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Background: Breast malignancy is the major cause of cancer-related deaths among women globally. Therefore, early diagnosis is the primary requisition for an effective treatment plan. Objective: To determine the diagnostic accuracy (sensitivity, specificity, positive predictive value, and negative predictive value) of fine needle aspirate cell blocks made by the HistoGel-tube method in patients with breast cancer. Methods: This cross-sectional study was carried out at the Department of Pathology, King Edward Medical University/Mayo Hospital, Lahore. The study duration was six months. 62 patients with breast lumps, of all ages, both genders, having easily accessible breast lesions and C III, C IV, C V smears on rapid onsite evaluation were included while patients who had received neo-adjuvant chemo- or radiotherapy and those reported as C I, C II smears on ROSE were excluded. FNA was performed and HistoGel cell blocks were made in addition to the conventional smears. Data was entered in SPSS version 26. Results: The mean age of patients included in the study was 47 ± 13 years. 61(98.4%) patients were female while only 1(1.6%) patient was male. Sensitivity, Specificity, Positive predictive value, Negative predictive value and diagnostic accuracy came out to be 96%, 69%, 92%, 81%, and 90% respectively. Conclusion: HistoGel cell blocks have overall good diagnostic accuracy for the evaluation and diagnosis of breast malignancy. [ABSTRACT FROM AUTHOR]

Objectives: In this study it was intended to study mammaglobin expression as a marker for the detection of breast cancer and correlate it with the Bloom-Richardson grading system of breast carcinoma. Materials and Methods: The study was conducted from May 2007 to May 2008. Tissue samples were collected from 50 patients of breast cancer in the various stages of their disease and correlated histologically with the Bloom-Richardson grading system for breast carcinoma. The clinical data of the patients were obtained from their respective files. Results: Positive immunostaining for mammaglobin was seen in 84% of breast carcinoma cases. This immunoreactivity did not correlate with histological and nuclear grades of the tumors, yet it varied according to the histological type of the tumor with ductal carcinoma showing stronger and diffuse staining than other varieties. Conclusion: These results elicit that mammaglobin is overexpressed in carcinoma breast as compared to the normal breast epithelium. This mammaglobin expression can act as a useful tool in the diagnosis of women with breast cancer.

Objectives: This study has been designed to assess the knowledge, attitude and practices of healthcare workers at Mayo Hospital regarding biomedical waste segregation. Study Design: Cross-sectional study. Setting: Teaching Hospital of King Edward Medical University Lahore, Pakistan. Period: February 2018 to January 2019. Material & Methods: Structured questionnaires in English and Urdu were employed to collect data from healthcare workers (nurses and doctors) on duty in different wards of Mayo Hospital. The demographics, level of knowledge, practices and attitude regarding biomedical waste segregation are reported using descriptive statistics. The comparison of doctors and nurses is done using chi- square. Results: Significantly fewer number of doctors correctly identified the container for bio hazardous waste (p=0.016), while majority (89.4%) of respondents were able to correctly identify the container for sharps and general waste. Significantly more (p=0.00) number of nurses had training in waste segregation as compared with doctors. Majority (95.0%) of nurses acknowledged that guidelines regarding waste segregation were available in their departments, whereas significantly lesser number (64.5%) of doctors acknowledged existence of guidelines at their workplace (p=0.00). 21.3% of respondents claimed to have acquired infection from waste with no statistical difference between the two groups (p=0.19). A minority of the participants agreed that the practices were satisfactory (14.6%) and the required equipment was available (27.7%), yet there was a significant difference between the responses of doctors and nurses with the nurses being more satisfied with the available facilities and equipment (p=0.00) than doctors. Conclusion: The knowledge of the healthcare workers regarding waste segregation is better than their practices, nonetheless there is a dire need to improve the quality of training of these health care workers in and emphases must be put on ensuring that correct practices are adopted. [ABSTRACT FROM AUTHOR]

Needle stick injuries have a fairly common incidence in surgical practice exposing surgeons to an array of transmissible diseases. The aim of the study was to assess the prevalence of needle stick injury, and their reporting among surgeons in tertiary hospital setting. Study Design: Cross-sectional study. Setting: Various tertiary care hospital of Lahore. Period: January 2016 through April, 2016. Materials and Methods: Our sample size was 935 Surgeons. We determined the prevalence of needle stick injuries, reporting of NSI, the reasons for not reporting and the reasons for acquired injuries. Results: Needle stick injury was reported by only 85 (9.1%) participants. The reasons for not reporting varied; 363 (38.8%) did not report due to unawareness of the existence of a relevant system, 250 (26.7%) did not know whom to report, 86 (9.2%) were not able to spare time to report, 81 (8.7%) were afraid of results, 48 (5.1%) thought that patient was low risk and 107 (11.4%) did not bother. Conclusion: There was a lack of hospital policy to cater to the reporting of injuries sustained during surgical practice. A dire need for a system was observed to educate the healthcare workers and provide a medium to assist the process of reporting. [ABSTRACT FROM AUTHOR]

Fine-needle aspiration cytology (FNAC) is used as a valuable method for examining suspected salivary gland lesions. It is a simple, cost-effective, and minimally invasive procedure with high specificity and sensitivity. Due to the cellular heterogeneity and overlapping architectural features, it can be difficult to distinguish between non-neoplastic processes, benign lesions, and/or malignancies in salivary glands on routine stains. Cell block methods are currently replacing surgical biopsy-based diagnostic methods on the basis of utilizing aspirates from FNAC with a rapid and reliable potential for reaching a conclusive diagnosis. Ancillary investigations including a panel of immunohistochemical markers are frequently applied on cytology specimens in the era of precision diagnostics to offer a specific diagnosis and even prognostic information for optimal patient care. [ABSTRACT FROM AUTHOR]

Objectives: Adenoid cystic carcinoma (AdCC) and mucoepidermoid carcinoma (MEC) are the commonest salivary gland malignancies in Pakistan constituting almost 75% of all malignant salivary gland tumours. The objective of this study was explore the clinical & morphological spectrum of these tumours in local population and to grade them w.r.t. modern grading criteria. Study Design: Descriptive study. Setting: Department of Morbid Anatomy and Histopathology/ Oral Pathology, University of Health Sciences Lahore, Pakistan. Period: Jan. 2014 to Sep. 2015. Method: Paraffin embedded blocks and detailed clinical data of 20 cases each of adenoid cystic carcinoma and mucoepidermoid carcinoma reported at local tertiary care hospitals. The histologic diagnosis was made on Hematoxylin and Eosin staining. The tumours were graded into grades I, II & III according to the most recent grading criteria. AdCC was studied with respect to its morphological patterns (tubular, cribriform and solid) while MEC was studied with special concern to the cell types seen in it (mucous, intermediate, squamous and clear cells). Results: The most frequently observed age group for the patients of AdCC was the 5th (45%) decade with mean age of 41.50±12.224 years and a female predilection of 1.5:1. Minor salivary glands were the commonest site involved (80%) of which palate was most frequently affected (37.5%) followed by maxilla (25%). Grade I (75%) was most frequently noted grade in AdCC. Cribriform pattern (60%) was the most frequently encountered predominant histological pattern followed by equal distribution of tubular and solid Patterns (20% each). MEC affected most patients in 3rd (30%) decade with mean age of and 32.35±13.674 years and male predilection (60%). Parotid gland (70%) was the commonest site involved followed by maxilla (10%). Histologically, grade III (40%) was most frequently noted followed by grade I (35%) and grade II (25%). Squamous cells (65%) were the predominant cell type in most cases followed by mucous cells in (35%) cases. Conclusion: Adenoid cystic carcinoma and mucoepidermoid carcinoma both affect a younger age group in our population with a female (1.5:1) and male (1:1.5) predilection respectively. The most favoured site for AdCC and MEC is palate and parotid gland respectively. Grade I AdCC and cribriform pattern are the commonest grade and pattern encountered in this study. On the other hand, high grade (Grade III) MEC is the most regularly encountered grade in MEC. So, proper grading and staging along with meticulous surgical approach is needed to improve the life expectancy in these patients. [ABSTRACT FROM AUTHOR]

Medical error reporting is essential in creating a culture of accountability in our healthcare system. The aim of this study was to evaluate the frequency of reporting errors by surgeons in our setup and to analyse the factors resulting in under-reporting of medical errors. A total of 96 practicing surgeons at Mayo Hospital, Lahore were surveyed between the months of February, 2018 to June 2018 on their beliefs regarding the reporting of medical errors by means of a specifically designed questionnaire. This study revealed that 71 (74%) respondents had committed a medical error but only 16 (16.6%) of them reported those errors. Major factors in under-reporting of errors included work stress and fear of medico-legal consequences due to disclosure of error. Eighty-four (87.5%) believed that increase in reporting medical errors would contribute to a better system. Most surgeons had a positive view towards the process but believed that the reporting system was ineffective.

Objective: To evaluate pre-microscopic errors in anatomical pathology., Methods: The cross-sectional descriptive study was conducted at the Department of Pathology of a tertiary care hospital in Lahore, Pakistan, from September, 2016, to January, 2017, and comprised surgical pathology specimens. Errors were noted across the pre-microscopic process. Defects per million opportunities were calculated to determine sigma metric value in every step, from requisition to slide preparation. Root cause analysis was applied to the process of histology preparation to identify the root cause of each previously identified problem using Eindhoven classification. All errors were recorded on a pre-designed proforma., Results: There were 2420 specimens. While errors were encountered in all phases of the pre-microscopic process, but the (G6: n=1085, 44.83%), followed by requisition (R3: n=893, 36.9%) and cover slipping (C1: n=776, 32.06%)., Conclusions: Development of standard procedures and protocols with staff training is likely to help in controlling the errors.

Objective: To evaluate the skill of postgraduate residents in breaking bad news to the patients in a tertiary care hospital., Methods: The cross-sectional study was conducted at King Edward Medical university, Lahore, Pakistan, from January to April 2016, and comprised postgraduate residents of different specialties at Mayo Hospital, Lahore. The subjects were examined in terms of their personal experience in breaking bad news to the patients by means of a specifically-designed questionnaire based on six-step protocol of Setting, Perception, Invitation, Knowledge, Empathy and Summarising model. Data was qualitatively and quantitatively analysed using SPSS 22., Results: Of the 200 respondents, 141(70.5%) were males and 59(29.5%) were females. Overall mean age of the sample was 23 } 2.55years. Of the total, 94(47%) respondents were only fairly satisfied with their breaking bad news skill, while 130(65%) were eager to get training in this regard. The knowledge regarding breaking bad news protocols was lacking across all comparisons (p>0.05)., Conclusions: Majority of the residents had little satisfaction regarding their breaking bad news skill. It is necessary to plan special training for the residents in this key area.

Objective: To determine the role of lymph node biopsy in the diagnosis of lymphadenopathy and to find out the pattern of different diseases in relation to age, gender, and the site of lymph nodes involved., Methods: This retrospective study was carried out at the Histopathology Department of the Children's Hospital and The Institute of Child Health, Lahore, Pakistan, over a period of 9 years, from January 1999 to December 2007. Tissue samples were collected from 898 children presenting with lymphadenopathy, and the diagnosis was confirmed on histology and through various specific tests. The clinical data of the patients were collected from computerized hospital records., Results: Among the total 898 consecutive lymph node biopsies, the most common pathology encountered was reactive hyperplasia in 356 children (39.6%), followed by tuberculosis in 262 (29.1%) and malignant lymphomas in 132 children (14.6%). The rest of the lesions include; 72 cases of granulomatous lymphadenitis (8%), 13 of histiocytosis X (1.4%), 44 (4.9%) of metastatic tumors, 16 of chronic inflammation (1.8%), and 3 cases of Kikuchi's disease (0.3%). The cause of lymphadenopathy was found to be significantly associated with age, gender, and site of the lymph nodes involved., Conclusion: Lymphadenopathy is a relatively common condition in the pediatric age group. Although 39.6% of children had reactive hyperplasia of unknown etiology, 60.3% children presented with a specific diagnosis.