Chronic gastritis and Helicobacter pylori: a histopathological study of gastric mucosal biopsies

The aim of this study was to observe the histological features of chronic gastritis and associated effects due to Helicobacter pylori infection in 176 randomly selected antral biopsy specimens of chronic gastritis cases. The specimens were reviewed for the presence or absence of H.pylori. The activity (neutrophilic infiltration) of gastritis and the presence or absence of mucosa-associated lymphoid tissue (MALT) were also noted. Chi-square test (Pearson value) was used to analyze categorical variables. H.pylori was detected in 110 (62.5%) cases of chronic gastritis. There was a significant association between H.pylori infection and activity of chronic gastritis (p=0.002). Lymphoid aggregates were significantly more frequently noted in H.pylori-positive patients (68.2%) vs. H.pylori negative group (47%), (p=0.005). It is concluded that H.pylori is significantly associated with active chronic gastritis and with formation of mucosa-associated lymphoid tissue (MALT), which may develop into gastric lymphoma (MALT type)

Clinico-morphological pattern of intracranial tumors in children

Objective: The objective of present study was to observe the histopathological pattern of intracranial tumors in children (\u3c 15 yrs) and to correlate the site of lesion along with the histological diagnosis. Setting: The study included consecutive cases of intracranial tumors diagnosed in children (\u3c 15 yrs.) in the section of histopathology at the Aga Khan University Hospital, Karachi during the period of three years. Methods:The initial histological evaluation of these lesions was performed on H and E stained section of paraffin embedded tissue. Special stains and immunohistochemical analysis was done whenever indicated. Results:During the study period, fifty-four cases of intracranial tumors were diagnosed in children. The age ranged from 1-1/2 years to 4 years with male to female ratio of 1.1:1. Astrocytoma comprised 39% of all intracranial tumors of childhood. Medulloblastoma (18.6%) ranked the second most prevalent brain tumor followed by empendymoma (13%), oligodendroglioma 7.5% while non-Hodgkin\u27s lymphoma, primitive neuroblastoma 3.7% and ganglioglioma 3.7% while non-Hodgkin\u27s lymphoma, primitive neuroectodermal tumors, mixed germ cell tumor, pineoblastoma, choroid plexus carcinoma and malignant meningioma constituted 1.8% each. Conculsion: Astrocytoma was the most common pediatric brain tumor. Medulloblastoma was more common in males while pilocytic astrocytoma was more frequent in females. Posterior cranial fossa was the most common site (43.5%) of pediatric brain tumors. Low grade astrocytoma was more prevalent in posterior cranial fossa as compared to high grade astrocytoma which was more frequent in the supratentorial region

Interaoperative frozen section consultation: an analysis of accuracy in a teaching hospital.

This Is a retrospective quality assurance study of all frozen sections done at The Aga Khan University Hospital during a six year period (1986 to 1991). There were 1,031 frozen sections out of a cumulative total of 42,985 surgical specimens (2.39%). Nine hundred and seventy-six (94.66%) were concordant. In 92(8.9%) fresh specimens were brought from other hospitals of Karachi, in 37 cases (3.58%) the diagnosis was deferred till the evaluation of permanent paraffin sections and 18 (1,74%) were discordant with 7 (0.67%) false positive and 11(1,06%) false negative. Among the discordant cases, 9 were attributed to misinterpretation, 7 due to sampling errors and 2 due to technical reasons. Some of these errors might have been avoided, but appear to be an Irreducible minimum

Candida esophagitis: Risk factors in non-HIV population in Pakistan

AIM: Candida esophagitis is a frequent infection in immunocompromised patients. This study was designed to determine its characteristics in non- human immune deficiency virus (HIV) infected patients attending a teaching hospital. METHODS: Clinical records of all patients coded by international classification of diseases 9th revision with clinical modifications\u27 (ICD-9-CM), with candida esophagitis diagnosed by esophagogastroduodenoscopy (EGD) and histopathology over a period of 5 years were studied. RESULTS: Fifty-one patients (27 males, 24 females, range 21-77 years old and mean age 52.9 years) fulfilled the criteria (0.34% of the EGD). The common predisposing factors were carcinoma (OR 3.87, CI 1.00-14.99) and diabetes mellitus (OR 4.39, CI 1.34-14.42). The frequent clinical symptoms were retrosternal discomfort, dysphagia and epigastric abdominal pain with endoscopic appearance of scattered mucosal plaques. Another endoscopic lesion was associated with candida esophagitis in 15% patients. CONCLUSION: Carcinomas, diabetes mellitus, corticosteroid and antibiotic therapy are major risk factors for candida esophagitis in Pakistan. It is an easily managed complication that responds to treatment with nystatin

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

Comparative analysis of viral titers and histologic features of Pakistani patients infected with hepatitis C virus type 3

Background: Serum hepatitis C virus (HCV) RNA levels and genotypes are considered to be important determinants of the response to interferon treatment. Generally, patterns of viral loads have been reported for HCV type 1 infections and categorized as low- or high-level viremia. We studied the distribution of HCV RNA levels in patients predominantly infected with HCV type 3 and correlated it with hepatic damage.Methods: Serum HCV RNA levels and HCV serotypes were determined in 245 anti-HCV-positive patients representing all the major ethnic groups of Pakistan. Patients were grouped according to their HCV RNA levels as: level I (up to 50th percentile); level II (50th to 75th percentile); and level III (\u3e75th percentile).Results: Sixty-one patients (25%) had high-level viremia (level III) of 13.9 mega equivalent per milliliter (MEq/mL) or greater. These were more likely to be males (48 versus 13, P\u3c0.05). A higher viral load correlated with advanced levels of fatty changes in liver. HCV type 3 was found in 68% of the samples, and type 1 in 14%; the rest were undefined. Mean HCV RNA levels were lower in patients infected with HCV type 3 than in patients infected with HCV type 1 (8.63 MEq/mL versus 37 MEq/mL; P\u3c0.001).CONCLUSIONS: Most patients with HCV type 3 infection had viremia that was significantly lower than that in HCV type 1-infected patients. This may be the reason for the better response to treatment usually seen in such cases. The severity of histologic changes was not associated with HCV type 3 viremia levels

Large-scale pathology-based cancer data--a reflection of population-based cancer data.

ABSTRACTPathology-based cancer data is a high quality reflection of the patterns of cancer in the population it represents, provided the demographic details of the patients are carefully recorded. Relative frequency data is neither a replacement for population-based data nor a suggested alternative; it simply enhances the quality of population data and in very large data sets reflects the cancer patterns observed in the representative populations. Aware of the standard shortfalls of pathology-based data, the department of pathology, ‘The Aga Khan University Hospital’ (AKUH) standardized its data, representing 53.4% of the cancer data of Karachi Division (Pakistan) and also reflecting the cancer pattern of other provinces of Pakistan. This data was compared with 4 different population and institutional-based data sets. The findings substantiate the observation that “despite the problems of interpretation of data from pathology laboratories, they are an invaluable source of information on cancer patterns in much of the world where incidence data are unavailable“. If developing countries, unable to organize National Population-Based Registry should as an alternate develop National Pathology-based Registers a well targeted and monitored, a Cancer Control Program would be possible. A good quality, large-scale pathology data with demographic details of the patient recorded can also be extended to give coverage to the population

Cancer of the Oral Cavity and Pharynx in Karachi - Identification of Potential Risk Factors

The objective of the study was to provide an overview of the demographics of cancer of the oral cavity and ‍pharynx in Karachi South (1995-2001), and identify potential risk factors. Cases recorded for Karachi South, at ‍Karachi Cancer Registry during 1st January 1995 to 31st December 2002 were analysed. For maximum completion ‍of data cancer cases, recorded from 1st January 1995 to 31st December 2001 were included for final analysis. The age ‍standardized incidence rates per 100,000 population (ASIRs) for cancer of the oral cavity (excluding salivary gland) ‍in Karachi South were 17.1 and 16.5 in males and females whereas the ASIRs for cancer of the pharynx (excluding ‍nasopharynx) were 7.1 and 2.4 in males and females, respectively. The oral pharyngeal ratios were 2.4 and 6.9 for ‍males and females and gender ratios (M F) were 1.04 for the oral cavity and 3.0 for the pharynx. The mean ages were ‍51 years (95% CI 49.6; 52.2) and 56.1 years (95% CI 54.4; 57.8) respectively. Cancer of the oral cavity ranked 2nd in ‍Karachi in both genders. Cancer of the pharynx ranked 7th in males and 14th in females. Approximately 97% of the ‍oral cavity and pharyngeal cancers were histologically confirmed. The majority of the oral (47.1%) and pharyngeal ‍(51.9%) cancer cases presented as grade II lesions, and were discovered at advanced stages. Of the cancers reported ‍during 1995-2001, 60.4% of the oral and 78.1% of the pharyngeal lesions had spread to a distant site at the time of ‍diagnosis. Squamous cell carcinoma comprised 96.5% and 91.8% of the totals. The incidences of these cancers are ‍comparable to the highest risk regions of the world. As distinct from other geographical areas oral cancer is as ‍common in females as in males, which may reflect the pattern of exposure to known risk factors such as betal quid, ‍arecanut and tobacco and the absence of alcohol as a risk factor in both genders. Apergillus contamination of ‍arecanut could also be a risk factor but no confirmation studies or quantification is available. Despite the common ‍risk factors, incidence of pharyngeal cancer is three times higher in men as compared with women. The keys to ‍reducing the incidence and mortality due to oral and pharyngeal cancers are prevention and control, emphasizing ‍cessation of tobacco use and cancer screening. However a targeted cancer and tobacco control program does not ‍presently exist in Pakistan.