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Professor, Consultant Pathologist, American Board Certified Pathologist, Fellow College of American Pathologists. Areas of interest Fine Needle Aspiration Cytology, Cytology, Cancer, Ethics, Islam, Humanity

EDITORIAL: Strict Accountability & Self Improvement are the Keys to the Success

Anwar Ul Haque

Who are applying these golden principles of success today? So called Muslim world or non- Muslim world Sad to say these principles are mostly applied by several non-Muslim nations e.g., USA. Of course, not in all fields but only in certain areas. Even though it is partial implementation; mostly limited to the society working atmosphere, it is reaping enormous benefits. You will see feedback about services in every field form post office to doctor’s clinic. Everybody is held accountable and at multiple levels. How doctor talked to you? What do you think about facilities and then further dissection covering every aspect of the services. Based on these feedbacks and appraisal persons are promoted, demoted or fired.
Now compare this to a developing country e.g., Pakistan. Here every rule is broken by a single phone call from high ups. Here appointments are often made by cruelly crushing all standards and procedures. Not only in Governmental institutions but also in some high fame private institutions. So, the results are not surprising; we are being destroyed bit by bit and piece by piece. We heavily pay every day and at every step. We have for example very high incidences of airline and railway accidents. Many patients succumb to poor treatment and management at the hospitals. Our land and airspace are used for attacks on Muslims in a neighboring country and our country is infested by foreign controlled terrorist mafias and our budget is sucked by IMF and other global money landers. On the other hand, West not benefitting from Quran also suffers in areas of family life, drugs and uncalled wars.
Solution is same for both i.e., divine guidance. We must adopt and implement the principles of merit and accountability in every sphere of our lives. To implement and infuse Quran in our lives, we must understand it. Sadly, the theocracy has no interest in teaching Quranic Arabic as they have taken religion as profession and money making rather than purifying the society.

Original Article: Prevalence of Abnormal Thrombophilia Profile in Chronic Kidney Disease

Sehrish Khurshid1, Rabbia Tariq2, Javeria Qureshi3, Raffia Mazher4
1Department of Pathology, Hamdard University.2Department of Pathology, Isra University. 3Department of Hematology, Sindh Institute of Urology and Transplantation, 4Department of Nephrologhy, Liaquat University of Medical and Health Sciences.

Objective: To determine the prevalence of altered thrombophilia in chronic kidney disease.
Study Design: Descriptive retrospective study
Place and duration of study: The study was conducted at Isra University hospital from June 2019 to December 2020
Material and Methods: 150 patients of stage 3, 4 and 5 of chronic kidney disease were enrolled in the study. Patients with stage 1 and 2 chronic kidney disease and on anticoagulation treatment were excluded from study. Stages of chronic kidney disease were classified according to KDIGO criteria. Thrombophilia screening for Antithrombin-III, protein C, protein S, Lupus anticoagulant and Activated Protein C was performed on coagulation analyzer. Findings were recorded and data were analyzed by SPSS version 25
Results: Fifty Seven out of 150 patients were positive for thrombophilia screening with Antithrombin-III deficiency in 28.3%, Protein C deficiency in 7.9%, Protein S deficiency in 3.3%, Lupus anticoagulant in 6.6% and activated Protein C resistance in 2.0%. Out of 43 Antithrombin-III deficient patients, 53.4% (n=23) were on hemodialysis. Out of 12 Protein C deficient patients, 58.3 %(n=7) were on hemodialysis. Out of 10 patients with lupus anticoagulant, 60% (n=6) were on hemodialysis and out of 3 patients with Activated Protein C resistance, 33.3% (n=1) were on hemodialysis.
Conclusion: In this study, Antithrombin-III deficiency was most common finding in CKD and thrombophilia was most common in stage 5 chronic kidney disease and lupus anticoagulant was common finding in relation to hemodialysis. More studies are needed to define true significance of thrombophilia screening in all stages of CKD patients.

Original Article: Determine the Obesity as a Risk Factor for Gestational Diabetes Mellitus and Gestational Hypertension as Compared to Non-Obese Patients

Samreen Riaz1, Saleha Ijaz2, Hina Zafar2, Sameena Gardezi2, Sidra Fareed1 and 3Hafiza Sobia Ramzan
1Kot Khawaja Saeed Hospital, 2Lady Aitchison Hospital, 3Institute of Molecular Biology and Biotechnoloy, University of Lahore

Introduction: Obesity has been recognized by the World Health Organization as a pandemic nutritional disorder which represents a rapidly growing threat to the health of populations of an increasing number of countries worldwide.
Objectives: The objective was to determine the obesity as a risk factor for Gestational Diabetes Mellitus and Gestational Hypertension when compared with non-obese patients. Material & methods: A cohort study in which comparison of obese patients versus non-obese patients for developing gestational diabetes mellitus and gestational hypertension was done during November 2019 to October 2020. Results: The results of the current study reveals that mean BMI was as 27.86±4.21 in Group-1 and 26.33±3.87 years in Group-2. Comparison of risk factors (gestational diabetes mellitus) in both groups was done which reveals 15.33% (n=23) in Group-1 and 3.33% (n=6) in Group-2, relative risk shows 3.83, which is significant. Conclusions: The frequency of maternal complications is higher among obese pregnant females as compared to normal weight females.

Original Article: Single Nucleotide Polymorphism; A Molecular Marker for Genetic Variations

Ayesha Nayyar1, Suhaib Ahmed2 and Shaista Nayyar3
1-2 Department of Pathology, Islamic International Medical College, Riphah International University,
Islamabad, Pakistan, 3 Department of Radiology, Fazaia Medical College, National university of medical sciences Islamabad, Pakistan.

Objective: Single nucleotide polymorphisms are the most common genetic variations in a human DNA. The aim of the study was to determine the genotype frequency of single nucleotide polymorphisms by a simple PCR technique in order to find the genetic variations in general population.
Design: Descriptive study.
Place and Duration: It was conducted at Genetic Resource Centre Lab Rawalpindi from Oct 2017- May 2018.
Methods: A total of hundred unrelated healthy individuals were selected and assessed for the genotype frequency of eighteen biallelic single nucleotide polymorphisms. Extraction of DNA was done from the whole blood and single nucleotide polymorphism were amplified by using conventional PCR assay. Electrophoresis was carried out and 6% polyacrylamide gels were used for the resultant amplified DNA products.
Results: A positive reaction was shown by a discrete band of DNA on the polyacrylamide gel. The most commonly found SNPs were S01, S03, S06, S07a, and S10a.
Conclusion: Our results demonstrate the successful screening and genotype frequency of each single nucleotide polymorphism by using a PCR amplification of polyacrylamide gel electrophoresis in general population. This research has provided a new and comprehensive methodology for carrying out further studies using SNPs as a marker of discrimination in the donor/recipient pairs having undergone haematopoietic stem cell transplantation in Pakistan. This PCR assay of SNPs appears to be a simple, rapid, reliable and technically feasible method for a use in a lab equipped with PCR.

Original Article: Role of Social Media in Medical Education – A Peep into the Pre-Covid 19 Scenario

Hijab Shah1, Rizwan Hashim2, Soffia Khursheed3, Bushra Anwar4, Nazish Babar5, Rubina Riaz6, Daniyal Tariq7 and Adam Irshad8
1,2,4,5,6,7,8 Department of Pathology. Fazaia Medical College. 3 Department of Pathology. Benazir Bhutto Hospital, Rawalpindi.

Introduction: The platforms developed by social media are valued tools for educational purposes. However there is a lack of indigenous data especially in the Pre-COVID-19 situation that would give a glimpse of social media usage for educational purposes in Pakistan.
Objective: To determine the awareness and frequency of use of social media for educational purposes by medical students and faculty in the Pre-COVID-19 period.
Materials & Methods: It was a mixed method study comprising of self-constructed questionnaire, with closed ended questions for quantitative study and open ended questions for qualitative study. The study was carried out in Fazaia Medical College, Air University Islamabad, Pakistan over a period of 6 months (August 2018 to Jan 2019). Third year medical students and medical faculty participated in the study. Formal permission of the Institutional Review Board Bioethical Committee was obtained.
Results: Ninety eight percent (70/71) students used social media for their educational purposes, 97% (69/71) & 77% (55/71) students believed that social media platforms increased their knowledge & skills respectively, 37% students (26/71) expressed time constraints with respect to use of social media in educational sphere, however 100% (28/28) faculty members were well aware of use of social media in medical education, whereas 60% (17/28) had time constraints, regarding the use of social media for education purposes. Themes and subthemes were derived from qualitative data and presented in a tabulated form.
Conclusion: Use of social media in medical education is a challenging task for institutes and facilitators that requires adaptation

Original Article: Determination of Factors that may Lead to Acquisition and Transmission of New SARS-CoV-2 Variant VUI-202012/01 in Pakistan- A Multicenter Cross-Sectional Survey

1Yusra Shafquat, 2Riyasat Ahmed Memon, 3Hira Shafquat Memon, 4Muhammad Rahil Khan, 5Ikram Din Ujjan and 6Faisal Imran
1Assistant Professor, Department of Pathology, Bilawal Medical College for Boys, Liaquat University of Medical and Health Sciences, Jamshoro, 2 Senior Lecturer, Department of Pathology, Bilawal Medical College for Boys, Liaquat University of Medical and Health Sciences, Jamshoro, 3Women Medical Officer, Liaquat University of Medical and Health Sciences, Jamshoro, 4Assistant Professor, Department of Pathology, Liaquat University of Medical and Health Sciences, Jamshoro, 5Pro- Vice Chancellor, Liaquat University of Medical and Health Sciences, Jamshoro, 6 Quality Manager, Diagnostic and Research Laboratory, Liaquat University of Medical and Health Sciences, Jamshoro

Introduction: COVID-19 has become a major public threat. Implementation of no strict preventive measures would increase the cases unless the local community has knowledge of disease and its preventive measures. Emergence of variants and mutant strains is expected with the introduction of mass vaccination and validated treatment, hence making preparedness against them is essential. In this study we have determined the attitude of local population to COVID-19 and its prevention, and the factors associated with compliance with preventive measures. The data will help in estimating the expected increase in disease burden and measures that need to be taken to stop the spread of new SARS-CoV-2 variant VUI-202012/01.
Methodology: This cross-sectional survey was performed by the Department of Pathology, Bilawal Medical college for boys and Liaquat University of Medical and Health sciences and included residents of Hyderabad, Jamshoro and Mirpur Khas, from 1st December to 31st December 2020, using a questionnaire on telephone. Knowledge about the disease and the preventive measures were analyzed. Factors associated with compliance with preventive measures were determined using logistic regression.
Results: 1020 participants were included. 94.5% frequently washed hands, 89.2% wore masks and 31.6% practiced social distancing. On logistic regression, those with high school education and belonging to occupations of teaching and shopkeepers showed statistically significant association with adherence to precautionary measures. 15.3% participants had taken chloroquine or hydroxychloroquine.
Conclusion: Our survey shows most of the participants were not following the recommended preventive measures. Appropriate education of preventive measures and strict reforms are imperative, to stop transmission of new SARS-CoV-2 variant VUI-202012/01.

Original Article: Comparison of Different Staining Techniques for Identification of Helicobacter Pylori in Gastric Biopsies

1Saima Nadeem, 2Nuzhat Sultana, 3Shazia Naz, 4Momena Ali, 5Amina Gul and 6Ambareen Moatassim
1Department of Pathology, Khyber Girls Medical College, Peshawar, 2Department of Pathology, Northwest Medical College, Peshawar, 3Department of Pathology, Kabir Medical College, Peshawar, 4Department of Pathology, Khyber Medical College, Peshawar, 5Department of Pathology, Khyber Medical College, Peshawar, Pakistan, 6 PAEC Hospital, Islamabad, .

Objective: To compare the efficacy of different staining (H&E, modified Giemsa stain and Immunohistochemical stains) for detecting H pylori in gastric biopsies.
Methodology: This descriptive study was carried out at the Department of Pathology, Khyber Girls Medical College/ Hayatabad Medical Complex Peshawar. A non-probability convenience sampling technique was used to select study participants from December 2018 to July 2019. Total 104 gastric biopsies obtained through upper GI endoscopy were processed for identification of H pylori through various staining techniques. All the participants consented to participate in the study. The study was conducted after approval by institutional ethical committee.
Results: Among total 104 cases analyzed, 63 cases were found positive for h pylori infection using H and E stain. Based on Immunohistochemical analysis 101 turned out to be infected with H pylori. The third stain used for H pylori detection was Giemsa stain which revealed the highest percentage of H pylori positivity (100%) after IHC stain. All the 104 cases analyzed were found positive on Giemsa stain.
Conclusion: In daily practice modified Giemsa stain may be sufficient for diagnosis of H.pylori organism.

Original Article: Predictive Value of Serum p53 Antibodies in Oral Squamous Cell Carcinoma

1Abbas Saleem Khan, 2 Sajjad Ahmad, 3Zahoor Ullah, 4Mohsina Haq, 5Muhammad Khalid Usman and 6 Atta ur Rehman
1 Department of Oral Pathology, Peshawar Dental College, Riphah International University, Islamabad, Pakistan, 2 Department of Pathology, Peshawar Medical College, Riphah International University, Islamabad, Pakistan, 3 Department of Biochemistry, Peshawar Medical College, Riphah International University, Islamabad, Pakistan, 4 Department of Microbiology, Peshawar Medical College, Riphah International University, Islamabad, Pakistan, 5 Department of Pathology, Peshawar Medical College, Riphah International University, Islamabad, Pakistan (Ex postgraduate student), 6 Associate Professor, Department of Oral and maxillofacial surgery, Khyber College of Dentistry, Peshawar

Background: Oral cancer represents a remarkable component of global cancer burden with marked mortality and morbidity. This study is designed to determine the predictive value of serum p53 antibodies in cases of oral squamous cell carcinoma (OSCC) and among healthy individuals.
Materials and Methods: A comparative cross-sectional study was conducted between April, 2016 to March, 2017; on serum samples of 120 subjects comprising of 60 OSCC cases and 60 healthy individuals, collected from oral and maxillofacial surgical units of various institutes. Serum anti-p53 Ab concentrations were determined by enzyme-linked immunosorbant assay (ELISA) at the department of Pathology (Microbiology section), Peshawar Medical College (PMC). Data was recorded, evaluated and analysed by SPSS version 20. Sensitivity, specificity, positive and negative predictive value, likelihood ratios, accuracy, misclassification rate, diagnostic odds ratio were calculated. Receiver operating characteristic (ROC) curve was plotted and area under the curve (AUC) was calculated for measuring the diagnostic accuracy.
Results: Among the study participants, statistically significant difference was observed for serum p53 Ab levels and status. The ROC curve analysis (AUC=0.852) suggested that the p53 seropositivity can significantly discriminate between the cases of OSCC and healthy individuals. Conclusion: The present study showed that serum p53 antibodies could be a useful test due to its high sensitivity for p53 seropositivity among subjects of OSCC and healthy individuals.