EXPEDIENCY OF MARKERS FOR EARLY DETECTION OF ACUTE KIDNEY INJURY SEQUELAE TO TYPE 2 DIABETES MELLITUS

ABSTRACTObjective: Estimation of Cystatin C (Cys C), traditional markers, inflammatory, and endothelial cell activation markers can identify subjects who areat increased risk for future acute kidney injury (AKI) after diabetes.Methods: A total of 210 subjects, having 70 subjects in each group between the age group of 45-75 years were enrolled in our study.Results: Body mass index (BMI), obesity index, waist circumference, and waist–hip ratio higher in Group III and Group II compared to Group I with asignificant p<0.001. All the biochemical parameters were significantly higher in Group III compared to Group I and Group II with a narrow differencebetween Group III and Group II. Serum Cys C was significantly correlated with creatinine and NO. Whereas serum creatinine (SCr) shows strongpositive correlation with BMI, fasting blood sugar, HbA1c, NO, and high-sensitivity C-reactive protein. Estimated glomerular filtration rate (eGFR) andtriglycerides show inverse relation to creatinine with a significant p-value. The serum Cys C showed an area under the curve (AUC) of 0.950 with acutoff value of 1.06, SCr with an AUC of 0.617, and eGFR with AUC of 0.588.Conclusion: Elevated levels of biomarker Cys C, SCr, and albumin-creatinine ratio are predictors of AKI in the setting of diabetes. Baseline inflammatoryand endothelial activation markers may also be useful for predicting future risk of AKI in diabetes mellitus. Hopefully, the advent of new biomarkerswill help defining the kidney at risk rather than relying simply on creatinine. To date, none of the new AKI biomarkers have undergone a similarrigorous assessment, but the current progress will hopefully lead to success and ultimately to improvement in patient outcome.Keywords: Type 2 diabetes mellitus, Acute kidney injury, Biomarkers, Inflammation, Endothelium

N-terminal Pro Brain Natriuretic Peptide (NT-proBNP) as a Marker for Risk Stratification and Prediction of Functional Outcome in Acute Ischaemic Stroke

Introduction: Stroke is the second leading cause of mortality and disability worldwide. A large proportion of stroke survivors are left with significant disability. Assessing stroke severity and predicting morbidity and mortality is essential for treatment decisions and counseling. Traditionally used tools like the National Institutes of Health Stroke Scale (NIHSS) are not reliable in predicting mortality. Studies have shown that B-type Natriuretic Peptide (BNP) and N-terminal pro Brain Natriuretic Peptide (NT-proBNP) are elevated in acute stroke. Aim: To assess the prognostic importance of NT-proBNP in stroke. Materials and Methods: A prospective cohort study was conducted at Sri Devaraj URS Medical College (SDUMC), SDUAHER, Kolar, Karnataka, India involving 64 consecutive stroke patients from July 2018 to September 2019. Serum NT-proBNP levels were measured on both the day of admission and on day 7. Stroke severity was assessed using the NIHSS on admission day, and functional disability was determined using the Barthel Index (BI) at the 3-month mark. Data were entered into MS Excel for statistical analysis, where a p-value of <0.05 was considered statistically significant. Results: The average age of the subjects was 62.36 years with a standard deviation of 12.15 years. The average NIHSS on the day of admission was 12.81 (7), and it was 20.2 (5.882) among deceased patients. The mean NT-proBNP on admission was 776.70 (1023.6) pg/mL, significantly elevated in deceased patients at 2014.65 (1320.546) compared to survivors at 328.94 (239.353). NT-proBNP is strongly associated with stroke severity (NIHSS) (R2=0.522; Spearman’s correlation coefficient=0.843, p-value <0.001) and functional outcome (BI) (R2=0.824; Spearman’s correlation coefficient -0.923, p-value <0.001) at three months.On Receiver Operating Characteristic (ROC) analysis, a serum NT-proBNP level of 960 pg/mL had a sensitivity and specificity of 94.1% and 97.9% in predicting mortality, and a value of 435.1 pg/mL had a sensitivity and specificity of 90% and 81% in predicting disability. Conclusion: Serum NT-proBNP was significantly elevated in patients after stroke and was strongly associated with stroke severity and functional outcome at three months. Measuring serum NT-proBNP on the day of admission can predict mortality and functional dependence after acute ischaemic stroke

Evolution of proteomic biomarker for chronic liver disease

Liver is the vital organ for synthesis of proteins whose concentration in blood reflects liver dysfunction. Variations in protein domain can generate clinically significant biomarkers. Biomarker pipeline includes discovery of candidates, qualification, verification, assay optimization, and validation. Advances in proteomic approach can discover protein biomarker candidates based on “up-or-down” regulation or fold change in expression which is correlated with disease state. Despite numerous biomarker candidates been discovered, only few are useful in clinical practice which indicates the need for well-established validation regimen. Hence, the main purpose of this review is to understand the protein biomarker development and pitfalls. Companion diagnostics provide insights into potential cost-effective diagnosis for chronic liver disease

A CORRELATIVE STUDY OF THYROID PROFILE AND MINERAL STATUS IN PATIENTS WITH HYPOTHYROIDISMÂ -Â AÂ HOSPITALÂ BASEDÂ CASEÂ CONTROLÂ STUDY

Objective: To evaluate the alteration in mineral status by estimating serum calcium, phosphorus, and magnesium in hypothyroid patients comparedto healthy volunteers and its correlation with thyroid profile (triiodothyronine [T3], thyroxine [T4], and thyroid stimulating hormone [TSH]).Methods: Blood samples were collected from 30 hypothyroid patients and 30 healthy volunteers and analyzed for serum levels of calcium, magnesium,and phosphorus and for thyroid profile.Results: There were 22 females and 8 males in the hypothyroid patients group and 24 females and 6 males in the control group. The mean age inthe two groups was 39±13. The study observed a significantly decreased levels of serum magnesium, significantly increased serum phosphorusand serum creatinine levels among hypothyroid patients as compared to the control group (p&lt;0.001), respectively, serum calcium levels did notshow a significant change in hypothyroid patients compared to the control group. Among hypothyroid subjects, there was a significant positivecorrelation of T3 and T4 with serum magnesium and a negative correlation of T4 with serum phosphorus and serum creatinine. TSH showed apositive correlation with serum phosphorus and serum creatinine and a negative correlation with serum magnesium. However, T3, T4, and TSH didnot show any correlation with serum calcium levels.Conclusion: The direction of effect of overt hypothyroidism on the blood levels of calcium, magnesium, and phosphorus is inconsistent affecting thevarious metabolisms and clinical manifestations; in these patients, hence all patients with overt hypothyroidism need to be evaluated for mineralstatus to provide individualized holistic disease management strategies to these patients.Keywords: Hypothyroidism, Calcium, Magnesium, Phosphorus

A proteomic approach of biomarker candidate discovery for alcoholic liver cirrhosis

Alcoholic liver disease (ALD) progresses from steatosis to alcoholic hepatitis to fibrosis and cirrhosis. Liver biopsy is considered as the gold standard method for diagnosis of liver cirrhosis and provides useful information about damaging process which is an invasive procedure with complications. Existing biomarkers in clinical practice have narrow applicability due to lack of specificity and lack of sensitivity. The objective of this article is to identify proteomic biomarker candidates for alcoholic liver cirrhosis by differential expression analysis between alcoholic liver cirrhotic and healthy subjects. Blood samples were collected from 20 subjects (10 alcoholic liver cirrhosis and 10 healthy) from R. L. Jalapa Hospital and Research Centre, Kolar, Karnataka, India. Differential protein analysis was carried out by two-dimensional electrophoresis after albumin depletion, followed by liquid chromatography–mass spectrometry. The image analysis found 46 spots in cirrhotic gel and 69 spots in healthy gel, of which 14 spots were identified with significant altered expression levels. Based on the protein score and clinical significance, among 14 spots, a total of 28 protein biomarker candidates were identified: 13 with increased expression and 15 with decreased expression were categorized in alcoholic liver cirrhosis compared to healthy subjects. Protein biomarker candidates identified by “-omics” approach based on differential expression between alcoholic liver cirrhotic subjects and healthy subjects may give better insights for diagnosis of ALD. Prioritization of candidates identified is a prerequisite for validation regimen. Biomarker candidates require verification that demonstrates the differential expression will remain detectable by assay to be used for validation