ABSTRACT
The objective of the study was to evaluate and compare the role of total and free/total ratio of serum prostate specific antigen level in diagnosing carcinoma prostate. A cross sectional study was conducted at the Department of Biochemistry, Dhaka Medical College (DMC) with collaboration of the Department of Urology, Dhaka Medical College Hospital (DMCH), Dhaka from July 2008 to June 2009. This study was carried out on 60 patients above 50 years of age who attended the Department of Urology, Dhaka Medical College Hospital, complaining of irritative or obstructive lower urinary tract symptoms (LUTS) suspected as clinically benign prostatic hyperplasia (BPH) or cancer prostate. It was aimed to assess the role of total and free/total ratio of serum PSA in diagnosis of BPH and carcinoma prostate with reference to histological diagnosis. All the cases were evaluated by history, physical examination including digital rectal examination, serum prostate specific antigen level, transabdominal/ trans-rectal ultra- sonogram. From all patients, blood sample were collected before digital rectal examination or any per urethral manipulation. Final diagnosis was obtained by histo-pathological examination, specimen being obtained by perrectal biopsy with biopsy-gun. Histopathological examination detected prostate cancer in 20 out of 60 patient and 17 of these Cap 20 have a total PSA 4 ng/ml and only 3 have total PSA 4 ng/ml. 18 of these 20 have free to total ratio 0.16 and 02 have f/t ratio 0.16. Among 60 patients, 40 patients were detected BPH on histopathological diagnosis. 20 of these BPH patient have tPSA 4 ng/ml and 20 of BPH have tPSA 4 ng/ml. 38 of 40 BPH patient have f/t ratio>0.16 and 2 of 40 patient are f/t ratio 0.16. Receiver operating characteristic analysis indicated a threshold f/t ratio 0.16 was optimum discriminatory level. The sensitivity of total serum PSA (at cut off value of>4 ng/ml) in correctly differentiating prostatic carcinoma of those who have the condition is 85%, while the specificity of the test in correctly detecting those who do not have the disease is 50%. The PPV is 45.9%, NPV is 87% and accuracy is 61.7%. The sensitivity of free/total serum PSA (at cut off value of 0.16 ng/ml) in correctly differentiating prostatic carcinoma from BPH is 90%, while the specificity of the test in correctly detecting those who do not have prostatic carcinoma is 95%. The PPV of the test is 90% and the NPV of the test is 95%. The overall accuracy of the test is 93.3%. This study showed significant difference of total and free/total ratio of serum prostate specific antigen (PSA) in differentiating benign prostatic hyperplasia (BPH) from carcinoma prostate. Receiver operating characteristic curves showed advantage for the f/t PSA ratio when compared with total PSA in detecting prostate cancer. From the study it may be concluded that total and f/t ratio of prostate specific antigen (PSA) is a useful marker in diagnosis of carcinoma prostate. Free/total ratio is more accurate than total PSA.
ABSTRACT
Serum cystatin C is a new promising marker of renal function. The aim of this study was to analyze serum cystatin C as a better predictor of renal function in diabetic nephropathy. In 60 diagnosed diabetic patients, serum cystatin C and serum creatinine were assessed. Glomerular filtration rate was estimated based on the cystatin C concentration according to Cockcroft- Gault formula and based on serum creatinine concentration according to Larsson formula. DTPA-GFR (Diethylenetriamene pentaacetate Renogram) was done as reference standard. The cross tabulation of DTPA-GFR was done with eGFR- creatinine and eGFRcystatin C. The calculated sensitivity, specificity and accuracy of eGFR- creatinine were 85%, 87.2% and 85% respectively. The eGFR- cystatin C showed higher sensitivity, specificity and accuracy than eGFR- creatinine in studied diabetic subjects. The cystatin C showed more significant correlation, r=0.78, p<0.001 than serum creatinine, r=0.59, p<0.001 with DTPA-GFR in diabetic patients. This study demonstrates that serum cystatin C may be used for early prediction for renal function impairment in diabetic kidney disease.
ABSTRACT
Hypertension is one of the most important modifiable risk factors for ischemic stroke. Cigarette smoking is a risk factor for atherosclerotic disease. There is a strong relationship between hypertension and cigarette smoking with ischaemic stroke. A case control study was undertaken to see the association of hypertension and cigarette smoking with ischaemic stroke. The study was done from January to December 2009 in the Department of Biochemistry, Dhaka Medical College, Dhaka. A total of 60 subjects were selected as study population. Among them 30 were diagnosed case of ischaemic stroke and 30 were age-and sex-matched control subjects. It was found that 60% patients of case group and 20% respondents of control group were hypertensive and diffrence was significant. Study showed that 56.66% of cases and 53.33% of controls were smoker and the findings were insignificant. The mean duration of smoking was 27.41 ± 2.98 years in cases and 15.63 ± 2.85 years in controls which was significant. The study suggests that hypertension is significantly associated with ischaemic stroke and longer duration of smoking also associated with ischaemic stroke.
ABSTRACT
This prospective study on assessment of renal insufficiency in pregnancy induced proteinuric hypertension was carried out on 104 cases, in Bangabandhu Sheikh Mujib Medical University (former IPGM&R), Dhaka during period of August 1997 to September 1998. The objective of this study, to find out the impairment of renal function in mild (<110 mmHg) and severe (>110 mmHg) hypertension. The frequency of mild hypertension was 96.29% and severe hypertension was 3.71% in third trimester of pregnancy. In this study mean age of the patient was 26.53+/-3.9 years, mean gestional age was 36.46+/-1.93 weeks and mean diastolic BP was 99.07 mmHg. The prevalence of hypertension was more in primigravida which was (72.23%) than multigravida (27.77%). Proteinuria was diagnosed as quantitative measurement of 24 hour urinary protein in photometric colorometer. The mean value of total urinary protein was 335+/-74.14 mg/24 hour (range 280-800 mg/24) hour). 1+Oedema was present in 48.14%, 2+ was 12.96% and 3+ was 14.81% of cases. There is a correlation of proteinuric hypertension with renal function which was done on the basis of laboratory investigations. Findings of parameters of renal function found to declined: Serum creatinine mean value 1.0+/-0.14 (P<0.001) (normal range 0.6-0.8 mg/dl.), Urinary creatinine mean 57.69+/-12 mg/dl., Creatinine clearance mean 53.72+/-11.63 ml/min, Total urinary protein mean 335.52+/-74.14 mg/24 hour. Total urinary volume mean 2985+/-49 ml/24 hr. All the patients and their babies were followed up till discharge from hospital. Cesarean section was done in 76% of cases and vaginal delivery was done in 24% cases. Mean hospital stay was prolonged in proteinuric hypertension 7+/-1 days than non proteinuric normotensive goup 3+/-1 days. All of those were average socio-economic status. Extreme low birth weight was 14.81% in 50% of IUGR cases.