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.

Evaluation of 'CKD-EPI Pakistan' equation for estimated glomerular filtration rate [eGFR]: a comparison of eGFR prediction equations in Pakistani population

Objective: To evaluate the results of 24-hour urinary creatinine clearance [CrCl] with estimated glomerular filtration rate [eGFR] using the Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI], CKD-EPI Pakistan [CKD-EPI Pak], Cockcroft Gault [CG] and 4-variable Modification of Diet in Renal Disease [MDRD] equations

Study Design: Descriptive, cross-sectional study

Place and Duration of Study: Section of Clinical Chemistry, Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, from June to October 2013

Methodology: Laboratory data of subjects ³18 years ordering 24-hour urinary CrCl from June to October 2013 was retrieved. Statistical comparison of eGFR using CKD-EPI, CKD-EPI Pak, CG and MDRD with the timed urine collection CrCl was done using regression analysis

Results: The mean age of the group [n=670] was 51.3 +/-15.4 years with a median of 53 [IQR:22.3] years, 55.7% being males. Median BMI of males and females was 26.98 kg/m[2] [IQR: 7.09] and 26.16 kg/m[2] [IQR: 6.97], respectively. Mean GFR using 24-hour creatinine clearance was 57.1 +/-35.9 ml/min/1.73m[2] with a median of 51 ml/min/1.73m[2]. Urinary creatinine clearance showed strong correlation with CG, MDRD, CKD-EPI and CKD-EPI Pak, showing r=0.78, r=0.79, r=0.82, and r=0.82, respectively. Sensitivity was highest for the CKD-EPI Pakistan [84.7%]. Similarly, CKD-EPI Pakistan equation showed the highest agreement [88.7%] with CrCl compared to the other formulae

Conclusion: The CKD-EPI Pak equation is more accurate and precise than the CG, CKD-EPI and MDRD in estimating GFR in Pakistani population