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1.  Hydrogen Breath Tests in Gastrointestinal Diseases 
Hydrogen breath tests are widely used to explore pathophysiology of functional gastrointestinal (GI) disorders. Small intestinal bacterial overgrowth (SIBO) and carbohydrate malabsorption are disorders detected by these tests that have been proposed to be of great importance for symptoms of GI diseases. Glucose hydrogen breath test is more acceptable for diagnosis of SIBO whereas lactose and fructose hydrogen breath tests are used for detection of lactose and fructose maldigestion respectively. Lactulose hydrogen breath test is also used widely to measure the orocecal transit time for GI motility. These methods are noninvasive and inexpensive. Many patients with functional gut disorders are unaware of the relationship between diet and GI symptoms they present. In particular, patients with chronic symptoms may regard their condition as normal and may not be aware that their symptoms can be effectively managed following a proper diagnosis. Patients with symptoms of abdominal pain, bloating, flatulence and altered bowel movements (diarrhea and constipation), or with a medical diagnosis of irritable bowel syndrome or celiac disease, may have undiagnosed carbohydrate malabsorption or SIBO. Hydrogen breath tests are specific and sensitive diagnostic tests that can be used to either confirm or eliminate the possibility of carbohydrate malabsorption or SIBO in such patients. Breath tests, though valuable tools, are underutilized in evaluating dyspepsia and functional bloating and diarrhea as well as suspected malabsorption. However, because of their simplicity, reproducibility and safety of procedure they are now being substituted to more uncomfortable and expensive techniques that were traditionally used in gastroenterology.
PMCID: PMC4175689  PMID: 25298621
Hydrogen breath tests; Carbohydrate malabsorption; Small intestinal bacterial overgrowth; Orocecal transit time
2.  Monitoring and Root Cause Analysis of Clinical Biochemistry Turn Around Time at an Academic Hospital 
Quality can be defined as the ability of a product or service to satisfy the needs and expectations of the customer. Laboratories are more focusing on technical and analytical quality for reliability and accuracy of test results. Patients and clinicians however are interested in rapid, reliable and efficient service from laboratory. Turn around time (TAT), the timeliness with which laboratory personnel deliver test results, is one of the most noticeable signs of laboratory service and is often used as a key performance indicator of laboratory performance. This study is aims to provide clue for laboratory TAT monitoring and root cause analysis. In a 2 year period a total of 75,499 specimens of outdoor patient department were monitor, of this a total of 4,142 specimens exceeded TAT. With consistent efforts to monitor, root cause analysis and corrective measures, we are able to decreased the specimens exceeding TAT from 7–8 to 3.7 %. Though it is difficult task to monitor TAT with the help of laboratory information system, real time documentation and authentic data retrievable, along with identification of causes for delays and its remedial measures, improve laboratory TAT and thus patient satisfaction.
PMCID: PMC4175690  PMID: 25298634
Clinical biochemistry; Root cause analysis; Turn around time; Outdoor patient department
3.  Additive Effect of Lipid Lowering Drug (Simvastatin) in Combination with Antidiabetic Drug (Glibenclamide) on Alloxan Induced Diabetic Rats with Long Term Dyslipidemia 
High blood glucose level, elevated level of liver enzyme, necrosis and shrinkage of islets of Langerhans has been implicated in the pathogenesis of type 2 diabetes. High blood glucose cause oxidative stress, production of free radical as well as elevated SGPT and SGOT level. Both glibenclamide and simvastatin in fixed dose used as antihyperglycemic antidyslipidemic and antioxidative agents for type 2 diabetes treatment. This study therefore aimed to evaluate the antihyperglycemic, antidyslipidemic and antioxidative effect of fixed dose combination of glibenclamide (0.6 mg/70 kg body weight) and simvastatin (5 mg/70 kg body weight) on long term alloxan induced diabetic rats with cardiovascular disease using various diagnostic kits as a parameter of phamacotherapeutic and pharmacological effect. The study was carried out using 96 Swiss Albino male rats weighing about 200–220 g. Combination therapy induced a significant decrease in blood glucose level in alloxan induced diabetic rats, from 33.75 ± 1.65 to 5.80 ± 0.07 mmol/l 2 h after last dose administration, after 4 weeks treatment. In case of dyslipidemic effect, combination therapy reduced total cholesterol (45 %), triglyceride (36 %) and low density lipoprotein-cholesterol (32 %) levels significantly and increased high density lipoprotein-cholesterol level (57 %) in comparison with their respective diabetic control groups. Results of this study showed that combination therapy effectively decreased SGPT (ALAT) (55 %) and SGOT (ASAT) (51 %) in comparison with diabetic control group. It was also observed that catalase and superoxide dismutase enzyme activity was increased by 58 and 91 % respectively in comparison with diabetic control group after 4 weeks treatment with combination of both drugs. In conclusion, these findings of combination therapy (glibenclamide and simvastatin) on alloxan induced diabetes in rats are significantly better than monotherapy using single drug. The results of the present study suggest that, combination of the fixed dose of glibenclamide and simvastatin might be efficacious in patients with diabetic dyslipidemia and increased oxidative stress. Furthermore, this combination therapy offer dosage convenience to the patients and by virtue of its dual mode of action might be a useful addition to the therapeutic armamentarium for patients with diabetic dyslipidemia and oxidative stress.
PMCID: PMC4175691  PMID: 25298626
Diabetes with CVD; Glibenclamide; Simvastatin; Combination drugs; Beneficial effects
4.  A Case of Sanfillippo’s Disease Correlating Clinical and Biochemical Findings 
The mucopolysaccharidoses (MPSs) are a heterogeneous group of rare inherited disorders caused by deficiency of lysosomal enzyme necessary to break down mucopolysaccharides or glycosaminoglycans (GAGs). We had combined clinical findings and ophthalmological features. Biochemical test for urine glycosaminoglycans was done for confirmation of diagnosis in the patient. The case of Sanfillippo’s disease was characterized by delayed development, hyperactivity with aggressive behaviour. Coarse facial feature, hirsutism and sleep disorder. Urine GAG tests for MPS was positive in the case. Based on clinical findings and biochemical tests for MPS, this case was diagnosed as a type III mucopolysaccharidoses. Urinary GAG’s electrophoresis is an important screening test for MPS suspected cases.
PMCID: PMC4175692  PMID: 25298638
Sanfillippo’s; Mucopolysaccharidoses (MPSs); Glycosaminoglycans (GAG)
5.  Alleviation of Dimethylnitrosamine-Induced Liver Injury and Fibrosis by Supplementation of Anabasis articulata Extract in Rats 
Anabasis articulata (Forssk) Moq. (Chenopodiaceae) is an herb, grows in Egypt, and used in folk medicine to treat diabetes, fever, and kidney infections. The protective and therapeutic effects of the ethanol extract of A. articulata aerial parts were evaluated against dimethylnitrosamine (DMN)-induced liver fibrosis, compared with the standard drug, silymarin. Hepatic hydroxyproline content, serum transforming growth factor-β1 (TGF-β1), interleukin 10 (IL-10) and fructosamine were measured as liver fibrosis markers. Hepatic malondialdehyde (MDA), nitric oxide (NO), catalase (CAT), glutathione reductase (GR) and glutathione content (GSH) were measured as oxidant/antioxidant markers. Parallel histopathological investigations were also performed. Protective and therapeutic administration of A. articulata (100 mg/kg daily for 4 weeks), markedly prevented DMN-induced loss in body and liver weights. The extract significantly inhibited the elevation of hepatic hydroxyproline, NO and MDA (P < 0.05), as well as serum fructosamine, and TGF-β1 (P < 0.05) induced by DMN while it restored IL-10 to normal level in both protective and therapeutic groups. Furthermore, A. articulata prevented the depletion in CAT, GR, and GSH levels (P ≤ 0.05). In addition, oral administration of A. articulata extract and silymarin to both protective and therapeutic groups reduced the increase in liver function enzyme activities; alanine and aspartate amintransferases, gamma-glutamyl transferase in addition to alkaline phosphatase, and caused significant increase in serum albumin concentration as compared to DMN group. These data corresponded closely with those obtained for the drug silymarin. Histopathological studies confirmed the biochemical data and revealed remarkable improvement in liver architecture. Thus, it could be concluded that, A. articulata extract exhibited in vivo hepatoprotective and therapeutic effects against DMN-induced liver injury and may act as a useful agent in controlling the progression of hepatic fibrosis through reduction of oxidative stress and improving liver function.
PMCID: PMC4175693  PMID: 25298623
Dimethylnitrosamine; Oxidative stress; Liver fibrosis; Anabasis articulata
6.  Fatty Acid Oxidation Disorder with Secondary Mitochondrial Energy Production Defect: A Case Report 
The presentation of long-chain fatty acid oxidation disorders (FAOD), unlike short and medium-chain disorders can be with secondary defects in mitochondrial function along with typical features of FAOD. We report an infant with Reye-like presentation and acylcarnitine profile suggestive of very-long-chain acyl-CoA dehydrogenase deficiency who had lactic acidosis and urine gas chromatographic pattern of mitochondrial defects.
PMCID: PMC4175694  PMID: 25298636
Lactic acidosis; Reye-like; Urine organic acids; Very-long-chain acyl-CoA dehydrogenase deficiency
7.  Immunoisolated Transplantation of Purified Langerhans Islet Cells in Testis Cortex of Male Rats for Treatment of Streptozotocin Induced Diabetes Mellitus 
The objective of this study is to induce experimental diabetes mellitus by streptozotocin in normal adult Wistar rats via comparison of changes in body weight, consumption of food, volume of water, urine and levels of glucose, insulin and C-peptide in serum, between normal and diabetic rats. Intra-venous injection of 60 mg/kg dose of streptozotocin in 250–300 g (75–90 days) adult Wistar rats makes pancreas swell and causes degeneration in Langerhans islet β-cells and induces experimental diabetes mellitus in 2–4 days. For a microscopic study of degeneration of Langerhans islet β-cells of diabetic rats, biopsy from pancreas tissue of diabetic and normal rats, staining and comparison between them, were done. In this process, after collagenase digestion of pancreas, islets were isolated, dissociated and identified by dithizone method and then with enzymatic procedure by DNase and trypsin, the islet cells changed into single cells and β-cells were identified by immune fluorescence method and then assayed by flow-cytometer. Donor tissue in each step of work was prepared from 38 adult male Wistar rats weighted 250–300 g (75–90 days). Transplantation was performed in rats after 2–4 weeks of diabetes induction. In this study, the levels of insulin, C-peptide and glucose in diabetic rats reached to normal range as compared to un-diabetic rats in 20 days after transplantation of islet cells. Transplantation was performed under the cortex of testis as immunoisolated place for islet cells transplantation.
PMCID: PMC4175695  PMID: 25298622
Streptozotocin; Diabetes induction; Islet cells; Purification; Flow cytometry; Immunoisolated-transplantation
8.  The Dynamic Roles Played by a Biochemist 
PMCID: PMC4175697  PMID: 25298620
9.  Does Friedewald Formula Underestimate the Risk of Ischemic Heart Disease? 
Traditionally Friedewald formula has been used to calculate low density lipoprotein cholesterol (LDL-C) concentration though now direct homogenous methods for its measurement are also available. Clinical guidelines recommend the use of calculated LDL-C to guide therapy because the evidence base for cholesterol management is derived almost exclusively from trials that use calculated LDL, with direct measurement of LDL-C being reserved for those patients who are non fasting or with significant hypertriglyceridemia. In this study our aim was to compare calculated and direct LDL and their variation at different cholesterol and triglyceride levels. Fasting lipid profile estimation was done on 503 outpatients in a tertiary hospital. Both direct and calculated LDL were then compared. Mean fasting direct LDL was found to be higher than calculated LDL in 87.1 % of subjects by 8.64 ± 8.35 mg/dl. This difference was seen a all levels of cholesterol and triglyceride. Using 130 mg/dl LDL cholesterol as cut off fewer subjects were classified as high risk by calculated LDL than direct LDL. In conclusion, direct LDL is higher than calculated LDL. Compared with direct measurement, the Friedewald calculation underestimates the risk for ischemic heart disease.
PMCID: PMC4175698  PMID: 25298632
Friedewald formula; Direct LDL; Calculated LDL
10.  Salivary Alpha Amylase Activity in Human Beings of Different Age Groups Subjected to Psychological Stress 
Salivary alpha-amylase (sAA) has been proposed as a sensitive non-invasive biomarker for stress-induced changes in the body that reflect the activity of the sympathetic nervous system. Though several experiments have been conducted to determine the validity of this salivary component as a reliable stress marker in human subjects, the effect of stress induced changes on sAA level in different age groups is least studied. This article reports the activity of sAA in human subjects of different age groups subjected to psychological stress induced through stressful video clip. Differences in sAA level based on sex of different age groups under stress have also been studied. A total of 112 subjects consisting of both the male and female subjects, divided into two groups on basis of age were viewed a video clip of corneal transplant surgery as stressor. Activity of sAA from saliva samples of the stressed subjects were measured and compared with the activity of the samples collected from the subjects before viewing the clip. The age ranges of subjects were 18–25 and 40–60 years. The sAA level increased significantly in both the groups after viewing the stressful video. The increase was more pronounced in the younger subjects. The level of sAA was comparatively more in males than females in the respective groups. No significant change in sAA activity was observed after viewing the soothed video clip. Significant increase of sAA level in response to psychological stress suggests that it might act as a reliable sympathetic activity biochemical marker in different stages of human beings.
PMCID: PMC4175699  PMID: 25298630
Age groups; Biomarker; Psychological stress; Salivary alpha amylase; Sympathetic nervous system
11.  Hb Hope: A Rare Variant of Haemoglobin-Forged a Rise in HbA1c on Immunoturbidimetric Assay 
Glycosylated hemoglobin (HbA1c) determination is a powerful means for assessing the evaluation and management of patients with diabetes mellitus. Hemoglobin (Hb) variants and chemically modified derivatives of Hb can affect the accuracy of measurement of HbA1c done by various analytical methods. We report a patient with a rare variant of Hb (Hb Hope) that caused an abnormally high value of HBA1c when assayed using immunoturbidimetric assay (“Tina-quant” 2nd generation assay) and also elucidate the nature of the variant.
PMCID: PMC4175701  PMID: 25298637
Glycosylated hemoglobin; Diabetes mellitus; Immunoturbidimetric assay
12.  Lactobacillusacidophilus Protected Organs in Experimental Arthritis by Regulating the Pro-inflammatory Cytokines 
Arthritis is an inflammatory disease of joints. Exact etiology of the disease is not understood yet; but histopathological examination of vital organs like liver, kidney, ovary and knee joint can anticipate immune mediated damage. In this study, Lactobacillus acidophilus was administered orally by both prophylactic and curative protocol in freund’s complete adjuvant induced arthritic rats. Indomethacin was used as standard anti-arthritic drug. Histopathology of liver, kidney, ovary and right hind knee joint were done. Cytokine concentrations were determined by using ELISA. Effects shown by L. acidophilus were comparable with indomethacin. Histopathological analysis of liver, kidney, ovaries and knee joints of L. acidophilus fed groups revealed significantly less damage as compared with other counterparts. Lactobacillus treatment has down-regulated pro-inflammatory level and up-regulated anti-inflammatory cytokines level in serum samples. L. acidophilus managed organs damage associated with arthritis. It has significantly down regulated the pro-inflammatory cytokines.
PMCID: PMC4175702  PMID: 25298628
Freund’s complete adjuvant; Probiotics; Neutrophil infiltrations; Bone damage
13.  Maternal Leptin, Adiponectin, Resistin, Visfatin and Tumor Necrosis Factor-Alpha in Normal and Gestational Diabetes 
Gestational diabetes mellitus (GDM) is a common medical complication associated with pregnancy. The present study evaluates the changes in maternal adipocytokines (leptin, adiponectin, resistin, visfatin and tumor necrosis factor-alpha; TNF-α) in pregnancy complicated with GDM compared to normal pregnancy at 2nd and 3rd trimesters. The study included total number of 142 pregnant women classified into 4 groups: normal pregnancy (n = 33) and pregnancy with GDM (n = 24) both at 2nd trimester and normal pregnancy (n = 38) and GDM (n = 47) at 3rd trimester. Both GDM groups were significantly presented with elevated body mass index, fasting blood sugar and abnormal oral glucose tolerance test compared to their matched control. Results indicated reduction in maternal serum leptin and adiponectin in GDM compared to normal pregnancy at 3rd trimester. Elevated resistin and TNF-α were evident among pregnancy complicated with GDM at both tested trimesters. On the other hand, significant elevation in maternal visfatin was noted between GDM and matched control at 2nd trimester only. Significant increase in maternal leptin and visfatin and resistin was noted by advances in gestational period in healthy pregnancy. On the other hand, reduced adiponectin and elevated visfatin mean values were noticed in GDM at 3rd compared to 2nd trimester. It could be concluded that increased insulin resistance accompanies GDM is associated with suppressed leptin and adiponectin and increased resistin and TNF-α which might suggest their involvement in the development of GDM.
PMCID: PMC4175703  PMID: 25298627
Diabetes; Adipocytokines; Pregnancy
14.  Delineation of the Structural Elements of Oriental Liver Fluke PLA2 Isoforms for Potent Drug Designing 
Clonorchis sinensis or the Chinese liver fluke is one of the most prevalent parasites affecting a major population in the oriental countries. The parasite lacks lipid generating mechanisms but is exposed to fatty acid rich bile in the liver. A secretory phospholipase A2, an enzyme that breaks down complex lipids, is important for the growth of the parasite. The enzyme is also implicated in the pathogenesis leading up to the hepatic fibrosis and its complications including cancer. The five isoforms of this particular enzyme from the parasite therefore qualify as potential drug targets. In this study, a detailed structural and ligand binding analysis of the isoforms has been done by modeling. The overall three dimensional structures of the isoforms are well conserved with three helices and a β-wing stabilized by four disulfide bonds. There are characteristic differences at the calcium binding loop, hydrophobic channel and the C-terminal domain that can potentially be exploited for drug binding. But the most significant feature pertains to the catalytic site where the isoforms exhibit three variations of either a histidine-aspartate-tyrosine or histidine-glutamate-tyrosine or histidine-aspartate-phenylalanine. Molecular docking studies show that isoform specific residues and their conformations in the substrate binding hydrophobic channel make unique interactions with certain inhibitor molecules resulting in a perfect tight fit. The proposed ligand molecules have a predicted affinity in micro-molar to nano-molar range. Interestingly, few of the ligand binding interaction patterns is in accordance to the phylogenetic studies to thereby establish the usefulness of evolutionary mechanisms in aiding ligand design. The molecular diversity of the parasitic PLA2 described in this study provides a platform for personalized medicine in the therapeutics of clonorchiasis.
Electronic supplementary material
The online version of this article (doi:10.1007/s12291-013-0377-1) contains supplementary material, which is available to authorized users.
PMCID: PMC4175704  PMID: 25298624
Clonorchis sinensis; Structural analysis; Isoform specific potent drug designing; Phospholipase A2
15.  An Evaluation of the Point-of-Care Analyzer, i-Smart 30, for Measurement of Electrolytes 
Analytical functioning of a point-of-care analyzer, i-Smart 30 (i-sens: Seoul, South Korea), for electrolyte quantification was investigated at Sant Parmanand Hospital, a tertiary-care hospital in Delhi, India. Samples that were received for electrolyte assay were assayed, double-blinded for their Na and K level using the arterial blood gas analyzer, the ABL 555 (Radiometer, Copenhagen) and the i-Smart 30 electrolyte analyzer. There was satisfactory correlation between the results obtained with the two analyzers with an encouraging bias, standard deviation and the 95 % limits of agreement between the data generated for Na and K levels. The performance of the i-Smart 30 would be satisfactory during the point-of-care measurements of Na and K levels in emergency rooms and clinical laboratories with inadequate infrastructure only if its day-to-day performance was monitored to ensure reliability of the generated reports.
PMCID: PMC4175705  PMID: 25298635
Electrolytes; Point-of-care assays; Field studies; Emergency investigations; Laboratory infrastructure
16.  Effects of Nanoliposomal and Pegylated Nanoliposomal Artemisinin in Treatment of Breast Cancer 
This study is aimed to investigate the nanoliposomal artemisinin preparation, and its implementation on breast cancer cells. Side effects have been one of the common challenges of drug usage, as well as cancer treatment. In order to reduce such effects, nanotechnology has been a great help. Nanoliposomes are provided through reverse phase evaporation. In this method, certain proportions of phosphatidylcholine, cholesterol and artemisinin were mixed together. Besides, the obtained formulation was pegylated by using polyethylene glycol 2000 in order to increase its stability and solubility. The mean diameter of non-pegylated and pegylated liposomal artemisinin was determined by Zeta sizer system. The percent of drug released from liposome was performed by dialysis. The encapsulation efficiency of both formulations was estimated by spectrophotometry method. As a result, encapsulation and drug release of nanoliposomal formulation were more than the pegylation of the same formulation. In addition, this study indicated that cytotoxicity effect of pegylated nanoliposomal artemisinin was more, in comparison with nanoliposomal artemisinin.
PMCID: PMC4175706  PMID: 25298633
Artemisinin; Nanoliposome; Breast cancer; Drug delivery; Cytotoxicity
17.  When is a South Indian Really Anemic? 
To determine the normal range of Hemoglobin and cutoff values in healthy adults of Southern India, blood samples were analyzed for parameters of RBC and iron metabolism in 177 male and 203 female medical students. The data were compared with the American white population (NHANES III) and the WHO criteria for detection of anemia. The mean values for hemoglobin and hematocrit in male students differed minimally from American white males. However, values for parameters of iron metabolism were lower except total iron binding capacity (TIBC) which was higher. In female students, hemoglobin, hematocrit and parameters of iron metabolism were lower than American white females, except TIBC which was higher. Lower 5th percentile cutoff point (Mean − 1.645 SD) in males and females were 13.5 and 10 g/dl respectively. In conclusion, South Indian adult males have Hb values similar to American male adults, but South Indian females have considerably lower Hb levels than American females, raising the questions about appropriateness of WHO or US criteria for detection of anemia in Indian females.
PMCID: PMC4175707  PMID: 25298629
Hemoglobin; Anemia; South Indian; Serum iron
18.  Alkaline Phosphatase: An Overview 
Alkaline phosphatase (ALP; E.C.3.I.3.1.) is an ubiquitous membrane-bound glycoprotein that catalyzes the hydrolysis of phosphate monoesters at basic pH values. Alkaline phosphatase is divided into four isozymes depending upon the site of tissue expression that are Intestinal ALP, Placental ALP, Germ cell ALP and tissue nonspecific alkaline phosphatase or liver/bone/kidney (L/B/K) ALP. The intestinal and placental ALP loci are located near the end of long arm of chromosome 2 and L/B/K ALP is located near the end of the short arm of chromosome 1. Although ALPs are present in many mammalian tissues and have been studied for the last several years still little is known about them. The bone isoenzyme may be involved in mammalian bone calcification and the intestinal isoenzyme is thought to play a role in the transport of phosphate into epithelial cells of the intestine. In this review, we tried to provide an overview about the various forms, structure and functions of alkaline phosphatase with special focus on liver/bone/kidney alkaline phosphatase.
PMCID: PMC4062654  PMID: 24966474
Enzymes; Isoenzymes; Alkaline phosphatase; L/B/K alkaline phosphatase; Liver alkaline phosphatase; Intestinal alkaline phosphatase; Placental alkaline phosphatase
19.  Diagnostic Value of Lactate Levels in Acute Abdomen Disorders 
The supply of oxygen is limited in certain intra abdominal conditions due to direct vascular invasion or inflammatory process, resulting in high lactate levels. Aim of this study was to find the predictive value of lactate levels in the peritoneal fluid (PF) and blood of patients with acute abdomen. The study comprised of fifty patients with acute abdominal conditions, admitted in emergency ward of tertiary care hospital, thirty patients were with surgical abdomen (group I) and twenty patients with non surgical abdomen (group II). Lactate was estimated in PF and blood on Blood Gas Analyzer (NOVA, M-7). The mean lactate levels in PF were significantly higher in group I as compared to group II (14.65 ± 1.195 vs. 5.92 ± 0.97 mmol/L, p < 0.001). There was no significant difference in blood lactate levels in both the groups. When PF and blood lactate levels were compared within groups, we found that PF levels were significantly higher than blood in group I (14.65 ± 1.195 vs. 3.85 ± 0.54 mmol/L, p < 0.001) but not in group II (5.92 ± 0.97 vs. 4.36 ± 0.95 mmol/L). Diagnostic value was obtained using ROC curve. Cut off values obtained for PF lactate, difference and ratio of PF and blood lactate (≥6.4 mmol/L, ≥3.3 and ≥2.1 respectively) are at very high degree of sensitivity and specificity. So it can be useful marker of surgical emergency in patients with acute intra abdominal pathology, especially in clinically ill patients or in whom physical examination is not yielding because of neurologic disorders or unresponsiveness.
PMCID: PMC4062655  PMID: 24966491
Acute abdomen; Blood lactate; Peritoneal fluid lactate
20.  Assessment of Serum Calcium and Phosphorus in Pulmonary Tuberculosis Patients Before, During and After Chemotherapy 
Our study was aimed to assess the levels of serum calcium and phosphorus in pulmonary tuberculosis patients. Blood samples were collected from 40 patients with pulmonary tuberculosis before treatment (PTB-0), at the end of 2 months of intensive phase of treatment (PTB-2) and after 6 months of treatment (PTB-6). Age and weight matched normal healthy volunteers (n = 37) served as normal controls. Serum was analyzed for calcium and phosphorus. Serum calcium significantly decreased to hypocalcemic levels and serum phosphorus significantly decreased but was within normophosphatemic limits in pulmonary tuberculosis. Chemotherapy for tuberculosis managed to raise serum levels of both the ions, with hypocalcemia still persisting in majority of patients during treatment but getting resolved in a significant percentage of patients at the end of 6 months of treatment. Results indicate the need for calcium and phosphorus supplements in tuberculosis patients during chemotherapy. This study also warrants the need for regular monitoring of serum calcium and phosphorus in patients undergoing anti-tuberculosis treatment.
PMCID: PMC4062656  PMID: 24966490
Hypocalcemia; Normophosphatemia; Anti-tuberculosis treatment; Chemotherapy
21.  Hematological and Biochemical Parameters in Apparently Healthy Indian Population: Defining Reference Intervals 
Clinical reference intervals among Indian population are poorly defined. Therefore, there is an urgent need to establish local clinical laboratory reference intervals for healthy Indian population. The present study aimed to identify the 95 % reference interval for hematological and biochemical parameters in apparently healthy Indian population. We undertook a multicentric cross-sectional study conducted at Apollo Hospitals Educational and Research Foundation across India. Of which 10,665 reference individuals identified as healthy by physicians. The 95 % of the reference distribution was estimated using 2.5th and 97.5th percentile reference limits. The 95 % reference intervals for hemoglobin (Males: 12.3–17 g/dL; Females: 9.9–14.3 g/dL), platelet count (Males: 1.3–3.8; Females: 1.3–4.2 Lakhs/µL), erythrocyte sedimentation rate (Males: 2–22; Females: 4–55 mm/h), serum uric acid in males: 3.5–8.2 mg/dL, gamma glutamyl transferase (Males: 13–61 U/L), fasting blood glucose (Males: 78–110 mg/dL), total cholesterol (Males: 115–254 mg/dL), low density lipoprotein (Males: 60–176 mg/dL) and triglycerides (Males: 55–267 mg/dL, Females: 52–207 mg/dL) were different from currently used reference values. Additionally need for gender based partitioning were observed for triglycerides and gamma glutamyl transferase. The observed findings are of clinical significance and it needs to be validated with additional community based studies.
PMCID: PMC4062657  PMID: 24966476
Reference intervals; Normal values; India; Lipoproteins; Hemoglobin; Resource-limited settings
22.  Effect of Gold Nanoparticles on Properties of Nanoliposomal Hydroxyurea: An In Vitro Study 
New hopes in cancer treatment have been emerged using functional nanoparticles. In this work, we tried to synthesize gold nanoparticles and gold nanoparticles conjugated with DNA extracted from human breast cancer cells. After synthesizing, gold nanoparticles were mixed with nanoliposomal hydroxyurea and corresponding compounds were formed. They were described by UV–Visible spectrophotometry and Zeta sizer. Amount of drug loading into liposomes was determined by spectrophotometry and cytotoxicity effect on MCF-7 cells was measure by MTT assay. Drug loading was determined to be 70 %. Size, size distribution and Zeta potential of particles were 473 nm, 0.46 and −21 mV for control nanoliposomal ones and 351 nm, 0.38 and −25 mV for nanoliposomal particles containing hydroxyurea. This was 29 nm, 0.23 and −30 mV for gold nanoparticles and 502 nm, 0.41 and −38 mV for nanoliposomes containing drug loaded by gold nanoparticles conjugated with DNA. It was found that nano conjugated complex in concentrations less than 20 μM of hydroxyurea can improve efficiency compared with liposomal drug. In maximum concentration of drug (2,500 μM), cytotoxicity was equal to 95 %. In minimum concentration of drug (5 μM), cytotoxicity of liposomal drug and conjugated complex were 70 and 81 %, respectively which probably comes from increased drug entry into cells due to the presence of gold nanoparticles. Free drug resulted in toxicity of 32 % in 5 μM and 88 % in 2,500 μM. Results demonstrated higher drug efficiency in nanoparticle form compared with free form which can be used in in vivo studies.
PMCID: PMC4062658  PMID: 24966479
Gold nanoparticle; Liposome; Hydroxyurea; Drug delivery
23.  Hyperemesis Gravidarum is a Syndrome of Metabolic and Endocrine Disturbances: A Case Description 
Hyperemesis gravidarum is a clinical syndrome characterized by excess vomiting, dehydration and weight loss associated high human chorionic gonadotropin levels, usually occurring in the first trimester of gestation. It often presents with severe electrolyte imbalance, mental confusion and may be associated with thyroid dysfunction. We are describing the management of one such case riddled with multiple metabolic events.
PMCID: PMC4062659  PMID: 24966493
Hyperemesis gravidarum; Hyponatremia; Transient hyperthyroidism of hyperemesis gravidarum (THHG); Wernicke’s encephalopathy; Central pontine myelinolysis
24.  A Case of Severe Ovarian Hyperstimulation Syndrome 
Ovulation induction has been an important mode of treatment of infertility. Ovarian stimulation may result in a supraphysiologic response leading to an iatrogenic complication known as the ovarian hyperstimulation syndrome (OHSS). This syndrome is potentially a lethal condition, the pathophysiologic hallmark of which is the accumulation of massive extravascular exudate combined with profound intravascular volume depletion and hemoconcentration. We report a case of severe OHSS with very large ovaries in a 35 year old case of embryo transfer. The patient presented to the emergency department with abdominal pain, massive ascites, respiratory distress and amenorrhea. The patient was managed symptomatically with no complications. Although ovarian hyperstimulation is a rare entity, it is important that the physician recognizes this condition. Prompt diagnosis and successful management is likely to avoid serious and rapid development of complications.
PMCID: PMC4062660  PMID: 24966492
Ovarian stimulation; Ovarian hyperstimulation syndrome; Gonadotropin; Ovulation induction; Assisted reproduction; Anti cardiolipin antibodies
25.  Preparation and Characterization of Gold Nanoparticles with Amino Acids, Examination of Their Stability 
We report a novel strategy for the synthesis and capping of gold nanoparticles (GNPs) by tryptophan, glutamic acid and aspartic acid. The ratio of chloroaurate ions to amino acid was optimized in the reaction medium to obtain monodispersed GNPs. The size of nanoparticles and size distribution were controlled by sodium dodecyl sulfate which demonstrated high stability in aqueous solution over a period of time. GNPs were characterized by UV–Vis spectroscopy, dynamic light scattering and transmission electron microscopy.
PMCID: PMC4062661  PMID: 24966478
Gold nanoparticles; Amino acids; Stability; SDS

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