Pakistan Journal of Pathology

Complete Issue 2023; Vol: 34 (No. 03, Jul-Sep)

Editor Office — Thu, 28 Sep 2023 00:00:00 +0000

Complete Issue 2023; Vol: 34 (No. 03, Jul-Sep)

ROLE OF GATA3 AND STAT6 IMMUNOHISTOCHEMISTRY IN CLASSIC HODGKIN LYMPHOMA (CHL) AND NODULAR LYMPHOCYTE PREDOMINANT HODGKIN LYMPHOMA (NLPHL)

Thu, 21 Sep 2023 00:00:00 +0000

Objective: The purpose of our study is to investigate the utility of immunohistochemical expression of GATA3 and STAT6 in differentiating Classic Hodgkin Lymphoma (CHL) from Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL).

Material and Methods: We approached database of Shaukat Khanum Memorial Cancer Hospital and Research Centre and selected a total of 79 CHLs and 15 NLPHLs diagnosed either on Trucut biopsy or excision biopsy diagnosed during the time 2020-2021. One slide from each of these 94 cases was stained with GATA3 and STAT6 independently and pattern of staining (either nuclear or cytoplasmic or dual nuclear and cytoplasmic) was accessed.

Results: 75/79(95%) cases of CHL were positive for GATA3 staining [60/79(75.9%) cases showed nuclear GATA3 staining, 15/79(18.9%) cases showed both nuclear and cytoplasmic staining] and 4/79(5%) CHL cases were negative for GATA3. 15/15(100%) cases of NLPHL were negative for GATA3[12/15(80%) cases showed no staining and 3/15(20%) cases showed only cytoplasmic blush]. 65/79(82%) cases of CHL were positive for STAT6[17/79(21.5%) cases showed nuclear STAT6 expression, 48/79(60.7%) cases showed both nuclear and cytoplasmic staining], and 14/79(18%) cases of CHL were negative for STAT6 expression [8/79(10%) cases showed only cytoplasmic staining and 6/79(8%) showed neither nuclear nor cytoplasmic staining]. 14/15(93.3%) cases of NLPHL were negative for STAT6[5/79(33.3%) cases showed only cytoplasmic staining and 9/15(60%) cases showed no staining] and 1/15(6.7%) case of NLPHL was positive for STAT6[showed nuclear STAT6 staining].

Conclusion: Nuclear staining of GATA3 and STAT6 either alone or in combination with cytoplasmic staining can be used to differentiate CHL from NLPHL. GATA3 effectively excludes NLPHL with 100% negative predictive value.

Keywords: GATA3, STAT6, Classic Hodgkin lymphoma, Nodular lymphocyte predominant Hodgkin lymphoma

COMPARISON OF POINT-OF-CARE HEMOGLOBIN A1C TESTING WITH CENTRAL LABORATORY METHOD FOR ITS USE IN SCREENING AND MONITORING OF DIABETES MELLITUS IN A RESOURCE-CONSTRAINED SETTING

Sara Reza, Hafiz Muhammad Salman Yousaf, Lubna Sarfraz, Adil Mehmood — Thu, 28 Sep 2023 00:00:00 +0000

Objective: The aim of this study is to evaluate the analytical performance of the Point-Of-Care Testing HbA1c analyzer for its use as an alternate to the central/core laboratory method.

Material and Methods: This was a cross-sectional study in which 176 samples of HbA1c were analyzed by POCT HbA1c analyzer (A1C EZ 2.0) and central laboratory analyzer (Cobas 6000) as comparative instrument.

Results: Based on the Bland-Altman plot, the HbA1c level for 164 out of 176 (93.18%) subjects analyzed by the POCT-HbA1c was within the range of the 95% limit of agreement. The area under the receiver operating characteristic (ROC) curve for clinical diagnosis of diabetes was 0.91. The sensitivity and specificity for HbA1c POCT were 94.5% and 88.0%. Using regression analysis, the slope of the A1C EZ 2.0 vs the Cobas 6000 Analyzer was 0.934, with an intercept of 0.20 and a correlation coefficient of 0.97.

Conclusion: This study concludes that the POCT-HbA1c analyzer is a suitable replacement for central/core laboratory HbA1c measurement. It is useful for screening and monitoring of diabetes mellitus in certain situations especially in a resource constraint setting.

Keywords: Diabetes mellitus, Screening, Monitoring, HbA1c, Point-of-care testing

SERUM ACTIVIN A & INHIBIN A: POSSIBLE BIOCHEMICAL MARKERS OF PREECLAMPSIA & PREGNANCY INDUCED HYPERTENSION

Thu, 21 Sep 2023 00:00:00 +0000

Objective: The objective of this study was to compare the levels of Serum Activin A and Inhibin A in Pregnancy induced hypertension, Preeclampsia & Normal Pregnancy

Material and Methods: An analytical, cross-sectional study conducted at Chemical Pathology Laboratory Collaborating with Gynae/Obstetric Department of Pakistan Railway Teaching Hospital, Rawalpindi over the period of one year (18 Sep 2019 to 18 March 2020). The study started after the approval of Ethical Review Committee, Riphah International University Islamabad. The sample size was calculated using WHO sample size calculator. Taking Prevalence of PIH and PE is 8%.³ Non probability convenient sampling technique was used. An overall 100 pregnant women with gestation of 20 – 25 weeks, were included. Patients of UTI, Carcinomas, Diabetes Mellitus and other chronic disorders were not included. The subjects were divided into three groups. Group I PIH: This group included 30 pregnant women of PIH; 20 - 25 weeks of gestation, BP: ≥140/90 mmHg on two separate occasions without proteinuria. Group II PE: This group included 20 pregnant women of preeclampsia; 20 - 25 weeks of gestation, BP: ≥140/90 mmHg on two separate occasions with proteinuria (>0.3 g protein/24 hours Urine). Group III Control Group: This group included 50 pregnant women with gestational age of 20 – 25 weeks without any complication as healthy controls.

Results: It was determined that Serum Activin A and Serum Inhibin A levels were significantly increased in PIH and PE groups as compared to healthy group. Mean of Serum Activin A in PIH, PE and Control group was (251.53+200.23 pg/ml), (466.95 + 237.40 pg/ml) and (43.35 + 85.22 pg/ml) respectively. Similarly Mean and Standard Deviation of Serum Inhibin A levels in PIH, PE and Control group was (194.78 + 173.00 pg/ml), (349.20 + 190.30 pg/ml) and (17.27 + 44.33 pg/ml) respectively. One-way ANOVA and post-hoc Tukey analysis was conducted to compare the mean of Serum Activin A and Serum Inhibin A levels among three different groups i.e Group 1(PIH and PE), Group 2(PIH and Control) and Group 3 (PE and Control). p-value< 0.05 was considered as statistically significant.

Conclusion: It can be concluded that Serum Activin A and Serum Inhibin A can be used as biochemical markers of PIH and PE. Estimation of Serum Activin A and Inhibin A at an early stage can detect PIH and PE early and further prevents their complications such as Eclampsia and HELLP syndrome.

Keywords: Pregnancy induced hypertension (PIH), Pre-eclampsia (PE), HELLP syndrome (H – Hemolysis, EL- Elevated Liver Enzymes, LP – Low platelets count), Serum activin A, Serum inhibin A.

REFERENCE RANGE OF NT PRO BNP IN HEALTHY PREGNANT FEMALES

Thu, 21 Sep 2023 00:00:00 +0000

Objective: To define the Reference Range of NT pro-BNP (N-terminal pro–B-type natriuretic peptide) during the first trimester of pregnancy in healthy females.

Material and Methods: This Cross-sectional study was conducted in the Department of Chemical Pathology, Combined Military Hospital, Lahore from September to November 2022. This cross-sectional study focused on the reference range of NT pro-BNP in healthy pregnant females. Sampling of the data was done by using the nonprobability consecutive sampling technique. A maximum number of available participants (365 pregnant females) during the study period were recruited. Descriptive statistics were shown as mean ±SD. For the reference range for NT pro-BNP 2.5^th percentiles (lower limit) and 97.5^th percentiles (upper limit) were estimated.

Results: A total of 365 pregnant females were included with first trimester pregnancy, having the mean age 28.54±5.18 years. Out of 365 participants, 299 females had BMI <25 whereas 66 were overweight. Forty-One females had Hb level ≤ 10 g/dl and 324 females had HB >10 g/dl. The Platelet count was >150 x 10^9/L in 338 women, and ≤150 x 10^9/L in 26 women. The Median of NT pro-BNP was 56.80 pg/mL in the first trimester. Reference range of NT pro-BNP in pregnant women with BMI <25 was (17.89 – 257.00) pg/mL as compared to (16.88 – 130.63) pg/mL in those with BMI >25.

Conclusion: The Reference range of NT pro-BNP changes in pregnancy as compared to healthy non-pregnant adults, likely due to hemodynamic changes associated with pregnancy. This study has defined a Pregnancy-specific reference range of NT pro-BNP in the first trimester which can help diagnose pregnant women with underlying cardiovascular disease.

Keywords: NT pro-BNP, Reference range, Pregnancy

CORRELATION OF DEMOGRAPHIC VARIABLES AND CLINICAL FINDINGS WITH CHEMICAL BIOMARKERS IN TYPE 1 DIABETES

Thu, 21 Sep 2023 00:00:00 +0000

Objective: To find correlation between different demographic variables and chemical markers in Type 1 Diabetes so that disease can be picked up at an early stage if individuals are categorized properly.

Material and Methods: It was a cross sectional analytical study conducted at Chughtai Institute of Pathology, from April 2021 to March 2022. We included 100 male and female diagnosed cases of T1D of age below 18 years as per inclusion and exclusion criteria. Relevant details of demographic variables & clinical findings were noted on a predesigned proforma. 5ml whole blood was taken from each subject. All samples were analyzed for Plasma Glucose, HbA1c%, Total Cholesterol, Triglyceride, Creatinine and C-peptide. SPSS 25.0 was used for statistical analysis.

Results: Mean age of the study participants was 14.2 ±3.6 years. Mostly were male (57%). Mean height was 4.89±0.69 feet, mean weight was 57.8±18.0 Kg and mean BMI was 27.0±7.7 kg/m2. Majority (57%) belonged to middle socioeconomic class, had normal BMI with a poor glycemic control. There was a significant difference in FBS levels and HbA1C among different socioeconomic groups (p <0.05) with poor socioeconomic group having higher values. Group having active symptoms and poor glycemic control had significantly higher FBS levels, HbA1c, Cholesterol and TG levels. Group having BP lower than 130/80 mm Hg had significantly lower FBS, HbA1c, Cholesterol and TG. Subjects with positive family history had higher HbA1c values.

Conclusion: Patients with T1DM in our study population are characterized by poor glycemic control, dyslipidemia, high BMI and majority belonged to middle socioeconomic class. Targeted therapy of high-risk groups can result in better disease management.

Keywords: Type 1 Diabetes Mellitus, Demographic, Biomarkers, Chronic.

ANTIMICROBIAL SUSCEPTIBILITY PATTERN OF COMMON BACTERIAL UROPATHOGENS, A COMPREHENSIVE STUDY AT TERTIARY CARE HOSPITAL OF BALOCHISTAN

Thu, 21 Sep 2023 00:00:00 +0000

Objective: To assess the frequency of the bacterial agents responsible for UTIs and their antibiotic susceptibility patterns in a tertiary care hospital.

Material and Methods: This Laboratory- based cross- sectional study was conducted at The Microbiology Department, Combined Military Hospital, Quetta in time duration of one year from April 2022 to March 2023. This study encompassed 512 bacterial isolates that were cultured positive from a collection of 1282 urine samples obtained from patients receiving care both in indoor and outdoor settings. The specimens were inoculated on CLED agar. Identification of isolated colonies was done by standard microbiological techniques and the Kirby Bauer disc diffusion method was used for antibiotic susceptibility testing. Quality control was ensured by using reference strains, and antibiotics were tested according to the CLSI 2022 recommendations.

Results: Bacterial uropathogens were identified in urine samples of 33.5% of male and 44.7% of female patients, with an overall infection rate of 39.93%. Of the 512 bacterial isolates, 91.79% were Gram-negative and 8.21% were Gram-positive. Escherichia coli was the most common isolate (69.53%), followed by Klebsiella pneumoniae (12.1%), Enterococci (7.6%), Pseudomonas (2.92%), among other bacterial species. The gram-negative isolates were sensitive to Nitrofurantoin (96%), Fosfomycin (93%), Amikacin (79%), Imipenem (75%), and Meropenem (74%), while gram positive isolates were highly sensitive to Linezolid (100%), Vancomycin (95%) and Nitrofurantoin (90%).

Conclusion: E. coli was the most common cause of UTIs at our hospital, followed by Klebsiella pneumonia with Nitrofurantoin and Fosfomycin being effective treatment options.

Keywords: E coli, Nitrofurantoin, Uropathogens.