Associação entre desnutrição, escore prognóstico de Glasgow modificado e índice inflamatório nutricional em pacientes com câncer / Association between malnutrition, modified Glasgow prognostic score and nutritional inflammatory index in cancer patients

Introdução: A desnutrição é um achado comum em pacientes oncológicos e sua etiologia é multicausal, sendo influenciada significativamente pela resposta inflamatória sistêmica. Os indicadores de inflamação podem ser ferramentas úteis na avaliação nutricional dos pacientes com câncer. Objetivo: Avaliar a associação entre o Escore Prognóstico de Glasgow modificado e o Índice Inflamatório Nutricional (IIN) com a presença e o grau de desnutrição em pacientes com câncer. Método: Pacientes admitidos em um hospital universitário, com diagnóstico confirmado de câncer, participaram deste estudo. Exames laboratoriais de albumina e proteína C-reativa foram realizados para obtenção do EPGm e do IIN. A avaliação nutricional foi realizada por meio da Avaliação Subjetiva Global. Resultados: Foram avaliados 70 pacientes com idade média de 58,51±14,85 anos, dos quais 50 (71,5%) apresentaram algum grau de desnutrição, enquanto 27 (38,6%) apresentaram desnutrição grave. As categorias de risco do EPGm e do IIN estiveram presentes em 41 (58,6%) e 39 (55,7%) pacientes, respectivamente. O EPGm e o IIN associaram-se à presença da desnutrição (p<0,05). Conclusão: O EPGme o IIN mostraram-se ferramentas úteis, de fácil interpretação, com possibilidade de complementar a avaliação nutricional do paciente oncológico, uma vez que se associaram com a desnutrição.(AU)

Introduction: Malnutrition is a common finding in patients with cancer; its etiology is multifactorial and significantly influenced by the systemic inflammatory response. Inflammation indicators can be useful tools in the nutritional assessment of patients with cancer. Objective: We intended to evaluate the association of the modified Glasgow Prognostic Score (mGPS) and the InflammatoryNutritional Index (INI) with the presence and degree of malnutrition in cancer patients. Methods: We evaluated patients who were admitted to university hospital with a confirmed diagnosis of cancer participated in this study. Laboratory tests for albumin and C-reactive protein were conducted to obtain mGPS and INI scores. Nutritional assessment was carried out by subjective global assessment. Results: A total of 70 patients with a mean age of 58.51±14.85 years were evaluated, of which 50 (71.5%) presented some degree of malnutrition, while 27 (38.6%) presented severe malnutrition. The risk categories of mGPS and INI were present in 41 (58.6%) and 39 (55.7%) patients, respectively. Conclusion: Them GPS Score and the INI are simple tools, easy to interpret, with the possibility of complementing the nutritional evaluation of cancer patients, since they were associated with malnutrition.(AU)

Intervenção nutricional sobre medidas antropométricas, percentual de gordura corporal e parâmetros bioquímicos / Nutritional intervention on anthropometric, percentage of body fat and biochemical parameters

Objetivo: Avaliar a eficácia da intervenção nutricional sobre medidas antropométricas, percentual de gordura corporal (%G) e parâmetros bioquímicos de pacientes, maiores de 18 anos, atendidos em uma Clínica de Nutrição do município de Passos, MG. Método: Trata-se de um estudo de intervenção realizado com pacientes que procuraram o Centro de Atendimento Nutricional (CAN) da Universidade Estadual de Minas Gerais, unidade de Passos, e possuíam desvios nutricionais. Como instrumento de medida, utilizou-se a anamnese alimentar ou história dietética. Analisou- se, antes e após a intervenção nutricional, peso, índice de massa corporal, %G, circunferência abdominal, triglicérides, colesterol total e glicose de jejum. Realizou-se análise estatística descritiva e o teste T Student pareado. O nível de significância adotado foi de 5%. Participaram do estudo 19 indivíduos, com média de idade de 35±17 anos, sendo 84% do sexo feminino. Resultados: Verificou-se redução significativa no %G (t=2,469; p=0,024), triglicérides (t=2,551; p=0,020) e colesterol total (t=2,526; p=0,021) após a intervenção nutricional. Conclusões: Os resultados sugerem que a intervenção nutricional contribuiu para a redução do %G, dos parâmetros bioquí- micos e para qualidade de vida dos pacientes.(AU)

Objective: To evaluate the effectiveness of nutritional intervention on anthropometric measure- ments, body fat and biochemical parameters of patients, older than 18 years-old, attended in a Nutrition Clinic in Passos (Minas Gerais). Methods: This is an intervention study of patients who sought the Service Center Nutrition at the State University of Minas Gerais, Passos unit, and had nutritional problems. The measurement instrument was used food history or diet history analyzed before and after nutritional intervention, weight, body mass index, %G, waist circumference, triglycerides, total cholesterol and fasting glucose. A descriptive statistical analysis and paired Student T test. The study included 19 subjects with a mean age of 35±17 years, 84% female. Results: It was found significant reduction in% body fat, triglycerides and total cholesterol after nutritional intervention. Conclusions: The results suggest that dietary intervention contributed to the reduction in body fat C, biochemical parameters and quality of life of patients.(AU)

Influence of Vitamin C and Maltose on the Accuracy of Three Models of Glucose Meters

No abstract available.

Veracidad de un analizador de gasometria para determinar glucemia, respecto a un metodo de laboratorio convencional / Reliability of a gas analyzer to determine glycemia compared to the conventional laboratory method

Objetivos:Determinar el grado de veracidad en los resultados de glucosa, medidos en un equipo de gasometría, mediante lacomparación con un procedimiento de uso habitual en el laboratorio, siguiendo el procedimiento indicado en la guía EP9–A2 delClinical and Laboratory Standards Institute(CLSI).Diseño:Estudio descriptivo con muestreo no probabilístico.Institución:HospitalEdgardo Rebagliati Martins, EsSalud, Lima, Perú.Material:Muestra sanguínea de 234 sujetos provenientes de los servicios deemergencia y la unidad de cuidados intensivos.Métodos:Se procesó glucemia en los equipos ADVIA1800 y el gasómetro ABL800.Se comparó los resultados de ambos analizadores siguiendo las directrices de la mencionada guía, además del análisis gráfico deBland-Altman y el cálculo del coeficiente de concordancia correlación (CCC) de Lin.Principales medidas de resultados:Concentraciónde glucosa sérica.Resultados:La media de glucemia obtenida fue 1,6 mg/dL mayor para ABL800 que para el ADVIA1800. Los dosmétodos de medida seguían una relación lineal, obteniéndose un coeficiente de correlación de 0,9995, con un intervalo de confianza(IC) al 95% de 0,9994a 0,9996. Los resultados de glucosa del método de estudio fueron aceptables según los requerimientos decalidad, lo cual se confirmó con los análisis estadísticos de Bland-Altman y el valor del CCCL de 0,9995, con un IC de 95% de 0,9993a 0,9996.Conclusiones:El analizador ABL800 resultó adecuado para la monitorización de glucemia; presentó una buena asociaciónlineal y veraz, cuando fue comparado con el método de referencia del laboratorio.

Objectives: To determine the glucose reliability results measured in a gas equipment as compared with a reference method commonly used in the laboratory. The Clinical and Laboratory Standards Institute (CLSI) guide EP9- A2 instructions were followed. Design: Descriptive study with non-probability sampling. Setting: Hospital Edgardo Rebagliati Martins, EsSalud, Lima, Peru. Materials: Blood sample of 234 subjects from the emergency services and intensive care unit. Methods: Blood glucose was processed with the ADVIA1800 equipment and the ABL800 gasometer. Results of both analyzers were compared following the mentioned guide directives, the Bland-Altman plot analysis and the Lin’s concordance correlation coefficient (CCC) calculation. Main outcome measures: Serum glucose concentration. Results: Average blood glucose levels obtained were 1.6 mg/dL higher for ABL800 than for ADVIA1800. Both methods showed a high positive correlation (beta coefficient 0.9995 and 95 per cent, 95 per cent CI 0.9994 to 0.9996). Glucose results for the method studied were acceptable, as confirmed with the Bland-Altman statistical analysis (0.9995 CCC value, 95 per cent CI 0.9993 to 0.9996). Conclusions: The ABL800 analyzer is suitable for blood glucose monitoring, presenting an excellent correlation with the reference laboratory method.

Development of an Integrated Reporting System for Verifying Hemolysis, Icterus, and Lipemia in Clinical Chemistry Results

BACKGROUND: Hemolysis, icterus, and lipemia (HIL) cause preanalytical interference and vary unpredictably with different analytical equipments and measurement methods. We developed an integrated reporting system for verifying HIL status in order to identify the extent of interference by HIL on clinical chemistry results. METHODS: HIL interference data from 30 chemical analytes were provided by the manufacturers and were used to generate a table of clinically relevant interference values that indicated the extent of bias at specific index values (alert index values). The HIL results generated by the Vista 1500 system (Siemens Healthcare Diagnostics, USA), Advia 2400 system (Siemens Healthcare Diagnostics), and Modular DPE system (Roche Diagnostics, Switzerland) were analyzed and displayed on physicians' personal computers. RESULTS: Analytes 11 and 29 among the 30 chemical analytes were affected by interference due to hemolysis, when measured using the Vista and Modular systems, respectively. The hemolysis alert indices for the Vista and Modular systems were 0.1-25.8% and 0.1-64.7%, respectively. The alert indices for icterus and lipemia were <1.4% and 0.7% in the Vista system and 0.7% and 1.0% in the Modular system, respectively. CONCLUSIONS: The HIL alert index values for chemical analytes varied depending on the chemistry analyzer. This integrated HIL reporting system provides an effective screening tool for verifying specimen quality with regard to HIL and simplifies the laboratory workflow.

Comparison of the Accuracy of Noninvasive Hemoglobin Sensor (NBM-200) and Portable Hemoglobinometer (HemoCue) with an Automated Hematology Analyzer (LH500) in Blood Donor Screening

BACKGROUND: The Hb levels of prospective blood donors are usually determined using a finger prick test. A new noninvasive Hb device has the advantage of not causing any sampling pain. The purpose of this study was to evaluate the accuracy of the noninvasive Hb sensor and to compare its measurements with those of a currently used portable hemoglobinometer. METHODS: Hb was measured using a noninvasive Hb sensor (NBM-200; OrSense, Israel), a portable hemoglobinometer (HemoCue; HemoCue AB, Sweden), and an automated hematology analyzer (LH500; Beckman Coulter, USA). The correlations between Hb measurements taken by the NBM-200 and HemoCue with those by an automated hematology analyzer were assessed using intraclass correlation coefficients (ICCs). Hb measurements were compared among 3 different Hb level groups. RESULTS: The mean Hb values of 506 blood donors were 14.1 g/dL by the NBM-200, 14.0 g/dL by the LH500, and 14.3 g/dL by the HemoCue. The correlation between the LH500 and the NBM-200 was substantial (ICC=0.69), while that between the LH500 and the HemoCue agreed almost perfectly (ICC=0.86). CONCLUSIONS: The possibility to judge to be eligible for donors who are ineligible to donate was substantial when using NBM-200. Even though the NBM-200 has the apparent advantage of noninvasiveness, its use in pre-screening should be given meticulous attention. Since pre-donation testing is crucial to protecting donors' health, complete evaluation of the instrument should be performed prior to use.

Reference Intervals for Platelet Parameters in Korean Adults Using ADVIA 2120

No abstract available.

Trueness Assessment for Serum Glucose Measurement Using Commercial Systems through the Preparation of Commutable Reference Materials

BACKGROUND: Commutable reference materials (RMs) are suitable for end-users for evaluating the metrological traceability of values obtained using routine measurement systems. We assessed the performance of 6 routine measurement systems with validated secondary RMs. METHODS: We tested the homogeneity, stability, and commutability of 5 minimally processed human serum pools according to the standard guidelines. The serum pools were assigned values as per the reference procedure of the United States Centers for Disease Control and were used to evaluate the trueness of results from 6 commercial measurement systems based on enzymatic methods: 3 glucose oxidase (GOD) and 3 hexokinase (HK) methods. RESULTS: The prepared RMs were validated to be sufficiently homogenous, stable, and commutable with the patient samples. Method bias varied for different systems: GOD01, -0.17 to 2.88%; GOD02, 1.66 to 4.58%; GOD03, -0.17 to 3.14%; HK01, -3.48 to -0.85%; HK02, -3.83 to -0.11%, and HK03, -1.82 to -0.27%. CONCLUSIONS: We observed that the prepared serum glucose RMs were qualified for trueness assessment. Most of the measurement systems met the minimal quality specifications.

Comparison of HbA(1c) Analyzers: D-10, Variant II Turbo, Cobas Integra 800, and Afinion AS100 / 대한진단검사의학회지

BACKGROUND: The purpose of this study was to evaluate the performance and agreement among HbA(1c) values measured using selected analyzers certified by the National Glycohemoglobin Standardization Program (NGSP) and standardized by the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC). METHODS: HbA(1c) determined using D-10 (Bio-Rad, USA), Variant II Turbo (Turbo; Bio-Rad, USA), Cobas Integra 800 (Integra; Roche, Switzerland) and Afinion AS100 (Afinion; Axis-Shield, Norway) were compared with each other. Precision and method comparisons with Deming regression were evaluated according to CLSI recommendations. We also compared the HbA(1c) values obtained with each analyzer using either IFCC or NGSP methods by correlation analysis and kappa statistics. RESULTS: The repeatability and method/device precisions of D-10 and Afinion were acceptable. The correlation coefficients of HbA(1c) were 0.986 for D-10 vs. Afinion, 0.997 for D-10 vs. Turbo, 0.988 for D-10 vs. Integra, and 0.991 for Integra vs. Afinion. The average biases of HbA(1c) Afinion (IFCC) and HbA(1c) Integra (IFCC) against HbA(1c) D-10 (NGSP) were -1.90% and -1.79%, respectively. Kappa agreement statistics for the three diabetic control group HbA(1c) values of "less than 6.5%," "6.5%-7.5%," and "greater than 7.5%" for D-10 vs. Turbo, D-10 vs. Integra, and D-10 vs. Afinion were 0.872, 0.836, and 0.833, respectively. CONCLUSIONS: The strong correlations and good clinical agreements of HbA(1c) between each analyzer expressed in terms of either NGSP or IFCC-derived NGSP indicate that these analyzers can be used interchangeably.

Performance Evaluation of the Piccolo xpress Point-of-care Chemistry Analyzer / 대한진단검사의학회지

BACKGROUND: Point-of-care (POC) tests are used increasingly due to fast results and simple test procedures, which enables rapid diagnosis and therapeutic monitoring. We evaluated the performance of the Piccolo xpress Chemistry Analyzer (Abaxis, USA) a POC chemistry analyzer. METHODS: Fourteen analytes, Na+, K+, Cl-, Ca2+, total carbon dioxide, AST, ALT, total bilirubin, alkaline phosphatase, blood urea nitrogen, creatinine, albumin, total protein, and glucose; were measured simultaneously with a 100 microliter of whole blood sample using a Comprehensive Metabolic Reagent disk. Within-run and total precision and linearity were evaluated according to CLSI EP15-A and EP6-A guidelines, respectively. Comparison with a central laboratory chemistry analyzer was performed using 144 patient samples. RESULTS: The coefficients of variations of within-run and total precision were all within 5% for three levels except for total carbon dioxide, ALT, alkaline phosphatase, total bilirubin, and creatinine in low level, and creatinine in middle level. The results of 14 analytes were linear within a commonly encountered range in clinical samples (r2> or =0.98). More than 10% of samples in Na+, AST, ALT, glucose, BUN did not satisfy CLIA analytical quality requirement. CONCLUSIONS: The Piccolo xpress Chemistry Analyzer can analyze multiple analytes with a minimal amount of whole blood in a short time. It showed an acceptable performance for precision, linearity and comparison with central laboratory analyzer. It can be useful as a screening tests modality in mobile clinics, ambulances, and field clinics for military use, and for pediatric patients from whom enough sample volume is difficult to obtain.

Utilidad de la determinación cualitativa de troponina I y creatinfosfocinasa isoenzima MB en los síndromes isquémicos coronarios agudos / Usefulness of rapid bedside assay of cardiac troponin I and creatine phosphokinase-MB in acute ischemic coronary syndromes

Recently, a rapid bedside assay for quantitative determination of cTI and CPK-MB has been developed that provides a positive or negative result in 10 to 15 minutes allowing for a better therapeutic approach. The objective of our study was to validate the diagnostic usefulness of cardiac troponin I in patients with chest pain. We determined sensitivity, specificity, positive and negative predictive values in 40 patients that arrived to the hospital with chest pain. These patients were assigned to four different groups: Group A: Patients with acute myocardial infarction. Group B: Patients with unstable angina and normal ECG. Group C: Patients with atypical chest pain and normal ECG. Group D: Control. Eighteen (45%) patients were woman and 22 (55%) were men; age 54.1 +/- 26, range 32 to 85 years. In Group A, sensitivity, specificity, positive and negative predictive values for cTI were 95%, for CPK-MB, they were 40, 50, 90, 7.1%. For Group B, cTI: 64, 90, 90, 64%; CPK-MB: 50, 90, 87, 56%. Group C, cTI and CPK MB 25, 95, 50, 86%. Group D, cTI and CPK-MB: 50, 95, 50, 95%. This study suggests that the rapid bedside qualitative test through cardiac troponin I assessment is a test with higher predictive value for early diagnosis of acute myocardial infarction than CPK-MB.

Accuracy of transcutaneous bilirubinometer estimates using BiliCheck in Thai neonates.

BACKGROUND: Neonatal jaundice is the most frequently encountered diagnostic and therapeutic problem in the newborn. In the jaundiced infant, it is thought that the binding capacity of plasma albumin is exceeded, which allows free bilirubin to diffuse into and accumulate within extravascular tissues, such as the central nervous system. Affected newborns may develop kernicterus. The standard method of serum bilirubin measurement requires blood specimen taken by heel prick or venepunetue which involves pain of the newborn and is time consuming. A non invasive, transcutaneous measurement of bilirubin concentration is developed to be an alternative method as a reliable for the screening method to detect hyperbilirubinemia OBJECTIVE: To compare the estimates of serum bilirubin using a recently introduced device called a BiliCheck and its transcutaneous bilirubinometer index with the standard direct spectrophotometric measurement of serum bilirubin. DESIGN: Prospective descriptive study. MATERIAL AND METHOD: Estimates of serum bilirubin, as measured using the BiliCheck, were compared with serum bilirubin concentration measured by direct spectrophotometry in neonates at Songklanagarind Hospital. Transcutaneous bilirubinometer readings were taken on the forehead. RESULTS: Eighty-two newborns were enrolled in the present study. The means and standard deviations of serum bilirubin concentration and transcutaneous bilirubinometer index were 11.96 +/- 2.98 and 11.61 +/- 2.93 mg/dl, respectively. There was no statistically significant difference (p = 0.44, paired t-test). The correlation coefficient between total serum bilirubin and BiliCheck index was 0.95 with the linear regression equation of Y= 0.99x + 0.4. CONCLUSION: Serum bilirubin can be accurately measured by the transcutaneous bilirubinometer index in full term newborn infants prior to any intervention modalities.

Comparison of outpatient point of care glucose testing vs venous glucose in the clinical laboratory

The purpose of this study was to evaluate the accuracy of glucometers in assessing glucose levels in outpatients. The investigation consisted in the analysis of retrospective validation data (obtained at the Clinical Laboratory of the Puerto Rico Medical Services Administration) and the analysis of data obtained from forty outpatients. Glucose concentration was obtained from these outpatient samples using the patients' glucometers and a clinical laboratory analyzer (hexokinase method). Statistical analysis included descriptive and correlation measures and t-test. Results revealed that accurate glucose values were obtained by the glucometers utilized in both the validation process and the outpatients (POCT) procedure. The investigation also demonstrated the need by outpatients to receive proper training in handling their glucometers.

Hemoglobin measured by Hemocue and a reference method in venous and capillary blood: a validation study

Objective. To assess the comparability of hemoglobin concentration (Hb) in venous and capillary blood measured by Hemocue and an automated spectrophotometer (Celldyn) and to document the influence of type of blood (capillary or venous) and analysis method on anemia prevalence estimates. Material and Methods. Between February and May 2000, capillary and venous samples were collected from 72 adults and children at Hospital del Niño Morelense (Morelos State Children's Hospital) in Cuernavaca, Morelos, Mexico, and assessed for Hb using the Hemocue and Celldyn methods. Estimated Hb levels were compared using the concordance correlation coefficient and Student's t test for paired data. The sensitivity and specificity for anemia diagnosis were estimated and compared between type of blood and method of assessment. Results. Capillary blood had higher Hb (+0.5g/dl) than venous blood in adults and children, as did samples assessed by Celldyn compared to Hemocue (+0.3g/dl). Specificity to detect anemia was adequate (>0.90) but sensitivity was low for capillary blood assessed by Hemocue (<0.80). Conclusions. The difference in Hb between venous and capillary blood is likely related to biological variability. Hemoglobin concentration in capillary blood assessed by Hemocue provides an adequate estimation of population anemia prevalence but may result in excess false negative diagnoses among individuals. The results of this study stress the importance of sample collection technique, particularly for children. Method of analysis and sampling site need to be taken into consideration in field studies.

Objetivo. Evaluar la comparabilidad de la concentración de hemoglobina (Hb) en sangre venosa y capilar medida por Hemocue y por espectrofotómetro automatizado (Celldyn), así como documentar la influencia del tipo de sangre (capilar o venosa) y del método de análisis sobre la prevalencia de anemia. Material y métodos. De febrero a mayo de 2000, se recolectaron muestras de sangre capilar y venosa en 72 adultos y niños en el Hospital del Niño Morelense, Cuernavaca, Morelos, México. Se determinaron los niveles de Hb con los métodos Hemocue y Celldyn. Las cifras de Hb estimadas se compararon con el coeficiente de concordancia y la prueba pareada de t de Student. También se comparó la sensibilidad y especificidad para el diagnóstico de anemia, utilizando sangre de los dos tipos y métodos de análisis. Resultados. La Hb fue mayor en sangre capilar comparada con sangre venosa (+0.5g/dl) en adultos y niños, y en las determinaciones por Celldyn comparadas con las de Hemocue (+0.3 g/dl). La especificidad para el diagnóstico de anemia fue adecuada (>0.90), mientras que la sensibilidad fue baja para las muestras capilares medidas por Hemocue (<0.80). Conclusiones. Es probable que la diferencia en la Hb entre sangre venosa y capilar refleje variabilidad biológica. La Hb en sangre capilar medida por Hemocue provee una estimación adecuada de la prevalencia de anemia en poblaciones, pero podría resultar en un exceso de diagnósticos falsos negativos. Los resultados de este estudio ponen énfasis en la importancia de la técnica de recolección de la muestra, particularmente en niños. Los métodos de análisis y tipos de muestra de sangre deben ser tomados en cuenta en estudios de campo.

Glicemia capilar medida por dois aparelhos de automonitorizaçäo: quanto eles podem estimar a glicemia plasmática na rotina médica? / Capillary blood glucose measurement by tho self-monitoring equipment: how can they to estimate a plasma blood grucose in medical routine?

O desenvolvimento de monitores portáteis para automonitorização da glicose sangüínea tem fácil aceitação pelos pacientes e médicos, sendo amplamente utilizado atualmente, o que torna essencial avaliar o quanto esses resultados correspondem à glicemia plasmática. Assim, avaliamos a acurácia e precisão de dois monitores digitais à disposição no mercado: um utiliza a glicose desidrogenase (Ap1) e o outro a glicose oxigenase (Ap2) na mensuração da glicemia capilar

Accuracy and precision of the i-STAT portable clinical analyzer: an analytical point of view.

The introduction of a new point-of-care testing (POCT) instrument into the market affects medical practice and laboratory services. The i-STAT is designed to improve the speed in the decision making of the medical profession. However, reliability of results would ensure the quality of laboratory data. We, therefore, made an evaluation of the performance of i-STAT using a disposable cartridge EG7 + which is capable of measuring pH, pO2, pCO2 (blood gas), Sodium, Potassium (Electrolytes), Ionized calcium and Hematocrit with only 10 microliters of lithium heparinized blood in 2 minutes. The results were compared with those obtained from routine methods. The results were found to be accurate, precise and correlated with acceptable methods used routinely in the laboratory.

Country report: Clinical chemistry in Indonesia.

Seven hundred clinical laboratories in all over 27 provinces in Indonesia participated the Indonesian External Quality Assurance Scheme (Program Nasional Pemantapan Kualitas Laboratorium Kesehatan bidang Kimia Klinik). Among those laboratories, the government laboratory account for 288 (41%), and the rest 412 (59%) are private laboratories. Automatic analyzer was used by approximately 22% of the participating laboratories. Seventeen analytes were included in the program: bilirubin, cholesterol, creatinine, glucose, total protein, urea, uric acid, triglycerides, AST, ALT, calcium, albumin, alkaline phosphatase, gamma-GT, sodium, potassium, and chloride. Using WHO scoring system, median overall VIS of 128 was obtained. It means that the all over performance was fairly good . Bilirubin got the best median VIS (33). Sodium (median VIS 177), potassium (162) and chloride (209) got the worst VIS compared to the other parameters.

Assessment of carbonic anhydrase activity in blood by alteration in pH.

Carbonic anhydrase enzyme activity could be measured by manometeric and colorimetric techniques. A simpler and modified method of carbonic anhydrase enzyme activity assessment in blood is proposed. In the present method differences in pH by hydration of CO2 in absence and presence of carbonic anhydrase inhibitor have been used to measure the carbonic anhydrase activity in the blood.