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Background HIV/AIDS has emerged as a serious public health issue across the globe, and particularly in developing countries. Comprehensive knowledge and positive attitudes are cornerstones for the prevention, control and treatment of HIV/AIDS. However, there are various misconceptions associated with HIV/AIDS transmission, which lead to negative attitudes towards people living with AIDS. The present study aims to explore the effects of these determinants, related to socio-demographic characteristics and autonomy, on women’s overall knowledge and attitudes regarding HIV/AIDS in Pakistan. Methods Secondary data analysis was carried out using the national representative dataset of the 2012–13 Pakistan Demographic and Health Survey. A series of questions related to HIV/AIDS was asked of 13,558 ever-married women aged 15–49 years to assess respondents’ knowledge regarding modes of HIV/AIDS transmission and preventative measures, as well as their attitudes towards people living with HIV/AIDS. Descriptive and bivariate statistics were used to identify associations with socio-demographic and autonomy-related variables. Furthermore, bivariate and multivariate logistic regression analyses were performed to assess the association between multiple factors and overall HIV/AIDS knowledge as well as attitudes towards people living with AIDS. Results The results show that only 42% of Pakistani women have heard about HIV/AIDS. Amongst these women, the majority (68%) have good overall knowledge of HIV/AIDS and more than 55% have positive attitudes towards people living with AIDS. Furthermore, women residing in urban areas, having at least secondary-level education, with high autonomy, belonging to the richest wealth quintile and having exposure to mass media had high overall knowledge and positive attitudes towards people living with AIDS. Conclusion The findings of this research support the relevance of women’s autonomy, education and exposure to mass media, particularly in rural areas of Pakistan, to address the lack of knowledge and eliminate various myths and stigmatisation of people living with HIV/AIDS. Furthermore, it reveals a need to increase focused and targeted interventions to enhance women’s knowledge and positive attitudes towards people living with HIV/AIDS. In this regard, the media can play a proactive role to gauge wider audience in creating awareness and eradicating the myths and misconceptions regarding HIV/AIDS.

The accumulation of heavy metals by crops irrigated with wastewater has been considered as a serious environmental problem in many developing countries, where the wastewater irrigation has emerged as a common practice. In this research, we were concerned with the highly toxic metal lead (Pb) in water, agricultural soils, and wheat crops, and the possible risk on human health in the peripheral agricultural regions of Punjab, Pakistan. Various types of irrigated water (ground, sewage, industrial), soil, and wheat plant (root, shoot, grain) samples of five different varieties (Seher-2006, Punjab-2011, Faislabad-2008, Watan, and Galaxy-2013) were collected from seven different districts and then pooled up to make one composite sample and analyzed for Cd concentration. The various pollution and mobility indices (pollution load index, enrichment factor, daily intake of metal, health risk index, translocation factor, bioaccumulation factor, and bio-concentration factor) were also calculated. The descending order for Pb concentration was as follows: water>soil>wheat plant. The range of concentration of Pb in all types of water, soil, and wheat plant (root, shoot, grains) samples was (7.05–7.83 mg/l), (6.32–7.74 mg/kg), (3.23–4.82, 1.14–2.75, 0.09–0.51 mg/kg), respectively. The concentration of Pb in all types of water samples exceeded the maximum permissible limit. There were values found to be < 1.00 in all the pollution and mobility indices for all types of samples. These results reveal that high levels of Pb in irrigated water may pollute the soil and wheat plants of these regions in the near future, if various control measures have not been taken. It may pose a great health risk to the local human and animal populations. Preventive measures should be taken to reduce heavy metal pollution of irrigation water and soils to protect both human and animal health in various regions of Punjab, Pakistan.

Collision tumors are type of tumors where two histologically distinct type of tumors occur at the same anatomic location. Breast collision tumors comprising carcinoma and lymphoma or invasive ductal carcinoma with invasive lobular carcinoma are relatively common. However, a collision tumor between metaplastic breast carcinoma (MBC) and invasive lobular carcinoma (ILC) is extremely rare. Here, we report a case of collision tumor in breast comprising MBC and ILC. A 60-year-old female patient presented in outdoor department with palpable painless firm mass in left breast. FNAC diagnosis of class V smears was made. Wide local excision was done and specimen sent for frozen section analysis. On frozen section, diagnosis of malignant neoplasm was made and suspicion of malignant phyllodes and MBC was raised. All margins were reported free as free of the tumor. Further sectioning revealed another tumor, 0.1 cm away from main tumor. Sections from this tumor showed a malignant neoplasm arranged in cords with tumor cells having eccentric nuclei and moderate amount of cytoplasm. Immunohistochemical (IHC) analysis showed spindle cell tumor with profile favoring MBC while IHC analysis of second tumor was consistent with the diagnosis of ILC. Final diagnosis of collision tumor was made. © 2019 Tehran University of Medical Sciences. All rights reserved. Acta Med Iran 2019;57(4):271-275.

Introduction Although the cytology of effusion fluids is considered a routine laboratory test, it has recently emerged as an essential tool in determining the primary site of origin of carcinoma of unknown primary. The sensitivity for diagnosing malignancy has enhanced with the inclusion of cytospin, cell block (CB), and immunohistochemistry (IHC) to effusion fluid cytology due to the improvement in morphological preservation and good cellular yield. The purpose of this study was to assess the diagnostic yield, sensitivity, specificity, positive predictive value, and negative predictive value of IHC and CB in effusion cytology. Methodology An institution-based cross-sectional study was conducted over a period of six months on 150 cases of effusion fluids submitted for diagnostic purposes. After the preparation of cytospin, the residual amount of centrifuged deposit was mixed with CytoLyt solution, thrombin, and plasma, and CBs were prepared. IHC was applied to the CB. Calretinin was used for mesothelial cells, and BerEP4, TTF-1, ER, WT-1, and CD-X2 were used for the confirmation and origin of malignant cells. Results The mean age of the patients was 51.75 ± 16.63 years. The male-to-female ratio was 1:1.24. Out of 150 cases, 78 were pleural effusions, 68 were peritoneal effusions, and four were pericardial effusions. Out of 150 cases, based on cytological examination alone, 66 (44%) were classified as benign, 27 (18%) as malignant, and 57 (38%) were suspicious for malignancy. When cytology was combined with CB and IHC, the diagnostic yield was increased to benign 95 (63.33%), malignant 48 (32%), and suspicious for malignancy 7 (4.67%). The most common cause of malignant pleural effusion was breast carcinoma in females and lung carcinoma in males. The most common primary tumor in malignant peritoneal effusion was ovarian carcinoma in females and colonic adenocarcinoma in males. The sensitivity and specificity of combined cytology with cell block and IHC were 92.31% and 98.95%, respectively. This combination produced significantly better results (p-value = 0.001) for detecting malignancy and reduced suspicious cases from 38% to 4%. Conclusion CB, in combination with IHC, increases the diagnostic yield and aids in detecting malignancy at an unknown primary site in effusion fluids. Both of these techniques can thus enhance the sensitivity and specificity of the diagnosis of effusion cytology. Hence, CB and IHC have advanced utility over cytological smears in effusion fluid cytological diagnosis.

Objective: To determine the frequency of resolution of pulmonary embolism 6 months after diagnosis and treatment using CT pulmonary angiography. Study Design: Analytical, Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi, from Dec 2022 to May 2023. Methodology: This study was conducted on thirty-one patients with pulmonary embolism, enrolled by consecutive sampling technique. Patients underwent computed tomography pulmonary angiography (CTPA). Pulmonary embolism protocol was used for taking the computed tomography angiography and resolution of embolism was also assessed. Results: Out of total 31 patients, males were 10(32.3%) and females were 21(67.7%). Mean age was 48.58±9.61 years. Prevalence of PE resolution and no resolution at all was 21(67.7%) and 10(32.3%) respectively. Thrombus in major pulmonary arteries was resolved in 15(68.1%) out of 22, while segmental arteries’ thrombus was resolved in 21(67.7%) out of 31 patients and there was significant association with the type of thrombolytic drug used (p<0.05). Conclusion: The present study found that prevalence of PE complete resolution on CT angiography was 67.7%. Heparin gave comparatively good instant results. Resolution was comparatively low in smokers, diabetic and cancer patients while 0.0% resolution of PE was observed in patients with hypercoagulability.

Background Skin adnexal tumors (SATs) are categorized per the site of origin, for example, hair follicles, sebaceous glands, and sweat glands. In our population, there is limited information related to the clinicopathological characteristics of these tumors. Management and prognosis depend largely upon the morphological type of the tumor. In this study, we assessed the disease spectrum and most prevalent subtypes of benign SATs. Methodology An analysis of 565 cases was conducted in this cross-sectional study between January 2018 and December 2022, using a non-probability consecutive sampling approach. Patient age, gender, site of involvement, and diagnosis were documented according to the fourth edition of the WHO Classification of Skin Tumors published in 2018. Data were entered and analyzed using SPSS Version 26.0 (IBM Corp., Armonk, NY). Results Our study had 565 patients, out of which 271 (47.9%) were males and 294 (52.1%) were females. The mean age was 40.97±19.3 years (range, 2-100 years). Anatomical site variations were as follows, head and neck (n=336, 59.4%), extremities (n=124, 22%), trunk (n=84, 14.9%), and genital areas (n=21, 3.7%). The most common histological subtypes of benign SATs were sweat gland origin (n=350, 62.0%), followed by hair follicle origin (n=161, 28.5 %), and sebaceous gland origin (n=54, 9.5%). Conclusion Sweat gland tumors were the most prevalent class of benign SATs in our study, in which hidradenoma and poroma were the most frequent subtypes. Hair follicle origin was the second most prevalent class of tumors with pilomatricoma being the most frequent. Sebaceous tumors were overall uncommon; nevus sebaceous of Jadasshon was the most common tumor in this class.

BackgroundCysts are common skin abnormalities that are mostly benign; however, sometimes malignant lesions may present clinically as cystic manifestations. Benign cutaneous cysts can be of different morphological types and their diagnosis relies on histological evaluations. The most common mode of treatment is surgical excision, which is curative.MethodologyThis is a retrospective cross-sectional study conducted at the Department of Histopathology, Chughtai Institute of Pathology, Lahore, Pakistan from 1st January 2020 to 31st December 2022. Non-probability consecutive sampling was done, and all the cases of benign cutaneous cysts were included. All cases were microscopically reviewed by two histopathologists, and variables like age, gender, site of the lesion, and histological diagnosis were noted. The data were analyzed using IBM SPSS Statistics for Windows, Version 29 (Released 2022; IBM Corp., Armonk, New York, United States).ResultsA total of 1160 recorded cases of benign cutaneous cysts were included. Overall gender distribution revealed males (n=489, 42.1%) and females (n=671, 57.8%). The age range was 3 to 91 years with a mean age of 37.56 ± 16.05 years. The three most common cysts were epidermal inclusion cysts (74.3%), trichilemmal cysts (15.1%), and dermoid cysts (6.3%). Other cysts were uncommon including hidrocystoma (1.9%), steatocystoma (0.3%), verrucous cysts (0.3%), comedones (0.6%), hybrid cysts (0.2%), milia (0.3%), and vellus hair cysts (0.2%). The most common site was back (23.5%) for epidermal inclusion cysts, scalp (74.4%) for trichilemmal cysts, and eye (33.8%) for dermoid cysts.ConclusionBenign cutaneous cysts have a broad morphological spectrum with a wide age range. Epidermal inclusion cysts, trichilemmal cysts, dermoid cysts, and hidrocystoma account for the four most common types. For each of the other cyst type, the prevalence was under 1%. Female gender predominated in epidermal inclusion cysts, trichilemmal cysts, and dermoid cysts while male gender was common in other cysts. Overall majority of the cysts presented in the head and neck area.

The study was carried out to evaluate the health risks associated with accumulation of cadmium in the different genotypes of wheat, grown in agricultural regions of Punjab, Pakistan. Five genotypes irrigated with three varied water sources were selected randomly from each region. Among all sources of water, types of soil, and grain samples, the cadmium (Cd) quantities were found (2.24–2.82 mg/L, 1.75–4.16 mg/kg, 0.86–1.90, respectively), exceeding the maximum permissible limits (0.01 mg/L, 1.1 mg/kg, 0.2 mg/kg, respectively) described by FAO/WHO. The pollution load index (PLI) exhibited by all of the samples was higher than 1.00, the permissible limit; however, other factors including bioaccumulation, translocation, bio-concentration, daily intake, and enrichment values of Cd were less than 1.00. Moreover, the health risk index for cadmium in all types of wheat grain samples was less than 1.00. The study concluded that the continuous use of wastewater resources may lead to the accumulation of cadmium in the vital body organs that may cause severe health hazards.

Her-2 (ErbB-2) is an oncogene frequently overexpressed in breast and gastric adenocarcinomas, and anti-Her-2 targeted therapy can be given to such patients. Her-2 overexpression and role of anti-Her-2 targeted therapy in cases of gallbladder adenocarcinomas (GBC) are still debatable. Scoring protocols for Her-2 expression in breast and gastric carcinomas are standardized, however, not for carcinomas arising in other body organs like the gallbladder. This study is conducted to evaluate the expression of Her-2 in patients with GBC, which may benefit from targeted therapy. It is a cross-sectional study conducted on patients with GBC (n=63; 53 women and ten men). An automated immunohistochemical technique was used with an anti-ErbB2 antibody. Scoring was conducted according to the CAP (College of American Pathologists) criteria for breast cancer. Positive (3+) Her-2 staining was observed in 8/63 (12.7%). Nine cases (14.3%) showed equivocal staining (2+) pattern. All of the tumors showing Her-2 overexpression were moderately differentiated. This study indicates that a significant number of GBC cases show Her-2 overexpression. This subgroup may benefit from inhibitors of the Her-2 pathway. Standardization of scoring protocol for Her-2 expression in GBC is needed to better evaluate the predictive potential of Her-2 for the treatment of these tumors.