Publications by authors named "Mudassar Hussain"

22 Publications

  • Page 1 of 1

Morbidity and Mortality Associated with Typhoid Fever Among Hospitalized Patients in Hyderabad District, Pakistan, 2017-2018: Retrospective Record Review.

JMIR Public Health Surveill 2021 May 17;7(5):e27268. Epub 2021 May 17.

Department of Public Health, Community Medicine and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.

Background: Hyderabad, Pakistan, was the first city to witness an outbreak of extensively drug resistant (XDR) typhoid fever. The outbreak strain is resistant to ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, fluoroquinolones, and third-generation cephalosporin, thus greatly limiting treatment options. However, despite over 5000 documented cases, information on mortality and morbidity has been limited.

Objective: To address the existing knowledge gap, this study aimed to assess the morbidity and mortality associated with XDR and non-XDR Salmonella serovar Typhi infections in Pakistan.

Methods: We reviewed the medical records of culture-confirmed typhoid cases in 5 hospitals in Hyderabad from October 1, 2016, to September 30, 2018. We recorded data on age, gender, onset of fever, physical examination, serological and microbiological test results, treatment before and during hospitalization, duration of hospitalization, complications, and deaths.

Results: A total of 1452 culture-confirmed typhoid cases, including 947 (66%) XDR typhoid cases and 505 (34%) non-XDR typhoid cases, were identified. Overall, ≥1 complications were reported in 360 (38%) patients with XDR typhoid and 89 (18%) patients with non-XDR typhoid (P<.001). Ileal perforation was the most commonly reported complication in both patients with XDR typhoid (n=210, 23%) and patients with non-XDR typhoid (n=71, 14%) (P<.001). Overall, mortality was documented among 17 (1.8%) patients with XDR S Typhi infections and 3 (0.6%) patients with non-XDR S Typhi infections (P=.06).

Conclusions: As this first XDR typhoid outbreak continues to spread, the increased duration of illness before hospitalization and increased rate of complications have important implications for clinical care and medical costs and heighten the importance of prevention and control measures.
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http://dx.doi.org/10.2196/27268DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8167610PMC
May 2021

Müllerian Adenosarcoma: A Single-Centre Experience of 59 Cases of This Rare Entity.

Cureus 2021 Feb 15;13(2):e13360. Epub 2021 Feb 15.

Histopathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK.

Background and objective Müllerian adenosarcomas (MA) are rare biphasic tumors with benign epithelial and sarcomatous stromal components. There is very limited cohort study data on MA in the South Asian countries and no such study has been attempted in Pakistan. Our aim was to evaluate the clinicopathological characteristics of MA and to review the published literature on the condition. Additionally, we also analyzed the impact of various prognostic factors on the overall survival (OS) of patients with MA. Materials and methods This was a retrospective observational study performed at the Shaukat Khanum Memorial Hospital and Research Centre, Lahore from 2003 to 2020. A total of 59 histologically confirmed cases of MA were included in the study and critically reviewed. Results The mean age of the patients was 54 ±16 years, and the most common tumor location was the uterine corpus (48, 81.4%), followed by the cervix (eight, 13.6%), ovary (two, 3.4%), and vagina (one, 1.7%). Sarcomatous overgrowth (SO) was seen in 22 (37.3%) patients, and high-grade cytology was observed in 18 (30.5%) patients. Furthermore, lymphovascular invasion (LVI) was present in six (10.2%) patients, and myometrial invasion was noted in 25 (42.4%) patients. The follow-up details of 29 patients were available, and death was recorded in 13 (44.8%) patients with a median OS of three years. Conclusion MA is a rare and diagnostically challenging entity due to its wide differential diagnosis. It is essential to take note of different morphological features such as SO, cytological features, LVI, and heterologous differentiation because of their significant prognostic impact.
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http://dx.doi.org/10.7759/cureus.13360DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7969483PMC
February 2021

C4d at Crossroads Between Post-Infectious Glomerulonephritis and C3 Glomerulopathy.

Int J Nephrol Renovasc Dis 2021 11;14:87-95. Epub 2021 Mar 11.

Department of Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, 54000, Pakistan.

Background: Post-infectious glomerulonephritis (PIGN) (immune complex-mediated glomerulonephritis) and C3 glomerulopathy are sub-types of glomerulonephritis (GN) with hypercellularity. Both have overlapping clinical and morphologic features on a kidney biopsy, however, the treatment and prognosis of these diseases are quite different making their distinction of utmost importance. Immune complex-mediated glomerulonephritis arises from glomerular deposition of immune-complexes (Igs) and C3 as a result of activation of classical (CP) and lectin pathways (LP). C4d is produced as a result of activation of the CP/LP. On the other hand, C3 glomerulopathy results from activation of alternative pathway of complement.

Aim: To distinguish between PIGN and C3 glomerulopathy with the help of C4d IHC stain.

Materials And Methods: We studied 28 biopsies reported as GN with hypercellularity from January 2015 to January 2020. Clinical information, histological features and immunofluorescence patterns were analyzed. C4d IHC was performed on all the biopsies. Six known cases of immune complex-mediated GN were selected to act as a positive control for C4d staining.

Results: Amongst 28 cases originally reported as GN with hypercellularity, 18 were labeled as post-infectious GN and 10 as C3 glomerulopathy based on clinical information and serological findings. 13 of 18 (72.2%) cases of PIGN had mild to moderate (1-2+) C4d staining, 2 (11.1%) had strong (3+) staining and 3 (16.7%) cases were negative for C4d staining. In the 10 biopsies of C3 glomerulopathy, mild (1+) C4d staining was noted only in 3 (30%) biopsies. C4d had moderate to strong (2-3+) staining in the control group.

Conclusion: C4d IHC stain can be helpful in distinguishing PIGN from C3 glomerulopathy.
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http://dx.doi.org/10.2147/IJNRD.S285302DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7958999PMC
March 2021

Renal Transplant Pathology: Demographic Features and Histopathological Analysis of the Causes of Graft Dysfunction.

Int J Nephrol 2020 7;2020:7289701. Epub 2020 Dec 7.

Department of Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore 54000, Pakistan.

Background: Renal transplant has emerged as a preferred treatment modality in cases of end-stage renal disease; however, a small percentage of cases suffer from graft dysfunction.

Aim: To evaluate the renal transplant biopsies and analyze the various causes of graft dysfunction.

Materials And Methods: 163 renal transplant biopsies, reported between 2014 and 2019 and who fulfilled the inclusion criteria, were evaluated with respect to demographics, clinical, histological, and immunohistochemical features.

Results: Of 163 patients, 26 (16%) were females and 137 (84%) were males with a mean age of 34 ± 7 years. 53 (32.5%) cases were of rejection (ABMR and TCMR), 1 (0.6%) was borderline, 15 were of IFTA, and rest of 94 cases (57.7%) belonged to the others category. SCr (serum creatinine) in cases of rejection was 3.85 ± 0.55 mg/dl. Causes of early graft dysfunction included active ABMR (7.1 ± 4.7 months), acute TCMR (5.5 months), and acute tubular necrosis (after 6 ± 2.2 months of transplant) while the causes of late rejection were CNIT and IFTA (34 ± 4.7 and 35 ± 7.8 months, respectively).

Conclusion: Renal graft dysfunction still remains a concerning area for both clinicians and patients. Biopsy remains the gold standard for diagnosing the exact cause of graft dysfunction and in planning further management.
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http://dx.doi.org/10.1155/2020/7289701DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7787863PMC
December 2020

Regional disparities in Preventive measures of COVID-19 pandemic in China. A study from international students' prior knowledge, perception and vulnerabilities.

Environ Sci Pollut Res Int 2020 Oct 10. Epub 2020 Oct 10.

School of Economics and Management, Nanjing University of Science and Technology, Nanjing, 210094, People's Republic of China.

The COVID-19 pandemic needs immediate solution before inflicting more devastation. So far, China has successfully controlled transmission of COVID-19 through implementing stringent preventive measures. In this study, we analyze the effectiveness of preventive measures taken in thirteen regions of China based on the feedback provided by 1135 international students studying in China. The study uses factor analysis combined with varimax rotation of variables. It was found that awareness raising and dispersing actionable knowledge regarding trust and adapting measures remained significantly important. Therefore, recognition of information gaps, improvements in the level of alertness, and development of preventive measures in each sector are imperative. The findings of this study revealed that trust, students' health, waste disposal, and the efforts of the Chinese government/international institute of education to prevent this pandemic were significantly and positively associated with preventive measures. The results showed that prior knowledge, global pandemics, and food and grocery purchases were firmly related to the preventive measures of COVID-19. Moreover, anxiety, transportation, and economic status were negatively related to the preventive measures. During this epidemic situation, international students suffered various types of mental stresses and anxiety, especially living in most affected regions of China. The study adopted a mixed (qualitative and quantitative) approach where the findings can act as a set of guidelines for governmental authorities in formulating, assisting in the preparation, instructing, and guiding policies to prevent and control the epidemic COVID-19 at national, local, and divisional levels.
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http://dx.doi.org/10.1007/s11356-020-10932-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7547302PMC
October 2020

Symmetric and asymmetric impact of oil price, FDI and economic growth on carbon emission in Pakistan: Evidence from ARDL and non-linear ARDL approach.

Sci Total Environ 2020 Jul 8;726:138421. Epub 2020 Apr 8.

Department of Business Administration, School of Management, University of Science and Technology of China (USTC), Hefei, Anhui, China. Electronic address:

Several studies have examined the impact of economic growth on carbon emission; however, the symmetric and asymmetric impact of oil price along with FDI on carbon emission has not studied in the case of Pakistan. For this purpose, the long and short-run impact of per capita income, FDI, and oil price on carbon emissions investigated by employing the ARDL and non-linear ARDL cointegration methodology, along with Granger causality in the context of Pakistan for 1971-2014. This study confirms the EKC hypothesis for Pakistan under both methodologies, whereas symmetric results show that economic growth and FDI intensify carbon emission in both the long and short-run, while oil price increase emission in the short-run and reduces emission in the long-run. Whereas asymmetric results in the long-run show that an increase in oil price reduces emissions and decrease in oil price intensify emissions. The causality analysis also supports the above findings and suggests a feedback effect between economic growth and carbon emission in Pakistan. This study provides implications for policymakers, where the descending flow of FDI allows limited space to Pakistan in FDI selection; however, the presence of emission convergence and adoption of carbon pricing may facilitate Pakistan in achieving its environmental targets. While diversifying the overall energy mix towards more renewable/clean energy along with formulating favorable policies for the adoption of renewable energy like solar by the industrial and residential consumers can further reduce the overall emission levels.
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http://dx.doi.org/10.1016/j.scitotenv.2020.138421DOI Listing
July 2020

Proteomics analysis of colon cancer progression.

Clin Proteomics 2019 28;16:44. Epub 2019 Dec 28.

2Institute of Cancer Therapeutics, University of Bradford, Tumbling Hill Street, Bradford, BD7 1BD UK.

Background: The aim of this pilot study was to identify proteins associated with advancement of colon cancer (CC).

Methods: A quantitative proteomics approach was used to determine the global changes in the proteome of primary colon cancer from patients with non-cancer normal colon (NC), non-adenomatous colon polyp (NAP), non-metastatic tumor (CC NM) and metastatic tumor (CC M) tissues, to identify up- and down-regulated proteins. Total protein was extracted from each biopsy, trypsin-digested, iTRAQ-labeled and the resulting peptides separated using strong cation exchange (SCX) and reverse-phase (RP) chromatography on-line to electrospray ionization mass spectrometry (ESI-MS).

Results: Database searching of the MS/MS data resulted in the identification of 2777 proteins which were clustered into groups associated with disease progression. Proteins which were changed in all disease stages including benign, and hence indicative of the earliest molecular perturbations, were strongly associated with spliceosomal activity, cell cycle division, and stromal and cytoskeleton disruption reflecting increased proliferation and expansion into the surrounding healthy tissue. Those proteins changed in cancer stages but not in benign, were linked to inflammation/immune response, loss of cell adhesion, mitochondrial function and autophagy, demonstrating early evidence of cells within the nutrient-poor solid mass either undergoing cell death or adjusting for survival. Caveolin-1, which decreased and Matrix metalloproteinase-9, which increased through the three disease stages compared to normal tissue, was selected to validate the proteomics results, but significant patient-to-patient variation obfuscated interpretation so corroborated the contradictory observations made by others.

Conclusion: Nevertheless, the study has provided significant insights into CC stage progression for further investigation.
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http://dx.doi.org/10.1186/s12014-019-9264-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6935225PMC
December 2019

A comprehensive review of climate change impacts, adaptation, and mitigation on environmental and natural calamities in Pakistan.

Environ Monit Assess 2019 Dec 16;192(1):48. Epub 2019 Dec 16.

CAS Key Laboratory of Crust-Mantle Materials and the Environments, School of Earth and Space Sciences, University of Science and Technology of China, Hefei, 230026, People's Republic of China.

The devastations and damages caused by climate change are apparent across the globe, specifically in the South Asian region where vulnerabilities to climate change among residents are high and climate change adaptation and mitigation awareness are extremely low. Pakistan's low adaptive capacity due to high poverty rate, limited financial resources and shortage of physical resources, and continual extreme climatic events including varying temperature, continual flooding, melting glaciers, saturation of lakes, earthquakes, hurricanes, storms, avalanches, droughts, scarcity of water, pest diseases, human healthcare issues, and seasonal and lifestyle changes have persistently threatened the ecosystem, biodiversity, human communities, animal habitations, forests, lands, and oceans with a potential to cause further damages in the future. The likely effect of climate change on common residents of Pakistan with comparison to the world and their per capita impact of climate change are terribly high with local animal species such as lions, vultures, dolphins, and tortoise facing extinction regardless of generating and contributing diminutively to global GHG emissions. The findings of the review suggested that GHG emissions cause climate change which has impacted agriculture livestock and forestry, weather trends and patterns, food water and energy security, and society of Pakistan. This review is a sectorial evaluation of climate change mitigation and adaption approaches in Pakistan in the aforementioned sectors and its economic costs which were identified to be between 7 to 14 billion USD per annum. The research suggested that governmental interference is essential for sustainable development of the country through strict accountability of resources and regulation implemented in the past for generating state-of-the-art climate policy.
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http://dx.doi.org/10.1007/s10661-019-7956-4DOI Listing
December 2019

Efficacy of Prednisolone in bronchiolitis with and without family history of atopy.

J Pak Med Assoc 2019 Oct;69(10):1448-1452

Allama Iqbal Memorial Teaching hospital, Sialkot.

Objective: To determine decrease in respiratory distress and hospital stay in bronchiolitis patients with and without family history of atopy when treated with prednisolone.

Methods: The multi-centre quasi-experimental study was conducted in three hospitals of Sialkot, Pakistan, from October 2017 to March 2018, and comprised patients of bronchiolitis who were divided into 2 groups on the basis of presence or absence of family history of atopy. Half of the patients in each group received oral prednisolone 2mg/kg/day for three consecutive days along with supportive care, and the remaining half received only supportive care. Patients were monitored at 12 and 24 hours for clinical response using Modified Respiratory distress Assessment Instrument score. Length of hospital stay was monitored upto 72 hours. SPSS 20 was used for data analysis.

Results: Of the 212 patients, 72(34%) were in the atopic group and 140(66%) in the non-atopic group. In atopic group, there was a significant respiratory distress difference observed between steroid and non-steroid subgroups at 24 hours (p=0.001) and all (100%) patients in the steroid subgroup got discharged at 24 hours, while only 8(22%) were discharged in the non-steroid subgroup. In non-atopic group, no significant improvement in corresponding terms was observed (p>0.05).

Conclusions: Oral prednisolone in bronchiolitis was found to be only effective in patients with family history of atopy.
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October 2019

Divisional disparities on climate change adaptation and mitigation in Punjab, Pakistan: local perceptions, vulnerabilities, and policy implications.

Environ Sci Pollut Res Int 2019 Oct 2;26(30):31491-31507. Epub 2019 Sep 2.

CAS Key Laboratory of Crust-Mantle Materials and the Environments, School of Earth and Space Sciences, University of Science and Technology of China, Hefei, 230026, People's Republic of China.

Climate change is a global challenge faced by everyone, but the developing countries are highly vulnerable to variations in the environment. This research focuses on the Punjab province of Pakistan and evaluates the impacts and consequences of climate change on general public at local and divisional level. In order to cope with the impacts of climatic changes at all levels, especially divisional level, raising reliable awareness and dispersing actionable knowledge regarding mitigating and adapting measures is significantly important. Therefore, recognition of information gaps, improvements in the level of alertness, and development of preventive measures in each sector is imperative. The impacts of climate change are observed across the country through gradual increase in temperature, human health issues, pest diseases, droughts, floods, and irregular weather patterns leading to changes in lifestyles, and these issues are likely to continue in the future. The main cause of climate change in Punjab, Pakistan, can be attributed to excessive release of greenhouse gases (GHG) into the atmosphere due to human activities involving inefficient energy usage, rapid urban expansion, improper waste management, industrial development, increasing transportation, agricultural activities, and livestock mismanagement. The findings of this study revealed that transportation sector is the major source of GHG emissions in the country, followed by industrialization and waste, at national, as well as divisional, level. The extent of impacts of climate change at divisional level is distinguishable and displayed a direct relationship with climate, geography, variation of effects, and modes of production in various regions of Punjab. The study strategically investigated all nine divisions of the province for comprehensive understanding of climate change phenomenon, and the results indicated that nearly three-fourths of the respondents have never indulged in taking steps towards climate change mitigation and adaptation. The study adopted a mixed (qualitative and quantitative) approach where the findings can act as set of guidelines for governmental authorities in formulating, assisting in preparation, instructing, and guiding policies for climate change mitigation and adaptation at national, local, and divisional levels. Graphical abstract.
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http://dx.doi.org/10.1007/s11356-019-06262-zDOI Listing
October 2019

A Diagnostic Challenge: Erdheim Chester Disorder

Mol Imaging Radionucl Ther 2019 Mar;28(1):30-33

Shaukat Khanum Memorial Cancer Hospital and Research Centre, Clinic of Medical Oncology, Lahore, Pakistan

Erdheim-Chester disease (ECD) is a rare, multisystemic, idiopathic disease often associated with BRAF V600E mutation. Its diagnosis is typically delayed and challenging due to its variable manifestations. Although it has an indolent course, advanced stages can manifest fulminant behavior with multiple vital organ involvement. It is a class 2a, non-Langerhans cell histiocytosis with characteristic radiological appearance. Whole body imaging might be helpful, particularly, to assess skeletal lesions. Although widespread disease with typical skeletal involvement on imaging can prompt diagnosis, histopathology with immunohistochemistry is required for confirmation. The disease can also manifest itself with a large variety of central nervous system related or orbital symptoms. Cardiac involvement is quite common. We present an interesting image of a patient with ECD who underwent PET/CT. Informed consent of the subject described in this image is waived by the Institutional Review Board.
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http://dx.doi.org/10.4274/mirt.galenos.2018.72677DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6455103PMC
March 2019

Outcome Of Use Of Nasal Continuous Positive Airway Pressure Through Infant Flow Drivers In Neonates With Respiratory Distress In A Tertiary Care Hospital In Pakistan.

J Ayub Med Coll Abbottabad 2018 Oct-Dec;30(4):511-555

Iqbal Memorial Teaching Hospital/Khawaja Muhammad Safdar Medical College Sialkot, Pakistan.

Background: Nasal continuous positive pressure has been used for management of respiratory distress in neonates in various conditions as a primary modality. Objective of the study is to evaluate the frequency of improved outcome and complications of use of nasal CPAP through infant flow drivers in neonates with respiratory distress. The study was conducted from 2nd April 2017 to 2nd October 2017 in neonatal intensive care unit of Allama Iqbal Memorial Teaching Hospital Sialkot.

Methods: All neonates with respiratory distress fulfilling the clinical criteria (Neonates with gestational age 28 weeks to 40 weeks having clinical signs of respiratory distress classified according to down score (tachypnea, grunting, decreased air entry, cyanosis, recessions), neonates having pc02 <60 mmhg, neonates having x-ray findings consistent with respiratory distress syndrome (RDS), Transient tachypnea of newborn (TTN) and pneumonia) were included in the study. Nasal CPAP was used at variable settings. Outcome, complications, indications, associated diseases and hospital stay along with other baseline characteristics were assessed. Success was defined as improvement of the respiratory distress as assessed by down score, maintenance of SPO2 above 90% in room air after weaning from CPAP for about consecutive 4 hours and normalization of blood gases while the failure as need for mechanical ventilation.

Results: Total 60 neonates were included in the study. Mean weight was 2113.3±580.32 g while mean gestational age was 33.35±2.59 weeks. Total 52 (86.7%) babies were successfully weaned off from nCPAP while only 8 (13.3%) neonates required mechanical ventilation. Main indication of use of CPAP was RDS (65%). No complications were observed in 73.3% babies while 26.7% had complications of which nasal deformities accounted for 20% and abdominal distension for 6.37%.

Conclusions: Nasal CPAP can be safely and easily used as primary support for neonates with respiratory distress even in resource limited developing countries. It reduces the need for mechanical ventilation and thus hospital stay.
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February 2019

Evaluation of floor-wise pollution status and deposition behavior of potentially toxic elements and nanoparticles in air conditioner dust during urbanistic development.

J Hazard Mater 2019 03 3;365:186-195. Epub 2018 Nov 3.

EcoHealth Research Group, Department of Environmental Sciences, PMAS Arid Agriculture University Rawalpindi, Pakistan. Electronic address:

The study was undertaken to investigate deposition behaviors of various size-segregated particles and indoor air quality using dust accumulated on the air conditioner filter acting as a sink for PTEs and nanoparticles that can pose a significant health risk. However, the particulate matter size and chemical composition in AC dust and its relationship with PTEs remains uncertain. Current study aims to investigate the PTEs and nanoparticles composition of AC dust using different analytical approaches including ICP-MS, XRD, XPS, SEM/TEM along with EDS and Laser Diffraction particle size analyzer. The mean concentration of PTEs like Al, As, Cd, Cu, Li, Pb, Sb, Se, Sn, Ti, V and Zn exceeded the corresponding background value. Pb, As, Sn, Sb, Cd were categorizing under geo-accumulation index class IV. Most of the particles were found to be > 100 μm and it decreased significantly with increase in floor altitude. A significantly negative correlation was found between particles size and PTEs concentration showing a significant increase in PTEs content with decrease in particles size. The XPS results showed dominant peaks for TiO, Ti-O-N, AsO, Fe, Fe, Al-OH and Al0. Additionally, As, Pb, Si and Fe were dominant metallic nanoparticles identified using SEM/TEM along with EDS.
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http://dx.doi.org/10.1016/j.jhazmat.2018.11.005DOI Listing
March 2019

Diagnostic accuracy of glypican-3 in differentiating hepatocellular carcinoma from metastatic liver tumours.

J Pak Med Assoc 2018 Jul;68(7):1029-1031

Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore.

Objective: To determine the diagnostic accuracy of Glypican-3 in differentiating hepatocellular carcinoma from metastatic liver tumours while taking histopathology as the gold standard..

Methods: The cross-sectional study was conducted at Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan, from January 1 to June 30, 2016, and comprised cases of malignant liver tumours. Samples were collected from the pathology department. Glypican-3was applied on them. Tumours were classified as positive when they showed >5% positivity and negative when showing <5% positivity. Frequencies and percentages of cases showing GPC3 positivity and negativity along with frequency and percentages of hepatocellular carcinoma and metastatic tumours were calculated.

Results: Of the 240 patients, 143(59.58%) were males and 97 (40.42%) were females. Overall mean age was 54.65 ± 13.46 years. On histopathology, 134 cases were hepatocellular carcinoma (55.83%) and 106 (44. 17%) cases turned out to be metastatic carcinoma. Glypican-3staining was positive in 116 (48.33%) cases and negative in 124(51.67%). Sensitivity was 82%, Specificity 94.33%, positive predictive value 94.82% and negative predictive value 80.64%. Diagnostic accuracy was 87.5%.

Conclusions: Glypican-3 was found to be a highly sensitive and specific Immunohistochemistry stain distinguishing hepatocellular carcinoma from the clear majority of metastatic carcinomas of the liver.
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July 2018

Effectiveness of Vascular Markers (Immunohistochemical Stains) in Soft Tissue Sarcomas.

J Coll Physicians Surg Pak 2018 May;28(5):352-356

Department of Histopathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore.

Objective: To ascertain the effectiveness of IHC markers of vascular origin like CD31, CD34, FLI1 and ERG in vascular soft tissue sarcomas including angiosarcomas, Kaposi sarcomas, epithelioid hemangioendothelioma and a non-vascular soft tissue sarcoma (Epithelioid sarcoma).

Study Design: Descriptive study.

Place And Duration Of Study: Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, from 2011 to 2017.

Methodology: Diagnosed cases of angiosarcomas (n=48), epithelioid hemangioendothelioma (n=9), Kaposi sarcoma (n=9) and epithelioid sarcoma (n=20) were selected. Immunohistochemical staining as performed on formalin fixed paraffin embedded sections. The sections were stained for the following markers: CD34 (VENTANA clone Q Bend 10), CD31 (Leica clone 1 A 10), FLI1 (CELL MARQUE clone MRQ-1) and ERG (CELL MARQUE clone EP111).

Results: A complete panel of CD34, CD31 and ERG was applied on 8/48 cases of angiosarcomas with triple positivity in 6 cases. Eight cases showed positivity for only CD31 and ERG and 2 cases showed positivity for only ERG. A complete panel of CD34, CD31 and ERG was applied on 3/9 cases of epithelioid hemangioendothelioma with positivity for all markers in 2 cases. Combined positivity for ERG and CD34 was seen in 2 cases and on 4 cases only CD31 immunohistochemical was solely applied with 100% positivity. FLI1 was not applied on any case. Among 9 cases of Kaposi sarcoma, ERG, CD34 and CD31 in combination were applied on only 1 case with triple positivity. Remaining cases show positivity for either CD34, CD31 or FLI1. Majority of cases of epithelioid sarcomas were diagnosed on the basis of cytokeratin and CD34 positivity with loss of INI1. The other vascular markers showed negativity in all cases.

Conclusion: Among these four markers, ERG immunohistochemical stain is highly effective for endothelial differentiation due to its specific nuclear staining pattern in normal blood vessel endothelial cells (internal control) as well as neoplastic cells of vascular tumors and lack of background staining.
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http://dx.doi.org/10.29271/jcpsp.2018.05.352DOI Listing
May 2018

Fluorescence in Situ Hybridization (FISH) for Differential Diagnosis of Soft Tissue Sarcomas

Asian Pac J Cancer Prev 2018 Mar 27;19(3):655-660. Epub 2018 Mar 27.

Department of Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan. Emaile:

Introduction:Soft tissue sarcomas are rare tumors comprising 1 percent of solid malignancies. The latest edition of WHO soft tissue pathology lists 94 benign and malignant soft tissue tumors. Many of these show a large degree of morphological overlap. Immunohistochemistry has been shown to be reliable in many cases for differential diagnosis of lesions, although cytogenetic tests are considered the gold standard for many entities.Fluorescence in-situ hybridization (FISH) is a cytogenetic technique that uses fluorescent probes that bind to only those parts of the chromosome which have a high degree of sequence complementarity. Many soft tissue tumors show recurrent genetic mutations that are now being used as diagnostic markers. Knowledge of the molecular identity allows prediction of behavior, prognosis and treatment response. Objective:The aim of this study was to identify genetic mutations in soft tissue sarcomas using FISH testing and to assess correlations with histological diagnosis. Material and methods:A total of 25 cases of different soft tissue sarcomas diagnosed on histology with the help of immunohistochemical staining and for which FISH studies were requested were included in this study. Three pathologists with a special interest in soft tissue sarcomas reviewed the cases. FISH tests for EWS, the X:18 translocation, FOXO1 and MDM2 were respectively applied for 8 cases of Ewing sarcoma, 8 cases of synovial sarcoma, 2 cases of rhabdomyosarcoma and 7 cases of dedifferentiated liposarcoma and atypical lipomatous tumors/well differentiated liposarcomas. Results:EWS gene fusion was detected in 7 out of 8 cases of Ewing sarcoma and the X:18 translocation was positive in 3 of the 8 cases of synovial sarcoma. FOXO1 was not detected in either of the two rhabdomyosarcomas. MDM2 by FISH was detected in only one out of 5 cases of atypical lipomatous tumors and 1 out of 2 dedifferentiated liposarcomas. Conclusion: FISH is a useful adjunct in the diagnostic assessment of different types of soft tissue sarcomas. It is easy to set up, is relatively inexpensive and has the ability to diagnose sarcomas with great accuracy, especially in cases which can not be accurately classified even after thorough histological and immunohistochemical evaluation. It may play a very important role in the accurate diagnosis and correct management of patients.
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http://dx.doi.org/10.22034/APJCP.2018.19.3.655DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5980837PMC
March 2018

Right-Sided and Left-Sided Colon Cancers are Two Distinct Disease Entities: an Analysis of 200 Cases in Pakistan.

Asian Pac J Cancer Prev 2016 ;17(5):2545-8

Department of Pathology, Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan E-mail :

Background: There is growing evidence that there are differences in histological and genetic characteristics along with clinical behavior between right- and left-sided colon carcinomas. We have compared various parameters of the two types and assessed associations of the results with prognosis in patients in Pakistan.

Materials And Methods: We reviewed 200 cases from our institutional database; 100 cases of right-sided and 100 cases of left-sided colon cancer. Parameters including age, gender, TNM stage, histological features and clinical outcome were analyzed.

Results: The patients with right-sided colon cancer were significantly older as compared to their counterparts with left-sided cancer. They presented with a lumbar mass rather than symptoms of obstruction and perforation as seen in left-sided colon cancers, and the histology showed higher percentage of poorly differentiated tumors with advanced pT stage. Moreover, Crohn's-like reactions, intra tumoral lymphocyte responses and other poor prognostic factors like lymph vascular invasion and perineural invasion were more common in right-sided cancers.

Conclusions: We found that right- and left-sided colon cancers are different from each other in terms of clinical presentation, histology and clinical behavior. Right-sided colon cancers are more aggressive and are associated with poorer clinical outcome as compared to left sided colon cancers in our population.
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January 2017

METASTATIC RADIOIODINE AVID STRUMA OVARII ASSOCIATED WITH PSEUDO-MEIGS' SYNDROME.

J Ayub Med Coll Abbottabad 2015 Jul-Sep;27(3):731-4

We report a case of 21 years old lady who presented with ascites, left adnexal mass and elevated CA-125. With suspicion of ovarian malignancy, she underwent left salpingo-oophorectomy with omental biopsy. Histopathology revealed: 'follicular variant of papillary thyroid carcinoma arising in struma ovarii' with metastatic papillary thyroid carcinoma in omental and peritoneal nodules. Patient underwent total thyroidectomy followed by radioactive iodine therapy for metastatic omental and peritoneal disease. Post-therapy whole body scan, revealed extensive I-131 avid disease metastatic disease involving the chest, abdomen, pelvis and the musculoskeletal system. Patient was treated with multiple doses of high dose radioactive iodine. She became symptom free on supra-physiologic doses of oral thyroxin however her high thyroglobulin levels and residual radioiodine avid metastatic disease required further treatment. In literature a few cases of struma ovarii have been reported with elevated CA-125 and associated pseudo-Meigs' syndrome. The treatment for this rare disease is still not standardized and poses a therapeutic challenge. Our case emphasizes the need for a multidisciplinary approach for managing struma ovarii.
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February 2016

Immunohistochemical expression of CD-10, BCL-6 and MUM-1 antibodies and immediate clinical response in patients of diffuse large B-cell lymphomas after six cycles of chemotherapy.

J Coll Physicians Surg Pak 2014 Oct;24(10):722-7

Department of Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore.

Objective: To determine the expression of CD-10, BCL-6 and MUM-1 in patients with diffuse large B-cell lymphoma (DLBCL) and its association with immediate clinical response after six cycles of CHOP chemotherapy.

Study Design: Analytical study.

Place And Duration Of Study: Armed Forces Institute of Pathology (AFIP), Rawalpindi in collaboration with Nuclear medicine, Oncology and Radiotherapy Institute (NORI), Islamabad from September 2010 to September 2011.

Methodology: CD-10, BCL-6 and MUM-1 antibodies were applied on cases diagnosed as DLBCL. Immediate clinical response was noted after 6 cycles of chemotherapy with the help of oncologist and divided into complete response, partial response, stable disease and relapse/ progression. Patient's age, results of expression of CD-10, BCL-6 and MUM-1 and results of immediate clinical response to chemotherapy were noted. Regarding analysis of prognostic markers (CD-10, BCL-6 and MUM-1), chi-square test was used for immediate clinical response to chemotherapy in DLBCL.

Results: CD-10 was positive in 40% cases, BCL-6 in 58.7% cases and MUM-1 was positive in 46.7% cases. About 41.3% of patients showed complete response, 10.6% partial response, 17.3% stable disease and 30.8% showed relapse/progression. CD-10 expression in DLBCL was associated with better immediate clinical response (p=0.011) whereas MUM-1 expression in DLBCL was associated with poor immediate clinical response (p<0.0001). However, there was no statistically significant association of BCL-6 with immediate clinical response (p=0.22).

Conclusion: DLBCL shows expression of CD-10, BCL-6 and MUM-1 in nearly fifty percent of the cases. CD-10 is associated with good whereas MUM is associated with poor response. However, there was no association of BCL-6 with immediate clinical response.
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http://dx.doi.org/10.2014/JCPSP.722727DOI Listing
October 2014

Mucinous tubular and spindle cell carcinoma of kidney: a clinicopathologic study of six cases.

Indian J Pathol Microbiol 2012 Oct-Dec;55(4):439-42

Department of Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan.

Background: Mucinous tubular and spindle carcinoma (MTSCC) of kidney is a rare, low-grade polymorphic tumor. Recent studies have described a wide morphology spectrum of this tumor.

Aim: To report the clinico-pathologic features of six cases of MTSCC of kidney.

Materials And Methods: Six cases of MTSCC of kidney were studied and literature was reviewed. Immunohistochemistry was done by Envision method.

Results: The age of the patients ranged from 44 to 84 years (mean 58.5 years). Four patients were males and two were females. The tumor was located in the left kidney in four cases and in the right kidney in two cases. The tumor size ranged from 4.5 to 15 cm (mean 6.4 cm). All tumors exhibited an admixture of tubules, spindle cells, and mucinous stroma in variable proportions. Tubules were predominant in five cases and spindle cells in one case. Psammomatous calcifications, papillations, and necrosis were seen in two cases. Collections of foamy histiocytes were noted in four cases. Cytoplasmic vacuoles and osseous metaplasia were seen in one case each. All cases were Fuhrman's nuclear grade II. Five cases were of stage pT1, and one was pT3. All cases stained positive for alcian blue at pH 2.5. Immunohistochemical stain CK7 was positive in all cases and CD10 was positive in 1/1 case. All patients were alive and well at follow-up of 12-59 months (mean 33.5 months). No metastases were detected.

Conclusions: We report six cases of MTSCC of kidney, a rare distinct variant of RCC, with a favorable prognosis. A male predominance was seen in our cases. MTSCC shares histologic and immunohistochemical overlap with papillary renal cell carcinoma (PRCC) and cytogenetic analysis should be performed in difficult cases to avoid a misdiagnosis.
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http://dx.doi.org/10.4103/0377-4929.107776DOI Listing
November 2013

Ureteric nephrogenic adenoma: a report of two cases.

Indian J Pathol Microbiol 2012 Apr-Jun;55(2):250-2

Department of Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Johar Town, Lahore, Pakistan.

Nephrogenic adenoma is a rare, benign, metaplastic lesion predominantly seen in urinary bladder, which occurs even more rarely in the ureters. We report two such cases, arising in the ureter. Both patients were young adult males. Histology of both cases was similar, showing tubules lined by columnar cells with hobnailing of nuclei. Immunohistochemically, both cases resembled their counterparts in urinary bladder. These lesions are important to recognize, since they can easily be confused with several malignancies.
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http://dx.doi.org/10.4103/0377-4929.97897DOI Listing
October 2012

Study of parameters to ensure quality control in histopathology reporting: a meta-analysis at a tertiary care center.

Indian J Pathol Microbiol 2012 Apr-Jun;55(2):180-2

Department of Pathology, Sultan Qaboos University Hospital, Muscat, Oman.

Context: When surgical pathology reports are dispatched to patients and clinicians, sometimes they are discovered to have errors, and it is a common practice for the pathologists to issue amended reports. Measuring the rate at which surgical pathology reports are amended can be used as a tool for assuring quality control in histopathology.

Aim: The aim of this study was determine the parameters that can be used as an assessment tool to minimize errors in histopathology.

Materials And Methods: This study was carried out at a major histopathology center. The duration of this study was from January 2001 through January 2011(ten years). Following parameters were looked for: Interpretational errors, permanent and frozen section correlation, intradepartmental consultation and cases sent for second opinion, cases brought in tissue committee meetings, audits, and cases discussed in hospital meetings.

Results: A total of 28,1931 surgical pathology cases were signed out during the ten-year period. On these, addendums were issued on 5730 cases (2.0%). Additional report issued on 3521 (1.3%). Addendum/corrected report issued for 2209 cases, which was 0.7%, representing the true interpretational error. And out of this number, a second opinion was taken for 5980 cases, and 78 were sent abroad for second opinion.

Conclusion: Review by a second pathologist is a strong tool to minimize errors in surgical pathology reporting. This may be done prior to or after the report is dispatched and the case is discussed in the hospital for treatment purposes. This analysis concludes that true interpretational error occurred only in 0.7% of cases, which is an attribute to the strong peer review in the department.
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http://dx.doi.org/10.4103/0377-4929.97857DOI Listing
October 2012