[en] To analyze the pattern of deaths on autopsy carried out on Armed Forces personnel in CMH Sialkot. Study Design: Retrospective analytical study Place and Duration of Study: Combined Military Hospital Sialkot (CMH), from 2009 to 2012 Materials and Methods: In a total of fifty (50) cases detailed postmortems were carried out and gross features on external examination and different systemic examinations were recorded. Histopathology of various organs was done in all cases. Chemical and toxicological examination of various abdominal viscera was carried out in all sudden and suspicious deaths. Results: Ischemic Heart Disease (IHD) was most common cause of death (38%) followed by road traffic accidents (14%) and electrocution (8%). Sudden adult death syndrome accounted for 4 cases of deaths. Other causes were drowning, cerebral malaria, heat stroke, gunshot wounds, myocarditis, brain hemorrhage, meningitis and diabetic ketoacidosis. Most of these cases were young soldiers (n=30) followed by Non-Commissioned Officers (n=17). Conclusion: A large number of our young soldiers dying of heart problems is an alarming situation. Awareness among the troops of various risk factors is most important. Precautionary measures against preventable causes should be taken. (author)

[en] Objective: To determine the HCV sero-types in patients with chronic liver disease, secondary to chronic hepatitis C in Northern Pakistan. Method: Patients with canonical features of chronic liver disease, elevated ALT , positive anti - HCV, and HCV RNA positive by PCR sero-type determination. Results: Out of 148 patients there are 95 (64.1%) patients who have HCV SERO-TYPE III. The second and third most common categories were untypable and HCV sero-type-I. Females out numbered males. Patients with chronic liver disease due to hepatitis C virus infection in this part of Pakistan had predominantly HCV sero - type III. (author)

[en] Objective: To evaluate the histological effects on insulin, metformin and insulin-metformin combination on liver morphology in high fat diet (HFD)/ streptozotocin (STZ) induced diabetic albino rat. Study Design: experimental and comparative study. Place and Duration of Study: institute of basic medical sciences (IBMS), Dow university of health sciences (DUHS), Ojha campus, karachi, from january to august 2012. Methodology: The study was conducted on 50 HFD/STZ induced diabetic albino wistar rats which were randomized into 5 group. One of the groups was treated with insulin, one with metformin, and the other group with insulin-metformin combination for 4 weeks. One of the group was left untreated. One group was control group. After the treatment period, the rate were sacrificed and livers were isolated, weighted, processed and stained to analyse the difference in hepatic morphology in each treated and untreated group, then the results were compared with control rats. Results: Statistically significant difference (p <0.0001) was seen between the groups by using kruskill wallis test. To further investigate the effectiveness of insulin, metformin and insulin-metformin combination, Mann-whitney U-test was applied. Statistically significant difference was noticed when diabetic rats were given insulin-metformin combination (p < 0.0001). Conclusion: The combination therapy was observed to have better effects on liver morphology than insulin and metformin used separately. (author)

[en] Objective: To establish the reference intervals in healthy pregnant females of Quetta, Baluchistan, for Glycosylated Hemoglobin (HbA1c) in all three trimesters of pregnancy. Study Design: Cross-sectional study. Place and Duration of Study: Pathology Department Combined Military Hospital, Quetta Pakistan, from Jun 2018 to Jun 2019. Methodology: Blood samples of healthy pregnant females were drawn for Glycosylated haemoglobin (HbA1c). Fasting plasma glucose and haemoglobin were also measured to rule out hyperglycemia and anaemia. Samples for Glycated haemoglobin (HbA1c) were analyzed by Turbidimetric Immuno-inhibition (TINIA) method. For all the trimesters, 5th and 95th percentiles were taken as reference intervals for Glycosylated haemoglobin (HbA1c) and compared for each trimester. Results: A total of 388 samples were taken, of which 136(35.05%) females were from the first trimester, 128(32.98%) and 124(31.97%) from the second and third trimesters, respectively. The mean age of the study population was 25.1±3.7 years in the first trimester, 26.7±4.5 years in the second-trimester while and the third trimester it was 26.8±4.8 years. In the first, second, and third trimesters, the reference intervals for Glycosylated haemoglobin (HbA1c) were 3.8-5.2%, 4.1-5.4%, and 4.2-5.7%, respectively. Conclusion: For the exact diagnosis of hyperglycemia in pregnancy, each laboratory should establish its reference intervals of Glycated haemoglobin (HbA1c) for each trimester as it varies from trimester to trimester. (author)

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

[en] Objective: To identify effect of pre-analytical variables on serum thyroid stimulating hormone. Study Design: Cross sectional study. Place and Duration of Study: Armed Forces Institute of Pathology (AFIP) Rawalpindi, Department of Chemical Pathology & Endocrinology, from Mar 2018 to Aug 2018. Methodology: Hundred subjects with ages ranging from 18 to 34 years, irrespective of gender, were randomly selected for this study. Five milliliters venous blood sample was collected from each subject in a serum separator and divided into two aliquots. First aliquot was centrifuged and analyzed immediately for TSH, while second aliquot was stored for 24 hours and was then analyzed. TSH was measured by third generation assay using chemiluminescence technique on ADVIA Centaur® XP. Serum TSH levels were also analyzed twice daily; in the morning (0800 to 0900 hours) and afternoon (1400 to 1600 hours). Data was analyzed using SPSS version 24. Frequency and percentages were calculated for qualitative variables like gender and pre-analytical variables. Test of significance Mann-Whitney U-test was applied and p-value <0.05 was taken as significant. Results: Mean age of subjects was 23 ± 3.4 years. Change in circadian rhythm was observed in 17 (28%) males and 14 (36%) females. Statistically significant association was found between morning and evening TSH levels, while no change was observed in TSH level by early and late centrifugation of samples. Conclusion: TSH levels vary significantly between blood samples collected at different timings of the day from the same person. TSH is resistant to degradation, immunologically stable, and reasonably insensitive to potential problems associated with routine specimen handling, when measured by immunoassay technique. Therefore, it is helpful in large epidemiological studies and small size laboratory, which require long transportation time and storage. (author)

[en] Objective: The objective of this study was to evaluate impact of high altitude on various parameters of Liver Function Tests, Renal Function Tests, and Lipid profiles in local population reporting to CMH Skardu. Material and Methods: This Cross-sectional observational study was conducted in the department of pathology of CMH Skardu from January 2023 to August 2023. Participants underwent a comprehensive medical examination. Serum samples were obtained for the assessment of Liver Function Tests (LFTs), Renal Function Tests (RFTs) and lipid profiles of patients in clot activator vaccutainers and analyzed on Selectra Pro XI by their respective spectrophotometric methods. One way ANOVA and Pearson correlation were used to statistical analysis between different groups according to altitude and p value <0.05 was considered significant. Results: The study involved 150 participants, with ages ranging from 28 to 71 years with the mean age of 46.5 ±10.71 years. Altitude varied between 1700 and 2500 meters among participants with mean altitude of 2018.6±21.9 meters. A total of 105(70%) participants were male, and 45(30%) participants were female. Significant negative correlations were observed between altitude and ALT (-0.227, p = 0.005) and AST (-0.212, p = 0.009) For ALT, AST, ALP, BUN, TGs, HDL, and LDL, there are significant differences among groups (p-values < 0.05). For BIL and Creatinine, there are no significant differences among groups (p-values > 0.05) Conclusion: This study underscores the multifaceted nature of altitude's impact on human physiology, highlighting the need for comprehensive research to optimize health and performance in high-altitude environments. (author)

[en] To develop and evaluate a new high-performance liquid chromatography (HPLC) based method for Voriconazole (VRC) analysis in blood. Study Design: Cross sectional study. Place and Duration of Study: Department of Chemical Pathology and Endocrinology Armed Forces Institute of Pathology (AFIP), Rawalpindi, from May 2017 to Oct 2017. Material and Methods: Trough venous blood samples of twenty-five patients on VRC therapy were collected, after five days of starting VRC. Samples were centrifuged. About 100 mu l of Lorazepam as internal standard (5.0 mu g/ml), was added to 0.5ml of each sample. Then extraction was done with 4.0 ml of mixture of hexane and ethyl acetate. Centrifugation was again done and supernatant layer was collected and dried under nitrogen. It was reconstituted with 200 mu l of deionized water and acetonitrile. Samples were analyzed on HPLC. Results: Method was validated in terms of linearity, limit of detection, limit of quantification, precision, accuracy, recovery, analytical specificity and stability. Linearity calibration curve plot for assay obtained was linear over analytical measurement range of 1.0 to 8.0 μ g/ml and correlation coefficient was 0.99. Mean intra-assay accuracy for 1.0, 5.0 and 8.0 μ g/ml was 96%, 98.6%, 99.5% respectively, and percentage Relative Standard Deviation (RSD) was 5.9%, 1.15%, 1.44% respectively. Mean inter-assay accuracy for 1.0, 5.0 and 8.0 μ g/ml was 95%, 98.6%, 99.5% respectively, and % RSD was 5.68%, 1.03% and 1.01% respectively. Limit of Detection (LOD) was 0.25 μ g/mL and Limit of Quantitation (LOQ) was 1.0 μ g/ml. Conclusion: HPLC based method for VRC determination is accurate and specific with good clinical correlation. This method may be used in routine for Therapeutic Drug Monitoring (TDM) of VRC. (author)

[en] Objective: To evaluate the association of hypomagnesemia with hyperglycemia and its renal complication in outpatients. Study Design: Case control study. Place and Duration of Study: Department of chemical pathology and endocrinology, Armed Forces Institute of Pathology, Rawalpindi, from October 2014 to July 2015. Material and Methods: Adults of either gender aged 20 years and above comprising 63 subjects with hyperglycemia and 63 controls with normoglycemia were consecutively inducted in the study. Patients with malabsorption, thyroid dysfunction or adrenal dysfunction, renal impairment, taking mineral supplement, pregnancy, lactation and any acute illness were excluded from the study. Fasting plasma glucose (FPG) and serum magnesium (Mg) level were measured on ADVIA 1800 siemens clinical chemistry auto-analyzer with hexokinase and xylidyl blue methods, respectively. Urine albumin was analyzed by Immunoturbidimetric method and urine creatinine was measured by the Jaffe kinetic assay on same analyzer. Albumin/creatinine ratio (ACR) was calculated. Pearson correlation coefficient 'r' was calculated for serum Mg with FPG and ACR. Mean serum Mg levels in hyperglycemic and normoglycemic groups were compared using in dependent sample 't' test. Frequency of hypomagnesemia (serum magnesium ≤ 0.66 mmol/L) was also calculated in hyperglycemic subjects with type 2 diabetes mellitus (T2DM). A p-value <0.05 was considered statistically significant. Results: Serum Mg has significant inverse correlation with FPG (r=-0.543, p=0.001) and ACR (r=-0.474; p=0.001).Mean serum Mg was 0.78 mmol/l in hyperglycemics and 0.88 mmol/l in normoglycemics (p=0.001). The frequency of hypomagnesemia in subjects with type 2 Diabetes Mellitus (T2DM) was found to be 18.8 percent while no subject with pre-diabetes and normoglycemia had hypomagnesemia. Conclusion: Subjects with hyperglycemia had significantly lower mean serum Mg levels compared with healthy counterparts. Hypomagnesemia was also associated with poor glycemic control and diabetic nephropathy. (author)

[en] To determine the frequency of HFE gene mutation in iron overload patients. Study Design: Cross sectional study. Place and Duration of Study: Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology (AFIP), from Feb 2017 to Jan 2018. Patients and Methods: Sampling technique use was non-probability consecutive sampling, patients who reported in AFIP were selected. Data was collected from 196 participants, of 20 to 60 years of age and both genders. Therefore 43 participant individuals, were included who were presented with transferrin saturation >45% or either serum ferritin >1000 ng/mL. Serum ferritin was analyzed by Immulite 2000, serum iron and serum total iron binding capacity were analyzed by Random access ADVIA at the rate1800 to calculate %TS by Total Iron/TIBC*100, C-Reactive Protein (CRP) was measured by BTat the rate 1500. DNA was extracted by using Puregene Blood Core kit. Results: Forty-three patients sample was analyzed that showed increased serum ferritin, transferrin saturation (%TS). Mean age of study participants was 42.16 +- 11.18 years. Out of 43 patients there were 38 (88.4%) males and 5 (11.6%) were females. Frequency of serum ferritin >1000 ng/mL was 35 (74.5%), <1000ng/mL was 8 (17%) as well as transferrin saturation <45 was 11 (23.4%) and >45 was 32 (68.1%). Consanguinity was reported 34 (79.1%). Only a single 33 years old patient was reported with C282Y mutation in our study samples. Conclusion: C282Y homozygosity should be suspected in patients showing biochemically elevated levels of %TS and serum Ferritin. (author)