Determination of neuron specific enolase [NSE] in small cell lung carcinoma [SCLC] and non-small cell lung carcinoma [NSCLC] patients

Neuron specific enolase [NSE] is routinely used as tumor marker in Small cell lung carcinoma [SCLC], and to some extent in non-small cell lung carcinoma [NSCLC]. In Pakistan, tumor marker technology is not a new one. It is however mostly directed towards uses in hepatic, breast, ovarian, uterine and colorectal cancers, whereas availability and general practice of its use for diagnosis of respiratory metastasizing disease such as lung cancer is seldom and rare, especially the SCLC/NSCLC specific NSE. The aim of present study is to determine the potential usefulness of NSE in diagnosis and prognosis of SCLC and NSCLC patients in our setting. Fifty-eight patients of lung cancer were identified and selected, between January 2004 to December 2007, and divided into various groups depending upon their clinical stage of disease. NSE level was determined in all patients and clinical history data and related pathophysiological components of all selected patients were carefully assessed and compulsorily followed to avoid any bias. Cancer status of patients were evaluated by data available from multiple bronchoscopies, X rays, cytology and histopathology examinations and grouped as SCLC with all five stages [I, II, IIIA, IIIB and IV] and NSCLC with only stage IV. NSE level was also determined in Healthy subjects and patients with non-malignant lung diseases [NMLD] for comparison. We observed significant elevation in levels in NSE for different stages of SCLC and NSCLC in comparison with healthy and NMLD groups. Most significant increase was noted in SCLC stage IV not only in comparison with healthy [P <0.001] and NMLD groups [P < 0.001] but also with stage I [P <0.001] within the group. Elevated difference in NSE levels was also correlated with stage II, IIIA and IIIB of SCLC group. As regard NSCLC, where patients belonged only to stage IV of disease, significant difference was observed with healthy [P <0.01] when compared with NSCLC, whereas non-significant difference in NSE levels was noted in group-SCLC stage II, IIIA and IIIB. In comparison, all stage IV patients [n=7] of SCLC exhibited higher levels of NSE with a range of 136.19 ng/ml to 175.01 ng/ml, higher than detected in patents of stage IV in NSCLC. The result of our study suggests that NSE appears to be a useful tumor marker for SCLC and to some extent, NSCLC. Moreover, NSE exhibits higher levels in some stages of SCLC suggesting, its specificity, not only for advanced stage of SCLC but also for SCLC in general as compared to NSCLC. Its determination, therefore, is beneficial in the diagnosis, treatment and a possible follow-up for patients survival

Assessment of sub-clinical hypothyroidism and hyperthyroidism status in adult patients

Generally sub-clinical hypothyroidism and hyperthyroidism are diagnosed on the basis of laboratory evaluation and mostly such patients' manifest with mild or devoid of any clinical signs or symptoms. It is known to be a common disorder, also refer to as sub-clinical thyroid disease particularly in middle-aged and elderly individuals. Moreover, it is reported that most patients who were found to have sub-clinical hyperthyroidism depicts TSH values between 0.1 to 0.45 micro IU/L and those with sub clinical hypothyroidism between 4.5 to 10 micro IU/L. In this respect, studies were carried out during January 2006-Dec 2007 in 230 adult patients [98 males, 132 females] for evaluation of sub-clinical thyroid disease. TSH and thyroid hormones [T3 T4, FT3 and FT4] levels of all patients were determined by standard methods to assess the extent of the sub-clinical status. In female group which comprised of 132 patients, a total of n =28 [21.20%] exhibited sub-clinical thyroid disorders [n = 18; 13.63% Sub-clinical hypothyroidism, n=10; 7.57% sub-clinical hyperthyroidism], whereas 59 [44.69%] exhibited true-thyroid disorder. Subsequent assessment in males shows that out of 98 patients; n = 15 patients [15.30%] showed sub-clinical thyroid disorders [n = 9; 9.18% sub-clinical hypothyroidism; n = 6; 6.12% sub-clinical hyperthyroidism], whereas 20 [20.40%] without any sub-clinical or true thyroid disease, respectively and thus presented as normal. It is concluded that sub-clinical thyroid dysfunction prevails in females with 12.17% occurrence whereas 6.52% in males. Furthermore, the evaluation and subsequent review of existing literature and reports, it is also advisable that routine screening for thyroid disease through clinical investigations aided with lab findings be promoted, especially in pregnant women

Evaluation of urinary protein to creatinine ratio as a predictor of end-stage renal disease

To evaluate the role of urinary protein to creatinine [P:C] ratio as a predictor of end-stage renal disease [ESRD] in renal failure patients. This study was conducted at Liaquat National Medical College and Hospital, Karachi from Jan-Dec 2006 on 121 patients [77 males, 44 females] with acute renal failure [ARF] and chronic renal failure [CRF]. Clinical history, relevant investigations, renal status, dialysis routine and frequency were recorded. Random Urine samples [single void] were collected and the P:C ratio were calculated. Out of 121 patients, 21 patients developed ESRD including 16 males [12 CRF, 4 ARF] and 5 females [all CRF]. Statistical analyses shows no significant difference between sum of P:C ratio of CRF and ARF patients. However moderate significance [P < 0.05] was noted among P:C ratio of ESRD patients when compared with males CRF and ARF groups. Similarly, female groups also showed non-significant difference, whereas ESRD patients [FCES], depicts moderate [P < 0.05] significance when compared with female CRF and ARF groups. P:C ratio of males and females ESRD groups showed no significance difference. Mean P:C ratio in male CRF end stage category was 4.12 +/- 0.82 [range 2.5 - 9.1] where as in male ARF end stage 3.78 +/- 1.67 [range 1.80- 7.12]. Mean P:C ratio in female CRF end stage category was 3.94 +/- 0.79 [range 1.76 - 5.98]. Patients with > 1.0 of P:C ratio has developed ESRD. Higher the ratio of P:C, the more was risk of deterioration of clinical condition

Hepatitis 'B' and 'C' viral infections in patients with hepatocellular carcinoma

Chronic exposure to Hepatitis B and C viral infections are strongly suspected of causing hepatocellular carcinoma [HCC]. Moreover, in considerable numbers of HCC cases, the patients found positive for Hepatitis infections. The development HCC is related to the integration of viral DNA into the genome of host hepatocytes. It is noted that African and Far East counties, where HCC is common, have high rates of hepatitis carriers, probably with vertical transmission, of viruses from generation to generations. The scope of present study is to evaluate the incidence of HBV or HCV infections in patients with HCC. A brief clinical history of 98 patients [Males; n = 59, Females n = 39] with confirmation of HCC along with base-line value of alpha-fetoprotein [AFP], is taken and cumulated. In all patients, AFP values were found to be elevated ranging from 15 to 1329 ng/ml in males [mean 184.82 +/- 39.26 ng/ml] and 17.00 to 1218 ng/ml in females [mean 179.26 +/- 41.11 ng/ml] with relevant clinical data. It was noted that in most of the confirmed cases of HCC, hepatitis infections of HBV and HCV origin is prevalent. In male HCC patients, 19 were diagnosed with HBV whereas 21 with HCV infection. In females 12 HCC patients were HBV positive and 14 with HCV. Remaining patients were investigated thoroughly for any infection, but found devoid of any. However, cirrhosis of biliary origin, haemochromatosis cystic fibrosis and drug-induced cirrhosis are persistent infections. The results are presented in relation to various risk factors, and clinical and diagnostic characteristic

role of bezafibrate in lowering risk factors for cardiovascular disease in diabetic patients

A number of hypolipidaemic drugs have been shown to lower the raised plasma fibrinogen concentrations indicating that lipid and haemostatic system may act synergistically in pathogenesis of cardiovascular diseases. The current study examines the possible role of lipid lowering drug bezafibrate to induce change in blood coagulation system and the architecture of fibrin network in addition to its known effects on lipid profile in diabetic patients. Methods based on turbidity for measurement of mass length ratio of fibrin fibers, permeability of the networks and their tensile strength have been used to assess the alterations induced by lipid lowering agent. The study group consisted of 38 patients [18 male and 20 female; age 40 - 65 years]. The patients were categorized into two groups. Group one included 20 diabetic patients, selected from Liaquat National Hospital, Karachi, with normal lipid profile as control [9 male, age 51.88 +/- 1.93 years; 11 female, age 48.36 +/- 2.44 years]. Second group included 18 diabetic patients, selected from National Institute of Cardiovascular Disease, Karachi, with altered lipid profile i.e. hypertriglyceridaemia and/or hypercholesterolemia [9 male, age 47.33 + 3.08 years; 9 female, age 48.66 +/- 3.99 years]. Blood samples were collected after 12-14 hours fasting at the start of the study and after administration of Bezafibrate [200 mg TDS] for 4 weeks. The samples were analyzed for blood parameters like cholesterol, low-density lipoprotein-cholesterol [LDL-C], high-density lipoprotein-cholesterol [HDL-C], triacylglycerol [TG],-and fibrin network characteristics. In addition to the changes in lipid profile, significant alterations were observed in the characteristics of fibrin networks by the drug. Amongst the changes induced are the properties of networks that make the networks more lysable by fibrinolytic agents. Clinical and pharmacological implications of these findings need further investigations