An Assessment of the Utility of Serum Fructosamine in the Diagnosis and Monitoring of Diabetes Mellitus.

BACKGROUND: Fructosamine (FA) has gained importance as a new biomarker for hyperglycemia in the past decade and may be of indispensable use in certain conditions where hemoglobin A1c (HbA1c) falls short of utility such as disorders of red blood cells, patients with rapid glycemic excursions requiring more short-term monitoring, pregnancy, chronic kidney disease, etc. Methods: The present study was a hospital-based observational cross-sectional study conducted in the Department of Biochemistry, All India Institute of Medical Sciences (AIIMS), Nagpur, India. Serum HbA1c, FA, albumin-corrected fructosamine (AlbF), total protein-corrected FA (PrF), hemoglobin (Hb), and hematocrit (Hct) were estimated in 32 controls (Group I) and 32 cases of diabetes mellitus (DM) (Group II). The clinical data and lab results were presented as mean±SD/±standard error (SE) of the mean. Student's t-test and ANOVA were used to compare various parameters between the groups. Pearson correlation analysis was performed to assess the correlation between different diagnostic parameters. The receiver operating characteristic (ROC) curve was plotted to assess the diagnostic significance and cut-off value for FA, AlbF, and PrF. RESULTS: The controls and cases were matched for age and gender distribution. Serum HbA1c (p<0.0001), serum FA (p<0.0001), fasting blood sugar (p=0.001), postprandial blood sugar (p<0.0001), random blood sugar (p=0.001), hematocrit (p=0.002), AlbF (p<0.0001), and PrF (p<0.0001) were found to be significantly higher in known diabetic subjects compared to controls. The case group was further subdivided into pre-diabetic and diabetic groups. On correlation analysis of HbA1c with various parameters, a moderate correlation of HbA1c was noted with FA (r=0.522, p<0.0001) and AlbF (r=0.375, p=0.002) in all subjects. Additionally, a moderate correlation of FA (r=0.479, p=0.033), AlbF (r=0.444, p=0.050), and PrF (r=0.441, p=0.065) with HbA1c was also found in subjects with diabetic range glycemia. No such correlation was noted in the pre-diabetic group. No significant correlation was noted between FA and its corrected values in any range of glycemia. None of the parameters assessing glycemia were found to be significantly affected by hemoglobin status. On ROC curve analysis, HbA1c was found to be the best parameter (area under the curve (AUC) =83%, p<0.0001) followed by AlbF (AUC= 80.5%, p<0.0001) and uncorrected FA (AUC=80.5%, p<0.0001) to diagnose DM. CONCLUSION: Serum FA should be considered a valid diagnostic biomarker and of indispensable use in special populations where HbA1c falls short of utility such as patients with red blood cell disorders or those showing rapid glycemic excursions such as those on corticosteroid therapy or insulin therapy, etc. It exhibits additional advantages over HbA1c with respect to lower reagent cost and easy automation on any conventional laboratory instruments based on simple colorimetry.

Evaluating Ischemia-Modified Albumin as an Early Biomarker for Hypertensive Disorders During Pregnancy: A Case-Control Study.

Background Ischemia-modified albumin (IMA) is looked upon as a newer marker of myocardial ischemia. There is a paucity of literature however with regard to studies correlating levels of IMA in patients with hypertensive disorders of pregnancy. The present study therefore aimed at estimating the levels of IMA in patients with gestational hypertension and assessing its utility in predicting hypertensive disorders of pregnancy. Methods The present study was a hospital-based case-control study conducted in the Department of Biochemistry, All India Institute of Medical Sciences (AIIMS), Nagpur. IMA was estimated in 30 controls (Group I) and 20 cases of gestational hypertension (Group II) using a spectrophotometric assay detecting free unbound Cobalt left behind. The clinical data and lab results were presented as mean ± SD. Student's t-test was applied and Pearson's correlation coefficient was calculated. A value of p < 0.05 was taken as statistically significant. The ROC (Receiver Operator Characteristic) curve was used to establish the cut-off of serum IMA levels in pregnancy-induced hypertension (PIH). Results There was no significant difference in age and period of gestation (POG) at the time of sample collection between the groups. There was a significant difference in the systolic and diastolic blood pressures (BPs) of both groups. The mean level of serum IMA was significantly higher in cases of gestational hypertension (0.88 ± 0.14 absorbance units {ABSU}) as compared to controls (0.69 ± 0.08 ABSU) (p<0.001). On correlation analysis, the systolic and diastolic BPs were found to be highly positively correlated with serum IMA levels (p<0.001). ROC curve analysis suggested that at a cut-off of 0.73 ABSU, IMA has 85% sensitivity and 80% specificity for predicting gestational hypertension. Conclusion Statistically significant results of serum IMA levels obtained in gestational hypertension which falls on the lesser severe spectrum of the disease imply that serum IMA can be used for early diagnosis of gestational hypertension and impending Pre-eclampsia (PE) and Eclampsia.

Elevated copper, hs C-reactive protein and dyslipidemia in drug free schizophrenia: Relation with psychopathology score.

Inflammation, dyslipidemia and altered copper levels have been reported in several psychiatric disorders, including schizophrenia. However, their association with the severity of psychopathology in schizophrenia is yet to be established. The present study was designed to assess the serum levels of copper, highly sensitive C-reactive protein (hs-CRP) and lipid profile and to explore their association with psychopathology scores in schizophrenia. 40 cases and 40 controls were included in the study. Serum copper, hs-CRP and lipid profile were estimated in all the subjects. Disease severity was assessed using Positive and Negative Syndrome Scale (PANSS). Copper, hs-CRP, total cholesterol and LDL-Cholesterol were significantly increased and HDL-Cholesterol was significantly reduced in schizophrenia cases when compared with controls. Copper was positively correlated with hs-CRP (r=0.338, p=0.003). Total cholesterol was significantly correlated with PANSS total (r=0.452, p=0.003) and negative symptom scores (r=0.337, p=0.033). Triacylglycerol was positively correlated with general psychopathology symptom score (r=0.416, p=0.008). Copper and hs-CRP were increased and correlated well with each other in schizophrenia cases. Though total cholesterol and triacylglycerol showed positive association with severity of the psychopathology, copper and hs-CRP were not associated with the disease severity.

Association between prolactin and thyroid hormones with severity of psychopathology and suicide risk in drug free male schizophrenia.

BACKGROUND: Hormonal deregulation is associated with suicidal risk in various psychiatric disorders. Thyroid hormones and prolactin play a role in the pathophysiology of schizophrenia. The present study aimed to analyze thyroid hormones and prolactin levels in patients with schizophrenia, and to explore its association with disease severity and suicide risk. METHODS: Thirty-eight cases and 38 controls were included in the study. Serum thyroid hormones and prolactin were estimated in all the subjects. Disease severity was assessed using the Positive and Negative Syndrome Scale and suicidal ideations were assessed using the Columbia Suicide Severity Rating Scale. RESULTS: Serum prolactin (p=0.004) and free T4 (p=0.029) were significantly elevated in the schizophrenia group as compared to controls. Serum prolactin was significantly associated with higher negative symptom scores (r=0.418, p=0.008), but not positive symptoms or general psychopathology of schizophrenia. Thyroid hormones were not associated with disease severity scores. Suicidal ideas were more common in schizophrenia patients with higher free T4 (p=0.011). CONCLUSION: Prolactin and free T4 were increased in patients with schizophrenia as compared to controls. Suicidal ideation was associated with increased free T4, but not prolactin levels.