Author Archives: د.حسام أبو فرسخ

Venous thrombosis is among the three most common cardiovascular diseases affecting about 1:1000 individual each year. Thrombosis risk is determined by genetic risks, in addition to other factors surgery, age, pregnancy, contraceptives

We would like to announce that we have an updated profile of causes of thrombosis

Factor V leiden (by PCR): is most common point mutation in our population that causes venous thrombosis (20-60%) of the cases

Factor II (prothrombin factor by PCR): a gene defect that causes elevated plasma prothrombin and causes vein thrombosis by 3-5 folds

Homocysteine gene (By PCR): Hyperhomocysteinemia is caused by a defect in an enzyme 5,10-methylenetetrahydrofolate (MTHFR). This enzyme defect is common (5-20%) of the cases

Anti-Thrombin III deficiency, Protein S deficiency and protein C deficiency: All these proteins can affect thrombosis susceptibility

Anti-phospholipid, anti-cardiolipin and lupoid anticoagulant: cause venous thrombosis and can cause repeated abortions in pregnant ladies

All of the above thrombosis factors are responsible of over 90% of genetic diseases for thrombosis. Requesting the full Thrombosis Profile is essential in the management of all these cases

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

:We would like to announce our wide Panel for Viral Encephalitis that includes the followings

Tick born encephalitis �

West Nile Valley Virus �

Dungue fever �

Flavi virus group �

CMV �

(Herpes simplex I&II (by western blot �

EBV �

HIV I & II �

(Measles (paramyxovirus group �

(Mumps (paramxoyvirus group �

Coxsackie A, Coxsackie B �

Echovirus �

Varicella Zoster virus �

(Influenza Virus (A and B �

The sample that is required in the above causes are blood serum sample

Additional causes that may mimic viral encephalitis and can be tested in CSF are T.B in CSF (by our new tests Anda-tb and Patho-tb) and Entameba Nigleria subtype

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 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

Since the outbreak of West Nile valley virus in New York in 1999, more and more cases are being reported. It is becoming very common in the United State as 5% of all screened blood donors are affected. The most common presentation of this virus is fever of unknown origin that may last for a month or so with body aches. However, in about 1% of affected individuals, they will have beside the fever, Gillian Barrie like symptoms and will deteriorate if not appropriately treated. West Nile virus is part of Flavivirus group. It causes meningoencephalitis and affect the anterior horn cells of the spinal cord and may extend into brain stem and cerebral cortex. Autopsy studies from this virus showed increased microglial cells in spinal cord with loss of ganglion in anterior horn cells. Microglial nodules also seen. Muscle biopsy shows evidence of neurogenic atrophy. EMG studies shows usually classic poliomyelitis picture rather than a demyelinating process as usually suspected from the clinical presentation. Due the importance of recognizing such a virus, blood donor screening for West Nile Valley Virus was implemented in the United States in July 2003

In summary West Nile virus is becoming increasingly recognized as a lethal virus if not properly treated. It should be suspected in any patient with �fever with muscle weakness, or symptoms of encephalitis�. The test that is available in our lab is blood serum test for IgM specifically against West Nile Valley virus

 
We, in the First Medical Lab, 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

Small Lymphocytic Lymphoma (SLL) represented 6.7% of non-Hodgkin lymphomas in the International Lymphoma Study Group Classification Project. The average age of patients with SLL was 65 years, and 53% of the patients were male. The average age of patients with Chronic Lymphocytic Leukemia (CLL), the most common type of chronic leukemia, is 65 years, and the male to female ratio is reported to be approximately 2:1. Recent advances in our understanding of CLL/SLL have led to the realization that CLL/SLL is a heterogeneous disorder with a highly variable clinical course

A significant recent discovery has been that outcome of leukemic CLL/SLL patients can be predicted based on the mutational status of the immunoglobulin heavy chain variable region (IgVH) genes. CLL/SLL can now be broadly divided into 2 groups based on the mutational status of IgVH: those cases with unmutated IgVH regions having an unfavorable clinical course, and those with mutated IgVH having a favorable clinical course. Patients with un mutated IgVH genes were found to have a median survival of 95 months compared with 293 months for those with mutated IgVH genes. Gene expression profiling of CLL/SLL has revealed characteristic patterns of gene expression that correlate with the mutational status of the IgVH genes. ZAP-70, a protein tyrosine kinase normally expressed in T-cells that plays an important role in T-cell receptor signaling, was found to be expressed in CLL/SLL with unmutated IgVH genes. Consequently, ZAP-70 has been suggested as a surrogate marker for IgVH mutational status. Comprehensive investigations in CLL/SLL have confirmed that cases with ZAP- 70 expression usually carry unmutated IgVH genes and patients with these neoplasms have a shorter time to disease progression and a reduced overall survival compared with those without ZAP-70 expression

In Summary, part of the essential work up for cases with CLL/SLL is performing ZAP-70 immunostaining. Expression of this marker indicate a poor outcome in such a relatively indolent tumor and requires more aggressive therapy

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 medicine to clinical practice to Jordan

Dr. Hussam Abu-Farsakh

American Board of Anatomic & Clinical Pathology, and Cytopathology

Triple test consists of alpha feto protein (AFP), unconjugated estriol (uE3) and Human chorionic gonadotropin (B-HCG). Inhibin A is now added to the triple test to become Quadruple test

Inhibin A is produced in pregnancy from the placenta. It plateaus during weeks 14-30 weeks. Inhibin A levels are not influenced by maternal age

Measurement of inhibin A is only of value after 14 weeks of gestation, best between 16-18 weeks

Clinical significance

Down syndrome associated with increased inhibin A (bout 2 folds) , increased B-HCG , decreased alpha-feto protein and decreased uE3. Inhibin A increases detection of Down�s syndrome by 10% (from 65% to 75%), with false positive rate of about 5%

Neural tube defects: associated with increased AFP, normal HCG , normal uE3 and normal Inhibin A

Trisomy 18 : associated with decreased AFP; Decreased HCG, and decreased uE3 and decreased inhibin A. It detects 92% of cases of this chromosomal anomaly

Turner syndrome: is associated with increased inhibin A in cases with hydrops , but decreased in cases without hydrops. It generally detects 53% of Turner cases

In summary: Quadruple test can be of value in increasing sensitivity and specificity of detecting chromosomal anomalies in fetuses in pregnancy

.Dr. Hussam Abu- Farsakh, M.D

American boards of Anatomic, Clinical Pathology and Cytopathology

Normal range: 10.7-18.4 mmol/L

Comment: Effect on growth, development, weight loss, immune function, and CNS

Sample: serum

Used mainly for the detection of mycobacterium sp. Smears maybe negative even with positive cultures. Usually tested in conjunction with AFB culture or by PCR

Part of the essential work up for cases with CLL/SLL is performing ZAP-70 immunostaining. Expression of this marker indicate a poor outcome in such a relatively indolent tumor and requires more aggressive therapy

Sample: bone marrow aspirate or biopsy

Normal range: Negative

Comment: it causes diarrhea and inflammation of distal ileum

Sample: Serum

:Normal range

Adult, 1 hr (dose, 25 g): ³ 25

Adult with intermediate renal insufficiency, 1 hr (dose, 25 g): ³20

Pediatric < 12y, 1 h (dose, 5 g): ³20

Comment: Used for malabsorption. Normal renal function essential to perform the test

Sample: Serum