Multi-level Analysis of HbA1c in Diagnosis and Prognosis of Diabetic Patients.

BACKGROUND: Type 2 diabetes (T2D), a multifaceted metabolic disorder, may cause health tribulations and changes in biochemical blood markers. Other research has examined the relationships between several biomarkers and the risk of T2D. Few studies have examined the relationships between these biomarkers and potential changes to the network of biomarkers associated with diabetes. METHOD: Glycated hemoglobin, or HbA1C, is used to evaluate and track the blood glucose history throughout the previous two to three months of testing. The ability to reflect the cumulative glycemic history of the previous two to three months makes HbA1c an essential biomarker of long-term glycemic control. HbA1c offers a trustworthy indicator of chronic hyperglycemia and strongly correlates with the likelihood of long-term consequences from diabetes. RESULT: Additionally, elevated HbA1c has been recognized as a stand-alone risk factor for patients with and without diabetes developing coronary heart disease and stroke. One HbA1c test offers a wealth of information that makes it a reliable biomarker for the diagnosis and prognosis of diabetes. A clinical examination may be required to establish the connection between diabetes, prediabetes, biochemical blood indicators, age, and body mass index (BMI). CONCLUSION: We observed that diabetes, BMI, age, HbA1c, cholesterol, triglycerides, LDL, VLDL, and HDL were all linked using multivariate analysis.

Clinical Risk Assessment and Comparison of Bias Between Laboratory Methods for Estimation of HbA1c for Glycated Hemoglobin in Hyperglycemic Patients.

INTRODUCTION: Hemoglobin A1c (HbA1c), also known as glycated hemoglobin, is a blood test used to evaluate and track a patient's blood sugar levels over the previous 2-3 months. We have compared the analytical performance of the D10 hemoglobin (HPLC) testing system to that of the immunoturbidimetric technique, which is a light-scattering immunoassay. OBJECTIVES: To assess the clinical risk assessment between two methods (Compare the two Immunoturbidometric methods (AU680) vs HPLC method (D10)) in hyperglycemic patients and assess the acceptability of the respective methods in the clinical biochemistry Laboratory. METHODS: The charge of the globins in Hb was used as the basis for the HPLC method used to measure HbA1c. HPLC detects and quantifies even the tiniest Hb fractions and the full spectrum of Hb variants. HbA1c was measured using the immunoturbidimetric (AU 680 Beckmann coulter analyzer) and high-performance liquid chromatography (HPLC) techniques. Experiments also made use of immunoturbidimetric techniques (using an AU 680 Beckmann coulter analyzer equipment). RESULTS: There is no statistically significant difference in HbA1c readings between male and female patients, as measured by either the Immunoturbidimetric or HPLC techniques. CONCLUSION: The immunoturbidimetric and high-performance liquid chromatography techniques for estimating HbA1c yielded identical results. From the results of this study, we may deduce that both techniques are valid for estimating HbA1c. As a result, it may be suggested that both approaches can be used to estimate HbA1c in diabetic individuals.

Adenosine deaminase activity in normal pregnancy and pregnancy associated disorders.

Adenosine deaminase (ADA) is an enzyme of purine salvage pathway and has two important isoenzymes ADA1 and ADA2. The activity of ADA has been changed in diseases characterized by altered cell-mediated immunity. It was observed that total serum ADA activity was decreased during normal pregnancy compared with non-pregnant women. However, total serum ADA activity and serum ADA2 activity was increased in hyperemesis gravidarum and pre-eclampsia in pregnant women. Less information is available regarding role of ADA in abortions (recurrent and missed) and anembryonic pregnancies. Here, we review the activity of ADA and its isoenzymes. Despite these findings, it will be interesting to know whether activity of ADA will be same if ADA is estimated throughout the pregnancy and in pregnancy related complications from early first trimester to third trimester, as all studies until now were carried out at a particular stage of pregnancy.

Relation of oxidative stress, zinc and alkaline phosphatase in protein energy malnutrition.

OBJECTIVE: To determine serum zinc (Zn), total anti-oxidant capacity (TAC), malondialdehyde (MDA), alkaline phosphatase (ALP) and albumin in protein energy malnutrition (PEM) and to analyse the appropriateness of using low weight-for-age for detecting childhood under-nutrition. METHODS: This study comprised 455 children (355 malnourished and 100 normal). They were classified according to the Nutrition Subcommittee of Indian Academy of Pediatrics, Z-Score Classification and Composite Index of Anthropometric Failure. Serum Zn, TAC, MDA, ALP and albumin levels were determined. RESULTS: The serum Zn, TAC, ALP and albumin levels were found to be significantly decreased and MDA levels were significantly increased in malnourished children as compared with control (P < 0.001). CONCLUSION: The significant increase in serum MDA concentration associated with the decrease in serum TAC, Zn and ALP in malnourished children suggest that these children were potentially susceptible to high oxidative stress. Current study also suggest that conventional measures of detecting under-nutrition (low weight-for-age) may be missing out a considerable proportion of undernourished children present in the population.

Sputum adenosine deaminase and alkaline phosphatase activity in pulmonary tuberculosis.

OBJECTIVE: The aim was to determine adenosine deaminase (ADA) and alkaline phosphatase (ALP) activity in sputum for the diagnosis of pulmonary tuberculosis. METHODS: This study comprised of 64 subjects (33 pulmonary tuberculosis and 31 lung cancer). The ADA and ALP activity was measured in sputum and serum. RESULTS: The mean ADA activity in sputum, serum and mean sputum/serum ADA ratio was 205.20 IU/L, 42.32 IU/L and 4.90 in pulmonary tuberculosis and 127.74 IU/L, 29.90 IU/L and 4.27 in lung cancer subjects respectively. The mean ALP activity in sputum, serum and mean sputum/serum ALP ratio was 461.34 IU/L, 159.24 IU/L and 2.90 in pulmonary tuberculosis and 226.64 IU/L, 119.87 IU/L and 1.99 in lung cancer subjects respectively. CONCLUSION: The mean ADA and ALP activity was significantly increased in pulmonary tuberculosis as compared to lung cancer subjects and hence may be a useful tool for the diagnosis of pulmonary tuberculosis.

Elevated adenosine deaminase activity in overweight and obese Indian subjects.

OBJECTIVE: To determine adenosine deaminase activity in overweight and obese Indian subjects. METHODS: This study comprised of 100 subjects. The body mass index (BMI) of subjects was calculated and adenosine deaminase activity was determined in their fasting blood sample. The study was divided into three groups depending upon BMI: Control (n = 40, BMI < 25 kg/m(2)), Overweight (n = 30, BMI 25-29.9 kg/m(2)) and Obese (n = 30, BMI ≥ 30 kg/m(2)). RESULTS: The serum adenosine deaminase activity was significantly increased in overweight and obese subjects and as well as in combined overweight and obese group as compared to control (P < 0.0001). CONCLUSION: Adenosine, an endogenous anti-inflammatory metabolite, is increased in response to inflammation produced by adipose tissue in obesity. However, adenosine deaminase acts on adenosine to convert it into inosine, thereby increasing adenosine deaminase activity in overweight and obese Indian subjects.

Alkaline phosphatase: Distinguishing between tuberculous and nontuberculous pleural effusion.

OBJECTIVES: To evaluate the value of pleural fluid alkaline phosphatase and pleural fluid/serum alkaline phosphatase ratio for the purpose of differentiating tuberculous from nontuberculous pleural effusion. MATERIALS AND METHODS: A total of 60 indoor patients, admitted to our hospital, having pleural effusion and suffering from varying etiologies, were included in this study. According to the final diagnosis, these 60 patients were divided into two groups: Tuberculous (30) and nontuberculous (30) pleural effusion. RESULTS: The mean pleural alkaline phosphatase and pleural fluid/serum alkaline phosphatase ratio was significantly higher in tuberculous compared to nontuberculous pleural effusion. (P < 0.0001). In receiver operating characteristic curve analysis, sensitivity and specificity values were 90% and 80% for a cut-off value of 71 IU/L for pleural alkaline phosphatase activity; and were 90% and 86.66% for a cut-off value of 0.51 for pleural fluid/serum alkaline phosphatase ratio. CONCLUSION: From this study it is concluded that alkaline phosphatase activity remains a useful test in differentiation of tuberculous from nontuberculous pleural effusion.

Serum zinc and malondialdehyde concentrations and their relation to total antioxidant capacity in protein energy malnutrition.

The aim of present study was to assess the association between serum zinc and oxidant/antioxidant status in children with protein energy malnutrition. Serum zinc, total antioxidant capacity and malondialdehyde were measured spectrophotometrically in 100 children (6 mo to 5 y); out of these, 50 children were malnourished and 50 children served as controls. Serum zinc levels were found to be significantly low in the malnourished (p<0.001). Serum zinc levels in Grade I and Grade II malnourished were 82.7 and 67.7 microg/dL respectively and in Grade III and IV combined was 53.2 microg/dL as compared to 109.5 microg/dL in the control group. These levels were significantly lower in children who had skin lesions than in those without such lesions (p<0.001). Total antioxidant capacity was found to be significantly lowered in malnourished children (Grade I=1.3 mmol/L, Grade II=1.1 mmol/L, Grade III and IV=0.5 mmol/L) as compared to 2.0 mmol/L in the control group (p<0.001). The malondialdehyde concentration in malnourished children was significantly higher (p<0.001) (Grade I=1.6 nmol/mL, Grade II=1.9 nmol/mL, Grade III and IV=2.9 nmol/mL) as compared to 1.3 nmol/mL in controls. Total antioxidant capacity and hypoalbuminaemia were also correlated positively with low serum zinc level. Serum trace element deficiency leading to depleted antioxidant protection may be a contributing factor to the pathophysiology of protein energy malnutrition and replacement of these elements in the management of this condition might be important.

Diagnostic value of adenosine deaminase to differentiate exudates and transudates.

The differentiation of pleural effusions as exudates or transudates is the first step in the diagnosis of pleural effusions. The aim of this study was to evaluate the value of adenosine deaminase (ADA) concentration in the pleural effusions for differentiating exudates from transudates. Sixty indoor patients, admitted to our hospital, having pleural effusions and suffering from varying etiologies were included in this study. According to the final diagnosis, these 60 patients were divided into two groups: exudates (50) and transudates (10). The mean pleural ADA, serum ADA and pleural fluid/serum ADA ratio were significantly (P < 0.0001) higher in exudates as compared to transudates. Using a cut-off point of 22 IU/L, the sensitivity and specificity of pleural ADA in the diagnosis of exudates was computed to be 90% and 90% respectively. At a cut-off point 1.28, pleural fluid/serum ADA ratio was found to have sensitivity 84% and specificity 90%, respectively. From this study it is concluded that, ADA is a useful biochemical marker to suggest exudative effusions.