratin and CD99. Both genders were included. Patients' gender, age, tumour size, site, histological subtype, grade, microscopic margin status, depth and stage were noted. The data were analysed using SPSS Version 21. Frequencies and percentages were calculated for qualitative data and the standard deviation and mean for quantitative data

Results: Sixty-seven cases of synovial sarcoma [SS] were included in this study. The mean age of the patients was 35.1 years, with males at 55.2%. The most common site was the lower extremity 41.8%. The average size was 8.5 cm. The most common stage was pT2b [64.2%]. Monophasic histological subtype was more common at 58.2%. Grade 2 tumours were 77.6%. Microscopic positive margins were 30.0%. Specimens that were fragmented or not oriented properly were 33.3%

Conclusion: The clinicopathological spectrum of synovial sarcoma in our institution is similar to that of other parts of the world. This study has highlighted that a significant proportion [33.3%] of resection specimens were fragmented or unmarked; therefore surgical margins could not be evaluated in these cases, increasing the chances of inadequate surgeries

Allelic variance among ABO blood group genotypes in a population from the western region of Saudi Arabia

BACKGROUND: Characterization of the ABO blood group at the phenotype and genotype levels is clinically essential for transfusion, forensics, and population studies. This study elucidated ABO phenotypes and genotypes, and performed an evaluation of their distribution in individuals from the western region of Saudi Arabia. METHODS: One-hundred and seven samples underwent standard serological techniques for ABO blood group phenotype analysis. ABO alleles and genotypes were identified using multiplex polymerase chain reaction, and electrophoretic analysis was performed to evaluate the highly polymorphic ABO locus. RESULTS: A phenotype distribution of 37.4%, 30.8%, 24.3%, and 7.5% was found for blood groups O, A, B, and AB respectively in our study cohort. Genotype analysis identified 10 genotype combinations with the O01/O02 and A102/O02 genotypes being the most frequent with frequencies of 33.6% and 14.95%, respectively. Common genotypes such as A101/A101, A101/A102, A101/B101, B101/B101, and O01/O01 were not detected. Similarly, the rare genotypes, cis-AB01/O02, cis-AB01/O01, and cis-AB01/A102 were not found in our cohort. The most frequently observed allele was O02 (35.98%) followed by the A102 allele (17.76%). Furthermore, our findings are discussed in reference to ABO allele and genotype frequencies found in other ethnic groups. CONCLUSION: The study has a significant implication on the management of blood bank and transfusion services in Saudi Arabian patients.

Incidence and transferability of antibiotic resistance in the enteric bacteria isolated from hospital wastewater

This study reports the occurrence of antibiotic resistance and production of β-lactamases including extended spectrum beta-lactamases (ESβL) in enteric bacteria isolated from hospital wastewater. Among sixty-nine isolates, tested for antibiotic sensitivity, 73.9% strains were resistant to ampicillin followed by nalidixic acid (72.5%), penicillin (63.8%), co-trimoxazole (55.1%), norfloxacin (53.6%), methicillin (52.7%), cefuroxime (39.1%), cefotaxime (23.2%) and cefixime (20.3%). Resistance to streptomycin, chloramphenicol, nitrofurantoin, tetracycline, and doxycycline was recorded in less than 13% of the strains. The minimum inhibitory concentration (MIC) showed a high level of resistance (800-1600 µg/mL) to one or more antibiotics. Sixty three (91%) isolates produced β-lactamases as determined by rapid iodometric test. Multiple antibiotic resistances were noted in both among ESβL and non-ESβL producers. The β-lactamases hydrolyzed multiple substrates including penicillin (78.8% isolates), ampicillin (62.3%), cefodroxil (52.2%), cefotoxime (21.7%) and cefuroxime (18.8%). Fifteen isolates producing ESβLs were found multidrug resistant. Four ESβL producing isolates could transfer their R-plasmid to the recipient strain E. coli K-12 with conjugation frequency ranging from 7.0 x 10-3 to 8.8 x 10-4. The findings indicated that ESβL producing enteric bacteria are common in the waste water. Such isolates may disseminate the multiple antibiotic resistance traits among bacterial community through genetic exchange mechanisms and thus requires immediate attention.

Sensitivity and specificity of ultrasonography in diagnosis of maxillary sinusitis as compared to antral lavage

To compare the sensitivity and specificity of ultrasonography in the diagnosis of maxillary sinusitis as compared to antral lavage. Validation study. Otolaryngology Department Combined Military Hospital Rawalpindi from 1st march 07 to 28th February 2008. Consenting 60 patients diagnosed clinically as a case of sinusitis, presenting in ENT OPD during the study period fitting the inclusion criteria were selected. Ultrasonography of maxillary sinuses focusing on fluid level was done of all the patients. After ultrasonography all the patients had an antral lavage with isotonic saline to look for mucopurulent discharge. Sensitivity and specificity of ultrasonography was evaluated in diagnosis of maxillary sinusitis. The sensitivity of ultrasonography in diagnosis of maxillary sinusitis taking antral lavage as Gold Standard was very low 35.89%. The specificity of ultrasonography in diagnosis of maxillary sinusitis taking antral lavage as Gold Standard is good i.e. 80.95%.Ultrasonography has low sensitivity but high specificity in diagnosis of maxillary sinusitis.