Agreement Between Mucicarmine-Stained Bronchial Brushing and Bronchial Biopsy in Subtyping Non-small Cell Lung Carcinoma.

Background Bronchial brushing and biopsy are used for the diagnosis of lung carcinoma as most of these tumors are unresectable. Recently, the subclassification of non-small cell lung carcinoma (NSCLC) into adenocarcinoma (ADC) and squamous cell carcinoma (SCC) has become mandatory due to the emergence of targeted therapies. Due to the inherent limitations of small samples, subcategorization of a tumor is not always possible. Immunohistochemical and mucin stains are being used for this purpose, especially for tumors with poorly differentiated features. In our study, we utilized mucicarmine mucin stain to refine the differentiation of SCC and ADC on bronchial brushing and determine its agreement with bronchial biopsy. This study aimed to measure the degree of agreement between mucicarmine-stained bronchial brushing and bronchial biopsy for subtyping NSCLC into SCC and ADC. Methodology This descriptive, cross-sectional study was conducted in the pathology department of Allama Iqbal Medical College. Samples were collected by the pulmonology department of Jinnah Hospital Lahore. The study was conducted for 10 months from June 2020 to April 2021. A total of 60 cases diagnosed as NSCLC, aged between 35 and 80 years, were included in this study. After cytohistological evaluation of bronchial brushing and bronchial biopsy specimens, the agreement was deduced using kappa statistics. Results The strength of agreement between mucicarmine-stained bronchial brushing and bronchial biopsy for subtyping NSCLC into SCC and ADC was found to be substantial. Conclusions As significant agreement exists between the two modalities, mucicarmine-stained bronchial brushing can be used for a reliable and rapid categorization of NSCLC.

Association of Serum Vitamin D and Immunoglobulin E Levels With Severity of Allergic Rhinitis.

Objective The aim of this study was to determine the association of serum vitamin D and immunoglobulin E (IgE) levels with the severity of allergic rhinitis (AR). Methods This case-control study was conducted at Mayo Hospital, Lahore, from June to September 2020 after obtaining ethical approval. Patients of AR were included and divided with the help of allergic rhinitis and its impact on asthma (ARIA) classification, into group A (cases), patients presenting with moderate to severe symptoms, and into group B (control), patients with mild symptoms, after treatment of AR. The mean difference between serum IgE and serum Vitamin D levels of both groups were compared by t-test. Association was determined by logistic regression and odds ratio. Results A total of 224 patients were included in the study, 112 patients in group A and 112 patients in group B. There were 106 (47.3%) female and 118 (52.7%) male. The mean age of patients in group A was 26.78± 8.92 years and in group B, it was 25.72±8.12 years. Mean serum vitamin D levels in group A were 16.24±6.7 ng/ml and in group B 26.92±35 ng/ml (p=0.0001). Mean serum IgE levels in group A were 383.69±154.86 IU/ml and in group B, they were 373.03±106.83 IU/ml (p=0.0001). Vitamin D deficient patients were 24 times more likely to develop moderate to severe AR disease. Conclusion This study showed that in moderate-severe AR, IgE levels are raised statistically as compared to mild AR and the deficiency of Vitamin D is associated with increasing severity of allergic rhinitis symptoms.

Estrogen and Progesterone Receptor Expression in Breast Carcinoma and Its Association With Clinicopathological Variables Among the Pakistani Population.

Introduction The prognosis of breast cancer depends on the histological type, size of the tumor, tumor necrosis, skin, nipple and chest wall invasion, lymphovascular invasion, grade, stage, the status of estrogen receptor (ER), progesterone receptor (PgR), and human epidermal growth factor receptor 2 (HER2), cell proliferation marker (ki-67), and type of therapy. Estrogen receptor and progesterone receptor expression in breast cancer is, so far, the most useful predictive marker. We have undertaken this study to find the expression of ER and PgR in breast carcinoma and its association with other prognostically important clinicopathological variables. Materials and methods In this cross-sectional study, a total of 130 cases of modified radical mastectomy that have been diagnosed as malignant on histopathology were collected from the pathology department of Allama Iqbal Medical College, Lahore, from January 2016 to May 2018. The demographic data and gross and microscopic findings were recorded. Immunohistochemistry (ER, PgR) was applied to suitable tumor sections and their status was evaluated semi-quantitatively by histopathologists using College American Pathologist (CAP) guidelines. Result Most of the breast cancer patients (69; 53.1%) were below 50 years of age. Fifty-nine (45.4%) and 48 (36.9%) cases were positive for ER and PgR, respectively, showing lower hormonal receptor positivity than that reported in the western population where ER expression has been found in 50%-80% of cases and PR expression is found in 60%-70% of cases of invasive ductal carcinoma. The association of the expression of hormone receptors with a clinicopathological variable was demonstrated. ER-/PgR- tumors showed a higher histologic grade, greater tumor size, and more lymph node involvement by metastasis. Conclusion Low hormone receptor positivity is associated with young patients, advanced stage at presentation, and higher grade in our population. The tumor characteristics are different as compared to the western population. This suggests more consideration to the screening, early diagnosis, and molecular or immunohistochemical typing of this cancer in our population.

Blood Group Rhesus D-negativity and Awareness Toward Importance of Anti-D Immunoglobulin Among Pregnant Women in Bisha, Saudi Arabia.

Background Rhesus D (RhD) antigen alloimmunization has been a focus of concern for hematologists and obstetricians. It contributes to perinatal morbidity and mortality. The objectives of this study were to assess the awareness of pregnant women toward the clinical importance of blood group Rh(D)-negativity and anti-D immunoglobulin and to determine the prevalence of blood group Rh(D)-negativity among them. Methods and materials This cross-sectional study was conducted in a routine antenatal care clinic of King Abdullah Hospital in Bisha, Saudi Arabia from September 2018 to January 2019. The awareness of pregnant women toward the clinical importance of blood group Rh(D)-negativity and prophylaxis with anti-D immunoglobulin was assessed through a self-administered questionnaire. Samples were analyzed for ABO and Rh (D) blood groups using the microplate grouping method. The presence of anti-D alloantibodies was detected by the indirect antiglobulin test. Data were analyzed by IBM SPSS Statistics for Windows, Version 25.0 (Armonk, NY: IBM Corp.). A p-value ≤0.05 was considered statistically significant. Results A total of 108 respondents fulfilled the inclusion criteria and completed the survey. Forty-five pregnant women (41.7%) were observed to be aware of the blood group Rh(D)-negativity and anti-D immunoglobulin issue. The prevalence of the negative blood group was 11.1% (12/108). Awareness was found to be significantly associated with age, education, vaginal bleeding, blood groups, and previous administration of anti-D immunoglobulin (p-value ≤0.05). Conclusion The prevalence of blood group Rh(D)-negativity among respondents was found to be comparative with other populations, although the overall awareness was found to be suboptimal (41.7%). Structured health education programs by hematologists and obstetricians are needed to increase awareness and to address women at reproductive age.

Heterotopic pancreatic tissue in the gallbladder.

Heterotopic pancreas is defined as aberrantly located pancreatic tissue without anatomical, vascular, or neural connection to the pancreas. Usual sites include the stomach, duodenum, jejunum, and spleen; in rare cases, heterotopic pancreas can be found in the lungs, gallbladder, Meckel's diverticulum, and the mediastinum. In most cases, it is an insignificant, incidental finding. Pre-operative diagnosis is not possible, and histopathological examination is mandatory for establishing a definite diagnosis. Less than 40 cases of heterotopic pancreas in the gallbladder have been reported worldwide. Recently, a laparoscopic cholecystectomy specimen from a 43-year-old male showed a small nodule in the gallbladder neck. Microscopy revealed heterotopic pancreas composed of exocrine and endocrine glandular tissue with ducts. We report this case to highlight this rare, incidental finding. This condition should not cause pathologists to over diagnose such occurrences as malignancies; neither should they be neglected because they have potential complications.