Objectives: The purpose of this study is firstly to signify the occurrence ofunusual nasal polypoid masses by analyzing their histopathological spectrum and to be on thelookout for them. Secondly to highlight the fact that nasal polypoid masses should not be takenlightly as they may be representing an underlying grave pathological process meriting urgentmedical advice. Study Design: Retrospective/observational study. Setting: Charsada TeachingHospital affiliated with Jinnah Medical College Peshawar. Period: March 2010 to March 2015.Methods: In this study, all the surgical pathology cases with clinical diagnosis of nasal polypswith no suspicion for malignancy were retrieved from archives of Charsada Teaching Hospitalaffiliated with Jinnah Medical College Peshawar. The slides and diagnoses of all the retrievedcases were reviewed. The number of cases for each diagnostic category were recorded andanalyzed according to the non-neoplastic, neoplastic and their subcategories. Results: Thereview of cases from March 2010- March 2015 showed that most of the polypoid masses werenon-neoplastic, while only few were neoplastic. Of all the non-neoplastic masses, inflammatory/allergic polyps were much more common followed bypolyps with fungal infections andeosinophilic angiocentric fibrosis. Amongst the neoplastic masses, benign tumors were morecommon than the malignant. The benign masses comprised of hemangioma, angiofibroma,inverted papilloma and schwannoma. The malignant nasal masses constituted one case eachof polypoid extraskeletal Ewings sacoma, plasmacytoma, non-Hodgkin lymphoma and renalcell carcinoma. Conclusions: Awareness about the occurrence of the usual and unusualentities in the nasal cavities needs to be increased. Important diagnostic categories requiringurgent management include polyps with invasive fungal infection, inverted papilloma and allmalignant cases. Therefore, all unilateral nasal cavity masses with frequent epistaxis, pain orbone erosions should be submitted for histopathological examination.
Acute appendicitis is a common cause of acute surgical abdomen and manyappendectomies are performed daily. All disease processes involving appendix will present asacute appendicitis. Clinically diagnosed acute appendicitis is treated by urgent appendectomy.As most of the removed appendices will reveal acute suppurative inflammation, therefore,appendectomy specimens are not usually submitted for histopathological examination unlessthe surgeon notices advanced disease or grossly recognizable abnormalities. Objectives: Thepurpose of this study is; 1, to explore the spectrum of diseases affecting the appendix in thecommunity; 2, to find the age and gender association of appendicular diseases; and 3, to seeif all the surgically removed appendices should be submitted for histopathological examinationas a routine procedure. Study Design: Retrospective study. Setting: Charsada TeachingHospital affiliated with Jinnah Medical College Peshawar. Period: January 2013 to January2016. Methods: The histology slides and diagnoses of all the retrieved cases were reviewedwith regards to morphology, patient’s age, gender and presence or absence of any associateddisease. Results: Nine disease entities were identified affecting the appendix, which from mostto least common were acute suppurative appendicitis, lymphoid hyperplasia, fecalith, fibrousluminal obliteration, oxyuriasis, carcinoid tumor, submucosal fibrosis, acquired diverticulosis,and inflammatory mucocele. The first three commonest diseases were most frequent in thesecond decade of life; fibrous luminal obliteration in the fourth decade, carcinoid tumors inthe third decade, and oxyuriasis in the first decade. Moreover, acute suppurative appendicitis,fecalith, oxyuriasis, and submucosal fibrosis were more frequent in males; whereas, lymphoidhyperplasia and fibrous luminal obliteration were more common in females. Conclusions:Acute suppurative appendicitis was the most common histological diagnosis. Acute suppurativeappendicitis, fecalith, oxyuriasis, and submucosal fibrosis were more common in males;whereas, lymphoid hyperplasia and fibrous luminal atresia were more common in females.Acute suppurative appendicitis, lymphoid hyperplasia, and fecalith were most common in thesecond decade of life. In view of the nine different histological disease entities identified in thisstudy under one clinical diagnosis of acute appendicitis, it is highly recommended to submit allappendectomy specimens for histopathological examination.
Objectives: The purpose of this study is; firstly, to study the histopathologicalspectrum of the pigmented skin lesions in the community, to signify that not all pigmented skinlesions are malignant melanomas; secondly, to assess the age-wise distribution of the commonpigmented skin lesions; and thirdly, to determine the commonly affected body sites by thesepigmented skin lesions. Study Design: Retrospective/Observational study. Setting: CharsadaTeaching Hospital affiliated with Jinnah Medical College Peshawar. Period: 100 consecutivecases with clinical diagnosis of pigmented skin lesion, starting in the year 2013. Methods: Inthis study, 100 consecutive surgical pathology cases with clinical diagnosis of pigmented skinlesion were retrieved from the archives of Charsada Teaching Hospital affiliated with JinnahMedical College Peshawar. All the specimens were incisional biopsies of skin, fixed in 10%formalin, embedded in paraffin, and stained with Hematoxylin and Eosin stains. Results: Onanalyzing 100 consecutive pigmented skin lesions (n=100) starting from the year 2013, it wasfound thatthe large majority of these lesions were benign. The most common pigmented skinlesion was melanocytic nevus. Moreover, majority of pigmented skin lesions were seen infemales. Seborrheic keratosis and malignant tumors, like basal cell carcinoma and squamouscell carcinomas, were more commonly seen in males in the 6th and 7th decades of life; whereas,dermatofibroma and post-inflammatory pigmentation were more common in females in the 4thand 5th decades of life. Overall, the pigmented skin lesions were more common in the 3rd, 4th, and5th decades of life with peak in the 4th decade. Skin of face was the most common site affectedby melanocytic nevi and malignant epidermal skin tumors. Conclusions: In conclusion, mostof the pigmented skin lesions are benign, encountered in the 4th decade of life, and commonlyaffect the skin of face. Also, most of the melanocytic nevi are encountered in females, whilemost of the malignant epidermal neoplasms are encountered in males affecting the skin of face.
Objectives: Urine cytology is an easy to perform non-invasive screening test forpatients who are suspected of having urinary tract malignancy. Urothelial carcinoma constitutesapproximately 90% of all primary tumors of urinary bladder.1 High-grade urothelial carcinomasare represented by well characterized cytological features. Whereas cytological features forlow-grade urothelial carcinomas show considerable overlap with features secondary to chronicinflammation, calculi, indwelling catheters or effects of intra-vesical chemotherapy.2 Thepurpose of this study is to find an appropriate set of cytological features of shed urothelial cellsthat will be useful to differentiate low-grade urothelial carcinoma cells from atypical urothelialcells secondary to non-neoplastic conditions. Study Design: Retrospective study. Setting:Charsada Teaching Hospital affiliated with Jinnah Medical College Peshawar. Period: 2010to 2015. Methods: All cases of urine and bladder washing cytology were retrieved for threediagnostic categories namely: low-grade urothelial carcinoma (LGUC), high-grade urothelialcarcinoma (HGUC), and “atypical urothelial cells”; for which histological diagnoses were alsoavailable. These cases were reviewed for cell clusters with smooth or irregular communityborders, cytoplasm texture, nucleomegaly, high nucleus to cytoplasm ratios (N/C ratio),presence of nucleoli, nuclear membrane irregularity, and chromatin texture. Results: Cellclusters with smooth borders were common in reactive changes, whereas irregular communityborders were seen in low-grade urothelial carcinomas and dyscohesive pattern was a featureof HGUC. The increase in N/C ratio ›2:1 was always associated with malignancy. The nuclearmembrane irregularity was also a strong indicator of malignancy. Cytoplasmic homogeneityand nuclear hyperchromasia were more prominent and consistently seen in high-gradeurothelial carcinomas. Conclusions: The study showed that nuclear membrane irregularity,nucleomegaly and high N/C ratio of › 2:1 were the most consistent features found in LGUC.These features can be used with high certainty to differentiate LGUC (malignant) from atypicalurothelial cells (non-neoplastic).
Objective: To identify rapidly changing antibiotic susceptibility of ESBL & Uropathogens. Study Design: Comparative Cross-sectional prospective study. Setting: Allied Hospitals of Peshawar Medical College. Period: 8th November 2021 to 5th March 2022. Material & Methods: 10-15ml of midstream urine was collected in a sterile container from 158 patients Pus cells, red blood cells, and bacteria were examined using microscopy. The standard loop technique was used to inoculate urine specimen on MacConkey and Blood agar. Plates were incubated for 24 hours at 37oC. A colony count of 105 cfu/ml was thought to be significant. Gram staining of the colonies was performed. The biochemical tests were conducted on API 10S for the identification of organisms. Extended-spectrum beta-lactamase organisms were identified by the double-disc synergy method. The Kirby-Bauer disc diffusion method was used to test antibiotic susceptibility on Mueller-Hinton agar according to CLSI guidelines 2021. A statistical package for the social sciences (SPSS) version 20.0 was used for statistical analysis. Results: Out of 158 urine samples 135 (85.5%) had positive culture growth with 35 (25.9%) ESBL confirmed. Antibiotic susceptibility was Nitrofurantoin (70.1%), Trimethoprim-sulfamethoxazole (26.8%), Ciprofloxacin (51.5%), Levofloxacin (51.5%), Ceftriaxone (25.77%) Cefotaxime (23.7%) Ceftazidime (19.5%) Cefepime (27.8%) Aztreonam (2.1%) Meropenem (86.6%) Amoxicillin/clavulanic (37.1%) Gentamycin (73%) Penicillin (0%). Conclusion: Surprisingly, only nitrofurantoin was found to be advised orally as a suitable drug for the treatment of UTIs among the 13 commonly used antibiotics.
Objectives: The purpose of this study is; firstly, to study the histopathologicalspectrum of the pigmented skin lesions in the community, to signify that not all pigmented skinlesions are malignant melanomas; secondly, to assess the age-wise distribution of the commonpigmented skin lesions; and thirdly, to determine the commonly affected body sites by thesepigmented skin lesions. Study Design: Retrospective/Observational study. Setting: CharsadaTeaching Hospital affiliated with Jinnah Medical College Peshawar. Period: 100 consecutivecases with clinical diagnosis of pigmented skin lesion, starting in the year 2013. Methods: Inthis study, 100 consecutive surgical pathology cases with clinical diagnosis of pigmented skinlesion were retrieved from the archives of Charsada Teaching Hospital affiliated with JinnahMedical College Peshawar. All the specimens were incisional biopsies of skin, fixed in 10%formalin, embedded in paraffin, and stained with Hematoxylin and Eosin stains. Results: Onanalyzing 100 consecutive pigmented skin lesions (n=100) starting from the year 2013, it wasfound thatthe large majority of these lesions were benign. The most common pigmented skinlesion was melanocytic nevus. Moreover, majority of pigmented skin lesions were seen infemales. Seborrheic keratosis and malignant tumors, like basal cell carcinoma and squamouscell carcinomas, were more commonly seen in males in the 6th and 7th decades of life; whereas,dermatofibroma and post-inflammatory pigmentation were more common in females in the 4thand 5th decades of life. Overall, the pigmented skin lesions were more common in the 3rd, 4th, and5th decades of life with peak in the 4th decade. Skin of face was the most common site affectedby melanocytic nevi and malignant epidermal skin tumors. Conclusions: In conclusion, mostof the pigmented skin lesions are benign, encountered in the 4th decade of life, and commonlyaffect the skin of face. Also, most of the melanocytic nevi are encountered in females, whilemost of the malignant epidermal neoplasms are encountered in males affecting the skin of face.
Advanced laboratory investigations at reference laboratories play a key role in the diagnosis of the disease, but misuse of this precious and expensive tool may misguide the physician in patient management. This study was carried out as an audit of investigations performed at a reference laboratory, in order to assess their cost effectiveness, to identify various errors, the degree of correlation of requested tests with the clinical diagnosis and benefit to the patients.A four phase audit of 337 laboratory investigation prescription was performed from April 2012 to March 2013 in the Medical, Administration in collaboration with Department of Medical Laboratory and various Clinics at the King Salman Armed Forces Hospital in Northwestern Region, - Kingdom of Saudi Arabia. All the information was recorded on a questionnaire pro forma.On data compilation and analysis it was found that 174(51.63%) test results were within normal reference range, while 163 (48.37%) test results were reported as positive. Also 218 (64.69%) investigations results correlated with clinical assessment by the physician, while 119 (35.31%) investigation results did not correlate with the clinical assessment by the physician. The expenses incurred Euro 12868 were spent on non-correlated tests while on correlated tests were Euro 31831. In terms of benefit to the patients 243 (82.09%) patients were reported by clinicians to have benefited from the reference laboratory tests, while 53 (17.91%) cases did not benefit from the reference laboratory tests as assessed by the clinicians and 41 (12.16%) cases in which even clinician did not respond regarding the benefit to the patients. Three categories of errors were identified (26.40%), i.e., at the level of clinicians (12.75%), at the level of hospital lab (5.04%) and at the level of reference lab (8.60%).Thorough clinical assessment and judicious utilization of available preliminary laboratory tests are the keys to precise diagnosis and are instrumental in reducing reliance on reference laboratory investigations.
In the community and among hospitalized patients, urinary tract infections (UTIs) rank as the most common bacterial infections. The researchers processed urine samples obtained from affiliated hospitals of Peshawar Medical College. The samples were examined under a microscope to assess the presence of bacteria, pus cells and red blood cells. Following this, the samples were inoculated on MacConkey and blood agar and subsequent antibiotic susceptibility testing was conducted. The findings revealed that 35.9% of hospitalized patients and 16.9% of outpatients were diagnosed with UTIs. Furthermore, 82.2% of the identified UTIs were found to be multidrug-resistant (MDR), with MDR Escherichia coli accounting for 77% of cases. Trimethoprim sulfamethazine (26.8%), penicillin (0%), cefepime (27.8%), cefotaxime (23.7%), aztreonam (2.1%), meropenem (86.6%), ciprofloxacin (51.5%), amoxicillin/clavulanic acid (37.1%), nitrofurantoin (70.1%), gentamycin (73%), ceftazidime (19.5%), levofloxacin (51.5%) and ceftriaxone (25.77%) were subjected to antibiotic susceptibility testing. It is concerning that among the 13 antibiotics examined, solely nitrofurantoin displayed oral efficacy as an effective treatment choice for UTIs.
Acute appendicitis is a common cause of acute surgical abdomen and manyappendectomies are performed daily. All disease processes involving appendix will present asacute appendicitis. Clinically diagnosed acute appendicitis is treated by urgent appendectomy.As most of the removed appendices will reveal acute suppurative inflammation, therefore,appendectomy specimens are not usually submitted for histopathological examination unlessthe surgeon notices advanced disease or grossly recognizable abnormalities. Objectives: Thepurpose of this study is; 1, to explore the spectrum of diseases affecting the appendix in thecommunity; 2, to find the age and gender association of appendicular diseases; and 3, to seeif all the surgically removed appendices should be submitted for histopathological examinationas a routine procedure. Study Design: Retrospective study. Setting: Charsada TeachingHospital affiliated with Jinnah Medical College Peshawar. Period: January 2013 to January2016. Methods: The histology slides and diagnoses of all the retrieved cases were reviewedwith regards to morphology, patient’s age, gender and presence or absence of any associateddisease. Results: Nine disease entities were identified affecting the appendix, which from mostto least common were acute suppurative appendicitis, lymphoid hyperplasia, fecalith, fibrousluminal obliteration, oxyuriasis, carcinoid tumor, submucosal fibrosis, acquired diverticulosis,and inflammatory mucocele. The first three commonest diseases were most frequent in thesecond decade of life; fibrous luminal obliteration in the fourth decade, carcinoid tumors inthe third decade, and oxyuriasis in the first decade. Moreover, acute suppurative appendicitis,fecalith, oxyuriasis, and submucosal fibrosis were more frequent in males; whereas, lymphoidhyperplasia and fibrous luminal obliteration were more common in females. Conclusions:Acute suppurative appendicitis was the most common histological diagnosis. Acute suppurativeappendicitis, fecalith, oxyuriasis, and submucosal fibrosis were more common in males;whereas, lymphoid hyperplasia and fibrous luminal atresia were more common in females.Acute suppurative appendicitis, lymphoid hyperplasia, and fecalith were most common in thesecond decade of life. In view of the nine different histological disease entities identified in thisstudy under one clinical diagnosis of acute appendicitis, it is highly recommended to submit allappendectomy specimens for histopathological examination.
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