Fine needle aspiration cytology: a useful diagnostic tool in childhood tumors

To find out the diagnostic role and utility of fine needle aspiration cytology [FNAC] in pediatric tumors /swellings. Descriptive case series. Department of Pathology National Institute of Child Health Karachi, from January 2005 to December 2011. Children up to 13 year of age were included in this study. The procedure was explained and consent taken. Material from the tumor / swelling was aspirated with a 10ml syringe having 20G needle for superficial tumors while 22G needle with trocar was used for deeper tumors. Slides were made, air dried, fixed and stained with Leishman and Papanicolaou stains. Clot taken was preserved in 10% formaline and processed for histology. A total of 1337 FNAC procedures were performed. There were 1067 [79.8%] benign and 270 [20.2%] malignant cases. Further breakup of benign cases revealed tuberculosis in 279 [26.1%], chronic inflammation / cold abscess in 421[39.5%], post BCG lymphadenitis in 52 [4.9%], reactive lymphadenitis in 130 [12.2%], acute inflammation in 44 [4.1%], lipoma in 30 [2.8%], hematoma in 34 [3.2%], lymphangioma in 31 [2.9%], thyroid cyst in 08 [0.75%], gynecomastia in 03 [0.28%] and benign inconclusive tumors in 35 [3.3%] cases. The malignant cases diagnosed by FNAC were Hodgkins disease [n=64 - 23.7%], Non-Hodgkins Non-Burkitts lymphoma [NHNBL] [n=60 - 22.2%], Burkitts lymphoma [n=09 - 3.3%], malignant histiocytosis 41 [15.2%], round blue cell tumour of childhood 13 [4.8%], neuroblastoma [n=17 - 6.3%], rhabdomyosarcoma 12 [4.4%], nephroblastoma 10 [3.7%], retinoblastoma [n=9 - 3.3%], metastatic nasopharyngeal carcinoma [n=3 -1.1%], and malignant teratoma [n=2 - 0.7%]. Thirty [11.1%] malignant lesions remained inconclusive as to exact pathology. FNAC is an important diagnostic tool with high yield. It can be used with confidence in making diagnosis specially differentiating benign from malignant conditions.

Isolation and antimicrobial susceptibility pattern of methicillin resistant and methicillin sensitive staphylococcus aureus

To find out frequency and antibiotic sensitivity pattern of methicillin resistant and methicillin sensitive staphylococcus aurues. Descriptive study. Microbiology section of Department of Pathology in National Institute Of Child Health Karachi, from March 2008 to April 2009. All the clinical samples received in laboratory were processed. All staphylococcus aureus isolates were then identified by conventional method. The isolates were tested by the modified Kirby Baur disc diffusion method and results were interpreted as outlined by National Committee for Clinical Laboratory Standard criteria. Eighty seven isolates of staphylococcus aureus were recovered from various clinical samples. Sixty six [75.86%] were isolated from various swabs and 21[24.13%] from blood. Twenty isolates [22.9%] were methicillin resistant. In this group high resistant was found to cloxacillin [100%], cephradine [100%], co-trimoxazole [95%], erythromycin [70%], chloromycetin [65%], gentamicin [55%] and low resistance was observed to ciprofloxacin [30%]. In MSSA 0% resistance was seen to meropenem, ciprofloxacin and chloromycetin and high resistance found to co-trimoxazole [98.5%] and pencillin [73.13%]. Low resistance was also observed with amoxiclav [20.89%]. Both MRSA and MSSA were 100% sensitive to vancomycin. In this study high resistance pattern to non b-lactam antibiotic was found in MRSA leaving restricted choice for the treatment. Good hygiene practices, infection control and emphasis on hand washing etc may slow down the process of resistance

Typhoid fever: comparison of tests available for its diagnosis

To determine the most reliable, rapid, easy to perform and cheaper test for the diagnosis of typhoid fever. Two years hospital based comparative and analytical study. Place and Duration of the study: This study was carried out at the National Institute of Child Health, Karachi in collaboration with Department of Microbiology, University of Karachi from April 2003 to March 2005. One hundred and ten patients up to 13 years of age were included in the study after taking verbal informed consent from their parents/caregivers. Patients had fever of more than five days with presumptive diagnosis of typhoid. Patients who did not meet the above mentioned inclusion criteria or suffering with any other/obvious cause of fever were excluded from the study. Total leucocyte count, Widal test, blood/bone marrow cultures and typhi dot tests were performed for comparison. Out of 110 patients 90 [81.82%] were confirmed positive for typhoid fever taking bone marrow cultures as standard. Most of the typhoid fever positive cases had normal or slightly raised total leucocyte count. By blood culture isolation rate of pathogen was only 14% while by bone marrow culture isolation rate was 82%. Widal test correlated in about 65% cases. Typhi dot test was performed on 32 patients only, with the positivtiy of 75% and the sensitivity about 100%. It is concluded that Dot Elisa [Typhi Dot] is specific and sensitive and comparatively rapid test, but bone marrow culture still remains the gold standard as it provides high isolation rate of organism and sensitivity pattern too

Status of hepatitis B vaccination amongst health care workers and their knowledge about prevention strategies

To assess the status Of Hepatitis B Vaccination Amongst Health Care Workers [HCW] and Their Knowledge About Prevention Strategies. A questionnaire based report. National Institute of Child Health, Karachi from January 2006 to April 2006. Three hundred and eighteen health care workers [age range 20-59 years] filled the questionnaire. Amongst them 186 [58.49 percent] were male. The study showed that 159 [50 percent] were completely vaccinated, 59 [18.55 percent] partially vaccinated and 100 [31.44 percent] were unvaccinated. The study also showed that among vaccinated HCW, 21 [13.20 percent] had their antibody titer done. Only 25 [15.72 percent] had booster dose. Needle stick injury was reported by 174 [54.71 percent] health care workers. Out of this only 56.60 percent had complete vaccination. Only 181 [56.91 percent] health care workers wear gloves while handling blood and blood products. Awareness among health care workers about getting them vaccinated is present but it did not materialize in actuality. The reasons mentioned are not forthcoming with, when one calculates the life long complications that may result from not getting vaccinated. The careless attitude in their clinical practice expose them to the risk of getting infected with contaminated materials