Author Archives: admin

About admin

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

Brief Communication: High Heels and Low Back Pain in Young Female Students

Iqra Nadeem*, Muhammad Kashif**, Sidra Mushtaq*, Rumaisa Hussain*, Nimra Naseem*,      Haider Darain*** and Danish Khan****

*Department of Physical Therapy, Sargodha Medical College, University of Sargodha, Sargodh,

**Riphah College of Rehabilitation Sciences, Riphah International University, Faisalabad Campus, ***IMPR, Khyber Medical University, Peshawar, ****Northwest Institute of Health Sciences, Peshawar



Objective: Prolonged use of high-heeled shoes is considered a possible cause of low back pain in female students. The aim of study is to investigate the association between high heels and LBP.

Methods: A cross-sectional survey based on a standard self-reporting questionnaire was conducted among 50 female university students (aged 18-28 years) mean 21.1 years and mean height 5.1 feet using high heels of GCU Faisalabad. Purposive sampling technique was used to. Out of 50 students wearing high heels, 28 (56%) students were suffering from low back pain. Pearson Chi-Square test was applied.

Results: Statistical analysis showed significant association between high heel and LBP, p=0.001. Coefficient of contingency=0.567 indicated strength of association is intermediate.

Conclusion: This study also revealed that students who wear high heels for 2 or more years suffer from a bit of lower back pain and that the height of the heel increases the incidence and the intensity of pain increases as well.

Keywords: Low Back Pain, High Heel, Foot Wear, Fashion Heel

Original Article: Molecular Subtypes of Breast Cancer by Immunohistochemical Profiling

Rubina Gulzar, Ruqaiya Shahid and Omema Saleem

Dow International Medical College, Dow University of Health Sciences, Karachi, Pakistan



Objective: To evaluate the frequency of molecular sub types of breast cancer on core needle biopsy and to correlate the subtypes with these clinic-pathologic parameters: age of the patient, histologic type and grade of cancer and lymph-vascular invasion (LVI).

Methods: A cross-sectional, observational study, conducted at Dow University of Health Sciences, Karachi, from December 2014 to December 2015. It included core needle biopsies of 285 patients of breast cancer. Immunohistochemical staining with antibodies for Estrogen Receptor (ER), Progesterone Receptor (PR) and Human Epidermal Growth factor 2 (Her 2) was performed and breast cancers were classified into four molecular subtypes: Luminal A (ER/PR +, HER2-), Luminal B (ER/PR +, HER2+), Triple Negative Breast cancer (TNBC) (ER/PR -, HER2-) and HER 2 (ER/PR -, HER2+). Clinical parameters were compared using chi-square test.

Results: 285 cases were included in this study. The mean age of the patients was 43.3 years(17-88).The frequency of the molecular subtypes of breast cancers was Luminal B 139(48.77%), Luminal A 60(21.05%), Her2 54(18.94%) and Triple Negative Breast cancer 32(11.22%).The most common diagnosis of breast cancer was Invasive Ductal Carcinoma 258 (90.52%) and grade II 230 (80.70 %). There was significant association of molecular subtype of breast cancer with the grade of tumor (p<0.001) and with lymph-vascular invasion (p<0.011). Her 2 cancers showed the highest frequency of grade 3 and Triple Negative Breast cancer had the highest frequency of lymph-vascular invasion.

Conclusion: Luminal B is the most common molecular subtype in our population. The mean age of breast cancer was younger than most studies. We recommend that the molecular subtyping of breast cancers using immunohistochemistry should be incorporated into histopathology reporting of core needle biopsies, as this may facilitate the clinicians in selection of treatment for the patients.

Key words: Breast cancer, molecular subtypes, receptor status, hormone receptors, immunohistochemistry, Triple negative breast cancer, ER, PR, HER2, HER2/neu

Original Article: Emerging Trends of Antibiotic Resistance pattern of Salmonella Typhi

Fouzia Zeeshan Khan, Samina Baig , Sambreen Zameer and Shaheen Sharafat

Dow University of Health Sciences, Karachi, Pakistan



Introduction: Salmonella typhi is the major serotype of Salmonella accountable for enteric fever. Emergence of antimicrobial resistance limits the available treatment options for enteric fever and is one of the foremost contributors to the increase in morbidity and mortality rates.

Materials and Methods: This was cross-sectional study conducted at Dow University of Health Sciences over a period of 6 years, between January 2010 to December 2016. Blood samples were collected and incubated in Bact/Alert automated system (bio-Merieux). The isolates were identified and characterized by standard and specific methods. Antibiotic susceptibility of all isolates was assessed by the Kirby-Bauer disc diffusion method according to the guidelines of Clinical and Laboratory Standards Institute (CLSI).

Results: During the period of 2010 to 2013, the highest frequency of S. typhi was observed in pediatric age group and males. Ampicillin (57.1%), Trimethoprim/sulfamethoxazole (60.1%), and Chloramphenicol (57.1%) showed highest resistance.  From 2014 to 2016, the incidence of infection was greatest in children and females. Ciprofloxacin (7.6%), Ampicillin (54.7%), Trimethoprim/sulfamethoxazole (60.1%), and Azithromycin (4.6%) were observed to have increasing pattern of resistance.

Conclusion: Our study showed emergence of multi drug resistant isolates of S. typhi. Therefore, Antibiotic steward ship program, vaccination and local surveillance are highly recommended to control the spread of multi drug resistance among isolates of S. typhi.

Key Words: S.typhi. antibiotic susceptibility, multidrug resistance, emerging trends

Original Article: Acute Myeloid Leukemia: Pattern of Clinical and Haematological Parameters in a Tertiary Care Centre

Muhammad Ihtesham Khan
Department of Pathology, Khyber Medical College, Peshawar
Objective: To determine the pattern of clinical features, hematological parameters and subtypes of acute myeloid leukemia in our setup.
Material and method: This Cross-Sectional Descriptive study was done in Khyber Teaching Hospital, Peshawar, from January 2015 to July 2017. All patients diagnosed as acute myeloid leukemia on bone marrow biopsy were included in the study. The demographics, clinical data and hematological parameters were noted on a proforma and results were drawn accordingly. Mean and standard deviation were used for quantitative data like age, while frequency and percentages were used for qualitative data like gender.
Results: 41 cases were diagnosed as acute myeloid leukemia and were included in the study. Age of the study sample ranged from 3 years to 65 years, with mean of 41 ± 9.8 SD years. The commonest chief complaint was fever (51%), while the commonest sign was pallor (61%). There was decreased hemoglobin level and platelet count. M-2 was the commonest subtype seen in 24 (59%) cases.
Conclusion: Acute myeloid leukemia occurs in younger age in our setup as compared to Western population. AML-M2 was the commonest subtype in AML. Fever and pallor were the commonest clinical findings while anemia and thrombocytopenia were the significant hematological findings.
Keywords: Acute myeloid leukemia, Fever, Pallor, Anemia, Thrombocytopenia, Hemoglobin level

Original Article: Frequency of Subclinical Hyper and Hypothyroidism

Syed Iftikhar Ali Shah*, Sardar Muhammad**, Naveed Sharifand*** Faridullah Shah****
*Department of Medicine Northwest school of Medicine, Peshawar, ** Department of Pathology
Peshawar Medical College, Peshawar, ***,****
Introduction: Thyroid disorders are one of the commonest endocrine diseases. Subclinical thyroid dysfunction is a laboratory base diagnosis and patients may be asymptomatic. However, later on it can lead to some serious health problems. The purpose of this study is to assess the frequency of subclinical hypo and hyperthyroidism in a population of patients presenting to the private clinic.
Patients and Methods: This descriptive study was carried out in a private clinic in Peshawar between 2007 and 2012. The patients of all age groups, regardless of gender were selected by non-probability, random sampling technique. These patients presented with non-specific symptoms such as palpitation, constipation and generalized body aches. The findings of history, clinical examination and lab investigation of thyroid function were recorded and analyzed in SPSS v19.
Results: Out of 4198 patients 3229(76.92%) were female and 969 (23.08%) were male. Both in male and female population, most of the patients belonged to middle age group i.e. 25 to 44 years. Among male patients 117 (12%) were hyperthyroid and 51 (5%) were hypothyroid. Sixty-nine patients (7%) were found in each category of Subclinical hyperthyroidism and hypothyroidism. Similarly, regarding female population, hyperthyroidism was detected in 505 (16%), hypothyroidism in 182 (6%), subclinical hyperthyroidism in 211 (7%) and subclinical hypothyroidism in 260 (8%) patients.
Conclusions: Subclinical thyroid dysfunction is detected in substantial numbers in all the age groups. These patients should be monitored for complications of thyroid diseases, and patients with nonspecific symptoms and known risk factors should be evaluated for subclinical hypo or hyperthyroidism.
Key words: Subclinical thyroid dysfunction, Hypothyroidism, Hyperthyroidism, Euthyroid, Thyroid-stimulating hormone

Original Article: Assessment of Iron Reserves: Association of Serum Ferritin with Red Cell Indices

Kiran Zulfiqar1 and Asma Naseer Cheema2

1M.Phil Trainee (Chemical Pathology), 2Associate Professor of Pathology

Department of Pathology, University Medical & Dental College, The University of Faisalabad



Background: Iron deficiency is one of the major nutritional deficiency diseases of developing countries. Females are at higher risk of developing Iron deficiency in reproductive years of life. Usually serum Ferritin gives us good estimate of iron status in the body. However, this biomarker is not in the reach of the poor patients and falsely rises in any inflammatory condition.

Objective: To assess and correlate serum ferritin with easily accessible red cell indices in females of reproductive age in district Faisalabad to determine if the latter alone are sufficient to make diagnosis of iron deficiency anemia

Methods: 199 females aged 13-45 years were enrolled in the study after written informed consent. Pregnant females and those suffering from acute or chronic illnesses were excluded. Blood was drawn in plain tube to assess serum Ferritin, Iron and Total Iron binding capacity,  EDTA plasma tube was used for the analysis of red cell indices mean cell volume, mean hemoglobin concentration and red cell distribution width

Results: Based on lone Hemoglobin levels, Anemia was found in 77/101(75.81%) of population. Of these 77 anemic subjects, 52(67.53%) had iron deficiency. Low serum ferritin level was observed in 60 (59.40%) of total females. Among low ferritin subjects, 10 % (6/60) had normal hemoglobin levels. Significant positive correlation was observed between serum ferritin and MCV (r=0.709=; P=<0.001), MCHC (r=0.729=; P=0.001) and significant negative correlation was seen between Serum ferritin and RDW (r=0.676; P=0.001). No significant correlation was appreciated between serum ferritin and MCH. The main cause of iron deficiency was determined as use of iron deficient diet followed by repeated pregnancies.

Conclusions: A substantial proportion 57.42% (58) of females of reproductive age years was suffering from Iron deficiency in district Faisalabad. MCV, MCHC and RDW may still be used as indicators of Iron deficiency in places where serum ferritin is not available or patients cannot afford and when there is any associated inflammatory condition.

Key words: Anemia, Iron deficiency, serum ferritin

Original Article: Acute Poisoning Cases in a Tertiary Care Hospital of Peshawar

Rizwan Zafar Ansari*, Yasmin Aamir**, Aftab Alam Tanoli***, Sayed Muhammad Yadain ****, Zahid Hussain Khalil***** and Muhammad Yousaf******

*Department of Forensic Medicine, Northwest School of Medicine, Peshawar, **Department of Forensic Medicine, Foundation University Medical College, Islamabad, ***Department of Forensic Medicine, Women Medical College, Abbottabad, ****Department of Forensic Medicine, Abbottabad International Medical College, Abbottabad,***** Department of Forensic Medicine, Kabir Medical College, Peshawar, ******Department of Forensic Medicine, Khyber Medical College, Peshawar



Objective: We aimed herein to assess mode, manner, type and clinical characteristics of poisoning in patients presented to Lady Reading Hospital emergency department.

Methods: All information related to poisoning including mode of transmission, demographic information, duration of hospital stay, name of poison ingested, inhaled and intension of poisoning was retrieved from the medical record room of Lady Reading Teaching Hospital (LRH) casualty department. The cases reported with a history of acute poisoning were recorded for a period of one year from February 2016 to January 2017.

Results: Acute Poisoning contributed to 1.96% (n=430) of all the cases admitted to emergency. 60.2% (n = 259) percent of the patients were female. The majority of the victims were in 18-25 years age group (P < 0.001).232 (54%) patients admitted with a history of suicide. 111 (25.8%) were poisoned with drug over dose, 237 (54.3%) of patients were either the victim of accidental or homicidal poisoning. Suicidal poisonings were more common in young age group and females (P <0.001). Among prescribed medications the most common poisoning agent were neurotics (39.6%) followed by drug over dose (25.8%) and analgesics (23.7%). Antidepressant drugs were the most common prescription drugs taken for suicidal purposes. Analysis of duration of hospital stay revealed that 29.8% (n = 128) of patients stayed in hospital for 2 days. The mortality rate was 0.5%.

Conclusion: The majority of poisonings were due to over dose of prescription drugs such as anti-depressants, abuse of alcohol and cannabis. Suicidal tendency was more in young age groups and in females. Most common agents causing poisoning were antidepressants, analgesics, rat pills and other psychotropic substances. The study also indicated that most of the incidents occur at home when victim was either alone or left unattended.

Key Words: Acute poisoning, suicide, drugs, antidepressants, analgesics, rat pills, psychotropic substance

Original Article: Fetor Oris and Oral Health Practices among Undergraduate Medical & Dental Students

Muhammad Adnan Kanpurwala*, Musarrat Jehan**, Uzma Zareef***, Aneel Aslam**** and Arif Ali****

*Department of Physiology, Karachi Institute of Medical Sciences, **Department of Pathology

Jinnah Medical & Dental College, Karachi, *** Department of Oral Pathology Liaquat College of Medicine and Dentistry, **** Department of Anesthesia Karachi Institute of Medical Sciences, ***** Department of Statistics Dow University of Health Sciences


Abstract: The undergraduate dental and medical students are considered to adopt better oral practices and lifestyle practices. It is important to assess oral health practices of dental and medical students as they are the future health professionals of a country. The present study aims to evaluate bad breath problem among the dental and medical students of a private institute of Karachi, and relate it to their various oral health practices and lifestyle activities. It was a cross sectional study and the data was collected from the 240 undergraduate medical and dental students of a private medical and dental college of Karachi with the help of a questionnaire. However, only 200 forms were adequately filled and returned back with a response rate of 83.33%. Statistical analysis was conducted by SPSS version 21. It was observed that approximately 15% students complained of bad breath or fetor oris. Medical students were found significantly more concerned about brushing their teeth as compare to dental students (92% Vs 73.5%). It was also observed that only 25% of students flossed their teeth daily although 40-60% of students had history of dental carries. It is concluded that poor oral health practices and lifestyle activities were observed for both the dental and medical students. Hence it is recommended that knowledge and practices regarding self-oral healthcare should be emphasized among these students as they are the role model for their patients and society.

Key words: Oral healthcare, fetor oris, medical and dental students