Indian journal of Medical Biochemistry

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Volume 24, Number 3, September-December 2020

EDITORIAL

Dr Binita Goswami

Covid-19 Vaccines: Lets Go for It

[Year:2020] [Month:September-December] [Volume:24] [Number:3] [Pages:1] [Pages No:00 - 00]

PDF  |  DOI: 10.5005/ijmb-24-3-iv  |  Open Access |  How to cite  | 

Original Article

Rajni R Shivkar, Supriya R Gulajkar, Vinod V Wali

Effectiveness of Early Clinical Exposure Module in Biochemistry to Understand the Basis and Rationale of Biochemical Tests for Diabetes Mellitus in First Phase MBBS Students

[Year:2020] [Month:September-December] [Volume:24] [Number:3] [Pages:3] [Pages No:89 - 91]

Keywords: Competency, Diabetes mellitus, Early clinical exposure, Student centric

PDF  |  DOI: 10.5005/jp-journals-10054-0141  |  Open Access |  How to cite  | 

Abstract

Background: Competency-driven curriculum designed and implemented for MBBS from year 2019 comes with some unique features, and early clinical exposure (ECE) is one of them. Biochemistry is considered by students as a subject of metabolic pathways that are difficult to retain and recall when learned. In biochemistry, ECE helps to recognize importance of subject in diagnosis, patient care, and treatment. It will motivate student for active learning through its context and clinical case exposure. ECE allows students to learn basic science subject with its applicative perspective. Aim and objective: To study the effectiveness of ECE module of diabetes mellitus (DM) over didactic theory lecture in the understanding the disorder of carbohydrate metabolism. Materials and methods: The present interventional study was carried out in SKNMC, Pune, on 80 voluntary first-year MBBS students of academic year 2019 to 2020. Participants were evaluated with pretest and posttest questionnaire that was designed on DM keeping in mind the competencies given in the curriculum for the said topic. Statistical analysis was done using paired t test. Results: We have seen improved performance of students in posttest after ECE on DM as compared to pretest which was taken after traditional didactic lecture. Pretest and posttest score of students was 6.58 ± 2.86 (mean ± SD) and 12.36 ± 2.34, respectively. The p value for comparison was <0.001 which is highly significant. Conclusion: ECE for DM in biochemistry improved interest of students in the topic making learning more interactive.

Original Article

Pratik Raghavani, Ajay S Rajput, Deepak Parchwani, Uday Vachhani

Gender-wise Variation in Performance in Formative Assessment and Class Attendance in the Subject of Biochemistry in First-year MBBS Students

[Year:2020] [Month:September-December] [Volume:24] [Number:3] [Pages:4] [Pages No:92 - 95]

Keywords: Female, Gender, Male, Performance, Practical, Theory

PDF  |  DOI: 10.5005/jp-journals-10054-0159  |  Open Access |  How to cite  | 

Abstract

Introduction: The medical profession is one of the most demanding disciplines and historically remained a male-dominated profession. Academic performance in medical science is affected by various sociodemographic factors. Various studies have been done to predict academic performance in medical school regarding the influence of gender and attendance. In this study, an attempt was made to study the effect of gender and attendance on performance in formative assessment in the subject of biochemistry. Aims and objectives: To compare performance in theory, practical, and combined (theory and practical) formative assessments between male and female students in the subject of biochemistry in the first-year MBBS and to compare class attendance in theory, practical, and combined (theory and practical) between male and female students in the subject of biochemistry in the first-year MBBS. Materials and methods: This study was carried out at the Department of Biochemistry, GMERS Medical College, Himmatnagar. Students’ academic records in the subject of biochemistry during their first professional year of MBBS were studied. For the study, data of 450 (251 male and 198 female) students from 3 academic years were collected. Performance in theory and practical formative assessments was compared between male and female students. A comparison of marks of male and female students was carried out using Student\'s t-test. The effect of attendance on performance was assessed gender-wise. For comparison of attendance, Kruskal–Wallis test was applied. For all comparisons, a p value <0.05 was considered significant. All statistical analyzes were carried out using Microsoft Excel 2010. Results: The performance of female students was better than male students in theory and combined formative assessments (p < 0.05). The attendance of female students in theory classes and combined attendance of theory and practical was significantly higher (<0.05) than their male counterparts. In different attendance groups for both male and female students, the performance was significantly better with more attendance (p < 0.05). Discussion: In our study, we explored how gender and attendance can affect the performance of the student in the subject of biochemistry. Our study demonstrates female students have more class attendance and better performance in formative assessment in the subject of biochemistry and both the genders’ performances are positively correlated with their attendance.

Original Article

Anju Radhakrishnan, Neeta Malukar, Shilpa Jain

Serum CA-125 and Serum CEA Ratio to Distinguish between Ovarian Malignancies and Non-ovarian Malignancies

[Year:2020] [Month:September-December] [Volume:24] [Number:3] [Pages:3] [Pages No:96 - 98]

Keywords: Cancer antigen 125, Cancer antigen 125 to carcinoembryonic antigen ratio, Epithelial ovarian malignancies

PDF  |  DOI: 10.5005/jp-journals-10054-0161  |  Open Access |  How to cite  | 

Abstract

Introduction: Globally, ovarian carcinoma is the 7th most common cancer. Cancer antigen 125 (CA-125) is the most frequently used biomarker for ovarian cancer (OC). Carcinoembryonic antigen (CEA) is present only at very low levels in healthy adults and is raised in colon cancer, pancreatic malignancies, pancreatitis, cirrhosis, etc. The present study is to evaluate the ability of CEA in combination with CA-125 to differentiate epithelial ovarian malignancies from non-ovarian malignancies. Aims and objectives: To study, compare, and calculate the ratio of serum CA-125 and serum CEA levels in cases of epithelial ovarian malignancies and non-ovarian malignancies. Materials and methods: Thirty patients of epithelial ovarian malignancies in group I and 30 female patients of non-ovarian malignancies in group II are included. Results: Specificity and positive predictive value (PPV) increase when CA-125 to CEA ratio increases and both are 100% if the ratio is >50. When CEA (<5 ng/mL) alone is used for distinguishing an ovarian malignancy from a non-ovarian malignancy, sensitivity is only 93%, specificity 67%, PPV 74%, negative predictive value (NPV) 91%, respectively. Conclusion: When CA-125/CEA ratio increases, the sensitivity and NPV fall but the specificity and PPV increase and became 100% when it is >50. By knowing the ratio we can have an early diagnosis of OC. We cannot always consider the cut-off for CEA as <5 ng/mL because in smokers the reference value is up to 10 ng/mL.

Original Article

B Vinodh Kumar, K Ramadevi

Association of Dimethylarginine Dimethylaminohydrolase 2 (DDAH-2 1154 C > A) Gene Polymorphism with Coronary Artery Disease

[Year:2020] [Month:September-December] [Volume:24] [Number:3] [Pages:5] [Pages No:99 - 103]

Keywords: Asymmetric dimethylarginine, Atherosclerosis, Coronary artery disease, Dimethylarginine dimethylaminohydrolase, Gene polymorphism, Nitric oxide, Nitric oxide synthase

PDF  |  DOI: 10.5005/jp-journals-10054-0163  |  Open Access |  How to cite  | 

Abstract

Background: Coronary artery disease is one of the most common causes of death. The initiation of atherosclerosis is due to endothelial dysfunction and is mainly due to decreased nitric oxide bioavailability. The nitric oxide is synthesized from L-arginine by endothelial nitric oxide synthase. The nitric oxide synthase inhibitor has been identified namely asymmetric dimethylarginine (ADMA). The major route of degradation of ADMA is by the dimethylarginine dimethylaminohydrolase enzymes. The gene silencing studies in rats have shown that the dimethylarginine dimethylaminohydrolase (DDAH) enzyme through the degradation of ADMA, regulates the function of nitric oxide synthase. Therefore, this study was undertaken to find the association of DDAH-2 gene polymorphisms with coronary artery disease. Aims and objectives: The objective of the study is to find out the association of DDAH-2 gene (1151 C/A) polymorphism with coronary artery disease. To estimate the serum nitric oxide levels and find its relationship with the above gene polymorphism. Materials and methods: Case-control study. One hundred cases of coronary artery disease in the age group between 35 years and 60 years old verified by coronary angiogram having >50% stenosis of at least one of the major coronary arteries were randomly recruited. Cases may be with or without risk factors like smoking, alcohol, and hypertension. Age, sex, and risk factors matched 100 controls who had no clinical evidence of coronary artery disease were selected. Assessment of DDAH-2 (1154 C > A) gene polymorphism was done by TaqMan assay using real-time PCR and confirmation of SNP genotypes was done by Sanger sequencing. Results: AA genotype of DDAH-2 was significantly higher among cases (29%) when compared with controls (14%) with a statistically significant p value of 0.009. The odds ratio of 2.1 showed that subjects with the A+ allele carry a higher risk for coronary artery disease when compared with the A allele. The serum nitric oxide was significantly lower in the AA genotype when compared with the CA and CC genotypes of the DDAH2 gene. Conclusion: In this study, there is a good association of the A allele of DDAH-2 with the development of coronary artery disease (odds ratio of 2.19). Thus, A allele may be an independent risk factor for coronary artery disease. Multiple logistic regression predicts AA genotype as a significant and independent predictor of coronary artery disease.

Original Article

Chandrakant G Kamble, Prashant Hisalkar, Shekhar B Padhyegurjar, Jagdish D Powar, Bhausaheb V Jagdale

Study of Serum Homocysteine Level Variations in Sickle Cell Disease: A Meta-analysis Study

[Year:2020] [Month:September-December] [Volume:24] [Number:3] [Pages:11] [Pages No:104 - 114]

Keywords: Meta-analysis, Serum homocysteine level, Sickle cell disease

PDF  |  DOI: 10.5005/jp-journals-10054-0166  |  Open Access |  How to cite  | 

Abstract

Background: Serum homocysteine levels have been observed to be increased in sickle cell disease (SCD). The biological mechanism of synthesis and regulation of the homocysteine remains unclear. This meta-analysis aims to provide an overview of the serum homocysteine level changes and to discuss its significance in SCD. Materials and methods: This meta-analysis is to determine serum homocysteine level changes during SCD and was conducted under the PRISMA guidelines. Without language restrictions, the articles were identified through BioMed, Embase, Pub Med® (U.S. National Library of Medicine, USA), and www.Blood Journal.org, PLoS ONE, Web of Science, LILACS (Latin American and Caribbean Health Sciences Literature), ISI Web of Science, Chemical abstract services-(CAS), Europe PMC, Bio sis Previews, Elsevier Properties S.A., USA. The studies have been considered which were published before March 31, 2018. Results: Thirty comparative studies were identified out of 8,630 articles and included in the meta-analysis. From the final selected articles, the mean, standard deviation, sample size of cases vs controls were showing compared and calculated by the SPSS latest software version-24. From 30, 18 articles were statistically highly significant, and the remaining 12 articles were statistically not significant. The p <0.05 was considered to be statistically significant. The combined estimation of the meta-analysis study is highly significant, since p <0.000000, calculated “t” is 25.07, and degree of freedom is 2,829. Conclusion: The study concludes that there is an extremely significant difference between mean serum homocysteine levels in cases and healthy controls. So, the serum homocysteine level can be used as a clinical biomarker for the diagnosis of SCD.

RESEARCH ARTICLE

Arun Sinha, C Vibha, HL Vishwanath, B Prabhakar

A Comparative Study of Serum Cystatin C with Serum Creatinine as an Early Marker of Acute Renal Dysfunction in Intensive Care Patients

[Year:2020] [Month:September-December] [Volume:24] [Number:3] [Pages:4] [Pages No:115 - 118]

Keywords: MDRD, Renal function, Renal function test, ROC curve

PDF  |  DOI: 10.5005/jp-journals-10054-0140  |  Open Access |  How to cite  | 

Abstract

Introduction: Acute kidney injury (AKI) is a very common complication occurring in medical intensive care, causing significant morbidity and mortality. Several biomarkers have been studied for their utility in diagnosing acute renal failure but without much success. Still, serum creatinine is the marker of choice despite having several shortcomings. In this study, we have tried to see the usefulness of serum cystatin C in comparison to serum creatinine as an early marker of AK. Materials and methods: A cross-sectional study was conducted involving 50 cases admitted in the ICU of our hospitals and their Cystatin C and creatinine was estimated. The results were compared with cystatin c and creatinine values of healthy controls. Results: In cases, the mean cystatin C was found to be 744.58 ± 321.00 ng/mL. Data showed that 50% of cases had abnormal values for serum cystatin C. Estimation of serum creatinine in cases showed a value of 1.07 ± 0.45 mg/dL with a p = 0.008. Among cases, 20% of patients had abnormal creatinine. Receiver operator curve (ROC) analysis with AUC showed that cystatin C with a cutoff >40 had sensitivity and specificity of 100% and AUC 1.000 (p =1.0) the sensitivity and specificity were 50 and 70%, respectively, and AUC 0.637 (p = 0.013). The creatinine clearance as estimated by both MDRD and CKD EPI formulae were found to be normal in both cases and controls. Conclusion: The results clearly showed that estimation of serum cystatin c in ICU patient could go long way in reducing mortality due to acute renal dysfunction.

RESEARCH ARTICLE

Prashant Kumar, Shashi Ranjan, Himani Rathi, Raman Kumar, Shilpa Puluturu, Bela Goyal, Manisha Naithani, Swati Rajput, Satyavati Rana, Senkadhirdasan Dakshinamurthy, Ravi Kant, Anissa A Mirza

Biochemical Variations of Serum Magnesium with Lipid Analytes in Different Clinical Groups of Type 1 and Type 2 Diabetes Mellitus: A Hospital-based Cross-sectional Study

[Year:2020] [Month:September-December] [Volume:24] [Number:3] [Pages:6] [Pages No:119 - 124]

Keywords: Hypercholesterolemia, Hypertriacylglycerolemia, Hypomagnesemia, Type 1 and type 2 diabetes mellitus

PDF  |  DOI: 10.5005/jp-journals-10054-0162  |  Open Access |  How to cite  | 

Abstract

Objective: Hypomagnesemia associated with dyslipidemia in type 2 diabetes mellitus (T2DM) has been well documented globally by various researchers, as there found a paucity in related data for type 1 diabetes mellitus (T1DM), present observational hospital-based cross-sectional study was planned to estimate, correlate serum magnesium with lipid analytes in different clinical groups of both T1DM and T2DM, and validate its diagnostic significance. Materials and methods: The study comprised 250 subjects with random inclusion of 200 of both T1DM, T2DM, and 50 normoglycemic healthy controls. Based on medical history and clinical records of 52 T1DM and 148 T2DM clinical cases, they were subgrouped into group I—newly diagnosed, group II—stabilized controlled, and group III—with long course, uncontrolled with associated complications. Biochemical analyses of plasma glucose, serum total magnesium, total cholesterol, and triacylglycerol were analyzed, compared, and correlated statistically with each group and healthy controls. Results: Comparison and correlations of studied analytes in T1DM and T2DM groups of subgroups with healthy controls, clearly depicted biochemical variations of hypomagnesemia in overt hyperglycemic-hyperlipidemic clinical cases. Hypomagnesemia was inversely correlated with hypertriacylglycerolemia and hypercholesterolemia in hyperglycemic of both T1DM and T2DM with varied statistical significances in different clinical groups with (p < 0.001) in group III, (p < 0.01) in group I, and (p > 0.05) non-significant in group II. However, no statistical significance (p > 0.05) for analytes was noted between type 1 and type 2 of all subgroups. Conclusion: As biochemical variations of hypomagnesemia in overt hyperglycemic-hyperlipidemic type 1 and type 2 clinical cases of diabetes mellitus was depicted and correlated, it is recommended for clinicians to prescribe serum magnesium as a routine investigation of diabetes diagnostic profile for early screening, periodic monitoring, and better management with its supplementation to prevent long-standing critical diabetes complications.

REVIEW ARTICLE

HG Nadini Dewangani, Bimali Jayawardena, HD Sameera P Wijayagunarathne

Yoga-based Lifestyle Intervention for Prevention and Management of Type 2 Diabetes Mellitus and Associated Complications: A Clinical Research Review

[Year:2020] [Month:September-December] [Volume:24] [Number:3] [Pages:5] [Pages No:125 - 129]

Keywords: Blood sugar, Hypertension, Lifestyle intervention, Obesity, Type 2 diabetes mellitus, Yoga

PDF  |  DOI: 10.5005/jp-journals-10054-0165  |  Open Access |  How to cite  | 

Abstract

Type 2 diabetes mellitus (T2DM) has become a major health challenge in the 21st century. Prevention and management of this metabolic disease could be achieved by healthy lifestyle interventions. Yoga is one such lifestyle intervention practice that has been identified and proved its beneficial effects on T2DM through several studies. The purpose of this comprehensive review was to assess the available evidence from both short-term and long-term studies regarding the beneficial effects of yoga intervention on adult patients with T2DM and the significant impact on diabetes-related risk indices. According to the evidence of past literature used for this review, yoga plays a significant role in the prevention and management of T2DM through the improvement of weight, blood pressure, glycemic parameters, lipid profile, and oxidative stress. Side effects or complications due to yogic practices have not been mentioned up to date in any study conducted. To conclude, most of the findings suggest that yoga may play a vital role in the prevention and management of T2DM, but the lack of standard research studies performed in a diverse population is a big barrier to make evidence-based conclusions. Additional high-quality, long-term investigations should be performed in diverse populations to evaluate the effectiveness of yoga in the prevention and management of T2DM and its complications.

REVIEW ARTICLE

Amit Samadhiya, Rajeev Goyal, Aditi Singh, Santosh K Gupta

Role of Vitamin D in COVID-19

[Year:2020] [Month:September-December] [Volume:24] [Number:3] [Pages:4] [Pages No:130 - 133]

Keywords: ARDS, ACE-II, COVID-19, Cytokine storm, SARSCov-2, Vitamin D

PDF  |  DOI: 10.5005/jp-journals-10054-0150  |  Open Access |  How to cite  | 

Abstract

Aim: To review the role of vitamin D in COVID-19. Background: The COVID-19 pandemic has caused a tremendous social and economic impact worldwide, and rapid outspreading of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is still being seen in India. Currently, there are two explanations available for the fatal ARDS in COVID-19 cases. Cytokine storm is characterized by unregulated release of various proinflammatory cytokines, i.e., TNF-α, INF-γ, IL2, IL6, IL8, IL12, CCL2, CCL3, and CXCL10, after interaction between SARS-CoV-2 and host immune cells. On the other hand, bradykinin storm is happening due to downregulation of ACE in the lung tissue. Immunomodulatory effects of vitamin D is proved through various studies. There is no individual therapy and vaccination for the SARS-Cov-2; thus, repurposing of available medicines is crucial now. Antiviral, anti-inflammatory, and immuno-boosting effects of vitamin D has proven in many studies. These effects are very relevant for its putative beneficial effect in SARS-CoV-2. Review result: Vitamin D has already been used as a repurposed drug in H5N1 pneumonia. Immunomodulatory and antibacterial role of vitamin D is well established. There are studies suggesting toward the cytokine storm as a main culprit behind deadly ARDS in COVID-19. Vitamin D was found as an anti-inflammatory and lung protective substance. Vitamin D was also found protective against bacterial LPS-induced injury by increasing expression of ACE-II and producing antibacterial protein cathelicidin. Conclusion: Before COVID-19 pandemic, we realized the silent pandemic of vitamin D deficiency. The immunomodulatory, anti-inflammatory, and antibacterial role of vitamin D has been shown in many studies. There are studies which have demonstrated the inverse relationship between vitamin D level and susceptibility to COVID-19. Vitamin-D also plays a crucial role in limiting the fibrosis in the damaged pulmonary tissue and also responsible for deciding overall morbidity of the patient. Thus, it is imperative to think about the potential of vitamin D as a repurposed drug for COVID-19 cases.

NARRATIVE REVIEW

Sukhyanti Kerai, Kirti N Saxena

Intensivists Perspectives on COVID-19

[Year:2020] [Month:September-December] [Volume:24] [Number:3] [Pages:3] [Pages No:134 - 136]

Keywords: COVID-19, Intensive care, ICU

PDF  |  DOI: 10.5005/jp-journals-10054-0144  |  Open Access |  How to cite  | 

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has overwhelmed the healthcare system across the globe. The highly contagious nature of the disease, enormous caseload, and acute hypoxemic respiratory failure associated with the disease has led to a surge in demand for intensive care unit (ICU) beds. As in our country, intensive care facilities are already limited and unevenly distributed, the challenges of providing care to the critically ill are manifold. Furthermore, despite intense research, there is currently no effective treatment against the COVID-19 infection. The ICU mortality rate of COVID-19 is twice compared to other viral pneumonia. Apart from disrupting the physical health, COVID-19 infection has mental health ramifications for ICU patients, such as, depression, insomnia, post-intensive care syndrome. Additionally, the frontline healthcare workers of ICU are at risk of adverse physical and mental consequences directly as the result of providing care to patients. To maintain a sustainable workforce there is an urgent need for the implementation of strategies aimed to reduce the burden of health consequences.

CASE REPORT

Satish Ramanathan, Srinivas Chakravarthy, Smitha Sankaranarayanan, Thirumalai Nallathambi, Prithvi Mohandas

Mastering the Five Elements of Nature: The Essence of Clinical Laboratory Medicine

[Year:2020] [Month:September-December] [Volume:24] [Number:3] [Pages:6] [Pages No:137 - 142]

Keywords: Evolution, Five basic elements of nature, Good clinical laboratory practices, Panchabooth, Technology

PDF  |  DOI: 10.5005/jp-journals-10054-0164  |  Open Access |  How to cite  | 

Abstract

Aim and objective: The study aims to illustrate how laws of nature govern man and his machine and aid laboratory medicine specialists to revisit basics of good clinical laboratory practices (GCLP) without which none of the modern tools of quality including sigma, lean, 5S, etc., would bring improvement in the quality of performance of a clinical laboratory and add on to patients’ safety. Background: The culture, tradition of India is deep-rooted in its history and heritage, which are governed by laws of nature. The modern era of healthcare has evidenced magnanimous evolution in terms of technological revolution wherein machines equipped with artificial intelligence would in near future take center stage in the field of clinical laboratory medicine. To whatever heights evolution might climb, in terms of technology, it has to obey laws of nature which, in simple terms, means GCLP. Case description: We experimented with a study of the impact of five elements of nature on specific analytes’ performance in the VITROS 5600 integrated testing platform. Performance characteristics of these analytes were analyzed and we have tried to explore the outcome of this study through five case scenarios wherein we have attempted to invigilate whether the basic elements of nature play a significant role in the quality of results produced by a testing system. Conclusion: Hence, it is a need of the hour to focus on the fundamentals of clinical laboratory medicine which stand as pillars of quality and contribute to patient safety. Clinical significance: There is a constant surge in the number of clinical laboratories globally, moving toward technological advancements. But the basic ingredients for achieving the ultimate goal—the quality of the result and patient safety lies deep in form of panchabooth, which are five key essential elements that govern the laws of nature including man and his environment (testing environment) in the field of laboratory medicine.

SHORT COMMUNICATION

Dushyanth R Vennapu, Mahesh S Palled

Ligand-based Drug Design Approach in Designing New Leads from Existing Pharmacophores; Binding Pocket Estimation and Binding Pocket-directed Screening of Antiviral Drugs for Treatment of Novel Corona COVID-19 and Topoisomerase Inhibitors

[Year:2020] [Month:September-December] [Volume:24] [Number:3] [Pages:6] [Pages No:143 - 148]

Keywords: Docking, Hits and leads, Homology

PDF  |  DOI: 10.5005/jp-journals-10054-0160  |  Open Access |  How to cite  | 

Abstract

Using the homology modeling-derived protein structure, and literature-reported cases of the treatment of coronavirus by chloroquine and remdesivir. ICMR guidelines for the usage of a low toxic metabolite of chloroquine hydroxychloroquine as prophylactic medication for healthcare professionals as preventive measures for those who treat corona patients. Further, Japanese flu drug favipiravir in treatment is efficient in the treatment of corona. The protein model suggested by I-TASSER was used in docking; the active site of the protein was predicted using similarity search and the potential leads are screened for their efficiency in combating corona outbreak from epidemic to pandemic.

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