Indian Journal of Medical Biochemistry

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2021 | May-August | Volume 25 | Issue 2

EDITORIAL

Binita Goswami

The Nobel Prize in Physiology or Medicine 2021 was Awarded Jointly to Researchers—A ‘touchy’ story.....

[Year:2021] [Month:May-August] [Volume:25] [Number:2] [Pages:1] [Pages No:00 - 00]

PDF  |  DOI: 10.5005/ijmb-25-2-iv  |  Open Access |  How to cite  | 

Original Article

Prabhjot Kaur, Navjot Bajwa, Sunil K Gupta, Abhra Ghosh, Manraj Kaur

Study of Levels of Free Testosterone in Patients with Acne Vulgaris before and after Treatment

[Year:2021] [Month:May-August] [Volume:25] [Number:2] [Pages:4] [Pages No:47 - 50]

Keywords: Acne, anti-androgen therapy, Free testosterone

PDF  |  DOI: 10.5005/jp-journals-10054-0175  |  Open Access |  How to cite  | 

Abstract

Background: Acne vulgaris is one of the most common diseases afflicting humans and it is the skin disease most commonly treated by physicians. The prevalence of acne is about 15% in all age-groups and it is seen more frequently in women than men. Abnormal follicular differentiation, increased cornification, enhanced sebaceous gland activity, hyperseborrhea, bacterial hypercolonization, as well as inflammation and immunological host reaction are the major contributors to acne formation. Other factors such as diet, exposure to the sun, poor hygiene, stress, and genetics are believed to cause or worsen acne symptoms. Hormonal imbalance also plays a role in acnegenesis. Out of all the hormones, androgens are thought to be most important due to its association with the follicular and sebaceous glands. Aim and objective: Our aim of the study is to compare the severity of acne vulgaris with free testosterone levels and to correlate its level before and after treatment. Ninety-three patients attending OPD of the Department of Dermatology, Venereology and Leprosy of Dayanand Medical College and Hospital, Ludhiana, were enrolled in the study period of 1 year. Results: The mean free testosterone levels before treatment were 1.58 ± 1.50 pg/mL and after treatment were 1.34 ± 0.90 pg/mL. These values were statistically significant (p = 0.006). The mean free testosterone levels in the age-group of <20 years before treatment were 1.93 ± 1.65 pg/mL and after treatment were 1.61 ± 1.06 pg/mL. These values were statistically significant (p = 0.016). Conclusion: The increase in free testosterone levels may be responsible as one of the factors for the development of acne vulgaris. Clinical significance: As free testosterone is associated with acne vulgaris, free testosterone levels should be measured in patients presenting with acne vulgaris, especially in the age-group 15–30 years and treatment-resistant cases and anti-androgen treatment may be indicated in cases with elevated free testosterone levels.

Original Article

Vidya S Patil, Vijayetha P Patil, Deepak R Kanabur, Pravinchandra R Kangokar

Effectiveness of Early Clinical Exposure as a Motivational Tool to Improve Students’ Learning in MBBS Phase 1

[Year:2021] [Month:May-August] [Volume:25] [Number:2] [Pages:9] [Pages No:51 - 59]

Keywords: Early clinical exposure, Independent learning, Integrated teaching, Learning strategies, Motivation to learn, Self-determination theory

PDF  |  DOI: 10.5005/jp-journals-10054-0179  |  Open Access |  How to cite  | 

Abstract

Aim and background: Early clinical exposure (ECE) supports intrinsic motivation which is associated with deep learning and better performance. The self-determination theory of motivation in learning proposes that optimal performance of students’ results from actions motivated by intrinsic interests or by extrinsic values that are internalized. We propose an ECE module supporting students’ three basic psychological needs of relatedness, autonomy, and competence extrinsically to improve students’ learning. Objectives: To evaluate the effectiveness of ECE module on students learning attitude and academic performance. Materials and methods: One hundred students of 1st phase MBBS were divided into a control group of first 50 and a study group of next 50 students. Early clinical exposure module for the study group included diagnostic lab and ward visits for three cases (anemia, jaundice, renal failure) in small groups and motivational videos focusing on independent learning. Motivated strategies for learning questionnaire (MSLQ) were taken pre- and post-intervention to know its effect on students learning. The class test was conducted and scores were compared to know its effect on academic performance. Results: Mean comparisons of MSLQ Likert scale responses showed significant improvements in learning strategies of elaboration, organization, and critical thinking among the study group (p = 0.005, 0.04, and 0.001, respectively) and also motivation for learning as improved self-efficacy compared to the control group (p = 0.01) which shows improved self-confidence in their own ability to perform the task. Mean class test score comparison after ECE module showed significant improvement among study group (p = 0.001). Conclusion: Our study supports the inclusion of ECE as a motivational tool for learning as it is effective in improving students’ learning strategies, motivation to learn, and academic performance.

Original Article

Kavyashree P Siddaramegowda, Anitha Devanath

Perception of Measurement Uncertainty among Laboratorians and Clinicians in Indian Scenario

[Year:2021] [Month:May-August] [Volume:25] [Number:2] [Pages:5] [Pages No:60 - 64]

Keywords: Measurement uncertainty, MU implementation, Perception of MU, Qualitative research, Serial result monitoring

PDF  |  DOI: 10.5005/jp-journals-10054-0180  |  Open Access |  How to cite  | 

Abstract

Aim and objective: Measurement uncertainty (MU) calculation for quantitative parameters is a mandatory requirement as per ISO 15189:2012. The concept of MU and its applicability is still ambiguous although the terminology has been around for more than two-and-a-half decades. Since accreditation bodies are aligned to ISO 15189:2012, it is interesting to understand the extent of awareness of MU and perception of its usefulness in our clinical setting. Materials and methods: A questionnaire-based survey was conducted to understand the awareness and perception of MU along with interviews and focused group discussions. Prior training on how to use MU in a clinical setting was given before the survey. Responses to the questionnaire were analyzed using Microsoft Excel. Results: The majority of laboratorians were aware of the terminology and confident to explain the use of MU during test result-related queries. However, there were challenges anticipated such as complexity in calculating the ranges, incorporation in laboratory information system, and acceptability by patient population. Both laboratorians and clinicians felt that MU helps in analyzing patient results more accurately and this process of change would require more time for better acceptance. Conclusion: We conclude from our study that laboratory consultants with enough knowledge of MU can confidently introduce and implement MU in their daily practice. Clinicians were willing to interpret results with MU provided it was documented alongside the test report especially for the critical parameters which is obviously the challenging aspect for the labs. Clinical significance: The feasibility of the introduction of MU alongside patient\'s report is useful in interpreting critical parameters and provides a scientific evidence for consideration in a change of patient management rather than an arbitrary subjective analysis of serial monitoring of results.

Original Article

Sangita M Patil, Mangesh P Bankar

Study of Correlation between the Paraoxonase 1 (PON1) Activity and Lipid Profile in Various Types of Coronary Heart Disease

[Year:2021] [Month:May-August] [Volume:25] [Number:2] [Pages:6] [Pages No:65 - 70]

Keywords: Coronary heart disease, Lipid profile, Paraoxonase-1

PDF  |  DOI: 10.5005/jp-journals-10054-0184  |  Open Access |  How to cite  | 

Abstract

Aim and background: Coronary heart disease (CHD) is the major cause of mortality and morbidity worldwide. Human serum paraoxonase-1 is a high-density lipoprotein (HDL)-bound enzyme exhibiting anti-atherogenic properties. Objective: The current study aimed to determine the serum paraoxonase-1 activity and lipid profile with CHD in addition to correlate the relationship between serum high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein (LDL) cholesterol, and paraoxonase-1 level in patients with CHD. Materials and methods: In the present case-control study, 265 with coronary artery disease (age range 26–75) and 120 age- and sex-matched healthy controls were recruited. Serum paraoxonase activity was measured spectrophotometrically by using phenylacetate as substrate by kinetic assay while lipid profile was analyzed by an enzymatic method by cholesterol oxidase peroxidase (CHOD-PAP) method of total cholesterol and HDL-C and glycerol 3-phosphate oxidase (GPO-PAP) method of triglyceride. Values were expressed as mean ± standard deviation and data from patients and controls were compared by using the Student\'s “t” test. Results: Serum paraoxonase-1 activity was significantly (p < 0.01) decreased in CHD when compared with healthy controls. Similarly, there was a significant difference between mean values of paraoxonase-1 when all CHD groups compared with each other (p < 0.01). Correlation between paraoxonase-1 vs HDL-C was positive in stable angina (Karl Pearson\'s correlation coefficient r = 0.04671), myocardial infarction (MI) (r = 0.2643), and controls (r = 0.06384) and it was negative in unstable angina (UA) (r = −0.098). There was negative correlation between paraoxonase-1 vs low-density lipoprotein (LDL)-cholesterol in stable angina (r = −0.0291), MI (r = −0.2265), and control group (r = −0.1767), and was positive in UA (r = 6185). Conclusion: Low paraoxonase-1 may be reducing the capacity of HDL to prevent the oxidation of LDL cholesterol, therefore, lead to CHD. So interventional means of dietary antioxidants to conserve or even to raise paraoxonase-1 activity may contribute to attenuation of atherogenesis.

RESEARCH ARTICLE

Murat CAN, Berrak Guven, Abdulkadir Tekin

Analytical Performance Assessment of the Prothrombin Time and Activated Partial Thromboplastin Time Tests by Roche Cobas t511 Coagulation Analyzer

[Year:2021] [Month:May-August] [Volume:25] [Number:2] [Pages:5] [Pages No:71 - 75]

Keywords: Activated partial thromboplastin time, Analytic performance, Coagulation analyzer, Prothrombin time, Roche t511

PDF  |  DOI: 10.5005/jp-journals-10054-0174  |  Open Access |  How to cite  | 

Abstract

Aim and objective: The study aims to evaluate the performance of a newly installed fully automatic coagulation analyzer Roche t511. Materials and methods: The prothrombin time (PT), activated partial thromboplastin time (aPTT), and international normalized ratio (INR) values obtained from 150 patients by a Roche t511 were compared with those obtained by Siemens Sysmex CS 2000i. Coagulation assays were performed under routine conditions using standard reagents and an analyzer. Reference intervals were established using 2.5th and 97.5th percentiles for hematologic analytes and minimum and maximum values for coagulation tests. Results: In our study, within- and between-run precision CVs for PT and aPTT in Cobas t511 analyzer were excellent according to the criteria for acceptance. Reference intervals are reported. Conclusion: The data reported here show that the PT and aPTT assay on the t511 fully automated analyzer is highly sensitive, accurate, and specific for the measurement of hemostasis.

RESEARCH ARTICLE

Anu RI, Charanjeet Kaur, Prabhash Bhavsar, Jagdish Prasad

Genotyping of Lipoprotein(a) Gene Variants in Coronary Artery Disease in Indian Population

[Year:2021] [Month:May-August] [Volume:25] [Number:2] [Pages:7] [Pages No:76 - 82]

Keywords: Allele-specific PCR, Cardiovascular genetics, Coronary artery disease, Lipoprotein(a), LPA aspirin genotype, LPA gene polymorphism, Molecular cardiology, rs1321196, rs3798220, rs9364564

PDF  |  DOI: 10.5005/jp-journals-10054-0178  |  Open Access |  How to cite  | 

Abstract

India is undergoing an epidemiological transition and an alarming rise in the prevalence of coronary artery disease (CAD). The etiopathology of the disease is evolving to a more complex setting with the discovery of novel risk factors. In the quest for non-traditional risk factors, we found that Lipoprotein(a) gene and its product are unique and pertinent to the Indian population. To unravel the genetic blueprint of the variations within the LPA gene in Indians, we studied novel exonic and intronic SNPs in 60 patients with angiographically proven CAD and matched them with healthy volunteers. From the study, we observed that in our patients, LPA aspirin genotype rs3798220 did not cause variation in Lp(a) levels in either of the two groups which is a novel finding as it is at odds with most published studies from other populations, on this variant. The polymorphic allele of SNP rs1321196 increased serum Lp(a) levels but the presence of the variant was however not limited to the patient population. The SNP rs9364564 did not influence Lp(a) levels in either of the two groups of the study. The study is unique as it bears witness to the novelty of the genotype background in Indian patients with CAD.

RESEARCH ARTICLE

Minal M Pore, Meghana K Padwal, Annapurna V Raichurkar

Biochemical Markers Associated with COVID-19 Disease Severity in a Tertiary Care Teaching Hospital

[Year:2021] [Month:May-August] [Volume:25] [Number:2] [Pages:5] [Pages No:83 - 87]

Keywords: Biomarkers, Coronavirus disease-2019, C-reactive protein, Ferritin, Lactate dehydrogenase, Procalcitonin

PDF  |  DOI: 10.5005/jp-journals-10054-0183  |  Open Access |  How to cite  | 

Abstract

Aims and objectives: The coronavirus disease-2019 (COVID-19) pandemic has led to an urgent need for reliable biomarkers to identify disease severity. Infection with COVID-19 is rapidly spreading posing a serious threat to community health. This study aims to identify the most effective biomarker among C-reactive protein, procalcitonin, lactate dehydrogenase, and ferritin to predict disease severity. The routine biochemical markers (LFT, RFT, electrolytes, CKNAC, CKMB, blood glucose level) were also evaluated for correlation with disease severity. Materials and methods: The present study is retrospective type. The study protocol was approved by IEC. The levels of biochemical markers of admitted COVID-19 positive patients were analyzed after determining the normal distribution and their significance was determined by calculating the p value. The accuracy of the biomarkers [C-reactive protein (CRP), PCT, lactate dehydrogenase (LDH), and ferritin] was checked using ROC analysis. Results: Five hundred and ninety-one COVID-19 positive patients admitted to the hospital (from May 2020 to December 2020) were considered for the study. Out of these 231 (39.1%) were admitted to the intensive care unit (ICU) and 360 (61%) were in-ward patients. The mean age of the study population was 50.39 ± 16.7, with ICU patients significantly older than non-ICU patients (p < 0.001) and 50–75 years being the most common age group. There was a statistically significant difference in the values of CRP, LDH, PCT, ferritin, AST, albumin, urea, CKNAC, sodium, potassium, and blood glucose levels (p value < 0.05). Conclusion: The severity of COVID-19 disease can be identified at an early stage by following the different routine biochemical marker levels and subsequently improve prognosis. Inflammatory markers (CRP, PCT, LDH, and ferritin) serve as useful guidance for determining disease severity in COVID-19 patients.

CASE REPORT

Nandita M Jindal, Maria Thomas, Ashish K Joy

Turbid Challenge in Diabetic Ketoacidosis

[Year:2021] [Month:May-August] [Volume:25] [Number:2] [Pages:3] [Pages No:88 - 90]

Keywords: Diabetic ketoacidosis, Electrophoresis, Hypertriglyceridemia, Lipemia, Lipoproteins

PDF  |  DOI: 10.5005/jp-journals-10054-0185  |  Open Access |  How to cite  | 

Abstract

Background: Interference due to lipemia poses major challenges in laboratory analysis. Turbidity in the sample is due to the accumulation of triglyceride (TG)-rich lipoprotein particulates. The most common cause of hypertriglyceridemia is inadequate fasting whereas secondary causes include alcoholism, chronic renal failure, hypothyroidism, and diabetes mellitus. Aim and objective: To analyze a highly lipemic sample received in the laboratory, to aid in diagnosis. Case description: A highly lipemic plasma drawn from a previously well 32-year-old woman presenting to the emergency department with fever, vomiting, breathlessness, and epigastric pain was received in the lab. Increased serum cholesterol (1,067 mg/dL) with highly raised TG levels (16,117 mg/dL) was seen. Insulin was found to be low (4.2 μI/mL) with raised blood glucose (379 mg/dL) and serum was found positive for acetone. Initial serum lipoprotein electrophoresis showed prominent bands of very-low-density lipoprotein (VLDL) and chylomicrons, which after the start of insulin treatment were found to be only of VLDL. The patient was managed as a case of diabetic ketoacidosis subsequently resulting in a fall in the levels of TG (1,022 mg/dL) and glucose (176 mg/dL) and negative serum acetone. Conclusion: We report the approach taken by the laboratory toward a highly turbid serum sample to achieve reliable laboratory results from a patient eventually diagnosed with diabetic ketoacidosis and acute pancreatitis. Clinical significance: Diagnosis of a patient in current times is mostly dependent on accurate laboratory results which are affected by preanalytical variables like lipemia. Appropriate sample handling in such cases as well as using techniques at our disposal like lipid electrophoresis can aid in diagnosis and ruling out differential causes.

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