International journal of Clinical Biochemistry and Research

324-328

Authors: Akshatha LN, Srikrishna R, Swathi Vijay Kumar, Mamatha T Shenoy, Poornima A. Mansrekar.

Malaria is a major health problem in the tropics. Liver dysfunction has been a common finding in malaria patients. Malaria causes inhibition of certain liver functions without showcasing signs of hepatic insufficiency. After termination of such attack, normal liver may be restored but a continued low-grade malarial infection can cause permanent liver damage. This retrospective study was done in order to study the proportion of hepatic and renal involvement to find possible ways of modifying the clinical outcomes. All malaria positive cases from June 2012 to June 2015 in Kasturba Medical College hospitals were included. The patients were stratified into 3 groups based on the type of malaria Group I – P. vivax, Group II – P.falciparum and Group III- mixed (P.falciparum and P.vivax) and sub-divided based on age and sex. Their hepatic and renal functions were evaluated. Statistical analysis was done using SPSS vers.11.5 using descriptive analysis and ANOVA. A total of 2139 cases of malaria were diagnosed based on their peripheral blood pictures of which males (75%) outnumbered females (25%). In the three groups the proportion of infection was 81.5%, 3.4%, and 15.1% respectively and hepatic dysfunction was 57.3%, 39.2% and 74.7% respectively. Out of the 67 P.falciparum infected patients 70% had renal dysfunction. 61% patients had anaemia. We conclude that malaria is a major health concern in this region, majority being infected with P.vivax. The proportion of patients having severe manifestations like severe anaemia, jaundice, hypoalbuminemia and hepatopathy was more significantly associated with mixed malaria followed by P.vivax.

335-337

Authors: Madhubala V, Anusha R.

Introduction and Objectives: Osteoporosis characterized by low bone mass is a major health problem in post-menopausal women. Bone Mineral Density (BMD) represents the density or thickness of bones. Vitamin D plays an important role in bone growth and maintenance. Vitamin D inadequacy is implicated in the development of osteopenia and osteoporosis. To study the Bone Mineral Density and serum 25-hydroxy Vitamin D levels in post-menopausal women. Materials and Method: This was a cross sectional study conducted in the Gynaecology OPD at a tertiary care centre in Chennai. 3o postmenopausal women in the age group of 45 and above were chosen for the study. Bone mineral density was measured by ultrasound bone densitometer and expressed as T score. Serum 25 hydroxy vitamin D levels were estimated by Chemiluminescence method. The data was analysed using SPSS software version 16. Results: T score of all the subjects ranged between -2.5 to -4.25. The mean serum 25-hydroxy Vitamin D level was 16.6 ± 4.8 ng/ml. Pearson correlation analysis was done. A significant correlation was seen between Age and Bone Mineral Density (p<0.000), 25- hydroxy Vitamin D and Bone Mineral Density (p<0.000), age and 25- hydroxy Vitamin D (p<0.000). Interpretation: In this study the T score of all the subjects ranged from -2.5 to -4.25 which is suggestive of osteoporosis. In this study 37% of the subjects had 25-hydroxy Vitamin D levels less than 20ng/ml suggestive of Vitamin D Deficiency. Conclusion: Vitamin D could be an important factor implicated in the development of osteoporosis in these post-menopausal women.

342-347

Authors: D. Sridevi, G. Lakshmi Chaitanya, Amrut A. Dambal, V. Sampath Kumar, Ch. Anila Sushma.

Introduction: The Metabolic Syndrome is a constellation of risk factors predictive of future Cardio Vascular Accidents (CVA) and Type 2 Diabetes Mellitus (T2DM) in adults. Recently several studies revealed that metabolic syndrome is present in younger populations, suggesting that the origin of chronic metabolic diseases manifest relatively early in life. Objectives: To assess the risk of metabolic syndrome in young obese students by assessing physical and biochemical parameters. Materials and Method: This study comprised of students studying MBBS at Guntur Medical College. 30 Males and 31 Females between 18 to 22 years, with increased BMI were considered as cases and age matched 30 Male and 34 Female students with normal BMI were considered controls. Physical Parameters like Weight, Height, Blood Pressure, Waist Circumference and Biochemical parameters like Fasting Plasma Glucose and Lipid profile were analyzed for risk assessment of metabolic syndrome. Results: It was observed that 23.33% of male cases and 19.35% of female cases had Metabolic Syndrome. Conclusion: In our study, young obese subjects were more prone to Metabolic Syndrome. The metabolic syndrome and its future consequences, including CVA and T2DM, continue to increase until we find ways to prevent obesity. This can be achieved through adopting the required healthy life style changes.

354-356

Authors: Pritee Gopalrao Pendkar, Tushar Vaijanathrao Bansode.

Introduction: Alteration of lipid levels in ARF patients fastens the atherosclerotic process which causes cardiovascular complications.(1) It is observed that levels of different lipoprotein fractions were changed in acute renal failure patients. Materials and Method: This case control study includes total 100 subjects. Out of these 50 subjects were clinically diagnosed ARF patients having age more than 20 years and remaining 50 subjects were chosen from healthy controls not having any major medical problem. Fasting venous blood samples were collected and serum levels of Total cholesterol (TC), Triglycerides (TG), High density lipoprotein cholesterol (HDL-C), Low density lipoprotein cholesterol (LDL-C), Very low density lipoprotein cholesterol (VLDL-C) were measured. Results: It is seen that Total cholesterol, Triglycerides, Very low density lipoprotein cholesterol and Total cholesterol to High density lipoprotein cholesterol ratio were significantly increased in ARF group as compared controls while mean value of High density lipoprotein cholesterol was significantly decreased in ARF as compared to control. The mean level of Low density lipoprotein cholesterol did not show any significant difference between these two groups i.e. controls & ARF. Conclusion: The present study indicates that due to dyslipidemia in ARF, there is increased risk of cardiovascular complications.

363-367

Authors: Leelambika C, Pushpa Sarkar.

Aim: The present study is to assess the effect on the variations of total cholesterol, triglycerides, HDL cholesterol and LDL cholesterol in patients with acne vulgaris on low dose isotretinoin treatment. Materials and Method: A total of fifty patients diagnosed having moderate to severe acne with the age group of 15-45yrs attending dermatology department, was treated with 20mg of isotretinoin daily for 4 months. Blood Samples were collected on day 0, 2nd wk, 1month, 2month, 3month and 4month. Result: Measured baseline values of cholesterol in continuous therapy group 116.86 ± 23.55, then after at 4wks, 8wk, 12wk, 16wk and at the end of the treatment were increased above the baseline values at every interval. Significant P-value is obtained when compared with the baseline. There was statistically significant increase in cholesterol, triglycerides, LDL at all the intervals compared with baseline and above normal limit with significant decrease in HDL levels. Conclusion: Low dose continuous isotretinoin therapy caused increase in cholesterol, triglycerides, LDL above the normal range with grade 1 increase and decrease in HDL levels. Side effects were mild and well tolerated and did not need termination of the treatment. However it is important to educate about the consequences. We advise our specialist that the usage of low dose isotretinoin in moderate to severe acne can be done with minimal concern but close follow up is important.

374-378

Authors: Mihir Mehta, Simbita Marwah.

Aim: To determine the synergistic role of CKMB mass (CKMBM) and high sensitivity Troponin T (hs-cTnT) in the diagnosis of Acute Coronary Syndrome (ACS). Study Design: This was a cross-sectional study comprising of 140 individuals out of which 90 were cases and 50 healthy controls. The study was carried out in a tertiary care hospital between July 2014 to June 2015. Materials and Method: On the basis of clinical history and 12 lead electrocardiogram initial diagnosis of acute coronary syndrome was made in the cases. High sensitivity troponin T and CKMB mass was measured in all the individuals. Results: The sensitivity, specificity, positive and negative predictive value is 80.3%, 86.2%, 92.4% and 67.5% in case of CKMBM, while it is 98.3%, 65.5%, 85.7% and 95% in case of hs-cTnT, while the area under curve in case of CKMBM is 0.832 and in case of hs-cTnT is 0.819. Conclusions: Thus, we have concluded that hs-cTnT and CKMBM correlate well in the diagnosis of ACS. But hs-cTnT can detect false positive cases which can be avoided by using CKMBM along with hs-cTnT in the diagnosis of ACS.

383-386

Authors: Sunita M. Aghade, Jayshree S. Bavikar, Shilpa B. Asegaonkar.

Introduction: Preeclampsia is a hypertensive disorder of pregnancy characterized by endothelial dysfunction. The present study was planned to assess and compare the levels of serum Lipoprotein (a) and lipid profile in preeclampsia and normal pregnant women and to determine the association of Lp (a) with severity of the disease. Materials and Method: The study comprised of 60 preeclamptic women and 30 normal pregnant women in third trimester of pregnancy. The serum levels of lipoprotein (a) [Lp (a)], triglycerides (TG), total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL) and very low density lipoprotein (VLDL) were determined. Results: A significant alteration in Lp (a) and lipid profile parameters was observed in preeclamptic patients. Serum Lp (a), TG and VLDL were significantly increased while HDL was significantly decreased in preeclamptic group compared to normal pregnant women. Positive correlation was found between serum Lp (a) and blood pressure in preeclampsia patients. Conclusion: The present study demonstrates a dyslipidemic profile in preeclamptic patients. These findings are significant in understanding the pathologic processes of preeclampsia and may help in developing strategies for prevention and early diagnosis of the disorder.

391-394

Authors: Kapila Raina, Bageshwari Sharma, Neelima Verma.

Introduction: Haemoglobinopathies are major public health problems in India. Haemoglobinopathies are inherited single gene disorders having abnormal globin protein. Genes in α-globin and β-globin genes clusters (on chromosomes 16 and 11) control globin chain production. Due to spontaneous mutation in globin genes haemoglobin variants are produced. Disorders range from thalassemia to many hemoglobin variants with no, mild or severe consequences for the carrier. Materials and Method: The present laboratory-based retrospective study was conducted for a period of two years from January 1, 2013 to December 31, 2014 in the Government Medical College, Jammu. Data of 543 patients who had come to the laboratory for their hemoglobin electrophoresis was compiled and studied. Complete blood count was carried out on HMX (Beckman Coulter) and hemoglobin electrophoresis for diagnosing any abnormal hemoglobin disorder was done on D10 (BIO RAD). Results: Out of 543 patients, 368 (67.77%) were normal and 175 (32.23%) had abnormal hemoglobin pattern. Spectrum of haemoglobinopathies prevalent in descending order were 13.99% β-thalassemic trait, 6.26% α-thalassemic trait, 4.6% elevated fetal haemoglobin, 2.57% false elevation of hemoglobin A2 because of mean corpuscular volume, 1.29% β-thalassemic major, 0.93% haemoglobin S homozygous, 0.74% borderline hemoglobin A2, 0.55% patients were with other type of hemoglobinopathies. Conclusion: High prevalence of haemoglobinopathies in Jammu division makes the disease a major public health problem in our population. Population screening, genetic counseling and prenatal diagnosis can prevent these genetic disorders.

400-404

Authors: GSR Kedari, PM Abraham Sam Rajan, Ratnashree Biswas.

Introduction: Several studies were conducted worldwide to estimate various endogenous hormone levels in breast cancer patients of post-menopausal women and very few studies were done in premenopausal women. In India, our study is the first study conducted to estimate the endogenous hormones in breast cancer patients of premenopausal age group. Materials and Method: 50 breast cancer patients of premenopausal age group were taken as cases and 75 age matched controls were selected for this study. Total testosterone, follicular estrogen, mid luteal estrogen, luteal estrogen, follicular progesterone, mid luteal progesterone, luteal progesterone were estimated for all the subjects. Results and Conclusion: Statistical significant increase was observed in the levels of testosterone in cases when compared to controls. Statistical significant difference was observed in the levels of follicular progesterone between cases and controls. No statistical significant difference was observed in other parameters between cases and controls.

408-412

Authors: Monika Patel, N. Haridas.

Introduction: Globally oral cancer is the sixth most common cause of the death with India accounts for 86% of the world’s oral cancer cases.(1) Chronic use of tobacco, areca nuts and betel quid consumption results in progressive premalignant condition called oral sub mucous fibrosis.(2) Free radicals are released during the metabolism of tobacco and areca nut, that’s associated cell damage, leads to an imbalance between the pro-oxidant and antioxidant states. This imbalance plays an important causative role in carcinogenesis.(3) This malignant transformation rate is around 7.6%.(4) Materials and Method: Total 150 patients are selected for this study, out of which 50 patients are diagnosed oral submucous fibrosis, 50 patients are oral cancer and 50 patients are healthy non tobacco consuming control were included. In this study oxidative stress, Ascorbic acid, α-tocopherol, copper, iron and acute phase protein were measured by using standard kit method. Result: Serum Melondialdehyde, C-reactive protein and copper concentration was found to be significantly higher (p < 0.05) as compared to healthy control due to the generation of free radicals by lipid peroxidation. Serum iron, Ascorbic acid and α-tocopherol were found to be significantly reduced (p < 0.001) than healthy control due to damage the epithelium and disturbance in collagen metabolism. Conclusion: Our observation suggested that serum Melondialdehyde, vitamin C, vitamin E can be used as marker of OSMF. Decreased Vitamin C & E is closely associated with increased Melondialdehyde, as the marker of oxidative stress is significant. Among the all trace elements, Serum copper and iron are highly significant markers for the early diagnosis of oral submucous fibrosis. The CRP Concentration is associated with development of oral cancer and also serves as a potential prognostic biomarker.

416-420

Authors: Prasad P Torkadi, AK Bhutey, IC Apte.

Introduction: Variety of liver diseases including alcoholic liver disease (ALD) is responsible for liver related morbidity and mortality in India. Distinguishing ALD from non-alcoholic steatohepatitis (NASH) and viral hepatitis may not be easy. The history of alcohol intake may be unreliable. Clinico-pathological findings may not yield the correct diagnosis. So aim of our study was a) To compare the patients of ALD with those of NASH and acute viral hepatitis by biochemical parameters like serum Cholinesterase, Lactate dehydrogenase and Albumin/Globulin ratio and b) To assess the utility of these parameters in differentiating patients of ALD from NASH and acute viral hepatitis. Materials and Method: Study was carried out on 50 patients of ALD, 35 patients of NASH and 35 patients of acute viral hepatitis. All the patients were in the age group of 20-70. Selection criteria were history of alcohol, clinical examination, raised serum bilirubin levels and viral studies. Blood sample analysis was done for bilirubin, cholinesterase, lactate dehydrogenase, total protein and albumin by Diazo, kinetic, biuret and BCG method respectively on fully automatic analyser. Statistical analysis was done by Student unpaired ‘t’ test. Results: The patients of NASH and acute viral hepatitis had normal serum ChE, albumin and LDH levels compared to patients of ALD who had lower serum ChE and albumin with higher LDH levels. These differences in the findings were statistically significant (P<0.05).Lowered serum ChE and albumin levels with A/G ratio reversal might be because of long term alcohol induced hepatic injury resulting in lowered synthetic capacity. Increased LDH in ALD might suggest a hypoxic injury and a progression towards necrosis. Normal serum ChE, A/G ratio and LDH in patients of NASH as well as acute viral hepatitis suggested that hepatic synthetic capacity is intact with no hepatocyte hypoxia. Conclusion: So our study concluded that NASH and viral hepatitis patients had less hepatocyte injury and fair prognosis as compared to ALD patients who had more hepatic loss with worse prognosis. Further our study has drawn a conclusion that we can biochemically differentiate NASH and acute viral hepatitis from ALD on the basis of parameters like ChE, LDH and A/G ratio. This finding can be used by clinicians to support their diagnosis whenever clinical dilemma occurs.

427-431

Authors: Sangappa Virupaxappa Kashinakunti, Manjula Rangappa, Gurupadappa Kallaganada

Introduction: Mild increase in liver enzymes, may be a marker for significant liver injury. The increased transaminases and hepatomegaly are found to be reversible with glycemic control. Objectives: 1. To compare the liver enzyme levels between type 2 DM with healthy controls 2. To study the correlation between FBS, HbA1c and Liver enzymes 3.To find the best cut-off values of AST and ALT, to suspect the non-alcoholic fatty liver disease (NAFLD) in DM. Materials and Method: The study was conducted at HSK hospital, Bagalkot. Fifty subjects participated in Uncontrolled type 2 DM (HbA1c >7) group and Controls.Biochemical parameters like FBS, urea, creatinine, liver function tests and HbA1c were estimated. All the subjects underwent ultrasonography of abdomen to detect the fatty liver. Results: The biochemical parameters FBS, HbA1c, blood urea, serum bilirubin, liver enzymes namely AST, ALT and GGT were raised significantly in T2DM patients compared to controls. There was positive correlation between FBS and HbA1c and the liver enzymes AST, ALT and GGT(P=0.0001). Best cut-off value of liver enzymes was calculated using ROC curve and the values for AST, ALT and GGT were >34 IU/L, 28 IU/L and 24.3 IU/L respectively. Conclusion: Increased liver enzymes in uncontrolled type 2 DM, positively correlated with glycemic markers, when AST >34 u/l and ALT >28U/L, can act as a predictor NAFLD and may be useful for further evaluation of patients.

435-438

Authors: Smita Kottagi, Triveni Jamble, Srinivas Deshpande.

Aim: Hypothyroidism is proved to be associated with atherosclerosis and cardio-vascular disease. But correlation between subclinical hypothyroidism (SCH) and increased cardiovascular risk is yet to be established. This study was done to investigate subclinical hypothyroidism and its associations with cardiovascular diseases. Objectives: To quantitatively detect the levels of lipid profile parameters and range of blood pressure, in subclinical hypothyroid and euthyroid subjects. To correlate cardio vascular disease risk factors and their association with subclinical hypothyroidism. Materials and Method: total sixty SCH cases and sixty euthyroid controls were compared. Serums levels of T3, T4, TSH were estimated by standard ELISA kit method, Serum LDL-Cholesterol using Friedewald equation, Triglycerides by GPO-POD with espas method, and Total-Cholesterol, HDL-Cholesterol by enzymatic CHOD-PAP by enzyme colorimetric method. Result: Study showed increased mean serum levels of LDL Cholesterol, Total cholesterol, TSH, Triglycerides, systolic & diastolic BP. Serum levels of T4, HDL-Cholesterol remained normal. Number of people with increased Total Cholesterol, Triglycerides, LDL-C, systolic BP & diastolic BP and decreased HDL-C were more in subclinical hypothyroidism compared to euthyroid cases suggesting the dyslipidemic and hypertensive changes in SCH cases. Conclusion: Study showed that cardio-vascular risk factors are highly associated with hypertension and dyslipidemic state seen in subclinical hypothyroidism cases, suggesting the higher association with subclinical hypothyroidism and risk factors of cardio-vascular disease.

443-447

Authors: Imran Mustafa, Manisha Arora, Sudeep Kumar, Jyoti Batra, Sumesh P. Sah.

Introduction: Chronic kidney diseases (CKD) comprise the conditions that damage the kidneys and decrease their ability to keep you healthy by doing the jobs listed. If kidney disease gets worse, wastes can build up to high levels in the blood and make you feel sick. Materials and Method: We screened 7462 subjects from outpatient department of Muzaffarnagar Medical College and Hospital from September 2016 to February 2017. Of the 7462 screened subjects, 6668 eligible subjects were enrolled in this study. We obtained personal and medical history data through a specifically designed questionnaire. Blood and urine samples were collected. Results: In our study the prevalence of chronic kidney disease (CKD) was 11.19%. 52.95% chronic kidney disease patients were suffering from diabetes with hypertension, 29.49% from diabetes alone, 16.75% from hypertension alone and 0.8% from other diseases. Conclusion: The major risk factor for chronic kidney disease (CKD) appears to be diabetes mellitus with hypertension which is taking a large chunk of the patients towards CKD than Diabetes or Hypertension alone.

453-455

Authors: Ranjeet V. Jadhav, GJ Belwalkar, PE Jagtap, SP Dhande, NS Nagane.

Introduction: Oxidant lead to cell death through apoptosis and necrosis. The effects of reactive oxygen radicals are balanced by the antioxidant action. The aim of the study was to assess oxidative stress and antioxidant status in coronary artery disease patients before percutaneous transluminal coronary angioplasty and in healthy controls. Materials and Method: 120 patients of coronary artery disease, before PTCA and 120 healthy controls were included in the study. Malondialdehyde (MDA), Superoxide Dismutase (SOD), Vitamin C, Creatine Phosphokinase total (Cpk total) and Creatine Phosphokinase-MB (Cpk-MB) levels were measured before PTCA in patents and in controls. Result: There were increased levels of MDA, Cpk-total and Cpk-MB, 9.42 ± 1.07 nmole/ml, 105.95 ± 45.44 U/L, 12.20 ± 6.03 U/L (p < 0.001, p < 0.001 & p > 0.05) respectively, however oxidative stress significantly increased in patients than that of controls. Activity of SOD was 3.19 ± 0.45 (p > 0.05) and Vitamin C was 0.88 ± 0.32 (p > 0.05), decreased in patients before PTCA as compared to controls. Conclusion: These findings suggest that cardial lipo peroxidation may be a common event following brief episodes of myocardial ischemia and support a role for antioxidant therapy in patients with ischemia heart disease.

461-466

Authors: V. Yogeswari, P. Nirmaladevi, R. Chitraa, Poongughali Gopinath, P. Senthil Nathan.

Introduction: Osteopontin plays an important role in the pathogenesis of Systemic Lupus Erythematosus(1) and lupus nephritis. OPN may influence the autoimmune disease, SLE through its immunoregulatory effects, enhancing the pro-inflammatory Th1 cell response and inhibiting the Th2 responses.(2,3) We carried out this study to determine the association of osteopontin gene 9250 C→T polymorphism and increased plasma osteopontin activity with systemic lupus erythematosus. Aim: The aim of the study was 1) To determine the association of single nucleotide polymorphism at 9250 C→T in exon 7 of OPN gene among the patients with SLE (with and without nephritis) and healthy controls. 2) To assess the plasma OPN activity among study groups and correlate their level with the genotype. Materials and Method: The study population includes Group 1A: 50 SLE patients with lupus nephritis, Group 1B:50 SLE patients without lupus nephritis, Group 2: 50 age and sex matched healthy individuals. OPN gene 9250 polymorphism was detected by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP). Plasma Osteopontin level was estimated by ELISA. Results: A significant difference was observed in the frequencies of OPN gene 9250 T allele between the SLE patients with nephritis and the controls (72% vs 33%, P<0.05). Highest level (305.79ng/mL) of OPN activity in TT genotype, lowest level (96.42ng/mL) in CC genotype and intermediate level(187.84ng/mL) in CT genotype was observed in our study with significant statistical difference(p value<0.001). Conclusion: There was a significant association between OPN gene 9250 C→T polymorphism and increased plasma OPN level with SLE.