Fibroblast growth factor 23 (FGF23) levels, phosphate Intake and its association with Indices of renal handling of phosphate in healthy volunteers

FGF23 is a novel phosphaturic hormone; we aimed to assess the FGF23 levels and its association with dietary phosphate intake and indices of renal handling of phosphate in this study. Prospective study was conducted in which dietary phosphate intake was assessed by food frequency questionnaire (FFQ) along with blood and spot urine samples were collected after overnight fast for determining serum phosphate, FGF23, fractional excretion of phosphate (FePO4 ) and tubular maximum for phosphate (TmP/GFR). FGF23 (C-Term) was measured by a sandwich ELISA. The mean dietary phosphate intake of eighty healthy adults (mean age of 29 ± 5 years) was 1220 ± 426 mg; median FGF23 was 49.9 RU/ml (IQR=33, 76) and mean FePO4 was 7 ± 4.7. Subjects were stratified into two groups according to serum phosphate levels. Significant difference was not found in dietary phosphate intake and FGF23 levels in the two groups. However, TmP/GFR and creatinine were significantly different in the two groups. FePO4 was high in both the groups. Overall a rising pattern of FGF23 levels was seen with increasing serum phosphate levels. Significant positive correlation was found between FGF23 and dietary phosphate (r=0.22, p\u3c0.05) and negative correlation was seen between FGF23 and FePO4 (r=-0.260, p\u3c0.05)

Indirect determination of serum creatinine reference intervals in a Pakistani pediatric population using big data analytics

Background: The indirect methods of reference intervals (RI) establishment based on data mining are utilized to overcome the ethical, practical challenges and the cost associated with the conventional direct approach.Aim: To generate RIs for serum creatinine in children and adolescents using an indirect statistical tool.Methods: Data mining of the laboratory information system was performed for serum creatinine analyzed from birth to 17 years for both genders. The timeline was set at six years from January 2013 to December 2018. Microsoft Excel 2010 and an indirect algorithm developed by the German Society of Clinical Chemistry and Laboratory Medicine\u27s Working Group on Guide Limits were used for the data analysis.Results: Data were extracted from 96104 samples and after excluding multiple samples for the same individual, we calculated RIs for 21920 males and 14846 females, with stratification into six discrete age groups.Conclusion: Serum creatinine dynamics varied significantly across gender and age groups

Pattern of drugs of abuse identified in chemical samples

OBJECTIVE: To determine the pattern of drugs of abuse in urine and blood samples processed at referral laboratory in Pakistan so that information on the type of drugs used can be identified and used for ready reference for future strategy. Study Design: Observational study. PLACE AND DURATION OF STUDY: Clinical Laboratory of The Aga Khan University Hospital, Karachi, from July 2006 to March 2008. Methodology: Retrospective review of records were done for the common drugs that are used for screening at the Clinical Laboratory include alcohol, amphetamine, barbiturates, benzodiazepines, cannabinoids, cocaine and opiates. Alcohol was tested in blood and others were identified using urine. Percentages of tests screened positive and negative for individual drugs were computed by using SPSS 16.0. The ratio between male and female users was also established. RESULTS: A total of 17,714 tests were performed for drugs. The mean age of the patients whose samples were processed was 30+/-14.84 years. Majority used benzodiazepines 520/1317 (39.5%) among the samples tested for drug of abuse, followed by cannabinoids 423/5450 (7.8%), alcohol 75/1302 (5.8%), barbiturates 32/1148 (2.8%), opiates 137/5640 (2.4%), cocaine 5/1655 (0.3%) and amphetamine 3/1202 (0.2%). In all, males 15411 (87%) were tested more frequently as compared to females 2303 (13%). CONCLUSION: Males were more frequently tested for drug abuse; however, drug abuse is increasingly seen among females. Benzodiazepines are the most frequently used. The same pattern of drugs abuse existed in different gender and age group. There is a need to explore the pattern and type of drug abuse on national scale

Antibiotic susceptibility profiling and virulence potential of Campylobacter jejuni isolates from different sources in Pakistan

AbstractObjectiveTo determine antibiotic resistance patterns and virulence potential of Campylobacter jejuni (C. jejuni) isolates from clinical human diarrheal infections, cattle and healthy broilers.MethodsAntibiotic sensitivity patterns of C. jejuni isolates were determined by Kirby Bauer Disc Diffusion assay. These isolates were then subjected to virulence profiling for the detection of mapA (membrane–associated protein), cadF (fibronectin binding protein), wlaN (beta–l,3–galactosyltransferase) and neuAB (sialic acid biosynthesis gene). Further C. jejuni isolates were grouped by random amplification of polymorphic DNA (RAPD) profiling.ResultsA total of 436 samples from poultry (n=88), cattle (n=216) and humans (n=132) from different locations were collected. Results revealed percentage of C. jejuni isolates were 35.2% (31/88), 25.0% (54/216) and 11.3% (15/132) among poultry, cattle and clinical human samples respectively. Antibiotic susceptibility results showed that similar resistance patterns to cephalothin was ie. 87.0%, 87.1% and 89%among humans, poultry and cattle respectively, followed by sulfamethoxazole+trimethoprim 40.0%, 38.7% and 31.0% in humans, poultry and cattle and Ampicillin 40%, 32% and 20% in humans, poultry and cattle respectively. Beta–lactamase activity was detected in 40.00% humans, 20.37% cattle and 32.25% in poultry C. jejuni isolates. CadF and mapA were present in all poultry, cattle and human C. jejuni isolates, wlaN was not detected in any isolate and neuAB was found in 9/31 (36%) poultry isolates. RAPD profiling results suggested high diversity of C. jejuni isolates.ConclusionsDetection of multidrug resistant C. jejuni strains from poultry and cattle is alarming as they can be potential hazard to humans. Moreover, predominant association of virulence factors, cadF and mapA (100% each) in C. jejuni isolates from all sources and neuAB (36%) with poultry isolates suggest the potential source of transmission of diverse types of C. jejuni to humans

Determining bone turnover status in patients with chronic liver disease

Introduction: Hepatic osteodystrophy is an osteoporotic bone disease that occurs in chronic liver disease patients. The global prevalence of osteoporosis in patients with chronic liver disease is 30% to 40%. The pathogenesis of hepatic bone disease is not clear, but it occurs due to unstable bone remodeling with increased bone resorption and decreases bone formation. There has been an interest in determining the clinical utility of bone turnover markers (BTMs) in the assessment of osteoporosis in chronic liver patients.Methods: This was a cross-sectional study conducted in patients with chronic liver disease at the section of chemical pathology, department of pathology and laboratory medicine, Aga Khan University (AKU). A total of 50 patients with age \u3e8 years and a history of liver disease \u3e6 months were recruited from January to October 2019. Liver function tests, i.e. aspartate aminotransferase (AST), alanine transaminase (ALT), albumin, and bilirubin, along with clinical signs of liver disease chronicity, were noted. The samples for BTMs, i.e. total serum alkaline phosphatase (ALP) and serum C-terminal telopeptide of type-1 collagen (CTX) were withdrawn and analyzed on Microlab (ELItech Group, Puteaux, France) and ADVIA Centaur (Siemens Diagnostics, NY), respectively.Results: The majority of patients were males (n=34, 68%). Twenty-four (48%) patients suffered from fibrosis while 26 (52%) were without fibrosis. Median platelet count (68×109/L (102.5-50)) and median cholesterol levels (102.5 mg/dl (147-99.5)) were decreased, whereas gamma-glutamyl transferase (GGT) levels were higher in the fibrosis group as compared to the non-fibrosis group. The median levels of total ALP were 91.5 IU/L (103-82), and the median levels of CTX were 0.24 pg/ml (0.34-0.21).Conclusion: In the present study, no significant difference was found in the BTMs of patients with and without chronic liver disease (CLD). However, there was a positive and significant correlation of BTMs, particularly CTX with age, bilirubin levels, and hepatomegaly

Prospective evaluation of serum procalcitonin in critically ill patients with suspected sepsis- experience from a tertiary care hospital in Pakistan

Background: Sepsis is the leading cause of mortality in critically ill patients. Procalcitonin (PCT) is a promising marker for identification of bacterial sepsis. The aim of this study was to determine the diagnostic accuracy of serum PCT concentration in patients with suspected sepsis admitted to mixed medical-surgical Intensive care unit (ICU).Material and methods: A cross-sectional study conducted at section of Chemical Pathology, Department of Pathology and Laboratory Medicine and ICU. Patients with suspected sepsis were included, serum PCT cut off ≥0.5 ng/ml was taken for diagnosing sepsis. Diagnostic accuracy was measured in terms of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) taking blood culture as gold standard. Furthermore, different cut offs were compared by using receiver operating characteristic curves (ROC). Data analysis was done on SPSS version 20. Results: Median age of the study group (n = 103) was 48 years (IQR: 22), 60% being males. Out of the 103 patients included 82 patients had PCT levels above the optimal cut off. At a serum PCT cutoff of 0.5 μg/L, the sensitivity and specificity for the diagnosis of sepsis was found to be 93.75% and 43.59% respectively. NPV was higher compared to PPV making PCT a reliable marker to for the screening out of sepsis patients. Furthermore, it was revealed that PCT having an AUC = 0.70 outperformed WBC (AUC = 0.5) and CRP (AUC = 0.6). Conclusion: Elevated PCT concentration is a promising indicator of sepsis in newly admitted critically ill patients capable of complementing clinical signs and routine laboratory parameter

Septic emboli of the lung due to Fusobacterium necrophorum, a case of Lemierre\u27s syndrome

© 2019 The Authors Fusobacterium necrophorum plays a causal role in a rare and life-threatening condition, Lemierre\u27s syndrome. It is characterized by infection involving the posterior compartment of the lateral pharyngeal space complicated by septic suppurative thrombophlebitis of the internal jugular vein with F. necrophorum bacteremia and metastatic abscesses, primarily to the lung and pulmonary septic emboli. Herein, we present a very rare case of oropharyngeal infection complicated by Lemierre\u27s syndrome with characteristic septic emboli to the lungs presenting as sore throat in a previously healthy patient. A 23-year-old woman presented with sore throat and was found to be in sepsis and acute kidney injury. She was found to have septic emboli in lung and Streptococcus anginosus and F. necrophorum in blood. She was diagnosed with Lemierre\u27s syndrome and successfully treated with antibiotics. Lemierre\u27s syndrome should be included in the differential diagnosis in young patients who deteriorate in the setting of a sore throat. If the suspicion is high, throat swabs from young patients with nonstreptococcal group A tonsillitis should be cultured anaerobically on selective medium to detect the presence of F. necrophorum. While clinicians of the infectious disease team may be familiar with this condition other departments including internal medicine and critical care team may less so. Unless clinicians are aware of this syndrome, diagnosis and treatment can be delayed leading to higher morbidity and mortality

High burden of subclinical lead toxicity after phase out of lead from petroleum in Pakistan

OBJECTIVE:To evaluate the frequency of subclinical lead toxicity.STUDY DESIGN:Cross-sectional study.PLACE AND DURATION OF STUDY:Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Karachi, from January 2011 to December 2014.METHODOLOGY:Analysis of laboratory data for blood lead levels (BLL) was performed. Lead was tested by atomic absorption spectrometer. For all subjects, only initial test results were included while the results of repeated testing were excluded. Exemption was sought from institutional ethical review committee. BLL of 2-10 ug/dl and 10-70 ug/dl in children and adults, respectively were taken as subclinical lead toxicity.RESULTS:Amongst the total number of subjects tested (n=524), 26.5% (n=139) were children (\u3c16 years) while rest were adults. Overall median BLLs was 6.4 ug/dl (20.9-3.1). The median BLL was 4 ug/dl (6.7-2.6) in children and 8.3 ug/dl (27.9-3.4) in adults, respectively. The BLL increased with age; higher levels were observed in age range 21-30 years of subjects [median lead level 16.9 ug/dl (36.1-4)] and lower level [4.2 ug/dl (6.8-2.6)] in children with \u3c10 years of age. Only 16% (n=22) children had desirable lead levels while most had either subclinical (76%, n=106) or toxic lead levels (8%, n=11). In adults, (55%, n=212) subjects had desired lead levels, and 40% (n=154) and 4.99% (n=19) had subclinical and toxic lead levels.CONCLUSION:Presence of subclinical lead poisoning even after phasing out of lead petroleum in Pakistanis is alarming, especially in children. A national population-based study to determine the lead status and targeted intervention to identify potential sources is need of the time

Predictors of mortality in brain abscess

Objective: Brain abscess carries significant morbidity and mortality. Our objective was to elucidate the clinical presentation of brain abscess and to assess predictors of mortality in these patients.Methods: All patients with a brain abscess presenting to the Aga Khan University Hospital, a tertiary care referral center in Karachi, Pakistan, were studied retrospectively. Statistical analysis involved univariate analysis and a logistic regression model.Results: Among the 66 patients analyzed, a distant metastatic focus of infection was the most commonly identified predisposing factor (29%). Otogenic infection was the commonest contiguous source and sinusitis was noticeably absent. Multiple abscesses were frequent (35%). Streptococci were the most common isolates (39%). Lumbar puncture was performed in 44% and steroids administered in 33%. Treatment was surgical in 58%. Most comatose patients were treated conservatively. Overall mortality was 29%. Univariate analysis identified comatose presentation and identification of a distant focus of infection as predictors of mortality. The logistic regression model, however, identified a distant focus of infection as the only independent predictor.Conclusion: Age greater than 30 years, corticosteroid use, multiple abscesses, performance of lumbar puncture and conservative management had no affect on outcome

Association of Beta-2 Adrenoreceptor Single Nucleotide Polymorphism with Risk of Type II Diabetes Mellitus

Objective: To determine the genotype of Arg16Gly & Gln27Glu polymorphism in type-2 diabetes mellitus and to find possible association of ADRβ2with type-2 diabetes mellitus. Methodology: A case control study was designed and a total of 192 subjects (98 in each group) were included. After formal approval, subjects were recruited from North West General Hospital (NWGH) Peshawar. After taking consent blood samples were collected from the participants and DNA analysis was done using commercially available kits by salting out protocols, while other biochemical parameters were analyzed using normal laboratory protocols for respective tests. Results: The comparative analysis of SNP rs1042713 indicates that allele G/A was 42(49.4%) in diabetic and 43(50.6%) in non-diabetic subjects. While GG was more frequent 22(59.5%) in diabetic as compare to non-diabetic 15(40.5%). Among AA allele, 19 (65.5%) were non-diabetic while 10(34.5%) were diabetic. However the difference was not statistically significant (p=0.22). In case of “rs1042714” gene the commonest allele was C/C 80 (41.7%) out of which, 47(58.8%) was found in diabetic and 33(41.2%) were non-diabetic. Similarly CG was second common allele out of which diabetics were 27(44.3%) while non-diabetics were 34(55.7%). Allele G/G was found only among 11 subjects (p=0.085). Conclusion: Based on the result of the present study, it is concluded that polymorphism in ADRB2 genes rs1042713 (Arg16Gly) and rs1042714 (Gln27Glu) is associated with susceptibility of T2DM through alteration in BMI & HbA1c