CUT-OFF VALUES OF PROSTATE SPECIFIC ANTIGEN DENSITY– AN EFFECTIVE SCREENING MARKER BEFORE PROSTATE BIOPSY

OBJECTIVE: To determine cut-off values for prostate specific antigen density (PSAD) in diagnosing prostate carcinoma in symptomatic patients. METHODS: This cross sectional, observational study conducted at Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan from June 2020 to May 2021. Symptomatic patients (309) having prostatic enlargement on ultrasound were selected through consecutive sampling. All the patients underwent prostate biopsy for histopathological diagnosis. Prostate specific antigen density was calculated and compared between different age groups and different diseases. ROC curve was constructed and area under the curve was calculated to find out cut-off values value for PSAD. Sensitivity, specificity and accuracy were calculated at the cut-off values. RESULTS: Among 309 patients of median age was 68 years (IQR 43 – 75). There was a significant difference of PSAD in different age groups (p<0.001) and diseases like prostate carcinoma, benign prostatic hyperplasia and other prostatic disorders. PSAD had AUC of 0.878 at cut-off value of 0.135 ng/ml where sensitivity was 100%. A higher cut-off 0.20 ng/ml was suggested in younger age group as compared to the old age group where cut-off was found 0.135. CONCLUSION: Using PSAD as part of evaluation profile for prostate lesion, number of unnecessary biopsies can be significantly decreased. PSAD cut-off to aid in decision of invasive prostate biopsy is suggested to be 0.135 ng/ml with close biochemical follow up afterwards

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. Study Design: Cross-sectional validation study. 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. 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. 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. 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

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. Study Design: Cross-sectional study Place and Duration of Study: Department of Chemical Pathology, Armed Forces Institute of Pathology, Rawalpindi Pakistan, from Jan to Mar 2021. 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. 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 <0.001).Pearson correlation coefficient (r-value = -0.86, p-value <0.001) revealed a symmetrical increase in differences between the two methods as the albumin level decreased. 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

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. Study Design: Comparative cross-sectional study. 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. 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. 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<0.001). A moderate positive association was found between NT-pro BNP and glycosylated haemoglobin (r=0.541, p-value<0.001). 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

Evaluation of Apolipoprotein B / Apolipoprotein A Ratio as an Alternate of Lipid Profile for Cardiovascular Risk Assessment in a Tertiary Care Hospital

Objective: To compare the predictive utility of serum Apo B/Apo A ratio with serum lipid profile in evaluation of cardiovascular disease (CVD) risk assessment. Study Design: Cross sectional study. Place and Duration of Study: Research was done at Department of Chemical Pathology & Endocrinology, Armed Forces Institute of Pathology (AFIP), Rawalpindi from 1 January 2021 to 31 March 2022. Materials and Methods: A total of 204 patients were enrolled from a tertiary care hospital admitted for recent cardiac events and were compared with 96 healthy individuals. A serum sample was taken from all the members of both groups. Their lipid profile, Apo A, and Apo B were analyzed. Apo B/ Apo A ratio was calculated. The data was analyzed using SPSS version 21. Results: Means of patient group for total cholesterol, LDL-cholesterol, HDL-cholesterol, VLDL-cholesterol, triglycerides, and Apo B/Apo A ratio were 4.18±1.21, 2.52±1.06, 0.83±0.34, 0.71±0.31, 1.66±0.86, 0.96±0.60 respectively, whereas means for control group were 3.99±0.54, 2.31±0.56, 1.00±0.31, 0.59±0.15, 1.22±0.33 and 0.70±0.18 respectively. Independent t-test was applied to compare means between two groups, which showed statistically significant difference between Apo B/Apo A ratio, HDL, and TG (p value <0.001). Chi-square test was applied for comparison of two groups which was statistically significant (p value <0.001). Conclusion: Apo B/Apo A ratio is a better indicator for evaluation of cardiovascular disease as compared to lipid profile suggesting it to be a new and robust marker for CVD risk evaluation in our population

Association of Serum Gamma-Glutamyl Transferase and C-Reactive Protein as a Biomarkers of Oxidative Stress in Patients of Type 2 Diabetes Mellitus

Objective: To compare Serum gamma-glutamyl transferase and serum C-reactive protein as biomarker of oxidative stress in patients of type 2 Diabetes Mellitus. Study Design: Comparative cross-sectional study. Place and Duration of Study: The study was conducted at Armed Forces Institute of Pathology, department of Chemical Pathology and Endocrinology Rawalpindi. The duration of study was 6 months i.e., 17 Nov 2021 – 17 May 2022 after approval from Institutional Review Board FC-CHP21-12/Read-IRB/22/846. Materials and Methods: An analytical, cross-sectional research was carried out at Armed Forces Institute of Pathology Rawalpindi. An overall 300 diabetic patients were included between ages of 45 – 65 years. Group I had 100 nondiabetic individuals of 45 – 65 years of age with HbA1c < 5.7 %. Group II and III included 100 patients each of DM of matched age with HbA1c 6.5 – 7 % and greater than 7 % respectively, without any other chronic disease. Serum gamma-glutamyl transferase, HbA1c, Serum C-Reactive Protein were analyzed. Moreover, some more biochemical investigations such as serum liver enzymes were measured to rule out any liver disease. One-way ANOVA was followed up by post-hoc Tukey analysis for intergroup comparison. Results: Mean serum gamma-glutamyl transferase levels were markedly increased in group III patients followed by group II and normal in group I. The mean of serum gamma-glutamyl transferase in group I was (9.38+4.05U/l), group II (34.27+15.07 U/l) and group III (47.08+20.56 U/l). The mean of Serum C-Reactive Protein in group I was (11+6.02 mg/l), group II (62.07+ 26.94 mg/l) and group III (107.73+57.03 mg/l). Pearson correlation revealed prominent positive correlation between HbA1c, serum gamma-glutamyl transferase and Serum C-Reactive Protein with r value of serum gamma-glutamyl transferase (0.838367) and Serum C-Reactive Protein (0.684722). One-way ANOVA and post-hoc Tukey analysis had p value of < 0.05 which was statistically significant. Conclusion: Serum gamma-glutamyl transferase is better marker of oxidative stress in patients of type 2 diabetes mellitus as compared to Serum C-Reactive Protein. The r value of serum gamma-glutamyl transferase is (0.838367) and Serum C-Reactive Protein is (0.684722) indicating strong positive correlation of serum gamma-glutamyl transferase with HbA1c. Therefore, Serum gamma-glutamyl transferase can be used for the prevention and monitoring of complications of type 2 Diabetes Mellitus

Clinical parameters and treatment outcome in patients of acromegaly: A retrospective analysis of 51 patients

The aim of the study was to analyze the pattern of clinical presentation and management outcome in patients of acromegaly. It is a cross-sectional study based on the clinical records of 51 patients of Acromegaly. All the recorded clinical data was analyzed to see the pattern of clinical presentation and management outcome. IBM SPSS statistics version 22 was used for statistical analysis. The median age was 32 years. Twenty seven patients underwent surgery and 6 (22.2%) achieved remission. With pharmacological management, 35.8% patients achieved control of the disease with Octreotide LAR and 7.1% with cabergoline. Eighteen patients were treated with External Beam Radiation (EBR) and Stereotactic Radiosurgery (SRS). Remission rate has been 88.9% with SRS and 33.3% with EBR. The study shows higher prevalence of Growth Hormone (GH) secreting tumour in younger people and men. Remission rate was highest in patients treated with radiotherapy after partial response to TSS. Keywords: Acromegaly, trans-sphenoidal surgery, radiotherapy, Octreotide. Continuous..

Establishing biotinidase reference interval, a foundation stone for newborn screening of biotinidase deficiency in Pakistan

Objective: To determine the reference interval of biotinidase activity in healthy neonates. Method: The cross-sectional study was conducted at the Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan, from May to November 2019, and comprised blood samples collected from healthy neonates aged 2-6 days. The samples were collected on filter paper and analysed on genetic screening processor based on dissociation-enhanced lanthanide flouroimmunoassay. Data was analysed using SPSS 21. Results: Of the 120 dried blood spot specimens, 81(67.5%) were from male babies and 39(32.5%) from female babies. Reference interval for biotinidase activity, based on 2.5th and 97.5th percentiles, was from 3.0 to 11.0 nmol/ml/min. Conclusion: Screening of newborns for biotinidase deficiency is crucial to prevent irreversible neurological damage. Key Words: Biotinidase reference interval, Biotinidase deficiency, Newborn screening in Pakistan