ABSTRACT
Objective: To determine the diagnostic accuracy and cut-off values of serum cystatin C as early diagnostic biomarker of diabetic kidney disease. Study Design: Cross-sectional analytical study. Place and Duration of Study: Department of Pathology, Army Medical College, Rawalpindi in collaboration with Endocrinology Department, Military Hospital [MH], Rawalpindi from November 2015 to November 2016
Methodology: One hundred and nineteen diagnosed patients of type 2 diabetes mellitus were enrolled in the study from the outpatient Endocrinology Department of the MH Rawalpindi. Fifty disease-free controls were also included. Fasting blood samples of the patients and controls were analysed for creatinine by Jaffé's kinetic method and estimated GFR was calculated using MDRD-based equation for GFR. Serum cystatin C was estimated by quantitative turbidimetric method
Results: Serum cystatin C was higher in the diabetic group [mean = 1.022 +/-0.33 mg/dl] as compared to the control group [mean = 0.63 +/-0.14 mg/dl]. ROC curve analysis, keeping less than 60 ml/min/1.73 m2 GFR [CKD-MDRD based] as reference value of the stat variable/gold standard; revealed an area under the curve of 0.914 [95% CI 0.85-0.98] and at optimal sensitivity of 88.2% and specificity of 84.8% the established cut-off of serum cystatin C was 1.26 mg/L
Conclusion: Cystatin C is an accurate biomarker of diabetic kidney disease with good sensitivity and specificity
ABSTRACT
Objective: To evaluate the analytical and diagnostic challenges in interpreting the various organic acid results by gas-chromatography-mass spectrometry and to devise a protocol for analysis that is beneficial for prompt interpretation and diagnosis
Study Design: Retrospective study
Place and Duration of Study: Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi, from Apr 2015 to May 2017
Material and Methods: We reviewed clinical data, biochemical investigations and urine organic acid profiles of 110 patients received for evaluation of a suspected organic acid disorder. Urine organic acid analysis was carried out by gas chromatography - mass spectrometry using Mass Hunter software
Results: A total of 104 [99 percent] cases received were from the pediatric patients and 7 [6.3 percent] from adult patients. A total of 11 different organic acidurias were diagnosed. Other diseases [n=10] were also detected on the basis of their pathognomics metabolites and included tyrosinemia type 1 [n=4], alkaptonuria [n=5] and ornithine transcarbamoylase deficiency [n=1]. Twenty eight [25 percent] urine samples were either recalled or repeated for reasons like random urine sample yielding negative profiles in setting of a strong suspicion for organic aciduria [n=6], non-availability of clinical data [n=12] or delay in transportation >8 hours [n=10]. Raised non-specific organic acid metabolites were seen in 23 [21 percent] cases. Lactic acid and ketones were detectable in 12 [11 percent] samples in the absence of raised plasma levels
Conclusion: Urine OA profiles must be interpreted in context of complete clinical, nutritional and biochemical findings. Each laboratory equipped with this facility should devise their analytical protocols for meaningful interpretation of results
ABSTRACT
Objective: To determine the association of metabolic syndrome with atypical antipsychotic drug [olanzapine] short term versus long term use
Study Design: Case control study
Place and Duration of Study: Chemical pathology department Army Medical College Rawalpindi, from Nov 2014 to Oct 2015
Material and Methods: The study was carried out on 240 subjects, 120 cases and 120 controls. For the purpose of the study cases were divided into four groups A, B, C and D according to the duration of drug use. Group A patients included those who the last the drug olanzapine for the last three months. Group B patients included those who were using the drug olanzapine for the last six months. Group C and D included those who were using the drug for last 1 year and more than one year [2-5 years] respectively. By employing non probability convenience sampling technique the data was collected from patients having the diagnosis of psychosis as per DSM IV modified criteria through a proforma and fasting blood samples were drawn. These samples were tested for fasting serum lipid profile and fasting plasma glucose. The data obtained were analyzed using SPSS version 21. For quantitative data Mean and SD were calculated. For qualitative data frequency and percentages were calculated. Qualitative data was compared using chi square test whereas quantitative data was compared using independent sample t-test
Results: There was statistically no significant difference in fasting plasma glucose between group A and B and their controls whereas in group C and D these levels were significantly high as compared to controls. Triglyceride levels were significantly higher and HDL cholesterol levels were significantly lower in all four groups as compared to controls. Comparison of qualitative data which included waist circumference and blood pressure showed statistically no significant rise for group A whereas waist circumference showed insignificant rise and blood pressure showed statistically significant rise for group B. On the other hand both waist circumference and blood pressure were significantly higher for group C and D as compared to controls. Overall study revealed a graded increase in components of metabolic syndrome with duration of olanzapine use. Out of thirty patients in each group two patients in group A, 5 in group B, 7 in group C and 10 patients in group D developed metabolic syndrome as per NCEP ATP III modified criteria
Conclusion: Development of metabolic syndrome is strongly associated with long term use of atypical antipsychotic drug olanzapine
ABSTRACT
Objective: To compare e-GFR estimated by creatinine or cystatin C based and combined creatinine and cystatin C based equations in type 2 diabetics in different stages of albuminuria. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Chemical Pathology, Army Medical College Rawalpindi in collaboration with endocrinology outpatient department Military Hospital Rawalpindi, from Nov 2015 to Nov 2016
Material and Methods: A total of 119 type 2 diabetic subjects of either gender, aged 30- 60 years were enrolled in the study with duration of diabetes less than 15 years and were divided into further sub groups on the basis of degree of albuminuria determined by spot urine albumin to creatinine ratio [uACR]. Fifty age matched disease free controls with no history of any systemic disease were also included in the study. Known patients of type 1 diabetes, chronic inflammatory disorders, uncontrolled hypertension, thyroid disease, chronic kidney disease, on lipid lowering drugs, steroids, ACE inhibitors and pregnant ladies were excluded from the study. Serum creatinine serum cystatin C were assessed on fully automated chemistry analyzer selectra. E-GFR was calculated by online GFR calculator by National Kidney Foundation. Comparison of means of e-GFR calculated by various equations was carried out by one way ANOVA and post-hoc Tukey tests. Degree of agreement between various equations for the estimation of GFR was assessed by kappa statistics. A p-value less than 0.05 were considered statistically significant
Results: Mean e-GFR [ml/min/1.73m[2]] was lowest in cystatin C based CKD-EPI equation [89.56 +/- 39.84] followed by combined cystatin C and creatinine based CKD-EPI [92.34 +/- 37.88]. Values of e-GFR by creatinine based CKD-EPI equation [95.84 +/- 27.24], and by creatinine based MDRD equation [105.37 +/- 64.98] were both higher. In creatinine based MDRD, equation normo albuminuria and micro albuminuria groups did not show statistically significant difference as compared to each other and control group. The mean value of e-GFR was found to be lowest in the normo albuminuric diabetics when estimated by cystatin C based CKD-EPI equation [88.82 +/- 46.98] followed by combined creatinine and cystatin C based CKD-EPI equation [95.73 +/- 42.96]
Conclusion: Cystatin C based CKD-EPI equation for e-GFR identifies more patients with glomerular dysfunction in normo-albuminuric stage of DKD as compared to cystatin C and creatinine based CKD-EPI and creatinine based MDRD equations. Therefore, e-GFR estimated by serum cystatin C based CKD-EPI formula is a better option for assessing the renal status in patients of early DKD
ABSTRACT
Aim of the study was to determine the incidence of dental caries in one grade children and to convey them the importance of oral hygiene. Development of proper brushing habit is beneficial for children at this stage Dental status of one grade children in a semi government school was evaluated with proforma. Details regarding carious missing and filled teeth were recorded after their dental checkup. The. risk of caries development in male and female students was evaluated. Frequency of low and high DMFT was also analysed. High incidence of unfilled carious teeth was observed in Class one children. The mean DMFT value was moderate and risk of caries was found slightly more in males. Community awareness programs at school, especially targeting one grade students can affect the oral health of our children in a positive manner. Following proper hygiene instructions and regular dental visits can promote their oral health
Subject(s)
Humans , Male , Female , Child , Prevalence , Cross-Sectional Studies , Risk , Students , Child , Oral Health , Oral HygieneABSTRACT
To compare serum concentration of Total Cholesterol, Triglyceride, LDL-cholesterol, HDL-cholesterol and lipoprotein [a] between post menopausal women on HRT and without HRT. Comparative, cross-sectional study. Place and Duration of Study: The study was conducted in the department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi from 2006 to 2007. Materials and Postmenopausal women with no co-morbidities and on any type of HRT for at least one year were selected as cases and healthy postmenopausal women not taking any type of HRT were taken as controls. All these cases were selected randomly. After clinical history and physical examination, blood sampling was carried out for lipid profile including Lp[a] in fasting state. A total of 50 postmenopausal women on HRT and their age matched healthy controls [postmenopausal women without HRT] were studied. The mean age of HRT treated group was 56.7 +/- 5.0 [mean +/- SD] years. The mean age of menopause of study group was 50.4 +/- 1.6 years and the mean years since menopause were 8.4 +/- 4.6 years. There was no statistically significant difference in age, age at menopause and years since menopause between study and control groups. The frequencies for the type of HRT were calculated. Thirty two of the women were using combination therapy i.e.; estrogen plus progesterone while 18 of them were using estrogen therapy alone. None of them were using other types of HRT like SERMs or tibolone. The mean values of TC, LDL-C and Lp [a] were lower than the control group. The mean value of HDL-C and TG was higher in study group as compared to control group. On comparative analysis of the lipid profile of the two groups employing unpaired t-test, statistically significant difference was observed in the levels of LDL-C, HDL-C and Lp[a]. However TC and TG levels were not significantly different in women belonging to either group. Conclusions: HRT has beneficial effects on lipoprotein levels in postmenopausal women