Pakistan Journal of Pathology 2022-03-31T08:08:38+00:00 Dr Wajid Hussain, Assistant Editor Open Journal Systems A RARE ASSOCIATION OF ANTI- GABA-B RECEPTOR WITH ANTI HU ANTIBODIES IN AUTOIMMUNE ENCEPHALITIS: A CASE REPORT 2022-02-09T08:03:40+00:00 Tahira Mohammad Muhammad Amjad Aftab Akhtar Tahir Aziz Ahmed <p>ABSTRACT</p> <p>Antibodies to the gamma aminobutyric acid-B receptor (Anti-GABA-B-R) encephalitis is an uncommon subtype of autoimmune encephalitis (AE) in which IgG antibodies directed against the B1 subunit of the GABA-B-R has been described. Clinically it presents as limbic encephalitis (LE) which is characterized by seizures, psychosis, and memory loss with progression to autonomic dysfunction, altered consciousness and death. We present a case of an elderly male who presented in the ER due to progressive agitation, confusion, and irritability. Immunological workup revealed anti GABA-B-R antibody and anti Hu. After admission his consciousness rapidly deteriorated over the next few days, and he was intubated. The patient developed septic shock and due to poor prognosis, the patient’s family requested withdrawal of ventilatory support.</p> 2022-03-31T00:00:00+00:00 Copyright (c) 2022 Pakistan Journal of Pathology PARADIGM SHIFTS IN VITAMIN D TESTING AND DIAGNOSIS: A DECADE-LONG OBSERVATIONAL STUDY 2021-12-29T05:50:23+00:00 Hafsa Majid Muhammad Abbas Abid Nawazish Zehra Siraj Muneer Lena Jafri Aysha Habib Khan <p><strong>Objective: </strong>Awareness about vitamin D deficiency has linearly increased over the years. Lack of clear guidelines regarding optimum dosage and inadvertent use of higher doses can lead to toxicity. This study was done to evaluate the changes in trends of vitamin D testing and status of serum levels of 25-hydroxy vitamin D (25-OHD) submitted for analysis to a large-volume reference laboratory.</p> <p><strong>Material and Methods:</strong> An observational study was conducted at the section of Chemical Pathology, Department of Pathology and Laboratory Medicine, Aga Khan University. Data analysis of serum 25-OHD tests from January 2010 to December 2019 was performed. The patients were categorized as deficient, insufficient, optimal, hypervitaminosis or toxic based on 25-OHD values. Data was analyzed using Microsoft Excel version 16.</p> <p><strong>Results:</strong> Total 903,282 tests were analyzed during the 10 years’ period Mean age (SD) was 40.7 (16.5) years, with 35.8% males. The 25-OHD testing since 2010 to 2019 increased by 62.3% in adults and 66.6% in children. The mean 25-OHD levels improved from 18.8 ng/ml in 2010 to 24.5 ng/ml in 2019 in adults, while no change in mean 25-OHD levels was noted in children.</p> <p><strong>Conclusion:</strong> Testing and status of vitamin D improved with increased mean vitamin D levels and a decline in deficiency over 10 years. Our study calls for developing local guidelines for vitamin D-deficiency management, and taking caution when prescribing supplements, as vitamin D intoxication is concurrently increasing in the population.</p> <p><strong>Key Words: </strong>25OHD, Deficiency, Toxicity, Pakistan.</p> 2022-03-31T00:00:00+00:00 Copyright (c) 2022 Pakistan Journal of Pathology PREVALENCE OF IRON DEFICIENCY IN INDIVIDUALS WITH β-THALASSEMIA TRAIT 2021-12-02T15:11:00+00:00 Faiza Salman Faiza Fahim Azhar Saleem <p><strong>Objective:</strong> To determine the prevalence of iron deficiency in β-Thalassemia trait individuals.</p> <p><strong>Material and Methods</strong>: This cross-sectional study was conducted from January 2018 to December 2019 in the department of Hematology, KRL hospital Islamabad. Serum ferritin level of all β-thalassemia trait individuals was performed to determine the iron status.</p> <p><strong>Result: </strong>We studied the iron status of 132 β-thalassemia trait individuals. Out of these 132; 75 were females and 57 were males. 30 (22.7%) individuals were found to be iron deficient. 26 (34.7%) females and 04 (7%) males were iron deficient.</p> <p><strong>Conclusion:</strong> It can be concluded that iron status should be investigated and promptly treated in individuals with β- thalassemia trait especially those with a low hemoglobin level for age and gender. </p> <p><strong>Key Words:</strong> β-thalassemia trait, Iron deficiency anemia.</p> 2022-03-31T00:00:00+00:00 Copyright (c) 2022 Pakistan Journal of Pathology EFFICACY OF TENOFOVIR DISOPROXIL FUMARATE COMPARED WITH ENTECAVIR TO TREAT CHRONIC HEPATITIS B VIRUS MONOINFECTION PATIENTS 2022-03-10T07:12:32+00:00 Saira Saleem Naila Iqbal Sundas Shabbir Firdous Iqbal Lubna Ghazal Fatima Tuz Zahra <p><strong>Objectives: </strong>To assess the efficacy among tenofovir disoproxil fumarate (TDF) and entecavir (ETV) in the treatment of chronic hepatitis B monoinfection patients.</p> <p><strong>Material and Methods</strong>: A cross sectional analytical study carried out at District Headquarter Hospital Attock at PKLI (Pakistan Kidney and Liver Institute) between January 2019 to July 2020. Total 120 chronic HBV patients with quantitative PCR having DNA viral load &gt; 20,000IU /ml after the treatment failure with any other Nucleos(t)ide Analogues (Lamivudine, Adefovir, Telbivudine) or PEG-IFN (peglyated interferon) were considered. The patients were sorted in two groups, 60 were given TDF (group 1) and 60 were given entecavir (group 2) for a period of 6 months. Follow up carried out after 24 weeks by comparing HBV-DNA levels to compare efficacy between two drugs. Assessment of treatment eligibility for chronic HBV mono-infection is formed by investigating the extent of existing liver disease by ultrasound examination, complete blood count (CBC), liver function tests (LFTs) and Aspartate aminotransferase to platelets ratio index (APRI) score.</p> <p><strong>Results: </strong>Range for age of patients was 15~65 years, divided further into three groups 15~19 years 12(10%), 20~60 years 84(70%) and 61~65 years 24(20%). The gender distribution based on these groups was 84(70%) males and 36(30%) females. After 6 months of treatment with TDF / entecavir drugs, compensated liver with better prognosis was showed by TDF 60(50%) and decompensated liver 19(15.8%), cirrhosis 29(24.2%), and fibrosis 12(10%) by entecavir with significant p value &lt;0.001. Post treatment virological response (HBV-DNA levels) at 24 weeks was markedly higher among group 1 (TDF treatment) rather than group 2 (ETV treatment) i.e. 53(88.3%) and 42(70%) respectively.</p> <p><strong>Conclusion: </strong>Efficacy of TDF is better than ETV for treatment of chronic HBV monoinfection patients.</p> <p><strong>Key Words: </strong>APRI score, Chronic HBV, Entecavir, Tenofovir disoproxil fumarate.</p> 2022-03-31T00:00:00+00:00 Copyright (c) 2022 Pakistan Journal of Pathology ASSOCIATION OF AGE, GENDER, AND PLATELET INDICES WITH BLOOD CULTURES AND ISOLATED BACTERIA IN SEPSIS 2022-01-12T06:05:55+00:00 Aamna Latif Rabia Latif Uzma Ishaq Sara Ali Zaidi Nimra Anwar Jahanzeb Malik <p><strong>Objectives:</strong> Present study explored the association of sepsis with patients’ age, sex, and platelet indices [Platelet Count (PC), Mean platelet volume (MPV), MPV/PC)] with blood cultures and isolated bacteria.</p> <p><strong>Material and Methods:</strong> Adult patients (18-70 years old) with clinically diagnosed “sepsis” and had at least one blood culture and complete blood count performed during January to September 2020 were included in this cross-sectional study conducted at a tertiary care hospital in Pakistan. Data was collected regarding patients' age, sex, platelet indices, blood culture and bacterial profile.</p> <p><strong>Results:</strong> In 150 patients (79.3% females and 20.7 % males), Staphylococcus aureus was the most frequently isolated pathogen (52%) followed by Pseudomonas aeruginosa (12%). Chi-square test failed to reveal any association of gender (χ2 0.33, p 0.6); age (χ2 3.17, p 0.20); PC (χ2 0.1, p 0.9); MPV (χ2 2.36, p 0.30); MPV/PC (χ2 0.02; p 0.9) with blood culture results. No association was found between gender (χ2 0.68, p 0.4); age (χ2 2.99, p 0.84); PC (χ2 0.8, p 0.8); MPV (χ2 0.98, p 0.75); and MPV/PC (χ2 0.27; p 0.6) with isolated bacteria. Binary logistic regression showed that culture results and bacterial profile outcome cannot be predicted based on gender, age, PC, MPV or MPV/PC (p 0.50, 0.95, 0.83, 0.12, 0.84 and p 0.16, 0.12, 0.28, 0.43, 0.39 respectively).</p> <p><strong>Conclusion:</strong> The predominant bacteria in our subjects was Staphylococcus aureus, followed by Pseudomonas aeruginosa. Blood culture results and bacterial profile are not associated with and cannot be predicted based on age, gender and platelet indices.</p> <p><strong>Key Words: </strong>Blood culture, Mean platelet volume, Pathogens, Platelet count, Sepsis. </p> 2022-03-31T00:00:00+00:00 Copyright (c) 2022 Pakistan Journal of Pathology ASSOCIATION OF SUBCLINICAL HYPOTHYROIDISM WITH INCREASED RISK OF RECURRENT MISCARRIAGES DURING ANTENATAL THYROID STIMULATING HORMONE SCREENING 2022-01-12T06:12:53+00:00 Beenish Zafar Ayesha Farooq Naveeda Zaigham Roomisa Anis Ayesha Shafaqat Misbah Batool <p><strong>Objective: </strong>The present study was designed to ascertain the association of raised TSH in sub-clinical hypothyroidism with history of miscarriages in pregnant females coming to Al-Nafees Medical College Islamabad, for antenatal care.</p> <p><strong>Material and Methods:</strong> This Comparative cross-sectional study was conducted at department of Biochemistry, in assistance with Gynecology/ Obstetrics and Pathology department of Al-Nafees Medical College &amp; Hospital Islamabad, Pakistan. In this study random screening of 150 pregnant females for serum TSH levels was done to identify cases of SCH. Females were divided in to three equal groups i.e., 50 females in first, second and third trimester each. We measured serum TSH levels by using ELISA and then observe association of the raised TSH levels with H<sub>x</sub> miscarriages. Data were analyzed by SPSS version 20. Statistical methods used to analyze the data included mean ± SD, percentages, ratio, ANOVA and Pearson correlation tests</p> <p><strong>Results:</strong> The data obtained from this study indicates that 34.7% of females were found positive for SCH in our local population. Trimester wise reference values of TSH as given by ATA guidelines were used for diagnosing cases of SCH. In our study we found a statistically significant association of raised TSH levels with H<sub>x</sub> miscarriages as depicted by a significant p-Value ≤ 0.001.</p> <p><strong>Conclusion:</strong> Therefore, it is concluded from our study that there is an increased incidence of miscarriages in SCH positive females in contrast to females with normal TSH levels. Therefore, this finding highlights the role of antenatal TSH screening to avoid maternal and fetal poor outcome i.e., miscarriages associated with raised TSH levels.</p> <p><strong>Key Words: </strong>Subclinical hypothyroidism, Serum TSH levels, Obstetrical outcomes, Miscarriages, Trimester specific cut off values for TSH.</p> 2022-03-31T00:00:00+00:00 Copyright (c) 2022 Pakistan Journal of Pathology HIGH TITRE ANTI-A AND ANTI-B ANTIBODIES IN GROUP ‘O’ BLOOD DONORS - A TERTIARY CARE HOSPITAL BLOOD BANK EXPERIENCE 2022-02-28T06:47:27+00:00 Anum Sharif Mansoor Ishaq Raja Waqas Hanif Muhammad Sajid Yazdani Hamid Iqbal Noreen Anwar <p><strong>Objective:</strong> To determine the frequency of titre anti-A and anti-B antibodies in donors with blood group O.</p> <p><strong>Material and Methods:</strong> The study was conducted at Combined Military Hospital Multan from October 2019 to April 2020. This cross-sectional study has conducted after the approval of ethics review committee; A total of 300 individuals with blood group O reported for blood donation during the study period were considered in this study. After their consent, 10 ml whole blood of each donor was collected in two tubes, 3 ml collected in Ethylenediaminetetraacetic acid (EDTA) tube and 7 ml in plain tube. Anti-A &amp; anti-B antibodies titers were performed using pooled blood group A and B red cells by tube method at room temperature and 37° C.</p> <p><strong>Results: </strong>Male consisted of 174 (58%) and female consisted of 126 (42%) with male to female ratio of 1.5:1 out of 300 blood donors. The ages of individuals range from 20 to 50 years (32.8 ± 7.2). The frequencies of titer of anti-A antibodies and anti-B antibodies were found to be 17.7% and 9.0% respectively.</p> <p><strong>Conclusion: </strong>Titer of anti-A antibodies is high in considerable number of blood group O donors supports cautious use of Blood group O products in non-O recipients without screening. However, frequency of titer of anti-B antibodies was found to be relatively low.</p> <p><strong>Key Words</strong>: Anti-B, Anti-A, High titre, Blood group O, Non-O Blood group.</p> 2022-03-31T00:00:00+00:00 Copyright (c) 2022 Pakistan Journal of Pathology IMMUNOHISTOCHEMICAL EXPRESSION LEVELS OF CYCLIN E1 IN THREE HISTOLOGICAL GRADES OF ORAL SQUAMOUS CELL CARCINOMA 2022-03-08T06:35:29+00:00 Arooj Khurshid Sabeen Nasir Sadaf Alam Madiha Insha Natasha Kamran Rabia Alamgeer <p><strong>Objective:</strong> The objective of this study is to assess and compare the immunohistochemical expression levels of Cyclin E1 in three histological grades of oral squamous cell carcinoma.</p> <p><strong>Material and Methods:</strong> A descriptive cross-sectional study was designed. Sample size was 90 and categorised into three groups as i.e., well, moderate and poorly differentiated oral squamous cell carcinoma (OSCC) with 30 cases in each group. Specimens were collected from Histopathology Laboratories at Pakistan Institute of Medical Sciences (PIMS) and Foundation University Dental College and Hospital (FUDC&amp;H) Islamabad, to evaluate the expression levels of Cyclin E1 (CCNE1) with the help of immunohistochemical (IHC) staining. Statistical analysis was performed using the statistical analysis software, SPSS version 25.</p> <p><strong>Results: </strong>In OSCC cases, average age of patients was 61.1±10.2 years. Over all age range of patients was 40-79 years (min – max) which was statistically significant (p=0.02). Male to female ratio was 1.1:1 (p=0.003). The most common site of development of OSCC was Buccal mucosa (p= &lt; 0.001). According to immunoreactive scoring system (IRS) value of CCNE1 expression levels was low in 42.2% of cases and high in 57.7% of cases. The high final score of 6 and 9 was found in 80% cases of poorly differentiated OSCC cases and the results were found statistically significant (p&lt;0.001)</p> <p><strong>Conclusion: </strong>It is concluded that increased expression levels of Cyclin E1 significantly correlated with lack of differentiation in OSCC.</p> <p><strong>Key Words</strong>: Cyclin E1, Immunohistochemistry, Oral squamous cell carcinoma.</p> 2022-03-31T00:00:00+00:00 Copyright (c) 2022 Pakistan Journal of Pathology COMPARISON OF CAPILLARY ELECTROPHORESIS AND CELLULOSE ACETATE ELECTROPHORESIS IN DIAGNOSIS OF ΒETA-THALASSEMIA TRAIT 2021-11-17T06:46:01+00:00 Aqsa Noureen Irfan Ahmed Aneela Faisal Sadia Ali Faiqa Aslam Altaf Hussain Chowdhry <p><strong>Objective:</strong> To determine correlation between mean HbA2 value for screening of β thalassemia trait by capillary electrophoresis and cellulose acetate electrophoresis.</p> <p><strong>Material and Methods:</strong> A cross-sectional study was undertaken at the Armed Forces Institute of Pathology Rawalpindi's Department of Hematology from September 2017 to February 2018. Consent was taken from all patients or their immediate family members. All confirmed anemic patients with hemoglobin level below the normal limits for age and gender, MCV&lt;75 fL and MCH &lt;25 pg, belongs to either gender, aged 2 to 35 years, presented during the study duration were included. A written questionnaire was utilized to collect the patient information.</p> <p><strong>Results:</strong> Total 60 participants fulfilled the selection criteria according to G-Power analysis and included in the study. The mean age of (with age range 2-35 years) participants was 17.7±7.39 years. Majority of 33 (55.0%) participants were male. The mean hemoglobin of all patients was 11.06+_0.71fL and mean corpuscular volume was 67.84±5.87 fL, while mean corpuscular hemoglobin was 20.82±2.16 pg. Among all, 9 (15.0%) patients were diagnosed as β-thalassemia trait. The mean reticulocyte count was significantly higher in patients with β-thalassemia trait (2.5±0.85 vs. 1.99±0.68%). It was significantly higher in individuals with β-thalassemia trait on capillary (5.31±0.74 vs. 2.36±0.60%) and cellulose acetate (5.11±0.49 vs. 2.58±0.28%) electrophoresis.</p> <p><strong>Conclusion:</strong> Strong difference between hemoglobin A2 for screening of β thalassemia trait on capillary electrophoresis and cellulose acetate electrophoresis respective to patient’s age and gender. Capillary Electrophoresis (CE) is similar to Cellulose Acetate (CA) for consistent extent of Hemoglobin (Hb) elements. Many clinical laboratories can use it to screen for hemoglobinopathies.</p> <p><strong>Key Words: </strong>Beta thalassemia, Hemoglobin A2, Capillary electrophoresis, Cellulose acetate electrophoresis.</p> 2022-03-31T00:00:00+00:00 Copyright (c) 2022 Pakistan Journal of Pathology