Relapsing fever, a rare disease in Saudi Arabia

Background: relapsing fever is an acute febrile illness caused by blood spirochetes belonging to genus borrelia. This spirochete can be acquired through the bite of an infected soft tick [Ornithodoros species] or contact with an infected louse [Pediculus humanus] and thus constituting two types of relapsing fever [RF] depending upon the responsible vector i.e. Tick borne relapsing fever [TBRF] and Louse-borne relapsing fever [LBRF]. It is characterized by recurrent cycles of pyrexia which are separated by intervals of apparent recovery. During pyrexia, organisms are found in blood. While during afebrile period, organisms hide themselves in spleen, liver and even central nervous system

Methods: one hundred and thirteen patients presenting with high grade fever were studied for disease pattern. They underwent routine and special investigations for meningitis, malaria, dengue, enteric fever, HBV, HCV and HIV on quality control maintained analyzers by standard methods

Results: all the 113 patients after diagnosis were classified as enteric fever [41], malaria [37], meningitis [20], dengue fever [14] and a patient of relapsing fever i.e. Borrelia recurrentis. This patient was brought in unconscious state, looked jaundiced, dehydrated, had hepatosplenomegaly. His CBC showed WBC 10. 7X1 0A9/L, Hb 10.5g/dl, Platelet count 35x10"9/1. Giemsa stained blood film showed multiple number of spiral shaped organisms- borrelia recurrentis. He had signs of splenic rupture; he underwent splenectomy. Histopathology of spleen for spirochetes confirmed spiral shaped organisms [borrelia recurrentis]

Conclusions: there is very little information about borrelia infection in Saudi Arabia. The prevalence or incidence in Saudi Arabia is unknown. Its apparent rarity may be due to under diagnosis and under reporting. A high index of suspicion in appropriate clinical situations will lead to its early recognition and treatment

Patterns of argyrophilic nucleolar organiser regions in pleural and peritoneal effusions

To evaluate AgNOR size and dispersion as alternate methods to AgNOR counts in order to differentiate malignant from non-malignant effusions. Comparative study. Department of Pathology, Postgraduate Medical Institute, Lahore, from January 2003 to June 2004. A total of 240 samples of pleural and peritoneal effusions were centrifuged, deposits smeared on slides and stained with H and E and AgNOR stain. The diagnosis of malignancy or otherwise was made on H and E staining. AgNOR counts, variation in size and dispersion of AgNOR dots in smears were graded and compared in malignant and non-malignant effusions. Mean AgNOR counts of 11.47 +/- 3.60 and 11.04 +/- 3.89 in malignant pleural and peritoneal effusions, respectively, were significantly [p<0.0001] greater as compared with counts of 3.36 +/- 0.69 and 3.35 +/- 0.66 in non-malignant effusions. AgNOR size and dispersion were of higher grade in significantly greater proportion of malignant as compared with non-malignant effusions [p<0.0001]. Typing of AgNOR size and dispersion was found to be an easy and reproducible alternative to traditional AgNOR counts for differentiating malignant from non-malignant effusions. These parameters should be correlated with already established but expensive techniques of AgNOR area and size imaging by electron microscopy and flow cytometry, as an economical alternative

Pattern and frequency of various utrine tumours: a retrospective study over a period of 26 months

This is a retrospective study to find out the frequency of various uterine tumours. It includes hystrectomy specimens, tumour excisions and endometrial curettings which were sent to Department of Pathology, Allama Iqbal Medical College, Lahore and author's laboratory during a period from January 2001 to March 2003. A total of 471 cases are analysed. Leiomyomas were seen in 369 patients [78.34%] and endometrial polyps in 49 cases [10.41%]. Malignant tumours were found less frequently with adenocarcinoma in 23 patients [4.88%] followed by leiomyosarcoma in 8 patients [1.70%], Endometrial stromal tumours in 7 patients [1.49%], Choriocarcinoma in 6 patients [1.27%] and Mixed Mullarian tumours in three patients [0.64%]. NonHodgkin's Lymphoma was seen in one patient [0.21%] while in five patients [1.06%], metastatic tumours were found. Three were squamous cell carcinomas, two from cervix and one from lung while two were invasive ductal carcinomas coming from breasts. It is concluded that in the uterus benign tumours and tumour like conditions are more common with leiomyomas as the most common uterine neoplasms whereas malignant tumours are less common and endometrial adenocarcinoma being the most common uterine malignant tumour

Role of fine needle aspiration cytology in the diagnosis of focal liver lesions

Fine Needle Aspiration [FNAC] of focal liver lesions was carried out at Allama Iqbal Medical College / Jinnah Hospital, Lahore and author's lab. in 108 patients between January 2000 to August 2002 to evaluate the role of FNAC in diagnosis of focal liver lesions and to find out different patholigies which present as focal liver. Out of these 108 patients, most of them [87.96%] were above the age of 40 with male preponderance [55.55%]. Morphologically, malignant lesions were more common [74.08%] with hepatocellular carcinoma[HCC] as the most common malignancy [42.59%] followed by metastatic malignancies [23.15%], undifferentiated malignancies [5.55%] and Non-Hodgkin's Lymphoma in 3[2.78%] patients while in two patients [1.85%] only normal hepatocytes were aspirated. In 13 [12.04%] patients aspirates were inadequate for any morphological evaluation. It is concluded that FNAC is a useful technique in evaluating the liver masses. However there are some difficulties which can be overcome by more experience in aspiration and better coordination between radiologist, pathologist and clinicians