Association of [hypovitaminosis v] with persistent non-specific musculoskeletal pains

Objective: The study was conducted in Pakistani population to find association of vitamin D deficiency with persistent non-specific musculoskeletal pains by comparing with pain free controls

Study Design: Case control study

Material and Methods: Patients aged 12 years or more presenting to Medical OPD with persistent nonspecific musculoskeletal pains for more than 3 months were selected as cases, while healthy individuals served as controls

Results: A total of 60 cases [patients with persistent non-specific pains] presenting to medical outpatients department at Military Hospital Rawalpindi and 60 controls were studied. Mean age of cases was 43.9 +/- 14.0 years and amongst controls were 33.2 +/- 17.8 years. Mean serum vitamin D level of 32.8 nmol/L was reported in cases whereas mean serum vitamin D level amongst controls was 26.7 +/- 17.8 nmol/L. Hypovitaminosis D amongst cases and controls was 86.6% and 95% respectively. The proportion of vitamin D deficiency did not differ significantly as compared to controls. There was non-significant difference in proportion of deficiency amongst cases and controls

Conclusion: Overall there was no association between persistent non-specific musculoskeletal pains and vitamin D deficiency

Decreased serum 25-hydroxycalciferol levels in pre-diabetic adults

Objective: To determine the serum 25-hydroxycalciferol levels [25[OH]D] in adults with pre-diabetes and normoglycaemia to examine a possible association of vitamin D deficiency with pre-diabetes

Study Design: Case control study

Place and Duration of Study: Armed Forces Institute of Pathology, Rawalpindi, from November 2012 to July 2013

Methodology: A total of 272 adults including 136 pre-diabetics and 136 normoglycaemics of either gender aged 20 years and above were consecutively inducted. Patients with diabetes mellitus, pregnancy, rickets and osteomalacia, ischemic heart disease, chronic kidney disease and chronic liver disease were excluded. Fasting Plasma Glucose [FPG] was estimated with hexokinase method on Modular p800 Roche chemistry analyzer while serum 25[OH]D was measured on Diasorin Liaison immunoassay analyzer using the chemiluminescent technique. Mean 25[OH]D levels in pre-diabetic and normoglycaemic groups were compared using Mann-Whitney U test. Spearman's correlation coefficient 'r[s]' was determined between serum 25[OH]D and FPG. Odds ratio for vitamin D deficiency was also calculated

Results: Mean serum 25[OH]D level was low in pre-diabetics [23.2 nmol/L] as compared to normoglycaemics [29 nmol/L; p=0.001]. Serum 25[OH]D level had inverse correlation with FPG [r[s] = -0.448, p=0.000]. There was also significant association of vitamin D deficiency with pre-diabetes compared with normoglycaemia [OR: 2.21, p= 0.016; 95% CI: 1.15-4.27]

Conclusion: Vitamin D deficiency with pre-diabetes suggested that vitamin D may have an important role in pathogenesis of pre-diabetes

Premature coronary artery disease; potential role of a 13 SNP gene risk score in the risk prediction of Pakistani patients

Introduction: Genetic information which is specific to an individual has the potential to improve Coronary Artery Disease [CAD] risk prediction. 13 CAD risk SNPs were selected by removing SNPs in loci which had not been identified in CARDIoGRAMplusC4D GWAS. Linkage disequilibrium patterns differ between ethnic groups pointing towards the need to investigate how the gene score would perform in different populations which is still largely unknown. Objective of the study was to investigate whether the 13 SNP CAD risk gene score has a role in the risk prediction of Pakistani Premature Coronary Artery Disease [CAD] cases and controls and to compare the CAD risk allele frequency between Pakistanis and Caucasians [samples obtained from the Northwick Park Heart Study II]

Study Design: Case control study

Setting: Army Medical College, National University of Sciences and Technology [NUST] in collaboration with the Cardiovascular Genetics Institute, University College London, UK

Materials and Methods: Total of 650 subjects with a history of chest pain were selected by non-probability convenience sampling. Out of these subjects with > 70% stenosis in at least 1 coronary vessel on angiography were labelled as Premature coronary Artery disease [PCAD] cases [n=340]. The 13 SNPs were genotyped in a Pakistani case-control study [n=340 CAD cases, 310 controls] using KASPar and Taqman assays. The use of 13 SNP gene score was tested in the prospective Northwick Park Heart Study [NPHSII] of 2775 healthy UK men [284 cases] and the Pakistani case-control study subjects [n=650]

Results: Mean +/- SD age of CAD patients was 42.7 +/- 3.80yrs while in controls it was 39.0 +/- 7.8yrs. Complete genotyping was obtained for 635 samples [333 cases, 302 controls]. The mean 13 SNP gene score was significantly higher in cases compared to controls [p=0.044]. Odds ratio for CAD for each quintile of 13 SNPs gene score showed a trend for higher quintiles of gene score to have increased odds ratio for CAD [p-value for trend=0.01] especially after adjusting for age, sex and ethnicity. There was a significant difference in risk allele frequency between Pakistanis and Caucasians [NPHSII] for all CAD risk SNPs except rs599839 [SORT1] [p=0.08]

Conclusion: A 13 SNP gene score has significant potential role at differentiating between Pakistani PCAD cases and controls. Risk allele frequencies for CAD differ significantly between Pakistanis and Caucasians stressing the need to develop population specific gene score keeping in view the ethnic stratification

Comparison of friedewald formula and modified friedewald formula with direct homogeneous assay for low density lipoprotein cholesterol estimation

To compare the Friedewald and modified Friedewald formulae with direct homogeneous assay for serum lowdensity lipoprotein cholesterol [LDL-C] levels estimation. Cross-sectional study. Armed Forces Institute of Pathology, Rawalpindi, from June to December 2011. Healthy subjects of either gender, from Rawalpindi, aged 18-75 years were included by consecutive sampling. Patients with diabetes mellitus, chronic liver disease, chronic kidney disease, those taking lipid lowering drugs and samples with triglyceride [TG] > 4.52 mmol/l were excluded from the study. Total cholesterol, high-density lipoprotein cholesterol, TG and LDL-C were measured on Hitachi 912 chemistry analyzer [Roche]. LDL-C levels were also calculated by Friedewald formula [FF] and Vujovic modified formula [VMF]. Paired sample t-test and scatter plots were used for statistical analysis. Although both calculated methods showed good correlation with direct assay [r > 0.93] in 300 subjects, but the difference was statistically significant. The ffLDL-C were 0.12 A +/- 31 mmol/l [p < 0.001] lower and vmfLDL-C were 0.11 A +/- 26 mmol/l [p < 0.001] higher than dLDL-C. The difference was not significant between ffLDL-C and dLDL-C at TG levels < 1.70 mmol/l [p = 0.58] and between vmfLDL-C and dLDL-C at TG levels 2.26 - 4.52 mmol/l [p = 0.38]. At all other TG levels, the difference between LDL-C calculated by both formulas and dLDL-C was statistically significant [p < 0.001]. As compared to direct assay, 11% and 14% subjects were classified in wrong National Cholesterol Education Programm's cardiac risk categories by FF and VMF respectively. LDL-C should be measured by direct homogeneous assay in routine clinical laboratories, as the calculated methods did not have a uniform performance for LDL-C estimation at different TG levels

Rapid detection of acute kidney injury by urinary neutrophil gelatinase-associated lipocalin after cardiopulmonary bypass surgery

To determine the accuracy of neutrophil gelatinase-associated lipocalin [NGAL] in early detection of acute kidney injury [AKI] after cardiopulmonary bypass [CPB] surgery by comparing with serum creatinine. Descriptive study. Department of Chemical Pathology and Endocrinology, AFIP in collaboration with AFIC/ NIHD, Rawalpindi, from April to December 2011. Eighty eight patients undergoing CPB surgery in AFIC/NIHD were included by consecutive sampling. Blood samples of subjects for serum creatinine analysis were drawn pre-operatively, 4 h, 24 h and 48 h after CPB surgery. Spot urine samples for NGAL were collected at 4 h after CPB surgery. Urine samples were analyzed on Abbott ARCHITECT i2000SR analyzer whereas serum creatinine samples were measured on Beckman UniCel DxC 600 Synchron Clinical System. Out of 88 patients, 11 [13%] cases developed AKI 4 h postoperatively. Urinary NGAL increased markedly at 4 h postoperatively as compared to serum creatinine which showed rise at 24 - 48 h after cardiac surgery. Analysis of urine NGAL at a cutoff value of 87 ng/ml showed area under the curve of 0.91 [95% confidence interval [Cl] 0.83 - 0.96] with sensitivity of 90.9% [95% Cl 58.7 - 98.5] and specificity of 98.7% [95% Cl 92.9-99.8]. There was a positive correlation of 4 h urine NGAL and serum delta creatinine at 48 h, which was statistically significant [r[s] = 0.33, p = 0.001]. The study demonstrated that levels of urine NGAL in patients suffering from AKI increased significantly at 4 has compared to serum creatinine levels. Urine NGAL is an early predictive biomarker of AKI after CPB

Comparison of urine with plasma neutrophil gelatinase-associated lipocalin in detecting acute kidney injury after cardiopulmonary bypass surgery

To compare the accuracy of urine with plasma neutrophil gelatinase-associated lipocalin [NGAL] in early detection of acute kidney injury [AKI] following cardiopulmonary bypass [CPB] surgery. A prospective cohort study. Department of Chemical Pathology and Endocrinology, AFIP from December 2011 to July 2012. Ninety three adult patients planned for CPB surgery in AFIC/NIHD were consecutively included. Blood for serum creatinine were collected preoperatively, 4, 24 and 48 hours [h] after CPB surgery. Blood and urine samples for NGAL analysis were collected only at 4 h. Serum creatinine, plasma and urine NGAL samples were analyzed on UniCel[R] DxC 600 [Beckman], TRIAGE meter pro [Biosite] and ARCHITECT i2000SR analyzer [Abbott] respectively. Out of 93 patients undergoing CPB surgery, 12 [13%] developed AKI. AKI patients had significantly higher median interquartile range [IQR] urine NGAL of 180 ng/ml [105-277 ng/ml] as compared to control of 6 ng/ml [2-15 ng/ml] and median plasma NGAL of 170 ng/ml [126-274 ng/ml] as compared to control of 75 ng/ml [61-131 ng/ml]. The patients had increased urine vs plasma NGAL area under curve [AUC] [0.91 vs 0.70 [p = <0.001]], better sensitivity [91% vs 82%] and specificity [98% vs 65%]. Plasma and urine NGAL values increased significantly in AKI patients as compared to serum creatinine values. Urine in comparison to plasma NGAL revealed more sensitivity and specificity in detecting AKI following CPB surgery

Validation of modified estimated glomerular filtration rate in chronic kidney disease patients

To derive the ethnic factor and validate the modified estimated Glomerular Filtration Rate [eGFR] by Modification of Diet in Renal Disease [MDRD] equation for Chronic Kidney Disease [CKD] patients of Rawalpindi. Cross- sectional study. Armed Forces Institute of Pathology [AFIP], Rawalpindi, from July 2011 to July 2012. A total of 140 patients with CKD reporting to AFIP for GFR measurement by [99m] Technetium diethylenethiaminepenta-acetic acid [[99m]Tc-DTPA] renal scan were consecutively inducted. Serum creatinine was measured by the Jaffe's assay on Beckman DxC 600 Analyzer prior to the renal scan. Ethnic factor for population of Rawalpindi with CKD was derived for the MDRD eGFR equation using [99m]Tc-DTPA renal scan by Gates method as the reference method. MDRD equation was modified by inclusion of the ethnic factor in it. Agreement between the reference GFR [rGFR] and the modified MDRD eGFR [mGFR] was assessed by applying paired samples t-test. Out of 140 patients of CKD, 99 [71%] were males and 41 [29%] females, with mean age of 55 +/- 13.42 years. The mean values were 32.91 +/- 14.96, 34.89 +/- 16.45, 0.971 +/- 0.20 and 33.87 +/- 15.97 for rGFR, original eGFR, ethnic factor and mGFR respectively. The mGFR with new ethnic factor of 0.971 showed improved performance as compared to original eGFR and showed a significant level of correlation with rGFR [r[2] = 0.817], at a p-value of 0.000. This study validates the mGFR equation by inclusion of newly derived ethnic factor of 0.971 in the population of Rawalpindi with CKD and it was found to be not significantly different from the rGFR.

Adverse effects of low dose methotrexate in rheumatoid arthritis patients

To determine the frequency of adverse effects attributed to Methotrexate [MTX] toxicity and serum minimum toxic concentration with low dose MTX in Rheumatoid Arthritis [RA] patients. Cross-sectional observational study. Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi, from March 2010 to March 2011. One hundred and forty adult patients of RA receiving low dose MTX [10 mg/week] for at least 3 months, were included by consecutive sampling. Blood samples were collected 2 hours after the oral dose of MTX. Serum alanine transaminase and creatinine were analyzed on Hitachi and blood counts on Sysmex analyzer. Serum MTX concentration was measured on TDX analyzer. Out of one hundred and forty patients; 68 males [49%] and 72 females [51%], 38 developed MTX toxicity [27%], comprising of hepatotoxicity in 12 [8.6%], nephrotoxicity in 3 [2.1%], anaemia in 8 [5.7%], leucopenia in 2 [1.4%], thrombocytopenia in 3 [2.1%], pancytopenia in 2 [1.4%], gastrointestinal adverse effects in 5 [3.6%] and mucocutaneous problems in 3 [2.1%]. Receiver operating characteristic curve revealed serum minimum toxic concentration of MTX at cutoff value of 0.71 micro mol/l with a sensitivity of 71% and specificity of 76%. Adverse effects of low dose MTX were found in 27% of RA patients, mainly comprising of hepatotoxicity and haematological problems. MTX toxicity can be detected by therapeutic drug monitoring of serum concentration of 0.71 micro mol/l with sensitivity of 71% and specificity of 76% in the patients on low dose MTX maintenance therapy

Frequency of steroid contamination in drugs prescribed by quacks in Rawalpindi

To determine the frequency of contamination of steroids in drugs prescribed by quacks, being used by patients in Rawalpindi. Cross- sectional study. Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology Rawalpindi, from June 2010 to March 2011. One hundred and seventy eight drugs distributed by quacks in Rawalpindi were collected from the patients. Quackery formulations [QF] were analyzed by thin layer chromatography on fluorescent Aluminum silica plates by using mobile phase of methylene chloride: ether: methanol: water [77:15:8:1.2] and relative flow of spots were noted. Samples positive for steroids were confirmed by high performance liquid chromatography. Out of In total of 178 samples, 125 [70.2%] were received by patients from unregistered hakeems, 29 [16.3%] unregistered homeopaths and 24 [13%] directly from nonmedical shopkeepers, prescribed for in joint pains 84 [47%], generalized weakness 43 [24%], dermatitis 28 [16%], gastrointestinal diseases 12 [7%] and respiratory diseases 11 [6%]. Out of 178 samples, 38 [21%] QF were contaminated with steroids found in 18 [48%] tablets, 10 [26%] powders, 5 [13%] creams, 3 [8%] capsules and 2 [5%] syrups. Out of 38 Steroid contaminated QFs 20 [53%] countrained dexamethasone, 12 [32%] prednisolone, 4 [10%] hydrocortisone and 2 [5%] betamethasone. In modern era, patients are still using drugs prescribed by quacks and 21% of QF in Rawalpindi is contaminated with steroids. The steroids comprise mainly of dexamethasone and prednisolone in adulterated tablets and powders prescribed by hakeems.

Evaluation of stable coronary artery disease by multiple cardiac biomarkers

Effective management of stable coronary artery disease [SCAD] relies on early detection of coronary atherosclerosis. The objective was to evaluate diagnostic accuracy and risk stratification of SCAD patients by high sensitivity C reactive protein [hs CRP], Myeloperoxidase [MPO] and Pregnancy Associated Plasma Protein-A [PAPP-A]. validation study was conducted at Pathology Department of the Army Medical College, in collaboration with Armed Forces Institute of Cardiology [AFIC/NIHD] Rawalpindi. Total 122 subjects consisting of 61 patients of SCAD and 61 angio-negative controls were included. The levels of biomarkers were measured before angiography by using kits provided by Siemens [UK] for hs CRP and Abbott for MPO on Immulite 1000 and Architect Analyzer respectively, whereas serum PAPP-A was measured by an ELISA based method using kit provided by IBL Germany. The mean age of the patients was 56.57 +/- 8.35 years and consisted of 53 [86.9%] males and 8 [13%] females. Area under curve [AUC] and 95% CI of hs CRP 0.817 [0.736-.881] was significantly higher than that of MPO 0.685 [0.594-0.766] [p=0.018] and PAPP-A 0.565 [0.472-0.655] [p<0.001] for the diagnosis of SCAD. Patients in the highest quartile of PAPP-A were at the highest risk for adverse events as PAPP-A had the highest Hazard Ratio [HR] of 3.4 [p=0.004], as compared to hs CRP 1.124 [p=0.191] and MPO 0.998 [p=0.176]. hs CRP has superior diagnostic ability for detection of SCAD than MPO whereas PAPP-A is a more reliable marker for risk stratification among the cardiac biomarkers

Diagnostic Performance of High-Sensitivity Troponin T, Myeloperoxidase, and Pregnancy-Associated Plasma Protein A Assays for Triage of Patients with Acute Myocardial Infarction / 대한진단검사의학회지

BACKGROUND: Early diagnosis is the cornerstone of management of acute myocardial infarction (AMI). We aimed to compare the diagnostic accuracy of high-sensitivity troponin T (hs-cTnT) with myeloperoxidase (MPO) and pregnancy-associated plasma protein A (PAPP-A) for early diagnosis of AMI in patients at the time of presentation to the emergency department (ED). METHODS: We enrolled 289 patients who presented at the ED of the National Institute of Heart Disease (NIHD) Rawalpindi, Pakistan, within 4 hr of onset of chest pain. Clinical assessment, electrocardiography (ECG), and angiography were carried out. Blood samples were collected at 0, 3, 6, and 12 hr. Analyses of plasma hs-cTnT, MPO, and PAPP-A were carried out using commercial kits. RESULTS: Out of 289 subjects who presented to the ED, we diagnosed 180 patients with coronary heart disease as having AMI (N=61) and 119 as without AMI (stable coronary artery disease, N=61; unstable angina, N=58). Compared to non-AMI patients, the patients with AMI had significantly higher levels (represented here as median [inter quartile range]) of plasma hs-cTnT (136 [39-370] vs. 12 [7-21] ng/L), MPO (906 [564-1,631] vs. 786 [351-1,299] pmol/L) and PAPP-A (5.78 [2.67-13.4] vs. 2.8 [1.8-4.9] mIU/L). Receiver operator characteristic curves (95% CI) for hs-cTnT (0.952 [0.909-0.978]) were significantly higher (P<0.001) than those for MPO (0.886 [0.830-0.929]) and PAPP-A (0.797 [0.730-0.854]), with AMI sensitivity and specificity percentages of 87% and 98% (hs-cTnT), 82% and 84% (MPO), and 65% and 87% (PAPP-A), respectively. CONCLUSIONS: The diagnostic performance of hs-cTnT was superior to that of MPO and PAPP-A for early triage and diagnosis of AMI among patients of coronary heart disease presenting with chest pain to the ED.

Diagnostic Performance of High-Sensitivity Troponin T, Myeloperoxidase, and Pregnancy-Associated Plasma Protein A Assays for Triage of Patients with Acute Myocardial Infarction / 대한진단검사의학회지

BACKGROUND: Early diagnosis is the cornerstone of management of acute myocardial infarction (AMI). We aimed to compare the diagnostic accuracy of high-sensitivity troponin T (hs-cTnT) with myeloperoxidase (MPO) and pregnancy-associated plasma protein A (PAPP-A) for early diagnosis of AMI in patients at the time of presentation to the emergency department (ED). METHODS: We enrolled 289 patients who presented at the ED of the National Institute of Heart Disease (NIHD) Rawalpindi, Pakistan, within 4 hr of onset of chest pain. Clinical assessment, electrocardiography (ECG), and angiography were carried out. Blood samples were collected at 0, 3, 6, and 12 hr. Analyses of plasma hs-cTnT, MPO, and PAPP-A were carried out using commercial kits. RESULTS: Out of 289 subjects who presented to the ED, we diagnosed 180 patients with coronary heart disease as having AMI (N=61) and 119 as without AMI (stable coronary artery disease, N=61; unstable angina, N=58). Compared to non-AMI patients, the patients with AMI had significantly higher levels (represented here as median [inter quartile range]) of plasma hs-cTnT (136 [39-370] vs. 12 [7-21] ng/L), MPO (906 [564-1,631] vs. 786 [351-1,299] pmol/L) and PAPP-A (5.78 [2.67-13.4] vs. 2.8 [1.8-4.9] mIU/L). Receiver operator characteristic curves (95% CI) for hs-cTnT (0.952 [0.909-0.978]) were significantly higher (P<0.001) than those for MPO (0.886 [0.830-0.929]) and PAPP-A (0.797 [0.730-0.854]), with AMI sensitivity and specificity percentages of 87% and 98% (hs-cTnT), 82% and 84% (MPO), and 65% and 87% (PAPP-A), respectively. CONCLUSIONS: The diagnostic performance of hs-cTnT was superior to that of MPO and PAPP-A for early triage and diagnosis of AMI among patients of coronary heart disease presenting with chest pain to the ED.

Determination of glycosylated hemoglobin reference range in adult population attending a military care set up in Rawalpindi

To determine the glycosylated hemoglobin reference range in healthy adult population attending a military care setup in Rawalpindi in accordance with National Glycohemoglobin Standardization Program [NGSP] and International Federation of Clinical Chemistry [IFCC]. Descriptive cross-sectional study. Armed Forces Institute of Pathology Rawalpindi from May- Oct 2010. A total of 254 healthy adults [18-80 years] comprising 169 males and 85 females, were included by non probability consecutive sampling from Rawalpindi. History and clinical examination were carried out. Blood HbA1c was analyzed high performance liquid chromatography on biorad D-10. Data were analyzed by SPSS-17. Total 254 subjects consisting of 169 males and 85 females were recruited from Rawalpindi Pakistan. The reference range of total population was found 4.6-6.56% and 2.69-4.81 mmol/ mol in accordance with NGSP and IFCC, respectively. When compared in gender, HbA1c levels were not significantly changed. However, the healthy elderly population had higher HbA1c levels. Reference range for HbA1c based on NGSP in individuals <40 years was found 4.52-6.4% while for individuals aged > 40 years, it was 4.8-6.68%. The reference ranges for healthy individuals and the recommended values for optimal therapy in diabetic patients have to be revised and adjusted. Population based reference ranges should be established to provide better patient care services

Pregnancy-associated plasma protein-A levels in individuals with and without coronary artery disease

To compare pregnancy-associated plasma protein-A [PAPP-A] levels in individuals with and without coronary artery disease [CAD]. Cross-sectional comparative study. Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology [AFIP], Rawalpindi, in collaboration with Armed Forces Institute of Cardiology [AFIC], from September 2008 to March 2010. One hundred and twenty five [125] individuals both male and female were included in the study. Blood for PAPP-A and lipid profile was collected, just before angiography. On the basis of angiography, the individuals were divided into those with and without CAD. PAPP-A was analyzed by using Diagnostic System Laboratories [DSL] Enzyme Linked Immunosorbent Assay [ELISA] kit and reading was taken by ELISA reader. Lipid profile was determined on automated analyzers Selectra-2 and Vitros 5.1. Amongst the 125 individuals, 41 individuals were without CAD whereas 84 individuals were having CAD. Mean PAPP-A levels were 0.74 +/- 0.35 mIU/L in those without CAD whereas mean PAPP-A levels in those with CAD were 1.35 +/- 0.57 mIU/L. The difference between the two groups was statistically significant [p < 0.001]. A PAPP-A cut off level of 0.85 mIU/L had a sensitivity and specificity of 78% and 70% respectively for diagnosing atherosclerotic CAD. PAPP-A is a potentially relevant marker of the presence and extent of coronary atherosclerosis as its levels are elevated in CAD as compared to individuals without CAD

Variations in thyroid stimulating hormone levels in various non-thyroidal illnesses

To find out the pattern of variations in thyroid stimulating hormone [TSH] levels in hospitalized patients with major Non-Thyroidal Illnesses [NTIs] leading to stressful state. A cross-sectional study was carried out in the Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology [AFIP] and the Department of Pathology, Army Medical College Rawalpindi in collaboration with Department of Internal Medicine MH, Rawalpindi. Two hundred patients, were selected by convenience sampling, who were suffering from acute febrile illness, acute psychiatric illness, acute myocardial infarction and surgical trauma [50 each]. Fifty age and sex matched subjects without present or previous history of thyroid disorders were also included as controls to neutralise the confounding variables affecting TSH estimation. Serum TSH, triidothyronine [T[3] and free tetraidothyronine [fT[4] were measured during the course of these illnesses and after complete recovery. Serum TSH, T[3] and fT[4] were estimated in the laboratory by chemiluminescence method using auto-analysers lmmulite-2000 [DPC-USA] and LIA-Mat [Sangtech-Germany] at AFIP and Army Medical College, respectively. Tests related to the concurrent illnesses e.g. liver and renal function tests and cardiac enzymes were assayed by routine end-point and kinetic methods using commercial kits manufactured by M/S Linear Chemicals [Spain] on Selectra 2 Chemistry Auto-analyser. [Mecrk-Germany]. In patients of acute febrile illness there was no statistically significant difference in serum TSH levels in patients [mean: 2.03 mlU/L] and control group [mean 1.99 mlU/L] [P>0.05]. Serum TSH was significantly higher in patients of surgical trauma [mean 3.87 mlU/L [J/L] acute myocardial infarction [mean 5.55 mlU/L] and in patients with acute psychiatric illness [mean: 3.94 mlU/L] as compared to controls [P<0.05]. The transient abnormalities in serum TSH levels can mimic or at times mask the biochemical changes observed in patients with intrinsic thyroid disease, so realisation and recognition of these responses help in avoiding misdiagnosis

Zinc deficiency in patients with persistent viral warts

To determine the association of low serum zinc levels with persistent, progressive or recurrent viral warts. A comparative study. Dermatology outpatient department of Combined Military Hospital, Abbottabad in collaboration with Department of Chemical Pathology, Army Medical College, Rawalpindi, from June 2006 to May 2007. Seventy five patients having warts of more than six months duration, more than 10 in number, who either not responded to or had recurrence after previous treatments for viral warts and not having other chronic dermatological or systemic illness were included in the study after informed consent. Seventy five age and gender matched healthy individuals were taken as control. Serum zinc analysis was carried out by atomic absorption spectrometry using Perkin elmen [USA] apparatus. Independent sample t-test was used to compare mean zinc levels in microgram/litre with significance at p<0.05. Age of the patients as well as controls ranged from 12-65 years with a mean of 25.88 +/- 8.90 years. Serum zinc level was low in 42 [56%] patients and 24 [32%] controls [p=0.003]. Among the patients, serum zinc level ranged from 695-1090 micro-gram/litre with a mean of 804.38 +/- 100.60, whereas the level ranged from 690-1100 microgram/litre with a mean of 836.17 +/- 91.04 among controls [p 0.044]. Zinc deficiency is associated with persistent, progressive or recurrent viral warts in the studied patients. Randomized controlled trials with careful dose adjustment of oral zinc sulphate may be helpful to formulate guide lines to manage such patients

Iron, folate and cobalamin deficiency in anaemic pregnant females in tertiary care centre at Rawalpindi

Anaemia in pregnancy is a common clinical problem contributing to increased maternal and foetal morbidity. This study was carried out to determine frequency of iron, folate and cobalamin deficiency and associated risk factors in the anaemic pregnant females who reported first time during second and third trimester for antenatal check-up in the tertiary care hospital at Rawalpindi. This case control study was carried out in a tertiary care hospital at Rawalpindi. Two hundred and fifty pregnant women [age: 19-43 years] consisting of 125 anaemic [Hb< 110 g/L] and 125 non-anaemic who reported first time at antenatal clinic were included. Data on socio-demographic characteristics, parity and dietary intake were collected. Complete blood counts were done. Serum ferritin, folate and cobalamin assays were performed by using DPC kits on Immulite-1000. The pregnant women were categorised having mild [Hb up to 54%], moderate [Hb up to 36%], or severe [Hb up to10%] anaemia during antennal visit. They had significantly lower median [range] levels of haemoglobin 96 [40-110] g/L, ferritin 8 [3-142] micro g/L, folate 15 [3-54] ETA mol/L and cobalamin 171 [111-629] RHO moll than controls [p=<0.01]. Micronutrient analysis revealed secondary pregnancy related deficiency of Iron [57%], folate [20%], combined iron and folate [19%] and cobalamin [4%] in the female. Among the risk factors, low income [OR: 7.69], multiparty [OR: 2.93], lack of iron/folate supplementation [OR 2.91] and inadequate dietary intakes [OR 2.51] were associated with anaemia. The pregnant anaemic women had iron [57%]; folate [20%], followed by combined iron folate [19%], and cobalamin [4%] deficiency during first antenatal visit. Low income, multiparty, poor diet and lack of supplements are the main contributor in development of anaemia during pregnancy

Evaluation of cardiac risk by oxidative stress and inflammatory markers in diabetic patients

To evaluate the diabetic patients for cardiac risk by measuring oxidative stress and inflammatory markers in relation with glycaemic control. A total of 140 subjects were included in this case-control study, comprising of 70 diabetic patients with coronary heart disease [CHD] and an equal number, age and sex matched controls. The patients were non-alcoholic and had age >40years, BMI < 30 kg/m2 and glycated hemoglobin [HbA1c] 7-10%. Serum total cholesterol [TC] and gamma glutamyltransferase [GGT] were analyzed on selectra-E auto analyzer. Serum nitrate was measured at 540nm on ELISA. HbA1c on was analyzed by using Human kit. Serum high sensitivity C-reactive protein [hS-CRP] was analyzed on immulite 1000. Patients mean age was 51 [range 40-73] years. Diabetic patients had significantly elevated median of HbA1c [7.9 vs 4.9], hS CRP [6.0 vs 2.12], TC [5.95 vs 4.45], nitrate [19.20vs 10.70] and GGT [29.50 vs 22.50] as compared to controls [p< 0.001]. HbA1c showed a positive correlation [p <0.001] with hS-CRP [r=0.49], TC [r=0.69], nitrate [r=0.41] and GGT [r=0.30]. Oxidative stress and inflammatory markers should be used in addition to HbA1c for assessment of increased cardiac risk in un-controlled diabetic patients because of accelerated atherosclerosis due to free radical injury

Monitoring the biochemical effect of haemodialysis in the patients with end-stage renal disease using saliva as an alternative to serum

To compare the effect of haemodialysis on biochemical changes in saliva with changes in serum in patients with end- stage renal disease [ESRD]. This is a Quasi-experimental study, which was conducted in the Department of Pathology and Nephrology, Army Medical College, Rawalpindi, Pakistan from Sep 2008 to Dec 2008. Total thirty nine patients of ESRD consisting of 28 males and 11 females on maintenance haemodialysis were included by convenient sampling technique. Pre and post haemodialysis 3 ml blood samples and saliva were collected under sterile conditions. Biochemical analysis of urea, creatinine and uric acid were carried out on clinical chemistry autoanalyser Selectra E. Electrolytes were analyzed on ion selective electrode analyzer Easylyte. Serum and salivary nitrite were estimated by Griess reaction on ELISA reader. The results were analyzed on SPSS version 16.0. The patients' age ranged from 15 to 80 years. The causes of ESRD were hypertension 15 [38%], diabetes mellitus 7[18%], pyelonephritis 6[15%], glomerulonephritis 3[8%], nephrolithiasis 3[8%] miscellaneous 2[5%] and unknown 3[8%]. The post dialysis serum and saliva revealed a significant decrease in urea [35.48% vs 30.54%], creatinine [37.48% vs 29.65%], uric acid [44.33% vs 37.51%] and nitrites [67.47% vs 52.00%] [P<0.001]. The study demonstrated significant Pearson's correlation between serum and salivary [pre and post dialysis] urea [r=0.73;p<0.001; r=0.69;p<0.001], creatinine [r=0.83;p<0.001; r=0.72;p<0.001], uric acid [r=0.69;p<0.001; r=0.64;p<0.001] and nitrite [r=0.59;p<0.001; r=0.53;p<0.001] respectively. The study demonstrated significant parallel decrease in urea, creatinine, uric acid and nitrite in the post dialysis samples of serum and saliva. Saliva offers an alternative to serum as a biological fluid that can be analyzed in the laboratory for monitoring biochemical change in the patients of ESRD

Determination of chromium reference range in biological samples of adult males living in Sialkot

Chromium is among the heavy metals with varying concentration varies in different population depending on the environmental exposure and personal hygiene. The objective was to determine the reference value of chromium in the biological samples including blood, serum and urine of an adult healthy male population living in Sialkot. A total of 131 healthy male subjects aged 18-60 who are not working in the chromium related industry, were randomly recruited from Sialkot, Pakistan. Blood and urine samples were collected in metal free vacutainers and plastic urine containers respectively. Whole blood samples were pretreated by digestion in Multiwave 3000 microwave oven. Whole blood chromium [WBCr], serum chromium [SCr] and urine chromium [UCr] were analyzed on graphite furnace atomic absorption spectrophotometer [GFAAS] Perkin Elmer model 200. Total 131 males with mean age of 34.1+10.53 years participated in the study. Chromium levels in different biological fluids revealed non-Gaussian distribution. The subjects had median [2.5-97.5 percentile] of WBCr 318.45 [44.94 - 550.59], SCr 8.12 [3.1 - 26.17] nmol/L and UCr 1.16 [0.12 - 9.17] nmol/mmol of creatinine. The male [> 40 years] had lower chromium levels as compared to younger individuals. Positive correlation was observed between blood and serum[r =0.40, p= 0.001]; blood and urine levels[r =0.29, p= 0.001]. Chromium reference range in all the biological samples in adult male population of Sialkot is higher than reported in literatures for the western population but comparable to Asians. Senior citizens have lower chromium levels as compared to the younger. Positive correlation was observed among all biological fluids