Indian Journal of Medical Biochemistry

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Volume 27, Number 2, May-August 2023
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EDITORIAL

Binita Goswami

Particulars of Particulate Pollution…

[Year:2023] [Month:May-August] [Volume:27] [Number:2] [Pages:1] [Pages No:iv - iv]

   DOI: 10.5005/ijmb-27-2-iv  |  Open Access | 

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ORIGINAL RESEARCH ARTICLE

Monika Garg, Neera Sharma, Saswati Das

Sigma Metrics Assessment as Quality Improvement Methodology in a Clinical Chemistry Laboratory

[Year:2023] [Month:May-August] [Volume:27] [Number:2] [Pages:5] [Pages No:23 - 27]

Keywords: Bias, Biochemistry, Clinical Biochemistry, Coefficient of variation, External quality control, Internal quality control, Laboratory, Quality control, Six sigma, Total allowable error

   DOI: 10.5005/jp-journals-10054-0218  |  Open Access |  How to cite  | 

Abstract

Background: The concept of sigma metrics and lean six sigma is well known in the field of health care. However, not many labs utilize the six-sigma metrics for the maintenance of high-quality laboratory performance. A minimum value of 3 σ is desired in any clinical laboratory and a value of σ ≥6 is regarded as the gold standard for obtaining high-quality lab reports. Objective: To calculate bias, Coefficient of variation (CV) and sigma metrics from the internal quality control (IQC) and external quality control (EQC) data to ascertain the extent of quality management. Materials and methods: An extensive study of sample processing and quality practices was carried out in the Central Laboratory of Department of Biochemistry, PGIMER and Dr. RML Hospital, New Delhi; from February 2020 to July 2020. The IQC used (both Level I and II) was from Biorad Laboratories India (Lyphochek assayed chemistry control) and the EQC used was from Randox Laboratories, UK. All the controls were run on Beckman Coulter clinical chemistry analyzer AU 680. A total of 14 clinical parameters were analyzed and subsequently, mean SD, CV, bias and σ were calculated through their respective formulas. Results: Amylase showed σ >6 for both levels of IQC. It indicates world-class performance. Total bilirubin, AST, triglyceride and HDL depicted σ values between 3.1 and 6 for both L1 and L2. Iron showed an σ value of 5.5 in L1 whereas it was 3.78 in L2. The remaining parameters had σ <3 in L1. As far as L2 is concerned, besides ALT which had σ value of 4.24; the rest of all analytes had σ <3. Conclusion: Sigma metrics in the clinical laboratory are an essential technique to ascertain poor assay performance, along with the assessment of the efficiency of the existing laboratory process.

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ORIGINAL RESEARCH ARTICLE

Sanghapriya Pal, Kiran Dahiya, Rajeev Atri, Hemang Kumar, Aman Chauhan, Shweta Gaur

Effect of Prostate Cancer on Non-protein Nitrogenous Substances

[Year:2023] [Month:May-August] [Volume:27] [Number:2] [Pages:5] [Pages No:28 - 32]

Keywords: Cancer, Creatinine, Chronic kidney disease, Gleason's scoring, Prostate cancer, Prostate-specific antigen, Urea, Uric acid

   DOI: 10.5005/jp-journals-10054-0219  |  Open Access |  How to cite  | 

Abstract

Introduction: Prostate cancer is one of the most common non-cutaneous malignancies in American males. In 2008, it was the sixth leading cause of death from cancer among males. Population-based cancer registries in India show that this has become a growing health concern in many parts of India. There are many interfaces between cancer and chronic kidney disease (CKD). Materials and methods: Serum levels of urea, creatinine, and uric acid of 50 prostate cancer patients were compared with those of 50 healthy controls, at 95% confidence level taking p < 0.05 as significant. The association of urea, creatinine and uric acid levels with staging, Gleason's scoring and serum prostate-specific antigen (PSA) level was analyzed with the help of appropriate statistical analysis. Results: Among the three prominent non-protein nitrogenous (NPN) substances used for renal assessment, the levels of urea and uric acid in serum were found to be statistically significantly raised (p < 0.05) in patients with prostate cancer as compared with healthy controls. The serum levels of creatinine were higher in cases as compared with controls but the difference was not found to be statistically significant (p = 0.088). Only uric acid level (p = 0.01) changed significantly among the stage A through stage D. We did not find the statistical significant correlation between the level of urea (r = –0.05, p = 0.75), creatinine (r = –0.24, p = 0.09) and uric acid (r = –0.05, p = 0.75) with PSA. Conclusion: From our study, it can be concluded that the evaluation of serum levels of urea, creatinine and uric acid may be of utmost diagnostic and prognostic significance in patients with prostate carcinoma.

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ORIGINAL RESEARCH ARTICLE

Dipak Kumar Chattopadhyay

Beneficiary Effect of Zinc Supplementation in Tuberculosis as Reflected by Serum Level of Diagnostic Biomolecules

[Year:2023] [Month:May-August] [Volume:27] [Number:2] [Pages:7] [Pages No:33 - 39]

Keywords: Cholinesterase, Extrapulmonary tuberculosis, Glutamine synthetase, Metallothioneins, Pulmonary tuberculosis, Superoxide dismutase, Zinc transporters, Zrt-Irt-related proteins

   DOI: 10.5005/jp-journals-10054-0221  |  Open Access |  How to cite  | 

Abstract

Aim and objective: This author had indoctrinated a higher Mycobacterium tuberculosis (Mtb) origin serum superoxide dismutase (SOD), detectable Mtb origin serum glutamine synthetase (GS) and inhibited host origin serum cholinesterase (ChE) as diagnostics for tuberculosis (TB). Mycobacterium tuberculosis by secreting abundant siderophores, the Fe+3 chelators, scavenges iron (Fe) from transferrin, lactoferrin, etc.; and thus, major decompartmentalized state of Fe takes place in host tissues, generation of superoxides is accentuated, which are used up by Mtb for dismutation reaction to evolve soluble oxygen for survival of this obligatory aerobe. Zinc (Zn), a redox inert metal, accelerates reversion to normal compartmentalized state of Fe by replacing Fe from thiol group binding site. Zn, by decreasing generation of reactive oxygen species renders an onslaught on Mtb. In this study, the author had mulled the effect of Zn supplementation (25 mgm of elemental Zn daily orally for 1 month) on the serum level of TB diagnostics as mentioned. Materials and methods: Serum SOD, GS, and ChE were assayed for TB patients at baseline and also after 1 month with anti-TB drugs as two groups; one without and other with Zn supplementation. Same parameters were also measured for normal control and lung disease control subjects at baseline. Result: Significant decrease in serum SOD (p = 0.01) and GS (p = 0.01) in TB patients with Zn supplementation for 1 month had been recorded in comparison to those without Zn supplementation. Also, recovery of serum ChE activity with Zn supplementation was significant (p = 0.002). Conclusion: With the assertive and veritable improvement by instituting Zn supplementation in TB patients as reflected by serum level of diagnostic parameters, it is a great solemnity to promulgate that oral Zn supplementation might be added to anti-TB (A-TB) drug regime for early onslaught on Mtb and also for an effective weapon preventing development of primary drug resistance.

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REVIEW ARTICLE

Aditya Chilay, Neha Mehra, Moumita Misra, Raj Jatale, Shibani Ramchandran

Liver Function Test and Diabetes Mellitus: Correlation from a Laboratory Perspective

[Year:2023] [Month:May-August] [Volume:27] [Number:2] [Pages:5] [Pages No:40 - 44]

Keywords: Alanine aminotransferase, Alkaline phosphatase, Aspartate aminotransferase, Gammaglutamyltranspeptidase, Liver function tests, Type 2 diabetes mellitus

   DOI: 10.5005/jp-journals-10054-0220  |  Open Access |  How to cite  | 

Abstract

Aims and objectives: To study the correlation of LFTs with DM in the Indian population. Background: Diabetes mellitus (DM) is a metabolic disorder characterized by increased blood glucose levels, resulting from defects in insulin secretion, insulin action, or both. Glucose is an important regulator of various pancreatic β-cell processes, including insulin biosynthesis and release. The liver plays an important role in glucose homeostasis. Evidence of deranged liver functions is observed in long-standing DM and a slight elevation of liver enzymes is seen in insulin resistance. Insulin resistance results in the production of free fatty acids which damage the liver parenchyma and result in elevation of the liver enzymes, such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and gammaglutamyltranspeptidase (GGTP) in the serum. Materials and methods: A retrospective analysis of 46,344 cases over a span of 3 years (2020–2022) was conducted in a referral laboratory in Mumbai. The patients included those who had tested for liver function tests (LFTs) [including SGPT, SGOT, ALP, GGTP, lactate dehydrogenase (LDH)], blood sugar (fasting and post lunch), and HbA1c. Results: Overall 32.11% of the study population was diabetic. Among patients who had done glucose fasting, glucose postprandial, and HbA1c, 17.61% of patients were found to be diabetic at fasting, 15.76% at postprandial and 32.59% had elevated HbA1c levels. Maximum abnormality in LFT was observed in direct bilirubin (18.76%). Multiple logistic regression determined that abnormal ALP [odds ratio (OR): 1.4267, p < 0.0001], abnormal GGTP (OR: 1.87, p < 0.0001), and abnormal SGPT (ALT) (OR: 1.33, p < 0.0001) were independent associates with diabetes. Conclusion: Long-standing or chronic diabetes due to its multisystem affection can adversely affect liver functions. Regulator monitoring of LFTs is essential in diabetic patients to avoid long-term complications.

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