Association of Serum Biomarkers with the Mortality of Trauma Victims in a Level -1 Trauma Care Centre of Eastern India.

OBJECTIVE: To determine correlation of important biochemical laboratory investigations in different trauma patients and their degree of injury severity and overall mortality association. METHODS: In this hospital based retrospective observational study, 238 trauma patients were divided into two groups. Group I with injury severity score (ISS)<16 and group II with ISS>16. Haemoglobin (Hb), international normalized ratio, serum creatinine, blood urea nitogen (BUN), serum electrolyte, serum uric acid and liver function parameters were recorded and statistically analyzed. RESULTS: Group II had statistically significant (p<0.0001) elevated levels for referral pulse rate, creatinine, BUN, liver enzymes and decreased level in Hb% and potassium level compared to Group I. Strong positive correlation only exists between BUN and severity score, moderate positive correlation exists between creatinine, aspartate transaminase, and alanine transaminase, alkaline phosphatase and severity score and negative correlation between potassium and severity score. In this study, higher odds of high BUN and creatinine and lower potassium to normal values are associated with bad outcome such as higher mortality in the population of high ISS (>16). CONCLUSION: The study establishes the absolute need of doing three laboratory parameters (serum creatinine, serum blood urea nitrogen and serum potassium) instead of doing laboratory tests battery at the time of trauma victims admission and predicting survival among injured patients in trauma population from Indian settings.

Liver Function Status in COVID-19: An Indian Perspective.

INTRODUCTION: In SARS-CoV2 infection multi-organ involvement of heart, kidney pancreas and liver are reported. Most studies suggest that though mild derangements of liver function may be experienced by most COVID-19 patients but significant liver injury is not common. The aim of this study was to describe clinical characteristics of COVID-19 patients admitted to this level 4 COVID hospital and find out their relation to the liver parameters. MATERIALS AND METHODS: COVID-19 patients admitted in this level -4 COVID hospital during the study period were classified as mild (Group 1,n=42), moderate (Group 2,n=40) and severe (Group 3,n=35) cases as per national guidelines. Serum samples were analyzed using biochemistry autoanalyzer. Serum levels of total and direct bilirubin, Alanine Transaminase (ALT) and Aspartate Transaminase (AST), Alkaline Phosphatase (ALKP), total protein and albumin were assayed. RESULTS: Patients with higher BMI (Body mass index) had developed greater COVID-19 related complications and hence had to be admitted either in HDU (Group 2) or in ICU (Group 3) set up. Total and direct serum bilirubin levels were normal and almost similar in the various study groups. The primary liver enzymes ALT and AST were raised in the entire study population. However differences between the study groups were statistically insignificant. ALKP was within normal reference range for all the cases. Serum total Protein levels were within normal physiological limits in all the three groups. However serum albumin levels were reduced significantly in Groups 3 and 2 in comparison to Group 1. CONCLUSION: Derangements of LFT in COVID-19 Patients are common especially in patients with severe disease but its long term impact is unknown. Hence, further investigation and long term follow up of recovered COVID-19 cases is warranted to understand the pathophysiology and implication of liver injury that occurs both in overt and covert forms during infection.

Status of Health-care Workers in Relation to COVID-19 Infection: A Retrospective Study in a Level 4 COVID Hospital in Eastern India.

INTRODUCTION: Healthcare workers (HCWs) have a high risk of acquiring SARSCoV- 2 infection, due to repeated occupational exposure, long working hours, stress and fatigue. In India, there is lack of data regarding the prevalence of COVID-19 amongst HCWs due to absence of routine screening programme within the hospital premises. We have designed this study in order to improve our understanding of the incidence of SARS-CoV2 within the health care workers working in a level 4 COVID hospital in Kolkata. MATERIALS AND METHODS: A retrospective observational study was conducted at the Department of Microbiology, ID and BG Hospital, Kolkata upon health care workers who presented with symptoms suggestive of Covid 19 and their direct contacts. Oropharyngeal and nasopharyngeal swabs collected from the participants were subjected to Real time RT-PCR for detection of E, RDRP and ORF1B N gene for Covid 19 detection. RESULT: Out of the 274 HCW tested, 75 (27%) of total HCWs were found to be positive. Among them 33(44%) were frontline workers and rest of them 42 (56%) were non-frontline workers. Predominance of SARS- CoV2 infection was found in male HCWs (57%) than female HCWs (43%). HCWs younger than 45 years (68%) were more infected.52 (69%) HCWs presented with symptoms like fever, sore throat, bodyache, loss of sensation of smell, coughs etc. 23(31%) were asymptomatic with history of direct contact with Covid-19 positive cases. CONCLUSION: Heath care workers are at higher risk of being exposed to SARS-CoV2 and could potentially has a role in transmission in and out of the hospital. Hence, routine screening of both symptomatic as well as asymptomatic hospital staff is essential for early diagnosis to prevent transmission of COVID 19 infection.

Retinol Levels in Serum and Chronic Skin Lesions of Atopic Dermatitis.

BACKGROUND: Atopic dermatitis (AD) is a common childhood dermatosis and a distressing cause of morbidity. The pathogenesis of AD is known to be associated with disorders of immune response and defect in antioxidant defense, genetic predisposition, environmental triggers, psychosomatic factors, and other mechanisms. Retinol has immunomodulatory and antioxidant effects, thus may have a protective role in AD. OBJECTIVE: The objective of this study was to evaluate the correlation of retinol levels in skin lesions and serum, with AD. MATERIALS AND METHODS: The study was a hospital-based, case-control study. Punch biopsy from the skin and venous blood of 86 participants (including 43 cases and 43 controls) were assayed for retinol levels by a reversed-phase high-performance liquid chromatography method. Analysis of data was performed using appropriate statistical methods. RESULTS: Skin and serum retinol levels were highly significantly decreased in patients in respect to that of controls. CONCLUSION: Retinol levels were decreased in AD. Retinol estimation may be used as a promising parameter for the elaboration of treatment strategy and monitoring.

Effect of Copper on l-Cysteine/l-Cystine Influx in Normal Human Erythrocytes and Erythrocytes of Wilson's Disease.

Wilson's disease is a disease of abnormal copper metabolism in which free serum copper level is raised. The objective of the study was to determine, whether in Wilson disease, l-cysteine/l-cystine influx into RBC was decreased or not and the specific amino acid transporter affected by copper in normal human RBC. For l-cysteine/l-cystine influx, ten untreated cases, ten treated cases and ten age and sex matched healthy controls were recruited. To study the effect of copper on l-cysteine/l-cystine influx in RBC, 15 healthy subjects were selected. RBC GSH and l-cysteine/l-cystine influx were estimated by Beautler's and Yildiz's method respectively. In untreated cases, l-cysteine/l-cystine influx and erythrocyte GSH level were decreased showing that elevated level of free copper in serum or media decreased l-cysteine/l-cystine influx in human RBC. Copper treatment inhibited L amino acid transporter in normal RBC specifically.

Correlation Study Between HCV Genotypes Distribution Pattern and Viral Load in a Tertiary Care Hospital in Kolkata, India.

BACKGROUND: Hepatitis C virus infection is a leading cause for chronic liver disease. It has wide population specific genotype variability. Genotype knowledge and viral load assessment are equally important for designing therapeutic strategies and as predictors of treatment outcome among hepatitis C (HCV) infected patients. MATERIALS AND METHODS: Between June 2012 and 2013 an observational study was conducted among 350 chronic hepatitis patients visiting Calcutta National Medical College, Kolkata, India. Among them, 110 anti-HCV antibody positive cases were diagnosed and subjected to viral RNA extraction, viral genotyping and viral load quantification using polymerase chain reaction (PCR) based techniques. STATISTICAL ANALYSIS: Statistical analysis was done with IBM SPSS Statistics software, version 20. p-value <0.05 was regarded as statically significant. RESULTS: Among 66 HCV RNA positive cases, genotypes 1a, 3a and 3b were observed among 18 (27%), 44(67%) and 4(6%) cases respectively. Genotype 3a had higher viral load than patients infected with genotypes 1and 3b. However, no statistical significance was observed for viral load among the various HCV RNA genotypes. CONCLUSION: Genotype 3a accounted for the highest number of cases with positive HCV RNA. However, no statistically significant difference existed for viral load among the various HCV RNA genotypes in this study.

Association of obesity and leptin with insulin resistance in type 2 diabetes mellitus in Indian population.

Obesity and diabetes mellitus are two modern epidemics. But their interrelationship is debated. Here we explored the probable association among obesity, leptin and insulin resistance in type 2 diabetes mellitus. 60 recent onset (< 5 years) diabetics and age-sex matched 33 non diabetic controls were assessed for physical and chemical parameters like Body Mass Index, abdominal circumference, waist/hip ratio, fasting blood glucose, insulin and leptin. Degree of insulin resistance was calculated by HOMA-IR method (Homeostatic Model Assessment). All the physical parameters showed positive correlation with leptin and the HOMA-IR score, strength of association being highest between insulin resistance and abdominal circumference. Leptin and insulin resistance showed no correlation. Findings were lower in controls. Study concluded that, obesity mainly central type might be responsible for insulin resistance in type 2 diabetes mellitus where as leptin, a potential marker for obesity, may not. This perhaps points towards the multifactorial causation of insulin resistance in type 2 diabetes mellitus.

Liver Function Profile Anomalies in HIV Seropositive Tuberculosis.

BACKGROUND: The Human Immunodeficiency Virus (HIV) and the Tuberculosis (TB) co infection are contributory to each other in causing a progressive decline in the cell mediated immunity and a damage to the hepatobiliary system. The aim of our study was to estimate the extent of liver damage which was caused by these infections before the start of the therapy with hepatotoxic drugs like Antiretroviral Therapy (ART) and Antitubercular Drugs (ATD). METHODS: One hundred and ninty three confirmed HIV positive cases were enrolled in this study. The cases were divided into 2 groups; Group 1-100 subjects with TB and Group 2-93 subjects without TB.80 age and sex matched controls were also included (Group 0). Some parameters of the serum Liver Function Test (LFT) were estimated biochemically by using an auto analyzer (ERBA XL600,Transasia). RESULTS: The serum total bilirubin, Alanine Transaminase (ALT), Aspartate Transaminase (AST) and the Alkaline Phosphatase (ALK-P) levels were significantly higher in the cases as compared to those in the controls, more so in the cases with the associated TB co infection, except the AST levels. The Group 1subjects had lower serum total protein and albumin levels and altered albumin/globulin ratios as compared to the controls. A statistically significant difference was absent in the serum total protein levels between the Group 2 cases and the Group 0 controls. No significant differences were observed when the values for serum total protein, albumin and globulin and the albumin: globulin ratios among the two case groups (1 and 2) were compared. CONCLUSION: The results have shown the importance of estimating some LFT parameters, prior to the start of ATD and ART in these cases. Hence, a mandatory performance of LFT is recommended, as it is simple and cost effective.

Diagnostic Role of Tumour Markers CEA, CA15-3, CA19-9 and CA125 in Lung Cancer.

The aim of this study was to assess the diagnostic yield of the tumour markers carcinoembryonic antigen, carbohydrate antigen 15-3, carbohydrate antigen 19-9 and carbohydrate antigen 125, in serum and bronchoalveolar lavage fluid in a group of patients with bronchogenic carcinoma. Serum and bronchoalveolar lavage fluid samples were collected in a group of 90 patients with benign or malignant pulmonary diseases. After appropriate processing, tumour markers were determined by enzyme immunoassay. The diagnostic yields (sensitivity, specificity and predictive values) in each environment (serum and bronchoalveolar lavage fluid) were obtained by using "Receivers operating characteristic" curve. Determined individually, carcinoembryonic antigen, carbohydrate antigen 19-9 and carbohydrate antigen 125, showed the greatest diagnostic accuracy in bronchoalveolar lavage fluid. Carbohydrate antigen 15-3 did so in serum. Carcinoembryonic antigen was the most relevant marker in bronchoalveolar lavage fluid. For the factors evaluated in this study, determination of carcinoembryonic antigen, carbohydrate antigen 19-9 and carbohydrate antigen 125 in bronchoalveolar lavage fluid were clinically more useful markers in comparison with serum, although the latter may also be helpful in certain situations. Although there is no specific tumour marker for lung cancer, the combination of several can be used to diagnose most patients with lung cancer and also to rule out false positive and negative cases.

Cell block cytology in pleural effusion.

Cell blocks prepared from residual tissue fluid can be used as adjuncts to smear for establishing a more definitive cytopathological diagnosis. It can be useful for categorisation also. Improved ethanol formalin fixative is used which offers excellent cytomorphologic features corresponding closely to cell in Papanicolaou stained smears. The technique is simple, safe, cost effective and reproducible even in resource limited rural areas. In this study among a total of 60 cases of suspected malignant pleural effusion, 56 were confirmed to be of malignant aetiology by all modalities. Only cell block preparation diagnosed 46 cases. Other modalities of diagnosis like bronchoscopy, broncho-alveolar lavage fluid study, fine needle aspiration cytology also have a great role in diagnosis. Twenty-two cases were diagnosed by Papanicolaou stain smear. So cell block preparation have more effective role in definitive diagnosis. It can be useful for better diagnosis in cases of poorly differentiated malignant neoplasms by immunocytochemistry.