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

Occurence of carcinoma in situ in association with invasive cancer of breast

The objectives of this study were to find out the frequency and the pattern of carcinoma in situ occurring in association with different types of breast cancers. This study was conducted in the Department of Clinical Oncology and the Department of Pathology, King Edward Medical University/ Mayo Hospital, Lahore on breast cancer patients diagnosed between 1[st] January 2001 and 31[st] December 2005. The age, menopausal status, histopathological type, grade, and presence or absence of carcinoma in situ were recorded. Histopathological features were recorded according to WHO system. Grade was recorded only when it was assigned according to the Elston-Ellis modification of Scarff-Bloom-Richardson grading system. A total of 1230 histopathologically documented invasive and non-invasive breast cancers patients were included in the study. DCIS alone was seen in seven patients [00.57%] and LCIS alone in two patients [00.16%]. Invasive ductal carcinoma was seen in 998 patients [81.14%] and invasive lobular carcinoma in 96 patients [07.80%]. Majority of breast cancers were grade II whereas grade I seen in 23.90% patients only. Areas of carcinoma in situ in different types of invasive cancers were seen in 328 [26.86%] patients. Majority of these patients were below 50 years of age. DCIS was present in 246 of 998 patients [24.65%] of invasive ductal carcinoma [NOS]. Comedo pattern was seen in 154 of 290 [53.10%] of DCIS. LCIS was present in 38 of 96 patients [39.58%] of invasive lobular carcinoma. Carcinoma in situ of breast is a turely diagnosed disease entity in our setting. It is seen mostly in association with invasive carcinoma of breast cancer. Ductal carcinoma in situ with comedo pattern is most frequent

Incidence of salivary gland tumors: a morphological study at pathology department of king edward medical university / Mayo hospital, Lahore

This study was conducted to see the incidence of the lesions of Salivary Gland. All the cases of salivary tissues submitted to the Pathology Department of King Edward Medical University were taken at the end of year [Jan 2005-Dec2005] and reanalyzed. There were 42 cases of salivary glands, out of which 19[45%] were males and 23[55%] were females. Age range was 12-72 years. Major number of cases [17] were from parotid, whereas 15 were from submandibular, 04 and 06 were from sublingual and minor salivary glands like palate respectively. There were 25[59.52%] pleomorphic adenoma, 01[2.3%], 01[2.3%], 04[9.5%], 07[16.6%] were monomorphic adenoma, lymphoepithelioma, mucoepidermoid carcinoma, adenoid cystic carcinoma respectively. Only 04[9.5%] cases showed chronic sialadenitis

AgNOR stain in normal, cirrhotic and carcinomatous liver

In this era of tumor marker AgNOR stain has still retained the diagnostic yield in tumor pathology. This study was conducted to evaluate the role of AgNOR number and morphological features in cirrhotic and carcinomatous liver. A total of one hundred liver biopsy specimens were included, twenty cases were of hepatocellular carcinoma, sixty were those of cirrh0sis of the liver and twenty cases with normal histology as control. The mean AgNOR count, size and distribution were significantly of higher grade in hepatocellular carcinoma as compared to cirrhosis of liver

assessment of coagulation parameters in liver cirrhosis

This study was carried out to assess the haemostatic defects in patients of liver cirrhosis by estimating prothrombin time [PT], activated partial thromboplastin time [APTT], plasma fibrinogen level, fibrinogen degradation products [D-dimer], and platelet count. It was carried out at the Department of Pathology, King Edward Medical College, Lahore. A total of 50 patients from all age groups of both gender with cirrhosis of liver were selected from Mayo Hospital, Lahore. All the investigations were carried out by standard procedures. Results were analyzed statistically with appropriate tests of significance. The mean values of PT and APTT were 14 second and 19 seconds longer than the control values respectively. These prolongations were highly significant statistically [p<0.0001]. Thirty-four out of fifty patients showed a serum fibrinogen level lower than normal with the mean value of 1.90 +/- 1.30 g/L The difference from normal value was not significant statistically. All but one patient of cirrhosis, sho wed raised level of D-dimer i.e.>250 ng/ml. Mean platelet count in patients was significantly lower than normal value [p<0.05]. Prolongation of PT and APTT indicates plasma clotting factors deficiency due to impaired hepatic synthesis. Derangements of other coagulation parameters indicate that multiple factors like fibrinolysis, hypofibrinogenaemia, thrombocytopenia, and low grade DIC, all play a role in liver cirrhosis

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

Mutation of p53 in skin papilloma and tubular breast adenoma of albino mice

To determine the mutation of p53 in chemically induced carcinogenesis on albino mice in skin papilloma and tubular adenoma breast by immunohistochemistry. An experimental study. The animal house of Postgraduate Medical Institute and Pathology Department of King Edward Medical College University, Lahore, for the duration of 20 weeks, from 15 February, 2004 to 15 July, 2004. Twentyfive albino mice [male and female] were selected for a study on chemical carcinogenesis. These animals were divided into five groups [A-E], five animals in each. DMBA [Dimethylebenz[a] Anthracene] and TPA [Tetradecanoylphorbal- 13-Acetic Acid] [chemical carcinogens] were given to produce the tumors and mutation of p53 expression was evaluated on the tumors appearing during this period of carcinogenesis. Squamous cell papillomas and tubular adenoma breast were selected for this study. All the papillomas showed faint reactivity for immunomarker p53, while tubular adenomas were nonreactive. The results of this study show that p-53 is a marker for premalignant lesions and helps in selecting patients for constant monitoring, upon the clinical verification of these results

Prevalence and sensitivity of different strains of bacteria; Special reference to MRSA in a surgical unit of MAYO Hospital Lahore

The correct registration, reporting and analysis of the resistance situation within a hospital is the first step in halting the emergence of antibiotic resistance, we therefore decided o analyze prevalence of bacteria and current trends of antibiotic resistance within our hospital. Orthopaedic ward of Mayo Hospital Lahore. Nov 2003 to Apr 2004. Isolates were taken from 157 patients admitted in Orthopaedic ward of Mayo Hospital Lahore during 6 months period randomly. The samples were collected from patient's wounds, the patients were not given any antibiotics 48 hours prior to collection of the specimen. Isolates were also taken from the environment [Rooms, AC ducts, corridors of the wards, operation theatre] and OT instruments. Isolates were inoculated on standard media in optimum environment and standard internationally accepted methods were applied for identification of bacteria. We found out that the most prevalent bacterium to be staphylococcus aureus 33 [1 8.75%] and seven were MRSA susceptible to Amikacin only. Where as the other bacteria pseudomonas auregenosa 38 [21.59%], E. Coli 19 [10.79%]. Proteus 14 [7.95%]. Streptococcus pyogenes 10 [5.68%], enterobacter 8 [4.55%], Klebsiella 5 [2.84%] more or less showed sensitivity to Amikacin. No growth was seen in 36 cases From among the 50 evironmental isolates, Bacillus 18 [36%] Staphylococcus in combination with bacillus 23 [46%] and No growth in 9 [18%]

Retinoblastoma; bone marrow infiltration: a study of 30 cases

Thirty patients of Retinoblastoma presenting in the Haematology Department of King Edward Medical College, Lahore were included in the study to find out the bone marrow involvement. The patients underwent bone marrow aspiration and peripheral blood examination was also done. The aspirates were screened for the presence of tumor cells. Of the patients studied 21[70%] were males while 9[30%] were females giving a male to female ratio of 2.8:1. Maximum number of patients were in the 2-3years age group. Twenty seven patients had unilateral Retinoblastomas while three patients had bilateral disease at presentation. The bone marrow of three patients showed presence of tumor cells

Salivary gland tumors - a three years experience at King Edward medical college, Lahore

Salivary gland tumours make an important part of oral and maxillofacial pathology. Only few studies have been done in Pakistani population. The aim of this study was to describe morphological types of salivary gland tumours diagnosed at King Edward Medical College/ Mayo Hospital, Lahore during the years 1999-2001 and to compare their demographic data with those previously published. Material and This descriptive cross-sectional study was carried out at King Edward Medical College/ Mayo Hospital, Lahore. It reports 117 cases of salivary gland tumours diagnosed at Pathology Department during 1999-2001. Of the 128 specimens of salivary glands, 117[91.4%] were confirmed as salivary neoplasms. Out of them, 62.7% were benign and 37.6% malignant and a slight female predominance [58.1%] was found. The most common location was the parotid gland [65.8%] followed by minor salivary glands [19.6%]. Majority oft he t tumours was diagnosed during 3rd to 5 decades of life. Median age for benign tumours was 33 years [range 1-78] and a female predominance [58.9%] was seen again. Median age for malignant neoplasms was 45 years [range 9-70] with a female predilection [56.8%]. However, 4 out o f 5 patients with Warthin's tumour were men. Pleomorphic adenoma was the most frequent tumour [51.3%], followed by mucoepidermoid carcinoma [25.6%], adenoid cystic carcinoma [7.7]], Warthin's tumour [4.3%] and monomorphic adenoma [2.6%]. Two cases each of oncytoma and adenocarcinoma were recorded. Rare categories [single case each] of salivary tumours included lipoma, acinic cell carcinoma, basal cell adenoma, capillary haemangioma, metastatic carcinoma and non Hodgkin's lymphoma. The principal site of salivary tumours was the parotid gland and females were most affected. Pleomorphic adenoma was the most frequent finding. The results of this study are comparable with other studies

laboratory study of susceptibility of methicillin resistant staphylococcus aureus [MRSA]

To study the mode of infection, incidence of Methicillin resistant Staphylococcus aureus [MRSA] and their susceptibility against glycopeptides and Fucidic acid, so that awareness may be created for consultants against such notorious rapidly spreading bacteria and recommendation can be made for their prevention and control. Design: 350 S.aureus Strains were isolated from 1800 random clinical specimens. 135 MRSA out of these cultures were selected for determining susceptibility to Vancomycin, Teicoplanin 13 Fucidic acid. Place and Duration: The samples were processed in the Department of Pathology, King Edward Medical College, Lahore, during June 2000 to December 2000. The specimens from various infections suspected on clinical ground were processed by Standard methods and antibiotic susceptibility testing of all the 350 S.aureus and 135 MRSA isolates was done by using modified Kirby Bauer Disc diffusion technique. Result: Of 350 positive S.aureus cultures, 135 were found to be Methicillin resistant [38.5%] which showed susceptibility 96%, 94% and 86% to Vancomycin, Teicoplanin and Fucidic acid respectively. This study showed a high incidence of MRSA at Mayo Hospital Lahore. Glycopeptides and Fucidic acid were found to be valuable antibiotics against MRSA

Maternal nutritional status and its impact on the health of the newborns

Maintenance of good nutrition during pregnancy is important to meet the nutritional demands of the growing fetus. The research was carried out to study the effect of maternal nutrition on biochemical and physical parameters of the infants. Mothers between the age range of 20 to 40 years visiting Lady Willingdon Hospital, Ittefaq Hospital and Hameed Latif Hospital were included in the study. They were divided in two groups each consisting of 15 mothers belonging to low-income class

FNAC and core needle biopsy - A comparison in space occupying lesions of liver

A prospective analysis was conducted on 110 FNAC and results were compared with histologicul reports of patients with intrahepatic focal defects. Cytology permitted a diagnosis of the lesion in 98% cases. When aspirates with insufficient material were excluded [4], the diagnostic accuracy of FNA was 94%. Among the 106 patients who underwent both procedures, FNAC and CNB had the some diagnostic accuracy 94% i.e., sensitivity 96% and specificity 93% of FNAC. There were no complications during the execution of FNAC and CNB. FNAC is an effective and safe method in the diagnosis of focal hepatic lesions, with diagnostic accuracy almost similar to that of CNB. When the two techniques are combined, the accuracy of the diagnosis of malignancy of focal liver lesions increases

value of fine needles aspiration cytology in the diagonsis of lymphodenopathy

A study of one hundred and five patients of lymphadenopathy was carried out to determine the diagnostic role of Fine needle aspiration cytology [FNA] and to see the pattern of diseases with which patients presented. The commonest lesion encountered was tuberculosis [55.238%] followed by reactive hyperplasia [28.571%], malignant lymphoma [7.169%] and metastatic carcinoma [5.714%]. Biopsy results were compared with cytological findings which revealed an accuracy of 95%. As the sensitivity of FNAC in cases of tuberculosis and malignancy is 100% and specificity 98% in the present study, it is recommended that this highly useful technique should be routinely adopted

Evaluation of the relationship of maternal nutritional status with that of the newborn

To evaluate and see the relationship of maternal nutritional status with that of the newborns. Design: This was a prospective observational study. Place and Duration of Study: The research was carried out on mothers between the age of 20 to 40 years in the Lady Willingdon and Ittefaq Hospital. Patients and The study was carried out on 30 mothers, divided in two groups, comprising 15 in each. 15 mothers belonging to the low socio-economic class whose income was < Rs 6000/month, and 15 to those belonging high socio-economic class with an average monthly income Rs > 20000 / month. Anthropometrics indexes of the infants from Lady Willingdon Hospital indicated that all the infants were of low birth weight [<2500gm]. Low hemoglobin [<10gm/dl] were found in many women though the ferritin stores were satisfactory. Similarly half of the infants had low hemoglobin levels [11-13 gm/dl] with an adequate ferritin stores. It was also found that high maternal hemoglobin levels [>11 gm/dl] were positively correlated with higher infant hemoglobin, serum ferritin, weight, height and head circumference measures. It was thus concluded that maternal nutritional status is directly related with that of newborn

Prevalence of methicillin resistant staphylococcus aureus [mrsa] infection laboratory study at mayo hospital lahore

To study the prevalence of methicillin resistant Staphylococcus aureus [MRSA] so that recommendation can be made for their prevention and control. Design: 350 Staphylococcus MINUS strains were isolated from Swvab/pus and other specimens randomly. Place and Duration: The samples were processed in the Department of pathology King Edward Medical Lahore College, during June 2000 to December 2000. Subject/The specimens from various types of infection sites suspected on clinical ground were processed by Standard methods and antibiotic susceptibility testing of all the isolates was done by using modified Kirby Bauer Disc diffusion technique. Result: Of these 350 positive cultures for Staphylococcus aureus, 135 were found to be methicillin resistant [38.5%]. This study shows a high prevalence of MRSA, which is of serious concern in Pakistan, In addition to the economic burden for antibiotic treatment MRSA Infections are serious threat to patients and a challenge for doctors

Multidrug resistant salmonella typhi in Gujranwala

One hundred and thirty strains of Salmonella typhi were isolated from the blood of patients clinically suspected to be suffering from typhoid fever for the 5-year period from Jan 1995 to Dec. 2000. The blood cultures were taken in brain heart infusion broth. The isolates were identified based on morphological, biochemical and serological characteristics. The susceptibility of the strains was tested by disc diffusion tests as per standard methods. A high level of resistance to first-line drugs was observed. 43.85 percent strains of S. typhi revealed resistance to chloramphenicol, 42.3 percent to ampicillin, 46.15 percent to co-trimoxazole, 37.69 percent to Amoxicillin, 6.15 percent to ciprofloxacin, 0.77 percent to pefloxacin, enoxacin, and ofloxacin. No resistance to ceftriaxone and cefotaxime was observed