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.

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.

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.

Page No. 1-5

Authors: PM Abraham Sam Rajan

Introduction: Clinical biochemistry laboratory uses many techniques for measuring the concentration of specific biochemical substances. All these techniques are subject to interference from variety of sources. The aim of our study is to see the changes in concentration of serum bilirubin on exposure to special blue light of 440nm for six hours and to study the usefulness of photolysis for the elimination of bilirubin interference in the estimation of creatinine, glucose, and alkaline phosphatase. Method: We have taken 218 samples and the samples were analyzed for the estimation of total bilirubin, direct bilirubin, creatinine, glucose and alkaline phosphatase before and after photolysis. Results & Conclusion: There was significant decrease in the concentration of total and direct bilirubin after photolysis. There was a significant negative interference of creatinine and glucose and significant positive interference of alkaline phosphatase with an increasing concentration of bilirubin which was also eliminated by photolysis.

Page No. 11-14

Authors: Asmabi M, Netravathi Basappa Sajjan, Tousif Devale, Shivaleela M Birasar, Shireen Quadri

Background: The leading cause of chronic renal disease and end stage renal disease is diabetic nephropathy, so early recognition is very important. The important biochemical test for diagnosis of renal function is estimation of glomerular filtration rate (GFR). The accurate methods of GFR estimation are Inulin clearance and 24h urine collection, which are expensive and time consuming and require experts to perform. Hence some formulas have been developed for the GFR measurement. Objective: To find out the prevalence of renal dysfuntion based on the levels of serum creatinne and estimated GFR, calcuted using Cockcroft-Gault (CG) and Modification of Diet in Renal Disease (MDRD) equations in type 2 diabetic patients. Materials and Methods: A case control study was carried out on 50 type 2 diabetic patients and 50 healthy controls. Renal function was analyzed through serum creatinine and GFR estimated using the CG and MDRD equations. Results: Among the 50 diabetic patients, 34% show high level of serum creatinine i.e. > 1.4 mg/dl, while the low eGFR that is < 90ml/mim is seen in 58% of diabetic patients by MDRD equation and 64% of patients by CG equation. The mean serum Creatinine level is significantly high p value (<0.001) in diabetic patients when compared with controls. The eGFR is significantly low p value (< 0.001) in diabetic patients when compared with controls. Conclusion: The prevalence of renal dysfunction based on serum creatinine level is low when compared with eGFR by MDRD and CG equation, indicating the significance of these equations in estimating GFR. Hence for the better assessment of renal function these equations can be used as compliment to the levels of serum creatinine alone.

Page No. 19-21

Authors: Deepa Singh

Studies have shown that Vitamin D is necessary for normal insulin secretion. Vitamin D reduces insulin resistance through regulation of the insulin receptor gene and its effects on calcium and phosphorus metabolism. Therefore, deficiency of vitamin D results in decreased insulin secretion and increased insulin resistance, both of which are characteristics of type 2 Diabetes mellitus. The predisposition of Vitamin D deficiency to Glucose intolerance via altered insulin secretion may be done either through a direct action via Vitamin D receptor (VDR) activation or indirectly via calcemic hormones and also via inflammation. The study is aimed to measure and correlate Vitamin D status with serum level of fasting and postprandial Glucose, Total Cholesterol and Triacylglycerol level in individuals of Udaipur. The study was carried out on total 300 vegetarian subjects, out of which 190 were females and 110 were males with an average age of 54.25±8.94 years. Subjects were divided into two categories depending upon their serum total Vitamin D value. Category A included subjects with total Vitamin D value below 10 ng/ml and category B included subjects with total Vitamin D value between 30-70 ng/ml. The subjects with total Vitamin D value between 10-30 ng/ml were excluded from the study. Results clearly indicated that Category A with Vitamin D value below 10 ng/ml had significantly higher serum fasting, post prandial Glucose, Total Cholesterol and Triacylglycerol level as compared to subjects with Vitamin D value between 30-70 ng/ml (category B) with significance (p value <0.05). Vitamin D deficiency can lead to dysregulation of Glucose and lipid metabolism. Supplementation of Vitamin D in Vitamin D deficient individuals may reduce the risk of Diabetes mellitus and dyslipidaemia by improving insulin secretion and Glucose tolerance.

Page No. 25-29

Authors: Dhiraj J. Trivedi, Vishwaraj PK

Aim: To evaluate erythrocyte surface electric charge in β- thalassemia by using Alcian Blue dye binding. Objective: Estimate the binding of AB dye to Sialic acid on the surface of thalassemia and normal, healthy erythrocytes. Compare negative charge due to Sialic acid on the surface of erythrocyte of thalassemia with healthy control subjects. Result: The study was performed on 60 thalassemia subjects (39 male, 21 female, mean age 8.3years) and 30 age and sex matched normal control subjects (17 male, 13 female, mean age 6.8years). Hematological parameters analyzed on beta thalassemia subjects’ shows significant difference among control and Thalassemia group. Levels of HbA2 showed a marginal difference (p=0.041). Cationic dye, Alcian Blue, in PBS (pH7.4) was used as a reagent to demonstrate binding of the dye to Sialic acid. Results of dye bound to thalassemic erythrocytes was significantly less (p<0.05) as compared to binding on erythrocytes of the control group. Conclusion: We believe, our data support the perception that there is decreased negative charge on the erythrocyte membrane in thalassemia reflected by cationic Alcian Blue dye binding.

Page No. 33-38

Authors: Chakrabarti C, Jatin D. Patel, Hitesh Mewada

Aim: Evaluation of different alternatives for Blood Gas Analysis of paediatric Cardiac surgical patients. Objectives: Arterial blood gas (ABG) analysis is very important tool for assessment of the clinical condition of patients in various critical conditions; however, arterial puncture may associate with many complications, particularly in paediatric patients. This study is conducted to determine whether venous blood gas (VBG) values can replace arterial blood gas values in paediatric age group patients undergoing cardiac surgery for congenital heart disease. To study correlation between arterial blood gas and venous blood gas we have examined arterial as well as venous blood pH, PCo2, PO2, HCO3- , Base excess, Ct O2, SO2 and Ct CO2. Method: The study was conducted during June 2008 to December 2010 at an academic tertiary care hospital in Ahmedabad where DM and MCH super specialist are available as a consultant. Totally, 50 paediatric patients suffering from congenital heart disease included in this study and arterial as well as venous blood sample were collected for blood gas analysis. Result: There was no significant difference observed between arterial and venous blood respectively in pH (7.37 +/-0.04, 7.33+/-0.04), PCo2 (35.51+/- 5.08, 43.54+/-4.94), HCO3- (20.64+/-1.69, 21.30+-1.81) but significant difference observed in PO2 (77.26+/-37.43, 38.05+/-6.81), Ct O2 and SO2. Conclusion: We do not recommend venous blood sample as an alternate of arterial blood sample for blood gas analysis as there is poor correlation in PO2, CtO2 and SO2.

Page No. 43-46

Authors: Anju Sharma, Neha, Sahiba Kukreja, Jaskiran Kaur, Amandeep Kaur

Background: The prevalence of thalassemias and various hemoglobinopathies are a major public health problem in Punjabi population. These cases are mainly overlooked and thus only treated as a part of anaemia. Thus it is worthwhile to study its prevalence and occurrence. The main objective of our study was to find the prevalence of hemoglobinopathies in Punjab and implement strategies for preventing marriages between two carriers for effective control of these diseases. Material and Methods: This was a case control retrospective study for screening for haemoglobinopathies of patient samples collected in biochemistry clinical laboratory, SGRDIMSAR, Vallah, Amritsar from 1 June 2015 to 30 May 2016 using automated Interlab Genios S electrophoresis system. EDTA samples were collected and 30 µL of lysate was applied on Genios S electrophoresis system in alkaline haemoglobin buffer. The results were interpreted by densitometer were obtained as a graph and interpreted. Results: In this study, out of 187 samples we received for screening of haemoglobinopathies, total of 143 (78.5%) were found to have a normal electrophoretic pattern and 44 patients (21.4%) were found to have one or other form of hemoglobinopathy. Conclusion: Punjabi population has high prevalence of haemoglobinopathy screening being an affordable and accessible way to detect carriers, it should be made mandatory in high schools, before marriage and antenatal clinics. Also, public education and awareness for screening in areas of high prevalence of consanguinity should be made mandatory.

Page No. 56-59

Authors: Prakash S. Hundekar, Adinath Suryakar, Aarti Karnik, Rahul Ghone, Sonali Bhagat

Background: Sickle cell anaemia (SCA) is a hereditary disorder, associated with severe haemolytic anaemia, periodical vasooclussive pain, and premature death. Prevalence of SCA is alarmingly high in north Maharashtra comprising districts of Nandurbar, Dhule, Jalgaon and Nashik. Non heme iron and depleted erythrocytic glutathione are associated with generation of free radicals leading to oxidative stress. Oxidative stress may enhance haemolysis by damaging erythrocytic membrane. Aim and Objectives: To evaluate serum iron, erythrocytic MDA and erythrocytic Glutathione in relation with possible markers of oxidative stress in the steady state of SCA individuals. Methods: A total of 90 subjects were recruited in the study including 30 sickle cell trait (HbAS), 30 sickle cell disease (HbSS) and 30 healthy controls. In all subjects serum iron and bilirubin, erythrocytic Malondialdehyde (MDA) and glutathione (GSH) concentration were investigated simultaneously. Results: Serum iron level found significantly (p<0.001) lowered in sickle cell trait (HbAS) while significantly (p<0.001) elevated in sickle cell disease (HbSS) compared to control. Serum bilirubin and Erythrocytic MDA found significantly (p<0.001) elevated in HbAS and HbSS. Erythrocytic glutathione was found significantly (p<0.001) depleted in both HbAS and HbSS in comparison of control. There is positive correlation between erythrocytic MDA and serum iron. Conclusion: Our study suggests, elevated serum iron and bilirubin is result of excessive hemolysis. Depleted Erythrocytic glutathione and elevated malondialdehyde reveals hyphened oxidative stress, further which could be sickling and hemolytic propagator aspect in sickle cell anaemia.

Page No. 64-67

Authors: Sreekumari RG, Sandhya CV

Background: The hypermetabolic state seen in hyperthyroidism causes increased oxygen consumption resulting in an increased formation of Reactive Oxygen Species leading to tissue injury. Increased oxidative stress characterised by elevated levels of free radicals and diminished antioxidant status has been described in animal models as well as in patients with hyperthyroidism. Thyroid gland is characterized by high activity of the antioxidant enzyme Glutathione Peroxidase (GSHPx) and this has been studied much reflecting the imbalance of antioxidant enzyme systems in thyroid dysfunction. However, contradictory results have been obtained regarding plasma and erythrocyte GSHPx levels in hyperthyroidism. Studies have also shown that antithyroid drugs like Methimazole and propyl thiouracil have antioxidant effects. How the treatment with these drugs affect the antioxidant status is also a matter of debate. Hence, the present study aimed to evaluate the erythrocyte Glutathione Peroxidase levels in hyperthyroidism in comparison with normal controls and evaluate the effect of methimazole treatment. Methods: The study was carried out in patients attending the special investigation laboratory in the department of Biochemistry of our college for assessment of their thyroid function. The study groups included: Group 1 (n = 40) consisting of healthy euthyroid controls. Group 2: (n=30) clinically diagnosed hyperthyroid patients, 17 were untreated fresh cases (series1) and 13 patients were undergoing treatment with methimazole for the past one month (series2). Erythrocyte Glutathione peroxidase enzyme levels were analyzed in blood samples collected from these subjects along with thyroid function tests T3, T4 and TSH. Results & Conclusion: Comparison of the mean values showed that the elevated levels of thyroid hormones have come down in the Methimazole (MMI) treatment group as expected. There were very low TSH levels in the untreated group whereas in treated group TSH levels were at the lower limit of normal range. The mean GSH Px levels in untreated hyperthyroid patients were significantly elevated (6.970± 0.302μmoles/L) compared to normal controls (6.117 ± 0.133μmoles/L). The GSHPx levels in the treated group were closer to the GSHPx values of the control group.(6.125 ± 0.482μmoles/L)

Page No. 73-76

Authors: Shruthi Rai P, Sukanya Shetty, Roopa Bhandary, Ashalatha V Rao

Introduction: Reference Intervals are the most common decision making tools for interpretation of various biochemical reports. Age, sex, ethnicity, diet, physical and socio-economic conditions, affect the physiology of population. Hence it is necessary to setup reference values that are applicable to specific population rather than to borrow them from other population based studies or from literature from reagent kit manufacturers. So we intend to establish the reference intervals of serum bilirubin profile in southern coastal Karnataka population. Methodology: Hospital based cross sectional study was done involving 200 subjects. The subjects were randomly selected from the population, which included medical students, health professionals, and those who attended different OPDs and health camps organized by the K S Hegde hospital for general check-ups under health plan scheme. Total bilirubin and direct bilirubin was estimated by dichlorodiphenyl diazonium method. Indirect bilirubin (Total bilirubin-Direct bilirubin) was calculated. Results: The reference intervals observed for men and women are as follows: Total bilirubin (0.1-1.3)mg/dl and (0.1-1.38)mg/dl, serum direct bilirubin (0-0.5)mg/dl and (0-0.3)g/dl, and serum indirect bilirubin (0.1-0.9)mg/dl and (0.1-1.3)mg/dl respectively. With the advancement of age, a difference in the reference interval was observed among both the sex. Conclusion: The present study showed a difference in the reference intervals between males and females and also a categorical age wise difference was obtained.

Page No. 81-84

Authors: K. Vani, G. Sasirekha

Aim: To assess the biochemical parameters of renal and hepatic function in women with GDM and compare the results with those of normal pregnant women. Materials and Methods: Cases: The study group consisted of 45women with GDM. Controls: 45 healthy pregnant women without any complications of pregnancy were taken as controls. The parameters of renal function which include serum urea, creatinine, uric acid and liver function which includes serum bilirubin, albumin, alanine aminotransferase, aspartate aminotransferase and alkaline phosphatase were estimated between 24 to 28 weeks of gestation using a fully automated clinical chemistry analyzer. Results: Serum creatinine and uric acid levels were found to be significantly elevated in cases. On the contrary, the serum albumin levels were significantly reduced in cases. No significant change was found in serum urea, bilirubin, alanine aminotransferase, aspartate aminotransferase and alkaline phosphatase levels between the groups. Conclusion: The increased serum creatinine and uric acid levels in cases suggest that GDM may jeopardize the renal function and also increase the risk for future kidney disease in these women

Page No. 88-93

Authors: Khot Varsha V, Yadav KS, Haldankar VA

Introduction: Type 2 diabetic nephropathy (T2DN) develops inflammation in kidney which leads to failure. Study designed to evaluate risk of diabetic nephropathy (DN) by inflammatory gene expressions (IL6, IL10) and renal parameters at the early stage in type II diabetes mellitus (T2DM) in Indian population. Methods: This study includes 241 subjects (118 men, 123 women, and age ranges 30-70 years, distributed in three groups on the basis of age. Subjects recruited after screening for T2DM by measurement of blood glucose in fasting, post-prandial and glycosylated hemoglobin, microalbumin was measured from spot urine for screening of DN. Results: Analysis of data of routinely used renal parameters found within reference interval except e-GFR marginally deviated from control group (p <.00). Other parameters showed marginal significance within and between the groups. Pro-inflammatory cytokines IL-6 and IL-10 evaluated by rt-PCR, showed high degree of significance (p <.00) in both study groups. Results of this study suggest that measurements of renal parameters are not enough to diagnose early stage of diabetic nephropathy (DN) and eventually to prevent progression of the disease. Conclusion: It was concluded that early measurement of IL6, IL10 along with direct and indirect renal marker was suggested to prevent morbidity & mortality in DN.

348-353

Authors: Ranjan Agrawal, Miti Gupta, Nitesh Mohan, Biswajit Das, Rajat Agarwal

Pleural effusion is a common clinical problem resulting from thoracic or systemic diseases. Several biochemical parameters, serological and cytological markers are used to classify the type of pleural effusion. The oldest classification is Light’s criteria which categorizes exudates by meeting one of these criteria: Pleural to serum protein ratio> 0.5, pleural to serum LDH ratio> 0.6 and isolated LDH > two third of normal upper limit of serum L. DH. Others criteria are protein gradient and Serum effusion albumin gradient. Combination of clinical findings along with biochemical findings along with cytology helps in determining the etiology of pleural effusion. Materials and Methods: One hundred fifty samples of pleural fluid paired with serum were examined. Pleural fluids were also subjected to biochemical study to find out the level of protein, albumin, glucose, Adenosine deaminase levels, LDH, total and differential cell counts, Gram’s stain and Modified Ziehl-Neelsen stain. Serum samples were evaluated for protein, albumin and LDH levels. Results: Out of 250 samples, total of 71.2% samples were exudative and 28.8% were transudative. There were 184 males and 66 females. Tuberculosis (42.7%) followed by para-pneumonic effusion (22%) was commonest etiology seen in exudative pleural effusions. In transudates, chronic liver disease (10.8%) followed by chronic renal disease (8.4%) was the commonest etiologies encountered. Light’s criteria was nearly successful in classifying all exudates. All the inflammatory effusions were 100% classified by pleural LDH levels. All transudates are correctly classified by Serum effusion albumin gradient. Conclusions: Light’s criteria was most sensitive in identifying exudates but not specific in cases of transudates specially heart failure patients. Light’s criteria was 97.7% successful in classifying exudative pleural effusion. Combination of pleural LDH and pleural fluid to serum protein ratio was successful in classify all the exudates correctly.

357-362

Authors: MA Bari Siddiqui, Addanki Yottoshuka

Diabetes has become a universal major health concern, personal habits form an integral part of its etiology and poor control of blood sugar is a major contributor of associated morbidity. Betel nut (Areca catechu) has become a personal habit of at least 10% of the world population. The alkaloids and nitrosated compounds inside betel nut are competitive inhibitors of GABA receptors affecting the body in various ways, including the brain, cardiovascular system, lungs, gut and pancreas. Betel nut usage is also associated with increased central obesity in man and effects of chronic usage in man are similar to those of smoking and increase the risks of ill health. In line with the above theory the present crossectional study was conducted in department of Biochemistry, Bhaskar Medical College, Yenkepally and Siddhartha Medical College, Vijayawada. 70 patients were enrolled in the study and the usage and effects of betel nut chewing in diabetic patients were documented. The majority of patients enrolled with diabetes were in age group of >45 years, many of them being overweight or obese. Those with the habit of betel nut chewing had poor glycemic control evidenced by the high mean of post prandial blood sugar of 160mg/dl (p<0.001) and HBA1C levels indicating poor control of > 7% (p<0.001) whereas the fasting blood sugar levels had no significant differences (p>0.001). Because most of the occasion’s betel nut being taken after food and on the balance of evidence we can conclude that chronic consumption of betel nut in diabetic people is a major contributing factor for poor control of post prandial blood sugar levels and the explanation for the poor control being inhibition of GABA receptors on pancreas. Further work in the probable mechanism of poor control needs to be done to highlight the problem of this habit and necessary actions to be taken to prevent morbidity.

368-370

Authors: Deepa Singh

Cigarette Smoking is associated with adverse effects on lipid profile and Homocysteine thus increasing risk for atherosclerosis and coronary heart disease. Smoking is a prominent risk factor for coronary artery disease, atherosclerosis and peripheral vascular disorders. This study was undertaken to evaluate serum lipid profile in chronic smokers and to compare it with healthy non-smokers, considered as controls. Serum lipid profile was measured in 300 male subjects. Out of which 150 were smokers and 150 non-smokers (controls) with an age range of 50 to 60 years. Only chronic smokers who were smoking for more than 20 years were included in the study. It was revealed that mean serum Total Cholesterol (268.88±29.23 mg/dl), Triglyceride (192.12±56.42 mg/dl), Low Density Lipoprotein Cholesterol (189.76±15.74 mg/dl), Very Low Density Lipoprotein Cholesterol (38.42±11.28 mg/dl) were significantly higher in chronic smokers as compared to non-smokers with mean serum Total Cholesterol (182.56±21.33 mg/dl), Triglyceride (115.71±32.11mg/dl), Low Density Lipoprotein Cholesterol (107.68±9.55 mg/dl), Very Low Density Lipoprotein Cholesterol (23.14±6.42 mg/dl). On the other hand value of mean serum High Density Lipoprotein Cholesterol was lower in chronic smokers (40.7±2.21 mg/dl) than in non-smokers (51.74±5.36 mg/dl). Thus this study concludes that cigarette smoking produced adverse effects on lipid profile, leading to increase cardiovascular disease risk among smokers.

376-379

Authors: Dipti Basavaraj Sanakal, Sagar Chandrakant Mhetre, Ramesh S Patil, Abdul Kayyum Shaikh

Electrolyte and blood gas analysis are essential for most patients who are admitted in the casualty. Routinely simultaneous arterial and venous sample would be sent to the laboratory for blood gas analysis and serum electrolytes respectively. Electrolytes can also be measured by the blood gas analyzer. We wanted to find out if these values were reliable. Methods: This study has been checked and permitted by the hospital ethics committee. We obtained two samples, one venous and one arterial sample from patients in the intensive care unit (ICU) and casualty of Ashwini rural medical college, hospital and research centre, (ARMCH&RC) Kumbhari Solapur. The arterial blood samples were analyzed on the ABOTT arterial blood gas analyzer (ABG) and venous samples were analyzed on PROLYTE electrolyte autoanalyzer (AA). Both instruments were placed in our biochemistry laboratory. Results: A total of 200 samples were analyzed. The mean ABG sodium value was 132.0 mmol/L (SD 9.82) and the mean AA sodium (Na+) was 135.7 mmol/L (SD 9.99). The mean AA sodium value was more than mean ABG sodium but statistically significant difference was not found (p=0.18). The mean ABG potassium (K+) value was 3.4 mmol/L (SD 0.68) and the mean AA potassium (K+) was 3.8 mmol/L (SD 0.79). The mean AA potassium value was more than mean ABG potassium and found statistically significant difference (p=0.02). Conclusion: We found that there was no significant difference in the sodium values measured by the ABG analyzer and the auto-analyzer. However, there was a significant difference in the potassium values measured by these instruments.

387-391

Authors: Jaskiran Kaur, Anju Sharma, Mandeep Kaur, Neha, Amandeep Kaur

Cataract is a vision impairing disease characterized by gradual, progressive thickening of the lens. It is one of the leading causes of blindness in the world today. Dietary antioxidant vitamins, in particular vitamin C can play a role in preventing the onset or progression of age related cataract. The aim of this study was to determine the plasma ascorbic acid levels in normal individuals and in patients suffering from various subtypes of cataract. Method: The study was carried out on 100 subjects of either sex with the age ranging from 40-70 years. Out of these 50 were Cataract patients attending the Out-patient department (OPD) and wards of Ophthalmology Department, Ram Lal Eye Hospital, Amritsar. Fifty adult patients of either sex suffering from cataract were selected for study. Assessment of activity of disease was done on the basis of clinical signs and symptoms and slit lamp examination. The patients suffering from diabetes mellitus, malignancies, tuberculosis, hypertension, coronary artery disease or the patients taking antioxidant drugs were excluded from the study. It was case-control prospective study. The patients and the controls were screened for plasma ascorbic acid. Results: The mean plasma ascorbic acid level in the test group was were 0.60–0.8/mg/dl with mean±S.D of 0.68±0.09 and in control group was from 2.72–0.98 mg/dl with mean±SD of 0.85±0.09 mg/dl. The difference between the levels of control and patients was statistically highly significant with level of plasma ascorbic acid lower in cataract patients as compared to controls. Aging had a reverse relation with plasma ascorbic acid level. Conclusion: This study revealed that plasma ascorbic acid level in cataract patients was lower than normal individuals. Since vitamin C can be made easily available to the elderly population and its beneficial effects popularized through educational and social instructions on the nutritional status of the food we eat, we can make the right decision to prevent or delay the initiation of cataract in developing countries like India.

395-401

Authors: Khaja Moinuddin, Sharanabasappa M Awanti

Previous studies have demonstrated that serum uric acid (SUA) is an independent predictor of incident type 2 diabetes mellitus (T2DM) and have shown the positive association of hyperglycemia with increased serum uric acid. While some have reported lower serum uric acid levels in patients with severe hyperglycemia. The relationship between SUA and diabetes is controversial. Hence, present study was designed to establish the association of serum uric acid with different glycemic state. Objectives 1. To evaluate serum uric acid levels in patients of Type 2 Diabetes Mellitus. 2. To correlate serum uric acid levels with glycemic parameters in patients of Type 2 Diabetes Mellitus. Materials and Methods: 50 cases and 50 controls were included. Fasting blood sugar (FBS), HbA1c and SUA were measured. Based on FBS levels cases were divided into 4 groups i.e., Group I (126mg/dl to 175mg/dl), II (176mg/dl to 225mg/dl), III (226mg/dl to 275mg/dl) and IV (≥276mg/dl) and based on HbA1c levels cases were divided into 3 groups i.e., Group A (6% to 7.9%), B (8% to 9.9%) and C (≥10%). Data was statistically analyzed using SPSS–17. Results: Based on FBS levels classification significant positive difference to serum uric acid was observed among Group I Vs II (p<0.05) & Group I Vs III (p<0.01), No significant difference among Group II Vs III (p>0.05) and significant negative difference among Group I Vs IV (p<0.0001), Group II Vs IV (P<0.0001) & Group III Vs IV (p<0.0001). Based on HbA1c levels classification significant positive difference to serum uric acid was observed among Group A Vs B (p<0.0001) and negative significant difference among Group A Vs C (p<0.01) & Group B Vs C (p<0.0001). Conclusion: We found increase in serum uric acid in cases compared to controls. Serum uric acid initially increased with increase in FBS and HbA1c ranging from 126 mg/dl to 275 mg/dl and 6% to 9.9% respectively and thereafter decreased with further increase in FBS and HbA1c.

409-412

Authors: Mahesh Basavaraj Madole, Dilip Bhave, Mamatha MT, Ankur Patel

Lactate dehydrogenase (LDH) enzyme is found in almost every tissues of the body and its level is increased in serum in many tissue damaging pathological disorders. Patients with chronic cough mostly have history of cigarette smoking and prone to airway inflammation. Documentary studies shows cigarette smoking is associated with altered lipid profile. The aim of the present study is to assess whether there is alteration in the concentration of serum lactate dehydrogenase and lipid profile in patients with chronic cough by estimation of lactate dehydrogenase level and lipid profile in serum. Material and Methods: It is a case control study consisting of 50 cases with chronic cough compared with 50 healthy controls. Serum level of lactate dehydrogenase, total cholesterol, and triglyceride, LDL, VLDL and HDL were estimated in both the study groups. Statistical analysis was done by using unpaired t test. Values were expressed as means and standard deviation (SD). Results: Statistically significant increase in the levels of LDH was found in patients with chronic cough as compared to controls. Serum levels of LDL were increased significantly in cases as compared to controls. Serum levels of cholesterol, triglyceride VLDL and HDL were not altered in cases as compared to control. Conclusion: Serum LDH level was increased in patients with chronic cough which may be due to respiratory tract inflammation commonly caused by smoking. Increased level of LDL in patients with chronic cough is significantly correlated with smoking.

417-420

Authors: Binny Sarai, NP Singh

Hypertension is a major health hazard of present day life and is a leading cause of global burden of disease. There is close association of hypertensive patient with dislipidemia. Low dose thiazide diuretics are used as first line agents alone or in combination with other antihypertensive drugs. Thiazide and loop diuretics increase triglycerides, total cholesterol, LDL cholesterol and VLDL cholesterol.

426-428

Authors: Nirmitha Dev. M, Krishnamurthy U

To compare the indices available to measure obesity such as BMI and “lipid accumulation product” (LAP) with respect to risk for development of Type-II Diabetes mellitus. Methodology: The study design was cross sectional with sample size of 120. Anthropometric measurements (BMI and LAP) and biochemical estimations (blood glucose & lipid profile) were carried out. Results: We compared the values of LAP and BMI with Fasting blood glucose. The area under the curve was 0.75 and 0.73 respectively which meant LAP was better in identification of overt Type 2 Diabetes. The cut off for BMI is 25.98 with Sensitivity of 0.83, Specificity of 0.64 & youden index 0.47. The cut off for LAP is 50.79 with Sensitivity of 0.79, Specificity of 0.68 & youden index 0.46. Conclusion: LAP was able to identify the risk for type 2 Diabetes better compared with BMI in our study subjects.

433-437

Authors: Pramod Sudam Kamble, MP Bankar, DJ Trivedi, Srirang Kulkarni, Rakesh M

Cerebrovascular stroke is complex heterogeneous multifactorial disorder associated with number of risk factors, including diabetes mellitus,hypertension, tobacco smoking or chewing; etc. MethylenetetrahydroFolate reductase (MTHFR) enzyme is one of the main regulatory enzymerequired for the metabolism of homocysteine. An impaired function of this metabolic pathway leads to accumulation of homocysteine in blood. The elevation of plasma total homocysteine and deficiency of B-vitamins such as folic acid and vitamin B12 factors associated with increased cardiovascular cerebrovascular and thromboembolic risk. A single nucleotide polymorphism of the MTHFR gene C677T causes reduction in enzyme activity. In the current study, we determined the prevalence of C677T mutation andcorrelated them to plasma total homocysteine, folic acid and vitaminB12. Total 50 cerebral stroke patients and 50 normal, healthy subjects acting as controls were taken for the study. The total homocysteine level in plasma was determined by high performance liquid chromatography (HPLC). Plasma level of folic acid and vitamin B12were estimated by competitive immunoassay using direct chemiluminescence technology. ARMS PCR was used toexamine MTHFR C677T polymorphism. Result shows concentration of significantly low plasma Folatelevels,whereas vitamin B12 does notshow any significant differencein patients than controls.Total homocysteine concentrations in plasma were significantly higher in stroke as compared to controls. The variation in gene of MTHFR C677T and reduced level of B-vitamins have been related to hyperhomocysteinemia.

442-445

Authors: Srinidhi Rai, Tirthal Rai, Swetapadma Nayak, Prajna K

Type 2 diabetes mellitus and its complications is an important health problem. As oxidative stress and inflammation appears to play a major role in the pathogenesis of diabetes mellitus and development of its complications; we intend to study the serum GGT activity and hs- CRP levels in type 2 diabetes mellitus without complications, type 2diabetes with complications and age and sex matched normal controls. Materials and Methods: Study consisted of 75 subjects out of whom 25 subjects were type 2 diabetics without any complications, 25 subjects were type 2 diabetics with complications and 25 were age and sex matched normal controls. Serum GGT, serum hsCRP, FBS and glycated hemoglobin were measured in these subjects. Results: Levels of serum hs- CRP and GGT is increased in type 2 diabetics without any complications and type 2 diabetics with complications, when compared to controls, which was statistically significant (p < 0.001). Conclusion: Present study showed increase in the levels of hs- CRP and GGT levels in type 2 diabetics without complications and type 2 diabetics with complications when compared to healthy controls. These findings provide evidence that oxidative stress and inflammation plays a role in the pathogenesis of diabetes mellitus and development of its complications

449-452

Authors: Udaya Kumari Ganapathy, Nagendran Ramachandran

This study aimed to compare the effectiveness of D, L Glyceraldehyde (GLY) with Plain Sodium Fluoride (NaF) as an antiglycolytic agent and its interferences in the estimation of Serum creatinine by Modified Jaffe′s method and Serum Sodium and Potassium by ion selective electrode(ISE) method. Materials and Methods: Eighty random blood samples were collected from the OP patient after obtaining explicit consent. Serum Glucose, Creatinine, Sodium and Potassium were estimated in all the three tubes and the results were compared across. Statistical Analysis: ANOVA test was done to compare the analytical values obtained from all the three tubes. Results: Mean Glucose concentration in Plain Tube with Clot activator (PTC), NaF tube and the GLY tube were 142.25 mg/dl, 124.41mg/dl and 139.23mg/dl respectively. p-value for GLY tube vs NaF was 0.483, GLY tube vs PTC was 0.970 and NaF vs PTC was 0.349(p value < 0.05 considered significant). There was Positive interference with creatinine measurement by modified Jaffe’s method (p<0.0001) and for Serum Potassium estimation by ISE method (p<0.0001). Both sodium and potassium estimation in NaF tube showed significantly increased values when compared to analysis in PTC. Conclusions: For preventing ex vivo glycolysis, D, L-Glyceraldehyde coated tubes is as good as PTC tube for glucose estimation by glucose oxidase peroxidase (GOD-POD) method. D, L Glyceraldehyde coated tubes can be used for the estimation of serum sodium but not for potassium by ISE method and creatinine by Modified Jaffe’s method. PTC tube cannot be replaced by GLY tube for routine chemistry analysis.

461-465

Authors: Veena V, M. Ganesh, Santhi Silambanan

A significant proportion of patients diagnosed as heart failure have preserved ejection fraction. However, the differentiation between heart failure with reduced & preserved ejection fraction is difficult. Method: The medical records of young patients (20–40 years) admitted during the two years 2014 & 2015 and diagnosed with Heart Failure were scrutinized in an attempt to determine the proportion of patients with preserved vs reduced ejection fraction and to assess the relationship between their Brain-type Natriuretic Peptide (BNP) levels & Left Ventricular Ejection Fraction (LVEF) in both the groups. Results: After Statistical analysis, it was found that around 36% of heart failure patients had preserved ejection fraction. There was a negative correlation between BNP levels & LVEF in both heart failure with reduced ejection fraction (HFrEF) as well as that with preserved ejection fraction (HFpEF). Majority of patients in HFpEF group were females. Mean BNP level in HFpEF group was significantly lower than that in the HFrEF group. Conclusion: Around one third of patients had Heart Failure with preserved systolic function, of which majority are females. There is a strong negative correlation between BNP levels and LVEF% in both the groups. Thus. BNP levels can be used in the differentiation of HFpEF and HFrEF.

469-471

Authors: Juwairia Mohammed Fariduddin, Syed Shabbar Masih

Smoking cigarette/beedi leads to increased concentration of serum total cholesterol, triglyceride, low density lipoprotein and very low density lipoprotein, decreased in level of anti atherogenic high density lipoproteins and uric acid levels. Material & Methods: The study was carried out in 50 healthy male smokers and 50 healthy male non smokers selected from volunteers from general public, patient attendants and hospital staff of Owaisi Hospital Santosh Nagar, Hyderabad. The data was analyzed using SPSS software version 17.0. Descriptive results were expressed as mean and standard deviation (SD) of various parameters in different groups. Results: Levels of triglycerides, LDL, VLDL, and TC were significantly higher among smokers compared to non smokers. Anti atherogenic HDL and uric acid levels were lower among smokers. Conclusions: The alteration of lipid profile and uric acid level in smokers have raised serious medical concern with respect to atherogenic risk and recommendation for counseling the smokers to quit smoking and routine evaluation of serum lipid profile in uric acid has been suggested.

477-481

Authors: Maitreyee DS, Preethi BP, PM Gangadhara Swamy

Non protein Bound iron has the capacity to generate reactive oxygen species is called Free iron causing lipid peroxidation and protein oxidation. Free radicals have been implicated in the pathogenesis of diabetes mellitus. Hence the present study was conducted to compare serum levels of free iron, superoxide dismutase, malondialdehyde & glycated hemoglobin between type 2 diabetes mellitus with microvascular complications (retinopathy and nephropathy) and type 2 diabetes mellitus without complications. Methods: Cross sectional observational study included total 121 subjects. 60 were healthy controls, 31 cases with type 2 diabetes mellitus without complications, 30 cases with microvascular complications (15 nephropathy and 15 retinopathy cases). Estimation of serum levels of free iron, superoxide dismutase, malondialdehyde, random plasma glucose, and HbA1c, were estimated by spectrophotometric method. Results: Serum levels of random plasma glucose (<0.001), HbA1c(<0.001), serum free iron(<0.001), serum malondialdehyde (<0.001) were significantly high and serum superoxide dismutase activity(<0.001) was significantly low in type 2 diabetes mellitus with microvascular complications (retinopathy and nephropathy) when compared to type 2 diabetes mellitus without complications & healthy controls respectively. Conclusion: The study showed higher levels of serum free iron in type 2 diabetes mellitus patients with microvascular complications (retinopathy and nephropathy) when compared to type 2 diabetes mellitus without any complications. Serum free iron can be used as oxidant marker to assess the progression of complications in type 2 diabetes mellitus.