Routine Biochemical Parameters Research Articles

Does Prolonged Storage of Serum Samples alter the Lab Results?

ABSTRACT Background Sample storage for prolonged periods can lead to alterations in routine biochemical parameters. Aim This study was undertaken to observe the biochemical changes on serum samples when they are stored for prolonged periods at –20°C on different routine biochemical parameters. Results Significant changes were observed in serum glucose, aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatinine, and potassium levels after 72 hours of storage, which further deteriorate in 3 months. Rest of the parameters did not show any significant alteration. Conclusion Prolonged storage of samples lead to alterations in the analyte concentration in serum. Serum glucose, AST, ALT, creatinine, and potassium levels should be estimated within 72 hours if prolonged storage is unavoidable. In conclusion, all the parameters should be assayed within 24 hours to avoid misinterpretation of results and better patient care. How to cite this article Tayal D, Gupta M, Goswami B. Does Prolonged Storage of Serum Samples alter the Lab Results? Indian J Med Biochem 2017;21(1):30-33.

Study of Red Cell Fragility in Different Stages of Chronic Kidney Disease in Relation to Parathyroid Hormone.

Anaemia is one of the common complications associated with Chronic Kidney Disease (CKD) responsible for the increase in the morbidity and mortality in such patients. Several factors have been attributed to cause renal anaemia, amongst which hyperparathyroidism is one of the less recognised reasons. Most studies have been conducted in this regard in CKD patients undergoing haemodialysis. The level of PTH in early stages of chronic kidney disease has not been much studied. The excess amount of Parathyroid Hormone (PTH) secondary to CKD has been suggested to be a causative factor for anaemia. To evaluate the serum PTH level in CKD patients before haemodialysis and to study the association of the haemoglobin status with the parathyroid hormone. Forty CKD patients above 18 years of age before haemodialysis and 25 age and sex matched healthy controls were included in the study. Routine biochemical and haematological parameters such as Routine Blood Sugar (RBS), urea, creatinine, Na+, K+, Ca2+, PTH and Hb% were perfomed. Red cell osmotic fragility was measured by serial dilutions of whole blood with varying concentrations of sodium chloride ranging from 0.1% to 0.9%. The study revealed a significant fall in Hb%, along with a rise in Median Osmotic Fragility (MOF) and PTH in the CKD patients when compared to the control group. Linear regression of PTH with Hb% revealed significant negative association between both the parameters with a R2 value of 0.677. Multilinear regression analysis of MOF and other independent variables such as Hb%, Na+, K+, Ca2+, urea, PTH and creatinine highlighted the variance of MOF by 72%, maximal variance contributed by PTH. Receiver Operating Curve (ROC) analysis revealed an area under the curve of 0.980 with a sensitivity of 100% and specificity of 87% in detecting osmotic fragility at a cut off value of PTH ≥100 pg/ml. The underlying cause of anaemia should be identified early in the CKD patients before haemodialysis. Secondary hyperparathyroidism should be ruled out as a causative factor of anaemia to slow down the progression of the disease process.

Hematological and Biochemical Profile of Patients Suffering from Non-Atopic Asthma

Background: The prevalence rate of asthma is increasing at an alarming rate worldwide and number of patients with asthma is projected to reach 100 million by 2025. Few tests are being used for diagnosis of asthma, but at present no established biomarker is available which may be used for diagnosis and prognosis of asthma. Main aim of this study was to investigate the potential of routine hematological and biochemical parameters as reliable diagnostic biomarker(s) of asthma. Methods and findings: We performed hematological and biochemical analysis by following standard clinical methods using Sysmex and Spectra. Results: Many hematological and biochemical parameters were either upregulated (i.e., Hb, WBC, LYM#, MXD#, NEUT#, NEUT%, Albumin/Globulin ratio, cholesterol, creatinine, urea, blood urea nitrogen, Na+ and K+) or down-regulated (i.e., MPV, LYM%, total protein, globulin, bilirubin, AST and ALT) in both male and female asthma patients as compared to the gender specific normal controls. However, few parameters (RDW, HCT, MCH, MCV, RBCs, CK-NAC, CK-MB-NAC, albumin, triglycerides, and HDL-C) exhibited gender specific variations (p<0.05). Conclusion: To our knowledge this study is the first to confirm the role of hematological and biochemical parameters in the pathogenesis of asthma. We suggest that combinatorial use of multiple parameters can be helpful for asthma diagnosis.

Decreased eicosapentaenoic acid levels in acne vulgaris reveals the presence of a proinflammatory state

This study aimed to determine circulating levels of polyunsaturated fatty acids (PUFAs), secretory phospholipase A2 (sPLA2), lipoprotein lipase (LPL) and measure circulating protein levels of angiopoietin-like protein 3 (ANGPTL3), ANGPTL4, cyclooxygenase-2 (COX-2) and prostaglandin E2 (PGE2) in patients with acne vulgaris. Serum from 21 control subjects and 31 acne vulgaris patients were evaluated for levels of arachidonic acid (AA, C20:4n- 6), dihomo-gamma-linolenic acid (DGLA, C20:3n-6), eicosapentaenoic acid (EPA, C20:5n-3) and docosahexaenoic acid (DHA, C22:6n-3). PUFA levels were determined by an optimized multiple reaction monitoring (MRM) method using ultra fast-liquid chromatography (UFLC) coupled with tandem mass spectrometry (MS/MS). Lipid profile, routine biochemical and hormone parameters were assayed by standard kit methods Serum EPA levels were significantly decreased while AA/EPA and DGLA/EPA ratio were significantly increased in acne vulgaris patients compared to controls. Serum levels of AA, DGLA and DHA showed no significant difference while activity of sPLA2 and LPL were significantly increased in acne vulgaris compared to controls. Results of this study reveal the presence of a proinflammatory state in acne vulgaris as shown by significantly decreased serum EPA levels and increased activity of sPLA2, AA/EPA and DGLA/EPA ratio. Increased LPL activity in the serum of acne vulgaris patients can be protective through its anti-dyslipidemic actions. This is the first study reporting altered EPA levels and increased sPLA2 activity in acne vulgaris and supports the use of omega-3 fatty acids as adjuvant treatment for acne patients.

Lipoprotein redox status evaluation as a marker of cardiovascular disease risk in patients with inflammatory disease.

Patients with chronic inflammatory disorders (ID) have an increased risk of developing cardiovascular disease, and routinely determined parameters do not reveal the real metabolic status of specific subgroups, such as patients with rheumatoid arthritis (RA). In this study, in order to evaluate state of the art markers for the assessment of cardiometabolic risk, abnormalities in lipoprotein levels in patients with a low-grade inflammatory status [diabetes mellitus (DM) subgroup] and in patients with a high systemic inflammatory burden (RA subgroup) was determined. The study group comprised patients with ID [DM (n=20) and RA (n=20)], with an aged-matched control group (n=17). Patient serum was used to determine routine biochemical parameters and to isolate low-density lipoprotein (LDL) and high-density lipoprotein (HDL). The heparin-citrate method was used for LDL precipitation and the phosphotungstic acid-MgCl2 technique for the isolation of HDL. Further, Amplex Red and advanced oxidation protein product (AOPP) assays were applied to determine lipid peroxides and protein oxidation, respectively, while the levels of serum advanced glycation end products (AGEs) were also determined. Although the differences in the routinely determined lipidemic profile were notable between the DM and RA subgroups, markers of lipid peroxidation and of advanced protein oxidation/glycation did not differ significantly, indicating possible similar oxidative damage of serum lipoproteins. On the whole, as alterations in lipoprotein functionality can occur long before any changes in routinely measured biochemical parameters are observed, more sensitive markers for the assessment of cardiovascular risk are required. As AOPPs, AGEs, oxidized LDL (oxLDL) and especially oxidized HDL (oxHDL) are affected during the early stages of inflammatory disease, and due to their known link to coronary artery disease, it would be wise to include these markers in the routine cardiovascular evaluation of patients with chronic inflammatory disease, such as those with RA.

Is peritoneal dialysis causing a measurable burden of inflammatory and endothelial injury on top of metabolic syndrome?

Low-grade chronic inflammation is present in patients on peritoneal dialysis (PD) and in metabolic syndrome (MS). Due to possible greater endothelial changes in dialyzed patients, inflammatory response and oxidative stress are probably stronger in patients on PD. The objective of the study was to investigate possible in between adipokines, inflammatory, endothelial and oxidative stress markers between MS patients and patients on PD. Concentrations of adipokines (leptin, resistin), inflammatory markers [interleukin-6 (IL-6), soluble tumor necrosis factor alpha receptor (sTNF-R), myeloperoxidase (MPO), monocyte chemoattractant protein 1 (MCP-1)] and endothelial markers [soluble intracellular adhesion molecule-1 (sICAM-1), soluble CD40 ligand (sCD40L)] were determined in 55 MS patients and 18 patients on PD, with flow cytometry, and visfatin concentration was measured with ELISA. Routine biochemistry parameters were measured on Beckman Coulter AU2700 analyzer. Patients on PD have significantly higher concentration of: CRP [6.5 (3.7-12.1) versus 2.6 (1.3-4.0) mg/L, P<0.001], IL-6 [13.83 (8.48-31.31) versus 2.05 (0.67-4.11) pg/mL, P<0.001], MCP-1 [2172.28 (1563.84-2922.77) versus 1353.58 (1166.33-1961.70) pg/mL, P=0.023], sTNF-R [18.25 (12.81-25.22) versus 1.23 (0.89-1.43) ng/mL, P<0.001] and sICAM-1 [830.03 (599.21-967.02) versus 463.85 (315.25-751.71) ng/mL, P=0.006] than subjects with MS. MS patients have higher concentrations of MPO [175.47 (120.15-231.67) versus 101.76 (53.55-186.06) ng/mL, P=0.016] and visfatin [1.5 (0.9-2.3) versus 0.9 (0.6-1.6) ng/mL, P=0.013]. In patients on PD, inflammatory reaction is higher than in patients with MS. On the contrary, patients with MS have stronger oxidative stress response and adipose tissue activity caused probably by the chronic low level of inflammation and underlying metabolic disorders.

PS 05-63 PRO- AND ANTI-INFLAMMATORY FACTORS AND VASCULAR STIFFNESS IN END-STAGE RENAL DISEASE PATIENTS

Objective: Vascular calcification (VC) has crucial importance in the accelerated arteriosclerosis of chronic renal disease patients. The aim of this study was to assess the extent of arteriosclerotic lesions and to relate vascular stiffness parameters to pro-inflammatory markers (hsCRP, TNF-α, TGF-β1) and to protective factors (α-Klotho, fetuin-A, vitamin D3) in patients on chronic hemodialysis. Design and Method: 96 consecutive patients in stable condition were enrolled. 20 healthy individuals served as controls. Beside routine biochemical parameters, TNF-α, TGF-β1 α-Klotho and fetuin-A were measured with ELISA. Carotid-femoral pulse wave velocity was measured using applanation tonometry (SphygmoCor, AtCor Medical Australia) before hemodialysis sessions. Carotid-femoral pulse wave velocity (cfPWV) was calculated. Results: Pro-inflammatory (pro-calcigenic) biomarkers (hsCRP, TNF-α, TGF-β1) were elevated (p < 0.01), whereas anti-inflammatory (anti-atherosclerotic) factors (fetuin-A: p < 0.05, α-Klotho: p < 0.01, vitamin D3 p < 0.01) depressed compared to controls. cfPWV correlated positively with total cholesterol (r = 0.244, p < 0.05) and fetuin-A (r = 0.282, p < 0.05) but inversely with the time spent on dialysis (r = -0.262, p < 0.05). hsCRP was negatively influenced by plasma vitamin D3 (β = −0.23, p < 0.01), sodium (β = −0.26, p < 0.00) and albumin levels (β = −0.36, p < 0.00), positively by BMI (β = 0.76, p < 0.00). TNFα and TGFβ1 as dependent variables were found to correlate with α-Klotho (β = 0.41, p < 0.00) and plasma creatinine (β = 0.30, p < 0.003), as well as with fetuin-A (β = −0.24, p < 0.02) and plasma albumin (β = 0.33, p < 0.002), Fetuin-A showed significant negative correlation with age (β = −0.225, p < 0.05), TGF-β1 (β = −0.228, p < 0.02), and dialysis time (β = −0.26, p < 0.01), while positive relationship was found between fetuin-A and triglyceride levels (β = 0.43, p < 0.00). α-Klotho correlated positively with TNF-α (β = 0.44, p < 0.00) and negatively with plasma calcium (β = −0.24, p < 0.01). Conclusions: Our study confirmed that the pro-inflammatory cascade of arteriosclerosis was activated and inflammatory biomarkers (hsCRP, TNF-α, TGF-β1) prevailed over protective factors (vitamin D, α-Klotho, Fetuin-A) in patients on hemodialysis. We demonstrated that PWV was significantly affected by total cholesterol, fetuin-A and dialysis time. Several clinical and laboratory factors were associated with pro- and anti-inflammatory biomarkers rather than PWV.

Higher minor hemoglobin A2 levels in multiple sclerosis patients correlate with lesser disease severity.

ObjectiveTo define whether minor adult hemoglobin A2 (HbA2, α2δ2) exerts any protective activity in multiple sclerosis (MS).MethodsHbA2 levels were measured in 146 MS patients with high performance liquid chromatography and association with MS Severity Scores (MSSS) were determined. HbA2 associations with blood count parameters were also studied using blood counts evaluated on the same day of high performance liquid chromatography sampling. Routine biochemical parameters were also determined to rule out elusively influential factors, such as anemia and thyroid disorders.ResultsHbA2 levels negatively correlated with MSSS (Spearman correlation, R: −0.186, P=0.025). Exclusion of confounding factors with a generalized linear model revealed an even stronger negative correlation between HbA2 and MSSS (P<0.001). HbA2 positively correlated with red blood cells (RBCs) (R=0.350, P<0.001) and in turn, RBCs negatively correlated with MSSS (R=−0.180, P=0.031). Average HbA2 levels were highest among patients treated with interferon β1a.ConclusionRBC fragility is increased in MS, and recent data suggest that circulating free Hb contributes to neural injury in MS. HbA2 and its oxidative denaturation product hemichrome A2 enhance RBC membrane stability to a greater extent than do major HbA or hemichrome A. Reductions in ischemic cerebrovascular vascular events are reported in β-thalassemia carriers and HbA2 levels are considerably higher in this population. Episodic declines of cerebral blood flow were shown in bipolar disorder, and we have recently shown a protective role of HbA2 against postpartum episodes in females with bipolar disorder. HbA2’s erythroprotective functions may reduce free Hb and long-term neural injury in MS.

Serum Total Sialic Acid Level is Elevated in Hypothyroid Patients as an Atherosclerotic Risk Factor.

Serum total sialic acid (TSA) concentration is regarded as an indicator of the risks of atherosclerosis and cardiovascular diseases. The association between SA levels and atherosclerosis risk factors has not been assessed in patients with thyroid diseases. Sixty newly diagnosed treatment-naive hypothyroid patients, 35 with subclinical and 25 with overt hypothyroidism, and 30 euthyroid individuals were analyzed. SA was measured in fasting blood samples, as were routine biochemical parameters, some atherosclerosis markers and carotid artery intima media thickness (CIMT). Mean SA (38.1 ± 12.0 vs. 46.0 ±15.8; P = 0.019) and CIMT (0.57 ± 0.06 vs. 0.62 ± 0.12; P = 0.013) were found to be higher in the patient group compared with the control group. Mean sialic acid was higher in overt hypothyroidism patients compared with subclinical hypothyroidism patients and the control group. No difference was found between the subclinical hypothyroidism group and the control group. Sialic acid level and CIMT had a positive correlation in both the entire population and the hypothyroidism group. The linear regression model established for mean CIMT level in the entire population showed that risk factors of LDL (B ± SE = 0.454 ± 0.206; P = 0.030), uric acid (B ± SE = 1.902 ± 0.686; P = 0.007), hs-CRP (B ± SE = 1.003 ± 0.380; P =0.010), and SA (B ± SE = 2.419 ± 0.450; P < 0.001) were independent predictors of CIMT level. Sialic acid level is elevated in hypothyroid patients. However, this elevation is not related to thyroid hormone levels and autoantibodies. Correlations between SA and atherosclerosis indicators, such as CIMT, LDL, hs-CRP, and uric acid, in hypothyroid individuals suggest that SA may be an indicator of atherogenesis in these patients.

Intra-individual variation of plasma trimethylamine-N-oxide (TMAO), betaine and choline over 1 year.

Circulating trimethylamine-N-oxide (TMAO) has been implicated in the development of cardiovascular and chronic kidney diseases (CKD). However, while higher TMAO levels have been associated with increased risks of cardiovascular or renal events in first prospective studies, it remained unclear how much plasma TMAO concentrations vary over time. We measured fasting plasma levels of TMAO and two of its precursors, betaine and choline by LC-MS, in two samples of 100 participants of the European Investigation into Cancer and Nutrition (EPIC)-Heidelberg study (age range: 47-80 years, 50% female) that were collected 1 year apart, and assessed their intra-individual variation by Spearman's correlation coefficients (ρ). Correlations of metabolite concentrations over 1 year were at ρ=0.29 (p=0.003) for TMAO, ρ=0.81 (p<0.001) for betaine, and ρ=0.61 (p<0.001) for choline. Plasma levels of TMAO were not significantly associated with food intake, lifestyle factors, or routine biochemistry parameters such as C-reactive protein (CRP), low-density lipoprotein (LDL)-cholesterol, or creatinine. In contrast to fasting plasma concentrations of betaine and choline, concentrations of TMAO were more strongly affected by intra-individual variation over 1 year in adults from the general population. The modest correlation of TMAO levels over time should be considered when interpreting associations between TMAO levels and disease endpoints.

Changes in the inflammatory markers with advancing stages of diabetic nephropathy and the role of pentraxin-3

Background: Immunological and inflammatory mechanisms have been shown to have role in both the development and progression of diabetic nephropathy (DNP). There is need for more specific markers for inflammation as the ones commonly used are influenced by many factors. Pentraxin-3 (PTX-3) seems to be a potential candidate. We aimed in our study to evaluate the changes of PTX-3 levels in different stages of DNP and its relationship with other inflammatory markers.Methods: This is a cross sectional study in which patients with DNP at different stages were involved. Patient were divided into three groups according to estimated glomerular filtration rate (eGFR), microalbuminuria and proteinuria levels: Group-1: eGFR >60 mL/min and microalbuminuria, Group-2: eGFR >60 mL/min and macroalbuminuria, Group-3: eGFR <60 mL/min and macroalbuminuria. Besides the routine biochemical parameters, levels of PTX-3, high sensitivity C-reactive protein (hsCRP), interleukin (IL)-1 and tumor necrosis factor (TNF)-α was measured. Groups were compared with each other regarding the study parameters and correlation of PTX-3 with other markers was evaluated.Results: The mean PTX-3 level in Group-2 (0.94 ± 0.26 ng/mL) and -3 (1.35 ± 1.55 ng/mL) were higher than in Group-1 (0.81 ± 0.25 ng/mL) (p = 0.009 and p = 0.012). There was a significant correlation of PTX-3 with proteinuria (r = 0.266, p = 0.016), microalbuminuria (r = 0.304, p = 0.014) and hypoalbuminemia (r = 0.197, p = 0.043). PTX-3 was not correlated with other markers of inflammation (IL-1, TNF-α and hsCRP) and diabetic metabolic parameters (hbA1c, C-peptide, insulin and HOMA-IR). PTX-3, IL-1 and TNF-α levels increased with the advancing stage of DNP while hsCRP level did not change.Conclusion: PTX-3 that increases similar to other markers of inflammation (IL-1, TNF-α) is a better inflammatory marker than hsCRP. Furthermore, there is a relationship between PTX-3 and proteinuria independent from eGFR.

Relationship between Cardiovascular Risk Score and Traditional and Nontraditional Cardiometabolic Parameters in Obese Adolescent Girls.

SummaryBackgroundSince the cardiovascular (CV) risk score in the young population, children and adolescents, is underestimated, especially in developing countries such as Montenegro, where a strong interaction exists between the genetically conditioned CV risk and environmental factors, the purpose of this study was to estimate CV risk in apparently healthy adolescent girls. Moreover, we aimed to test some new, emerging CV risk factors and their interaction with the traditional ones, such as obesity. Precisely, we aimed to assess the impact of low bilirubin levels, as a routine biochemical parameter, as an additional risk factor for atherosclerotic disease in the adult phase.MethodsForty-five obese adolescent girls (mean age 17.8±1.22 years) and forty-five age- and sex-matched normal weight controls, all nonsmokers, were included. Anthropometric and biochemical parameters were measured. Cardiovascular Risk Score (CVRS) was calculated by adding the points for each risk factor (e.g. sex, HDL-c, non-HDL-c, blood pressure and fasting glycemia).ResultsA significant positive relationship between CVRS and ALT, hsCRP and TG/HDL-c, but an opposite relationship between CVRS and total bilirubin were found (P<0.001). Multiple linear regression analysis showed that higher waist circumference (WC) and LDL-c, but lower HDL-c were independent predictors of lower bilirubin values (adjusted R2=0.603, P<0.001).ConclusionsObese adolescent girls are at an increased risk of cardiovascular disease late in life. In addition to the traditional risk factors, total bilirubin may have the potential to discriminate between low and higher risk for cardiovascular disturbances in healthy adolescent girls.

Mean platelet volume and red cell distribution width to platelet ratio for predicting the severity of hepatic fibrosis in patients with chronic hepatitis C.

We designed this study to investigate the relationship between the severity of fibrosis and mean platelet volume (MPV), red cell distribution width, and red cell distribution width to platelet ratio (RPR) in patients with chronic hepatitis C (CHC). Overall, 98 biopsy-proven naïve CHC cases were enrolled in the study. Complete blood count variables, including white blood cell, hemoglobin, platelet count, MPV, red cell distribution width, platelet distribution width as well as aspartate transaminase, alanine transaminase, total bilirubin, albumin, and other routine biochemical parameters, were tested. Liver biopsy samples were assessed according to the Ishak scoring system. Data analyses were carried out using SPSS-15 software. Statistical significance was set at a P-value of less than 0.05. Of the 98 cases, 80 (81.6%) were men and 18 (18.4%) were women. Fibrosis scores of 69 cases (70.4%) (group 1) were less than 3, whereas 29 cases had fibrosis scores at least 3 (29.6%) (group 2). Significant differences in MPV and RPR were observed between these two groups (MPV: 8.19±1.002 vs. 8.63±0.67 fl, P<0.05; RPR: 0.0526±0.02 vs. 0.0726±0.02, P=0.001). The areas under the curve of the RPR and MPV for predicting significant fibrosis were 0.705 and 0.670, which was superior to the aspartate transaminase-to-alanine transaminase ratio and aspartate transaminase-to-platelet ratio index scores of the study group. Cut-off values were calculated for diagnostic performance, and the cut-off values for MPV and RPR were 8.5 and 0.07 fl, respectively. MPV and RPR values were significantly higher in patients with CHC, associated with severity, and can be used to predict advanced histological liver damage. The use of MPV and RPR may reduce the need for liver biopsy. Further studies are required to determine the relationship between these parameters and the severity of fibrosis in hepatitis C patients.

Serum Pro-Oxidant-Antioxidant Balance, Advanced Oxidized Protein Products (AOPP) and Protein Carbonyl in Patients With Stroke

Abstract Background: Stroke is the second cause of death and disability in the world, and oxidative stress which could be considered as a prognostic factor in patients for prevention, follow up and determination of stroke’s severity has a conceivable role in neural damage. Objectives: The aim of our study was to explain the association between oxidant/antioxidant imbalance as a prognostic factor in patients with stroke. Patients and Methods: Pro-oxidant-antioxidant balance (PAB), advanced oxidized protein products (AOPP) and protein carbonyl were measured in patients with ischemic stroke and hemorrhagic stroke as well as healthy group. Sera were collected from 18 is- chemic and 23 hemorrhagic stroke patients, and 34 healthy volunteers. The PAB assay, routine biochemical parameters, lipid profile and total protein concentration were assessed in patients and healthy group. Results: The level of AOPP (P < 0.007), protein carbonyl (P < 0.001) and PAB (P < 0.01) were significantly higher in stroke patients than the healthy group. Conclusions: There are increased level of protein carbonyl, AOPP and PAB in patients with stroke. Measuring these factors may be beneficial as prognostic factors in treatment and follow up of the patients with both hemorrhagic and ischemic strokes. More investigations withmore cases and longer follow up are needed to approve that these factors play an important role in prognosis of stroke.

The Effects of Ferulic Acid Against Oxidative Stress and Inflammation in Formaldehyde-Induced Hepatotoxicity.

This study was designed to elucidate the protective effects of ferulic acid (FA) on formaldehyde-induced hepatotoxicity by measuring some routine biochemical parameters, cytokine levels, and oxidative stress-related parameters in addition to YKL-40 in male Wistar albino rats. Tissue superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-Px) activities, and tissue malondialdehyde (MDA) levels were measured. Also, serum YKL-40, TNF-α, IL-6, IL-1β, IL-8, total protein, albumin, total bilirubin concentrations, and AST, ALT, ALP, and LDH activities were measured. Histological specimens were examined in light microscopy. Formaldehyde significantly increased tissue MDA, and serum cytokine levels and also decreased activities of antioxidant enzymes. FA treatment decreased MDA and cytokine levels and increased activities of antioxidant enzymes. FA also alleviated degeneration due to formaldehyde toxicity. We suggested that FA can be used as a promising hepatoprotective agent against formaldehyde toxicity because of the obvious beneficial effects on oxidative stress parameters.

Serum bilirubin: a simple routine surrogate marker of the progression of chronic kidney disease

Background: Studies suggest that Chronic Kidney Disease (CKD) is a global burden health associated with significant comorbid conditions. Few biochemical parameters have gained significance in predicting the disease progression. The present work aimed to study the association of the simple biochemical parameter of serum bilirubin level with the estimated glomerular filtration rate (eGFR), and to assess their association with the co-morbid conditions in CKD.Methods: We recruited 188 patients with CKD who attended a Nephrology out-patient department. eGFR values were calculated based on the serum creatinine levels using CKD-EPI formula. Various biochemical parameters including glucose, creatinine, uric acid, total and direct bilirubin were assayed in all study subjects. Study subjects were categorized into subgroups based on their eGFR values and their diabetic status and the parameters were compared among the different subgroups.Results: We observed a significantly decreased serum bilirubin levels (p < 0.001) in patients with lower eGFR values, compared to those with higher eGFR levels. There was a significant positive correlation between the eGFR levels and the total bilirubin levels (r = 0.92). We also observed a significant positive correlation between the eGFR levels and the direct bilirubin levels (r = 0.76). On multivariate linear regression analysis, we found that total and direct bilirubin independently predict eGFR, after adjusting for potential confounders (p < 0.001).Conclusions: Our results suggest that there is significant hypobilirubinemia in CKD, especially with increasing severity and co-existing diabetes mellitus. This finding has importance in the clinical setting, as assay of simple routine biochemical parameters such as serum bilirubin may help in predicting the early progression of CKD and more so in diabetic CKD.

Changing of Uric Acid Levels by Age and Sex in Patients with Diabetes Mellitus

Objective: We examined the association between uric acid and glycemic status by the aspects of age and sex. Methods: The retrospective was performed study at Okmeydani Educate and Research Hospital. All data were obtained from the patient records. Only one sample of HbA1c or glucose measurement within a year was included. To evaluate the pattern of glucose control, we categorized the patients according to HbA1c levels and grouped them according to a range of values. HbA1c was measured by high performance liquid chromatography, routine biochemistry parameters were determined by photometric method. Results: Serum uric acid levels showed an increasing trend with the age in female group and this trend became significant after 30 years old (p<0.001). The significant effect of HbA1c and gender on uric acid levels were determined in the subjects having no renal failure. There was a significant increase of uric acid levels in prediabetics than normal group and decrease in unregulated diabetics. But in both sex groups the pattern of changing was different. Conclusion: In conclusion, we found that age is an important factor examining the serum uric acid levels of female subjects. The peak values of serum uric acid were detected in prediabetic group in males but in females this peak point was diabetic group. J Clin Exp Invest 2016; 7 (1): 1-6 Key words: Diabetes mellitus, uric acid, age, gender

Changing of Uric Acid Levels by Age and Sex in Patients with Diabetes Mellitus

Objective: We examined the association between uric acid and glycemic status by the aspects of age and sex. Methods: The retrospective was performed study at Okmeydani Educate and Research Hospital. All data were obtained from the patient records. Only one sample of HbA1c or glucose measurement within a year was included. To evaluate the pattern of glucose control, we categorized the patients according to HbA1c levels and grouped them according to a range of values. HbA1c was measured by high performance liquid chromatography, routine biochemistry parameters were determined by photometric method. Results: Serum uric acid levels showed an increasing trend with the age in female group and this trend became significant after 30 years old (p<0.001). The significant effect of HbA1c and gender on uric acid levels were determined in the subjects having no renal failure. There was a significant increase of uric acid levels in prediabetics than normal group and decrease in unregulated diabetics. But in both sex groups the pattern of changing was different. Conclusion: In conclusion, we found that age is an important factor examining the serum uric acid levels of female subjects. The peak values of serum uric acid were detected in prediabetic group in males but in females this peak point was diabetic group. J Clin Exp Invest 2016; 7 (1): 1-6 Key words: Diabetes mellitus, uric acid, age, gender

Nutritional Risk, Micronutrient Status and Clinical Outcomes: A Prospective Observational Study in an Infectious Disease Clinic.

Malnutrition has been associated with increased morbidity and mortality. The objective of this study was to determine the nutritional status and micronutrient levels of hospitalized patients in an infectious disease clinic and investigate their association with adverse clinical outcomes. The nutritional status of the study participants was assessed using the Nutritional Risk Screening 2002 (NRS 2002) and micronutrient levels and routine biochemical parameters were tested within the first 24 h of the patient’s admission. The incidence of zinc, selenium, thiamine, vitamin B6, vitamin B12 deficiency were 66.7% (n = 40), 46.6% (n = 29), 39.7% (n = 27), 35.3% (n = 24), 14.1% (n = 9), respectively. Selenium levels were significantly higher in patients with urinary tract infections, but lower in soft tissue infections. Copper levels were significantly higher in patients with soft tissue infections. In the Cox regression models, lower albumin, higher serum lactate dehydrogenase levels and higher NRS-2002 scores were associated with increased death. Thiamine, selenium, zinc and vitamin B6 deficiencies but not chromium deficiencies are common in infectious disease clinics. New associations were found between micronutrient levels and infection type and their adverse clinical outcomes. Hypoalbuminemia and a high NRS-2002 score had the greatest accuracy in predicting death, systemic inflammatory response syndrome and sepsis on admission.

The relationships among the levels of oxidative and antioxidative parameters, FEV1 and prolidase activity in COPD

Introduction: Chronic obstructive pulmonary disease (COPD) is a progressive condition characterized by poorly reversible airflow limitations associated with an abnormal inflammatory response of the lung.Methods: We investigated whether prolidase levels in serum, total antioxidant status, total oxidative status (TOS), and the oxidative stress index (OSI) were associated with the etiopathogenesis of COPD, and whether there is a relationship between prolidase activity and oxidative parameters and carotid artery intima-media thickness (CIMT) in patients with COPD. This study included 91 patients with COPD and 15 control cases. Routine haematological and biochemical parameters were determined in all patients. All subjects were fully informed about the study and provided consent.Results: The mean age of the patients with COPD was 61.3 ± 10.5 years and that of the control group was 56.2 ± 12.1 years. The control group had a significantly higher plasma prolidase level than that in the COPD group. TOS and OSI levels in the control group were significantly lower than those in the COPD group. However, no significant differences were found in TALs or CIMT levels between the COPD and control groups. A negative correlation was detected between prolidase activity and age; however, no significant difference in age was observed between the two groups.Conclusion: These results indicate that prolidase activity decreases in patients with COPD.