Chemical Pathology Department Research Articles

Comparison of Turbidimetric Inhibition Immunoassay, High-Performance Liquid Chromatography, and Capillary Electrophoresis Methods for Glycated Hemoglobin Determination.

The purpose of this study was to compare the performances of and evaluate the agreement among glycated hemoglobin values analyzed by using National Glycohemoglobin Standardization Program-certified and International Federation of Clinical Chemistry-standardized analyzers. Armed Forces Institute of Pathology, Department of Chemical Pathology from March 2019 to May 2019. Glycated hemoglobin (HbA1c) was measured in the blood specimens from 100 patients on an ADVIA 1800 by a turbidimetric inhibitory immunoassay (TINIA), Sebia instrument by electrophoresis, and Bio-Rad Variant II Turbo system by high-performance liquid chromatography (HPLC). Quantitative variables were calculated as the mean ± standard deviation (SD). Precision and method comparisons were carried out according to Clinical and Laboratory Standards Institute recommendations. The results obtained from each analyzer were compared by correlation analysis. Method comparison was done by linear regression and Bland-Altman plots using the SPSS software version 24. The mean ± SD HbA1c values from TINIA, electrophoresis, and HPLC were 7.188% ± 1.89%, 7.164% ± 1.866%, and 7.160% ± 1.85%, respectively. The between-run coefficients of variation for TINIA, electrophoresis, and HPLC were 0.64%, 0.61%, and 0.60%, respectively. All 3 showed good correlation (TINIA, R2 = .994, P = .00; electrophoresis, R2 = .992, P = 0.00; and HPLC, R2 = .994, P = 0.00). The good clinical agreements of HbA1c and strong correlations between analyzers indicate that these analyzers can be used interchangeably.

General biochemical derangement related to the use of Statins in the treatment of Familial Hypercholesterolemia.

Objectives: This study was carried out to evaluate the patients of familial hypercholesterolemia (FH) on statin therapy for general biochemical abnormalities. Study Design: Case-Control observational study. Setting: Department of Chemical Pathology (Army Medical College/Military Hospital Rawalpindi) in collaboration with center for research in experimental and applied medicine (CREAM lab). Periods: From Jan 2017 to Jan 2018. Material & Methods: A total of one hundred participants were recruited in this study. These hundred cases were further divided into two groups. First group comprised of fifty disease free healthy cases, while the second group included the patients of familial hypercholesterolemia diagnosed on the basis of Simon Broom criteria. This second group was categorized into further two groups on the basis of patients taking statin therapy or not. Fasting blood sample was taken from these cases complete blood count, liver function tests, fasting plasma glucose, glycosylated hemoglobin, lipid profile and renal function tests were performed on these blood samples and the results were compared to find out any biochemical variance in control and cases. Results of this study were analyzed on SPSS v.23. Results: The analysis of lipid profile including total cholesterol (T.Ch), triglycerides (TRG), low-density lipoprotein cholesterol (LDL-C) and high density cholesterol (HDL-C) showed a highly significant difference in cases and controls. Alanine aminotransferease (ALT), alkaline phosphatase (ALP) and bilirubin also showed a significant variation. While diabetic profile, urea, creatinine, hemoglobin and body mass index didn’t show any significant variation among cases and controls. Conclusion: It is well-known that statins prove to be more superior to other classes of anti-hyperlipidemic, but at same time use of statins are also associated with other biochemical derangements. Diabetes mellitus is one of them. Therefore, a close monitoring protocol is required during statin therapy.

Determination of high sensitive cardiac troponin I 99th percentile upper reference limits in a healthy Pakistani population.

Objective:This study aims to establish the 99th percentile upper reference limits of high sensitive cardiac troponin I in a healthy Pakistani population.Methods:It was an Observational cohort study carried out in Department of Chemical Pathology and Endocrinology Rehman Medical Institute Peshawar, over the period of one year (January 2019- December 2019). Total 299 cardio-healthy males and females were interviewed and taken past medical history. Based on history, clinical examination, echocardiogram and laboratory data including results of estimated glomerular filtration rate (eGFR) and N-terminal pro-B-type natriureteric peptide (NT-proBNP), subjects with possible subclinical diseases were excluded. High Sensitive Cardiac Troponin I (hs-cTtrop I) was analysed on Abbot ARCHITECT STAT ci8200 using chemiluminescent immunoassay technique. The 99th percentile upper reference limit (URL) of hs-cTtrop I was determined using a non-parametric statistic, while gender specific results were compared.Results:In this study, 178 males (59.5%) and 121 females (40.5%) were included. The median Interquartile ranges (IQR) of age was 57 (11.6) for males and 56 (13) for females. The 99th percentile URL hs-cTtrop I was found to be 33.9 ng/L, while gender specific values were 38.41ng/L and 15.73ng/L for males and females, respectively (p= 0.0045).Conclusion:High sensitivity cardiac troponin I 99th percentile URL in our study population was found to be 33.9 ng/L with gender specific values being 38.41 ng/L and 15.73ng/L for males and females respectively. Troponin I in males was substantially high in comparison with females.

Trace metal profiling in patients with depression in Pakistani population.

To determine level of trace metals in patients with depression in order to explore any association between the two. The case-control study was conducted at the Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology and Armed Forces Institute of Mental Health, Rawalpindi, Pakistan, from January to December 2017, and comprised diagnosed cases of depression with equal number of age- and gender-matched controls. Depression was diagnosed by a consultant psychiatrist as per the International Classification of Diseases version 10 / Diagnostic and Statistical Manual of Mental Disorders -IV criteria and a self-reported depression screening through Siddiqui-Shah Depression Scale. Blood samples were collected from each subject for the measurement of metals like zinc, chromium and copper. Data was analysed using SPSS 24. Of the 370 subjects, there were 185(50%) in each of the two groups. There were 82(44.3%) males and 103(55.7%) females among the cases with an overall mean age of 37.75±11.49 years, and 65(35.1%) males and 120(64.9%) females with an overall mean age of 39.38±12.56 years among the controls. Mean levels of zinc and copper were significantly different between the groups (p<0.05), while the difference was non-significant for chromium (p>0.05). Equivocal prevalence of depression was present between males and females (p=0.04) without any significant age group association (p=1.92). Blood level of serum zinc and copper were found to be associated with depression.

Ameliorative Effect of Pleurotus ostreatus on Lipid Levels and Atherogenic Indices in Hyperlipidemic Rats

Aim: To evaluate the effects of Pleurotus ostreatus on the lipid profile and atherogenic indices in Hyperlipidemic rats.&#x0D; Study Design, Place and Duration of Study: This case-control study was done for 60 days between March and April, 2017 at the department of Medical Laboratory Science and Department of Chemical Pathology, Babcock University, Ogun State, Nigeria.&#x0D; Methodology: Thirty male wistar rats weighing 117-130 g were divided randomly into 3 groups: Normolipidemic (NL) rats (fed with standard rodent chow), Hyperlipidemic (HL) rats (fed with standard rodent chow + duck yolk and reused oil), Hyperlipidemic Treated (HL+T) rats (fed with standard rodent chow + duck yolk and reused oil + 5% Pleurotus ostreatus powder). &#x0D; Changes in the animal body weights were measured in this study. Serum was obtained from fasting blood samples for the standard biochemical analyses of total cholesterol (TC), triglycerides (TG), High density lipoprotein cholesterol (HDL-C), creatinine, urea, Alanine aminotransferase (ALT) and Aspartate aminotransferase (AST). Low density lipoprotein (LDL), very low density lipoprotein (VLDL), TC/HDL, LDL/HDL and Log (TG/HDL) ratios were calculated.&#x0D; Results: The HL+T rats compared to HL rats had significantly reduced body weight, TC, TG, LDL, VLDL, TC/HDL, LDL/HDL and Log(TG/HDL) by 19.59%, 14.38%, 15.82%, 25.52%, 15.83%, 28.89%, 20.24% and 27.27% respectively (p ≤ 0.05) but recorded no significant change in HDL-C (p &gt; 0.05). Creatinine, urea, AST and ALT did not show any significant change in HL rats and HL+T rats (p &gt; 0.05).&#x0D; Conclusion: Treatment of hyperlipidemic male wistar rats with Pleurotus ostreatus reduced body weight, lipid levels (TC, TG, LDL, VLDL) and atherogenic indices (TC/HDL, LDL/HDL, Log (TG/HDL)) and appeared to have no detrimental effects on the liver and kidneys. These findings may provide insights and scientific basis for the promotion of the use of Pleurotus ostreatus in controlling hyperlipidemia and associated complications.

Triglycerides-to-HDLC Ratio as a Marker of Cardiac Disease and Vascular Risk Factors in Adults.

To find out correlation of triglycerides-to-HDL cholesterol ratio in elders with cardiac risk factors like obesity, diabetes, and hypertension. Observational cross-sectional study. Department of Chemical Pathology and Endocrinology, Combined Military Hospital, Rawalpindi, from January to June 2018. Inclusion standards were participants aged 20-59 years .Patients with comorbidity and chronic illness were excluded from the study. A planned standardised homogeneous survey was conducted as a pilot study. Social, economic and physical variables like age, gender, marital status and presence of diseases, all were taken into consideration. To check association among cardio metabolic risk factors like diabetes, obesity, hypertension, and TG/HDL-C ratio, Chi-square test was computed for all cardio metabolic risk factors. Overall 350 participants were studied after attainment of authorisation from Ethical Review Board of Combined Military Hospital, Rawalpindi, in which 268 (76.6%) were women; whereas, 82 (23.4%) were men with mean age of 37 ± 11.64 years. There was strong association of TG/HDL ratio with BMI, HOMA-IR, WBISI, visceral fats, smooth muscle mass, HDL, LDL, and triglycerides with p <0.04, p <0.001, p <0.01, and p <0.001, respectively. TG/HDLC ratio can be considered as a potential biomarker for the early prediction of cardiometablic risk factors.

Analysis of Reported Critical Values and Their Associated Clinical Conditions in a Clinical Chemistry Laboratory of a Tertiary Health Institution in Nigeria

Studies involving critical values in recent time have mainly dwelt on compliance to timely reporting as well as the volumes of the individual reported critical analytes. There is paucity of data however, especially in this environment, on the relationships that exist between reported critical biochemical analytes and the presenting clinical conditions of the patients as at the time of the laboratory investigation. This study therefore sought to investigate such relationships.&#x0D; This study is a retrospective study of data obtained in the year 2018 from the critical value register of the Department of Chemical Pathology, Babcock University Teaching Hospital Ilisan-Remo, Ogun state, Nigeria. Data obtained was analyzed using Statistical Package for Social Sciences (SPSS) version 21.0. Level of statistical significance was set at p &lt; 0.05. Relationship between variables was determined using Chi-square Test.&#x0D; In the year under review, a total of 270 critical values from various biochemical analytes were obtained; out of which 34.0% was potassium, representing the highest occurrence. Calcium had the highest proportion of its tests from the year having critical outcomes (2.2%) compared to other biochemical parameters. Kidney disease was the most frequently reported clinical condition (25.1%) with critical values of biochemical analytes. This study also showed a strong statistical association (p = 0.000) between diabetic ketoacidosis and critical levels of hyperkalemia, critical outcomes of hypocalcaemia and infection/sepsis as well as critical level of azotemia and pregnancy related complications.&#x0D; This study has shown potassium as the most reported critical biochemical analyte which occurred mostly as cases of critical hyperkalemia. This was associated with a high burden of kidney diseases among the study population. The study has also drawn attention to the need for immediate and constant check of blood calcium and urea levels in patients that have sepsis and pregnancy related complications respectively.

Serum antioxidant status and some selected trace metal levels in patients with cervical intraepithelial neoplasm in Benin City, Nigeria

Antioxidants are important in the detoxification of free radicals, which are the hazardous derivatives of metabolic processes in the body. However, the mop up of free radicals in the prevention and management of cervical intraepithelial neoplasm is not clear. This study presented an assessment of the status of catalase (CAT), glutathione peroxidase (GPx), superoxide dismutase (SOD), total antioxidant capacity (TAC) and some trace metals (Ca, Mg, Cu and Zn) in women diagnosed with Cervical Intraepithelial Neoplasm (CIN) lesions. The study was carried out at the Department of Obstetrics and Gynaecology, University of Benin Teaching Hospital Benin City and Department of Chemical Pathology, Edo University Iyamho, Edo state Nigeria. Study participants were grouped into two; those with CIN lesions (n = 144) and the control (n = 53). Venous blood was obtained from participants and serum antioxidant levels were determined using standardized laboratory methods. Results showed that CAT levels increased significantly from 23.88 u/μl/min in the control group to 31.79 u/μl/min in CIN. The incidence of cervical intraepithelial neoplasm lesions did not significantly affect total antioxidant capacity (TAC) of the study population (2.43 - 2.70 mM, P>0.05). There were minimal increases in antioxidant status between the control and CIN groups respectively (P> 0.05). Cu was implicated as the only trace metal within the CIN group without significant correlation to the antioxidants investigated. Keywords: Epithelial cell, cervical cancer, neoplasm, antioxidant status

Comparison of various steady state surrogate insulin resistance indices in diagnosing metabolic syndrome

BackgroundInsulin resistance is core cause of metabolic syndrome. Determining insulin resistance is one of the foremost requirements imperative to understanding the pathophysiology of disease. The gold standard “Euglycaemic clamp test” is cumbersome, long and non-feasible in routine clinical setups to diagnose metabolic syndrome. Various continuous and steady state insulin resistance indices are now available in literature. We plan to evaluate commonly utilized steady state insulin resistance indices directly and Homeostasis Model Assessment for Insulin Resistance (HOMAIR) with added triglyceride (HOMA-TG index).MethodsThe cross-sectional study was carried from Jan-2016 to Dec-2018 at PNS HAFEEZ and department of chemical pathology, AFIP with following objectives: (1) To evaluate steady state insulin resistance markers for diagnosing metabolic syndrome as per IDF defined criteria by ROC curve analysis, (2) to measure Kendal Concordance between various insulin resistance indices and (3) to correlate steady state insulin resistance markers with anthropometric and lipid indices. After several exclusions we selected 224 subjects based upon “non-probability convenience sampling” for inclusion in study. Clinical history, anthropometric measures were calculated and sampling was done for insulin, glucose and other biochemical parameters. Metabolic syndrome was diagnosed as per IDF criteria, while HbA1c was utilized to diagnose diabetes mellitus. Pearson correlation was used to correlate various steady state insulin resistance indices including HOMAIR, HOMA2 index, QUICKI, G/I ratio, HOMA-TG index and serum insulin. AUC was calculated by ROC analysis for all surrogate insulin measures in diagnosis of metabolic syndrome.Results“HOMA-TG index” has shown the highest AUC for diagnosing metabolic syndrome along with higher correlation with lipid markers and anthropometric indices in comparison to other steady-state insulin resistance markers. Furthermore, QUICKI and G/I ratio showed the lowest AUC for detection of metabolic syndrome.Conclusion“HOMA-TG index” has shown highest AUC for metabolic syndrome diagnosis. However, QUICKI and G/I ration showed the lowest AUC for detection of metabolic syndrome. It is hoped that the potential “HOMA-TG index” may provide better diagnostic efficiency for diagnosing metabolic syndrome.

Frequency of Primary Hyperaldosteronism in Young Hypertensives in a Tertiary Care Setting of Rawalpindi.

To determine the frequency of primary hyperaldosteronism in young hypertensives in hospital settings of Rawalpindi. Cross-sectional study. Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology (AFIP), Rawalpindi, from June 2016 to May 2017. Two hundred and fifty patients with hypertension (blood pressure of more than 140/90 mm Hg) of both genders, with age between 17-40 years were recruited in the study. Patients on anti-hypertensive medications, renal function derangement, pregnant females and those labelled with secondary hypertension were excluded. Blood samples were taken for the analyses of plasma renin, aldosterone, electrolytes, and blood gases. Parametric quantitative variables were presented as mean + SD. Eight cases, out of a total 80 subjects fulfilling the inclusion criteria, were diagnosed with primary hyperaldosteronism and 72 with essential hypertension. Mean age of patients having primary hyperaldosteronism was 29.25 +7.1 years. The mean diastolic blood pressure of all patients was 90.3 +6.5 mm of Hg, while mean systolic blood pressure was 142.7 +10.5 mm of Hg. Frequency of primary hyperaldosteronism was found to be 10%, emphasising on the fact that it is not very uncommon in young hypertensives.

Evaluation of multiple risk factors involved in the development of Diabetic Retinopathy.

Objective:To determine the role of hypertension, hyperlipidemia, smoking and positive family history of diabetes and hypertension in the development of diabetic retinopathy.Methods:This prospective cohort study was conducted at the Department of Chemical Pathology, Armed Forces Institute of Pathology, Rawalpindi over 2 years period from June 2014 to June 2016. One hundred consecutive diabetic patients with no signs of diabetic retinopathy and good glycemic control (HbA1c<6.5%) were registered by non-probability convenient sampling after taking written informed consent. They were evaluated for hypertension, hyperlipidemia and smoking status. These patients were then followed 6 monthly for 2 years to look for the development of diabetic retinopathy.Results:The mean age of the patients was 50.72±9.29 years and there were 57 (57%) male and 43 (43%) female patients. Majority (82%) of the patients had NIDDM. The mean duration of diabetes was 8.31±6.83 years. 11% of the patients were smoker, 37% were hypertensive, 6% had hyperlipidaemia, 62% had family history of diabetes and 30% had family history of hypertension. At the end of follow-up, 9 (9.0%) patients had diabetic retinopathy. The frequency of diabetic retinopathy increased with increasing age of the patient; however, the difference was statistically insignificant. A comparatively higher frequency of diabetic retinopathy was also seen in patients with IDDM and those with positive family history of diabetes and hypertension yet again, the difference was statistically insignificant. Also, no significant difference was noted among male and female genders and smokers vs. non-smoker. However, the frequency of diabetic retinopathy increased significantly with increasing duration of diabetes. It was also higher among those with hypertension and hyperlipidemia.Conclusion:Higher patient age (≥50 years), increasing duration of diabetes (≥20 years), insulin dependent diabetes mellitus, hypertension, hyperlipidemia, and positive family history of diabetes and hypertension were found to be associated with increased frequency of diabetic retinopathy.

Association of Sex Steroid Priming on Growth Hormone Stimulation Test in Tertiary Care Hospital Settings Rawalpindi

Objective: To determine association of Sex steroid priming on Growth hormone stimulation test in tertiary care hospital settings Rawalpindi. Study design: Cross sectional study. Place and duration of study: Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology (AFIP) Rawalpindi from January 2018 to June 2018. Methodology: This study was a cross-sectional study conducted after the Institutional Review Board (IRB) approval at AFIP from January 2018 to June 2018. Data was collected from 149 children of 9-13 year of age reported to endocrinology clinic AFIP, after informed consent. Inclusion criteria included healthy adults with age of 9-13 years with no minor or subclinical illness or endocrinology disorders like hypothyroid, Cushing syndrome or Addison disease. Patients with comorbidity like cancer, tuberculosis and bed ridden patients were excluded from study. Sampling technique was non probability convenience sampling which was done in endocrine clinic of AFIP. Results: A total of 149 patients were inducted in study who visited Endocrine clinic in AFIP. Mean age of participants was 9.9 ± 3.9 year while 96 (64.4%) were male and 52 (34.9%) were female. Total of 149 patients there were 100 (67.1%) patients were below 3rd percentile, while 44 (29.5%) were above 3rd percentile but below 50th percentile and 4 (2.7%) were at 50th percentile. Independent T test was applied for Priming and response level after growth hormone stimulation test and it gives significant level (P value=0.00) which is considered significant (P value <0.05). Conclusion: This study concluded that priming after sex steroids can effect on growth hormone level in pre pubertal children’s and it will help in appropriate diagnosis of growth hormone deficiency.

Diagnosis of inherited metabolic disorders by selective metabolite testing: three years' experience at a tertiary care center in Rawalpindi.

To determine the pattern of various inherited metabolic disorders specifically through plasma amino acid and urine organic acid testing in high-risk paediatric population.. The cross-sectional retrospective study was conducted at the Armed Forces Institute of Pathology, Rawalpindi, Pakistan, and comprised data from April 2015 to March 2018 of children referred to the Department of Chemical Pathology and Endocrinology for work-up of suspected inherited metabolic disorders. Complete clinical history, baseline biochemical investigations, plasma amino acid and urine organic acid profiles, where indicated, were collected. Quantitative plasma amino acid and analysis was carried out by Ion Exchange Chromatography on Biochrome 30+ amino acid analyser, and urine organic acid analysis by Gas Chromatography-Mass Spectrometry. Findings were linked to the identified disorders. SPSS 21 was used for data analysis. Of the 805 cases reviewed, 49(6%) had an inherited metabolic disorder. Male:Female ratio of the cases was 1.5:1, and the median age was 240 days (interquartile range: 1-15695 days). The most common presenting symptom was seizures 316(39.3%) followed by lethargy 283(35.2%). Of the diagnosed cases, aminoacidopathies were 28(57%) and in them, non-ketotic hyperglycaemia accounted for 7(25%.). There were 12(24.5%) cases of organic acidurias followed by 9(18.4%) that were other than the two diagnoses. The cases of inherited metabolic disorder detected indicated significant prevalence. Non-ketotic hyperglycinemia was the commonest disorder diagnosed.

Low-density lipoprotein receptor gene mutation at Exon 2 and 4 in premature coronary artery disease in our population.

Objective:To determine the frequency of mutations in Low density lipoprotein receptor gene at exon 2 and 4 and its association with premature coronary artery disease (PCAD).Methods:A case-control study was conducted at Armed Forces Institute of Cardiology and Chemical Pathology department of Army Medical College Rawalpindi for a period of six months from June 2017 to December 2017. A sample size of 50 (40 patients, 10 controls) with 5% significance and 95% confidence interval was calculated with 4:1 case to control ratio. Consecutive sampling was used for distribution of participants into both groups. .Diagnosed patients of premature coronary artery disease that is any cardiac event before the age of 45 in males and 50 in females were taken as cases. Controls were healthy males less than 45 years of age and females less than 50 years. Patients with diabetes mellitus, thyroid illnesses, any acute infection, low white blood cells count and kidney disorders were excluded. A total of fasting 10ml blood was withdrawn from each patient. 5ml was utilized for the routine blood tests and the rest 5ml was used for further genetic analysis.Results:Total 50 participants were included in study. Mean age of participants in years was 42.48 ± 4.02 SD. Mean total cholesterol (TC) (mmol/l) were higher among cases (4.91±0.64 SD) than controls (4.22±0.66 SD). Serum triglyceride(Tg) (mmol/l) and low-density lipoprotein(LDL) (mmol/l) was also high among cases (2.07±0.58; 2.84±0.46) than controls (1.99±0.24; 1.98±0.32). One synonymous mutation in exon 2 of low-density lipoprotein receptor gene (LDLR) and one non-synonymous mutation in exon 4 (LDLR gene) were identified in our population in four patients among the forty cases. Data was analyzed by Statistical Package for the Social Science (SPSS) 21 version and a p-value of less than 0.05 was taken as significant.Conclusion:Glutamic acid (E) is replaced by Lysine (K) at position number 207 (E207K) mutation at exon 4 of low-density lipoprotein receptor (LDLR) gene may be the causative genetic basis of premature coronary artery disease among Pakistani population. The identified synonymous mutation at exon 2 was not causative as there is no change in the amino acid.

Bilirubin Interference in Plasma Amino Acid Analysis by Ion Exchange Chromatography.

To evaluate the effect of bilirubin interference on plasma amino acid analysis by Ion Exchange Chromatography (IEC). Cross-sectional (method validation) study. Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi from August 2016 to July 2017. Twenty non-icteric samples from paediatric patients were collected in lithium heparin tubes and analysed for amino acids on IEC-based Biochrome® 30+ Analyzer (Harvard Biosciences UK). Baseline bilirubin levels were noted. Samples were spiked with neonatal bilirubin standard with concentration of 488.4 mol/L (Spinreact®-Spain) at final concentrations of 50, 150 and 230 mol/L and re-analysed for amino acids at these three concentrations. Among the 20 selected patients with normal amino acid profiles, 12 (60%) were males. Majority (55%) were in age group of 1-5 years. Significant difference was observed for Arginine (p = 0.01), Histidine (p = 0.001), Isoleucine (p = 0.01), Leucine (p = 0.007), Lysine (p = 0.005), Ornithine (p = 0.03) and Phenylalanine (p = 0.02). Mean rank of these amino acids showed decreasing trend with the increase of bilirubin concentration, and pronounced interference was identified at bilirubin level of 50 mol/L. No difference was observed for alanine, citrulline, glutamic acid, glycine, methionine, proline, threonine, tyrosine, asparagine, aspartic acid, cystine, valine and tryptophan. Bilirubin significantly interferes with certain amino acid levels when analysis is carried out by ion exchange chromatography. A close follow-up of such patients with other biochemical tests and a repeat amino acid analysis, after jaundice is settled, is recommended to confidently rule out any possible inherited metabolic disorder in these patients.

Evaluation of thyroid function status in patients with alopecia areata

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Epidemiologic reports suggest a high prevalence of thyroid function abnormalities among patients with alopecia areata. Hence, this study was designed to investigate this hypothesis among indigenous Nigeria patients with alopecia areata.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The study was a retrospective analysis of records of thyroid function investigations of patients with alopecia areata who had presented to the Department of Chemical Pathology and Metabolic Medicine of the University of Port Harcourt Teaching Hospital (UPTH), Nigeria over a 10-year period (1&lt;sup&gt;st&lt;/sup&gt; January 2007 and 31&lt;sup&gt;st&lt;/sup&gt; December 2016). Records of patients’ age, sex, thyroid stimulating hormone (TSH), total thyroxine (T4), and total triiodothyronine (T3) were acquired from laboratory records and analyzed using SPSS version 15. A p&amp;lt;0.05 was applied as being significant.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; One hundred and thirteen (113) records of patients with alopecia areata were reviewed, among them 55 (48.7%) males and 58 (51.3%) females with no sex difference (p=0.778). The mean age of study cohorts was 29.42±10.27 (range 16–63) with the majority (61.9%) between the age group 20 to 40 years. No difference in the mean age, TSH, and T3 levels were observed between the males and females. Thyroid function abnormalities were observed in 27.3% of study cohorts and the most prevalent abnormality was hypothyroidism (16.8% subclinical and 4.4% primary) with a female preponderance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The study suggests an association of alopecia areata with thyroid function abnormalities. Patients with alopecia areata should be screened for thyroid function abnormalities irrespective of clinical status.&lt;/p&gt;

TNF-alpha Levels in Serum and Mononuclear Cell Lysate of Nigerian Tuberculosis Patients at Diagnosis

&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Background and Objectives: The need for additional markers for differential diagnosis of drug resistant Mycobacterium tuberculosis (M.tb) and drug sensitive M.tb have been raised by previous studies. Tumor necrosis factor-alpha (TNF-á) produced by monocyte/macrophage, neutrophilic and lymphocytic linkage plays a central role in effective immunity to many disease conditions including M.tb. Since M.tb either preferential inhabits or transits cells producing TNF-á, it istherefore diagnostically useful to measure the levels of TNF-á in the both mononuclear cell lysate and serum of drug sensitive TB (DS-TB) patients and multi-drug resistant TB (MDR-TB) patients compared with healthy controls.Materials and Methods: The study was conducted in the Department of Chemical Pathology and Immunology, University of Ibadan, Nigeria; Medical Out-Patients' Department and Multi-Drug Resistant Tuberculosis Center, University College Hospital, Ibadan, Nigeria. TB patients were selected by Consultant Chest physician after detailed laboratory and clinical procedures. The levels of mononuclear cell lysate- and serum- TNF-á were measured using enzyme linked immunosorbent assay (ELISA).Results: Serum and lysate TNF-á levels were significantly elevated in DS-TB patients (p &lt;0.05) and MDR-TB patients (p &lt; 0.05) compared with the control. But serum and lysate TNF-á levels were not significantly different in DS-TB patients compared with MDR-TB patients (p &gt; 0.05).Conclusions: Serum level of TNF-á or lysate TNF-á does not differentiate DS-TB patients from MDRTB patients and the use of antagonist of TNF-á be handled with caution in TB patients.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D;

TNF-alpha Levels in Serum and Mononuclear Cell Lysate of Nigerian Tuberculosis Patients at Diagnosis

Background and Objectives: The need for additional markers for differential diagnosis of drug resistant Mycobacterium tuberculosis (M.tb) and drug sensitive M.tb have been raised by previous studies. Tumor necrosis factor-alpha (TNF-á) produced by monocyte/macrophage, neutrophilic and lymphocytic linkage plays a central role in effective immunity to many disease conditions including M.tb. Since M.tb either preferential inhabits or transits cells producing TNF-á, it is therefore diagnostically useful to measure the levels of TNF-á in the both mononuclear cell lysate and serum of drug sensitive TB (DS-TB) patients and multi-drug resistant TB (MDR-TB) patients compared with healthy controls.&#x0D; Materials and Methods: The study was conducted in the Department of Chemical Pathology and Immunology, University of Ibadan, Nigeria; Medical Out-Patients' Department and Multi-Drug Resistant Tuberculosis Center, University College Hospital, Ibadan, Nigeria. TB patients were selected by Consultant Chest physician after detailed laboratory and clinical procedures. The levels of mononuclear cell lysate- and serum- TNF-á were measured using enzyme linked immunosorbent assay (ELISA).&#x0D; Results: Serum and lysate TNF-á levels were significantly elevated in DS-TB patients (p &lt;0.05) and MDR-TB patients (p &lt; 0.05) compared with the control. But serum and lysate TNF-á levels were not significantly different in DS-TB patients compared with MDR-TB patients (p &gt; 0.05).&#x0D; Conclusions: Serum level of TNF-á or lysate TNF-á does not differentiate DS-TB patients from MDR- TB patients and the use of antagonist of TNF-á be handled with caution in TB patients.

Cost-effectiveness of Screening and Confirmatory Tests for Multiple Myeloma in Pakistani Population: An Audit Report.

To find out the use of screening and confirmatory tests for diagnosis of multiple myeloma as ordered by clinicians. An Audit. Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi, from January 2012 to January 2017. Data retrieved from Laboratory Information Management system (LIMs) by selecting serum protein electrophoresis (SPE) as screening test and immunoelectophoresis (IE) and immunofixation (IF) as confirmatory tests. There were 3,108 tests of serum protein electrophoesis and 1,329 tests of immunoelectophoresis had been performed in last five year. Cost-effective clinical audit of SPE tests showed that only 17.1% tests of SPE were either used for proper diagnosis of multiple myeloma (totally justified tests 13%) or useful for diagnosis of other important diseases whose early diagnosis were helpful for patients management (partially justified tests 4.1%). The cost related to these tests were justified while 82.8% tests of SPE were either normal (total unjustified tests 24.4%), or diagnosed irrevalent and nonspecific diseases (partially unjustified 58.4%). IE and IF audit revealed that only 26.6% tests were properly utilised for diagnosis and differentiation of multiple myeloma and its subtypes and cost attributable to these tests were justified while 73.4% of these confirmatory tests were normal and cost related to them was not justified. Overutilisation of laboratory tests for diagnosis of multiple myeloma can be minimised by proper clinical scrutiny of request forms.

Pattern of utilisation of oral glucose tolerance test: the experience of Aminu Kano Teaching Hospital, Kano

Oral glucose tolerance test (OGTT) is the gold standard test for the diagnosis of type 2 diabetes mellitus (DM). It is considered as the oldest dynamic function test in clinical practice and has several advantages over other plasma-based tests for diagnosis of type 2 DM, notably random plasma glucose (RPG) and fasting plasma glucose (FPG). For instance, it is the only means through which diagnosis of impaired glucose tolerance can be made, and has a higher diagnostic yield compared to FPG. There is paucity of data on the utilization of OGTT particularly in northern Nigeria. This study therefore aimed to determine the utilization of OGTT in a tertiary Hospital in Kano, Northwestern Nigeria. This was a retrospective study carried out in Aminu Kano Teaching Hospital between January, 2013 and December, 2014. Following ethical approval, Hospital records of all clients who had OGTT in Chemical Pathology department of the Hospital were retrieved. The OGTTs were done using the 75g, 120 Minutes as recommended by WHO. Plasma Glucose were analyzed using quantitative glucose oxidase method described by Trinder. Data obtained were entered into Microsoft Excel and analyzed using statistical package for social sciences (SPSS) version 20.About 335 OGTTs were performed during the study period but 312 were selected. Majority of the clients were females, 290 (92.9%), aged between 20-39 years (74.0%). About 2/3rd of the clients 224 (78.5%) were pregnant women referred from antenatal clinic due to previous history of Gestational Diabetes Mellitus (GDM), previous macrosomic baby, and unexplained intra uterine foetal death. Non-obstetric indications for OGTT encountered were obesity, impaired fasting glycaemia and suspected acromegaly. Majority of clients who had OGTT were pregnant women who were referred for obstetric indications. Previous history of GDM was the commonest indication for OGTT. There was under-utilization of OGTT for non-obstetrics medical indications. Keywords: OGTT, Diabetes mellitus, Gestational Diabetes, Nigeria