Author Archives: د.حسام أبو فرسخ

Hereditary Hemochromatosis (HH) is a common autosomal recessive disorder of iron metabolism. The frequency of the gene carriers among Northern European descent is estimated to be 1 in 10, resulting in up to 1: 200 homozygous subjects being predisposed to develop the disease

HH is characterized by progressive accumulation of iron in various organs (liver, heart, pancreas), ultimately leading to liver cirrhosis, diabetes, arthritis, cardiomyopathies, and premature death

A number of mutations within a novel MHC class I like gene have been identified and related to HH. In the majority of Caucasian HH patients homozygosity for a single point mutation (C282Y) in exon 4 is observed . In addition, compound heterozygotes for C282Y and one of two other common mutations (H63D, S65C) within exon 2 are at increased risk for developing Hemochromatosis

Molecular genetic testing for HH-associated mutation is considered valuable for carrier identification and well as for presymptomatic diagnosis of the disease. With early detection and simple and very effective treatment by therapeutic bleeding (phlebotomy) in order to remove the iron overload, irreversible organ damage can be completely prevented and survival of patients can be markedly improved

We, in our lab, test for the following genes mutation: H63D; S65C and C282Y

We, in the First Medical Laboratory , are determined to bring the best of laboratory medicine in clinical practice to Jordan

Please call us for any further information

.Dr. Hussam Abu-Farsakh, M.D

American boards of Anatomic, clinical pathology & Cytopathology

Both HSV types (type I&II) tests have cross reactivity in most of the routinely used test because the genetic material in both types are similar in over 85% of their contents. The discovery of glycoproteins on both HSV�s viruses gave us a lead in diagnosing them with very high sensitivity and specificity. Glycoproteins are found on the surface of the virons and have different functions and are species specific. For example Glycoprotein G-I (in HSVI) have at least 10 parts (A,B,C,D,H,L etc). The C- component is very important for adsorption of the virus to the human cell. While B,D,H,L glycoproteins are important for virus fusion with the cell. Vaccines are now made against some glycoproteins in both species and found to be effective in preventing infection with these viruses. Recently, Western Blot testing (by extraction of the virus different proteins) has been implemented to test the presence of antibodies against different glycoproteins in HSV infected patients. Recognizing different glycoproteins by Western Blot is both species specific and very sensitive. Patients who have antibodies to 1-B, 1-C, or I-D are having antibodies against HSV-1. While patients having antibodies in their sera for Glycoprotein (G-2) are definitely infected with HSV II. This test has a very high sensitivity (99%) and specificity of 100%

:This test is recommended for use in the following situations

-1

In any patients who has ulcers in the genital areas

-2

In patients who have sexual contacts with more than one partner. Please remember that over half of HSVII infected patients are asymptomatic

-3

In pregnant women who want to be sure that they do not harbor this virus in their genital tract

-4

In patient where discrimination between type I and type II is essential, especially for socio-psychological reasons

Please do not hesitate to contact us for any further inquiries

We, in the First Medical Lab, are dedicated to bring the best of laboratory test to clinical practice in Jordan

.Dr. Hussam Abu- Farsakh, M.D

Consultant Pathologist and Cytopathologist

American boards of Anatomic, Clinical Pathology and Cytopathology

Herpes simplex ulceration in the vulva can mimic other clinical condition of dermatitis. Exact diagnosis of herpes etiology has definite and different treatment compared to other types of vulvar ulceration and dermatitis. Histology alone only can till herpetic origin if typical nuclear inclusions seen. With immunohistochemistry to herpes simplex virus, we can diagnose up to 100% of all herpetic lesions

Material required: 2 smear slides (at least) from the vulva ulcer scraping

Cost of the test: 30 J.D

We, in the First Medical Laboratory, are dedicated to bring the best of laboratory medicine to clinical practice to Jordan

Dr. Hussam Abu-Farsakh

American Board of Anatomic & Clinical Pathology, and Cytopathology

Circular: is a periodic circular that distributed to clinician informing them about new and important tests available at First Medical Laboratory. All information listed are supported by recent literature

In our effort to bring the best of laboratory medicine in clinical practice to Jordan, We are glad to announce that identification of Human papilloma virus (HPV) genotyping by PCR is available now at our lab for most common 20 genotypes and include the followings

(6,11,34,40,42,43,44,16,18,31,35,39,45,51,52,56,58,59,66,68)

Human papilloma virus is double stranded DNA virus that is incorporated with DNA of the nuclei of the basal layer of the keratinocytes of the exocervix and in the vulvar area.. The virus has the capability of transforming cells into mucosal malignancies

This virus is associated with dysplasia of the cervix (intraepithelial Neoplasia) and squamous cell carcinoma of the cervix

:Different genotypes have different potentials for malignancies

The genotypes that are associated with carcinomas are 16,18 (strong association); genotypes 31, 33,35,39,45,51,52,56 (moderate association); genotypes 6,11,42,43,44 (weak association ). Cervical squamous dysplasia (intraepithelial Neoplasia) is associated with genotypes 16,18,31,33,35,39,42,43,44,45,51,52,56. Genital warts (condyloma accuminata) are associated with 6 and 11. Flat condylomata is associated with genotypes 6,11,16,18,31

Material required: The test can be done on blood or online casino on cervical swabs

Treatment of HPV infections depends largely on the site of the infections and on the genotype of the virus. HPV genotypes with strong or moderate association, require more aggressive therapy with closer follow up

Conclusion: genotyping of Human papilloma virus has very important role in clinical practice and decision making. It is strongly advised that any patient with Human papilloma virus changes in the pap smear, has to be examined for genotyping of HPV. This first will confirm the HPV presence and second will determine the mode of therapy to be taken

Please call us for any further information

.Dr. Hussam Abu-Farsakh, M.D

American boards of Anatomic, clinical pathology & Cytopathology

We introduce several new tests in ” small lymphoma cell type group” that help in their differential. The lymphomas that may morphologically closely mimic each other, however treatment and prognosis may be quite different

 Small lymphocytic lymphoma-
Mantle cell lymphoma-
Follicular center lymphoma-
Marginal zone lymphoma-
Lymphoblasmacytoid lymphoma-

Chronic lymphocytic leukemia/small lymphocytic lymphoma: diffuse infiltrate of small round lymphocytes, with few paraimmunoblasts. The cells are

-CD20+, CD 5+, CD 10 -, Cyclin D1

Mantle cell lymphoma: composed of monotonous proliferation of small lymphocytes with slightly irregular nuclear contour. Scattered epitheliod histiocytes is useful feature. Immunohistochemistry shows that these cells are

+CD20 +, CD5 +, CD 10 -, Cyclin D1

Follicular center lymphoma: mixture of centocytes, and centroblasts in a follicular pattern. . Immunohistochemistry shows that these cells are

-CD20+, CD 5-, CD 10 +, Cyclin D1

Marginal zone lymphoma (includes MALT type and Splenic lymphoma with villous lymphocytes). The cells are of marginal zone type (centrocytes like). Monotypic plasma cells a helpful hint. Immunohistochemistry shows that these cells are

-CD20+, CD 5 -/+, CD10 -/+, Cyclin D1

Lymphoblasmacytoid lymphoma: It is associated with Waldestrom’s macroglobulinemia. Diffuse proliferation of round lymphocytes with cells with plasmacytoid of plasmacytic features. Immunohistochemistry shows that these cells are

-CD20+, CD 5 -, CD 10 -, Cyclin D1

All the above tests are performed now in the First Medical Laboratory

We , in the First Medical Laboratory, are dedicated to bring the best of laboratory medicine in clinical practice to Jordan

Please contact for any further inquires

.Dr. Hussam Abu- Farsakh, M.D

American boards of Anatomic, Clinical Pathology and Cytopathology

 With new development in immunology, medical scientists discovered new tests fairly specific for Crohn’s disease and / or ulcerative colitis. These tests can also differentiate between Crohn’s disease and ulcerative colitis

Antibodies against Saccharomyces cervisiae: They are frequently found in serum of patients with Crohn’s disease. IgA level, specific marker for Crohn’s disease, detectable in 63% of the cases (compared to 4% of ulcerative colitis patients, and 2% in normal population), Combined IgA and IgG detect 73% of the cases

Auto-antibodies against exocrine pancreases: is very specific marker for Crohn’s disease, 39% of the cases, while is 0 % in ulcerative colitis and 0% in healthy controls

Antibodies against intestinal goblet cells: This antibody is pathognomonic for ulcerative colitis (IgA: in 28% of cases, IgG in 69%) of the cases

p-ANCA: occur in ulcerative colitis in 66%, and in Crohn’s disease in 85%

These panel of 4 antibodies can detect altogether up to 90% of the cases of Crohn’s or ulcerative colitis. All these antibodies are important for follow up of the cases

Test Price for all antibodies: 50 J.D

We, at the First Medical Laboratories, are dedicated to bring the best of Laboratory medicine in clinical practice to Jordan

Please call us for any further details

.Dr. Hussam Abu- Farsakh, M.D

American boards of Anatomic, Clinical Pathology and Cytopathology

Circular: is a periodic circular that distributed to clinician informing them about new and important tests available at First Medical Laboratory. All information listed are supported by recent literature

We, at the First Medical Laboratory, provide you with several important tests for dermatology diagnosis

 -1

 Immunoflourescence test on the skin biopsy (IgG, IgA, IgM, C3, C4) : This test is important in cases of Pemphigus (intercellular IgG pattern), Pemphigoid (linearly deposited C3 and IgG along epidermal basement membrane) , Dermatitis herpetiformis (linear IgG along epidermal basement membrane) , SLE (granular C3 and IgG along basement), Herpes gestationis ( linear C3 deposition along epidermal basement membrane) , Vasculitis (IgG or IgA plus C3 along vessel wall).. etc

-2

Test for early cases of Mycosis Fungoides by doing Immunohistochemical staining of lymphocytes for CD4/CD8

-3

(Doing Frozen section services for cases of basal cell carcinoma (to document complete excision

-4

We perform direct Immunoflourescence for Chlamydia antigen for recurrent urethritis in Sexually transmitted disease cases

-5

Immunoflourescence studies for ANA, Anti-DNA, ASMA, AMA, ANCA�(important for cases of vasculitis, SLE or autoimmune conditions)..etc

We, at the First Medical Laboratories, are dedicated to bring the best of Laboratory medicine in clinical practice to Jordan

         Please call us for any further details

.Dr. Hussam Abu- Farsakh, M.D

American boards of Anatomic, Clinical Pathology and Cytopathology

A BETTER MEASUREMENT OF OVARIAN FUNCTION THAN FSH

Inhibin is a hormone that is produced from granulosa cells of the ovary. It acts by inhibiting secretion of FSH. Measurement of Inhibin has been found recently to have a superior indication of the ovarian status than measurement of FSH

Measurement of inhibin in the 3^rd day of the menstrual cycle is a better predictor to female response to hormonal stimulation in preparation for IVF, IUI or other assisted reproduction techniques than FSH measurement. Since inhibin is produced in the ovaries, while FSH from the anterior pituitary, they can serve as a direct measure of ovarian function

Researchers found that measuring the levels of inhibin were a more sensitive test of a woman�s ovarian reserve — or reproductive potential — than the most commonly used test today. The current test measures the levels of follicle stimulating hormone (FSH). Danforth study at Ohio University, USA

Production of inhibin drops as a woman goes through perimenopause, the phase just before menopause.. Levels of inhibin are lower in women aged 46-52 than in women aged 39-45. This is consistent with the fact that older women, who are nearer menopause, should have reduced ovarian function compared to younger women with no difference between the older and younger women in terms of FSH levels

�This suggests that inhibin levels may be a more sensitive gauge of ovarian function than FSH levels,� Danforth said. �FSH levels alone may be a less reliable indicator of reproductive potential in older women. The decline in ovarian inhibins but not a rise in pituitary FSH suggests that the inhibins may be a better and more direct marker of ovarian age than FSH

If Day 3 Inhibin is abnormally low with a positive Anti-Ovarian Antibody test; It is suggested to treat for Anti-Ovarian Antibodies with Dexamethasone or Prednisone. Treatment should start on day one of the cycle. For low responders to induction of ovulation, treatment is also to start on day one of the cycle. If Day 3 Inhibin is abnormally low with a negative Anti-Ovarian Antibody test; then increase HMG dosage

Both inhibin hormone and anti-ovarian antibodies tests are available at First Medical Lab

Please do not hesitate to contact us for further inquiries

We, in the First Medical Laboratory, are dedicated to bring the best of laboratory medicine to clinical practice to Jordan

Dr. Hussam Abu-Farsakh

American Board of Anatomic & Clinical Pathology, and Cytopathology

Circular: is a periodic circular that distributed to clinician informing them about new and important tests available at First Medical Laboratory. All information listed are supported by recent literature

This is a newly described form of kidney transplant acute rejection in 1999, which is not uncommon. It affects about one third of all transplanted kidneys in the first 3 months post transplant. This form of rejection affects the microvascular peritubular capillary area. It is a form of acute antibody mediated rejection (humoral type). However, It lacks the typical fibrinoid necrosis arterial humoral rejection. Histological sections with routine staining may show variable number of scattered neutrophilic tubulitis,

variable number of peritubular and glomerular capillary luminal neutrophils, but they may be no apparent histologic features. The only way to identify with certainty this type of acute rejection is by performing C4d immunostaining which highlights the peritubular capillary area

Important facts you should know about this type of rejection: in about one third of cases, immunostaining for C4d may be the only pathological finding. It could be accompanied by acute tubular interstitial cell mediated rejection in 24-43%. Up to 45% of specimen showing endarteritis, have peritublar capillary C4d immunostianing. It can be misdiagnosed as acute cellular rejection in 25% of cases. This form of rejection can be also seen in chronic rejection

The importance of recognizing such a form of rejection: it is a relatively common type of humoral rejection. It requires an aggressive form of treatment and it has a worse course than cellular rejection, but It carries a better prognosis than the usually type of humoral rejection

In Summary, requesting immunostaining for C4d is an essential part of work up cases for suspected renal transplant rejection, especially in the first 3 months post transplant. However, this form of rejection can occur in chronic rejection. This test is important since it can be the only constant and reliable indicator for kidney transplant rejection

We in the FIRST MEDICAL LAB are determined to bring the best of laboratory tests to

clinical practice in Jordan. Please do not hesitate to contact me for any further inquiries

.Dr. Hussam Abu- Farsakh, M.D

Consultant Pathologist and Cytopathologist

American boards of Anatomic, Clinical Pathology and Cytopathology

Low molecular weight heparin (LMWH) has many advantages over usual heparin. It has more predictable response rate with low side effect (like osteoporosis and thromboc ytopenia). LMWH is used as anti-coagulant in venous thromboembolic disease, in antiphospholipid syndrome , in repeated abortion in pregnancy and experimentally in some cancer treatment as an important �Tissue Factor Pathway Inhibitor (TFPI)� which could prevent cancer angiogenesis and spread

LMWH affects mainly factor Xa by inhibiting the coagulation cascade, and to lesser extent Factor II with a ratio of anti-Xa/ anti-IIa usually exceeding 3. That is why measurement of activity of anti-Xa is the best test for monitoring low molecular weight heparin

In addition, patients with lupus anticoagulants or factor XII deficiency are bettered monitored by anti-Xa when given heparin. PTT is not reliable in these instances

The anti-Xa therapeutic range 0.5-1.0 IU/mL

(Specimen required: Plasma (blue top: sodium citrate

We in the First Medical Lab are dedicated to bring the best of Laboratory medicine to clinical practice in Jordan

Dr. Hussam Abu-Farsakh

American Board of Anatomic & Clinical Pathology, and Cytopathology

Circular: is a periodic circular that distributed to clinician informing them about new and important tests available at First Medical Laboratory. All information listed are supported by recent literature