Mesenteric cyst of Mullerian origin: A case report and review of literature.

Mesenteric cysts are rare entities, and the Mullerian origin subtypes even rarer. They are classified on the basis of their origin and morphology. The gold standard test for diagnosis is histopathology, whereas radiological imaging provides only supportive findings. The treatment of choice is surgical excision. We present the case of a 42-year-old female who presented in the surgical emergency of Mansoorah Teaching Hospital, Lahore, on August 16, 2022, with acute abdominal pain associated with nausea and vomiting. She was initially diagnosed as a case of simple unilocular left-sided ovarian cyst based on clinical symptoms and radiological findings. However, biopsy revealed a mesenteric cyst of Mullerian origin. As mesenteric cysts are not common, therefore they becomes extremely challenging for the radiologist, pathologist, and surgeon equally, due to the difficulties encountered in their diagnosis and management. We, hereby, present the muchneeded literature review of these cysts with special emphasis on reproducible classification of mesenteric cysts and their clinical implications.

Cervical cancer screening practices in HIV positive females - a missing link in health care delivery in Pakistan.

Objectives: To probe cervical cancer screening practices in local women positive for human immunodeficiency virus, and to determine the cervical cytological changes in them. METHODS: The serial cross-sectional study was conducted at the Jinnah Hospital and Services Hospital, Lahore, Pakistan, from April 2019 to October 2020, and comprised female patients aged 18-45 years who were positive for human immunodeficiency virus or acquired immunodeficiency syndrome and were registered with the relevant programme being run by the provincial government in Punjab. Blood samples of all the patients were collected for the determination of human immunodeficiency virus viral load and cluster of differentiation 4+ count. Cervical smears were taken for cytopathological analysis, while the swabs were analysed for culture sensitivity. The same individuals were subjected to the same testing one year later, and the status of the disease and clinical stability or disease progression was explored. Data was analysed using SPSS 25. RESULTS: There were 150 women with mean age 32.08±7.13 years (range: 21-45 years). Age at marriage/sexual activity was 17.33±4.73 years in 15(10%) subjects. Cytological examination showed atypical squamous cells of undetermined significance in 6(4%) of the cases whereas 3(2%) cases showed atypical squamous cells, which cannot rule out high grade squamous intraepithelial lesion on cytology, while the rest were classified as negative for intraepithelial lesion or malignancy. Cervical microbial changes revealed methicillin-resistant staphylococcus aureus infection in 9(6%) cases, extended-spectrum beta-lactamase in 15(10%) cases, whereas fungal infection and trichomonas vaginalis infection were found in 30(20%) smears. There was a significant association between cluster of differentiation 4+ cell count and stability of high-risk patients (p<0.001). After one year, 84(56%) patients remained clinically stable, while 51(34%) developed some chronic illness. There was a significant association between cluster of differentiation 4+ cell count <200/mm3 and the risk of developing a chronic illness (p<0.001). CONCLUSIONS: There was a dire need to educate healthcare workers to offer regular cervical screening to patients with high-risk sexually-transmitted infections to prevent them from the morbidity and mortality related to cervical cancer.

Prevalence of Human Papilloma virus in potentially malignant oral disorders is a risk factor for development of early dysplasia-A cytological investigation.

Objective: The proposed study was planned to screen Human Papilloma Virus (HPV) status in potentially malignant oral disorders (PMOD) and correlated HPV positivity with cytological changes in oral smears. Methods: This descriptive cross-sectional study was conducted at University of Health Sciences Lahore, Pakistan from April 2020 to April 2021. Oral smears from N=162 patients with PMODs were taken by the Cytobrush and Manual Liquid Based Cytology was performed followed by p16 antibody detection on immunohistochemistry and HPV-DNA detection by conventional polymerase chain reaction (PCR). The cytological changes were categorized according to the updated Bethesda Classification system 2014. SPSS was used to analyze data and p-Value of <0.05 was considered as statistically significant. Results: Out of total N = 162 patients, the most prevalent lesion [39% (n=63)] was lichen planus. Fifty six percent (n=90) of the patients were habitual chewers and 43% (n=70) were smokers. Pap staining of oral smears revealed atypical squamous cells of undetermined significance (ASCUS) in 45% (n=69) cases and in 2 % (n=4) of the samples diagnosis of atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion (ASC-H) was made. A total of 37% cases showed HPV positivity by polymerase chain reaction (PCR) while positive p16 expression was observed in 24% of the cases. ASC-H and ASCUS category showed significant association with HPV positivity (p=0.003). Conclusion: Early detection of PMODs by adopting minimally invasive cytological techniques and screening for HPV infection in local population is pivotal to reduce the morbidity and mortality associated with the advanced disease and carcinoma.

Challenges in screening of sexually transmitted viral infections of the female genital tract: Where do we stand? - A scoping review.

Globally more than a million sexually transmitted infections occur daily, and over 53 000 [47,000-60,000] women aged 15 and over were living with human immunodeficiency virus / acquired immunodeficiency syndrome in Pakistan by the year 2020. This situation becomes graver when the sexually transmitted infections exist as co-infections while remaining undiagnosed or under-diagnosed. Additionally, herpetic or papillomavirus lesions are more recurrent, more extensive and have more serious consequences in human immunodeficiency virus-positive patients. Literature shows a dramatic increase in morbidity and mortality due to the occurrence of malignancies in genital co-infections. There is a key concern that every single adolescent female living in Pakistan is at a high risk of acquiring viral sexually transmitted infections along with malignancy of the cervix. As such, the health and future of this age group is already imperilled. Needless to mention that the practice of routine cervical screening and diagnostic laboratory services offered to a common woman in Pakistan have been less than satisfactory for decades. Therefore, to meet the minimum expectations regarding the Millennium Development Goals for sexual and reproductive health and rights 2030, it has now become imperative for the health sector to develop and implement scientific and community-based policies for comprehensive and multidisciplinary diagnostic strategies leading to early and effective management of viral sexually transmitted infections and subsequent neoplasia.

Analysis of Isocitrate dehydrogenase (IDH) mutation in Gliomas: A call for neurosurgeons and pathologists in Pakistan.

Tumours of the central nervous system, though not very common, pose a serious health burden owing to their high mortality rate. Glial tumours are the commonest type of brain tumours in Pakistani population. Diagnosis of gliomas has been greatly revolutionised over the past few years with integration of immunohistochemistry and molecular subtyping in the World Health Organisation's updated 2016 classification of glial tumours. One of the major changes was incorporation of isocitrate dehydrogenase mutation detection that is considerably a significant prognostic and predictive marker. The published data on isocitrate dehydrogenase mutation in the local population is hard to find. The current narrative review was planned to briefly describe the international trends regarding frequency of isocitrate dehydrogenase mutation in gliomas, its predictive and prognostic significance and its impact on accurate diagnosis leading to a targeted therapeutic approach for patients.