Jaundice is the visible manifestation of chemical bilirubinemia and is characterized by yellow discoloration of skin. In a pediatric emergency department, evaluation of jaundice includes a precise medical history, physical examination, and estimation of bilirubin by laboratory tests. Measurement of total serum bilirubin (TSB) by transcutaneous bilirubin (TcB) is interpreted according to the age (in hours) of the newborn infant. Studies have also indicated that the TcB determination is more accurate than visual estimation methods.

To compare BiliCare System against standard laboratory testing for bilirubin estimation.

The coefficient of correlation was r = 0.7245, and the standard deviation between the mean values of TcB and TSB is ±0.55.

It is concluded from the study that there is good correlation between TcB measurement and laboratory estimation of total bilirubin levels. It is recommended that transcutaneous measurement can be used for initial screening of jaundice as well as monitoring of phototherapy in neonates.

Warade J. Comparison of BiliCare Transcutaneous Bilirubinometer with Standard Laboratory Assay. Indian J Med Biochem 2017;21(1):1-4.

Despite the lifesaving potential, mechanical ventilation (MV) imposes a considerable amount of mechanical stress on the lung. Pulmonary and systemic cytokine release due to inflammatory process triggered by MV may give valuable information on patient outcome.

Thirty patients aged >18 years with acute respiratory distress who required MV were enrolled for the study. Three milliliters of the venous blood was collected immediately after the initiation of MV and at 24 hours. Serum levels of interleukin (IL)-6, IL-8 and, tumor necrosis factor-α (TNF-α) were estimated using quantitative immunometric sandwich enzyme immunoassay technique. Based on their outcome from MV, they were divided into two groups: Survivors (group I) and nonsurvivors (group II).

Serum levels of IL-6 and IL-8 significantly increased in group II (n=13) when compared with group I (n = 17) (p < 0.0001 and p < 0.001 respectively) at 24 hours of MV. However, TNF-α did not show any significant difference between the two groups. The IL-6 >111.9 pg/mL at 24 hours of MV increases the probability of mortality by factor 2.40. An increase of IL-6 by 1 pg/mL significantly increases the relative probability of mortality by a factor of 1.004 (95% CI, 1.0003–1.0078, p = 0.0001).

Estimating the levels of IL-6 and IL-8 at 24 hours of connecting the patient to MV will help in predicting the outcome of the patient.

Prashant A, Vishwanath P, Kotekar N, Nataraj SM, Kuruvilla C, Nagalakshmi CS, Doddamani P. Systemic Cytokine Response predicts the Outcome of Patients from Mechanical Ventilation. Indian J Med Biochem 2017;21(1):5-10.

Singh M, Thakral D, Kar HK, Rishi N, Mitra DK. Immune Response Profiling of Patients with Anogenital Warts. Indian J Med Biochem 2017;21(1):11-16.

Maternal thyroid hormone levels during pregnancy are vital for the health of the mother as well as the developing child. Fetal growth is affected by maternal thyroid levels. Various physiological changes like alterations of thyroxine-binding globulins, human chorionic gonadotropin level, and changes in iodide metabolism affect maternal thyroid hormone levels. Therefore, reference intervals (RIs) for thyroid hormones in pregnant population require to be established separately from the general population.

The RIs of serum triiodothyronine (T3), thyroxine (T4), and thyroid-stimulating hormone (TSH) were determined in healthy pregnant women by enzyme-linked immunosorbent assay (ELISA) technique after segregating them into three trimesters. This study was conducted in a 492-bedded zonal-level hospital. The reference population was chosen from a study population of pregnant women by strict inclusion and exclusion criteria. The assays were done by the most-commonly used, economical ELISA method employing standard kits. Tests were done using accurate and precise methods with proper quality control measures.

The RIs were calculated from the central 95% of distribution of total T3, total T4, and TSH values located between 2.5 and 97.5 percentile values. The 0.90 confidence intervals for the upper and lower reference limits were calculated. The values thus obtained were different from those provided by the manufacturer kit literature.

It is recommended to determine one's own laboratory-specific, method-specific, trimester-wise RIs for maternal thyroid hormone status and use them for screening of pregnant women.

Chakrabarty BK, Mitra B, Pal R, Hazra N. Specific Reference Intervals of Serum Triiodothyronine, Thyroxine, and Thyroid-stimulating Hormone in Normal Pregnant Indian Women as per Trimester. Indian J Med Biochem 2017;21(1):17-21.

Reference intervals are the most common decision-making tools for the interpretation of various biochemical reports. Age, sex, ethnicity, diet, physical, and socioeconomic conditions affect the physiology of population. Hence, it is necessary to set up the reference values that are applicable to a specific population rather than using the reference values established for other population-based studies or from the literature provided by the reagent kit manufacturers.

To establish the reference intervals of serum hepatic enzymes in tertiary care hospital.

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 attending different outpatient departments and health camps organized by the hospital for general checkups under health plan scheme. Serum alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT) were estimated by the International Federation of Clinical Chemistry-recommended kinetic method and GGT by enzymatic colorimetric method. To obtain reference interval, 97.5th percentile and 2.5th percentile were used.

The results for serum AST and GGT were found to be statistically significant. Hence separate reference intervals for both male and female were set up. Generalized reference intervals were established for serum ALT and ALP levels.

The present study revealed a significant difference in the reference intervals between males and females.

Rai PS, Shetty S, Patil P, Bhandary R. Establishment of Reference Intervals of Serum Hepatic Enzymes in Tertiary Care Hospital: A Pilot Study. Indian J Med Biochem 2017;21(1):22-24.

Thyroid disorders are one of the most common endocrine diseases in India. Thyroid disorders are more common in women than in men and contribute to significant morbidity. In this postiodization era, there is paucity of pan-Indian data of thyroid disorder status among adult nonpregnant women. This study was done to analyze the thyroid hormone levels in women of Jharkhand region, which is traditionally known to be an iodine-deficient area.

Three hundred and forty nonpregnant adult females in Ranchi area who were consuming iodized salt formed part of the study group. Clinical evaluation was done by a gynecologist pertaining to thyroid illness. Thyroid function tests encompassing triiodothyronine, thyroxine, and thyroid-stimulating hormone were carried out by quantitative enzyme immunoassay method. Thyroid status of the population was defined as per kit reference range.

Subjects with age range 20 to 67 years were divided into three groups as per clinical status of thyroid disorder, viz. total, disease free, and control. A total of 19.6% had biochemical evidence of thyroid disorder and 82.4% were euthyroid as per reference ranges in kit literature. Out of hypothyroid subjects, 3.2% had clinical and 14.4% had subclinical hypothyroidism. In the study group, no subjects were detected to have overt or subclinical hyperthyroidism. Multiple comparison analysis was done with Statistical Package for the Social Sciences version 20.0, a statistical software package.

This is the first study in Jharkhand area on nonpregnant adult female population that are getting iodine sufficient foods in an iodine-deficient region. The study showed high prevalence of thyroid disorders in the study group. Hypothyroidism, predominantly subclinical hypothyroidism, is prevalent among women in this region.

Chakrabarty BK, Mitra B, Shahbabu B, Hazra N, Singh S. Thyroid Function Status in Indian Adult Nonpregnant Females in Ranchi, India. Indian J Med Biochem 2017;21(1):25-29.

Sample storage for prolonged periods can lead to alterations in routine biochemical parameters.

This study was undertaken to observe the biochemical changes on serum samples when they are stored for prolonged periods at –20°C on different routine biochemical parameters.

Significant changes were observed in serum glucose, aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatinine, and potassium levels after 72 hours of storage, which further deteriorate in 3 months. Rest of the parameters did not show any significant alteration.

Prolonged storage of samples lead to alterations in the analyte concentration in serum. Serum glucose, AST, ALT, creatinine, and potassium levels should be estimated within 72 hours if prolonged storage is unavoidable. In conclusion, all the parameters should be assayed within 24 hours to avoid misinterpretation of results and better patient care.

Tayal D, Gupta M, Goswami B. Does Prolonged Storage of Serum Samples alter the Lab Results? Indian J Med Biochem 2017;21(1):30-33.

Vitamin D has a great impact on human health and disease. Recent studies proved that hypovitaminosis D is a possible risk factor for the pathogenesis of diabetes and its complications. In the present study, we evaluated vitamin D levels and its correlation with the duration of diabetes, sex, glycosylated hemoglobin (HbA1C), and microvascular complications in type II diabetes mellitus (T2DM) patients with and without microvascular complications.

To study and correlate vitamin D levels and its relation with duration of diabetes, sex, glycemic control, and microvascular complication in T2DM patients with and without microvascular complications.

Cross-sectional case–control study of 200 patients (35–70 years) suffering from T2DM was included. The T2DM patients without microvascular complications served as control group. Enrolled subjects underwent complete physical examination to detect the presence of microvascular complications, which includes microfilament tests, detailed fundus examination, urinary microalbumin/creatinine ratio. Fasting blood sugar, HbA1C, and serum vitamin D were also measured by using serum sample.

Prevalence of vitamin D deficiency and insufficiency was found to be significantly higher in T2DM patients with microvascular complications (19.54 ± 2.56 vs 28.57 ± 2.93) as compared with T2DM patients without microvascular complications (p < 0.001). Hypovitaminosis D was found to be significantly more in females (60.75%) compared with males (39.96%) in both the study groups (p < 0.0001). Hypovitaminosis D was correlated with glycemic control and prevalence of microvascular complications.

Vitamin D is correlated with glycemic status and sex difference and has a role in pathogenesis of T2DM and its complications.

Kishore PK, Choudhary I. Status and Effect of Vitamin D on Microvascular Complication in Type II Diabetes Mellitus Patients. Indian J Med Biochem 2017;21(1):34-37.

Cardiovascular disease (CVD) is the major leading cause of mortality in men and women around the globe. The incidence of CVD increases with age in both the sexes, whereas it has been noted that there is a marked increase in risk among women after menopause. The hormonal changes associated with the menopause like low level of plasma estrogen and marked increase in follicle stimulating hormone levels exert a significant effect on metabolism of plasma lipids and lipoproteins leading to atherosclerosis, thereby increasing the risk of CVD in postmenopausal women.

To study the lipid profile parameters and to calculate and compare the lipid indices with lipid profile parameters in pre- and postmenopausal women.

The study group included 90 women comprising 45 postmenopausal (cases) and 45 premenopausal (control) women. To estimate lipid profile, enzymatic method was used and for calculation of lipid indices appropriate formula was used.

Altered lipid profile was observed in postmenopausal women, but it was not statistically significant. Atherogenic Index of Plasma, Castelli's risk index-I, atherogenic coefficient, and nonhigh-density lipoprotein cholesterol were significantly increased in postmenopausal women compared with premenopausal women, but there was no significant increase in Castelli's risk index-II.

Lipid indices may be considered as a better and cost-effective tool in assessing the risk of CVD in postmenopausal women.

Sirigere M, Meera S. Novel Lipid Indices as a Better Marker of Cardiovascular Disease Risk in Postmenopausal Women. Indian J Med Biochem 2017;21(1):38-41.

Hypovitaminosis D in pregnancy has been reported to cause various maternal effects, i.e., hypocalcemia, subclinical myopathy, increased risk of preeclampsia (PE), gestational diabetes mellitus (GDM), cesarean sections, and fetal effects, i.e., neonatal tetany, hyperbilirubinemia congenital rickets, infantile rickets, etc. Only few Indian studies are available in this regard.

To estimate serum vitamin D levels in pregnant women, cord blood, and study fetomaternal outcomes.

A prospective observational study was conducted on 54 consecutive pregnant women and their newborn babies. Serum 25-hydroxy vitamin D [25(OH)D] level was estimated in all women at the time of admission in labor ward. They were followed up to delivery and 48 hours postpartum. Vitamin D was also estimated in cord blood collected during delivery. All results were recorded and analyzed statistically.

The mean 25(OH)D level in pregnancy was 6.81 ± 7.38 ng/mL. The mean 25(OH)D level in their babies (cord blood) was 6.34 ± 7.05 ng/mL. There was very strong positive correlation between maternal and fetal serum 25(OH)D levels (p-value 0.001, r-value 0.9). Vitamin D deficiency was strongly associated with obesity, PE, and GDM (p-value 0.001). Neonatal jaundice and tetany were also significantly associated with severe vitamin D deficiency.

Low levels of vitamin D have been observed in pregnant women and their newborn babies. Hypovitaminosis D has been associated with adverse fetomaternal outcomes. As there is a strong correlation of maternal and neonatal levels, supplementing vitamin D in a pregnant women might improve these adverse pregnancy outcomes.

Gupta M, Debnath A, Jain S, Saini V, Ray S. Vitamin D Status in Pregnancy: Fetomaternal Outcome and Correlation with Cord Blood Vitamin D. Indian J Med Biochem 2017;21(1):42-48.

Oxidative stress is characterized by an increased generation of O₂-derived molecules called reactive oxygen species that provoke critical, even irreversible, cell injury.

To evaluate oxidative stress status through measurement of malondialdehyde (MDA) and to analyze association of changes in MDA status with respect to fluctuations in glycemic control.

A total of 112 subjects, both males and females, aged above 30 years were enrolled for this study, in which 81 had type II diabetes and 31 were without diabetes. Random blood sugar (RBS) was measured by glucose oxidase and peroxidase method. Serum MDA was measured by thiobarbituric acid reactive substances method. Glycated hemoglobin (HbA1c) was measured by ion exchange resin method.

The MDA and HbA1c levels were increased in diabetics and were statistically significant. In all the studied groups, MDA was positively correlated with RBS and HbA1c.

The study suggests that MDA should be measured along with routine parameters of disease and the use of redox active antioxidants to tone down MDA levels may be evaluated to contribute in early and improvised clinical management of type II diabetes mellitus and also to delay the development of secondary complications of the disease.

Arafeen S, Chatterjee M. Study of Oxidative Stress Status in Relation to Glycemic Index Fluctuations in Type II Diabetes Mellitus Patients. Indian J Med Biochem 2017;21(1):49-53.

In Indian population there are 42 million people suffering from hypothyroidism. Hence, even though thyroid-stimulating hormone (TSH) has been used as the diagnostic marker of hypothyroidism, there arises a need to evaluate an earlier and a causative marker for hypothyroidism and thus it could be a better predictor of the disease in the earlier stages only.

The aim of the study is to identify a reliable earlier and one of the causative biomarkers of hypothyroidism.

This study was conducted in 200 cases of newly diagnosed hypothyroidism and 200 controls of healthy individuals. Vitamin D, intact parathyroid hormone, TSH, triiodothyronine, thyroxine, and calcium were measured.

It was observed that vitamin D was significantly decreased in hypothyroid cases. There was a negative correlation between vitamin D and TSH.

Vitamin D being one of the causative factors in thyroid disorders should be included as a routine parameter of analysis in hypothyroid cases and supplementation of vitamin D also to be initiated by the clinicians to avoid the progression to overt hypothyroidism in the newly diagnosed cases.

Prabha AGT. Reliable Earlier and Causative Biomarker in newly Diagnosed Hypothyroid Cases‗Vitamin D: A Case–control Study. Indian J Med Biochem 2017;21(1):54-57.

Kesar V. Thyroid Hormones and Oxidative Stress. Indian J Med Biochem 2017;21(1):58-61.

The main focus of case-based learning (CBL) is to integrate basic science material with clinical science. Case-based learning may be designed and introduced along with traditional didactic lectures in a way that it creates interest, promotes better understanding, active participation, and self-directed learning. The student should be motivated to become a life-long learner.

We have formulated an innovative criterion-based module for implementation and evaluation of MBBS phase 1 students. This includes framing of a time schedule for distribution of teaching hours based on multiple teaching tools and module for conducting CBL sessions. This will be assessed by evaluation of student performance using a newly developed valid assessment tool.

For the CBL sessions, 100 students of phase 1 MBBS course were included. They were divided into 10 groups of 10 students each. Ten clinical cases were selected for CBL sessions. Each student was given two cases for discussion. Pretest was conducted before and posttest after the CBL session. The session was conducted as planned in the module. The performance of the students was analyzed. Feedback from the students and teachers were taken and analyzed for its utility and effectiveness.

The performance of the students showed drastic improvement after the CBL sessions (p < 0.0001); 85% of the students and 80% of the teachers agreed that CBL helps in deep learning and critical thinking; 84% of students and 73% teachers felt that CBL makes subject interesting with good retention of contents and reasoning ability for their future medical practice.

Our newly formulated assessment tool stands appropriate, which can be included in the present curriculum. Both the teachers and the students were satisfied with this kind of teaching method. This innovative teaching module and our newly formulated assessment tool proved to be very effective for learning biochemistry.

Patil VP, Patil VS, Kulkarni SP, Trivedi DJ, Axita VC, Mudaraddi RT, Shetty P, Bargale AB, Kamble PS, Ingleshwar DG, Shilpasree AS. Case-based Learning in Biochemistry: An Innovative Criterion-based Assessment Module for Effective Learning among MBBS Phase 1 Students in India. Indian J Med Biochem 2017;21(1):62-68.

Chakravarthy SN, Ramanathan S, Menon S, Durairaj M. Bisalbuminemia in an African Male with Sickle Cell Disease. Indian J Med Biochem 2017;21(1):69-71.