Introduction: Psoriasis is one of the debilitating diseases of the skin of chronic inflammatory origin. Oxidative stress is considered as the culprit for the oxidant and antioxidant imbalance, resulting in psoriasis.
Objectives: This study was undertaken to know the effects of oxidative stress in the origin and development of psoriasis and to evaluate the beneficial effect of antioxidant therapy in psoriatic patients along with conventional treatment.
Materials and methods: Thirty-three patients of age group 20–60 years with chronic plaque psoriasis, from the outpatient department of Dermatology, Mamata General Hospital, Khammam, Telangana, India were considered for the study. Patients with a duration of disease from 6 months to 2 years were enrolled for the study. The severity of psoriasis was determined using the psoriasis area severity index (PASI). Informed consent from the patients and institutional ethical committee clearance were taken.
Antioxidant therapy was given for 8 weeks along with conventional therapy. Malondialdehyde (MDA) and total antioxidant capacity were measured and compared before and after the therapy.
Results: After antioxidant therapy for 8 weeks, it was observed that there was a significant decrease in mean serum levels of MDA and increased levels of total antioxidant capacity (TAC).
Conclusion: The results revealed that antioxidant therapy along with conventional therapy of psoriasis is more beneficial in the treatment of psoriatic cases.
Introduction: Vitiligo is a pigmentation disorder affecting about 1–2% of the population with a multifactorial etiology. This condition may be acquired or often an inheritable disorder with polygenic inheritance pattern and complex pathogenic behavior. Increased Serum homocysteine levels and oxidative stress resulting from oxidant–antioxidant imbalance may play a vital role in the pathogenesis of vitiligo.
Objectives: The present study aims to evaluate the serum levels of homocysteine and serum malondialdehyde (MDA) and total antioxidant capacity (TAC) in vitiligo patients and also to study the role of the same in the pathogenesis of the disease.
Materials and methods: The study group comprised of 32 vitiligo patients of 16–40 years age group, attending outpatient department (OPD) in the Dermatology department of Mamata General Hospital, Khammam, Telangana, India. Thirty-two healthy individuals of the corresponding age group were selected as controls (control group) from the patient\'s attendants and hospital staff. Approval was obtained from the Institutional Human Ethical Committee. Prior informed consent was obtained from the selected participants. Serum level of homocysteine was measured using Axis homocysteine enzyme immunoassay (EIA). The MDA was determined as thiobarbituric acid reactive substances (TBARS). The total antioxidant capacity was estimated using ferric reducing ability of plasma (FRAP) assay.
Results: Mean serum levels of homocysteine and MDA were significantly increased, and TAC was decreased considerably in vitiligo cases compared to controls.
Conclusion: In cases of vitiligo patients, along with routine screening for homocysteine and oxidative stress status, the usage of antioxidants and homocysteine lowering agents such as vitamin B6, B12, and folic acid may prove beneficial as therapeutic agents.
Kuzhandai Velu V,
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V KV, Ramasamy R, Hanifah M, M L. Circulating MiR-1 Levels in Acute Myocardial Infarction and Its Significance in Differential Diagnosis and Prognosis. Indian J Med Biochem 2019; 23 (1):174-177.
Background: Acute myocardial infarction (AMI) is a condition where there is a formation of thrombus which reduces the blood flow in the coronary arteries resulting in coronary vasospasm, further leading to cardiac muscles dysfunction or even death. Quick and accurate diagnosis of AMI plays a major role in the management and prognosis of this disease. Circulating miRNA has been a promising cardiac biomarker for AMI as well as cardiovascular disease in recent years. In the circulation miR 1 overexpressed when there is any damage in the cardiac cell. A very few articles documented the use of miR-1 as a diagnostic marker in AMI. The aim of the study was to find the diagnostic and prognostic role of miR-1 in AMI.
Methodology: In this study, 62 AMI patients in the age group of 30–75 years and 30 healthy controls were included. Blood samples were collected at a different time of admission, 6 hours, 12 hours, 24 hours and 72 hours for the subject. Serum was separated immediately for the analysis of CK (NAC) and CK MB, Hs troponin T and micro-RNA-1 was quantification by RT-PCR. To study the kinetics of miR-1 repeated measure of analysis of variance (ANOVA) was analyzed. To find the diagnostic utility AUC, likelihood and odd\'s ration was performed.
Results: The miR-1 expression is expressed in a change in fold 27.36, 57.17, 43.55, 32.50 and 24.09 fold increase at the different time. The study revealed that the sensitivity 69%, specificity 66%, LR was 1.59 and OR 4.04 in the differential diagnosis of AMI.
Conclusion: In a total expression of miR-1 showed statistical significance in different time internal which will help us to use in the differential diagnosis of AMI.
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Kughapriya P, Elanchezhian J. Stability of Common Biochemical Analytes in Serum when Subjected to Changes in Storage Conditions and Temperature. Indian J Med Biochem 2019; 23 (1):178-181.
Aim: The aim of the study was to assess the effect of storage time and temperature on the test results of 8 common biochemical analytes in serum.
Materials and methods: Five mL of blood was collected from apparently healthy 80 volunteers in a clot activator tube without anticoagulant. Serum was separated after allowing the sample to clot for 30 minutes at room temperature. Separated serum was made into four aliquots. The first part analyzed within two hours act as a baseline value, while the other three aliquots were stored at room temperature for four hours, at 2–8° C for four hours and at 2–8° C for 24 hours, respectively.
Results: Baseline serum values of common biochemical analytes analyzed within two hours of sample collection on comparison with the same sample stored at room temperature for four hours showed a significant change in the values of glucose, urea, creatinine, total bilirubin, albumin, and total protein. Also the values of glucose, urea and albumin were significantly changed on comparing the baseline sample with the sample that is stored for four hours at 2–8° C. Finally we compared the baseline values with the sample stored at 2–8° C for 24 hours and found a significant change among the values of glucose, total bilirubin, and albumin. Other analytes were found to be stable.
Conclusion: According to our study, storage of common biochemical analytes in serum like glucose, urea, bilirubin, and albumin is not advisable. Serum creatinine and total protein were stable on refrigeration. Total cholesterol and triglycerides were found to be stable.
Clinical significance: In the context of patient centered approach to the delivery of healthcare services, clinical laboratories play a vital role. Despite the improvements made in the laboratory, errors still occur due to inadequate insight about the importance of sample collection and storage procedures. Errors in sample handling affects test report which diminishes the confidence in healthcare services and damages an institution\'s reputation. Significant interdepartmental cooperation is very essential for identification and proper management of preanalytical errors which inturn will help to make valuable medical decision and effective patient care.
Damini S Tomar,
Prafulla K Khodiar,
Pradeep K Patra
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Rath D, Tomar DS, Khodiar PK, Patra PK. Evaluation of Serum Electrolytes in Sickle Cell Disease Patients with Respect to Hydroxyurea Therapy. Indian J Med Biochem 2019; 23 (1):182-184.
Background: Sickle cell disease is one of the oldest genetic disorders known to medical science. The morbidity and mortality associated with the disease and its complication, sickle cell crisis, amounts to be a significant health issue. Hydroxyurea, originally used as an anticancer agent, has proved to be the wonder drug in lower doeses in sickle cell diease. The severity and impact of the disease on the affected person is decreased by a great extent by its use. The mechanism of action of the drug in sickle cell disease is yet to be completely understood. Electrolytes play a crucial role in the pathophysiology of sickle cell disease.
Aim: The current study aims to evaluate the serum electrolyte levels in sickle cell disease patients and look for the effect of hydroxyurea on them.
Materials and methods: Fifty two sickle cell disease (SS) patients and 20 normal individuals were included in the study (AA). Thirty four of the SS patients were under hydroxyurea therapy. The serum levels of magnesium, sodium, potassium, chloride, calcium, phosphate were estimated in all the study subjects.
Results and discussion: No significant difference was found with respect to the serum electrolytes in the sickle cell patients under and not under hydroxyurea therapy. But the serum electrolytes varied significantly between the sickle cell disease patients and the normal individuals.
Conclusion: Serum electrolytes play a crucial role in the pathophysiology of sickle cell disease, but hydroxyuera therapy does not seem to play a great role in altering their levels in the patients.
Sudha B Sreenivas
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Kamal S, Jayaram S, N S, BL D, Sreenivas SB. Estimation of Serum Electrolytes in Cases of Irritable Bowel Syndrome and Healthy Adults: A Comparative Study. Indian J Med Biochem 2019; 23 (1):185-188.
Irritable bowel syndrome (IBS) is one of the most prevalent, multifactorial, heterogeneous and complex disorders that affects up to 1 in 5 people over their lifetime. It significantly reduces patients’ quality of life. Individuals diagnosed with IBS have “low-grade intestinal inflammation”, and increased intestinal permeability. This can create an electrolyte imbalance. This study was taken up as there is a paucity of literature and controversial reports on serum electrolytes in IBS.
Objectives: The objectives of this study were to estimate serum electrolyte levels in patients with IBS and to compare the same with that of normal healthy adults.
Materials and methods: This study was conducted on 108 individuals in the age group of 18–60 years of whom 54 were diagnosed IBS cases and 54 were normal controls. Estimation of serum electrolytes was done with the collected venous blood samples using the Ion selective electrode technique in an electrolyte analyzer.
Results: Near normal mean serum sodium levels and a slight decrease in mean potassium level with a statistically significant increase in the mean serum chloride were the findings observed in our study group when compared with the controls.
Conclusion: IBS remains an enigmatic cause of significant distress, morbidity and disability. Our study implies that serum electrolyte levels are not greatly altered in IBS cases probably due to the rapid transit in colon, mucoidal consistency and small volume of stools. Lack of specific biomarkers adds to its complexity. Hence a multipronged approach is essential to improve the health related quality of life in these patients.
Clinical significance: Since this functional disorder is highly associated with significant emotional distress, impaired health-related quality of life, disability and high health care costs, this study tries to understand the possible changes that can be incorporated in the diet or serum electrolyte supplementation in IBS cases.
Introduction: Heart failure (HF) is a major and growing public health problem among the global population. Cardiac biomarkers are a promising tool for the early and specific detection of heart failure. B-type natriuretic peptide (BNP) is one such cardiac biomarker released in response to ventricular myocyte stretch.
Aim: The aim of the present study was to estimate the levels of plasma BNP in patients with stable chronic heart failure (CHF) and to compare them with controls. Further to correlate the relationship between plasma BNP levels and factors like age, gender and left ventricular ejection fraction (LVEF), in the two groups.
Materials and methods: A case-control study conducted in Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India consisting of 55 stable CHF patients on treatment and 35 controls. Serum creatinine was estimated adopting modified Jaffe\'s method. eGFR was calculated using the modification of diet in renal disease (MDRD) formula. Plasma BNP levels were measured by ELISA.
Results: The mean BNP concentration in patients with stable CHF was 60.46 ± 16.13 pg/mL, while in controls it was 20.94 ± 5.81pg/mL and the difference was highly significant (p= 0.001). As the age increases an increasing trend in the values of plasma BNP was observed in both groups. There was a strong negative linear relationship (r = -0.798) observed between LVEF and BNP levels in the study population. A cut-off level of 30.2pg/mL for plasma BNP had a 100% sensitivity and specificity to predict CHF.
Conclusion: Our study concludes that plasma BNP was significantly higher in patients with stable chronic heart failure than in the controls. Plasma BNP as a biomarker will help in identifying stable CHF patients who are asymptomatic, on their adequacy of treatment.
Introduction: Pleural effusion is one of the most important debilitating disorders caused by various pathological conditions. It is a common clinical disorder and is either a manifestation or a complication of one or other respiratory of non-respiratory diseases. Diagnosing the type of effusion as an exudate or transudate is equally important in identifying the cause and treating accordingly to the type of pleural effusion. Hence, the use of light\'s criteria to separate transudate from exudate has been generally the admitted first step in any study of pleural effusion of the unknown cause. As the pleural effusion may increase the local oxidative stress so that pleural fluid can be analyzed for the oxidative stress marker as one of the tool additives with the light\'s criteria for the better differentiating the exudative from transudative type of effusion.
Aim: Estimate levels of malondialdehyde (MDA), C-reactive protein (CRP) and uric acid in pleural fluid and compare the levels in exudative and transudative pleural fluid.
Materials and methods: The samples for the study were collected after taking informed consent. The pleural tapping was done under all required aseptic precaution. It was divided into two groups—transudative pleural effusion (group 1) and exudative pleural effusion (group 2) by using Light\'s criteria. Samples were analyzed for the MDA, CRP and uric acid.
Results and conclusion: MDA and CRP values have shown significantly increased levels in the pleural fluid of exudative type compared to transudative, but pleural uric acid levels were lower in exudative. However, there was no much difference between these parameters in serum levels among groups. The present study showed that oxidative stress is more in the exudates compared to transudates, probably due to the higher production of reactive oxygen species; it may serve as markers for differentiating between exudates and transudates.
Ivvala A Shaker,
Neha D Sheth,
Diabetes mellitus (DM) is associated with thyroid dysfunction. The aim of this present study was to measure the level of thyroid hormones (FT3, FT4, TSH), FPG, PPG, HBA1C, serum C3 in type II diabetic patients of either sex and to assess their clinical presentations and to compare and correlate the findings with males and females. In this study, 177 type II diabetic subjects and 100 healthy control subjects were investigated for FT3, FT4, and TSH. FPG, PPG, HbA1C, and S C3 complement were measured as supplementary parameters to predict the immune system. The level of TSH was significantly higher in type II diabetics as compared to control, but FT3 and FT4 did not show statistical significance. Significantly higher levels of FPG, PPG, HbA1C, and serum C3 and were also noted but serum C3 showed a significant increase with some immune dysfunction compared to control subjects. Type II diabetes should undergo regular screening to detect asymptomatic thyroid dysfunction along with complement C3 and other biochemical parameters to improve the quality of life and reduce the complication rate.
Palani S Mohanraj,
Angel M Sylus,
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Mohanraj PS, Nandeesha H, Sylus AM, Chitra T. Elevated Luteinizing Hormone, Testosterone and Free Triiodothyronine with Increase in Body Mass Index in Polycystic Ovary Syndrome. Indian J Med Biochem 2019; 23 (1):203-206.
Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women in the reproductive age group. The association of testosterone, luteinizing hormone (LH), follicle stimulating hormone (FSH) and thyroid hormones in obese PCOS women are not clear. Hence, the present study was performed to assess the serum levels of gonadotrophins, testosterone and thyroid hormones in obese and nonobese PCOS women.
Materials and methods: Sixty-three patients (41 obese and 22 nonobese) with PCOS were recruited for the study. Serum levels of testosterone, LH, FSH, thyroid stimulating hormone (TSH), free thyroxine (free T4) and free triiodothyronine (free T3) levels were measured.
Results: Serum LH (p = 0.040), testosterone (p = 0.010) and free triiodothyronine (p = 0.006) levels were significantly elevated in obese PCOS women as compared to non-obese PCOS women. Both LH (r = 0.478, p = 0.002) and free T3 (r = 0.379, p = 0.036) were correlating positively with body mass index (BMI) in obese PCOS subjects. Testosterone was positively associated with duration of infertility in obese PCOS women (R2 = 0.187, â = 0.433, p = 0.005)
Conclusion: We conclude that LH, testosterone and free T3 levels are increased with increase in BMI among women with PCOS.
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Manju M, Rajendran S, Mishra S, M P. Serum Liver and Pancreatic Enzymes in Chronic Kidney Disease with and without End-stage Renal Disease: A Comparative Study. Indian J Med Biochem 2019; 23 (1):207-212.
Introduction: Chronic kidney disease (CKD) is emerging as an important chronic disease globally. The occurrence of liver and pancreatic diseases as comorbid conditions is very common. Estimation of liver and pancreatic enzymes still remains the main modality of diagnosis and monitoring hepatic and pancreatic diseases. Alterations in the enzyme levels in the absence of liver and pancreatic diseases have been reported. Hence we decided to compare the serum levels of liver and pancreatic enzymes (AST, ALT, ALP, GGT amylase and lipase) among CKD patients without end-stage renal disease (ESRD), patients with ESRD and healthy controls and to correlate the enzyme levels with eGFR (severity).
Materials and methods: The present study was conducted in a tertiary care hospital with 100 controls, 100 CKD patients without ESRD and 100 ESRD patients. All the 300 patients had no evidence of hepatic or pancreatic diseases. Alanine transaminase (AST), aspartate transaminase (ALT), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), amylase and lipase were estimated in all 300 study subjects.
Results: There was a significant decrease in the levels of AST and ALT and increase in ALP, GGT, amylase and lipase levels in the CKD patients without ESRD and ESRD patients as compared to the controls (p < 0.05). eGFR was found to have a strong negative correlation with ALP, amylase, and lipase in CKD patients without ESRD and with ESRD.
Conclusion: Our study emphasizes that, using the present reference ranges for these enzymes in CKD patients will result misdiagnosis of hepatic or pancreatic disease, hence emphasizing the need to establish new reference ranges for these enzymes in various stages of CKD which ultimately will help the treating physicians in diagnosis and management of hepatic and pancreatic dysfunction in CKD patients.
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K G, Bhaktha G, B M, P, S P. Prevalence of Prediabetes at the Tertiary Healthcare Center, McGann Teaching District Hospital, Shivamogga, Karnataka, India. Indian J Med Biochem 2019; 23 (1):213-216.
Aim: The aim of this study was to assess the prevalence of prediabetic state among the people with no clinical symptoms of hyperglycemia and factors underlying the risk of prediabetes.
Materials and methods: Patients visiting medicine outpatient department (OPD) were recruited for the study at the tertiary healthcare center, McGann Teaching District Hospital, Shivamogga. Data regarding the health-related status and other risk factors were collected between May 2016 and April 2017. In this cross-sectional study, factors related to the risk of diabetes were analyzed and tabulated.
Results: The prevalence of prediabetes was 0.17%, out of which 36.36 % were male, and 63.64% were females, respectively. Participants had a mean age of 47.45 ± 9.95 years, with a higher percentage of people under IFG (39%). The average BMI was 24.44 ± 3.89 with more percent of subjects in impaired fasting glucose (IFG) are having a BMI 25–29.9.
Conclusion: Future intervention should include strategies to address social isolation and also focus on middle-aged subjects with the low socioeconomic state. Knowledge enhancement program is warranted for the prevention of prediabetes in this population.
Rama K Reddy YV,
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YV RK, P S, Cherian K, Babu S. Comparison of Serum and Salivary Neopterin with Troponin-I and CK-MB Levels in Acute Coronary Syndrome. Indian J Med Biochem 2019; 23 (1):217-220.
Objective: To determine the levels of serum and salivary neopterin in acute coronary syndrome (ACS) in comparison with established biomarkers like Troponin-I and CK-MB.
Background: Neopterin is the product of activated macrophage which is released by activated monocyte by cytokines during the acute phase response of ACS, can be used as a biomarker for diagnosis of ACS.
Materials and methods: ACS (n = 675) individuals with or without ST-segment elevation myocardial infarction were enrolled for the study, for three years. Serum and saliva neopterin were estimating by HPLC and compared with established biomarkers like Troponin-I and CK-MB.
Results: Increased serum and salivary neopterin levels were observed in patients with STEMI, NSTEMI, and UA of ACS. From the ROC analysis serum and salivary neopterin were found to be more sensitive and specific than the established biomarkers of ACS like Troponin-I and CK-MB, in diagnosing ACS.
Conclusion: Neopterin being more sensitive and specific than troponin and CK-MB, can be a marker of ACS. The collection of saliva being Non-invasive salivary neopterin can be easily estimated than serum neopterin.
Vanitha Gowda MN,
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KS K, MN VG, KC V, K R. A Study Comparing Values of Serum Potassium Estimated by Colorimetric KIT Method with those Obtained by Direct and Indirect ION Selective Electrode Methods. Indian J Med Biochem 2019; 23 (1):221-225.
Introduction: Electrolyte abnormalities are treatable, but known to cause significant morbidity and mortality amongst the general population seeking health care services. The instruments with Ion selective electrode (ISE) (direct or indirect ISE) are the reference methods which are unavailable in rural health care facilities.
Materials and methods: A prospective study was undertaken with 120 serum samples. Potassium was estimated using direct, indirect ion-selective electrodes ISE and colorimeter. Statistical analysis was done using statistical package for social sciences (SPSS) version 17, NCSS 11 and MINITAB 18 software. A p < 0.05 was considered statistically significant.
Results: A strongly positive correlation for potassium values between the instruments was noted. A simple linear regression analysis was done and a regression equation was derived for potassium values while comparing between the instruments. The Bland Altman analysis with 95% Limits of agreement was computed for potassium values between the instruments. It was well within the CLIA suggested target value ± 0.5 mmol/L for potassium.
Conclusion: The values of potassium estimated on the colorimeter are comparable with direct and indirect ISE in all the ranges. The derived regression equation calculates a predicted value for direct and indirect ISE using the values obtained on the colorimeter. This will be beneficial in identifying the altered levels of potassium in patients attending the peripheral health centers, use appropriate intervention and thereby reduce the morbidity and mortality with the use of a cost-effective and logistically feasible instrument viz., colorimeter.
Arup K Banerjee,
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Mukherjee S, Banerjee AK, Bhattacharyya S, Saha S. Silent Gallbladder Stone Associated with Nonalcoholic Fatty Liver Disease in a Scenario of Insulin Resistance in Young Adults. Indian J Med Biochem 2019; 23 (1):226-229.
Nonalcoholic fatty liver disease (NAFLD) is considered as the hepatic expression of insulin resistance. The high occurrence of obesity and dyslipidaemia in insulin resistant condition favours NAFLD.
The hepatic effect of insulin resistance are diverse including increased hepatic cholesterol secretion, biliary cholesterol supersaturation and decreased biliary motility all of which leads to gallstone formation.
NAFLD and gallstone disease (GSD) shares common pathological factors like hyperinsulinemia, dyslipidaemia. As all the factors are common association with Insulin resistance there could be common occurrence of NAFLD and GSD in patients with insulin resistance.
During a study two patients with insulin resistance were found to have both NAFLD and GSD. Both the patients were found to be dyslipidemic and on sonography one was found to have multiple gall bladder stones and the other with a single gall bladder stone.
Creatine kinase-MB (CK-MB) is a widely evaluated testing enzyme in diseases related to cardiac or injury. Here we relate a clinical scenario of a patient presenting with no chest pain or symptom related to the cardiac disease whose CK-MB levels were remained inordinately elevated despite normal total CK levels. Clinically and subsequent pathological examination showed no evidence of infarction, inflammation or cardiac ischemia. Further evaluation of the patient reveals the presence of the primary prostate carcinoma with the secondary metastatic lesions in the hepatic lobe.