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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

CR Adenoid Cystic Carcinoma of the Trachea

Nosheen Nabi, Ahmareen Khalid and Ashok Kumar Tanwani

Pakistan Institute of Medical Sciences, Islamabad, Pakistan


Abstract: Adenoid cystic carcinoma is a malignant tumor of salivary glands. It is extremely rare in trachea worldwide. They arise in the subepithelioal minor salivary glands, grow slowly and metastasize by perineural invasion. Patient usually presents with dyspnea. It is diagnosed by histopathological evaluation of biopsy taken by endoscopy. Its treatment includes surgical resection with or without radiotherapy. They frequently recur after initial treatment.

Keywords: Tracheal lesion, Adenoid Cystic Carcinoma, Minor Salivary Glands

History of Science

Compiled by Dr. Kanwal Zahra*

*Department of Pathology, Pakistan Institute of Medical Sciences, Islamabad


(Disclaimer: This is not an original article. It’s a simple compilation from different sources; mostly copy and paste with slight modification for editing purposes. We thank their authors, books and websites and specially


Muslim women participated with men in constructing Islamic culture and civilization, excelling in poetry, literature and the arts. In addition, Muslim women have demonstrated tangible contributions in mathematics, astronomy, medicine and in the profession of health care. However, the study of the role of Muslim women in the advancement of science, technology and medicine is difficult to document as there are only scant mentions of it. New light might arise from the study of not yet edited manuscripts. There are about 5 million manuscripts in archives around the world. Only about 50,000 of them are edited and most of these are not about science. Editing relevant manuscripts is indeed a strategic issue for discovering the role of Muslim women in science and civilization.From the early years of Islam, women had crucial roles in their society. They contributed substantially to the prominence of Islamic civilization. For example, Aisha bint Abu Bakr, wife of the Prophet Muhammad, had special skills in administration. She became a scholar in hadith, jurisprudence, an educator, and an orator. There are also many references which point to Muslim women who excelled in areas such as medicine, literature, and jurisprudence. This long tradition found its counterpart in modern times. For example, in a more recent and unusual role, SabihaGökçen (1913-2001) was the first female combat pilot in the world. She was appointed as chief trainer at the Turkish Aviation Institution.

Detection of Hepatotoxicity by Non-Transferrin Bound Iron in Beta Thalassemia Major

Asma Naseer Cheema, Dilshad Ahmed Khan

Department of Pathology Army Medical College, National University of Sciences and Technology, Islamabad-Pakistan.

Background: Hepatotoxicity due to iron overload as a result of multiple transfusions along with concomitant hepatotropic infections has not been studied in detail.

Objective: The objective of our study was to estimate the relationship between the extent of hepatocellular injury as reflected by serum levels of alanine aminotransferase (ALT) and  iron status indices like Ferritin and  Non-transferrin bound iron(NTBI) .

Materials & Methods: A total of 137 transfusion dependent thalassemic patients with median age of 10 (range 3-21) years (73 males; 58 females) participated in the study. Total 76 (58%) patients were positive for hepatitis B&C and 55 (42%) negative. Serum ALT and Aspartate aminotransferase (AST) were more significantly raised in hepatitis positive patients in comparison to other thalassemics. Significant correlation was found between hepatocellular damage (raised ALT) and NTBI (r=0.305) in thalassemic patients (figure. 3). No correlation was seen between serum ferritin and hepatocellular injury (r=0.028). We compared ROC curves of NTBI and Ferritin to detect hepatotoxicity (table 2). Serum NTBI proved to be better between the two. ROC curve of serum NTBI is shown (figure 4). Using cutoff value of 1.75uM and with AUC of 0.81, serum NTBI can detect hepatocellular damage in beta thalassemia major (BTM) with 76%sensitivity and 88% specificity.

Conclusion: A high percentage of thalassemic patients (58%) suffer from viral hepatitis after getting transfused.  NTBI is the best measure of iron toxicity showing the good association with iron overload complications as compared to serum ferritin.

Key words:     NTBI, Ferritin, Thalassemia majo

Editorial: Need for Faculty Development Programs in Medical Colleges

Institutions are made from people and not from bricks and cements. Even single great individual can change the course of the history. Divine guidance had been documented to bring fundamental changes! The best and the most authentic evidence comes from the example of the final Prophet Muhammad ﷺ whose influence is not only well documented but also well recognized even by learned non Muslims! Michael Hart’s book on 100 most influential people therefore rank him # 1 in the list. The seeds of human development which was sown in his life time through final divine book Quran and his wise, honest and dedicated explanation of the Quran through deeds and words brought the big bang in the universe of science. This can be seen in the 8 most glittering centuries of human history i.e. 600-1400.  Imam Malik; a single individual teacher at Great Masjid (mosque) of the Prophet ﷺ in Madinah Munawwarah  produced such great patrons of sciences as Ma’moon Rashid who nurtured, patronized and supervised the great culture of scientific work. Famous Muslim conquerers such as Slahuddin Ayyubi and Mehmood Ghaznawi are known for their bravery and great war abilities but most people are unaware about their great contributions as most generous patrons of sciences.  Ma’moon, Ayyubi and Ghaznawi had madly love for education, science and research and this is all blended with humility and softness in their character toward common man.  Had these individuals not properly trained we all might still be living in dark ages! Their generosity and selflessness had no match. Little they spent on themselves; Salahuddin Ayyubi for example did not perform hajj, a muslim obligation for those who can afford its expense; a middle class person easily can afford but Ayyubi did not have even that money for himself and he didn’t dare to use state money for that purpose! Mehmood Ghaznawi likewise was found of getting talented scientists to help and groom them. He succeeded in getting great scientist al-Baironi but failed to get Ibn-e-Sina for that he was even ready to go on war with Iran of that time! Lesson is simple unless you invest in people you will not build institutions and you will not have balanced terrific growth in field of science and humanity together!

Frequency of New Onset Atrial Fibrillation in Acute Myocardial Infarction Patients with high CHADS2 Score

Muhammad Habeel Dar1, Sohail2, Yasir Adnan3, Lubna Noor4 and Mohammad Hafizullah5

Department of Cardiology, Lady Reading Hospital, PGMI, Peshawar, Pakistan



Objectives: This study was designed to find out the Frequency of new onset atrial fibrillation in patients with acute myocardial infarction having HIGH CHADS2 SCORE.

Material and Methods: This was a Cross Sectional Descriptive study. The study was carried out at the Department of Cardiology, Lady Reading Hospital Peshawar From 7th March to 6th September 2014. All Patients with acute myocardial infarction having CHADS2 SCORE 3 and above were enrolled. Patients were monitored for AF during their total hospital stay. Study end point was new onset atrial fibrillation that last for more than 30 seconds. Data analysis was done using SPSS version 16.

Results: We enrolled 186 patients of acute myocardial infarction patients having CHADS2 SCORE three or more at admission. The mean age was 56.55 years + 13.992SD years. Out of 186, 99(53.23%) were male and 87(46.77%) were female patients. Over all new onset atrial fibrillation was observed in 40(21.51%) patients having acute myocardial infarction patients with High CHADS2 SCORE while 146(78.49%) have not faced the new onset atrial fibrillation during the study period.  About 20(23%) female patients presented with acute myocardial infarction patients having High CHADS2 SCORE, developed new onset atrial fibrillation as compared to 20(20.2%) male patients who developed new onset atrial fibrillation. However, this difference was statistically not significant.

Conclusion: Atrial fibrillation is one of the most common heart rhythm disorders, with a prevalence that is on the rise. Risk factors for the development of AF are very similar to those for developing coronary artery disease. AF is often associated with acute myocardial infarction in patients with High CHADS2 SCORE. Emphasis should be given on prevention, early detection and immediate management of atrial fibrillation in patients of acute myocardial infarction having High CHADS2 SCORE.

Key Words: Atrial Fibrillation, Acute Myocardial infarction, CHADS2 SCORE.

Prevalence of Worm Infestation and Malnutrition in School going Children and risk factors responsible for Worm Infestation

Muhammad Mateen Khan1, Abdul Khalid Awan2, Raja Muhammad Arif Khan3, Naveed Ahmed2, Wafa Hussain4 and Muhammad Asif Khan5

1Azad Jammu & Kashmir Medical College, Muzaffarabad 2Abbas Institute of Medical Sciences, Muzaffarabad

3 Department of Education, Govt. of AJK, Muzaffarabad, 4Central Blood Transfusion Services, Muzaffarabad, 5Agricultural Department, Govt. of Azad Jammu & Kashmir, Muzaffarabad.



Objectives: Prevalence of malnutrition in AJK is very high in children between the age of 5-14 years and research based information about these health problems are generally lacking in school going children. The purpose of the present study was to find out the relationship between malnutrition and worm infestation in school going children.

Methodology: The study was carried out in Abbas Institute of Medical Sciences (AIMS) Muzaffarabad. Total 1902 students from nine Government schools of Muzaffarabad of age 5-14 were examined. Among these, 200 children were found with 3rd degree malnourished excluding children who were suffering from chronic diseases. Weight and height of the students was recorded. Stool samples of the students were collected and examined within one hour of collection under direct light microscope.

Comparison of Honey With Alcohol as a Fixative in Fine Needle Aspiration Cytology

Ruqqayya Ishaq, Henna Azmat, Maria Omair, Ahmareen Khalid Sheikh and Ashok Kumar Tanwani

Department of Pathology, Pakistan Institute of Medical Sciences, Islamabad Shaheed Zulfiqar Ali Bhutto Medical UniversityPakistan


Abstract: Fine Needle Aspiration Cytology (FNAC) is a useful diagnostic aid in benign and malignant lesions. The diagnostic accuracy of FNAC depends on the sampling technique, fixative used, quality of staining and of course the meticulosity of interpretation by the pathologist. The widely used fixative in this procedure is 95 % Alcohol which although readily available, has a number of limitations for use. It is expensive and hence subject to pilferage. Also, it is a volatile liquid with an irritant smell and is said to be carcinogenic. Recent attempts have been made to prove that honey is also a comparable fixative for cytological specimens. It is a natural organic product, odourless and not known to cause any disease. Secondly it is relatively cheaper and not prone to be mishandled, making it an efficient contender for use as a fixative. In this study, we analyzed and compared the efficacy of cytological smears fixed in 95% alcohol and 20% honey solution. The results of our study showed no statistical significant difference in the fixative properties of honey and alcohol. Our results, therefore, confirmed that honey can safely be used as an alternate to alcohol in cytology specimens.

Key words: Honey, alcohol, Fixative, Fine Needle Aspiration Cytology, FNAC

Septoplasty can be adopted as a Daycare Surgery

Muhammad Farooq

Department of ENT Azad Jammu and Kashmir Medical College Muzaffarabad


Abstract: Presently Septoplasty is being performed as admitted case by most of Otorhinolaryngologists and anterior nasal packaging is applied for about 24 hours, which is not free of complications.

Objective: To study the significance of early (after about 4 hours) removal of nasal packing after Septoplasty and its feasibility as daycare surgery.

Patients and Methods: This was a prospective and experimental study conducted on 100 patients for 18 months, who were operated for symptomatic deflected nasal septum (DNS). Patients were randomly divided into two equal groups. In Group-A admitted patients, after septoplasty nasal packing was removed after 24 hours and in Group-B after septoplasty, it was removed after about 4 hours; allowing patients to go home after 5-6 hours. Patient’s discomfort caused by nasal packing was evaluated by means of a visual analog scale from zero to 10. Post-operative complications of septoplasty were also compared in both groups.

Results: Patients discomfort score due to nasal packing and complications of septoplasty were found significantly less in Group-B as compared to Group-A.

Primary Pulmonary Ewing’s Sarcoma

Kausar Rehana and Muhammad Mudassir Shafiq

Department of Pulmonology, Pakistan Institute of Medical Sciences Islamabad


Abstract: Ewing sarcoma is a malignant small round blue cell peripheral primitive neuroectodermal tumor (PNET). Its most common location is flat bones including pelvic bones, ribs and clavicle. It does however occasionally occur in femur and humerus. Rarely Ewing’s sarcoma occurs in soft tissues known as Extraskeletal Ewing’s sarcoma. A large Ewing sarcoma arising in the chest from rib or vertebral column is known as a skin tumor! We report a case of a 10-year-old girl who presented with right sided lung mass. Radiology, histopathology and immunohistochemistry confirmed the diagnosis of Ewing’s sarcoma. Our case highlights the fact that Ewings sarcoma/PNET should be considered in differential diagnosis of patients presenting with lung mass.

Keywords: Ewing’s sarcoma, Ewing’s sarcoma, Extraskeletal Ewing’s sarcoma, small blue cell tumor, Primitive Neuroectodermal tumor, PNET