Research Question: Whether the Copper sulphate specific gravity method is a valid screening test to detect anaemia at the field
level and if it is affected adversely by any common prevalent nutritional and physiological or obstetric factors of the women.
Objectives: To find out the validity of Copper sulphate specific gravity method to detect anaemia at 11 gm% and 12 gm%
haemoglobin level among women.
Design: Cross-sectional, Observational, Epidemiological, Community-based study.
Setting: Urban Health Clinic at Ghoshbagan slum of Kolkata, the field practice area of Dept. of Community Medicine, R G K M C &
H.
Participants: Women of 10 – 45 years of the area, selected by systematic random sampling.
Result: The study recruited 373 women from the slum area. For haemoglobin level of 12gm%, the sensitivity was 91.19%,
specificity was 82.14%, Predictive value for positive test was 92.25% and that for negative test was 80.0%. Respective results for
Haemoglobin level of 11gm% were 81.53%, 96.30%, 94.12% and 87.76%. Similar high values of validity were obtained for
different physiological and nutritional status of the women. The results implied that copper sulphate specific gravity method is a
valid screening procedure for detection of anaemia irrespective of differing physiological and nutritional statuses of women.

Clear cell sarcoma of the kidney is a highly malignant pediatric renal neoplasm occurring most frequently in the second to third
year of life. Its occurrence in adults is extremely rare and a subject of isolate case reports. This neoplasm must be differentiated
from other sarcomatoid tumors, sarcomas and round cell tumors because of its unique histomorphologic characteristics and mode
of treatment. We present a rare case of Clear cell sarcoma of the kidney, presenting in adulthood with emphasis on its differential
diagnosis.

Introduction: Malarial parasites (genus Plasmodium) are blood sporozoans threatening to human life especially in equatorial,
tropical and sub tropical world. Out of four species of plasmodium of men, only P. vivax and P. falciparum have been reported
to occur in the country. The disease in which plasmodium multiplies in red blood cells causing rupture of millions of blood cells
is still a major health hazard in Pakistan.
Patients and Methods: Malarial parasites were identified in the blood slides of suspected patients of the disease from July,
2004 to June, 2006, and encompassed 11866 subjects. Inclusion criteria were the presence of fever, chills and vomiting at the
time of interview or within the last one month. Exclusion criteria like Widal test, blood culture and Brucella antibody tests were
not done.
Results: Out of 11866 suspected cases of malaria, 3353 (28.25 %) were found to be positive for malarial parasite in blood
smear slides. In Pishin, out of 5934 suspected cases, 2440 (41.11 %) were found to be positive for malarial parasites. 76.51%
(1867/2440) cases were identified as P. vivax and 23.48 % (573/ 2440) were with P. falciparum infection. These results are
compared with those of other studies conducted in the country. In Quetta, out of 5932 suspected cases, 913 (15.39 %) were
found to be positive for malarial parasites. 64.95 % (593/913) cases were identified as P. falciparum. and 35.04 % (320/913)
were with P. vivax infection.
Discussion: In our study the over all prevalence rate of 65.22 % (2187/3353) of P. vivax poses a significant health hazard like
cerebral malaria as it was pointed out in previous investigation in the country. There was no case of Plasmodium malariae and
P. ovale infection observed in the present study. It seems that there is no association between types of infection and age
groups.
Conclusion: Therefore, it can be said that the incidence of any type of infection can happen to any age group person
independently.

Objective: To study the haematological features and JAK2 mutation in Pakistani patients of myeloproliferative disorders.
Design: Descriptive cross sectional.
Place and duration of study: Department of Heamatology, Armed Forces Institute of Pathology, Rawalpindi from Jan 2004 to Jan
2007.
Patients and methods: Forty seven consecutive patients of myeloproliferative disorders (MPD) diagnosed by the conventional
haematological criteria were included in the study. The patients on treatment were excluded. Age, sex, splenic enlargement, blood
complete counts and bone marrow examination findings were recorded. All patients were screened for G-T Point mutation (V617F)
in the JAK2 gene on chromosome 9 by an allele specific PCR.
Results: Out of the 47 MPD patients, 17 (36%) had polycythaemia rubra vera (PRV), 7 (15%) had essential thrombocythaemia
(ET) and 18 (38%) had idiopathic myelofibrosis (IMF). JAK2 positive was seen in 37/47 (79%) patients including 17/17 (100%) in
PRV, 4/7 (57%) in ET and 13/18 (72%) in IMF.
Conclusion: MPDs are an important group of haematology disorders in Pakistan. Vast majority of these disorders (79%) showed
mutation in the JAK2 gene. JAK2 mutation analysis is especially useful in the diagnosis of polycythaemia vera where it was found
in 100% of the cases.

Objective: To evaluate the significance of platelet count in cases of malaria at presentation.
Design: Descriptive study.
Place and duration of study: Department of pathology CMH Lahore, from Aug 2007 to Sep 2008.
Material and methods: A total of 256 patients of all ages with short history of febrile illness, rigors and chills were included in the
study. Three ml blood sample was taken to prepare thick and thin blood smears. The smears were stained with Leishman’s stain
and examined for malarial parasite. Complete blood counts of all the subjects were carried out with Sysmex KX -21 hematology
analyzer.
Results: Out of 256 patients, 102 (40%) were positive for malaria on microscopy. 80 (31%) had Plasmodium vivax and 22 (9%)
had Plasmodium falciparum infection. Thrombocytopenia was found in 66 (82.5%) and 19 (86.45%) patients of Plasmodium vivax
and plasmodium falciparum respectively.
Conclusion: Thrombocytopenia is a frequent finding in cases of malaria at presentation. Its presence in a patient with acute febrile
illness increases the probability of malaria. Replacement therapy is usually not required and platelet count becomes normal after
anti malarial treatment.

Post-transplantation lymphoproliferative disorders (PTLD) are lymphoid proliferations or lymphomas that develop as a result of
immunosuppression in recipients of solid organs and bone marrow allografts. Post-transplatation lymphoproliferative disorder is
seen in 1-2 % of renal transplant recipients with a variable time period of presentation and is usually seen within the first year
following transplantation. We report a case of B–cell lymphoma (PTLD WHO class-3) presenting with skin involvement in a patient
of renal transplantation, eight years after receiving the transplant.

Objective: To determine the frequency of hepatitis delta virus (HDV) seropositivity in patients with chronic Hepatitis B Virus (HBV)
infection at Armed Forces Institute of Pathology (AFIP), Rawalpindi.
Study design: Cross-sectional study.
Patients and methods: The study was conducted at department of Virology, AFIP, Rawalpindi. A total of 227 serum samples
were collected at AFIP, Rawalpindi, from patients with chronic hepatitis B virus (HBV) infection along with a short history regarding
the age, sex and socioeconomic status. Enzyme Linked Immunosorbent Assay (ELISA) for detection of HDV Immunoglobulin G
(IgG) and Immunoglobulin M (IgM) antibodies was performed on all the collected serum samples.
Results: A total of 30 (13.2%) patients out of 227, were found positive for IgG. The mean age of the patients was 35.8±10.7 years.
Seropositivity of HDV-IgG was 12.8% (25/195) in males and 15.6% (5/32) in females. 11.8% (6/51) of patients from higher
socioeconomic group and 13.6% (24/176) in lower socioeconomic group were positive for HDV-IgG (p=0.728%).
Conclusion: Our study shows that 13.2% of chronic hepatitis B virus infected patients at AFIP, Rawalpindi, were positive for HDV
IgG. HDV seropositivity was not affected by demographic variables such as age, gender and socioeconomic status of patients.

Object ive: To determine the seroposi t ivi ty for vi ral hepat i t is B, hepat i t is C and HIV in heal thy blood
donor populat ion of Nor thern areas of Pak istan.
Mater ials and Methods: The blood donors at tending the blood bank of Hayatabad Medical Complex,
Peshawar were screened for seromarkers of vi ral hepat i t is B, C and HIV by us ing enzyme l inked
immunoassay (ELISA) over a per iod of 05 years. The data of blood donor screening was obtained f rom
Serv ices Hospi tal , Peshawar for compar ison.
Resul ts: Blood donors screened at H.M.C. Hospi tal showed seropos i t ivi ty of 1.40% and 1.34% for
hepat i t is B and hepat i t is C respect ively f rom 1999 – 2003. Screening of blood donors at Services
Hospi tal , Peshawar dur ing the same per iod, detected 1.75% HBsAg posi t ive and 2.60% ant i–HCV
posi t ive subjects. No HIV posi t ive blood donor was detected in both the hospi tals dur ing this per iod.
Conclusion: This study concluded a decreas ing t rend in the seroprevalence of vi ral hepat i t is (B & C) in
the blood donor populat ion of Nor thern Pakistan.

Objective: To study the impact of psychological stress following a natural disaster on specific immunological parameters.
Methods: The study was carried out over a 3 month period (Feb 2006 to May 2006) at the Armed Forces Institute of Pathology,
Rawalpindi, Pakistan. Physically uninjured male adults between 15-60 years of age, with no prior history of an active physical or
psychological disorder, who witnessed the earthquake on 8th Oct, 2005 in Pakistan but escaped physical injury, were included in
the study. Age and gender matched healthy adults were also studied as control group. Analysis of haemoglobin, total leucocyte
count, lymphocyte count, lymphocyte subsets, IgG, IgA, IgM levels, C reactive protein and nitrobluetetrazolium (NBT) dye
reduction test was carried out on both the groups.
Results: Psychologically distressed individuals had increased CD 3+ cells (p=0.02), increased CD4:CD8 ration (p=0.04), reduced
CD19+ cells count (p=0.03) and IgG levels (p=0.01). Neutrophil oxidative burst activity without stimulation was increased (p= 0.02).
Conclusion: Psychological stress consequent to exposure to a natural disaster can suppress humoral immune response.

Objective: A retrospective analysis of the laboratory results was performed to explore the turnaround time (TAT) for the
laboratory services.
Materials and methods: The TAT for specimens arriving at the main laboratory from wards, main laboratory and critical care
areas was noted and compared with the standard set for reporting.
Results: Median TAT for results of 169 blood samples was on average 195 min (n=170), 172 min (n=169), 121 min (n=167)
from main lab, wards and for STAT samples from critical care areas respectively. Median analytical time was 170 min, 105 min,
and 72 min from main lab, from wards and for STAT samples respectively.
Conclusion: This TAT is within acceptable limits according to the standard sets. However, high transport time from critical care
areas (median 49 min) was noted, which can be further improved if the portering and transport arrangements of the specimens
are made more effective (Abbreviation: Coronary Care Unit CCU, Intensive Care Unit, ICU, Emergency Department, ER, Aga
Khan University Hospital AKUH, Turnaround time TAT, (Laboratory information system LIS).