International journal of Clinical Biochemistry and Research

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.