International journal of Clinical Biochemistry and Research

106-110

Authors: Abhijit Ninghot, Kanchan Mohod, Satish Kumar.

Introduction: There is need of precise and faster diagnosis for pulmonary (PTB) and extra-pulmonary tuberculosis (EPTB). Accordingly, there develops a considerable interest in the development of tests based on biochemical response of body towards tuberculosis infection (i.e. estimation of serum adenosine deaminase). These tests appear to be a promising approach for the diagnosis of pulmonary as well as extra pulmonary TB. Materials & Method: Total 150 individuals recruited for this study, out of which 50 cases each of PTB and EPTB. 50 age and sex matched controls were included, out of which 15 were healthy controls and 35 were diseased controls. Serum adenosine deaminase (ADA) was estimated by using commercial ADA-MTB kit. Results: Serum ADA concentration in patients with PTB & EPTB was found to be significantly higher (p < 0.05) as compared to diseased and healthy controls. Conclusion: Our observations suggest that serum Adenosine deaminase (ADA) measurement has a good detection potential for PTB & EPTB.

115-118

Authors: C. K. Vijayasamundeeswari, N. Ananthi, R. Sudha.

Introduction: Measurement of electrolytes plays a significant role in the management of critically ill patients. The accuracy of electrolyte measurement depends on a number of pre-analytical variables. Electrolytes are the positively and negatively charged ions that are essential for normal cellular functioning of the body. Most of the metabolic processes are mediated through electrolytes. Electrolyte abnormalities are seen in a number of conditions and can end up in life threatening conditions unless accurate results are given from the laboratory. Aim: To check the effect of different storage temperature on estimation of electrolyte values using serum and plasma samples of venous blood. Materials and Method: Analysis of electrolyte levels was conducted in venous blood samples collected from 30 patients stored under room temperature and at 2-4 0C. Serum and plasma electrolytes-sodium [Na], potassium [K], chloride [Cl] were analysed using electrolyte analyser at different time intervals and storage conditions. The samples at room temperature were analysed immediately after collection and at 6hours, 12hrs, 24 hrs, 36hrs and 48hrs.The samples kept at 2 - 40C were also analysed at 6hrs, 12hrs, 24 hrs, 36hrs and48hrs simultaneously. Results: Serum K, Cl has no significant changes till 48 and 12hrs, both at 2-40C and at room temperature respectively. Serum Na at 2-40C is relatively stable for a longer time than its counterpart stored at room temperature (48hrs vs 36 hrs). Similarly, plasma samples also showed more stability at 2-40C than at room temperature. Conclusion: Estimation of electrolytes as early as possible at proper storage conditions is the best solution to avoid analytical errors.

123-125

Authors: Hemantha Kumara D.S., Prashanth Kumar B.G., Muralidhara Krishna C.S., H.L. Vishwanath.

Introduction: Thyroid dysfunction is related to damaging effect on glomerular and tubular functions. In recent studies it was found that hypo and hyperthyroidism was accompanied with renal derangement resulting in abnormal levels of serum creatinine and uric acid. So this study was conducted for estimation of serum non-protein nitrogenous constituents in hypo and hyperthyroidism. Materials and Method: 60 patients, with 30 hypothyroid and 30 hyperthyroid patients were included in this study along with 30 controls. Thyroid hormones (T3, T4, and TSH) were estimated by Beckman coulter Access-2 immunoassay analyser. Uric acid, creatinine and urea parameters were measured using fully automated Beckman coulter clinical chemistry analyser AU480. Analysis of Statistical data was done by SPSS 20. Results: There was a significant increase in the levels of serum uric acid and (p<0.0001) in hypothyroid patients and hyperthyroid patients showed significant decrease in serum creatinine levels (p<0.0001). When correlated with TSH, Serum creatinine showed positive correlation, whereas it was negative for serum uric acid in hypothyroidism, in hyperthyroid patients, there was a negative for serum creatinine and uric acid levels. Conclusion: The results of this study indicate that the non-protein nitrogenous constituent’s mainly uric acid and creatinine were significantly altered in hypothyroid and hyperthyroid patients. Therefore, we have emphasize and the importance of the routine evaluation of these biochemical parameters in hypo and hyperthyroid patients.

129-135

Authors: Patel J. D., Chakrabarti C..

Introduction: Rising incidence of coronary artery disease in India which is rather common causes of morbidity and mortality is not good news. Even by conservative estimate Indian spending an amount that’s nearly 40% entire central Government health budget for the treatment of CAD. Hyperhomocysteinemia is considered as an independent risk factor of premature Coronary Artery Disease (CAD), but the probable role of homocysteine along with biochemically related folate & vitamin B12 with homocysteine in early onset of CAD is not well studied in this part of country. The aim of this study was to assess the role of hyperhomocysteinemia, folate and vitamin B12 deficiency in the development of premature CAD. Materials and Methods: We have performed observational case-control study in total 200 participants having age more than 20 years in both male and female sex, out of these 100 are patients suffering from CAD who were admitted for selective coronary angiography in academic tertiary care hospital in Ahmedabad and 100 healthy controls group participants attended the said institute. The homocysteine, folate and vitamin B12 concentration were measured using standard reagent kit on Abbott AxSYM close system. Result: Mean homocysteine in study group was significantly higher in study group compare to control group (33.02+/-17.41 μmol/l; 13.88+/-3.86 μmol/l). Mean homocysteine level in each age group of study group patient is significantly high than the control group participant (P < 0.001). Mean folate and vitamin B12 level is lower in each age group of study group patients than control group participants. Mean serum folate (7.13+/-3.46 ng/ml versus 12.35+/-3.36 ng/ml) and vitamin B12 (156.41+/-127.36 pg/ml versus 449.86+/-169.90 pg/ml) level are lower in study group than the control group participants respectively. Folate and vitamin B12 shows negative correlation with homocysteine. There was a significant positive correlation between homocysteine and age is observed while folate and vitamin B12 shows negative correlation with age. Conclusion: We may conclude from our study that increase homocysteine level may be one of the risk factor of CAD in young age. Our study also shows that age is non-modifiable while folate and vitamin B12 deficiency are modifiable risk factor of hyperhomocysteinemia.

140-144

Authors: A Multi Marker Evaluation of Cardiovascular Disease Risk in Patients with Rheumatoid Arthritis

Background: Rheumatoid arthritis (RA), an inflammatory joint disease, is also associated with systemic effects. Patients with RA have an increased risk of morbidity and mortality that is mainly attributable to cardiovascular disease (CVD). Both traditional and novel risk factors are implicated in causing the increased CVD risk in RA patients. Materials and Method: Forty six RA patients, diagnosed with RA as per 1987 revised ARA criteria and forty six age and sex matched healthy controls were studied. Fasting lipid profile (Total cholesterol, triglycerides, HDL cholesterol), inflammatory markers (high sensitivity C reactive protein [hsCRP] and fibrinogen), oxidant and antioxidant markers (malondialdehyde [MDA] and ferric reducing ability of plasma [FRAP]), uric acid, homocysteine and Nitric oxide (NO) were measured in all subjects. Results: Among the traditional lipid parameters studied, triglycerides were increased in RA patients compared to controls (p=0.023). Both hsCRP (p<0.001) and fibrinogen (p=0.006) were elevated in RA patients than in controls. MDA levels were increased (p<0.001) and FRAP levels decreased (p<0.001) in patients with RA compared to controls. Uric acid and homocysteine levels showed no significant difference between RA patients and controls. Nitric oxide levels were increased in RA patients when compared with controls (p=0.030). Conclusion: Patients with rheumatoid arthritis were found to have an increased risk of CVD as evidenced by increased triglyceride levels, increased inflammatory markers, presence of oxidative stress. Hence, management of these patients should also include evaluation of CVD risk besides treatment of joint symptoms.

149-153

Authors: S.S. Pramanik, K.N. Harley, R.K. Jambhulkar, R.K. Das, J.S. Sathe.

Background: Arterial blood gas analysis is a common investigation exercised in emergency room and ICU. In post-operative CABG patients, acid base alterations is the commonest problem encountered. Thus, constant check on these parameters is necessary to minimize post-operative mortality. Aim and Objectives: To document the pre-operative and post-operative ABG, hemoglobin and serum potassium in patients undergoing CABG. Materials and Method: Present observational study was conducted on 27 patients (Male=12 & Female=15) in the department of clinical biochemistry and cardiovascular thoracic unit at GMC-SSH, Nagpur. Fresh Arterial blood Samples were collected in dept. of biochemistry for ABG, hemoglobin and serum potassium pre-operatively and post operatively. Data were expressed in mean and standard deviation. Level of significance was expressed in P value applying student paired “t” tests. Results: Findings suggested significant decrease in PaO2, in post-operative 5th & 9th day (P=0.0001) as compared to pre-operative Pa02.Raised PH observed on 5th and 9th day following CABG. Non-significant PaC02 changes in pre and 1st day following CABG. However, significant drop observed in PaCO2 on 5th and slight improved PaC02 on 9thday but still significant changes as compared to pre-operative values (P=0.001). Extremely Significant (P=0.0001) decrease in Serum potassium (K+) and Hemoglobin (Hb) and hematocrit observed on 1st and 5th post-operatively as compared to pre-operative, However, improved serum K+ (p=0.03) and Hb (p=0.02 )demonstrated on 9th day following CABG but still quite significantly decreased. However, when compared in female and male patients in pre and post-operative state, non-significant PH, alterations in PaO2,PaCo2, potassium (K+) and hemoglobin was significant between male and females. Conclusion: Pre and post-operative serial ABG analysis is most important parameters to know status of acid base imbalance amongst CABG patients. By knowledge of ABG, one can manage post-operative CABG complications, provided ABG should be interpreted properly by physician.

159-163

Authors: Shylaja T.V., Asmabi Makandar, Raghavendra D.S., Patnaik A.N. , Shanthi Naidu.

Background: Despite more than half a century of investigations, Acute kidney injury (AKI) remains a major healthcare issue in medicine today, reported to occur in 1–32% of all hospital admissions and 10–90% of intensive care unit admissions and the diagnosis of AKI is usually based on changes in Serum Creatinine (SCr) which is a poor marker of early renal dysfunction. Objectives: To study the role of Serum Cystatin C (CysC) as early marker of AKI and to correlate the Serum Cys C with conventional marker like SCr in early detection of Contrast induced acute kidney injury (CIAKI) in subjects undergoing Percutaneous transluminal coronary angiogram (PTCA). Materials and Method: Prospective cohort study was conducted, where SCr and Serum CysC were serially measured in a heterogeneous group of subjects (n=60) presenting to cardiology department and the primary outcome was CIAKI. Results: The study population consisted of 60 subjects. All subjects were divided into 2 groups: “CIAKI group” and “no-CIAKI group” according to predefined definition. The Serum Cys C increased at 4 hours and reached the peak at 24 hours, whereas SCr increased at 24 hours and reached peak at 48 hours respectively(P<0.001) and there was no significant correlation between Serum Cys C with SCr at 0 hours, 4 hours , 24 hours and 48 hours . Conclusion: Serum CysC is an early marker for detecting CIAKI compare to conventional marker SCr. So earlier detection of CIAKI by this novel biomarker can reduce morbidity and mortality and also hospital stay.

168-174

Authors: B. Sudhakar, R.M. Shah.

Background: There are no effective studies in west part of India on relationship between higher serum ferritin levels in impaired glucose individuals, type 2 diabetes mellitus patients are markers for insulin resistance and reinforce to metabolic syndrome. The association between serum ferritin levels, insulin resistance marker (HOMA IR), Glycosylated Hemoglobin A1C with individual components of metabolic syndrome in type 2 diabetes mellitus, impaired fasting glucose, obesity and healthy subjects are unclear. Objectives: This research was delineated to find out the interrelation between serum ferritin levels with fasting glucose levels, waist hip ratio, fasting insulin levels, insulin resistance marker (HOMA-IR) and components of metabolic syndrome in type 2 diabetes mellitus patients, newly identified type 2 diabetes mellitus patients, Impaired fasting glucose subjects and healthy participants. To investigate any menopause transition effects on serum ferritin levels and components of metabolic syndrome for identifying insulin resistance and early diagnosis of type 2 diabetes mellitus in men and women of age 30-65 years. Subjects and Methods: The number of individuals included in this study 1058, out of them 365 patients with previously diagnosed type 2 diabetes mellitus with poor and good glycemic control patients, 144 patients with newly identified type 2 diabetes mellitus, 189 with participants with impaired fasting glucose levels and 360 healthy participants. Ferritin levels in serum, fasting glucose in plasma, fasting insulin levels in serum, Glycosyalted HbA1c in blood and serum lipid levels were analyzed. Waist Hip ratio is measured. Homeostasis Model Assessment-Insulin Resistance (HOMA-IR) is calculated. Results: In our analysis, out of 1058 participants, 289 individuals (27.2%) with increased levels of ferritin levels in which 46.6% (newly identified type 2 diabetes mellitus patients), 31.95% previously diagnosed type 2 diabetes mellitus 20.4% impaired fasting glucose subjects and 10.55% healthy participants. The odd ratios for men in newly diagnosed diabetes mellitus were 4.94 and for women 3.61. Linear regression analysis between serum ferritin, blood insulin, and glucose and glycosylated hemoglobin showed significant correlation. Conclusion: our research findings suggest increased ferritin in blood as marker for insulin resistance and early indicator for diagnosis of type 2 diabetes. High ferritin in metabolic syndrome identify early indicator for insulin resistance and pre diabetes mellitus.

178-181

Authors: M. Prasad, P.Aruna, D.R. Rajeswari, K. Ramalingam, J.N. Naidu.

Essential hypertensionis a typical example of complex, multifactorial trait and a well studied risk factor for cardiovascular disease. hs-CRP is well known marker of inflammation resulting in atherosclerosis and cardiovascular disease. Recent studies showed that 25-OH-vitamin-D has ananti-inflammatory role and decreased levels may increase the cardiovascular risk in subjects with essential hypertension. The study included 30 adults both male and female with essential hypertension (Systolic Blood Pressure ≥ 140 mm Hg and Diastolic Blood Pressure ≥ 90 mm Hg) as cases. 30 age and sex matched healthy individuals both male & female between the age group of 24-60 years attending General OPD, General Medicine Department, NMCH, were taken as controls. The inverse relationship of Vitamin D with hs-CRP levels leads to cardiovascular risk in subjects with essential hypertension.

187-190

Authors: A .G. Thivyah Prabha.

Aims & Objectives: The aim of the study is to compare the available analytical methods of measurement of HbA1c like immunoturbidimetric and HPLC methods. Materials and Method: Total of 150 pre-diabetic and diabetic patients are included in the study. HbA1c was measured by immunoturbidimetric and HPLC methods as these are the common methods used by the clinical laboratories. Results: The HbA1c values of two methods have a significant difference. The value of immunoturbidimetric method was less than the HPLC method. The two methods correlated with the correlation coefficient of 0.972. Conclusion: Both the methods are reliable and show a strong correlation .Even though the immunoturtbidimetric values are low it is specific and more cost effective than the HPLC methods. HPLC is a sensitive method.

195-197

Authors: Sapna Jangir, Jairam Rawtani.

Introduction: Polycystic Ovarian Syndrome consists of a constellation of metabolic abnormalities and is now well recognised having a major effect throughout life on the reproductive, metabolic and cardiovascular health of affected women. Objective: The present study was conducted to evaluate hsCRP, insulin and insulin resistance levels in PCOS patients. Materials and Method: 30 PCOS subjects in the age group of 18 to 34 years and 25 age-matched healthy women as controls were evaluated. Result: Serum hsCRP, insulin, insulin resistance, BMI and waist-to-hip ratio were significantly elevated (p<0.0001) in PCOS cases when compared with controls. There was a positive correlation between hsCRP and insulin (p=0.2001) and hsCRP and insulin resistance (p = 0.127) in PCOS patients. Conclusion: PCOS women have added risk of complications of cardiovascular disease and Diabetes mellitus.

201-205

Authors: Shilpa A., Krishnaswamy D., Indumati V., Vijay V., Shanthala D..

Introduction: Liver biopsy and ultrasound are the gold standard methods to assess liver fibrosis in chronic liver disease (CLD). Recently Fibrosis Quotient test (Fibro Q test), AST: ALT Ratio (AAR) & AST: Platelet Ratio Indices (APRI) are the three non-invasive and simple indices proposed for assessing liver fibrosis in CLD. Objectives of the study: To know the efficacy of the indices- Fibro Q test, AAR, APRI as markers of fibrosis in CLD and to know which among these indices would be a high sensitive marker in estimating fibrosis. Materials and Method: The study includes 60 subjects, out of which 30 were clinically diagnosed as CLD and were confirmed by abdominal ultrasound (USG) and 30 were age and sex matched healthy controls. Fasting blood sample was collected; and AST, ALT, prothrombin time and platelet count were analysed. Fibro Q test, AAR & APRI were calculated. Receiver operating characteristic (ROC) curves were constructed to compare the accuracy of these three non-invasive tests in predicting significant fibrosis in patients with CLD. Results: Fibro Q, AAR, APRI were significantly increased in cases compared to controls. Fibro Q is a better marker than AAR & APRI, in the prediction of significant liver fibrosis. Conclusion: Fibro Q test, AAR & APRI indices are efficient markers to evaluate liver fibrosis in patients with CLD. Fibro Q, a novel non-invasive test, is a high sensitive marker than AAR & APRI.

210-212

Authors: Sushama Dhonde, Miss Lizelle Rodrigues, Pratap Jagtap, G.J. Belwalkar, Vinayak Mane.

Introduction: Tobacco in any form is responsible for the generation of free radicals which cause oxidative damage, producing lesions in the mouth like ulcers, leukoplakia, erythroplakia, sub mucus fibrosis and is responsible for the progression of oral cancer. We aimed to find out the use of salivary malondialdehyde as a marker of oxidative stress, and salivary uric acid as a antioxidant, in the tobacco chewers. Materials and Method: 60 healthy tobacco chewers and 60 healthy non chewers were included in the study. Salivary MDA was measured by method of K. Satoh, and Salivary Uric acid with the help of Biochemistry analyzer. Results: The mean concentration of salivary MDA of control group was 0.0179 ± 0.008 and of study group was 0.073 ± 0.140 n moles/L. The increase in the MDA was statistically significant (p < 0.004). Salivary uric acid concentration of control group was 1.97 ± 1.38 and of study group was 2.11 ± 1.41mg/dl. The difference was not statistically significant (p > 0.05). Discussion: Oxidative stress increased by the use of tobacco, leads in the increased lipid peroxidation followed by increased malondialdehyde. This may be the cause for the significantly increased salivary malondialdehyde concentration in the study group. Increased mean uric acid levels, though nonsignificant, may indicate initial phase of cellular injury. Conclusion: Present study suggests that increased concentration of salivary Malondialdehyde and uric acid may be used as screening tool in tobacco chewers, for cellular injury.