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Objective: To evaluate the predictive value of neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) with procalcitonin in cord blood. Study Design: Case control study. Place and Duration of Study: Study was conducted in Army Medical College and Pak Emirates Military Hospital Rawalpindi, Jul 2018 to Mar 2019. Methodology: Those mothers, having deliveries with early rupture of membranes (EROM), premature rupture of membranes (PROM), preterm, dai handled, meconium and failure of induction have been included. Total 60 neonates were included in this study. Nineteen neonates were taken as a continuous clinical unsteadiness with a clearly documented suspicion of sepsis and two neonatologists decided sepsis within 1-3 days of life. While remaining neonates were control who have no infection. Results: Laboratory values show there was a gross difference in mean values of case and control for white blood cell (WBC), platelets, neutrophil, platelet to lymphocyte ratio and procalcitonin with statistical significance except lymphocyte count and neutrophil to lymphocyte ratio. In combined ROC curve. The cutoff of procalcitonin was calculated to be 0.4ng/ml with an area under curve of 84.5%. Similarly, cutoff of neutrophil to lymphocyte ratio was determined to be 1.39 with an area under curve of 65.1% at sensitivity of 63% and specificity of 58.5%. Cutoff of platelet to lymphocyte ratio was determined to be 47.48 with an area under curve of 66.8% at sensitivity of 78.9% and specificity of 49%. Conclusion: Combined hematological markers neutrophil to lymphocyte ratio and platelet to lymphocyte ratio with procalcitonin in cord blood could be used as a simple, sensitive and predictive parameter for identifying neonates susceptible to sepsis. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of mutations in Low density lipoprotein receptor gene at exon 2 and 4 and its association with premature coronary artery disease (PCAD). Methods: A case-control study was conducted at Armed Forces Institute of Cardiology and Chemical Pathology department of Army Medical College Rawalpindi for a period of six months from June 2017 to December 2017. A sample size of 50 (40 patients, 10 controls) with 5% significance and 95% confidence interval was calculated with 4:1 case to control ratio. Consecutive sampling was used for distribution of participants into both groups. Diagnosed patients of premature coronary artery disease that is any cardiac event before the age of 45 in males and 50 in females were taken as cases. Controls were healthy males less than 45 years of age and females less than 50 years. Patients with diabetes mellitus, thyroid illnesses, any acute infection, low white blood cells count and kidney disorders were excluded. A total of fasting 10ml blood was withdrawn from each patient. 5ml was utilized for the routine blood tests and the rest 5ml was used for further genetic analysis. Results: Total 50 participants were included in study. Mean age of participants in years was 42.48 ± 4.02 SD. Mean total cholesterol (TC) (mmol/l) were higher among cases (4.91±0.64 SD) than controls (4.22±0.66 SD). Serum triglyceride(Tg) (mmol/l) and low-density lipoprotein(LDL) (mmol/l) was also high among cases (2.07±0.58; 2.84±0.46) than controls (1.99±0.24; 1.98±0.32). One synonymous mutation in exon 2 of low-density lipoprotein receptor gene (LDLR) and one non-synonymous mutation in exon 4 (LDLR gene) were identified in our population in four patients among the forty cases. Data was analyzed by Statistical Package for the Social Science (SPSS) 21 version and a p-value of less than 0.05 was taken as significant. Conclusion: Glutamic acid (E) is replaced by Lysine (K) at position number 207 (E207K) mutation at exon 4 of low-density lipoprotein receptor (LDLR) gene may be the causative genetic basis of premature coronary artery disease among Pakistani population. The identified synonymous mutation at exon 2 was not causative as there is no change in the amino acid. [ABSTRACT FROM AUTHOR]

Objective: To assess the effect of delayed centrifugation on integrity of serum chemistry. Study Design: Quasi experimental study. Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi, from Jul 2018 to Sep 2018. Patients and Methods: A sample of 20 ostensibly healthy adult subjects were recruited in the study. 16 cc of blood was drawn from each individual. It was distributed evenly (2 cc each) in plain tube. One tube was centrifuged immediately after clotting while remaining 7 at the time of expiry of delay period up to 12 hours. All the samples were stored at room temperature (25±1°C). Samples were analyzed for routine chemistry analytes. Data was analyzed by using SPSS 23. Repeated samples ANOVA and Paired t-test was used to access the variation in the levels of different analytes. Results: Urea and ALT levels showed significant variation over time. While other remained stable up to 12 hours. Urea showed significant change at test on 4th hours (p≤0.001). ALT remained stable up to 6 hours, 8th hour analysis showed significant variation (p=0.001) with sharp increase in the results of both urea and ALT. Conclusion: Variation in urea levels became significant at 4th hour while ALT, bilirubin and calcium levels were stable up to 6th hour. Cholesterol levels remained within non-significant variation till 8th hour while all other analytes showed stability up to 12 hours. [ABSTRACT FROM AUTHOR]