http://pakjpath.com/index.php/Pak-J-Pathol/issue/feed Pakistan Journal of Pathology 2018-06-11T06:43:24+00:00 Lt Col Asif Ali Memon asifpath9@gmail.com Open Journal Systems http://pakjpath.com/index.php/Pak-J-Pathol/article/view/449 FREQUENCY OF GLUCOSE-6-PHOSPHATE DEHYDROGENASE (G6PD) DEFICIENCY AMONG THE ASYMPTOMATIC HEALTHY INDIVIDUALS 2018-06-11T04:38:15+00:00 Muhammad Arif Sadiq drarifsadiq@hotmail.com Ahmad Muqeem test@test.com Asma Bilal test@test.com Rizwan Hashim test@test.com <p><strong>Objective:</strong>&nbsp; To determine the frequency of G6PD deficiency among the asymptomatic healthy individuals.&nbsp;&nbsp; <br> <strong>Study Design:</strong> Cross sectional study.</p> <p><strong>Place and Duration of study:</strong> This study was done at Pakistan Air Force (PAF) Hospital Islamabad and PAF Hospital Lahore from July 2015 to March 2017.</p> <p><strong>Patients and Methods:</strong> The candidates tested were of both genders that came from all provinces of Pakistan for Central Medical Board selection in PAF or admission in PAF Public Colleges, Sargodha and Lower Topa. Their minimum age was 11 year and maximum 28 year. Their screening test for G6PD deficiency was carried out on Tuber by Merux Pty Ltd Australia. It is a qualitative, colorimetric procedure using dichlorophenol indophenols as an indicator for determining G6PD deficiency.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</p> <p><strong>Results:</strong> A sum of 1289 subjects was enrolled in the study. Out of them 1150 (89.2%) were male and 139 (10.8%) were females. Among 1150 males, 21 (1.82%) were found deficient for G6PD whereas only 1 (0.7%) female was G6PD deficient.&nbsp; A frequency of 1.7% was found in all subjects. All the candidates had normal blood counts except for 33 females who were anaemic with hemoglobin levels &lt; 12.0 g/dl.</p> <p><strong>Conclusion:</strong> &nbsp;In this study a frequency of 1.7% was found in all subjects. G6PD deficiency can present in apparently healthy individuals and remain undiagnosed even in third decade of life.&nbsp; G6PD screening can be included in normal health screening profile at least once in lifetime.</p> <p><strong>Keywords:</strong> Glucose-6-phosphate dehydrogenase, G6PD, NADPH, Haemolysis.</p> 2018-06-11T00:00:00+00:00 ##submission.copyrightStatement## http://pakjpath.com/index.php/Pak-J-Pathol/article/view/451 COLISTIN RESISTANCE AMONG GRAM-NEGATIVE NON FERMENTORS ISOLATED FROM PATIENTS AT A TERTIARY CARE REFERRAL BURN CENTRE 2018-06-11T05:05:14+00:00 Amina Asif aminasif79@gmail.com Kanwal Hassan Cheema test@test.com Zohaib Ashraf test@test.com Muna Malik test@test.com Fareeha Imran test@test.com <p><strong>Objectives: </strong>Colistin has been increasingly used for the treating infections caused by carbapenem resistant bacteria. Resistance to colistin is increasingly being reported among carbapenem–resistant Enterobacteriaceae as well as <em>Acinetobacter</em> and <em>Pseudomonas </em>species. This study was undertaken to determine the frequency of colistin resistance among fermenter and non-fermenter Gram-negative rods in our setup.</p> <p><strong>Methods: </strong>The present study was conducted in the Microbiology section of Pathology Laboratory of Jinnah Burn and Reconstructive Surgery Centre, Lahore, Pakistan from April 2017 to August 2017. Gram-negative organisms, recovered from different specimens of hospitalized and follow-up burn patients resistant to all routinely used antimicrobial drug groups were included in the study. Colistin Minimum Inhibitory concentrations (MICs) were performed by E test for selected organisms.</p> <p><strong>Results: </strong>A total of 434 extremely-drug resistant Gram-negative bacteria, consisting of 244 <em>Pseudomonas spp</em> 126 <em>Acinetobacter spp,</em> 57 <em>Klebsiella spp</em> and 7 <em>Escherichia spp</em> were isolated during the present study. Among these Gram-negative bacteria, three Colistin resistant organisms were isolated. All three were non-fermenters. Two isolates were <em>Pseudomonas aeruginosa</em> and one was <em>Acinetobacter baumnnii</em>. The MIC results of Colistin as tested by E strip were 8 mg/ L for one <em>Pseudomonas aeruginosa</em>, 16 mg/L for the other <em>Pseudomonas</em> isolate and 12 mg/L for <em>Acinetobacter species</em>.</p> <p><strong>Conclusion: </strong>Our study highlights the emergence of Colistin resistance in non-fermenters. This is alarming, as it leaves almost no options for clinicians to treat infections caused by such organisms. It is the need of the hour to establish a policy for antimicrobial stewardship and to control antimicrobial resistance&nbsp;in our country.</p> <p><strong>Key words: </strong>Non-fermenters, Colistin, Carbapenem resistance.</p> 2018-06-11T00:00:00+00:00 ##submission.copyrightStatement## http://pakjpath.com/index.php/Pak-J-Pathol/article/view/450 ROLE OF FINE NEEDLE ASPIRATION CYTOLOGY AND THYROID SCINTIGRAPHY IN EVALUATION OF SOLITARY THYROID NODULE; A COMPARATIVE STUDY 2018-06-11T05:07:04+00:00 Ayesha Qaiser test@test.com Muhammad Zubair mzubair84@hotmail.com Muhammad Sohail Babar Niazi test@test.com Waqarul Hassan Zaidi test@test.com Salma Gul test@test.com <p><strong>Objectives: </strong>Colistin has been increasingly used for the treating infections caused by carbapenem resistant bacteria. Resistance to colistin is increasingly being reported among carbapenem–resistant Enterobacteriaceae as well as <em>Acinetobacter</em> and <em>Pseudomonas </em>species. This study was undertaken to determine the frequency of colistin resistance among fermenter and non-fermenter Gram-negative rods in our setup.</p> <p><strong>Methods: </strong>The present study was conducted in the Microbiology section of Pathology Laboratory of Jinnah Burn and Reconstructive Surgery Centre, Lahore, Pakistan from April 2017 to August 2017. Gram-negative organisms, recovered from different specimens of hospitalized and follow-up burn patients resistant to all routinely used antimicrobial drug groups were included in the study. Colistin Minimum Inhibitory concentrations (MICs) were performed by E test for selected organisms.</p> <p><strong>Results: </strong>A total of 434 extremely-drug resistant Gram-negative bacteria, consisting of 244 <em>Pseudomonas spp</em> 126 <em>Acinetobacter spp,</em> 57 <em>Klebsiella spp</em> and 7 <em>Escherichia spp</em> were isolated during the present study. Among these Gram-negative bacteria, three Colistin resistant organisms were isolated. All three were non-fermenters. Two isolates were <em>Pseudomonas aeruginosa</em> and one was <em>Acinetobacter baumnnii</em>. The MIC results of Colistin as tested by E strip were 8 mg/ L for one <em>Pseudomonas aeruginosa</em>, 16 mg/L for the other <em>Pseudomonas</em> isolate and 12 mg/L for <em>Acinetobacter species</em>.</p> <p><strong>Conclusion: </strong>Our study highlights the emergence of Colistin resistance in non-fermenters. This is alarming, as it leaves almost no options for clinicians to treat infections caused by such organisms. It is the need of the hour to establish a policy for antimicrobial stewardship and to control antimicrobial resistance&nbsp;in our country.</p> <p><strong>Key words: </strong>Non-fermenters, Colistin, Carbapenem resistance.</p> 2018-06-11T00:00:00+00:00 ##submission.copyrightStatement## http://pakjpath.com/index.php/Pak-J-Pathol/article/view/453 PATTERN OF CAUSATIVE ORGANISMS IN INFECTIVE KERATITIS IN A TERTIARY CARE HOSPITAL 2018-06-11T05:14:06+00:00 Muna Malik mmkamboh@hotmail.com Iffat Javed test@test.com Saeed Anwar test@test.com Sohaila Mushtaq test@test.com Fahd Kamal Akhtar test@test.com <p><strong>Background:</strong> According to worldwide survey for blindness and visual impairment, the blindness and visual impairment, which is caused by corneal, scaring, is the second most common reason after cataract and this is accountable for around 20-30% of all optical harm in developing countries. After improvement in medical field technology and antimicrobial therapy, the occurrence of infective keratitis has been condensed in advanced countries. However, due to absence of medical training and therapy, keratitis is the foremost cause of monocular morbidity in most undeveloped countries like Pakistan.</p> <p><strong>Objective:&nbsp; </strong>To determine frequency and pattern of causative bacterial and fungal pathogens of infective keratitis in clinically diagnosed cases.</p> <p><strong>Study design, Place and Duration of Study:&nbsp; </strong>This is a descriptive study carried out in Lahore General Hospital, Lahore from June, 2016 – June 2017. According to standard operating procedures, the samples of corneal scrapings were processed at Microbiology laboratory of department of Pathology PGMI, Lahore.</p> <p><strong>Materials and Methods: </strong>The samples of corneal scrapings were collected from fifty patients of clinically identified cases of infectious keratitis by the ophthalmologists of Ophthalmology department of Lahore General Hospital, Lahore. &nbsp;These corneal scrapings, which were taken by the ophthalmologist, were immediately inoculated on Blood agar, Chocolate agar, MacConkay agar and Sabouraud’s Dextrose agar, which had added antibiotics (chloramphenicol, gentamicin). The scrapes taken from cornea were immediately smeared on glass slides, they were air-dried and by heating method, they were fixed for Gram’s staining and Kinyoun method of staining and with alcohol fixation for Giemsa stain. Identification of bacterial and fungal pathogens was done by Microbiological standard operating procedures in Microbiology lab of PGMI, Lahore.</p> <p><strong>Results:</strong>&nbsp; Out of 50 cases, 21 (42 %) patients were diagnosed as having fungal keratitis while 12 (24 %) cases were diagnosed as bacterial keratitis and 3(6 %) were having bacterial or/ and fungal pathogen. The commonest isolated pathogen was <em>Aspergillus spp</em>. 7 cases, which is followed by five cases of <em>Staphylococcus aureus</em> in keratitis.</p> <p><strong>Conclusion:</strong> The present study shows that the fungal keratitis is more common as compared to bacterial keratitis.</p> <p><strong>Key words:</strong> Infective keratitis, <em>Aspergillus spp.</em></p> 2018-06-11T00:00:00+00:00 ##submission.copyrightStatement## http://pakjpath.com/index.php/Pak-J-Pathol/article/view/454 TEACHING PATHOLOGY TO MEDICAL UNDERGRADUATES IN AN INTEGRATED MODULAR CURRICULUM 2018-06-11T05:17:46+00:00 Rifat Nadeem Ahmad rifatahmad@gmail.com Mahwish Majid Bhatti test@test.com Asna Haroon Khan test@test.com <p><strong>Objective:</strong> To assess the perceptions of students and faculty regarding teaching of pathology in an integrated modular curriculum at Shifa College of Medicine.</p> <p><strong>Materials &amp; Methods:</strong> This cross-sectional survey was conducted at Shifa College of Medicine, Islamabad, between June 2011 and July 2017. Students of 3<sup>rd</sup> Year MBBS for seven consecutive years along with the faculty of pathology were asked to respond to structured questionnaires based on a 3-point Likert scale regarding delivery of pathology in the integrated modular curriculum being followed in the college. Simple descriptive statistics were used to calculate frequencies and percentages for each variable in the questionnaire. Enrolment in the study was voluntary and anonymous.</p> <p><strong>Results: </strong>A total of 537 students and 66 faculty members responded to the questionnaires. Most of the students had a positive perception of integrated modular system, which they felt provides good clinical relevance (75%) and understanding of pathology (73%), allowing them to achieve their learning objectives (89%), promotes critical thinking (68%), self-learning (68%) and communication skills (66%), and is a student-friendly and interesting learning strategy (67%). The faculty also preferred integrated modular system (76%), as it encourages active learning (80%), and provides better clinical relevance (85%) and understanding (64%) of the subject than the traditional system. However, they had concerns regarding standardization in course delivery and logistic facilities.</p> <p><strong>Conclusion: </strong>Integrated modular curriculum has wide acceptability among the students and faculty of pathology, who feel that it is student-centred, promotes critical thinking, and provides good clinical relevance and subject understanding.</p> <p><strong>Keywords:</strong> Education, Medical, Undergraduate; Models, Educational; Competency-based education; Curriculum; Pathology.</p> 2018-06-11T00:00:00+00:00 ##submission.copyrightStatement## http://pakjpath.com/index.php/Pak-J-Pathol/article/view/455 PRIMARY BONE LYMPHOMA: A CASE REPORT OF A 22 YEAR YOUNG MALE AND REVIEW OF LITERATURE 2018-06-11T05:29:54+00:00 Akhter Ali Bajwa akhterbajwa251281@gmail.com Hafeez Ud Din test@test.com Muhammad Tahir Khadim test@test.com Syed Salman Ali test@test.com Unaiza Jamil test@test.com Umair Aslam Shahzad Khan test@test.com <p>Primary bone lymphoma (PBL) is comparatively rare disease process and distinct clinical entity. Previously reported most cases showed its particular tendency to affect senior adults. Although PBL can occur at any age and site with slight male predominance but femur bone has been reported the most commonly involved single site. Majority of PBL patients have early stage disease, and the stage 1 disease is the most important prognostic factor. Majority of the case series were reported from West with a little share from Asia including Japan. We report a case of DLBCL involving the upper end of humerus in a 22 years old male with review of literature.</p> <p><strong>Keywords: </strong>Primary bone lymphoma</p> 2018-06-11T00:00:00+00:00 ##submission.copyrightStatement##