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Atique M, Javed R, Seerat I, Atique U, Bhatti T. The Intensity and Pattern of Syndecan-1 (CD138) Expression in Normal and Diseased Livers. Cureus 2023; 15:e46718. [PMID: 38022112 PMCID: PMC10630907 DOI: 10.7759/cureus.46718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Heparan sulfate proteoglycans (HSPGs) belong to the syndecan family, and syndecan-1 (CD138) is a heparan sulfate proteoglycan. Syndecan-1 has a potential role in cell-matrix and cell-cell communications as they are present in cell epithelium. Its expression is different in an extensive range of benign, inflammatory, and neoplastic diseases. In routine histopathology, it is used as a marker for plasma cells. However, it is expressed in a large variety of normal and neoplastic epithelia including squamous epithelium and gastric glandular epithelium expressed in other tissues, i.e., the liver. In the liver, variable expression is seen in cirrhosis, hepatitis, and carcinoma. The objective of this study was to investigate the expression of this marker in normal, inflammatory, and neoplastic lesions of the liver. This in turn may help clinicians to select patients who may benefit from anti-CD138 therapy. It is currently used in the diagnosis and management of plasma cell proliferations. Material and methods This is a retrospective study in which we retrieved 53 formalin-fixed paraffin-embedded (FFPE) liver specimen blocks and selected one block from each case by reviewing the hematoxylin and eosin (H&E) slides of each case. Syndecan-1 (CD138), pancytokeratin, and CD68 expression were analyzed immunohistochemically (IHC) to evaluate the percentage and intensity of CD138 expression in various hepatic entities and identify those entities where syndecan-1 can be consistently used to make a definitive diagnosis. Results The expression of pancytokeratin and CD68 was analyzed in hepatocytes and Kupffer cells, respectively. For syndecan-1 (CD138), 15.4% of cases showed basolateral membranous positivity, 44.6% of cases showed complete membranous positivity, and 40% of cases showed no positivity in hepatocytes. Cytokeratin (CK) was positive as expected in hepatocytes, and CD68 was expressed in Kupffer cells. Conclusion CD138 does not appear to be a reliable surrogate marker for liver disease. However, it may be included with other ancillary markers as a predictor of the stage of chronic liver disease and metastatic potential. The response to anti-CD138 therapy needs to be further studied.
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Affiliation(s)
- Muhammad Atique
- Histopathology, Pakistan Kidney and Liver Institute and Research Center, Lahore, PAK
| | - Rabia Javed
- Histopathology, Pakistan Kidney and Liver Institute and Research Center, Lahore, PAK
| | - Iqtadar Seerat
- Pediatric Gastroenterology and Hepatology, Pakistan Kidney and Liver Institute and Research Center, Lahore, PAK
| | - Usman Atique
- Histopathology, Pakistan Kidney and Liver Institute and Research Center, Lahore, PAK
| | - Tayyaba Bhatti
- Pathology, Pakistan Kidney and Liver Institute and Research Center, Lahore, PAK
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Shaukat Z, Imtiaz M, Naqeeb R, Seerat I, Atique M, Dar F. Managing Hepatocellular Carcinoma in Children. Cureus 2022; 14:e26386. [PMID: 35911356 PMCID: PMC9336830 DOI: 10.7759/cureus.26386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 11/15/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is a rare pediatric tumor. It differs from its adult counterpart in many ways like etiology, biological behavior, and association with cirrhosis. Treating HCC requires a multidisciplinary team involving pediatric gastroenterology, oncology, hepatobiliary surgery, and interventional radiology. This case series aims to describe presenting features and management plan of three children with HCC treated at a tertiary care liver transplant center in Pakistan.
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Seerat I, Muhammad Atique, Eitzaz Uddin Khan. Spectrum of chronic gastrointestinal diseases with final outcome in children at a tertiary care centre: a single-centre study. J PAK MED ASSOC 2022; 72:1188-1192. [DOI: 10.47391/jpma.3546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
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.
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Usman A, Seerat I, Rizvi SB, Sheraz S, Yousaf HA. Outcome of Treatment in Children With Chronic Viral Hepatitis C: A Single Centre Study. Cureus 2022; 14:e21073. [PMID: 35155029 PMCID: PMC8825321 DOI: 10.7759/cureus.21073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2022] [Indexed: 11/05/2022] Open
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Seerat I, Khan EUD, Atique M, Aujla UI. Clinical spectrum of chronic liver disease with final outcome in children at a tertiary centre: A single - centre study. Pak J Med Sci 2021; 37:680-683. [PMID: 34104147 PMCID: PMC8155432 DOI: 10.12669/pjms.37.3.3862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background and Objectives Chronic liver disease (CLD) in children present a broad spectrum of symptoms. Limited resources in Paediatric Hepatology in developing countries like Pakistan present considerable challenges in investigating and treating children with chronic liver disease in a timely fashion. This study aimed to determine the spectrum and outcomes of CLD other than chronic hep B & C virus (HBV& HCV) liver disease in children. Methods This retrospective descriptive study was conducted at the Paediatric Gastroenterology and Hepatology Department, Pakistan Kidney and Liver Institute and Research Centre in Lahore, Pakistan. The duration of the study was from August 2019 to January 2020. A total of 162 children of CLD were seen during this period of time. Of 162 there were 130 children with chronic HBV & HCV who were excluded from this study. 32 children aged 15 years or younger with chronic liver disease were included. The referrals were received from primary and secondary health care centres in different parts of the country. The data were collected from hospital electronic medical records database and then incorporated into a spreadsheet for analysis. The statistical analysis was performed by applying t-test with p value determined. Results Of 32 children autoimmune hepatitis (n=11; 34.3%) was the most common cause for chronic liver disease referrals, followed by progressive familial intrahepatic cholestasis type-2, (n=7; 21.8%), post Kasai for biliary atresia, (n=4; 12.5%), glycogen storage disease type-1 (n=5; 15.6%), Wilson disease (n=3; 9.3%) and primary sclerosing cholangitis (n=2; 6.2%). The diagnosis was principally established with the assistance of liver ultrasound, liver biopsy, magnetic resonance cholangiopancreatography and genetic testing. Conclusion Autoimmune hepatitis was the most common chronic liver disease. Our systematic approach, in addition to an extensive workup, helped us to diagnose and then initiate an appropriate treatment, which resulted in a more optimal outcome. Prompt referrals to tertiary centres are recommended where resources and expertise are available to reduce patient morbidity and mortality.
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Affiliation(s)
- Iqtadar Seerat
- Dr Iqtadar Seerat, MRCPCH, FRCPCH. Consultant and Head of Department of Paediatric Gastroenterology & Hepatology, Pakistan Kidney and Liver Institute & Research Centre, Lahore, Pakistan
| | - Eitzaz Ud Din Khan
- Dr. Eitzaz UD Din Khan, FCPS. Consultant & Head of Department of Anaesthesia, Pakistan Kidney and Liver Institute & Research Centre, Lahore, Pakistan
| | - Muhammad Atique
- Dr. Muhammad Atique, FCPS, FRCPath. Consultant and Head of Department of Pathology, Pakistan Kidney and Liver Institute & Research Centre, Lahore, Pakistan
| | - Usman Iqbal Aujla
- Dr. Usman Iqbal Aujla, Consultant Gastroenterologist , Pakistan Kidney and Liver Institute & Research Centre, Lahore, Pakistan
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Seerat I, Rafiq M. Is It Tuberculosis Or Crohn's Disease? J Ayub Med Coll Abbottabad 2020; 32:572-574. [PMID: 33225666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Tuberculosis is very prevalent in countries like Pakistan. It can be a diagnostic challenge when it has extra pulmonary organ involvement. Variation in clinical signs and symptoms, lack of access to a specialist and limited financial resources often result in delayed diagnosis. This leads to an increase in overall morbidity and mortality. We are presenting a case of disseminated tuberculosis with predominant intestinal symptoms in an eleven years old boy. He remained undiagnosed for several years despite frequent visits to multiple general practitioners. After appropriate investigations and initiation of treatment for tuberculosis, he showed an excellent recovery.
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Affiliation(s)
- Iqtadar Seerat
- Department of Paediatric Gastroenterology & Hepatology, Pakistan Kidney and Liver Institute & Research Centre, Lahore, Pakistan
| | - Memona Rafiq
- Department of Paediatric Gastroenterology & Hepatology, Pakistan Kidney and Liver Institute & Research Centre, Lahore, Pakistan
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Seerat I, Atique M, Khan EUD, Akram A, Iqbal A. Diagnosing Primary Sclerosing Cholangitis in Children. Cureus 2020; 12:e8334. [PMID: 32617210 PMCID: PMC7325345 DOI: 10.7759/cureus.8334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
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.
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Affiliation(s)
- Iqtadar Seerat
- Pediatric Gastroenterology & Hepatology, Pakistan Kidney and Liver Institute and Research Center, Lahore, PAK
| | - Muhammad Atique
- Histopathology, Pakistan Kidney and Liver Institute and Research Center, Lahore, PAK
| | - Eitzaz Ud Din Khan
- Anesthesiology, Pakistan Kidney and Liver Institute and Research Center, Lahore, PAK
| | - Ambreen Akram
- Pediatric Gastroenterology, Pakistan Kidney and Liver Institute and Research Center, Lahore, PAK
| | - Amjad Iqbal
- Radiology, Pakistan Kidney and Liver Institute and Research Center, Lahore, PAK
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Seerat I, Mushtaq H, Rafiq M, Nadir A. Frequency and Associated Risk Factors of Hepatitis B Virus and Hepatitis C Virus Infections in Children at a Hepatitis Prevention and Treatment Clinic in Lahore, Pakistan. Cureus 2020; 12:e7926. [PMID: 32494536 PMCID: PMC7265754 DOI: 10.7759/cureus.7926] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Objective This study evaluated the frequency of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection and the associated horizontal risk factors in children being screened for viral hepatitis in Lahore, Pakistan. Methods Children aged 15 years or younger who were brought to a specialized outpatient viral hepatitis clinic affiliated with a tertiary hospital in Lahore, Pakistan, for viral hepatitis screening from March 2017 to March 2018 were enrolled. Children were screened for HBV and HCV infection by enzyme-linked immunosorbent assay; if results were positive, HBV and HCV concentrations were quantitatively assayed by polymerase chain reaction. Children positive for HBV or HCV infection were matched with 100 controls of the same age and sex. All subjects completed a questionnaire on viral infection and its associated risk factors. Results During the study period, 3500 children living in the Punjab Province of Pakistan were screened for HBV and HCV infection. Of these children, 28 (0.8%) were positive for HBV and 66 (1.88%) were positive for HCV. A comparison of the 94 (2.68%) children positive for HBV or HCV with 100 controls identified several risk factors associated with infection. Unexpectedly, ten (35.7%) of the 28 HBV-positive children were born of HBV-negative mothers and had been fully vaccinated for HBV during infancy. Conclusion The frequency of HCV infection was higher than that of HBV infection among Pakistani children aged ≤15 years. Several horizontal risk factors were found to cause viral hepatitis. Several children born of HBV-negative mothers and vaccinated for HBV during infancy later developed HBV infection.
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Affiliation(s)
- Iqtadar Seerat
- Pediatric Gastroenterology & Hepatology, Pakistan Kidney and Liver Institute and Research Center, Lahore, PAK
| | - Humaira Mushtaq
- Pediatric Gastroenterology & Hepatology, Pakistan Kidney and Liver Institute & Research Centre, Lahore, PAK
| | - Memona Rafiq
- Pediatric Gastroenterology & Hepatology, Pakistan Kidney and Liver Institute & Research Centre, Lahore, PAK
| | - Abdul Nadir
- Gastroenterology & Hepatology, Pakistan Kidney and Liver Institute & Research Centre, Lahore, PAK
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Alvi MA, Alghamdi S, Seerat I, Matarfi OA. Could It Be Schistosomiasis? J Ayub Med Coll Abbottabad 2018; 30:133-134. [PMID: 29504351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Schistosomiasis may cause diverse symptoms and it is usually not considered as a cause of disease especially in patients with normal immune system. We are reporting an eleven-year-old child who was initially diagnosed as a case of lymphoma but later on proved to be a case of acute schistosomiasis.
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Affiliation(s)
- Muhammad Arshad Alvi
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, King Faisal Specialist Hospital & Research Centre, Jeddah, KSA
| | - Sharifa Alghamdi
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, King Faisal Specialist Hospital & Research Centre, Jeddah, KSA
| | - Iqtadar Seerat
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, King Faisal Specialist Hospital & Research Centre, Jeddah, KSA
| | - Omar Al Matarfi
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, King Faisal Specialist Hospital & Research Centre, Jeddah, KSA
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Abstract
Rickets in early childhood has been well documented in the literature. We present the case of a teenage Somalian boy who had a generalised tonic-clonic fit (an unusual presentation of rickets in late childhood) and was diagnosed with vitamin D deficient rickets.
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Affiliation(s)
- I Seerat
- Royal Free Hospital, Pond Street, London NW3 2QG, UK
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Seerat I, Yazaki E, Parsons V, Meadows N. Case 1: Psychological feeding disorder? (discussion and diagnosis). Acta Paediatr 2008; 97:827. [PMID: 18460112 DOI: 10.1111/j.1651-2227.2008.00859.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- I Seerat
- 92-Empress Avenue, Ilford, Essex. IG1 3DF, United Kingdom.
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Seerat I, Yazaki E, Parsons V, Meadows N. Case 1: Psychological feeding disorder? (Case Presentation). Acta Paediatr 2008; 97:692-3. [PMID: 18460100 DOI: 10.1111/j.1651-2227.2008.00779.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- I Seerat
- 92-Empress Avenue, Ilford, Essex. IG1 3DF, United Kingdom.
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Seerat I, Greenberg M. Hypocalcaemic fit in an adolescent boy with undiagnosed rickets. Arch Emerg Med 2007; 24:778-9. [DOI: 10.1136/emj.2007.050237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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