study of Galactin-3 on fine needle aspiration as a diagnostic marker differentiating benign from malignant thyroid neoplasm

Background and Objective: Thyroid nodules are very common in our setup and their diagnosis on fine needle aspiration is not easy and is a taxing affair. It is a challenge to differentiate between follicular adenoma and follicular carcinoma without histology. Our objective was to investigate the role of Galectin-3 in fine needle aspirates of thyroid nodules as a prospective diagnostic marker and consequently its ability to differentiate benign from malignant neoplasms

Methods: The research was conducted at the department of Pathology, King Edward Medical University, in association with other teaching institutions of Lahore from June 2012 to July 2014. Sixty cases of solitary thyroid nodules were included in the study. Haematoxylin and eosin staining of the fixed smears and Galectin-3 immunohistochemical staining of the sections prepared from the cell block was performed

Results: There were 60 patients in our study with a mean age of 33.35 years. The Bethesda system for reporting thyroid cytopathology was used to classify the smears and only categories IV, V and VI were included. On histological examination of the resected nodules there were 38.3% [23/60] cases of follicular adenoma, 46.6% [28/60] were of papillary carcinoma and follicular carcinoma made up to 15% [9/60] of all cases. Galectin-3 was negative in 100% [23/23] cases of follicular adenomas. Out of 37 malignant cases 65% lesions showed positivity, while 35% showed negativity for this immunomarker. Considering the malignant lesions, 75% cases of papillary carcinomas showed a positive reaction while only 33% of follicular carcinomas were positive for the immunomarker. This showed that the positive expression was more common in papillary as compared to follicular carcinomas

Conclusion: Galectin-3immunomarker is considerably expressed in malignant tumors, but it is not expressed in benign follicular lesions

Use of antibiotics within the integrated management of childhood illness [IMCI]: guidelines in pediatric outpatient settings

Background: The success of standardized measures for disease classification and treatment has led disease-specific approaches led WHO and UNICEF to incorporate them into a set of guidelines for the integrated management of childhood illness [IMCI], which includes modules or subsets of guidelines for the recognition and management of children with acute respiratory infections, diarrhea, measles, malaria and other febrile illness, and malnutrition

Objective: To assess the use of antibiotics within the IMCI Guidelines in Pediatric Outpatient Settings of Jinnah Hospital

Methodology: It was a cross-sectional study conducted at Pediatrics OPD Jinnah Hospital from May 1, 2014 - August 21, 2014. The 150 children and their parents / accompanying person fulfilling the inclusion criteria after consultation from pediatric consultation were interviewed regarding their disease status and prescription by the doctor regarding antibiotics and other conditions. All the information was entered in a structured questionnaire. The samples were collected by non-probability / purposive sampling technique

Results: Among 150 children included in study mean age of children was 36 months SD 20.42 months. 60% were male and 40% female. Presenting complaints among children were, 75.0% presented fever, 26.4% had loose motions, 22.3% has vomiting, 20.3% had cough. 12.8% presented with abdominal pain. Among those who received antibiotics, 10% received third generation cephalosporin [ceftriaxone, cefexime], 10.7% penicillin's [mostly amoxicillin and piperacillin], and 4% ciprofloxacin. 30% received combination of 2 or 3 antibiotics [14.7% combination of ceftriaxone and amikacin [aminoglycoside], According to IMCI guidelines 34% were not appropriately treated, 20.7% received antibiotics when they should not and 13.3% did not received antibiotics when they should have

Conclusion: Their low adherence to integrated management of childhood illness [IMCI] recommendations for prescription of antibiotics in routine outpatient settings the study shows highly prevalent use of third generation cephalosporins

Psychosocial determinants of hypertension

Abstract: Hypertension or high blood pressure is a condition in which blood pressure in the arteries is persistently elevated. It is a serious problem in the community leading to social stagnation

Objectives: To determine the association between various psycho-social factors and hypertension. Design: Population based Case-Control study. Place and Duration: Urban Lahore. From May 2012-September 2012

Subjects and Methods: A population based case-control study with 1:1 case to control ratio was conducted. A total of 100 persons [50 cases and 50 controls] were recruited in the study. The selection was made on laid down criteria from adult population living in Urban Lahore in the vicinity of Mayo Hospital Lahore after taking due consent. Data was collected through a pretested questionnaire by a 5 membered team of MBBS students of King Edward Medical University, Lahore under direct supervision of Department of Community Medicine, KEMU. Data was collected, compiled and analyzed through SPSS version 20

Results: Overall 47% were males and 53% were females. Hypertension was found more in females, in the age group 51-65 years, who were married and in graduates. In bivariate analysis, hypertension was found significantly associated with anxiety [OR: 3.167, 95%CI: 1.398-7.174], restlessness [OR: 5.060, 95%CI: 2.150-11.910], anger [OR: 3.083, 95%CI: 1.330-2.963], and income [OR: 3.019, 95%CI: 1.315-6.929]. Whereas diet [OR:0.667, 95%CI: 0.302-1.472], sedentary lifestyle [OR: 1.000, CI: 0.454-2.203], smoking [OR: 1.976, CI: 0.612-6.380], alcohol intake [OR: 2.042, CI: 0.719-23.266], intake of tea/coffee [OR:2.125, 95%CI:0.943-4.789] and unemployment [OR:0.583,95%CI:0.177-1.925] were not found to have any association with hypertension

Conclusion: Hypertension was found significantly associated with anxiety, restlessness, anger, and income

Ileocaecal schistosomiasis - a case report from King Hamad University Hospital Bahrain

Bilharziasis [schistosomiasis] is a chronic parasitic infection caused by the nematode family called Schistosoma species which include; S. mansoni which is common in southern and sub-Saharan Africa, South America and Caribbean and transmitted through contaminated fresh water. S. haematobium is distributed throughout Africa and is transmitted through contaminated water. S. japonicum, found in Southeast Asia. S. mekongi found in Cambodia and Laos. S. intercalatum, found in parts of Central and West Africa. A case of Schistosomiasis was reported of the ileo-cecal area and discuss the clinical and pathological features, and review the relevant literature

Incidence of beta-thalassemia carriers in Muzaffarabad, Azad Kashmir

Objective: To determine the frequency of beta-thalassemia carriers in healthy population from Muzaffarabad Azad Kashmir

Methods: In this cross sectional population based study, people from Muzaffarabad were motivated to get themselves tested for beta thalassemia trait. People found healthy on basis of a questionnaire and clinical examination were included in the study. Complete blood counts and peripheral smear review were performed on EDTA samples. Hemoglobin [Hb] electrophoresis was performed. Subjects with mean corpuscular volume [MCV], <76 fl, and/or mean corpuscular Hb [MCH], < 27 pg were subjected to hemoglobin A2 [HbA2] level estimation by elution method. Hemoglobin A2 of more than 3.5% was considered diagnostic for beta-thalassemia trait. Azad Kashmir is a territory with considerable ethnic heterogeneity. This is basically a tribal society with a high proposition of consanguineous marriages. We created awareness among the general population

Results: Found that gene is present in almost all tribes studied

Conclusion: Using strict criteria for healthy population, we conclude that incidence of thalassemia trait is 5.6 % in our study population. beta -thalassemia trait is present in almost all ethnic groups. To control thalassemia major, screening program for thalassemia carriers must be initiated in the area

Retroperitoneal schwannoma, incidental detection - case report King Hamad University Hospital Bahrain

Shwannomas are benign nerve sheath tumors that mostly occur in the head and neck, extremities, and mediastinum. These rarely present as retroperitoneal masses. A case was reported of an incidentally detected retroperitoneal shwannoma in a 32-year-old female. Schwannomas, the benign nerve sheath tumors, grow slowly but they may cause pain, weakness, numbness, or stay asymptomatic. Symptoms depend on the location and size of the tumor. Sometimes the patients, who present to the Accidents and Emergency with vague abdominal pain. Imaging incidentally may detect a pelvic lesion that is always diagnosed on histopathology after complete resection

Facts sheets of cartilage tumors. classifications and differential diagnosis - review article

Tumors, which differentiate to cartilage, share characteristic features for the production of chondroid matrix by these tumor cells. The cartilage tumors are ranged from completely benign lesions to highly malignant. These are subdivided by location into peripheral, surface, central and intramedullary lesions. Benign bone tumors are a group of neoplasms that are most frequent in children and young adults, although they may also present in later stages of life. The malignant cartilage tumors affect bones and joints but rarely as compared to osteogentic tumors. The Malignant tumors cannot be differentiated from benign simply by biopsy without radiographic evidence. However, CT and MRI imaging may be of some use in defining the extent of tumour spread locally

Antigen expression on blast cells and hematological parameters at presentation in acute lymphoblastic leukemia patients

To analyze the expression of various antigens on the leukemic blasts and to determine the hematological parameters, in Acute Lymphoblastic Leukemia [ALL] patients at presentation. Observational study. King Edward Medical University, Lahore and Hameed Latif Hospital, Lahore, from February 2013 to March 2014. A total of 50 newly diagnosed and untreated patients of ALL were selected from Mayo Hospital and Hameed Latif Hospital. These patients included both genders and all age groups. Hemoglobin, total leukocyte count and platelet count were determined on hematology analyser-Sysmex-Kx-2I. Blast cell percentage was estimated on Giemsa stained blood smears. Immunophenotyping was done on bone marrow samples by 5 colour flowcytometery on Beckman Coulter Navious Flowcytometer. An acute leukemia panel of 23 antibodies was used. The data was entered and analyzed in SPSS version 22. Of the 50 ALL patients, 36 [72%] were B-ALL and 14 [28%] T-ALL. There were 18 [36%] children and 32 [64%] adults. T-ALL included 22% of the childhood and 31% of the adult cases. Immunophenotypic analysis showed that CD19, CD79a and CD20 were B-lineage specific markers whereas cCD3, CD3 and CD5 were T-lineage specific. CD10 was the most sensitive marker for B-ALL and CD7 was the most sensitive marker of T-ALL. TdT was expressed in 92% B-ALL and 71% T-ALL cases, CD34 in 58% and 43% cases and CD45 in 83% and 100% respectively. High leukocyte count [> 50 x 10[9]/L] was present in 58% cases. Hemoglobin was < 10 g/dl in 74% patients and platelet count was below 20 x 10[9]/L in 12% patients. Leukocyte count, hemoglobin, platelet count and blast cell% did not show a significant difference in the two ALL immunotypes. The frequency of T-ALL is higher in childhood as well as adult ALL in our population compared to the Western literature. Antigenic expression of the blast cells also shows some interesting differences. A large number of our patients present with high leukocyte count which is a known factor associated with poor prognosis

Oral squamous cell carcinoma; clinico-pathological parameters and AgNOR status in grading

The aim of this study was to evaluate clinico-pathological parameters and the status of argyrophilic nucleolar organizer regions stain in various histological grades of oral squamous cell carcinoma. A cross sectional study was conducted on fifty cases of oral squamous cell carcinoma. The specimen were collected from the department of Oral and Maxillofacial Surgery and processed for hematoxylin and eosin stain and AgNOR stain Pathology Laboratory, King Edward Medical University Lahore. Bidi smoking is associated with oral squamous cell carcinoma. The AgNOR [mAgNOR and pAgNOR] status was significantly low in well differentiated and moderately differentiated compared to poorly differentiated oral squamous cell carcinoma [p =0.001]. AgNOR size in poorly differentiated was significantly higher than the AgNOR size in well differentiated oral squamous cell carcinoma. Similarly the distribution of AgNOR in moderately and poorly differentiated oral squamous cell carcinoma was significantly high. The AgNORs index was significantly high in poorly differentiated squamous cell carcinoma as compared to well differentiated and moderately differentiated squamous cell carcinoma. The use of AgNORs stain is easy, valid and reliable method to assess the histological grading of oral squamous cell carcinoma and should be used to predict the prognosis of patients

Bone mineral density and diet of teachers of college of home economics at Lahore

To evaluate the Bone Mineral Density [BMD] and diet of teachers of a Govt. College of Home Economics in Lahore. It was survey research. Purposive sampling technique was adopted for the selection of 50 teachers from Govt. College of Home Economics of age group 30 - 60 years. About 46% of the subjects had BMD ratio in between -2.58 to -4.0 [Osteoporotic category]. The root cause of low BMD ratio was not really age related but in majority of the sample it was due to sedentary life style and lack of awareness about the importance of exercise in relation to bone health. The total mineral and vitamin intake required for bone health [calcium, magnesium, phosphorus and vitamin D] was below the recommended, among majority of the sample

Use of supravital toluidine blue staining to improve the efficiency of fine-needle aspiration cytology reporting in comparison to papanicolaou stain

To see the efficiency, adequacy and accuracy of toluidine blue stained smears of FNAC of Breast thyroid and salivary glands swelling with comparison to conventional stained FNAC smears witt Papanicolaou. A total of 114 aspirates from various sites were included in the study. The smears were stainec with toluidine blue and conventional Papanicolaou stain and the cytomorphology of both the smears were compared. The values were tabulated and statistical tests of significance was applied. Of the 114 aspirates included in our study the diagnostic accuracy by using papanicolaou wa 78%, while it was upto 100% with supravital toluidine blue stained smears. The percentage of inadequacy was reduced to just 25%. The observations were statistically significant. Breast 37/48 [77%] and Salivar glands 11748 [23%] respectively. The most commonly used categorization of a five-tier system was used for reporting of breast cytology, with categories ranging from insufficient materials [C1], benign [C2], atypics [C3], suspicious of malignancy [C4], or [C5] frankly malignant. Most of breast lesions were benign 2 [67.56%]. There were only 9 [24.32%] malignant cases followed by 2 cases of C-4 and one case of C-3. Benig thyroid lesion were more frequent comprising of 51 [72.27%] cases. One case [1.5%] of papillary carcinoma was found while 13 case were follicular lesions. There were 4 [36.4%] cases of pleomorphic adenoma an 3 [27.3] cases of non-specific sialadenitis. There was one case [9%] of each lesion for mucoepidermoi carcinoma, adenoidcytic carcinoma and benign cyst. Toluidine blue stained study of FNAC improves the diagnostic accuracy by minimizing the smearing and drying artifact, loss of cell sample during fixation and staining which influences the diagnost accuracy

Gestational diabetes; to compare the efficacy of metformin with insulin in diabetes mellitus in terms of fetomaternal outcome

Objectives: To compare the efficacy of Metformin with insulin in gestational diabetes mellitus in terms of fetomaternal outcome

Study Deign: Randomized clinical trial study

Setting: Lady Aitchison Hospital Lahore

Period: January 2014 to March 2015

Methodology: Total 500 pregnant females with GDM were included in the study through nonprobability, consecutive sampling. Patients were divided into 2 equal groups [A: B]. Patients in group A were given tablet metformin 500 mg by oral route and group B was administrated regular injection Insulin by subcutaneous route

Results: The mean age of females was 32.14 +/- 6.13 years. The mean gestational age was 31.07 +/- 3.8 weeks. There were 78 [15.6%] females who had 0 parity, 107 [21.4%] females had parity 1, 175 [35%] females had parity 2, 95 [19%] females had parity 3, 33 [6.6%] females had parity 4 and 12 [2.4%] females had parity 5.There were 54 [10.8%] cases had PTB, out of which 12 [4.8%] had PTB with metformin while 42 [16.8%] had PTB with insulin. There were 115 [23%] neonates required NICU admission, out of which 37 [14.8%] neonates with metforminand78 [31.2%] neonates with insulin. There were 87 [17%] neonates who had neonatal hypoglycemia, out of which 23 [9.2%] neonates with metformin and64 [25.6%] neonates with insulin. The difference was significant between both groups for all fetal outcomes [P<0.05]

Conclusion: The metformin is more effective in preventing adverse fetal and maternal outcome as compared to insulin

Anemic patients; relationship of frequency and severity of iron deficiency anemia with preterm labor and eventual perinatal outcome

Pregnant women are particularly considered to be the most vulnerable group because of the additional demands that are made on maternal stores during pregnancy. The iron deficiency anemia is the most common nutritional deficiency problems in females and is responsible of high maternal death rate in our society

Objectives: to determine the relationship of frequency and severity of iron deficiency anemia to preterm labor and eventual perinatal out come in anemic patients

Study Design: it was a case control study

Study Setting: in Obstetrics and Gynecology Unit-III, Sir Ganga Ram hospital, Lahore from July 2012 to June 2013

Methodology: the study was conducted on 200 patients [100 cases and 100 controls] were studied. Cases were patients admitted in labor room with preterm labor and Controls were females in labor at term at. Convenience sampling was done. On admission relevant history taking examination and investigation were done. The data was collected on a Performa

Results: there were 50 patients with anemia amongst the patients with preterm labor. In the control group, 40 patients were suffering from anemia. In the patients with preterm labor the mean hemoglobin was 9.83 grams/deciliter. In the control group the mean hemoglobin was 10.3gm/dl. [Pregnant women having hemoglobin <10 gm/dl are considered to be anemic]. The odds ratio was calculated to be 3.4 and P value was <0.05

Conclusions: iron deficiency anemia was associated with increased risk for low birth weight, preterm delivery, and perinatal mortality. The frequency of iron-deficiency anemia was seen in both groups of pregnant women

Frequency of placenta previa in previously scarred and non scarred uterus

To determine the frequency of placenta Previa in patients coming to a tertiary care unit with previously scarred and non-scarred uterus. A descriptive cross sectional study was carried on 114 cases who underwent caesarean sections [37 cases out of 645 cases with non scarred uterus and 77 cases from 721 cases with scarred uterus] in the department of obstetrics and gynecology Lady Willingdon Hospital from January 2008- December 2011. Most patients [47.36%] were between 26-30 years age group, presented with gestational age between 36-40 weeks [70.17%], were mostly G2-4, while frequency of placenta Previa in non-scarred uterus was 32.45% [37 cases], and frequency in previously scarred uterus was 67.54% [77 cases]. Major degree Previa was found in 88 cases [77.19%]. There were 5.70% cases of placenta Previa from non-scarred uteruses and 10.67% cases of placenta Previa [10.67%] from already scarred uteruses. Stratification revealed a higher trend of the morbidity with the increase in number of previous caesarean sections. A significantly higher frequency of placenta Previa was found among patients coming to a tertiary care hospital with previously scarred uterus

Endometrial abnormalities on transvaginal ultrasonographyand histopathology in women after quinacrine sterilization

To describe endometrial abnormalities on transvaginal ultrasonography and histopathology in women after quinacrine sterilization. It was an analytical cross sectional study conducted during February 2012 to April 2013. The sample size calculated at 95% confidence level was 540. Sampling technique used was simple random sampling. The medical history, examination, transvaginal ultrasonography and biopsy of suspected lesion was performed in quinacrine sterilized women. The calculation of statistics showed the mean age at quinacrine sterilization was 38.5 years, standard deviation 6.517, and standard error 0.461. The endometrium was regular and smooth with homogenous images in 86% [n=466], irregular endometrium with heterogeneous images on transvaginal ultrasound in 9.4% [n=51] and endometrial growth with high level echoes in 4.2% women [n=23]. The histological findings included hyperplasia and well differentiated adenocarcinoma in two patients respectively. The irregular endometrium, adhesions, and growths were found after quinacrine sterilization. The risk of endometrial growth was more after 10 years duration of quinacrine sterilization

Primary isolated hepatic tuberculosis

Isolated hepatic tuberculosis without pulmonary or bowel involvement is a diagnostic challenge and can cause considerable morbidity. A young lady from Lahore presented with fever, pain in right hypochondria, nausea and weight loss. CT scan of abdomen showed multiple small hypodense non-enhancing lesions and a heterogeneous texture of liver. Biopsy confirmed the diagnosis of hepatic tuberculosis. It was concluded a case of isolated hepatic tuberculosis without evidence of other primary sites involvement. It is important to consider tuberculosis in the differential diagnosis when suspecting lymphoproliferative or metastatic diseases in a patient with vague symptoms and abnormal hepatic texture on CT

Morphology of grafted tendon comparative study of first stage silicone rubber rod implantation

This is the first research done to explore the morphologic changes in two stage tendon grafting as compared to one stage tendon grafting. To compare morphology of grafted tendons with and with out first stage silicon rubber rod implantation. Comparative experimental study. 1994-2007. 30 patients were included in this study. They was divided into 3 groups. Group 1 underwent 2 stage tendon grafting group 3 was used as control morphological study of tendons. Group 1 [1-stage] tendon grafting showed degeneration and fibrous reaction as morphological changes. Group 2. [2 Stage] appeared as normal tendons morphologically. This study concludes that instead of direct tendon grafting, two stage tendon grafting is recommended

Comparative gastroprotective effects of natural honey, Nigella sativa and cimetidine against acetylsalicylic acid induced gastric ulcer in albino rats

Natural honey [NH] and Nigella sativa [NS] seeds have been in use as a natural remedy for over thousands of years in various parts of the world. The aim of this study was to assess the protective effects of NS [Nigella sativa] and NH [natural honey] on acetylsalicylic acid induced gastric ulcer in an experimental model with comparison to Cimetidine [CD]. Experimental, case control study. Pharmacology and Pathology Department of King Edward Medical University, Lahore, from June to August 2007. The study was conducted on 100 male albino rats, divided into 5 groups, with 20 animals in each group. Group A was used as a control and treated with gum Tragacanth [GT]. Eighty animals of the other groups were given acetylsalicylic acid [0.2 gm/kg body weight for 3 days] to produce ulcers by gavage. Two animals from each group were sacrificed for the detection of gastric ulcers. The remaining 72 animals were equally divided in four groups [B, C, D and E]. The rats in group B, C and D were given NS, NH, and CD respectively while those in E were kept as such. No gastric lesions were seen in control group A while all the animals in group E revealed gastric ulcers. The animals of group B, C and D showed healing effects in 15/18 [83%], 14/18 [78%] and 17/18 [94%] animals grossly; 13/18 were almost the same in all three groups therefore, the statistical difference was not significant among them [p= 0.40 and 0.65] while significant from group E [p= 0.0000075, 0.0000016 and 0.0000012 respectively]. NS and NH are equally effective in healing of gastric ulcer similar to cimetidine. Further broad spectrum studies as well as clinical trials should be conducted before the use of these products as routine medicines

Renal cell carcinomas: Correlation of size with tumor grade and extracapsular extension

To find the association of tumor size with grade of tumor and its extra capsular extension. A review of record of all renal biopsies performed at pathology department King Edward Medical University over a period of two years was done. It was found that large sized tumors tend to have a higher grade and this correlation was found to be statistically significant [P=0.02]. A significant correlation was also seen between the size of tumor and extra capsular extension [P=0.001]. It was concluded patients presenting with larger renal tumors, who subsequently underwent nephrectomy and histopathological analysis were diagnosed with a higher grade. This relation implies that these patients with larger tumors will in turn have poorer prognosis

Use of AgNOR index in grading and differential diagnosis of astrocytic lesions of brain

This study was conducted to see the importance of AgNOR staining in grading and differential diagnosis of Astrocytic lesions. It was a descriptive and prospective study conducted in Department of Pathology King Edward Medical University, from June-December 2002. AgNOR staining was performed on 60 randomly selected brain specimens of Astrocytic lesions including Astrogliosis and Astrocytoma. AgNOR count, size and dispersion were normal in Astrogliosis, low in Pilocytic Astrocytoma, high in grade II, higher in grade III and highest in grade IV. AgNOR counts of different grades of astrocytoma [2.97 +/- 0.96, 3.97 +/- 0.43, 6.01 +/- 2.74 and 8.01 +/- 3.56] were significantly [P< 0.01] greater as compared with counts of normal brain [0.40 +/- 0.01], and reactive gliosis [0.60"0.01]. There was no statistical difference in normal brain tissues and inflammatory lesions of the brain. AgNOR size and dispersion were of higher grade in significantly greater proportion in malignancy as compared to benign conditions. [P <0.05]. AgNOR size and dispersion were normal in Astrogliosis. Typing of AgNOR count, size and dispersion was found to be an important marker in grading and differential diagnosis of Astrocytic lesions, especially in Astrogliosis and low grade Astrocytoma