Impact of Age, Gender, post infection and post vaccination status on antibody response in COVID 19 patients.

OBJECTIVE: To evaluate severe acute respiratory syndrome coronavirus-2 spike protein antibodies against coronavirus disease-2019 in post-infection and post-vaccinated individuals. METHODS: The cross-sectional study was conducted from June, 1 to July 31, 2021 at the Rehman Medical Institute, Peshawar, Pakistan, and comprised subjects of either gender in whom immunogenicity was checked 35 days post-vaccination and 90 days post-infection. Correlation with age and gender was checked. Specimens were collected and investigated for severe acute respiratory syndrome coronavirus-2 spike protein antibodies by consuming electro-chemiluminescence immunoassay. Data was analysed using SPSS 23. RESULTS: Of the total 256 patients enrolled, 70(27.34%) were included; 49(69%) males and 21(29.6%) females. The overall mean age was 44±7.75 years. Among 30(42.8%) patients with positive polymerase chain reaction test, the mean time between the positive test and antibody screening was 90±30 days. Among the 40(57.2%) vaccinated individuals, the time between vaccination and antibody screening was 35±9.74 days. Overall, 68(97%) patients revealed robust positive findings to severe acute respiratory syndrome coronavirus-2 spike proteins antibodies >50IU/mL. Male subjects had significantly higher immunogenic response compared to females (p=0.001), and immunogenicity decreased with advancing age (p<0.001). Also, post-vaccinated patients' antibody response was significant compared to post-infection patients' response (p=0.001). Conclusion: Majority of the patients had significantly higher antibody titers against severe acute respiratory syndrome coronavirus-2 post-infection and post-vaccination. Males and younger individuals developed a significant humoral immunity compared to females and the elderly.

B-type natriuretic peptide as diagnostic and prognostic marker in various forms of acute coronary syndrome.

Objectives: This study was conducted to evaluate the diagnostic and prognostic value of B-type natriuretic peptide (BNP) in different categories of acute coronary syndrome (ACS) patients on arrival. Methods: This cohort study included 197 patients admitted in Coronary Care Unit (CCU) of Rehman Medical Institute (RMI) Peshawar from January 2020 to June 2020. Patients were categorized in two subgroups. Subgroup-I with BNP below 100pg/mL. Subgroup-II having BNP above 100pg/mL. Samples were obtained on admission from these patients for Cardiac Troponin I (Trop-i), BNP and serum creatinine. BNP samples were analyzed on Cobas® using chemiluminescence method. Descriptive statistics were derived for age; gender and cardiac biomarkers. Receiver-operating characteristic curves (ROC) were generated. Diagnostic accuracy parameters were determined for Non ST- segment elevation myocardial infarction (STEMI), ST- segment elevation myocardial infarction (STEMI) and unstable angina (UA). Result: One hundred fourteen patients (58.2%) were males and 82 were females (41.8%).Our of this 89 patients were NSTEMI in group II. Mean BNP was 1438±1463.Age distribution shows 120 individuals were over 55 years (61.2%). Hypertension, diabetes, smoking and previous infarcts were the risk factors for ACS. Sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive value (NPV), likelihood ratios, and overall accuracy of BNP at admission for the entire sub categories in ACS (cut-off value 100 pg/mL) were determined by using Trop-i the gold standard. ROC curve showed AUC = 0.557, (95% confidence interval: 0.476-0.638). When Pearson correlation was applied, BNP was found to be a noteworthy independent predictor. Conclusion: BNP can be a useful Biomarker along with standard cardiac biomarkers in various categories of patients with ACS.

Comparison of SARS-CoV-2 antigen electrochemiluminescence immunoassay to RT-PCR assay for laboratory diagnosis of COVID-19 in Peshawar.

OBJECTIVES: Antigen based rapid diagnostic tests possesses a potential to be utilized along with Gold standard methods to detect Covid-19 infection to cope with the demand of testing. The aim of this study was to determine diagnostic accuracy of electrochemiluminescence based automated antigen detection immunoassay comparing with molecular based test RT-PCR (Covid-19). METHODS: It was a cross-sectional study conducted in RMI Peshawar, from 1st April 2021 till 30th April 2021. The study comprised 170 individuals who were suspected of having Covid-19. Nasopharyngeal samples taken from suspected individuals were analyzed by RT-PCR and automated antigen test (Elecsys SARS-CoV-2 Antigen) simultaneously. The correlation of SARS-CoV-2 antigen with PCR positive and negative cases was analyzed for specificity, sensitivity respectively. RESULTS: The ECLIA based Elecsys antigen test (Roche) revealed overall sensitivity 72%, specificity 95% and accuracy of 94.9%. Sensitivity of antigen test progressively declined from 94.3% in Ct <25 to 70.8% in Ct 26-29 and then to 47.2% in Ct 30-35. CONCLUSIONS: Based on the findings of our study we conclude that automated antigen testing (Elecsys SARS-CoV-2 Antigen) cannot replace molecular based testing like RT PCR. Elecsys SARS-CoV-2 Ag test should be used complementary to RT-PCR in testing algorithms. Frequent testing strategy should be adopted while using automated antigen testing to overcome its limitation in individuals with low viral loads.

Hyperhomocysteinemia as a risk factor for ischemic heart disease.

OBJECTIVE: To determine association of hyperhomocysteinemia with myocardial infarction and conventional risk factors for ischemic heart disease. DESIGN: A non-interventional comparative case control study. PLACE AND DURATION OF STUDY: The study was conducted at the department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi and Armed Forces Institute of Cardiology / National Institute of Heart Diseases, Rawalpindi from January 2001 to June 2001. PATIENTS AND METHODS: A total of 100 hospitalized patients having myocardial infarction (MI) were randomly selected comprising 85 males and 15 females. The average age of the patients was 53 +/-4.5 years. A similar number of age and gender-matched healthy controls were also selected. The demographic details, history and clinical examination of both patients and controls were recorded and their blood was collected in fasting state for estimation of serum total cholesterol, plasma glucose and serum total homocysteine. RESULTS: Serum total homocysteine level in controls was significantly lower (10.8 +/- 4.1 micromol/L) as compared to patients (18.0 +/- 5.9 micromol/L) (p < 0.0001). Smoking showed statistically significant association with hyperhomocysteinemic patients (p = 0.04). CONCLUSION: Ischemic heart disease was associated with moderate hyperhomocysteinemia in our patients and it was also associated with smoking.