ABSTRACT
Objective: To determine the frequency of Macroprolactin [MaPRL] in patients with increased total prolactin and its clinical and financial impact
Study design: Cross-sectional study
Place and duration of study: Section of Clinical Chemistry, Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Karachi, from March to May 2015
Methodology: Patients with high total prolactin were screened by polyethylene glycol [PEG] precipitation for determination of MaPRL. Clinical history, imaging work-ups, and cost incurred in further investigations were collected by telephonic interview after verbal consent. Patients were stratified into true hyperprolactinemia and macroprolactinemia after PEG treatment, based on monomeric prolactin levels. Medical records of cases registered with AKUH were reviewed to confirm the diagnosis
Results: Two hundred and thirty-nine patients were identified with high prolactin levels. Macroprolactinemia was identified in 145 [60.7%] and true hyperprolactinemia in 94 [39.3%] patients. Galactorrhea was significantly more in true hyperprolactinemic females [p=0.022], followed by visual disturbances [p=0.01] and headache [p=0.006]. Moreover, as majority of population were females, the clinical features in the macroprolactinemia group as compared to true hyperprolactinemic group were mostly related to non-pituitary causes like drug intake [42.5% [54] vs. 37% [30]], heat intolerance due to thyroidal illness [41.7% [53] vs. 38.3% [31]] and surgery [26.8% [34] vs 22.2% [18]] in females. Further radiological workup [MRI, CT] were conducted in 35 [37.2%] patients with true hyperprolactinemia. Twenty-one [60%] of the patients were confirmed to have pituitary adenomas. In eight [5.5%] patients with MaPRL, only one had pituitary microadenoma on radiological workup. Total cost impact on the basis of investigations, was significantly higher in the group undergone imaging, despite 7 out of 8 individuals found to have normal imaging results. The median total cost in true hyperprolactinemic group undergone imaging was Rs. 4370 [IQR=2412.5, 22850] as compared to macroprolactinemic groups; Rs. 3,250 [IQR=2150, 4278]. There was significant difference in the cost burden of both the groups [p <0.001]
Conclusion: High frequency of MaPRL was identified in patients with hyperprolactinemia. Screening with PEG precipitation in hyperprolactinemic sera is simple and cost-effective
ABSTRACT
Objectives: To determine median HbA1c level in patients screened for DM and compare the diagnostic accuracy of HbA1c with the currently recommended ADA cut off, using 2 hours [h] plasma glucose [2-h PG] post 75 grams oral glucose tolerance test [OGTT] as gold standard
Study Design: Cross sectional study
Place and Duration of Study: Aga Khan University Hospital Karachi, from Jul 2014 to Nov 2015
Patients and Methods: Consecutive subjects screened by OGTT for diabetes mellitus [DM] were included. Blood sample for plasma glucose and HbA1c were analyzed on ADVIA 1800
Results: Total 146 subjects were included with median age 45 [IQR 54.2-35] years; 53 percent [n=77] being females. Median HbA1c of the study subjects was 6 percent [IQR 6.6-5.6]. Positive correlation was observed between age and HbA1c [5.7 percent [IQR 6.2-5.3] <40 y, 6.2 percent [IQR 6.8-5.8] in >40 y subjects; r 0.34, p=0.000]. Males had higher HbA1c than females [6.1 percent [IQR 6.8-5.7] years. 5.9 percent [IQR 6.4-5.4]; r 0.17, p=0.036]. HbA1c levels were significantly different amongst the different ethnic groups residing in Pakistan [p-value<0.03]. HbA1c was positively correlated with FPG [r=0.59, p-value<0.001] and 2-h PG [r=0.56, p-value<0.001]. Sensitivity, specificity, PPV, NPV for HbA1c at cutoff of 6.5 percent in diagnosing diabetes mellitus [DM] were 70 percent, 89 percent, 72 percent and 80 percent respectively
Conclusion: High median HbA1c levels is noted in our subjects. At cut off level of HbA1c >/=6.5 percent, 70 percent of subjects with DM were diagnosed using ADA criteria of 2-h PG for diabetes as gold standard. Ethnic differences were also observed in levels of HbA1c. There is a need to define cut off for our population
ABSTRACT
Objective: To determine the clinical characteristics of Budd-Chiari syndrome [BCS], its causes and outcome at a tertiary care hospital
Study Design: An observational study
Place and Duration of Study: The Aga Khan University Hospital, Karachi, from 2004 to 2014
Methodology: A retrospective analysis of data was conducted. A predesigned questionnaire was filled from medical records of patients with BCS. Clinical features, etiology, management and outcome was noted from 2004 to 2014. Descriptive statistics were determined
Results: Forty-five patients' charts were reviewed; 26 [57.8%] were male patients. The median [IQR] age at diagnosis was 26.0 [20.5 to 34.5] years. Primary BCS was seen in 27 [60.0%] patients. The most frequent clinical features included ascites [82.2%], abdominal pain [55.6%], and hepatomegaly [31.1%]. A combined hepatic vein/inferior vena cava block was found in 25 [55.6%] patients. Out of the 28 tested patients protein C and protein S deficiencies were detected in 22 [78.6%] and 17 [60.7%] patients, respectively. Antithrombin III deficiency was detected in 14 [58.3%] of those tested patients. Anticoagulants were used in 24 [53.3%] patients. TIPS was done in 11 [24.4%] patients. Mortality was 6.7% [n=3]
Conclusion: Congenital thrombophilia was a major causal factor. Age, clinical features, biochemistry and management are important factors in survival
ABSTRACT
Objective: To evaluate the frequency of subclinical lead toxicity
Study Design: Cross-sectional study
Place and Duration of Study: Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Karachi, from January 2011 to December 2014
Methodology: Analysis of laboratory data for blood lead levels [BLL] was performed. Lead was tested by atomic absorption spectrometer. For all subjects, only initial test results were included while the results of repeated testing were excluded. Exemption was sought from institutional ethical review committee. BLL of 2-10 ug/dl and 10-70 ug/dl in children and adults, respectively were taken as subclinical lead toxicity
Results: Amongst the total number of subjects tested [n=524], 26.5% [n=139] were children [<16 years] while rest were adults. Overall median BLLs was 6.4 ug/dl [20.9-3.1]. The median BLL was 4 ug/dl [6.7-2.6] in children and 8.3 ug/dl [27.9-3.4] in adults, respectively. The BLL increased with age; higher levels were observed in age range 21-30 years of subjects [median lead level 16.9 ug/dl [36.1-4]] and lower level [4.2 ug/dl [6.8-2.6]] in children with <10 years of age. Only 16% [n=22] children had desirable lead levels while most had either subclinical [76%, n=106] or toxic lead levels [8%, n=11]. In adults, [55%, n=212] subjects had desired lead levels, and 40% [n=154] and 4.99% [n=19] had subclinical and toxic lead levels
Conclusion: Presence of subclinical lead poisoning even after phasing out of lead petroleum in Pakistanis is alarming, especially in children. A national population-based study to determine the lead status and targeted intervention to identify potential sources is need of the time
ABSTRACT
Objective: To evaluate the results of 24-hour urinary creatinine clearance [CrCl] with estimated glomerular filtration rate [eGFR] using the Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI], CKD-EPI Pakistan [CKD-EPI Pak], Cockcroft Gault [CG] and 4-variable Modification of Diet in Renal Disease [MDRD] equations
Study Design: Descriptive, cross-sectional study
Place and Duration of Study: Section of Clinical Chemistry, Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, from June to October 2013
Methodology: Laboratory data of subjects ³18 years ordering 24-hour urinary CrCl from June to October 2013 was retrieved. Statistical comparison of eGFR using CKD-EPI, CKD-EPI Pak, CG and MDRD with the timed urine collection CrCl was done using regression analysis
Results: The mean age of the group [n=670] was 51.3 +/-15.4 years with a median of 53 [IQR:22.3] years, 55.7% being males. Median BMI of males and females was 26.98 kg/m[2] [IQR: 7.09] and 26.16 kg/m[2] [IQR: 6.97], respectively. Mean GFR using 24-hour creatinine clearance was 57.1 +/-35.9 ml/min/1.73m[2] with a median of 51 ml/min/1.73m[2]. Urinary creatinine clearance showed strong correlation with CG, MDRD, CKD-EPI and CKD-EPI Pak, showing r=0.78, r=0.79, r=0.82, and r=0.82, respectively. Sensitivity was highest for the CKD-EPI Pakistan [84.7%]. Similarly, CKD-EPI Pakistan equation showed the highest agreement [88.7%] with CrCl compared to the other formulae
Conclusion: The CKD-EPI Pak equation is more accurate and precise than the CG, CKD-EPI and MDRD in estimating GFR in Pakistani population