Thiamine: An indispensable regulator of paediatric neuro-cardiovascular health and diseases.

The sustainable developmental goals emphasize good health, reduction in preventable neonatal and under-five mortalities, and attaining zero hunger. However, South Asian countries report a higher incidence of neonatal and under-five mortalities when compared to the Western world, many of which are attributed to maternal and perinatal micronutrient deficiencies. Isolated nutrient deficiency in the absence of calorie deficit poses a diagnostic challenge since such deficiencies present with acute multisystemic and enigmatic manifestations. Thiamine (vitamin B1) is a micronutrient of prime importance which exerts indispensable roles in energy metabolism. Deficiency of thiamine can lead to catastrophic consequences. This review provides insight into the biochemical actions of thiamine in energy metabolism, the compromised aerobic metabolism resulting from thiamine deficiency, and the crucial role of thiamine in the proper functioning of the nervous, cardiovascular, and immune systems. The review also explores the acute life-threatening consequences of thiamine deficiencies in neonates and infants and the speculative role of thiamine in other pathologies like encephalopathy, sepsis, and autism spectrum disorders. However, routine assessment of thiamine in pregnant women and neonates is yet to be implemented, due to the lack of affordable and automated diagnostic techniques, and the cost-intensive nature of mass spectrometry-based quantification. CONCLUSION: Physicians are recommended to have a low threshold for suspecting thiamine deficiency especially in vulnerable populations. Laboratory diagnosis of thiamine deficiency needs to be implemented as a standard of care, especially in endemic regions. Further, public health policies on food fortification, mandatory supplementation, and surveillance are imperative to eliminate thiamine deficiency-induced health hazards. WHAT IS KNOWN: • South Asian countries report a higher incidence of neonatal and under-five mortalities, many of which are attributed to maternal and perinatal micronutrient deficiencies. • Preventable causes of neonatal/ infantile deaths include birth factors (low birth weight, birth asphyxia), infectious diseases (pneumonia, diarrhoea, tetanus, tuberculosis, measles, diphtheria, malaria, acute infections), deficiency diseases and genetic diseases (vitamin & mineral deficiencies, IEMs, congenital heart disease, unexplained PPHN, SIDS etc). WHAT IS NEW: • Acute thiamine deficiency presenting as multisystemic syndromes, has unfortunately been a long standing unresolved public health concern. However, accessible surveillance and diagnostic strategies remain elusive in most clinical settings. • Despite decades of reports and emerging guidelines, diagnosis of thiamine deficiency is often missed and policy mandates at national level are yet to be implemented even in endemic countries. • This review provides a comprehensive summary of the biochemical role of thiamine, its key functions and effects on major organ systems, the diagnostic gap, the enigmatic presentation of acute thiamine deficiency, the plausible role of thiamine in other pathologies and the preventive measures at individual and community level.

Glucose 6 phosphate dehydrogenase deficiency quantitative test in dried blood spot- a potential marker for adult unknown G6PD deficiency.

Glucose 6 Phosphate Dehydrogenase (G6PD) enzyme activity estimation in a freshly collected blood sample is the most widely used diagnostic method for the diagnosis of G6PD deficiency. The objective is to evaluate the need for newborn screening for G6PD deficiency over post-malarial diagnosis and the feasibility and reliability of using dried blood spots (DBS) as samples for screening. A total of 562 samples were analyzed for G6PD and parallel measurement of G6PD activity by the colorimetric method in whole blood and DBS was carried out in the neonatal subset. Among 466 adults, 27 (5.7%) showed G6PD deficiency, out of whom 22 (81.48%) were diagnosed after the malarial encounter. In the pediatric group, 8 neonates showed G6PD deficiency. G6PD activity estimated from DBS samples agreed with whole blood, with a statistically significant strong positive correlation. Screening of G6PD deficiency at birth to prevent future unwarranted complications, using DBS is feasible.

VARK preference and perception of online versus offline professional development training of medical laboratory technologists.

OBJECTIVE: This study aims to understand the learning preferences and perception of medical laboratory technologists on sudden shift from offline to online training sessions during COVID-19 pandemic. METHODS: Microsoft form containing twenty-four questions was circulated to the twenty-five laboratory technologists after 1 year of online continuous professional development training. VARK questionnaire was circulated to understand the learning style. RESULTS: Provision of recording lectures, significant reduction of performance anxiety, anxiety associated with criticism, and QA sessions emerged as the major positive aspects of a virtual training platform. Analysis of learning preferences revealed that most technologists had a unimodal aural (45%) or kinesthetics (33%) than visual (11%) and reading (11%) learning preference. In bimodal learning preference, AK (44.44%) emerged as the predominant form. Forty percent of the technologists showed trimodal learning pattern with 50% among them showing an ARK pattern while 25% each showing VAK and VRK patterns of learning preferences. CONCLUSION: Medical laboratory technologists adapted well to the sudden shift from offline to online continuous development programs. However, efficient managerial mechanisms to address the major perceived hurdles and designing a multimodal training module to accommodate the learning preferences of our technologists can ensure enthusiastic participation and effective learning among medical laboratory technologists.

Anti-hyperglycemic, anti-hyperlipidemic, and anti-inflammatory effect of the drug Guggulutiktaka ghrita on high-fat diet-induced obese rats.

BACKGROUND: Ayurveda is a holistic system of medicine and describes a vast array of herbs and herbal mixtures that are been demonstrated to possess efficacy in research investigations. Guggulutikthaka gritha (GTG) is one such drug evaluated for its role in skin and bone diseases. OBJECTIVE: In the current study, the hypoglycemic, hypolipidemic, and anti-inflammatory effect of the drug GTG was studied with the scope to treat dyslipidemia and thereby reduce the risk of cardiovascular disease. MATERIALS AND METHOD: The animals (Wistar rats) were fed a high-fat diet and dyslipidemia was induced. The control group was provided with a normal chow diet and had free access to water. The treatment with the drug GTG was given for 21 days after confirming dyslipidemia. The blood glucose was measured immediately using a glucometer. The serum was analyzed for lipid profile and Vascular Cell Adhesion Molecule - 1(VCAM 1) by ELISA method before and after treatment. The histopathology of the heart and liver was also performed. RESULTS: The abnormal change in lipid profile, blood glucose, and inflammatory marker along with the accumulation of intracellular fats in the arteries of the heart and liver confirmed dyslipidemia. A significant reduction in serum lipid profile (p < 0.05), blood glucose (p < 0.05), and VCAM 1 (p < 0.05) was noted after the treatment with significant histopathological changes in arteries of the heart and liver. CONCLUSION: The study provides scientific validation on the drug GTG being effective in hyperglycemia, hyperlipidemia, and inflammation in dyslipidemia.

The mechanistic role of neutrophil lymphocyte ratio perturbations in the leading non communicable lifestyle diseases.

Inflammation plays a critical role in the development and progression of chronic diseases like type 2 diabetes mellitus, coronary artery disease, and chronic obstructive pulmonary disease. Inflammatory responses are indispensable for pathogen control and tissue repair, but they also cause collateral damage. A chronically activated immune system and the resultant immune dysregulation mediated inflammatory surge may cause multiple negative effects, requiring tight regulation and dampening of the immune response to minimize host injury.  While chronic diseases are characterized by systemic inflammation, the mechanistic relationship of neutrophils and lymphocytes to inflammation and its correlation with the clinical outcomes is yet to be elucidated. The neutrophil to lymphocyte ratio (NLR) is an easy-to-measure laboratory marker used to assess systemic inflammation. Understanding the mechanisms of NLR perturbations in chronic diseases is crucial for risk stratification, early intervention, and finding novel therapeutic targets. We investigated the correlation between NLR and prevalent chronic conditions as a measure of systemic inflammation. In addition to predicting the risk of impending chronic conditions, NLR may also provide insight into their progression. This review summarizes the mechanisms of NLR perturbations at cellular and molecular levels, and the key inflammatory signaling pathways involved in the progression of chronic diseases. We have also explored preclinical studies investigating these pathways and the effect of quelling inflammation in chronic disease as reported by a few in vitro, in vivo studies, and clinical trials.

Evaluation of total LDH and its isoenzymes as markers in preeclampsia.

BACKGROUND: Preeclampsia, a rapidly progressing pregnancy-specific multi-systemic syndrome is globally the leading cause of maternal and neonatal morbidity and mortality. This study aims to evaluate the serum total Lactate dehydrogenase levels in women with preeclampsia when compared to normotensive pregnant women and assess the electrophoretic pattern of the LDH isoenzymes in normal pregnancy, preeclampsia and eclampsia. METHODS: The study, carried out in the Department of Biochemistry of MVJ Medical College, included 30 patients of preeclampsia and 30 normotensive gestational age-matched pregnant women admitted to the Department of OBG. Serum total LDH was analysed by DGKC method. Serum and cord blood samples for isoenzyme distribution analysis were collected from a normal pregnant woman undergoing delivery, a woman with mild eclampsia, two women with eclampsia, and analysed by slab gel electrophoresis followed by activity staining. RESULTS: LDH was significantly elevated in cases as well as between the case (mild and severe) groups, showed a moderate positive statistically significant correlation with systolic, diastolic blood pressure and a sensitivity of 50% and a specificity of 80%. Further, the isoenzyme pattern showed a decreasing distribution of aerobic forms of LDH in preeclampsia-eclampsia. CONCLUSIONS: Serum total LDH may serve as a robust and affordable marker of preeclampsia. Serum total LDH, along with its isoenzyme profile, might serve as a predictor and a stronger marker of preeclampsia when compared to serum LDH analysis alone. It may also be used to assess the severity of preeclampsia and hence help in predicting and preventing adverse maternal and foetal outcomes.

Efficiency of Galanti and Guisti Method of ADA Estimation in Comparison with the Gold Standard.

BACKGROUND: Adenosine Deaminase, the key enzyme of purine metabolism catalyzing the irreversible hydrolytic deamination of adenosine to inosine is implicated in a varied spectrum of human diseases ranging from SCID to TB and pneumonia. Estimation of ADA offers an easy, relatively affordable and reliable diagnostic alternative and/ or adjunct (specially in a TB endemic nation) which emphasizes the necessity of a feasible and implementable alternative method to the Diazyme method of ADA estimation requiring high end autoanalyzer and infrastructural setup. METHODS: Sixty body fluids samples (irrespective of gender, age, diagnosis or sample type) received by the Clinical Biochemistry Laboratory, Kasturba Medical College, Manipal for fluid ADA estimation by the Diazyme assay method (cobas 6000) was simultaneously processed by the Galanti and Guisti manual method to estimate the comparability and the aggregability of results obtained by the two analytical techniques. RESULTS: The Galanti and Guisti manual method of ADA estimation showed aggregability with the Diazyme autoanalyzer method for 90% of the assayed study samples with the manual method uniformly showing higher values when compared to the analyzer method. A correction factor of 2.44 was arrived at which could effectively achieve comparability between the two assay methods. CONCLUSION: The Galanti and Guisti manual method of ADA estimation might be a feasible, rapid, reliable and cost-effective method for estimation of fluid ADA when compared to the cost and infrastructure intensive autoanalyzer.

Absorption spectroscopy for the estimation of glycated hemoglobin (HbA1c) for the diagnosis and management of diabetes mellitus: a pilot study.

OBJECTIVE: The purpose of this study was to explore the possibility of using absorption spectroscopy technique for the estimation of glycated hemoglobin HbA1c (%). BACKGROUND DATA: Glycated hemoglobin (HbA1c) is an important marker in the diagnosis and management of diabetes mellitus. Different assay techniques have been employed for the estimation of glycated hemoglobin, including ion exchange high performance liquid chromatography (HPLC), electrophoresis, affinity chromatography, immunoturbidimetric assay and colorimetric assays, which measure different glycated products and report using different units. Spectroscopic measurements have been shown to be very sensitive and nondestructive, and require very little quantity of material for analysis. In the present study, we have employed absorption spectroscopy technique for the estimation of glycated hemoglobin in hemolysate samples of diabetic patients. MATERIALS AND METHODS: The blood samples of individuals with normal glycemic status and confirmed diabetic patients were collected from the Clinical Biochemistry Laboratory, Kasturba Hospital, Manipal. The absorption spectra of glycated hemoglobin (HbA1c) samples were recorded in the spectral range 200-850 nm using an optic fiber based Ocean Optics CHEMUSB4-UV-VIS single beam spectrophotometer. The parameter "area under the curve" of each baseline corrected absorption spectrum was used for the estimation of HbA1c (%). The glycated hemoglobin values obtained by this spectroscopic method were compared with the values reported by the standard ion exchange HPLC method. RESULTS: A total of 30 absorption spectra were recorded from hemolysate samples with HbA1c (%) in the range 4-10.5%. A good correlation was observed between the glycated hemoglobin values obtained by the spectroscopic method and those obtained by the standard HPLC method. CONCLUSIONS: It appears that the direct absorption spectroscopy of hemolysate samples, therefore, may be utilized as a supplementary technique for the estimation of HbA1c (%), even at the primary healthcare centers.