Estimated reference interval of ionized [free] calcium

To determine the reference values of Ca++ in whole blood in our setup. The Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi from Jan 2008 to June 2008. Three hundred healthy individuals were included in the study after obtaining written consent. Out of these 76 individuals were excluded from the study after clinical assessment and collection of laboratory data. One hundred and fourteen were males with mean age 35 +/- 12 years and 110 were females, with mean age 28 +/- 9 years of age. Their Ca++ was estimated by ion selective electrode [ISE] method in heparinized whole blood [WB]. The mean and SD of whole blood Ca++ was calculated separately for the females and the males. The results showed that in our setup males have Ca++ levels of 1.12 +/- 0.05 [mean +/- SD] mmol/l and females have Ca++ levels of 1.12 +/- 0.04 [mean +/- SD] mmol/l. The study revealed that estimated reference range of Ca++ of the studied population was lower than the reference range published for the western population that is used by our physicians for the interpretation and comparison of results

Comparison of serum creatine kinase estimation with short tandem repeats based linkage analysis in carriers and affected children of Duchenne Muscular Dystrophy

Duchenne Muscular Dystrophy [DMD] is an X-linked recessive lethal, genetic disorder characterised by progressive weakness of skeletal muscles which is untreatable and transmitted to males by carrier females. Advances in laboratory techniques now focus direct mutational analysis as the most reliable and indirect analysis based on Short Tandem Repeats [STR] based linkage analysis as feasible, inexpensive, and efficient method for carrier detection and prenatal diagnosis. The objective of this study was to compare the sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV] and diagnostic efficiency of Serum Creatine Kinase [SCK] with Short Tandem Repeats [STR] based linkage analysis in carriers and affected children of Duchenne Muscular Dystrophy. The study was carried out from Dec 2006 to Dec 2007 in families having index clinical cases of DMD who were referred from different hospitals for evaluation/workup of DMD. SCK was done as a preliminary investigation in all index cases. The PCR assay with STR based linkage analysis with Intron 44, 45, 49 and 50 of DMD gene were performed in all families. Six families were informative with Intron 44 of DMD gene and one family was non-informative with all four intronic markers of DMD. SCK analyses were done in all the family members and compared with PCR analysis in informative families. SCK was not performed on Chorionic villous sample [CVS] done for prenatal diagnosis of DMD, and CVS and non-informative family members were excluded from the study. In carriers of DMD, the sensitivity and negative predictive value of SCK were 33.3%, and specificity and positive predictive were 100% with diagnostic efficiency of 50%. In affected cases of DMD the sensitivity and negative predictive value of SCK were 100%, and specificity and positive predictive were 91% and 88.8% respectively and diagnostic efficiency of 94.1%. The SCK is an excellent screening test for affected cases of DMD. For carrier identification we have to resort on PCR analysis so as to provide safer diagnostic tool for genetic counselling and prenatal diagnosis

Feasibility of short tandem repeats [STR] analysis for carrier detection and prenatal diagnosis in families with duchenne muscular dystrophy [DMD]

To determine the feasibility of Short tandem Repeats [STR] based linkage analysis for carrier detection and prenatal diagnosis [PND] in families having children affected with Duchemnne Muscular Dystrophy. Case series. Department of Chemical Pathology and Endocrinology in collaboration with Department of Molecular Biology, Armed Forces institute of Pathology [AFIP], Rawalpindi. From February 2007 to January 2008. six unrelated families with at least one affected child in each family who had characteristic features of DMD [index case]. PCR for Duchenne Muscular Dystrophy was carried out with STR based linkage analysis at introns 44, 46, 49 and 50 of DMD gene. Thermal cycling in TC-480 [Perkin Elmer] included 25 cycles each comprising 30 sec denaturation at 94 [degree sign] C, annealing at 62 [degree sign] C for 30 sec, extension at 65 [degree sign] C for 2 min. The final extension was done for 3 min. The amplified products were run on 8% nondenaturing polyacrylamide gel electrophoresis [PAGE] carried out at 200V for three hours on electrophoresis apparatus [Bio-Rad UK]. The gels were stained in silver nitrate. By comparing STR pattern of X-chromosome allele of index case with X-chromosome alleles of the mother, the diseased or affected X-chromosome was ascertained. Carrier detection and prenatal diagnosis was feasible with STR marker at intron 44 in DMD families. It was informative in 5 out of 6 DMD families. Carrier detection and PND by STR based linkage analysis is technically feasible in Pakistani families with DMD

Comparison of low dose short synacthen test [1 microgram] with standard dose short synacthen test [250 microgram] in patients of adrenal insufficiency

To determine the diagnostic accuracy of low dose 1 microg short synacthen test taking standard dose 250 microg short synacthen test as gold standard. A descriptive study. Department of Chemical Pathology and Endocrinology Armed Forces Institute of Pathology Rawalpindi from Jan 2006 to Jan 2007. Thirty patients with clinical suspicion of adrenal insufficiency and equal number of age matched healthy males and females as controls were included in the study. Relevant clinical history and physical examination was recorded on designated proforma. Short synacthen test was performed between 0800 - 1000 h by using ACTH doses of 1 microg and 250 microg with interval of 3 days in all patients and controls. Three blood samples were obtained for cortisol [basal, 30 min and 60 min after l/M ACTH injection]. Using 250 microg short synacthen test as a standard test, the 1 microg short synacthen test had sensitivity of 100%, specificity of 72%, positive predictive value of 71% and negative predictive value of 100% and 83% accuracy. The low dose 1 microg short synacthen test is as sensitive as standard dose 250 microg short synacthen test but less specific in the diagnosis of adrenal insufficiency

Thyroid dysfunction induced by recombinant interferon-alpha therapy for chronic active type C hepatitis

The aim of this study was to assess the frequency and types of thyroid dysfunction that develops during IFN-alpha therapy in patients of Chronic Hepatitis C. Case control study. Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi. The study was carried out on a total of 50 patients of chronic hepatitis C on recombinant IFN-alpha therapy. In addition 50 patients with chronic hepatitis C, not on any antiviral treatment, were included as controls. After informed consent, clinical history was obtained, physical examination was done and findings recorded on a pre-designed proforma. Blood sampling was done for thyroid profile at the beginning of interferon therapy, at 12 weeks and finally at 24 weeks. Thyroid dysfunction [TD] was observed in 14% [n=7] of the patients on antiviral therapy for CHC [n=50].Amongst these seven patients with TD, hypothyroidism was observed in 5 and hyerthyroidism in 2 patients. In contrast the frequency of thyroid dysfunction observed in control group [n=50] was 2%. The frequency of thyroid dysfunction in patients of chronic hepatitis C treated with interferon approaches 14%, with hypothyroidism being the more commonly observed pattern

Comparison of lipoproteins as coronary risk factors in postmenopausal women with and without hormonal replacement therapy in Rawalpindi/Islamabad area

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

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

Common anthropometric indices and insulin resistance

To correlate common anthropometric indices with insulin resistance. A cross-sectional study was conducted at the Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi, between April 2004 to March 2006.The target population constituted subjects who presented at the institute for evaluation of their glucose fasting. A total of 141 subjects were selected for the study and they were categorized into 4 groups depending upon their glucose levels. Normoglycemic [plasma glucose fasting /= 5.6 to 6.9 mmol/L] diabetes mellitus [plasma glucose fasting 7.0 to 9.9 mmol/L] and severe diabetes mellitus [plasma glucose fasting >/= 10 mmol/L]. Common anthropometric indices including weight, body mass index, waist circumference, waist to hip ratios, waist to height ratios and body mass index adjusted for waist to hip ratio were measured on each individual as per World Health Organization guidelines on physical status. Homeostasis Model Assessment for Insulin Resistance was used as a marker for measuring insulin resistance and the calculations were made following Mathew's method. Waist to hip ratio proved to be the most useful anthropometric index in the evaluation of insulin resistance and obesity [r= +0.5361]; while it's adjustment with body mass index or with waist to hip ratio did not improve the diagnostic performance[r= +0.507 and r=+0.333 respectively]. Parameters like weight [r=+0.137], waist circumference [r= +0.196] and body mass index [r= +0.299] were not useful in the assessment of insulin resistance. Waist circumference correlated better with insulin resistance than other routinely used anthropometric parameters. Waist to hip ratio can be used for evaluation of insulin resistance and obesity

Role of glycated hemoglobin in the diagnosis of Diabetes mellitus

To evaluate glycated hemoglobin as a marker for diagnosis of diabetes mellitus. Comparative cross-sectional study This study was carried out between July 2005 to April 2006 at department of chemical pathology and endocrinology, Armed Forces Institute of Pathology [AFIP] Rawalpindi. Subjects [n=104] demonstrating impaired glucose regulation at the endocrine clinic of AFIP were selected. Forty seven age and sex matched normoglycemic healthy looking controls were also included in the study. Samples under complete medical fasting state were collected for glucose and glycated hemoglobin analysis, and then samples were collected at 1 hour and 2 hour for plasma glucose as part of oral glucose tolerance testing [OGTT]. These subjects were later stratified to have all the disease ranges in terms of severity by 75 g OGTT results into following groups: Group-1: Controls, Group-2: Subjects with impaired fasting glucose [IFG], but became normoglycaemics on performing OGTT [Plasma glucose fasting result = 5.6 -6.9 mmol/L, but 2 h OGTT result < 7.8 mmol/L], Group-3: Subjects with impaired glucose tolerance [IGT] as per ADA recommendations [2 h OGTT result between 7.8-11.1 mmol/L], and Group-4: Subjects with diabetes mellitus as per American diabetic association [ADA] recommendat ions [2 h OGTT result >11.1 mmol/L]. Receiver operating curve [ROC] curve analysis and diagnostic performance in terms of sensitivity, specificity, predictive values were used to evaluate the performance characteristic of glycated hemoglobin, in comparison with plasma glucose fasting and 1 hour OGTT results against 2 hour OGTT results taken as gold standard. ROC curve analysis showed an area tinder the curve [AUC] of 0.722 for plasma glucose fasting, 0.607 for 1 hour OGTT and 0.564 for glycated hemoglobin. Moreover, the diagnostic performance as measured by sensitivity, specificity, predictive values and efficiency stood higher for plasma glucose fasting than glycated hemoglobin in the diagnosis of diabetes mellitus. Glycated hemoglobin, as determined by ion exchange resin chromatography is less useful for the diagnosis of diabetes mellitus than plasma glucose fasting. So the present approach for using plasma glucose fasting for diagnosing diabetes mellitus must remain in vogue

Spectrum of lipid and lipoprotein indices in human subjects with insulin resistance syndrome

Insulin resistance syndrome or metabolic syndrome is one of the major metabolic threats our recently urbanized society is going to face in near future. The management of this syndrome requires a very effective biochemical marker for screening. The objective of this cross sectional study were to compare various lipid and lipoprotein indices in human subjects with insulin resistance syndrome This study was carried out between April 2004 to January 2006 at the department of chemical pathology and endocrinology, Armed Forces Institute of Pathology, Rawalpindi. A total of forty-seven subjects with metabolic syndrome were selected as per the criteria of National Cholesterol Education Program, Adult Treatment Panel III [NCEP, ATP III] from a target population diagnosed to have impaired glucose regulation at AFIP. Forty-seven age and sex-matched healthy controls were also included in the study. Insulin resistance was calculated by the method of HOMA-IR, using the formula of Mathew's et al. The various lipid and lipoproteins, their ratios and log-transformed versions were evaluated for differences between subjects with metabolic syndrome and controls. Finally the diagnostic performances of these candidate lipid markers were evaluated. Results between subjects with metabolic syndrome and controls were found to be significant for serum triglyceride [P < 0.05], HDL-C [P < 0.05], triglyceride/HDLC [P < 0.01], Log triglyceride/HDL-C [P < 0.01], total cholesterol/HDL-C [P < 0.01], LDL-C/HDL-C [P < 0.01]. However there was weak correlation between these lipid based markers and HOMA-IR [[serum triglyceride: r= 0.225], [HDL-C: r= -0.235], [triglyceride/HDL-C: r= 0.333], [total cholesterol/HDL-C: r= 0.239]]. The AUCs for the diagnosis of metabolic syndrome remained highest for HOMA-IR [0.727 [95%CI: 0.642-0.812]], followed by triglyceride/HDL-C [0.669 [95%CI: 0.572-0.766]] and LDLC/ HDL-C [0.639 [95%CI: 0.537-0.742]]. The differences for lipids and lipoproteins between subjects with metabolic syndrome and controls remained significant. However, these markers have shown poor correlations with HOMA-IR along-with weaker diagnostic accuracy for the diagnosis of metabolic syndrome. Recommended cut-offs must be used, once these markers are employed in the diagnosis of metabolic syndrome

Hypertension and metabolic syndrome: impact of clustering of hypertension in subjects with metabolic syndrome

To compare insulin resistance between hypertensive and non-hypertensive subjects. It is a comparative cross-sectional study which was carried out between April 2004 to March 2006 at department of chemical pathology and endocrinology, Armed Forces Institute of Pathology, Rawalpindi. A total of sixty-three subjects with metabolic syndrome were selected as per the criteria of National Cholesterol Education Program, Adult Treatment Panel III [NCEP, ATP III] from a target population diagnosed to have impaired glucose regulation at AFIP, along with forty-seven age and sex-matched controls. Insulin resistance was calculated by the method of HOMA-IR, using the formula of Mathew's et al. Blood pressure was measured as per recommendations of JNC7 report on prevention, detection, evaluation and treatment of high blood pressure. The difference for hypertension for diastolic blood pressure between subjects with and without metabolic syndrome were found to be significant [Metabolic syndrome: 86.79 mm of Hg [95% CI: 83.75-89.84], Age and sex matched controls: 80.21[95% CI: 76.80-83.62] [p<0.05]. However the difference for systolic blood pressure were not found to be significant between the two groups [p=0.860].Hypertensive individuals had higher HOMA-IR [[n=33]: 2.87 [95% CI: 2.37-3.05]] than non-hypertensive [[n=30]: 1.76[95% CI: 1.53-2.05]] [p<0.05].The effect of obesity as determined by waist circumference between patients with and without hypertension remained significant [p=< 0.05]. Hypertensive individuals have higher insulin resistance than subjects without hypertension. Thus it is recommended that vigorous search be made to diagnose insulin resistance in subjects diagnosed to have hypertension, and to demonstrate other components of metabolic syndrome

Antioxidant vitamin status in type 1 Diabetes Mellitus patients

The study was designed to determine and compare the levels of both water soluble and fat soluble naturally occurring antioxidant vitamins, in order to know the antioxidant vitamin status of the type 1 diabetic and non-diabetic healthy individuals. Material and This case control study was conducted at Department of Chemistry, University of Peshawar from November 2004 to August 2005. Blood glucose, triglycerides, total cholesterol, HDL-c, LDL-c, VLDL-c and antioxidant vitamins [beta-Carotene, A, E, and C] levels were determined in 30 Type 1 diabetic and 30 healthy subjects. Values of blood glucose and lipid parameters were observed to be significantly increased [P 0.001] with exception of HDL-c, which was significantly decreased [P 0.001] in Type 1 diabetic patients. The concentration of antioxidant vitamins [b-carotene, E and C] were found to be significantly low in Type 1 diabetics when compared with normal healthy controls. Observation of low levels of antioxidant vitamins suggests possibly significant defects in antioxidant protection in Type 1 diabetes mellitus patients

High growth hormone levels in clinically short stature children

Growth Hormone [GH] is secreted from the anterior pituitary gland. It binds to receptors on the surface of target cells, stimulates production of Insulin-like growth factor-I [IGF-I] leading to growth of almost all tissues of the body capable of growing. Growth failure [height below 3rd centile] occurs in children who do not secrete sufficient amount of GH. In some children, however, short stature is present in the presence of high levels of GH in their blood and they also secrete normal to increased amounts of GH in response to stimulation tests when tested for possible deficiency of GH. This condition is known as GH resistance syndrome or Larons syndrome [LS]. All patients after a thorough clinical evaluation underwent GH evaluation protocol as follows. On arrival in the lab a blood sample was collected for basal GH level in each patient. Screening was performed by subjecting the patients to exercise stimulation test and/or L-dopa stimulation test. Patients with GH deficiency underwent insulin tolerance test [ITT] after one week for confirmation. All the basal and post-stimulation samples were analyzed for GH levels. A level below 10mIU/L indicated GH deficiency, between 10-20mIU/L as borderline and an adequate response was defined as a GH >20mIU/L. Patients with a basal GH level of >20mIU/L and/or a post-stimulation level of >40mIU/L were arbitrarily considered as having exaggerated GH levels. This article evaluates the high plasma growth hormone levels among clinically short stature children undergoing growth hormone stimulation tests. Two hundred ninty-three patients reported for GH evaluation. Twenty were excluded for various reasons. Thus 273 patients were included for GH evaluation out of which 66[24.2%] showed GH deficiency, 89[32.6%] were borderline while 118[43.2%] patients exhibited adequate response, with GH levels of >20mIU/L. A number of patients unexpectedly showed very high GH levels on screening tests. Out of 118 patients, 21 showed either very high basal levels of >20mIU/L and/or a much-exaggerated response to stimulation tests with levels more than about 40mIU/L. Close consanguinity was found in 67% of patients showing very high GH levels. Some children with idiopathic short stature may show high levels of GH during their evaluation for GH deficiency. We identified a considerable number of such patients. These patients require further investigations

Iron deficient children and significance of serum ferritin

To evaluate the significance of serum ferritin in iron deficiency anaemia as compared to other indices. Children were selected as anaemic and non-anaemic on the basis of hemoglobin [10g/dl] and transferrin saturation [15%]. Red cell morphology, hemoglobin, serum iron, TIBC, transferrin saturation and serum ferritin were determined. Red cell morphology was of little significance. Haemoglobin, serum iron, transferrin saturation and serum ferritrin were all lower in children. A positive correlation of serum ferritin with age, haemoglobin, serum iron and transferrin saturation and a negative correlation with TIBC was found. Serum ferritin was more sensitive indicator as compared to serum iron, TIBC, and transferrin saturation

Iron deficient children and significance of serum ferritin

to evaluate the significance of serum ferritin in iron deficiency anaemia as compared to other indices. Children were selected as anaemic and non-anaemic on the basis of hemoglobin [10g/dl] and transferrin saturation [15%]. Red cell morphology, hemoglobin, serum iron, TIBC, transferrin saturation and serum ferritin were determined. Red cell morphology was of little significance. Haemoglobin, serum iron, transferrin saturation and serum ferritrin were all lower in children. A positive correlation of serum ferritin with age, haemoglobin, serum iron and transferrin saturation and a negative correlation with TIBC was found. Serum ferritin was more sensitive indicator as compared to serum iron, TIBC, and transferrin saturation

Deoxypyridinoline [DPD], a marker of bone resorption which predicts osteoporosis

With the improvements in medical facilities, the life expectancy of ladies has crossed fifty years in Pakistan. Because of this, problems related to menopause and senility is increasing. A cross-sectional study was conducted to determine the incidence of osteoporosis in Pakistani postmenopausal women residing at Rawalpindi. This was done by estimation of deoxypyridinoline [DPD], a marker of bone resorption, for its potential for early diagnosis; so that the patients are benefited by early treatment before the disease is severe and crippling. Seventy postmenopausal women having intact ovaries were selected randomly from the general public in the locality. Control group consisted of thirty healthy premenopausal women. The mean urinary DPD level in premenopausal ladies i.e. Controls was [5.8 nmol/mmol of creatinine], while in postmenopausal women the mean DPD level was significantly higher [27.4 nmol / mmol of creatinine]. The very high loser ladies [Urinary DPD level > 30 nmol / mmol of creatinine] were regarded to have osteoporosis. X-ray of the wrist remained a poor diagnostic marker as it was positive in only 15% of postmenopausal subjects. The frequency of osteoporosis was 13.5% in ladies between 50-59 years, while in ladies between 60 - 69 years the frequency was 78% and 100% in ladies over 70 years. These figures are quite alarming

Frequency of growth hormone deficiency in short statured children

To determine the frequency of growth hormone deficiency among short stature children referred for growth hormone evaluation. A cross-sectional survey. The study was conducted in the Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi, from June 1999 to July 2000. A total of 293 children were referred for growth hormone evaluation. All the patients underwent thorough clinical evaluation including recording of height, weight, presence of chronic diseases and malnutrition. Twenty children were excluded for various reasons. Screening for GH deficiency was carried out by exercise stimulation test and /or L-dopa stimulation test. The children with GH level < 10 mlU/L on screening tests were provisionally considered to have GH deficiency. These children underwent insulin tolerance test [ITT]. Out of 273 children, 189 were subjected to both exercise and L-dopa stimulation test, while 60 patients underwent only exercise stimulation test. The remaining 24 patients were subjected to L-dopa administration alone because of their physical weakness or inability to perform exercise. Sixty-six patients exhibited GH levels < 10 mlU/L on screening tests. The frequency of GH deficiency was found to be 24.17% on screening. Out of these 66 patients, 54 underwent an ITT, while 12 patients did not report back for the test. Thirty-eight children showed lack of response on ITT, therefore, after ITT, the frequency of GH deficiency was revealed to be 13.9%. GH deficiency is responsible for about 14% cases of short stature in a hospital setting. Screening tests showed a positive predictive value of 70.4% and a false positivity of 6.8%

Pre-operative evaluation of ovarian mass: risk of malignancy index

To evaluate the risk of malignancy index [RMI] for pre-operative diagnosis of ovarian mass. Design: Observational study. Place and Duration of Study: Department of Chemical Pathology and Endocrinology at Armed Forces Institute of Pathology [AFIP], Rawalpindi from January 2001 to January 2002. Subjects and The study consisted of 100 female patients consecutively admitted for surgical exploration of ovarian mass. Pre-operatively ultrasonic evaluation of ovarian mass, menopausal status and serum cancer-associated antigen 125 [CA 125] levels were carried out. Postoperatively histopathology of the resected ovarian mass was done to confirm the diagnosis. To increase the sensitivity and specificity of CA 125 for early detection of ovarian cancer, a combination of serum CA 125 with ultrasonography and menopausal status, designated as risk of malignancy index [RMI] for each patient, was calculated. The sensitivity and specificity of CA 125 alone for the diagnosis of ovarian cancer, at cutoff level of 35 U/ml, were 83% and 82% respectively. Using RMI, at cutoff level of 125, the sensitivity was 87%, and specificity was 88%. Receiver operating characteristic [ROC] curves reveal that RMI was a better discriminant than CA 125 alone for differentiating between benign lesions and malignant ovarian tumors. The risk of malignancy index [RMI] is a better diagnostic marker as compared to CA 125 alone because of its high specificity and sensitivity in differentiating ovarian cancer from ovarian benign lesions. It is a simple scoring system and, therefore, its application is recommended to evaluate ovarian masses in clinical practice

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