Clinical Pathology Department Research Articles

Expression of Hepcidin and Growth Differentiation Factor 15 (GDF-15) Levels in Thalassemia Patients with Iron Overload and Positive Anti Hepatitis C Virus

Background: Thalassemia patients who undergo life-long recurrent blood transfusion will experience iron overload in various organs including the liver and possibly suffer from chronic hepatitis C infection which may lead to liver impairment. The liver produces hepcidin, a hormone which plays role in the regulation of iron level in the blood. Various factors may influence hepcidin level in the blood. Chronic hepatitis C causes iron overload and liver impairment. Liver impairment and haemolytic anaemia due to haemoglobinopathy will suppress hepcidin production. Anaemia stimulates growth differentiation factor 15 (GDF-15) to increase erythropoiesis and suppress hepcidin production. Iron overload causes increase in hepcidin level. Presence of factors which decrease or increase hepcidin production will express various levels of hepcidin. This study aimed to identify the expression of hepcidin and GDF-15 levels in thalassemia patients with iron overload and positive anti-HCV. Information on hepcidin and GDF-15 levels are beneficial in the management of iron overload in thalassemia with positive anti-HCV.Method: This study was a descriptive analytic study in thalassemia patients who had received recurrent blood transfusion ≥ 12 times, suffered from iron overload (transferrin saturation 55% and ferritin 1,000 ng/mL), which consisted of 31 individuals with positive anti-HCV and 27 individuals with negative anti-HCV. This study was performed in Thalassemia Centre Department of Child Health and Department of Clinical Pathology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, in October 2011–January 2012. Serum hepcidin and GDF-15 examinations were performed using enzyme-linked immunosorbent assay (ELISA) method. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) examinations were performed using colorimetry method. Data on ferritin and transferrin saturation were obtained from medical records in the last 3 months. Data was analysed using SPSS Windows version 17 software.Results: Characteristics of subjects in this study included ferritin level, transferrin saturation, AST, and ALT were 5,289 (SD 2,492) ng/mL, 96.7 (SD 9.2)%, 41.8 (SD 26.7) U/L, and 50.6 (24.9) U/L, respectively. It was obtained that the hepcidin levels were within the normal limits with median of 51.5 (19-166) pg/mL, while GDF-15 levels were higher than the normal range with median of 1,936 (643-2,475) pg/mL. There was no significant difference of hepcidin and GDF-15 levels between positive and negative anti-HCV groups, with p value of 0.842 and 0.115, respectively.Conclusion: We obtained that the hepcidin levels were within normal limits and GDF-15 levels were higher than the normal range. There was no significant difference of hepcidin and GDF-15 levels between positive and negative anti-HCV group.

METABOLIC SYNDROME AND ELEVATEDOSTEOPONTIN: THEIR ASSOCIATED COMORBIDITIES IN PATIENTS WITH PSORIASIS.

20Jan 2017 METABOLIC SYNDROME AND ELEVATEDOSTEOPONTIN: THEIR ASSOCIATED COMORBIDITIES IN PATIENTS WITH PSORIASIS. Hoda G. Bakr , Fatma Eldesouky , Abdallah H kandil and Samar M. Sharaf. Department of Internal Medicine. Faculty of Medicine, Zagazig University, Egypt. Department of Dermatology.Faculty of Medicine, Zagazig University, Egypt. Department of Clinical pathology, Faculty of Medicine, Zagazig University, Egypt.

DIAGNOSTIC VALUE OF CONVENTIONAL CYTOGENETIC ANALYSIS IN SELECTED CHILDREN WITH ATTENTION-DEFICIT HYPERACTIVITY DISORDER.

20Jan 2017 DIAGNOSTIC VALUE OF CONVENTIONAL CYTOGENETIC ANALYSIS IN SELECTED CHILDREN WITH ATTENTION-DEFICIT HYPERACTIVITY DISORDER. Mohamed Abdel Malik Hassan , Ali Alnabawy and Shaimaa Abdelmalik Pessar. Pediatrics Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt. Psychiatry Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt. Clinical Pathology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.

Weil-Felix Test - A Diagnostic Tool for Rickettsial Diseases

Rickettsial diseases are generally classified under the causes of pyrexia of unknown origin (PUO) and high prevalence of this disease is found in developing countries like India. Diagnosis in such cases is difficult because early sign and symptoms are non-specific and varied. Mortality may be as high as 30-40% if untreated. Weil Felix in one of the cheapest screening method available for laboratory diagnosis of rickettsial diseases but the major drawback of this method is its less sensitivity. A prospective testing was carried out in clinical pathology department in Haffkine Institute as a routine testing for the patients who are advised for extended Widal test. These patients comes from the various government hospitals, private hospitals and tertiary care centres. The serum samples from 1464 PUO cases which included patients of all age group and from both government and private hospitals, were subjected to Weil–Felix test (R.K. Diagnostics, Malad, Mumbai, India). The test was performed according to the manufacturer’s instructions. Titers of ≥ 1:80 for OX K, OX 2 and OX 19 were considered significant. Of 1464 samples, rickettsial diseases were detected in 485(33.13%) samples. Seropositivity was higher among male subjects 262(54.02%) when compared with female subjects 223(45.98%) Most of the positive cases were in 5-10 age group. Prevalence of rickettsial diseases 485(33.13%) is significantly high, especially in children’s and hence should be included in the differential diagnosis of PUO.

Evaluation of HiaureusTM Coagulase Confirmation Kit in Identification of Staphylococcus aureus.

Staphylococcus aureus is a facultative anaerobic Gram positive coccal bacterium whose incidence ranges to different infections. It is a cause of various uncomplicated skin infections, abscesses, septicaemia/bacteraemia, gastroenteritis, endocarditis, toxic shock syndrome and food intoxications. Various methods with varied time, sensitivities, specificities and costs are available, but may not be used as a reliable test for the identification and differentiation of S. aureus. Therefore, there is a need to evaluate newer tests. To compare the conventional tests with a commercial available kit for reliable, cost effective identification and confirmation of S. aureus. The current prospective study was conducted in the Department of Clinical Pathology, Haffkine Institute for a period of six months. A total of 341 clinical isolates of staphylococci isolated from pus, urine, blood culture and sterile body fluids were subjected to conventional tests like Tube Coagulase Test (TCT) using Rabbit Plasma (RP) and Human Plasma (HP), culture media such as Mannitol Salt Agar (MSA) and Deoxyribonuclease (DNase) media in parallel to HiaureusTM Coagulase Confirmation Kit (HACCK), a commercially available kit for identification of S. aureus. Amplification of the femA gene was used as a comparative reference point test to calculate the sensitivity, specificity and concordance values of the conventional tests. Amongst the coagulase based tests, HACCK was 100% sensitive and specific. The TCT using RP was 98.58% sensitive while TCT using HP was less sensitive (95.37%). A total of 100% specificity was observed for TCT using RP while TCT using HP was 96.68% specific. The MSA and DNase media were 97.86% vs 96.44% and 96.67% vs 91.67% sensitive and specific respectively. The combination tests had varying sensitivity and specificity ranges. The HACCK demonstrated 100% concordance with femA amplification and was labelled as an ideal perfect test (κ=1) with MSA as an alternative test for S. aureus identification. The HACCK can be used as an exclusive, reliable and cost effective test for identification of S. aureus. Alternatively, in view of the cost factor MSA either as a single test or in combination with TCT using HP could be used as screening tests and confirm discordant results with HACCK.

Early Pregnancy Microalbuminuria as a Predictor of Pre-Eclampsia

Patients and methods: This study was done on 110 pregnant women attended the department of Obestatric and Gynecology, Sayed Galal University Hospital in the period from 4/2014 to 5/2015. From those 110 cases, 4 did not accept to be included in the study and another 6 cases were excluded due to history of significant liver disease, leaving one hundred cases to be included in the study. The laboratory investigations were done for all of the 100 cases in the department of Clinical Pathology, Sayed Galal University Hospital. Results: Although microalbuminuria were more frequently seen among high risk group, the difference was nonsignificant. The cause may be the limited number of cases in the two groups. The mean age of cases was slightly higher than controls, but with a non-significant difference. Taking into consideration that primigravida per se is a risk factor for preeclampsia, all of the 21 primigravida cases were considered as high risk. All of the low risk groups were in the full term, with three cases of the high risk group were preterm. The mean gestational age of the two groups showed non-significant difference. The mean blood pressure both at booking and at delivery showed non-significant differences between the cases and the control subjects. We found a mild rise of blood pressure by around 6-9 mm Hg. The difference between the blood pressure at booking and at delivery was highly significant, which means that this rise was seen in nearly all cases and controls. Slightly higher than one quarter of cases and control group delivered by CS, with the remaining delivered by normal vaginal delivery. There is no significant difference between the two groups as regards the mode of delivery. Birth weight was slightly lower in the cases group than in the control group, with a non-significant difference. The 24 h protein in urine was higher in the cases group than in the control group by around 35 mg. However, the difference between the two groups was non-significant. The non-significance here may be due to the high standard deviation in both groups. PIH was seen only in 7 subjects; 3 in the cases group and 4 in the control group, with a non-significant difference between the two groups. Preeclampsia was seen in 6 cases (12%) of the cases group, compared to 4 cases (8%) of the control groups. This difference was non-significant both because of the low difference between the two groups (only 2 cases) and the limited number of positive cases in both groups. No cases of eclampsia were diagnosed in our study patients or controls. Although age was directly related with the albuminuria, with maximum age among patients with macroalbuminuria and minimum age among patients with no albuminuria; the difference was non-significant. There was non-significant relation between parity and the albuminuria. The cause of this non significance is due to the limited number of micro and macro-albuminuria in our study groups. Blood pressure showed a steady increase between the normal and microalbuminuria and between micro and macroalbuminuria. However, the only significant difference was seen in the diastolic blood pressure at delivery. There was no significant relation between the gestational age and the occurrence of albuminuria. We found a non-significant relation between microalbuminuria and the mode of delivery. Although patients with albuminuria tended to give lower birth weighted babies, the difference was non-significant. There was non-significant relation between PIH and albuminuria. Among the 10 cases who developed preeclampsia, 5 had macroalbuminuria (41.7% of all macroalbuminuria cases), compared to 3 cased had microalbuminuria (14.3%) and only two cases having no albuminuria (3%). The difference was highly significant among the three groups. The most common risk in the high risk group was primigravia, seen in 42% of cases, followed by the maternal age>34 years, seen in 40% of cases (38% alone and 2% associated with twins). Previous history of preeclampsia was seen in 14% of cases and lastly twins were seen in 6% of cases. We found a non-significant relation between the occurrence of preeclampsia and the traditional risks for preeclampsia. The cause of this non significance may be due to the limited number of preeclampsia cases (only 6 cases in the high risk group). The predictive values of microalbuminuria in the pathogenesis of preeclampsia were as follows: sensitivity 80%, specificity 72.2%, positive likelihood ratio 288%, negative likelihood ratio 22.7%, positive predictive value 24.2%, negative predictive value 97%, Odd’s ratio 10.4 and lastly accuracy 76.1%. Conclusion: Microalbuminuria should be considered as an important risk factor for the development of preeclampsia, with high sensitivity and specificity values.

Growth differentiation factor 15 as a marker of ineffective erythropoiesis in patients with chronic C virus infection

Objective The aim of this study was to determine the expression of growth differentiation factor 15 (GDF-15) in patients with chronic hepatitis C virus and its association with iron-loading anemia in these patients. Background Significant shortened red cell survival has been reported in patients with liver diseases even in the absence of anemia. The mechanism for the observed decreased red cell lifespan is not fully understood, and it is most probably multifactorial. GDF-15, a member of the transforming growth factor-β super family, was first cloned from human monocytoid cell line and was found to inhibit tumor necrotizing factor production by macrophages and negatively regulate hepcidin. Recent studies suggest that GDF-15 levels increase in conditions of cell stress and apoptosis. In bone marrow (BM), GDF-15 increases in case of ineffective erythropoiesis. Patients and methods This study was carried out at Clinical Pathology Department, Faculty of Medicine and National Liver Institute, Menoufia University, in the period from May 2013 to May 2015. The study included 70 individuals: 50 patients with compensated chronic hepatitis C with unexplained anemia and 10 patients with idiopathic thrombocytopenic purpura who had normal red blood cell counts and no signs of erythroid dysplasia, as a control group for BM expression of GDF-15. In addition, 10 unrelated healthy age-matched and sex-matched adult individuals were included as a normal control group. Serum GDF-15 was measured by ELISA, and GDF-15 mRNA was measured by real-time RT-PCR. Results There were significant differences between the different studied groups regarding iron profile, GDF-15 serum level, and BM expression of GDF-15 mRNA, being higher in patients with chronic hepatitis C than other groups. GDF-15 was positively correlated with serum iron indices and negatively correlated with hemoglobin concentration. Conclusion Ineffective erythropoiesis contributes to iron overload and anemia in patients with chronic hepatitis C.

STUDY OF ALTERNATIVE WILMS TUMOR GENE EXPRESSION IN ACUTE MYELOID LEUKEMIA.

23Nov 2016 STUDY OF ALTERNATIVE WILMS TUMOR GENE EXPRESSION IN ACUTE MYELOID LEUKEMIA. Magdy Mamdouh El Bordiny , Ashraf Hussien Al-Ghandour , Reham Abdel Haleem Abo Elwafa and Omneya Mohamed Kamal Fayed. Professor in Clinical Pathology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt. Professor in Internal Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt. Lecturer in Clinical Pathology Department, Faculty of medicine, Alexandria University, Alexandria, Egypt. Specialist in, Alexandria University Hospitals, Alexandria, Egypt.

COMPARATIVE STUDY BETWEEN ORAL PENICILLIN AND LONG ACTING PENICILLIN IN TREATMENT OF RECURRENT STREPTOCOCCAL TONSILLOPHARYNGITIS.

30Nov 2016 COMPARATIVE STUDY BETWEEN ORAL PENICILLIN AND LONG ACTING PENICILLIN IN TREATMENT OF RECURRENT STREPTOCOCCAL TONSILLOPHARYNGITIS. Shahin Aly Dabour , Yaser Mahmud Ismail , Effat Hussein Assar , Eman R. Abd Almonaem and Hatem Hamid Yousef. Pediatric department, Faculty of medicine, Banha University, Qalyubia, Egypt. Clinical pathology department, Faculty of medicine, Banha University, Qalyubia, Egypt.

HoSPITAL ACQuIReD PneuMonIA onSeT DAN BAKTEREMIA

Hospital acquired pneumonia (HAP) is significantly impact the patient morbidity and mortality that cause etiologic identification becomes a microbiological emergency in HAP. The etiologic identification based on the onset of pneumonia is important to determine the specific pathogens, that impact patient prognosis and prevent bacteremia. The aim of the study is to know the bacterial profile and antibiotic susceptibility pattern of early onset HAP by determination, late onset HAP and HAP with bacteriaemia in the intensive care setting. The design of this study was retrospective descriptive. The data was collected from the Clinical Microbiology Laboratory, Department of Clinical Pathology and the medical record from Dr. Hasan Sadikin hospital Bandung, from April 2013–March 2013. From the 61 episodes of HAP, 18 were early onset HAP and 43 were late onset HAP, including five (5) related to (8.2%) HAP with bacteriaemia. Klebsiella pneumoniae is the most common etiology of the early onset HAP (22.2%), with the highest susceptibility (75%) to amikacin, meropenem, and tigecyclin. Acinetobacter baumannii is the most common etiology of the late onset HAP (27.9%), with the highest susceptibility (75%) to amikacin and cotrymoxazole. The most common etiology of HAP with bacteriaemia is Klebsiella pneumoniae confirmed ESBL (40%) with the highest susceptibility to amikacin and meropenem (100%). Based on this study, it can be concluded that the most common bacterial profile of the early onset HAP is K. pneumoniae, while for the late onset HAP is A. baumannii, and HAP with bacteriaemia is K. pneumoniae confirmed ESBL. All of them have the highest susceptibility to amikacin.

Atherosclerosis Is Associated with Neutrophil Lymphocyte Ratio As An Inflammatory Marker in Type 2 Diabetes Mellitus Patients with Coronary Artery Disease

Background: Increased neutrophil lymphocyte ratio is associated with major adverse outcomes of cardiac events in type 2 diabetes mellitus (DM) patients.Objective: To assess the NLR as an inflammatory marker in atherosclerosis in type 2 DM patients with coronary artery disease (CAD).Methods: This case control study was conducted in the Department of Clinical Pathology in collaboration with Department of Cardiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from March 2014 to February 2015. Total 134 patients were enrolled in this study who were waiting for coronary angiography in the Department of Cardiology, BSMMU; 84 cases were considered as Group I (DM with CAD) and 50 controls were Group II (DM without CAD). A 2 ml of blood was collected in EDTA tube from the patients prior to coronary angiogram for complete blood count (CBC) were measured by haematology autoanalyzer, rechecked manually and NLR was calculated in the Department of Clinical Pathology, BSMMU. Coronary artery disease with 50% coronary artery stenosis and more critical lesion that were diagnosed by coronary angiography were included in this study as cases. Coronary artery disease with less than 50% coronary artery stenosis that was diagnosed by coronary angiography was included in this study as control.Results: NLR was higher in CAD positive group compared to group without CAD negative in type 2 DM patients (2.76 (±0.74) vs. 1.56 (±0.15), p<0.001).Conclusion: With the help of neutrophil lymphocyte ratio we can take preventive measure and precaution to reduce the progression of atherosclerosis in type 2 diabetic patients with coronary artery disease.J Dhaka Medical College, Vol. 24, No.1, April, 2015, Page 24-29

ANTIBIOTIC SUSCEPTIBILITY ANALYSIS OF CLINICAL BACTERIAL ISOLATES IN CAIRO, EGYPT.

31Aug 2016 ANTIBIOTIC SUSCEPTIBILITY ANALYSIS OF CLINICAL BACTERIAL ISOLATES IN CAIRO, EGYPT. Hussien H. El-Sheikh , SoheirAbdelRahmanSalih , Mahmoud M. Elaasser , Nesreen A. Safwat and Mostafa Y. Ibrahim. Department of Botany and Microbiology, Faculty of Science, Al-Azhar University, Cairo, Egypt. Department of Clinical pathology, Faculty of Medicine, Al-Azhar University (Girls Branch), Cairo, Egypt. The Regional Center for Mycology and Biotechnology, Al-Azhar University, Cairo, Egypt.

Large vessel involvement in biopsy-proven giant cell arteritis: incidence, distribution, and predictors

Objectives: Giant cell arteritis (GCA) is a systemic disease with extensive vascular involvement. The aim of this study was to investigate the cumulative incidence of large vessel involvement (LVI) in GCA, the distribution of vessels involved, and predictors for LVI.Method: Patients with biopsy-proven GCA in a defined area in southern Sweden, diagnosed between 1997 and 2010, were identified through the register of the regional Department of Clinical Pathology. A structured review of all medical records and imaging and histopathology reports was performed. Imaging studies for an age- and sex-matched reference cohort were also reviewed.Results: A total of 164 patients with GCA were investigated, of whom 24 (15%) had LVI. LVI manifestations were detected a median of 3.7 [interquartile range (IQR) 0.7–7.5] years after GCA diagnosis. Aortic involvement was found in 16 patients (10%), mainly aneurysms/ectasias of the thoracic aorta. Two patients had aortic dissections. Fourteen patients had tributary involvement. In the reference population, the cumulative incidence of LVI overall was 10.8% and aortic involvement was found in 5.4%. The presence of giant cells in the biopsy was significantly less frequent among GCA patients with LVI (23% vs. 52%; p = 0.01), and a presentation with polymyalgia rheumatica (PMR) was more frequent (44% vs. 20%, p = 0.01).Conclusions: The estimated incidence of LVI, detected by imaging in a clinical setting, was higher among patients with GCA than the reference population. The aorta was the most commonly affected vascular territory. The negative association with giant cells may suggest particular mechanisms in this subset of GCA.

Study of rs17251221 single nucleotide polymorphism of calcium sensing receptor gene and its association with calcium nephrolithiasis in a cohort of Egyptian calcium nephrolithiasis patients.

30Jun 2016 Study of rs17251221 single nucleotide polymorphism of calcium sensing receptor gene and its association with calcium nephrolithiasis in a cohort of Egyptian calcium nephrolithiasis patients. Abla Abou Zeid , Doaa Hashad , May Selim and Hitham Badawy. Clinical Pathology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt. Urosurgery Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.

SERUM CHEMERIN AS A PREDICTOR OF CORONARY ARTERY DISEASES IN TYPE 2 DIABETES

30Jun 2016 SERUM CHEMERIN AS A PREDICTOR OF CORONARY ARTERY DISEASES IN TYPE 2 DIABETES Hala Abdel-Hameed Abdel-Azeez , Manar Mostafa Al-Zaki and Maher Borai Mohammad Borai. Clinical PathologyDepartment, Faculty of Medicine, Zagazig University, Egypt. CardiologyDepartment,Faculty of Medicine, Zagazig University, Egypt.

EFFECT OF DIFFERENT HUMAN MUSCLE TISSUE PRESERVATIVES ON QUALITY AND QUANTITY OF DNA: MEDICO LEGAL ASPECT

Background: Disaster victim identification (DVI) is a part of a collective response to mass disasters with the intention of identifying victims and body parts. Muscle tissue is sampled during DVI operations to identify victims by DNA analysis. Aim: To provide an effective field based method for preservation of DNA in human muscle tissues. Methods: A cross sectional comparative study was carried out on normal healthy human muscle tissues which were collected from patients admitted to Suez Canal University Hospital for surgical amputation of a part of limb. Muscle tissue was stored for 4 weeks in a number of preservatives at room temperature (15- 20°C). This process was repeated at 37°C to simulate the conditions expected during DVI operations in warm conditions. Samples were also stored at -20oC which represents the optimum storage condition used in many countries. Quantitative and qualitative analysis of DNA extracted from samples was done for each preservative during the 4 weeks. The study was conducted in the clinical pathology department in faculty of medicine-Suez Canal University, Ismailia, Egypt. Results: All preservatives could retain DNA up to the 4 weeks. Ethanol 70% (EtOH) gave the highest DNA concentration in both conditions (p value <0.001), followed by Dimethyl sulfoxide (DMSO) in room temperature and Sodium Chloride (NaCl) in 37 oC. All used preservatives did not show degradation in room temperature, while NaCl and Ethanol 70% showed degradation in DNA extracted in day 28 in 37 oC condition ( p value <0.001). Conclusion: DMSO is a successful method of preservation of DNA in human muscle tissue up to 4 weeks in both room temperature and 37 oC. While NaCl and Ethanol 70% are successful methods of preservation of DNA in muscle tissue up to 2 weeks only in 37 oC and up to 4 weeks in room temperature (15-20oC).

Serum Neutrophil Gelatinase-Associated Lipocalin (NGAL) in Acute Kidney Injury and Its Relation to Troponin T in cardiac and renal patients.

30May 2016 Serum Neutrophil Gelatinase-Associated Lipocalin (NGAL) in Acute Kidney Injury and Its Relation to Troponin T in cardiac and renal patients. Yousef Kadry , Mohamed El Sayed , Said M. Al-Barshomy and Hesham Omer. Internal medicine and nephrology department Zagazig university – Egypt. Clinical pathology department Zagazig university - Egypt.

Occurrence of coronary artery disease in patients with type 2 diabetes mellitus can be predicted by neutrophil lymphocyte ratio

Neutrophil lymphocyte ratio (NLR) is the sign of balance between neutrophil &amp; lymphocyte levels in the body and is an indicator of systemic inflammation. NLR is a new predictor for cardiovascular risk and mortality and by which occurrence of coronary artery disease can be predicted in type 2 DM patients. This case control study was conducted in the Department of Clinical pathology in collaboration with Department of Cardiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from March 2014 to February 2015 to assess the NLR as a useful predictive marker for coronary artery disease in type 2 DM patients detected by coronary angiography. Total 134 patients waiting for coronary angiography in the Department of Cardiology, BSMMU were enrolled in this study. Among them, 84 patients were considered as Group A (DM with CAD). All of them had ? 50% coronary artery stenosis on coronary angiography. Fifty patients with DM but without CAD were enrolled in Group B and considered as controls. Statistically significant increased NLR was found in Group A (type 2 DM patients with CAD) compared to Group B (type 2 DM patients without CAD). So, NLR can be used to predict adverse outcome i.e. coronary artery disease in patients with type 2 DM.Bangladesh Med J. 2015 Sep; 44 (3): 130-135

Gamma-glutamyl transferase is an indicator of gestational diabetes mellitus

Increased gamma-glutamyl transferase (GGT) is associated with gestational diabetes mellitus (GDM) and type 2 diabetes mellitus in pregnant women. This cross sectional study was conducted in the Department of Clinical Pathology in collaboration with Department of Obstetrics and Gynecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from March 2014 to February 2015 to assess the GGT as an indicator of GDM. Total 66 pregnant women were enrolled in this study in the Department of Obstetrics and Gynecology, BSMMU. Total 33 cases were considered as Group I (GDM) and 33 controls were Group II (normal healthy pregnant women). Two ml of blood was collected in plain test tube from each patient. Gestational diabetes mellitus were diagnosed by FBS and 2hr after 75g glucose in this study as cases. Normal healthy pregnant women was included in this study as control. GGT was higher in GDM group compared to normal healthy pregnant women (30.60±7.78 vs. 16.45±4.97, p&lt;0.001). So, with the help of GGT we can take preventive measure and precaution to reduce the risk of GDM in pregnant women.Bangladesh Med J. 2015 Sep; 44 (3): 152-156

Detection of Mycobacterial Lipoarabinomannan with A Monoclonal Antibody Qualitative ELISA in Urine of Tuberculous Meningitis Patients

BACKGROUND: Tuberculous meningitis is the most severe manifestation of tuberculosis. The diagnostic approach of tuberculous meningitis is difficult. Combination of clinical, laboratory and radiological criteria were used in diagnostic approach of tuberculous meningitis. Urinary mycobacterial lipoarabinomannan (LAM) antigen detection is a promising diagnostic tool. Detection of mycobacterial antigen in concentrated urine sample is predicted to improve the positivity rate of the qualitative enzyme-linked immunosorbent assay (ELISA) diagnostic tool. The purpose of this study is to examine the detection ability of a monoclonal antibody qualitative ELISA in concentrated and unconcentrated urine of tuberculous meningitis patients.METHODS: This research is a descriptive, crosssectionally designed. The study was conducted in the Clinical Pathology Department laboratory of Dr. Hasan Sadikin Hospital, in July-October 2014. A total of 27 patients diagnosed as tuberculous meningitis patients were included and the subjects were classified into possible and probable criteria according to consensus criteria. The subjects were classified as definite if the cerebrospinal fluid culture was positive for Mycobacterial tuberculosis growth. The subjects were examined for the presence of LAM in unconcentrated and concentrated urine with a monoclonal antibody qualitative ELISA method.RESULTS: Unconcentrated urinary LAM examination positivity was 0% while in concentrated urine was 14.8%. The positivity of concentrated urinary LAM were higher among the definite criteria group.CONCLUSION: Concentrating urine sample increase the positivity rate of urinary LAM detection with ELISA method as high as 14.8%. The urinary antigen detection is higher among the definite tuberculous meningitis patients.KEYWORDS: LAM, concentrated urine, tuberculous meningitis, qualitative ELISA