Colon biopsies for evaluation of acute graft-versus-host disease (A-GVHD) in allogeneic bone marrow transplant patients

BACKGROUND: Proper histomorphological interpretation of intestinal acute graft versus host disease (A-GVHD) associated with allogeneic bone marrow transplantation (BMT) is critical for clinical managaement. However, studies methodically evaluating different histomorphological features of A-GVHD are rare. METHODS: Colonic biopsies from 44 allogeneic BMT patients having biopsy-proven cutaneous A-GVHD were compared with colon biopsies from 48 negative controls. RESULTS: A-GVHD showed intra-cryptal apoptosis in 91% and pericryptal apoptosis in adjacent lamina propria in 70% (p < 0.002). Nonspecific apoptosis along the surface epithelium was observed in all groups with comparable frequency. The number of apoptotic cells in mucosa were approximately four times (5.3 per 10 HPF) the negative controls (p < 0.002) in A-GVHD group. 48% of cases with A-GVHD showed decreased number of lymphocytes in lamina propria. Some features, including intraepithelial lymphocytes in surface or crypt epithelium; and neutrophils, eosinophils, and edema in lamina propria, did not demonstrate significant difference in A-GVHD and negative controls. Pericryptal apoptosis, dilated crypts, irregular distribution of crypts, decreased lymphocytes, increased microvessel network, focal fibrosis, presence of muciphages, reactive changes in surface epithelium with mucin depletion, mucosal ulceration, and/or reduced mucosal thickness showed higher association with A-GVHD group. CONCLUSIONS: Intracyptal apoptosis is a reliable indicator of A-GVHD. Its diagnostic significance was improved if intracyptal apoptosis was associated with features which were observed more frequently in A-GVHD group as mentioned above

Ophthalmology: a dwindling specialty in Pakistan

Madam Editor, Ophthalmology is a branch of medical science that deals with diagnosing and treating eye disorders. It comprises both the medicinal and surgical aspects of eye care. Medical students choose a specific field of their interest as their future speciality. It is the dream of every medical student to go far in his or her field of study and to make good progress. Some students choose Medicine while others opt Surgery. Even in surgery, some students choose General surgery, while others choose other surgical interests, such as Cardiac surgery, Gynaecology, Neurosurgery, etc. The same thing happens in the field of medicine i.e., they want to become Internists, Pediatricians, Dermatologists, Neurologists and Cardiologists. But the tendency of students to opt Ophthalmology is observed to be less in Pakistan (1). According to Aslam M, et al. (2011), only 1.7% of medical students in the .public sector and 3.3% of medical students in private sector medical colleges preferred Ophthalmology.(2). Another study by Hamid S et al., in 2019 conducted on the fourth and final year medical students, and house officers showed that only 3.8% of the participants were interested in Ophthalmology as a future subject of speciality, with a  male to female ratio being 1:3 ,which is alarming as well (3). The main factors influencing medical students not to choose Ophthalmology include, fewer chances of residency, prolonged duration of residency, and limited opportunities in the private sector (4). Besides this, students often perceived Ophthalmology as a ‘dry subject’ by students. The basics of the eye i.e., anatomy, histology, embryology, and physiology are also extensive and difficult to be retained for a prolonged period. Poor retention of concepts can also affect the specialty preference concerning Ophthalmology among medical students. Though there are many benefits of choosing the field as a speciality, some being high income, less working hours and no duties in the night (4). Almost all cases in Ophthalmology are treated in daycare settings and the surgeries are also mainly elective procedures as there are fewer emergency calls. Moreover, sub-specialties are offered including Paediatric Ophthalmology, Orbit and Oculoplastics, and Vitreoretinal Ophthalmology (5). According to the International Council of Ophthalmology, there are 1860 ophthalmologists in Pakistan with 11 ophthalmologists per million of the  population (1). There is a dire need for ophthalmologists in the country. ---Continu

Etiology and genetic factors in clefts of lip and/or palate reported at children′s hospital, Lahore, Pakistan

The etiology of cleft lip (CL) and/or cleft palate (CP) has been extensively studied in industrialized countries and is suggested to be heterogeneous with increasing evidence that both genetic and environmental factors are operating. To evaluate this assertion in a developing country like Pakistan, a case finding cross-sectional study was completed from 1 st July 2010 to 31 st May 2011 for 100 cases of CL and/or CP referred to the Genetic Clinic of the Children′s Hospital, Lahore, Pakistan. A clinical examination followed by necessary diagnostic work-up was completed for each case. The cause of CL and/or CP was clear in 18% of the children ( n = 18). Environmental causes were found in 6 children (four mothers developed hyperthermia during the 2 nd month of gestation, one mother was diabetic, and one mother was a known case of epilepsy and took sodium valproate throughout her pregnancy). Six children were suffering from known genetic malformation syndromes (each with Jarcho-Levin syndrome, Oral-Facial-Digital syndrome type XI, Oral-Duplication syndrome, Kabuki syndrome, Fronto-nasal dysplasia and Nager syndrome). Novel chromosomal aberrations were identified in 2 children. In 82% of the children ( n = 82) the cause of oro-facial clefts remained unknown. Impact of gender and consanguinity on the development of CL and/or CP was also studied. Prevalence of CP was significantly more among female children as compared to that in males ( P < 0.05). Associated anomalies were present in 18% of the cases, anomalies of the craniofacial region being the most common. These findings were compared with regional and international studies

Postharvest starch and sugars adjustment in potato tubers of wide-ranging dormancy genotypes subjected to various sprout forcing techniques

Abstract The development of an efficient, safe, and environment-friendly technique to terminate tuber dormancy in potatoes (Solanum tuberosum L.) is of great concern due to the immense scope of multiple cropping all over the globe. The breakage of tuber dormancy has been associated with numerous physiological changes, including a decline in the level of starch and an increase in the levels of sugars during storage of freshly harvested seed potatoes, although their consistency across genotypes and various dormancy-breaking techniques have not yet been fully elucidated. The purpose of the present research is to assess the efficacy of four different dormancy-breaking techniques, such as soaking in 90, 60, or 30 mg L−1 solutions of benzyl amino purine (BAP) and 30, 20, or 10 mg L−1 gibberellic acid (GA3) alone and in the combination of optimized concentrations; cold pre-treatment at 6, 4, or 2 °C; electric shock at 80, 60, 40, or 20 Vs; and irradiation at 3.5, 3, 2.5, 2, 1.5, or 1 kGy on the tuber dormancy period and sprout length of six genotypes. Furthermore, the changes that occurred in tuber weight and endogenous starch, sucrose, fructose, and glucose contents in experimental genotypes following the application of these techniques were also examined. Overall, the most effective technique to terminate tuber dormancy and hasten spout growth was the combined application of BAP and GA3, which reduced the length of dormancy by 9.6 days compared to the untreated control, following 6.7 days of electric current, 4.4 days of cold pre-treatment, and finally irradiation (3.3 days). The 60 mg L−1 solution of BAP greatly reduced the dormancy period in all genotypes but did not affect the sprout length at all. The genotypes showed a weak negative correlation (r =  − 0.4) (P < 0.05) of endogenous starch contents with dormancy breakage and weight loss or a moderate (r =  − 0.5) correlation with sprout length, but a strong positive correlation (r = 0.8) of tuber glucose, fructose, and sucrose contents with dormancy breakage and weight loss. During 3 weeks of storage, sprouting commencement and significant weight loss occurred as tuber dormancy advanced towards breakage due to a reduction in starch and an increase in the sucrose, fructose, and glucose contents of the tubers. These findings could be advantageous for postponing or accelerating seed potato storage as well as investigating related physiological research in the future