Significance of invitro isolation of Alternaria alternate from Onychomycotic patients

Objectives: To determine the isolation rate of Alternaria alternata in patients with clinical Onychomycosis

Study Design: Descriptive [cross sectional] study

Place and Period of Study: Department of Microbiology, Armed Forces Institute of Pathology Rawalpindi, from August 2011-April 2012

Material and Methods: Sample size; 200 nail samples, Sampling Technique; Non probability convenience sampling. Nail clippings and nail scrapings were obtained from affected nails of patients clinically having onychomycosis. Direct microscopic examination with 30% potassium hydroxide mounts and culture on Sabouraud's dextrose agar [SDA], SDA containing Chloramphenicol, and SDA containing actidione and chloramphenicol were used for species identification

Results: Out of 200 nail specimens, 94 [47%] yielded positive fungal growth, while 106 [53%] nail specimens were found negative on culture. Non-dermatophyte moulds [NDMs] accounted for 62 [66%] of total culture positive cases, out of which Alternaria alternata was the commonest species [29%]. Dermatophytes were isolated from 20 [21%] all belonging to genus Trichophyton spp. and 12 [13%] were yeast

Conclusion: Study has yielded high number of NDMs especially Alternaria alternata, hence large scale multicenter clinical studies are required to ascertain the clinical significance of Alternaria alternata as pathogen particularly in patients with immunosuppression, as a causative agent of onychomycosis. Moreover, clinical trials to see the treatment outcome of NDMs isolated from these patients, will further help to unfold the clinical significance of this study

metabolic syndrome and inflammation: role of insulin resistance and increased adiposity

We sought to determine the role of obesity and insulin resistance [IR] in the pathogenesis of inflammation in metabolic syndrome [MetS]. Our study included 100 patients with MetS and 100 age and gender matched control patients who attended a tertiary care laboratory in Rawalpindi, Pakistan. Anthropometric data was obtained including height and weight to calculate body mass index. A record of patient's blood pressure [BP], waist circumference [WC] and hip circumference [HC] was made. Biochemical analysis included measurements of fasting glucose, triglycerides [TG], high-density lipoprotein cholesterol [HDL-c], insulin, and high-sensitivity C reactive protein [hsCRP]. IR was determined by the homeostasis mode assessment insulin resistance [HOMA-IR] method. The levels of hs-CRP were found to be elevated in all patients with MetS where it correlated significantly with all its components including measures of obesity, fasting insulin and glucose levels, IR, TG and HDL-c. However, on linear regression analysis only WC, fasting insulin, and HOMA-IR remained significantly correlated with hs-CRP. MetS is a condition characterized by chronic low-grade inflammation, which arises because of increased abdominal adiposity and IR. Large multicenter studies are needed to gain insight into its pathogenesis and derive treatment strategies

Comparison of serum calcium estimation by direct colorimetric and volume / volume colorimetric methods based on O-cresolphtalein principle

Calcium is the most abundant mineral and fifth most common element in the body. There are many different methods for estimation of serum calcium like spectrophotometeric, ion selective electrode [ISE] and atomic absorption methods. Aim of our study was to compare serum calcium estimation by using direct colorimetric and volume / volume colorimeteric [v/v] methods based on o-Cresolphthlein principle. The study was performed in a tertiary care laboratory in Rawalpindi from March to June '2011. It was a comparative prospective study. Seventy commercial quality control samples of Randox laboratories were simultaneously tested by both the methods. Results were analyzed on SPSS version 17. In normal controls, the v/v method kit gave the mean result of 2.34 mmol/L +/- 0.04 with a CV of 1.70% while with the direct colorimetric method kit the values were 2.31 mmol/L +/- 0.03 with a CV of 1.30%. In abnormal controls, v/v method kit gave the mean value to be 3.09 mmol/L +/- 0.04 with a CV of 1.29% while with the direct colorimetric method kit, the mean value was 3.07 mmol/L +/- 0.03 with a CV of 0.97%. Both the kits are recommended for use in a tertiary care laboratory as the precision and accuracy of both kits is comparable. But the volume / volume colorimetric kit is more cost effective

need and rationale of thyroid function tests in a tertiary care laboratory

To find out the outcome of thyroid function tests in a tertiary care laboratory and to assess the rationality of thyroid function tests advice. It was a descriptive study which was carried out in a tertiary care laboratory of Rawalpindi. Patient's demographic data and clinical details were recorded. Blood samples were obtained and analysis was done. Results were analyzed on SPSS version 17. One hundred twenty seven samples of both sexes with age range 15-80 years were selected for study and non probability random sampling was done. There were 94 [74%] females and 33 [26%] males. Age range of the patients was 38.8 +/- 14.4 years. Majority of the patients were found to be euthyroid 76.38%. On basis of history, the most common symptom for which thyroid testing was advised was lethargy. For non-specific symptoms, full thyroid profile should not be advised, rather Thyroid Stimulating Hormone [TSH] should be used as a first line screening test. Full thyroid profile is an expensive test and has financial implications on both patients as well as the laboratory, so rational use o thyroid function tests is recommended

Biochemical pattern of liver function tests in hepatitis E epidemic

To evaluate the biochemical pattern of liver function tests in acute hepatitis E epidemic. Cross sectional descriptive study. Department of Pathology Army Medical College, Rawalpindi from June '09 to Dec '09. A total of 81 patients of acute hepatitis of all age groups, both male and female were included in the study. Patients who reported with symptoms of acute hepatitis and tested positive for hepatitis E IgM antibody were included. Detailed history, clinical examination and serial liver function tests [LFTs] were carried out. Weekly data of LFTs was arranged serially up to 4 weeks. The results were analyzed on SPSS version 17. The patients' age ranged from 17-59 years. Serum Alanine Transaminase [ALT] values were highest in the first 2 weeks reaching 100 times the upper limit of normal [ULN]. Similarly serum total bilirubin [TBil] reached up to 8 times ULN in the 1st week. The increase in serum alkaline phosphatase [ALP] was 2 times ULN and then returned to within the reference range in the 3rd and 4th weeks before other variables. Serum albumin levels remained unchanged. Prothrombin time [PT] was found to be prolonged. Two cases ended up fatally. Rest recovered fully and became symptom free. Hepatitis E is a serious clinical condition. LFTs play an important role in its diagnosis. There is marked derangement of LFTs. Sharp rise in serum ALT up to 100 times ULN is a significant feature and should raise the suspicion of acute Hepatitis E

Clinical presentation in an outbreak of hepatitis E

In many cases of acute hepatitis, hepatitis E virus [HEV] is a common cause. Hepatitis E is a self limiting disease which shares many epidemiological, clinical and morphological similarities with hepatitis A. Both are enterically transmitted. The purpose of this study was to evaluate the clinical presentation of hepatitis E during an epidemic and correlate the clinical features with liver function tests [LFTs]. It is a cross sectional retrospective study. The study was conducted at Army Medical College [National University of Sciences and Technology] and Military hospitals Rawalpindi from July to December 2009. One hundred patients admitted to the hospital with clinical features of acute hepatitis including anorexia, nausea, vomiting, pain epigastrium, jaundice, raised serum total bilirubin [TBil] and serum aminotransferase [ALT] were included in the study. Hepatitis E in these patients was confirmed by detecting the presence of anti HEV IgM. The patients were monitored during their stay in the hospital and changes in their clinical condition were correlated with liver function tests [LFTs]. The most prominent symptoms in all patients were fatigue, nausea, anorexia, jaundice and dark urine, followed by pain epigastrium [50%], low grade fever [48%] and hiccups [2-3%]. Jaundice developed when mean total bilirubin was 127micromol/L, mean ALT was 1527 U/L and mean ALP 127 U/L. Serum bilirubin correlates with the development of jaundice. Hepatitis E presents with varying clinical features. The presentation is acute with marked anorexia, nausea and fatigue coupled with sharp rise in LFTs. Any adult presenting with acute onset of these symptoms should be investigated for LFTs and anti HEV IgM