Decreased serum 25-hydroxycalciferol levels in pre-diabetic adults

Objective: To determine the serum 25-hydroxycalciferol levels [25[OH]D] in adults with pre-diabetes and normoglycaemia to examine a possible association of vitamin D deficiency with pre-diabetes

Study Design: Case control study

Place and Duration of Study: Armed Forces Institute of Pathology, Rawalpindi, from November 2012 to July 2013

Methodology: A total of 272 adults including 136 pre-diabetics and 136 normoglycaemics of either gender aged 20 years and above were consecutively inducted. Patients with diabetes mellitus, pregnancy, rickets and osteomalacia, ischemic heart disease, chronic kidney disease and chronic liver disease were excluded. Fasting Plasma Glucose [FPG] was estimated with hexokinase method on Modular p800 Roche chemistry analyzer while serum 25[OH]D was measured on Diasorin Liaison immunoassay analyzer using the chemiluminescent technique. Mean 25[OH]D levels in pre-diabetic and normoglycaemic groups were compared using Mann-Whitney U test. Spearman's correlation coefficient 'r[s]' was determined between serum 25[OH]D and FPG. Odds ratio for vitamin D deficiency was also calculated

Results: Mean serum 25[OH]D level was low in pre-diabetics [23.2 nmol/L] as compared to normoglycaemics [29 nmol/L; p=0.001]. Serum 25[OH]D level had inverse correlation with FPG [r[s] = -0.448, p=0.000]. There was also significant association of vitamin D deficiency with pre-diabetes compared with normoglycaemia [OR: 2.21, p= 0.016; 95% CI: 1.15-4.27]

Conclusion: Vitamin D deficiency with pre-diabetes suggested that vitamin D may have an important role in pathogenesis of pre-diabetes

Extensively and pre-extensively drug resistant tuberculosis in clinical isolates of multi-drug resistant tuberculosis using classical second line drugs [levofloxacin and amikacin]

To find out the frequency of Extensively Drug Resistant [XDR] and pre-XDR tuberculosis in clinical isolates of Multi-Drug Resistant [MDR] Tuberculosis [TB] by determining the susceptibilities against Levofloxacin and Amikacin [classical second line antituberculosis drugs]. A descriptive cross-sectional study. Microbiology Department, Armed Forces Institute of Pathology [AFIP], Rawalpindi, from September 2011 to August 2013. Amikacin [AK] and Levofloxacin [LEVO] were obtained in chemically pure form from Sigma [Taufkirchen, Germany]. The breakpoint concentration used for AK was 1.0 microg/ml and for LEVO 2.0 microg/ml. Mycobacterial Growth Indicator Tube [MGIT] 960 system was used to carry out drug susceptibility testing as per recommended protocol. A total of 3 MDR-TB isolates [3%] turned out to be XDR-TB based upon simultaneous resistance to injectable second line antituberculosis drug AK and one of the fluoro-quinolones [LEVO]. A total of 24 MDR-TB isolates [24%] were found to be pre-XDR based upon resistance to LEVO alone. Treatment status record of patients with XDR and pre-XDRTB isolates revealed that majority of patients had received fluoroquinolones [FQs] during the course of treatment. XDR-TB has started to emerge in MDR-TB isolates in our set up. The worrying sign is the high frequency of pre-XDR tuberculosis. Urgent steps need to be taken to stem the tide of pre-XDR-TB in our population. It is thus recommended to develop facilities to carry out drug susceptibility testing to monitor the status of pre-XDR and XDR-TB in our population

Rapid mycobacterium tuberculosis dna detection on fine needle aspirates from extra pulmonary lymph nodes

To evaluate the diagnostic efficacy of two rapid methods i.e. Mycobacterium tuberculosis [MTB] Polymerase Chain Reaction [PCR] on Fine Needle Aspiration [FNA] samples by comparing with cytology of respective site sample. Cross-sectional comparative study. Department of Microbiology, Armed Forces Institute of Pathology [AFIP], Rawalpindi, Pakistan, from July 2010 through November 2013. A total of 105 extra pulmonary lymph nodes aspirates obtained through fine needle aspiration were processed. Cytology and PCR were done on each specimen. Cytology was taken as gold standard. Out of the total 105 samples, 71 [67.6%] were positive for the MTB PCR while 34 [32.4%] showed negative status. According to FNA cytology [FNAC] results, 72 [68.6%] cases were positive for the disease while 33 [31.4%] were negative. Sensitivity of PCR was 90.3%, specificity 81.8%, positive predictive value [PPV] 91.5%, negative predictive value [NPV] 79.4%, with diagnostic accuracy of 87.6%. Area under the curve was 0.860 [p < 0.001]. PCR is a sensitive tool for detection of MTB on FNA samples from EPTB cases. The results are available within few hours which is helpful for the clinicians to initiate therapy

In vitro evaluation of linezolid and meropenem against clinical isolates of multi drug resistant tuberculosis by mycobacterial growth indicator tube [MGIT] 960

To evaluate the in vitro effectiveness of multiple breakpoint concentrations of newer antituberculosis agents [Linezolid and Meropenem] against Multi Drug-Resistant Tuberculosis [MDR-TB] isolates. A descriptive cross-sectional study. Microbiology Department, Armed Forces Institute of Pathology [AFIP], Rawalpindi, from September 2011 to August 2013. A total of 100 MDR-TB isolates recovered during the study period were subjected to susceptibility testing against multiple breakpoint concentrations of Linezolid [LZD] and Meropenem [MER]. The breakpoint concentration used for LZD were 0.5, 1.0 and 2.0 microg/ml, while for MER were 4.0, 8.0 and 16 microg/ml. Mycobacterial Growth Indicator Tube [MGIT] 960 system was used to carry out drug susceptibility testing as per recommended protocol. At break point concentration of 0.5 microg/ml, 80 out of 100 [80%] MDR-TB isolates were susceptible to LZD while at breakpoint concentration of 1.0 microg/ml and 2.0 microg/ml, 96/100, [96%] of MDR-TB isolates were susceptible. For MER, at breakpoint concentrations of 4.0 microg/ml no MDR-TB isolate was susceptible, while at 8.0 microg/ml 3/100, [3%] and at 16.0 microg/ml 11/100, [11%] of MDR-TB isolates were susceptible. LZD was found to have excellent in vitro efficacy as 96% of MDR-TB isolates were susceptible at breakpoint concentration of 1.0 microg/ml or more. In case of MER it was found that in vitro susceptibility improved as the break point concentrations were increased

Comparison of friedewald formula and modified friedewald formula with direct homogeneous assay for low density lipoprotein cholesterol estimation

To compare the Friedewald and modified Friedewald formulae with direct homogeneous assay for serum lowdensity lipoprotein cholesterol [LDL-C] levels estimation. Cross-sectional study. Armed Forces Institute of Pathology, Rawalpindi, from June to December 2011. Healthy subjects of either gender, from Rawalpindi, aged 18-75 years were included by consecutive sampling. Patients with diabetes mellitus, chronic liver disease, chronic kidney disease, those taking lipid lowering drugs and samples with triglyceride [TG] > 4.52 mmol/l were excluded from the study. Total cholesterol, high-density lipoprotein cholesterol, TG and LDL-C were measured on Hitachi 912 chemistry analyzer [Roche]. LDL-C levels were also calculated by Friedewald formula [FF] and Vujovic modified formula [VMF]. Paired sample t-test and scatter plots were used for statistical analysis. Although both calculated methods showed good correlation with direct assay [r > 0.93] in 300 subjects, but the difference was statistically significant. The ffLDL-C were 0.12 A +/- 31 mmol/l [p < 0.001] lower and vmfLDL-C were 0.11 A +/- 26 mmol/l [p < 0.001] higher than dLDL-C. The difference was not significant between ffLDL-C and dLDL-C at TG levels < 1.70 mmol/l [p = 0.58] and between vmfLDL-C and dLDL-C at TG levels 2.26 - 4.52 mmol/l [p = 0.38]. At all other TG levels, the difference between LDL-C calculated by both formulas and dLDL-C was statistically significant [p < 0.001]. As compared to direct assay, 11% and 14% subjects were classified in wrong National Cholesterol Education Programm's cardiac risk categories by FF and VMF respectively. LDL-C should be measured by direct homogeneous assay in routine clinical laboratories, as the calculated methods did not have a uniform performance for LDL-C estimation at different TG levels

Molecular and serological assessment of chronic HBV carriers and additional burden of applying updated guidelines in Pakistan

To assess the additional burden of the patients eligible for treatment, based on recommendations on viral load, in the light of 2009 version of AASLD guidelines, as compared to 2004 guidelines and to determine the frequency of HBeAg in chronic HBV carriers. Descriptive cross-sectional study. Virology Department, Armed Forces Institute of Pathology, Rawalpindi, from November 2010 to January 2012. Persons with chronic HBV infection, reporting for HBV DNA PCR test, were included in the study and blood samples were collected. HBV DNA load was determined by Real Time PCR. HBsAg and HBeAg were tested by ELISA. Out of the 801 subjects positive for HBsAg, 74 [9.24%] were positive for HBeAg. Out of them, 113 [14.1%] had HBV DNA load > 100,000 copies/ml and were eligible for treatment according to AASLD 2004 guidelines. Forty one [5.1%] had HBV load between 10,000 and 100,000 copies/ml, and were additionally eligible for treatment as per AASLD 2009 guidelines. The 5.1% of 4.5 million estimated HBV carries in Pakistan comes to 229500. There was a low HBeAg positivity and HBV DNA positivity in our chronic HBV infected persons. Moreover, there is an increase of 229500 potential candidates for HBV treatment in Pakistan based on viral load testing, according to the AASLD 2009 guidelines when compared with 2004 guidelines. The increase in the number of candidates for treatment may require an additional expenditure of tens of billions of rupees

Rapid detection of acute kidney injury by urinary neutrophil gelatinase-associated lipocalin after cardiopulmonary bypass surgery

To determine the accuracy of neutrophil gelatinase-associated lipocalin [NGAL] in early detection of acute kidney injury [AKI] after cardiopulmonary bypass [CPB] surgery by comparing with serum creatinine. Descriptive study. Department of Chemical Pathology and Endocrinology, AFIP in collaboration with AFIC/ NIHD, Rawalpindi, from April to December 2011. Eighty eight patients undergoing CPB surgery in AFIC/NIHD were included by consecutive sampling. Blood samples of subjects for serum creatinine analysis were drawn pre-operatively, 4 h, 24 h and 48 h after CPB surgery. Spot urine samples for NGAL were collected at 4 h after CPB surgery. Urine samples were analyzed on Abbott ARCHITECT i2000SR analyzer whereas serum creatinine samples were measured on Beckman UniCel DxC 600 Synchron Clinical System. Out of 88 patients, 11 [13%] cases developed AKI 4 h postoperatively. Urinary NGAL increased markedly at 4 h postoperatively as compared to serum creatinine which showed rise at 24 - 48 h after cardiac surgery. Analysis of urine NGAL at a cutoff value of 87 ng/ml showed area under the curve of 0.91 [95% confidence interval [Cl] 0.83 - 0.96] with sensitivity of 90.9% [95% Cl 58.7 - 98.5] and specificity of 98.7% [95% Cl 92.9-99.8]. There was a positive correlation of 4 h urine NGAL and serum delta creatinine at 48 h, which was statistically significant [r[s] = 0.33, p = 0.001]. The study demonstrated that levels of urine NGAL in patients suffering from AKI increased significantly at 4 has compared to serum creatinine levels. Urine NGAL is an early predictive biomarker of AKI after CPB

Comparison of urine with plasma neutrophil gelatinase-associated lipocalin in detecting acute kidney injury after cardiopulmonary bypass surgery

To compare the accuracy of urine with plasma neutrophil gelatinase-associated lipocalin [NGAL] in early detection of acute kidney injury [AKI] following cardiopulmonary bypass [CPB] surgery. A prospective cohort study. Department of Chemical Pathology and Endocrinology, AFIP from December 2011 to July 2012. Ninety three adult patients planned for CPB surgery in AFIC/NIHD were consecutively included. Blood for serum creatinine were collected preoperatively, 4, 24 and 48 hours [h] after CPB surgery. Blood and urine samples for NGAL analysis were collected only at 4 h. Serum creatinine, plasma and urine NGAL samples were analyzed on UniCel[R] DxC 600 [Beckman], TRIAGE meter pro [Biosite] and ARCHITECT i2000SR analyzer [Abbott] respectively. Out of 93 patients undergoing CPB surgery, 12 [13%] developed AKI. AKI patients had significantly higher median interquartile range [IQR] urine NGAL of 180 ng/ml [105-277 ng/ml] as compared to control of 6 ng/ml [2-15 ng/ml] and median plasma NGAL of 170 ng/ml [126-274 ng/ml] as compared to control of 75 ng/ml [61-131 ng/ml]. The patients had increased urine vs plasma NGAL area under curve [AUC] [0.91 vs 0.70 [p = <0.001]], better sensitivity [91% vs 82%] and specificity [98% vs 65%]. Plasma and urine NGAL values increased significantly in AKI patients as compared to serum creatinine values. Urine in comparison to plasma NGAL revealed more sensitivity and specificity in detecting AKI following CPB surgery

Validation of modified estimated glomerular filtration rate in chronic kidney disease patients

To derive the ethnic factor and validate the modified estimated Glomerular Filtration Rate [eGFR] by Modification of Diet in Renal Disease [MDRD] equation for Chronic Kidney Disease [CKD] patients of Rawalpindi. Cross- sectional study. Armed Forces Institute of Pathology [AFIP], Rawalpindi, from July 2011 to July 2012. A total of 140 patients with CKD reporting to AFIP for GFR measurement by [99m] Technetium diethylenethiaminepenta-acetic acid [[99m]Tc-DTPA] renal scan were consecutively inducted. Serum creatinine was measured by the Jaffe's assay on Beckman DxC 600 Analyzer prior to the renal scan. Ethnic factor for population of Rawalpindi with CKD was derived for the MDRD eGFR equation using [99m]Tc-DTPA renal scan by Gates method as the reference method. MDRD equation was modified by inclusion of the ethnic factor in it. Agreement between the reference GFR [rGFR] and the modified MDRD eGFR [mGFR] was assessed by applying paired samples t-test. Out of 140 patients of CKD, 99 [71%] were males and 41 [29%] females, with mean age of 55 +/- 13.42 years. The mean values were 32.91 +/- 14.96, 34.89 +/- 16.45, 0.971 +/- 0.20 and 33.87 +/- 15.97 for rGFR, original eGFR, ethnic factor and mGFR respectively. The mGFR with new ethnic factor of 0.971 showed improved performance as compared to original eGFR and showed a significant level of correlation with rGFR [r[2] = 0.817], at a p-value of 0.000. This study validates the mGFR equation by inclusion of newly derived ethnic factor of 0.971 in the population of Rawalpindi with CKD and it was found to be not significantly different from the rGFR.

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

Adverse effects of low dose methotrexate in rheumatoid arthritis patients

To determine the frequency of adverse effects attributed to Methotrexate [MTX] toxicity and serum minimum toxic concentration with low dose MTX in Rheumatoid Arthritis [RA] patients. Cross-sectional observational study. Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi, from March 2010 to March 2011. One hundred and forty adult patients of RA receiving low dose MTX [10 mg/week] for at least 3 months, were included by consecutive sampling. Blood samples were collected 2 hours after the oral dose of MTX. Serum alanine transaminase and creatinine were analyzed on Hitachi and blood counts on Sysmex analyzer. Serum MTX concentration was measured on TDX analyzer. Out of one hundred and forty patients; 68 males [49%] and 72 females [51%], 38 developed MTX toxicity [27%], comprising of hepatotoxicity in 12 [8.6%], nephrotoxicity in 3 [2.1%], anaemia in 8 [5.7%], leucopenia in 2 [1.4%], thrombocytopenia in 3 [2.1%], pancytopenia in 2 [1.4%], gastrointestinal adverse effects in 5 [3.6%] and mucocutaneous problems in 3 [2.1%]. Receiver operating characteristic curve revealed serum minimum toxic concentration of MTX at cutoff value of 0.71 micro mol/l with a sensitivity of 71% and specificity of 76%. Adverse effects of low dose MTX were found in 27% of RA patients, mainly comprising of hepatotoxicity and haematological problems. MTX toxicity can be detected by therapeutic drug monitoring of serum concentration of 0.71 micro mol/l with sensitivity of 71% and specificity of 76% in the patients on low dose MTX maintenance therapy

Frequency of steroid contamination in drugs prescribed by quacks in Rawalpindi

To determine the frequency of contamination of steroids in drugs prescribed by quacks, being used by patients in Rawalpindi. Cross- sectional study. Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology Rawalpindi, from June 2010 to March 2011. One hundred and seventy eight drugs distributed by quacks in Rawalpindi were collected from the patients. Quackery formulations [QF] were analyzed by thin layer chromatography on fluorescent Aluminum silica plates by using mobile phase of methylene chloride: ether: methanol: water [77:15:8:1.2] and relative flow of spots were noted. Samples positive for steroids were confirmed by high performance liquid chromatography. Out of In total of 178 samples, 125 [70.2%] were received by patients from unregistered hakeems, 29 [16.3%] unregistered homeopaths and 24 [13%] directly from nonmedical shopkeepers, prescribed for in joint pains 84 [47%], generalized weakness 43 [24%], dermatitis 28 [16%], gastrointestinal diseases 12 [7%] and respiratory diseases 11 [6%]. Out of 178 samples, 38 [21%] QF were contaminated with steroids found in 18 [48%] tablets, 10 [26%] powders, 5 [13%] creams, 3 [8%] capsules and 2 [5%] syrups. Out of 38 Steroid contaminated QFs 20 [53%] countrained dexamethasone, 12 [32%] prednisolone, 4 [10%] hydrocortisone and 2 [5%] betamethasone. In modern era, patients are still using drugs prescribed by quacks and 21% of QF in Rawalpindi is contaminated with steroids. The steroids comprise mainly of dexamethasone and prednisolone in adulterated tablets and powders prescribed by hakeems.

Single flexible postprandial plasma glucose test as a new screening modality for diabetes mellitus

The study was aimed at assessing the adequacy of single flexible potprandial plasma glucose [FPPPG] test with time of sampling between 30-120 min after breakfast/meal as a screening test for diabetes mellitus and IGT. Cross sectional study. Study was carried out in the Department of Chemical Pathology and Endocrinology at Armed Forces institute of Pathology, Rawalpindi from January to November 1995. Eighty eight consecutive patients referred to AFIP for oral glucose tolerance test were included. The ages of patients ranged from 30-65 y. In the first step, on day 1 oral glucose tolerance test and in the second step, on day 2 flexible time based postprandial plasma glucose [FPPPG] 30-120 min after breakfast/snack/meal were performed. 12 patients did not turn up on day 2 for FPPPG test. In this study we performed FPPPG test on 76 patients as a screening test, with a cutoff point of 7.0 mmol/l. The study revealed that all 22 diabetic patients [100%] had levels above the limit whereas, 15 [83.3%] out of 19 patients of IGT had levels above cutoff level. On the other hand out of 35 healthy subjects only 2 [5.71%] had values above the limit. This study proposes a new screening test [FPPPG] for diabetes mellitus and IGT, which has a sensitivity of [100%], specificity of [66.7%] and positive predictive value of [55%]

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

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

Pregnancy-associated plasma protein-A levels in individuals with and without coronary artery disease

To compare pregnancy-associated plasma protein-A [PAPP-A] levels in individuals with and without coronary artery disease [CAD]. Cross-sectional comparative study. Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology [AFIP], Rawalpindi, in collaboration with Armed Forces Institute of Cardiology [AFIC], from September 2008 to March 2010. One hundred and twenty five [125] individuals both male and female were included in the study. Blood for PAPP-A and lipid profile was collected, just before angiography. On the basis of angiography, the individuals were divided into those with and without CAD. PAPP-A was analyzed by using Diagnostic System Laboratories [DSL] Enzyme Linked Immunosorbent Assay [ELISA] kit and reading was taken by ELISA reader. Lipid profile was determined on automated analyzers Selectra-2 and Vitros 5.1. Amongst the 125 individuals, 41 individuals were without CAD whereas 84 individuals were having CAD. Mean PAPP-A levels were 0.74 +/- 0.35 mIU/L in those without CAD whereas mean PAPP-A levels in those with CAD were 1.35 +/- 0.57 mIU/L. The difference between the two groups was statistically significant [p < 0.001]. A PAPP-A cut off level of 0.85 mIU/L had a sensitivity and specificity of 78% and 70% respectively for diagnosing atherosclerotic CAD. PAPP-A is a potentially relevant marker of the presence and extent of coronary atherosclerosis as its levels are elevated in CAD as compared to individuals without CAD