International journal of Clinical Biochemistry and Research

354-356

Authors: Inder Pal Kaur, Ashish Shukla, Sukanya Gangopadhyay, Akash Gupta, Gautam Sarkar

Pre-eclampsia (PE) is defined as the new onset of hypertension and proteinuria during the second half of pregnancy. In the Indian scenario, it accounts for 44.44% of all cases of hypertensive disorders of pregnancy. Microalbuminuria is one the classic signs of pre-eclampsia. The aim of the study was to determine microalbuminuria as predictor of pre-eclampsia. Methods: A total of 145 pregnant women in their second trimester of pregnancy were included in the study. From all these subjects, clean catch morning urine sample (5ml) was collected in a sterile container. Urinary Creatinine and urinary microalbumin was estimated by kit based method on Vitros Fusion 5.1 FS fully automated analyzer from Ortho Clinical Diagnostic USA. The statistical significance of difference between mean values was assessed by Student’s unpaired t-test. Result: Pregnant women who developed pre-eclamsia were having significantly higher micro albumin level and Albumin Creatinine Ratio as compared to normotensive pregnant women. Conclusion: To determine microalbuminuria as predictor of pre-eclampsia, further detailed study is required in large group of population.

363-367

Authors: Bibekananda Modak, Bulbul Purkait, RN Maity

To compare the Insulin resistance among Type 2 Diabetics of the local tribal and nontribal population who are reporting to OPD of Midnapur Medical College and Hospital. Method: This was a Unicentric, cross sectional, observational study. Estimated Glucose disposal rate which is used to analyse Insulin resistance among Type 1 Diabetics, has been utilized for the same in type 2 Diabetics. Result: A significantly larger proportion of male non-tribals had uncontrolled FPG (˃ 130 mg/dl), HbA1c (both ≥ 8.5% and ≥ 7%), estimated glucose disposal rate less than lower limit (i.e. ˂ 9 mg/kg/min) of the normal range, compared to the male tribals. Compared to the male tribals, a larger proportion of the male non-tribals had PPPG ≥ 180 mg/dl. A significantly larger proportion of female nontribals had uncontrolled PPPG, HbA1c and estimated glucose disposal rate less than lower limit of the normal range, compared to the female tribals. Compared to the female tribals, a larger proportion of the female non-tribals had uncontrolled FPG. Conclusion: Tribal Population with Type 2 Diabetes showed better achievement of Treatment goal.

371-375

Authors: Dhiraj J. Trivedi, Vijayalaxmi Shindhe, Chandramati J. Rokhade

Birth weight is an important determinant of infant mortality. Two third of all deaths occurring in first twenty eight days of life happen due to low birth weight. LBW infants suffer higher risk of health complications at adult life. Maternal nutrition maybe the major intrauterine environmental, non-genetic, controllable factor which influences the growth of the fetus. Aim: To evaluate the influence of maternal nutritional status on developmental achievement of neonates in the first thirty days of independent life. Objective: 1. To study the nutritional status of mothers during pregnancy. 2. To evaluate birth weight, 5 min Apgar score, developmental outcome of newborn. 3. To correlate birth weight with health and developmental achievement of neonates in the first 30 days of independent life. Materials and Method: 121 mother-neonate pairs formed study population. Serum total protein, Albumin and Hemoglobin were evaluated for mother’s nutritional status. Gestational age, Birth weight, APGAR score and Cord blood Albumin were analyzed for neonates. The overall developmental outcomes were observed for the first 30 days of neonatal life. Results: Mean Birth weight of neonates was in the acceptable range, 39.67% LBW was observed at our hospital. LBW frequency was higher among female infants and small for gestational age. 5min Apgar score was good among ABW, but poor among LBW infants. LBW deliveries were high among mothers having poor nutritional status. LBW babies had low cord albumin levels & had higher frequency of health related problems. Overall developmental growth was poor amongst LBW, low cord albumin level and infants having a low Apgar score. Conclusion: Nutritional status of the mother during pregnancy influences the health and overall development of the newborn observed during first 30days of independent life. Promotion of optimal nutrition may ensure optimal fetal development and reduces the risk of chronic diseases in adulthood.

380-386

Authors: Hasit Dalpatbhai Lad, Neeta Maheshchandra Rana, Vibhuti Sundarbhai Chaudhari, DVSS Ramavataram

The errors associated with the total testing process in laboratory, affecting clinical decision making, may occur at the pre-analytical, analytical and post-analytical phase. This study is aimed at finding out the types and frequencies of errors recorded and recommending the corrective measures in pre analytical phase, which accounts for preventable errors significantly. Materials & Methods: This was a retrospective analysis of errors observed and recorded over 3 months period in clinical biochemistry laboratory at SMIMER hospital, Surat. Data analysis was done on an average of 12680 samples collected and tested. Samples included blood, urine and other fluids. Pre-analytical errors were identified and recorded subsequent to visual inspection of the samples and corresponding request forms by laboratory staff. Results: Pre-analytical errors were classified as A) inappropriate form (28.24%), B) inappropriate sample (3.52%), C) inappropriate transport (22.16%) and D) inappropriate centrifugation (7.29%). For category A, high error rate for date and time of sample collection (99.97%), provisional diagnosis (99.92%) and physician’s detail (100%) were observed. For category B, error rate for insufficient sample volume was 26.38%. For category C, error rate for date and time of sample receipt was 100%. Pre-analytical error rate was highest for samples received from outpatient department (18.37%) and for urine sample (18.61%) comparatively. Conclusion: Pre-examination errors were high at this study location. Measures aimed at reducing the same and exposure to accreditation are recommended for improved laboratory quality output.

392-394

Authors: Sumathi K, Prakash M, Parameaswari PJ, Mary Chandrika A

The most common morbid complication of Type-2 diabetes mellitus is vestibulopathy. Microangiopathy & Oxidative stress due to diabetes mellitus is one of the causative factor of this vestibular dysfunction. Aim and Objectives: The aim of the study is to find the significance of hs-CRP in vestibular dysfunction in type 2 diabetes mellitus. Materials and Methods: A cross-sectional study of 100 diabetic patients were tested for vestibular function by electronystagmography. Clausen butterfly chart is generated based on the bithermal caloric stimulation and the code is ascertained & Serum hsCRP was estimated for these patients by immunoturbidometry. Data analysis done using SPSS package. Results: 65% of diabetic population with hsCRP>3mg/L had vestibular dysfunction which is significant. It is also found that 70% of diabetic patients with greater than 4 years duration had vestibular dysfunction. Conclusion: From this study it is concluded that the proportion of diabetic vestibulopathy is higher in those having hsCRP of >3mg/L. So it is advisable to do screening for all diabetics by estimating hsCRP & vestibular dysfunction particularly those having hsCRP >3mg/L so as to prevent the morbid complication diabetic vestibulopathy.

402-408

Authors: Mahantesh Patil, Shubha Jayaram, Meera S

Coronary Artery Disease is the leading cause of death worldwide and LDL has been recommended as the primary lipid subset for prediction of risk of CAD NCEP guidelines. Many assays have been developed for measurement of LDL levels and have shown reasonable accuracy as compared to reference method but still not cost effective and cannot be affordable by majority of laboratories. Laboratories use the cost effective Friedewald’s formula for calculating the LDL instead of direct assay which give near to accurate value but has its own limitations. In recent days many newer formulae have come up with lesser limitations and here an attempt is made to evaluate these formulae and to correlate with direct measurement of LDL. Methodology: It’s a cross sectional study. Sampling technique is Census method and involves sample size of 1020 cases. The entire lipid Parameters (LDL, HDL, TC, and TG) were estimated using Kits purchased by Roche /Cobas and then LDL also calculated using various formulae. Data was entered in Excel and analysed by Epi info software. Descriptive statistics like mean, standard deviation, standard error of mean were calculated. Student t test and Pearson’s correlation are used to find the correlation between measured LDL and calculated LDL at different intervals of TG, TC and HDL. Results: A total of 1020 samples were studied. The Cordova Formula correlated well in all the 1000 samples as a whole and in subjects with normal lipid profile and also at all lipid levels except for TG < 200mg/dl, TC < 100mg/dl. At TG < 200mg/dl Anandaraja’s formula shows better correlation and at TC < 100mg/dl none of the formulae performed well as all formulae negatively correlated with the direct measurement of LDL. Conclusion: Even though Cordova formula in our study has outperformed the other formulae, there are lots of factors which will affect the calculation. So it is highly recommended to switch to newer direct assays available in the market which are more precise, accurate, cost effective and also having low total allowable error < 12 and and a CV of <4%.

413-416

Authors: Nagalakshmi CS, Santhosh NU, Krishnamurthy N

Pregnancy induced hypertension (PIH) is a multifaceted syndrome with involvement of several important organs and it is associated with endothelial dysfunction. The results from many clinical studies show the relationship between the aggravation of the hypertensive complication and the change in concentrations of various chemicals in mother. Lowering of serum calcium and increase of intracellular calcium can cause an elevation of blood pressure in pre-eclamptic mothers. Hence in this study we propose to estimate urinary calcium-creatinine ratio, for early diagnosis of pre-eclampsia, with an intention to bring down maternal and fetal morbidity and mortality. Methods: 50 hypertensive pregnant women and 50 age matched normotensive pregnant women were checked for their blood pressures, BMI and proteinuria by dipstick method. Sterile random mid-stream urine sample was used to estimate urinary calcium (OCPC method), urinary creatinine (Jaffe’s method) and its ratio CCR. Cut off value for CCR was taken as ≤ 0.04. Results: Amongst the cases, 84% of the patients had CCR ≤ 0.04, in contrast to 6% of controls with CCR ≤ 0.04. Chi square (χ2) value was 58.34 showing that ratio is highly significant (p<0.0001). Conclusions: A single random urinary CCR may be used as an effective tool for the early diagnosis of hypertensive pregnancy and may identify population at greater risk to be included in primary prevention programmes. In addition, early supplementation of hypertensive pregnant women with calcium may significantly reduce the morbidity and mortality.

421-425

Authors: Chandana G, Nina M. Veigas, Raghavendra DS

Metabolic syndrome (MetS) and Diabetes mellitus (type I and type II) are emerging as epidemics among non communicable diseases. A lot of research has been done on hyperglycemia in Diabetes mellitus and Metabolic syndrome, but very few studies on pancreatic exocrine function have been conducted in these conditions. Therefore, the present study is an attempt to link endocrine and exocrine parts of the pancreas by investigating the association of serum amylase with insufficient insulin action in clinical settings. Objectives: To estimate and compare serum amylase and insulin levels in Metabolic syndrome and in type I Diabetes mellitus and type II Diabetes mellitus. Materials and Methods: The subjects included in this study were divided into 3 groups. Group I consisted of 30 Diabetes mellitus Type I patients aged ≤ 25 yrs. Group II consisted of 30 patients of Diabetes mellitus Type II aged ≥ 40 yrs and Group III consisted of 30 Metabolic syndrome patients aged ≥ 40 yrs. Serum insulin, Serum amylase, Fasting blood sugar (FBS) and lipid profile were measured using autoanalyser. Statistical package for social science software version 15 was used for statistical analysis. Results: Serum amylase was significantly less in DM Type I (40.53±16.58) compared to both DM Type II (75.13±44.81) and Metabolic syndrome (58.77±17.45). The insulin levels were lowest in DM Type I compared to both DM Type II and MetS. In DM Type I, there was a positive correlation between insulin & amylase levels. In DM Type II and MetS there was a positive correlation between insulin & amylase levels at low insulin levels of ≤10 µIU/ ml and negative correlation with insulin résistance i.e. the serum amylase was lower with higher insulin résistance than with moderate insulin resistance. Conclusion: Our results suggest a significant association between serum amylase levels and insufficient insulin action either due to inadequate insulin secretion and/or insulin resistance in Type I DM, Type II DM and MetS. This indicates a possible exocrine-endocrine relationship in these clinical conditions. Low serum amylase is associated with decreased basal insulin levels and insulin secretion, as well as high insulin resistance than with moderate resistance. Low serum amylase suggests exocrine pancreatic insufficiency and if pancreatic amylase replacement therapy is given to these patients it may improve the nutritional status and also analysis of serum amylase could provide valuable information regarding prognosis of the illness.

429-432

Authors: Pradnya Shree Dhotre, Abdul Kayyum Shaikh

There are many reports regarding renal stone disease, which have documented that it is a complex disease process and widely distributed in developed as well as developing world with varied chemical constitution of these stones in relation to a varied risk factors. The present study was designed to qualitatively investigate the chemical constitution of the renal stones in the rural population of South Solapur, Maharashtra and also to study the dietary habits and water used for drinking purpose in renal stone patients. Method: The study was conducted on a total of 130 renal stone patients, comprising 90 males and 40 females, selected from Ashwini Rural Medical College, Hospital and Research Centre, Kumbhari, Solapur, Maharashtra. Results: The analysis of chemical composition of renal stones showed that all the analysed stones were of different types. Carbonate was predominantly present (96.1%) which was followed by uric acid (94.6%), calcium (92.3%), phosphate (83.8%), oxalate (52.3%), ammonia (44.6%) and cystine (23.0%). The relative frequency of urolithiasis was more (67.6%) in patients who used ground water for drinking purpose as well as in those with a non-vegetarian diet (73.8%). Conclusion: The study concludes that simple qualitative chemical analysis helps us to evaluate chemical composition of renal stones and serves as a reliable diagnostic marker. Thus it can be useful in advising people for taking preventive measures.

438-441

Authors: Ramesh, Krishnaswamy D, Indumati V, Vijay V, Rajeshwari

Non-alcoholic fatty liver disease (NAFLD), is a major cause of chronic liver disease. NAFLD can progress to fibrosis, cirrhosis, liver failure and hepatocellular carcinoma, like alcoholic fatty liver disease (AFLD). However there are only few studies regarding lipid profile in NAFLD and AFLD that have been undertaken. Recently AST/ALT Ratio (also known as De-ritis Ratio), has been used as a marker of alcoholic liver disease. Hence this study was conducted to study the biochemical markers in NAFLD and AFLD. Objectives: 1. To compare lipid profile and De-ritis ratio in ultrasound diagnosed NAFLD and AFLD 2. To assess the usefulness of these parameters to differentiate NAFLD from AFLD and also to monitor their prognosis. Materials and Methods: 30 cases of USG diagnosed NAFLD and 30 cases of USG diagnosed alcoholic liver disease aged between 25 to 60 years, from MCH, VIMS, Ballari were studied and compared with 30 healthy age and sex matched healthy controls. After obtaining informed consent from all the patients, 5ml of fasting blood was collected and lipid profile, AST, ALT levels were estimated and De-ritis ratio was calculated. Results: There was significant increase in the total cholesterol, LDL and Triglycerides levels in NAFLD patients (p=0.0001) when compared to AFLD patients. De-ritis ratio was significantly increased in AFLD patients (p=0.0001). Conclusion: Hence it was concluded from our study that, NAFLD patients showed atherogenic dyslipidemia when compared to AFLD. De-ritis ratio can be used as parameter to differentiate between NAFLD from AFLD.

446-448

Authors: Sarala Devi Tenepalli, Karunasree Yerrajwala, Lalitha Devi Seerla

Obesity is associated with complications like Diabetes, Asthma, Hypertension and cardiovascular risks which are to be managed of health care worldwide. Increased BMI during childhood and adolescence may lead to premature death from disease and may increase the risk of CVD at adult age. Methods: 30 obese children with an age group of 8-15 years attending paediatric department and 30 healthy age matched non obese children were taken in the study. BMI was calculated for all and biochemical markers like fasting blood glucose, Insulin resistance (HOMA-IR) were determined using commercial enzymatic kits. MDA, FRAP, and NO was determined by chemical methods. Results: A significant increased levels of BMI, Insulin and insulin resistance (HOMA-IR), MDA and NO levels (P<0.05) was observed in obese children compared to non-obese but, the levels of Fasting blood sugar levels and FRAP were not statistically significant in cases compared to controls. Conclusions: As childhood obesity can influence many risk factors like diabetes, hypertension, asthma, endothelial dysfunction which may lead to CVD risk and atherosclerosis most of the studies reported that there are possible chances to minimize these risk factors by proper medication and most of the events are even reversible. Therefore the parent should be suggested to have a proper dietary management and medication in order to avoid the progression of these risk factors in adulthood.

453-460

Authors: Ayesha Almas, Vanitha Gowda MN

Osteocalcin has recently been proposed to play an important role in modulating glucose, lipid and energy metabolism. This study was undertaken to determine serum osteocalcin levels in metabolic syndrome and to study its association with measures of insulin resistance and cardiovascular risk factors. Methods: The study included 45 cases diagnosed as having metabolic syndrome defined by NCEP ATPIII criteria and 45 normal healthy subjects as controls. A fasting serum sample was collected from each subject and assayed for Fasting Blood Sugar, Lipid Profile, Insulin and Osteocalcin. Body Mass index (BMI), Waist hip ratio (WHR) and Homeostatic model assessment (HOMA) were calculated. Results: The mean serum Osteocalcin (ng/mL) levels were 4.56±1.75 and 10.302±1.96 in cases and controls respectively (p<0.001). In cases, Hyperglycemia and Hypertriglyceridemia were the most prevalent risk factors. The cases had a statistically significant negative correlation between osteocalcin and BMIand Triglyceride and a statistically significant positive correlation between osteocalcin and High Density Lipoprotein (HDL)(r = +0.964, p< 0.001). Metabolic syndrome subjects had lower serum osteocalcin levels. Greater the number of risk factors present, the lower was the osteocalcin level. The strongest positive association was found between osteocalcin and HDL. Osteocalcin was negatively associated with HOMA, FBS, BMI and triglyceride. Conclusions: These findings suggest that osteocalcin may have an essential role in modulating glucose and energy metabolism and in the pathophysiology of metabolic syndrome. Further studies may determine the utility of osteocalcin for cardiovascular risk prediction and strategies to increase osteocalcin levels, thus efficiently optimizing glucose, lipid and energy utilization.

466-468

Authors: Vijatha Thomas, Arun T. Mithrason, Santhi Silambanan

Blood transfusions save lives and improve health. The general impact of blood donation on iron status has been studied since the late 1970’s. Iron deficiency anemia is a common finding in regular blood donors. According to current guidelines hemoglobin (Hb) is used to screen donors in blood bank. Hb measurement alone may not detect donors with iron-deficiency, thus accepting many donors with depleted iron stores, but normal Hb values. In this study we have assessed the iron status of regular male blood donors. 240 male donors were included in this study and were divided into two groups depending on number of donation. Group A consisted of 110 first time donors and group B consisted of 130 regular donors, who had donated more than three times in past 2 yrs. Serum ferritin, iron, total iron binding capacity (TIBC), transferrin saturation and complete blood count (CBC) was done in all the donors. The mean serum ferritin level in group B (57.6±37.5ng/ml) was significantly lower compared to group A blood donors (75.5±50.8ng/ml). 4.5% of donors in group B and 2.3% of donors in group A had reduced serum iron. Thus Hb estimation alone will not detect iron-deficiency in regular male donors. Serum ferritin and serum iron should be done in all blood donors to ensure donor safety.

472-476

Authors: Vinod V Wali, Smita S. Patil

Diabetes, specifically type 2 diabetes mellitus (T2DM), is one of the most challenging health problems in the 21st century. The cause of higher prevalence of coronary artery disease (CAD) in T2DM is multifactorial. Increased concentrations of acute phase proteins particularly high sensitive high reactive protein (hsCRP) have been reported in patients with T2DM. Aim: To know the association of hsCRP with other risk factors for CAD in T2DM. Materials and Methods: This was a case control study conducted at tertiary care hospital in South India from May 2014 to May 2015. 100 patients (69 males and 31 females) aged between 30-60 years of either sex with type 2 diabetes mellitus and diagnosed for coronary artery disease (clinically and by ECG findings) were selected as cases. 100 controls (64 males and 36 females) without T2DM were chosen. Student ‘t’ test used to test the significance, between cases and controls and P values of <0.05 were considered as statistically significant, P values of <0.01 was considered highly significant. Correlation coefficients (r values) were used to study the association of hsCRP with various risk factors. Results: There was statistically significant difference between the parameters such as BMI, waist circumference, waist hip ratio and family history of CAD and T2DM (P<0.05). Triglycerides and LDL levels were highly significant (P<0.01). Serum hsCRP shows strong positive association with serum total cholesterol, triglycerides and LDL, negative correlation with HDL level. Maximum cases had serum hsCRP levels of more than 3 mg/l. Conclusion: The present study shows that hsCRP levels are increased in CAD patients with T2DM, even with a relatively short disease duration of 2 years. There was a positive correlation of serum hsCRP with other cardiovascular risk factors like BMI, blood glucose and lipid parameters which was highly significant.

482-486

Authors: Rana Usmani, Bharat Kumar Gupta, Jaskiran Kaur

Metabolic Syndrome (MetS) is cluster of physical conditions and metabolic abnormalities commonly found in association with increased risk for development of type-2 diabetes mellitus (T2DM), cardiovascular disease (CVD) and other medical conditions.1 Definition proposed by the International Diabetes Federation (IDF) 20052 is the most recent; according to which, a person is identified as having the MetS if he/she has central obesity (defined with ethnicity specific values) plus any two of the following: raised triglycerides; reduced HDL cholesterol; raised blood pressure; or raised fasting plasma glucose (Table 1 & 2). The IDF, having recognized the difficulties in identifying unified criteria for MetS that were applicable across all the ethnicities, has proposed a new set of criteria with ethnic/racial specific cut-offs.3 Worldwide prevalence of MetS ranges from <10% to as much as 84%. Higher socioeconomic status, sedentary lifestyle and high Basal Metabolic Index (BMI) were significantly associated with MetS. Furthermore, the prevalence is 1.5–2 times higher in women compared to men. C-peptide is composed of 31 amino acids, released -cells during cleavage of insulin from proinsulin, which is a single polypeptide chain of 86 amino acids and has three “C_C” cystine bonds, stored in secretory granules, and eventually released into the bloodstream in amounts equimolar with those of insulin. It is mainly excreted by the kidney, and its half-life is 3-4 times longer than that of insulin. It has an essential function in the synthesis of insulin in that it links the A and B chains in a manner that allows correct folding and “C_C” disulfide bond formation.4

262-266

Authors: Arun Kumar, Vishal Kalasker, K. Pratibha, K. Srinivas Rao, Harish Bhat

Introduction: Acute ischemic stroke (AIS) is one of the leading cause of death worldwide and the main causes of long-term disability. Brain CT shows no abnormality in the early event of AIS and the infarct may not be seen reliably for 24-48 hours. Oxidative stress is proposed as a fundamental mechanism of brain damage in ischemic stroke. Earlier it was reported that free radicals alters the N-terminus of the albumin which decreases its binding capacity for metals and is termed as Ischemia Modified Albumin (IMA). Recently it was found that IMA is increased in cerebrovascular diseases and may serve as biomarker for early identification of acute stroke. There is little information regarding the use of IMA for the prognosis of AIS. There is growing evidence of the importance of high sensitive C-reactive protein (hs-CRP) in Acute Ischemic Stroke. Therefore, the current study aims to determine the prognostic evaluation of time course of serum level of IMA and hs-CRP in Acute ischemic Stroke patients. Material and Method: 56 AIS patients diagnosed (clinically/ radiologically) of either sex and >18 years of age were taken as cases. 56 age and sex matched healthy subjects were taken as controls. Serum IMA levels were estimated by spectrophotometric method and hs-CRP levels were estimated by Auto-analyzer. Results: There was a significant increase in IMA levels in AIS patients at the time of admission (488.82±24.84) and on 3rd day (397.17±32.44) when compared to control (324.27±36.45) group. It was found to be statistically significant (P < 0.001). There was a significant increase in Hs-CRP levels in AIS patients at the time of admission (9.55±1.63) than in control (0.95±0.40) group. It was found to be statistically significant (P < 0.001). Conclusion: Estimation of serum IMA in AIS patients has both diagnostic and prognostic application. Routine hs-CRP measurement will be a useful tool for identifying AIS patients, in order to plan aggressive diagnostic protocols and prevention therapies. Diagnosis of AIS can be made very early then the available routine investigation & the cost of the test is less, can be used in Primary health care & remote places where CT & MRI are far from their reach.

272-276

Authors: Dhanunjay Kalvakuri, Srinivasa Rao K, Manjunath G.A

Objective: This study is to evaluate significance of serum ferritin in differentiating between different hematological conditions. Methods: This is a prospective study conducted on children aged between 1 to 12 years attending Pediatric OP and IP of Navodaya Medical College, Raichur for period of one year. 200 children who fulfilled WHO criteria for anemia were taken as cases and 200 normal healthy children of same demographic data were taken as controls. Serum ferritin levels were compared between the normal healthy children and children with different types of anemias. Results: The mean value of serum ferritin in normal controls (106.8 ± 38.0ng/ml), in IDA (5.1 ± 2.3ng/ml), in Dimorphic anemia (330±40ng/ml), in Sickle cell anemia (430±83ng/ml), in Thalassemia major (1520±230 ng/ml), and in leukemias (1550±140ng/ml) Conclusion: Serum ferritin is moderately raised in dimorphic anemia, in Sickle cell anemia, Thalassemia and leukemias it is significantly raised. And we found that serum ferritin is the most sensitive and reliable parameter compared to other parameters in iron profile in evaluating both iron deficient and iron overload conditions.

280-284

Authors: Anita M Raut, D.V. Andure, Dilip Mhaisekar, Smita Mhaisekar, R.K. Padalkar

Introduction: The primary abnormality in respiratory acidosis is retention of CO2 (increased H2CO3) due to impaired alveolar ventilation resulting in a rise in pCO2 causing acidemia. However, respiratory alkalosis occurs when there is decrease in H2CO3 concentration. A fall in pCO2, reduces the ratio of carbonic acid to bicarbonate resulting in alkalemia. Aim: To study variations in biochemical parameters in respect to respiratory acidosis and alkalosis. Material and Methods: The biochemical parameters of respiratory acidosis and alkalosis like blood pH, concentration of CO2, pO2, pCO2, level of HCO3 - . Results: The studied components of respiratory acidosis and alkalosis were found to be highly significant in chronic conditions of respiratory acidosis and alkalosis (p<0.01) than acute condition of respiratory failure when compared with the healthy controls. Conclusion: In this study, we observed that there is marked increase in product of metabolism in acute and chronic phase of respiratory syndrome when compared with the healthy controls.

292-294

Authors: Laxman Siddha, Ghanshyam Singh Sengar, Sikha Khandelwal, Niranjan Nagaraj, Pramod Kumar Berwal

Background: various researchers have shown association of celiac disease with altered lipid profile. We studied serum cholesterol levels in patient with celiac disease and effect of gluten free diet on it. This study aims to compare the serum cholesterol levels in celiac disease patient with general population and to study effect of gluten free diet on serum cholesterol in them. Methods: 50 children with celiac disease (either newly diagnosed or having poor dietary compliance for gluten free diet) and 50 healthy children were enrolled. Their serum cholesterol levels were collected and compared. After 6 months of strict gluten free diet, serum cholesterol levels for celiac patients were measured and compared with the previous levels. Result: mean serum cholesterol in patients with celiac disease was significantly lower (16.78%) than the healthy children (p<0.001). Boys with celiac disease had 13.07% and girls with celiac disease had 21.34 % lower mean serum cholesterol when compared to their healthy peers. The difference between both sexes was significant. After 6 months of strict gluten free diet, celiac patients showed 22.87% increase in their serum cholesterol. Boys had 15.03% and girls had 24.81% increase in their serum cholesterol. These levels were significantly higher than those measured at the start of therapy and comparable to their healthy peers. Conclusion: hypocholesterolemia is significantly associated with celiac disease. Gluten free diet significantly increases serum cholesterol levels in the range comparable to healthy population. The serum cholesterol levels were not found to be abnormally high suggesting that gluten free diet should not adversely affect cardiovascular health in long term.

299-303

Authors: Sangappa Virupaxappa Kashinakunti, Pampareddy B. Kollur, Manjula Rangappa, Gurupadappa Shantappa Kal

Background: Serum gamma glutamyl transferase (GGT) which is a simple and reliable marker of liver fat deposition leads to hepatic insulin resistance and long term hepatic insulin resistance may lead to type 2diabetes mellitus (DM). In this context, the present study was under taken to study the serum GGT levels and its possible associations with serum triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), very low density lipoprotein cholesterol (VLDL-C) and high density lipoprotein cholesterol (HDL-D) in type 2 DM. Material and methods: The study was conducted at HSK hospital, Bagalkot from Jan 2016 to Jun 2016. The diagnosis of DM was based on WHO criteria. Sixty subjects participated in each group (DM and Controls). Fasting sample was collected and fasting blood sugar (FBS), HbA1c, urea, creatinine, GGT, and lipid parameters were estimated. Data was analysed using SPSS software. Student’s t test and Pearson correlation was applied for quantitative data. Results: The serum levels of FBS, PPBS, HbA1c, creatinine, urea, TG and VLDL were raised significantly in cases compared to controls, whereas serum HDL was significantly decreased in cases compared to controls (p=0.000). There was statistically significant (p=0.001) positive correlation between the TGL and GGT. HDL-C was significantly, negatively correlated with GGT. Conclusion: There was positive correlation between GGT and TG, TC, LDL-C and VLDL-C, only TGL was significant, and there was significant negative correlation between HDL and GGT. Hence serum GGT can be used as marker of cardiovascular diseases in type 2 DM patients.

308-311

Authors: Shimi Mahesh Sundharan, Kavita Anil Dipnaik, Pramod Waman Ingale, Sudarshan Nandkumar Shelke, Pooja

Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder affecting women of reproductive age group with a worldwide prevalence of about 4 to12%1,2 . PCOS is seen in up to 25% of the Caucasians and 50% of the South Asian women respectively3,4 . It is a heterogeneous disorder of unknown aetiology with a strong genetic element5 . PCOS does not exclusively involve the reproductive apparatus; it has a complex number of systemic relevancy symptoms. It leads to Metabolic Syndrome with severe consequences on the cardiovascular system6 . The precise cardiovascular disease (CVD) risk in women with PCOS remains unclear because there are no longitudinal studies pertaining to cardiovascular events. There is a paucity of data in regard to cardiovascular event rates and mortality in PCOS hence the present study was aimed to assess cardiovascular disease risk in women with PCOS. Aim: To evaluate cardiovascular disease risk in women with Polycystic ovary syndrome. Materials and Methods: 50 diagnosed cases of PCOS and 50 age matched healthy females were included in this study. Cases were diagnosed based on new Rotterdam criteria formulated by the American Society for Reproductive Medicine (ASRM) and the European Society for Human Reproduction and Embryology (ESHRE). Blood samples were collected after overnight fasting. Serum High sensitivity-C Reactive Protein (hs-CRP), Total Cholesterol(TC), Triglycerides(TG), HDL Cholesterol(HDL-C), VLDL Cholesterol(VLDL-C), LDL Cholesterol (LDL-C) were estimated. Body Mass Index (BMI) was calculated for women in both the groups. Statistical analysis: Results were analyzed using unpaired t-test and p-value was calculated. BMI was correlated with hs-CRP using one way ANOVA test. Statistically non-significant increased levels of serum total cholesterol, Triglycerides, HDL cholesterol, LDL cholesterol, VLDL cholesterol and hs-CRP in PCOS cases as compared with control were observed. BMI was found to be significantly increased in cases as compared to control. Conclusion: hs-CRP is a known cardiovascular risk marker. In this study though hs-CRP was increased in the case group compared to controls but it was not statistically significant. hs-CRP levels vary with age, sex and BMI. Therefore, age, sex and BMI should be considered when interpreting hs-CRP. Women with PCOS who participated in our study were quite young (15- 35years) and majority of them had a normal BMI and this may be the reason for a relatively smaller risk of CVD compared with other studies

316-319

Authors: Anurag Yadav, Arun Kumar K, James Gonsalves, Avinash SS, Sudarshan Surendran

Ischemia modified albumin (IMA), a recently developed marker for myocardial ischemia is measured by using albumin cobalt binding (ACB) assay. The correlation between the formation of IMA and alterations in the pH levels are of considerable importance and the same was not clear in the available literature. Based on our literature search, the study was designed to check and compare the levels of IMA and the pH in acidosis and alkalosis patients with those in normal patients. The mean of IMA in patient with acidosis (0.832±0.16) was higher when compared with the normal pH patients (mean 0.71±0.21). The IMA levels in patients of alkalosis were also found higher (mean 0.804±0.19) compared to that of the normal control. It was also observed that the mean of IMA was lower in the patients with alkalosis than the patients with acidosis. When the IMA levels and the pH levels in acidosis and alkalosis patients were correlated, there was a weak negative correlation between pH levels in acidosis and IMA levels. In alkalosis, the correlation was positive but there was no significance in these changes. In conditions of acidosis and alkalosis, where the pH levels are altered which could be one of the factors responsible for increase in the IMA levels. However, the correlation was weak and an increase in the sample size could provide us with a better relation between the levels of pH and IMA

325-329

Authors: Nagalakshmi CS, Ganashree CP, Krishnamurthy N, Chethana Chethan, Shilpashree MK

Background & Objectives: Psychosomatic disturbances faced by women approaching their fifth decade have been a matter of concern since many years. Many approaches have been tried to help them, including nutritional, pharmacologic and hormone replacement therapies. However, the importance of regular yoga practice is not much debated though it is believed to improve blood glucose levels & serum lipid concentrations and also to combat oxidative stress. The current study was designed to broadly analyze the clinico-biochemical challenges encountered by such women and to suggest better measures to face them. Methods: A total of 90 women aged around 40-60 years were grouped into perimenopausal, postmenopausal and healthy control groups and were checked for anthoropometric and biochemical parameters like FBS, HbA1c, lipid profile, calcium, magnesium, copper, ceruloplasmin, TSH, uric acid, alkaline phosphatase (ALP) and total proteins. Results: Age of the subjects, their BMI, blood pressure and waist hip ratio (WHR) together with levels of glycated Hb, LDL cholesterol, TGs, calcium, magnesium, copper, ceruloplasmin and uric acid levels exhibited significant variation among the groups. Conclusions: Several psychosomatic changes encountered in and around menopause and few biochemical changes can be better handled by persistent yoga practice, either alone or in combination with conventional treatment, as it can effectively bring down the oxidative stress levels, chances of developing metabolic syndrome, risk of CVD events and improve the quality of life in such women

335-339

Authors: Suchitra Kumari, Ipsita Dash, Manaswini Mangaraj

Introduction: Decompensated diabetes mellitus with impaired renal function, acid-base disorders are often associated with electrolyte imbalance. Analysis of electrolytes is often advised without a true indication in Diabetes Mellitus. So our objective was to analyze serum electrolyte profile in diabetes mellitus to determine whether routine measurement of electrolytes can be safely avoided in diabetes. Study Design: This was a retrospective study of hospital records of all Diabetes Mellitus cases who were advised kidney function test during the period January 2014 - August 2015. Medical records and laboratory results of 190 Diabetes Mellitus cases could be retrieved and retrospectively viewed for clinical diagnosis, result of Laboratory investigation i.e. Fasting blood sugar, serum urea, creatinine, Na+ , K+ , Cl- , Ca2+, PO4- .One hundred ninety Diabetes Mellitus cases were divided into 3 groups based on their serum creatinine levels i.e. Group-I (n=98) serum creatinine <1.5 mg/dl, Group-II (n=74) serum creatinine 1.5-3 mg/dl and Group- III (n=18) serum creatinine >3 mg/dl. Results: Out of 190 patients 114 had electrolyte disorder. Serum sodium levels were altered in 45% of Group-I patients, more evident in Group-II (64%) and Group III (89%). Approximately 51% Diabetes Mellitus cases had deranged Serum K+ levels in Group I. Hyperkalemia and hypochloremia were common electrolyte disorders both in Group-II and Group III. Group- I had hypercalcemia and hyperphosphatemia whereas hypocalcemia and hypophosphatemia were more commonly registered in GroupII (40%, 37% respectively) and Group-III (68%, 61% respectively). Conclusion: So it is concluded that in diabetes mellitus electrolyte derangements occur even with normal renal function. So routine measurement of serum electrolyte could not be avoided in Diabetes Mellitus. However, the frequency of electrolyte derangement is more with deterioration of the renal function in Diabetes Mellitus.

343-347

Authors: Vikas Kumar Gupta, Prashant Nigam, S.K.B. Patil

Background: Thyroid diseases are common worldwide. In India too, there is a significant burden of thyroid diseases. According to a projection from various studies on thyroid disease, it has been estimated that about 42 million people in India suffer from thyroid diseases. Thyroid dysfunction has varied impact on pregnancy outcome. Thyroid disorders are amongst the most common endocrine diseases in India. The prevalence and pattern of thyroid disorders depends on sex, age, ethnic and geographical factors and especially on iodine intake. A high iodine intake is associated with lower prevalence of goitre and higher prevalence of hypothyroidism. This study was designed to address this question. We undertook this study to provide reference data for TSH, T4 and T3 in women of this region and evaluate their status of thyroid function. Material and Methods: The study was carried out at Department of Biochemistry, Chhattishgarh Institute of medical sciences, Bilaspur (C.G.). The study was conducted on 1100 subjects of age group 15- 65. The thyrotropin, TSH levels of serum samples were analysed using kits (Diagnostic Product Corporation (DPC), LosAngeles, USA) on the I25 GAMA Counter. Serum T3 and T4 were performed using competitive RIA technique and serum TSH was performed using IRMA technique. Result and Discussion: Of the 1100 total subjects in the age range 15–65 years, 24.1% had thyroid dysfunction and 75.9% were euthyroid. The prevalence of thyroid dysfunction in group I, 19% hypothyroid, 5% hyperthyroidism 75.9% euthyroid and in group II, 16% hypothyroidism, 4% hyperthyroid and 79.5 were euthyroid. The finding that a large number of women unknowingly have laboratory evidence of thyroid dysfunction supports the usefulness of screening for early detection. We hope to extend the study to a larger cross section of men and women in this region keeping in mind environmental and etiopathological factors like auto immunity, drugs, Iodine and non-thyroidal illness.

139-144

Authors: Addanki Yohoshuva, Bari Siddique M A

An estimated 40% of patients diagnosed with Type I diabetes and 5 - 15% of patients with Type II diabetes eventually develop ESRD and diabetes has become the leading cause (44%) of end-stage renal disease in India. There is substantial evidence that early treatment will delay or prevent the onset of diabetic nephropathy, or diabetic kidney disease. In its earliest stage Diabetic nephropathy manifests with low levels of albumin (microalbuminuria) in the urine. This often is referred to as incipient nephropathy. With the progress of disease, urine albumin levels will increase until overt nephropathy (defined as more than 300 mg per 24 hours or more than 200 mcg per minute). The present hospital based observational descriptive study was conducted in Siddhartha Medical College, Vijayawada and Bhaskar Medical College & General Hospital, Moinabad from June 2014 to February 2016. 94 type I diabetes patients on Insulin therapy for 5 years as subjects along with 30 normal people as controls were enrolled in the study. T1D-Overt exhibit significantly increased FENa compared with T1D-Incipient, T1D-normal and Control subjects. Our study illustrates the importance of tubule-glomerular feedback as a major pathway of renal sodium handling in T1D-Overt as well as the important role of ambient glucose levels in kidney functioning. Future studies should determine the clinical role of blocking proximal tubular sodium reabsorption with SGLT2 inhibitors, because these agents have the potential to reduce hyper filtration and blood pressure predominantly in T1D-H, thereby protecting against the initiation and progression of diabetic nephropathy. Early identification of incipient nephropathy in Type I Diabetics with FENa may substantially assist in the early management and prevention of delaying end stage renal disease in Diabetics thus reducing morbidity.

150-153

Authors: Liggy Andrew, Nikunj Patel

Background: Preeclampsia is one of the common conditions of unknown etiology which increases the risk of maternal and perinatal morbidity and mortality. According to some studies, serum uric acid lacks sensitivity and specificity as a diagnostic tool whereas another group of the researchers indicated uricemia as a predictor of preeclampsia in pregnant ladies. Objective: The present study was designed to assess whether serum uric acid can be used as a biochemical indicator or not, in pregnancy induced hypertensive (PIH) patients. Study period & Method: Total number of 98 PIH patients admitted in GMERS Medical College, Dharpur, from Dec 2013 to Feb 2015 were included in this study and 60 normal healthy pregnant ladies served as control. Serum uric acid levels were estimated using modified Trinder's test. Results: Out of the 98 cases mild preeclamspsia was 60(61.2±%), severe Preeclampsia 24 (24.5%) and eclampsia 14(14.3%). Serum Uric acid levels significantly increased with the severity of PIH, normal pregnant women (4.58±0.37), mild preeclampsia (5.32+0.40), severe preeclampsia (6.29±0.57) and eclamspsia (7.88±1.26). Out of these women with uric acid levels more than 5.5mg/dl was seen in 28(46.6%) mild preeclampsia, 19(79.2%) severe preeclampsia and 12 (85.7%) eclampsia. Maternal mortality was observed in 05(5.1%)PIH cases and out this 04(80) had uric acid level > 5.5mg/dl. Perinatal mortality was observed in 25 (25.1%) cases, out of these 19(76%) were stillbirths and 06(24%) were neonatal deaths. Out of the 25 perinatal deaths 18(72%) had uric acid level >5.5mg/dl. Conclusion: Serum uric acid level could be used as a biochemical indicator of preeclampsia/eclampsia and its complications.

159-161

Authors: Mohammed Sabiullah, Naazia Arifuddin, Jyotchna Devi Bade, Babu Rao R., Mohammed Abdullah Saad, Sadha

Introduction: Hypoalbuminemia is a common and vexing problem in hospitalized individuals. Serum albumin levels fall, often dramatically from early in the course of critical illness and will not increase again until the recovery phase of the illness. Increased risk of morbidity and mortality are correlated with lower serum albumin levels. Objective: This study was done to find out the prevalence of hypoalbuminemia in hospitalized patients. Materials and Methods: The study was a retrospective observational study which was carried out on 1071 patients. Serum total protein and serum albumin were measured. Results: 165 patients had hypoalbuminemia which accounts for a prevalence of 15%. Patients from burns ward accounted for 44.8%, those from medical wards accounted for 34.5% and from surgical wards for 20.1%. Mean±S.D of serum albumin was 2.5±0.42 g/dl in both burn and medical wards patients and 2.4±0.38 g/dl for those admitted in surgical wards. Conclusion: Hypoalbuminemia results from decreased production, defective synthesis, deficient intake or increased losses of albumin. Measuring serum albumin concentration can serve as a prognostic marker for predicting morbidity and mortality. The prevalence of hypoalbuminemia was high in patients admitted in burns ward in our study.

169-171

Authors: Pankaj R Kambale, Deepa Haldar, B.C. Kabi, Kalpana P. Kambale

Background: Prostate cancer is the second most common cancer among men worldwide contributing to three fourth of the registered cases across the globe. Although it is more common in western countries, its incidence is rising in India due to demographic and epidemiological transitions. Some epidemiological studies have suggested that vitamin D has anticancer properties. But the data on vitamin D deficiency and prostate cancer is inconsistent, particularly in Indian population. Materials and Methods: In this case control study, we compared Vitamin D levels in 120 subjects with prostate cancer with those of 120 age-matched healthy controls. 25(OH) vitamin D levels in were estimated by ELISA. Data was collected and analysed by suitable statistical methods. Result: Levels of 25 (OH) vitamin D were 11.7±1.06 ng/ml in cases as compared to 24.3±1.54 ng/ml in controls (p value <0.0001) Conclusion: There is a strong inverse association between 25(OH) vitamin D serum levels and prostate cancer risk. Keywords: vitamin D, prostate cancer, vitamin D receptor.

177-180

Authors: Vinod V Wali, Smita S Patil

Background: The prevalence of type 2 DM is increasing worldwide, more so in South Asian population due to various factors like, high degree of genetic predisposition and high susceptibility to environmental factor, characterized by a high BMI, high upper body adiposity, a high body fat percentage and a high level of insulin resistance. The dyslipidemia in type 2 DM is different than in non-diabetics, as it has been proposed that composition of lipid particles in diabetic dyslipidemia is more atherogenic than other types of dyslipidemia. Aim: To compare post prandial lipid levels with fasting lipid levels in type 2 diabetes mellitus. Materials and Methods: This was a prospective study conducted in a tertiary care hospital in South India from March 2011 to March 2012. The study was approved by the institutional ethics committee. Informed consent was taken from all the included subjects. Blood was drawn from the subjects after 12 hours fasting and 6 hours after meals with staple food for two days. Estimation of lipid profile was done using enzymatic method. The significance of the difference between the groups was assessed by unpaired Student’s t-test or Mann Whitney U tests, between cases and controls and P values of <0.05 were considered as statistically significant. Results: The lipid profile (both fasting and post prandial) was significantly altered in individuals with type 2 diabetes when compared with controls. The postprandial lipid parameters were significantly increased in the type 2 DM subjects as compared to the fasting lipid parameters and the postprandial HDL level was significantly decreased as compared to the fasting HDL level. Conclusion: It is important to include postprandial lipid profile, in addition to the fasting lipid profile, which helps in better cardiovascular risk assessment in type 2 diabetes mellitus. Appropriate lifestyle changes, such as weight reduction and increased physical activity should be the first step followed by medication with lipid lowering drugs in controlling dyslipidemia in type 2 diabetes mellitus.

186-189

Authors: Narendra S. Dange, Abhay N. Nagdeote, Rajeshree A. Nandanwar

Background: Liver enzymes AST, ALT, GGT (Gamma Glutamyl Transferase), ALP levels in serum was measured in Chronic alcoholics and acute viral hepatitis and controls. Analysis was done to find out the significance of liver associated enzyme levels among the chronic alcoholics and viral hepatitis. Materials and Methods: Fifty one chronic male alcoholics aged between 30-60 years and thirty six patients with viral hepatitis who were admitted to the medicine ward at Govt. Medical College, Jagdalpur, Chhattisgarh during March 2014 to December, were the subjects. Forty eight age-matched, normal, healthy controls were also included in the study. GGT, ALT, AST and ALP were assayed in the clinical biochemistry laboratory using auto analyser by kit method (By Accurex Co. kinetic method). Results: Chronic alcoholics (n=51) subjects show increased serum levels of GGT (185.42±58.32), ALT (83.43±32.48), AST (139.29±64.34), ALP (173.42±31.62),(p values < 0.05) as compared to controls which was statistically significant. In Acute Viral hepatitis (n=36), all enzymes levels were statistically increased significant as compared to controls. But the levels of GGT (108.47±31.54) & ALT (293.43±54.62) (p value < 0.01) were more significant in viral hepatitis as compared to controls and chronic alcoholics. Ratio of AST/ALT was significantly increased (1.66, p value < 0.05) as compared to controls (0.92). But the ratio of AST/ALT was more significantly decreased (0.49, p value < 0.01) in acute viral hepatitis as compared to chronic alcoholics. Conclusion: Serum GGT and the ratio of AST/ALT increased much more in chronic alcoholics than viral hepatitis. ALT level increased much more significantly in viral hepatitis, while the ratio of AST/ALT more significantly decreased.

194-200

Authors: Padmanabhan P, Hotkar KN, Nagarkar VD, Jangle SN

Background & Objectives: Neonatal jaundice causes yellow discoloration of the skin and sclera of the infants, caused by the accumulation of bilirubin in the skin and the mucous membrane. Before discharge the newborn should be examined, monitored and risk due to high bilirubin which maybe genetic be identified to prevent brain damage. Neonatal bilirubin was measured using micro slide technology, whereas Diazo method by Wet chemistry was utilized on the Erba analyzer. Methods: Neonatal bilirubin (N-Bil) was measured using micro slide technology on Vitros 250 (Ortho Clinical Diagnostics USA) Dry Chemistry analyzer. Wet technology was measured using wet technology based on diazo principle by a kit performed on Erba analyzer. Results: Direct Bilirubin showed significantly higher values than conjugated bilirubin (Bc) values and shows poor correlation. Cross reaction may occur between Direct bilirubin and Bc which is clinically misleading. Conclusion: Neonatal bilirubin (N-Bil) is better parameter than total bilirubin (T Bil) in assessing neonatal jaundice in newborns. The slide provides bichromatic accurate readings of unconjugated bilirubin (Bu) at 460nm and conjugated bilirubin (Bc) 420 nm without photometric interference from hemoglobin and albumin. Diazo method is the most widely used method for bilirubin estimation till date. The Kodak Ektachem (Eastman Kodak company Rochester NY 14650) dry –slide method directly estimates unconjugated(Bu) and conjugated bilirubin (Bc) by a rapid automated method developed in the 1980’s.Bc concentrations are a marker of variety of infections, metabolic or liver conditions.

208-213

Authors: Dipti Basavraj Sanakal, Sagar Chandrakant Mhetre, Shailaja Katti

Background & Objectives: Diabetes mellitus is one of the most common endocrine disorders affecting about 6% of the world’s population. Diabetes mellitus is the leading cause of end stage renal disease (ESRD), a major cause of non-traumatic amputations, responsible for preventable blindness and a leading cause of cardiovascular mortality. Hyperglycemia and dyslipidemia play an important role in the development of microvascular and macrovascular complications, leading to significant impact on the quality of life. The objective of the study was to assess the glycemic control by estimation of glycosylated hemoglobin (HbA1c), and lipid profile in patients of Diabetes mellitus without complications and in Diabetes mellitus with complications like neuropathy, retinopathy and nephropathy and compare with controls. Methods: The present study comprised of 100 clinically diagnosed and confirmed cases of type 2 Diabetes mellitus attending and admitted in Navodaya Medical College Hospital and Research centre, Raichur. The subjects were grouped as follows Age and Sex matched controls - 25 Group A. Diabetes mellitus without complications - 25 Group B. Diabetes mellitus with retinopathy - 25 Group C. Diabetes mellitus with nephropathy - 25 Group D. Diabetes mellitus with peripheral neuropathy - 25 Glycosylated hemoglobin (HbA1c), Total Cholesterol, Triglycerides and HDL-Cholesterol were estimated in all groups. LDL-Cholesterol and VLDL-Cholesterol were calculated in all groups by using Friedewald’s formula. Results: Our study showed that HbA1c levels were significantly higher (p<0.01) in all groups of patients as compared to controls. The increase in Serum Cholesterol, Triglyceride, LDL-Cholesterol, VLDL-Cholesterol and decrease in HDL-Cholesterol levels were statistically significant (p<0.01) in Diabetic retinopathy group and Diabetic nephropathy group as compared to controls, whereas in Diabetic neuropathy group and in Diabetes mellitus without complication, the increase in Serum Cholesterol, Triglyceride, LDL-Cholesterol, VLDL-Cholesterol and decrease in HDL-Cholesterol levels was not statistically significant as compared to controls. Conclusion: Impaired insulin secretion or insulin resistance impairs glucose utilization by the insulin sensitive tissue which in turn increases hepatic output of glucose, contributing to hyperglycemia. Hyperglycemia leads to diverse cellular and organ dysfunction. Dyslipidemia acts synergistically with hyperglycemia in the development of Diabetes mellitus associated complications. Our study revealed that poor glycemic control and dyslipidemia are associated with Diabetic complications like neuropathy, retinopathy and nephropathy. Estimation of glycosylated hemoglobin and lipid profile helps in predicting the development of microvascular complications. Therefore intensive glycemic control and aggressive treatment of dyslipidemia can help in reducing Diabetes mellitus associated complications.

227-230

Authors: Amrut A Dambal, D. Sridevi, Samata K. Padaki, Shilpa HD, Sangappa V Kashinakunti, Gurupadappa Kallag

Introduction: Acute Myocardial Infarction, the most important form of Cardio Vascular Disease (CVD) continues to be the leading cause of death in the industrialized countries. Increased serum uric acid levels are observed in patients with Myocardial Infarction. Serum Uric acid levels reflect the xanthine oxidase activity and increased levels are associated with reduced production of nitric oxide and endothelial dysfunction. So the present study was taken up to assess the variation in the levels of serum Uric Acid and to correlate them with CK-MB in patients with MI. Materials and Methods: This study was taken up on 50 subjects with Myocardial Infarction and 50 apparently normal healthy subjects. Venous blood sample was collected from all the subjects. Serum CK-MB and uric acid were estimated in cases and serum uric acid in controls. Unpaired t test and Pearson’s correlation coefficient were employed to analyze the results. Results: The mean ± SD of serum uric acid among cases and controls were 7.10 ± 0.9 and 5.62 ± 0.58 respectively displaying a highly significant statistical difference (p<0.001). The mean CK-MB among the cases was 48.2 ± 3.4 IU/ L. Serum uric acid showed positive correlation with CK-MB in subjects with Myocardial Infarction with ‘r’ and ‘p’ value being +0.38 and 0.007 respectively. Conclusion: This study concludes that serum uric acid levels were high and had a positive correlation with CK-MB in patients with Myocardial Infarction.

236-239

Authors: D. Sridevi, Amrut A Dambal, Sidrah, Anila Sushma Challa, Samata K. Padaki

Introduction: Hypothyroidism, the commonest form of hormonal dysfunction, is due to thyroid hormone deficiency or its impaired activity. Various electrolyte disturbances in association with hypothyroidism were observed in many studies. The role of thyroid hormones on mineral metabolism is not well understood and the underlying mechanism too. The present study was undertaken to assess and analyze the alterations in the levels of serum calcium, magnesium and phosphorous and their relation with T3, T4 and TSH in hypothyroid state. Materials and Methods: A case control study was taken up on 40 normal healthy subjects and 40 subjects with thyroid hormone deficiency. Blood sample for analysis was collected from all the subjects. Serum T3, T4, TSH, magnesium, calcium and phosphorous were estimated in all the subjects. Results: A significant hypocalcemia was observed among cases compared to controls (p<0.0001).Serum phosphorous (p<0.0001) and magnesium(p<0.0001) were significantly increased among cases compared to controls. Conclusion: The present study indicated significant effect of thyroid hormones on these minerals. This study concludes that serum phosphorous and magnesium levels were high whereas serum calcium level was low in hypothyroidism when compared to normal subjects. A regular follow up of these serum minerals should be done in thyroid hormone deficiency which would be of great help in its management.

245-249

Authors: Sumathi M.E, Ruta Ujjval Joshi, Gomathy E, Shashidhar KN

Introduction: Pre-eclampsia is a multisystem disorder, unique to pregnant women after twenty weeks of gestation. In India the incidence of pre-eclampsia is reported to be 8-10% of the pregnancy. It contributes significantly to maternal and perinatal mortality and morbidity. Among the biochemical markers, uric acid and LDH have been extensively studied in pregnancy induced hypertensive disorders. Very limited studies are available about the role of GGT in preeclampsia. This study intended to know the correlate the biochemical levels of GGT, LDH and Uric acid with the severity of pre-eclampsia. Materials and Methods: 50 pregnant women clinically diagnosed as preeclampsia after 20 weeks of gestation between 18-35 yrs of age group. Preeclampsia is diagnosed based on the American College of Obstetrics and Gynecology (ACOG) criteria. Cases were classified into two groups mild preeclampsia (Group II) and severe preeclampsia (group III). 50 Age matched healthy normotensive pregnant women after 20 weeks of gestation enrolled in the study as controls and categorized as Group I. Results: Serum AST, ALT, LDH and uric acid levels were increased in cases compared to controls. Serum LDH is significantly increased in severe pre-eclamptic cases compared to controls. There was no significant correlation observed between GGT with serum LDH and Uric acid. ROC curve indicates that Serum LDH is the better indicator of severity in preeclampsia when compared to serum GGT and uric acid. Conclusion: Serum LDH and uric acid are the better indicators of severity in preeclampsia when compared to serum GGT.

255-258

Authors: Mallikarjuna Swamy, Arati Ganiger, Shankar Prasad DS, Sanjeev Ratna

Background: Type 2 diabetes mellitus (DM) is a disease of impaired carbohydrate metabolism. Vitamin D deiciency and diabetes mellitus are two common conditions and they are widely prevalent across all ages, races, geographical regions, and socioeconomic conditions. The present study aimed to see the effect of 25 hydroxy (OH) vitamin D levels on glycemic control and to show their role in pathogenesis. Materials and Methods: It was a case control study. The study included 100 cases of clinically diagnosed type 2 DM and 100 age and sex matched healthy controls. Venous blood sample was analysed for fasting blood sugar(FBS), post prandial blood sugar (PPBS), serum 25-OH vitamin D and glycosylated hemoglobin(HbA1c) in both cases and controls. Statistical analysis was done using student’t’ test. Pearson's correlation was performed to establish the relationship between study variables. Results: There was decreased levels of serum 25-OH vitamin D levels (p<0.001) in cases as compared to the controls. There was negative correlation between 25-OH vitamin D levels and glycosylated hemoglobin (HbA1c) in cases of type 2 DM. Conclusion: 25-OH Vitamin D levels were lower in patients of type 2 DM as compared to control group. Early detection of vitamin D deficiency and supplementation may help in improvement of glycemic control and prevent complications.

6-10

Authors: Arati Ganiger, K Mallikarjuna Swamy, Shivanand Gundalli, Rutuja Kolekar

Background: Type 2 diabetes mellitus(DM) is a disease of impaired carbohydrate metabolism. The onset of uncontrolled hyperglycemia causes various microvascular complications such as retinopathy and nephropathy. The present study aimed to see the effect of serum magnesium on glycemic control in the presence of retinopathy and to show their role in pathogenesis. Objectives: The study was designed to estimate and compare serum magnesium levels in cases of type 2 diabetes mellitus with and without retinopathy and healthy controls. A correlation of serum magnesium was done with glycosylated hemoglobin in diabetics with retinopathy and without retinopathy. Materials and methods: It was a case control study. The study included 60 cases of clinically diagnosed type 2 DM with retinopathy, 60 cases of type 2 DM without retinopathy and 60 matched healthy controls. Venous blood sample was analysed for fasting blood sugar(FBS), post prandial blood sugar (PPBS), serum magnesium and glycosylated hemoglobin(HbA1c) in both cases and controls. Statistical analysis was done using student 't' test .Pearson's correlation was performed to establish the relationship between study variables. Results: There was significantly decreased levels of serum magnesium (p<0.001) in cases of retinopathy as compared to the controls. There was highly significant negative correlation between serum magnesium and glycosylated hemoglobin (HbA1c) in cases of DM with retinopathy. Conclusion: The severity of diabetic retinopathy in the study group was influenced by factors such as good glycemic control and hypomagnesemia. These parameters could be used as a supportive diagnostic tool in type 2 DM.

16-22

Authors: Priyanka Chandel, Harish Uraon, Vivek Choudhary

Background: At many centers tumor markers are used to detect disease recurrence and to monitor response to chemotherapy therapy in patients with advanced disease, although the real value of serial observation of marker levels remains disputed. In this study, we evaluated the changes in biochemical and tumor maker (CA 15.3) with respect to Chemotherapy among breast cancer patients. Aim: The present study was aimed to ascertain the changes in biochemical and tumor maker (CA 15.3) with respect to Chemotherapy among breast cancer patients. Material & Methods: 40 breast cancer patients and 10 cancer patient other than breast cancer (control subject) from regional cancer center were studied. All the cancer patients were aged between 27 to 56 years old with BSA and BMI ranged between 1.30-1.98 and 13.06-39.51 respectively. Tumor marker CA 15.3 level was done by ELISA, haematological test was measured by cell counter and biochemical assay was measured by Autoanalyzer. Tumor size was measured before and after chemotherapy. Patients were followed 6 years. Survival at 6 years is 60%. The data were analyzed using SPSS (20.0). Results: The result revealed that as compared to control patients the CA 15.3 maker was statistically significantly higher among breast cancer patients in before as well as in after chemotherapy cycles as well as it accessed the normal range of CA 15.3 (9-36 U/ml). Further, results of Chi-square test revealed statistically significant changes in serum parameters after chemotherapy. Glucose, urea, creatinine, bilirubin (total), bilirubin (direct), ALT (Alanine amino transferase), AST (Aspartate amino transferase), ALP (Alkaline phosphatase) and globulin were found to be significantly increase whereas, CA (15.3), WBC, Hb (haemoglobin), platelets, serum serum sodium, serum potassium, total protein and albumin were found to be significantly decreased, after chemotherapy. 83.3% tumour reduction in case group reported. The 6-year overall survival was 51% in the case group. Overall survival in operated group was 49.4 % and non-operated group was 52.1%. Conclusion: It is concluded that CA (15.3) is specific and sensitive maker for breast cancer. Further, prominent fluctuations in serum parameters due to chemotherapy specify consequent side-effects among breast cancer patients.

28-30

Authors: Ketan K Mangukiya, Mittal Panchal

Background: Majority of biochemical investigations requires pipette for delivery of reagents and samples in clinical laboratory so that pipette that is used for the same must be properly calibrated for accurate results. Aims: The aim of this study to investigate that the impact of automatic pipette calibration on quality control results. Methodology: Total 6 pipettes are used in our study. Among them 3 pipettes are with volume 1.0 ml and another 3 are with volume 0.1 ml, all pipettes were examined for work calibration. Distilled water weighing method is used for calculation of accuracy and precision of pipettes. Control sera of glucose and uric acid is used for determining accuracy and Precision of pipettes. Result & Conclusion: Uncalibrated pipette had high effect on accuracy of control data as well as patients results therefore it is recommended that all pipette that is used in clinical laboratory must be periodically checked for calibration.

36-41

Authors: Netravathi Sajjan, Mohammed Shamsuddin

Background: Type 2 diabetes is a heterogeneous metabolic disease characterised by insulin resistance in peripheral tissue together with impaired insulin secretion. It affects more than 285 million peoples worldwide and estimated that it will affect more than 438 million by the year 2030. It is the leading cause of morbidity and mortality. Magnesium is an important intracellular cation. Hypomagnesaemia is associated with diabetes. Dyslipidemia is seen in Diabetes mellitus. Objectives: To estimate serum magnesium and lipid profile in type 2 diabetes mellitus patients and controls. To correlate serum Magnesium level with lipid profile in type 2 diabetes mellitus patients. Materials & methods: A total of 100 subjects were included, out of which 50 were cases and 50 were controls. Fasting blood sugar (FBS), serum magnesium and lipid profile were measured. Data was statistically analyzed using SPSS 17thversion. Results: There was statistical significant difference of serum Magnesium levels 1.56mg/dI due to hyperglycemia induced osmotic diuresis , Total cholesterol (TC), Triglycerides, Low density lipoprotein(LDL) and High density lipoprotein(HDL) due to increased flux of free fatty acids to liver secondary to insulin resistance was observed in Type 2 diabetes when compared with healthy controls. Significant negative correlation was observed between serum magnesium with Fasting blood glucose, TC, Triglycerides and LDL. Significant positive correlation was observed between serum magnesium and HDL levels. Conclusion: Hypomagnesaemia has role in perturbation of lipid metabolism in diabetics.

45-49

Authors: Niranjan Gopal, Kiriprasad R, Subiman S, Sathish Babu M, Ramesh R, Hanifah M, Prakash H Muddegowda

Background: The use of edible oils depends on the traditional practices, educational and socio-economic status. There is a need to educate people regarding the harmful effects of saturated, trans fatty acids, proper storage and avoiding repeated usage of edible oils. Surveys, screening programmes and health camps organized by doctors and health professionals are needed to impart the knowledge, which helps in decreasing the incidence of metabolic syndrome and related complications. Methods: This interventional study was conducted on 10 rural and 15 semi-urban (n=55) families of Puducherry. A set of pre-validated questionnaire in local language was prepared and interview was conducted with the home makers who were involved in handling cooking oils and its storage. KAP scores were calculated and compared with their blood pressure, FPG, serum lipids, HbA1c and insulin resistance. Later, health education was provided to the family members. After 4 months the same procedure was repeated and data were analysed for statistical significance. Results: The KAP scores, insulin resistance, MDA and serum lipids were significantly improved after four months of intervention (p<0.05). But we did not find significant difference among FPG, HbA1c and blood pressure. Conclusion: Significant improvement was noted in KAP scores, serum lipids, MDA and insulin resistance four months after providing health education for the people residing in rural and semi-urban population of Puducherry.

56-61

Authors: Hamsa M, Raghunath H, Kruthi BN, T Sibi Mandela

Introduction: Cardiovascular diseases are showing an increasing trend in both developing as well as developed countries. Raised triglycerides is considered as an important risk factor of cardio vascular diseases. Collection, storage and transportation of the blood samples from the field becomes a major limiting factor in areas lacking modern laboratory facilities. In such situations, dry blood or serum spots can become an alternative for the estimation of triglyceride. The objectives of our study was to evaluate the use of dry blood or dry serum spot to estimate triglyceride levels as an alternative method to estimate serum triglyceride and also to study the effect of storage time and storage temperature on the triglyceride content in the dry blood and serum spots. Methodology: Blood samples were collected from 100 study participants. Seven spots each of blood and serum from these samples were made on Whatman paper 3. After drying, one dried spot each from blood and serum was analysed on same day. Three of blood and three of serum dried spots were kept at room temperature and remaining at a temperature of 2-8° in separate re-sealable bags which were analysed on days 7, 15 and 30. Triglyceride was measured by Glycerol-3-phosphate oxidase-Peroxidase method. For estimating triglycerides in the eluate, 100 microlitre of the extract from the test-tube was added to 1 ml of the commercially available enzymatic reagent kit and incubated at 37°C for 15 min, and the absorbance was measured at 500 nm using a spectrophotometer. The data collected was analysed by Pearson’s correlation using SPSSv15. Results: Study showed a good correlation between the serum triglyceride values and the dry serum or blood spot triglyceride values. Dried serum spot triglyceride was found to be stable for about 15 days at room temperature and 7 days at 2-8°C with good correlation with serum value. The triglyceride concentration in the dry blood spots remained stable for 7 days at both room temperature and at 2-8°C. Conclusion: Dry blood/serum spots can be used as an alternative to serum for the estimation of triglyceride level which can be used to estimate various biochemical parameters at community level in remote areas which lack modern laboratory facilities.

67-71

Authors: Subrat Kumar Tripathy, Viyatprajna Acharya, Sarthak Ranjan Nayak, Pramila Kumari Mishra

Background: Menopause is a normal occurrence in the life of every woman. As the life expectancy of woman all over the world now increases, a woman has to spend almost 1/3rd of her life in menopause years. Along with the increase in life expectancy the cardiovascular disease is increasing. Objectives: To study the association between oxidative stress and various cardiovascular risk factors in post-menopausal women. Methods: 50 postmenopausal women with cardiovascular risk factors like hyperglycemia, hypertension, high Body Mass Index and Hyperlipidaemia were selected as cases and compared with 50 age matched apparently healthy controls. Malon-di-aldehyde (MDA) was taken as the marker for oxidative stress and vitamin E & vitamin C were taken to assess antioxidant status. Student’s t-test was applied to compare different parameters between the groups and Pearson’s correlation was applied to see the correlation with different parameters in the case group. Results: It was found that MDA values in postmenopausal women with cardiovascular risk factors were significantly higher as compared to the post menopausal women without cardiovascular risk factors (p < 0.001). There is significant decrease in vitamin E and C values in cases (p is < 0.001 and < 0.01 respectively). Comparing the various oxidative markers in cases and control it was found that MDA values have a significant negative correlation with vitamin E and C (r= -0.4 and r= -0.7 respectively). Whereas correlation between changes in Vitamin E and vitamin C was positive but not significant (r= +0.2, p ˃0.05). Conclusion: Antioxidant medication and other measures can be adopted to reduce oxidative stress in post menopausal women with cardiovascular risk factors and reduce the morbidity and mortality associated with cardiovascular disease.

76-81

Authors: Arati Ganiger, K Mallikarjuna Swamy, Shankar Prasad DS, Neela B Mannangi, Shivanand Gundalli

Background: Diabetes Mellitus (DM) is a global public health problem. It is associated with increased level of free radicals which lead to oxidative stress and dangerous complications like retinopathy. Trace elements have specific role in progress to complications of DM. Objectives: The study was designed to estimate and compare the levels of serum copper and zinc among type-2 DM with and without retinopathy and to compare them with matched healthy controls. A correlation of serum copper and zinc was done with glycosylated haemoglobin (HbA1c) in patients of type 2 DM with retinopathy. Materials and Methods: It was a case control study. The investigation included 50 cases of type 2 DM with retinopathy and 50 cases of type 2 DM without retinopathy and 50 matched healthy controls. Venous blood sample was analysed for fasting blood sugar(FBS), post prandial blood sugar (PPBS), serum copper, serum zinc and glycosylated haemoglobin(HbA1c) in both cases and controls. Statistical analysis was done using student 't' test. Pearson's correlation was performed to establish the relationship between study variables. Results: There was statistically highly significant increase in serum copper levels in cases of retinopathy compared to controls(p<0001) and significantly decreased levels of serum zinc in cases of DM with retinopathy(p<0.001). There was significant positive correlation between serum copper with HbA1c and highly significant negative correlation between serum zinc with HbA1c in cases of retinopathy. Conclusion: Diabetic retinopathy is influenced by various factors such as glycemic status, trace elements such as copper, zinc which correlated well with HbA1c. Hence these parameter can be used as a supportive diagnostic tool.

89-99

Authors: Neha Sharma, Pooja Gandhi, K.L. Mali, Arjun Lal Jain

Introduction: Challenges to human being fertility may occur from numerous condi­tions caused through hereditary abnormalities, communicable or else environ­mental agents, as well as certain behaviors. Reproduction is one of the essential functions for every life form. The age of male or female is a reason along with others to be able to have an effect on fertility. Owing to chase of education as well as supplementary factors, lots of couple is choose to wait for childbearing. Methods: This study was done on hypothyroid reproductive age group women at Geetanjali Medical College and Hospital, Udaipur, Rajasthan after obtaining GMCH ethical committee approval. Serum TSH, FSH LH, PRL was performed on automated system cobas e-411 (CLIA) and IL-6 was done by ELISA method. Results and conclusions: Significant changes were occurred in serum FSH, LH and PRL along with IL-6 in 20-36 years of age group of subjects and changes in menstrual pattern along with the stress. Positive correlation between IL-6 and TSH was found in hypothyroid reproductive age group women, individuals who were childless.

105-109

Authors: Liggy Andrews, Haridas Namboothiri, Smruti Vaishnav

Background: Perinatal mortality is an important indicator of the status of maternal and child health, the conditions of obstetric care and the level of economic development of a community. The perinatal mortality rate (PMR) reflects both the characteristics of reproductive health and the quality of antenatal care, delivery, and newborn care. Objective: To find out the corelation between laboratory parameters with perinatal outcomes in PIH cases. Method: 320 patients having an average systolic blood pressure ≥ 140 mm hg and/or diastolic blood pressure ≥ 90 mm Hg were included in the study and biochemistry parameters like serum AST, ALT analysed by UV kinetic, LDH by UV kinetic IFCC, Uric acid by modified Trinder’s method and calcium by arsenazo III methods, were measured by Xl 300 autoanalyzer. Result: In our study overall incidence of PIH was 14.3 %. Maternal death occurred in 09 cases(2.8%). Perinatal mortality occurred in 86(23.3%) with 57(17.8%) Stillbirth and 29(9.0%) Neonatal deaths. Low birthweight<2.5Kg 73(84.8%) was the common complication observed followed by prematurity 64(74.4%) and IUGR 40(46.5%) leading to perinatal deaths. PMR increased as the BP increased. It was 14.9% for BP 140/90 to 149/94, to 57.3 % at BP >160/110 and above (Table 2). Perinatal death increased significantly in PIH women with increased levels of serum AST, ALT, uric acid, LDH and with a significant decrease in serum calcium levels. Perinatal death occurred in 63(73%) cases with Uric acid >6.0 mg/dl, 48(55.8%) in cases with > 600U/l LDH and in 48(55.8%) cases with < 8.0 mg/dl Calcium. Conclusion: A positive correlation has been made out between serum AST, ALT, uric acid, LDH, calcium and perinatal deaths in relation to the severity of PIH and these may be useful markers and diagnostic tools for predicting the progression of PIH.