Clinico-pathological Factors in Malignant Transformation of RRP.

Various clinico-pathological factors play role in the papilloma proliferation and pathogenesis of Recurrent respiratory papillomatosis (RRP). However, it is not known if they are directly responsible for malignant transformation of these papillomas or not. We did this study to elucidate any such association. The most recent debrided tissue of RRP in 20 patients was evaluated for p16 expression, VEGF estimation (tissue expression and serum levels), and tissue HPV DNA concentration. The final histopathology results were then correlated with these pathological factors and with clinical factors like duration of illness, age of onset of symptoms, extent of disease, etc. Squamous papilloma was seen in 60%, dysplasia in 25%, and squamous cell carcinoma (SCC) in 15% of the patients. Positive immunostaining for p16 (staining in ≥70% of tumor cells) was seen only in one case, which was SCC. There was no statistically significant difference between p16 expression, tissue VEGF expression, serum VEGF levels, and tissue HPV DNA in any of the histological groups. The mean age of disease onset was significantly higher in patients with SCC (p = 0.03). A significantly higher number of patients with dysplasia had tracheobronchial involvement (p = 0.022). We concluded that no single pathological factor is solely responsible for development of malignancy in RRP, whereas clinical factors like tracheobronchial involvement and age of onset may contribute to development of dysplasia or carcinoma.

Relevance of Partial p16 Immunostaining in Oral Squamous Cell Carcinoma and Co- Relation with HPV DNA Status.

INTRODUCTION: Immunostaining criteria for p16 positivity in oropharyngeal squamous cell carcinoma have been laid down by College of American Pathologists (CAP) and the American Society of Clinical Oncology (ASCO). The staining should be of moderate to strong intensity seen in 70 percent of the tumor cells. Recent studies have pointed out that a small minority of cases are missed using p16 as the surrogate marker at above mentioned cut off. By convention the same criteria have been used for oral squamous cell carcinoma. MATERIAL AND METHODS: The authors revisited the results of their previous study where immunohistochemistry for p16 was found to be positive by AJCC criteria in 139 out of 800 cases of oral squamous cell carcinoma. For this study, all the p16 immunonegative cases (by AJCC criteria) were analysed again for partial staining patterns, defined for this study as cases with 50-75% cells showing 2+/3+ intensity of nuclear p16 immunostaining and for basal predominant pattern of immunostaining. These cases were subjected to HPV DNA PCR. RESULTS: Out of the 661/800 cases found to be negative for p16 immunohistochemistry, a total of 34/800(4.25%) showed partial staining based on the criterion of 50-75% cells showing p16 immunostaining intensity of 2/3+.The basal predominant pattern of immunostaining for p16 was seen in 43/800 (5.38%) cases. When these cases were subjected to HPV DNA analysis, 11/34 (32.35%) of the cases showing partial staining and 02/43 (4.7%) of the cases showing basal predominant pattern of p16 immunostaining were found to be HPV-DNA positive. CONCLUSION: The inclusion of partial immunostaining patterns of p16 in HPV analysis of oral squamous cell carcinoma can improve our understanding of HPV driven oral squamous cell carcinoma.

Exploring The Link Between Obesity And Hypothyroidism.

BACKGROUND: Obesity and hypothyroidism are two common clinical conditions that are often connected. This connection is now more important because of an exceptional rise in the prevalence of obesity around the world. Both of these conditions have a noteworthy impact on human health and well-being. The main objective of this study was to determine the frequency of hypothyroidism in obese patients presenting at Ayub Teaching Hospital, Abbottabad. METHODS: This cross-sectional study was carried out on 242 patients in the Department of Medicine of Ayub Teaching Hospital, Abbottabad from 1st March to 31st August 2022. SPSS version 23.0 was used for data analysis. RESULTS: In this study, 242 obese patients were included. The mean age of the patients was 39.55±9.361 years. The mean BMI was 41.62±8.099kg/m2 ranging from 31 to 61kg/m2, the mean TSH level was 3.04±2.604mU/l, the mean T4 level was 8.53±2.215pmol/L and the mean T3 level was 1.2195±0.35795nmol/L. Out of a total of 242 patients, 34 (14.0%) were male and 208(86.0%) were female patients. Patients found with overt hypothyroidism were 11 (4.5%), subclinical hypothyroidism were 31 (12.8%) and euthyroid were 200 (82.6%). CONCLUSIONS: The proportion of hypothyroidism among the obese patients was quite less in our setup and not significantly associated with age and gender of the patients.

Covid-19 Pandemic-Knowledge, Perception, Anxiety And Depression Among Frontline Healthcare Workers Of Ayub Teaching Hospital Abbottabad, Pakistan.

Background: The COVID-19 pandemic is a viral infection that spreads through different mediums and has a high rate of mortality. At its initial stages, there is no particular medicine that can cure patients of COVID-19. The aim of the present study was to understand the COVID-19 knowledge, perception, and its effects in terms of anxiety and depression among frontline health care workers of Ayub Teaching Hospital, Abbottabad. Methods: This cross-sectional study was conducted in Ayub Teaching Hospital, Abbottabad from June to July 2021 in which data was collected from 200 hospital healthcare workers who have performed duties in COVID isolation wards through standard questionnaire. SPSS version 24.0 was used for data analysis. Results: Out of 200 participants in the study 100 (50.0%) were male. Regarding safety measures taken during COVID -19, 144 (72.0%) individuals reported that they have not been given training to handle known or suspected cases of COVID-19. Moderate anxiety and depression was found in 153 (76.5%) healthcare workers, mild in 25 (12.5%) and 22 (11.0%) had severe anxiety and depression at the time of COVID-19 pandemic. Conclusion: This study revealed that a significant anxiety and depression was found in frontline healthcare workers during the COVID-19 pandemic. In addition, a more extensive study should be conducted which involves many other hospitals like Ayub Teaching Hospital.

Frequency Of Folic Acid Deficiency In Women Of Childbearing Age Presenting At Ayub Teaching Hospital Abbottabad.

BACKGROUND: Folic acid deficiency is one of the most common deficiencies among women of childbearing age. It can lead to neural tube defects, a significant cause of disability and mortality among infants. Therefore, the main objective of this study was to determine a folic acid deficiency in women of childbearing age in Ayub Teaching Institute, Abbottabad. METHODS: This cross-sectional study was carried out in Ayub Teaching Institute, Abbottabad from January to June 2020. In this study, a total of 193 women of childbearing age were included through consecutive sampling. RESULTS: In this study 193 women of childbearing age were included. Mean age was 30±4.87 years. Out of 193 patients, 56.7% were found to be anemic and 38.9%were found to have folic acid deficiency. CONCLUSIONS: Our study concludes that the majority of women of child bearing age are anemic in our set up. Moreover, the frequency of folic acid deficiency is 38.9 % which is high.

Intergenerational fairness: lessons from pandemic contexts.

The present paper, focusing on the concept of intergenerational fairness, analyzes the obligation to ensure fairness to the young and future generations who experience serious deprivations from pandemics and similar hazards, and evaluates legitimacy of their claims. The paper examines the problem of shortsightedness of the dominant population which undermines the rights and interests of the future generations, and elucidates long-term impacts of our actions on humanity at large. The idea of intergenerational fairness is validated by the humanistic normative framework which is moored on rationality and virtuous disposition of persons. Among other things, the discussion evaluates the significance of the idea of fairness in using and preserving natural resources for future generations, grounds for prioritizing interests of the young while allocating healthcare resources, the obligation of the present population to ensure subsequent generations a decent minimum level of living, and the necessity to incorporate intergenerational concerns while formulating public policies. It is argued that pandemics and similar hazards remind us of our obligation to do reasonable, and morally justifiable, sacrifices for the young and future generations.

Demographic Profile of p16 Immunopositive and HPV DNA PCR Positive Oral Squamous Cell Carcinoma in a Large Cohort of Indian Patients.

BACKGROUND: The Indian subcontinent has the highest incidence of oral cavity squamous cell carcinoma in the world. The high incidence of tobacco chewing habit with or without smoking has been found to be the chief culprit. However in a minor subset of patients Human Papilloma Virus may play a role. MATERIALS AND METHODS: A total of 800 cases of Oral squamous cell carcinoma were included in the study. The patients were given a questionnaire comprising of questions about demographic details and habits. The biopsy samples were routinely processed for immunohistochemistry for p16 (E6H4 clone, CINtec histology, Roche diagnostics). Cases with 2+/3+ positive nuclear staining with more than 75% cells immunopositive were taken as p16 immunopositive as per the AJCC criteria and were further subjected to HPV DNA PCR for which DNA was extracted from the formalin fixed paraffin embedded tissue. RESULTS: Out of 800 OSCC cases 139 (17.37%) showed p16 immunopositivity by AJCC criteria. Out of these, 104 (104/139, 74.8%) cases were positive by HPV DNA PCR for HPV-16/18. Following patient characteristics were associated with a higher proportion of p16 and HPV DNA positivity-urban residence, vegetarian diet, illiteracy, graduate or higher education. No correlation was noted with gender, tobacco smoking or chewing habits, religion, occupation or site of tumor. The p16 immunopositivity was higher in the younger age group with no tobacco habits. CONCLUSION: A significant proportion of OSCC cases in India are associated with HPV infection. A higher percentage of p16 immunopositivity amongst younger patients with no tobacco habits points towards a distinct subset of patients in whom HPV may be the chief culprit and not just playing a supporting role.

Therapeutic effects of Typha elephantina leave's extract against paracetamol induced renal injury in rabbits.

Present study focuses on ameliorative potential of Typha elephantina leave's aqueous (TE.AQ) extract against Paracetamol (PCM) induced toxicity in rabbits. We fed the male rabbits with 300 mg PCM in alone and in combination with TE.AQ at different doses i.e. (100, 200 and 300 mg/kg body weight) or silymarin (100 mg/kg) daily for 21 days. PCM in alone significantly (P < 0.5) increased serum urea, uric acid, creatinine, total protein, albumin, globulin and blood urea nitrogen. Serum sodium, potassium and magnesium level were high. The glutathione, radical scavenging activity and Thiobarbituric acid reactive substances were significantly reduced. Treatment with TE.AQ at dose rate 300 mg/kg body weight and Silymarin significantly ameliorated all the parameters when compared with PCM administered group. The 100 and 200 mg of TE.AQ showed no significant effects. The histopathological examination confirmed the therapeutic potential of TE.AQ. These results established the presence of natural antioxidants in Typha elephantina leaves.

Therapeutic role of Typha elephantina leaves aqueous extract in paracetamol intoxicated rabbits.

Present study is aimed to investigate the hepatoprotective and hematopoietic effect of Typha elephantina leaves aqueous (T.E.AQ), extract in paracetamol (PCM) intoxicated rabbits. Experimental animals were divided into various groups. The blood was taken on day 7th (W1=Week 1), day 14th (W2 = week 2) and day 21st (W3 = week 3) of treatments and was analyzed for all hematological and serum biochemical markers. PCM administration caused marked increase in the levels of serum biochemical and hematological parameters. The leaves of T.E.AQ extract at dose rate 300mg/kg body weight significantly (P<0.05) reduced the elevated levels of serum biochemical and hematological indices towards normal values on third week (day 21st) of treatment while treatment in the first two weeks revealed non-significant effects even at all doses of extract. The levels of glutathione (GSH) and radical scavenging activity (RSA) were reduced and thiobarbituric acid reactive substances (TBARS) levels was high in the PCM feed animals. Administration of (T.E.AQ) extract at high dose (300mg/kg) significantly regulated and normalized these antioxidant values. The antioxidant capacity of (TE.AQ) extract, showed increase inhibition against various extract concentrations on the basis of percent scavenging of (DPPH) free radical. The histological sections of liver further supported the hepatoprotective activity of extract.

Smartphone-assisted tele-gynepathology: A pilot study.

INTRODUCTION: Traditional telepathology techniques like whole slide imaging require expensive equipment and are currently out of reach of the developing countries. However, the improvements in smartphone camera resolution and availability of faster internet have made smartphone-assisted telepathology possible. METHODS: A total of 186 cases pertaining to gynecologic pathology reported by single consultant (NT) were retrieved from the records of the histopathology department. A trained histopathologist then photographed representative areas of each case by using the smartphone camera. After a wash off period of 6 months, the images along with the clinical details were sent by Whatsapp Messenger to the same reporting pathologist. The reporting pathologist replied with the diagnosis of each case by using Whatsapp. RESULTS: The smartphone diagnosis was concordant in 179/186 (96.2%) cases. The intraobserver concordance rates varied with the organ involved - it was highest for endometrial and myometrial pathology (123/126, 97.6%) lowest for ovarian lesions (08/10, 80%). For cervical pathology, it was 97.2% (35/36) and for fallopian tube pathology it was 92.9% (13/14). CONCLUSION: Although the initial results of this pilot study are encouraging, there is a long way to go before smartphone-assisted telepathology can be put to routine use for the second opinion. More experience of the pathologists with this technique and faster internet and better smartphone cameras will further improve the concordance of smartphone-assisted telepathology diagnosis with conventional microscopy diagnosis.

Protocols Of Treatment Of Meningitis In Medical Department: Are There Any?

BACKGROUND: Meningitis, whether viral or bacterial is associated with high mortality rate and risk of severe lifelong disability. Early antibiotics administration and favourable outcomes have been demonstrated by previous studies. The purpose of the study was to evaluate whether the patients with suspected meningitis in general medicine department of Ayub Teaching Hospital Abbottabad were being managed according to protocols. METHODS: This cross-sectional study was carried out in the Medical Department of Ayub Teaching Hospital Abbottabad from March 2018-March 2019 in which data was retrospectively collected from the hospital records of all patients with suspected meningitis admitted in Medical Ward. SPSS version 20.0 was used for data analysis. RESULTS: Out of 41 patients in the study 19 (51.74%) were male. Viral encephalitis accounted for 23 (56.1%) tuberculous meningitis for 14 (34.1%), and 4 (9.8%) patients had septic meningitis. Lumbar puncture for CSF examination was performed in 38 (92.7%). Out of 41 patients, 19 (46.3%) received a combination of Ceftriaxone, Acyclovir and Dexamethasone, 16 (39.0%) patients received anti tuberculous treatment (ATT), Dexamethasone and Streptomycin combination, 3 (7.35%) patients were given Ceftriaxone (2g) and Dexamethasone and 1 ( 2.45%) patient was given a combination of Ceftriaxone(2gm) along with Vancomycin (1gm) and Dexamethasone; while 2(4.9%) patients were given a combination of Acycolvir and Dexamethasone. CONCLUSIONS: This study identified practice gaps in the management of patients with suspected meningitis according to guidelines, as lumbar puncture and CSF-RE were not timely done and proper laboratory records were not maintained. Secondly blood culture facilities were not available in the hospital.

Inquiring Voluntary Turnover For Female Nurses In Pakistan Through Focused Ethnography.

BACKGROUND: Pakistan is a country with very low nurses to population rate. This problem becomes more prominent due to voluntary turnover; especially among female nurses. This problem could be attributed to several social and demographic factors. PURPOSE: This study sought to identify the factors affecting voluntary turnover of female nurses in Pakistan. METHODS: This study is qualitative in nature. Focused ethnography was used for detailed exploration of the issue of voluntary turnover among female nurses. Ethnographic interviews of informants were conducted to identify the social and organizational determinants of voluntary turnover among female nursing staff. RESULTS: Social factors affecting voluntary turnover include religious beliefs, cultural values, lack of social respect, marital disruption, and lack of psychological support. While organizational factors affecting voluntary turnover include sexual harassment, work-family conflicts, workload and job stress, emotional labour, undefined career path and lack of promotion opportunities and bullying behaviour of co-workers. DISCUSSION: Both social and organizational issues affect voluntary turnover among female nursing staff. Policymakers at national and organizational level must identify and address these issues to provide congenial work environment and to reduce turnover of female nurses in Pakistan.

Biosafety of unmodified ultrafine gold particles (AuPs) upon interacting with human blood components before systemic use.

Ultrafine gold particles (AuPs) can be emerged as a good candidate in the field of drug delivery as well as in imaging applications. However, little attention has been paid to detailed study of nanoparticle's interaction with blood components before systemic use. An investigation into the interaction of ultrafine AuPs with blood components is must for its clinical application. In present study, the interaction of ultrafine sized AuPs (2 ±â€¯0.5 nm, 5 ±â€¯1 nm, and 10 ±â€¯2 nm) with blood components and its immunogenic property (pro-inflammatory reaction) was investigated. All three sized AuPs did not cause any significant hemolysis. Plasma coagulation study showed significant increase in Prothrombin time (PT) with International Normalized Ratio (INR) value raised to 1.53 with 10 nm AuPs. Maximum prolongation of activated partial thromboplastin time (APTT) (3.2 s) was seen with 5 &10 nm sized AuPs. Maximum thrombin time (TT) prolongation was seen with 2 nm (18.3s) with the difference of 1.4 s as compared to control. Platelet aggregation was faster in case of 5 & 10 nm sized AuPs. All three sized AuPs exhibited in-vitro C3 complement activation whereas they did not stimulate significant proliferation of peripheral blood mononuclear cells (PBMC). These findings further validate the utility of ultrafine AuPs for in-vivo applications.

Risk Factors Of Chronic Kidney Disease Leading To Dialysis In Patients Presenting At Ayub Teaching Hospital Abbottabad.

BACKGROUND: There has been an immense increase in the incidence and prevalence of chronic kidney disease (CKD) in the last few years globally. Developing countries are more prone to suffer the complications due to greater poverty and higher expenses of treatment. Dialysis has become a routine procedure rather than exception. This study was conducted with the purpose to determine risk factors of CKD patients leading to dialysis. METHODS: This cross-sectional study was conducted at Ayub Teaching Hospital, Abbottabad (ATH) from December 2018 to April 2019. Patients admitted at the dialysis unit of ATH with the diagnosis of CRF were included. Data was analysed using SPSS version 20.0. RESULTS: Out of 152 CRF patients 99 (65.1%) were males. Majority of patient with CKD were on dialysis for more than 10 months. Out of 152 patients of CRF, 32 (21.1%) were diabetic. Hypertension was previously diagnosed in 148 (97.4.%). CONCLUSION: Hypertension was identified as major cause leading to CRF and subsequently dialysis.

Biokinetics of ultrafine gold nanoparticles (AuNPs) relating to redistribution and urinary excretion: a long-term in vivo study.

Gold nanoparticles (AuNPs) of ultrafine size have drawn attention for their use in drug delivery systems. Tissue toxicity may be an issue when AuNPs are used for such applications. We investigated the long-term biokinetics (90 d), redistribution, and urinary excretion of three different-sized (2 ± 0.5 nm, 5 ± 1 nm, and 10 ± 2 nm) AuNPs after a single intravenous (i.v.) administration of 1250 µg/kg dose in mice. ICP-AES analysis of lungs, liver, spleen, heart, kidney, brain, blood, and urine revealed highest accumulation of gold in spleen around 15 d after injection. A low concentration was detected in brain after 1 d without any residual AuNPs after 30 d. Ultrastructural study of brain tissue also showed few AuNPs in lysosome with no changes in cellular architecture. Renal retention of AuNPs was limited indicating low nephrotoxic potential. AuNPs were detectable in urine till 30 d after single injection indicating slow excretion from the body. No evidence of significant toxicity was observed in hemogram, serum biochemistry, and tissue histology. No mortality, changes in behavior, hair color, weight, and food intake was observed as compared to control mice. Therefore, we conclude that the ultrafine AuNPs are predominantly excreted in urine without any systemic toxicity following i.v. administration and are hence safe for use in drug delivery systems.

Association Of Tricuspid Regurgitation And Severity Of Mitral Stenosis In Patients With Rheumatic Heart Disease.

BACKGROUND: Rheumatic heart disease is a common ailment in Pakistan and Mitral stenosis is its flag bearer Severity of mitral stenosis is the key factor in deciding for mitral valve surgery. METHODS: This case series study was conducted at Ayub Teaching Hospital .Cases of Rheumatic heart disease with mitral stenosis were diagnosed clinically. 2D echocardiography was used to find severity of mitral stenosis. Data was entered into SPSS-17.0 and results were recorded and analysed. Pearson's two tailed correlation was used to find the correlation between presence of tricuspid regurgitation in patients with severe mitral stenosis, p was <0.05. RESULTS: A total 35 patients with pure mitral stenosis were included in study, out of which 8 were male and 27 were females. Mean age in males was 34.5±15.85 years while in females it was 31±8 years. Twenty-two out of 35 (62.86%) patients had tricuspid regurgitation while 13 out 35 (37.14%) had no tricuspid regurgitation. Mean (MVA) mitral valve area in patients with tricuspid regurgitation was 0.84±0.3 cm2 while mean (MVA) mitral valve area in patients without tricuspid regurgitation was 1.83±0.7 cm2. Mean left atrial (L.A) size was 45.23±1.5 mm2 in patients with tricuspid regurgitation, while it was 44.13±6.14 mm2 in patients without tricuspid regurgitation. Mean RSVP was 57.5mmHg in patients with tricuspid regurgitation while RSVP could not be calculated in patients without tricuspid regurgitation. CONCLUSIONS: It was concluded that tricuspid regurgitation was strongly associated with severe mitral stenosis as almost all patients with severe mitral stenosis had tricuspid regurgitation and none of the patients with mild mitral stenosis had tricuspid regurgitation.

In vitro and in vivo efficacy of doxorubicin loaded biodegradable semi-interpenetrating hydrogel implants of poly (acrylic acid)/gelatin for post surgical tumor treatment.

The paper describes the preparation and evaluation of doxorubicin loaded semi-interpenetrating polymeric hydrogel network of polyacrylic acid (PAc) and gelatin (G). Post surgical antitumor efficacy and biodistribution of doxorubicin from the implanted degradable hydrogels was investigated on Ehrlich's ascites tumor model using albino mice. Polycaprolactone diacrylate (PCL-DAr) was employed as a crosslinking agent for PAc chains whereas G was kept free. The effect of crosslinking concentration on various physico-chemical properties such as thermal behavior, swelling, degradation behavior, drug release and polymer-polymer interactions was investigated by various physico-chemical tools. Semi-interpenetrating polymeric networks (IPNs) with 0.2 mol% crosslinking concentration showed degradation within 20 days in phosphate buffer (pH 6.5). To determine the in vivo anticancer efficacy, placebo and drug laden cylindrical implants (65 ± 5 µg/implant of 10 mg) were implanted in tumor cavity post tumor excision. After predetermined time intervals (day 7, 11, 14, 20 and 25), drug biodistribution was assessed in tumor, tumor periphery, residual hydrogel and all vital organs i.e. liver, spleen, kidney, heart, lung and blood (spectrofluorimetrically). The drug distribution study showed the concentration of drug in the tumor, tumor periphery and residual hydrogel decreased with increasing time; on the 7th day, drug concentration was highest while, on the 25th day, it was negligible; however, insignificant quantities of the drug was found in vital organs. Histological examination revealed no sign of tumor recurrence until the 25th day with 100% necrosis and slight inflammation in treated the group. In vivo results established that these biodegradable implants can be utilized as post surgical therapy for solid tumors.

Frequency of seropositivity of Helicobacter pylori in patients presenting with dyspepsia.

BACKGROUND: Dyspepsia is a common health problem and most of the causes of dyspepsia are related to infection by Helicobacter pylori (H. pylori). Prevalence of H. pylori infection is different in different parts of the world. Purpose of our study was to determine the frequency of H. pylori infection in patients with dyspepsia in our setting where the prevalence of H. pylori was expected to be high. Objective of this study was to determine the frequency of H. pylori seropositivity in patients with dyspepsia. METHODS: A Cross sectional, descriptive study was conducted at the Department of Medicine, Ayub Medical College, Abbottabad from March to September 2009. Patients presenting in Medical outpatient departments of Ayub Teaching Hospital, Abbottabad with dyspepsia were included in the study and interviewed according to Reflux Disease Questionnaire and their serum sent for estimation of anti H. pylori IgG antibodies by enzyme linked immunosorbent assay (ELISA). RESULTS: A total of 92 patients were included in this study. Out of these 31 (33.7%) were males and 61 (66.3%) were females. Out of them 68 (73.9%) were found seropositive for H. pylori by ELISA. CONCLUSION: H. pylori infection is frequent in patients with dyspepsia in our setting and apparently uncomplicated dyspepsia should always be tested for H. pylori and all seropositive patients should be offered eradication therapy.