C-Reactive Protein Level In Coronary Artery Disease And Its Correlation With Serum D-Dimer.

BACKGROUND: C-reactive protein concentration has continuous associations with risk of coronary artery disease, ischemic stroke and death from several cancers. In addition, several studies have shown that CRP could be used to predict first ever myocardial infarction and stroke in healthy subjects, as well as outcome in acute setting. High levels of another biomarker, D-dimer, have been found to be independently associated with occurrence of coronary events. METHODS: This correlational study was carried out at the Department of Cardiology, Ayub Teaching Hospital Abbottabad, in collaboration with the department of Biochemistry Postgraduate Medical Institute Lahore from 15th July 2013 to 15th May 2014. Patients aged 30 years or more of either gender having coronary artery disease was included in the study. Their serum D-dimer levels and Creactive protein levels were measured for correlation with coronary artery disease. RESULTS: A total of 50 patients of CAD were included in this study. Out of these 30 (60%) were males and 20 (40%) were females. Elevated CRP levels and D-dimer levels were noted in all of these patients. Pearson correlation coefficient test was performed on both CRP and D-dimer levels. Pearson correlation coefficient was calculated to be r= -0.1522 and when a p value was calculated, it was found to be 0.292 which implied that the results were not significant. CONCLUSIONS: This study showed that there is no correlation between CRP levels and D-dimer levels in patients with Coronary Artery Disease.

Effect of monosodium glutamate on the serum estrogen and progesterone levels in female rat and prevention of this effect with diltiazem.

BACKGROUND: Glutamate is found in a wide variety of foods. It induces the uterine fibroid in the rats by increasing the levels of estradiol. Diltiazem is an effective preventive medication. This study was conducted to analyse the effect of monosodium glutamate on the serum estrogen and progesterone levels in adult Sprague Dawley rat and its prevention with diltiazem. METHODS: This Laboratory based randomized controlled trial was conducted in the department of Anatomy, Army Medical College, Rawalpindi in collaboration with National Institute of Health (NIH), Islamabad from 9th April to 23rd April 2012. In this experimental study, 30 adult female Sprague Dawley rats of average weight of 500 g were randomly assigned into three groups. The experimental group B was given 0.08 mg/kg of monosodium glutamate (MSG) orally and experimental group C was given 0.08 mg/kg of MSG and 10 mg/kg of diltiazem in distilled water orally for 14 days. The control group (A) received only laboratory diet. Using intracardiac route 5 ml blood was taken from each animal for hormonal assay. RESULTS: Hormone assay of the serum in the experimental group B showed increase in serum estrogen and progesterone levels as compared to the group A and there was minor increase in the hormonal levels in group C. CONCLUSION: MSG causes increase in the serum estrogen and progesterone levels in adult female rats and diltiazem prevents this effect.

Atherosclerosis in relation to fat penniculus (obesity) between xiphoid and umbilicus.

BACKGROUND: It has been shown that possible influence of body weight is more evident for coronary than aortic atherosclerosis; and more in men than women. Coronary heart disease due to obesity in males becomes significant when body mass index (BMI) exceeds 30 (30% overweight) and does not affect the life expectancy particularly in women. This study was conducted to asses the relation of thickness of fat penniculus (obesity) between xiphoid and umbilicus to different atherosclerotic lesions; and to collect basic data about age and sex distribution of this relation METHODS: It was prospective descriptive study and conducted at mortuary of King Edward Medical University, and Department of Pathology, Allama Iqbal Medical College. Lahore. A total of 130 human autopsies were carried out in one-and-a-half year of study duration. The ages of the deceased ranged between 8 and 85 years. Heart aorta and its major branches were included in this study. In addition, fat penniculus between xiphoid and umbilicus was measured and atherosclerosis lesions were categorised and correlated with this parameter. Haematoxylin and Eosin, and different special stains were done in Pathology Department of Allama Lqbal Medical College, Lahore to asses to severity of atherosclerosis lesions. RESULTS: The fatty streaks were present in predominantly more cases with Fat Penniculus < 20 mm than in asses with Fat Penniculus < 10 mm and < 30 mm. The fibrolipid plaques, complicated and calcified lesions were present in a dominant number of cases with Fat Penniculus < 30 mm on percentage basis. CONCLUSION: Raised lesions were seen more frequently in cases with Fat Penniculus 20 mm to < 30 mm than in cases with Fat Penniculus < 10 mm and < 20 mm thickness.

Differences in detection rates for serious neonatal diseases before and after institution of newborn rounds by paediatricians in a private sector hospital.

BACKGROUND: Perinatal and infant mortality are two major contributors to child mortality in developing world. It is widely recognised that synergistic efforts by paediatric and obstetric healthcare providers result in improvement of neonatal and infant survival. Close working relationship between the 2 disciplines with attendance of all high risk births by paediatric healthcare providers and routine examination of all neonates is required for this purpose. Objectives were to compare 2 continuums of 100 neonatal cases for detection of serious neonatal disease. One set of neonates being examined by neonatal/paediatric service and other without this service in place. METHODS: One hundred Neonatal Exam sheets were selected randomly from records of 2007-2008 and compared with 100 Neonatal Exam Sheets of 2006-2007. Records were analysed for detection of serious neonatal conditions at 24 hours age. Data was analysed using MS EXCEL. Odds ratio was calculated for each disease with Haldane correction. RESULTS: Odds ratio was significantly higher for detection of serious neonatal diseases in 2007-2008 group when neonatal service was actively involved in newborn examinations of all neonates. Highest odds ratios were obtained for detection of Heart Murmur and neonatal sepsis. CONCLUSIONS: Newborn Examination within 24-48 hours of birth by trained neonatal healthcare provider is paramount for adequate detection of serious neonatal diseases. Such services should be instituted in all obstetric units for better neonatal outcome.

Effectiveness of routine urine analysis of patient attending rural health centers in Abbottabad.

BACKGROUND: Renal diseases may be discovered accidentally during routine urinalysis. This study was done to see the significance of urinalysis and study the magnitude of abnormal urinalysis in patients with no symptoms of renal disease. METHODS: From 15th February to 16th March 2005, a total of 1000 samples of urine were collected from the patients attending three rural health centers of Abbottabad. Dipstick Method was used for urinalysis. RESULTS: there were 600 males and 400 female patients. The age ranged from 1 to 55 years. Proteinuria was present in 2.3%, hematuria in 4.8% patients, pyuria in 10.2% and glycosuria in 2% patients. CONCLUSION: In our setup routine urine analysis should be performed in all patients to identify the presence of unrecognized renal diseases which may benefit from simple therapeutic measures.

Variations of serum sialic acid level in liver cirrhosis.

BACKGROUND: Cirrhosis liver claims many lives in our country. However early diagnosis carries good prognosis and prevents complications. Estimation of serum sialic acid level may be helpful in the diagnosis of liver cirrhosis and following the dynamics of the disease especially during treatment and follow up to see the prognosis. METHODS: Sialic acid level of 82 confirmed liver cirrhosis patients of age between 18-60 years and admitted in Khyber Teaching Hospital Peshawar was determined and compared with 40 normal controls. The patients were studied in three groups according to the stage of the disease, i.e. the patients in early stages, in advancing stage, and those in terminal stage of liver cirrhosis. Sialic acid level was determined on HPLC (Hitachi) with D-2500 chromatographer. RESULT: Significantly high levels of sialic acid were recorded in patients as compared to controls. It was normal in early stage of liver cirrhosis (667 +/- 8.06 nmol/ml), markedly increased in advancing cirrhosis (952 +/- 3.29 nmol/ml) (P<0.05) and very high levels were observed in terminal stage (1058 +/- 7.50 nmol/ml). CONCLUSION: Serum Sialic acid level was high in advancing and terminal stages of disease as compared to early stage and controls that showed normal levels.

An audit of serological tests carried out at clinical laboratory of Ayub Teaching Hospital, Abbottabad.

BACKGROUND: Clinical audit is an important tool for reviewing and improving the quality of service in clinical laboratories. Here we present an audit of total serology test requests and the frequency of positive tests out of these in a calendar year. METHODS: This is an audit of serology tests carried out at Microbiology section of Clinical Laboratory of Ayub Teaching Hospital, Abbottabad. We counted all the serology test requests for the year 2004. These tests requests were grouped month wise. The frequency of positive tests out of the total test requests were calculated. The tests included Widal, Toxoplasma, Brucella, Anti DNA, Anti Nuclear factor (ANF), Rheumatoid Arthritis Factor (RAF), HIV, HBsAg, HCV, Intra Chromatographic Technique for tuberculosis (ICT-TB), Purified Protein Derivative (PPD), Venereal Disease Research Laboratory (VDRL) test, Anti-Streptolysin-O-test (ASOT) and pregnancy test. RESULTS AND CONCLUSIONS: This audit gives a clear idea of trends of test requests in our hospital. It reflects accuracy of clinicians' judgment in some tests and failure in others, prevalence of different diseases, seasonal variation in number of test requests for some tests and impact of awareness campaigns on attitude of clinicians towards certain diseases. This will help us in planning our laboratory requirements to improve quality.

HBsAg and HCV: increasing test requests and decreasing frequency of positive tests at clinical laboratory of Ayub Teaching Hospital, Abbottabad.

BACKGROUND: This audit was carried out to assess the frequency of positive results out of the total test requests made for HBsAg and HCV at our laboratory. The frequencies for three years were compared for significance. We have reported monthly total test requests and frequency of positive tests for each of these years in this article. METHODS: This study is an audit of all HBsAg and HCV test requests received at clinical laboratory of Ayub Teaching Hospital, Abbottabad during a three year period from 2002 - 2004. Both the tests were made using Rapid device (immunochromatographic kits) method. Frequencies of positive results were calculated from the total test requests for each month of these three years. Cumulative frequencies were compared for statistical significance of difference. RESULTS: Total HBsAg tests requested for years 2002, 2003 and 2004 were 2058, 2563 and 5207 respectively. The frequencies of HBsAg positive cases out of these were 5.53%, 4.36% and 2.68% respectively. The number of test requests for HBsAg increased significantly from 2002 to 2003 and 2004, while the frequency of positive tests decreased significantly (p < .001) during this period. Total HCV requests for years 2002, 2003 and 2004 were 1261, 1671 and 4638 respectively. The frequencies of HCV positive cases out of these were 14.19%, 8.79% and 5.84% respectively. Just like HBsAg, number of test requests for HCV increased significantly from 2002 to 2003 and 2004, while the frequency of positive tests decreased significantly (p < .001) during this period. CONCLUSIONS: The test requests have considerably increased in the last few years, probably as a result of increasing awareness of clinicians and public. However most of these tests are negative. In view of high prevalence of both HBsAg and HCV in Pakistan, this overcautious attitude of clinicians is understandable although this is a burden on the pocket of patients and hospital resources.