Concomitant presence of culture-proven active pulmonary tuberculosis in patients with chronic obstructive pulmonary disease - a hospital based study

Objective: To find out the prevalence of concomitant active pulmonary Tuberculosis [TB] in patients of Chronic Obstructive Pulmonary Disease [COPD] using the gold standard liquid and solid culture media for the detection of acid fast bacillus

Methods: Eighty clinically and radiologically diagnosed cases of COPD of any severity, >/= 40 years of age with no previous history of anti-tuberculous therapy were selected from department of Pulmonology, Jinnah Hospital, Lahore. Detailed demographic profile, clinical symptomatology and history of smoking were recorded. Sputum samples of these patients were subjected to ZiehlNeelsen [ZN] stain and culture on Lowenstein-Jensen [L.J] medium and Mycobacterium Growth Indicator Tube [MGIT] for the detection and isolation of Mycobacteriumtuberculosis [MTB]

Results: Out of 80 COPD patients, 6 [7.5%] were culture positive for acid fast bacillus consistent with active tuberculous infection. The concomitance was more prevalent in elderly, male, smokers. MGIT was a more sensitive and a rapid technique to detect the presence of mycobacterium as compared to LJ culture media and ZN stain

Conclusion: The prevalence of active TB in COPD patients was 7.5%. Detection was improved when liquid culture media was employed for the detection of acid fast bacillus. Regular monitoring and screening of patients with COPD for PTB should be routinely carried out in susceptible cohort to avoid cross spreading of infection and appropriate management

Rapid diagnosis of tuberculosis using Xpert MTB/RIF assay - report from a developing country

To evaluate the diagnostic accuracy of the Xpert MTB/RIF assay for the detection of M. tuberculosis in pulmonary and extrapulmonary specimens and to compare it with conventional techniques. During a period of 10 months from December 2012 through September 2013, two hundred and forty five clinically TB suspects were enrolled for Xpert MTB RIF assay. The cohort comprised of 205 suspects of pulmonary TB and 40 of extrapulmonary TB [EPTB]. The 40 EPTB samples included pus aspirated from different sites of the body [n=19], pleural fluid [n=11], ascitic fluid [n=7], pericardial fluid, CSF and urine one each. Ziehl-Neelsen [ZN] Stained smear microscopy, culture on LJ media and Xpert MTB/RIF assay was performed on samples from these patients. M. tuberculosis [MTB] were detected by Xpert MTB/RIF test in 111 [45.3%] out of 245 samples. Of these, 85 [34.7%] were smear positive on ZN staining and 102 [41.6%] were positive on LJ cultures. Rifampicin resistance was detected in 16 [6.5%] patients. Nine out of 19 pus samples [47.3%] were positive for MTB by Gene Xpert, 03 [15.8%] on ZN staining and 04 [21%] on LJ culture. MTB could not be detected in any other extrapulmonary sample. Xpert MTB/RIF is a sensitive method for rapid diagnosis of Tuberculosis, especially in smear negative cases and in EPTB as compared to the conventional ZN staining. Among EPTB cases the highest yield of positivity was shown in Pus samples. For countries endemic for TB GeneXpert can serve as a sensitive and time saving diagnostic modality for pulmonary and EPTB

Power doppler ultrasonography guided and random prostate biopsy in prostate cancer diagnosis - a comparative study

To compare the diagnostic accuracy of power Doppler-guided targeted prostate biopsy and random sextant biopsy in the diagnosis of prostate cancer. The prospective study was carried out at the Allama Iqbal Medical College and Jinnah Hospital, Lahore, Pakistan, from January to December, 2012, and comprised clinically suspected cases of carcinoma prostate. Power Doppler-guided biopsies using automatic biopsy gun were obtained from the suspected targeted site. One to three cores per suspected site were obtained. Subsequently random sextant biopsies were performed in the same sitting. Six cores were obtained from 6 random sites using the same gun. Biopsies from both sources were processed for routine haematoxylin and eosin stainstained sections for histopathological examination. Of the 50 patients in the study, 30[60%] were diagnosed with power Doppler-guided biopsy as malignant, whereas random sextant biopsy could pick up 22[44%] cases. For benign prostatic hyperplasia, random sextant biopsy labelled 28[56%] as benign, whereas only 20 [40%] were labelled as benign with power Doppler-guided biopsy. Discrepancy in the results between the two procedures was observed in 14[28%] cases, and of them, 11[22%] were labelled as malignant on power Doppler-guided biopsy while histopathology of sextant biopsies labelled these as benign. The sextant biopsies rendered a specificity, sensitivity, negative predictive value, positive predictive value and diagnostic accuracy of 60.71%, 86.36%, 85%, 63.33% and 72% respectively. Random sextant biopsy in combination with power Doppler-guided targeted biopsy increases the rate of detection of prostate cancer whereas both procedures in isolation have low sensitivity and specificity for cancer detection

Spectrum of pathologies in cases of intestinal obstruction and perforation based on histopathological examination of resected intestine - Report from a third world country

Cases presenting with intestinal perforation and obstruction constitute a substantial work load on our surgical service. Etiologies vary in underdeveloped and developed countries. Histopathological examination of resected intestine is expected to provide the definite evidence of the underlying etiology- guiding a better health care planning for preventive measures. Our objective was to study the spectrum of histopathological findings in resected intestines from cases of intestinal obstruction and perforation in our local population to document the underlying etiology. A total of 120 cases of intestinal resection were included. Detailed gross and microscopic examination with routine stains was performed. Definite evidence of any specific etiology on the basis of morphology was documented. A total of 95 cases with clinical/radiological diagnosis of obstruction [79.2%] and 25 of intestinal, perforation [20.8%] were included. Tuberculous enteritis was the commonest etiology [n=41; 43.1%] in cases of intestinal obstruction followed by malignant tumours [n=30; 31.5%]. Ischemic infarct/gangrene, post op illeal adhesions, polyps and ulcerative colitis followed. In cases of perforation, Typhoid enteritis [n=15; 60%], was the commonest pathology followed by idiopathic perforation [n=5; 20%], tuberculous enteritis [n=3;12%], carcinoma [4%] and ulcerative coliti [4%]. In developing countries infective etiology remains a dominant cause of intestinal obstruction and perforation. Its presentation in younger age leading to intestinal resection demands effective preventive measures in this part of the world to prevent morbidity and mortality

Posttransplantation lymphoproliferative disorder presenting with skin involvement

Post-transplantation lymphoproliferative disorders [PTLD] are lymphoid proliferations or lymphomas that develop as a result of immunosuppression in recipients of solid organs and bone marrow allografts. Post-transplatation lymphoproliferative disorder is seen in 1-2% of renal transplant recipients with a variable time period of presentation and is usually seen within the first year following transplantation. We report a case of B-cell lymphoma [PTLD WHO class-3] presenting with skin involvement in a patient of renal transplantation, eight years after receiving the transplant

Comparison of diagnostic efficacy of rapid diagnostic devices for Dengue virus infection-a pilot study

To compare the diagnostic efficacy of commercially available rapid diagnostic test devices for Dengue serology. To find out the sensitivity and specificity of rapid diagnostic devices with Elisa results as the Gold standard. During the dengue virus epidemic in Lahore a pilot study was conducted in order to evaluate the diagnostic efficacy of two most frequently used immunochromatographic rapid test devices in public sector hospitals. The results of both the kits were compared to each other. Sensitivity and specificity was calculated against results of ELISA as the reference gold standard. Results of kit-A revealed a very high false negative rate when compared to ELISA where actual prevalence rate shown by ELISA was 96.0% compared to prevalence rate of 44.0% with rapid diagnostic test device kit-A. Similarly the results of rapid test device Kit-B showed high false negative results for dengue virus prevalence. Actual prevalence rate of dengue fever shown by ELISA was 96.0% where as it turned out to be 50% with the kit-B rapid test device. Comparison of Results of two kits revealed no significant difference of test positivity rates. Rapid test devices based on immunochromatographic method supplied in the public sector hospitals are not reliable diagnostic tools for screening for dengue virus infection Health authorities need to review their strategy for supply of more reliable tools during epidemics in order to avoid false negative results

Malignant tumors of head and neck region - a retrospective analysis

To evaluate the spectrum of malignant tumors of head and neck region. Design: A department-based retrospective study. Place and Duration of Study: It was carried out at the Department of Pathology, Allama Iqbal Medical College, Lahore, over a period of two years [1997-1999]. Subject and The data of total 375 neoplastic lesions of both the sexes between 8-70 years of age was collected and compared with the findings reported from centers in other parts of the country. Among the total 375 cases of neoplastic lesions, 148 were benign whereas 227 proved to be malignant histologically in 155 male and 72 female patients. Squamous cell carcinoma [SCC] was the most frequently encountered histological category [45.8%] followed by lymphoma [14.5%], basal cell carcinoma [10.5%], carcinoma thyroid [10.5%] and salivary gland tumors [8.80%]. These were followed by infrequently encountered tumors including nasopharyngeal carcinoma [n=5], small blue round cell tumors [n=3], undifferentiated carcinoma [n=3], retinoblastoma [n=2] and transitional carcinoma nose [n=1]. The anatomical regions involved with this tumor were larynx [53.5% of all SCC] followed by pharynx [18.7%], tongue [10.71%], oral cavity [4.4%], metastasis [5.3%] and skin [2.60%].The frequency of the various malignancies was found comparable to the findings reported from other centres in Punjab and SCC was found to be the most common cause of malignancy

Benign ovarian cysts-a retrospective evaluation over two years

Histological analysis of 89 "benign" ovarian cysts received over a period of 2-1/2 years [January, 1991 to July, 1993] at the department of Pathology, Fatima Jinnah Medical College, Lahore showed that 44 were neoplastic, 22 dysfunctional, 19 simple and 4 endometriotic. Clinical presentation and gross features could not serve to differentiate these types. Routine histological examination had to be supplemented with ample blocking and deeper sections for a more specific typing. With this procedure the original diagnosis was altered in 11.2% cases, 7 cases originally labelled as "simple cysts", were categorized as dysfunctional [N=2], neoplastic [N=1] and endometriotic cysts [N=3]. Similarly in 3 cases the primary diagnosis of endometriotic cysts was altered in favour of dysfunctional [N=2] and neoplastic [N=1] cysts. The neoplastic and dysfunctional cysts have different clinical implications. It is proposed that the clinical diagnosis of benign ovarian cyst should be supported by a careful histological evaluation