Iodine Deficiency in Neonates: Where Do We Stand After a Quarter Century of Initiating Iodization Programs?

An observational study was conducted at the Section of Clinical Chemistry, Department of Pathology and Laboratory Medicine, to assess the iodine status using the World Health Organization (WHO), United Nations International Children's Emergency Fund (UNICEF), and the International Council for Control of Iodine Deficiency Disorders (ICCIDD) consensus criteria, which state that >3% prevalence of serum thyroid stimulating hormone (TSH) ≥10 mIU/L in the population is an indicator of iodine deficiency. Serum neonatal TSH was analyzed from January to December 2013. In a period of one year, a total of 11,597 neonates with the mean (25 percentile, 75 percentile value) age of 2.0 days (0.5–3.5) were tested for serum TSH. The overall mean TSH level was 3.38 mIU/L (5.63–1.96), with optimal levels (1–39 mIU/L) in 93%, <1 mIU/L in 6.3%, and ≥40 mIU/L in 0.3% neonates. Of all the neonates, 7.9% (N=916) showed TSH ≥10 mIU/L which is higher than the recommended WHO/UNICEF/ICCIDD criteria for mild endemicity for iodine deficiency in the population. These results suggest that iodine deficiency is still prevalent in our population, indicating a need for effective intervention programs and increasing awareness regarding the use of iodized salt and supplementation in all reproductive-aged women to prevent iodine deficiency in neonates.

High burden of subclinical lead toxicity after phase out of lead from petroleum in Pakistan

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

Frequency of thyroid peroxidase antibody and its association with miscarriages among pregnant women

Objective: To measure the frequency of thyroid peroxidase antibody [TPO Ab] among clinically euthyroid pregnant women during first trimester and determine its association with pregnancy outcome as miscarriage or live birth by estimating the relative risk. Study Design: Cohort study. Place and Duration of Study: Section of Chemical Pathology, Department of Pathology and Laboratory Medicine and the Gynaecology and Obstetric outpatient clinics of the Aga Khan University Hospital, Karachi, from July to December 2012

Methodology: The study subjects comprised of apparently euthyroid pregnant women, who were tested for TPO Ab during first trimester of pregnancy and followed till pregnancy outcomes Pregnancy outcome was noted and relative risk was determined

Results: TPO Ab was found positive in 127 [13.5%] pregnant women from a cohort of 943 subjects. A 2.03% increased risk of miscarriages was observed in TPO Ab positive subjects

Conclusion: There was a positive association of presence of TPO Ab with loss of pregnancy

Bone turnover markers for osteoporosis status assessment at baseline in postmenopausal Pakistani females

Objective: To assess bone turnover status in osteopenic and osteoporotic postmenopausal females

Study Design: Cross-sectional analytical study

Place and Duration of Study: The Aga Khan University Hospital, Karachi, from January to December 2013

Methodology: A cross-sectional study was conducted on 203 postmenopausal females undergoing bone mineral density testing [BMD] by DXA scan. Patients with clinical history of any disorder or medications affecting bone turnover were excluded. Bone turnover was assessed with osteocalcin and beta-CTx. Data was analyzed by SPSS version 19

Results: Mean age of the participants was 54 +/- 4.66 years with a mean BMI of 28.7 +/- 5.5 kg/m2. Mean beta-CTx [0.28 +/- 0.24 ng/ml] and osteocalcin [21.5 +/- 10.6 ng/ml] levels were within the normal reference range. Subjects were grouped into normal [26.6%], osteopenic [44.8%], and osteoporotic [28.6%] based on the t-scores. Serum levels of osteocalcin and beta-CTx between normal, osteopenic, and osteoporotic groups were not significantly different. beta-CTx was negatively and significantly associated with only lumber spine BMD [r = -0.13, p=0.04]. Positive association [< 0.0001] was noted between both markers in normal, osteopenic, and osteoporotic females. However, association of these markers with BMD in the 3 groups were not found. Multivariate linear regression showed a positive and significant effect of BMI on BMD [beta = 0.332, p= < 0.0001]. beta-CTx had negative but significant effect on BMD [beta = -0.155, p= 0.018] of postmenopausal women

Conclusion: Association between baseline levels of BTM and rate of bone loss is variable and site dependent. beta-CTx correlates better with BMD. However, role of osteocalcin in postmenopausal osteoporosis is uncertain and needs further investigation

Pattern of drugs of abuse identified in chemical samples

To determine the pattern of drugs of abuse in urine and blood samples processed at referral laboratory in Pakistan so that information on the type of drugs used can be identified and used for ready reference for future strategy. Observational study. Clinical Laboratory of The Aga Khan University Hospital, Karachi, from July 2006 to March 2008. Retrospective review of records were done for the common drugs that are used for screening at the Clinical Laboratory include alcohol, amphetamine, barbiturates, benzodiazepines, cannabinoids, cocaine and opiates. Alcohol was tested in blood and others were identified using urine. Percentages of tests screened positive and negative for individual drugs were computed by using SPSS 16.0. The ratio between male and female users was also established. A total of 17,714 tests were performed for drugs. The mean age of the patients whose samples were processed was 30 +/- 14.84 years. Majority used benzodiazepines 520/1317 [39.5%] among the samples tested for drug of abuse, followed by cannabinoids 423/5450 [7.8%], alcohol 75/1302 [5.8%], barbiturates 32/1148 [2.8%], opiates 137/5640 [2.4%], cocaine 5/1655 [0.3%] and amphetamine 3/1 202 [0.2%]. In all, males 15411 [87%] were tested more frequently as compared to females 2303 [13%]. Males were more frequently tested for drug abuse; however, drug abuse is increasingly seen among females. Benzodiazepines are the most frequently used. The same pattern of drugs abuse existed in different gender and age group. There is a need to explore the pattern and type of drug abuse on national scale

Comparision between bed side testing of blood glucose by glucometer vs centralized testing in a tertiary care hospital

To determine the accuracy, turnaround time and cost effectiveness of bedside monitoring of blood glucose levels by non-laboratory health care workers and centralized testing of blood glucose by automated analyzer in a tertiary care hospital. The study was conducted in Section of Chemical Pathology, Department of Pathology and Microbiology and Section of Endocrinology Department of Medicine, Aga Khan University and Hospital Karachi, from April 2005 to March 2006.One hundred and ten patients were included in the study. The blood glucose levels were analyzed on glucometer [Precision Abbott] by finger stick, using Biosensor Technology. At the same time venous blood was obtained to analyze glucose in clinical laboratory on automated analyzer [SYNCHRON CX7] by glucose oxidase method. We observed good correlation between bed side glucometer and laboratory automated analyzer for glucose values between 3.3 mmol/L [60 mg/dl] and 16.7 [300 mg/dl]. A significant difference was observed for glucose values less than 3.3 mmol/L [p=0.002] and glucose values more than 16.67 mmol/l [p=0.049]. Mean Turnaround time for glucometer and automated analyzer were 0.08 hours and 2.49 hours respectively. The cost of glucose testing with glucometer was 48.8% lower than centralized lab based testing. Bedside glucometer testing, though less expensive does not have good accuracy in acutely ill patient with either very high or very low blood glucose levels

Diagnosis of genetic defects by chromosomal analysis

Of 901 karyotypes performed over a period of 4 years, genetic anomalies were detected in 162 cases. Down's syndrome [trisomy 21] was the most common [68.6%] genetic disorder followed by Turner's syndrome, Philadelphia chromosome, Klinefelter's syndrome, Edward's syndrome [trisomy 18] and Patau's syndrome [trisomy 13]. All the three trisomies were detected very early in life. Mean age at the time of diagnosis for Turner's syndrome was 13.3 years, allowing a timely hormone replacement therapy to improve secondary sexual characters. Patients with Klinefelter's syndrome were diagnosed late [mean age 23.6 years], which greatly reduced their chances for an effective therapy to improve the clinical and social outcome