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Melinkeri RR. Serum Ferritin Levels in Patients of Chronic Kidney Disease on Hemodialysis: A Need to Redefine Cutoff for Iron/Erythropoietin Therapy. Indian J Med Biochem 2018; 22 (2):95-99.
Introduction: Anemia is the common complication of chronic kidney disease (CKD) that mainly affects patients on hemodialysis therapy. The most precise tool to evaluate body iron stores is the measurement of serum ferritin levels. However, serum ferritin is also an acute phase reactant, and its levels may be influenced by inflammation.
Objectives: (1) To measure serum ferritin and C-reactive protein (CRP) in the study group; (2) To correlate the levels of serum ferritin and CRP in patients on hemodialysis; (3) To establish a cutoff value for serum ferritin in patients of CKD on hemodialysis receiving Iron/EPO therapy.
Materials and methods: The study participants (n = 240) were divided into three groups as group I: Total 80 cases of CKD on hemodialysis receiving iron/erythropoietin (EPO) therapy, Group II: Total 80 cases of CKD on hemodialysis not receiving iron/erythropoietin (EPO) therapy, and Group III: Age and gender-matched 80 healthy controls. Estimation of serum ferritin was done by automated chemiluminescent microparticle immunoassay (CMIA) and CRP by immunoturbidimetric technique.
Results: We observed a statistically significant rise in serum ferritin Group I (1957.6 ± 714.1), Group II (1063.5 ± 478.6) as compared to Group III (101.21 ± 60.29) and CRP levels in group I (104.6 ± 70.8) as compared to group II(74.9 ± 55.8) and (3.7 ± 0.9) (p < 0.005).There is a significant positive correlation between ferritin and CRP (p < 0.005).
Conclusion: High ferritin levels can be because of both increased iron stores and inflammation which may be associated with erythropoietin resistance, malnutrition, and increased mortality. A cutoff value of ferritin needs to be established for better interpretation.
Introduction: Hemoglobinopathies are a group of inherited disorders because of abnormalities in hemoglobin synthesis or structure. Thalassemia and sickle cell anemias are the most prevalent hemoglobinopathies and a national health burden. To reduce this burden, detecting them in the carrier stage is crucial. The health of pregnant women determines the future of the progeny. Hence identifying these disorders during the antenatal period is necessary to take the appropriate measures. Complete blood count (CBC) and peripheral smear are routinely done investigations during antenatal check up. Red blood cell (RBC) indices like mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) can be used for initial screening, followed by electrophoresis for detecting these hemoglobinopathies.
Aim: To determine the prevalence of hemoglobinopathies during antenatal period using red blood cell indices for screening.
Materials and methodology: The study included 80 pregnant women whose CBC revealed MCV ≤ 80 fL, MCH ≤ 27 pg and microcytic hypochromic picture on peripheral smear. Hemoglobin electrophoresis was done to detect hemoglobinopathies.
Results: Elevated HbA2 fraction (> 3.5%) was found in 5 (6.25%) women suggestive of β-thalassemia trait. HbA and HbS bands were present in 3 (3.75%) subjects suggestive of sickle cell trait.
Conclusion: Red blood cell (RBC) indices, MCV and MCH, can be used for initial screening of hemoglobinopathies followed by more confirmatory methods (electrophoresis). Detection of these hemoglobin disorders in the carrier stage would thus be possible.
Clinical significance: Simple screening methods can reduce the incidence of the most prevalent hemoglobinopathies (β-thalassemia trait and sickle cell trait/disease) during antenatal care.
Introduction: Preeclampsia is a disorder marked by the onset of hypertension and a significant amount of protein in the urine which begins after 20 weeks of pregnancy.
Aim and objectives: To evaluate the role of serum sodium and potassium levels as a predisposing factor in the etiology of preeclampsia in pregnant women living in Bhilai, Chhattisgarh.
Material and methods: It was a retrospective cross-sectional study, conducted in the Department of Biochemistry at Shri Shankracharya Institute of Medical Science and Hospital, Bhilai, Chhattisgarh a tertiary care institute.
Results: The mean serum sodium level in preeclamptics was 123.9 ± 3.03 mmol/L and in normotensives was 140.6 ± 1.73 mmol/L which was statistically significant (p-value < 0.05). The mean serum potassium levels in preeclamptics were 2.49 ± 0.23 mmol/L and in normotensives was 3.96 ± 0.32 mmol/L which was statistically significant (p-value <0.05).
Conclusion: Serum sodium level was observed to be reduced in preeclampsia compared to normotensive pregnant women. Early diagnosis and counseling of preeclampsia should be done at regular intervals for such cases to prevent any antenatal complications.
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Jabir FA, Hamzah SK. SOX17 and RASSAF1A Promoters Methylation in Circulation Tumor Cell and Cell Free Deoxyribonucleic Acid Isolated from Plasma in Breast Cancer. Indian J Med Biochem 2018; 22 (2):108-113.
Purpose: The study was to evaluate SOX17, and RASSEF 1A promoters methylation levels in patients with malignant breast tumors compared with healthy women.
Materials and methods: Fifty women with breast cancer (range 26 to 75 years) were included in this study. They were admitted at Al-Diwaniyah Teaching Hospital, Iraq, compared with 25 women as the control. We obtained plasma samples from 50 patients (breast cancer) stages II, III, IV and normal (healthy women). Cell-free deoxyribonucleic acid (DNA) (cfDNA) extracted and methylation analysis for SOX17 and RASSEF1A gene.
Results: We found different methylation pattern of the RASSEF1A gene in plasma samples between patients with breast cancer and control (p < 0.05) ranging in all cases 30 (60%) and unmethylation in 20 (40%), hyper methylation frequency in all studied cases [13 (44.8%) for II stage, 12 (80%) III stage and 4 (66.6%) IV stage of breast cancer in this study association between the hypermethylation was significant with age. 50 11.4 (71.2%) and < 50 26 (76%)] than normal cases, we found different methylation pattern of the SOX17 gene in plasma samples between patients with breast cancer and control (p < 0.05) ranging in all cases 29 (58%) and unmethylation in 21 (42%),hyper methylation frequency in all studied cases 11 (37.9%) for II stage, 13 (86.6%) III stage and 5 (83.3%) IV stage of breast cancer in this study association between the hyper methylation was significant with age (. 50 13 (81.2%) and < 50 23 (67%) than normal cases also this study association between the hypermethylation was significant with menopause (premenopause 6 (66%), post menopause 31 (75.6%) than the control group (0%).
Conclusions: Our data indicate that methylation of the RASSAF1A and SOX17 genes are the frequent event in primary breast cancer and that it plays a major role in the silencing of the expression of this gene during tumor development.
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N SK, Krishnan S. Comparison of Gamma-glutamyl Transferase and Troponin-I Levels in Patients Presenting with Acute Coronary Syndrome. Indian J Med Biochem 2018; 22 (2):114-119.
Introduction: Atherosclerosis is the predominant cause of acute coronary syndrome, and is usually associated with rupture of an atherosclerotic plaque resulting in the formation of partial or complete thrombosis of the coronary artery. The main objective of the study is to compare the levels of biochemical marker of atherosclerosis-gamma-glutamyl transferase (GGT) and sensitive marker of myocardial necrosis-cardiac Troponin-I (cTnI) in patients presenting with acute coronary syndrome (ACS). Materials and methods: The design was a prospective casecontrol study where a total of 161 patients, 110 ACS patients and 51 control subjects with the age group of 30 to 80 years were enrolled for the study. GGT was estimated by kinetic colour test using Beckman Coulter AU2700 analyser. Troponin-I was estimated by chemiluminescent micro particle immunoassay using Abbott ARCHITECT system. Results: The mean GGT levels of ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI) and unstable angina (UA) subgroups were 91.58, 84.12 and 30.46 U/L respectively, which showed a statistically significant difference (p < 0.001) when compared with control subjects. The mean Troponin-I levels of STEMI, NSTEMI and UA subgroups were 14.31, 4.68 and 0.02 ng/mL respectively, which showed a statistically significant difference (p < 0.001) when compared with control subjects. Correlation between GGT and Troponin-I done using Spearman's Rho coefficient correlation test showed a positive correlation between GGT and Troponin-I in ACS patients. Conclusion: Gamma-glutamyl transferase (GGT) level elevates as an indicator of increased oxidative stress in patients with coronary artery disease who are not alcoholic and have no liver disease. The strong correlation between GGT and Troponin-I complement the usefulness of gamma-glutamyl transferase for predicting troponin positivity in patients presenting with acute coronary syndrome.
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Kalahasthi R, Barman T. Serum High Sensitivity-C-reactive Protein and Hs-CRP/albumin Ratio in Workers Exposed to Lead from Lead-battery Manufacturing Process. Indian J Med Biochem 2018; 22 (2):120-125.
Purpose: The present study assessed the serum high sensitivity- C-reactive protein (Hs-CRP) and Hs-CRP/albumin ratio of workers exposed to lead (Pb) from Pb-battery manufacturing process with the use of center for disease control and prevention (CDC)/american hospital association (AHA) recommended risk categories of serum Hs-CRP and receiver operating characteristic curve (ROC) to examine the diagnostic accuracy.
Materials and methods: This study involved a total of 256 subjects, including both study and control. The study group consists of 176 workers involved in Pb-battery manufacturing process. Control group consists of 80 office workers with no occupational exposure to Pb. Blood lead levels (BLLs) in the study and control groups were determined with atomic absorption spectrophotometer. Serum Hs-CRP concentration was determined using the latex turbidimetric immunoassay method. Serum albumin concentration was measured by using the bromo-cresol green (BCG) method. The serum Hs-CRP/albumin ratio was calculated by dividing the serum Hs-CRP by the serum albumin. Analysis of data was done by using statistical package for the social sciences (SPSS), version 20.0.
Results: The mean levels of serum Hs-CRP and Hs-CRP/ albumin ratio were shown significantly higher in the study group than in the control group. The abnormal frequency distribution of serum Hs-CRP and Hs-CRP/albumin ratio among study group found significantly higher than in control. Spearmen correlation coefficients (r) was found a positive and significant association between BLLs and serum Hs-CRP (r = 0.190) and Hs-CRP/albumin ratio (r = 0.193). Area under the curve (AUC) of ROC values among the study group noted as 0.465 (95% of CI = 0.393-0.537, p = 0.366) for serum albumin, 0.601(95% of CI = 0.526-0.675, p = 0.010) for serum Hs-CRP and 0.598 (95% of CI = 0.524-0.672, P = 0.012) for Hs-CRP/ albumin ratio.
Conclusion: The levels of Hs-CRP and Hs-CRP/albumin ratio were significantly increased in the study group as compared to the control and reduction of Pb-exposure is needed to avoid the risk of cardiovascular disease (CVD) and atherosclerosis.
Introduction: Peroxisome proliferator activated receptor-γ (PPAR-γ) and its polymorphisms have an important role in polycystic ovary syndrome (PCOS), pathogenesis of which concentrates mainly around insulin resistance.
Aims and objectives: To identify PPAR-γ Pro12Ala Polymorphism in subjects with PCOS and controls along with an estimation of PPARγ levels and to correlate these with biochemical and anthropometric parameters of insulin resistance.
Materials and methods: A hospital-based case control study was conducted in 50 diagnosed cases of PCOS (15 to 45 years of age), as per revised Rotterdam criteria along with 50 age-matched healthy controls. PPAR-γ levels were estimated using sandwich enzyme-linked immunosorbent assay (ELISA). Polymorphism was detected through DNA extraction from whole blood followed by polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP). Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 16 employing independent sample t-test for intergroup comparison of means and Pearson's correlation coefficient for correlation analysis. Categorical data analysis for polymorphism was done using chi-square test. ROC analysis was done for comparison between various markers.
Results and conclusion: Peroxisome proliferator activated receptor γ (PPAR-γ) Pro12Ala polymorphism analysis revealed a higher proportion of Pro/Pro homozygotes (78%) in contrast to a lower proportion of Pro/Ala heterozygotes (22%) in cases. Also, Pro/Pro homozygotes were associated with a higher proportion of insulin resistance (86.7%) and obesity (83.8%) as compared to Pro/Ala heterozygotes in PCOS cases. PPAR-γ levels were significantly reduced in cases [13.16 (11.78–17.08) ng/mL] as compared to controls [16.05 (12.07-33.0) ng/mL]. This strengthens the fact that insulin sensitivity is related to enhanced PPAR-γ expression. ROC analysis revealed PPAR-γ to be a better indicator of PCOS (AUC = 0.605). To conclude, this study is suggestive of a protective role of Pro/Ala (CG) heterozygotes in PCOS and their possible association with insulin resistance and obesity.
Introduction: As we know endothelial dysfunction is an initial stage of vascular complications in type 2 diabetes mellitus (DM). Hypoglycaemic drugs have shown a beneficial effect on endothelial function. Insulin is a regulator hormone for endothelial function in vessels. But, there was a controversial report on the effect of exogenous insulin on endothelial function in type 2 diabetes subjects.
Aim and objectives: The study has been designed to observe the effect of insulin therapy on endothelial dysfunction in type 2 diabetic subjects without any complications.
Materials and methods: This Study include 120 Subjects (60-Diabetics and 60-Healthy Controls). MDA was manually estimated by thiobarbituric acid reactive substances (TBARS) method and anti-oxidant capacity was estimated as FRAP.19 NO was measured by using kinetic cadmium reduction method.
Result: Significantly high level of body mass index (BMI) was identified in insulin-treated subjects than subjects with hypoglycemic drugs and healthy controls. Nitric oxide (NO) has shown significantly lower in insulin-treated subjects compared to subjects with hypoglycemic drugs and healthy controls. There was no sign in the levels of lipid profile and oxidative stress in between two treatment groups.
Conclusion: Significant effect of insulin therapy was observed on endothelial dysfunction in type 2 DM. Exogenous insulin itself may cause endothelial dysfunction by hyperinsulinemia because of a high-fat diet or high dosage of insulin.
I Anand Shaker,
Anupam K Bansal,
Aim: Pregnancies, including preeclampsia, are low-grade systemic inflammation which has been associated with complications. Endothelial dysfunction in preeclampsia is accompanied by elevated levels of inflammatory markers and cytokines such as high sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α) and interleukin-10 (IL-10). Our aim in this study is to assess the levels of these above markers in preeclampsia and to predict its severity.
Materials and methods: A case-control study was performed on 100 pregnant women with preeclampsia as cases (50 mild and 50 severe) as per clinical guidelines and 50 healthy pregnant women as controls. They were all age and parity-matched primigravidas at the third trimester of pregnancy.
Results: Significantly increased (p <0.001) serum levels of hs-CRP, TNF-α and IL-10 were found in cases of mild and severe preeclamptic when compared to controls. In severe preeclamptics, all these parameters were also found highly significant in comparison to mild.
Conclusion and clinical significance: The observed high levels of hs-CRP, TNF-α, and IL-10 in preeclamptic women indicate that these markers can be used in identifying the severity of preeclampsia and it can help the clinician in their diagnosis, treatment, and management.
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GK VG, Javarappa D. Correlation of Protein Carbonyl and Protein Thiols in Oxidative Stress-induced Senescence of Red Blood Cell Membrane in Type 2 Diabetes Mellitus. Indian J Med Biochem 2018; 22 (2):143-146.
Introduction: Diabetes mellitus (DM) is an endocrine dysfunction, which is associated with metabolic disease. Wherein chronic hyperglycemia presets the oxidative process which in turn biochemically leads to advanced glycation. The aim is to study the changes caused by oxidative stress upon the red blood cell (RBC) membrane composition by protein carbonyl and protein thiols in type 2 DM (T2DM) in comparison with that of controls.
Materials and methods: The study includes two groups, consists of 100 cases of T2DM and 100 healthy subjects as controls. Blood samples were collected under strict aseptic precautions as per the criteria and estimation of fasting blood sugar (FBS), hemoglobin A1c (HbA1c), protein carbonyl with RBC membrane ghost preparation and estimation of protein thiols were done.
Results: It was found that there was significant increase of protein carbonyl in cases (1.20 ± 0.08), in comparison to normal controls (0.90 ± 0.06) with a statistical significance of (p < 0.001) along with Protein thiols of RBC membrane which was significantly decreased (1.42 ± 0.10) in cases in comparison to normal controls. (2.12 ± 0.12) with a statistical significance of (p < 0.001). In our study, the positive correlation of protein carbonyl and protein thiols was established with 74% of cases of type 2 DM falling into a HbA1C control group of 7 to 8% indicating the increased protein carbonyl and decreased protein thiols are early indicators of progressive diabetic changes.
Conclusion: Changes in RBC membrane of persons with T2DM acts as an early indicator by means of an increase in protein carbonyl and decrease in protein thiols, and this will further lead to progressive diabetic changes.
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DS HK, CS MK, Vishwanath H. A Comparative Study in Assessing the Usefulness of Serum Cholinesterase, High Sensitivity C-reactive Protein with Liver Function Tests in Alcoholic Liver Disease. Indian J Med Biochem 2018; 22 (2):147-153.
Introduction: Chronic alcohol ingestion is one of the major causes of liver disease. The pathology of alcoholic liver disease consists of three major lesions (1) fatty liver; (2) alcoholic hepatitis; and (3) cirrhosis. Fatty liver is present in >90% of binge and chronic drinkers with a smaller percentage of heavy drinkers progressing to alcoholic hepatitis thought to be a precursor to cirrhosis. A lot of studies have been conducted in the past but requires further studies to prove its usefulness in the diagnosis of liver diseases. The present study has been planned to find out the use of assay of serum cholinesterase and high-sensitivity C-reactive protein (hs-CRP) in the diagnosis of alcoholic liver disease.
Materials and methods: Thirty male cases diagnosed with the alcoholic liver disease were compared with 30 male normal subjects as controls and 30 male non-alcoholic liver disease patients as an additional study group. The diagnosis was based on interview and questionnaire, clinical signs of liver disease and supporting laboratory tests [bilirubin, total protein, serum albumin, albumin:globulin (A:G), aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP), and gamma-glutamyl transferase (GGT)] and ultrasound.
Results and discussion: The study showed deranged liver function tests in both alcoholic and non-alcoholic cirrhosis patients compared to controls and normal liver function tests in controls. The serum cholinesterase levels were significantly decreased in alcoholic cirrhosis patients (2112.43 ± 1195.94) compared to non-alcoholic cirrhosis (4004.73 ± 971.03) patients with p-value < 0.001 whereas hs-CRP levels were significantly increased in non-alcoholic cirrhosis patients (1.79 ± 0.28) compared to alcoholic cirrhosis patients (1.23 ± 0.42) with p-value < 0.001.
Conclusion: To conclude, the marked decrease in serum cholinesterase in alcoholic cirrhosis patients suggest that its activity might be a specific indicator of liver dysfunction and may be used for the diagnosis of alcoholic cirrhosis patients and the hs-CRP can be used as a strong predictor of non-alcoholic cirrhosis.
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DS HK, K G. Correlation of Serum Cholinesterase with Lipid Indices in Type 2 Diabetes Mellitus Patients in McGann Teaching Hospital, Shimoga, Karnataka, India. Indian J Med Biochem 2018; 22 (2):154-156.
Introduction: Type 2 diabetes mellitus (DM) is a cluster of conditions categorized by longstanding hyperglycemia accompanying with disturbances of carbohydrate, lipid and protein metabolism due to absolute/relative deficiency of insulin secretion and/or its action. Serum cholinesterase is an enzyme, which has been associated with diabetes, hypertension, cardio, and vascular disease and also it has a role in the metabolism of lipoproteins. Few studies showed that serum cholinesterase activity has been positively’ correlated with lipid indices and blood lipoprotein levels.
Aim and objectives: To estimate serum cholinesterase levels in clinically diagnosed type 2 DM patients and to evaluate the correlation between true cholinesterase level and lipid indices in the type II diabetes patients.
Materials and methods: Total 120 subjects were involved in this study. Out of which 60 were clinically diagnosed type II diabetes mellitus cases, and 60 were age and sex-matched healthy controls. Serum cholinesterase enzyme activity, fasting blood glucose levels and lipid profile and indices analysis done in event-eelated brain activation (ERBA) autoanalyzer. Statistical data analysis was performed by using Statistical Package for the Social Sciences (SPSS) 19.2 software.
Results: The enzyme cholinesterase activity levels raised in cases compared to healthy controls. The enzyme cholinesterase levels in cases revealed 9576 ± 1542.78 (IU/L) and in controls was 6783.9 ± 798.98 (IU/L). The enzyme cholinesterase showed a positive correlation with every lipid indices namely total cholesterol, triglycerides, low-density lipoprotein-cholesterol (LDL-C), total cholesterol to high-density lipoprotein-cholesterol (HDL-C) ratio and negative correlation with HDL-C in cases as compared to healthy controls.
Conclusion: The outcome of our study showed that serum (true) cholinesterase level may assist as a budding risk assessment indicator of cardiovascular disease in type 2 DM.
Introduction: Advances in biochemical sciences have led to a significant progress in medical treatment. However, not much change has been made in the medical school curricula.
Current teaching practices and lacunae: Medical schools follow didactic teaching. Policy makers hark on the pedagogical skills of the medical educators. However, one should talk about the “andragogical skills” of a medical educator. Adults approach learning in a way fundamentally different from children. Our country is still far away from fully adopting innovative teaching methods for medical education. There is absence of strong teacher-training programs.
The way forward: Regulatory body for medical education has emphasized need based curriculum. Large scale training of the faculties of all medical colleges has been initiated. However, the scope and pace of all such activities is probably insufficient. Consideration should be given to shift towards andragogical approach, robust teacher-training programs and earnestly implementing innovative teaching methodologies for medical education.