Indian Journal of Medical Biochemistry

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2024 | May-August | Volume 28 | Issue 2

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EDITORIAL

Binita Goswami

Interaction of Genomics and Medical Biochemistry: Implications for Precision Medicine

[Year:2024] [Month:May-August] [Volume:28] [Number:2] [Pages:1] [Pages No:iv - iv]

   DOI: 10.5005/ijmb-28-2-iv  |  Open Access | 

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ORIGINAL RESEARCH ARTICLE

Preethi B Patil, Prasanna Saka, Abhay K Chidananda

Umbilical Cord Blood Bilirubin as a Predictor of Significant Hyperbilirubinemia Requiring Phototherapy among Full-term Healthy Neonates: A Prospective Study

[Year:2024] [Month:May-August] [Volume:28] [Number:2] [Pages:5] [Pages No:31 - 35]

Keywords: Cord blood bilirubin, Full-term neonates, Neonatal hyperbilirubinemia, Phototherapy, Serum total bilirubin

   DOI: 10.5005/jp-journals-10054-0231  |  Open Access |  How to cite  | 

Abstract

Aim and background: Jaundice is a clinical condition characterized by transient bilirubin conjugation deficiency resulting in neonatal hyperbilirubinemia. Hyperbilirubinemia is defined as a serum total bilirubin concentration greater than 95th centile for the hour of life. Approximately 60% of term and 80% of preterm infants are affected with hyperbilirubinemia, which may lead to complications such as brain neuron damage after several years. Early discharge of healthy-term newborns after delivery has become a common practice, which may be the cause for readmission during the early neonatal period. Universal follow-up within 1–2 days of early discharge, pre-discharge serum total bilirubin, transcutaneous bilirubin measurement, and universal clinical assessment of risk factors of developing jaundice are various strategies to predict significant neonatal hyperbilirubinemia. An association between cord blood bilirubin levels and subsequent risk of neonatal hyperbilirubinemia has been reported. However, the utility of cord blood bilirubin as a screening test to predict subsequent hyperbilirubinemia has been widely debated. We aimed to verify whether cord blood bilirubin at birth could be used as a predictor of significant neonatal hyperbilirubinemia requiring phototherapy among full-term neonates. Materials and methods: Cord blood bilirubin was estimated in 110 neonates immediately after delivery. These neonates were followed up for the next 3 days and serum total bilirubin was estimated on the third day of life. Neonates with significant hyperbilirubinemia requiring phototherapy were designated as cases and those without hyperbilirubinemia as controls. The association between cord blood bilirubin and serum total bilirubin was determined followed by the identification of the cut-off level of cord blood bilirubin that could predict significant neonatal hyperbilirubinemia requiring phototherapy among term neonates. Results: Among 100 neonates followed up, 50 developed significant hyperbilirubinemia requiring phototherapy. The mean ± SD of cord blood bilirubin was 2.66 ± 0.65 and serum total bilirubin estimated on day 3 of life was 16.16 ± 1.6 and the difference was statistically highly significant at a p-value of <0.00 with paired t-test. The cord blood bilirubin and day 3 serum bilirubin were positively correlated with an r-value of 0.087. The specificity and sensitivity with cord blood bilirubin of 2.5 mg/dL were 98 and 56%, and with day 3 bilirubin of 11.5 mg/dL was 72 and 100%, respectively. Conclusion: A cut-off of 2.5 mg/dL in cord blood bilirubin can be used to predict significant neonatal hyperbilirubinemia requiring phototherapy among full-term neonates. Clinical significance: Umbilical cord blood bilirubin measurement is a simple, economical, and non-invasive method to predict subsequent neonatal hyperbilirubinemia which can aid clinicians in early discharge of normal neonates and selective follow-up of high-risk infants.

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ORIGINAL RESEARCH ARTICLE

Rashmi Rasi Datta, Anurag Bansal

Clinical Chemistry and Autoverification: A Path Less Traversed

[Year:2024] [Month:May-August] [Volume:28] [Number:2] [Pages:5] [Pages No:36 - 40]

Keywords: Algorithms, Automation, Autoverification, Clinical chemistry, Laboratory information systems, Turn-around-time

   DOI: 10.5005/jp-journals-10054-0233  |  Open Access |  How to cite  | 

Abstract

Aims and background: Autoverification (AV) is an application of artificial intelligence that uses computer-based algorithmically established rules for release of patient reports. This allows effective time management, prevents probable laboratory errors, and ensures consistent results. However, not many labs have adopted AV into practice due to hesitations concerning cost-effectiveness, lack of robust software and informatics support along with dearth of knowledge for its implementation. Additionally, there is scant published literature on AV implementation. This study has been conducted as an attempt to outline benefits of AV and address the existing gaps. Methods: The study was conducted in the Department of Clinical Chemistry of a standalone lab. Autoverification implementation was done in stepwise manner. (i) Test selection and developing algorithms, (ii) Setting-up rules in middleware to prevent release of erroneous results, (iii) User acceptance testing (UAT), (iv) Going-live. Results: Efficacy of AV system was gauged based on following factors. (i) AV passing rate—initial 53.7–85.4% later was achieved with inclusion of more parameters and extension of tolerance limit, (ii) Significant improvement was observed in TAT for both immunoassay (from 88.28 to 97.32%) and routine chemistry (from 82.7 to 95.68%), (iii) decreased error rates as evidenced by reduced number of amended reports, (iv) reduction in staff required for manual verification allowing their utilization for other departmental activities. Conclusion: Implementation of AV by laboratories provides efficient and cost-effective work opportunities with scope for continuous growth. However, it doesn't preclude the need for careful quality control.

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ORIGINAL RESEARCH ARTICLE

Suresh Shiva Kumar, Rangaswamy Ranga Raju, Mallikarjun Aradhya, Riyaz A Kalaburgi, Pavithra Venkateshaiah, Sathisha T Gururaja

A Correlation Study on Serum Biomarker and Biochemical Parameters in Acute Heart Failure with Duration of Hospital Stay among Patients with Acute Heart Failure

[Year:2024] [Month:May-August] [Volume:28] [Number:2] [Pages:4] [Pages No:41 - 44]

Keywords: Acute heart failure, Duration of stay, In-patients, N-terminal pro-B-type natriuretic peptide, Prospective observational study

   DOI: 10.5005/jp-journals-10054-0232  |  Open Access |  How to cite  | 

Abstract

Aims and background: Cardiac biomarker like serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) has revolutionized the diagnosis of heart failure and also plays an important role in prognosticating heart failure. Limited data exist in correlating the level of cardiac biomarkers and biochemical parameters with duration of hospital stay in patients with clinical evidence of acute heart failure. Materials and methods: Our study comprised of 200 inpatients diagnosed with acute heart failure both men and women using convenience sampling method. It is a prospective observational study. The inpatients were from the Department of Cardiology of Shridevi Institute of Medical Sciences and Research Hospital, Tumkur, Karnataka, India. The duration of study was from April 2022 to Sep 2023. Results: There was a positive correlation observed in serum NT-proBNP and potassium values with the duration of stay in the inpatients with acute heart failure (p < 0.05). Serum NT-proBNP was highly significant over a week stay at hospital with a median value of 4784 pg/mL (p < 0.05). Conclusion: The current study highlights the role of serum NT-proBNP and potassium ion as biomarker as well as prognostic factor in the morbidity of acute heart failure in patients. Clinical significance: The estimation of their serum levels may help in early prediction of duration of stay in hospital.

279

REVIEW ARTICLE

Najmunnissa, Kishorkumar M Guruswamy, Jadeppa Gowda, NK Swetha, Akila Prashant, Suma M Nataraj

Unveiling the Significance of Surrogate Markers of Insulin Resistance in Metabolic Health Assessment

[Year:2024] [Month:May-August] [Volume:28] [Number:2] [Pages:9] [Pages No:45 - 53]

Keywords: Adiponectin, Homeostatic model assessment-insulin resistance, Insulin resistance, Metabolic health assessment, Surrogate markers, Triglycerides and glucose index

   DOI: 10.5005/jp-journals-10054-0227  |  Open Access |  How to cite  | 

Abstract

Recent years have evidenced an alarming increase in the incidence of diabetes mellitus (DM) and other metabolic disorders. Rapid urbanization and lifestyle changes have been the major factors for this increase. Early diagnosis is the key to better risk stratification and prompt management of these patients. Insulin resistance (IR) plays a pivotal role in the pathogenesis of various metabolic disorders. Assessing the IR in the initial stages would therefore help in early detection of patients who are susceptible to metabolic disorders. The hyperinsulinemic-euglycemic clamp technique has been the gold standard method for assessing IR. The major limitation of this technique is it is invasive and requires a specialized setup. Hence, identifying reliable surrogate markers for assessing IR is the need of the hour both in clinical and research settings. This review delves into the current knowledge of surrogate markers utilized to assess IR, providing a comprehensive overview of their strengths, limitations, and emerging trends. We explore commonly employed surrogate markers such as fasting insulin, homeostatic model assessment-insulin resistance (HOMA-IR), adiponectin, triglyceride-to-glucose index, etc. The search for accurate and cost-effective surrogate markers holds significant promise for early detection, risk stratification, and targeted interventions. This review aims to contribute to the existing knowledge on IR and highlight future directions in the quest for effective markers for IR.

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