Pakistan Journal of Pathology Pakistan Association of Pathologists en-US Pakistan Journal of Pathology 1024-6193 <p>The Pakistan Journal Pathology follows "CC BY NC" creative commons licensing. <a href=""><strong></strong></a>.</p> REFERENCE INTERVAL OF PLACENTAL GROWTH FACTOR IN NON-PREGNANT AND PREGNANT FEMALES <p><strong>Objective: </strong>To determine the reference interval of placental growth factor in healthy non-pregnant and pregnant females.</p> <p><strong>Material and Methods</strong>: This cross-sectional study was conducted at Chughtai Institute of Pathology Chemical pathology department from January 2023-May 2023. Reference individuals were selected by purposive, non-probability sampling technique from 130 diseased free non-pregnant and 130 disease free pregnant females. Informed consent was obtained from females of reproductive age group who fulfilled the inclusion criteria. Levels for PGF was measured by a fully automated immunoassay analyser Elecsys system Cobas e601. Data was analyzed by using SPSS21. Kolmogorov-Smirnov test was applied. P value &lt;0.05 was considered significant. The 2.5<sup>th</sup> and 97.5<sup>th</sup> percentiles were calculated at 90% CI by using the formula 0.025x(n+1) at rank number 1 and 0.975x(n+1) at rank number 7.</p> <p><strong>Results: </strong>Reference intervals were calculated by Rank-based method. Data values were arranged and rank numbers were allocated. Reference interval of PGF in non-pregnant and pregnant females were determine on the basis of 2.5<sup>th</sup> and 97.5<sup>th</sup> percentiles was 3.8 to 12.7 pg/mL and 46.43 to 1148 pg/mL respectively.</p> <p><strong>Conclusion: </strong>Current study findings add on contribution in comparison between reference interval of PGF in healthy non-pregnant and pregnant females. It will subsequently help the gynaecologist, clinicians, pathologist to interpret the results in order to decrease the feto/maternal complications related to pre-eclampsia. PGF levels can be cost effective by reducing unnecessary hospitalization and investigations in females at minimal risk of pre-eclampsia.</p> <p><strong>Keywords: </strong>Reference interval, Placental growth factor, Pre-eclampsia.</p> Asma Afaaq Muhammad Dilawar Khan Hijab Batool Omer Chughtai Akhtar Sohail Chughtai Shakeel Ashraf Copyright (c) 2023 Pakistan Journal of Pathology 2023-12-29 2023-12-29 34 4 102 108 10.55629/pakjpathol.v34i4.772 CHARACTERIZATION OF NEONATAL THROMBOCYTOPENIA AT TEACHING HOSPITAL OF RAHIM YAR KHAN <p><strong>Objective:</strong> To determine the prevalence and characterization of thrombocytopenia in neonates and the pattern of illnesses in these thrombocytopenic neonates.</p> <p><strong>Material and Methods:</strong> A cross sectional study was conducted on 400 neonates in Pathology and Pediatric departments of Sheikh Zayed Medical College/Hospital, Rahim Yar Khan, from November 2022 to July 2023. Analysis of data was done by using SPSS 23.</p> <p><strong>Results:</strong> Out of 400 studied neonates, males made up 238 (59.5%), while females were 162 (40.5%). Thrombocytopenic neonates were 76(19%) while 324(81%) neonates had normal platelet count. Out of the 76 thrombocytopenic neonates, 42(10.5%) neonates had mild thrombocytopenia, 25(6.25%) had moderate thrombocytopenia and 9 (2.25%) had severe thrombocytopenia. Degree of thrombocytopenia revealed that 46 (11.5%) of neonates had thrombocytopenia in late onset phase while 30 (7.5%) had early onset thrombocytopenia. Correlation of thrombocytopenia with several disorders displayed that neonatal sepsis and anemia were significantly linked with thrombocytopenia, followed by birth asphyxia, neonatal birth in preterm and full-term neonates, low birth weight and Neonatal jaundice, furthermore, the p-value for bleeding in neonates allied with thrombocytopenia was found significant with value of 0.03.</p> <p><strong>Conclusion:</strong> The current study discovered that mild thrombocytopenia among neonates is frequent followed by moderate and severe. Thrombocytopenia has strong correlation with neonatal sepsis, anemia, birth asphyxia, neonatal birth (pre term, full term) and bleeding. Severe thrombocytopenia can be used as a prognostic indicator in sick neonates. Hence thrombocytopenia is a frequent challenge for neonatologists to cope the serious consequences of neonatal health. </p> <p><strong>Keywords:</strong> Neonatal thrombocytopenia, Platelet, Low birth weight neonates, Sepsis, Asphyxia.</p> Muhammad Bilal Ghafoor Faiza Sarwar Hafiz Muhammad Tayyab Samina Waseem Farhan Ali Khanzada Amna Mehmood Copyright (c) 2023 Pakistan Journal of Pathology 2023-12-29 2023-12-29 34 4 109 112 10.55629/pakjpathol.v34i4.783 EMERGENCE OF CEFTAZIDIME-AVIBACTAM RESISTANCE IN ENTERO-BACTERALES AND PSEUDOMONAS AERUGINOSA <p><strong>Objective: </strong>The objective of this study is to determine the emergence of resistance to Ceftazidime-Avibactam (CAZ-AVI) by <em>Enterobacterales</em> and <em>Pseudomonas aeruginosa</em> in clinical isolates.</p> <p><strong>Material and Methods</strong>: In this cross-sectional study (6-months) March-August 2022 Carbapenem resistant <em>Enterobacterales</em> were tested for Ceftazidime-Avibactam (30/20 µg, Oxoid Pvt Ltd) using Disk diffusion technique and enzymes were identified in resistant strains by Carbapenem Inactivation Method (mCIM, eCIM) as per CLSI M100 Guidelines 2022.</p> <p><strong>Results: </strong>CAZ-AVI effectiveness has greatly decreased among <em>Enterobacterales</em> and <em>P. aeruginosa</em> isolates in recent past. Antimicrobial susceptibility testing results were interpreted using CLSI M100 document. Resistance against CAZ-AVI in <em>Enterobacterales</em> was found to be 80.8 % in <em>E. coli</em> and 72.1% in <em>Klebsiella pneumonia </em>isolates. This higher emergence is associated with CRE isolates majorly comprising MBLs in our country. Moreover, it has been observed that Metallo- β-lactamases mediated enzyme resistance is one of the major resistance patterns followed by serine carbapenemases.</p> <p><strong>Conclusion: </strong>The high frequency of resistance 77% was observed against CAZ-AVI in CRE and in CRPA, the resistance is 80.1% respectively. In our country this tremendously increase in CAZ-AVI resistance is attributed to the existence of NDM in the region.</p> <p><strong>Keywords: </strong>Carbapenem Resistant <em>Enterobacterales</em> (CRE), Metallo beta lactamases (MBLs), Carbapenem Resistant <em>Pseudomonas aeruginosa</em> (CRPA) Ceftazidime-Avibactam (CAZ-AVI), Modified Carbapenem Inactivation Method (mCIM), EDTA-modified Carbapenem Inactivation Method(eCIM), Multiple Drug Resistance (MDR)</p> Alina Mehwish Irim Iftikhar Copyright (c) 2023 Pakistan Journal of Pathology 2023-12-29 2023-12-29 34 4 113 117 10.55629/pakjpathol.v34i4.755 ASSOCIATION OF THE PRESENCE OF BCR-ABL1 GENE REARRANGEMENTS AND MYELOID ABERRANT ANTIGENS IN PRECURSOR B-ACUTE LYMPHOBLASTIC LEUKEMIA (PRE-B-ALL) PATIENTS <p><strong>Objective: </strong>To determine the association of the presence of BCR-ABL1 gene rearrangements and myeloid aberrant antigens in precursor B-ALL patients.</p> <p><strong>Material and Methods: </strong>Both males and females, of all age groups, diagnosed with precursor B-ALL on flow cytometry were included in the study. BCR-ABL1 gene rearrangement was identified by performing Fluorescence in situ hybridization (FISH) using Vysis LSI BCR/ABL, Dual color, Dual fusion translocation probe set. The results were noted and compared with the results of flow cytometry.</p> <p><strong>Results: </strong>Male patients were 36 (60%) and female patients were 24 (40%) out of total 60 patients. Median age was 22 years (range 1-73). BCR-ABL1 fusion gene was identified in 47 (78%) patients while 13 (22%) patients were negative for BCR-ABL1. Aberrant myeloid antigens were expressed in 24 (40%) patients and all of these patients were BCR-ABL1 positive. None of BCR-ABL1 negative patients expressed aberrant antigens. There was statistically significant association between BCR-ABL1 positivity and CD117 expression (P&lt;0.05).</p> <p><strong>Conclusion:</strong> </p> <p><strong>Keywords:</strong> BCR-ABL1, Pre B-ALL, Myeloid aberrant antigens, Flow cytometry, FISH.</p> Ayesha Younas Isma Imtiaz Mohammad Jamil Awan Ayisha Imran Touqeer Nazir Noman Aslam Malik Copyright (c) 2023 Pakistan Journal of Pathology 2023-12-29 2023-12-29 34 4 118 123 10.55629/pakjpathol.v34i4.786 INCIDENCE OF VULVO VAGINAL CANDIDIASIS IN YOUNG WOMEN; EXPERIENCE FROM A TERTIARY CARE HOSPITAL, KARACHI PAKISTAN <p><strong>Objective:</strong> To study the incidence of <em>Candida</em> species in women of child bearing age presenting with abnormal vaginal discharge with and without symptom of pruritus vulvae.</p> <p><strong>Material and Methods:</strong> The descriptive cross sectional study was done from Feb 2022 to Jan 2023, HVS of 300 women were taken who presented with abnormal discharge from vagina and pruritus vulvae. Samples were taken for microbiological culture testing, after thorough assessment of pertinent gynecological and obstetric history. The cultures were followed up and the results recorded.</p> <p><strong>Results: </strong>The most frequently identified organism causing abnormal vaginal discharge was <em>Candida</em><em> albicans</em> (62.27%) with pregnant women experiencing a 59.09% considerably higher prevalence rate. The study found that vaginal candidiasis symptoms were itching, white curdy vaginal discharge, burning, and dyspareunia. <em>Candida albicans</em> was found in 62.2% of cases, while non-albicans were found in 37.7%. Pregnant women accounted for 59.09% of positive cases, with 74 cases of <em>Candida</em> albicans and 56 cases of non-albicans. Non-pregnant women accounted for 40.9% of positive cases, with 63 cases of <em>Candida</em><em> albicans</em> and 27 cases of non-<em>albicans</em>.</p> <p><strong>Conclusion: </strong>Vulvo Vaginal Candidiasis associated with <em>C. albicans</em> as well as non albicans species of <em>Candida</em> is very common in women of reproductive age especially in developing countries. Specific diagnosis of is important as it leads to prompt treatment with antifungal, thus improving patient's health and preventing chronicity associated with disease.</p> <p><strong>Keywords: </strong>High vaginal swab, Vaginal candidiasis, Vaginal discharge.</p> Ayisha Raja Abeera Ahmed Sindhu Fareed Namra Sohail Raja Ameera Tariq Syed Rehan Asghar Naqvi Copyright (c) 2023 Pakistan Journal of Pathology 2023-12-29 2023-12-29 34 4 124 127 10.55629/pakjpathol.v34i4.771 CORRELATION OF ER, PR, AND HER2 WITH HISTOLOGICAL GRADES OF INVASIVE DUCTAL CARCINOMA OF BREAST <p><strong>Objective: </strong>To study the correlation of histological grades of breast cancer with the expression of hormone receptors ER, PR, and HER2/neuin patients of invasive ductal carcinoma breast.</p> <p><strong>Material and Methods: </strong>A Descriptive, cross-sectional was conducted at the Department of Pathology, PNS Shifa Hospital, Karachi from 13th February 2021 to 12th August 2021.77 cases of invasive ductal carcinoma breast were included in this study with subjects falling between the age groups of 25 and 85. On H&amp;E-stained sections, The Nottingham Scarff Bloom Richardson System variant was used to grade the histology of the samples. The formalin-fixed paraffin-embedded (FFPE) tissues were subjected to immunohistochemistry for ER, PR, and HER-2 receptors using the DAKO Envision kit.</p> <p><strong>Results: </strong>In our study, histological grading of invasive ductal carcinoma was found to be as follows; grade I in 01 (1.30%), grade II in 53 (68.83%), and grade III in 23 (29.87%) patients. Among the hormone receptors, the ER receptors revealed non-significant correlation i.e. 0.090. Also, PR receptors revealed 0.192 and HER-2 showed 0.410 values respectively in accordance to the grades of invasive breast carcinoma.</p> <p><strong>Conclusion:</strong> According to the study's findings, grade II (75.71%) and grade III (22.86%) had the highest prevalence among invasive ductal carcinoma cases. Additionally, the estrogen receptor (ER) expression was higher than that of HER-2 and the progesterone receptor (PR).</p> <p><strong>Keywords: </strong>Histologic grade, Invasive ductal carcinoma, ER, PR, HER-2.</p> Yusra Saleem Hina Wasti Beenish Hussain Nomani Misbah Riaz Shaista Bakhat Hira Faisal Copyright (c) 2023 Pakistan Journal of Pathology 2023-12-29 2023-12-29 34 4 128 132 10.55629/pakjpathol.v34i4.761 A YOUNG MALE WITH ACUTE ABDOMEN: HEREDITARY ANGIOEDEMA <p>Hereditary angioedema (HAE) is a freak, life-threatening genetic disorder caused by insufficiency or impaired function of the C1 inhibitor. HAE is difficult to diagnose due to its rarity, unusual symptoms similar to other conditions, and lack of C1 inhibitor in tertiary centers. This case is being reported due to its uncommon appearance with symptoms mostly affecting the gastrointestinal tract.</p> <p>We present a case of young boy who presented with abdominal pain and dysentery. History revealed its periodic nature since puberty, only abdominal tenderness was positive on clinical examination. Blood complete picture, ESR, CRP, Stool investigations for WBCs, ova/parasites, stool culture, occult blood, <em>Clostridium difficile</em> toxin and antigen were also negative. CT scan of abdomen revealed edema of bowel wall and acute extensive colitis involving the ascending and transverse colon. Complement C4 levels &lt;0.05 and very low values of C1 esterase inhibitor &lt;0.2 led to diagnosis of HAE type I.</p> <p><strong>Keywords: </strong>Abdominal pain, Complement levels, C1 inhibitor, Hereditary angioedema</p> Mustajab Alam Muhammad Hussain Hamid Nawaz Tipu Muhammad Aftab Hassan Usama Bin Khalid Hafiza Monaza Batool Copyright (c) 2023 Pakistan Journal of Pathology 2023-12-29 2023-12-29 34 4 133 135 10.55629/pakjpathol.v34i4.762 Complete Issue 2023; Vol 34: No 4 October-December Editor Office Copyright (c) 2023 Pakistan Journal of Pathology 2024-01-02 2024-01-02 34 4