Chemical Pathology Department Research Articles

Fifth Generation Quality Control of Immunoassay Parameters by Six Sigma Value.

To determine the sigma value of immunoassay parameters which are within the 2Z score on external quality control (EQC). A cross-sectional study. Place and Duration of the Study: Department of Chemical Pathology and Endocrinology (AFIP),non-ability ity consecutive from June to November 2022. Ten immunoassay parameters were selected on the basis of the internal quality control (IQC) and external quality control (EQC) programs. The Clinical Laboratory Improvement Amendments (CLIA) is used for Total Allowable Error (TEa). Sigma value was calculated from coefficient of variation (CV) and bias, which was determined by IQC and EQC, observed for 6 subsequent months. If the sigma values are ≥6, between 3 and 5, and <3, they are classified as good, acceptable or unacceptable, respectively. T4, prolactin, Vitamin B12 at >3 óat IQC level 1. TSH, T3, T4, and Vitamin B12 showed that on level 2 IQC at >3 óT3, Vitamin D at 4-5 ó level, Prolactin, FSH, and LH at 6 ó level in level 2 IQC. In the EQC program, the sigma level calculated for ten assays found that almost all parameters were at sigma >3 ó level except TSH which was at 5.8 ϭ level during June to August 2022. From September to November 2022, all parameters at >3 ó level except for TSH, growth hormone, FSH, LH, and Vitamin b12 which showed at 4.4 ó level. Most of the immunoassay parameters show good performance in the EQC program and at both levels of IQC level with sigma value 4-5. Bias, Six sigma, Key performance indicators, External quality control.

Correlation of Serum Chromogranin A with HbA1c and eGFR in Different Groups of Type 2 Diabetic patients

Background: World health organization estimated that around 422 million people are living with diabetes and there is an increasing trend in the number of diabetic patients. Aim: To correlate the levels of serum chromogranin A with HbA1c and eGFR in different groups of type 2 diabetic patients based on urinary Albumin- Creatinine Ratio. Methodology: This cross sectional comparative study was done by enrolling 116 patients at Chemical Pathology Department, LGH-Lahore through probability convenient sampling. Urine samples of all subjects were centrifuged in-order to measure urinary albumin and creatinine. Laboratory parameters like Urinary albumin, Serum creatinine and HbA1c were measured. HbA1c was measured using HPLC method. Serum creatinine was measured kits on fully automated spectrophotometer. Abbreviated MDRD equation calculated eGFR. Data SPSS v.24 analyzed the data. ANOVA test applied with P-value of less than 0.05 was considered significant. Spearman correlation was also applied to correlate HbA1c and eGFR with CgA in each group. Results: The results showed that eGFR was normally distributed whereas, the distribution of albumin creatinine ratio, HbA1c, serum creatinine and serum chromogranin-A were not normal. Between the A, B, and C groups, no discernible variation in the mean HbA1c values was found. Practical Implication: Due to lack of literature review and high incidence of diabetes induced nephropathy in our setups, there is need to find a parameter than can correlate nephropathy among diabetics. Conclusion: It was concluded that early diagnosis of diabetic nephro-pathy can be evaluated by using serum Chromogranin-A but it has a negative correlation with eGFR and positive correlation with HbA1c. Keywords: Diabetic Nephropathy, HbA1c, Estimated Glomerular Filtration Rate, Serum Chromogranin-A and Type-2 Diabetes.

Assessment of Frequency and Composition of Renal Stones in a Reference Laboratory of Pakistan

Objective: To determine frequency and chemical composition of renal stones in Northern Pakistan using FTIR Spectroscopy.&#x0D; Study Design: Cross-sectional study&#x0D; Place and Duration of Study: Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi Pakistan, from Jan 2017 to Jul 2020.&#x0D; Methodology: One thousand and twenty-nine stones were analysed in 3 years at AFIP of patients aged from 1 to 98 years. They were analysed by Automatic FT-IR type IRAffinity-1. The results were verified by manual analysis of spectrograms and then confirmed by standard peaks feed on NICODOM LIBRARY.&#x0D; Results: Calcium oxalate stones were the most frequent (1065,80.1%), followed by uric acid stones (179,13.5%), mixed stones (44,3.3%), calcium appetite (31,2.3%), struvite (6,0.5%), hydroxy appetite (1,0.1%) and cysteine stones (3,0.2%). Male predominance was noted in patients with renal stones (1057,79.5%). The majority of the patients were from the age group 21 –40 years (47.5%)&#x0D; Conclusion: Calcium oxalate stones are most commonly followed by uric acid stones in patients of northern Pakistan. The frequency of renal stones is high in male patients.

A Survey of Growth Hormone Stimulation Test Efficacy for Workup of Short Stature in a Referral Laboratory

Objective: To assess growth hormone (GH) stimulation test efficacy in short stature workup for establishing GH deficiency.&#x0D; Study Design: Cross-sectional survey.&#x0D; Place and Duration of Study: Diagnostic Endocrine Section, Department of Chemical Pathology &amp; Endocrinology, Armed Forces Institute of Pathology (AFIP), Rawalpindi Pakistan, from Aug 2020 to Jan 2021.&#x0D; Methodology: The study was conducted on 129 individuals aged 2-16 years. History, axiological data and biochemical parameters were assessed to establish GH deficiency for short stature workup.&#x0D; Results: Out of 129 individuals, 76(59%) boys and 53(41%) girls reported GH stimulation tests. 81(62.3%) children were in &lt;3rd percentile, 29(22.3%) in &lt;5th percentile, 9(6.9%) in &lt;10th percentile and 5(3.8%) in &lt;25th percentile. Among the group with bone age difference &gt;2 years, 34(82.9%) fell in &lt;3rd percentile. GH Stimulation test post-Levo Dopa was performed in 102(78.46%) patients. 49(37.4%) patients responded inadequately to the GH stimulation test. The adequate response to the GH Stimulation test improved as the percentile declined from the 50th to the 3rd percentile.&#x0D; Conclusion: GH stimulation test results can only partially rely upon though their importance remains in combination with other short-stature workup parameters for ruling out growth hormone deficiency.

Evaluation of Adjusted Calcium Levels in Patients of Chronic Renal Failure with Hypo-Albuminemia

Objective: To compare adjusted calcium levels with ionised Calcium in chronic renal failure patients with hypoalbuminemia for the correct assessment of their Calcium status.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi Pakistan, from Mar 2020 to Jan 2021.&#x0D; Methodology: A total of 304 individuals aged 18 to 90 years, of either gender were included in the study. Participants were differentiated into stages of Chronic renal failure based on the estimated glomerular filtration rate calculated through the Chronic Kidney Disease Epidemiology Collaboration equation. Serum total Calcium, urea and creatinine were analysed on ADVIA 1800R Clinical Chemistry Auto analyser. In addition, ionised Calcium was analysed on Cobas b221 blood gas and electrolyte analyser.&#x0D; Results: Mean age of the study participants was 56.3±16.03 years. 130(42.5%) individuals had stage-5 while 102(33.3%) had stage 4 chronic kidney disease. Based on ionised Calcium concentration, 37.3% of participants had hypocalcaemia, 57.2% had normocalcaemia, and 4.9% had hypercalcaemia. 57.5% had albumin concentration between 20-29g/L. Cohen’s Kappa statistical analysis showed adjusted Calcium to be a poor predictor of the correct Calcium status of the patients with hypoalbuminemia.&#x0D; Conclusion: Adjusted Calcium, using the Modified Payne formula, overestimates Calcium status in patients of chronic renal failure with hypoalbuminemia when compared with total unadjusted Calcium levels hence misclassifying true hypocalcaemic patients as normocalcaemic.Keywords: Adjusted calcium, Chronic renal failure, Estimated glomerular filtration rate, Hypoalbuminemia, Ionised calcium.

Correlation of Serum Erythropoietin Levels with Different Stages of Diabetic Retinopathy.

To determine the correlation of serum erythropoietin concentration with diabetic retinopathy in patients with type 2 diabetes mellitus. Cross-sectional study. Place and Duration of the Study: Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology (AFIP), Rawalpindi, from July to December 2021. A total of 180 individuals were enrolled in the study and placed in 2 groups as group 1 have 90 cases of type 2 diabetes mellitus and group 2 having 90 age-matched healthy controls. Group 1 was further subclassified into proliferative diabetic retinopathy (PDR) and non-proliferative diabetic retinopathy (NPDR) subgroups by an expert ophthalmologist. Serum erythropoietin, creatinine, blood HbA1c, and haemoglobin were analysed. Correlation between stages of proliferation and serum erythropoietin, creatinine, blood HbA1c, and haemoglobin were analysed. An independent-sample student t-test was applied to compare mean Serum erythropoietin between PDR and NPDR groups. Pearson's correlation was applied among disease severity, and type of retinopathy. A p-value of ≤0.05 was considered significant. The average age of participants in groups 1 and 2 was 45.88±8.6 and 56.6±10.23 years, respectively. More males (n=60, 66.7%) were noted in cases compared to controls (n=42, 46.7%). serum erythropoietin concentration observed in cases (8.4±1.87 IU/L) was higher than controls (6.50±0.9). The mean serum erythropoietin concentration in PDR (9.35±1.74 IU/L) was significantly greater than that in NPDR (7.3±1.38 IU/L, p <0.001). The serum concentration of erythropoietin in group 1 increased linearly with the severity of the disease (r=0.103). Serum erythropoietin concentrations increased in uncontrolled type 2 diabetics more so in proliferative retinopathy cases, and increased with disease severity. Erythropoietin, Diabetic retinopathy, Proliferative diabetic retinopathy.

ROLE OF SEX HORMONE BINDING GLOBULIN AS AN INDICATOR OF INSULIN RESISTANCE

Objective: To determine the role of Sex Hormone Binding Globulin (SHBG) in cases of hyperinsulinemia and insulin resistance among our population. Material and Methods: It was a cross-sectional analytical study conducted at Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi, from Jun 2022 – Dec 2022. Study is comprised of total 90 samples consisting of both males and females. Study individuals were categorized as Pre-Diabetic and Diabetic according to their fasting plasma glucose levels. Fasting plasma insulin levels were done on Advia Centaur XPT Chemiluminescence Immunoassay analyser. Serum SHBG was done on Immulite 2000 by chemiluminescent immunometric assay. Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) was calculated from fasting glucose and insulin levels. Cut off value of 2.2 was used for labelling insulin resistance. Data was analyzed on SPSS version 23. Mean and standard deviation (SD) was calculated for glucose, insulin and SHBG. T test was used to compare means of pre diabetic and diabetic groups. Pearson’s correlation was used to establish correlation between SHBG and HOMA-IR. Results: Our study included 57 males and 33 females with mean age of 47±11 years and 47±12 years, respectively. SHBG levels were significantly higher in pre-diabetics as compared to diabetics. The Pearson’s correlation between SHBG and Fasting serum insulin is weak negative (r = 0.3, p = -0.23), same is between SHBG and HOMA-IR (r = 0.25, p = -0.86), showing no significant association between SHBG and HOMA-IR among our population. However, two tailed t-test showed marked difference between means of serum SHBG, fasting serum insulin and HOMA-IR among diabetic and pre-diabetic groups with 95% confidence Interval. Conclusion: The negative association of SHBG with insulin resistance is not marked in our population. Various epidemiological, external and metabolic factors could affect and should be excluded before establishing this negative correlation between SHBG and Insulin resistance for predicting the development of diabetes mellitus (DM) Key Words: SHBG, Hyperinsulinemia, HOMA-IR, Correlation

Spectrum of Biochemical Derangements in Patients with Covid-19 Infection

Objectives: To evaluate the biochemical derangements in COVID-19 patients according to disease severity. Place and Duration of Study: This Cross-Sectional Study was conducted at Chemical Pathology Department of Armed Forces Institute of Pathology, Rawalpindi from March to August 2021. Methodology: A total of 996 patients of age between 20 to 75 years admitted at Pak Emirates Military Hospital Rawalpindi with COVID-19 were selected and further categorized into mild, moderate, and severe groups. Serum samples were collected and analyzed for various biochemical parameters. A mean comparison of the results of these biochemical markers amongst three groups was carried out by applying a one-way analysis of variance (ANOVA), p value = 0.05 was statistically significant. Results: The values of total bilirubin, ALT, AST, CK, CK MB, troponin I, LDH, urea, creatinine, CRP, PCT, and ferritin increased with the severity of the disease. Whereas the values of albumin and total protein decreased with the severity of the disease. The difference in these parameters amongst all three groups was found to be statistically significant with p value &lt;0.05. However, the values of GGT, total cholesterol, and TG were found non-significant amongst all three groups (p value&gt;0.05). Conclusion: Derangement of biochemical parameters increased proportionately with the severity of the disease. Hence these markers can provide significant assistance to categorize patients into different severity groups as well as monitoring and prognosis of the disease. In this way, earlier and more accurate medical interventions can be provided to patients for a better outcome from this pandemic.

Clinical Utility of N-Terminal Prohormone B-Type Natriuretic Peptide Levels in Patients of Type 2 Diabetes Mellitus with Heart Failure

Objective: To evaluate the effect of type 2 diabetes mellitus on plasma N-terminal prohormone B-type natriuretic peptide levels in patients with heart failure and correlate it with glycosylated haemoglobin levels.&#x0D; Study Design: Comparative cross-sectional study.&#x0D; Place and Duration of Study: Department of Chemical Pathology in collaboration with the Department of Cardiology,Combined Military Hospital, Multan Pakistan, from Feb to Sep 2021.&#x0D; Methodology: We assayed plasma NT-pro BNP levels in 194 individuals with established heart failure, (98 non-diabetics, and 96 patients with diabetes). Plasma NT-pro BNP levels were compared between groups in addition, the correlation of glycosylated haemoglobin with plasma NT-pro BNP levels was explored.&#x0D; Results: The mean plasma NT-pro BNP values were higher in patients with diabetes (15826.08 ±8143.434pg/mL) than in nondiabetics (12534.06±6323.92pg/mL) with a p-value 0.02. When NT-pro BNP was compared there was no significant found difference between the non-diabetic group and the Controlled Diabetes-Group (p-value 0 .882), but it was significantly higher in the Uncontrolled Diabetes-Group (p-value&lt;0.001). A moderate positive association was found between NT-pro BNP and glycosylated haemoglobin (r=0.541, p-value&lt;0.001).&#x0D; Conclusion: Although obesity has an inverse relation with plasma natriuretic peptides level and most patients with diabetes are overweight, the plasma NT-pro BNP is still a very informative tool and holds its significance as a diagnostic and prognosis marker in diabetic patients with heart failure.

Comparison of Serum Chromogranin-A with Albumin-Creatinine Ratio among different groups of Type-2 Diabetics

Background: Diabetic nephropathy is a common complication of diabetes mellitus that cause high morbidity &amp; mortality. Aim: To compare levels of serum chromogranin-A among different groups of type-2 diabetes mellitus patients based on urinary Albumin-Creatinine Ratio. Study design: Cross sectional comparative. Methodology: Present study was conducted at Chemical Pathology Department of General Hospital-Lahore. Patients (n=116) were enrolled through probability convenient sampling. Urine samples were centrifuged to obtain clear supernatant. In this separated supernatant urinary albumin and creatinine was measured. Blood samples were segregated according to the study groups (A, B, C and D). Serum was separated for analysis of serum creatinine and serum chromogranin A by ELIZA method. Data was evaluated by using SPSS v.24. ANOVA was used to compare mean levels of urinary ACR AND serum CgA among the groups with P-value of 0.05 was considered as significant. Results: The results showed that serum Chromogranin-A level was high in diabetic patients with normal ACR and kept on rising with increasing ACR. Data of age was normally distributed whereas, the distribution of albumin creatinine ratio and serum chromogranin-A was not normal. Conclusion: It was concluded that serum Chromogranin A can be used as early marker for the diagnosis of diabetic nephro-pathy thus can help in better management of nephropathy due to diabetes. Keywords: Diabetic Nephropathy, Albumin-Creatinine Ratio, Serum Chromogranin-A and Type-2 Diabetes.

Comparing the effect of Hypoalbuminemia on Sodium measured by Indirect versus Direct Ion Selective Electrode Method

Objective: To evaluate the effect of low serum Albumin levels on serum sodium measurement when analyzed by the indirect Ion Selective Electrode (ISE) method and to compare the results with the direct Ion selective electrode (ISE) method.&#x0D; Study Design: Cross-sectional study&#x0D; Place and Duration of Study: Department of Chemical Pathology, Armed Forces Institute of Pathology, Rawalpindi Pakistan, from Jan to Mar 2021.&#x0D; Methodology: Patients of either gender, aged 18 to 70 years, who were admitted to the Intensive Care Unit of Combined Military Hospital, Rawalpindi, were selected. A total of 200 blood samples were collected in a gel tube. Serum samples were analyzed for albumin and sodium within two hours of sample collection. Sodium levels were measured concurrently by both direct and indirect ISE methods. The difference in results between these two techniques was studied.&#x0D; Results: Hypoalbuminemia was detected in 176(88%) patients, while 24(12%) had normal albumin levels. In Hypoalbuminemic patients, serum sodium measurements were higher using the indirect ISE method(134.07±5.55) compared to the direct ISE method (130.95±6.04); the difference between the two techniques was statistically significant (p-value &lt;0.001).Pearson correlation coefficient (r-value = -0.86, p-value &lt;0.001) revealed a symmetrical increase in differences between the two methods as the albumin level decreased.&#x0D; Conclusion: In Hypoalbuminemic patients, the indirect ISE method gave falsely raised results of serum sodium. In such patients, serum sodium measurement by the Direct ISE method offers more accurate and consistent electrolyte results.

Validation of Vanillylmandelic Acid (VMA) with Plasma Metanephrine and Normetanephrine for Screening Adrenal Medullary Disorders

Objective: To validate urinary Vanillylmandelic acid (VMA) for screening adrenal medullary disorders, taking plasma-free Metanephrine as the gold standard.&#x0D; Study Design: Cross-sectional validation study.&#x0D; Place and Duration of Study: Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology,Rawalpindi, in collaboration with Armed Forces Institute of Urology, Rawalpindi from Pakistan, Jan 2020 to Mar 2021.&#x0D; Methodology: One hundred and thirty (130) symptomatic hypertensive patients with adrenal masses on ultrasound were selected Urine and blood samples were collected under specified conditions after taking necessary precautions and subsequently analyzed. Taking plasma Metanephrine as a reference, sensitivity, specificity and predictive values were calculated at predefined cut-off values. &#x0D; Results: In a young population with a mean age of 28.55±5.54 years, headache, palpitations and sweating were the predominant symptoms having a frequency of 130(100%), 116(89.2%) and 111(85.4%), respectively. Twenty-four hours urinary Vanillylmandelic acid had lower sensitivity (66.3%) than a random urinary VMA/cr ratio (72.1%) but similar specificity(97.7%). On the other hand, plasma-free Normetanephrine had 100% sensitivity but lower specificity (93.2%). ROC curve was plotted, and AUC for 24 hours urinary VMA, urinary VMA/cr ratio and plasma-free Normetanephrine were 0.820, 0.849 and0.966, respectively.&#x0D; Conclusion: Plasma-free Metanephrine could be used for screening pheochromocytoma and other adrenal medullary disorders like paraganglionoma. In addition, VMA/cr ratio can be used for biochemical confirmation of the disease owing to the high specificity found in our study.

Etiological study of short stature in children and role of insulin like growth factor-1 and insulin like growth factor binding protein-3 as screening markers for growth hormone deficiency.

To determine aetiological factors in children with short stature, and to evaluate the role of insulin like growth factor-1 and insulin like growth factor binding protein-3 as screening markers for growth hormone deficiency. The cross-sectional study was conducted at the Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan, from August 2020 to July 2021, and comprised children with short stature. Evaluation protocol included complete history and examination, baseline laboratory investigations, X-ray for bone age and karyotyping. Growth hormone status was assessed using growth hormone stimulation tests, and serum insulin like growth factor-1 and insulin like growth factor binding protein-3 levels were also assessed. Data was analysed using SPSS 25. Of the 649 children, 422(65.9%) were boys and 227(34.9%) were girls. The overall median age was 11 years (interquartile range: 11 years). Of the total, 116(17.9%) children had growth hormone deficiency. Familial short stature was present in 130(20%) children and constitutional delay in growth and puberty in 104(16.1%). There was no significant difference in levels of serum insulin like growth factor-1 and insulin like growth factor binding protein-3 in children who had growth hormone deficiency and those who had other causes of short stature (p>0.05). Physiological variants of short stature were found to be more common in the population followed by growth hormone deficiency. Serum insulin like growth factor-1 and insulin like growth factor binding protein-3 levels alone should not be used to screen children with short stature for growth hormone deficiency.

DISTURBANCES IN SERUM CALCIUM AND PHOSPHATE LEVELS IN PRE-DIABETES AND TYPE 2 DIABETES MELLITUS

Objective: To evaluate serum calcium and phosphate levels in Pre-diabetic, Diabetic &amp; non-diabetic subjects. Material and Methods: This comparative cross-sectional study was conducted at the Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, from July to December 2021. The study used a non-probability consecutive sample to include 300 people. Those people have been divided into three groups; diabetics, pre-diabetics and non-diabetics with a hundred people in every group. Blood specimens had been taken for the estimation of calcium, phosphate, HbA1c, plasma glucose and insulin in fasting in their respective tubes. SPSS version 24 was used to inspect the data. All descriptive variables had their means and standard deviations calculated. To examine descriptive characteristics within and between all groups, one way ANOVA and post hoc LSD were performed, and p-values 0. 05 were considered significant. Results: Calcium and Phosphorus levels were lower in Diabetic group (Ca= 1.97±0.16mmol/l, PO4 = 0.76±0.07 mmol/l) as compared to pre-diabetic group (Ca= 2.15±0.18 mmol/l, PO4 = 0.93±0.06 mmol/l) and higher in non-diabetic group (Ca= 2.33±0.10mmol/l, PO4 = 1.19±0.20 mmol/l) than both other groups. A one-way ANOVA and Post Hoc LSD revealed that the difference between and within groups was statistically significant with a p value of 0.01. Conclusion: Our research has shown that as glycemic control slowly deteriorates, blood calcium and phosphate levels fall. Keywords: Calcium, Phosphorus, Pre-diabetes, Type 2 diabetes mellitus.

Prevalence of Proteinuria among Type 2 Diabetic Patients Attending Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria

Background: Diabetes mellitus has been reported to be the primary cause of end-stage renal disease in some Asian and American countries. However, no such data were available among type 2 diabetic patients in North-Western Nigeria. This study was aimed to assess the prevalence and associated risk factors of proteinuria among type- 2 diabetic patients by measuring the total protein-to-creatinine ratio (TPCR) and to provide some possible recommendations to enhance the level of health care rendered to the patients. Methods: This was a cross-sectional study. Spot urine TPCR was performed on 182 diabetic patients who attended the diabetic clinic at Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria, from January 2018 to December 2018. Other relevant parameters were extracted from the Chemical Pathology Department register, and the patients' case folders. The data were statistically analysed using SPSS version 23.0 (Chicago IL). Results: Among the total of 182 diabetic patients recruited during the study period, 66(36.3%) were males and 116(63.7%) were females. Out of the patients, (82)45.1% had hypertension; and (105)57.7% of the study population were obese. The overall prevalence of pathological proteinuria (TPCR ≥ 150 mg/mmol creatinine) was found in 116 (63.7%) of the study population. Conclusions: The prevalence of proteinuria is high in the study subjects (63.7%). The high prevalence observed might be a result of kidney disease in a primary healthcare setting. However, this study is a hospital-based finding with a small sample size, therefore, a larger study population size is recommended for future studies. Keywords: prevalence, proteinuria, type 2 diab

Determination of Lipid Derangements in Human Immunodeficiency Virus Patients Undergoing Anti-Retroviral Therapy

Objective: To determine lipid derangements in HIV-positive patients receiving anti-retroviral therapy (ART).&#x0D; Study Design: Comparative cross-sectional study.&#x0D; Place and Duration of study: Chemical Pathology Department, in cooperation with the Department of Virology at Armed Forces Institute of Pathology (AFIP), Rawalpindi Pakistan, from Mar 2019 to Mar 2020.&#x0D; Methodology: In this study, two groups were made. In Group-1, lipid profile estimation was done in HIV patients without treatment. In contrast, lipid profile estimation was done after one year of treatment with anti-retroviral drugs in Group-2. &#x0D; Results: One hundred and two HIV-positive subjects were included in our study. Of these patients, 88(86.27%) were males,and 14(13.73%) were females. Independent sample t-test revealed a statistically significant difference (p-value&lt;0.05) in serum cholesterol, serum triglycerides, serum high-density lipoprotein (HDL-c), low-density lipoproteins (LDL) and very lowdensity lipoproteins (VLDL) between the two groups.&#x0D; Conclusion: Hyperlipidemia in HIV patients getting anti-retroviral therapy (ART) exposes them to a high risk of coronary artery diseases and myocardial infarction. Hence lipid profile of patients getting ART must be regularly monitored, and hyperlipidemia, if present, should be managed.

Variations in Lipid Profile During Critical Illness

Objective: To determine to mean change in levels of Triglycerides (TG), Total cholesterol (TC), High-Density Lipoprotein Cholesterol (HDL-C), and low-density lipoprotein (LDL-C) in critically ill patients at admission,18 hours and 42 hours after admission.&#x0D; Study Design: Cross-sectional study&#x0D; Place and Duration of Study: Department of Chemical Pathology &amp; Endocrinology, Armed Forces Institute of Pathology Rawalpindi (AFIP), in collaboration with Military Hospital Rawalpindi (MH), Combined Military Hospital Rawalpindi (CMH) and Armed Forces Institute of Cardiology Rawalpindi (AFIC) Pakistan, from Mar to Sep 2016.&#x0D; Methodology: A total of Fifty patients admitted to intensive care units of MH, CMH and AFIC for coronary artery disease(CAD), sepsis, burns and cancer were included in the study. Patients on lipid-lowering drugs and post-surgery patients were excluded.TC, HDL-C, LDL-C and TG were analysed on ADVIA 1800 (SIEMENS, Germany).&#x0D; Results: Fifty patients were included with mean age of 48.12±2.26 years. Parametric analyses revealed significant increase in serum TG levels during hospitalization in critically ill patients in various disease groups (Mean±SD at admission, 18 hours and 42 hours): TG (CNS disorders 1.35±0.18, 1.78±0.24 and 1.22±0.17; CVS 1.92±0.21, 2.15±0.28 ,2.32 ±0.20; sepsis 1.55±0.18,1.38+0.24,1.54+0.17; malignancies 1.24±0.31, 1.28+0.42,1.35+0.30; renal disorders 1.39+0.35,1.82+0.47,1.08+0.33; (p&lt;0.05). TC decreased in sepsis, CVS and cancer patients while increasing in CNS and renal disorders. HDL-C and LDL-C decreased in all diseases as an acute stress response.&#x0D; Conclusions: During critical illness, TG and LDL-C may change significantly; therefore, they should be monitored and interpreted with extreme care if requested to be performed within the course of the disease.

Assessment of Pattern of Drug Abuse from Different Clinical Settings in a Reference Laboratory of Pakistan During the COVID-19 Pandemic

Objective: To determine the pattern of drug abuse from different clinical settings in a reference laboratory of Pakistan during the COVID-19 pandemic and assess any change from the previous trend.&#x0D; Study Design: Comparative cross-sectional study.&#x0D; Place and Duration of Study: Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology (AFIP), Rawalpindi Pakistan from Mar to Dec 2020.Methodology: Out of 6902 subjects tested for drug abuse, 672 subjects with positive results were included in the study. The study population was divided into three main Groups. i.e., Psychiatry, ITC/Emergency and Workplace testing. A pattern of drug abuse was compared in the pre (Mar-Dec 2019) and post-COVID (Mar-Dec 2020) periods.&#x0D; Results: Out of 672 study subjects, 338(50%) were psychiatry patients. Around 629(94%) subjects were males. Mainly young individuals (306, 46%) were affected. Cannabis was the most frequent drug of abuse detected (357, 53%), followed by Benzodiazepines (BZD) (236, 35%) individuals and Opiates (47, 7%). Compared with pre-COVID data, an overall increase of 3% in the total frequency of drug abuse from 392(7%) to 672(10%) was found in 2020. About 14% decrease, from the frequency of 81(21%) to 47(7%) in Opiates usage, while 8% increase in frequency, from 106(27%) to 236(35%) in Benzodiazepines, was observed. There was significant mean difference (p&lt;0.001) between Psychiatric and ITC patients.&#x0D; Conclusion: Most frequent drug abuse in our settings is Cannabis, followed by Benzodiazepines and Opiates. An overall increase in drug abuse frequency while a decrease in the frequency of...........Keywords: COVID-19 pandemic, Pakistan, Substance abuse pattern.

Comparison of Serum Copper, Zinc, Lead, Aluminium and Iron Levels in Patients with Parkinson’s Disease with Healthy Controls in Tertiary Care Hospital

Objective: To compare serum Copper, Zinc, Lead, Aluminium and Iron levels in patients with Parkinson’s disease with healthy subjects and the association of these trace elements.&#x0D; Study Design: Comparative Cross-sectional study.&#x0D; Place and Duration of Study: Department of Chemical Pathology and Endocrinology at Armed Forces Institute of Pathology (AFIP), Rawalpindi Pakistan, from Nov 2019 to Jul 2020.&#x0D; Methodology: Out of the total of 129 study participants, 83 were Parkinson’s disease patients, and 46 were healthy subjects. Serum Iron level was measured on random access fully automated chemistry analyser advia 1800. In addition, Copper, Zinc, Lead and Aluminium were measured by atomic absorption spectrophotometry. These levels were compared between patients with Parkinson’s disease and healthy subjects using the Mann-Whitney U test.&#x0D; Results: Out of the total 129 subjects, males accounted for 51(61.4%) and females were 32(38.6%) in the diseased Group, while in healthy subjects, males accounted for 22(47.8%) and females for 24(52.2%). Levels of Copper, Zinc and Iron were signifi-cantly decreased in patients with Parkinson’s disease compared to healthy subjects (p&lt;0.001). However, serum concentrations of Aluminium and Lead showed an increasing trend in patients with Parkinson’s disease compared to age-matched healthy subjects (p&lt;0.001).&#x0D; Conclusion: Decreased levels of serum copper, iron and Zinc were seen in patients with Parkinson’s disease, while aluminium and lead levels were raised, showing the potential neurotoxic role of these elements.

Association of Apolipoprotein B and Triglyceride Levels with Coronary Artery Disease

Objective: To find the association of Apolipoprotein B and triglycerides with coronary artery disease.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi, in collaboration with HITEC Institute of Medical Sciences, Taxila Pakistan, from Mar 2019 to Mar 2020.&#x0D; Methodology: Four hundred and forty-four individuals of either gender and 18-70 years were included in the study. According to CT angiography, participants were differentiated into those with coronary artery disease and without coronary artery disease. In addition, serum triglycerides were analysed by glycerol phosphate enzymatic endpoint method on ADVIA 1800R Clinical Chemistry Auto analyzer, and apolipoprotein B was analysed on BT1500 Clinical Chemistry turbidimetric analyzer.&#x0D; Results: The sample population had 144(32.0%) females and 300(68.0%) males. 164(37.0%) patients had coronary artery disease. 120(27.0%) participants were between 35 and 45 years of age, and 96(22.0%) were between 56 and 65 years. 126(30.0%) patients had hypertension, 352(79.3%) had apolipoprotein B levels &gt;130 mg/dl. Positive Pearson’s correlation was found between apolipoprotein B and triglycerides with coronary artery disease.&#x0D; Conclusion: There is a strong association between apolipoprotein B and non-fasting triglyceride levels with coronary artery disease. The apolipoprotein B can be used as a routine biomarker for screening and treatment monitoring coronary artery disease along with other lipid profile parameters.