Prof Aamir Ijaz, MD - Rehman Medical Institute - Prof

Prof Aamir Ijaz

MD

Rehman Medical Institute

Prof

Peshawar, KPK | Pakistan

Main Specialties: Chemical Pathology

Additional Specialties: Paediatric Metabolic Disorders

ORCID logohttps://orcid.org/0000-0002-0190-0081


Top Author

Prof Aamir Ijaz, MD - Rehman Medical Institute - Prof

Prof Aamir Ijaz

MD

Introduction

Prof Aamir Ijaz
MBBS, MCPS, FCPS, FRCP (Edin), MCPS-HPE
Professor and Consultant Chemical Pathology
Rehman Medical Institute Peshawar, Pakistan
aamir.ijaz@rmi.edu.pk or ijaz_aamir@hotmail.com

Prof Aamir Ijaz, after graduation from Allama Iqbal Medical College, Lahore, Pakistan (1983), passed Membership Examination of College of Physicians and Surgeons Pakistan (CPSP) in Clinical Pathology (1988) and Fellowship in Chemical Pathology (1995) of CPSP. He was trained in Paediatric Metabolic Disorders at Great Ormond Street Hospital London. He has also attended courses on Biorisk Management at Sandia Laboratories, Albuquerque, USA and Patient Safety at Maryland, USA. He has served at UN Hospital in Croatia. He is a qualified medical educationist and done his MCPS-HPE from CPSP. He has completed course work for PhD (Pathology) from NUMS. He has over 100 publications, authorship of 6 books and book chapters and nearly 60 scientific presentations to his credit. He is Chief Editor of PSCP Newsletter ‘The Spectrum’. He remained editor of the Pakistan Journal of Pathology for three years He was awarded FRCP by Royal College of Physicians of Edinburg UK in 2011. He has trained many MPhil and FCPS trainees in Chemical Pathology. He is also Convener of the Committee of Chemical Pathology (CPSP) and Head of the Education and Publication Division Pakistan Society of Chemical Pathologist.

Primary Affiliation: Rehman Medical Institute - Peshawar, KPK , Pakistan

Specialties:

Additional Specialties:

Research Interests:


View Prof Aamir Ijaz’s Resume / CV

Education

Jan 2010 - Jan 2012
College of Physicians and Surgeons Pakistan
MCPS-HPE
DME
Jan 2011
Royal College of Physicians of Edinburgh
FRCP
Sep 1992 - May 1995
College of Physicians and Surgeons Pakistan
FCPS
Chemical Pathology
Oct 1987 - Nov 1988
College of Physicians and Surgeons Pakistan
MCPS
Clinical Pathology
Jul 1977 - Nov 1983
Allama Iqbal Medical College
MBBS

Publications

35Publications

948Reads

7Profile Views

13PubMed Central Citations

Subclinical-Hypothyroidism: A Pathology in Evolution.

J Coll Physicians Surg Pak 2019 Feb;29(2):150-158

Department of Chemical Pathology and Clinical Endocrinology, Armed Forces Institute of Pathology (AFIP), Rawalpindi, Pakistan.

Subclinical-hypothyroidism is identified as suboptimal thyroid hormonal production associated with mild TSH (thyroid stimulating hormone) elevation. Though several non-thyroidal illness in the later stages, medications and dietary supplements may resemble SCH (subclinical-hypothyroidism), but mild persistent subnormal thyroidal pathologies are usually termed as SCH. This review briefly describes the various cardiovascular risk associations with subclinicalhypothyroidism and attempts to provide an insight into the risk and benefit association, which a patient faces once treated for SCH.

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https://www.jcpsp.pk/archive/2019/Feb2019/13.pdf
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http://dx.doi.org/10.29271/jcpsp.2019.02.150DOI Listing
February 2019
30 Reads
0.439 Impact Factor

A Novel Clinico-Biochemical Score for Screening of Inherited Metabolic Diseases in Children.

J Coll Physicians Surg Pak 2018 Nov;28(11):853-857

Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan.

Objective: To evaluate a novel clinico-biochemical score for screening of inherited metabolic diseases (IMDs) in children in our setup.

Study Design: Descriptive analytical study.

Place And Duration Of Study: Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi, from August 2016 to August 2017.

Methodology: Clinical data, preliminary biochemical investigations, plasma amino acid (PAA) and organic acid profiles (where indicated) of 354 children, aged <1 year to 12 years, referred to the study place for evaluation of suspected inherited metabolic diseases, was collected and evaluated. A clinico-biochemical score card named Rawalpindi Inherited Metabolic Diseases Score (RISc) was devised, on a scale from 1 to 10, incorporating 5 clinical and 5 important biochemical findings, and each variable was assigned a score, based on its relative frequency/risk. Each case was then assigned the RISc score and evaluated for presence or absence of any inherited metabolic disease, based on the score. This score was validated keeping plasma amino acids and organic acid profiles (in selected cases) as reference standard.

Results: Patients were divided into three groups, based on RISc score as low RISc (0.5-2.5), medium RISc (3.0-5.5) and high RISc (6-10). A total of 354 cases reported in 2016 and 2017 and 33 (9.3%) were diagnosed to be having IMDs. One (3.0%) patient from low RISc, four (12.1%) from medium RISc, and 28 (84.8%) from high RISc group were found to test positive for any one IMD. High RISc group had a statistically significant higher IMD rate than the other two groups (p<0.001). Specificity, sensitivity, positive likelihood ratio, negative likelihood ratio, positive predictive value, negative predictive value and accuracy were 93%, 85%, 11.8, 0.16, 55%, 98% and 90%, respectively.

Conclusion: The cost effective RISc, based on clinical data and preliminary biochemical investigations, is highly accurate in diagnosing IMDs in cost restrained setups. It is strongly suggested that the initial screening for suspected IMDs and decision for advanced laboratory testing be carried out, based on the RISc card presented in the study.

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https://www.jcpsp.pk/archive/2018/Nov2018/10.pdf
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http://dx.doi.org/10.29271/jcpsp.2018.11.853DOI Listing
November 2018
171 Reads
0.439 Impact Factor

Determination of reference intervals of thyroid markers during pregnancy in Urban area of District Rawalpindi Pakistan.

J Pak Med Assoc 2018 Oct;68(10):1488-1492

Armed Forces Institute of Pathology.

Objective: To determine the reference values for thyroid stimulating hormone, free tetra-iodothyronine and total tri-iodothyronine for healthy pregnant women.

Methods: This cross sectional study was conducted at the Armed Forces Institute of Pathology, Rawalpindi, Pakistan, from January 2016 to June 2017. Pregnant women with normal, single intrauterine, uncomplicated pregnancy were recruited from the local population. Blood sample was taken to analyse thyroid stimulating hormone, free tetra-iodothyronine and total tri-iodothyronine using chemiluminescence immunoassay. For thyroid hormone levels during each trimester 5th and 95th percentiles were calculated as reference intervals. Data was analysed using SPSS 24.

Results: Out of 384 subjects, 188(48.95%) were in their first trimester and 196(51.04 %) females were in their second trimester. There were 109(57.97%) primigravida in the first trimester and 137(69.9%) in the second trimester. Mean age of subjects presenting in the first and second trimester was 25.37±3.78 years and 26.54±4.65 years respectively. Reference intervals for those in the first trimester for thyroid stimulating hormone was 0.05-2.8uIU/ml, for free tetra-iodothyronine14.4-22.7pmol/l and total tri-iodothyronine1.5-3.3nmol/l. For those in second trimester the corresponding values were 0.16-3.3 uIU/ml, 14.2-24.6.0 pmol/l and 1.6-3.1nmol/l.

Conclusions: Laboratories should adopt trimester-specific reference intervals for thyroid function tests in pregnancy..

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October 2018
28 Reads
0.718 Impact Factor

Bilirubin Interference in Plasma Amino Acid Analysis by Ion Exchange Chromatography.

J Coll Physicians Surg Pak 2018 Sep;28(9):667-671

Department of Chemical Pathology and Endocrinology, AFIP, Rawalpindi-National University of Medical Sciences, Rawalpindi, Pakistan.

Objective: To evaluate the effect of bilirubin interference on plasma amino acid analysis by Ion Exchange Chromatography (IEC).

Study Design: Cross-sectional (method validation) study.

Place And Duration Of Study: Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi from August 2016 to July 2017.

Methodology: Twenty non-icteric samples from paediatric patients were collected in lithium heparin tubes and analysed for amino acids on IEC-based Biochrome® 30+ Analyzer (Harvard Biosciences UK). Baseline bilirubin levels were noted. Samples were spiked with neonatal bilirubin standard with concentration of 488.4 ?mol/L (Spinreact®-Spain) at final concentrations of 50, 150 and 230 ?mol/L and re-analysed for amino acids at these three concentrations.

Results: Among the 20 selected patients with normal amino acid profiles, 12 (60%) were males. Majority (55%) were in age group of 1-5 years. Significant difference was observed for Arginine (p = 0.01), Histidine (p = 0.001), Isoleucine (p = 0.01), Leucine (p = 0.007), Lysine (p = 0.005), Ornithine (p = 0.03) and Phenylalanine (p = 0.02). Mean rank of these amino acids showed decreasing trend with the increase of bilirubin concentration, and pronounced interference was identified at bilirubin level of 50 ?mol/L. No difference was observed for alanine, citrulline, glutamic acid, glycine, methionine, proline, threonine, tyrosine, asparagine, aspartic acid, cystine, valine and tryptophan.

Conclusion: Bilirubin significantly interferes with certain amino acid levels when analysis is carried out by ion exchange chromatography. A close follow-up of such patients with other biochemical tests and a repeat amino acid analysis, after jaundice is settled, is recommended to confidently rule out any possible inherited metabolic disorder in these patients.

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http://dx.doi.org/10.29271/jcpsp.2018.09.667DOI Listing
September 2018
28 Reads
0.439 Impact Factor

Spectrum of renin angiotensin aldosterone system disorders in young hypertensives.

J Pak Med Assoc 2018 Aug;68(8):1179-1182

Armed Forces Institute of Pathology.

Objective: To analyse the spectrum of renin angiotensin aldosterone system disorders in young hypertensive patients in hospital settings.

Methods: This cross-sectional study was conducted at the Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan, from January to December, 2016. It comprised hypertensive subjects aged 17-40 years of either gender presenting in the outpatient department. All subjects were having blood pressure more than 140/90mmHg and were not on any anti-hypertensive medicine. Blood sample was taken from each patient to analyse arterial blood gases, plasma renin, serum aldosterone and electrolytes. Association of qualitative variables like age, systolic and diastolic blood pressure with essential hypertension and primary hyperaldosteronism was explored.

Results: Of the 80 patients, 72(90%) were diagnosed with essential hypertension and 8(10%) with primary hyperaldosteronism. None of the patients had Liddle syndrome, apparent mineralocorticoid excess or Gordon syndrome. Mean age of patients having essential hypertension was 30.97±7.1 years, whereas, for those with primary hyperaldosteronism it was 29.25±7.1 years. Systolic blood pressure was significantly higher (p = 0.000) among all patients. No statistically significant association was found between age, systolic and diastolic blood pressure (p<0.05).

Conclusions: Primary hyperaldosteronism as compared to other renin angiotensin aldosterone system disorders was found to be the leading cause of hypertension in young population.

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August 2018
14 Reads
0.718 Impact Factor

Cost-effectiveness of Screening and Confirmatory Tests for Multiple Myeloma in Pakistani Population: An Audit Report.

J Coll Physicians Surg Pak 2018 Jul;28(7):560-563

Department of Chemical Pathology and Endocrinology, AFIP, National University of Medical Sciences, Rawalpindi.

Objective: To find out the use of screening and confirmatory tests for diagnosis of multiple myeloma as ordered by clinicians.

Study Design: An Audit.

Place And Duration Of Study: Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi, from January 2012 to January 2017.

Methodology: Data retrieved from Laboratory Information Management system (LIMs) by selecting serum protein electrophoresis (SPE) as screening test and immunoelectophoresis (IE) and immunofixation (IF) as confirmatory tests.

Results: There were 3,108 tests of serum protein electrophoesis and 1,329 tests of immunoelectophoresis had been performed in last five year. Cost-effective clinical audit of SPE tests showed that only 17.1% tests of SPE were either used for proper diagnosis of multiple myeloma (totally justified tests 13%) or useful for diagnosis of other important diseases whose early diagnosis were helpful for patients management (partially justified tests 4.1%). The cost related to these tests were justified while 82.8% tests of SPE were either normal (total unjustified tests 24.4%), or diagnosed irrevalent and nonspecific diseases (partially unjustified 58.4%). IE and IF audit revealed that only 26.6% tests were properly utilised for diagnosis and differentiation of multiple myeloma and its subtypes and cost attributable to these tests were justified while 73.4% of these confirmatory tests were normal and cost related to them was not justified.

Conclusion: Overutilisation of laboratory tests for diagnosis of multiple myeloma can be minimised by proper clinical scrutiny of request forms.

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http://dx.doi.org/10.29271/jcpsp.2018.07.560DOI Listing
July 2018
8 Reads
0.439 Impact Factor

Classical Homocystinuria in a Juvenile Patient.

J Coll Physicians Surg Pak 2018 Jun;28(6):488-489

Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology (AFIP), Rawalpindi.

Classical homocystinuria, also known as cystathionine beta synthase deficiency, is a rare disorder of methionine metabolism, leading to an abnormal accumulation of homocysteine and its metabolites in blood and urine. A young child with homocystinuria is discussed, who presented with behavioral abnormalities, involuntary movement, mental retardation, and decreased vision since birth. The diagnosis of homocystinuria was not made at initial presentation. Subtle phenotypic features with developmental delay and MRI brain finding of bilateral medially dislocated lens, eventually provided the first indication at five years of age. Laboratory screening with plasma amino acid profile by ion exchange chromatography (IEC) showed elevated homocystine and methionine, and low cystine in plasma in the absence of vitamin B12, and folate deficiency; giving the diagnosis of classical homocysteinuria.

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http://dx.doi.org/10.29271/jcpsp.2018.06.488DOI Listing
June 2018
18 Reads
0.439 Impact Factor

Association of metabolic risks with subclinical hypothyroidism: A cross-sectional analysis.

Pak J Med Sci 2018 Mar-Apr;34(2):357-362

Dr. Nadeem Fazal (FCPS Med), Department of Medicine, PNS Hafeez Hospital, Pakistan.

Objective: To compare lipid parameters, HbA1c, uric acid and albumin creatinine ratio (UACR) among subjects having euthyroidism, Sub-Clinical Hypothyroidism (SCH) and overt hypothyroidism.

Methods: This comparative cross-sectional analysis was carried out from Dec-2015 to Oct-2016 in collaboration between PNS HAFEEZ hospital and department of chemical pathology and endocrinology, Armed Forces Institute of Pathology, Rawalpindi. Biochemical parameters including lipid indices, HbA1c and UACR were compared between euthyroidism (TSH: 0.5 to 4.0 mIU/L, n=163), subclinical hypothyroidism (TSH: 4.0 to 10 mIU/L, n=16) and overt hypothyroidism (TSH:? 10.0 mIU/L, n=9).

Results: LDL-cholesterol, non-HDL-cholesterol and UACR results were as: [(Euthyroid: 2.66 ± 0.73), (SCH: 2.68 ± 0.51) and (Overt hypothyroidism: 3.23 ± 0.59), p-value=0.063], [(Euthyroid: 3.49 ± 0.64), (SCH: 3.35 ± 0.59) and (Overt hypothyroidism: 4.01 ± 0.30), p-value=0.033] and [{Euthyroid: 2.48 (95% CI: 1.63-3.33)}, {SCH: 2.27 (95% CI: 0.37-4.90)} and {Overt hypothyroidism: 14.95 (95% CI: 10.71-19.14){, (p-value< 0.001)] Results for total cholesterol, triglycerides and HDL-cholesterol though increased in overt hypothyroid group were not found to be statistically significant.

Conclusion: LDL-cholesterol, non-HDL-cholesterol and UACR increased from euthyroid subjects to overt hypothyroidism group. However, these changes were found to be more subtle in the subclinical hypothyroid subjects than cases with overt hypothyroidism.

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http://dx.doi.org/10.12669/pjms.342.13873DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5954379PMC
May 2018
13 Reads
0.719 Impact Factor

Prevalence of selected pharmaceuticals in surface water receiving untreated sewage in northwest Pakistan.

Environ Monit Assess 2018 May 4;190(6):324. Epub 2018 May 4.

Department of Endocrinology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan.

This study investigated the occurrence of four non-steroidal anti-inflammatory drugs (NSAIDs) and four benzodiazepines/anti-depressants (ADs) in municipal wastewater in Mardan city, Pakistan, and in River Kabul and River Indus receiving untreated sewage. Liquid chromatography with a triple quadrupole tandem mass spectrometry (LC-MS/MS) was used for the analysis of paracetamol, diclofenac, ibuprofen, and codeine (NSAIDs) and diazepam, bromazepam, lorazepam, and temazepam (ADs). Except codeine and lorazepam, all the target compounds were observed in sewage and surface water in various concentrations. In sewage, paracetamol was found at the higher end (32.4 ?g/L) of the reported ranges in literature for other countries. Results of river samples showed that the target compounds were usually lower in concentration than the respective EC values for aquatic organisms. However, the levels for paracetamol and ibuprofen were critical depicting the consequence of untreated disposal. Environmental risk assessment by estimating the risk quotient (RQ) as the ratio of measured environmental concentration and predicted no-effect concentration showed medium to high (RQ >?1 and 0.1?

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http://dx.doi.org/10.1007/s10661-018-6683-6DOI Listing
May 2018
14 Reads
1.804 Impact Factor

Status of non-HDL-cholesterol and LDL-cholesterol among subjects with and without metabolic syndrome.

J Pak Med Assoc 2018 Apr;68(4):554-558

Armed Forces Hospital, PNS Hafeez, Islamabad.

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April 2018
9 Reads
0.403 Impact Factor

Effects of Delta-tocotrienol Supplementation on Liver Enzymes, Inflammation, Oxidative stress and Hepatic Steatosis in Patients with Nonalcoholic Fatty Liver Disease.

Turk J Gastroenterol 2018 03;29(2):170-176

Armed Forces Institute of Radiology, National University of Medical Sciences, Islamabad Pakistan.

Background/aims: Non-alcoholic fatty liver disease (NAFLD) is a growing public health problem worldwide and is associated with increased morbidity and mortality. Currently, there is no definitive treatment for this disease. ?-Tocotrienol has potent anti-inflammatory and antioxidant properties and may reduce liver injury in NAFLD. The present study aims to evaluate the efficacy and safety of ?-tocotrienol in the treatment of NAFLD.

Materials And Methods: The present study was a randomized, double-blind, placebo-controlled pilot study conducted in patients aged > 20 years, belonging to both sexes, having ultrasound-proven fatty liver disease, having a fatty liver index (FLI) of ? 60, and persistent elevation of alanine transaminase. A total of 71 patients were assigned to receive either oral ?-tocotrienol (n=35, 300 mg twice daily) or placebo (n=36) for 12 weeks. At the baseline and at the end of the study, clinical and biochemical parameters, including lipid profile, liver function tests, high-sensitivity C-reactive protein (hs-CRP), and malondialdehyde (MDA) were measured. Body mass index and FLI were calculated, and ultrasound grading of hepatic steatosis was performed.

Results: Out of 71 enrolled patients, 64 patients, 31 in the ?-tocotrienol group and 33 in the placebo group, completed the study. After 12 weeks of supplementation, ?-tocotrienol showed greater efficacy than placebo by decreasing serum aminotransferases, hs-CRP, MDA, and FLI score (p<0.001). However, it did not improve hepatic steatosis on ultrasound examination. No adverse effects were reported.

Conclusion: ?-Tocotrienol was safe, and it effectively improved aminotransferase levels and inflammatory and oxidative stress markers in patients with NAFLD. Large-scale randomized clinical trials are warranted to further support these findings.

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http://dx.doi.org/10.5152/tjg.2018.17297DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6284694PMC
March 2018
18 Reads
0.932 Impact Factor

Evaluation of random plasma glucose for assessment of glycaemic control in type 2 diabetes mellitus.

J Pak Med Assoc 2017 Sep;67(9):1353-1356

AFIP, Rawalpindi, Pakistan.

Objective: To evaluate the accuracy of random plasma glucose in outpatients with type 2 diabetes mellitus for assessing glycaemic control.

Methods: This comparative, cross-sectional study was conducted at the chemical pathology department of PNS Shifa Hospital, Karachi, from August 2015 to March 2016, and comprised data of subjects with type 2 diabetes mellitus who reported for evaluation of glycaemic control in non-fasting state. All blood samples were analysed for random plasma glucose and glycated haemoglobin. Random plasma glucose was compared as an index test with glycated haemoglobin considering it as reference standard at a value of less than 7% for good glycaemic control. SPSS 20 was used for data analysis.

Results: Of the 222 subjects, 93(42%) had good glycaemic control. Random plasma glucose showed strong positive correlation with glycated haemoglobin (p=0.000).Area under curve for random plasma glucose as determined by plotting receiver operating characteristic curve against glycated haemoglobin value of 7% was 0.89 (95% confidence interval: 0.849-0.930). Random plasma glucose at cut-off value of 150 mg/dl was most efficient for ruling out poor glycaemic control among patients with type 2 diabetes mellitus with 90.7% sensitivity and69.9% specificity and Youden's index of 0.606.

Conclusions: Random plasma glucose may be used to reflect glycaemic control in adults with type 2 diabetes mellitus in areas where glycated haemoglobin is not feasible.

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September 2017
22 Reads
0.718 Impact Factor

Occurrence of Selected Pesticides and PCPs in Surface Water Receiving Untreated Discharge in Pakistan

Saad M, Shams DF, Khan W, Ijaz A, Qasim M, et al. (2017) Occurrence of Selected Pesticides and PCPs in Surface Water Receiving Untreated Discharge in Pakistan. J Environ Anal Toxicol 7: 500. doi: 10.4172/2161-0525.1000500

Journal of r uoJ Environmental & Analytical Toxicology

This study investigated the presence of four pesticides (carbaryl, methomyl, carbofuran and chlorpyrifos) and two personal care products (PCPs) i.e., triclosan (TCS) and caffeine in River Kabul, upper River Indus and Kalpani stream receiving untreated wastewater from major towns in northern Pakistan. PCPs were also examined in domestic wastewater in Mardan district, Pakistan with untreated sewage disposal as common elsewhere in the country. Analysis were performed using liquid chromatography with a triple quadrupole tandem mass spectrometry (LC-MS/MS). All the target pesticides were detected in surface water bodies and in domestic sewage in various concentrations. Methomyl in River Kabul at maximum concentration of 8.3 µg/L was found above its reported LC 50 for water fleas. PCPs level in sewage were comparable to other countries but in the absence of any treatment practice, environmental discharge to water bodies was higher by many orders of magnitude compared to treated effluent. Eco-toxicological risk assessment revealed a risk quotient (RQ) of >1 for methomyl, chlorpyrifos and carbofuran for water fleas and fish in River Kabul, River Indus and Kalpani stream and TCS for algae in Kalpani indicating a serious toxicity risk to aquatic organisms in these rivers.

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September 2017

Impact Factor 1.510

7 Reads

Determination of Mean Glycated Haemoglobin in Healthy Adults of a Local Population.

J Coll Physicians Surg Pak 2017 Jul;27(7):399-403

Department of Pathology / Medical Student, Combined Military Hospital (CMH), Abbottabad.

Objective: To determine the mean hemoglobin HbA1C levels of disease-free adults in a local population and its optimum cutoff for the diagnosis of diabetes.

Study Design: Cross-sectional study.

Place And Duration Of Study: Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi, from January to September 2015.

Methodology: Healthy subjects aged 18 years and above of either gender were recruited from local population. Pregnant ladies and individuals with known diabetes, chronic kidney disease, chronic liver disease, congestive cardiac failure, anemia, hemoglobinopathies, mental illness and individuals on glucocorticoid therapy were excluded. Fasting plasma glucose (FPG) or 2-hour plasma glucose (2-h PG) was analyzed using hexokinase methodology and glycated hemoglobin (Hb A1C) was also analyzed using turbidimetric inhibition immunoassay technique. Receiver operating characteristic (ROC) curves were plotted. Differences among the groups were tested by one-way ANOVA, and p <0.05 was considered statistically significant.

Results: Among 558 subjects, 88.8% (496) were normoglycaemic (NG), 5.7% (32) were with impaired glucose fasting (IFG), and 5.4% (30) were diagnosed with diabetes mellitus (DM). A1C was 5.00 ±0.44% in NG and 6.28 ±1.16% in diabetics. FPG in NG was 4.55 ±0.95 mmol/Land in diabetics was 8.28 ±1.78 mmol/L. The optimal HbA1C cutoff value for diagnosis of DM was at 6.05% (AUC 0.827 95% CI 0.732 to 0.923, p ?0.05 with its sensitivity of 53.3% and specificity of 98.5%. However, HbA1C showed suboptimal sensitivity and specificity for prediabetes.

Conclusion: The mean HbAIC and cutoff point for diabetes in the study population is 5.07 ±0.58% and 6.05%, respectively (AUC 0.827, 95% CI: 0.732 to 0.923, p<0.001) with 53.3% sensitivity and 98.5% specificity.

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http://dx.doi.org/2652DOI Listing
July 2017
58 Reads
0.439 Impact Factor

Insulin Resistance and Glucose Levels in Subjects with Subclinical Hypothyroidism.

J Coll Physicians Surg Pak 2017 Jun;27(6):329-333

Department of Healthcare Administrator PNS Hafeez, Islamabad.

Objective: To compare insulin resistance and glycemic indicators among subjects with euthyroidism and subclinical hypothyroidism.

Study Design: Comparative cross-sectional study.

Place And Duration Of Study: Department of Pathology and Medicine, PNS Hafeez, Islamabad, in collaboration with the Department of Chemical Pathology and Endocrinology at the Armed Forces Institute of Pathology (AFIP), Rawalpindi, from December 2015 to September 2016.

Methodology: Subjects referred for executive screening of apparently healthy population (without any known history of diabetes, hypertension, heart disease or other chronic ailments), were included. Subjects were grouped as euthyroidism and subclinical hypothyroidism.

Results: Median (IQR) insulin resistance indices including fasting insulin and Homeostasis Model Assessment for Insulin Resistance in subjects with group-1 (n=176, 87%, Thyroid Stimulating Hormone: 0.5 - 3.5 mIU/L) and group-2 (n=26, 13%, Thyroid Stimulating Hormone: 3.51 - 15 mIU/L) were 7.6 (6.70) vs. 11.4 (13.72, p=0.040) and 1.77 (1.79) vs. 2.8 (3.07, p=0.071). The median differences for fasting plasma glucose were 5.0 (1.0) in group-1 vs. 5.0 (1.47) for Group-2 [p=0.618], and glycated hemoglobin was 5.60 (1.1) vs. 5.60 (1.7, p=0.824). Homeostasis Model Assessment for beta sensitivity index in paradox showed slightly higher values for group-2 [median (IQR) 86.67 (92.94)] than group-1 [111.6 (189.64, p= 0.040)].

Conclusion: Measures of insulin resistance including Homeostasis Model Assessment for Insulin Resistance and fasting insulin levels were significantly different between subjects with euthyroidism and having subclinical hypothyroidism.

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http://dx.doi.org/2630DOI Listing
June 2017
78 Reads
0.439 Impact Factor

Estimation of uncertainty measurement - A prerequisite of ISO1589 accreditation for clinical laboratories.

J Pak Med Assoc 2017 May;67(5):701-705

Department of Pathology, Dow International Medical College, Dow University of Health Sciences, Karachi.

Objective: To estimate relative expanded uncertainty measurement of routine clinical chemistry analytes for international organisation for standardisation 15189 accreditation.

Methods: This cross-sectional study was conducted at Dow International Medical College, Karachi, from September 2013 to May 2014. During the process of international organisation for standardisation 15189 accreditation, measurement uncertainty was estimated for 13 clinical chemistry analytes using top-down approach. Relative combined uncertainty of each analyte was calculated by combining uncertainties of imprecision, bias and calibrators. Results of estimated imprecision, bias and expanded uncertainties were observed for allowable imprecision, bias and total analytical error for the respective analyte..

Results: Uncertainties of imprecision were found within acceptable limits for all analytes except total protein (2.4% vs. 1.3%). Uncertainties of bias of all analytes were found within allowable limits. Relative expended uncertainties of all analytes were found acceptable except total protein (4.7%vs 3.63%).

Conclusions: The approach used to estimate the measurement uncertainty may be found simple and feasible by clinical laboratories interested in getting the relevant accreditation.

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May 2017
15 Reads
0.718 Impact Factor

Gitelman Syndrome.

J Coll Physicians Surg Pak 2017 Mar;27(3):S30-S32

Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi.

Gitelman syndrome (GS) is the most frequently inherited renal salt-wasting tubulointerstitial disease. It follows variable but usually asymptomatic benign course. We present a rare case of GS that remained clinical enigma. A 22-year male presented with severe episodic fatigue involving all limbs associated with episodes of sinking, palpitations, salt craving, increased thirst and frequent micturition hampering his routine daily activities. Laboratory workup revealed serum potassium, 2.7 mmol/L, serum magnesium, 0.69 mmol/L and metabolic alkalosis. Urine analysis showed surprising results, i.e. urine potassium 49.5 mmol/L, urine spot potassium creatinine ratio 5.1, chloride 93 mmol/L and low 24 hours urinary calcium excretion (1.19 mmol/day). Plasma active renin concentration was 135 mlU/L while plasma aldosterone was 1090 pmol/L, depicting secondary hyperreninemic hyperaldosteronism. Based on typical findings, a diagnosis of GS was made. Patient responded well to potassium and magnesium supplementation, 100 mg daily tablet aldactone® and liberal salt intake. The aim of this report is to revisit clinical approach to persistent hypokalemia with special emphasis to remember rare entities like GS in the differential diagnosis.

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http://dx.doi.org/245DOI Listing
March 2017
11 Reads
0.439 Impact Factor

Accuracy of Non-Fasting Lipid Profile for the Assessment of Lipoprotein Coronary Risk.

J Coll Physicians Surg Pak 2016 Dec;26(12):954-957

Department of Chemical Pathology and Endocrinology, AFIP, Rawalpindi. (National University of Medical Sciences, Islamabad).

Objective: To determine the diagnostic accuracy of non-fasting lipid profile in the diagnosis of hyperlipidemia, taking fasting lipid profile as gold standard, in adult population.

Study Design: Cross-sectional validation study.

Place And Duration Of Study: Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi, from July to December 2014.

Methodology: One hundred seventy-five adult patients coming for fasting lipid profile were included; their non-fasting samples were taken on the next day. Patients on anti-cholesterol treatment and indoor patients were excluded. Total cholesterol (TC), high density lipoprotein-cholestrol (HDL-C), and triglycerides were measured by direct enzymatic colorimetric method by Modular p-800®. Low density lipoprotein-cholesterol (LDL-C) was calculated by Friedewald's formula, but when triglyceride was greater than 4.5 mmol/l, then LDL-C was measured directly by homogenous enzymatic colorimetric method. Non-HDL-C was calculated by simple equation, i.e. TC-HDL-C.

Results: Non-fasting lipid profile had 93% specificity , 51% sensitivity, 94% positive predictive value and 49% negative predictive value; and 65% accuracy with 7.28 positive likelihood ratio and 0.52 negative likelihood ratio. Non-fasting TC and non-HDL-C were significantly higher than fasting TC and non-HDL-C by mean difference of 0.2 mmol/l each with p=0.001 and p=0.004, respectively. Fasting and non fasting HDL-C are comparable to each other with mean difference of 0.01 mmol/l (p=0.745). Receiver operating curve (ROC) of non-fasting non-HDL-C showed 0.804 (95%CI (0.738-0.870), (p=0.000) area under the curve (AUC) indicating that it was a significant test for ruling out hyperlipidemia. Bland-Altmann plot showed a significant difference between non-fasting, non-HDL-C and fasting LDL-C and non-fasting, non-HDL-C -0.087540 with bias -0.00109; therefore, these cannot be alternative to each other.

Conclusion: Diagnostic accuracy of non-fasting lipid profile was found significantly higher than fasting lipid profile (p=0.004) for the assessment of lipoprotein coronary risk on the basis of non-HDL-C, which seemed to be significant test for ruling out hyperlipidemia.

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http://dx.doi.org/2493DOI Listing
December 2016
13 Reads
0.439 Impact Factor

National External Quality Assurance Program Pakistan (NEQAPP) -A Milestone in Proficiency Testing in Pakistan.

EJIFCC 2016 Dec 1;27(4):344-350. Epub 2016 Dec 1.

Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology (AFIP) , Rawalpindi, Pakistan.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5282917PMC
December 2016
18 Reads

Diagnostic Accuracy of Serum Iron and Total Iron Binding Capacity (TIBC) in Iron Deficiency State.

J Coll Physicians Surg Pak 2016 Dec;26(12):958-961

Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology (AFIP), Rawalpindi. (National University of Medical Sciences, Islamabad).

Objective: To determine the diagnostic accuracy of serum iron and total iron binding capacity (TIBC) in detection of iron deficiency.

Study Design: Descriptive, analytical study.

Place And Duration Of Study: Department of Chemical Pathology and Endocrinology, from January 2013 to October 2015.

Methodology: Data of 1,815 patients with results of serum iron, TIBC and ferritin from January 2013 to October 2015 was retrieved from Laboratory information System (LIMS) of AFIP. Diagnostic Accuracy Studies (STARD) guidelines were followed. Subjects of either gender, aged 1 - 68 years were included. Cases with raised serum ferritin levels (male > 336 ng/ml, female > 307 ng/ml) were excluded. Serum Ferritin was taken as gold standard with specificity of 99% and sensitivity of 80% at concentration of 30 ng/ml. Transferrin saturation was determined by dividing serum iron by TIBC and multiplying by 100.

Results: Out of 1,815 subjects, 931 (51.29%) were males and 884 (48.71%) were females. The median age of the patients were 29.1 years (Inter-quartile range, IQR 19.1). Taking ferritin as gold standard, the sensitivity and specificity of serum iron was 63.5% and 38.6%, respectively; while that of TIBC was 64.5 % and 42.8%, respectively. Ferritin showed poor correlation with iron, TIBC and transferrin saturation.

Conclusion: Serum iron and TIBC give no additional information in the diagnosis of iron deficiency anemia and these tests are redundant for the diagnosis of iron deficiency state, if serum ferritin is available.

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http://dx.doi.org/2494DOI Listing
December 2016
22 Reads
0.439 Impact Factor

Decreased Serum 25-Hydroxycalciferol Levels in Pre-diabetic Adults.

J Coll Physicians Surg Pak 2016 Feb;26(2):87-90

Department of Radiology, PNS Hafeez, Islamabad.

Objective: To determine the serum 25-hydroxycalciferol levels [25(OH)D] in adults with pre-diabetes and normoglycaemia to examine a possible association of vitamin D deficiency with pre-diabetes.

Study Design: Case control study.

Place And Duration Of Study: Armed Forces Institute of Pathology, Rawalpindi, from November 2012 to July 2013.

Methodology: Atotal of 272 adults including 136 pre-diabetics and 136 normoglycaemics of either gender aged 20 years and above were consecutively inducted. Patients with diabetes mellitus, pregnancy, rickets and osteomalacia, ischemic heart disease, chronic kidney disease and chronic liver disease were excluded. Fasting Plasma Glucose (FPG) was estimated with hexokinase method on Modular p800 Roche chemistry analyzer while serum 25(OH)D was measured on Diasorin Liaison immunoassay analyzer using the chemiluminescent technique. Mean 25(OH)D levels in pre-diabetic and normoglycaemic groups were compared using Mann-Whitney U test. Spearman's correlation coefficient 'rs' was determined between serum 25(OH)D and FPG. Odds ratio for vitamin D deficiency was also calculated.

Results: Mean serum 25(OH)D level was low in pre-diabetics (23.2 nmol/L) as compared to normoglycaemics (29 nmol/L; p=0.001). Serum 25(OH)D level had inverse correlation with FPG (rs= -0.448, p=0.000). There was also significant association of vitamin D deficiency with pre-diabetes compared with normoglycaemia (OR: 2.21, p= 0.016; 95% CI: 1.15-4.27).

Conclusion: Vitamin D deficiency with pre-diabetes suggested that vitamin D may have an important role in pathogenesis of pre-diabetes.

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http://www.jcpsp.pk/archive/2016/Feb2016/03.pdf
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http://dx.doi.org/02.2016/JCPSP.8790DOI Listing
February 2016
23 Reads
0.439 Impact Factor

Serum inhibin B as a diagnostic marker of male infertility.

J Ayub Med Coll Abbottabad 2012 Jul-Dec;24(3-4):113-6

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May 2014
49 Reads

Frequency of impaired glucose tolerance and diabetes mellitus in subjects with fasting blood glucose below 6.1 mmol/L (110 mg/dL).

East Mediterr Health J 2013 Feb;19(2):175-80

Department of Pathology, PNS Rahat Hospital, Karachi, Pakistan.

The diagnosis of diabetes mellitus by the available criteria is controversial and relies heavily on fasting glucose results. This cross-sectional study in 2010-2011 aimed to measure the frequency of impaired glucose tolerance and diabetes mellitus in 127 subjects having fasting blood glucose < 7.0 mmol/L and to measure the agreement between different standard diagnostic criteria. Subjects presenting to a laboratory for analysis of fasting blood glucose for excluding diabetes mellitus underwent a 2-hour 75 g oral glucose challenge. A total of 40.6% of subjects with fasting blood glucose from 5.6-6.0 mmol/L had abnormal glucose regulation on the basis ofthe gold standard glucose challenge. Agreement between American Diabetes Association and World Health Organization diagnostic criteria was only fair (kappa = 0.32). Abnormalities of glucose metabolism including impaired glucose tolerance and diabetes mellitus can exist at fasting blood glucose results < 6.1 mmol/L (110 mg/dL).

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February 2013
9 Reads
0.663 Impact Factor

Evaluation of insulin-like growth factor-1 and insulinlike growth factor binding protein-3 in diagnosis of growth hormone deficiency in short-stature children.

J Ayub Med Coll Abbottabad 2009 Jul-Sep;21(3):40-5

Armed Forces Institute of Pathology, Rawalpindi, Pakistan.

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November 2010
46 Reads
1 Citation

EDTA contamination in laboratory specimens-effect of an awareness campaign.

J Coll Physicians Surg Pak 2010 Jun;20(6):405-7

Department Of Pathology, Combined Military Hospital, Peshawar.

Objective: To measure the effects of awareness campaign on the frequency of EDTA contamination.

Study Design: A cohort study.

Place And Duration Of Study: The study was carried out in Combined Military Hospital, Peshawar, from October to December 2008.

Methodology: A cohort of 200 doctors, nurses and paramedical staff involved in sample collection for laboratory investigations were selected for this three phased study. In all samples with plasma potassium level > 6.0 mmol/L, plasma Ca++ was measured for one month before, during and after a campaign of correct filling order of sample tubes for two weeks. Renal function test and LDH were also measured to rule out chronic renal failure and in-vitro haemolysis, respectively. Fisher's exact test was used for comparison of frequency of hyperhalemia.

Results: There was a significant decrease (75%, p < 0.01) in the cases of spurious hyperkalaemia and hypocalcaemia.

Conclusion: EDTA contamination is a common and important source of pre-analytical error which can be prevented to some extent by education of medical and nursing staff.

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http://dx.doi.org/06.2010/JCPSP.405407DOI Listing
June 2010
15 Reads
0.439 Impact Factor

Spectrum of lipid and lipoprotein indices in human subjects with insulin resistance syndrome.

J Ayub Med Coll Abbottabad 2008 Jul-Sep;20(3):17-22

Armed Forces Institute of Pathology, Rawalpindi, Pakistan.

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August 2009
11 Reads
1 Citation

Impact of new diagnostic criteria of diabetes mellitus.

J Coll Physicians Surg Pak 2007 Jun;17(6):327-30

Department of Pathology, CMH, Dera Nawab Sahib Cantt (Ahmed Pur East).

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http://dx.doi.org/06.2007/JCPSP.327330DOI Listing
June 2007
40 Reads
2 Citations
0.320 Impact Factor

Serum hyaluronic acid as a marker of hepatic fibrosis.

J Coll Physicians Surg Pak 2007 Jun;17(6):323-6

Department of Pathology, CMH, Rahim Yar Khan.

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http://dx.doi.org/06.2007/JCPSP.323326DOI Listing
June 2007
17 Reads
4 Citations
0.320 Impact Factor

Insulin resistance in human subjects having impaired glucose regulation.

J Coll Physicians Surg Pak 2007 Jun;17(6):331-5

Department of Chemical Pathology, PNS Rahat, Karachi.

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http://dx.doi.org/06.2007/JCPSP.331335DOI Listing
June 2007
10 Reads
1 Citation
0.320 Impact Factor

Estimation of ionized calcium, total calcium and albumin corrected calcium for the diagnosis of hypercalcaemia of malignancy.

J Coll Physicians Surg Pak 2006 Jan;16(1):49-52

Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi.

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http://dx.doi.org/1.2006/JCPSP.4952DOI Listing
January 2006
21 Reads
1 Citation
0.320 Impact Factor

Hyperhomocysteinemia as a risk factor for ischemic heart disease.

J Coll Physicians Surg Pak 2004 Sep;14(9):518-21

Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi.

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http://dx.doi.org/09.2004/JCPSP.518521DOI Listing
September 2004
46 Reads
2 Citations
0.320 Impact Factor