Histopathological changes in arsenic kushta induced nephrotoxicity in wistar rats

Objective: To determine the nephrotoxic effects of arsenic kushta [Kushta Sam-ul-Far] in Wistar rats

Study Design: Experimental study

Place and Duration of Study: Department of Morbid Anatomy and Histopathology, University of Health Sciences, Lahore from May to August 2014

Methodology: This experimental study was conducted on 48 healthy Wistar rats, each weighing 200 - 250 grams. The rats were randomly divided into 4 experimental groups each containing 12 rats. Group I was taken as control given flour pellets. Group II was given single dose [180 mg/kg] of arsenic kushta for 2 weeks. Group III received 150 mg/kg of arsenic kushta for 12 weeks; whereas, group IV was also given 150 mg/kg of arsenic kushta for 12 weeks along with 75 mg of BSA [bovine serum albumin]. Histopathological changes in glomeruli, tubules and interstitium were noted in the kidney

Results: Mesangial proliferation, thickening of basement membrane, necrosis, and interstitial edema were mainly observed in all the above groups except group I which served as control. These changes were seen in greater severity in high dose groups and the group given BSA injection along with kushta [group III, IV]

Conclusion: Herbo-mineral preparations of arsenic kushta are nephrotoxic in rats and may have similar toxic effects in human beings

Axillary lymph node status in primary breast carcinoma; association of axillary lymph node status with ER/PR, HER2/NEU and MMP-I in primary breast carcinoma

The most important prognostic factor in patients of breast carcinoma is axillary lymph node metastasis. Current study was conducted to find the frequency of lymph node metastasis in hundred cases of primary breast carcinoma and association of lymph node status with immunohistochemical expression of ER/PR,HER2/neu and MMP-1[matrix metalloproteinase-1]. Descriptive study. Aug 2012 to Jun 2013. U.H.S laboratory of Morbid Anatomy and Histopathology Lahore. One hundred mastectomy specimens with axillary lymph node dissection were included. After gross examination, tissue processing and microtomy the tissue slices of 4 micrometer were taken on frosted and lysine coated slides. H/E and IHC for ER/PR,HER2/neu and MMP-1 were done according to protocol. Among 100 breast cancer subjects, 72 were positive for lymph node metastasis while 28 subjects were negative. A significant association between lymph node status and ER IHC expression was noticed. When Chi square test was applied with p-value of 0.001 was observed.Also a significant association between lymph node status and PR IHC expression was noticed. Chi square test was applied and the p-value of 0.004 was obtained.Association between lymph node status and HER2/neu IHC expression was analysed. Chi square test was applied with a p-value of 0.467 was obtained [not significant].A significant association between lymph node status and MMP-1 IHC expression was observed. Chi square test was applied anda p-value of 0.004 was obtained. Most of the primary breast carcinomas were presented with axillary lymph node metastasis [72%].Significant associations were observed between lymph node status and ER/PR immuonohistochemical expressions however the association between HER2/neu IHC and lymph node status was not statistically significant. The immunohistochemical expression of MMP-1 is significantly associated with lymph node status. It shows that it is an important marker for metastatic potential in breast carcinoma

Presence of various fungi in the oral smears of HIV / AIDS patients

This study was designed to observe the various fungi present in the oral buccal smears of HIV/ AIDS patients and their relation to CD4+lymphocyte count. Oral smears from n=35 patients taking antiretroviral therapy [ART] and twenty five [n=25] patients not taking ART were taken. These smears were stained with routine [H and E, Pap] and special stains recommended for fungi i.e. Grocott-Gomori's Methenamine Silver [GMS] and Periodic Acid Schiff [PAS]. The CD4+ lymphocyte count was determined using flow cytometry. Candida albicans was the most common being present in 26% patients on ART and 44% in Non-ART patients. Cryptococcus neoformans was seen in 11.4% ART patients and 4% in Non-ART patients. Coccidioides immitis was observed in 2.9% ART patients and 4% of Non-ART patients. Aspergillus was seen in 1.6% Non-ART patients only. Mean CD4+ count at which various fungi were seen was <300 cells/mm3 in all types. The CD4+ lymphocyte count was quantitatively grouped as Group 1 with CD4 + lymphocyte count <350 cells/mm3 and Group 2 having CD4+ lymphocyte count >350 cells/mm3. Fungi was found to have significant [p=0.001] association with Group1 having CD4+ count less than 350 cells/mm3 which shows their association with immunosuppression. Determination of increased colonization of Candidal and Non-Candidal fungi in oral cavity by means of simple non-invasive methods like oral smears may be helpful in indirectly predicting the immune suffered status and such patients should be given early medical treatment to prevent from disseminated fungal infections

Experimental Study of Antimony Induced Hepato Toxicity in Rabbits

Objectives: To demonstrate the effects of antimony on hepatic tissues of Rabbits. To correlate the severity of tissue damage to the dose of antimony and to an immunologically altered state of the animal. Study Design: Experimental study. Place and Duration of Study: This study was carried out at PGMI and KEMU, Lahore from January 1988 to March 1988. Materials and Methods: This study was carried out on 40 healthy rabbits weighing 1.5kg divided into 4 groups each group having 10 animals with one control group. Group I animals were injected with antimony sodium tartrate of % MLD 6mgkg body weight VV at interval of 2 days for 12 weeks, whereas experimental dose of 1.7lmglkg body weight was injected VV at interval of 4 days to group I1 animals. Those of group 111 were injected 2ml of specific bovine albumin 30%[DADEUSA] followed by schedule of group I1 animals. Group IV [control group] animals were injected W with distilled water. Results: Hepatic Enzymes, Serum Alanine Arninotransferase and Serum Gamma Glutamyl transpeptidasc [GT] levels were estimated at the end of six weeks and twelve weeks. These were found to be raised gradually from 7' week onwards until the experiment was terminated. Conclusion: It is concluded from this study that antimony sodium tartrate has toxic effects on liver tissue and can cause hepatocellular damage [if given for prolong period]

clinicopathological study of orofacial squamous cell carcinoma in local population

Oral squamous cell carcinoma is one of the most common and devastating oral cancer. It is the sixth most common tumour worldwide with almost 90,000 cases reported annually. Its incidence is alarmingly increasing in many South Asian countries owing to the increase in areca nut, betel quid and tobacco chewing habits among vast population of this region. To see the clinical and histopathological pattern of oral squamous cell carcinoma in a tertiary care hospitals of Pakistan. This was a descriptive study. 39 patients of primary oral squamous cell carcinoma were studied from two tertiary care hospitals of Punjab namely Mayo Hospital Lahore and Allied Hospital Faisalabad. Detailed clinical histories of the patients were recorded. The histopathologic examination on the specimens removed was performed using haematoxylin and eosin [H and E] stain. Clinical data included age, sex of the patient and intraoral site of cancer. Histopathological data included the grade of Squamous cell carcinoma. The grading was done using Anneroth grading system. The data was analysed on SPSS 18. In our study the patients with squamous cell carcinoma had a mean age of 50.36 +/- 1.98 years with equal prevalence in both genders. It was observed that SCC was most commonly arising from tongue [23.1%] followed by lip mucosa [20.5%] and buccal mucosa [12.8%]. Most of the cases were moderately differentiated [51.3%], whereas the remaining were well and poorly differentiated. A very strong association [p = 0.001] was found between the site and grade of tumour using Fisher's exact test. Almost all the tumours on sublingual mucosa especially those arising from floor of the mouth were poorly differentiated

Two unusual tumours in a patient of xeroderma pigmentosum: angiosarcoma and basosquamous carcinoma

Xeroderma pigmentosum [XP] is a rare form of genodermatosis, characterized by cutaneous pigmentary changes, sensitivity to light and development of multiple cutaneous and internal malignancies at an early age as a result of nucleotide excision repair defect after ultraviolet light exposure. Cutaneous angiosarcomas are angry neoplasms that are rarely associated with XP. In this communication, we report the case of a 22-year-old male patient with XP who developed an angiosarcoma of the face and a basosquamous carcinoma at one time. It is probably the first such case reported from Pakistan

Demographic and clinicopathological parameters in lung cancer in a chest hospital, Lahore - Pakistan

We are presenting the clinical and pathological characteristics of lung cancer among patients reporting to Gulab Devi Chest Hospital Lahore, the largest and the oldest health care facility for chest diseases including lung cancer in Pakistan. It was a cross - sectional, descriptive study conducted at the department of histopathology, Gulab Devi Hospital Lahore between March 2011 and February 2012. A sample of 293 patients of primary lung cancer was taken. The demographic and clinical details i.e. age, sex, history of smoking and presenting symptoms were collected after the informed consent. Histopathological diagnosis and tumour grades were added in respective columns. Data was analysed with the help of S.P.S.S. version 17.0. Mean age was 53.19 +/- 0.92 years for male and 47.36 +/- 1.92 years for females. Male to female ratio was 3:1. History of tobacco smoking was present in 2/3[rd] of the patients. Smoking was strongly associated with squamous and small cell carcinoma of lung. Most common histological diagnoses were squamous cell, small cell and adenocarcinoma respectively. Majority of squamous cell carcinoma were poorly differentiated as compared to adenocarcinoma in which well and moderately differentiated tumours constituted 25% and 45% respectively. Most of patients presented at inoperable stage. Smoking is most strongly associated with the two most common histological entities of lung cancer viz. squamous cell carcinoma and small cell carcinoma. Bronchial biopsy was the commonest diagnostic procedure in practice and surgical resection is offered to only a few cases

Children with clinical presentation of Hirschsprung's disease - a clinicopathological experience

Enteric neuronal abnormalities include Hirschsprung's Disease [HD], hypoganglionosis, intestinal neuronal dysplasia [IND Type A and B], and immaturity of ganglion cells. All of these are mostly present with the same clinical features of the HD. A total of 92 patients presented with the clinical features of HD were recruited to this study from two tertiary care Children Hospitals from March 2009 to October 2009. They either had their first presentation or called for definitive surgeries with clinical presentation of HD. After applying exclusion criteria, 84 patients were finally left for the study. Among 84 patients, 13 [15.5% proved to be normally ganglionic on rectal biopsies and 71 [84.5%] showed enteric neuronal abnormalities. In these, 51 [71.8%] children had Hirschsprung's disease, 9 [12.7%] revealed immaturity of ganglion cells [IGC], 9 [12.7%] belonged to isolated hypoganglionic group and 2 [2.8%] showed isolated IND type B. In HD group, M: F ratio was 4.1:1, mean age at diagnosis was 1.9 years and the presenting complaints were in the descending order i.e., abdominal distention, constipation, vomiting and delayed passage of meconium. Among the group that showed IGC, M: F ratio was 2: 1, mean age at diagnosis was 12 days of life. The presenting complaints were same as that in HD in a similar order. In isolated hypoganglionic group, M: F ratio was 3.5.: 1, mean age at diagnosis was 2.3 years. The presenting complaints included constipation [88.9%], abdominal distension [77.8%], vomiting [33.3%] and delayed passage of meconium [33.3%]. In isolated IND type B, both patients were males, they came with constipation, abdominal distension and vomiting whereas one of them had history of delayed passage of meconium. HD was the most common enteric neuronal abnormality. Other neuronal abnormalities included isolated hypoganglionosis, immaturity of ganglion cells and isolated hyperganglionos [IND Type B]. Most common presenting complaints were abdominal distension, constipation, vomiting and delayed passage of meconium in all the groups

Muscular dystrophies and the role of dystrophin in their diagnosis

Muscular dystrophies [MD] traditionally refer to a group of genetically determined, progressive, degenerative disorders of the skeletal muscle. The most common disease manifestations being Duchenne Muscular Dystrophy [DMD] and Becker Muscular Dystrophy [BMD]. This descriptive study was carried out on 40 patients of muscular dystrophies, selected on clinical grounds and subjected to biochemical, morphological and immunohistochemical analysis. Muscle biopsies were taken from patients by an open method and formalin fixed paraffin embedded blocks were made. Haematoxylin and Eosin stain, PAS and Gomori's trichrome and immunohistochemical stains were conducted on the sections from these blocks. Dystrophin and beta - Spectrin antibodies were used for immunohistochemistry. Among the 40 cases of muscular dystrophy the above investigations were correlated with clinical findings to reach the final diagnosis in each case. In Pakistan the diagnosis of muscular dystrophies is still based on clinical grounds and CPK values only, however the present study has provided us an opportunity to combine clinical, biochemical, morphlogical and immunohistochemical evaluations of the patients with muscular dystrophies. It was concluded from this study that although muscular dystrophy can be diagnosed using clinical parameters and CPK levels, histochemistry and IHC can confirm and differentiate the various types of muscular dystrophy and make it possible to identify the female patients of DMD and BMD

study of the morphological patterns of extranodal non-hodgkin lymphoma in Pakistani and Saudi populations

The incidence of extranodal non-Hodgkin lymphoma [EN - NHL] is increasing particularly among the populations of South Asia and Middle East. On the whole 25 - 40% of NHL arise in the sites other than lymph nodes. This study was designed to assess the pathological patterns and the prevalence ofEN-NHL in Pakistan and in Saudi Arabia. A total 0/106 and 42 cases, from one centre in Pakistan and Saudi Arabia respectively, were included during a five year period [1998 - 2003] with a detailed account of their demographic and clinical characteristics. We observed that most of the Pakistani and Saudi patients presented in the 5[th] - 7[th] decades with the mean age being 43.2 and 46 years and a male to female ratio 0/1.07: i and 1.7: i respectively. Apart from a diverse pattern observed, diffuse large B cell lymphoma [57.5% and 63.4%] followed by MALT lymphoma [28.3% and 26.8%] were the commonest morphological subtypes of EN- NHL in both genders belonging to Pakistan and Saudi Arabia respectively. The tumours were found to be widespread, however, a predominant gastrointestinal tract [45% and 41.3%], in particular, gastric involvement was seen in [20.8% and 19.5%] Pakistani and Saudi patients respectively. However, predominant orbital involvement was seen exclusively in the latter. EN - NHL is an emerging malignancy in Pakistan and Saudi Arabia. Apart from a slight variation, no significant divergence was observed in the histological patterns of the EN -NHL in both geographical areas

Immunohistochemical expression of cytokeratin-19 in non small cell lung carcinomas - an experience from a tertiary care hospital in Lahore

Previous literature reveals a significant recognition of Cytokeratin [CK] 19 as a reliable tumour marker in epithelial malignancies. With the hypothesis that CK 19 is extensively released by the tumour cells in patients with non small cell lung carcinomas [NSCLCs], this study was designed to assess [1] the clinicopathological characteristics of lung cancer in this sub-region [2] the pattern of immunohistochemical expression of CK-19 in different NSCLC subtypes with respect to their histological grades. A cross-sectional descriptive study comprising of detailed account of clinical data of 225 patients presenting with NSCLCs. After H/E staining, immunohistochemistry [IHC] was performed using prediluted ready to use mouse monoclonal antibody to CK 19. Our findings of the study revealed that the mean age of the patients was 45 years with the male to female ratio being 5:1. Most prevalent type seen was squamous cell carcinoma [SCC] and adenocarcinoma [AC] in males and females respectively. Some cases were not easily classifiable as squamous or adenocacinoma and hence they are classified as NSCLs Unclassified. SCC was commonly associated with smoking in both genders. Immunohistochemical staining of the histological tissue sections of 93.7% NSCLCs demonstrated a varying immunopositivity while showing strong, diffuse to focal cytoplasmic staining of the tumour cells. A significant association [p=0.001] was found between the increasing grades of malignancy and the strength of CK-19 expression. Supporting the previous literature, we have also come across that CK-19 is credibly expressed in patients with NSCLCs and may be applied as a reasonably reliable immunohistochemical marker. In future the patients over expressing CK-19 histologically might constitute potential candidates to be followed up through non invasive serial serum levels estimation intended for assessment of tumour burden in recurrence or advanced disease

hepato-protective effect of cassia fistula [amaltas] leaves in isoniazid and rifampicin induced hepatotoxicity in rodents

Certain medicinal plants have been reported to have their effect on various experimentally induced diseases. Drug induced hepatitis [DIH] is one of them. The purpose of this study was to assess the effect of ethanolic extract of Cassia fistula leaves in experimentally induced drug hepatitis [DIH] in rodents. The rats were divided into four groups, i.e. a control group [A], antituberculous [ATT] group [B], and the remaining two groups [C and D] served as experimental therapy groups. They received Cassia fistula extract as hepatoprotective agent. Rats having normal liver functions were included in this study. Group C experimental rats received [INH/RIF] [50 mg/kg] each and ethanolic extract of Cassia fistula at 400 mg/kg of body weight. On the other hand group D experimental rats received [INH/RIF] [50 mg/kg] each and ethanolic extract of Cassia fistula at 500 mg/kg of body weight. Blood samples were taken at 30[th] day and liver in each was taken out for microscopical examination on day 30[th]. The [ATT] group rats showed variable increase in serum ALT, AST, ALP and total bilirubin levels. Group C treated with 400 mg/kg of body weight Cassia fistula treatment decreased the level of these parameters in rats. On the other hand group D rats treated with 500 mg/kg body weight of Cassia fistula dose significantly decreased levels of these biochemical parameters. The morphological examination of experimental group C rats showed slight recovery whereas the rats in experimental group D showed a significant recovery. Cassia fistula constituents, especially flavonoids and anthraquinones have strong anti-oxidant activity which provides hepato-protection against drug-induced hepatitis [DIH]. In conclusion, high dose of Cassia fistula ethanolic leaves extract [500 mg/kg] body weight showed hepatoprotection against INH/RIF induced hepatitis in rats

Significance of grade in relation to oestrogen receptor status and Ki-67 proliferative index in cancer breast

The objective of this study was to determine the relationship between oestrogeu receptor [ER] status and Ki-67 proliferation index in relation to age of the patients, grade, size of tumours and lymph node involvement in carcinoma of the breast in a local population. It is a cross-sectional and descriptive study. The study was conducted during a period of 12 months in the Department of Morbid Anatomy and Histopathology, University of Health Sciences, Lahore. A total of 100 cases of carcinoma of the breast were collected and immunohistochemistry was carried out on all the tumours. Statistical analysis was performed by using SPSS 16. A significant inverse correlation between ER and grade of tumours was observed with a p-value being < 0.005 and r value of -0.281. As a conclusion it was found that ER and grade of tumours had significant inverse correlation, whereas there was no significant correlation between Ki-67 proliferative index and grade of tumours. It was also concluded that there was no significance of age of the patients, tumour size and lymph node involvement

Audit of hepatitis b and c viruses in patients attending dental clinics

This study was carried out to audit hepatitis B and C viruses, detected in the department of pathology, on the patients who visited the dental clinics of Lahore Medical and Dental College, Lahore. This was a retrospective study conducted between March 2006 and January 2008. A total of 575 patients visited the clinic during this period, [250 males and 325 females], of these 80[13.91%] were positive for heaptitis B or C viruses. HCV was positive in 49 and HBV in 31 patients. Majority of infected patients were females i.e., 45 [7.8%]. Maximum number of patients were seen in the age groups between 50 and 60 years and 10-20 years respectively

Ki-67 proliferating index and histological grade, type and stage of colorectal carcinoma

The objective of this study was to assess the relationship of histological type, grade and stage of colorectal carcinoma with proliferative activity as measured by Ki-67 LI. It was a descriptive study and conducted at the Department of Pathology, University of Health Sciences, Lahore. Ki-67 is a protein associated with cell proliferation and is expressed in all the phases of cell cycle except G0. In the present study, Ki-67 expression in 50 patients with colorectal adenocarcinomas was observed using immunohistochemistry with monoclonal antibody MIB-1. Ki-67 LI was high in well and moderately differentiated adenocarcinomas [mean Ki-67 LI 392.50 +/- 56.58 and 342.24 +/- 96.84 respectively] as compared to poorly differentiated adenocarcinomas [mean Ki-67 LI 250.00 +/- 113.46]. Ki- 67 LI was high in non mucinous adenocarcinomas than mucin secreting and signet ring cell adenocarcinomas [mean Ki-67 393.93 +/- 55.91 vs 220.00 +/- 49.72 and 200.00 +/- 79.05 respectively]. As regard the Dukes' staging, Ki-67 LI was high in colorectal carcinomas in Dukes' stage B than tumours in Dukes' stage C [Mean Ki-67 LI 360.13 +/- 90.03 vs 241.66 +/- 101.31 respectively]. The proliferative activity as measured by Ki-67 antibody is related to histological type, grade and stage

Primary non Hodgkin's lymphomas of gastriointestinal tract a clinico pathological study

This study aims to retrospectively review the pattern of patients with various gastro-intestinal lymphomas seen in King Abdul Aziz Hospital, Jeddah, Saudi Arabia from June 1990 to June 2002 with a view to determine and analyze various clinical and pathological aspects of this disease. All cases of Primary non-Hodgkin's lymphoma of gastro-intestinal tract received and diagnosed in Histopathology department of King Abdul Aziz Hospital, Jeddah, between June 1990 and June 2002 were retrospectively reviewed and the data was analyzed to determine age gender, ethnicity, clinical presentation, anatomical localization, histological type and Helicobacter pylori status. A total of 47 patients were retrieved for this study, with 85.10% being Saudi nationals. The male to female ratio was 1 : 0.74%. The mean age was 52.44 years. The peak age of onset was in the 6th decade. About 45% of our patients had gastric lymphoma, whereas 20.53% had small bowel lymphoma. Among the total number of patients, 46.81% men had MALT type lymphomas. Helicobacter pylori were positive in all patients with gastric lymphoma. Gastrointestinal lymphomas are frequently seen in patients in Saudi Arabia, with MALT gastric lymphoma being the commonest tumour. The strong association between H. Pylori and gastric lymphoma as an important aetiological factor is emphasized

Phsicians'perception of evidence based medicine: a survey in Lahore, Pakistan

EBM is a growing worldwide movement in health care, that aims to bring the best evidence from medical research to the bedside, clinic and community. EBM appeared early in 1990 and since then it has developed and expanded worldwide. It has met a considerable success over the past three decades in promoting critical scientific and practical awareness of the status of different after research claims to therapeutic knowledge. This subject of EBM is only theoreticcally known to only some of our physicians. We assessed physician's attitude towards EBM in a cross-sectional study conducted in the district of Lahore, Pakistan; from March 2005 to August 2006, by a self-administered questionnaire [proforma], which included questions on whether the physicians were in favour of EBM, and at what level EBM should be taught. A fairly reasonable response [63.6%] was received from the physicians and among these, most had a fair idea about EBM. They believed that EBM, if practiced, will improve patient care [68.8%], can reduce health care cost [59.1%] and will update the knowledge of the physicians [92.7%]. A large majority [91%] believed that EBM and its usefulness should be taught only at postgraduate level

Effects of prolonged poisoning by cobra venom on blood coagulation, platelets and fibrinolysis

The effects of Cobra Venom [CV] on blood coagulation, platelets and fibrinolytic system were studied in rabbits after injecting repeated doses of 0.05 MLD of the Venom. Thrombocytopenia was the earliest change to appear. It was followed by rise in serum fibrinogen degradation products and prolongation of prothrombin time, [PT] activated partial thromboplastin time [APTT] and thrombin time [TT] indicating a progressive consumption coagulapathy and activation of fibrinolysis. Red blood cell morphology was unchanged during first three weeks; whereas fragmentation appeared after fourth week and it increased in severity with further envenomations i.e., when chronic disseminated intravascular clotting was established

Aggressive angiomyxoma of the vulva

We report a case of 24yrs old female with unilateral Vulval enlargement. The clinical impression was that of a benign tumour. The microscopic features were that aggressive angiomyxoma showing hypocellular proliferation of fibroblasts. This tumour is aggressive in the sense that it has a propensity for recurrence but usually in the long term. Surgery is the only treatment of choice