Objectives: The objective of the present study is to investigate the role of cystatin C as an early marker of glomerular dysfunction in thalassemia major. Study Design: Cross sectional comparative study. Setting: Department of Biochemistry Post Graduate Medical institute with the Thalassemia Center in Sir Ganga Ram Hospital Lahore. Period: July 2017 and July 2018. Material & Methods: This study examined 90 male children all between the ages of 5-11, using non probability sampling techniques. The children were grouped as 21 healthy male children as control group I and 69 diagnosed male thalassemia major children further subdivided on the basis of serum ferritin level as group II, serum ferritin level <2500ng/ml, group III, serum ferritin level 2500-5000ng/ml and group IV serum ferritin level >5000ng/ml respectively. Individuals with hereditary renal diseases, on steroid therapy, or other co-morbid renal diseases were excluded from the study. Complete blood analysis, serum ferritin, creatinine and cystatin C were measured by Micro lab 300 and solid phase enzyme linked immune sorbent assay (ELISA) respectively. The results were compared by using SPSS version 20. Results: Group I: n=21 healthy children with ferritin between normal range 105.33 ± 30.03, serum creatinine 0.41 ± 0.05, serum cystatin C 0.57 ± 0.14. eGFR-creatinine 133.38±7.63, eGFR-cystatin C 122.9±17.63. Group II: n=20 (β-TM with ferritin <2500ng/ml). Mean ferritin was 1997.5±300.68 ng/ml (P<0.001), creatinine was 0.43± 0.05, serum cystatin C 0.66 ± 0.05 (P<0.05). eGFR-creatinine 121.45±4.89 P<0.05, eGFR-cystatin C 105.15±6.49 P<0.001. Group III: n= 25 (β-TM with ferritin 2500-5000 ng/ml). Mean ferritin level was 3850.0± 718.18 ng /ml (P<0.001), creatinine was 0.5±.07, cystatin C 0.96±0.13 (P<0.001). eGFR-creatinine 103.29±8.26(P<0.001), eGFR-cystatin C 75.75±10.67 (P<0.001). Group IV: n=24 (β-TM with ferritin >5000 ng/ml). Mean ferritin level was 6311.67±1060.61 ng/ml P value (P<0.001), creatinine was 0.57 ± 0.07, cystatin C 1.11 ± 0.09 (P<0.001). eGFR-creatinine 94.42±8.69 (P<0.001), eGFR cystatin C 64.67±4.23(P<0.001). Conclusion: A highly significant positive relation was found between serum ferritin-cystatin C as compared to creatinine among the study groups II, III and IV and significant inverse relationship between cystatin C and eGFR that concluded cystatin C as an early marker of glomerular dysfunction than creatinine in thalassaemia major children.

Background: The Covid-19 pandemic has wreaked havoc throughout the world, with 150 million cases to date and over 3 million lives claimed worldwide. Aim: To explore the hypoxemia in COVID-19 patients in relation with genomic mutation and co-morbidities. Study Design: Experimental Study. Methodology: A total of 16 COVID-19 positive patients admitted to Aziz Bhatti hospital were included in this study. COVID-19 was confirm through nasopharyngeal swab specimen diluted in normal saline subsequent RT-PCR was performed as per the standard operating procedure. Genome sequencing and interpretation of analysis was done through Illumina MiSeq. Results: There was statistically significant difference (P < 0.05) in SaO2 in patients with N (Nucleocapisd) protein mutation compared with NSP13( Helicase) mutation. Conclusion: It was concluded that mutation of N (Nucleocapisd) protein causes more pronounced hypoxia compared with Helicase mutation of COVID-19 genome. Keywords: COVID-19, Hypoxia, Mutation and Genome.

Background: HIV treatment centres register HIV positive patients, specially trained doctors prescribe Antiretroviral Therapy to the selected cases that fulfill the criteria for initiation of HAART. Aim: To establish predictive markers of failure of 1st line ART in HIV positive patients on first line ART under treatment in HIV Treatment Centre of PIMS Islamabad. Study design: Retrospective case control study. Methodology: Retrospective case control study done at HIV Treatment Centre at PIMS Islamabad. Cases were patients who failed 1st line ART and started on second line ART from November 2005 to June 2020. Patients responding well to first line ART since more than five years or more were taken as controls. Various factors were analyzed in both groups and compared to find their level of significance. Data was analyzed by SPSS software, version 25 as qualitative variables were expressed as frequencies and percentages. Results: CD4 count of all 38 patients was below 300 on diagnosis. In 21 patients (55.3%) CD4 count initially increased but there was no rise in CD4 count in 17 patients (44.7%) after start of 1st line ART. Conclusion: We concluded that CD4 count is one of the most important predictive markers in success or failure of ART. Rising number of CD4 count on follow up visits gives a strong indication that patient is responding well to the prescribed treatment and is likely to benefit from the current regimen of ARVs for a longer period in future. Keywords: Predictive Markers, CD4 count, Viral Load, HIV, ART, Compliance and Co-morbidities