Diagnostic accuracy of risk of ovarian malignancy algorithm [ROMA] in post-menopausal patients with ovarian mass

Objective: To determine the diagnostic accuracy of ROMA in postmenopausal women with history of ovarian mass

Study Design: Observational study

Place and Duration of Study: Dr. Ziauddin University Hospital, Karachi, from May 2014 to June 2015

Methodology: Two hundred and sixty postmenopausal women of 40-65 years of age with ovarian masses, planned for surgery, were included in the study. Their samples were obtained preoperatively and analysed on Abbot Architect i1000 SR immunoassay analyser for quantitative estimation of tumor markers, i.e. HE4 and CA125. By combination of these two tumor markers, ROMA scores were calculated and studied after histopathological verification of masses

Results: Total number of patients were 260, out of which 122 [46.9%] were diagnosed as having ovarian cancer, while 138 [53.0%] were diagnosed as benign condition. Median ROMA score levels in patients with malignant masses were 95.58 [IQR=44.4] as compared to 20.6 [IQR=14] in benign masses. ROMA had sensitivity 92.6% [CI=86.47-96.04], specificity 78.3% [CI=70.09-83.82], positive predictive value 79% [CI=70.87-84.29], negative predictive value 92.3% [CI=86.02-95.9] and positive likelihood ratio 4.26, while negative likelihood ratio 0.1. Diagnostic accuracy of ROMA was 85%, based on ROC curve analysis. ROMA had the highest sensitivity in detecting ovarian carcinoma

Conclusion: ROMA is a very useful diagnostic tool for the preoperative stratification of patients with ovarian masses showing 85% diagnostic accuracy. However, there is need of more studies with homogenous laboratory procedures for HE4 and CA125 assays as well as patients, selection criteria, so we can draw firm conclusion about utility of ROMA in clinical setups

Serum hepcicin-25: a predictor of response to oral iron therpay

Background: Discovery of hepcidin, and its receptor in year 2000 has revolutionized iron metabolism studies. Measurement of serum hepcidin, may supplement existing investigational parameters of iron status in anemias. The aim of the study is to estimate baseline hepcidin level and evaluate it as a predictor of response after treatment of iron deficiency anemic with oral iron

Methods: This was a purposive follow up study; involving 102 patients aged 18 years and above selected from medical outpatient departments of a tertiary care hospital of Karachi. Baseline CBC, iron studies, and serum hepcidin-25 were measured. Patients of IDA were treated with oral ferrous sulphate 200mg thrice daily for 8 weeks. Repeat CBC on follow up visit assessed response, defined as increment in hemoglobin level by >1gm/dl post treatment. Logistic regression analysis was applied and receiver operating characteristics curves were plotted to find utility and identify hepcidin cutoff values as a predictor for response

Results: Mean baseline serum hepcidin-25 was 37.34+/-22.60 ng/mL. Regression models showed for every one unit increase of hepcidin, the odds of hemoglobin improvement decreased by [1-0.972]=0.028gm/dl, serum hepcidin-25 by itself significantly predicted improvement in hemoglobin level P=<0.05. The area under the curve for hepcidin compared with post treated hemoglobin was 0.73 [95% CI: 0.63-0.83]. For predicting response to therapy, hepcidin cutoff value of 40ng/mL, had sensitivity of 68%, specificity of 63%, positive predictive value of 85% and negative predictive value of 38%. Hepcidin quartiles were also constructed compairing 4th quartile parameters with 1st quartile parameters

Conclusion: Hepcidin 25 is a fair predictor for response of iron therapy in IDA patients; baseline hepcidin of 40ng/ml predicts treatment response

Visfatin and its relationship with the severity of coronary artery disease in Pakistani population

To determine plasma visfatin in patients with and without coronary artery disease and to correlate it with the coronary vessels blockage by using anagiography. Comparative Cross Sectional Study. This study was conducted at the Department of Biochemistry, Ziauddin University and Jinnah Medical and Dental College, Karachi from June 2009 to November 2010. The study includes 80 subjects [mean age 48.8 +/- 6.15; 40-55 years age range] who underwent coronary angiography for suspected coronary artery disease. Plasma visfatin levels were determined by using ELISA. Out of these 80 study subjects, 30 [37.5%] had single vessel CAD, 12 [15%] had two vessels CAD, 24 [30%] had three vessels CAD and 14 [17.5%] had non significant disease. Serum Visfatin levels were higher in three vessel disease [5.82 +/- 0.58] when compared with non significant [4.55 +/- 1.10] single vessel disease [4.86 +/- 0.93] and two vessels disease [5.53 +/- 0.79] respectively but these values were statistically nonsignificant in all four study groups. Serum Visfatin levels were high in all three study groups when compared with non significant disease group and positive correlation of serum visfatin with the extent of the coronary artery disease was observed