The Spectrum-3rd Issue (Dec 2014)

8/10/2019 The Spectrum-3rd Issue (Dec 2014)

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Inside this issue

Animated chemical pathology Role of Chemical Pathology in Screening and Diagnosis of Multiple Myeloma Harmonization-A global effort to improve patient care Meta-analysis

Accreditation of clinical laboratories

Changing Role of Laboratory Medicine

Retirement of a Great Teacher

Pqfessq (Big) Dilshad Ahmed Khao TI(M), Pesideot PSCP, has

etied ae 32 eas qf An seyice qo 31st

Avgwst 2014. Pqf Dil-shad is a gadvate qf st batch qf An medical Cqllege Razalrio-

di. He cqmrleted his FCPS io Chemical Pathqlqg io 1992. Theo he

rqceeded tq USA aod gqt MS degee io Clioical Tqicqlqg qm

Uoixesit qf Illioqis Chicagq. He cqmrleted his eseach rqject ae

etwpiog hqme aod gqt a PhD qm Qvaid-e-A{am Uoixesit Is-

lamabad. He svreyised sexeal FCPS, MPhil aod PhD stwdeots dv-

iog his sta io An Medical Cqllege aod AFIP Razalriodi. He zqo gqld medal qm Pakistao Aca

Scieoces io ecqgpitiqo qf his temeodqvs eseach achiexemeots. He zas azaded Fellqzshir qf t

Cqllege qf Phsiciaos qf Ielaod io 2011, aod io 2013, he had the voive hqoqv qf geiog Fellqzsh

Rqal Cqllege qf Pathqlqgists (Lqodqo) zithqvt eamioatiqo. Establishmeot qf a state-qf-the-au

Tqicqlqg lab at AFIP Rzr is qoe qf the mqst qvtstaodiog achiexemeots. A zqkahqlic zhq dqes

liexe io zastiog time io ao oqo-rqdvctixe actixities, Pqf Dilshad is a qle mqdel fq all the stw

Chemical Pathqlqg aod qthe discirlioes. He has beeo aliated zith PSCP sioce its iocertiqo aod

Pesideot he has eall cqotibvted a lqt io the rqgess qf the sqciet. Althqvgh 31stAvgwst 2014 i

mak io the meitqiqvs caee qf Pqf Dilshad, he zill be axailable tq his stwdeots aod cqlleagwe

dess qo a xe imrquaot arrqiotneot io Razalriodi. We zish him a xe harr life at his res

tiqo.

itor:

Prof. (Brig) Aamir Ijaz

b-editors: Dr. Sara Reza, Dr. Maryam Raq

ronGen Farooq Ahmad Khan HI (M),

ired)

sidentf Dilshad Ahmed Khan TI (M)

ional University of Med Sciences

e PresidentSamina Ghayyurfa College of Medicine, Islamabad

retaryf Rizwan Hashim

walInst of Med Sciences Islamabad

uncilf. Asim Mumtazlamar Medical & Dental College,

ore

Sami Saeedji Foundation Hospital, Rawalpindi

f. Asma Shaukataid-e-Azam Medical College, Baha-pur

Munawar Hussain Marritta Institute of Med Sciences,tta

Ejaz Hassan Khanyber Medical College, Peshawar

Adnan M. Zuberiud-Din Hospital, Karachi


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THE SPECTRUM

The Spectrum and PSCP welcome participants of 3rd Joint Conference of the Societies of Pathology and 7thNational Cence of PSCP from 19th to 21st Dec 2014 at Khyber Medical College, Peshawar

The PSCPsessions will be:Two Pre-Conference Workshops:

Research Designs in Diagnostic Studies 18thDecember 2014 (Thursday) from 0900 h to 1300 h.Interpretation of ABG Reports 18thDecember 2014 (Thursday) from 1400 h to 1800 h.

Plenary Session comprising talks by senior Chemical Pathologist on 19 thDecember 2014 (Friday) Four Scientific Sessions of free papers of Chemical Pathology

From The Editor`s Desk

Third issue of The Spectrum is in your hands. In this issue we are lucky to have assis-tance from Dr Maryam Rafiq who has joined the editorial staff this year. She is the

same Dr Maryam who won the title of Chemical Pathology Laureate in DLP-2. Herbrilliance in literature and IT skills was recognized by Dr. Sara Reza who recom-mended her name for sub-editorship. We are also greatly indebted to Dr Sara Rezaherself for sparing precious time, so close to her final examination, for this issue.We dedicate this issue to Prof Brig) Dilshad Ahmed Khan, President PSCP, who has

just retired from Army service. Once again the newsletter owes its success to the contributions from our young colleagues. Their brilliant and creativeideas were translated into some very interesting printed matter.For example, the survey appeared in this issue is a masterpiecefrom our two sub-editors.

Some very informative articles on Lab Accreditation, Role ofLab Medicine, Warburg Effect and Harmonization areuseful contributions in the issue.We are honoured to include an Islamic article in this issueand beautiful poem on Youth is the first piece of poetry inthe newsletter.Please go through the article What is in the name and giveYour opinion as requested at the end. Brief report on DLP-2 is included to archive this important educational activitywhile Animated Chemical Pathology is probably the first of

its kind in any Pathology literature.I hope you will find the issue not only entertaining but also a

source of some useful information. Lastly I want to pay mygratitude to Dr Qurat-ul-Ain, Dr Uzma Ansari and Dr Amina

Tariq for helping in proof reading and all the people who havesupported The Spectrum morally and physically.

Prof. Brig) Aamir Ijazemail:[email protected]

2
mailto:[email protected]:[email protected]:[email protected]


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Second Edition of Distance Learning Programme in Chemical

Pathology DLP-2)-Brief Report

Category: Distant Students

Category: Near Students (AFIPRwp)

Category: Junior Consultants

Chemical Pathology Laureate:Dr. Maryam Rafiq, QAMC Bahawalpur

1stPosition:Dr Qurat-ul-Ain 1stPosition:Dr Sajida Shaheen, PNS RA-HAT Karachi

2ndPosition:Dr Farheen Aslam, QAMCBahawalpur

2ndPosition:Dr Uzma Ansari 2ndPosition: Dr Muhammad Anwar Jatt,CMH Quetta

3rdPosition: Dr Sara Reza, QAMCBahawalpur

3rdPosition: Dr Amina Tariq 3rdPosition:Dr Saleha Zafar, QAMCBahawalpur

During the feedback of DLP-1, many participants de-manded that DLP should be continued in 2014, so DLP-2was started on 19 Jan 2014. The topics were selected afterproper consultation with senior Chemical Pathologists.Some of the seniors also prepared some lessons and DLP-2 is deeply indebted to them i.e. Prof Dilshad AhmedKhan, Dr Muhammad Aamir, Dr Naveed Asifand Dr Zujaja Hina Haroon (AFIP Rwp), ProfAsma Shaukat and Dr Lubna Sarfraz (QAMCBahawalpur), Dr Ayesha Habib Khan and DrLena Jaffery (AKU Karachi) and, Dr AsmaNaseer Cheema (AJK Medical College, Muz-zafarabad). A schedule of the lessons with dateswas sent to the participants and lessons were senton alternate Sundays without fail(Alhamdolillah).The number of participants was quitehigher as compared to DLP-1 and participants` responsewas also much more enthusiastic. DLP-2 consisted of 20lessons and was participated by 78 trainees and 23 con-sultants out of total 113 registered participants. Lessonswere made in a uniform pattern with 10-12 days for re-sponse. The students also contributed in the key presenta-tions and developed an increasing sense of participation

in the programme. Although in some lessons traineeAFIP (near students) were allocated topics to prepslides, generally participants sent slides voluntarilythis regard, contribution from Dr Sabiha Wase(Canada) is really commendable. Skype sessions lowed each lesson and the number of sessions ran

from one to three to facilitate the participaConnectivity remained an issue in the Sksessions but participants never got frustraindicating their deeply entrenched interesthe process of learning. Facebook pagePSCP was also extensively used for sharliterature and important announcements. Usman Munir, a very efficient administratothe group, changed the cover picture accord

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THE SPECTRUM

3

Winners of the top positions of DLP-2

to the running lesson and kept the group alive. At the of programme, nine top positions in three different cgories were announced based on the total scores earnIn addition, CME/CPD credits have also been awardethe participants at the rate of 5 credit points per lessFacilitators who developed the lessons were given doucredit points i.e. 10 per lesson.


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nimated chemical pathology

Here is a very unique way of presenting scientific concepts. We have given life to our favourite substances and molecules. Itmay help to remember these ideas besides entertainment

AST The CheAter: Heart expelled AST sayinggo away cheater -you are alsoloyal to the liver (AST has been removed from the list of cardiac markers because of its non-specificity). To add to its insult liver also gives preference to ALT on AST because of its relationwith heart. So poor AST is out of heart and liver, on the accusation of cheating. Do we have a lessonhere to learn?

HDL and CETP The Hero and The Traitor: H for hero and H forHDL, our hero has a lot of potentials and plays multiple roles just like Hercules again with an H. Hehas a lot of enemies to fight with alone e.g. LDL, VLDL, IDL and Lipoprotein (a). He very successfully

fights but unfortunately there is also a traitor in his army and it is Cholesterol Ester Transfer Protein(CETP). When the hero (HDL) is taking cholesterol away from periphery to the liver, the traitor (CETP)smuggles some of its cholesterol to VLDL, which becomes a very dangerous particle i.e. small denseLDL (SDL). In return VLDL gives some cash (triglycerides) to CETP but this money (triglycerides) doesnot stay long with CETP and is taken up by the liver by the action of hepatic lipase. So at the end of theday the traitor is left with nothing and vanishes.

Hepcidin The Iron Master:Hepcidin, holding a stick in his hand, has been assigned the duty of controlling the porters of iron(Ferroportin). On a normal day (with normal Iron levels) the iron master is sleeping in his chamber andthe porters keep on doing their job of transporting iron from inside the intestinal lumen to the enterocytes

(besides other sites). When body has enough iron stock and does not require more iron from intestine, ouriron master (hepcidin) gets a telephone call (from liver) to get up and stop his porters (ferroportin). Hetakes his stick and put all these porters in a cellar (internalization). In people with haemochromatosis, theiron master is off-stick and there is nobody to control the porters, with the result iron is continuously de-

posited in the body.

TSH The Worried Mother: A worried mother (TSH) brings her two sickchildren (T3 and T4) to the child specialist. Now whom should the doctor ask to get details?Mother of course, as children are too innocent to tell about their illness. So if you want to knowsomething about thyroid disease (dysfunction) ask from mother (TSH) and not from the children(T3 and T4). The anxiety of mother cannot be compared with that of children. Do you agree?

Fluoride -The RBC Controller :

In a sample tube Sodium (or Potassium) fluorideaddresses the RBCs Look gentlemen this glucoseis not for you; so please don`t eat it. Its patient`s

glucose and is sacred for us. In the tubes withoutfluoride, there is nobody to control RBCs and they

party with glucose as the main course!!

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THE SPECTRUM

Prof. (Brig) Aamir Ijaz,AFIP, RWP

IQ Test Lab Six drinking glasses stand in a row, with the first

full of juice and the next three empty. By movingone glass can you arrange them so empty and fulglasses alternate?

Fill in the sequence:prl, my,jn,jly, gst?

Please see the answers on page 104


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I e l la,H w wa l u seS si, I wa eui

y,M e h m

.

M ro k,

I ue t mnek.

I dne fnt M h i m l

I wa s nrose,

I yu ha I losI los i i ecn

Wihu nn i v e.

N I s l

Tha i i hr t hl.

M fa cve i I n m st

e.

T ha pase sHl loes s

hn,

Len n jus fa n n

Len me gn ba,

Wi I ea i u sa.

I ise t f w

Bu ha t t to.

Capt (Dr) Sumba2ndYear T

(ChemicaAF

TRIBUTE TO PROF DR. AAMIR IJAZ

From

Quaid e Azam Medical College

f. Dr Aamir Ijaz , for us , he is one of the most exciting teachers we have

me across in our academic career. We feel so grateful to have been taught by

h a diligent and committed teacher, putting his heart and soul into teaching ,

ven by a constant need to give his best in contributing to the enlightenment of

students all over Pakistan. Sir Aamir Ijaz has

way of communi- cating with his students that

onated far beyond what most teachers ever

nage to achieve. Teaching is not just a job for

m, it is a passion that flowed from his heart. Not

y he is a great chemical pathologist but he

o has a way of making us think critically, inspire

and could make his lessons resonate within us ,

n years afterward. His friendliness , constant motivation and impetus left an

elible mark in our educational journey . To put it briefly, this has made

mloved, appreciated, and respected by the chemical pathology trainees all over

kistan, especially the trainees from QAMC including me who has the privilege

earn from him over the past couple of years. We salute you Sir, these words

never be enough to laud your absolute dedication and impeccable allegiance

wards your endeavor !!!

Dr. Sara Khan2ndyear trainee, Chemical Pathology,

QAMC, BWP

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THE SPECTRUM

Rosalind Franklin, who was a scientist working in King`sCollege London, contributed greatly in the understanding of thestructure of DNA. She came very close to solving the DNAstructure between 1951 and 1953 but her crystallographic

portraits of DNA were shown to James Watson without herknowledge. On seeing these pictures the solution becameimmediately apparent to Watson, and the results went into anarticle in Nature (one of the world`s biggest science journal).Franklin's work did appear as a supporting article in the same issue of the journal.Franklin died in 1958 of ovarian cancer probably due to over-exposure to X-Rayradiations. Nobel Prize in Chemistry was awarded to James Watson and Francis

Crick, for their work in the discovery of the structure of DNA in 1962 four yearsafter her death.

Rosalind Franklin


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Multiple myeloma (MM) is a cancer of plasma cells in the bone marrow. Normally, plasma cells produce abodies and play a key role in immune function. However, uncontrolled growth of these cells leads to bone

and fractures, anaemia, infections, and other complications.Criteria for diagnosis the diagnosis of symptomatic multiple myeloma requires the following: M protein in the blood or urine, plusA bone marrow aspirate or biopsy showing that at least 10 percent of the cells are plasma cells or the presenc

a plasma cell tumor (called a plasmacytoma), plusEvidence of damage to the body as a result of the plasma cell growth, such as high Calcium in the blood, R

failure, Anaemia or destructive Bone lesions (CRAB)Screening Tests:Serum and Urine Protein Electrophoresis:During electrophoresis, intact monoclonal immunoglobulin molecules will migrate as a sharplydefined band called paraprotein. It is almost always found in association with Bence-Jones pro-tein in the urine protein electrophoretogram.

Quantification of non-isotypic immunoglobulins:

Measuring total concentrations of IgG, IgA and IgM in serum can reveal elevation of a specific immunoglobisotype that is suggestive of the presence of a paraprotein.Serum urea, creatinine, calcium & albumin:Many patients with myeloma have myeloma-related organ impairment (ROTI) in which corrected serum calcof usually >0.25mmol/l above the upper limit of normal or >2.75mmol/l and serum creatinine of 1.9 mg/dl is gestive of ROTI.Tests to Establish Diagnosis:Immunofixation electrophoresis (IFE) of serum and urine:Identification of the immunoglobulin isotype of a paraprotein by immunofixation of the paraprotein band enait to be classified as an IgG, IgA or IgM molecule.Tests to Estimate Tumor Burden and Prognosis:

Quantification of monoclonal protein in serum and urine:Concentrations of serum paraproteins below the threshold value are more likely to be monoclonal gammop

of uncertain significance and those above are more likely to be myeloma.eta-2 Microglobulin:As a tumor marker B2M test helps to determine the severity and spread (stage) of multiple myeloma and sometimes be ordered to evaluate the effectiveness of treatment.

Dr. Noreen Sherazi,Agha Khan University, Karachi

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THE SPECTRUM

Prof Dilshad Ahmed Khanand Dr Wafa Munir Ansari represented

PSCP at IFCC Conference at Istanbul, Turkey in June 2014

Role of hemical Pathology in Screening and

Diagnosis of Multiple Myeloma

6


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An Interesting Case Report

Name the phenomena causing Hypoglycae-mia in this patient and give its biochemical

mechanism?

nswer:Hyper-Warburgism. The extreme glucose

nsumption by the tumor and the paradoxical lactateneration by the tumor provide compelling evidencer an increased Warburg effect.

Dr. Sabiha WaseemTrainee Clinical Biochemistry

Canada

seful websites

Evolve:Evolveis a one-stop online portal for healthcare educators and students to access and purchase of their Elsevier digital teaching & learning materials.

http://evolve.elsevier.com/ Uptodate:UpToDateis the premier evidence-based clinical decision support resource, trusted world-

wide by healthcare practitioners to help them make the right decisions at the point of care.http://www.uptodate.com/home

A Useful Resource to Learn Electrophoresishttp://quizlet.com/4388803/cp_serum-proteins-ash-cards/original

American Association of Clinical Chemistry (AACC)

http://www.aacc.org/ 7

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THE SPECTRUM

Participants of Chemical Pathology Sessions at5th National Conference of PSCP and 37th

annual conference of PAP in Lahore, December 2013

Workshop with Professor Ichihara (Japan) atAFIP, Rawalpindi July 2014

64-year-old female presented with generalized fa-ue, poor appetite, and weight loss. She had hepato-enomegaly and diffuse petechiae. Her glucose was

4 mmol/L, HCO3: 12 mmol/L, lactate: 28.5 mmol/Lef range, 0.53.4), and pH 7.24. Urine ketones were

ce positive. She also had pancytopenia. Furtherorkup for insulin-mediated hypoglycemia, growthrmone deficiency, adrenal insufficiency, and vita-n deficiencies were within normal limits. Bone

arrow aspirate/biopsy confirmed the presence of Ep-in-Barr virus-positive diffuse large B-cell lympho-

a of the elderly.

Congratulations toProf Ejaz Hassan Khan,Ex-President of PSCP on hisappointment as Principal ofKhyber Medical College,

Peshawar

Congratulations toProf Asim Mumtaz,Founder Secretary of PSCPon his appointment asHead of Pathology Department

Shalamar Medical & Dental ColleLahore
http://quizlet.com/4388803/cp_serum-proteins-flash-cards/originalhttp://quizlet.com/4388803/cp_serum-proteins-flash-cards/originalhttp://quizlet.com/4388803/cp_serum-proteins-flash-cards/originalhttp://quizlet.com/4388803/cp_serum-proteins-flash-cards/originalhttp://quizlet.com/4388803/cp_serum-proteins-flash-cards/originalhttp://quizlet.com/4388803/cp_serum-proteins-flash-cards/originalhttp://quizlet.com/4388803/cp_serum-proteins-flash-cards/originalhttp://quizlet.com/4388803/cp_serum-proteins-flash-cards/originalhttp://www.aacc.org/http://www.aacc.org/http://quizlet.com/4388803/cp_serum-proteins-flash-cards/originalhttp://www.aacc.org/http://quizlet.com/4388803/cp_serum-proteins-flash-cards/originalhttp://www.aacc.org/http://quizlet.com/4388803/cp_serum-proteins-flash-cards/originalhttp://www.aacc.org/http://www.aacc.org/http://quizlet.com/4388803/cp_serum-proteins-flash-cards/original


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Harmonization

A global effort to improve patient care

odays healthcare system revolves around evidencebased clinical guidelines that frequently rely upon labora-ory test results to diagnose an ailment and to determine ifnd when treatment is necessary. This situation become

more complicated by rapidly expanding use of EHR as wells an increasingly mobile population that results in use of

ifferent laboratories for same test at different times. Unfor-unately, results of the same test from different laboratoriesften show large inter-laboratory variation and decisionsased on these non-uniform test results increase the risk ofrroneous clinical, financial, regulatory, or technical deci-ons that may have negative impact on patient care. Therewide agreement within the medical and laboratory com-

munity that harmonization of laboratory test results is criti-al to improve the quality and value of health care system.

Harmonization of clinical laboratory results means that re-ults between different clinical laboratory measurement pro-edures should be equivalent, within clinically meaningful

mits, to enable optimal use of clinical guidelines for dis-ase diagnosis and patient management.

Harmonization of test results includes consideration of pre-nalytical, analytical, and post-analytical aspects.

Pre-analyticalfactors such as vocabulary for the

of test procedure, patient preparation, specimen ction and transport needs a lot of improvement but are not yet internationally synchronized.

Analyticalconsiderations are the main focus of hanization efforts by various organizations. The aimhave the calibration of all procedures traceable tsame higher-level reference system and to have a mon calibrator that is commutable with clinical samfor all of its measurement procedures. The confeof AACC recommended organizing a worldwid

proach for prioritizing and managing the harmonizprocess. As a result International Consortium formonization of Clinical Laboratory Results (ICHwas formed to provide a systematic approach for ptization of clinically important and technically femeasurands to achieve harmonization and to formprocedures for harmonization of measurands wany reference measurement procedure was likely developed.Post analyticalaspects include harmonization of ring units, referenced interval and decision limits. working group for reference intervals and decision

its is running a global project to assess potentiaglobal reference intervals in various measurands. Ikistan, AFIP is also a part of this multicenter study

Major (Dr) Qurat-UIV Year Trainee (Chemical Patho

AFIP, Rawa

Structured Assessment of Skills (SAS) in Chemical Pathology

der the auspices of PSCP we have successfully conducted two DLPs for the improvement of cognitive domains of our studll interpretation and application of knowledge. In the feedback of DLP2 many students demanded a programme of practical twe have decided to organize a skill training programme by the name of Structured Assessment of Skills (SAS) in Chem Pagramme will focus on practical aspects including laboratory skills, data interpretation skills, lab and biosafety practices, mans and soft skills (e.g. communication with patients, staff, clinical colleagues, administrators and venders, ethical issues andalism). The collective wisdom of all qualified Chemical Pathologists will result in development of a valid and reliable ass

mat most suitable to our peculiar specialty. All the centers where MPhil and FCPS training in Chemical Pathology is conducticipate in SAS and all consultants, supervisors and examiners in Chemical Pathology may participate in preparation and con. Chemical Pathologists who are presently not on a teaching appointment may contribute in making the questions. SAS will ted on monthly basis and it will comprise two components:

Practicalwhich will include Major Biochemical Practical, Quality Control Procedure and TOACS.Data Interpretation Skills:Every month we may give a test of 10 cases. We will improve the format of this very ecomponent and give it a proper name. One suggested name is Quick Assessment of Data Interpretation Skills QADI

Further details of the programme will be communicated later.

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THE SPECTRUM

Breaking News

8


9/16

Presently, we are living in the age of ma-terialism and it can also be called theage of anti-spiritualism. Here, the body is splitfrom soul which consequently separated heartfrom brain. It led to research in the fields of bi-omedicine, psychology and social sciences toestablish a link between heart and brain. Re-searchers came with unique findings that thehuman heart possesses its own kind of intelli-

gence which affects the brainin various ways and it is notjust a pumping organ butmuch more than that.Quran uses qalb and fuadat various places for heart. Theword qalaba in Arabic meansto turn around, to turn upsidedown continuously. The word fuad in Ara-bic means a place of benefit. In the ac-ceptance of Islam, heart is the actual thing.When the heart agrees on a change and it is

convinced about a matter, then the whole bodyhas no choice except to obey the heart. Dothey not think deeply in Quran, or are their

hearts locked up (from under-standing it)?(Al-Quran) Itsfuel is Tazkiyah (purification)and Zikr (recitation from Quranand remembrance of Allah).The Muslims of today alsoneed a vaccine of Quran andSunnah at least once a day tomake their hearts united once

again.

NEUROCARDIOLOGY explainsthat, The heart possesses its ownlittle brain, capable of complexcomputational analysis on its own(containing more than 40,000 neu-rons). Intrinsic cardiac nervoussystem acts as much more than asimple relay station for the extrin-sic projections to the heart.

Functioning of the heart is not onlyin concert with the brain but alsoindependent of it. The heart inparticular, seemed to have its

own peculiar logic that fre-quently diverged from thedirection of other autonomic

nervous system responses.The heart seems to behave as if it had mindof its own(Dr Gohar Mushtaq)

Prophet Mohammad (PBUH) and his compan-ions used to weep while listening to Quran.Medically it has been proved that it stimulatesparasympathetic system of heart which causesstimulation of lachrimal glands of eye and caus-es tearing (weeping) and stimulation of erectorPilli muscles of skin which causes goosebumps.

Dr Rubina Shafi

Do they not think deeply in Quran, or

are their hearts locked up (from

understanding it)?

(Al-Quran)

(Al-Quran)

Human Heart

Versatile Thinker

9

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THE SPECTRUM

Facilitations

We oer our warmest congratulations to Dr. Syed Talha

Naeem, Agha Khan University, Karachi on passing his

FCPS II exam in April 2014. Wish you a bright future

lled with the promise of a wonderful career.

9

Chemical Pathology andEndocrinology Dept,

AFIP Rawalpindi


10/16

Advantages:

To increase power To improve precision To settle controversies arising

apparently conflicting studies ogenerate new hypotheses

Considered as evidence-based source

Disadvantages:

Difficult and time consuming ttify appropriate studies

Not all studies provide adequafor inclusion and analysis

Requires advanced statistical tniques

Heterogeneity of study populat

10

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THE SPECTRUM

Meta Analysis

Meta-analysis is a statistical procedure that integrates the results of severalndependent studies considered to be combinable.

Meta-analysis would be used for the following purposes:

To establish statistical significance with studies that have conflictingresults

To develop a more correct estimate of effect magnitude

To provide a more complex analysis of harms, safety data, and benefitsTo examine subgroups with individual numbers that are not statistically

significant

Conducting meta-analysesLocation of studies: Meta-analysis requires a comprehensive search

strategy which interrogates several electronic databases, hand search-ing of key journals and checking of the reference lists of papers.

Quality assessment: Good meta-analyses will use objective criteria for

inclusion or rejection of studies on quality grounds.

Calculating effect sizes: Two approaches used are: odds ratio(previously), and now the risk ratio (relative risk). Ratio of 2 im-plies that the defined outcome happens about twice as often in the in-tervention group as in the control group.

Checking for publication bias : Examine a funnel plot. It displays thestudies in a plot of effect size against sample size.

Sensitivity analysis A good sensitivity analysis will explore effect of ex-cluding various categories of studies. It may also examine how con-

sistent the results are across various subgroups.

Presenting the findings: Forest plotdisplays the findings from individualstudy as a blob or square, with squares towards the left side indicatingthe new treatment to be better, whereas those on the right indicate thenew treatment is less effective. The size of the blob or square is pro-portional to the precision of the study. A horizontal line (usually the95% confidence interval) is drawn around each of the studies squaresto represent the uncertainty of the estimate of the treatment effect. Theaggregate effect size obtained by combining all studies is usually dis-played as a diamond.

Heterogeneity: A major concern about meta-analyses is the extent to

which they mix studies that are different in kind. Studies can differ onthe types of patient studied, the nature of local healthcare facilities, theintervention given and the primary endpoint (death, disease, disabil-ity). Meta-analyses should test for the existence of heterogeneity with25% corresponding to low heterogeneity, 50% to moderate and 75% tohigh. If heterogeneity is absent, then the analysis employs fixed-effects modellingwhich assumes that variation seen between studiesis by chance. Random-effects modelsassume that variation betweenstudies exists. When the amount of heterogeneity is large, meta -regression is introduced to overcome this problem .

Dr. Farheen As4thYear trainee, Chemical PathoQAMC, Bahawa

Answers of IQ test on page

Pour the second glass into theglass.

sptmbrExplanation:Name of the monthremoving the vowels - APRIL, M

JUNE, JULY,AUGUST, SEPTE


11/16

linical laboratory results are central to diagno-sis, risk assessment, management and monitoring ofdisease and accreditation is a formal, third party recog-nition of competence to perform specific tasks. Labor-atory accreditation benefits laboratories by allowingthem to determine whether they are performing theirwork correctly and to appropriate standards, and pro-vides them with a benchmark for maintaining thatcompetence. Laboratory accreditation is a voluntaryactivity of complete, accurate and objective assess-

ment of laboratory processes and management practic-es. Accreditation helps laboratories demonstrate theirefficiency, accuracy, and cost-effectiveness whilekeeping the main focus on quality and patient safety.Approved international standards are applicable andfollowed by approved accreditation bodies for medicalor clinical laboratories accreditation. International or-ganization of standard (ISO) has developed a laborato-ry standard for use only by medical laboratories i.e.15189 (ISO 15189) which is a well-accepted interna-tional standard and specifies particular requirementsfor quality and competence of medical laboratories.

Other medical laboratories standards are adopted fromClinical and Laboratory standard institute (CLSI), Col-lege of American Pathologist (CAP), The Joint Com-mission (TJC) and World Health Organization(WHO). International Laboratory Accreditation Coop-eration (ILAC) is a global laboratory accreditation as-sociation.

In conjunction with ILAC, specific regions have estab-lished their own accreditation co-operations such asAsia Pacific Laboratory Accreditation Cooperation(APLAC) for Asian and Pacific Rim laboratories. Na-tional accreditation councils and bodies are approvedor affiliated with regional or international accreditationorganizations to provide accreditation service to medi-cal laboratories at national level.

Pakistan National Accreditation Council is thestatutory body, which have been assigned the task of

accreditation of clinical laboratories in the country andit has already accredited a few laboratories. Medicallaboratory accreditation bodies use standards to assessfactors relevant to laboratory and quality managementsystem. Usually a pre-assessment visit is scheduledbefore final assessment to highlight any area that re-quires attention with corrective action. At the end offinal assessment a detailed report on evaluation is pre-sented to laboratory to announce the decision aboutaccreditation. On the basis of report if laboratory ful-fils the minimum criteria for accreditation the labora-tory is declared accredited and an accreditation certifi-

cate and number is issued to laboratory. Later surveil-lance is carried out to assess the maintenance of com-petence.

Dr. Sahar IqbalConsultant Chemical Pathologist

Dow University of Health SciencesKarachi

Accreditation of Clinical Laboratories:

Stride along the Perfection

1

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Our heartiest congratula-ons to Prof Asma Shaukat,Professor of Chemical Pa-ology, present Councilorassume the responsibilitiesf Head of The Pathologypartment, Quaid-e-Azamedical College, Bahawalpur

First day of Prof. Asma Shaukat as Head ofDepartment

Pathology department, QAMC, Bahawalp


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12

C

linical laboratories represent an area of

healthcare that has always undergonemajor changes because of technological advances andexternal economic pressures. A hospital laboratory haso meet the requests for laboratory investigations by

maintaining adequate diagnostic facilities, to provideprofessional advice on management of the patient, toprovide laboratory facilities for research projects under-aken by clinicians, to collaborate in the development,tudy and control of new methods of treatment, to under-ake applied research on pathology problems and to col-aborate in education and training of medical and para-

medical personnel. Pathology service plays a pivotal role

n the disease diagnosis. With growing dependence onhe laboratory services, more than two third diagnoses

are made by the laboratory workup.

These are the days of economical considerationsand provision of cost effective services. It has been ob-erved that at least, one third laboratory tests are solicit-

ed, without their relevance to the patients care.

If the efforts are made in the right directio

many highly sophisticated and costly tests may easily breplaced with a few simple and widely acceped tests. The laboratory-clinic interface is, therefore, fundamental importance to ensure that the patient is given high quality care.

In order to fill the need for better quality health caravoidance of medical errors and cost reduction, threstrategies have been recommended for supporting anpromoting clinical consultancy in Laboratory Medicin

It is an era of Evidence-Based Laboratory Medicin

(EBLM) which focuses on the use of diagnostic tests anthe goal of improving patient outcomes. Asking a quetion is the first step of the evidence-based laboratomedicine (EBLM) cycle, the other steps being acquirinthe evidence, critically appraising the evidence, applyinthe evidence and auditing use of the evidence. Whilst thmain focus of the EBLM cycle is to provide a strong evdence base for use in clinical practice.

Sqn Ldr Muhammad Younas, FCPS (Chem Path)Consultant Pathologist, PAF Hospital Islamabad

hanging Role of Laboratory Medicine

Alfred Nobel

fred Nobel invented dynamite and made lot of money.his will, Nobel directed that the bulk of his estateuld be used to award prizes that would promotece, friendship, and service to humanity. After histh in 1896, the govern-ments of Sweden and Norway

ab-lished Nobel Prizes in five categories: chemistry,sics, physiology or medicine, literature, and peace. Ah category, economics, was added in 1969. Everyr, Nobel laureates assemble in Oslo or Stockholm oncember 10thon the anniversary of Nobel's death. Each-reate receives a medallion, a scroll, and all or part cash award currently valued at about $1 million per

egory.

12

Education is the most powerful weapon which you cause to change the world. Nelson Mandela)

Wherever you stand, be the soul of that place. Moula

Rumi)

There is nothing either good or bad, but thinking ma

it so. William Shakespeare)

More the knowledge lesser the ego, lesser the knowledge

more the ego. Albert Einstein)

The highest result of education is TOLERANCE. Helen

Keller)

Dr. Ayesha Siddiqa

QAMC, BWP

PSCP website

We proudly announce that the new interactive website ofPakistan Society of Chemical Pathologists is beingdeveloped by Dr Junaid Akhtar, who is an IT Expert and trained Chemical Pathologist. It will be available soon atthe following address:

www.PSCP.org.pk


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What is in the Name!!Our specialty is not universally known by one name but in different countries different names are used.Following is a list of countries using different names. The list is not only an interesting piece of informationbut also a fruit for thought for us:

*In some countries the names of their associations contains Clinical Biochemistry but Chemical Pathologyis also used in hospital and university labs.

Isn`t it astonishing that Pakistan is the only country, which is using the name of Chemical Pathologyforthis specialty. Should we consider a change of name? Let us start a national debate on it. Please send youropinion at any of our emails.

Albania, Australia, Bolivia, Bosnia, Brazil, China, Denmark,

Greece, India, Iran, Ireland, Malaysia, Nepal, New Zealand,

Norway, Paraguay, Russia, Singapore, Slovak Republic, South

Africa*, Spain, Sri Lanka, Thailand, UK*, Vietnam

Austria, Belgium, Canada, Egypt, France, Finland, Germany,

Greece, Hong Kong, Hungary, Indonesia, Italy, Japan, Kenya,

South Korea, Mexico, Morocco, Holland, Nigeria*, Portugal, Saudi

Arabia, Slovenia, Sweden, Switzerland, Turkey, USA

Pakistan

135th PSCP CME course in May 2014 at AFIP, Rawalpindi

linical

hemistry

ClinicalBiochemistry

ChemicalPathology


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14

I wanted to become everything but a pathologist!!On a serious note I entered in the field of Patholo-

gy because of AFIP and in Chemical Pathologybecause of inspiration from Maj Gen Farooq Ah-mad Khan (retd), my teacher and mentor.(Prof Aamir Ijaz)

I wanted to become doctor like my ideal moth-er .But I was inspired by my (late) father whowas Professor of Chemistry, so the interest ofbeing a doctor and Chemist turned out to be anamalgamchemical pathologist(Asma Shaukat )

My childhood dream was to become a nuclearscientist but I changed my mind just to fulfil themore prestigious wish of my mother to become adoctor. After joining army, I felt pathology, beinganemergencyfree field, was the most suitable forme. In pathology I love chemical pathologybecause of its vast canvasand closeness tomedicine.(Dr Qurat-Ul-Ain AFIP)

As a kid , it was my very " own " dream to be-come a doctor and I became a chemical

pathologist by choice as well.On realizing the

fact unlike other fields , there is still quite a lot ofopportunity for females to excel in this emergingspeciality. I then decided to take pathology part 1.(Dr Sara Khan QAMC)

I wanted to be a doctor and fortunately was luckyenough (but off the record sara josh thanda pargya .it was a stressful time .UHS exams tu bastension he tension thi). As I am anative of Baha-walpur and the only good option here is chemical

pathology so I decided to be a trainee of madamAsma, MASHALLAH a very co-operative andnice teacher.(Dr Kamran QAMC)

I always wanted to be a doctor. During 1styearof MBBS I decided to do Mphilin anatomy as Iobserved the easy and relaxed life of anatomyteachers. But in 3rd year. I started making mymind for specialization in pathology.(I still remember the very first lecture of Pathology was

taught by Prof Asma shaukat. When Maam in

troduced herself I was so inspired and told myfriend, that one day I will be like her and nowAlhumdulillah I am her trainee and I am proud ofit. (Dr Nudrat Khan QAMC)

As a kid I wanted to be a lawyer or justice butwhen I was not allowed to adopt the profession Itook MBBS as second option which was wish ofmy parents as well. I chose chemical pathologyfor specialization because It is an interesting field

and of course impressive personality of mysupervisor made me join chemical pathology( Dr shahnaz Noor QAMC)

As a child, I always wanted to be a scientist. As I

grew up, I chose to become a doctor as it was

suggested by my parents. I chose Chemical

Pathology because it is a vast and dynamic field

which also touches other fields of science besides

the medicine.

( Dr Masud Ansari QAMC)

As a kid I had not as much defined goals, just hadan inspiration to be a doctor. Ending up in chemi-cal pathology was such a sudden decision of mylife. I could not exactly figure out how I joinedthis field. May be I felt I cant cope with thehectic duties of medicine. I thought to opt a fieldin which there is an easy life style plus morechances to progress, as chemical pathology isrelatively less saturated.(Dr Faghia Shahid QAMC)

THE SPECTRUM SURVEY

As a Kid what did you want to bewhen you grew up? And how you

ended up becoming a chemical

pathologist?


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15

Because they get ample time and sufficient moneyto shop dopattas, angrakhas, choridaars and plas-mo? (What is the name of that very loose trouser?I am sorry I forgot) etc.( Prof Aamir Ijaz)

It goes very well with their family lives

(Prof Asma Shaukat)

The reason may be 3-fold; either the females are

never scared of difficult things so they love to bein this challenging field or theyare too innocent tounderstand the dire needs of this specialty or likeme they love the duty hours of this field.(Dr Qurat-Ul-Ain AFIP)

Chemical Pathology is all about colors and Ithink females reflect the colored side of na-

ture so females opt Chemical Pathology morethan male doctors.(Dr Ayesha Siddiqa QAMC)

Comfortable working environment makes themchoose chemical pathology.Dr Sara Khan QAMC)

I think female doctors prefer the basic medicalsciences over the clinical fields as they also haveto look after their families. Chemical pathologyhas good scope and offers opportunities to pro-gress for young pathologists.(Dr Masud Ansari QAMC)

As females have a double job in their lives i.e.

looking after their homes and kids and to excel intheir carrier so chemical pathology is a field whichprovide you both opportunities

, (Dr Faghia Shahid QAMC)

W

Yes it affects because LAURELS is moreimportant than friendship!!! But hold on, there isanother problem here. Some wise person oncesaid the friendship which ended was, in-fact,never there(Prof Aamir Ijaz)

Yes, I am more friendly with my juniors

( Prof Asma Shaukat)

Ahhmm! "kyun pakki dushmani karwani hai"just kidding. Certainly not, rather DLP helped usin making more friends that was nearly impossibleotherwise.Thanks to DLP we all are now a family.(Dr Qurat-Ul-Ain AFIP)

No my friendships are all the same: D(Dr Sara Khan QAMC)

DLP has created the atmosphere of competitionamong trainees and ironically it has created alethal atmosphere of jealousy as well ....LOLz(Dr Nudrat Khan QAMC)

DLP had an indirect impact on our friendships. Ithelped us to differentiate our real friends from therest.

( Dr Masud Ansari QAMC)

Yes, it created an environment of competitionamong my friends so had a great effect on friend-ships.(Dr sumbal Rani QAMC)

DLP provided a platform where PGRs all over Pa-kistan and abroad became familiar and developedgood relationships with one another like a family.( Dr Tahira Jabeen QAMC)

Certainly, DLP improved ourknowledge and had a vast impact on

our understanding, did it affect you

friendships??

hy female doctors opt ChemicalPathology more than male doctors??


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Sponsors Message

The Spectrum-3rd Issue (Dec 2014)

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Transcript of The Spectrum-3rd Issue (Dec 2014)