ABSTRACT
Diagnosis of dengue fever in financially constraint countries like Pakistan is usually made on immunochromatographic [ICT] based serological tests. To compare the diagnostic accuracy of commercially available dengue rapid immunochromatographic tests [ICT] with dengue ELISA in acute dengue infection in children. This retrospective study was carried out at the National Institute of Child Health, Karachi in the Department of Pathology from October 2010 to January 2011. Hospitalized children who fulfilled the WHO and CDC definition of probable dengue fever i.e. fever of 2 to 7 days with two or more than two of the associated symptoms like headache, retro orbital pain, myalgia, arthralgia, rash, hemorrhagic manifestation, leucopenia, thrombocytopenia and supporting serology were included in the study after taking informed consent from their parents / care givers. Malarial parasite positive cases were excluded from the study. Dengue ICT based IgG, IgM, IgA antibodies were done using rapid devices, dengue NS[1] was done on ICT rapid device and dengue IgM was done using enzyme linked immunosorbent assay [ELISA] by micro titer well plate. Data entered and analyzed on SPSS version 16. Out of 80 suspected cases [being a retrospective study it would be better that we give number of all suspected cases and then delete the numbers that did not have complete tests], 39 fulfilled the criteria of suspected dengue fever patients. Ages of these children ranged from 6 months to 13 years. There were 18 males and 21 females. Mean haemoglobin was 8.7g/dl and mean haematocrit was 26.3%. Elevated haematocrit was seen in 7.5% cases only. Mean WBC count was 6164/cmm, with leucopenia seen in 33.3% and leucocytosis in 5.12% cases. Thrombocytopenia was present in all cases except one. Positivity rate of dengue IgG was 25.64%, IgM 15.4%, IgA 43.59%, rapid antigen by ICT method 20.5% and ELISA IgM [by micro titer well- plate] was 76.9%. Sensitivity / specificity of dengue IgG, IgM, IgA and rapid antigen by ICT were compared with ELISA IgM [gold standard] and these were 33.3/100%, 16.67/88.89%, 50.0/77.78%, 23.3/88.8% respectively. ELISA IgM antibody [by micro titer well-plate] test was most reliable as compared to ICT tests. Among the ICT tests, dengue IgA antibody was superior to other tests
ABSTRACT
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.