Determination of specificity and pattern of antinuclear antibodies [ANA] in systemic rheumatic disease patients positive for ANA testing

Objective: To determine probability of finding antinuclear antibodies [ANA] and anti extractable nuclear antigens [ENA] positive samples and associating ANA patterns with anti-ENA reactivities among a consecutive cohort of samples of systemic rheumatic disease patients referred for ANA testing. Study Design: Prospective cohort study. Place and Duration of Study: Immunology Department, Armed Forces Institute of Pathology, Rawalpindi, Pakistan, from January to June 2016

Methodology: All the samples referred for ANA testing with clinical suspicion of systemic rheumatic disease were included. After screening, ANA positive samples were subjected to anti-ENA antibodies testing [including anti-SSA, antiSSB, anti-Sm, anti-RNP, anti-SCL-70 and anti-Jo-1 antibodies] and ANA pattern and titer determination

Results: Of 4,347 samples received, 397 were positive for ANA [9%]. Of 397, 96 [24%] samples positive on ENA screen were tested for anti-ENA reactivity. Anti-SSA antibodies were found in 59 samples. Commonest ANA patterns were coarse and fine speckled [43 and 22 samples of 81 tested], while majority of samples carried ANA in titers of 1:40 and 1:80 [22 and 18 samples of 81 tested]. No specific ANA pattern was associated with any particular anti-ENA reactivity

Conclusion: Among samples/patients referred for investigations of autoimmune disorders, probability of finding positive ANA is approximately 9%. Of these 9%, about 24% also show reactivity against ENA. Commonest ANA pattern is coarse speckled and majority of such patients carry ANA in titers ranging from 1:40 to 1:80. Commonest ENA reactivity was against SSA

prospective clinical and electrophysiological survey of acute flaccid paralysis in pediatric patients

Objective: Recognition of common causes of acute flaccid paralysis in children

Study Design: Descriptive study

Place and Duration of Study: Combined Military Hospital Peshawar, from Aug 2009 to Jun 2012

Material and Methods: The demographic data including age, gender and clinical data including history of injection, stool results, and final diagnosis [polio, non-polio enterovirus, traumatic injection neuritis, GBS and an unknown group] were expressed in terms of frequencies and percentages. Chi-square test was applied for the association of age-groups with various causes of AFP. A p-value of less than 0.05 was taken as statistically significant. SPSS version 20 was used for statistical analyses

Results: Injection neuritis and post-viral paralysis [polio, non-polio enterovirus] were the common causes of AFP

Conclusion: As the study identified common causes of AFP which are essentially preventable, it highlighted certain issues during the process. First is the lack of nursing staff training or iatrogenic disability due to quackery, which requires urgent intervention to prevent it. Second is a deficiency in the WHO management protocol for AFP. NCS EMG proved to be a vital diagnostic tool for AFP, which is not included in the WHO AFP protocol at present.It is suggested that this diagnostic modality should be included in the AFP diagnostic protocol for better diagnostic yield

Comparison of electromyography / nerve conduction studies and magnetic resonance imaging in diagnosis of lumbosacral radiculopathy

To compare EMG/NCS with MRI in diagnosis of lumbosacral radiculopathy. Cross-sectional comparative. The study was carried out at Armed Forces Institute of Rehabilitation Medicine, for a period of six months, from January 2007 to June 2007. Fifty consenting patients with clinical lumbosacral radiculopathy were included, they underwent MRI and NCS/EMG, and then both procedures were compared for diagnosis of radiculopathy. MRI and NCS/EMG had comparable sensitivity but MRI was less accurately correlated with clinical estimated level of radiculopathy. Both NCS/EMG and MRI are time sensitive investigations which provide different information regarding the pathology. NCS/EMG reveal physiological etiology of radiculopathy, compared to MRI, which gives the anatomical information. Every patient with clinical lumbosacral radiculopathy should undergo NCS/EMG for confirmation of diagnosis. However, when anatomical lesion is suspected, or surgical intervention is planned, MRI should complement it

Malaria infection: a clinicopathology correlation

Objectives: The hematological changes associated with malaria are well recognized. This study was conducted to assess and compare the incidence and severity of hematological changes in various types of malaria in local population of Gadap city who visited the Fatima Diagnostic Laboratory of Fatima Hospital, Baqai Medical University between Jan. 2007 to Dec. 2008

Methodology: This observational study included 3,263 cases of fever who were suspected for malaria visited Fatima Hospital Laboratory of, Baqai Medical University during January 2007 to December 2008. The age, sex, place of referral and species of malarial parasites were recorded. The total number of male patients was 211 and female was 168 with a mean age group of 21 years. The diagnosis of malaria was confirmed by thick and thin film stained with LeishmanAEuro[™]s staining for malarial parasite. Slides were reviewed by hematologist and Full blood counts were performed using automated Sysmex K-1000

Result: A total of 3,263 patients were subjected for malaria testing during the study period. Three hundred and seventy nine had a positive peripheral smear. There were two hundred and eleven [55.6%] male and one hundred and sixty eight [44.3%] female patients. One hundred and fifty eight [42%] were P falciparum positive, two hundred and three [53%] were P vivax positive and eighteen [5%] patients had mixed infection of both P. falciparum and P. vivax. Two hundred and eighteen [57.5%] patients had thrombocytopenia. Out of this, One hundred and ten [50.4%] patients with thrombocytopenia were P. falciparum positive and one hundred and eight [49.6%] patients with thrombocytopenia were P. vivax positive. One hundred and fifty seven [41%] patients had anemia. Out of this, Thirty seven [23.6%] patients with anemia were P. falciparum positive and one hundred and twenty [76.4%] patients with anemia were P. vivax positive. Sixty 16%] patients had leukopenia. Out of this, Thirty three [55%] patients with leukopenia were P. falciparum positive and 27 [45%] with leukopenia were P. vivax positive

Conclusions: Malaria was found to be one of the most prevalent infections in the surveyed population and the frequency of vivax species was more as compared to falciparum malaria. The majority of falciparum malaria patients develop significant haematological complications with high frequency of thrombocytopenia and anemia as compared to vivax infection while changes in the white blood cells was less dramatic

Infection associated hemophagocytosis: a clinicopathological correlation

To study the etiology and intensity of hemephagocytosis [HP] associated with infection and to observe the clinicomorphological effects of Hemephagocytic syndrome [HPS]. Sixty two patients suffering from infection of varied etiology [viral, tuberculosis, enteric fever, malaria, Leishmaniasis] were included in the study. Bone marrow aspiration was done in all cases along with complete blood counts. Bone marrow smears were examined for HP and its intensity and effect on hematological parameters was noted. Viral infection was found in 17 patients followed by tuberculosis 09 enteric fever 13 malaria 08, visceral leishmaniasis[9], brucellosis[3], and misc[3] Most patients showed either moderate, grade II[31] or severe degree, grade III[21] of HP. Hemophagocytic syndrome was present in 21 patients. Patients with increased intensity of HP in the bone marrow had profound effect on hematological parameters, particularly hemoglobin and platelet count, resulting in the depression of these cell lines. Viral, bacterial and parasites infections play an important role in the causation of histiocytic hyperplasia with HP. It may present as HPS with multisystem disorder which could be fatal if not properly diagnosed and treated. Severe intensity of HP has a profound effect on Hematology parameters of patients particularly on hemoglobin level and platelet count

Clinico-biochemical pattern in acute anicteric hepatitis

A clinico-biochemical study of 37 cases [19 adults, 18 children] of anicteric hepatitis is presented. Clinical features were non-specific, nausea/vomiting, generalized aches and anorexia were the leading symptoms. Transaminases were significantly high in both the groups, thus helping in early diagnosis. Mean values were notably higher in children as compared to the adult group. Phosphatase was normal or moderately elevated. Total bilirubin levels were higher inchldren than in adults; the ratio of conjugated to un-conjugated bilirubin was more than 0.8 in all the cases of anicteric, irrespective of age and sex, thus emphasizing on its importance in diagnosis. DeRitis ratio was of some diagnostic value in children only