Year 2023, Volume 39 - Issue 2

Dr. Shehla Javed Akram's candidacy during the  six months certificate course of Medical Editing and Journalism at University of Health Sciences, Lahore, Pakistan, is not only marked by her academic excellence but also by her exemplary character. In a world that sometimes equates privilege with success, Dr. Shehla's demeanor serve as a refreshing reminder that true achievements are built on a foundation of humility, unwavering dedication, and a commitment to the principles of equity, fairness and professionalism. We are proud to have such dedicated individuals among us, and she truly is a beacon of inspiration for us all.

The importance of intraoperative consultation through frozen sections can hardly be over-emphasized. The overall accuracy of frozen section diagnosis falls within the range of 92% to 97.98%; however, in brain tissues, the diagnostic accuracy is debatable, considering the artifacts due to ice crystal formation, crushing, and overstretching resulting in impaired histomorphology. On the other hand, reliance on immunohistochemistry on a frozen brain section is even more challenging because of reported interpretational problems. Hence, preserving the histomorphology of brain tissues and optimizing preanalytical variables is crucial for the accurate diagnosis of the patients.

Cystadenoma is a benign salivary gland tumor that develops very infrequently. The commonest site for their occurrence is minor salivary glands, where these present as cystic growths with papillary projections. Cystadenomas are often interpreted as mucous retention cysts. Therefore, histopathological confirmation is essential for further treatment and follow-up of the patients, even after the surgery, to keep a check on the recurrence and, in the long run, the exclusion of the possibility of malignant transformation. We report a case of mucinous cystadenoma of the salivary gland occurring in a 44-year-old male who presented with a painless mass, gradually increasing in size over the period of 3 years. The radiological evaluation reported it as a retention cyst. Fine needle aspiration cytology was performed, followed by complete surgical excision of the lesion. Diagnosis of mucinous cystadenoma in the parotid gland was made. There are only a few cases of mucinous cystadenoma of the parotid gland reported so far from the world, and to the best of author’s knowledge, it is the first case of its kind reported from Pakistan.

Background and Objective: Berberine has anti-inflammatory properties through pathways that are also involved in asthma. Therefore, it is postulated that it will be effective in reducing airway inflammation in the allergic asthmatic model. The objective of the current study was to observe the effects of berberine on the histopathology of lungs in sensitized Guinea pigs and compare the changes with that of the standard drug, dexamethasone.

Methods: This experimental study was conducted at the Postgraduate Medical Institute, Lahore, Pakistan, from February 2016 to April 2016. Twenty-four healthy Guinea pigs were divided randomly into four groups: normal control, Ovalbumin (OVA ) group, OVA + berberine group, and OVA + dexa group. The last three groups were sensitized on days 0 and 14 and challenged on days 25, 26, and 27 with OVA. Berberine and dexamethasone were administered intraperitoneally to the respective groups before each challenge. The animals were then sacrificed on day 28 under anesthesia, lungs were dissected, and tissue samples were assessed microscopically for morphology and status of inflammation in each group. Data were analyzed by applying the Kruskal-Wallis analysis of variance test followed by the Mann Whitney U test using SPSS 20.

Results: The comparison of histopathological changes revealed that the infiltration of inflammatory cells in the lung airways was significantly higher (p-value ≤0.01) in the OVA group as compared to the normal control group. Both OVA + berberine and OVA + dexa groups showed a reduction in total lung inflammation (p-value ≤0.01 vs. OVA group) equally. The effect of berberine on epithelial changes was nonsignificant (p-value 0.206 vs. OVA group), while dexamethasone showed significant improvement as compared to the OVA group (p-value 0.007). However, the difference between berberine and dexamethasone treatment was nonsignificant (p-value ≤0.05).

Conclusion: It was concluded that berberine improved the histopathological score of lung inflammation in sensitized Guinea pigs, equivalent to that of dexamethasone, with lesser effects on epithelial changes.

Background and Objective: Typhoid fever caused by Salmonella typhi (S. typhi) is an important cause of morbidity and mortality worldwide. The emergence of resistance against the first and second line of drugs has limited the range of drug choices for its treatment. Therefore, the present study was designed to assess the status of drug resistance in S. typhi isolated from the blood samples of pediatric patients reporting at a leading tertiary care hospital in Lahore.

Methods: This descriptive study was conducted at the Pathology Department of Allama Iqbal Medical College, Lahore, Pakistan, over a period of 2 years. A total of 1,306 blood samples were aseptically collected from the pediatric population of Jinnah Hospital, Lahore, Pakistan, after obtaining informed assent from the parents/guardians. The samples were transferred into a Bact/Alert blood culture bottle. After the detection of microbial growth by the Bact/Alert 3-D system, bacterial isolates were identified by standard microbiological procedures. VITEK 2 compact automated identification and antimicrobial susceptibility testing instrument (bioMerieux) was used for the antimicrobial sensitivity testing. Data were entered and analyzed by using Statistical Package for the Social Sciences version 21.0.

Results: A total of 235 out of 1,306 (17.9%) blood culture samples yielded bacterial growth, among which 62.5% (n = 147) were S. typhi. Among 147 S. typhi isolates, 70.6% were multidrug resistant, while 63% were extensively drug resistant (XDR). Maximum resistance against first-line drugs observed was for ampicillin (79.4) and co-trimoxazole (67.2).

Conclusion: The emergence and spread of XDR S. typhi with a high level of resistance are quite alarming, leaving limited treatment options for the pediatric population. Moreover, increasing resistance to antibiotics demonstrates the quick waning of the efficacy of available first and second-line drugs in the treatment of typhoid fever.

Background and Objective: Procedural error reporting system is an effective step towards patient safety. In Pakistan adverse event reporting system is deficient. The study aimed to identify the presence of procedural error reporting system and their referral in endodontic clinics of private and public dental institutes in Punjab.

Methods: This study was conducted in six private and two public dental institutes in Punjab via questionnaires developed by the authors and distributed online using Google forms. The questionnaire had 14 items targeting demographics, a procedural error reporting system, and ways to manage procedural errors.

Results: The majority of the dental colleges, both private and public, did not have any procedural error reporting system or a hierarchical order (70.1%) for the management of errors in their endodontic departments (60.5%). The most frequent approach was self-management of errors (86.5%), followed by referring to a senior endodontist (45%) and asking colleagues for help (36.5%). 13% of the respondents never informed patients, while 6% never reported procedural errors to their departments. There was a statistically significant difference between house officers, postgraduate trainees and demonstrators regarding self-management of errors and putting patients on follow-up.

Conclusion: Most endodontic departments lack a system for reporting procedural errors, with no significant difference between private and public institutes. Most respondents report errors to patients and departments, with self-management being the most common approach. Postgraduate trainees tend to manage errors independently. It is imperative to create a comprehensive error reporting system that could be implemented progressively

Background and Objective: Oral health is significantly impacted by an individual’s social interactions and quality of life. The aim of this study was to evaluate the association between oral health status and socio-demographic factors, in particular, monthly income and level of education, of a rural community in Pakistan.

Methods: This cross-sectional survey study was conducted among n = 380 people from the Jahangirabad community of Multan from July 2021 to September 2021. A validated questionnaire was designed to be filled by the subjects or the researchers in case of low literacy levels. Two qualified oro-dental examiners assessed all the subjects for their oral health status by using the community periodontal index of the treatment needs (CPITN index).

Results: There were 209 males and 171 females. As regards the status of education, 27% of the subjects had no formal education, 21% of respondents were primary (5th grade) pass, 31.9% attended secondary school, 10.7% got higher secondary school education, whereas 9.4% of respondents had passed the college/university examination. The majority of the participants (46.7%) had income within the range of 10,000-20,000 Pakistani rupees per month, whereas only 12.8% of subjects reported earning more than Rs. 50,000 per month. No significant association was found between average monthly income and oral health status; however, the CPITN score and the higher level of education (high school and college/university) showed a significant association (p-value = 0.012).

Conclusion: Level of education, independent of socioeconomic status, is identified as a potential risk factor for poor oral health status among the rural community in Pakistan. Dental practitioners should consider enhancing timely screening and awareness campaigns, especially within this specific class of community, to improve oral health outcomes.

Background and Objective: Canagliflozin reduces insulin resistance in diabetics and is hypothesized to produce a beneficial effect in polycystic ovarian syndrome (PCOS). Therefore, this study is planned to compare the effects of canagliflozin and metformin alone and in combination on ovarian histology of rat models with letrozole-induced PCOS.

Methods: It was a randomized experimental study on Sprague Dawley rats. A total of N = 40 female rats were divided randomly into six groups (A-F). With the exception of normal control group A, rats were given letrozole 1 mg/kg daily for 21 days till PCOS was induced. Group B was disease control, while rats in groups C-F were administered canagliflozin (10 mg/kg), metformin (100 mg/kg), a combination of canagliflozin (10 mg/kg) with metformin (100 mg/kg), and combination of canagliflozin (5 mg/kg) with metformin (50 mg/kg), respectively. Animals were sacrificed on the 48th day. Ovaries and uterus were removed, weighed, and processed for further histopathological analysis.

Results: All treatment groups showed significant improvement in ovarian histology. The number of primary and secondary follicles and cystic follicles was significantly lower (p < 0.001) in all treatment groups as compared to the disease control group.

Conclusion: Canagliflozin is effective for the treatment of PCOS and augments the effect of metformin in a rat model.

Background and Objective: Thyroid specimens constitute a major bulk of the head and neck surgical specimens received at the Pathology Departments. Careful handling of the specimens in the grossing room will result in an efficient reporting of useful histological parameters required for patient management and prognosis. The objective of this study was to analyze different errors and near-miss events in the grossing of thyroid specimens in the surgical pathology gross room of a Tertiary Care Hospital in Lahore, Pakistan.

Methods: A cross-sectional analysis was done on different thyroid specimens received at the Pathology reception of Lahore General Hospital, Lahore, Pakistan, from January 2022 to April 2023. Different types of errors involved in standard gross examinations were studied. Data were entered using SPSS version 23.0.

Results: Errors observed in the preanalytical phase included the use of inappropriate fixative (15.2%), insufficient clinical information (76.5), mislabeled jar/request form (7.6%), and loss of specimen (8%). Grossing errors included insufficient grossing notes (12.2%), cutting thick slices (10.7%), missing lesions on gross examination (9.9%), inappropriate inking (6.9%), overfilling cassette with large tissue sections (6.9%), mislabeled cassettes (93.8%), and incomplete submission of capsule (2.3%).

Conclusion: This study concludes that errors and near-miss events in handling thyroid specimens can be avoided by effective training of the handling staff and grossing residents. Collaboration between clinical wards and histopathology laboratories can also be helpful in this regard.