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