Chemical Pathology Department Research Articles

Serum Vitamin D Testing – A Necessity Or An Injudicious Expenditure

Objective: To evaluate the serum vitamin D levels and to determine the justification for vitamin D testing in patients. Study Design: Cross-Sectional study. Place and Duration of Study: Department of Chemical Pathology, Armed Forces Institute of Pathology Rawalpindi, Pakistan from Oct to Dec 2022. Methodology: Patients of either gender coming for vitamin D level estimation were included. Vitamin D levels were analyzed on Immunoassay auto-analyzer. Data was analyzed using SPSS version 26. Results: Out of 249 patients, 87(34.9%) were male while 162(65.1%) were female, with mean age 41.09±19.10 years and mean Vitamin D levels 73.08±45.86nmol/l. None of the patients (0%) had vitamin D deficiency, 174(69.9%) had vitamin D insufficiency, 72(28.9%) had vitamin D sufficiency, while 3(1.2%) had vitamin D excess. Major reasons for Vitamin D testing was bone pains, which were present in 72(28.9%) patients. A significant difference in vitamin D levels according to reason of testing (p<0.05) was observed. Total expense on vitamin D testing for 249 patients was PKR 722100/- (249x2900), as compared to cost of supplementation PKR 199200/- (249x800) in clinical suspected cases. Conclusion: Majority of patients that tested for vitamin D were in lower risk group, and were not vitamin D deficient, with bone pains being the complaint due to which most patients were tested.

Perturbation Patterns of Bone Metabolism Secondary to COVID-19 Among Nigerian Healthcare Workers

<i>Background</i>: Severe acute respiratory coronavirus-2 (SARS-CoV-2), the etiologic agent of coronavirus disease of 2019 (COVID-19) is known to affect several organ systems. However, the disease’s influence on bone metabolism is poorly characterized especially among native Nigerians. Consequently, the current study explored the effect of the disease on bone metabolism among Nigerian healthcare workers (HCWs). <i>Methods:</i> This was a prospective longitudinal study conducted in the Department of Chemical Pathology of the Rivers State University Teaching Hospital among unvaccinated HCWs in Rivers State, Southern Nigeria. Eligible HCWs (n=96) were followed up from when they unwittingly had contact with SARS-CoV-2 infected/COVID-19 patients until they developed symptomatic RT-PCR-confirmed COVID-19. Demographic, anthropometric, clinical, and laboratory data were obtained before and at diagnosis/confirmation of COVID-19 among the eligible HCWs. Statistical analysis was done using descriptive/inferential statistics at a p-value of <0.05. <i>Results</i>: At COVID-19 diagnosis, the HCWs had increased levels of inflammatory markers (procalcitonin, C-reactive protein, and D-dimer), raised bone resorption marker (s-CTX), but reduced bone formation marker (s-PINP) compared to the pre-COVID-19 parameters (p<0.001). These cardinal biochemical findings were more prominent among those with severe disease variant than those with non-severe disease variant (p<0.001). In addition, a negative correlation pattern was observed between these inflammatory markers and the bone formation marker, however, a positive correlation was observed between the inflammatory markers and the bone resorption marker (p<0.001). <i>Conclusion: </i>The current finding indicates perturbation of bone metabolism, associated with increased bone resorption pattern, secondary to COVID-19 among the studied population. Hence, it is highly recommended that the evaluation of bone metabolism status be incorporated into the management protocols for COVID-19.

The role of arginase estimation to predict hypertensive disorder of pregnancy at an earlier stage.

To determine the significance of serum arginase estimation as a predictor of pregnancy-induced hypertension and preeclampsia at an early stage. The observational, cross-sectional study was conducted from October 15, 2021, to October 15, 2022, at the Department of Chemical Pathology, in collaboration with the Department of Obstetrics and Gynaecology, Pakistan Railway Hospital, Islamic International Medical College Trust, Rawalpindi, Pakistan, and comprised pregnant women with 20-25 weeks of gestation who were divided into three groups. Those having no complications were placed in control group A, those with pregnancy-induced hypertension in group B, and those with preeclampsia in group C. Serum arginase, uric acid, alanine transaminase, platelet count and spot urinary protein levels were measured for each subject. Data was analysed using SPSS 26. Of the 90 women, 30(33.3%) were in group A with mean age 27.27±2.90 years, 30(33.3%) were in group B with mean age 30.17±2.48 years, and 30(33.3%) were in group C with mean age 29.33±3.11 years. There were significant intergroup differences in the mean levels of serum arginase, serum uric acid, alanine transaminase, platelet count and spot urinary protein (p<0.05). A moderate to marked increase in serum arginase levels in pregnancy-induced hypertension and preeclampsia cases, combined with abnormal serum uric acid and alanine transaminase levels along with low platelet count suggested that serum arginase estimation could be used to predict hypertensive disorders of pregnancy at an early stage.

Triglyceride-glucose index: A surrogate marker of homeostasis model assessment of insulin resistance to predict diabetic nephropathy.

To determine the association of triglyceride-glucose index with homeostasis model assessment of insulin resistance in type 2 diabetes mellitus patients, and to determine the association of triglyceride-glucose index with urinary albumin-to-creatinine ratio for predicting diabetic nephropathy. The observational, cross-sectional study was conducted from September 2021 to September 2022 at the Department of Chemical Pathology, Pakistan Railway Hospital, Rawalpindi, Pakistan and comprised recently-diagnosed type 2 diabetes mellitus patients. Recorded data included age, gender, vitals, diabetes duration, body mass index and other pertinent demographic and clinical information. Measurements included spot urine albumin-to-creatinine ratio, triglycerideglucose index, homeostasis model assesment of insulin resistance as well as fasting serum insulin, fasting plasma glucose, glycosylated haemoglobin, triglycerides, total cholesterol and serum creatinine. On the basis of triglyceride-glucose index scores, the participants were divided into 4 quartiles; Q1=4.5-5, Q2=5.1-5.5, Q3=5.6-6, and Q4=>6. Data was analysed using SPSS 26. Of the 218 patients, 141(64.7%) were females and 77(35.3%) were males. The overall mean age was 49.22±11.46 years. There were 102(46.8%) overweight patients, 33(15.1%) obese and 82(37.2%) had normal weight. There were 58(26.6%) patients in Q1, 86(39.4%) in Q2, 46(21.1%) in Q3 and 28(12.8%) in Q4. Those in Q4 showed elevated fasting plasma glucose, glycated haemoglobin, triglycerides, total cholesterol, low-density lipoprotein cholesterol, homeostasis model assessment of insulin resistance and urine albumin-to-creatinine ratio (p<0.05), as well as low values for high-density lipoprotein cholesterol and estimated glomerular filtration rate(p<0.05). Fasting serum insulin was negatively linked to glycated haemoglobin (r=-0.12, p=0.07). Triglyceride-glucose index (r=0.76, p<0.001), homeostasis model assessment of insulin resistance (r=0.48, p<0.001), and urine albumin-to-creatinine ratio (r=0.10,p=0.05) positively correlated with glycated haemoglobin. Fasting serum insulin (r=-0.13, p=0.05), negatively correlated with triglyceride-glucose index, while homeostasis model assessment of insulin resistance (r= 0.32, p<0.001) and urine albumin-to-creatinine ratio (r=0.28, p=0.05) had a positive correlation. The estimated glomerular filtration rate was significantly positively linked with fasting serum insulin (r=0.05, p=0.05), and correlated significantly negatively with triglyceride-glucose index (r=-0.35, p=0.01), homeostasis model assessment of insulin resistance (r=-0.01, p=0.86) and urine albumin-to-creatinine ratio (r=-0.02, p=0.8). The triglyceride-glucose index showed a strong association with homeostasis model assessment of insulin resistance, and surpassed it in terms of predicting diabetic nephropathy in type 2 diabetes mellitus patients.

Glycated hemoglobin (HbA1c) in diagnosis of gestational diabetes mellitus

Objective: To evaluate the diagnostic accuracy of glycated hemoglobin for diagnosing gestational diabetes mellitus. Material and Methodology: This cross-sectional comparative study was conducted at the Department of Chemical Pathology and Endocrinology, Reference Laboratory, Rawalpindi from June 2023 to October 2023. The study included women having gestational amenorrhea between 24th to 28th weeks, who gave informed written consent for a 75-gram oral glucose tolerance test (OGTT) at Reference Laboratory Rawalpindi. Women with diabetes, hypertension, hemoglobin&lt; 10g/dl, on steroid treatment, with gastrointestinal or thyroid diseases were excluded. The medical history and anthropometric measurement (height, weight, body mass index (BMI) and blood pressure were recorded on a predesigned proforma. Blood sample for glucose was taken in sodium fluoride tubes and HbA1c in potassium EDTA tubes. American Diabetes Association criteria 2023 was used to diagnose gestational diabetes mellitus (GDM). Study participants were divided into two groups on basis of 75g- OGTT results; Group 1 included GDM and Group 2 Normal Glucose Tolerance (NGT). Results: A total of 100 pregnant ladies were enrolled whose ages ranged from 15-45 (mean &amp; SD 29±5 &amp; 31±6 years in groups 1&amp; 2 respectively). Mean fasting plasma glucose (FPG) was 5.11±0.6 mmol/l &amp; 4.57±0.4mmol/l, and HbA1c was 6.12%±1 &amp; 5.26% ±0.48 in groups 1&amp; 2 respectively. GDM was found in 19 (group 1) of 100 patients, while 81 responded normally. HbA1c at 5.6% has 84.2% sensitivity, 87.6% specificity, 61.5% PPV, 95.9% NPV and 87% diagnostic accuracy. FPG, 1hr glucose and HbA1c exhibited an Area Under Curve (AUC) by Receiver Operating Characteristic (ROC) Curve of 0.762, 0.801 &amp; 0.894 respectively. Conclusion: HbA1c has shown higher diagnostic yield for gestational diabetes mellitus and can be used as a screening test. Keywords: Glycated hemoglobin, Oral glucose tolerance test, Gestational diabetes mellitus

Anti-Mullarian Hormone As A Diagnostic Marker of Polycystic Ovary Syndrome

Objective: To determine the utility of Anti-mullerian hormone (AMH) as a diagnostic marker of Polycystic ovarian syndrome (PCOS). Study Design: Comparative cross-sectional study Place and Duration of the Study: Department of Chemical Pathology and Endocrinology, Army Medical College Rawalpindi, Pakistan in collaboration with the Department of Gynaecology and Obstetrics, Pak-Emirates Military Hospital, Rawalpindi Pakistan from Jan 2019 to Jan 2020. Methodology: The study recruited 30 cases of PCOS and 30 age-matched Controls using Rotterdam criteria. Anti-mullerian hormone (AMH) and testosterone were measured for both the study groups. Results: Receiver operator curve (ROC) analysis confirmed the utility of anti-mullerian hormone in diagnosing patients with PCOS. The AUC was 0.754 with 95% CI (0.629-0.880). The optimal cut-off point was 3.22ng/mL (Sensitivity 80%, Specificity 66.7%). Conclusion: The AMH is appraised as an independent screening marker for PCOS patients. Using this single parameter can decrease the patient's inconvenience and financial burden on the health care system and the patient.

Diagnostic Accuracy of Heart Type Fatty Acid Binding Protein and Conventional Cardiac Troponin I in Early Diagnosis of Acute Myocardial Infarction

Background: Acute myocardial infarction (AMI) remains a leading cause of global morbidity and mortality, with early diagnosis being crucial for effective treatment and improved patient outcomes. The search for reliable early biomarkers to supplement traditional cardiac markers has been ongoing, with heart-type fatty acid-binding protein (H-FABP) emerging as a potential candidate due to its rapid post-ischemic release into the bloodstream. Objective: This study aimed to evaluate the diagnostic accuracy of H-FABP in comparison to conventional cardiac troponin I for the early detection of AMI in patients presenting with acute chest pain. Methods: A descriptive cross-sectional study was conducted at the Chemical Pathology Department of Combined Military Hospital Lahore from December 21, 2022, to April 21, 2023. Eighty patients presenting with symptoms suggestive of AMI were enrolled. Serum concentrations of H-FABP and cardiac troponin I were measured using the sandwich ELISA method. Diagnostic performance was assessed in terms of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and receiver operating characteristic (ROC) curves. Statistical analysis was performed using SPSS version 25. Results: H-FABP demonstrated a sensitivity of 96.2%, specificity of 60.0%, PPV of 91.3%, and NPV of 81.8%. In contrast, cardiac troponin I had a sensitivity of 81.3% and a specificity of 60.0%, with PPV and NPV values of 91.3% and 81.8%, respectively. The area under the ROC curve (AUC) for H-FABP was 0.640 (p=0.031), slightly higher than that for cardiac troponin I, which was 0.624 (p=0.057). Conclusion: H-FABP shows promise as a more sensitive early biomarker for AMI compared to cardiac troponin I, suggesting its potential utility in enhancing early diagnosis and improving patient care. However, its lower specificity highlights the need for its combined use with traditional markers for a more accurate diagnosis.

Pattern of Vitamin D Status in Patients with Non-Specific Bone Pains- A Single Centre Study

Objective: To determine the pattern of Vitamin D status in patients presenting with complaints of non-specific bone pains and to correlate the association of sunlight exposure with Vitamin D deficiency/insufficiency Study Design: Cross-sectional study. Place and Duration of Study: Department of Chemical Pathology, CMH, Abbottabad Pakistan, from Aug 2020 to Jul 2021. Methodology: All patients with non-specific bone pain were asked about demographic, clinical and sunlight exposure. Vitamin D assays were performed after history taking. Result: A total of 247 patients were tested for vitamin D levels. 103(41.7%) were male and 144(58.3 %) were females. 56(22.7%) had &gt;60 minutes of daily sunlight exposure, 67(27.1%) had 30 to 60 minutes, and 124(50.2%) had less than 30 minutes of daily sunlight exposure. Vitamin D deficiency was found in 132(53.4%) patients, insufficiency was seen in 74(30.0%) patients and 41(16.6%) patients had normal vitamin D levels. Vitamin D deficiency correlated significantly with low sunlight exposure time. Conclusion: Vitamin D deficiency was seen in 53.4% of patients with non-specific bone pains, while insufficiency was seen in 30.0% of patients. Moreover, our study showed association of Vitamin D deficiency with a decreased duration of sunlight exposure.

REFERENCE INTERVAL OF PLACENTAL GROWTH FACTOR IN NON-PREGNANT AND PREGNANT FEMALES

Objective: To determine the reference interval of placental growth factor in healthy non-pregnant and pregnant females. Material and Methods: This cross-sectional study was conducted at Chughtai Institute of Pathology Chemical pathology department from January 2023-May 2023. Reference individuals were selected by purposive, non-probability sampling technique from 130 diseased free non-pregnant and 130 disease free pregnant females. Informed consent was obtained from females of reproductive age group who fulfilled the inclusion criteria. Levels for PGF was measured by a fully automated immunoassay analyser Elecsys system Cobas e601. Data was analyzed by using SPSS21. Kolmogorov-Smirnov test was applied. P value &lt;0.05 was considered significant. The 2.5th and 97.5th percentiles were calculated at 90% CI by using the formula 0.025x(n+1) at rank number 1 and 0.975x(n+1) at rank number 7. Results: Reference intervals were calculated by Rank-based method. Data values were arranged and rank numbers were allocated. Reference interval of PGF in non-pregnant and pregnant females were determine on the basis of 2.5th and 97.5th percentiles was 3.8 to 12.7 pg/mL and 46.43 to 1148 pg/mL respectively. Conclusion: Current study findings add on contribution in comparison between reference interval of PGF in healthy non-pregnant and pregnant females. It will subsequently help the gynaecologist, clinicians, pathologist to interpret the results in order to decrease the feto/maternal complications related to pre-eclampsia. PGF levels can be cost effective by reducing unnecessary hospitalization and investigations in females at minimal risk of pre-eclampsia. Keywords: Reference interval, Placental growth factor, Pre-eclampsia.

Plasma Glycosaminoglycans (GAGS) Levels as a Biomarker in Renal Cell Carcinoma Patients

Objective: To determine the diagnostic accuracy of plasma Glycosaminoglycans (GAGs) in Renal Cell Carcinoma (RCC), taking histological findings as the reference standard. Study Design: Cross-sectional study. Place and Duration of Study: Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, in collaboration with Armed Forces Institute of Urology, Rawalpindi Pakistan, from Sep 2020 to Jun 2021. Methodology: The study comprised sixty-two (62) diagnosed cases of RCC. All the patients had nephrectomy, and histopathological findings confirmed the diagnosis. Plasma samples for GAG levels were collected in EDTA tubes and assayed by manual ELISA. The Receiver Operating Characteristic (ROC) curve was constructed, and the Area Under the Curve (AUC) was calculated. Results: The mean age of the study population was 52.7+10.5 years. At a cut-off of 34 ng/ml, the sensitivity and specificity of plasma GAG levels were 83.9% and 94.2%, respectively, in diagnosing RCC taking biopsy as a gold standard. Positive predictive value (PPV) and negative predictive value (NPV) at this cut-off were 93.7% and 84.9% respectively. The area under the curve (AUC) for plasma GAG levels was 0.97, which further supported the use of this test in diagnosing RCC. Conclusion: Plasma GAG levels can be used as a promising diagnostic test in patients with RCC. It can prove relatively more convenient and cost-effective for diagnosing such cases.

Diagnostic Validation of Fully Automated ANA Detection by Indirect Immunofluorescence: An Initiative towards Standardization

Objective: This study entailed the diagnostic validation of an automated system utilized for the detection of antinuclear antibodies (ANA) through the indirect immunofluorescence method, juxtaposed with the traditional manual approach for ANA detection. The study was undertaken in the Department of Chemical Pathology at Chughtai Laboratory, Lahore, spanning a period of three months, from December 2018 to February 2019. Methods: A total of 132 patient samples were gathered for the purpose of conducting this validation study. The manual detection of ANA was performed by using slides coated with HEp-2 cells. An LED fluorescence microscope was used for the interpretation of results by a trained technologist as well as by a pathologist. After manual detection of ANA, the same specimens were evaluated by a fully automated ANA-IIF detection system which has inbuilt characteristics of slide processing, microscopy, image capturing and displaying specific ANA patterns. The results were interpreted as positive for those samples having sample titers more than 1:80. The same criteria of positivity were used for both manual and automatic systems. Results: A total of 132 specimens underwent evaluation through both manual and automated ANA indirect immunofluorescence (IIF) detection systems. The concordance between these two methodologies exhibited an overall agreement of 95.7%, with a positive agreement of 97.5% and a negative agreement of 94.9%. Cohen's kappa value stood at 91.7% (ranging from 83.4% to 98.9%), indicating a robust correlation between the two detection systems. The diagnostic sensitivity of the fully automated IIF methodology demonstrated 89.38% (with a 95% confidence interval of 77.24% to 96.13%) and the diagnostic specificity of 95.22% (with a 95% confidence interval of 87.88% to 98.76%). Conclusion: The fully automated showed strong correlation with manual ANA detection methodology based on the principle of indirect immunofluorescence.

Assessment of Trace Metal Disturbances in Healthcare Workers Exposed to Low Dose Ionizing Radiations in a Tertiary Care Hospital

Objective: To determine the effects of ionizing radiations on trace metal levels in healthcare workers exposed to occupational radiation in a tertiary care health facility. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Chemical Pathology &amp; Endocrinology, Armed Forces Institute of Pathology, Rawalpindi Pakistan, in collaboration with the Department of Radiology, Combined Military Hospital, Rawalpindi Pakistan, from Apr to Oct 2021. Methodology: Healthcare workers (n=45) exposed to occupational radiations were compared with an equal number of Controls in a tertiary care health facility for their trace metal levels. An atomic absorption spectrophotometer (AAS) was used to measure serum zinc (Zn) and copper (Cu) levels. A calorimetric technique was used to measure serum iron (Fe) levels. Results: Mean serum Copper (9.54±2.52 µmol/l) and Zinc (11.78±1.90 µmol/l) concentrations of the Risk-Group were significantly lower than their respective Control-Groups (Copper: 14.76±3.13 µmol/l and Zinc: 14.67±3.01 µmol/l). At the same time, mean serum Iron levels in the Exposed-Group (17.55±3.88 µmol/l) were significantly (p&lt;0.001) higher than the Control-Group (14.41±4.23 µmol). The duration of radiation exposure was inversely proportional to serum Copper (p-value0.002) and serum Zinc (p&lt;0.001) concentrations, which is statistically significant. At the same time, serum iron level (p-value0.001) and TIBC (p-value 0.003) increased proportionately with increasing duration exposure, which was also statistically significant. Conclusion: Low-dose ionizing radiation exposure led to a significant decrease in serum Copper and Zinc levels, whereas an increase in serum Iron levels was no................

REFERENCE RANGE OF NT PRO BNP IN HEALTHY PREGNANT FEMALES

Objective: To define the Reference Range of NT pro-BNP (N-terminal pro–B-type natriuretic peptide) during the first trimester of pregnancy in healthy females. Material and Methods: This Cross-sectional study was conducted in the Department of Chemical Pathology, Combined Military Hospital, Lahore from September to November 2022. This cross-sectional study focused on the reference range of NT pro-BNP in healthy pregnant females. Sampling of the data was done by using the nonprobability consecutive sampling technique. A maximum number of available participants (365 pregnant females) during the study period were recruited. Descriptive statistics were shown as mean ±SD. For the reference range for NT pro-BNP 2.5th percentiles (lower limit) and 97.5th percentiles (upper limit) were estimated. Results: A total of 365 pregnant females were included with first trimester pregnancy, having the mean age 28.54±5.18 years. Out of 365 participants, 299 females had BMI &lt;25 whereas 66 were overweight. Forty-One females had Hb level ≤ 10 g/dl and 324 females had HB &gt;10 g/dl. The Platelet count was &gt;150 x 10^9/L in 338 women, and ≤150 x 10^9/L in 26 women. The Median of NT pro-BNP was 56.80 pg/mL in the first trimester. Reference range of NT pro-BNP in pregnant women with BMI &lt;25 was (17.89 – 257.00) pg/mL as compared to (16.88 – 130.63) pg/mL in those with BMI &gt;25. Conclusion: The Reference range of NT pro-BNP changes in pregnancy as compared to healthy non-pregnant adults, likely due to hemodynamic changes associated with pregnancy. This study has defined a Pregnancy-specific reference range of NT pro-BNP in the first trimester which can help diagnose pregnant women with underlying cardiovascular disease. Keywords: NT pro-BNP, Reference range, Pregnancy

Clinical and demographic characteristics of organic acidaemias in children in a tertiary care hospital in Sri Lanka: A 4-year experience in a single centre

Background: Organic acidaemias (OAs) are a biochemically heterogeneous group of inborn errors of metabolism. They are rare and infrequently reported worldwide. Most OAs are clinically apparent in the neonatal period or early infancy while some can present as a chronic progressive form or even an asymptomatic form. Objectives: To describe the clinical presentation, demographic characteristics and the incidence of OAs in Sri Lankan children. Method: A retrospective descriptive cross-sectional study was conducted over a 4-year period by reviewing records of children suspected of having OAs referred to the Department of Chemical Pathology, Lady Ridgeway Hospital. Demographic information, clinical manifestations, biochemical investigations and mutational results were recorded and analysed using descriptive statistics. Definitive diagnosis was established by gas chromatography and mass spectroscopy (GC-MS) of urine for organic acids. Results: Among the 458 patients suspected, 20 (4.3%) were confirmed to have an OA resulting in an incidence of 13/319,000 live births per year. The mean ages at onset of symptoms and diagnosis were 11.8 months (range; day 1 to 5 years) and 27.1 months (range; day 10 to 12 years) respectively. Among the 20 patients were 5 (25%) with propionic acidaemia and 4 (20%) with beta-ketothiolase deficiency. Nineteen (95%) presented acutely. Common manifestations were respiratory distress in 12 (60%) and persistent or recurrent vomiting in 10 (50%). Learning difficulty, dyskinesia and macrocephaly were some chronic manifestations. Biochemically, 15 (75%) had acidosis and 9 (45%) had ketosis. There were 13 (65%) deaths of which 6 were neonates with acute presentation. Conclusions: Propionic acidaemia and beta-ketothiolase deficiency were the common OAs identified. Common clinical presentations were respiratory distress and persistent or recurrent vomiting. Acidosis was a common biochemical finding.

Comparison of Parathyroid Hormone and Vitamin-D Levels in Individuals with Prediabetes, Diabetes and Normoglycemia

Objective: To evaluate levels of Parathyroid Hormone (PTH), Vitamin D and glycaemic control in individuals with diabetes, prediabetes and normoglycemia. Study Design: Cross-sectional study.Place and Duration of Study: Department of Chemical Pathology, Combined Military Hospital, Quetta Pakistan from Jan to Jun 2020. Methodology: We included subjects with diabetes, prediabetes, and normoglycemia and were divided into three groups i.e.,normoglycemic, prediabetics, and diabetics based on their Fasting Plasma Glucose and Glycosylated Haemoglobin (HbA1c) levels. They were further divided into subgroups based onsubjects’ Vitamin D and Parathyroid Hormone levels. Results: Vitamin D was deficient in all groups. Patients with prediabetes with Vitamin D deficiency had raised Parathyroid Hormone levels but patients with Vitamin D insufficiency had normal Parathyroid Hormone levels. Patients with diabetes with Vitamin D deficiency had raised Parathyroid Hormone while patients with Vitamin D insufficiency had normal Parathyroid Hormone levels. Healthy subjects with Vitamin D deficiency or insufficiency had normal Parathyroid hormone. About 90% of diabetics had Vitamin D deficiency and raised Parathyroid hormone with HbA1c&gt;7% while 10% were withVitamin D insufficiency and normal Parathyroid hormone level with good glycaemic control (HbA1c&lt;7%). Conclusion: Vitamin D was deficient in all groups suggesting the importance of Vitamin D supplementation. Patients having raised Parathyroid hormone levels and Vitamin D deficiency have glycaemic dysregulation in prediabetics and diabetics. It signifies the importance of measuring Vitamin D and PTH levels in Diabetes Mellitus, particularly response of Parathyroid hormone towards diabetics.

Comparison of Acid Base Status and Electrolytes in Individuals with Prediabetes, Diabetes and Normoglycemia

Objective: To determine the acid-base status and electrolytes in individuals with pre-diabetes, diabetes and normoglycemia. Study Design: Cross-sectional study. Place and Duration of Study: Department of Chemical Pathology, Combined Military Hospital, Quetta Pakistan, from Jan2020 to Jun 2020. Methodology: Two hundred study participants were part of this cross-sectional study. Study participants were divided into 3 groups based on plasma glucose levels normoglycemics, prediabetics, and patients with diabetes. Sample for serum electrolytes, plasma glucose, and venous blood gases was taken and analyzed. Results were calculated statistically by using SPSS 21. Results: Mean age of study participants as 40.11+/-13.93 years. Out of these, 130(65%) study participants were males and 70(35%) were females. Out of these 200study participants, 105(52.5%) had sodium level &lt;135mmol/L and serum potassium &lt;3.5mmol/L, 90(45%) had serum sodium level between 135-145mmol/L and serum potassium level between 3.5-5.5mmol/L and only 5(2.5%) had serum sodium level &gt;145mmol/Land serum potassium &gt;5.5mmol/L. Similarly, 5(2.5%) study participants had serum chloride level &lt;98mmol/L, 84(42%) between 98-108 mmol/L and 111(55.5%) ad &gt;108mmol/L with a mean of 106±5 mmol/L. Regarding acid base disturbance, metabolic acidosis was observed in patients with diabetes as compared to normoglycemic and prediabetics. Conclusion: Patients with different stages of hyperglycemia have a different pattern of electrolytes and acid-base status which can be used as surrogate markers of normoglycemia, prediabetes, and diabetes.

Comparison of arterial blood gas results obtained using two types of Heparinized Syringes

Objective: The objective of this study was to compare the arterial blood gas results obtained using syringes heparinized with liquid heparin and syringes containing lyophilized balanced heparin. Study Design: Comparative cross sectional. Place and Duration: This study was conducted in the Chemical Pathology department at Combined Military Hospital, Lahore for a period of six months from November 2022 to March 2023. Methodology: A total of 100 arterial blood samples were taken from 50 patients admitted in ICU using a regular plastic syringe flushed with 5000 IU/ mL liquid heparin and another containing lyophilized heparin. Samples were analyzed immediately after collection on Roche Cobas b121 ABG analyzer. Three of the measured parameters (pH, pCO2 and pO2) were then compared among both syringe groups. pH, pO2 and pCO2 were compared using mean difference. Results: The difference of means for pH was insignificant (p- Value &gt;0.05). But pCO2 and pO2 showed significant difference in means with p- Values &lt;0.05 (0.007 and 0.037, respectively). Bland Altman plots were also plotted for all three parameters. 12% of the pH values, 8% pco2 and 6% pO2 values exceeded the total allowable error. Conclusion: Arterial blood pH was comparable between the two types of syringes used. The pCO2 and pO2 differed significantly and where found to be lower in blood samples collected in the liquid heparin syringes. Keywords: Liquid Heparin, Lyophilized Heparin, Arterial Blood Gas, pH, pO2, pCO2. How to Cite This: Mahmood A, Sattar A, Shaheen S, Ahmad S, Hafeez A. Comparison of arterial blood gas results obtained using two types of Heparinized Syringes. Isra Med J. 2022; 14(4): 161-164. DOI: https://doi.org/10.55282/imj.oa1379

Assessment of the Clinical Utility of Interleukin-6 in Congestive Heart Failure

Objective: To determine the clinical utility of Interleukin-6 in Congestive heart failure by comparing its association with N terminal-pro brain natriuretic peptide (NT-pro BNP). Study Design: Diagnostic Accuracy Study. Place and Duration: Department of Chemical Pathology, Combined Military Hospital (CMH), Lahore, from 1st September 2022 to 30th November 2022. Methodology: Patients reporting to the CMH Lahore Emergency Department with symptoms suggestive of Congestive Heart Failure (CHF) and Left Ventricular Ejection Fraction (LVEF) &lt; 40% were included in the study after a detailed physical examination. Sample collection was done for analysis of N terminal-pro brain natriuretic peptide and interleukin-6. Standard echocardiography results were obtained from the patients. Their past medical history, the results of the clinical examination, and any additional findings were considered together when evaluating the data for diagnostic reasons. Results: The levels of N terminal-pro brain natriuretic peptide displayed a very weak positive correlation with interleukin-6 (r value=0.016; p value=0.859). Therefore, N terminal-pro brain natriuretic peptide and interleukin-6 were found to have a statistically insignificant association. Interleukin-6 was found to have sensitivity, specificity, and Area under Curve (AUC) (11.11%, 91.18%, and 0.482) respectively at a cut-off level of 65.6pg/ml, for the diagnosis of congestive heart failure. Conclusion: Interleukin-6 has a causative role in the progression and monitoring of congestive heart failure, however; we were unable to show its usefulness as a diagnostic marker of congestive heart failure. The positive correlation of interleukin-6 with N terminal-pro brain natriuretic peptide suggests that interleukin-6 can still be a target for therapeutics. Keywords: Interleukin-6, Diagnostic Accuracy, NT Pro-BNP (Gold Standard), Congestive Heart Failure, Biochemical Markers, Left Ventricular Ejection Fraction. How to Cite This: Saeed M, Rana MZ, Khan N, Anwar H, Awais H, Ahmed S. Assessment of the Clinical Utility of Interleukin-6 in Congestive Heart Failure. Isra Med J. 2023; 15(1): 7-10. DOI: https://doi.org/10.55282/imj.oa1380 This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

THE POTENTIAL ROLE OF EGFR IN DIFFERENTIATING BETWEEN TRUE AND PSEUDOHYPERKALEMIA AT A TERTIARY CARE HOSPITAL

Objective: To determine the potential role of eGFR in differentiating between true and pseudohyperkalemia at a tertiary care hospital. Material and Methods: Cross-sectional study conducted in department of Chemical Pathology, Sheikh Zayed Hospital, Rahim Yar khan from January 1, 2022 to August 31, 2022. A total of 101 study subjects satisfying the inclusion criteria were included in study. Included specimen were analysed for serum creatinine level and estimated glomerular filtration rate (eGFR) was calculated by using chronic kidney disease-Epidemiology Collaboration (CKD-EPI) creatinine equation. Results: Of the total 101 study subjects, 59(58.4%) were male and 42(41.65%) were females. Mean age of study subjects was 45.28±12.265 years. Of the total 101 study samples, 75(74.3%) were classified as true hyperkalemia while 26(25.7%) were classified as pseudohyperkalemia with statistically significant difference of eGFR between two groups (P value: 0.00). Conclusion: Serum electrolytes are one of the most frequently requested diagnostic tests; thus, errors in these readings may alter the course of treatment for patients. As shown in our study that true hyperkalemia is very rare in patients with normal kidney function. So, estimated GFR can be taken as useful tool to differentiate between true and pseudohyperkalemia. Key Words: Pseudohyperkalemia, True hyperkalemia, Estimated GFR, CKD

Comparison of COVID-19 Rapid Antigen Test Results with PCR Reactive/ Non-Reactive Cases

Objective: To evaluate the analytical accuracy of the COVID-19 Ag Rapid Test Device by Abbott PanbioTM using RT-PCR as the reference assay and to detect any false-positive/negative reactions to assess the specificity of this analytical procedure.&#x0D; Study Design: Cross-Sectional analytical study.&#x0D; Place and Duration of Study: Department of Chemical Pathology, Chughtai Institute of Pathology, Lahore Pakistan, from Feb to May 2021.&#x0D; Methodology: This study was comprised of a total of 105 samples. The result of these nasopharyngeal specimens was already established by Reverse-Transcriptase Polymerase Chain Reaction (RT-PCR). Then the same (nasopharyngeal) specimens were analysed on Rapid Antigen Detection Test Device.&#x0D; Results: Out of 105 specimens, we got 88(83%) PCR positive samples and 17(16%) PCR negative, which, when compared with the Abbott PanbioTM Rapid Antigen Test Device, showed 60(57%) positive and 45(42.8%) negative samples having a sensitivity of 75(86%) (CI 67.04%-83.32%) and specificity of 100%(80.49-100%). The accuracy of the test was found to be 78(95%). This assay was found convenient and more appropriate for outdoor settings.Keywords: COVID-19, RT-PCR, Rapid antigen test, Specificity, Sensitivity.