Serum fructosamine [glycated protein] and related biochemical parameters during normal pregnancy

Determine the pattern of change in serum fructosamine and related biochemical parameters during pregnancy, the influence of serum albumin or total protein on fructosamine values and the need for correcting them accordingly. Fasting plasma glucose [FPG] and serum fructosamine [FAm], corrected frucosamine [FAc], albumin and total protein were measured, in three groups of women who were attending Al-Batool and Al-Khansa antenatal clinics in Mosul from 1[st] November 2000 to 3 1[st] May 2001. These included 250 non-pregnant apparently healthy women [group 1], 242 normally pregnant women [group 2] and 39 normally pregnant women who were followed in their early, middle and late stages of pregnancy [group 3]. The distribution of serum FAm in group 1 showed a normal [Gaussian] pattern with a reference range of 1.37-2.49 mmol/1. A significant positive correlation was noted between FAm and albumin [r=0. 1 8, p < 0.01], but no significant correlation with total protein. In group 2, a significantly lower FAM values were observed [Z=4.1, p<0.001] with no significant correlation between FAM and albumin or total protein. There was a downward trend in FAM values with the progress of pregnancy. Serum albumin and total protein showed also a trend to decrease during the gestational stages with a highly significant difference from group 1 [p<0.001]. FPG showed no significant difference in all stages in comparison with group 1. Correction of FAM for albumin or total protein is required in group 2 and comparison between FAc in group 1 and group 2 revealed no significant difference. In group 3, all the parameters showed a significant difference in middle and late stages compared with early stage. In the early stage, no significant difference between FAM and FAc according to albumin was noted while there was a significant difference in FAc according to total protein [p<0.01]. In the middle and late stages, there was a significant difference between FAm and FAc according to albumin and a highly significant difference between FAm and FAc according to total protein. Serum fructosamine concentration is affected by the changes in serum albumin and total protein during the different stages of gestation. Hence, correction of its value accordingly improves its usefulness as an index of glycated protein for assessing glycaemic state

Validity of serum CK activity in the diagnosis of thyroid dysfunction

This study assessed the pattern of changes in serum creatine kinase [CK] activity in [100] patients with a variety of clinical manifestations of either increased or decreased thyroid function and evaluated the validity of such changes in the diagnosis of both conditions They were biochemically assessed for thyroid function and compared with a control group of 67 apparently healthy subjects According to thyroid function tests, the subjects were classified into 3 groups Group 1 Hypothyroid patients [n=50], which was divided into 2 subgroups Group A[Overt hypothyroidism] It included 43 patients with TT4 60 nmol/l. The second group [Group 2] included 50 hyperthyroid patients, while [Group 3] was composed of 67 euthyroid subjects. Serum CK activity was noticeably elevated in hypothyroid patients compared to both normal and hyperthyroid subjects [mean +SD was 204.10 + 97.72 Vs 79.97+ 26.35 and 79.36 + 26.88 u/L respectively]. There was no significant difference in the mean serum CK activity between group A and B [Z =87, P>0.05] A significant positive correlation was revealed between serum TSH and CK in hypothyroid patients [Group I] where [r=0.35, P<0.01], while there was no such significant association in either group A or B [p>O.O5],and thus did the hyperthyroid patients [r= -0.22, P>0.05]. For patients in group1, the sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], accuracy rate, positive likelihood ratio [PLR] and negative likelihood ratio [NLR] of elevated serum CK activity as a diagnostic test were 74%, 95.5%, 92.5%, 87%, 86%, 16.40, 0.27 respectively. However, they were 0%, 95.5%, 0%, 56%, 5.4%, 0 and 0.96 respectively for the diagnosis of hyperthyroidism. In conclusion high serum CK activity is a fairly sensitive and highly specific test for the diagnosis of hypothyroidism with a high PPV value mainly for overt [uncompensated] cases. This study indicates that the determination of CK might be a useful screening tool for hypothyroidism

Reference range of serum fructosamine in population of Ninevah province

Diabetes mellitus [DM] is a common health problem. Assessment of diabetic control requires regular monitoring of glycaemic state by measuring plasma glucose and glycated protein [including serum fructosamine] at regular periods. To determine the reference range for measured and corrected serum fructosamine [FAm and FAc] in adult population of Ninevah Province in Northern Iraq. This study represents a part of cross sectional survey of DM in Ninevah Province in Northern Iraq. Fasting plasma glucose [FPG] and serum fructosamine [FA] were compared in 1015 subjects aged >/= 25 years from different urban and rural areas in Ninevah Province. The subjects were classified into 3 groups: Non-diabetics [n= 910], diabetics [n= 92], and those with impaired glucose tolerance [IGT] [n= 13]. The distribution of FAm and FAc values among the non-diabetics showed a Gaussian pattern. No significant correlation was observed between serum FAm and albumin and FAm in non-diabetics [r= 0.14, p> 0.05] and diabetics [r= 0.08, p>0.05]. A highly significant correlation was also observed between FAm and FAc in both non-diabetics [r= 0.90, p< 0.0001] and diabetics [r= 0.97, p< 0.0001]. The reference range [normal range] for both FAm and FAc were calculated as mean +/- 2SD owing to the normal pattern of distribution. For FAm; it was 1.30-2.65 mmol/l and for FAc; it was 1.18-2.60 mmol/l. Elderly non- diabetics exhibited higher FA values than younger subjects. No sex difference was noted when FAm values were corrected according to serum albumin. It can be concluded that studies conducted in different parts of the world, including the current study, had exhibited different reference ranges for serum FA. It is recommended to establish local reference ranges whenever fructosamine test is used