Pakistan Journal of Pathology

EFFECT OF DELAYED PREPARATION OF PLATELET POOR PLASMA ON COAGULATION STUDIES AT ROOM TEMPERATURE

Ayesha Younas — 2023-03-31

Objective: To determine the effect of delay in the preparation of platelet poor plasma (PPP) on prothrombin time (PT) and activated partial thromboplastin time (APTT) at room temperature (RT).

Material and Methods: It was a cross sectional study, conducted at Chughtai Institute of Pathology from January 2022 to June 2022. Total 100 healthy individuals, both males and females, participated in the study. Centrifugation of four citrated blood samples was done at 4000 g for 10 minutes at RT; first sample at 0 hour (h), second sample at 4 h, third sample at 8 h and fourth sample at 24 h. PT and APTT were run on each PPP using Sysmex CS-1600.The values at different times were noted and compared through careful statistical analysis of the observed parameters.

Results: There was statistically significant difference for PT at 24h storage time when compared with baseline value at 0h (P value 0.0017) but no clinically relevant change up to 24h (<10% percent change). For APTT at RT, statistically significant difference was noted at storage time of 8h (P value 0.0001) and 24h (P value <0.0001) but a clinically relevant change was noted only at 24h (>10% percent change).

Conclusion: Blood samples for PT and APTT without centrifugation can be stored for up to 24 hours for PT at RT and for up to 4 hours for APTT at RT. PT and APTT values will not be affected if centrifugation of citrated sample is done within 1 hour of collection and transported at RT in small aliquots.

Key Words: Prothrombin time, Activated partial thromboplastin time, Platelet poor plasma, Pre analytical, Centrifugation

ROLE OF SEX HORMONE BINDING GLOBULIN AS AN INDICATOR OF INSULIN RESISTANCE

Nayab Zehra — 2023-03-31

Objective: To determine the role of Sex Hormone Binding Globulin (SHBG) in cases of hyperinsulinemia and insulin resistance among our population.

Material and Methods: It was a cross-sectional analytical study conducted at Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi, from Jun 2022 – Dec 2022. Study is comprised of total 90 samples consisting of both males and females. Study individuals were categorized as Pre-Diabetic and Diabetic according to their fasting plasma glucose levels. Fasting plasma insulin levels were done on Advia Centaur XPT Chemiluminescence Immunoassay analyser. Serum SHBG was done on Immulite 2000 by chemiluminescent immunometric assay. Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) was calculated from fasting glucose and insulin levels. Cut off value of 2.2 was used for labelling insulin resistance. Data was analyzed on SPSS version 23. Mean and standard deviation (SD) was calculated for glucose, insulin and SHBG. T test was used to compare means of pre diabetic and diabetic groups. Pearson’s correlation was used to establish correlation between SHBG and HOMA-IR.

Results: Our study included 57 males and 33 females with mean age of 47±11 years and 47±12 years, respectively. SHBG levels were significantly higher in pre-diabetics as compared to diabetics. The Pearson’s correlation between SHBG and Fasting serum insulin is weak negative (r = 0.3, p = -0.23), same is between SHBG and HOMA-IR (r = 0.25, p = -0.86), showing no significant association between SHBG and HOMA-IR among our population. However, two tailed t-test showed marked difference between means of serum SHBG, fasting serum insulin and HOMA-IR among diabetic and pre-diabetic groups with 95% confidence Interval.

Conclusion: The negative association of SHBG with insulin resistance is not marked in our population. Various epidemiological, external and metabolic factors could affect and should be excluded before establishing this negative correlation between SHBG and Insulin resistance for predicting the development of diabetes mellitus (DM)

Key Words: SHBG, Hyperinsulinemia, HOMA-IR, Correlation

BACTERIAL PROFILE AND ANTIBIOGRAM OF MICROORGANISMS ISOLATED FROM DIFFERENT BODY SITE INFECTIONS AMONG PATIENTS OF A PRIVATE HOSPITAL, KARACHI

Shaista Bakhat — 2023-03-31

Objective:It is crucial to keep an eye on current patterns of multi-drug resistance and extensively drug resistance at local level to facilitate physicians in making justified decision regarding empirical therapy during this era of rising superbugs.

Material and Methods: This antibiogram was made up according to CLSI (Clinical Laboratory Standard Institute) M100 guidelines. Samples were received for a period of 2-years from June 2019-June 2021 at National Medical Center Karachi. These samples were urine, blood, pus, cerebrospinal fluid (CSF), central venous pressure (CVP) tip, sputum and tracheal aspirates.

Results: Out of 10564 samples received, 4582 were positive for growth of microorganisms. Sample distribution patterns according to the frequency of positive growth of isolates were predominantly urine (58%) and blood (17%) followed by pus (8%) and pus swab (6%) 2% fluid and 2% tracheal secretions, and 7% others like tips growth. Blood cultures were mainly received from Intensive care unit (50%) followed by out-patients departments (34%). The pattern of resistance observed in Escherichia coli (E. coli) revealed ampicillin as the most resistant among all antibiotics (93%) followed by cefixime (77%). Most sensitive antibiotic was amikacin (99%). The Staphylococcus aureus isolates were highly susceptible to vancomycin and linezolid (100%) followed by gentamicin (89%) and chloramphenicol (85%). Vancomycin resistance was observed in Enterococcus faecium (8%).

Conclusion: Antimicrobial resistance among gram negative and gram-positive bacteria is increasing. This has left us with fewer therapeutic options which in turn highlights the issue of antimicrobial resistance being a global health concern. This emphasizes the significance of surveillance of antimicrobial patterns, development of antibiograms and implementation of antibiotic stewardship programs by judicious use of antibiotics for prevention of further spread of antimicrobial resistance.

Key Words: Antibiogram, Antimicrobial resistance, Multidrug resistance, Extensively drug resistance

DIAGNOSTIC EVALUATION OF NORFLOXACIN, FOSFOMYCIN AND NITROFURANTOIN IN URINARY ISOLATES CAUSING UTI

Saira Salim — 2023-03-31

Objective: Comparative evaluation of Norfloxacin, Fosfomycin and Nitrofurantoin in urinary isolates causing UTI

Material and Methods: It was Comparative Cross-sectional study. It was conducted at Department of Pathology at THQ hospital Pindigheb. The study was completed (including data compilation & analysis) in 1 year period from 28 Aug 2021 to 27 Aug 2022. Two hundred and seventy-five urinary isolates from urine specimens received for culture and sensitivity in the department of pathology at THQ hospital Pindigheb, were included in the study, as approved in the Internal Review Board. Non-probability consecutive sampling technique was used. Isolates were identified as urinary isolates by colonial morphology, Gram stain and biochemical tests. The zones of clearance around filter paper disc of Norfloxacin (10 µg), Fosfomycin (200µg) and Nitrofurantion (300µg) impregnated over lawn of bacterial isolate on Mueller-Hinton agar by Kirby-Bauer disc diffusion method as per Clinical and Laboratory Standard Institute (CLSI) guidelines were recorded.

Results: Out of total 275 samples 180(65.45%) samples yielded significant growth of Enterobacteriaceae. The females were 44.43% and males were 55.55% in in door and outdoor patient respectively. 0ut of 180 samples 100(55.55%) samples yielded growth of Escherichia coli followed by 50 (27.77%) were klebsiella pneumoniae and 30 (16.67%) were Enterobacter spp. The sensitivity pattern of Escherichia coli was noted to norfloxacin, Fosfomycin and nitrofurantoin {(50%,30%)},and {(6%, 2%)} resistance and sensitive respectively. klebsiella pneumonia and Enterobacter cloacae showed resistance and sensitive pattern {60%,10%)}(1), {(33.33%,16.67%)}, {(2%,10%)},{( 10%,6.7%)}and {(4%,2%)},{(13.33%,20%)} against norfloxacin, Fosfomycin and nitrofurantoin respectively.

Conclusion: Our study revealed high frequencies of norfloxacin, Fosfomycin and nitrofurantoin resistance among uropathogen at THQ hospital Pindigheb. A strong liaison between clinicians and microbiologists is recommended to keep abreast with the changes in antimicrobial susceptibility of uropathogens in order to suggest a suitable empiric therapy. Infection control measures are recommended, so that appropriate management can be instituted and spread of these resistant organisms curtailed.

Key Words: Norfloxacin resistance, Escherichia coli, Urinary tract infection. Urinary isolates, Fosfomycin

EPIDEMIOLOGICAL INVESTIGATION OF ACUTE VIRAL HEPATITIS OUTBREAK: SUBSTANTIATION OF A SINGLE SOURCE

Saba Rizwan — 2023-03-31

Objective: An outbreak of AVH was investigated with the objective of describing its epidemiological features.

Material and Methods: This descriptive outbreak investigation of AVH was done from August to December 2022, in the catchment area of the southern region of Karachi. An active surveillance of the affected region was conducted. WHO’s standard case definition for AVH was used to identify cases. Suspected cases were tested for hepatitis A virus (HAV) and E virus (HEV) using immunochromatographic testing (ICT). Drinking water samples were tested for faecal contamination. Control measures were implemented to contain the outbreak. Descriptive analysis was done as per time, person, and place.

Results: A total of 109 individuals were included in this study from 10th August 2021 to 31st October 2021. Out of these, 59 cases were confirmed serologically for Hepatitis A and E. Out of confirmed cases of AVH, 85.1% were positive for HEV, 12.8% for HAV, and 2.1% for both HAV and HEV. Males were affected more than females (P < 0.05). One of the areas reported leakage in the drinking water pipeline and had the highest attack rate. Drinking water samples were found negative for contamination

Conclusion: This study described the detailed methodology for the epidemiological investigation of an outbreak and described the epidemiological features of acute viral hepatitis and various measures taken to curb an outbreak.

Key Words: Acute viral hepatitis, Hepatitis A, Hepatitis E, Outbreak investigation, Jaundice