Category Archives: 2(2) July-Dec 2004

Touch Impression Cytology Versus Frozen Section as Intraoperative Consultation Diagnosis

Ahmareen Khalid and Anwar Ul Haque
Department of Pathology, Pakistan Institute of Medical Sciences, Islamabad.
The efficacy of Touch Imprint Cytology in the diagnosis of various pathological processes was evaluated and compared with Frozen Section in intraoperative consultation. We examined 60 cases from various sites of the body that were referred for intraoperative consultation. All cases were analyzed by Touch Imprint Cytology followed by Frozen section. We found diagnostic accuracy of both procedures comparable. The diagnostic accuracy in distinguishing benign from malignant lesions by combined procedures was 100%. There were no false positive or false negative cases. For diagnosing specific subtypes of malignancy, the diagnostic accuracy of each method alone was 96.6% with a sensitivity of 86% and specificity of 100% and the combined sensitivity 90%. Touch Imprint Cytology provided better cellular morphology and fewer artifacts. On the other hand Frozen Sections provided more tissue architectural details but frequently hampered by freezing artifacts. We conclude that both Touch Imprint Cytology and Frozen Sections are dependable intraoperative consultation diagnostic modalities.
Touch Imprint Cytology alone may provide a correct diagnosis in vast majority of cases with minimal expense and without the need of sophisticated cryostat machine thus making it quite suitable for many hospitals where cryostat machines are not available.

Iron Homeostasis: Current Understanding

Khalid Hassan and Nadeem Ikram*
Professor of Pathology, Pakistan Institute of Medical Sciences, Islamabad.
* Consultant Haematologist, DHQ Hospital, Rawalpindi.
Iron is an integral part of haemoglobin
molecule. Its deficiency leads to the commonest
type of anaemia in all geographic regions and
racial groups. Its overload, if associated with presence
of unbound iron in tissues, is characterized by tissue
injury which may be severe enough to cause
significant morbidity as a result of damage to heart,
liver, pancreas, endocrines and almost any tissue.
During the last decade, many poorly understood areas
of iron homeostasis have been unraveled, especially
pertaining to the influx of iron in the upper part of
small intestine, its trafficking in the plasma,
metabolism in the macrophage, red cell precursors &
hepatocytes, and role of genes in iron metabolism.

Touch Cytology – Touch of a Class

Anwar Ul Haque
Department of Pathology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
Man is composed of tissues. Tissues are made
up of cells. And the diseases occur in cells. Cytology is
study of cells, a study of the cell at core. Light
microscope is a powerful tool and can detect most
morphological changes at cell level. Even the chemical
changes, not visible can be detected through various
immunological and hybridization techniques at cell
level. Cytology is therefore a very useful technique
and mode of study. The study of peripheral smear of
the blood in practice for so many decades is a form of
cytology and of course bone marrow too.

Doctors’ Doctor: Ibn Sina (Avicenna)

Anwar Ul Haque
Head, Department of Pathology, Pakistan Institute of Medical Sciences, Islamabad.
When the first man and woman descended
from heaven, after sometime they might have fallen ill
and they might have tried some remedy to cure this
illness. Then Greeks came with elaborate philosophies
but no hard work, no meticulous observations, no
experimentation and no verification. They did not
have the required patience, perseverance, and sweat
and blood that the great poet Iqbal has described as
“Blood of Liver” without which no substantial thing
can be achieved. Working in the early hours of the
morning and getting in tune with the nature are
prerequisite for the balance growth of science and arts.
The required selflessness, rising about flesh and
materialism is required to reach at the greatest heights.
1200 years ago when the Europe was in utter darkness,
the light was shining in the East. Quran, the last and
the final version of the divine message kindled the
light! The Quran raised the most backward nation to
the top in all spheres of human life. It provided the
required milieu for hard and sincere work. It removed
the rust from the hearts and opened the eyes, ears and
minds of the people. As a result great miracles
occurred. Rapid advancements were made in all
spheres of life. Modern medicine was born. Modern
Surgery along with required inhalation anesthesia,
antiseptics and catgut sutures were all invented.
Modern Chemistry and laboratory sciences were born.
Physics, astronomy, mathematics, algebra, geometry
all came in to being. An embryo was conceived with
numerous facets. This embryo later became an adult in
Europe and other places. For many people in the West
perhaps the information may appear new and startling
due to the fact that they were kept blind due to
religious and other prejudices against Islam and
Muslims. It is the irony the very people whom
Muslims treated rather well and gave faculty positions
in the University Hospitals in Spain became very
active in maligning Islam through self created
terrorism and false propaganda
Today we will introduce you to a great
physician who along with some his contemporary
Muslim Physicians can be rightly regarded as father of
modern medicine.
Let us meet Ibn Sina whose original and
superb work in the fields of medicine, philosophy,
mathematics, and astronomy contributed a lot toward
starting the modern engine of science. He was born in
986 and physically passed away in 1037. But his 51
years of life had been extended to time immemorial as
every doctor; every pharmacist and every patient of
today is indebted to his great work and is beneficiary
of his planted trees.
Ibn Sina (Avicenna) started his education with
Quran. At very early age he had acquired good
knowledge of Quran. Then he began studying
philosophy by reading various Greek, Muslim and
other books on this subject. He had kind help of Abu
Abdallah Natili, a famous philosopher of the time. He
studied various drug and medicines afterwards. Based
on his keen observation, hard work, and superb
organizational capacity and capability Ibn Seen had
become a famous physician by the age of 17 when he
was fortunate in curing Nooh Ibn Mansour, the king of
Bukhhara, of an illness in which all the well-known
physicians had given up hope. On his recovery, the
king wished to reward him, but the young physician
only desi

Ferritin Levels in Patients of Beta Thalassaemia Major

Nadeem Ikram, Khalid Hassan, Muhammad Younas, Samina Amanat
 District Head Quarters Hospital, Rawalpindi
 Pakistan Institute of Medical Sciences, Islamabad
In Beta Thalassaemia Major repeated blood transfusions, ineffective erythropoiesis and increased gastrointestinal iron
absorption lead to iron overload in the body. The management of the iron overload in these patients requires the
administration of iron chelators continuously and evaluation of serum ferritin levels at regular intervals. In the present study
serum ferritin levels, of the patients with beta thalassaemia major registered at two different centers of Rawalpindi and
Islamabad, were measured. Majority of the patients revealed very high ferritin levels, with a mean of 3390 ng/ml. 21.34%
patients had serum ferritin between 1000 to 2500 ng/ml, while 76% patients had values above 2500 ng/ml. These levels
reflect inadequate chelation and vulnerability to develop iron overload related complications. There is a dire need to
rationalize the chelation therapy, as at present no chelation, inadequate chelation, improper methods of chelators
administration, non availability of infusion pumps, non affordability of patients to purchase pumps and chelators,
inappropriate evaluation of iron overload and high levels of serum ferritin gives an overall bleak view.
Key words: Beta Thalasaemia major; Ferritin; iron chelators ………

Community Based Pathology

Nadeem Ikram, Khalid Hassan*
Department of Pathology, District Head Quarters Hospital, Rawalpindi.
* Department of Pathology; Pakistan Institute of Medical Sciences, Islamabad
The basic aim of medical profession is to
provide health facilities to population at large. As far
as the medical education and research is concerned,
there must be reflection of the society in these
activities. The people related with medical education
and research, undoubtly, are doing their utmost in
their provided facilities in this regard. The internet and
international literature has given an apparent cosmetic
value to the research activities. But the real question is
the worth of these activities on grass root level.

Clinical Manifestations and Outcome among Acquired Immune Deficiency Syndrome (AIDS) Patients with Mycobacterium Tuberculosis

Wichai Supanaranond* and Maqsood Anwar**
* Associate Professor and Head, Faculty of Tropical Medicine, Mahidol University, Thailand.
** Department of Dermatology, Pakistan Institute of Medical Sciences, Islamabad.
Introduction: The most explosive HIV-AIDS pandemic areas in Asia and the world are India and Thailand while the
common opportunistic infection in most developing countries is Tuberculosis (TB). The risk of tuberculosis disease
progression is about 100 times greater in HIV sero-positive than in sero-negative people, and the mortality rate is about four
times greater in HIV positive people with tuberculosis than in HIV negative people with tuberculosis.
Objectives: The objective of this study was to determine the clinical manifestations and outcome among AIDS patients with
Mycobacterium tuberculosis infections.
Methods: This retrospective study was conducted at Bamrasnaradura infectious disease hospital Thailand, in which patients
were identified for a period of six months and then followed up for the next six months. Adults from both sexes 16 years old
and above diagnosed as AIDS-TB included in study. All the data collected by questionnaire was recorded, keyed, edited and
analyzed by using Epi info 6 software and data is presented by: median and range for quantitative variables, frequency and
percentage for qualitative variable.
Discussion: A series of studies have been conducted in Thailand regarding tuberculosis with AIDS. Most studies showed
tuberculosis as either the first or second most common opportunistic infection among AIDS patients. A high mortality of
about 30% seen among AIDS patients with tuberculosis was reported in one study. Sixteen months is reported as the mean
survival time among these cases.
Results: In this study the most common clinical features observed were fever, loss of weight, and loss of appetite, cough, and
enlarged lymph nodes. Oral candidasis is most frequently occurring opportunistic infection. PPE was a very common
cutaneous manifestation. Streptomycin found to be the most frequent resistant drug.
Conclusion: The majority of cases belong to the age group, which is socially and sexually active. Involvement of this group
leaves a major impact on social and economical well being of the country as well as they play an important role in
transmission of TB and AIDS. Lost of follow-up rate is very high and majority lost follow-up with in first month, an
important factor in occurrence of drug resistance.
Key words: Tuberculosis; Acquired Immune Deficiency Syndrome (AIDS); Multi Drug Resistance (NDR).