Reference Interval of Serum Gastrin 17 (G-17) for Healthy Population: A Non-Invasive Screening Biomarker for Gastric Disorders.

OBJECTIVE: To analyse fasting serum concentrations of G-17 in healthy individuals to establish the reference intervals (RIs) in the Pakistani population. STUDY DESIGN: Cross-sectional, observational study. Place and Duration of the Study: Department of Clinical Chemistry and Immunology, Chughtai Institute of Pathology, Lahore, Pakistan, from October to December 2022. METHODOLOGY: Fasting serum samples from one hundred and twenty healthy individuals between the age of 18-65 years were collected according to the CLSI recommendations after taking written informed consent. Samples were analysed on the auto-analyser for the quantitative measurement of serum G-17 by sandwich chemiluminescence immunoassay. Kolmogorov-Smirnov test was applied to check normality. A p-value of <0.05 was considered significant; 2.5th and 97.5th percentiles were computed using the formula 0.025 (n+1) and 0.0975 (n+1), respectively. RESULTS: Of the 120 samples, 74 were obtained from male patients and 46 from females. The mean age was 30.2 ±10.36 years. The histogram revealed a non-parametric distribution of the data. The established reference intervals by the rank-based method were 2.31 pg/mL and 49.36 pg/mL which corresponds to 2.5th and 97.5th percentiles, respectively. These were markedly different from the Chinese reference ranges. CONCLUSION: Ethnic and geographic variations affect the trends of RIs of Serum G-17. There is a need to establish its population-specific RIs for G-17, so it can be used as a non-invasive option in identifying patients requiring invasive endoscopic intervention. KEY WORDS: Gastrin, Atrophic Gastritis, Biomarker, Reference values.

Reference Interval of Soluble FMS­like Tyrosine Kinase­1 in Non-Pregnant and Pregnant Females: A Novel Biomarker for Pre-eclampsia.

OBJECTIVE: To determine the reference interval of soluble FMS-like tyrosine kinase-1 (sFIt-1) in healthy, non-pregnant and pregnant females. STUDY DESIGN: Observational study. Place and Duration of the Study: Department of Chemical Pathology, Chughtai Institute of Pathology, Lahore, from January to May 2023. METHODOLOGY: Blood samples were collected from 120 disease-free non-pregnant females of reproductive age group and 120 disease-free pregnant females with singleton fetuses from 15 to 28 weeks of gestational age. Healthy reference individuals were selected by correlating history with medical disorders like diabetes mellitus, hypertension, autoimmune diseases, inherited disorders, and by excluding any other drug history. All findings were recorded on health screening questionnaire. Levels of sFlt-1 were measured by a fully automated immunoassay analyser Cobas e601. Kolmogorov-Smirnov test was applied. The value of p <0.05 was considered significant. The 2.5th and 97.5th percentiles were computed at 90% CI by using the formula 0.025x (n+1) and 0.975x (n+1) which corresponded to rank number 1 and 7, respectively. The reference interval was calculated by the Rank-based method. RESULTS: Reference interval of sFlt-1 in non-pregnant and pregnant females were determined on the basis of 2.5th and 97.5th percentiles which were 57.7 to 118.5 pg/mL and 563.5 to 3288.0 pg/mL, respectively. CONCLUSION: The present study determined reference interval of sFlt-1 in healthy, non-pregnant and pregnant females in Lahore. KEY WORDS: Reference interval, Soluble FMS-like tyrosine kinase-1, Pre-eclampsia, Rank-based method.

An Overview of Complete Blood Count Sample Rejection Rates in a Clinical Hematology Laboratory Due to Various Preanalytical Errors.

Introduction The Chughtai Laboratory collects blood samples for complete blood counts from various hospitals, emergency departments, ICUs, and through home sampling services all across the country. The preanalytical phase is an integral component of laboratory medicine. A laboratory report has a key role in patient treatment and the clinician's decision in the management of the disease. Preanalytical errors are most frequently caused by the absence of a sample and/or inappropriate understanding of a test request, mislabeling, contamination from the sampling site, hemolyzed, clotted, insufficient samples, storage issues, and inappropriate blood to anticoagulant proportion or inappropriate choice of anticoagulant. Objective To identify the cause of rejection rates of the complete blood count samples and reduce the rejection rates by improving the accuracy of the results and lowering pre-analytical errors. Methods This cross-sectional study was done in the Hematology Department of Chughtai Laboratory's head office in Lahore between 19-06-2021 and 19-10-2021. Simple random sampling was applied to collect the data. About 3 ml of each blood sample was received in an ethylenediaminetetraacetic acid (EDTA) vial, inspected visually, run on Sysmex XN-9000 (Sysmex Corporation, Kobe, Hyogo, Japan), and was reviewed on peripheral smears. Results Out of 231,008 blood samples, 11,897 (5.15%) samples were rejected. The most common pre-analytical mistake was storage issues due to transportation delay (19.45%) followed by wrong medical records (19.16%), diluted samples (16.35%), incorrect tubes (16.01%), hemolyzed samples (15.13%), unlabeled samples (10.01%), and clotted sample (3.88%). Conclusion In the hematology department, the total rejection rate observed during the study period was 5.15%. Recognition of preanalytical errors and avoiding them will help us lower the sample rejection rate and raise the overall quality of laboratory management.

Granular Cell Astrocytoma.

Granular cell astrocytoma (GCA) is a rare glial neoplasm composed of abundant granular cytoplasm gives immunoreactivity for GFAP and S100 stains. We report a case of GCA in a 64 years old male presented with history of fits, right sided weakness and loss of consciousness. The microscopy showed sheets of large cells with abundant eosinophilic granular cytoplasm. No high-grade features were seen. Its differential diagnosis includes most of the benign histiocytic conditions. Granular cell astrocytoma has an aggressive clinical course and its survival rate is less than 1 year. That's why early correct diagnosis is very essential.

Seroprevalence of COVID-19 IgG antibodies among healthcare workers of Pakistan: a cross-sectional study assessing exposure to COVID-19 and identification of high-risk subgroups.

OBJECTIVE: In this study, we aimed to find the seroprevalence of healthcare workers (HCWs) of Pakistan involved in the treatment and care of patients with COVID-19. SETTING: This was a cross-sectional study and total of 15 000 HCWs involved in providing services and care to the patients with COVID-19 were randomly selected from all over Pakistan. PARTICIPANTS: Informed consent was taken from all participants and were included according to inclusion and exclusion criteria. All testing was done on serum samples for the qualitative detection of SARS-CoV-2 IgG antibodies using Abbott Chemiluminescent microparticle immunoassay. An index of 1.4 was used as a cut-off to mark reactive and non-reactive cases. SPSS V.23.0 was used for data analysis. OUTCOME: Immune status of the study population depicting seroprevalence among HCWs. RESULTS: Out of all the candidates, majority of the HCWs were men (61.9%) and were doctors (62.4%). The mean age of participants was 32.8 years (SD 8.7) and majority were asymptomatic (51.8%). In this study, 33% of the HCWs were reactive for SARS-CoV-2 IgG antibody. Around 44% of the reactive cases were asymptomatic. The symptoms more significantly associated with seropositivity were: fever (OR 1.31; 95% CI 1.16 to 1.48), headache (OR 2.43; 95% CI 2.16 to 2.73), cough and shortness of breath (OR 2.10; 95% CI 1.91 to 2.31), loss of sense of smell or taste (OR 3.70; 95% CI 3.29 to 4.17) (p<0.001). Factors which showed significant association with the presence of antibodies were professional category (absolute risk (AR) 0.09; OR 1.46; 95% CI 1.36 to 1.56), availability of protective masks (AR 0.02; OR 0.90; 95% CI 0.84 to 0.96), safety goggles (AR 0.02; OR 0.90; 95% CI 0.84 to 0.97) and living arrangements (AR 0.03; OR 1.12; 95% CI 1.04 to 1.20) (p<0.05). CONCLUSION: Our study showed a high seropositivity of HCWs dealing with patients with COVID-19 in Pakistan revealing significant association with professional category, nature of work place and precautions taken while performing duties.

Frequency of COVID-19 IgG Antibodies among Special Police Squad Lahore, Pakistan.

OBJECTIVE: To find out the sero-prevalence of COVID-19 IgG antibodies among policemen performing duties at high risk areas of Lahore, Pakistan. STUDY DESIGN: Cross-sectional, observational study. PLACE AND DURATION OF STUDY: Chughtai Lab Lahore from 20th to 30th May 2020. METHODOLOGY: One hundred and fifty-four young policemen (mean age 27.1 ±3.8 years) were included in the study after written consent. Squad officers who had any sign of acute respiratory infection were excluded from the study. The participants were asked to fill a questionnaire regarding nature of exposure with the infected cases, kind of personal protective equipment they are provided with and living arrangements. Three ml of blood samples were collected from the participants and immediately sent to the lab for analysis. COVID-19 IgG antibodies were analysed using chemiluminescence immunoassay method on Architect Ci8200 (Abbott). SPSS 23.0 was used for data analysis. RESULTS: All participants were males and mean age was 27.1 ±3.8 years. Out of 154 squad members, 24 were reactive for COVID-19 IgG antibodies and performing duties at the areas of high virus exposure. None of COVID-19 IgG reactive cases exhibited symptoms and most of them performed duties at high risk areas with only masks provided as personal protective equipment. Only 10% of the participants who were exposed to confirmed cases of COVID-19 were found to have anti-COVID IgG. CONCLUSION: COVID-19 IgG antibody reactive cases may not show any symptoms. Police force is at high risk of exposure. Serosurveys can help to find the spread of infection in the community and aid in planning healthcare strategies. Key Words: COVID-19, SARS CoV-2, Seroprevalence, Pandemic, Asymptomatic cases.