Pakistan Journal of Pathology https://pakjpath.com/index.php/Pak-J-Pathol en-US Pakistan Journal of Pathology 1024-6193 <p align="center"><strong>UNDERTAKING &amp; COPYRIGHT AGREEMENT</strong></p><p align="center"> </p><p align="center"><strong>Pakistan Journal of Pathology (Pak J Pathol)</strong></p><p align="center"><strong> </strong></p><p> </p><p>All manuscripts must be submitted along with <strong>"Undertaking &amp; Copyright Agreement" </strong>form, as given below, and signed by the Principal author and co-author(s).</p><p> </p><p>It is certified that the following Editorial/ Original/ Review article/ Case Report has been submitted to Pakistan Journal of Pathology (PJP) for publication. The undersigned stipulate that manuscript has been seen and approved by all authors involved and is neither published nor being considered for publication elsewhere. All copyrights ownership for the article are transferred to the Pak J Pathol.</p><p> </p><table width="705" border="1" cellspacing="0" cellpadding="0"><tbody><tr><td valign="top" width="187"><p><strong>Name</strong></p></td><td valign="top" width="132"><p><strong>Institute /</strong></p><p><strong> Affiliation</strong></p></td><td valign="top" width="103"><p><strong>Qualification</strong></p></td><td valign="top" width="95"><p><strong>Contact no</strong></p></td><td valign="top" width="94"><p><strong>Email</strong></p></td><td valign="top" width="94"><p><strong>Signature</strong></p></td></tr><tr><td valign="top" width="187"><p> </p></td><td valign="top" width="132"><p> </p></td><td valign="top" width="103"><p> </p></td><td valign="top" width="95"><p> </p></td><td valign="top" width="94"><p> </p></td><td valign="top" width="94"><p> </p></td></tr><tr><td valign="top" width="187"><p> </p></td><td valign="top" width="132"><p> </p></td><td valign="top" width="103"><p> </p></td><td valign="top" width="95"><p> </p></td><td valign="top" width="94"><p> </p></td><td valign="top" width="94"><p> </p></td></tr><tr><td valign="top" width="187"><p> </p></td><td valign="top" width="132"><p> </p></td><td valign="top" width="103"><p> </p></td><td valign="top" width="95"><p> </p></td><td valign="top" width="94"><p> </p></td><td valign="top" width="94"><p> </p></td></tr><tr><td valign="top" width="187"><p> </p></td><td valign="top" width="132"><p> </p></td><td valign="top" width="103"><p> </p></td><td valign="top" width="95"><p> </p></td><td valign="top" width="94"><p> </p></td><td valign="top" width="94"><p> </p></td></tr><tr><td valign="top" width="187"><p> </p></td><td valign="top" width="132"><p> </p></td><td valign="top" width="103"><p> </p></td><td valign="top" width="95"><p> </p></td><td valign="top" width="94"><p> </p></td><td valign="top" width="94"><p> </p></td></tr><tr><td valign="top" width="187"><p> </p></td><td valign="top" width="132"><p> </p></td><td valign="top" width="103"><p> </p></td><td valign="top" width="95"><p> </p></td><td valign="top" width="94"><p> </p></td><td valign="top" width="94"><p> </p></td></tr><tr><td valign="top" width="187"><p> </p></td><td valign="top" width="132"><p> </p></td><td valign="top" width="103"><p> </p></td><td valign="top" width="95"><p> </p></td><td valign="top" width="94"><p> </p></td><td valign="top" width="94"><p> </p></td></tr><tr><td valign="top" width="187"><p> </p></td><td valign="top" width="132"><p> </p></td><td valign="top" width="103"><p> </p></td><td valign="top" width="95"><p> </p></td><td valign="top" width="94"><p> </p></td><td valign="top" width="94"><p> </p></td></tr></tbody></table> CANCER DATA STATISTICS: AFIP MONOGRAPH (FOURTH EDITION) REVIEW https://pakjpath.com/index.php/Pak-J-Pathol/article/view/485 <p>Regular monographs of analysis of malignant tumours are being published by Armed Forces Institute of Pathology (AFIP) Rawalpindi, Pakistan. A recent monograph containing 10 years data (2009-2018) is published now. &nbsp;</p> <p>This recent analysis provides us the opportunity to find any changing trends of malignancies diagnosed at our institute, from our previous analysis and to compare it with other national and international data. There was an increase in the total number of the patients registered for the malignant tumours during this ten-year data analysis as compared to our previous 10 years data.</p> <p>Urinary bladder tumours were on the top of list in males as was in previous series. This change was not found in some other studies of southern part of the country. Smoking and tobacco use may be a contributory factor. The bias due to more number of cases being submitted from nearby Armed Forces Institute of Urology &nbsp;cannot be eliminated. More large-scale studies on this specific topic are required.&nbsp;</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; The prostatic cancer on second place was found comparable to risk reported in the American and African countries as well as in studies from Western, Northern European and Oceania countries.</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Comparison with the Karachi studies showed almost similar differences as reported earlier, with tumours of lung and oral cavity, lymphoma more frequent in Karachi as compared to present series. The contributory factors could be more industrial areas, increasing traffic load and extensive betel nut chewing with tobacco, as was found in a case control study of Karachi, where tobacco was strongly suspected to be causative agent.</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; In females, breast carcinoma remained on top not only in this series but in our previous studies and national and international studies, highlighting it to be a global problem. The peak incidence is 5-10 years earlier than what is reported in international studies. The reproductive factors may not be contributory in our set up but dietary factors, obesity, prolonged effects of reproductive hormones due to early menarche and late menopause other than familial predisposition may be possible contributory factors in our set up.</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; As far as paediatric cancer is concerned some changed pattern was observed to our previous analysis but overall childhood tumors as compared to developed countries were more frequent. Lymphoma, eye &amp; adnexal tumors constituted about 35% to 40% of all pediatric tumors. The rest of the pattern was predictable.</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; The earlier point that quite a number of cases were registered as of unknown and unspecified sites was slightly improved but still quite a number of cases were registered as other ill-defined sites. In a same pattern, cases were also registered as lymph node not other specified (NOS), mouth oral cavity NOS, other salivary glands, pharyngeal sites NOS, gastrointestinal NOS, Male/Female genital tract NOS etc. This requires discussion with our clinical colleagues for mentioning the proper site of biopsy and clinical details for better evaluation and future analysis of diseases.</p> <p>&nbsp;</p> <p><strong><em>The monograph can be purchased from AFIP, Rawalpindi, Pakistan at a price of PKR 500/=</em></strong>.</p> Muhammad Tahir Khadim Shahid Jamal ##submission.copyrightStatement## 2019-03-08 2019-03-08 29 4 60 60 SERUM HDL CHOLESTEROL LEVELS IN ADULT HYPERLIPIDEMIC PATIENTS BEFORE AND AFTER TREATMENT WITH NIACIN IN COMBINATION WITH STATIN https://pakjpath.com/index.php/Pak-J-Pathol/article/view/479 <p><strong>ABSTRACT</strong></p> <p><strong>Objective</strong>: Comparison of different treatment strategies on serum high density lipoprotein levels in adult hyperlipidemic patients.&nbsp;</p> <p><strong>Study Design</strong>: Randomized control trial</p> <p><strong>Place &amp; Duration of Study: </strong>Department of Biochemistry and Department of Chemical Pathology, Sheikh Khalifa Bin Zayed Medical Complex, Lahore. (Jan 2014-15).</p> <p><strong>Materials and Methods:</strong> Hyperlipidemic patients were selected for this study (n=44) and all study cases were equally distributed into two groups “A” and “B”. Different treatment was given to each group. Group A was given only oral statin drug and group B was given statin drug along with niacin. The effect of different drugs on high density lipoprotein (HDL) level of patients was seen on both groups by taking blood sample before commencement of therapy and 12 weeks after treatment.</p> <p><strong>Results: </strong>HDL levels did not vary in group A before and after the treatment but on the other hand group B taking the combination therapy had significantly higher levels of HDL twelve weeks after therapy. The difference between HDL levels in both groups was insignificant before starting therapy. However, this difference became significant after 12weeks of therapy. In our study HDL level decreased in group A but increased in group B after therapy.</p> <p><strong>Conclusion: </strong>‘Niacin along with stain gives far better results in raising HDL as compared to statin alone.</p> <p><strong>Key Words:</strong> Niacin, Statin, High density lipoproteins, Hyperlipidemia, Cardiovascular events.</p> Marium Shoukat Riffat Yasmin Talmeez Zaib Hijab Batool ##submission.copyrightStatement## 2019-03-08 2019-03-08 29 4 61 64 EFFECT OF PLASMA CELLS PERCENTAGE AND PATTERN OF INFILTRATION ON HEMATOLOGICAL https://pakjpath.com/index.php/Pak-J-Pathol/article/view/480 <p><strong>Introduction: </strong>Anemia has been documented in more than two thirds patients of myeloma. There are multiple reasons for this, some of which comprise anemia of chronic disorders, reduced erythropoietin production, decreased sensitivity of erythroid precursors and myeloma cell mediated apoptosis of erythroid progenitors. Crowding of marrow by plasma cells and replacement of marrow interferes with hematopoiesis and is also accountable for anemia.</p> <p><strong>Objective: </strong>To see the effect of percentage and pattern of infiltration of plasma cells on various hematological parameters.</p> <p><strong>Material and Methods: </strong>Prospective study, conducted in Department of Pathology, Pakistan Institute of Medical Sciences Islamabad, for a period of 2 years. Total 78 patients were included in the study. Patients having increased plasma cells on bone marrow aspirate were included in this study. Patients with history of chemotherapy, nutritional deficiency or any other comorbid were excluded in this study. Patients were categorized according to number of plasma cells on bone marrow aspirate as: 5 – 20%, 21 – 30%, 31 – 40%, 41 – 50%, 51-60%, 61 – 70%, 71 – 80%, &gt;80%. Patients were also categorized according to pattern of infiltration on bone marrow trephine biopsy as: Focal, interstitial and diffuse patterns.</p> <p><strong>Results: </strong>A total of 78 patients were selected for the study. Male to female ratio was (2:1). Hematological parameters i.e. hemoglobin, red blood cells, white blood cells and platelets etc. were shown to be deranged as number of plasma cells were increasing and pattern of infiltration was focal to diffuse. There was statistically significant difference between hemoglobin, red blood cells and nucleated red blood cells in patients having &lt;10% and &gt;10% plasma cells on bone marrow aspiration.</p> <p><strong>Key Words: </strong>Plasma cells, plasma cell dyscrasia, Hematological parameters, Bone marrow biopsy, Infiltration.</p> Shahzad Ali Jiskani Sundas Ali Aliena Sohail Lubna Naseem Asfa Zawar Humaira Rizwan Sarah Jamal Asma Mustafa, Bushra Anam Ali Maryam Zulfiqar ##submission.copyrightStatement## 2019-03-08 2019-03-08 29 4 65 68 FREQUENCY OF ABO AND RH (D) BLOOD GROUPS AMONG RECRUITS; RESIDENT OF SURROUNDING AREAS OF DERA ISMAIL KHAN https://pakjpath.com/index.php/Pak-J-Pathol/article/view/481 <p><strong>Objective: </strong>To assess the prevalence/frequency of different ABO and Rh (D) blood groups in recruits’ resident of surrounding areas of DI khan Pakistan.</p> <p><strong>Study Design: </strong>Cross-sectional descriptive.</p> <p><strong>Material and Methods: </strong>This study was conducted at Combined Military Hospital (CMH) Dera Ismail Khan from Dec 2017 to Nov 2018. A total of 4941 healthy adult recruits reported to CMH laboratory for their medical examination belonging to surrounding areas of D.I. Khan, were included. Upto 2 ml of blood was taken in the anticoagulant tube, from each recruit. By using commercially available antisera, ABO and Rh (D) blood groups were detected through the tube method. The frequency and percentage of each blood group type were calculated.</p> <p><strong>Results: </strong>Out of 4941 recruits, 1650 (33.4%) were B +ve, 1377 (27.9%) were O +ve, 1107 (22.4%) were A +ve, 372 (7.5%) were AB +ve, 153 (3.1%) were B -ve, 132 (2.7%) were O -ve, 102 (2.1%) were A -ve and 48 (1.0%) were AB -ve.</p> <p><strong>Conclusion: </strong>The most prevalent/frequent blood group, out of ABO and Rh (D) was B +ve. Awareness of different blood groups in the surrounding areas will guide in the effective management of blood banks / volunteer blood donors list.</p> <p><strong>Key Words: </strong>ABO and Rh (D) blood groups, Surrounding areas of DI Khan.</p> Muhammad Asif Syed Mohsin Manzoor Maqsood Ahmad Muhammad Zahid Younis ##submission.copyrightStatement## 2019-03-08 2019-03-08 29 4 69 71 AN INEXPENSIVE METHOD OF PREPARING EDTA DISKS FOR THE DETECTION OF METALO-BETA-LACTAMASES IN UROPATHOGENIC E COLI https://pakjpath.com/index.php/Pak-J-Pathol/article/view/482 <p><strong>Objective:</strong> The aim of this study was to determine the frequency of Metalo-beta lactamases in uropathogenic <em>Escherichia coli</em> and to check the efficiency of in house prepared EDTA disks against them.&nbsp;&nbsp;</p> <p><strong>Study Design: </strong>Descriptive and Quasi experimental.</p> <p><strong>Place and duration of study:</strong> The Microbiology Department, Combined Military Hospital, and Institute of Dentistry Lahore, Pakistan from February 2016 to August 2016.</p> <p><strong>Material and Methods:</strong> Uropathogenic <em>E coli</em> were isolated in 83 urine specimens, 12 isolates had shown resistance to Carbapenems (Imipenem and Meropenem), by Kirby-Bauer disk diffusion method. These isolates were further subjected to Modified Hodge Test as recommended by clinical laboratory standard institute. Isolates which were resistant to carbapenem discs one or both with positive MHT were further subjected to Double disk synergy test and combine disk test using in house prepared EDTA disks 750μg for the detection of Metalo-beta lactamases.</p> <p><strong>Result:</strong> Frequency of Carbapenemases in uropathogenic <em>E. coli</em> was 13.25 % with a frequency of Metalo-b- lactamases to be 9.64%. Double disk synergy test and combine disk test both prove highly sensitive (100%) for the detection of Metalo-beta lactamases.</p> <p><strong>Conclusion:</strong> Double disk synergy test and combine disk test, using in house prepared EDTA disks is an inexpensive technique and improves reporting of Metalo-beta lactamases.</p> <p><strong>Key Words:</strong> Modified Hodge test, Double disk synergy test, Carbapenemases.</p> Qanita Fahim Ayesha Khalid Fatima Hameed Muhammad Saeed ##submission.copyrightStatement## 2019-03-08 2019-03-08 29 4 72 75 FREQUENCY OF ESBL PRODUCTION AND CARBAPENEM RESISTANCE IN URINARY ISOLATES FROM A TERTIARY CARE HOSPITAL https://pakjpath.com/index.php/Pak-J-Pathol/article/view/483 <p><strong>Objective:</strong> To determine the frequency of ESBL production, Carbapenem resistance and antimicrobial susceptibility in <em>Escherichia coli</em> and <em>Klebsiella </em><em>pneumoniae</em> urinary isolates from a tertiary care hospital.</p> <p><strong>Materials and Methods:</strong> This cross-sectional study was performed from July to December, 2017 in the Department of Microbiology, Armed Forces Institute of Pathology in collaboration with CMH Rawalpindi, AFBMTC and AFIU Intensive Care Units. All urine specimens collected from indoor and outdoor patients yielding growth of <em>E.coli</em> and <em>K. pneumoniae</em> were processed as per standard protocols. ESBL production was detected by phenotypic confirmatory disc diffusion test as per CLSI guide lines. The antimicrobial susceptibility testing was performed by modified Kirby Baur disc diffusion method and the results were interpreted as per CLSI guidelines. Carbapenem resistance was reconfirmed by breakpoint MICs on VITEK 2 systems-version 08.01.</p> <p><strong>Results: </strong>Among 622 samples, 499 yielded <em>E.coli </em>(80.22%)&nbsp; and 123(19.77%) &nbsp;<em>K.pneumoniae. </em>Out of 499 <em>E.coli</em>, 320 (64%) were ESBL producers and 30(6%) were Carbapenem resistant. Out of 123 <em>K.pneumoniae</em> isolates, 73 (59%) were ESBL producers and 28 (23%) were carbapenem resistant. Fosfomycin and Nitrofurantoin were found sensitive in most of isolates with only 3% and 9% resistance respectively.</p> <p><strong>Conclusion:&nbsp; </strong>This study has highlighted the high frequency of ESBL production in uropathogens and significant Carbapenem resistance in <em>K.pneumoniae </em>in our setup. Detailed analysis of &nbsp;antibiogram will not only be useful in formulating the antibiotic policy but also strong antimicrobial stewardship program.</p> <p><strong>Key Words: </strong>Carbapenem resistance, ESBLs, <em>Escherichia coli, Klebsella pneumoniae</em></p> Riffat Bushra Wajid Hussain Gohar Zaman Umer Khursheed Muhammad Kaleem Muhammad Tahir Khadim ##submission.copyrightStatement## 2019-03-08 2019-03-08 29 4 76 80 FREQUENCY OF ACQUIRED DYSFIBRINOGENEMIA IN PATIENTS OF CHRONIC LIVER DISEASE https://pakjpath.com/index.php/Pak-J-Pathol/article/view/484 <p><strong>Objective: </strong>To determine the frequency of acquired dysfibrinogenemia in patients of chronic liver disease.</p> <p><strong>Study Design: </strong>It was a descriptive study.</p> <p><strong>Place and Duration of Study:</strong> This study was conducted in the Haematology department, Army Medical College, National University of Science and Technology in collaboration with the department of Medicine, Military Hospital, Rawalpindi in one year (November 2012- October 2013).</p> <p><strong>Material and Methods: </strong>A total of 100 patients of chronic liver disease were included and those with previous history of coagulation disorders were excluded. It was a simple random sampling. A specifically designed proforma was used for the data collection. Mean and standard deviation (SD) were calculated from quantitative variables like fibrinogen levels and age. Frequency and percentages were calculated for qualitative variables like thrombin time, its correction with toluidine blue and gender. To find an association between all categorical variables Chi-square test was used. p-value &lt;0.05 was considered significant.</p> <p><strong>Results:</strong> Frequency of acquired dysfibrinogenemia in patients was found to be 40/100 (40%). Child Pugh Score A, B and C was used for grading the severity of liver disease. The study showed that the frequency of acquired dysfibrinogenemia tends to increase significantly [3(7.5%), 8(20%), 29(72.5%)] with the progress in severity of liver disease graded by Child Pugh Score (p = 0.014).</p> <p><strong>Conclusion: </strong>The study shows that the frequency of acquired dysfibrinogenemia increases significantly with the progression of severity of liver disease. Thus, it can serve as a helpful tool in early management and follow up of patients of chronic liver disease.</p> <p><strong>Key Words: </strong>Thrombin time, Fibrinogen, Blood coagulation disorders, Thrombosis.</p> Ayesha Noor Maria Shafiq Nosheen Ali Amer Siddiq ##submission.copyrightStatement## 2019-03-08 2019-03-08 29 4 81 85