Bilirubin interference in plasma amino acid analysis by ion exchange chromatography

Objective: To evaluate the effect of bilirubin interference on plasma amino acid analysis by Ion Exchange Chromatography [IEC]

Study Design: Cross-sectional [method validation] study

Place and Duration of Study: Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi from August 2016 to July 2017

Methodology: Twenty non-icteric samples from paediatric patients were collected in lithium heparin tubes and analysed for amino acids on IEC-based BiochromeR 30+ Analyzer [Harvard Biosciences UK]. Baseline bilirubin levels were noted. Samples were spiked with neonatal bilirubin standard with concentration of 488.4 Mu mol/L [SpinreactR-Spain] at final concentrations of 50, 150 and 230 Mu mol/L and re-analysed for amino acids at these three concentrations

Results: Among the 20 selected patients with normal amino acid profiles, 12 [60%] were males. Majority [55%] were in age group of 1-5 years. Significant difference was observed for Arginine [p = 0.01], Histidine [p = 0.001], Isoleucine [p = 0.01], Leucine [p = 0.007], Lysine [p = 0.005], Ornithine [p = 0.03] and Phenylalanine [p = 0.02]. Mean rank of these amino acids showed decreasing trend with the increase of bilirubin concentration, and pronounced interference was identified at bilirubin level of 50 Mu mol/L. No difference was observed for alanine, citrulline, glutamic acid, glycine, methionine, proline, threonine, tyrosine, asparagine, aspartic acid, cystine, valine and tryptophan

Conclusion: Bilirubin significantly interferes with certain amino acid levels when analysis is carried out by ion exchange chromatography. A close follow-up of such patients with other biochemical tests and a repeat amino acid analysis, after jaundice is settled, is recommended to confidently rule out any possible inherited metabolic disorder in these patients

Bronchoalveolar lavage fluid [BALF] differential leucocyte count in patients with chronic obstructive pulmonary diseases

The aim of this study is to determine Bronchoalveolar lavage fluid [BALF] differential leukocyte count [DLC] in patients suffering from chronic obstructive pulmonary disease [COPD] and to identify the predominant cell type in our set of population. It is a cross sectional study. This study was conducted at a Tertiary Care Hospital in Karachi, Pakistan from March 2012 till October 2012. The study comprises of 140 patients with COPD with no treatment or poor compliance to treatment and no history of any interventional procedures. All patients have undergone pulmonary function tests [PFTs] to differentiate obstructive pattern disease from restrictive. Fiber optic bronchoscopy was also done, after which 10 cc of BALF was collected and run for DLC. Patients were divided in two groups A and B according to gender, and each group was further divided in to two subgroups on the basis of age i.e. above 40 years and below 40 years. All patients have higher percentage of lymphocytes as compared to polymorphs. A higher concentration of lymphocytes as compared to polymorphs in COPD patients is considered to be an uncommon in Pakistan as per literature survey is concerned, because very less work is done on BALF analysis. Our study suggests that percentage of lymphocytes in patients suffering from COPD is quite high and cases are not restricted to classical acute pulmonary infections

Pulmonary infections caused by nocardia species in patients with chronic obstructive pulmonary diseases

Pulmonary Nocardiosis [PN] is a severe and infrequent infection caused by Nocardia species, pathogen that can behave both as opportunistic as well as infectious with a high morbidity and mortality that mainly affects immunocompromised patients. In recent years, an increase in PN cases has been detected among patients with chronic obstructive pulmonary disease [COPD]. The factors that are associated with its presence and determinants of its prognosis remain unknown. The aim of this study is to identify the frequency of nocardia in bronco alveolar lavage fluid [BALF] of patients suffering from chronic obstructive pulmonary disease. Analyze the bronco alveolar lavage fluid [BALF] of patients suffering from COPD for presence of nocardia and determination of differential leukocyte count. Prospective study. This study was conducted at Tertiary Care Hospitals in Karachi from March 2012 till October 2012. It is a prospective study of COPD patients. The study comprises of 140 patients with chronic obstructive pulmonary disease with or without treatment. All patients were divided in two groups A and B according to gender, and each group was further divided according to age i.e. above 40 years and below 40 years. Out of 140 patients 68 turned out to be positive for Nocardia. Nocardiosis is considered to be uncommon in Pakistan, but out study suggests that prevalence of Nocardial infections in patients suffering from COPD is quite high and cases are not restricted to the classical immunocompromised host

Granulomatous mastitis: a case series

To find out the clinical and management profile of granulomatous mastitis [GM]. A case. This study was carried out at Civil Hospital and Dow University of Health Sciences, Karachi and Tuberculosis Clinic at Bantwa Hospital, Karachi, from January 1999 to January 2009. Histopathologically diagnosed cases of GM were studied. Data included, detailed history, examination, clinical diagnosis, ultrasound, mammogram and fine needle aspiration cytology [FNAC]. All patients were initially given antibiotics and corticosteroid for a period of 10 days. All patients were followed for a period of 6 months. Recurrent cases were managed by wide excision and followed for another period of 6 months. Percentage, mean and range values were determined on SPSS version 10. The mean age of the 22 patients was 37.6 years [range=22-52 years]. Right breast was affected in 54.5% and left breast in 45.5% patients. Eighteen [82%] were non-lactating. Patients presented clinically with painful breast lump in 54.5%, painless lump in 45.5% and additional discharging sinuses in 18%. Clinical diagnosis was chronic mastitis in 40.9%, tuberculosis of breast in 36.3% and malignancy in 22.7% patients. Mammography showed an ill-defined mass in 45.5% and asymmetrical density in 31.8%. Diagnosis was confirmed in all patients on histopathology. Recurrence was noted in 2 patients, managed by wide excision, and followed for another period of 6 months without evidence of complications. GM is an uncommon chronic inflammatory disease of the breast. Usually involving a single non-lactating breast in reproductive age group. It clinically mimics tuberculosis and carcinoma. Mammography remains non-conclusive. Excision and wide excision biopsy are both diagnostic and therapeutic in majority of cases. Treatment includes short course of steroids and antibiotic along with close regular surveillance

Spectrum of breast tuberculosis

To determine the presentation of breast tuberculosis, diagnostic methods and surgical treatments. A case series. This study was conducted at Dow University of Health Sciences and Tuberculosis Clinic at Bantwa Hospital, Kharadar, Karachi, from April 1999 to March 2007. Clinically diagnosed patients of breast tuberculosis, confirmed by laboratory work-up, were included in this study. Detailed history and examination of both breast and axillae were the primary diagnostic measures. Complete blood counts, ESR, Mantoux test, ultrasound, mammogram, fine needle aspiration cytology, staining for acid-fast bacilli both smear and culture were performed. Core biopsy for lumps more than 5 cm and wide excision biopsy for the lump less than 5 cm were the methods applied. Pre-designed research proforma was filled and descriptive statistics of age, site, side, clinical presentations, investigations were recorded and surgical treatment done. Anti-tuberculosis treatment was given to all patients. Thirty patients were studied with mean age of 28.4 years ranging from 16-48 years. Bilateral breast involvement was seen in 2 patients with 14 cases involving the right and left breast. Lymph node involvement was present in 7. Pulmonary tuberculosis was seen in 4 patients. Multifocal disease was present in 27 patients. The clinical presentation was with lump in 6, discharging sinuses in 14, cold abscess in 8, and non-healing ulcer in 2 patients. There were 5 lactating mothers. Montoux test was positive in 5, AFB smear and culture were positive in 3. Only AFB culture was positive in 4. Five patients required core biopsy for diagnosis of confirmation of lump more than 5 cm and wide excision biopsy was required in 7 patients with lump less than 5 cm. Despite antituberculous treatment, surgical management was required in 21 [70%] cases. Tuberculosis of the breast, simulating the carcinoma breast and granulomatous mastitis very closely and are difficult to be differentiated without tissue diagnosis. Surgical management is more often required

Pulmonary function test in a cohort of older Pakistani population

Pulmonary function test [PFT] depends on a number of factors as height, age, gender and race. Reference equations are used to determine a normal range of spirometry results which in turn are used clinically to determine whether the volumes measured in any individual fall within a range to be expected in a healthy person of the same gender, height and age. The study was conducted in Karachi on 249 healthy, nonsmoking subjects between 35 to 65 years of age were included in the study. The subjects included 149 males and 100 females whose pulmonary volumes and capacities were measured by spirometry. Prediction equation was first derived and the reference values were then calculated for FEV [1] and FVC. The values for both these parameters were found to be lower by about 13% and 18% in females and 10% and 12% in males respectively when compared with those given by researchers for Caucasians. Pulmonary function test reference values and prediction equations for both sexes between the ages of 35-65 years were derived for healthy, nonsmoking, urban Pakistani population. A considerable difference was found between prediction equations and reference values obtained in present study compared with other studies conducted in western countries