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.

Comparison of diagnostic accuracy of Glycated Hemoglobin [HBA1C] and 2-hour post Glucose for Diabetes using American Diabetic Association [ADA] cut offs in Pakistani population

Objectives: To determine median HbA1c level in patients screened for DM and compare the diagnostic accuracy of HbA1c with the currently recommended ADA cut off, using 2 hours [h] plasma glucose [2-h PG] post 75 grams oral glucose tolerance test [OGTT] as gold standard

Study Design: Cross sectional study

Place and Duration of Study: Aga Khan University Hospital Karachi, from Jul 2014 to Nov 2015

Patients and Methods: Consecutive subjects screened by OGTT for diabetes mellitus [DM] were included. Blood sample for plasma glucose and HbA1c were analyzed on ADVIA 1800

Results: Total 146 subjects were included with median age 45 [IQR 54.2-35] years; 53 percent [n=77] being females. Median HbA1c of the study subjects was 6 percent [IQR 6.6-5.6]. Positive correlation was observed between age and HbA1c [5.7 percent [IQR 6.2-5.3] <40 y, 6.2 percent [IQR 6.8-5.8] in >40 y subjects; r 0.34, p=0.000]. Males had higher HbA1c than females [6.1 percent [IQR 6.8-5.7] years. 5.9 percent [IQR 6.4-5.4]; r 0.17, p=0.036]. HbA1c levels were significantly different amongst the different ethnic groups residing in Pakistan [p-value<0.03]. HbA1c was positively correlated with FPG [r=0.59, p-value<0.001] and 2-h PG [r=0.56, p-value<0.001]. Sensitivity, specificity, PPV, NPV for HbA1c at cutoff of 6.5 percent in diagnosing diabetes mellitus [DM] were 70 percent, 89 percent, 72 percent and 80 percent respectively

Conclusion: High median HbA1c levels is noted in our subjects. At cut off level of HbA1c >/=6.5 percent, 70 percent of subjects with DM were diagnosed using ADA criteria of 2-h PG for diabetes as gold standard. Ethnic differences were also observed in levels of HbA1c. There is a need to define cut off for our population

Homeostatic model assessment for insulin resistance [HOMA-IR]: a better marker for evaluating insulin resistance than fasting insulin in women with polycystic ovarian syndrome

Objective: To assess the utility of HOMA-IR in assessing insulin resistance in patients with polycystic ovary syndrome [PCOS] and compare it with fasting insulin for assessing insulin resistance [IR]

Study Design: Observational study

Place and Duration of Study: Section of Clinical Chemistry, Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Karachi, from January 2009 to September 2012

Methodology: Medical chart review of all women diagnosed with PCOS was performed. Of the 400 PCOS women reviewed, 91 met the inclusion criteria. Insulin resistance was assessed by calculating HOMA-IR using the formula [fasting glucose x fasting insulin]/405, taking normal value <2 in adults and hyperinsulinemia based on fasting insulin levels >/=12 microIU/ml

Results: A total of 91 premenopausal women diagnosed with PCOS were included. Mean age was 30 +/- 5.5 years. Mean HOMA-IR of women was 3.1 +/- 1.7, respectively with IR in 69% [n=63] women, while hyperinsulinemia was present in 60% [n=55] women [fasting Insulin 18.5 +/- 5.8 microIU/ml]. Hyperandrogenism was present in 53.8% [n=49], whereas 38.5% [n=35] women had primary infertility or subfertility, while 65.9% [n=60] had menstrual irregularities; and higher frequencies were observed in women with IR. Eight subjects with IR and endocrine abnormalities were missed by fasting insulin

Conclusion: Insulin resistance is common in PCOS and it is likely a pathogenic factor for development of PCOS. HOMAIR model performed better than hyperinsulinemia alone for diagnosing IR

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