Liver histology in asymptomatic Hepatitis-C virus positive blood donors

Objective: To assess the Histological alteration of liver in asymptomatic HCV PCR positive family blood donors

Methods: This is a prospective cross sectional study carried out at Blood Transfusion Services, Clinical and Molecular Laboratory and Pakistan Health Research Council, Jinnah Postgraduate Medical Centre, Karachi from January 2011 to December 2016. One hundred thirteen [113] Anti HCV and HCV RNA positive family blood donors with normal or slightly raised ALT during three consecutive bimonthly visits were included. After taking consent liver biopsy was done to see the histopathological changes in these study participants. The software program SPSS for windows [Ver.19] was utilized for all statistical analysis

Results: One hundred thirteen blood donors who were Anti HCV and HCV RNA positive were included. Ninety eight were male and 15 Female with a mean age of 32.3 +/- 6.94 years. Nineteen [16.8%] had significant inflammation of grade 2-3. Nine [8.0%] had significant fibrosis and steatosis was seen in 65 [57.5%] cases. Cirrhosis or advanced liver disease was not found in this series

Conclusion: HCV infected individual with normal ALT level having good physical health, without any sign of advanced liver disease on ultrasonography and routine laboratory investigation like AST, Gamma GT, Alkaline Phosphatase, serum albumin, A/G ratio, platelet count and PT, INR might be highly helpful to predict mild or progressive liver disease. Ultimately it reduces the need of liver biopsy, an invasive procedure having significant complications

Impact of age at diagnosis on clinicopathological outcomes of oral squamous cell carcinoma patients in Karachi

Objective: A recent trend in diagnosis of oral cancer in young age is observed, however its impact on various clinicopathological parameters needs to be explored. The aim of the current study was to compare and analyze impact of age at diagnosis with clinicopathological parameters of oral squamous cell carcinoma patients

Methods: In this cross sectional study conducted at Department of Oncology Ziauddin Hospital Karachi, we included histologically confirmed cases of oral squamous cell carcinoma. The patients were categorized as young age group [40yrs and younger] and old age group [41 yrs and above]. A total of 115 patients diagnosed between 2013 and 2016 were enrolled in the study. The variables considered were age at diagnosis, sex, site of lesion, positive family history, tumor grade, stage, uric acid level and survival

Results: A statistically significant difference was observed between two age groups in overall survival, uric acid level and positive family history of cancer. No significant difference was observed in tumor location, grade and stage

Conclusion: Majority of oral cancer patients present at an advanced stage irrespective of age at diagnosis but young age has an overall improved survival. Moreover, a positive family history of cancer in young age group mandates further exploration of possible role of genetic polymorphisms which might be responsible for early onset of the disease

Clinicopathological features associated to MiRNA-195 expression in patients with breast cancer: Evidence of a potential biomarker

Background and Objective: MiRNAs are a systematic class of small non-coding RNAs with impending role; tumor biomarkers. Our objective was to identify the level of expression of Mir-195 in patients with brea cancer along with its correlation with clinicopathologic features

Methods: A total of 209 females in which 139 historically diagnosed breast cancer [BC] cases and] healthy controls matched for age, their relative clinical and histopathological findings were recorded fro their laboratory reports and hospital record of the patients. Plasma was used for extraction of total l" and cDNA was prepared by using both miR-195 stem loop RT primers and gene specific antisense prime while U6 IT was used as control. Quantitative real-time PCR [qRT-PCR] for miR-195 expression status w< performed and amplification [down regulation] was recorded

Results: Of 139 samples the expression of miR-195 was down regulated in 72.6% cases and the remains 27.3% cases behaved same as 70 healthy or normal controls. Significant correlation of low miR-15 expression with higher differentiation grade, lymph node metastasis and clinical stage was found

Conclusion: Significant correlation between miR-195 expression and some Clinicopathological feature were recognized. MiR-195 could be used as potential non-invasive, molecular biomarker for early detectio of breast cancer

Comparison of clinicopathological characteristics of lymph node positive and lymph node negative breast cancer

Objective: To record various clinicopathological characteristics of breast cancer [BC] in our population and to find an association between these characteristics and axillary nodal metastasis

Methods: This cross-sectional study included 150 BC patients from two tertiary care centers in Karachi from 15[th]February, 2013 to 31[st] March, 2015. Frequencies, percentages, and odds ratio were estimated to find out an association between various clinicopathological characteristics and lymph node status using SPSS version 20

Results: Approximately 75.4% patients had axillary lymph node metastasis ['1-3' IN = 34.4% and '>3' LN =44%]. Menopausal status [p<0.013], tumor grades [II' p <0.03; Mil' p<0.01], and stages [Mil'p <0.002; MV p <0.0001] tumor sizes [T2 p <0.014; T3' p <0.002], perineural invasion [PNI] [p <0.007], lymphovascular invasion [VI] [p <0.0001], and skin and nipple invasion [p <0.024] were significant predictors for '>3' LN metastasis. Association of these variables with '1-3' LN involvement was insignificant

Conclusion: Clinical spectrum of BC remains unchanged in 2016 with most of the patients presenting with high-grade, late-stage advanced disease. Moreover, clinicopathological variables, especially primary tumor size, tumor stage and lymphovascular invasion were significant predictors of >3 lymph node metastasis with high accuracy

Conventional clinical and prognostic variables in 150 oral squamous cell carcinoma cases from the indigenous population of Karachi

Objective: To analyze clinical and prognostic variables of Oral Squamous Cell Carcinoma [OSCC] cases from the indigenous population of Karachi and to correlate with the common risk factor of tobacco habit

Methods: The study was conducted at Ziauddin University, Karachi. One hundred fifty OSCC cases were collected from the Oncology Department of Ziauddin University Hospital, North Nazimabad, Karachi and Otolaryngology ward of Civil Hospital, Karachi, during 2011 and 2015. The reporting included demographic details and variables like intra-oral subsites, clinical stage and histological grade. Recurrence of tumor after initial resection was also documented

Results: The patient's population comprised of 98 males and 52 females. The mean age was 47.1 +/- 12.22 [range:20-78 years]. Maximum numbers were seen in the 41-50 years age group. Urdu-speaking community was the most affected ethnic group [n=75]. Clinico-pathological analysis revealed that majority of cases were moderately differentiated [59%] and were either clinical stage II [35%] or IV [29%] tumors. The most common intra-oral subsite came out to be buccal mucosa of cheeks [56%] followed by lateral borders of tongue [21%], lips [13%], alveolar [6%], palate [2.6%] floor of mouth [1.3%], etc. Recurrence was observed in 08 out of 150 cases. All patients underwent primary resection +/- neck dissection and reconstruction where possible

Conclusions: Overall experience with oral squamous cell carcinoma shows that it has a high tendency for local invasion as well as dissemination to regional lymph nodes, i.e. cervical lymph nodes, both are associated with a poor prognosis. Preventable risk factor of tobacco chewing has been observed in majority of these cases

[OMIC] tumor markers for i breast cancer: a review

Breast cancer is a global health issue, and as the tumor burden increases, we need to come up with newer, better technologies which are convenient, cheap, rapid, sensitive with a high specificity. Technological advancements in the field of cancer biomarker has led to the development of techniques such as mass spectrometric analysis and microarray analysis in which genes, proteins and hundreds and thousands of metabolites can be identified with the emergence of genomics, proteomics and metabolomics. This research is focused on finding biomarkers for diagnosis, prognosis, staging, treatment response and targets for chemotherapy, generating a panel of markers which provide better clinical information compared to a single marker in the panel. This review briefly summarizes application of genomics and proteomics followed by key concepts and applications of metabolomics in breast cancer, with the conclusion that an integration of the three [OMIC] technologies may hold the key to future biomarker discovery. Sources of Data/Study Selection: The information for this review was collected by searching the Google Scholar and PubMed database for English articles published in the period from 2002 to 2015. The search terms included [biomarkers in breast cancer] along with the following search terms: [genomics], [proteomics], [metabolomics], [breast cancer], "mass spectrometry], [molecular markers] and [cancer biomarker]. We have endeavored to quote only the primary sources. Titles and abstracts of retrieved studies were assessed first followed by selection and retrieval of selected full text articles

Risk factors associated with decreased mouth opening among patients with oral submucous fibrosis [OSMF]

To determine the risk factors associated with decreased mouth opening among patients with OSMF. A cross-sectional study was performed in out-patient Dental Clinics,Tertiary care hospital and cases [diagnosed with OSMF], and the controls [who did not have OSMF] were recruited. The study questionnaire to collect information on demographics and clinical features were distributed among cases and controls and saliva samples were obtained for malondialdehyde and superoxide dismutase. The variable [decreased mouth opening] was determined as a dependent/outcome variable. A descriptive comparative analysis was performed. The characteristics of cases and controls were compared. Co-relations were studied between various continuous variables. Cross-tabulations were performed between two categorical variables. A multivariate regression analysis was performed to determine the associations between various independent variables, and the dependent variable - decreased mouth opening. Our study demonstrated that the mean age of our patients was cases 22.5 +/- 2.8 vs. controls 23.0 +/- 3.7 year, and they were more male cases as compared to controls. The cases were predominantly from lower socio-economic background. A multivariate regression analysis demonstrated that male gender, educational status [lesser education], higher levels of malondialdehyde, and lower levels of superoxide dismutase were associated with a greater risk of decreased mouth opening among patients with OSMF. Our study concluded that male gender, educational status [lesser education], higher levels of malondialdehyde, and lower levels of superoxide dismutase were associated with a greater risk of decreased mouth opening among patients with OSMF

Clinico-pathological parameters of 50 Oral Squamous cell carcinoma cases in Karachi

Background: The incidence of oral squamous cell carcinoma remains high in Indo-Pak region. Worldwide oral and oropharyngeal carcinomas are the sixth most common cancers. A number of clinic-pathological parameters have been implicated in prognosis, recurrence and survival for this tumor. As a very high frequency reported in major hospitals of Karachi, this study documented some of the well known clinicpathological parameters in the indigenous population of Karachi

Objective: To analyze the clinicopathological parameters of cases of OSCC in the population of Karachi

Methods: The study protocol was approved by the Ziauddin University ethics committee for human research. The patients' data was entered onto questionnaires. The reporting included a range of clinical, operative and histopathological variables. Recurrence of tumor after initial treatment was also documented

Results: The patients' population comprised 31 males and 19 females. The mean age was 45.56 [SD + 12.08]. Minimum age was 15 years, while maximum was 75 years. Pathological analysis revealed that majority of SCC cases were moderately differentiated SCC with clinical stage T2 or T3, N0,M0/N1,M0. Most common oral sites came out to be buccal mucosa of cheeks followed by lateral borders of tongue and lips. All patients underwent primary resection +/- neck dissection and reconstruction when necessary

Conclusion: Overall experience with OSCC shows that it has a high tendency to disseminate to regional lymph nodes, i.e. cervical lymph nodes, as well as to re-emerge at the primary site after resection

Serum hyaluronic acid level does not reliably differentiate minimal and significant liver disease in chronic hepatitis C

To evaluate the predictive value of hyaluronic acid [HA] for the assessment of liver fibrosis and inflammation in chronic hepatitis C [CHC]. This cross-sectional study was conducted at Ziauddin University, Karachi, Pakistan from June 2006 to July 2010. Ninety-eight CHC patients, 52 [53%] males, and 46 [47%] females, with an age range of 20-60 years [mean 36.0 +/- 10.5] were recruited. Liver fibrosis was staged on a 5-point scale, F0 to F4, and inflammation was graded on a 4-point scale, A0 to A3. Patients were divided into minimal [F<2 and A<2] and significant [F >/= 2 or A >/= 2] overall disease groups. The HA was measured in the serum by ELISA. Diagnostic value was assessed through receiver operating characteristic [ROC] curve. Significant liver disease was present in 46 [47%] patients. Mean serum HA was significantly different among severity groups [p=0.001]. Area under ROC curve for overall disease was 0.716. Negative predictive value [NPV] for significant overall disease remained 71% at a low HA level of 20 ng/mL. Positive predictive value [PPV] of 85% was obtained at 60 ng/mL and 100% at 120 ng/mL. Those high levels were present in 15% and 10% of the patients. Serum HA levels showed a low NPV for significant liver disease. An acceptable PPV was found only in a small proportion of the patients. Hyaluronic acid may not be regarded as a reliable marker for making treatment decisions

Association of visfatin with chronic kidney disease in a cohort of patients with and without diabetes

To evaluate association of serum visfatin with CKD secondary to diabetic nephropathy and to compare it with patients of CKD secondary to other risk factors. Seventy eight individuals including 28 healthy controls and 50 patients of CKD were included in this study. Patients with CKD were further grouped based on etiology of CKD into diabetics and non-diabetics. Patients with type 1 diabetes mellitus, urinary tract infection, urolithiasis, liver cirrhosis, stroke, ischaemic heart disease, and rheumatoid arthritis were excluded. Measurement of Serum visfatin was done through EIA Kit [Phoenix pharmaceuticals Burlingame CA]. Visfatin concentration was significantly high in patients with CKD compared to controls [8.7 +/- 4.7 vs. 5.2 +/- 3.3 p = 0 .001]. No significant difference in Visfatin concentrations between patients of CKD with and without diabetes was detected [9.2 +/- 5.5 vs. 8.3 +/- 3.2 p = 0.694]. A significant negative correlation of visfatin with estimated GFR [r[2]= -0.383, p=0.01] and a positive correlation with degree of proteinuria [p=0.01] was observed. The present study confirms the association of visfatin with CKD, however further studies at molecular level to check its expression within renal tissue may clarify its definitive role in CKD

relationship of visfatin with measures of obesity in patients of diabetic nephropathy

Visfatin is proposed as an adipocytokine secreted from visceral fat and its blood level correlate with obesity, diabetes mellitus and inflammation. Aim of this study was to examine association of serum visfatin with measures of obesity in a group of patients with diabetic nephropathy and normal controls. This was a cross sectional study analyzing 60 subjects including 30 patients of diabetic nephropathy and 30 controls. Anthropometric measurements were done using standard methods and visfatin was measured through EIA Kit. Serum visfatin in obese subjects among both groups was not different from non obese subjects [7.9 +/- 6.1 vs. 6.4 +/- 3.2 p=0.238]. We found a positive correlation of visfatin with BMI [r=0.313, p<0.05] but no correlation with waist circumference [r=0.148 p=0.695] and waist to hip ratio [0.198, p=0.136]. Serum visfatin in subjects of diabetic nephropathy and non diabetics was [9.2 +/- 5.4 vs. 5.2 +/- 3.4 p<0.05. Serum visfatin does not correlate with markers of visceral obesity including waist circumference and waist to hip ratio. However, a positive correlation is observed with BMI. Future studies involving larger sample size and quantifying visceral tissue expression of visfatin may explain its potential role in visceral obesity

Diagnostic value of Ki-67 antigen in human thyroid tumors

To determine frequency of Ki-67-antigen over-expression in thyroid tumours. A retrospective study of 50 patients suffering form thyroid tumours. Was carried out in BMSI, Jinnah Postgraduate Medical Center, Karachi frornl993-2001. Maximum numbers of tumour among total cases were is age group ranging from 20-39 years. This age group 18 [72%] papillary Carcinoma, 04 [80%] medullary carcinoma, 03 [30%] follicular carcinoma, 04 [57%] follicular adenoma. The mean+ SD of follicular adenoma, follicular carcinoma, papillary carcinoma, medullary carcinoma and anaplastic carcinoma are 12.96 + 54.44, 49 + 8.90, 45.5 + 7.3, 44.62 + 4.7 and 5 1.7 + 2.2 respectively. The p value between benign and malignancy condition is 0.001 which is highly significant. The result and observation of study show that immunohistochemical study using Ki-67 antibody suggest that positive reaction for Ki-67 antigen could be used as a tool for distinguishing malignant tumour from benign tumors. Ki-67 proliferative activity has been shown to have a diagnostic value, further evaluation as prognostic indicator in the study of tumour pathology is warranted in hope that this parameter will allow clinicians to provide more appropriate treatment

Pulmonary histopathology in heroin involved deaths

Heroin addiction is an old and rapidly increasing socio economic and religions problem of our country. Abuse of narcotic drugs especially heroin is the most serious consideration of all international organizations. This study reveals bronchopneumonia with interstitial inflammation fibrosis seen in eight cases this [32%] pulmonary oedema, congestion with interstitial inflammation in three cases [12%] acute bronchopneumonia in six [24%], chronic interstitial pneumonia in four [16%] chronic initial inflammation with fibrosis focally suggestive or respiratory distress syndrome in thee [12%] and focal lung abscese in one case [4%]

Immunohistochemical study of progesterone receptors in thyroid gland

To determine the progesterone receptor status in thyroid gland. This study was based on immunohistochemical staining of formalin fixed paraffin embedded tissues, for progesterone receptors, in 50 previously diagnosed cases of various thyroid lesions and surrounding normal thyroid tissue. Out of 50 cases, 8 were nodular goiter, 9 cases of adenoma, 19 papillary carcinoma, 10 follicular carcinoma and four cases were of medullary carcinoma. Surrounding normal tissue was available in 4 non-neoplastic and 21 neoplastic lesions. Overall male patients comprised 20% [10 cases] and females 80% [40 cases]. Although a wide range of lesions in both the sexes including wide age range were available, none of our cases were positively stained for progesterone receptors. In contrary to earlier reports by immunohistochemical method using monoclonal mouse anti-PR antibody clone PgR 636, on formalin-fixed paraffin embedded thyroid tissues, the progesterone receptors were not detectable in our human samples. The effect of progesterone on thyroid gland may be an indirect one

Potential role of preoperative chemotherapy in breast cancer

This is a retrospective and prospective study carried out in the Department of Eljtelogy, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karacnr from October 2000 to October 2002. A total of fifty-breast carcinoma specimens were investigated comprising of forty invasive ductal carcinomas and ten invasive lobular carcinomas. Ki-67 antigen was immunostained on formalin-fixed paraffin embedded tissue and the positivity index in tumors of various sizes was determined. Thirty-three cases showed positive nuclear staining. Group-I contained tumors equal to or less than 2 cm in size. In ILC, 0.3 out of 08 cases and in IDC 07 out of 25 cases, showed a mean Ki-67 index of 13.9 +/- 0.4% and 15.65 +/- 11.65%, respectively. Group-II contained tumors between 2.1-5cm in size. In ILC, 02 out of 08 cases and in IDC, 07 out of 25 cases, showed a mean Ki-67 index of 10.9 +/- 3.2% and 14.04 ± 5.34%, respectively. Group-Ill contained tumors equal to or more than 5.1 cm in size. In ILC 03 out of 08 cases and in IDC 11 out of 25 cases, showed a mean Ki-67 index of 14.2 +/- 9.3% and 17.38 +/- 11.30% respectively. The results of ILC versus IDC in all three groups were statistically insignificant [P>0.05]. So it is concluded that preoperative chemotherapy is a useful therapeutic strategy for operable breast cancer of any size

morphological study of chronic granulomatous lymphadenitis with the help of special stains

To find out the causative organisms with the help of special stains in chronic granulomatous lymphadenitis. A retrospective study of 100 patients suffering from chronic granulomatous lymphadenitis. Surgical OPD, Wards and BMSI, Jinnah Postgraduate Medical Centre, Karachi Pakistan. Subjects: One hundred patients between the age of 11 to 75 years [34 males and 66 females] were selected over a period of three years suffering from chronic granulomatous lymphadenitis. Results of the study show that commonly involved sites were cervical lymph nodes [52%] other sites were inguinal and mesenteric, 10% each. Thirty-four were males and sixty-six females. Caseating granulomas were sixty two and non-caseating granulomas thirty eight. Twenty-two lymph nodes showed acid fast bacilli, four showed LD bodies and two gram negative bacilli. Results of the study indicates that isolated organisms were mostly mycobacterium tuberculosis in chronic granulomatous lymphadenitis but other etiological agents were also isolated

Squamous cell carinoma eye lis presentin as unilateral: Blepharoconjunctivitis

Two rare cases of squamous cell carcinoma [Scc] of eyelid presented with chronic unilateral blepharoconjunctivitis are jointly reported by Ophthalmology and Histopathology Departments of Jinnah Postgraduate Medical Centre, Karachi. Histopathological examination of resected tumor and reconstruction of eyelids with different surgical techniques was carried out in both the cases. No local recurrence was seen in 10 and 2 years of follow-up. Both of them, however, developed dry eyes with its complications. It was concluded that unilateral chronic blepharoconjunctivitis, not responding to medical treatment, should be subjected to histopathological examination to find out the cryptogenic cause of inflammation and extensive eyelids surgery in oculoplastic procedures may ultimately end up in dry eye. Case I. Sixty-five years old lady with unilateral blepharoconjunctivitis of five years standing reported out to be SCC on incision biopsy. Both of her right upper and lower lids were resected with 0.5 to 1.0 cm apparently healthy margin. Reconstruction of anterior lamina was done by glabellar and forehead flap for upper lid and Mastarde's flap for lower lid. Inner lamina was reconstructed with buccal mucosa. Ten years of follow-up showed no evidence of recurrence, though, she did developed complications of dry eye. She was kept on local lubricants but despite of her regular use of artificial tears she developed total corneal opacity. Case II. Sixty-two years old male presented with right chronic blepharoconjunctivitis of 3 years standing. SCC was found to be underlying cause on incision of biopsy. Total right upper lid resection followed by reconstruction of upper lid was done. Skin [by local flap] used for outer lamina, while donor sclera for inner lamina. Due to shrinkage of sclera, root of the upper lid gave way. This defect was filled with Cuttler Beard lid sharing technique successfully. Upper lid was mobile and functional and patient did not had any evidence of recurrence in two years of follow-up. This patient developed dry eye and is being managed on lubricants

Touch imprints cytology of lymph nodes

Touch imprints [Tl] is an inexpensive and a rapid diagnostic technique that can be utilized during surgery. In this study touch imprints of 54 cases of lymphadenopathy were studied and reports were delivered on the same day. The results were correlated with histopathology later on. In 38 cases tuberculosis was diagnosed, 5 were Non Hodgkin's lymphoma, 2 Hodgkin's lymphoma, 7 metastatic tumour and 2 had reactive hyperplasia. From this study it was concluded that touch imprints give early diagnosis with more than 90% accuracy, so it can be used for intraoperative diagnosis in radical surgery

Role of fine needle aspiration cytology [FNAC] in the diagnosis of lymphadenopathy

Fine needle aspiration cytology [FNAC] of 56 cases of lymphadenopathy using a 21 guage needle and Leurlok syringe was performed at the Jinnah Postgraduate Medical Centre [JPMC], Karachi during 1990-91. The result of the FNAC were compared with histological diagnosis and an accuracy of 95% was achieved. The study correlated highly with the findings of other authors. It was concluded from the study that FNAC is a reliable, easy, rapid and economic technique of diagnosis and can be adopted in our institutions to avoid unnecessary surgery