International journal of Clinical Biochemistry and Research

1-5

Authors: Anuva Mishra, Akshaya Kumar Rath, Srikrushna Mahapatra, Pooja Priyadarsini

Background and Objective: Intrahepatic cholestasis of pregnancy (ICP) is seen usually in 3rd trimester of pregnancy. Overall incidence is 1.2-1.5% of Indian pregnant women. The biochemical abnormalities often include raised liver enzymes, conjugated bilirubin and bile acids. ICP can complicate perinatal outcomes to a significant extent. The present study was conducted to find out the types and incidence of perinatal outcomes in pregnancy complicated with ICP diagnosed by abnormal LFTS (liver function tests), to help the clinician in initiating timely treatment. Materials and methods: In the present study, 51 pregnant women diagnosed with ICP and 49 number of age and gravida matched normal pregnant women were included as cases and controls respectively. LFT and Total bile acids were estimated by standard biochemical methods. Both cases and controls were followed to evaluate perinatal outcomes after 7 days of post- partum. Results: Total bilirubin (0.6 ± 0.08 Vs 0.4 ± 0.03)milligrams/decilitre*; Aspartate transaminases (48 ± 18.6 Vs 27 ± 9.5) International Units/ Litre**; Alanine transaminase (42 ± 14.2 Vs 28 ± 6.1) International Units/ Litre**; Alkaline phosphatase (251 ± 63 Vs 159 ± 58) International Units/ Litre**;Gamma glutamyl transferase (41 ± 5.2 Vs 35 ± 3.6) International Units/ Litre**; Total bile acids (12.7 ± 10.2 Vs 33.4 ± 15.6)µ mol/ Litre ; Albumin (3.3 ± 0.5 Vs 3.2 ± 0.4)grams/decilitre; Total Proteins(6.3 ± 1.2 Vs 6.1 ± 1.5)grams/decilitre were obtained in cases Vs controls. Significantly higher incidence of total complications in cases compared to controls(54.90% Vs 12.24%)*** were found which include respiratory distress(23.52 Vs 4.08)%***, meconium aspiration (9.80 Vs 2.04)%**, pre-term delivery (9.80 Vs 4.08)%*, hyperbilirubinemia (1.96 Vs 0.0)%, fetal bradycardia (7.84 Vs 2.04)%** and fetal loss(1.96 Vs 0.0)%. (*p value<0.05, **p value<0.01, ***p value ˂0.001). Conclusion: The present study found an increase in incidence of total morbidity and mortality during perinatal period in babies born to women suffering from ICP. These findings suggests estimation of total bile acids and liver enzymes for early diagnosis of pregnant women at risk, active monitoring, treatment and induction of labor around 36-38 weeks after establishment of lung maturity in pregnancy associated with ICP to prevent perinatal complications.

11-15

Authors: N. Asha Rani, J N Naidu

Background and Objectives: Preeclampsia (PE), a hypertensive disorder unique to pregnancy and contributes to majority of maternal and perinatal morbidity and mortality. The triggering event in preeclampsia is postulated to be placental ischemia and endothelial dysfunction. In this context the present study was undertaken to investigate serum levels of nitric oxide, thiobarbituiric acid reacting substances (TBARS) and Vitamin E (Vit E) and their correlation with blood pressure in preeclamptic pregnant women. Methods: Fifty clinically diagnosed preeclampsia patient and fifty age and trimester matched normotensive pregnant women were included in the study. Fasting venous sample were collected and nitric oxide, TBARS and vitamin E levels were measured. Results and Interpretation: The mean values of serum nitric oxide, TBARS were significantly higher (< 0.001) in women with preeclampsia when compared to normotensive group whereas vitamin E levels were significantly lower among cases than the control group. Also observed that nitric oxide levels and TBARS positively correlated and vitamin E negatively correlated with the blood pressure and correlations were statistically significant. Conclusions: The findings of present study points increased oxidative stress and decreased antioxidant levels may result in endothelial cell dysfunction. The levels of nitric oxide, TBARS and vitamin E could be used to assess the severity of preeclampsia in addition to other clinical and laboratory parameters.

23-27

Authors: Kavitha M M, Chandrashekharayya S H, Sangappa V Kashinakunti, Manjula R, Gurupadappa K

Background: Hypothyroidism is associated with dyslipidemia. The present study was conducted to assess the relation between hypothyroidism and lipid parameters and lipid ratios. It is also done to assess the severity of hypothyroidism on lipid parameters. Methods: Study comprises of 120 participants were divided into four groups depending on TSH levels, each group comprising of 30 participants. Group-1 euthyroid as controls, group-2 hypothyroid patients with TSH levels between 6-20 mIU/mL, group-3 TSH levels between 21-50 mIU/mL and group-4 consists of hypothyroid patients with TSH levels of > 50 mIU/mL. Fasting venous blood was collected from all the participants and analysed for estimation of thyroid profile and lipid profile. Lipid ratios were calculated. Results: There was significant (p < 0.05) increase in total cholesterol, triglycerides, LDL-C and HDL-C in all the groups compared to group-1 i.e controls. There was significant increase (p<0.05) in lipid ratios. There is positive correlation between TSH and lipid parameters. Conclusion: Our study shows hypothyroid patients show dyslipidemia and the effect of hypothyroidism on lipid parameters is more marked in patients with higher serum TSH levels. By calculating the lipid ratios from lipid parameters are better indicators of dyslipidemia and cardiovascular risk in hypothyroid patients.

31-35

Authors: Mohammed Shamsuddin, Netravathi Sajjan

The study is undertaken to estimate the total and free thyroid hormone levels i.e. TT3, TT4, FT3, FT4 & TSH and thyroid dysfunctions in chronic renal failure. The study also includes the thyroid abnormalities in relation to varying grades of CRF (serum creatinine). A cross sectional study was conducted consisting of 30 male patients of aged between 40-70yrs having serum creatinine > 4.0mg/dl & urea > 50mg/dl with frank proteinuria and symptoms & signs suggestive of CRF are taken in study. Serum levels of TT3, TT4, FT3, FT4 & TSH are estimated by chemiluminesence immune assay method, and the data obtained by the study subjects were compared with data from normal individuals of same age group using student t test. We got the results that TT3, TT4, FT3, FT4 decreases TSH increases significantly in study group compare to normal individuals i.e. controls. Out of 30 patients in study group 3 patients (10%) are in hypothyroid range. The hormone levels of TT3, TT4 and FT3, FT4 decreases and the levels of TSH increases as severity of CRF increases. We finally concluded that Total and free thyroid hormone levels decreases and TSH increases in CRF compare to controls even though are majority them are euthyroid. CRF is associated with increased risk of hypothyroidism and this risk increases as severity of disease increases.

42-44

Authors: Nikunj R Patel, Harshid L Patel, Liggy andrew

Background: Elevated serum bilirubin has been associated with reduced risk of cardiovascular disease (CVD). However, serum bilirubin is also related with several potential confounders related to CVD, such as obesity. Methodology: This study includes 120 male Indian subjects between 30 to 50 years of age. Biochemical test like Lipid profile, bilirubin and blood sugar were measured on a fully automated analyzer along with quality control sera. Results: Positive correlation is found between serum bilirubin and HDL cholesterol level while it was negatively correlated with Fasting blood sugar there were no statically significance present between serum total cholesterol and serum triglyceride in hospitalized patients, not in healthy subjects. Conclusions: From my study it will be conclude that level of serum bilirubin is important parameter for defining risk of cardiovascular disease.

50-54

Authors: Pradnya Shree Dhotre, Rajashree Basawraj Bhogade, Abdul Kayyum Shaikh

Background: There is growing evidence that nitric oxide (NO) is critically involved in obesity and its clinical consequences like cardiovascular disease, hypertension and diabetes. However the role of nitric oxide in oral condition like periodontitis in relation to obesity is not clearly understood. Hence we have attempted to elucidate role of serum and salivary nitric oxide in obese and non-obese periodontitis patients. Method: We investigated 100periodontitis patients; out of which 50 were obese (Group C) and 50 were non-obese patients (Group B) along with 50 normal weight, age matched healthy controls (Group A). Various dental and clinical parameters as well as body measurements were assessed. Results: Group B and Group C showed a marked increase (P <0.001) in clinical attachment loss and probing depth when they are compared with Group A. Group B and Group C patients are also compared for body mass index and waist circumference with Group A.BMI and WC was found to be non significant in Group B when compared with Group A. Group C patients exhibited a highly significant increase in BMI and WC when compared with Group A. Group C patients also showed a highly significant increase in BMI and WC when compared with Group B. The study also documented a significant increase in serum & salivary nitric oxide levels in Group B and C when compared to Group A. (P<0.001).Obese periodontitis patients (Group C) revealed highly significant increase (P <0.001) in nitric oxide levels than non-obese periodontitis patients (Group B). Conclusion: Obesity can be considered as an important contributing factor in enhancing the severity of periodontitis as well as nitric oxide production in these patients.

62-66

Authors: Sangappa Virupaxappa Kashinakunti, Kavitha Hiremath, Manjula Rangappa, Gurupadappa Shantappa Kallaga

Background: Hyperferritinemia probably contributes insulin resistance and subsequently to decreased insulin secretion causes for development of insulin resistance. Objectives: Compare HbA1c with Ferritin and find correlation between HbA1c and ferritin in type 2 diabetes mellitus patients, and also to find the best cut-off value for serum ferritin. Material and methods: The study was conducted on type 2 diabetes mellitus patients attended the outpatient department. Totally 99 participants were enrolled for the study, out of which 49 were cases and 50 were age and sex controls. The FBS, PPBS, HbA1c and serum ferritin were estimated. Statistical package for social science software version 19.0 was used for statistical analysis. Results: There statistically significant increase in all the biochemical parameters viz FBS, PPBS, HbA1c and serum ferritin levels in cases compared controls. The p value was 0.0001 for all the parameters, which is highly significant. There was a positive correlation between the HbA1c and Ferritin levels, but it was not statistically significant (r = 0.10). The area under the ROC curve for serum ferritin values at various cut-off was 0.904 and the best cut-off of serum ferritin levels greater than 124ng/ml. Conclusion: Serum ferritin levels were higher in type 2 Diabetes mellitus which positively correlated HbA1c. Thus, routine screening for serum ferritin concentration in diabetes patients can be done to assess the glecemic control in type 2 DM.

72-75

Authors: Anusha.R, Madhubala.V

Background & objectives: Neutrophil Gelatinase Associated Lipocalin NGAL predicts Acute Kidney Injury earlier than creatinine in cardiac surgery patients. This study aims at understanding the correlation between the two biomarkers. Methods: 53 patients who underwent major cardiac surgery were included in the study. Venous blood samples were collected before surgery and at 4 hours after surgery to estimate plasma NGAL and before surgery, at 4 hours, 24 hours, 48 hours and 72 hours after surgery from the patients to estimate serum creatinine. Correlation analysis was done between NGAL and creatinine using Pearson Correlation Coefficient. Results: The correlation coefficients for plasma NGAL values at 4 hours after surgery with the serum creatinine values were r = 0.87 at 4 hours, r = 0.86 at 24 hours, r = 0.91 at 48 hours and r = 0.87 at 72 hours after surgery. Interpretation: The correlation coefficient values shows that plasma NGAL values at 4 hours after surgery were highly correlated with the serum creatinine values at 4 hours, 24 hours, 48 hours and 72 hours after surgery. Conclusion: This study shows that NGAL values are highly correlated with creatinine values.

82-88

Authors: Ushanagadevi C.S., Beenakumari K., Moses.K. Daniel, M.R. Laveesh

Introduction: Diabetes mellitus and Tuberculosis are among the most prevalent chronic diseases in India. The correlation and coexistence of both the diseases are very important as they influence the clinical course and therapeutics of each other. Material and Methods: It was a cross sectional study conducted on 122 patients of newly diagnosed young sputum positive tuberculosis patients visiting a tertiary care hospital. Selected socio-demographic, laboratory and radiological data were elicited from these patients and recorded in the proforma. After GTT, patients were grouped according to ADA 2003 recommendations of hyperglycaemia into Normal, IFG, IGT and DM was done. Observation and results: The total number of patients with abnormal blood sugar values (IFG, + IGT + DM) account for 53.28% of the study group. IGT is significantly high in TB population (31%) when compared to (14%) that in normal population and p value is significant <0.05.On radiological examination, a total of 61% of the study group shows upper zone involvement and the lesions were mostly infiltrates. There was no statistical correlation between IGT or DM and increased BMI.IGT and DM was more among urban population and this was statistically significant. Conclusions: In view of the increased prevalence of diabetes mellitus in tuberculosis population it is suggested that all tuberculosis patients should be evaluated clinically and biochemically for diabetes mellitus as detection and control of diabetes mellitus will help to achieve better tuberculosis control.

100-104

Authors: Mohit Mehndiratta, Seema Garg, Rajarshi Kar, Dinesh Puri

Introduction: During a didactic lecture, information is given to the students by the teacher, where students are passive listeners and the teacher is the narrator. Interaction between the students and the teacher, though intended, is not always possible because of several reasons. Other formats for teaching (small group discussions, seminars by students etc.) have been utilized but in a limited way, particularly in India. In many medical institutes, students are expected to attend several lectures and there is no scheduled respite between lectures. This study has been done to understand the shortcomings of the current format and duration of lecture from the point of view of students. Method: Feedback was obtained from first year MBBS students under anonymity and was analyzed. There were 94 responses on the format of lectures and 98 for duration of lecture. Their responses were analyzed and the percentage of response for each choice was noted. Results: 57.14% students were of the opinion that didactic lectures must be supplemented with small group discussions and 46.81 % of students feel that the optimum duration of a lecture should be between 30 to 45 minutes. Discussion: Our study shows that majority of the students are of the opinion that duration of lecture should not be more than 45 minutes and more focus should be on supplementation of didactic lectures with small group discussion. Incorporating the students view point while forming educational policies may improve their performance to great extent.