Frequency and Characteristics of Breast lymphomas presenting to a tertiary care hospital, Pakistan

Objective: To assess the relative frequency of (primary and secondary) mammary lymphomas presenting to a tertiary care hospital, Pakistan and its categorization according to WHO classification of lymphoid neoplasms. Methods: All NHLs (nodal and extra nodal) diagnosed in the section of histopathology during 1992-2004 were retrieved and reviewed. All patients (n=30) diagnosed with lymphomatous involvement of the breast were selected. Distinction between primary and secondary breast lymphomas was not made owing to lack of availability of clinical information. Results: A total of 5637 breast malignancies were diagnosed in our department during the study period of 10 years and the total number of NHLs (Nodal and extra Nodal) was 2632. Thirty (n=30) patients accounting for 1.13% were diagnosed to have lymphomatous involvement of the breast. The Female to Male ratio was13.5:1; age range was 12-92 years with a median age of 43 years (Mean age 46.5 years and Standard deviation of age was 16.88 years). The sites of the lesions were the right breast in 11 cases (37.93%), left breast in 9 cases (31.03%) and both breasts in 2 cases (6.89%), while the location of 8 masses (27.58%) was unknown. Immunohistochemical studies were negative for cytokeratins (MNF and Cam 5.2) in all cases. All cases of DLBCL expressed B cell lineage antigens and were positive for LCA and Pan B (CD20 and 79a). Conclusion: We concluded that breast lymphomas represent 1.13% of all NHL and 0.5% of all breast malignancies in this study. The most frequent morphologic type was diffuse large B-cell lymphoma. As patients with primary breast lymphoma have a better prognosis than those with carcinoma of the breast or patients with extranodal lymphomas, a multidisciplinary approach including surgery, radiotherapy, and chemotherapy when needed would result in a more favourable outcome

Significance of immunohistochemistry in accurate characterization of malignant tumors

Background: To determine in a large series of surgical biopsies the role and significance of immunohistochemistry in the adequate and accurate characterization of malignant tumors. Methods: A retrospective study of 20,000 consecutive surgical biopsies reported in the Section of Histopathology, AKU in 2003. Data was obtained by retrieving the filed surgical biopsy reports in the section. Results And Conclusions: Out of the 20,000 biopsies, 6534 (32.67%) were neoplastic. 4726 neoplasms (72.33%) were malignant, and 1808 (27.67%) were benign. Immunohistochemistry was performed on 29.49% of malignant tumors, and 4.97% of benign tumors. Immunos were performed on only 2.82% of routine squamous cell carcinomas and adenocarcinomas of various organs, and in only 1.9% of infiltrating breast carcinomas, the commonest malignant tumors in females. In contrast, immunos were performed on 97.12% of non-Hodgkin\u27s lymphomas, 97.94% of Hodgkin\u27s lymphomas, 98.09% of malignant spindle cell neoplasms, 87.96% of small round blue cell tumors of childhood, 87.30% of neuroendocrine neoplasms, and 84.37% cases of malignant melanomas. In addition, immunos were performed on all cases of malignant undifferentiated neoplasms and were able to resolve the issue in over 89% of such cases. Immunos were also performed on 54.74% of metastatic tumors. Lymph nodes were the commonest organs on which immunos were performed i.e. 96.50% of lymph node tumors, followed by CNS and renal neoplasms with 33.01% and 25.92% respectively

Correlation of trainees\u27 selection scores with their subsequent performance during specialty training in anesthesiology

Objective: To determine the correlation of trainee selection scores (TSS) with subsequent performance in anesthesiology trainees at a university hospital.Study Design: Descriptive analytical study.Place and Duration of Study: The Aga Khan University Hospital, Karachi, from August 2016 to January 2017.Methodology: Data were collected on 44 anesthesiology trainees completing their training between 2009 and 2015. TSS consisted of entrance test, final-year medical school scores, and interviews. Assessment included written tests, viva voce, and clinical assessment. Non-parametric Spearman rank correlation coefficient was computed to assess the relationship between scores.Results: Weak correlation was found between TSS and overall assessment scores for first three years of training. Correlation of TSS with clinical component of assessment was weak throughout training, while it was moderately significant with cognitive component of assessment in third and fourth years of training. Correlation between interview scores and cognitive as well as clinical assessment was non-significant. TSS showed weak correlation with success in exit level examination.Conclusion: Correlation between overall TSS and assessment scores was weak for first three years of training, and becoming moderately positive in later years of training. Cognitive component of TSS had moderately positive correlation with cognitive assessment, but not with clinical performance. Anesthesiology training programmes need to strengthen their selection criteria; and development of structured interviews might prove useful. Future research should focus upon identifying most useful traits in selecting high performers in anesthesiology training

Low rate of recurrence of Helicobacter pylori infection in spite of high clarithromycin resistance in Pakistan

Background The aim was to investigate the reinfection rate of H. pylori during a follow-up period of 12 months in adults who had undergone eradication therapy. Methods One hundred-twenty patients; 116 with gastritis, 3 with duodenal ulcer and 1 gastric ulcer, were studied. Their mean age was 41 ± 13 years (range 18–77) and male: female ratio of 2:1. H. pylori were cultured and antibiotic sensitivity was determined by Epsilometer test (E-test) for clarithromycin (CLR) and amoxicillin (AMX). Primers of urease C gene of H. pylori and Sau-3 and Hha I restriction enzymes were used for polymerase chain reaction-restriction fragment length polymorphism analysis (PCR-RFLP). 14C urea breath test (14C-UBT) was performed 4 weeks after the eradication therapy. The successfully treated patients were observed for 12 months with 14C-UBT to assess H. pylori status. If 14C-UBT was negative, it was repeated after every 12 weeks. If 14C-UBT was positive, endoscopy was repeated with biopsies. Result The eradication therapy was successful in 102(85%) patients. Out of forty-seven H. pylori isolates cultured, clarithromycin sensitivity was present in 30(64%) and amoxicillin in 45(98%), respectively. Follow-up 14C-urea breath tests of all 102 patients who eradicated H. pylori remained negative up to 9 months. However, in 6 patients, the 14C-UBT confirmed recurrence at 12 months. The recurrence rate was 6%. Conclusion A low rate of recurrence of H. pylori infection was found in patients with dyspeptic symptoms. H. pylori isolates demonstrated a high invitro clarithromycin resistance

Retinoblastoma tells the story of our health care system

Objective: To review cases of retinoblastoma. Setting: Department of Pathology Aga Khan University Hospital Karachi. Method: Twenty three specimens from cases of retinoblastoma received over a period of eight years were routinely processes and stained with haematoxylin and Eosin stain Other stains were used for tuberculosis and melanin. Immunochemistry was resorted to in undifferentiated tumors. Results: Over 60% cases of retinoblastoma were diagnosed after 5 years and nine cases showed involvement of opti-nerve. Conclusion: Late diagnosis of retinoblastoma effects the stage of the tumors and the prognisis

Variation in the Quality of Life within Punjab: Evidence from MICS, 2007-08

Since quality of life research is essentially concerned with measuring and monitoring welfare. In order to measure quality of life, one must have a theory of what makes up a good life [Cobb (2000)]. There is a variety of such theories and notions of what constitutes a ‗good life‘ and correspondingly different concepts of welfare and quality of life have been developed. Various approaches and operationalisations are to be distinguished, each of which reveals a different concept of welfare and thus highlights different components and dimensions [Noll (2000)]. Among the various efforts to operationalise welfare in general and the quality of life concept in particular, two contrary approaches are to be distinguished, which define the two extreme positions on a broad continuum of concepts currently available: the Scandinavian level of living approach [Erickson (1993)] and the American quality of life approach [Campbell (1976)]. The Scandinavian approach focuses almost exclusively on resources and objective living conditions, whereas the American approach emphasises the subjective well-being of individuals as a final outcome of conditions and processes

Learning approaches and academic performance of undergraduate medical students in Pakistan

Objective: To classify undergraduate medical students according to their learning approaches and to correlate the learning approaches with their academic achievements.Materials and Methods: A questionnaire to appraise learning approaches of undergraduate medical students was administered and collected at the end of the regular certifying examinations. The responses were analysed through the principal component factor analysis.Results: The results did not depict formation of demonstrable learning approaches during academic years. However, increased self-awareness about the approaches was indicated by the responses of final year students as compared to the third year students. The correlation of the learning approaches with the scores of the certifying examination and a mock test (consisting of specially developed integrated questions), through multivariate analysis depicted statistically insignificant results.Conclusion: There was a non-significant relationship between the learning approaches and academic performances and a weak statistical significance between achievement, orientation and performance in certifying examination. It is essential that along with changes in the instructional and assessment strategies awareness should be created in students about various learning approaches

Frequency of primary solid malignant neoplasms in both sexes, as seen in our practice

Background: To determine the frequency of various histologic types of primary solid malignant neoplasms in males and females, in our practice, in a large series of surgical biopdies. Method: A retrospective study of 20,000 consecutive surgical biopsies in the section of Histopathology, Aga Khan University Hospital (AKU), Karachi, in 2004. Results: Squamous cell carcinoma of oral cavity was the commonest malignant neoplasm in males followed by diffuse Large B cell, Non-Hodgkin\u27s lymphoma and Prostatic adenocarcinoma. In females, infiltrating Ductal carcinoma of the breast was overwhelmingly the commonest malignant neoplasm followed by Squamous cell carcinoma of the oral cavity and esophagus. Conclusion: Out of 20,000 biopsies, there were 4616(23.08%) malignant neplasms. Carcinoma of oral cavity is very common in our population in both sexes

Case of xanthogranulomatous oophoritis

Xanthogranulomatous inflammation is characterized by destruction of the tissues of the organ involved and replacement by chronic inflammatory cells such as lymphocytes, plasma cells, occasional neutrophils with or without multinucleated or Touton giant cells. Exact aetiology is not known but the theory of infection with organisms like Proteus, E coli, and Bacteroides fragilis is most popular. Xanthogranulomatous inflammation of the female genital tract is not common and usually involves the endometrium; however, xanthogranulomatous inflammation of the ovaries is a rare entity