Objective: The objective of this study was to establish the diagnostic accuracy, specificity and sensitivity of fine needle aspiration cytology(FNAC) for intra-oral tumors, comparing with histopathology as the gold standard. Materials and methods: Forty cases of FNA cytology from intraoral tumors was performed in AFID along with the demographic data and clinical information and then diagnosed at AFIP, Rawalpindi. Then the cytology results obtained per FNAC were compared with the histopathological biopsy results of the same lesions. The following variables were recorded for each patient: Age, gender, site of biopsy, diagnosis. The data were entered and analyzed using Open-epi version 2.0. Diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value were calculated. Cohen Kappa was further applied to compare the agreement between the biopsy and FNAC diagnoses. A p-value of < 0.05 was considered as statistically significant. Results: Among the total patients included in the study there were 24 males and 16 females, with a ratio of 1.5:1. Age of the patients ranged from 24 to 80 years with a mean of 52 years. A total of six sites were aspirated from the oral cavity with maximum (11) aspirates taken from alveolar ridge. The results of FNAC revealed that there were 32 malignant and 8 benign aspirates. Confirmation through histopathological analysis came for 31/32 malignant cases while one was falsely given positive for malignancy on FNAC. Among a total of 40 cases, 31(77%) cases diagnosed were found to be malignant and remaining 9(23%) were benign. The FNAC results revealed 32 malignant and 8 benign lesions. Histopathology of the subsequent surgically excised specimen showed malignant lesions in 31(77%) and benign in 9(23%) patients. As a whole, it was found that the absolute sensitivity for introral FNAC was 100% and specificity 89% with positive predictive value of 97% and negative predictive value of 100%. Conclusion: Cytological diagnosis was almost corroborative with final histopathological diagnosis in all cases, with very few exceptions, exhibiting high diagnostic accuracy.

The technique of digital splenoportography with thin flexible needles and small amounts of dilute contrast medium is described as one particularly suitable for use in paediatric patients. The authors report a high incidence of spontaneous splenorenal shunting revealed in their patients by this technique.

Background/objectiveCoronavirus infectious disease (COVID-19) is a novel disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-COV-2). Some studies have shown that disease severity according to clinical and biochemical parameters are in direct relation to viral load while others have found no direct correlation. In this study, the COVID-19 cycle threshold (Ct) value, which is taken as a direct indicator of the viral load, has been correlated with the biochemical and clinical parameters in COVID-19 patients. MethodsIn this cross-sectional, retrospective, and single-center study, 365 patients admitted with COVID 19 were divided into three groups according to their Ct values obtained from reverse transcription-polymerase chain reaction RT-PCR as 1 (9-20), 2 (21-30), and 3 (31-40). The correlation of the COVID-19 Ct value with biochemical parameters and clinical presentation (taken as mild, moderate, and severe) was done and analyzed. The chi-square test was used for the correlation and calculated by using SPSS V-24.0 (IBM Corp., Armonk, NY). p-value <0.05 was considered significant statistically. ResultsDisease severity levels (mild, moderate, and severe) correlated in group 1 (Ct value 9 to 20), 2 (Ct value 21 to 30), and 3 (Ct value 31 to 40) but no significance was found between disease severity levels and the Ct value groups' p-value (>0.05). All the biochemical parameters analyzed (alanine transaminase (ALT), aspartate aminotransferase (AST), albumin, bilirubin, c-reactive protein (CRP), lactate dehydrogenase (LDH), ferritin, D-dimer, and total leucocyte count (TLC)) showed a significant p-value (<0.05) in all the three groups studied. Procalcitonin (PCT), however, did not show any significant value in any of the groups studied.In the intergroup assessment, it was found that the values of ALT, AST, albumin, CRP, ferritin, bilirubin, and TLC are maximum in group 2 with a downward trend in groups 1 and 2. Neutrophils and lymphocytes did not show any variations. LDH did not follow the trend of increasing viral load. ConclusionsThe severity of the disease was not statistically significant in the Ct value groups (p> 0.05). However biochemical parameters, i.e. ALT, AST, ALP, CRP, and bilirubin were statistically significant (p<0.05).Patients with COVID-19 should be closely monitored for the assessment of disease progression according to the above-mentioned biochemical parameters.

Chronic gastrointestinal (GI) diseases in children present with a wide range of symptoms. Limited resources in Paediatric Gastroenterology in developing countries like Pakistan cause considerable difficulties in managing children with chronic GI diseases in a timely fashion. This retrospective descriptive study aimed to determine the spectrum and outcomes of chronic GI diseases in children. The study was conducted at the Paediatric Gastroenterology and Hepatology Department, Pakistan Kidney and Liver Institute & Research Centre (PKLI &RC) in Lahore. The duration of the study was from August 2019 to August 2020. A total of 40 children below the age of 15 years with chronic GI diseases were included. The diagnosis was principally established with the assistance of esophagogastroduodenoscopy and ileo-colonoscopy. ---Continue

Primary sclerosing cholangitis (PSC) is a rare chronic cholestatic liver disease in children caused by chronic inflammatory process affecting either intrahepatic or extrahepatic bile ducts. Although it is infrequent, incidence is increasing worldwide, may be due to more awareness, understanding and expertise in managing children with chronic liver disease (CLD). In the developing world like Pakistan where resources and expertise are limited, very few tertiary centers are equipped to manage CLD in children. This case report is about a teenage child who presented to us with decompensated CLD in the form of jaundice and ascites. In our center, after a much needed workup he was commenced on appropriate treatment for PSC. After six months of treatment, he has managed to clear jaundice. The liver synthetic functions have improved with normal coagulation profile. His MELD (model for end-stage liver disease) score, which has come down from 19 to 9, delays liver transplant (LT) for years, which remains the best available treatment. MELD is a scoring system to assess the severity of CLD and remains an important tool to determine the outcome and ranking for receipt of an LT. Subsequently, he developed colitis and colonoscopy confirmed lymphocytic colitis (LC), which is a rare association of PSC.