Farooq Ghani

Low-level lead exposure and blood lead levels in children: a cross-sectional survey

Abstract The authors studied 53 girls (44.5%) and 66 (55.5%) boys in Karachi, Pakistan, to determine their blood lead levels. The association between blood lead levels/water lead levels and the possible risk factors and symptoms associated with lead toxicity was explored. The mean lead level for the entire group was 7.9 μg/dl (standard deviation = 4.5 μg/dl). Thirty (25.2%) of the children had lead levels that exceeded 10 μg/dl; 12 (10.0%) of these had lead levels that exceeded 15 μg/dl. Thirteen (20.9%) of the children under the age of 6 yr (n = 62) had lead levels greater than 10 μg/dl, and 6 (9.6%) had levels in excess of 15 μg/dl. The authors found no association (p > .05) between high lead levels in water and blood lead levels in children. Mean blood lead levels were highest in the group of children exposed to various risk factors for lead absorption (e.g., exposure to paint, remodeling, and renovation; use of lead utensils; pica). There was a significant association between a history of exposure to paint/renovation activities and a history of pica. High blood lead levels in the children in Karachi stress the urgency for actions that control lead pollution. Screening programs should be instituted by the state. Individuals must become aware of leads toxicity, and they must avoid substances that contain lead.

Diagnostic efficacy of 0, 30, 45, 60, 90 and 120 min growth hormone samples in insulin tolerance test: utility of growth hormone measurement at different time‐points and a cost‐effective analysis

Objective. To determine the utility of growth hormone (GH) measurement with the insulin tolerance test (ITT), and to carry out a cost‐effective analysis of the diagnosis of GH deficiency. Material and methods. Ninety‐nine patients clinically suspected of GH deficiency were evaluated over a period of 14 months (January 2005 to April 2006). Post‐insulin samples of GH and blood glucose (BG) samples were drawn at six different time‐points. Serum GH levels of <10u2005µg/L (prepubertal) and <6.1u2005µg/L (adolescents) were taken as cut‐off for the normal response. Results. Ninety‐nine ITTs were carried out during the study period, and GH levels were found to be deficient in 47 subjects. Specificities at different time‐points were 0u2005%, 54u2005%, 77u2005%, 62u2005%, 39u2005% and 23u2005% for 0, 30, 45, 60, 90 and 120u2005min, respectively, in the prepubertal group, and 5u2005%, 41u2005%, 80u2005%, 87u2005%, 77u2005% and 46u2005% at the same time‐points for the adolescent group. Accuracy was highest at 45 and 60u2005min in both the prepubertal and adolescent groups. The receiver operating characteristic curve showed that the highest area under the curve was found in samples drawn at 45, 60 and 90u2005min in both the prepubertal and adolescent groups. Conclusion. Our data suggest that 0, 45, 60 and 90u2005min samples are sufficient for diagnosing GH deficiency, which could lead to potential cost reductions of up to 29.8u2005%.

Prospective evaluation of serum procalcitonin in critically ill patients with suspected sepsis- experience from a tertiary care hospital in Pakistan

Background Sepsis is the leading cause of mortality in critically ill patients. Procalcitonin (PCT) is a promising marker for identification of bacterial sepsis. The aim of this study was to determine the diagnostic accuracy of serum PCT concentration in patients with suspected sepsis admitted to mixed medical-surgical Intensive care unit (ICU). Material and methods A cross-sectional study conducted at section of Chemical Pathology, Department of Pathology and Laboratory Medicine and ICU. Patients with suspected sepsis were included, serum PCT cut off ≥0.5u202fng/ml was taken for diagnosing sepsis. Diagnostic accuracy was measured in terms of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) taking blood culture as gold standard. Furthermore, different cut offs were compared by using receiver operating characteristic curves (ROC). Data analysis was done on SPSS version 20. Results Median age of the study group (nu202f=u202f103) was 48 years (IQR: 22), 60% being males. Out of the 103 patients included 82 patients had PCT levels above the optimal cut off. At a serum PCT cutoff of 0.5u202fμg/L, the sensitivity and specificity for the diagnosis of sepsis was found to be 93.75% and 43.59% respectively. NPV was higher compared to PPV making PCT a reliable marker to for the screening out of sepsis patients. Furthermore, it was revealed that PCT having an AUCu202f=u202f0.70 outperformed WBC (AUCu202f=u202f0.5) and CRP (AUCu202f=u202f0.6). Conclusion Elevated PCT concentration is a promising indicator of sepsis in newly admitted critically ill patients capable of complementing clinical signs and routine laboratory parameters.

Fibroblast growth factor 23 (FGF23) levels, phosphate Intake and its association with Indices of renal handling of phosphate in healthy volunteers

FGF23 is a novel phosphaturic hormone; we aimed to assess the FGF23 levels and its association with dietary phosphate intake and indices of renal handling of phosphate in this study. Prospective study was conducted in which dietary phosphate intake was assessed by food frequency questionnaire (FFQ) along with blood and spot urine samples were collected after overnight fast for determining serum phosphate, FGF23, fractional excretion of phosphate (FePO4) and tubular maximum for phosphate (TmP/GFR). FGF23 (C-Term) was measured by a sandwich ELISA. The mean dietary phosphate intake of eighty healthy adults (mean age of 29 ± 5 years) was 1220 ± 426 mg; median FGF23 was 49.9 RU/ml (IQR=33, 76) and mean FePO4 was 7 ± 4.7. Subjects were stratified into two groups according to serum phosphate levels. Significant difference was not found in dietary phosphate intake and FGF23 levels in the two groups. However, TmP/GFR and creatinine were significantly different in the two groups. FePO4 was high in both the groups. Overall a rising pattern of FGF23 levels was seen with increasing serum phosphate levels. Significant positive correlation was found between FGF23 and dietary phosphate (r=0.22, p<0.05) and negative correlation was seen between FGF23 and FePO4 (r=-0.260, p<0.05).

Automated Reporting of Estimated Glomerular Filtration Rate: A Comparison of Creatinine Clearance, Modification of Diet in Renal Disease and Cockcroft Gault Equations from Pakistan

Objectives: To facilitate early detection of chronic kidney disease, many organizations now recommend reflex reporting of estimated glomerular filtration rate (eGFR) whenever serum creatinine (Cr) is measured. To compare two widespread eGFR equations with creatinine clearance (CrCl) calculated through a timed urine collection. Methodology: Laboratory data of subjects’ ≥ 18 years tested for CrCl from October 2010 to December 2010 was retrieved from laboratory information system of Aga Khan University Hospital. Statistical comparison of eGFR using Cockcroft Gault (CG) and 4variable Modification of Diet in Renal Disease (MDRD) formulae with CrCl was performed. Results: Six hundred and seventy subjects with CrCl were studied. Mean age of the group was 51 ±15 years, 55.7 % being males. Mean glomerular filtration rate using CrCl, MDRD and CG were 57.1 (±35.9), 57.8 (±33.6) and 68.7 (±41.5) ml/min respectively. Deming regression analysis generated MDRD = 5.23 + 0.92 (CrCl) and CG = 0.23 + 1.2 (CrCl) for comparison of CrCl results with those of MDRD and CG respectively. Comparing MDRD and CrCl, Bland Altman revealed acceptable agreement with a minimal bias of 0.65 ml/min.