Indian Journal of Medical Biochemistry

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2021 | September-December | Volume 25 | Issue 3

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Sarika Jain Agrawal, Rajeev Goyal, Monil Singhai

Breakthrough Infections and Omicron Variant: Dealing with the Dilemma

[Year:2021] [Month:September-December] [Volume:25] [Number:3] [Pages:1] [Pages No:00 - 00]

   DOI: 10.5005/ijmb-25-3-iv  |  Open Access |  How to cite  | 



Anuradha Kumari, Ratna Biswas, Neeraj Yadav, Ekta Debnath

Initial and Day Four β-hCG Levels as Predictors of Outcome of Single-dose Methotrexate Therapy in Medical Management of Tubal Ectopic Gestation

[Year:2021] [Month:September-December] [Volume:25] [Number:3] [Pages:5] [Pages No:91 - 95]

Keywords: Drugs, Ectopic, β-hCG, Pregnancy

   DOI: 10.5005/jp-journals-10054-0195  |  Open Access |  How to cite  | 


Introduction: Ectopic pregnancy is defined as the implantation of a fertilized ovum outside the endometrial cavity. The most common site is the fallopian tube. The incidence of ectopic pregnancy is 1–2% of all pregnancies. Methotrexate is the most commonly used drug for the medical management of ectopic pregnancy. It is a folic acid antagonist that prevents the growth of rapidly dividing cells including trophoblasts and fetal cells by interfering with DNA synthesis. Aim and objective: To study initial and day 4 β-hCG levels as predictors of outcome of single-dose methotrexate therapy in the medical management of ectopic pregnancy. Materials and methods: Thirty patients after confirmed diagnoses of tubal ectopic pregnancy were enrolled in the study. β-hCG was estimated using a sequential two-step immunoenzymatic (sandwich) assay. Results: Out of 30 women who received inj MTX on day 0, 19 (63.3%) women were treated successfully with a single dose of methotrexate (group I), 8 (26.6%) women required a second dose of methotrexate, and 3 (10%) women required surgery. Women who required a second dose or surgery were treatment failure (group II) (36.6%) with a single-dose methotrexate regimen. The mean initial β-hCG β-hCG level was 2294.92 ± 1162.93 mIU/mL in group I and 3831.18 ± 1066.83 mIU/mL in group II. The difference of mean was statistically significant between group I and group II on day 0, day 4, and day 7. Conclusion: Results in the present study favor therapeutic intervention with a second dose of methotrexate on day 4 against day 7 as in the current protocol in women with a rising trend of β-hCG between day 0 and day 4. However, due to the small sample size, further studies are needed to validate these findings.



Manjusha Jangam, Hanumanthappa Nandeesha, Tamilarasu Kadhiravan, Sathishbabu Murugaiyan

Association of Severity Serum Iron Indices and High-sensitivity C-reactive Protein with Disease Severity in Men with Alcoholic Liver Disease

[Year:2021] [Month:September-December] [Volume:25] [Number:3] [Pages:4] [Pages No:96 - 99]

Keywords: Alcohol liver disease, C-reactive protein, Ferritin, Iron

   DOI: 10.5005/jp-journals-10054-0194  |  Open Access |  How to cite  | 


Aim and objective: Earlier studies have reported an association between chronic alcohol consumption, iron overload and liver disease. However, there are only limited data from India on serum iron indices and inflammatory markers in alcoholic liver disease. The objective of the study is to estimate serum iron indices and C-reactive protein levels in alcoholic liver disease and their association with disease severity. Materials and methods: We enrolled 46 alcoholic liver disease cases and 40 controls. Serum iron, ferritin and high-sensitivity C-reactive protein levels were estimated in both groups. Results: Serum iron, ferritin, transferrin saturation and C-reactive protein were significantly increased in alcoholic liver disease patients compared to controls. Both iron (r = 0.372, p = 0.011) and ferritin (r = 0.352, p = 0.016) were positively correlated with model for end stage liver disease score an indicator of severity in alcoholic liver disease. C-reactive protein had a significant correlation with iron (r = 0.294, p = 0.048), ferritin (r = 0.483, p = 0.001) and model for end stage liver disease score (r = 0.344, p = 0.019) in alcoholic liver disease cases. Conclusion: We conclude that serum iron indices and C-reactive protein are elevated in alcohol liver disease and associated with severity of liver disease. Clinical significance: Serum iron indices and C-reactive protein can be used as biomarkers for predicting disease severity in alcoholic liver disease.



Ratio of Serum Superoxide Dismutase and Whole Blood Glutathione Peroxidase: A Noteworthy Parameter for Tuberculosis Diagnosis

[Year:2021] [Month:September-December] [Volume:25] [Number:3] [Pages:5] [Pages No:100 - 104]

Keywords: Extrapulmonary tuberculosis, Hydrogen peroxide, Myeloperoxidase, Oxidative burst, Pulmonary tuberculosis, Siderophores, Superoxide, Thiol cofactor, Transferrin

   DOI: 10.5005/jp-journals-10054-0193  |  Open Access |  How to cite  | 


Aim and background: Mycobacterium tuberculosis secretes extracellularly abundant amount of two proteins superoxide dismutase (SOD) and glutamine synthetase (GS) having no leader sequences. The pathogenesis of M. tuberculosis is contributed by the secretion of iron-cofactored SOD which scavenges reactive oxygen intermediates (ROI) by dismutation reaction and also blocks activation of NF-kB and mononuclear cell apoptosis. The obligatory aerobe catalase-positive M. tuberculosis also secretes selenoenzyme glutathione peroxidase (GPx) catalyzing reduction of peroxides produced by dismutation reaction at the expense of reduced glutathione. In this study, the author has computed the statistical ratio of serum SOD and whole blood GPx level and mulled to use that as a diagnostic marker for tuberculosis (TB) and to monitor the effectiveness of drug therapy. Materials and methods: The participants were divided into three groups: Normal control; 2-Lung disease control and 3-TB patients (3A-pulmonary and 3B-extrapulmonary). The serum SOD and whole blood GPx activity were measured spectrophotometrically for all participants initially. Both of these parameters were assayed again after 1 month's usual additional treatment for groups II and III. Results: The ratio as calculated in TB patients is >9 and 8 times, respectively, than those of normal and lung disease control subjects. With anti-TB drug therapy for 1 month, there was a significant decrease in the ratio. Conclusion: The higher magnitude of the ratio might be well utilized to diagnose TB, the serial measurement of the said ratio during the course of A-TB drug treatment might confer effectiveness of drug therapy and diagnose drug-resistant cases.



Aparna Pandey, Amit K Shrivastava

High-sensitive C-reactive Protein and Lipid Profile in Early Phase of Acute Coronary Syndrome

[Year:2021] [Month:September-December] [Volume:25] [Number:3] [Pages:5] [Pages No:105 - 109]

Keywords: Acute coronary syndrome, Coronary heart disease, C-reactive protein, Dyslipidemia, Lipid profile

   DOI: 10.5005/jp-journals-10054-0192  |  Open Access |  How to cite  | 


Aim and objective: The goal of this study was to examine the association of high-sensitive C-reactive protein (hs-CRP) and lipid profile within 24 hours of onset of symptoms in acute coronary syndrome (ACS) patients. Materials and methods: We studied 300 patients with ACS and 100 age- and sex-matched control subjects with no cardiac disease. Acute coronary syndrome patients were classified into two groups (I) onset of ACS symptoms <6 hours and (II) onset of ACS symptoms ≥6 and <24 h. Blood samples were obtained within 24 hours of hospital admission. High-sensitive C-reactive protein and lipid profile were analyzed by latex enhanced immunoturbidimetric method and enzymatic colorimetric methods, respectively. Results: Overall serum levels of hs-CRP at the early phase of ACS were significantly higher (9.15 ± 5.89 vs 1.08 ± 0.7 mg/L, p < 0.001), along with altered lipid profile in patients than in control subjects. In subgroup analysis, serum concentrations of hs-CRP were approximately 3-fold higher in group I when compared with the control group (3.4 ± 2.08 vs 1.08 ± 0.7 mg/L, p < 0.001), and the levels of hs-CRP were almost 12-fold higher in group II than the controls (12.98 ± 4.26 vs 1.08 ± 0.7, p < 0.001). Between ACS patients subgroups, serum hs-CRP levels were almost 4-fold higher in group II when compared with group I (p < 0.001). Conclusions: Our results demonstrate that hs-CRP is significantly higher in the patient's group during the early phase of ACS suggesting that inflammatory processes play a role in ACS.



Monika Garg, Binita Goswami, Manju Puri

Interesting Phenomenon of Primer-induced Mutagenesis Seen in Subjects with Respect to PPARγPro12Ala Polymorphism in Polycystic Ovary Syndrome

[Year:2021] [Month:September-December] [Volume:25] [Number:3] [Pages:3] [Pages No:110 - 112]

Keywords: Insulin resistance, Polycystic ovary syndrome, PPARγPro12Ala polymorphism

   DOI: 10.5005/jp-journals-10054-0182  |  Open Access |  How to cite  | 


Introduction: Polycystic ovary syndrome (PCOS), the commonest cause of endocrinal disorder in women of reproductive age, has a very wide spectrum of presentations. Insulin resistance is most frequently associated with PCOS. PPARγPro12Ala polymorphism; by reducing insulin resistance in PCOS subjects has emerged as one of the promising modalities of treatment of this syndrome. Aim and objective: To explain the phenomenon of primer-induced mutagenesis with the help of PPARγPro12Ala polymorphism in subjects with PCOS. Materials and methods: A hospital-based case-control study was carried out in 50 diagnosed cases of PCOS (15–45 years of age); according to revised Rotterdam Criteria along with 50 age and BMI-matched apparently healthy controls. PPARγPro12Ala polymorphism was detected through DNA extraction from whole blood followed by PCR and restriction fragment length polymorphism (RFLP) using restriction enzyme BstU1 Fast Digest. When the C → G substitution at nucleotide 34 is present (missense mutation CCA to GCA), the mutagenic downstream primer introduces a BstU1 restriction site (CG || CG). The expected products after digestion with BstU1 are 270 bp for normal homozygotes, 227 and 43 bp for Pro12Ala homozygotes, and 270, 227, and 43 bp for heterozygotes. Statistical analysis was performed using SPSS version 16 through an independent sample t-test for intergroup comparison of means and Pearson's correlation coefficient for correlation analysis. Categorical data analysis for polymorphism was carried out using the Chi-square test. Results and conclusion: There was no significant difference in the genotypic distribution of C/G genotypes between cases and controls. Cases with CG genotype were associated with higher insulin sensitivity when compared with CC genotype though it was not statistically significant.



Archana Nimesh, Mohit Mehndiratta, Rajarshi Kar, Seema Garg, Dinesh Puri

Teaching Aids in Medical Education: An Integrated Approach over Conventional Methods

[Year:2021] [Month:September-December] [Volume:25] [Number:3] [Pages:5] [Pages No:113 - 117]

Keywords: Blackboard, Didactic lecture, Interactive whiteboard, Medical education, Overhead projector, PowerPoint, Teaching aids

   DOI: 10.5005/jp-journals-10054-0188  |  Open Access |  How to cite  | 


Aim and background: Didactic lecture is a predominant teaching method in medical colleges. Therefore, it should be made as effective as possible using appropriate and effective teaching aids. This paper assesses the preference of first-year medical undergraduate students for commonly used teaching aids during lectures and analyses the reasons mentioned by them for saying so. Materials and methods: A self-designed feedback form was distributed to students of four groups (namely A, B, C, D) to indicate their preference for teaching aids [PowerPoint (PPT), overhead projector (OHP), blackboard/interactive whiteboard (IWB), direct interaction without teaching aid] and mention reasons for their respective choice. Results: Batch A predominantly opted for PPT (50.6%) followed by blackboard/IWB (35.1%). Batch B predominantly opted for blackboard/IWB (52.0%) followed by PPT (42.2%). Batch C showed an equal preference for PPT (41.9%) and blackboard/IWB (41.9%). Batch D had a slightly higher preference for PPT (41.2%) over blackboard/IWB (38.8%). Preference for OHP was feeble in all batches (9.1, 1.9, 8.1, and 8.8% for Batch A, B, C, and D, respectively). Likewise, the preference for “direct interaction without teaching aid” was feeble in all batches (5.2, 3.9, 8.1, and 11.2% for Batch A, B, C, and D, respectively). Conclusion: Students were not satisfied with PPT or blackboard teaching owing to their demerits. Students recommended their combination. Interactive whiteboard could be an efficient tool to integrate the two and make lectures more effective. Interactive whiteboard has great potential in facilitating the integration of pre-clinical and clinical subjects by allowing videos/animations/internet functions. This may be particularly useful for the competency-based medical education curriculum where there is an emphasis on integrated teaching.



Almeida E Anthonio, Mohit Mehndiratta, Khan A Maroof, Rajarshi Kar, Dinesh Puri

E-learning in the Field of Medical Education: Journey from E-enhancement to Online and Moving towards Hybrid Mode

[Year:2021] [Month:September-December] [Volume:25] [Number:3] [Pages:3] [Pages No:118 - 120]

Keywords: COVID-19, e-enhancement, E-learning, Hybrid mode, Medical education, Online teaching

   DOI: 10.5005/jp-journals-10054-0187  |  Open Access |  How to cite  | 


Background: The coronavirus pandemic has affected all domains of our lives. Medical education is one such field that has been severely affected by disruptions in practical skill learning for which rapid adaptations were to be made. Closure of educational institutes to control the spread of the novel corona virus resulted in a drastic shift to the online teaching mode. A sparingly used modality in the developing countries. To continue medical education, our institute transitioned through various modes of E-learning, beginning with the e-enhancement mode, and ultimately moving toward the hybrid mode. Although we were off to an erratic start, as time progressed, events began to proceed smoothly as the students and faculty adjusted to the new normal which continues to date. In this article, we share our experience as we transitioned through the various modes of E-learning. Conclusion: E-learning has always played an important role in medical education. In the pre-COVID era, e-enhancement was already in use, but in a limited way, while during the peak of the pandemic, the online mode became indispensable. When the medical college re-opened and the physical presence of the students was now possible, the hybrid mode was predominant, i.e., there were in-person interactions between teachers and students, along with the continuation of other online components. This ensured that COVID norms were followed such as the maintenance of physical distancing, along with the continuous implementation of the curriculum of medical education.



Annapurna V Raichurkar, Rahul Jahagirdar, Meghana K Padwal, Minal M Pore

Establishing Umbilical Cord Thyroid-stimulating Hormone in Neonates at a Tertiary Care Teaching Hospital for Screening Congenital Hypothyroidism

[Year:2021] [Month:September-December] [Volume:25] [Number:3] [Pages:4] [Pages No:121 - 124]

Keywords: Chemiluminescent microparticle immunoassay, Congenital hypothyroidism, Neonates, Umbilical cord thyroid-stimulating hormone

   DOI: 10.5005/jp-journals-10054-0190  |  Open Access |  How to cite  | 


Aim: To find the normative value of cord thyroid-stimulating hormone (TSH) in neonates in our study group for screening congenital hypothyroidism (CH). Objectives: 1. To establish the cutoff level of cord TSH in full-term and preterm neonates. 2. Correlate cord TSH value with birth weight, gender, and gestational age. Materials and methods: A prospective study was conducted in tertiary care hospital for a period of 1 year from 1st February 2019 to 31st January 2020. Umbilical cord blood (3 mL) collected in sterile vacutainer under aseptic precaution, at the time of delivery from the maternal end of cord and TSH was estimated by chemiluminescent microparticle immunoassay (CMIA) technique. This study was carried out on 1,357 neonates. All data were collected prospectively. Mothers with thyroid illness and/or thyroid medication were excluded from the study. Results: Umbilical cord TSH sample was tested on all 1,357 babies delivered in tertiary hospitals for a period of 1 year. Seven hundred and fifty were males (55.2%) and 607 were females (44.7%). One thousand and sixteen were normal term (74.8%) babies. The mean, median, and standard deviation of cord TSH values were 6.8, 5.5, and 4.5, respectively, in term neonates. Thyroid-stimulating hormone value corresponding to 90th, 95th, and 97th percentile was 16.5, 18.9, and 24.8 percentile in term neonates. Cord TSH values of >20 mIU/L were found in 30 (2.2%) neonates. One neonate had persistently higher TSH on repeat testing. There was no significant correlation of cord TSH between birth weight and gender of neonates but we found a significant correlation of gestational age with cord TSH value (p value < 0.05). Conclusion: Incidence of CH was 1 in 1,357 in our study. Umbilical cord TSH is a significant investigation for screening CH and a cutoff of >20 mIU/L can be used for screening CH.



Lalna R Takale, Meghana K Padwal

A Systematic Review of Online Teaching during COVID-19 Pandemic: A Lock Opened in Lockdown

[Year:2021] [Month:September-December] [Volume:25] [Number:3] [Pages:6] [Pages No:125 - 130]

Keywords: Coronavirus disease 19 pandemic, Medical education, Online teaching

   DOI: 10.5005/jp-journals-10054-0189  |  Open Access |  How to cite  | 


Background: The medical curriculum emphasizes learner-centeredness and small group live classroom teaching. The lockdown imposed due to the coronavirus disease-2019 (COVID-19) pandemic turned into an opportunity and medical education had to adopt an online teaching method. Aim and objective: This systematic review aims to gain insights into the various aspects of online learning. The systematic review was done using two databases, PubMed and Web of Science. The manuscripts were analyzed on aspects like information on online platforms, choosing a platform, feedback about online learning, and assessment strategies. Results: The online platforms used for teaching were Zoom, Google Meet, and Microsoft Teams. Google forms being popular for online assessment. Feedback about online learning in medical education suggested an overall good acceptance. Implication: Implementing blended learning in medical education to be considered even after the COVID-19 pandemic is over.



Divya Mishra, Roshan Alam, Mohammad Kaleem Ahmed, Pulak Raj, Saba Khan, Mustafa Khan

RAGE and Serum Copeptin Act as a Potential Biomarker for Chronic Kidney Disease with and without Type 2 Diabetes Mellitus

[Year:2021] [Month:September-December] [Volume:25] [Number:3] [Pages:4] [Pages No:131 - 134]

Keywords: Adipocytes, Advanced glycation end product, Amadori products, Aminoguanidine, Autosomal dominant polycystic kidney disease, Chronic kidney disease, Copeptin, Diabetes mellitus, Nephropathy, Receptors for advanced glycation end products, Schiff base

   DOI: 10.5005/jp-journals-10054-0191  |  Open Access |  How to cite  | 


The critical role of receptors for advanced glycation end products (RAGEs) and serum copeptin in the progression of chronic diseases and their complications has recently become more apparent. This review summarizes the recent contributions to the field of RAGEs and serum copeptin in chronic kidney disease (CKD). Over the past 2 decades, RAGEs have been seen to be involved in the progression of CKD, and specifically, it leads to diabetic nephropathy. Although several in vitro and in vivo studies highlighten the detrimental role of AGEs accumulation in tissue injury. Recent studies have focused on the novel mechanisms that contribute to end-organ injury as a result of AGEs accumulation, as well as novel targets of therapy in kidney disease. Serum copeptin is related to the severity of the disease in autosomal dominant polycystic kidney disease (ADPKD), and it helps in the prediction of future renal events (decline in renal function and increase in total kidney volume). The main purpose of this review is to evaluate critically the role of RAGE and serum copeptin as a prognostic biomarker for renal outcomes in ADPKD, and it will be potentially helpful as a predictive marker of treatment response. As the prevalence and the incidence of CKD rises all over the world, nowadays it is very essential to identify the therapeutic strategies which must either delay the progression and aggressiveness of CKD or to improve the mortality rate in this population. The main focus of this review is to highlight the recent studies that enhance our current understanding of the mechanisms that mediate AGEs-induced progression in CKD as well as novel treatment strategies that have the potential to avoid this disease process. This review presents current knowledge regarding the roles of RAGE and copeptin in CKD with and without diabetes mellitus. Studies from human subjects are presented to highlight the breadth of evidence linking RAGE and copeptin to CKD consequences of these metabolic disorders.


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