Immunohistochemical expression of CD10, BCL6 and MUM1 in differentiating diffuse large B cell lymphoma subtypes

Objective: to determine the immunohistochemical expression of CD10, BCL6 and MUM1 in differentiating diffuse large B cell lymphoma subtypes. Study Design: Descriptive, cross-sectional study

Place and Duration of Study: department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi, from November 2014 to May 2015

Methodology: newly diagnosed cases of DLBCL on HandE stain as well as IHC markers, according to WHO blue book 2008, were included in the study. Patients' gender, age and site of lymphoma were noted. DLBCL subtypes [GCB and activated type or non-GCB] were assessed based on IHC expression of CD10, BCL6 and MUM1 and the results were recorded. The data were analyzed by using computer software program SPSS version 20. Descriptive statistics, frequencies and percentages were calculated

Results: out of 96 patients, 79 [82%] were male and 17 [18%] were female. Mean age was 54.66 +/-16.73 years. Thirty-six [37.5%] cases showed positivity for CD10 and BCL6 both [GCB type], whereas MUM1 was positive in 60 [62.5%] cases [non-GCB type or activated type]. A significant statistical association was seen between expression of IHC markers [CD10, BCL6 and MUM1] and DLBCL subtypes [GCB and non-GCB type, p<0.001]

Conclusion: in Pakistani population, the frequency of non-GCB type expressing MUM1 is 62.5%, which is quite high as compared to western countries. It needs to be further explored, because it represents high-risk subsets in which alternative strategies for diagnosis and management should be planned

The need for redesigned pharmacy practice courses in Pakistan: the perspectives of senior pharmacy students / 보건의료교육평가

PURPOSE: In Pakistan, courses in pharmacy practice, which are an essential component of the PharmD curriculum, were launched with the aim of strengthening pharmacy practice overall and enabling pharmacy students to cope with the challenges involved in meeting real-world healthcare needs. Since very little research has assessed the efficacy of such courses, we aimed to evaluate students' perceptions of pharmacy practice courses and their opinions about whether their current knowledge of the topics covered in pharmacy practice courses is adequate for future practice. METHODS: A cross-sectional study was conducted over two months among the senior pharmacy students of two pharmacy colleges. A content- and face-validated questionnaire was used to collect data, which were then analysed using SPSS version 20. Descriptive analysis and logistic regression were performed. RESULTS: Research in pharmacy practice (30.2%), applied drug information (34.4%), health policy (38.1%), public health and epidemiology (39.5%), pharmacovigilance (45.6%), and pharmacoeconomics (47.9%) were the major courses that were covered to the least extent in the PharmD curriculum. However, hospital pharmacy practice (94.4%), pharmacotherapeutics (88.8%), and community pharmacy practice (82.8%) were covered well. Although 94% of students considered these courses important, only 37.2% considered themselves to be competent in the corresponding topics. Of the participants, 87.9% agreed that the pharmacy courses in the present curriculum should be redesigned. CONCLUSION: Our results showed that the pharmacy practice courses in the current PharmD curriculum do not encompass some important core subjects. A nationwide study is warranted to further establish the necessity for remodelling pharmacy practice courses in Pakistan.

Comparison of the knowledge, attitudes, and perception of barriers regarding adverse drug reaction reporting between pharmacy and medical students in Pakistan / 보건의료교육평가

PURPOSE: The goal of this study was to compare the knowledge and attitudes of pharmacy and medical students regarding adverse drug reactions (ADRs), as well as their perceptions of barriers to ADR reporting, in a Higher Education Commission-recognised Pakistani university. METHODS: A cross-sectional study was conducted among final-year pharmacy (n=91) and medical (n=108) students in Pakistan from June 1 to July 31, 2014. A self-administered questionnaire was used to collect the data. The responses of pharmacy students were compared to those of medical students. RESULTS: Pharmacy students had a significantly better knowledge of ADRs than medical students (mean+/-SD, 5.61+/-1.78 vs. 3.23+/-1.60; P<0.001). Gender showed a significant relationship to knowledge about ADRs, and male participants were apparently more knowledgeable than their female counterparts (P<0.001). The attitudes of pharmacy students regarding their capability to handle and report ADRs were significantly more positive than those of medical students (P<0.05). In comparison to pharmacy students, a lack of knowledge of where and how to report ADRs was the main barrier that medical students perceived to ADR reporting (P=0.001). CONCLUSION: Final-year pharmacy students exhibited more knowledge about ADRs and showed more positive attitudes regarding their capacity to handle and report ADRs than final-year medical students.

Practice nurses and pharmacists: a perspective on the expectation and experience of nurses for future collaboration

To explore the nurses' expectations and experience about pharmacists in private sector hospitals of Karachi, Pakistan. A cross-sectional study was conducted from June to September 2012 in five private sector hospitals of Karachi, Pakistan. A convenient sample of nurses [n=377] were enrolled in this study. Data was obtained through a previously validated questionnaire. Responses were statistically analyzed using SPSSv.17. Questionnaires were returned giving a response rate of 63.6% of which 20 were unusable [n=240]. Out of the remaining 220, 24.1% [n=53] responded that they never or rarely interacted with a pharmacist. Respondents who expect pharmacists to collaborate with nurses to solve drug related problems were 45% [n=99]. Nurses' experience of pharmacists was not substantial as only 44.5% [n=98] respondents consider pharmacists as a reliable source of clinical drug information. The role of pharmacists is not well appreciated among nurses in Pakistan. Hence, pharmacists must bridge the observed gap and use a more strategic and consistent approach to build a more positive image in line with other healthcare professionals and in providing patient-centred pharmaceutical care. This research would impress upon the pharmacists the need to redefine their role in the healthcare settings

Ectodermal dysplasia syndrome with cleft palate, hypodontia, metatarsus adductus and imperforate anus: a new syndrome?

Ectodermal dysplasia constitute a large group of rare, heterogenous [under clinical and genetic aspects], congenital / hereditary disorders characterized by a constellation of findings involving a primary defect [hypoplasia or aplasia] in at least two embryonic ectodermal-derived tissues including the teeth, skin, appendageal structures, hair, nails, nerve cells, eccrine glands, sebaceous glands and parts of the eye [conjunctiva], ear, and certain other structures. More than 192 distinct disorders have been described. The most common Ectodermal dysplasias are X-linked recessive hypohidrotic / anhidrotic type known as Christ-Siemens Touraine syndrome with the gene mapping to Xq12-q13 and hydrotic type known as Clouston's syndrome. Several ED syndromes may manifest in association with midfacial defects, mainly cleft palate and / or lip. Hypodontia of the primary and permanent dentition is the most common oral finding. This study presents four cases of the same family, two suffering from Ectodermal dysplasia along with hypodontia and cleft palate, one of which also presents metatarsus adductus and imperforate anus [proband] and the remaining two out of four with hypodontia in the absence of ectodermal dysplasia, one of which also presents metatarsus adductus [elder sibling] with imperforate anus in the other [youngest sibling]. Oral and Maxillofacial Physicians and Dentists can be the first to diagnose ectodermal dysplasia due to the presence of specific facio-oral features and absence of teeth respectively

Field cancerization of oral lichen planus and prognostic aspects of oral squamous cell carcinoma occuring on its background

Lichen Planus first described by Erasmus Wilson in 1869 has moved from being regarded as an innocuous benign condition to being considered as a potentially malignant disorder by the World Health Organization and is now defined as an idiopathic immune mediated mucocutaneous chronic inflammatory disease that affects the stratified squamous epithelia and the appendices. Oral lichen planus carries a very small probability of becoming malignant. The objective of the present study was to assess the long term prognostic aspects of oral squamous cell carcinoma/dysplasia and field cancerization occurring on the background of oral lichen planus in a retrospective analysis of 51 OLP patients [mean age=54 years; female, n=35; male, n=16] who between 2001 to middle of 2010 were diagnosed with OLP-related OSCC at the Department of Oral Medicine, Eastman Dental Institute and one major Head and Neck Cancer unit, University College London Hospital, United Kingdom. 1500 OLP patients were analyzed by using a computerized data base [CDR, Clinical Data Repository] and case files of Eastman Dental Institute and UCLHNHS Trust, out of which 53 patients were found to have at least one neoplastic event [intraepithelial neoplasia and/or invasive OSCC]. 2patients were excluded from the study as the case files or CDR did not have sufficient data regarding the histopathological and clinical features of oral lichen planus and/or subsequent neoplastic events. The results of the present study suggest that 3.5% [5311500] of patients with OSCC have a previous history of OLP. The mean interval between the histological diagnosis of OLP and OSCC development was 4.5 years. The observation period following the detection of the first oral malignancy was at least 2.2 years for the majority of patients. 51 oral lichen planus patients suffered a total of 137 neoplastic events [OSCC I dysplasia]. Patients with OLP and subsequent development of dysplasia I oral squamous cell carcinoma are at risk of having multiple and multifocal neoplastic events of the oral cavity and therefore worse prognosis

Haim Munk syndrome: two siblings of southern Pakistan treated with acitretin

Haim Munk Syndrome [HMS] is an extremely rare autosomal recessive disorder with the allelic mutation of exon 6 codon in cathepsin C gene. It is characterized clinically by palmo-plantar keratoderma [PPK], aggressive early onset of periodontitis, onychogryphosis, arachnodactyly, acro-osteolysis and pes planus. This study presents two cases of the same family with HMS having almost all the cardinal features of this rare disorder. Both the siblings were treated with acitretin, co-trimoxazole and topical keratolytics and followed up for 6 months

C-reactive protein as a prognostic indicator of oral squamous cell carcinoma-a retrospective study

The objective was to determine Serum C-Reactive protein as a prognostic indicator for Oral Squamous Cell Carcinoma. It was a retrospective cross sectional study, conducted in the Department of Oral Medicine, Eastman Dental Institute, University College London. The medical records of the patients were reviewed by using NHS CDR [National Health Service Clinical Data Repository] and studying their hospital notes of the year 2005. All the patients who had histopathologically proven OSCC, being treated with surgery as primary treatment modality and had pre-operative CRP values were included in the study. Data collection included the pre-operative serum CRP values, treatment modalities, disease severity, out comes, complications and the survival time period of the patients. Thirty one patients with OSSC treated primarily with surgery were included in this study. Twenty four patients had elevated pre-operative serum CRP levels while seven patients had normal value of serum CRP. 12 were males and 19 females with male and female ratio of 1:1.6. The age of the patients ranged from 46-92 years with the mean age of 64.87+14.25 years. The pre-operative serum CRP levels ranged from 4-57.2 mg/L with the mean value of 35.94+19.68 mg/L. Higher values of CRP corresponded with higher TNM staging and poor overall 5-year survival. The study showed that patients with elevated pre-operative serum CRP levels showed the worst prognosis and almost all of them died within five years while the patients with normal CRP were alive even after 5 years of surgical resection. Hence, it can be concluded that elevated pre-operative CRP levels are prognostic indicators in patients with OSCC