Abstract: Protein- energy malnutrition, wasting and inflammation are frequent complication among patient with Chronic kidney disease (CKD). Malnutrition is associated with cardiac co-morbidity, inflammation and poor survival in CKD patients. Serum albumin is a well-known negative acute phase protein, marker of nutrition in CKD patients. C-reactive protein (CRP), the major acute phase response (APR) protein is elevated in these patients. High CRP levels are linked to the degree of atherosclerosis in coronary, peripheral, and extracranial brain arteries. The aim of the present study was to investigate nutritional factor (albumin) and CRP levels in CKD patients. This cross –sectional study was carried out in the Department of Biochemistry in collaboration with the Department of Medicine, Guru Gobind Singh Medical College & Hospital, Faridkot .Study involved 100 pre dialysis CKD patients (age 40.5 ± 12.3 years) admitted indoor and attending outdoor .Following investigations were carried out –CRP by fluorescence immunoassay method utilizing latex particles coated with CRP monoclonal antibodies (I-chroma). Serum albumin levels on fully automated chemistry analyzer Renal function by estimated glomerular filtration rate (eGFR). The data was later statistically analyzed. The study patients included 57 males (57%) and 43 females (43%) with average age of 40.5±12.3 years. The mean GFR was 38.3 ± 16.4 ml/min/1.73m2. The mean value of CRP was 10.93 ± 1.42 mg /dl. 67% of patients had elevated CRP (> 6 mg/L) with low serum albumin levels were present with mean value (3.02 ± 0.17 gm/dL). This study showed that low albumin and high CRP levels are the main predictors for death. There was a significant difference between CRP and albumin levels in CKD patients (P<0.001). Measuring CRP as a marker of inflammation can be helpful in managing these patients and Low levels of albumin are a marker of poor nutritional status in CKD patients. Our results indicate that CRP(as marker of inflammation) and albumin(as marker of nutritional status ) were very closely related to each other ,as the levels of CRP increased the albumin goes on decreasing due to degree of inflammation , malnutrition and decreased synthesis by liver exists in pre-dialysis CKD patients.

Abstract: The study aims to find out root cause for insufficient centrifugation and sample aliquoting of blood samples in clinical chemistry laboratory. Blood samples centrifuged in the laboratory were aliquoted by technicians in to 1.5 ml eppindorf cups for placement in to automated chemistry analyser. The aliquotes were allowed to settle for 1 hour and observed for presence of red rim of settled RBC at the bottom of the cups, indicating insufficient centrifugation and sample aliquoting. Frequency of such samples were analysed for time of day, type of sample tube, amount of residual serum/plasma after aliquoting, origin of sample from hospital departments. Total 13491 sample tubes analysed in 20 days at Biochemistry laboratory of New civil hospital Surat. There were 248 samples showing red rim of RBC at the bottom of the cups. Out of 248, samples received at night constituted 78%. Serum sample have 3 times chances of having insufficient centrifugation and sample aliquoting as compared to fluoride plasma. 86% of sample had residual serum/plasma of <200 ul. Neonate sample have 7 times chances of having insufficient centrifugation and sample aliquoting as compared to adult samples. 97% of samples having insufficient centrifugation and sample aliquoting were received from wards while only 3% were received from OPD. Under filling of collection tubes, neonatal samples, samples collected in plain vacuum tubes, samples collected by phlebotomist on duty at night are root causes for insufficient centrifugation and sample aliquoting.

Abstract: Type 2 diabetes mellitus has become a leading cause of morbidity and mortality world over. Insulin resistance plays a key role in the development of diabetic dyslipidemia, plasma lipid abnormalities contributes to the risk for atherosclerosis and coronary heart diseases in majority of patients with type 2 diabetes. The aim of the study was to assess the serum lipid profile in type 2 DM patients without and with complications. The current study was undertaken in 90 subjects. 30 diabetics without complications (group I), 30 diabetics with complications (group II) and 30 non diabetics as normal control group (Group III). The serum total Cholesterol, Triglycerides, LDL-C and VLDL-C levels were significantly much higher in diabetic cases with complications compared to cases without complications and HDL-C levels were significantly lower in cases of both the 3groups when compared to controls. The elevation of serum total Cholesterol, Triglycerides, LDL-C and VLDL-C levels were significant in both the study groups when compared to controls. We found significantly lower levels of HDL-C in diabetic cases with complications when compared to cases without complications. The lowering is significant in both the study groups when compared to control. Hence it is concluded that the serum lipid profile levels appears to be useful to prevent the diabetic complications and provide valuable information for proper medical intervention.

Abstract: Several new biochemical and hematological parameters are available to diagnose and monitor alcoholic liver disease (ALD), but none are independently sufficient for the purpose. Serum enzymes - Alanine aminotransferase (ALT), Aspartate aminotransferase (AST), Alkaline phosphatase (ALP), Gamma glutamyl transferase (GGT) and AST:ALT ratio (De Ritis Ratio) are conventionally used as markers for diagnosis, treatment, prognosis and monitoring of ALD, based on their correlation with values before and after treatment or abstinence from alcohol intake. We wanted to establish the utility and affordability of estimation of these serum enzymes in ALD. To assess the levels and analyse the costs of estimation of conventional serum liver enzymes in ALD. After IEC clearance, this hospital based study was carried out on 30 male patients of diagnosed ALD and 30 normal control (non-alcoholic, healthy male) subjects between 18-65 years without history of liver disease, HIV, upper gastrointestinal bleeding, shock and/or ischemia to the liver, hepatotoxic medication use or exposure to high levels of environmental hepatotoxins, renal disorders, diabetes mellitus, hypertension. Serum AST, ALT, ALP, GGT levels were estimated using commercially available Roche diagnostic kits and fully automated biochemistry analyser (eCOBAS 6000 c501, Roche). Enzyme levels were expressed as Mean ± SD in IU/ml. Statistical analysis of differences in Means was done with Unpaired Student’s ‘t’ test, using GraphPad Quickcalcs online software, considering significance level as P < 0.05 at 95% confidence interval. Cost calculation of all the tests was done. Serum AST, ALT, ALP, GGT levels were highly significantly raised in ALD patients compared to healthy controls. De Ritis ratio was greater than 2 in 70% ALD patients. Cost calculation revealed that each patient had to pay a total of Rs 80/- for the tests. Conventional serum liver enzyme estimation and calculation of De Ritis ratio are useful and affordable diagnostic and prognostic markers in ALD.

Abstract: Diabetic retinopathy is the most common cause of vision loss among people with diabetes and a leading cause of blindness among working age adults, it is a serious sight threatening complication of diabetes. Hs-CRP is a marker of low-grade inflammation and its levels are raised in patients with diabetic retinopathy. The current study was undertaken in 60 subjects. 30 diabetic retinopathy patients and 30 non diabetics as normal control group. The aim of the study was to assess the serum levels of hs-CRP in diabetic retinopathy patients. hs-CRP is significantly much higher in diabetic patients with retinopathy compared to control group. TC, TG, LDL-C and VLDL-C levels where significantly elevated and HDL-C levels were significantly lower in cases when compared to controls. Hence it is concluded that the serum levels of hs-CRP appear to be useful as markers of diabetic retinopathy and provide valuable information for proper medical intervention.