International journal of Clinical Biochemistry and Research

213-215

Authors: Nagaraj R. Shetkar, Anand K. Pyati.

Introduction: Preterm delivery is estimated to be one of the leading causes of perinatal morbidity and mortality, for which there are no known effective preventive measures. C - reactive protein (CRP) is one of the sensitive markers of systemic inflammation and ferritin is an acute phase reactant protein. Objectives: To compare the serum levels of high sensitive C-reactive protein (hsCRP) and Ferritin between pregnant women presenting with preterm onset of labor followed by delivery and age matched women who delivers at term. Materials and Method: The study included 50 women aged between 18-35 years with singleton pregnancy and gestational age between 24-34 complete weeks with the diagnosis of new onset of preterm labor and a control group of 50 healthy and age matched pregnant women in the term labor. In all the cases and controls, serum hsCRP and ferritin were measured by the latex enhanced immuno-turbidimetric methods using reagent kits from Agappe diagnostics. Results: Serum mean levels of hsCRP and ferritin were significantly higher in preterm labour cases when compared to controls. The difference was statistically highly significant (p < 0.001). Conclusion: Present results demonstrated that the assessment of maternal concentrations of hsCRP and ferritin can be used as suitable biomarkers for predicting preterm labor.

220-224

Authors: Ayaz Khurram Mallick, Marya Ahsan.

Context: Self-monitoring of glucose levels with a hand held glucometer is very popular among the diabetic patients and doctors as it is less traumatic and gives instant results. Capillary blood samples are commonly used for self-monitoring in comparison to venous plasma sample which are used in the diagnostic laboratories. Aims: This study was done to compare the glucose levels of a capillary blood sample determined by a glucometer with the glucose level determined by Glucose Oxidase Peroxidase (GOD-POD) method using a venous plasma sample. Setting and Design: This experimental study was carried out at Rohilkhand Medical College and Hospital. Methods and Material: Two hundred patients were randomly selected for the study. Their venous blood samples were collected in a fluoride containing blood collection tube. The plasma obtained was subjected to GOD-POD test. Simultaneously their capillary blood glucose was also determined by a glucometer. Statistical analysis used: The data collected was analyzed using SPSS 17.0 version. Data was expressed as mean ± SD. Significance of mean was analyzed using paired t test. P value < 0.05 was considered significant. Result: Glucose levels determined by a glucometer and GOD-POD method showed very good correlation (r=0.958; p<0.001). However, at very high and low glucose levels, the glucometer significantly under estimated (p=0.014) and over-estimated (p<0.001) the glucose levels respectively. Conclusion: Although glucometers are effective for routine monitoring of glucose levels, they should be used cautiously in emergency conditions.

229-233

Authors: Navikala K, Vasudha KC, Pramila Kalra, Radhika K.

Thyroid hormones are essential for normal growth, development and function of all tissues of the body by regulating basal metabolic rate of all cells, including hepatocytes. The present study was taken up to show the correlation between hyperthyroidism and hepatic dysfunction by measuring ALT and total bilirubin so that it helps in diagnosing patients of hyperthyroidism presenting with liver dysfunction or liver dysfunction as a manifestation of antithyroid drug treatment. 21 newly diagnosed hyperthyroid patients, 21 patients who are on treatment and Twenty one controls in the age group of 20-50yrs participated in the study. Serum T3, T4, TSH were analyzed by electrochemiluminescence, total bilirubin by diazzonium ion (blanked) and ALT (Alanine transaminase) by IFCC without PLP method. Kruskal Wallis test was done to compare T3, T4, TSH, total bilrubin and ALT levels among three groups. Post Hoc test was done for multiple comparisons between two groups. A significant difference for T3, T4, TSH (p <0.001) and total bilirubin values(p=0.012) was observed among the different groups. Post Hoc test for multiple comparisons between two groups revealed that total bilirubin levels were significantly high in newly diagnosed hyperthyroid patients and patients who are on treatment compared to controls. Six out of twenty one newly diagnosed hyperthyroid patients (29%) and five out of twenty one patients on treatment (24%) had total bilirubin values more >1mg/dl. ALT levels did not show statistically significant increase compared to controls. Conclusion: Assessing the liver function at the time of diagnosis and during treatment is necessary to monitor the hepatotoxic effects of hyperthyroidism so that an alternative treatment can be chosen for such patients.

237-241

Authors: Yasmeen Fatima, Sreekantha, Ramesh.

Objectives: Menopause is the permanent cessation of menstruation; since cardiovascular disease is the leading cause of death among post-menopausal women, which may be due to lower level of estrogen. The present study was undertaken to evaluate serum estrogen and lipid profile status in post-menopausal women and compare with premenopausal women. Materials and Methods: 50 post-menopausal women and 50 pre-menopausal women in the reproductive age group were selected in the study. We measured serum estrogen and serum lipid profile [total cholesterol (TC), triglyceride (TG), HDL-Cholesterol, LDL-Cholesterol, and VLDL-Cholesterol.] in both pre and post-menopausal women. The comparison and correlation of estrogen level with lipid profile was done using correlation test and P value less than 0.05 was considered significant. Serum estrogen and lipid profile determinations were done by competitive binding immunoassay and enzymatic methods respectively. Results: This study showed statistically significant lower values of serum estrogen in post-menopausal women compared to pre-menopausal women. (p<0.001). Significant higher values of serum TC, TG, LDL-C and VLDL-C levels and significant lower values of HDL-C in post-menopausal women compared to pre-menopausal women (p<0.001). Conclusion: Our study showed altered serum lipid profile in post-menopausal women, hence they are at an increased risk for cardiovascular diseases. Estrogen may be the protective factor in premenopausal women. Therefore screening for lipid profile and specific health education is needed for all postmenopausal women to prevent the emerging cardiovascular diseases.

245-248

Authors: Dhananjay Tiwari, Narendra Kumar, Roshan Alam, Mohammad Mustufa Khan.

Introduction: The complications of Type 2Diabetes, both microvascular and macrovascular develop at an early stage of life in Indian population. The reasons may be poor glycemic control and excessive loss of serum Mg and serum Zn. Aim: To estimate the serum magnesium and serum zinc levels in type 2 diabetes mellitus (T2DM) patients. Materials and Method: In the present case-control study, we inducted 94 subjects (47 T2DM and 47 age and sex matched healthy controls), aged between 25-70 years. Fasting blood sugar (FBS), post prandial blood sugar (PPBS), glycated haemoglobin (HbA1c), serum Mg and serum Zn were estimated in each of them. Statistical analysis was conducted by using SPSS version 20. Results were tested at 5% level of significance. Result: Level of serum Zn was found low in T2DM patients compared to healthy controls and the difference was statistically significant (p=0.03), whereas, there was no significant difference in serum Mg levels (p=0.14). FBS, PPBS and HbA1c have significant positive correlation in T2DM patients (p<0.01). Mg has shown negative correlation with FBS, PPBS and HbA1c. While, it showed positive correlation with Zn. However, Zn has shown positive correlation with FBS and PPBS, while negative correlation with HbA1c. All the correlations were found to be not significant. Conclusion: In the present study, the serum zinc level was low in Type 2 DM patients in comparison to healthy controls. The difference was statistically significant. However serum magnesium levels were not significantly different in T2DM in comparison to healthy controls. The reduced serum zinc levels in T2DM patients may be due to gastrointestinal malabsorption and excessive urinary loss of zinc.

253-256

Authors: K. Ponsuganthi, R. Sudha.

Introduction: ‘Lean NAFLD’ has been defined as the Non-alcoholic fatty liver disease(NAFLD)in the absence of overweight and/or obesity, defined by the anthropometric parameter, body mass index (BMI). Aims and Objectives: To assess the prevalence of lean NAFLD in type 2 diabetes mellitus(T2DM) patients and to compare the clinical and metabolic profile among lean, overweight and obese NAFLD patients. Materials and Method: 60 type 2 diabetes mellitus patients with NAFLD were analyzed for the demographic, anthropometric and biochemical data. The subjects were categorized into three groups according to their BMI, namely lean, overweight and obese NAFLD. One way Analysis of Variance was used to compare the means of continuous variables between groups. Results: The prevalence of lean NAFLD was 25% in our study population. Lean NAFLD patients had lower fasting, but higher postprandial blood glucose and higher insulin resistance. They had comparable blood pressure, HDL-C, total proteins, albumin and bilirubin. Triglycerides, total cholesterol, LDL-C, AST, ALT, AST/ALT ratio, and GGT were significantly different between the three groups. Conclusion:Lean NAFLD patients were unique in terms of their blood glucose, Insulin resistance, lipid profile and liver enzymes when compared to the overweight and obese NAFLD.

261-265

Authors: Vaishali S. Pawar, Ajit Sontakhe, DK Sindal, Sangeeta Patil.

Introduction: Human beings are blessed with five special senses and vision is the most precious. Cataract is the major cause of a visual impairment. Tobacco use is a modifiable risk factor for cataract. Dyslipidemia is associated with wide range of eye diseases. Therefore, we intended to study the relationship between the lipid profile and tobacco use in various forms of cataracts. Materials and Method: The study was carried out on 156 cataract patients aged 45 to 65 years. It comprised of two groups: tobacco user group (78 patients) and tobacco non user group (78 patients). A complete ophthalmic examination was done and fasting serum lipid profile was estimated. Information on tobacco use was collected through the questionnaire. Results: In this study, it was found that High Density Lipoprotein cholesterol (HDL-c) was lower in tobacco user group (P<0.05) than the tobacco nonuser group. Tobacco user group had higher values of Very Low Density Lipoproteins cholesterol (VLDL-c) (P<0.05) and Triglycerides (TG) (P<0.05) as compared to tobacco nonuser group. There is significant difference in various forms of cataract (P<0.05) between tobacco user group and tobacco nonuser group. However, no significant difference was found in total cholesterol, HDL-c, VLDL-c, TG and Low Density Lipoprotein cholesterol (LDL-c) in various forms of cataract irrespective of tobacco use. Conclusion: The study shows that tobacco use adversely affects lipid profile and it is significantly associated with nuclear and cortical cataract. However, there is no association was found between the lipid profile and different forms of cataract. As our sample size was small, further study with larger sample size is required to find out correlation.

270-274

Authors: Kirankumar P. Chauhan, Jatin D Patel, Amit Trivedi.

Introduction: Accurate test results are the core of healthcare system since physician's decisions mostly depends on the laboratory results. The evaluation of laboratory performance is critical to maintain accurate laboratory results. Nowadays six sigma is the newest version of total quality management. It is quantitative goal for process performance. We aimed to gauge our clinical biochemistry laboratory performance on sigma metrics. Materials and Method: Internal Quality control (QC) and proficiency testing data for 12 clinical chemistry analytes for two COBAS 400 Plus clinical biochemistry auto-analyzers were analyzed retrospectively over a period of 12 months from July 2012 to June 2013. For all 12 analytes the coefficient of variation was calculated for both the levels of IQC, percentage bias was calculated from EQAS. Process sigma was calculated using CV%, Percentage bias and TEa values of various parameters were taken from Clinical Laboratories Improvement Act (CLIA) guidelines. Results: Satisfactory sigma values (> 6) were derived for Alkaline Phosphatase, Aspartate aminotransferase, Alanine aminotransferase (L2), Triglycerides, Uric acid, Glucose (L2) signifying less stringent QC rules in an order to achieve high error detection and low false rejection. For parameters - Albumin, Alanine aminotransferase (L1), Total Cholesterol, Total Bilirubin, Glucose (L1), Total Protein the sigma values were found between 3 & 6, signifying more QC rules to be implemented. Urea and Creatinine analytes performed poorly on the sigma scale with sigma < 3, signifying needs improvement in these methods. No significant difference was found in both COBAS equipments in context to sigma value. Conclusion: Application of six sigma principles would significantly helps in improving IQC process as well provides the scientific basis for recommendation of amount of QC that is actually needed.

279-283

Authors: Mamta Choudhary, R.K. Vyas, Yogita Soni, Gajanand Joshi, Anil Kumar Lahoti.

Introduction: The thalassemias are group of haemoglobin disorders, initially found in 1925 in United States and Italy. It is the genetic disorder which passed down through families. In this disease deficient haemoglobin formation occurs which leads to gross destruction of R.B.C., subsequently leads to anaemia. The treatment of thalassemic patients involves mostly blood transfusion, lead to accumulation of excess iron in the body tissues. This secondary iron overload is responsible for peroxidative damage by increased production of reactive oxygen species within the erythrocytes leading to oxidative stress. This increased oxidative stress will cause damage of many organs including lungs, liver and brain. Materials and Method: This study was conducted in Department of Biochemistry with collaboration of Dept. of paediatrics S.P. Medical College and attached Hospital, Bikaner. Samples taken for study includes total 100 subjects, including 50 thalassemic and 50 healthy children as controls with age groups from 3 to 14 years. Serum malondialdehyde (MDA), Mg, Ca and Zn were estimated by using standard enzymatic kits and instruments. Results: The mean ± SD of serum MDA, Magnesium, calcium and zinc levels were found 8.99±1.33 nmol/ml, 2.04±0.22 mg%, 9.54 ± 0.53 mg% and 105.11±9.89 µg% respectively in healthy children and 17.16±1.79 nmol/ml,1.19±0.14 mg%, 6.88±0.61 mg% and 61.76±5.44 µg% respectively in thalassemic children. Conclusions: Children who were suffering from thalassemia disease, had increased level of MDA level and decreased levels of magnesium, calcium and zinc level with respect to healthy children. The inverse relation were found between MDA and magnesium, calcium and zinc levels in thalassemic subjects.

291-294

Authors: Sahithya CS, Meera S, Savitha Jagnnath.

Introduction: Thyroid diseases are the commonest endocrine disorders worldwide. 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. Hypothyroidism patients are more prone for cardiovascular abnormalities. In our study we have studied the marker of ischemia, Ischemia Modified Albumin & marker of inflammation hs CRP in hypothyroidism patients. Objectives: 1. To estimate the thyroid hormone levels (T3, T4, TSH) in hypothyroidism patients compared with normal subjects 2. To estimate levels of IMA & hs CRP in hypothyroidism patients compared with normal subjects Materials and Method: The study group includes 61 hypothyroidism patients and 61 age & sex matched healthy controls. hs-CRP was measured by immunoturbidimetric method using fully automated analyzer, IMA was measured by Albumin Cobalt Binding method & thyroid hormones are measured by ECLIA method. Statistical analysis was done using SPSS 16 version software. Results: In our study we have found that there is statistically significant (p value< 0.05) increase in hs-CRP & IMA levels in hypothyroidism patients compared to controls. Conclusion: The levels of IMA - a marker of ischemia & hs-CRP - a marker of inflammation were increased in patients with hypothyroidism. This indicates that the altered thyroid hormones have strong impact on the imbalances between the production of oxidants and their elimination by antioxidant systems in the circulation. The consequences of this imbalance cause lipid abnormality in the body which indicates that the hypothyroid patients are more prone for ischemic changes in the cardiac tissue leading to atherosclerosis & myocardial infarction. Therefore, estimation of these novel markers such as IMA & hs-CRP levels in hypothyroid patients might be useful as early markers to detect the future cardiac ischemic diseases.

299-304

Authors: Sivaa Rajendran, Thiagarajan Govindan, Meenakshi Vedavyasan, Kalaiselvi Selvaraj.

Introduction: Traumatic Brain Injury (TBI) due to road traffic accidents is one of the leading causes of mortality and morbidity in India. Since albumin is associated with the patho-physiological events following TBI, we aimed to estimate the same in these patients and to find whether it can be used as biomarker. Materials and Method: Fifty four consecutive patients admitted to our emergency intensive care with varying degrees of head injuries, were grouped into 3 categories based on the admission time Glasgow Coma Scale (GCS) as mild (13 to 15), moderate (9-12), and severe brain injury(8 or less) and their serum albumin were estimated. Results: Out of 54 patients, 15 had hypoalbuminemia (albumin <3.5g/dL), while for the rest the levels were normal. In the normal albumin group 87% patients showed good outcome and only 13% showed poor outcome. With Kaplan-Meier survival curves, patients with normal albumin levels showed a significantly higher chance to survive than patients with hypoalbuminemia. Further stratification of our cohort into groups according to the interquartile range of serum albumin and comparing it with their clinical outcome by Cox regression indicated that the probability of mortality increased with the decrease in serum albumin (hazard ratio[HR] = 0.15; 95% CI = 0.03- 0.6) with a significant p value of <0.05. Conclusion: Serum albumin can be used as a prognostic markers in predicting the adverse outcome in TBI patients.

309-314

Authors: Rina Raibhan Wasnik, Veerabhadra Goud GK, DHSV Sarma, KP Joshi, Nagalakshmi CS.

Type 2 Diabetes Mellitus (DM) has emerged as a major public health issue associated with various complications. Patients with metabolic syndrome (MS) have increased risk of developing cardiovascular disease and type 2 diabetes mellitus. C-reactive protein (CRP) correlates with individual components of metabolic syndrome and confer cardiovascular and metabolic risk. Magnesium is an essential ion involved in glucose homeostasis at multiple levels. Hypomagnesaemia has been reported in both IDDM and NIDDM patients. The present study is aimed to find the level of serum magnesium and CRP in type 2 diabetes mellitus and their association with development of metabolic syndrome and further development of type 2 diabetes mellitus. We have undertaken study on 120 subjects, categorized into three groups were involved in the study. FBS, lipid profile, serum magnesium and serum CRP levels were estimated in addition to recording of BP and anthropometric measurements. Results: Serum magnesium levels were towards lower limit of normal range in both T2DM and MS groups with respect to controls. Further, serum CRP levels were elevated to nearly two times in T2DM and MS groups. Conclusion: Our study findings suggest that serum magnesium and CRP levels are inversely related inflammatory markers are independent of Type 2 DM. This study could help in further studying degree of Hypomagnesemia and correlated elevation in CRP levels. Moreover, dietary supplementations of magnesium and/or other nutrient should be tried in case of Metabolic Syndrome along with assessment of Magnesium, CRP or other markers, in view to control these end stage pre diabetes condition from the development of Type 2 DM and to reduce the mortality resulting from cardiovascular diseases. Key Messages: Serum magnesium levels were significantly decreased in T2DM & Metabolic Syndrome. Serum CRP levels were significantly increased in T2DM & Metabolic Syndrome.

319-323

Authors: Syeda Shahana Jalees, M. Rosaline.

Increased oxidative stress may contribute to development of complications in diabetes may result from over production of precursors to reactive oxygen radicals and/ or decreased efficiency of inhibitory scavenger systems. Senile diabetic cataract is one of the chronic complications of diabetes mellitus. The present study has been carried out in patients suffering with NIDDM (Type-2) with or without associated cataract. Hyperglycemia causes oxidative stress, as measured by malondialdehyde (MDA) (a lipid peroxidation product) is more in diabetic patients (370.80 n.mol/l) compared to the normal individuals (181.04 n.mol/l) whereas the oxidative stress in diabetics with cataract is significantly more (399.12 n.mol/l) than that in diabetics without complications. Attempts have been made under present study to estimate serum MDA levels as a marker of free radical stress against free radical injury.