Indian Journal of Medical Biochemistry

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2022 | January-April | Volume 26 | Issue 1

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Anju Jain, Prabhat

Prenatal Screening for Genetic Disorders: Indian Scenario

[Year:2022] [Month:January-April] [Volume:26] [Number:1] [Pages:2] [Pages No:iv - v]

   DOI: 10.5005/ijmb-26-1-iv  |  Open Access |  How to cite  | 



Srihita Mahavadi, Jayakumari Shanthakumari

Effect of Matrix and Source of Quality Specification Data on the Sigma Metrics of Common Chemistry Analytes in Clinical Laboratory

[Year:2022] [Month:January-April] [Volume:26] [Number:1] [Pages:8] [Pages No:1 - 8]

Keywords: Biological variation, Clinical laboratory improvement amendments, Internal quality control, Matrix effect, The Sigma metric

   DOI: 10.5005/jp-journals-10054-0201  |  Open Access |  How to cite  | 


Introduction and aim: Internal and external quality control (IQC and EQC) is used to monitor and evaluate the analytical process. Six Sigma provides an objective assessment of performance. The Sigma metrics (σ) are calculated using the coefficient of variation (CV), bias, and total allowable error (TEa). One of the pitfalls of the Sigma metrics calculation is that it depends upon the source of the variables used in the formula and the measurand matrix. Hence, this study was conducted to calculate the Sigma metrics of urea, creatinine, Na, and K in serum and urine using Tea from biological variation (BV) (urine and serum) and Clinical Laboratory Improvement Amendments (CLIA) (serum) and subsequently comparing the Sigma metrics of all four analytes using TEa from BV between serum and urine control and using TEa from BV in the same matrix (serum). Materials and methods: A cross-sectional study was conducted in the Department of Clinical Biochemistry, St. John's Medical College for 1 year (January–December 2018). Bio-Rad IQC (serum and urine) data have been used to calculate σ of urea, creatinine, Na, and K. The cumulative CV and bias were obtained using unity real-time software from Bio-Rad Laboratories. Total allowable error values were obtained from BV and CLIA guidelines. Results: Urea, creatinine, Na, and K showed higher σ in the urine control than in serum controls indicating the better performance of these parameters in the urine matrix than in serum. In the same matrix (serum control), creatinine, Na, and K had higher σ using TEa from CLIA than TEa from BV. Na showed the highest difference in σ value between the two sources (p-value < 0.001). However, serum urea showed higher σ using TEa from BV compared to TEa from CLIA. Conclusion: Our study showed that σ varies with the matrix; henceforth, one should be careful in extrapolating the performance characteristics in terms of Sigma of an analyte from one matrix to another. In the same matrix, σ also varies depending on the source of TEa used in the calculation. It is, thus, essential to mention the source of the variables used to calculate σ for a better interpretation.



Kaushal Kishor Singh, Kalpana Singh, Mala Kumar

Understanding the Difference in Various Fractions of Serum Bilirubin while Estimated by Wet Chemistry and Dry Chemistry Method and its Importance in Neonatal Jaundice

[Year:2022] [Month:January-April] [Volume:26] [Number:1] [Pages:6] [Pages No:9 - 14]

Keywords: Conjugated bilirubin, Dry chemistry, Hyperbilirubinemia, Serum bilirubin, Unconjugated bilirubin, Wet chemistry

   DOI: 10.5005/jp-journals-10054-0200  |  Open Access |  How to cite  | 


Aim: The aim of this study is to find out the percentage of variation of bilirubin values in neonates by two different techniques: Dry chemistry versus wet chemistry method, and also to establish that unconjugated bilirubin ≠ indirect bilirubin and conjugated bilirubin ≠ direct bilirubin. Materials and methods: This comparative study was conducted over a period of 6 months from October 2019 to March 2020. Ethical approval was taken from Institutional Ethical Committee. Informed and written consent were taken from the parents of the enrolled neonates. A total of 195 blood samples were randomly collected from neonates (<14 days) admitted with neonatal hyperbilirubinemia in Department of Pediatrics for estimation of serum bilirubin fractions by two techniques, i.e., traditional wet chemistry and dry chemistry. The statistical analysis of data was performed by using software package SPSS version 16 and Microsoft Excel 2019. Results: In our study, mean total bilirubin measured by dry chemistry method Total bilirubin (TBild), neonatal bilirubin (BuBc/NBil) estimated by dry chemistry method, and total bilirubin estimated by wet chemistry method (TBilw) were 12.42 mg/dL, 12.21 mg/dL, and 11.72 mg/dL, respectively. Conclusion: Total bilirubin estimated by dry and wet chemistry methods differ due to difference in the principle of methods by which they are estimated in laboratories. Neonatal bilirubin (BuBc/NBil) may be preferred over total bilirubin estimated by wet chemistry as dry chemistry is estimating unconjugated and conjugated fractions of bilirubin, while in wet chemistry, direct bilirubin is estimated and indirect bilirubin is calculated. Hence, the term unconjugated bilirubin cannot be interchanged with indirect bilirubin and conjugated bilirubin as direct bilirubin. Clinical significance: Measurement of serum bilirubin among neonates with hyperbilirubinemia is an essential part for diagnosis and monitoring of neonatal jaundice. Both dry and wet chemistry methods correlated well, any method can be used for measurement of bilirubin, but switching the method while monitoring serum bilirubin levels during treatment must be discouraged.



Meghana Khandu Padwal, Abdulrahaman Abubakar Momin, Arundhati Diwan, Vrushabh Phade

Efficacy of Salivary Creatinine and Urea and their Association with Serum Creatinine and Urea Levels in Severe Chronic Kidney Disease Patients

[Year:2022] [Month:January-April] [Volume:26] [Number:1] [Pages:5] [Pages No:15 - 19]

Keywords: Chronic kidney disease, Receiver-operating characteristic curve analysis, Salivary creatinine, Salivary urea

   DOI: 10.5005/jp-journals-10054-0204  |  Open Access |  How to cite  | 


An increase in the incidence of chronic kidney disease (CKD) is seen worldwide due to increased burden of noncommunicable diseases and ageing. There is accumulation of several waste products in these patients due to kidney impairment, leading to various metabolic complications. Thus, for survival they have to undergo repeated hemodialysis. Therefore, the levels of urea and creatinine have to be continuously monitored in blood. Saliva as a sample for estimation of these parameters is emerging nowadays. The present study is an attempt to check the efficacy of urea and creatinine levels in saliva for assessment of CKD patients in comparison to their levels in the blood. The findings indicated urea and creatinine levels were differed significantly between CKD patients and controls in blood as well as in saliva. We also reported the significant positive correlation of salivary creatinine and urea with serum creatinine and urea, respectively. By means of receiver-operating characteristic (ROC) curve analysis, we found the cut-off value of 0.8 mg/dL and 40 mg/dL for salivary creatinine and blood urea, respectively, at highest sensitivity and specificity. So, the conclusion can be made that, salivary creatinine and urea can be used as an alternative to serum creatinine and urea values in calculating eGFR and staging of CKD. Also, collection of saliva, a noninvasive method, could be an alternative to blood, an invasive method, for diagnosis and monitoring patients with CKD.



Dipak Kumar Chattopadhyay

Zinc Supplementation Combats Tuberculosis by Reverting Back to Normal Compartmentalized State of Iron and Hence Increasing Blood Hemoglobin Concentration

[Year:2022] [Month:January-April] [Volume:26] [Number:1] [Pages:6] [Pages No:20 - 25]

Keywords: Antioxidant, Decompartmentalization, Dismutation, Iron, Siderophore, Superoxide, Tuberculosis, Thiol group, Transferrin, Zinc

   DOI: 10.5005/jp-journals-10054-0203  |  Open Access |  How to cite  | 


Aim and background: To acquire iron (Fe), Mycobacterium tuberculosis (Mtb) expresses high-affinity Fe+3-specific siderophores for scavenging Fe from host insoluble and protein-bound iron-like transferrin, lactoferrin, ferritin, and hemoglobin−haptoglobin. Mycobacterium tuberculosis by its specific membrane protein and Fe transporters can internalize Fe within cell cytoplasm. With infection by Mtb, activity of transferrin, the most dynamic Fe carrier gets setback with a decrease in its level due to infection and also by a decrease in its ability to leave out Fe in bone marrow cells through specific cell surface transferrin receptors. Thus, major decompartmentalization of Fe in host tissues sets in. Zinc (Zn), a redox-inert metal, acts as an antioxidant by stabilizing membrane structures, upregulating expression of metallothionein, protecting protein sulfhydryl group, and suppressing the formation of superoxides by competing with Fe and copper in the cell membrane and thiol group binding. The study interprets the effect of Zn supplementation on serum Fe and hemoglobin (Hb) percentage for tuberculosis (TB) patients. Materials and methods: Serum Fe and blood Hb percentage were measured initially for TB patients. The same parameters were also assayed with continuation of anti-TB drugs for 1 month with or without Zn supplementation. Results: Assertive and veritable increase in baseline serum Fe in TB patients had been recorded in this study. The same TB patients with anti-TB drugs for 1 month had recorded nonsignificant serum Fe and Hb percentage increase, whereas oral zinc supplementation with anti-TB drugs for 1 month had shown significant increase in serum Fe and Hb percentage. Conclusion: Zinc hastens the process of normal compartmentalized state of Fe depriving Mtb to get Fe and superoxide required for dismutation reaction to get soluble oxygen for this obligate aerobe.



Khushboo Jasotani, Kiran Dahiya, Raunak Ahlawat, Mohit Gupta, Sushil Kumar, Rakesh Dhankhar, Pragati Singh

NGAL: An Upcoming Biomarker of Interest

[Year:2022] [Month:January-April] [Volume:26] [Number:1] [Pages:5] [Pages No:26 - 30]

Keywords: Biomarker, Diseases, Neutrophil gelatinase-associated lipocalin, Lipocalins

   DOI: 10.5005/jp-journals-10054-0206  |  Open Access |  How to cite  | 


Aim: Neutrophil gelatinase-associated lipocalin (NGAL) performs important functions in the body. It has the potential to act as a diagnostic and prognostic biomarker for various diseases. Background: The role of NGAL has been well explored in acute and chronic kidney diseases (CKDs). It is considered a maker for acute kidney injury (AKI). Its role in other diseases has also been increasingly reported. Results: Neutrophil gelatinase-associated lipocalin takes part in the pathogenesis of several diseases, besides renal diseases, like cardiovascular diseases, inflammatory disorders, cancer, diabetes, etc. by a variety of mechanisms. Its levels have been correlated with the severity in most of the diseases. Conclusion: Neutrophil gelatinase-associated lipocalin can act as a biomarker in different diseases though, its potential is yet to be explored to the maximum. Clinical significance: Estimating the levels of NGAL in body fluids will help in making an early diagnosis, assessing the severity of the disease, establishing a prognosis, and improving the overall management of different diseases.



Surbhi Tyagi, Jaskiran Kaur

The Potential Effects and Role of Vitamin C on COVID-19 Infection and Progression: A Review

[Year:2022] [Month:January-April] [Volume:26] [Number:1] [Pages:3] [Pages No:31 - 33]

Keywords: Biochemistry, COVID, COVID-19, Healthcare workers, Seroprevalence, Severe acute respiratory syndrome 2, Total antibodies, Vitamin D

   DOI: 10.5005/jp-journals-10054-0207  |  Open Access |  How to cite  | 


Background: In the present scenario, COVID-19 has become a global pandemic, creating a life threat for humans. Some studies depicted that the use of vitamin C may minimize this infection. On the contrary, few studies have denied any beneficial role of vitamin C in COVID-19. The controversies still prevail that need to attain a consensus. Therefore, through this review, we tried to find out the effects of vitamin C on COVID-19 infection. Objective: The objective of this study is to find the impact of vitamin C supplementation on COVID-19 infection and its severity. Conclusion: Vitamin C supplementation can strongly help in reducing COVID-19 and many other infectious diseases by boosting the immune system. Therefore, a regular administration of vitamin C is required to develop strong immunity against the COVID-19 pandemic.



Lydia W Jeris, Mohamed Thayub, Sarasa Bharati, Kotturathu Mammen Cherian

Hypolipidemia: How Common Is It!!

[Year:2022] [Month:January-April] [Volume:26] [Number:1] [Pages:3] [Pages No:34 - 36]

Keywords: Case report, Critical illness, Hypocholesterolemia, Statins

   DOI: 10.5005/jp-journals-10054-0202  |  Open Access |  How to cite  | 


Aim: To throw light on the causes and complication of hypocholesterolemia. Background: Hypocholesterolemia is defined as total cholesterol and low-density lipoprotein (LDL) level below the fifth percentile of the general population. It is usually an incidental finding on routine lipid screening and thus much clinical importance is not given to the same. Though the first case of hypocholesterolemia was published in 1911, decades have passed since then with only a handful of cases of hypocholesterolemia being reported implying either a general lack of knowledge regarding the causes and consequences of low cholesterol or a lack of awareness in the diagnosis of hypocholesterolemia. Hypocholesterolemia can be caused due to many reasons and can lead to many complications as well. Case description: We report three cases of hypocholesterolemia, which had very low levels of total cholesterol and LDL at our tertiary cardiac specialty hospital over a period of one year. Hypocholesterolemia in our cases could be attributed to a combination of statins, liver dysfunction, critical illness, and chronic inflammation. More extensive work needs to be done on this subject as the incidence of hypocholesterolemia is on the rise. Conclusion: Hypocholesterolemia is equally dangerous as compared to hypercholesterolemia and more research work needs to be undertaken in this field. Clinical significance: Understanding the causes and complications of hypocholesterolemia as well as knowing the underlying molecular basis is of crucial importance as it would provide new insights into the management of hypercholesterolemia and cardiovascular diseases in particular.



Vishal Wadhwa, Puneet Kumar Nigam

Avoiding False Rejection in Comparison Studies

[Year:2022] [Month:January-April] [Volume:26] [Number:1] [Pages:4] [Pages No:37 - 40]

Keywords: Bias%, Comparison, Correlation

   DOI: 10.5005/jp-journals-10054-0205  |  Open Access |  How to cite  | 


Aim: Comparison studies are an integral part of method verification in a laboratory. Three cases shared clarify how acceptance criteria should be used carefully before rejecting a new method/analyzer. Background: Verification of a new method/analyzer is undertaken by all laboratories, but care needs to be exercised in the evaluation of results due to the complexity involved and the lack of proper guidance in the literature. Case description: Three examples comparing the results of two equipment have been shared to bring out the unique case scenarios that emerge in the interpretation of important parameters involved, namely, average bias% (B%), correlation (R), and strength of correlation (R2). Conclusion: Results of the comparison study should be evaluated with caution as all parameters may not perform as per acceptance criteria despite having no adverse impact on patient results. Clinical significance: Poorly evaluated verification studies can lead to false rejection of new methods leading to an increase in the cost of patient care.


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