Morphological spectrum of gastric lesions - endoscopic biopsy findings

A retrospective study was carried out to determine the morphological spectrum of gastric lesions at Pathology Department of Army Medical College, Rawalpindi for the duration of 02 years. Descriptive Study. The gastric mucosal biopsies of 787 patients received from Gastroenterology unit of Military Hospital Rawalpindi from January 2002 to December 2003, were studied by routine histopathology methods. A high frequency of gastric disease in males with a male to female ratio of 6:1 and an age range of 09 years to 85 years were observed. The clinical presentations mostly seen were abdominal pain, dyspepsia, vomiting, diarrhoea, decreased appetite and weight loss. On endoscopy the most frequently suspected lesions were gastritis 662[84.12%], stomach growth 45[5.72%], gastric ulcers 10[1.27%], while 70[8.89%] cases showed unremarkable mucosa. The histopathology revealed chronic non-specific gastritis 676[85.89%] followed by malignant tumours 45[5.72%], benign neoplasms 3[0.38%] and gastric ulcer 10[1.27%]. A number of biopsies 53[6.73%] were unremarkable histologically. The more prevalent lesions in this series were chronic active gastritis followed by tumours and gastric ulcers. H. pylori associated gastritis was seen in majority of the patients. Thus gastric biopsy is an essential tool for diagnosis and confirmation of clinically suspected cases

Estimation of ionized calcium, total calcium and albumin corrected calcium for the diagnosis of hypercalcaemia of malignancy

To measure levels of ionized calcium, total calcium and albumin corrected calcium in patients with different malignant disorders for the diagnosis of hypercalcaemia of malignancy. A case control comparative study. The study was carried out in the Department of Pathology, Army Medical College Rawalpindi, Armed Forces Institute of Pathology and Department of Oncology CMH, Rawalpindi from March 2003 to December 2003. Ninetyseven patients of various malignant disorders, admitted in the Department of Oncology, CMH, Rawalpindi, and 39 age and gender-matched disease-free persons [as control] were included in the study. Blood ionized calcium [Ca++], pH, sodium [Na+] and potassium [K+] were analysed by Ion selective electrode [ISE] on Easylyte[R] auto analyser. Other related parameters were measured by colourimetric methods. Blood Ca++ levels in patients suffering from malignant disorders were found significantly high [mean +/- SD: 1.30+017 mmol/L] as compared to control subjects [mean +/- SD: 1.23+0.03 mmol/L] [p<0.001]. The number of patients with hypercalcaemia of malignancy detected by Ca++ estimation was significantly higher [38%] as compared to total calcium [8.4%] and albumin corrected calcium ACC [10.6%] [p<0.001]. There was no statistically significant difference in other parameters e.g. phosphate, urea, creatinine, pH, Na+ and K+ levels in study subjects and controls. Detection of hypercalcaemia can be markedly improved if ionized calcium estimation is used in patients with malignant disorders

Assessment of proteinuria by using protein: creatinine index in random urine sample

To assess the quantitative measurement of proteinuria by using random urine protein: creatinine index/ratio in comparison with 24 hours urinary protein excretion in patients of renal diseases having normal glomerular filtration rate. One hundred and thirty patients, 94 males and 36 females, with an age range of 5 to 60 years; having proteinuria of more than 150 mg/day were included in this study. Qualitative urinary protein estimation was done on random urine specimen by dipstick. Quantitative measurement of protein in the random and 24 hours urine specimens were carried out by a method based on the formation of a red complex of protein with pyrogallal red in acid medium on Micro lab 200 [Merck]. Estimation of creatinine was done on Selectra -2 [Merck] by Jaffe's reaction. The urine protein: creatinine index and ratio were calculated by dividing the urine protein concentration [mg/L] by urine creatinine concentration [mmol/L] multilplied by 10 and mg/mg respectively. The protein: creatinine index and ratio of more than 140 and 0.18 respectively in a random urine sample indicated pathological proteinuria. An excellent correlation [r=0.96] was found between random urine protein: creatinine index/ratio and standard 24 hours urinary protein excretion in these patients [p<.001]. Dipsticks showed moderate correlation [r=0.52] and error in interpretation of proteinuria. The protein: creatinine index in random urine is a convenient, quick and reliable method of estimation of proteinuria as compared to 24 hours of urinary protein excretion for diagnosis and monitoring of renal diseases in our medical setup

Assessment of proteinuria by using protein: creatinine index in random urine sample

To assess the quantitative measurement of proteinuria by using random urine protein: creatinine index/ratio in comparison with 24 hours urinary protein excretion in patients of renal diseases having normal glomerular filtration rate. One hundred and thirty patients, 94 males and 36 females, with an age range of 5 to 60 years; having proteinuria of more than 150 mg/day were included in this study. Qualitative urinary protein estimation was done on random urine specimen by dipstick. Quantitative measurement of protein in the random and 24 hours urine specimens were carried out by a method based on the formation of a red complex of protein with pyrogallal red in acid medium on Micro lab 200 [Merck]. Estimation of creatinine was done on Selectra -2 [Merck] by Jaffe's reaction. The urine protein: creatinine index and ratio were calculated by dividing the urine protein concentration [mg/L] by urine creatinine concentration [mmol/L] multilplied by 10 and mg/mg respectively. The protein: creatinine index and ratio of more than 140 and 0.18 respectively in a random urine sample indicated pathological proteinuria. An excellent correlation [r=0.96] was found between random urine protein: creatinine index/ratio and standard 24 hours urinary protein excretion in these patients [p<.001]. Dipsticks showed moderate correlation [r=0.52] and error in interpretation of proteinuria. The protein: creatinine index in random urine is a convenient, quick and reliable method of estimation of proteinuria as compared to 24 hours of urinary protein excretion for diagnosis and monitoring of renal diseases in our medical setup

Hospital waste management in a tertiary care army hospital

This direct observational descriptive study was carried out in a tertiary care army hospital from 5th December 2003 to 19th December 2003 to assess its prevailing practices of health care waste management and to estimate hospital waste generated per bed per day. Presently the waste is being segregated and collected in different colour coded receptacles only at the nursing stations and carried in open unhygienic trolleys. The sanitary workers were not using protective devices while handling waste in the hospital. The waste generation was calculated by placing coloured receptacles in selected zones and constant observation for seven days each as mentioned above. Results showed that total waste generation was about 3.434 kg/bed/day [out of which 0.309 kg was infectious, 0.103 kg sharps and 3.022 kg non- infectious] and that final disposal of infectious and non-infectious waste was getting mixed-up while loading in the municipality carriage system. The awareness of sanitary workers regarding colour coding was fair but not up to the mark and they were also unaware of potential hazards of health care waste while handling it. Eighty one percent of sanitary workers were vaccinated against tetanus and typhoid but none of the 86 workers were vaccinated against Hepatitis B. Two single chambered, brick made, gas fired so called [incinerators] with enormously low temperature are being used for burning which are emitting smoke and obnoxious gases directly into the atmosphere, affecting the health of the people and environment. Liquid waste is thrown down the municipal sewerage system without any prior treatment, which is adding up to the water pollution. The study concluded that although some basic steps have been taken towards the effective waste management but still there is a long way to go. Several recommendations have been made to stream line the waste segregation, collection, transportation and final disposal along with the improvement in the awareness of sanitary workers about the potential hazards of health care waste and to get 100% vaccination against tetanus, typhoid and hepatitis B. In the end it is also recommended that national guidelines on hospital waste management must be practically implemented without any further delay

Changing frequencies and current status of multiple-drug resistant typhoidal salmonellae in year 2001-2003 at Rawalpindi

Typhoid fever is endemic in developing countries. Multiple drug resistant [MDR] typhoidal salmonellae are on the rise worldwide. We carried out a study in our setup to determine the changing frequencies of typhoidal salmonellae and to highlight their current antibiotic resistance patterns. The study was carried out on 15611 blood samples of admitted patients with febrile illness from 2001 to 2003. The blood culture samples were subcultured on Blood Agar and MacConkey Agar. Non lactose fermenting colonies were identified for typhoidal salmonellae and confirmed by using API 20E galleries and standard serological methods. Antibiotic susceptibility testing was performed using Modified Kirby-Bauer disk-diffusion method on Mueller-Hinton Agar. A total number of 333 isolates of Salmonella typhi and Salmonella paratyphi A were isolated from blood samples. Multidrug resistance was found in 172 [51.65%] isolates. The combined frequencies of MDR Salmonella typhi and MDR Salmonella paratyphi A decreased from 55.14% in year 2001 to 31.25% in year 2003 showing a decreasing trend. No Salmonella paratyphi B and Salmonella partyphi C were isolated in our study. None of the isolate was resistant to ciprofloxacin, ofloxacin and ceftriaxone. From 2001 to 2003, a changing trend in frequencies of MDR typhoidal Salmonella and reemergence of Salmonella typhi has been observed as compared to Salmonella paratyphi A. ciprofloxacin, ofloxacin and ceftriaxone are the drugs of choice for MDR typhoidal Salmonellae

Monitoring of progression in diabetic nephropathy by use of protein: Creatinine index

To assess the progression of nephropathy in diabetic patients by using protein: creatinine index in spot urine sample as compared to 24 hours urinary protein excretion rate. Comparative cross-sectional study. One hundred and fourteen patients, 45 male and 69 female, aged 18 to 67 years having proteinuria of more than 150 mg/day were included this study. Quantitative measurement of protein in the spot and 24h urine specimens were carried out by a method based on the formation of a red complex of protein with pyrogallal red in acidic medium, on Microlab 200 [R] [Merck]. Estimation of creatinine was done on Selectra [R]-2 [Merck] by Jaffe's reaction. The urine protein: creatinine index was calculated by dividing the urine protein concentration [mg/L] by urine creatinine concentration [mmol/L] and multiplying by 10. The protein: creatinine index in spot urine sample showed a reliable method of monitoring of progressive diabetic nephropathy as compared to 24 hours urine protein excretion rate. A significant correlation [r = 94] was found between the protein creatinine index and standard 24 hours urinary protein excretion in these patients [p< 0.001]. The index showed a significant negative correlation [r = 0.46] with glomerular filtration rate in progressive renal insufficiency in poorly controlled diabetics. The protein: creatinine index is quick and reliable method of estimation of proteinuria, to be used for monitoring of nephropathy leading to renal insufficiency in poorly controlled diabetics

Frequancy of different species of cockroaches in tertiary care hospital and their role in transmission of bacterial pathogens

To identify different species of cockroaches in tertiary care hospital of Rawalpindi and evaluate their role in the transmission of bacterial pathogens as carrier agents. Three species of cockroaches namely Periplaneta americana [American cockroach], Blatta orientalis [Oriental cockroach] and Blattella germanica [German cockroach] were identified. They were collected from nine sites of the hospital viz. Medical ward- 16, Medical ward-2, Medical ward- 10. Children medical ward, Gynecology and Obstetrics ward, Children surgical ward, Female surgical ward, Skin ward and Cook house. A total of 100 cockroaches were collected from various sites of a tertiary care Hospital from Oct-Dec 2004. American cockroaches were the most common in all the sites accounting for 73% followed by Oriental cockroaches 18% and German cockroaches 9%. Thirteen types of bacteria were isolated which included Enterococcus spp 13.4%, Proteus spp 11.5%, Citrobacter spp 11.3%, Klebsiella pneumoniae 12.8%, Escherichia coli 9.7%, Enterobacter spp 8.0%, Pseudomonas spp 8.0%, Bacillus spp 6.9%, Pseudomonas aeruginosa 5.7%, Serratia marcescens 4.7%, Providencia spp 3.4%, Staphylococcus spp 2.3% and Klebsiella oxytoca 1.8%. The prevalence of Periplaneta Americana was highly significant and Enterococcus spp was the most common bacterial isolate in the hospital environment. Cockroaches appear to be potential source of spread of infection in the hospitals. Effective measures need to be taken to tackle this issue

susceptibility patterns of methicillin resistant staphylococcus aureus in Quetta, Balochistan

This study was conducted at Pathology Laboratory, Combined Military Hospital, Quetta to evaluate susceptibility patterns of Methicillin Resistant Staphylococcus areus [MRSA] to commonly used anti staphylococcus antimicrobials during the period April 1996 to November 2000. One hundred consecutive, non-duplicate strains of MRSA isolated from different clinical samples were identified by standard microbiological methodology. They were studied for their susceptibility to co-trimoxazole, erythromycin, tetracycline, gentamicin, chloramphenicol, ciprofloxacin, fusidic acid and vancomycin by disc diffusion technique using modified Kirby-Bauer method. All the MRSA were sensitive to vancomycin. Four% strains revealed resistance to fusidic acid, 62% to chloramphenicol, 79% to ciprofloxacin, 80% to gentamicin, 88% to erythromycin 93 to tetracycline and 97% to co-trimoxazole. Most of the MRSA were multidrug resistant. These strains revealed higher degree of resistance [>60%] to routine anti-staphylococcus anti microbials. Vancomycin and fusidic acid could be life saving anti-staphylococcus antimicrobials in MRSA infections in Quettta

Antibiotic resistance in campylobacter jejuni in Rawalpindi and Islamabad. A preliminary study

To determine the antimicrobial resistance in Campylobacter jejuni isolated from stools of children suffering from diarrhoea/dysentery in our setup against the antimicrobials commonly used as empirical therapy. Study: A prospective cross sectional descriptive study. Place and duration of study: Department of Microbiology, Army Medical College and Military Hospital, Rawalpindi from 29 August to 29 November 2002. Patients and methods: The study was carried out on eighteen isolates recovered from one hundred stool samples of children up to the age of twelve years admitted with diarrhoea/dysentery in Military hospital, Rawalpindi. The samples were collected in clean polypropylene containers containing Cary Blair medium. These were transported to the Microbiology Department, Army Medical College, Rawalpindi within 1-2 hours. The samples were inoculated on Modified Preston [Oxoid] and Karmali media [Oxoid] beside other routine stool culture media. The cultures were incubated at 42oC under microaerophilic conditions. The growth after 48 hours was provisionally identified by colonial morphology, oxidase test, Gram staining and motility. The organisms were identified to species level by hippurate hydrolysis, urease test, nitrate reduction, catalase test, H2S production, resistance to cephalothin and sensitivity to nalidixic acid. Sensitivity testing was carried by Modified Kirby Bauer disc diffusion technique on lysed horse Blood Agar against ampicillin [10 ug], erythromycin [15ug], tetracycline [10ug], chloramphenicol [30ug], trimethoprim/ sulphamethoxazole [1.25ug/23.75ug], nalidixic acid [30ug] and ciprofloxacin [5ug]. One isolate [7.14%] was resistant to ciprofloxacin, three [16.66%] to chloramphenicol and four [22.22%] to nalidixic acid, five [27.77%] to erythromycin, seven [38.88%] to tetracycline, sixteen [88.88%] to trimethoprim/sulphamethoxazole and ampicillin respectively. The susceptibility pattern reflects variable susceptibility with maximum resistance to ampicillin and trimethoprim/sulphamethoxazole. Four isolates were resistant to nalidixic acid

Morphological Feature correlation with serum tumour markers in prostatic carcinoma

To find out Gleason grades, scores and to see the correlation of these morphological features with tumour markers in prostatic carcinoma. Design: A descriptive study. Place and Duration of Study: The study was conducted at the Departments of Histopathology and Chemical Pathology, Armed Forces Institute of Pathology, Rawalpindi, over a period of one year. Materials and Fifty cases of prostatic carcinoma were studied. Gleason grades and score of tumour were determined by doing haematoxylin and eosin [H and E] staining. Pre-operative serum prostatic acid phosphatase [PAP] and prostate-specific antigen [PSA] assays were carried out in these cases. The patients seen were between 50-102 years of age with an average of 70.9 years. There were 49 cases of adenocarcinoma and 01 case of mixed adeno and transitional cell carcinoma of prostate. Twenty-eight [56%] patients had Gleason score of 5-7. Twenty-nine [58%] patients were having serum PSA levels between 10.0 ng/ml and 50.0 ng/ml. Thirteen [26%] cases showed PSA assays > 50 ng/ml. The sensitivity of PSA test was 84% in these cases. Thirty-five [70%] patients were having PAP values > 3.7 U/l [sensitivity 70%]. The Gleason grading system is a specific morphological predictor. The serum PSA showed better sensitivity and specificity with Gleason grades and scores as compared to serum PAP. The serum PAP levels showed better correlation with morphological features as compared to serum PSA

Changing drug susceptibility pattern of Salmonella Paratyphi A

To know the change in susceptibility pattern of Salmonella paratyphi A, to conventional anti-typhoid drugs, if any, at Quetta, Balochistan. Design: An observational study. Place and Duration of Study: Pathology Laboratory, Combined Military Hospital, Quetta, during the period from April, 1996 to October, 2000. Subjects and About 161 blood culture strains of Sparatyphi A, were isolated from cases of febrile illness. The blood samples were taken in brain heart infusion [BH] broth in first week of illness and processed. The isolates were identified on morphological, biochemical and serological characteristics. These were subjected to disc diffusion susceptibility tests as per standard methods against chloramphenicol [CAP], ampicillin [AMP], trimethoprim sulphamethoxazole [TMP-SMX], ciprofloxacin [CIP] and ceftriaxone [CRO]. Out of 161 strains tested, 66 [40.9%] strains exhibited resistance to CAP, AMP and TMP-SMX, 3 [1.8%] isolates were resistant to CAP and AMP, 2 [1.2%] strains each to CAP and TMP-SMX as well as AMP and TMPSMX. Single drug resistance was observed in 19 [11.8%] isolates against TMP-SMX, 6 [3.7%] strains revealed resistance to AMP and 2 [1.2%] to CAP, none of the isolates was resistant to ciprofloxacin and ceftriaxone. However, 40.9% S.paratyphi A in our clinical practice were resistant to three conventional anti-typhoid drugs. There was an overall increased multi-drug resistance in S.paratyphi A' at Quetta from zero% in 1994 to 40.9% in October, 2000. Three conventional first line drugs i.e., CAP, AMP and TMP-SMX were rather ineffective regimen in about 75% cases of enteric fever due to S.paratyphi A in year 2000. This quantum of drug resistance against conventional anti-typhoid drugs is leaving us with limited choice of costly drug regimen to treat S.paratyphi A infections at Quetta