Institute Of Pathology Research Articles

Clinicopathological Features of Pakistani Patients with Anti Aquaporin-4 (Aqp-4) Antibody Positive Neuromyelitis Optica Spectrum Disorder (NMOSD): A Comparison with Local, Regional and International StudiesOPTICA SPECTRUM DISORDER(NMOSD)-A COMPARISON WITH LOCAL, REGIONAL AND INTERNATIONAL STUDIES

Objective: To characterize clinicopathological characteristics of patients with anti AQP-4 antibody positive Neuromyelitis Optica Spectrum Disorder in local population in order to facilitate clinicians in timely diagnosis and treatment of this rare debilitating illness. Study Design: Cross-sectional study. Place and Duration of Study: Department of Immunology, Armed Forces Institute of Pathology, Rawalpindi Pakistan, from Jun 2021 to Dec 2022. Methodology: The study included 369 individuals presenting at Armed Forces Institute of Pathology for serum anti AQP-4 antibody testing by indirect immunofluorescence. Commercial Anti Aquaporin-4 Indirect Immunofluorescence Test Slides along with control serum (EUROIMMUN Medizinische Labordiagnostika AG, Lubeck, Germany) were used and immune-fluorescence was observed using immunofluorescent microscope BA-310. Results: Out of 369 patients who were tested for Anti Aquaporin-4 antibody, 168(45.5%) were females and 201(54.5%) were males. Total 9(2.43%) patients tested positive including 5(55.5%) females and 4(44.4%) males (p=0.947). Most prevalent core clinical characteristics among patients with Neuromyelitis Optica Spectrum Disorder were optic neuritis 7(77.8%), acute myelitis 7(77.8%) and area postrema syndrome 6(66.6%). Common presenting core clinical characteristics were area postrema syndrome 4(44.4%) and acute myelitis 4(44.4%). Average diagnostic delay in our study was 2.7±3.2 years. Conclusion: By keeping high index of suspicion for presenting core clinical characteristics (area postrema syndrome and acute myelitis) clinicians may be able to diagnose and treat this rare disease timely hence decrease average diagnostic delay and prevent associated morbidity and mortality.

Molecular and Clinical Spectrum of Hemoglobin D: An Experience at a Tertiary Care Diagnostic Center

Objective: To determine the clinical and molecular pattern of Hemoglobin D in patients presenting at tertiary care hospital. Study Design: Cross-sectional study. Place and Duration of study: Department of Hematology, Armed Forces Institute of Pathology, Rawalpindi Pakistan, from Jul 2020 to Mar 2021. Methodology: An automated cell analyzer was used to determine the whole blood count and red cell indices. D-10 BIORAD HPLC was used for quantitative assessment of Hb A, Hb F, Hb D and Hb A2. Where D-10 BIORAD HPLC showed an abnormal Hb D, capillary electrophoresis was performed using Sebia Capillary 2 Flex Piercing. Chelex DNA Extraction method was used. Molecular analyses for the confirmation of homozygosity and heterozygosity were done using Polymerase Chain Reaction (PCR) amplification. The clinical symptoms of the patients such as anemia, jaundice, pallor, weakness, hepatomegaly and splenomegaly were also noted Results: Among 90 patients, Hemoglobin D trait was found in 78(80.4%) of the patients out of which HbD-Punjab was seen in 57(73%) and HbD-Iran was found in 21(27%). Compound Heterozygotes (HbD/β) was found in 17(17.5%) and Compound Homozygous HbD/D was found in 02 (2.1%). All HbD-Punjab and HbD-Iran traits patients were asymptomatic, and few clinical symptoms were found in Compound Heterozygotes (HbD/β) and Homozygous HbD/D. Conclusion: Collective clinical history records, full blood count and electrophoresis and molecular results allow for the conclusive detection of the variant of Hemoglobin D. More multicenter, organized and detailed studies with larger sample size are required to draw concrete conclusions.

Comparison of Urine Specimen with Recto-Vaginal Swab to establish carriage of Group B Streptococcus Colonization in Pregnant Females

Objective: To determine maternal vaginal colonization with Group B Streptococcus using both recto-vaginal swab and mid-stream urine in order to determine which specimen type can give better results. Study Design: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Pathology, Rawalpindi Pakistan, Department of Gynecology and Obstetrics, Combined Military Hospital and Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jan to Jun 2022. Methodology: Recto-vaginal swabs and mid-stream urine were taken from 194 pregnant women between 36th and 37th weeks of pregnancy. Swabs were inoculated on blood and MacConkey agar while urine specimen was inoculated on blood and CLED agar. All plates were incubated at 37°C in either ambient air or CO₂ incubator. Identification of Group B Streptococcus was made on the basis of colony morphology (β-haemolytic colonies on blood agar), Gram stain, catalase test and confirmation were done by means of latex agglutination tests. Results: In comparison to urine, a Group B Streptococcus carriage rate of 8.2% was detected in recto-vaginal swab. Urine specimen of only 3 patients yielded growth of Group B Streptococcus giving a urine carriage rate of 1.5%. Conclusion: Recto-vaginal swab gives a better insight to the presence of Group B Streptococcus as compared to mid-stream urine.

Reporting of somatic variants in clinical cancer care: recommendations of the Swiss Society of Molecular Pathology.

Somatic variant testing through next-generation sequencing (NGS) is well integrated into Swiss molecular pathology laboratories and has become a standard diagnostic method for numerous indications in cancer patient care. Currently, there is a wide variation in reporting practices within our country, and as patients move between different hospitals, it is increasingly necessary to standardize NGS reports to ease their reinterpretation. Additionally, as many different stakeholders-oncologists, hematologists, geneticists, pathologists, and patients-have access to the NGS report, it needs to contain comprehensive and detailed information in order to answer the questions of experts and avoid misinterpretation by non-experts. In 2017, the Swiss Institute of Bioinformatics conducted a survey to assess the differences in NGS reporting practices across ten pathology institutes in Switzerland. The survey examined 68 reporting items and identified 48 discrepancies. Based on these findings, the Swiss Society of Molecular Pathology initiated a Delphi method to reach a consensus on a set of recommendations for NGS reporting. Reports should include clinical information about the patient and the diagnosis, technical details about the sample and the test performed, and a list of all clinically relevant variants and variants of uncertain significance. In the absence of a consensus on an actionability scheme, the five-class pathogenicity scheme proposed by the ACMG/AMP guideline must be included in the reports. The Swiss Society of Molecular Pathology recognizes the importance of including clinical actionability in the report and calls on the European community of molecular pathologists and oncologists to reach a consensus on this issue.

Cause of death in patients with tuberculosis: A study based on epidemiological and autopsy records of Western Norway 1931-47

BackgroundWithout treatment, nearly 50 % of tuberculosis (TB) patients die. World Health Organization’s definition of TB deaths does not take into consideration whether the cause of death was TB or other non-TB co-morbid conditions. We aimed to improve our knowledge of the causes of death in patients with TB. MethodsSingle-center retrospective study conducted at Gade Institute of Pathology, Haukeland University Hospital, Bergen, Norway. Autopsy data of 269 patients with TB was collected from autopsy journals, and epidemiological data was collected from Norwegian Official Statistics books for period 1931–1947. ResultsOf all TB deaths reported in epidemiological reports, pulmonary TB accounted for 81 % and extrapulmonary TB for 19 %. However, in autopsy records, only 21 % of cases with active pulmonary TB died because of TB. Extrapulmonary involvement was significantly associated with higher mortality (OR EPTB as compared to PTB; 3.27, CI 1.91 – 5.61) and constituted 79 % of deaths attributable to TB. A significant burden of extrapulmonary TB was found in autopsy records (63 %), while in epidemiological records, only 4 % of cases were reported. ConclusionsExtrapulmonary involvement was a predictor of mortality due to TB in hospitalized TB patients. The contribution of extrapulmonary TB to TB mortality seems to be underestimated because extrapulmonary TB largely remains underdiagnosed and underreported in epidemiological data.

Immunohistochemical Expression of ROS1 in invasive ductal carcinoma of breast in association with hormonal receptor status and Her2Neu expression

Objective: To determine the frequency of immunohistochemical expression of ROS1 in invasive ductal carcinoma of the breast in relation to hormonal receptor status and HER2 expression. Study Design and Setting: Descriptive cross-sectional study. Department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi from May 2022 to Dec 2022. Methodology: This study was conducted on a sample size comprising 137 patients diagnosed with invasive breast carcinoma (ductal carcinoma) on histopathological biopsy specimen. Immunohistochemistry was performed using ROS1, estrogen receptor, progesterone receptor and HER2 antibodies on patients’ tissue samples. Results were interpreted by two independent histopathologists. Finally data was analyzed using SPSS version 25. Results: The mean age of sample population was 50.85 ± 12.17 years. 131 patients were women and 6 were men. ROS1 was positive in 54 cases. ROS1 shows weak staining in 41 cases and moderate to strong staining in 13 cases. ER and PR showed no significant statistical correlation with ROS1 expression. HER2 was positive in 37 cases, equivocal in 11 cases and negative in 89 cases. A significant statistical correlation was seen between ROS1 and HER2 as 23 of HER2 positive cases showed ROS1 expression (p=<0.001). Conclusion: Significant number of ROS1 expressing cases in invasive breast carcinoma can be more revealing in the understanding of pathogenesis of breast carcinoma. In addition, it can also lead to use of certain recent tyrosine kinase inhibitors for treatment of this most common carcinoma in females.

Immunohistochemical Expression of Cyclin D1 in Invasive Breast Carcinoma

Objective: This study was conducted to determine the immunohistochemical expression of cyclin D1 in invasive breast carcinoma and its association with already established prognostic parameters like estrogen receptor (ER), progesterone receptor (PR), HER2/Neu, and Ki67 status. Study Design & Setting: Cross sectional Observational. Department of Pathology, Armed Forces Institute of Pathology, Rawalpindi Methodology: The study included 350 cases of invasive breast cancer diagnosed between January 2023 and December 2023. Data collected included patient age, histological subtype, molecular subtypes, tumor size, and the presence of estrogen (ER) and progesterone (PR) receptors, as well as HER2/Neu and Ki67 status. Patients who had undergone chemotherapy, received radiation to the breasts, or experienced relapse were excluded from the study. Immunohistochemistry was conducted using a Cyclin D1 antibody to assess Cyclin D1 expression in tissue samples. The expression levels were categorized as negative, weak, moderate, strong staining in tumor cells. Data analysis was performed using SPSS 29.0, and statistical comparisons were made between Cyclin D1 staining and ER, PR, HER2/Neu, and Ki67 status. Results: Cyclin D1 moderate to strong staining was seen in 173/352 (49.14%) cases of invasive BC. Cyclin D1 expression was slightly statistically significantly associated with ER (x2 = 7.78, P value <0.051) and Ki67 positivity (÷2 = 7.27, P value <0.064). Conclusion: Cyclin D1 has the potential to serve as a prognostic marker. Incorporating it into the routine IHC workup for breast cancer could enhance patient management, especially with the development of new targeted therapies that inhibit the Cyclin D-CDK4/6 axis.

Exploring the Epidemiology of Melanocytic Tumors in Canine and Feline Populations: A Comprehensive Analysis of Diagnostic Records from a Single Pathology Institution in Italy.

MTs are prevalent in dogs, representing the most frequent oral malignancy, compared to cats, in which ocular melanomas predominate. This study investigates the canine and feline MT epidemiology (2005-2024) of cases submitted to the Veterinary Pathology Service (University of Perugia). Among the canine neoplasms, 845 (4%) were melanocytic: 329 (39%) melanocytomas; 512 (61%) melanomas. Of these, 485 (57%) were cutaneous (4% of canine cutaneous neoplasms), 193 (23%) were oral (50% of oral canine neoplasms), and 104 (12%) were mucocutaneous. The average age of affected dogs was 10 years. Older dogs were more likely to have melanomas compared to melanocytomas (p < 0.001). There were 60 (1%) feline MTs: 6 (10%) melanocytomas; 53 (88%) melanomas. Of these, 29 (48%) were cutaneous (1% of feline cutaneous tumors), 18 (30%) were ocular, and 9 (15%) were oral (22% of feline oral tumors). The average age of affected cats was 11 years. In dogs, mucocutaneous melanomas were more common compared to cutaneous ones (p < 0.05); oral melanomas were more common compared to all other sites (p < 0.001). In cats, ocular melanomas were more common compared to cutaneous ones (p < 0.05). Our study provides the MT prevalence in a selected canine and feline population, revealing MT epidemiological patterns, highlighting species-specific differences in the tumor prevalence, localization, and age distribution.

Intracardiac Ectopic Thyroid Tissue: A Case Report

We present the case of a 36-year-old female who visited the OPD of a local hospital in Lahore, Pakistan, with history of chest pain, shortness of breath and palpitations. Echocardiogram and transesophageal echocardiography revealed right ventricular outflow tract mass, dilated coronary sinus and atrial septal defect. Surgery was advised, and successful excision of the mass was done and the specimen later sent to Chughtai Institute of Pathology for histopathological evaluation and diagnosis. The results revealed benign thyroid tissue with no evidence of malignancy. The patient was symptom-free on follow up after 6 months.

Diagnostic Accuracy of Polymerase Chain Reaction Against Giemsa Staining on Tissue Biopsy for Cutaneous Leishmaniasis.

To evaluate the diagnostic accuracy of a commercial real-time polymerase chain reaction (PCR) kit targeting 18S rRNA against Giemsa-stained tissue slides in patients clinically suspected of cutaneous leishmaniasis (CL). Cross-sectional analytical study. Place and Duration of the Study: Department of Microbiology, Armed Forces Institute of Pathology / National University of Medical Sciences, Rawalpindi, Pakistan, from July to December 2022. Samples of skin tissue in 98 patients suspected of CL were evaluated. These samples were subjected to Giemsa-staining for microscopy and real-time PCR. Sensitivity, specificity, and accuracy of the PCR were calculated keeping Giemsa-stained tissue slide microscopy as gold standard. Out of the 98 tissue samples, 37 were found positive for leishmaniasis on PCR while 13 were found Leishmania positive on microscopy of Giemsa-stained slides. The sensitivity, specificity, and accuracy of the PCR for the detection of Leishmania species were 100%, 71.8%, and 91.8%, respectively with 100% negative predictive value. This study demonstrates that the commercial PCR is a reliable diagnostic test for the diagnosis of CL. The ease, rapidity, and reliability of the PCR make it a dependable tool in diagnostic repertoire of CL. Giemsa stain, Leishmania spp., Polymerase chain reaction, Viasure.

Diagnostic Accuracy of Immunohistochemical Expression of p16, MDM2, and CDK4 in Well-Differentiated and De-Differentiated Liposarcoma in MDM2 Fluorescent in situ Hybridisation Confirmed Cases.

To establish the diagnostic utility of immunohistochemistry markers p16 along with MDM2 and CDK-4 in confirming the diagnosis of well-differentiated and de-differentiated liposarcoma while taking Fluorescent in situ Hybridisation (FISH) as a gold standard. A cross-sectional study. Place and Duration of the Study: Department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan, from 30th January 2022 to 30th June 2023. A standard panel of three immunohistochemistry markers p16, MDM2, and CDK4 were applied to 36 cases of atypical lipomatous tumours, well-differentiated liposarcoma (WDLPS), and de-differentiated liposarcoma (DDLPS), on which the gold standard FISH was already performed. The sample size was calculated with the help of a WHO calculator taking prevalence 1-2% in Pakistani population. Qualitative variables such as gender and site of tumour were presented by calculating frequency and percentages and comparison of Immunohistochemistry results with FISH was done by using a 2x2 table. The sensitivity and specificity of this triple marker panel for detecting WDLPS/DDLPS were 43.47% and 15.38%, respectively. The sensitivity and specificity of CDK4 for detecting WDLPS / DDLPS were 82.6% and 15.4%, those of MDM2 were 73.9% and 61.5 %, and those of p16 were 60.9% and 53.8%, respectively. Among all three markers, CDK4 was the most sensitive and MDM2 was the most specific marker for detecting WDLPS-DDLPS. It also showed that a combination of these three markers improves the diagnostic credibility of the immunohistochemistry in diagnosing DDLPS and WDLPS but FISH is the most reliable and confirmatory method. De-differentiated liposarcoma, Well-differentiated liposarcoma, P16, CDK4, MDM2.

Histological and Biochemical Alterations Underlying Statin-Associated Pancreatic Toxicity in a Rat Model

ObjectiveTo investigate the histological and biochemical alterations in the pancreas associated with statin-induced toxicity using a rat model. MethodologyA one-year laboratory-based experimental control trial conducted at department of anatomy of a public sector medical college in Rawalpindi, in collaboration with the National Institute of Health (NIH) Islamabad and Armed Forces Institute of Pathology (AFIP) Rawalpindi. Twenty male Sprague-Dawley rats were assigned to the control group and another twenty to the experimental group. For a duration of 12 weeks, the experimental group was given 60 mg/kg/day of simvastatin orally, whereas the control group was given water and a conventional diet. The following characteristics were measured: body weight, pancreatic weight, biochemical parameters (cytokines, enzymes), and histological alterations (congestion, necrosis, fibrosis). Version 23 of the Statistical Package for the Social Sciences (SPSS) program was used to analyze the data. Qualitative variables were expressed as percentages and frequencies. The statistical significance was defined as P &lt; 0.05. Chi-square analyses contrasted the qualitative factors among the groups. ResultsCompared to controls, the simvastatin group showed significantly increased mean pancreatic weight (p=0.043), congestion (55% vs 0%, p&lt;0.001), higher levels of CRP (p&lt;0.030), IL-6 (p&lt;0.040), and TNF-α (p&lt;0.040). Trends of mild necrosis (25% vs 5%, p=0.182) and interstitial fibrosis (15% vs 0%, p=0.231) were observed but not statistically significant. DiscussionThis work shows that simvastatin significantly affects the pancreatic histomorphology and biochemical parameters in rats. It causes a noticeable amount of necrosis, interstitial fibrosis, and changes the pancreatic biochemical profile. These changes raise the possibility of long-term statin-associated pancreatitis and endocrine/exocrine dysfunction. Using a stable animal model, these new findings offer distinctive insights into the impact of simvastatin on pancreatic morphology. Conclusion Simvastatin profoundly impacts pancreatic histomorphology, warranting further investigation into mechanisms of toxicity and close monitoring of patients for pancreatic adverse effects during statin therapy.

Redefining chronic mountain sickness: insights from high-altitude research and clinical experience

Abstract Chronic Mountain Sickness (CMS), characterized by increased red blood cells above average values traditionally attributed to chronic hypobaric hypoxia exposure, is being redefined in light of recent research and clinical experience. We propose a shift in perspective, viewing CMS not as a singular entity but as Poly-erythrocythemia (PEH), as the Hematocrit/Hemoglobin/Red Blood Cells (Ht/Hb/RBCs) increase constitutes a sign, not a disease reflecting a spectrum of oxygen transport alterations in multiple diseases in the chronic hypoxia environment in high-altitude populations. Drawing on over five decades of experience at the High Altitude Pulmonary and Pathology Institute (HAPPI-IPPA) in Bolivia, we advocate for altitude-specific blood parameter norms and emphasize the importance of correct etiological diagnosis for effective management. This updated understanding not only aids in managing chronically hypoxemic patients at various altitudes but also offers valuable insights into global health challenges, including the recovery from COVID-19.

Impact of the COVID-19 Pandemic on Tumor Stage and Pathohistological Parameters of Vulvar Cancer.

Background/Objectives: Vulvar cancer (VC) comprises a small fraction of female neoplasms with notable high-incidence clusters among German regions. Despite a proposed impact of nationwide lockdowns in response to the COVID-19 pandemic on oncological diseases, the effect on VC staging and tumor characteristics remains yet to be resolved; therefore, analyzing pathological data from patients with squamous cell VC pre-, during, and post-COVID in a high-incidence region may offer insights into potential epidemiological and clinical trends. Methods: We identified a total of 90 patients who were diagnosed at the Institute of Pathology, University Hospital Saarland, between 2018 and 2023, and defined three distinct cohorts: a pre-COVID cohort (2018-2019), a COVID cohort (2020-2021), and a post-COVID cohort (2022-2023). Histomorphological data were collected from the individual patient reports and statistically analyzed using Fisher's exact test or the Kruskal-Wallis test. Results: Although we found no statistically significant differences in age, T-stage, perineural infiltration, blood vessel infiltration, resection status, grading, or resection margin between our three cohorts, surprisingly, we determined a greater extent of lymphovascular infiltration (Fisher's exact test; p = 0.041), as well as deeper tumor infiltration depth (Kruskal-Wallis test; p < 0.001) before the COVID-19 pandemic. Furthermore, we did not identify any soft indications of abnormalities in patient care within our center (unchanged status of the resection margins across all three cohorts). Conclusions: Our results clearly do not support a negative affection of clinical or pathobiological characteristics of VC during or after the pandemic. However, final assessments regarding the pandemic's effect on VC require additional study approaches in various regions, preferably with future extended timeframes of a longer follow-up.

Complete Blood Count and Biochemistry Reference Intervals for Healthy Adult Donkeys in the United States.

Previous hematologic and serum biochemistry reference interval (RI) values have been established for donkeys in various geographic regions, life-stages, or for specific donkey breeds. The last extensive investigation establishing RIs for adult donkeys in the United States (U.S.) was published over three decades ago. We aimed to establish updated robust RIs using a reference population of apparently healthy adult donkeys from across the U.S. Standard sized (n = 102), miniature (n = 17), and mammoth (n = 1) donkeys from four different states were enrolled, with 20% of the study population including donkeys captured directly from the wild in Death Valley National Park, CA. RIs were established in accordance with the American Society for Veterinary Clinical Pathology and Clinical Laboratory Standards Institute guidelines. The findings will assist practitioners with the interpretation of their complete blood count and biochemistry panel results in U.S. donkeys. This study also highlights a comparison of results for some important analytes in U.S. donkeys compared to U.S. horses and previously established donkey RIs.

A deep-learning-based model for assessment of autoimmune hepatitis from histology: AI(H).

Histological assessment of autoimmune hepatitis (AIH) is challenging. As one of the possible results of these challenges, nonclassical features such as bile-duct injury stays understudied in AIH. We aim to develop a deep learning tool (artificial intelligence for autoimmune hepatitis [AI(H)]) that analyzes the liver biopsies and provides reproducible, quantifiable, and interpretable results directly from routine pathology slides. A total of 123 pre-treatment liver biopsies, whole-slide images with confirmed AIH diagnosis from the archives of the Institute of Pathology at University Hospital Basel, were used to train several convolutional neural network models in the Aiforia artificial intelligence (AI) platform. The performance of AI models was evaluated on independent test set slides against pathologist's manual annotations. The AI models were 99.4%, 88.0%, 83.9%, 81.7%, and 79.2% accurate (ratios of correct predictions) for tissue detection, liver microanatomy, necroinflammation features, bile duct damage detection, and portal inflammation detection, respectively, on hematoxylin and eosin-stained slides. Additionally, the immune cells model could detect and classify different immune cells (lymphocyte, plasma cell, macrophage, eosinophil, and neutrophil) with 72.4% accuracy. On Sirius red-stained slides, the test accuracies were 99.4%, 94.0%, and 87.6% for tissue detection, liver microanatomy, and fibrosis detection, respectively. Additionally, AI(H) showed bile duct injury in 81 AIH cases (68.6%). The AI models were found to be accurate and efficient in predicting various morphological components of AIH biopsies. The computational analysis of biopsy slides provides detailed spatial and density data of immune cells in AIH landscape, which is difficult by manual counting. AI(H) can aid in improving the reproducibility of AIH biopsy assessment and bring new descriptive and quantitative aspects to AIH histology.

Mucoepidermoid carcinoma: A comparative analysis of histological grading systems

: Salivary gland carcinomas comprise of only 3-5% of all head and neck malignancies. Mucoepidermoid carcinoma (MEC) is the most common malignant salivary gland tumor. The morphologic diversity of MEC can pose diagnostic challenges hence, various histological grading systems have been proposed based on the quantitative and qualitative analysis. This proves to be greatly consequential in the management and prognosis of patients with MEC.To compare histologic grading methods in MEC of major &amp; minor salivary glands.20 histopathologically diagnosed cases of MEC (10 each major &amp; minor salivary gland) will be analysed using following methods: Qualitative Method: 1) Modified Healey 2) Memorial Sloan-Kettering Cancer Center method. Quantitative method: 1) Armed force Institute of Pathology (AFIP) 2) Brandwein method Histological findings were evaluated. In our study AFIP grading system, 50% Cases were classified as low grade, 35% as intermediate grade and 15% as high graded. According to Brandwein grading system20% of cases were categorized as low, 35% cases as intermediate, 45% cases as high grade MEC. Modified Healey grading system of MEC showed 50%, 40%, 10% cases as low, intermediate and high grade MEC respectively. MSKCC grading system revealed as 55%, 30% and 15% cases as low, intermediate and high grade MEC respectively. Our finding indicated that MSKCC grading system was the most favourable histological grading system as percentage of agreement found to be 85%.Careful microscopic examination is the most important parameter in the grading of MEC. This meticulous microscopic examination emerges as the cornerstone in grading MEC. Both MSKCC and Modified Healey grading methods exhibits effectiveness in evaluating MEC. Our finding indicated that Memorial Slon Kettering Cancer Center (MSKCC) was the most favourable histological grading system as percentage of agreement found to be 85%. However, further longer studies are imperative to substantiate this finding and for establish of universally accepted grading system for Mucoepidermoid carcinoma.

Spectrum of Lower Respiratory Bacterial Pathogens and their Antimicrobial Susceptibility in a Tertiary Care Hospital at Rawalpindi

Objective: To study the spectrum of bacterial etiological agents causing lower respiratory tract infections and their antimicrobial susceptibility pattern in a tertiary care hospital at Rawalpindi. Methodology: A descriptive, cross-sectional study was conducted in the department of Microbiology, Armed Forces Institute of Pathology (AFIP), Rawalpindi from June to December 2021. Total 130 patients with lower respiratory tract infections (LRTIs) irrespective of age and gender were included in the study while patients of pulmonary tuberculosis, fungal diseases and patients having prior antibiotic therapy before sample collection were excluded. Non quantitative cultures were performed for sputum, non- directed bronchial lavage (NBL), pleural fluid and quantitative cultures for bronchoalveolar lavage (BAL) and endobronchial (EB) washings specimens. Antibiotic susceptibility was performed using Clinical and Laboratory Standards Institute (CLSI) 2021 guidelines. Results: Pseudomonas aeruginosa (26.9%) was found to be the most prevalent bacterial pathogen followed by Klebsiella pneumoniae (23%). Both Gram negative and Gram-positive bacteria showed highest antimicrobial resistance to flouroquinolones. Gram negative bacteria were more susceptible to aminoglycosides and carbapenems. Gram positive bacteria were most susceptible to linezolid and vancomycin. Staphylococcus aureus was isolated from 8 samples, of which 5(62.5%) were Methicillin-resistant Staphylococcus aureus (MRSA). Conclusion: This study concluded that the most frequent bacterial pathogen causing lower respiratory tract infections was Pseudomonas aeruginosa and both Gram negative and Gram-positive bacteria showed highest antimicrobial resistance to flouroquinolones.

A PROPOSED METHOD FOR SPEECH AND LANGUAGE TESTING WITHIN A HEARING SCREENING PROGRAM FOR CHILDREN STARTING SCHOOL

This article sets out a proposal for how one might expand hearing screening in school children so as to include testing of speech mastery. From 2008 to 2019, the Institute of Physiology and Pathology of Hearing (IPPH) implemented a program to screen the hearing of Polish children starting school, covering over 1 million children. Its success prompted the development of a screening model to cover the entire process of verbal communication. One result was the "Equal Start in Education", a program implemented from 2019 to 2022 in the Lublin province, otherwise known as the "Lublin Program for Early Detection and Therapy of Communication Disorders in Children Starting School". It was conducted by the University Children’s Clinical Hospital in Lublin and the Maria Curie-Sklodowska University, in cooperation with IPPH, and was designed to assess hearing, auditory processing, voice, and speech-language. The program was successful in addressing various issues related to the screening of all communication skills. Here we present findings from the program and propose a testing procedure used to evaluate speech. The screening procedure might be applied more widely in the future, and could diagnose those children requiring audiological and speech-language therapy.

PITEVNÍ PROTOKOLY ZACHYCUJÍCÍ DOPRAVNÍ ÚRAZY NA ÚZEMÍ PRAHY A OKOLÍ V LETECH 1918–1968

This paper is based on analysis of autopsy protocols from the Czech capital Prague between 1918 and 1968. The protocols were produced by the staff of institutes of forensic pathology (before 1939 there were two such institutes, later only one). Surviving collection of protocols from that period consists of 59 413 items, which likely represent a complete set of postmortem examination done in Prague. This paper will focus on protocols related to traffic accidents which will be analysed according to several categories including gender, religion, age, type of vehicle involved etc.