Serum alkaline phosphatase screening for vitamin D deficiency states.

OBJECTIVE: To determine whether serum vitamin D levels are correlated with serum levels of alkaline phosphatase or not. STUDY DESIGN: Cross-sectional, observational study. PLACE AND DURATION OF STUDY: Multi-centre study, conducted at Liaquat National Hospital and Medical College, National Medical Centre and Medicare Hospital, Karachi, from January to October 2009. METHODOLOGY: Patients attending the Orthopaedic OPDs with complaints of pain in different body regions and serum vitamin D3 levels of ² 30 ng/ml were included in the study. Patients with vitamin D deficiency were further categorized into mild deficiency or insufficiency (vit. D3 = 20-29 ng/ml), moderate deficiency (vit. D3 = 5 - 19 ng/ml) and severe deficiency forms (vit. D3 < 5 ng/ml). Pearson correlation was applied to test the correlation of serum alkaline phosphatase levels with serum vitamin D3 levels. P-value < 0.05 was considered to be significant. RESULTS: Out of 110 samples, 26 had mild (23%), 61 had moderate (55%) and 21 had severe (19.1%) vitamin D deficiencies. All of the patients in the three groups had alkaline phosphatase with in normal limits and the total mean value of the enzyme was 135.97 ± 68.141 U/L. The inter group comparison showed highest values of alkaline phosphatase in the moderate vitamin D deficiency group. The correlation coefficient of alkaline phosphatase and serum vitamin D3 levels was r =0.05 (p =0.593). CONCLUSION: Serum vitamin D3 levels may not be correlated with increased serum alkaline phosphatase levels. Therefore, alkaline phosphatase may not be used as a screening test to rule out vitamin D deficiency.

Effect of low dose oral pill on haemostatic parameters in a set of Pakistani population.

OBJECTIVE: To observe the adverse effects of low dose combination contraceptive pills on blood coagulation in a set of local population. METHODS: Between December 2002 to December 2003 a comparative cross-sectional study was conducted at the Department of Pharmacology, Ziauddin Medical University, Karachi and Aga Khan University Hospital, Karachi. Fifty women of reproductive age were divided in two equal groups; one being the users of combination oral contraceptive pills (ethinyl estradiol and levonorgestrel) and the other being matching controls not taking any hormonal contraceptives. We studied, CBC, PT and INR, APTT, BT and platelet aggregation against ADP, collagen, epinephrine and ristocetin. RESULTS: PT, INR, and platelet aggregation response to ADP, collagen, epinephrine, and ristocetin were not significantly different among the groups. However, APTT was shortened in users of contraceptives (p = 0.003). CONCLUSION: The referred oral contraceptive is associated with enhanced activity of intrinsic pathway of secondary haemostasis.

Effect of a 'progestin only' contraceptive on platelet aggregation in a Pakistani set of population.

BACKGROUND: Safe use of progestin-only hormonal preparations has remained quite controversial though they are being employed in various disorders very commonly. These hormones result in a number of adverse effects in the body, the most drastic being predisposition to higher risk of thromboembolism with reports of involvement of platelets. Despite a large number of studies, no definite inference had been derived regarding the effects of these agents on blood coagulation. It has been reported that the response in various ethnic groups may vary. Therefore this study is designed to observe the effects of progestin-only hormonal contraceptives regarding primary hemostasis in our population. METHODS: We carried out this study on 50 women divided into two equal groups of 25 each, namely, a group of users of Progestin-only injectable hormonal contraceptive Norethisterone oenanthate 200 mg used as a 2-monthly injection and a control group and studied platelet aggregation against ADP, Collagen, Epinephrine and Ristocetin. RESULTS: There was no statistical difference regarding the platelet aggregation studies against ADP, collagen, epinephrine and ristocetin between users and nonusers of progestin-only injectable contraceptive. The menstrual irregularities were found to be more frequent in users of injectable hormonal contraceptives than in non-users, especially amenorrhea and irregularities of menstrual flow. In users of injectable hormnonal contraceptives, hemoglobin and hematocrit were slightly better maintained as compared to non-users. CONCLUSION: This suggests that Norethisterone oenanthate at currently used doses does not increase the platelet aggregation against ADP, collagen, epinephrine and ristocetin in our population.

Use of norethisterone oenanthate and predisposition to thrombosis.

OBJECTIVE: To observe the effects of progestin-only hormonal contraceptives in our population. DESIGN: Cohort study. PLACE AND DURATION OF STUDY: Department of Pharmacology, Ziauddin Medical University, Karachi and Department of Pathology, Faculty of Health Sciences, The Aga Khan University, Karachi from October 2002 to September 2003. PATIENTS AND METHODS: The study comprised of 50 women of reproductive age group, divided into two equal and matched groups of 25 each, namely, a group of users of progestin-only injectable hormonal contraceptive Norethisterone oenanthate [NET EN] 200 mg used as a 2-monthly injection and a control group not using any hormonal contraception. Complete blood counts, prothrombin time (PT) and international normalized ratio (INR) as well as activated partial thromboplastin time (APTT) were monitored. RESULTS: APTT and prothrombin time were not significantly different in both the groups. Menstrual irregularities were found out by more frequent in users of injectable hormonal contraceptives than in non-users (p= 0.001). Hemoglobin (p= 0.029) and hematocrit were slightly better preserved in the same group. CONCLUSION: Use of Norethisterone oenanthate does not predispose to thrombogenesis in current dose for contraception.

Transition from traditional to innovative teaching in and beyond pharmacology at Ziauddin Medical University.

Innovative teaching methodologies in different parts of the world are being practiced since last 3 decades. The aim of this review is to report the transition from traditional to innovative self learning process in Ziauddin Medical University, a new medical institute of Pakistan. Various problems encountered have been duly looked after by inducting faculty training programs and regular review sessions in which monitoring of the transition process was duly observed as well as further advancements were also planned. The University being a pioneer has attracted other institutions which have also planned to induct PBL in their curriculum. Vertical and horizontal integration has also inducted better understanding of subjects and fruitful advantages had been accomplished in subjects as pharmacology and pathology. In conclusion, the initial decision of the university to adapt innovative teaching methodologies along with following an integrated curriculum based on PBL and Community Oriented Medical Education system has now made ZMU a Novel institute amongst other medical institutes in the country.