To compare insulin resistance and glycemic indicators among subjects with euthyroidism and subclinical hypothyroidism.Comparative cross-sectional 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.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.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)].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.
OBJECTIVE: To observe the factors influencing the success of type-I tympanoplasty by underlay
technique, in closing tympanic membrane perforation of variable size and location with temporalis
fascia graft.
DESIGN: Prospective study.
PLACE AND DURATION OF STUDY: Department of Otorhinolaryngology, Head & Neck Surgery,
Jinnah Postgraduate Medical Centre, Karachi from April 2004 to November 2006.
PATIENT & METHODS: Hundred (100) consecutive patients of dry tympanic membrane perforation
undergoing type-I tympanoplasty were included. Specific inclusion and exclusion criteria
were set. Data were collected regarding age, gender, cause, site and size of tympanic membrane
perforation, pre and postoperative audiogram results. The data were entered in a set performa
and was analyzed using SPSS version 14.0
RESULTS: The male: female ratio was 2:3 with age varying from 18 to 40 years (mean age 31.2).
Overall success rate was 81% (81 out of 100 perforations closed successfully). There was no
significant effect of age, gender and size of perforation on closure. All patients with traumatic
perforation had successful closure (100% with a p-value of
During recent epidemic of dengue fever in Peshawar, there has been a significant increase in dengue-associated admission in hospitals. We performed a postmortem examination of dengue-related death in our hospital. He was a young man, who was given supportive care at our tertiary care hospital, despite that he died on seventh day of admission. The autopsy findings in this case included multiple organ involvement including heart, lungs, kidneys and brain. There was histopathological finding of microabscesses in heart, lungs, brain and kidneys, which have not been reported in the literature yet. In patients with severe dengue, deaths do occur despite current supportive management. Knowing the pathological processes involved in severe disease, it can help identify early predictors of disease severity and help applying adequate clinical interventions.
This is an era of globalization, and to maximize the competitive advantage, the banking industry is acknowledging and recognizing Human Resource practices and contributing their best to employ the organizational resources in best productive manner so that they can excel and enjoy competitive edge. Number of factors are affecting on performance of the employee. This research paper is mainly intended to explore the influence of employee diversity on the performance of employee in Private Banking business of Pakistan. Specifically in this paper, the performance of the employee in a banking sector has been predicted by the influence of employee diversity with respect to their education, age, gender, and ethnicity. The data was collected from 203 private banking representatives (serving on different positions at UBL, HBL, and MCB) by a convenience sampling method. In order to identify the relationship, the data has been tested by SPSS Regression and correlation analysis methods. Research findings suggested that the organizations with specific reference to banking sector should plan, design and execute the policies,, practices and strategies that have a wide range canvas inclusive every individual employee and workforce diversities.
To evaluate the risk of malignancy index (RMI) for pre-operative diagnosis of ovarian mass.Observational study.Department of Chemical Pathology and Endocrinology at Armed Forces Institute of Pathology (AFIP), Rawalpindi from January 2001 to January 2002.The study consisted of 100 female patients consecutively admitted for surgical exploration of ovarian mass. Pre-operatively ultrasonic evaluation of ovarian mass, menopausal status and serum cancer-associated antigen 125 (CA 125) levels were carried out. Postoperatively histopathology of the resected ovarian mass was done to confirm the diagnosis. To increase the sensitivity and specificity of CA 125 for early detection of ovarian cancer, a combination of serum CA 125 with ultrasonography and menopausal status, designated as risk of malignancy index (RMI) for each patient, was calculated.The sensitivity and specificity of CA 125 alone for the diagnosis of ovarian cancer, at cutoff level of 35 U/ml, were 83% and 82% respectively. Using RMI, at cutoff level of 125, the sensitivity was 87%, and specificity was 88%. Receiver operating characteristic (ROC) curves reveal that RMI was a better discriminant than CA 125 alone for differentiating between benign lesions and malignant ovarian tumors.The risk of malignancy index (RMI) is a better diagnostic marker as compared to CA 125 alone because of its high specificity and sensitivity in differentiating ovarian cancer from ovarian benign lesions. It is a simple scoring system and, therefore, its application is recommended to evaluate ovarian masses in clinical practice.
To determine the diagnostic accuracy of serum iron and total iron binding capacity (TIBC) in detection of iron deficiency.Descriptive, analytical study.Department of Chemical Pathology and Endocrinology, from January 2013 to October 2015.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.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.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.
Abnormalities in the circulating thyroid hormone concentration, without associated pituitary or thyroid disease, are seen in a variety of nonthyroidal illnesses (NIH). These abnormalities may be low plasma triiodothyronine (T3), low thyroxine (T4) or a combination of both, with an inappropriately normal plasma thyrotropin (TSH). These could be because of various factors acting on monodeiodinase, a key enzyme for the conversion of T4 to T3, or on transport system for thyroid hormones. Role of cytokines and other inflammatory mediators through their actions on hypothalamus, pituitary or thyroid gland has been extensively investigated, but their real action in vivo remains unclear. Knowledge of these hormone abnormalities is necessary to avoid errors in the diagnosis of thyroid disease. Whether the hormone responses in euthyroid sick syndrome represent part of an adaptive response, which lowers tissue energy requirement in systemic illness, or is a maladaptive response inducing damage to tissues in hypothyroidism, remains unclear. The thyroid function disturbances correlate with the disease severity, and low levels of thyroid hormones predict a poor prognosis in severe illness. The use of thyroid hormone therapy is still controversial in such illnesses, as few controlled trials have shown conflicting results for treatment with T3.
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 & 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% 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.
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