Comparison of role of serum- ascites albumin gradient and ascitic fluid total protein in liver cirrhosis patients

To compare the diagnostic sensitivity of serum/ ascites albumin gradient and ascitic fluid total protein in liver cirrhosis patients, using ultrasonography as gold standard. Validation Study. Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi and Department of Radiology CMH/ MH Rawalpindi from 15 Jul 2007 to 15 May 2008. Seventy three patients of liver cirrhosis were enrolled in the study by non-probability convenience sampling. Liver cirrhosis was confirmed on ultrasound abdomen. Ascitic fluid and 3 ml of blood were obtained simultaneously for analysis of serum albumin, ascitic fluid albumin and total proteins. Sensitivity of serum ascitic albumen gradient [SAAG] and serum ascitic fluid total protein [AFTP] was calculated by comparing with liver ultrasonographic findings [gold standard]. Among 73 patients, 52 [71%] were males and 21 [29%] females. Mean ages was 57 years. Age range was 30-80 years. It was observed that sensitivity of SAAG in liver cirrhosis was 97% and that of AFTP was 53% only. Diagnostic sensitivity of SAAG in liver cirrhosis is significantly higher than AFTP in workup of ascites related to portal hypertension

Combined use of intravenous immune globulin and steroid for acute myocarditis in pediatric population

The optimum treatment for acute viral myocarditis in pediatric population is unknown. Some studies have shown the beneficial effect of high dose intravenous immunoglobulin [IVIG] while other reports suggested the corticosteroid to be effective in the treatment of acute viral myocarditis. In this study, we present our experience with combined use of high dose IVIG and corticosteroid along with conventional antifailure treatment for clinical acute viral mypcarditis in pediatric population. Thirteen patients were included in the study with the clinical diagnosis of acute viral myocardistis and reduced cardiac function ie fractional shortening of < 28%. In the study group, 53% were male and 46% female with median age of 12 months and were treated with high dose IVIG and corticosteroid. Left ventricular function, left ventricular end diastolic dimension [LVEDD] and degree of mitral regurgitation [MR] were assessed echocardiographically at presentation; at 6 weeks and then at 6 months follow-up. At 6 months follow-up, LV function normalized in 92% of the patients, LVEDD improved in 62% and 84.6% of the patients had insignificant MR. Our data suggest that use of high dose IVIG in combination with corticosteroid is an effective treatment for acute viral myocarditis in pediatric population

Serum hyaluronic acid as a marker of hepatic fibrosis

To determine the serum hyaluronic acid [HA] levels as biochemical marker of hepatic fibrosis and cirrhosis and correlate it with the degree of hepatic fibrosis and cirrhosis. Comparative cross-sectional study. The Armed Forces Institute of Pathology, Rawalpindi from September 2003 to August 2004. This study was performed on 100 patients of chronic liver disease whose liver biopsies had been carried out. Fifty healthy controls were also included in the study. Routine liver function tests, hepatitis serology and serum hyaluronic acid levels were carried out on patients and controls. Liver biopsy of 100 patients revealed that 21 were in stage 0 fibrosis, 38 in stage 1 fibrosis, 26 in stage 3 fibrosis and 15 in stage 4 fibrosis. Mean Serum HA [mean +/- SD] concentration in patients were 189 +/- 98 micro g/L vs. 21 +/- 10 micro g/L of healthy controls. The difference observed was statistically significant [p < 0.001]. Patients in stage 4 fibrosis had significantly higher [p <0.001] mean serum HA concentration as compared to other stages of liver fibrosis. Diagnostic accuracy of serum HA at marginally elevated level of 60 micro g/L determined the sensitivity 78.4%, specificity 80.9%, positive predicted value 93.9% and negative predicted value of 50%. Serum HA is a useful non-invasive marker of liver fibrosis. There is a strong positive correlation between serum HA levels and degree of liver fibrosis. The concentration of serum HA rises according to progression of liver fibrosis and levels are highest in patients with liver cirrhosis

Impact of new diagnostic criteria of diabetes mellitus

To compare the frequency of diabetic individuals diagnosed by fasting plasma glucose [FPG] >/= 7.0 mmol/L with previous value i.e. >/= 7.8 mmol/L and to determine the diagnostic accuracy of FPG >/= 7.0 mmol/L. A cross-sectional study. The Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi, from April to July 2003. FPG of 5250 subjects was checked to compare the frequency of diabetic subjects diagnosed by FPG >/= 7.0 mmoI/L with >/= 7.8 mmol/L. Of them, 301 symptom-free subjects were subjected to 75 g Oral Glucose Tolerance Test [OGTT] and their 2 hours post glucose [2-h PG] challenge level was taken as [gold standard] to determine the diagnostic accuracy of FPG at >/= 7.0 mmol/L. By lowering the cut off point of FPG from 7.8 mmol/L to 7.0 mmol/L, the percentage of diagnosed diabetic subjects increased from 35% to 42%. Statistical analysis revealed a significant increase [p< 0.0001]. FPG >/= 7.0 mmol/L had a diagnostic sensitivity of 70%, specificity 91%, the predictive value of positive and negative diagnosis was 84% and 80% respectively. FPG at cut off point of >/= 7.0 mmol/L, will greatly facilitate the early diagnosis of diabetes mellitus [DM]. An early diagnosis can be further facilitated by a combination of FPG and 2-h PG estimation

Insulin resistance in human subjects having impaired glucose regulation

To determine insulin resistance in human subjects having impaired glucose regulation [IGR] by Homeostasis Model Assessment for Insulin Resistance [HOMA-IR]. Comparative cross-sectional study. This study was carried out between September 2004 to September 2005, at the Department of Chemical Pathology and Clinical Endocrinology, Armed Forces Institute of Pathology [AFIP], Rawalpindi. A total of 100 subjects with impaired glucose regulation were selected for evaluation of metabolic syndrome as per the criteria of National Cholesterol Education Program, Adult Treatment Panel III [NCEP, ATP III], along with 47 healthy age and gender-matched controls. Physical examination to determine blood pressure and waist circumference was carried out and so was sampling for plasma glucose, serum triglycerides, HDL-cholesterol and insulin. Insulin resistance was calculated by the HOMA-IR. Finally, subjects with and without metabolic syndrome were compared with controls [n=47], using one-way ANOVA for studying insulin resistance between groups, with Tukey's post-hoc comparison. The frequency of finding metabolic syndrome in cases of IGR remained 47%. The insulin resistance demonstrated stepwise worsening from control population [mean=1.54, 95% Cl: 1.77 - 2.37] to subjects suffering from only IGR [mean=2.07, 95% Cl: 1.77- 2.37] to metabolic syndrome [mean= 2.67, 95%, Cl: 2.34 - 3.00] [p < 0.001]. Patients with impaired glucose regulation may have significant insulin resistance. It is, thus, recommended that a vigorous search be made to measure insulin resistance in all cases diagnosed to have impaired glucose regulation

Evaluation of post challenge Glucose Estimation For Diagnosis of Gestational Diabetes Mellitus [W.H.O. - Criteria 1999]

To compare sensitivity, specificity and Positive Predictive Value [PPV] and Negative Predictive Value [NPV] of 75g Oral Glucose Tolerance Test [OGTT] i.e. WHO criteria 1999 with 100g OGTT of National Diabetes Data Group [NDDG criteria]. Study Design: Comparative cross sectional. Material and Methods:The study was conducted at Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology [AFIP], Rawalpindi. Duration of study: 1st January 2004 to 31st August 2004. Sample size: Approx one hundred pregnant ladies between 24 to 28 gestational weeks. Sampling technique: Non-probability convenience. Data collection procedure: Patients consent for participation in the study was taken with explanation of test procedure. Patient's characteristics such as age, obesity, family history of diabetes, pregnancy induced hypertension, previous bad obstetric history [of still birth, macrosomia, recurrence abortion] was recorded on a predesigned proforma. Patients were first called for 75g OGTT and then after a gap of 1-2 days for OGTT 100g. Both tests were performed according to standard protocols. OGTT 75g was found to have 87.5% sensitivity, 97.8% specificity, and 77.7% positive predictive value and 98.8% negative predictive value, when compared with 100g OGTT

Estimation of ionized calcium, total calcium and albumin corrected calcium for the diagnosis of hypercalcaemia of malignancy

To measure levels of ionized calcium, total calcium and albumin corrected calcium in patients with different malignant disorders for the diagnosis of hypercalcaemia of malignancy. A case control comparative study. The study was carried out in the Department of Pathology, Army Medical College Rawalpindi, Armed Forces Institute of Pathology and Department of Oncology CMH, Rawalpindi from March 2003 to December 2003. Ninetyseven patients of various malignant disorders, admitted in the Department of Oncology, CMH, Rawalpindi, and 39 age and gender-matched disease-free persons [as control] were included in the study. Blood ionized calcium [Ca++], pH, sodium [Na+] and potassium [K+] were analysed by Ion selective electrode [ISE] on Easylyte[R] auto analyser. Other related parameters were measured by colourimetric methods. Blood Ca++ levels in patients suffering from malignant disorders were found significantly high [mean +/- SD: 1.30+017 mmol/L] as compared to control subjects [mean +/- SD: 1.23+0.03 mmol/L] [p<0.001]. The number of patients with hypercalcaemia of malignancy detected by Ca++ estimation was significantly higher [38%] as compared to total calcium [8.4%] and albumin corrected calcium ACC [10.6%] [p<0.001]. There was no statistically significant difference in other parameters e.g. phosphate, urea, creatinine, pH, Na+ and K+ levels in study subjects and controls. Detection of hypercalcaemia can be markedly improved if ionized calcium estimation is used in patients with malignant disorders

Pattern of serum protein electrophoresis in various diseases

To determine the frequency and pattern of different clinical disorders on the basis of serum protein electrophoresis [SPE]. Descriptive cross sectional study. The study was conducted at the Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi, during May 2003. Five hundred SPE strips [spanning over a period of one year] of patients along-with relevant clinical information were analysed to determine the frequency and pattern of clinical disorders. Out of the 500 strips analyzed, 324 were from males [mean age: 53.5y] and 176 were from females [mean age 51.5 y]. Six major patterns were found including chronic inflammation [40.4%], acute phase response [20.8%], nephrotic syndrome [6.8%], paraproteinemia [9.2%], hepatic cirrhosis [0.8%] and normal pattern [21.18%]. Chronic inflammatory disease was found to be the most frequently observed pattern

Hyperhomocysteinemia as a risk factor for ischemic heart disease

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 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. Serum total homocysteine level in controls was significantly lower [10.8 +/- 4.1 mmol/L] as compared to patients [18.0 +/- 5.9 mmol/L] [p < 0.0001]. Smoking showed statistically significant association with hyperhomocysteinemic patients [p = 0.04]. Ischemic heart disease was associated with moderate hyperhomocysteinemia in our patients and it was also associated with smoking

Healthy population; reference values of thyroid hormones

The reference values of thyroid hormones in healthy population of Multan area were determined at Combined Military Hospital Multan. A total of 295 subjects comprising 105 adult males aged 18-50 years, 72 adult females [non pregnant] aged 16-45 years, 65 adult females [pregnant] aged 21-35 years and 53 newborns were included in the study. Serum TSH, total T4, total T3, free T4 and free t[number] were analyzed by enzymatic immunoassay on semi-automatic analyser [Serozyme-1] of Serono-USA. The reference values were calculated using 2.5 and 97.5 percentiles as lower and upper limits [95%]. In adult males, the reference values of TSH was 0.4 -6.0 IU/L and T$ was 52 - 180 nmol/l, total T3 was 1.1 - 2.9 nmol/l, free T4 was 8.2 - 24 pmol/l and free T3 was 1.5 - 7.3 pmol/l. In adult females [non pregnant], the values of the analytes were almost same as in adult males. In adult females [pregnant] the values of total T4 and T3 were significantly higher than adult males. In newborns the levels of TSH were significantly higher and level of other parameters moderately higher than adult males. It is recommended that reference values of thyroid hormones should be established in various areas of Pakistan by the concerned laboratories to make appropriate use of such investigations

Reference values of common blood chemistry analttes in healthy population of Rawalpindi-Islamabad area

The reference values of common blood chemistry analytes in healthy population, aged newborn to 80 years, of Rawalpindi Islamabad area were determined at AFIP, Rawalpindi. A total of 2115 healthy subjects, 1206 males and 909 females, were included in the study. Plasma glucose was analysed by GOD/POD, serum cholesterol by CHOD/PAP, triglycerides by GPO/PAP, urea by urease/GLDH, creatinine by Jaffe' rate reaction, uric acid by uricase, total bilirubin by Jendrassik and Grof, total protein by biuret, alanine transaminase [ALT] by optimized IFCC and alkaline phosphatase [AP] by optimized DGKC method. The between batch CVs of all the parameters were within acceptable quality goals. The reference values were calculated using 2.5 and 97.5 percentiles as lower and upper limits [95% CI]. In healthy adult males the reference values were: fasting plasma glucose, 3.6-6.0 mmol/l; serum cholesterol; 3.2-6.6 mmol/l; triglycerides, 0.6-2.3 mmol/l; urea, 2.8-6.4 mmol/l; creatinine, 65-132 umol/l; uric acid, 164-430 umol/l; total bilirubin, 5-18 umol/l; total protein, 57-83 g/l; ALT, 15-45 U/l and AP, 185-620 U/l. The values in adult females, children and elderly subjects were slightly different than adult males. The reference values of our population show mild to moderate differences from the other Asian, European and American populations. It is recommended that reference values of different biochemical investigations should be established in various areas of Pakistan to make appropriate use of such investigations