Metanephric adenoma: case report and review of literature

Metanephric Adenoma [MA] is a histologically and clinically unique and rare benign renal epithelial tumour. Only a few reports are found in literature regarding this novel tumour entity. We report this neoplasm in a 40-year old male who presented with flank pain and microscopic haematuria. USG and operative findings were suggestive of Renal Cell Carcinoma. Microscopic examination showed a tumour composed of small bland cells forming small tubular structures in an acellular stroma. Occasional papillary formations were also seen but no blastema was identified. The case was finally diagnosed as Metanephric Adenoma. It has a histological similarity to developing metanephric tubular epithelium and is considered to represent the benign counterpart of Wilms' Tumour. The unique pathological features of Metanephric Adenoma should be recognised because of its invariable indolent clinicobiological behaviour

Gastric ulcer healing effects of Nigella sativa; a comparative experimental study with cimetidine

Nigella sativa seeds have been in use as a natural remedy for over 4000 years in various parts of the world. These seeds are reported to benefit almost every system of the body; the present study was conducted to see the healing effects of Nigella Sativa in experimentally produced gastric ulcers with comparison to Cimetidine. It was an experimental study on 40 albino rats, performed in animal house of Postgraduate Medical Institute, Lahore. The animals were given Aspirin [0.2 gm/kg body weight] to produce ulcers. Four animals were killed after 2 weeks to confirm gastric ulcers by histopathology. The remaining animals [36] were equally divided in two groups and the 3 subgroups according to time schedule [2-6 weeks] for the treatment with Nigella Sativa [30 mg/kg body weight] and Cimetidine [15 mg/kg body weight]. Rats were anaesthetised and sacrificed at the end of experimental periods and the stomachs were removed, rinsed in lukewarm distilled water. Gross and microscopic examinations were performed to evaluate the results. On gross examination of stomach, 14/18 [78%] albino rats of group "A" [taking Nigella Sativa] did not reveal any abnormality due to complete response to Nigella sativa as compared to 17/18 [94%] of group "B" [taking Cimetidine]. On microscopic examination of stomach, 13/18 [72%] albino rats of group "A" [taking Nigella Sativa] revealed complete recovery as compared to 16/18 [89%] of group "B" [taking Cimetidine]. We concluded that Nigella sativa is equally effective in healing of gastric ulcer as is Cimitidine therefore we suggest the use of the N-sativa in the therapy of gastric ulcer disease in routine practice

Evaluation of primary pulmonary malignancies in central Punjab, Pakistan

To study the clincopathological findings of Primary Pulmonary Malignancy in central Punjab, Pakistan. Three hundred patients of primary malignancies of the lung from Gulab Devi Chest Hospital and other hospital of Lahore were studied. The history of the Patients and their clinical findings were recorded. The sections of all the cases were stained with Haematoxyllin and eosin whereas all large cell carcinomas were stained with Alcian Blue-Periodic Acid- Schiff [AB-PAS] stain. There were 255 males and 45 females with a male to female ratio of 5.7:1. The age ranged from 10-90 years with a mean age of 54.17 +/- 3.46 years. Different tumors were significantly more [p<0.001] in males than in females. The mean age in squamous cell carcinomas cases was significantly high [P<0.001] as compared with adenocarcinoma. Small cell carcinoma cases had significantly low [P<0.02] mean age as compared with squamous cell carcinoma. The difference of mean age in cases of adenocarcinoma approached significant level [0.1>P>0.05] as compared with small cell carcinoma. The primary lung carcinoma is more common in males. Its prevalence is increasing in young ages

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

Morphological evaluation of non neoplastic lesions of the thyroid gland

This study was conducted to see the frequency of non neoplastic lesions of thyroid glands in patients who underwent thyroid surgery at Mayo hospital, Lahore. It was a descriptive cross sectional study. It was a retrospective and prospective study commencing from Ist July 1999 to 30th June 2002 and was conducted at Pathology Department King Edward Medical University, Lahore. All thyroid samples submitted and reported at the Department of Pathology, King Edward Medical University, Lahore during a three year period commencing from Ist July 1999 to 30th June 2002 were included in this study. Out of the total number of 1136 thyroid surgical specimens, 855 specimens [75.26%] were shown to comprise of non-neoplastic lesions and were more common in females [77.2%] as compared to males [22.8%] giving a male to female ratio of 1:3.4. Regarding non neoplastic lesions maximum comprised of diffuse[74%] and multi nodular goiters [16%]. Others consisted of inflammatory conditions [5%], hyperplastic nodules[4%] and simple colloid filled cysts 1%. Inflammatory conditions included Hashimotos' thyroiditis [67.3%] deQuervain's thyroiditis [granulomatous thyroiditis] [16.3%], Lymphocytic thyroiditis [11.7%], and Riedel's thyroiditis[4.7%]. Non neoplastic thyroid lesions are more common than neoplastic lesions, especially in females. The frequency of diffuse colloid goiter was very high, while among inflammatory lesions Hashimotos' thyroiditis was the commonest lesion. Most of the cases of hypothyroidism were associated with iodine deficiency

Evaluation of anti tuberculous antibodies in healthy contact and non contacts persons

This study was conducted to see the presence of the antimycobacterial antibodies in healthy household contacts of tuberculous patients and healthy normal subjects who have never been in contact with tuberculous patients. A total of 200 subjects, 120 with history of household contact and 80 without such history were included in the study. Routine Haematological investigations were performed and all the sera of 200 subjects were tested for IgM, IgG and IgA anti tuberculous antibodies using ELISA technique. There was no difference in the average age of the household contacts and non-contacts. The complaints of pyrexia, night sweats and loss of weight was more in house hold contacts as compared to non-contacts. The awareness about BCG vaccination was equal among the household contacts and non-contacts. The combined serological positivity of the household contacts was 65.8% and the combined serological positivity for non-contacts was 34.1%. There was no statistically significant difference in the presence of I gM among household contacts as compared to non-contacts. However both IgG and IgA were present in significantly higher number of household contacts as compared to non-contacts. This study concludes that the persons living in the house with a patient suffering from active pulmonary tuberculosis [household contact] have more chances of being infected with Mycobacterium tuberculosis as compared to the healthy non-contacts

Evaluation of nucleolar organizer region in normal brain tissues and astrocytic gliomas

This study was performed to evaluate the importance of Ag NORs in different grades of Astrocytic Gliomas. It was a descriptive study and was performed at Lahore General Hospital and Sheikh Zayad Hospital, Lahore. A total of 50 cases were collected within one year, and AgNOR staining was performed on 50 brain tumors and specimens were selected randomly. AgNOR was low, high, higher and highest in Astrocytic Gliomas, grade I [Pilocytic], II, III, and IV respectively as compared to normal brain tissue. AgNOR staining technique is a simple, quick and a cheap method to assess proliferative index in astrocytic Proliferative activity is a good parameter to assess the disease outcome in astrocytic glioma

Hepatitis C virus genotypes in Bahawalpur

This study was conducted at Medical Unit-II Bahawal Victoria Hospital / Quaid-e-Azam Medical College Bahawalpur from May 1st, 2005 to December 31st 2005. The objective of this study was to determine hepatitis C virus [HCV] genotypes in Bahawalpur, Pakistan. In consecutive 105 anti-HCV [ELISA-3] positive patients, complete history and physical examination was performed. Liver function tests, complete blood counts and platelet count, blood sugar fasting and 2 hours after breakfast, prothrombin time, serum albumin, serum globulin and abdominal ultrasound were carried out in all the patients. Tru cut biopsy was performed on 17 patients. We studied HCV RNA in all these patients by Nested PCR method. HCV RNA was detected in 98 patients and genotyping assay was done by genotype specific PCR. Among total of 105 anti-HCV positive patients, HCV-RNA was detected in 98 patients. Out of these 98 patients there were 57 [58.2%] males and 41 [42.8%] females. Their age range was 18-75 years. The age 18-29 years 26 [26.5%], 3o-39 years 35 [35.7%] and 40-75 37 [37.8%], while to [10.2%] patients were diabetics and 34 [34.7%] patients were obese. Liver cirrhosis was present in to [10.2%] patients. Forty two [43.9%] patients were symptomatic while 56 [57.1%] were asymptomatic. Out of 98 patients 11 [11.2%] were un type-able and 87 [88.8%] were typeable. 70/98 [71.4%] were genotype 3; 10/98 [10.2%] were genotype 1; 03/98 [3.1%] were genotype 2; 03/98 [3.1%] were mixed genotype 2 and 3; 01/98 0%] were mixed genotype 3a and 3b. Genotype 3 is the most common HCV virus in our area which shows that both virological and biochemical response will be better. Because HCV genotype 3 is more frequent among the drug users which points towards unsafe injection practices in our area

Frequency of hepatitis B and C seropositivity in prisoners

This study was conducted on prisoners of Central Jail, Bahawalpur and on blood donors at Blood Bank Bahawal Victoria Hospital [BVD], Bahawalpur from Ist August 2005 to 30th November 2005. The intension was to study the seroprevalence of hepatitis B and C in prisoners and to note risk factor if any predisposing to the infection. All the prisoners of central jail Bahawalpur present during the study period, aged more than 18 years of either sex were included as the study group and a comparative group was blood donors presenting to blood bank BVH, Bahawalpur during this period. All the cases in study group [2086] as well as control group [9714] were screened for hepatitis B [HBs Ag] and hepatitis C [anti-HCV] infection detected on serum by One Step Test Device. All the positive cases were confirmed by Enzyme Linked Immunosorbant Assay. After an explanation, verbal consent was taken and a questionnaire was filled before taking samples from all the study group cases. On the basis of screening, prisoners were de vided into seropositive group and sero-negative group. The different variable applied on both the groups were age, sex, occupation, residence, marital status, self shaving / by barber, family history of [H/o] jaundice, H/o blood trans-fusion, operation, tattooing and body piercing, drug abuse, same sex/ extramarital sex and hepatitis B vaccination status. Total prisoners screened were 2086. Out of them 2072 were males [99.3%]. Mean age was 34 years. Total seropositive cases were 249 [11.9%] While during the same period seropositivity in blood donors [control group] was 5.9%. Seropositivity of HBV was 5.6% in study group and 3.1% in control group [p<0.001], HCV was 6.3% Vs 2.8% [p<0.001], statistically very significant difference. Risk factors analysis among prisoners revealed that drug abuse was significantly associated with seropositivity [27% Vs 12%, p value <0.001]. Among drug abusers, very high percentage of intravenous drug users was positive [89.2%, 25 out of 28]. Prisoners shaved by barber were also a t higher risk than self shaving [p value <0.001]. H/o operation [p<0.02] and rural origin [p<0.02] were other significant risk factors. Other risk factors evaluated were not statistically significant. Seroprevalence of hepatitis, both B and C is more in prison inmate than healthy blood donors. Main risk factor in them i is drug abuse, especially intravenous. Other significant risk factor is shaving by barber. There s a need to make some strategy to reduce the risk factors

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

Statistical analysis of astrocytic glioma

Fifty patients of both sexes of Astrocytic Glioma from Sheikh Zayed Hospital and Lahore General Hospital Lahore were included in this study. Ten normal brain tissues [control] were taken from accident cases. Out of 50 study cases there were 16 [32%] were low grade [I-II] Astrocytic Glioma and 34 [68%] were high grade Astrocytic Glioma. The male to female percentage was found out to be 26 [52%] and 24 [48%] respectively. Among the males, 11 [22%] were in grade I-II while 15 [30%] were in grade III-IV Astrocytic Glioma, while 5 [10%] females were in grade I-II and 19 [38%] were in grade No statistical sex difference was seen in the ratio of male and female who developed Astrocytic Glioma [P>0.05]. The ages of the patients ranged from 10 to 76 years with maximum number of cases in the age group 30-49 years. In this age group, 11 [22%] patients had grade I-II while 20 [40%] were in grade type of Astrocytic Glioma. The statistical difference of age in different groups was found to be highly significant, [P<0.01]. The most common presenting complaints were headache, vomiting, weakness of limbs, loss of orientation and giddiness. These were observed mainly in grade III-IV Astrocytic tumors. The complaints of difficulty in speech, papilloedema and fits were observed often with an almost equal ratio in all grades of Astrocytic Glioma. The loss of consciousness was observed only in Grade III-IV tumors. The most common site of Atstorcytic Glioma was Parietal lobe and Fronto-parietal lobe constituting 9 [18%] in grade I-II and 15 [30%] in grade HI-IV Astrocytic Gliomas, that is statistically significant, [P<0.05]. The most common site of Astrocytic Glioma was Parietal lobe, 17 out of 50 [7 in grade I-II and 10 in grade III-IV], while the second most common site of this tumor was Temproparietal region, [4 in grade I-II and 6 in grade III-IV]. There were 29 Astrocytic Gliomas in right lobe [10 in grade I-II, and 19 in grade III-IV], while 18 in left lobe [5 in grade I-II and 13 in grade III-IV]. This was statistically highly significant, [P<0.01]. High grade Astrocytic Glioma was also present in Thalamus, mid brain, and Interventricular septum

Functional outcome of ischemic stroke in diabetics

Objective was to determine whether the outcome of ischemic stroke is different or not in diabetics than nondiabetics. Prospective observational. analytical study Study place and Duration; It was conducted in medical unit-2 Bahawal Victoria Hospital, affiliated with Quaid-e-Azam Medical College Bahawalpur from October I, 2004 to September 30. 2005. 132 patients of ischemic stroke, confirmed by CT scan, were enrolled during one year study period. The patients of hemorrhagic stroke, TlA, focal deficits of non-vascular origin and infratentorial lesions were excluded. Patients were devided into two groups; diabetics and nondiabetics and were studied regarding their in hospital outcome according to the modified Rankin Scale. The variables applied were age, sex, hypertension and type of infarct [lacunar/cerebral]. Out of 132 ischemic stroke patients 36 [27%] were diabetics and 96 were nondiabetics. Hjipertension was present in 83 [62%]. Overall mortality wa s 11.3%. Mortality was significantly more frequent in diabetics than nondiabetics [16.6% Vs 9.3% p<0.05]. Disability was also more frequent in diabetics [25% Vs 13.5% p<0.05]. In diabetic group good recovery [8.8% Vs 12.5%] as well as partial recovery [50% Vs 64.5%] was less frequent. Patients <40 years were few in number with good recovery in both diabetics as well as nondiabetics. Diabetics of 40-60 years were found to have significantly high number of deaths [15.3% Vs 7% p<0.05] and disability [15.3% Vs 10.7% p<0.05] than non-diabetics. Similar pattern was seen in patients >60 years. Increasing age was found to be associated with poor outcome in both the groups but poorer in diabetics. Sex did not discriminate the poor outcome in diabetics. The presence of hypertension worsened the out come in both the groups but more in the diabetic group both in term of mortality [20.8% Vs 11.8% p<0.05] as well as disability [33.3% Vs 15.2% p<0.05]. Lacunar infarct was found in few patient with good prognosis while cere bral infarct was associated with poor prognosis and put the diabetics at higher risk in term of mortality [17.6% Vs 9.8% p<0.05] as well as disability [26.4% Vs 14.2% p<0.05]. Diabetes Mellitus is associated with poor outcome of ischemic stroke patients both in terms of mortality and morbidity during acute hospitalization. Hypertension. increasing age and large infarct size further worsens the outcome

Frequency of hepatitis C infection in diabetes mellitus

The study was conducted at diabetic clinic B.V. Hospital/Q.A.M.C Bahawalpur from December 1st, 2004 to March 15th, 2005. Diabetes mellitus and hepatitis C infections are common and emerging problems of the society. Either diabetes mellitus is common in chronic hepatitis C patients as reported initially by Ellison and co-workers or hepatitis C infection is more frequent in diabetes mellitus. We want to study the frequency of hepatitis c infection in diabetes mellitus. To study the frequency of hepatitis C infection in diabetic patients and to note any risk factors of diabetic patients predisposing to hepatitis C infection. A cross-sectionalObservational-descriptive analytic study. A total of 250 consecutive diabetic patients of either sex were compared with 6574 blood donors for hepatitis c infection. They were evaluated for hepatitis C infection by using Enzyme Linked Immunosorbant Assay [ELISA-3] which is an anti-HCV anti body test. On basis of this test, the patients were divided into two groups, anti-HCV +ve and anti-HCV -ye. Different variables of these patients were studied and compared in these two groups Variables studied were as follows:- Age, Sex, BMI, Mode of therapy area of their residence[rural or urban] Duration of diabetes mellitus, Blood pressure, Nephropathy and Control of diabetes mellitus. Among a total of 250 patients, 120 [48%] were male and 130 [52%] were female. Two hundred and forty-four [97.6%] patients were of type-II DM and 06 [2.4%] patients were of type-I DM. 22 [8.8%] patients were on insulin therapy while 228 [91.2%] were on oral hypoglycemic agents. Anti-HCV test was positive in 69 [27.6%] diabetic patients as compared to blood donors 41 [0.62%]. In anti-HCV positive group, longer duration of diabetic mellitus [15yrs 15.94%], poor control of diabetic mellitus[87%], insulin therapy[17.39%] hypertension[91.3%] and nephropathy[94.2%] were the significant vari ables while BMI, age, sex and whether they were belonging to either rural or urban area were not significant in both the groups. Hepatitis C infection is common in diabetic patients as compared to control group [27.6% vs 0.62%]. Out of diabetic patients HCV infection is more common with longer duration of diabetic mellitus, poor control of diabetic mellitus, hypertension, nephropathy and insulin therapy

Compensatory renal hypertrophy following unilateral nephrectomy in albino rats

This study was carried out on 72 albino rats [36 experimental and 36 control] following UNX and so we know the rate and extent of compensatory renal hypertrophy [CRH] of the remaining kidney. The mean absolute change in mass due to hypertrophy in the experimental kidney KW [compensatory] following unilateral nephrectomy after 10, 20, 30, 40, 50 and 60 days was 0.384 +/- 0.003, 0.674 +/- 0.005, 0.768 +/- 0.004, 0.926 +/- 0.006, 0.940 +/- 0.005 and 0.932 +/- 0.007 gm respectively. The mean relative change in mass due to hypertrophy in the experimental kidney,%KW[compensatory following unilateral nephrectomy after 10, 20, 30, 40, 50 and 60 days was 46.36 +/- 0.84, 77.66 +/- 1.16, 91.43 +/- 0.96, 105.71 +/- 0.77, 110.15 +/- 0.77 and 112.08 +/- 1.89 respectively. It was concluded that there was rapid compensatory increase in the renal mass of the experimental kidney within first 10 days, the mean relative compensatory increase in the renal mass of the experimental kidney was 46.36 +/- 0.84% than the control. From the 11th day to the 40th day there was a steady compensatory increase at a slower rate [59.35% in 30 days] until the mean relative compensatory increase in the renal mass of the experimental kidney had reached 105.71 +/- 0.77% of the control value

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

Prevalence of hepatitis C virus and its serotypes in Bahawalpur divison

To find the prevalence of hepatitis C virus serotypes in Bahawalpur division Design: It was a prospective study to asses the frequency of HCV serotyping Settings All the patients coming for the treatment of liver disease from Jan 2000-Dec 2002 in the departments of medicine and consultants in BVH Bahawalpur Subjects and Methods 125 patients of chronic liver disease, with persistently raised SGPT and positive anti HCV and HCV RNA, were included in this study. All these sera were serotyped using Murex Serotyping 1-6 assay system. Of 125 patients sera 105 [84%] were typable and 20 were [16%] untypable, no multiple serotypes were seen. Serotype 3 were 69.6% and serotype 1 [6%]. Serotype 2,4,6 were also detected 4.8%, 2.4% and 0.8 respectively, No serotype 6 was seen. The disease state was compared to different HCV serotypes by and more cirrhosis was observed in serotype 1 as compared to serotype 3. Cirrhosis was also observed in non-typable cases. Risk factors identified from data were transfusions [29%], parentral therapy [20%], Health workers 25[20%], sharing blades, Homosexuality 10 patients [08%], Intravenous drug abusers [04%], previous surgery [6.8%], dentists [7.2%]. No vertical group was seen in this study. Few other miscellaneous risk factors were pricking for ears and noses tattooing [in female groups]. One patient returned from USA, developed cirrhosis due to serotype 1 gave the history of out of family sex contact. No significant difference was noted in different groups of serotypes for HCV. HCV serotypes 3 were more common and serotype 1 was related to more sever disease. Risk factors are more important to control the spread of HCV

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

Vitamin A deficiency enhances the effects of 7-12 demethylbenz [A] anthracene [DMBA] induced skin carcinogenesis in albino rats

The present study was designed to see the effects of vitamin A deficiency in DMBA induced chemical carcinogenesis on skin of albino rats. The rats were kept on vitamin A deficient diet for 20 weeks and treated with 20 micro g/0.2ml of DMBA twice weekly. After 20 weeks 70% skin lesions were developed in animals taking vitamin A deficient diet [VAD] alone, while 90%skin lesions were seen in animals receiving VAD, DMBA group, however, 10-20% more skin lesions were seen in normal diet, DMBA and VAD DMBA group as compared to vad group. The results indicate that vitamin A deficiency enhances the effect of chemical carcinogenesis