Ischemia-modified Albumin Levels Research Articles

ABSTRACT 309

Background and aims: Ischemia modified albumin (IMA) is a new marker for ischemic process. Ischemia and asphyxia are important pathogenetic initiator for Hypoxic ischemic encephalopathy (HIE) but relationship between IMA and HIE have not been investigated previously. Methods: Between 2012 and 2013 newborns hospitalized for HIE were prospectively followed in our NICU. IMA was compared between HIE and control groups. Statistical analysis was performed by SPSS v.11.p value < 0.05 was considered as significant. IRB approval was taken. Results: There were 27 newborns with HIE and 39 normal newborns. There were no significant differences with respect to demographic factors. However, IMA levels significantly higher in patients with HIE group (96.28 ± 4.9 vs.80.5 ± 6.9, p<0.0001). Conclusions: IMA could be a marker for the diagnosis and monitorization for HIE. Further studies with larger sample size are urgently needed.

Serum ischemia-modified albumin levels at diagnosis and during treatment of late-onset neonatal sepsis

Sepsis is one of the most common infectious conditions in the neonatal period, and continues as a major source of morbidity and mortality. The aim of this study is to determine serum ischemia-modified albumin (IMA) levels in late-onset neonatal sepsis at the time of diagnosis and after therapy, and to show the meaningful on the follow-up. Also, it is aimed to compare serum IMA levels with serum C-reactive protein (CRP), procalcitonin (PCT) levels and white blood cell count. The study was performed on 33 premature babies with sepsis and 21 healthy premature controls at 7–28 days of age. In the sepsis group, biochemical parameters and blood culture samples were obtained from the blood at the onset and on the fifth day of treatment for each patient. Serum IMA, CRP, PCT and white blood cell count were significantly higher in the sepsis group before treatment when compared with the control group. In addition, the levels of IMA were positively correlated with white blood cell count, CRP and PCT in the sepsis group before treatment. In conclusion, serum IMA levels may be useful in late-onset neonatal sepsis at the time of diagnosis and after therapy. As far as we know this is the first report about the assesment of illness diagnosis and after therapy using serum IMA levels, and further studies are needed to confirm our results in larger groups of patients.

The protective effect of quercetin on IMA levels and apoptosis in experimental ovarian ischemia-reperfusion injury

ObjectiveTo investigate the protective effect of quercetin (QE), an anti-inflammatory and anti-oxidant agent, on torsion–detorsion induced histopathological changes and blood IMA levels in experimental ovarian ischemia-reperfusion (IR) injury. Study designTwenty-four female Wistar rats were randomly divided into four groups in this study (n=6). Group I, (sham operation); Group II, torsion–detorsion plus saline (IR); Group III, torsion–detorsion plus solvent (dimethylsulfoxide: DMSO, IR+DMSO); Group IV, torsion–detorsion plus 15mg/kg/bw quercetin (IR+QE) injected intraperitoneally 30min prior to detorsion. After 3h of reperfusion, the right ovaries were removed surgically. The ovary tissue samples were fixed in 10% formalin solution for histopathological and immunohistochemical examination. Blood samples were obtained at the end of the procedures for each group of animals. ResultsOvarian sections in Groups II and III showed higher follicular cell degeneration, hemorrhage, vascular congestion and edema when compared with Group I. Administration of quercetin in rats significantly prevented degenerative changes in the ovary. Significantly less histopathological changes were found in Group IV compared with Groups II and III. Caspase-3 and TUNEL positive cells were detected in the ovarian surface, follicle epithelium, and stromal cells in all experimental groups, and there was a significant increase in Groups II and III compared with Group I (P<0.05). Treatment with quercetin decreased the number of caspase-3 and TUNEL positive cells. IR increased the ischemia modified albumin (IMA) levels in comparison to the sham group (1.06±0.10ABSU and 0.92±0.08ABSU, P<0.05). Quercetin administration before IR reduced the levels of IMA (0.93±0.08ABSU, P<0.05). ConclusionAdministration of quercetin is effective in preventing tissue damage induced by IR injury in ovaries.

Resveratrol attenuates both small bowel and liver changes in obstructive jaundice.

It is well known that mucosal changes and alterations in liver function occur in the experimental obstructive jaundice model. We aimed to evaluate the effect of resveratrol on obstructive jaundice-induced changes in the small bowel mucosa and liver using ischaemia-modified albumin as a marker of oxidative damage. Animal experimentation. The study used a rodent experimental model of obstructive jaundice, including a sham group (1), a control group (2), and a study group (3). Wistar albino rats were used. Jaundice was produced by ligation of the bile duct in Groups 2 and 3. In Group 3, resveratrol was administered intraperitoneally for 14 days. In terms of the structure and the size of the mucosal villi, significant thickening and blunting were detected in Group 2 compared with Group 1. These changes were significantly less noticeable in Group 3 compared with Group 2. Levels of ischaemia-modified albumin were significantly higher in Group 2 compared with those in Group 1, and they were significantly decreased in Group 3 compared with Group 2. Resveratrol administration to obstructive jaundiced rats reduced the organic effects of obstructive jaundice on small bowel mucosa and liver oxidative stress. We believe that this reduction might attenuate bacterial translocation and systemic effects of secreted cytokines.

The short term effects of resveratrol on ischemia–reperfusion injury in rat testis

PurposeThe purpose of this study was to identify changes taking place in the rat testis at the 24th hour of reperfusion following testicular torsion and to evaluate the effects of resveratrol (RSV), a powerful antioxidant, in preventing these changes using novel biochemical parameters and histopathology. MethodsEighteen adult male rats were divided into three groups: Sham-operated (S), torsion/detorsion (T/D), and T/D+RSV groups. In the T/D group, testicular ischemia was achieved by rotating the left testis 720° clockwise for 4h. In the T/D+RSV group, 20mg/kg RSV was administered intraperitoneally 30min before detorsion. All rats were sacrificed 24h after detorsion. Serum and tissue malondialdehyde (MDA) concentrations, ischemia modified albumin (IMA), total oxidative status (TOS), total antioxidant status (TAS), oxidative stress index (OSI), and histopathological damage score were analyzed. ResultsSerum MDA, IMA, TOS, and OSI levels rose significantly in the T/D group. Serum MDA and IMA values were lower in the T/D+RES groups, but not significantly. OSI and TOS values were lower in the T/D+RES group, and the difference was significant. TAS values decreased significantly in the T/D group and rose in the T/D+RSV group, but not significantly. Ipsilateral tissue MDA values were significantly elevated in the T/D group and decreased in the T/D+RSV group, but not significantly. Apoptosis and histopathological damage increased significantly in the T/D group and decreased significantly in the T/D+RSV group. In the contralateral testis, apoptosis increased significantly in the T/D group. It decreased significantly in the T/D+RSV group. ConclusionsOur findings show that RSV had a protective effect against oxidative damage induced with a testicular T/D model, especially at the antiapoptotic and histopathological level. OSI may be a good guide to the clinical status of testicular T/D.

The effect of fluoxetine on ischemia–reperfusion after aortic surgery in a rat model

BackgroundAortic ischemia–reperfusion (IR) is an important factor in the development of postoperative acute lung injury after abdominal aortic surgery. The aim of the present study was to examine the effect of fluoxetine (Flx), a selective serotonin reuptake inhibitor widely used as a preoperative anxiolytic, on lung injury induced by abdominal aortic IR in rats. MethodsWistar rats were randomized into three groups (n = 7 per group): (1) control (sham laparotomy); (2) IR without Flx (60-min ischemia and 120-min reperfusion); (3) IR with Flx (Flx + IR) (Flx 20 mg/kg/d, intraperitoneally for 3 d before surgery). Lung tissue samples and bronchoalveolar lavage (BAL) were obtained for biochemical analysis of oxidative status. Ischemia-modified albumin (IMA) level and protein concentrations in BAL and lung wet to dry weight ratios were determined. Histologic evaluation of the lung tissues was also performed. ResultsIR without Flx led to significant increase in lipid hydroperoxide, malondialdehyde, and pro-oxidant–antioxidant balance and decrease in superoxide dismutase, glutathione, and ferric reducing antioxidant power activities (P < 0.05 versus control), whereas Flx was able to restore these parameters (P > 0.05 versus control) and decrease IMA level (P < 0.01 versus control) and protein concentration (P < 0.05 versus control) in BAL and wet to dry lung weight ratio. Histologic evaluation showed that Flx attenuated the morphologic changes associated with lung injury. ConclusionsThe results indicate that Flx confers protection against aortic IR-induced lung oxidative stress and cellular integrity. IMA levels in BAL may be used as a follow-up marker for the efficacy of treatment in lung injury.

English

BACKGROUND: Ischemia Modified Albumin (IMA) is an ischemia/reperfusion injury marker which has been considered to be formed under oxidative stress conditions. Endothelial L- Arginine/NO pathway dysfunction can lead to oxidative stress which has deleterious effects seen on the vascular wall causing ischemia. AIM: 1) The study was conducted to estimate the levels of IMA and NO in hyperthyroidism patients. 2) To evaluate the relationship between IMA and NO levels in hyperthyroidism. MATERIALS AND METHODS: A cross sectional study was done with 30 newly diagnosed hyperthyroid patients as cases and 30 age and sex matched healthy controls. Serum levels of IMA and NO were estimated by colorimetric methods and thyroid profile was done by ELIFA methodology. STATISTICAL ANALYSIS: Data were analyzed using SPSS. Values were expressed as Mean±SD. RESULTS: Nitric Oxide levels were significantly decreased in hyperthyroid patients (7.08±1.57µmol/L) as compared to healthy controls (39.76±4.98µmol/L) (p=0.001). Ischemia Modified Albumin levels were found to be significantly increased in hyperthyroid patients (0.73±0.10 ODU) when compared to healthy controls (0.28±0.01 ODU) (p=0.001). CONCLUSION: In our study there was increase in IMA levels with decreased NO levels which could be due to the consequence of

Ischemia modified albumin (IMA) for the diagnosis of bacterial infection in hospitalized patients with cirrhosis

Background/Aims: Human serum albumin (HSA) carries many non-oncotic functions, such as free radical scavenging and detoxification. The N-terminal site binds transition metal ions, thus acting against oxidative stress. Clinical conditions characterized by a pro-inflammatory state, including acute-on-chronic liver failure, have been found to impair this specific activity, which can be easily assessed by measuring the circulating level of ischemia-modified albumin (IMA). Thus, this study aimed to assess whether IMA can be considered a marker of bacterial infections in patients with cirrhosis.

Oxidative stress and ischemia-modified albumin in chronic ischemic heart failure

ObjectivesKnowledge about the role of oxidative stress in human diseases, including cardiovascular system disorders, emphasizes the need for reliable markers of oxidative stress. Here, we evaluated the levels of the novel marker ischemia-modified albumin (IMA), albumin-adjusted IMA (adj-IMA), and the IMA/serum albumin ratio (IMAR) in patients with chronic ischemic heart failure (CIHF).MethodsA total of 55 patients with CIHF and 40 age- and sex-matched healthy individuals were included in the study. Serum levels of IMA, total antioxidant status, and total oxidant status were analyzed, and the adj-IMA level, IMAR, and oxidative stress index were calculated.ResultsSerum IMA, IMAR, total oxidant status levels, and oxidative stress index were significantly higher in patients with CIHF than in the controls (all P < 0.0001), whereas albumin and total antioxidant status levels were significantly lower in the CIHF patients (P < 0.0001 and P = 0.0004, respectively). However, there was no significant difference in serum adj-IMA levels between the groups (P = 0.8).DiscussionWe observed impaired oxidant/antioxidant status in favor of oxidative stress in CIHF patients. Oxidative stress may be a key factor in the development of hypoalbuminemia in CIHF. Further studies are needed to establish the relationships among IMA, albumin, and redox balance in CIHF.

Ischemia-Modified Albumin May be a Novel Marker for the Diagnosis and Follow-up of Necrotizing Enterocolitis

We investigate the efficacy of serial ischemia-modified albumin (IMA) measurements in diagnosis and follow-up of necrotizing enterocolitis (NEC), and compare its effectiveness with C-reactive protein (CRP), interleukin-6 (IL-6), in NEC. Preterm infants, whose gestational age and weight matched each other, were grouped as control (n = 36) and NEC (n = 37). IMA, CRP, IL-6 levels were measured on the third day of life for the control group and on the day of diagnosis (first day), third, and seventh days of NEC. IMA, CRP, and IL-6 levels were significantly increased in NEC patients compared to the control group (P < 0.001) on the follow-up. IMA levels were significantly higher in infants with stage-III NEC than those in infants with stage-II NEC on the first, third, and seventh days (P < 0.001). The area under curve for IMA (0.815 at diagnosis, 0.933 at the third day, 0.935 at the seventh day) were significantly higher than CRP and IL-6 at all days for predicting perforation in infants with NEC (P < 0.001). Similarly, the area under curve for IMA (0.952 at diagnosis, 0.929 at the third day, 0.971 at the seventh day) was significantly higher than CRP and IL-6 at all consequent days of diagnosis for predicting mortality in infants with NEC (P < 0.001). Ischemia-modified albumin was found to be superior to CRP and IL-6 in both diagnosis and follow-up of NEC.

Comparative study of ischemia modified albumin and nitric oxide in hyperthyroidism

Objective: Ischemia modified albumin (IMA) is an altered type of serum albumin that forms under conditions of oxidative stress. Increased IMA has been described as a marker of ischemia reperfusion injury and dysfunction of the endothelial L-arginine/nitric oxide (NO) pathway (affecting NO levels) is a common mechanism by which several cardiovascular risk factors mediate their deleterious effects on the vascular wall. No reports are available in literature to comment on the simultaneous measurement of IMA and NO in hyperthyroidism. Therefore, this study was planned to evaluate these levels in newly diagnosed patients of hyperthyroidism. Materials and Methods: This study was conducted on 50 newly diagnosed hyperthyroid patients and the results were compared with 50 age and sex matched healthy controls. IMA levels and NO were estimated by standard colorimetric methods. Results: NO concentration was found to be significantly low in hyperthyroid patients (6.4 ± 3.8 μmol/L) as compared with control subjects (36.24 ± 7.61 μmol/L) (P < 0.05), while IMA levels were found to be higher in hyperthyroid group (0.662 ± 0.17 ABU) than healthy controls (0.290 ± 0.09 ABU) (P < 0.05). IMA levels were negatively correlated with NO (r = −0.761, P < 0.001) and correlation was highly significant. Conclusion: Increased ischemia modified albumin levels may be a consequence of and cause for decreased nitric oxide levels in hyperthyroidism and this study may help to establish the role of oxidative stress and ischemia reperfusion in the pathogenesis of hyperthyroidism.

Effect of Peripheral Arterial Disease on Serum Ischemia-Modified Albumin Levels in Type 2 Diabetic Patients

Background: The aim of this study is to evaluate the role of IMA and the effect of Type-2 diabetes in peripheral arterial ischemic patient. Methods: In our study, randomized patient groups to be undergone peripheral surgery, consisting of 16 diabetic and 12 non-diabetic patients diagnosed with peripheral arterial disease, have been examined. After standard anesthesia, the surgery was performed by the same surgical team, blood samples were taken before and after cross-clamp, and the levels of ischemia modified albumin (IMA), which is a new ischemic marker, were studied spectrophotometrically. Demographic data were compared with the type-2 diabetes association. Results: In this study, we found that there were no correlation with the ankle brachial index (ABI) and risk factors of diabetes between postoperative IMA levels (P: 0.47). Preoperative IMA serum blood levels were significantly higher in patients with peripheral arterial disease (P: 0.70), and positively associated with ABI (diabetic group P: 0.04, non-diabetic group P: 00). Also, no correlation was found with X clamp times, ABI, and IMA blood levels (P: 0.30). In diabetic group, ischemia marker increase was high and there was a positive correlation between HbA1c levels (P: 0.002). Conclusion: Our study suggested that, preoperative serum IMA levels were positively associated with ABI. In diabetic group, the increase in IMA levels was high and there was positive correlation between HbA1c levels. IMA was a benefit marker for monitoring and early diagnosis of the peripheral arterial disease.

Prognostic implications of ischemia modified albumin in known cases of 86 elderly hypertensive South Asian aged 56–64 years – a hospital based study

ObjectiveTo study associated ischemia modified albumin in hypertensive participants and to compare the results with normotensive healthy controls. MethodsA total of 86 hypertensive patients and 86 age-sex matched normotensive healthy volunteers were selected for this study. The study was conducted for a period of 3 years from September 2007 to August 2010. Biochemical parameters and other parameters such as smoking habits, systolic and diastolic blood pressure and family history were recorded. Lipid profile, ischemia modified albumin, malondialdehyde and conjugated diene were measured by standard methods and results were compared between patients and controls. ResultsTotal cholesterol, triglycerides, low density lipoprotein cholesterol were significantly higher (P<0.001) in hypertensive subjects when compared to normotensive control. Also, significant differences were seen in high density lipoprotein cholesterol levels between both groups (P<0.001). The index of lipid per oxidation comprising both malondialdehyde and conjugated dienes were significantly higher in hypertensive compared to normotensive controls. Ischemia modified albumin levels were significantly increased among hypertensive compared to normotensive controls (P<0.001). ConclusionsHypertensive patients have increased oxidative stress and are accompanied with rise in ischemia modified albumin. Ischemia modified albumin could be incorporated as a diagnostic test parameter in hypertensive to avoid the future acute coronary complications.

Serum ischemia-modified albumin and malondialdehyde levels and superoxide dismutase activity in patients with fibromyalgia.

The aim of the study was to determine serum ischemia modified albumin and malondialdehyde levels as markers of oxidative stress and serum superoxide dismutase activity as a marker of antioxidant defense and their associations with clinical outcomes in patients with fibromyalgia. 59 patients with fibromyalgia and 38 age and gender matched healthy controls were included in the study. The diagnosis of fibromyalgia was based on the classification criteria declared by American College of Rheumatology in 1990. All patients underwent the clinical assessment, consisting of evaluation for tender point count, visual analogue scale for pain, fibromyalgia impact questionnaire, multidimensional assessment of fatigue, Beck anxiety inventory, Beck depression inventory, and the health assessment questionnaire. Serum levels of ischemia modified albumin, malondialdehyde, and superoxide dismutase activities were measured using colorimetric methods. Malondialdehyde levels of fibromyalgia patients were significantly higher than they were in the control group. Ischemia modified albumin levels in the fibromyalgia group were not significantly different from the control values. There was no significant correlation between ischemia modified albumin and malondialdehyde and clinical measures with the exception that malondialdehyde levels positively correlated with health assessment questionnaire scores. We concluded that increased malondialdehyde levels in patients with fibromyalgia could be considered as a sign of increased oxidative stress. Ischemia modified albumin values were not in concordance with malondialdehyde levels and could not be considered as an oxidative stress marker in the follow-up of fibromyalgia. Further studies are needed to investigate IMA levels in newly diagnosed fibromyalgia patients.

The Association between Diabetic Retinopathy and Levels of Ischemia-Modified Albumin, Total Thiol, Total Antioxidant Capacity, and Total Oxidative Stress in Serum and Aqueous Humor.

Purpose. To investigate the oxidant and antioxidant status of patients with type 2 diabetes mellitus and nonproliferative diabetic retinopathy (DRP). Methods. Forty-four patients who had cataract surgery were enrolled in the study. We included 22 patients with DRP in one group and 22 patients in the control group. Samples of aqueous humor and serum were taken from all patients. Serum and aqueous ischemia-modified albumin (IMA), total thiol, total antioxidant capacity (TAC), and total oxidative stress (TOS) levels were compared in two groups. Results. Median serum IMA levels were 44.80 absorbance units in the DRP group and 40.15 absorbance units in the control group (P = 0.031). Median serum total thiol levels in the DRP group were significantly less than those in the control group (3051.13 and 3910.12, resp., P = 0.004). Mean TOS levels in the serum were 2.93 ± 0.19 in the DRP group and 2.61 ± 0.26 in the control group (P = 0.039). The differences in mean total thiol, TAC, and TOS levels in the aqueous humor and mean TAC levels in the serum were not statistically significant. Conclusion. IMA, total thiol, and TOS levels in the serum might be useful markers in monitoring the risk of DRP development.

The Reference Values Of Ischemia Modified Albumin Levels In Healthy People Admitted To A University Hospital

Objectives: The Ischemia Modified Albumin (IMA) test is a myocardial ischemia marker which may have potential use for the diagnosis of Acute Coronary Syndrome. The aim of this study was determine reference values of IMA test on the healthy people over the age of 15 who's admitted to Canakkale Onsekiz Mart University. Methods: This study was performed on 582 people over 15 years old and healthy in appearan- ce who had presented at the Canakkale Onsekiz Mart University Faculty of Medicine Rese- arch and Application Hospital. The year 2011 population of Turkey was taken as the reference in the distribution of the study group according to age group and gender. A survey which queried the demographic features and health problems was administered to the participants of the study and 9 cc venous blood was drawn. IMA levels were measured by using the spect- rophotometric method defined by Bar-Or. The mean, standard deviation, median, minimum, maximum, and 2.5 % - 97.5 % interval were used in order to detect the IMA reference values. Results: A total of 274 males (47.1 %) and 308 women (52.9 %) were studied. The mean IMA value of the examined group was 0.339 ± 0.093, and the median was 0.343 (Min-Max: 0.053- 0.631), while the 2.5 % - 97.5 % percentil values were 0.145 - 0.530. Conclusion: Studies that indicate the reference levels of the IMA for the diagnosis of ische- mic conditions are insufficient. Our study is expected to contribute to closing this gap.

The Effects of Spinal, Inhalation, and Total Intravenous Anesthetic Techniques on Ischemia-Reperfusion Injury in Arthroscopic Knee Surgery

Purpose. To compare the effects of different anesthesia techniques on tourniquet-related ischemia-reperfusion by measuring the levels of malondialdehyde (MDA), ischemia-modified albumin (IMA) and neuromuscular side effects. Methods. Sixty ASAI-II patients undergoing arthroscopic knee surgery were randomised to three groups. In Group S, intrathecal anesthesia was administered using levobupivacaine. Anesthesia was induced and maintained with sevoflurane in Group I and TIVA with propofol in Group T. Blood samples were obtained before the induction of anesthesia (t 1), 30 min after tourniquet inflation (t 2), immediately before (t 3), and 5 min (t 4), 15 min (t 5), 30 min (t 6), 1 h (t 7), 2 h (t 8), and 6 h (t 9) after tourniquet release. Results. MDA and IMA levels increased significantly compared with baseline values in Group S at t 2–t 9 and t 2–t 7. MDA levels in Group T and Group I were significantly lower than those in Group S at t 2–t 8 and t 2–t 9. IMA levels in Group T were significantly lower than those in Group S at t 2–t 7. Postoperatively, a temporary 1/5 loss of strength in dorsiflexion of the ankle was observed in 3 patients in Group S and 1 in Group I. Conclusions. TIVA with propofol can make a positive contribution in tourniquet-related ischemia-reperfusion.

Correlation of ischemia-modified albumin with SOFA and APACHE II scores in preoperative patients with colorectal cancer.

Purpose. Critical illnesses are assessed according to the sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation (APACHE) II. Circulating ischemia-modified albumin (IMA) is a biomarker generated under ischemic and oxidative conditions and may reflect disease severity in preoperative patients. This study investigated the correlations of IMA with SOFA and APACHE II scores in inpatients admitted for colorectal surgery. Methods. We examined 27 patients with advanced colorectal cancers (mean age 69 years, men/women = 15/12). Correlations between SOFA and APACHE II scores in addition to preoperative serum IMA and C-reactive protein (CRP) levels were analyzed. Results. The mean IMA level was 0.5 AU, and the median CRP level was 0.6 mg/dL. Median scores for SOFA and APACHE II were 2 and 12 points, respectively. Significant positive correlations between IMA and SOFA (r = 0.45, P < 0.05) and IMA and APACHE II (r = 0.45, P < 0.05) were identified which remained significant in confounder-adjusted analyses. In contrast, weak correlations were observed between CRP and the SOFA and APACHE II scores. Conclusions. The positive correlations between IMA and both SOFA and APACHE II scores suggest that serum IMA measurements reflect the severity of systemic failure in patients admitted for colorectal surgery in the preoperative phase.

Growth differentiation factor 15, ischemia modified albumin and pregnancy-associated plasma protein A in patients with coronary artery disease.

Growth differentiation factor 15 (GDF-15), ischemia modified albumin (IMA) might aid in the early diagnosis and risk stratification of patients with coronary artery disease (CAD), while pregnancy associated plasma protein-A (PAPP-A) can serve as a useful marker of vulnerable plaques and acute coronary syndrome (ACS). We sought to determine serum levels of GDF-15, IMA, PAPP-A and evaluate their diagnostic value in different types of CAD. We detected serum levels of GDF-15, IMA and PAPP-A in 348 patients with CAD and 205 controls. Levels of high-sensitivity C reactive protein, creatine kinase isoenzyme MB, and high-sensitivity cardiac troponin-T, which represent biomarkers of inflammation, damage or necrosis, were also evaluated. There were significant differences of GDF-15, IMA and PAPP-A in patients with CAD compared with the controls, where GDF-15 seemed to be associated with severity of CAD. GDF-15 demonstrated a sensitivity of 84.0% and specificity of 84.8% for diagnosis of UAP, while the negative predictive value was 87.4%. The sensitivity and specificity, negative predictive value of IMA in the diagnosis of UAP were 70.0%, 69.5%, and 70.0%, respectively. PAPP-A had the lowest sensitivity and negative predictive value compared with other markers. GDF-15 demonstrated a significant improvement in earlier prediction and assessment of overall patient risk of UAP comparing to IMA and PAPP-A.

Study of cord blood ischemia modified albumin levels in the evaluation of birth asphyxia

Objective: In birth asphyxia several new biochemical markers are now investigated. Recent studies indicate the role of ischemia modified albumin, a biomarker determined by assay of cobalt binding activity of albumin. The aim of this study was to evaluate the role of ischemia modified albumin in birth asphyxia. Materials and methods: 40 newborns with APGAR score less than 7 were selected at random. Low birth weight, premature and newborns from caesarian section were excluded. Ischemia modified albumin was determined by assay of its cobalt binding activity with spectrophotometer. Mothers with history of preeclampsia and preexisting renal disease were kept out of the study. Similar observations were made in 40 normal newborns taken as control. Results: Cord blood ischemia modified albumin levels were higher in asphyxiated newborns compared to controls (55.7±1.7 U/ml compared to 32.44±1.15 U/ml). Raised levels of IMA in those subjects had shown very significant correlations with the APGAR scores of 5 minutes, a finding also observed in case of controls. Conclusion: The findings of the current study indicate that ischemia modified albumin can be a very useful marker in evaluation of birth asphyxia.