Happy Chutia

Introduction: Coronary atherosclerosis is a condition that affects the arteries supplying the heart. The soluble Vascular Cell Adhesion Molecule-1 (sVCAM-1) belongs to the immunoglobulin superfamily, and its expression is increased in vascular endothelial cells in atherosclerosis. Aim: To estimate serum sVCAM-1 in atherosclerotic Coronary Artery Disease (CAD) patients with varying severity and to look for its association with the Atherogenic Index (AI). Materials and Methods: This hospital-based cross-sectional study was carried out in the Department of Biochemistry at NEIGRIHMS, a tertiary care Institute in the northeastern part, Shillong India, for a period of one year (2019) with 68 angiographically confirmed newly diagnosed CAD patients and were divided into three groups as Single Vessel Disease (SVD), Double Vessel Disease (DVD) and Triple Vessel Disease (TVD). The following biochemical tests were performed on fasting serum samples: Glucose, lipid profiles {Total cholesterol, High Density Lipid (HDL)-C, Low Density Lipid (LDL)-C, Triglycerides (TG)}, Interleukin-6(IL-6), and sVCAM-1. The Chi-square test was used to assess the significance of the association of risk factors such as hypertension, smoking, and diabetes in the participants. One-way Analysis of Variance (ANOVA) was conducted to identify significant differences in the levels of the estimated parameters among the participant groups. Results: The average age of presentation for the study participants was 61±10.8 years. The study involved 68 recently diagnosed patients with confirmed CAD, of whom 59 (87%) were males and 9 (13%) were females. Among the total patients, 44 (65%) were smokers, 45 (66%) had hypertension, and 29 (43%) were diabetic. The Chi-square test revealed a significant association between smoking (p-value=0.015) and hypertension (p-value=0.008) with CAD, but no association was found with diabetic status. The level of serum sVCAM-1 was found to increase with the number of vessels involved. Significant differences were observed in the levels of serum cholesterol and LDL-C among the groups (TVD>DVD>SVD). The bivariate Pearson’s correlation test between Antherogenic Index (AI) and sVCAM-1 showed a statistically significant positive correlation (r=0.33, p-value=0.0059). Conclusion: Serum sVCAM-1 levels may be used for the followup study of patients with CAD, which could be more economical and convenient compared to {Total cholesterol, High Density Lipid (HDL)-C, Low Density Lipid (LDL)-C, Triglycerides (TG)} angiography.

Introduction: In recent times, there has been a surge in proposed alternative approaches to computing lowdensity lipoprotein cholesterol (LDL-C), with a focus on enhancing precision, particularly within diverse demographic and clinical groups. Our aim is to assess the agreement, precision, and practicality of these methods compared to direct LDL-C measurements, with the goal of identifying the most effective approach for estimating LDL-C in the Indian context. Methods: It is a retrospective analytical study. Lipid profile data were gathered from the laboratory and organized in Microsoft Excel for analysis. LDL-C was computed using three different methods: the Friedwald formula, the Martin -Hopkins formula, and Sampson's formula. These calculations were then compared with the direct method of LDL-C estimation in two distinct groups: when triglyceride (TG) levels were less than 400 mg/dL and when TG levels exceeded 400 mg/dL. Bland -Altman plots were generated, and concordance correlation coefficients (CCCs) were computed to determine the most suitable calculated method. Results: Data from 1,776 participants were analysed and divided into two groups. In both Group 1 (TG < 400 mg/dL) and Group 2 (TG > 400 mg/dL) considering bias, limits of agreements, and correlation coefficient, as seen on the Bland -Altman and CCC, Martin -Hopkins equation was found to be performing better than Friedwald and Sampson's equation. Conclusion: In this study, the Martin -Hopkins formula appears to be the most appropriate choice for precise LDL-C level measurements and indicated improved accuracy and consistency in LDL-C measurements, especially in individuals with elevated TG levels. This underscores its importance in ensuring precise assessment and suitable clinical management.

AIM: The aim of this interventional study was to introduce classroom quality circles (QCs) among first-year MBBS students, to assess the effectiveness of QCs on learning experience of the students, and to evaluate the students' satisfaction level during the process of learning. MATERIALS And METHODS: A problem pool was created through a questionnaire. The study was carried out in the department of biochemistry, for a period of 6 months. Student's quality circle (SQC) group of five students was created. Then, feedbacks were collected from students by SQC after every class/topic delivered, and fortnightly meeting was held between the SQC group and faculty members of the department, and issues were brought to focus depending on these feedbacks collected by them. Possible initiatives and improvements were done on teaching–learning strategies depending on the outcome of these discussions. RESULTS: The effectiveness of SQC group was assessed by a pre-post questionnaire (Questionnaire-3) feedback from the students and scoring was done based on 5-point Likert scale. There was a statistically significant difference (P = 0.009) between the mean of pre-post questionnaire. To analyze the students' satisfaction level, a set of questionnaires were given to them and scoring was done. Thirty-four students agreed, 11 students were neutral, and 6 students were disagreed, that introduction of SQC was effective in solving their problems related to teaching and learning of biochemistry. CONCLUSION: SQC creates an environment of student centric, fairness, student empowerment, improving solving skills. Implementation of student-generated feedback through introduction of SQC has improved the quality of the course as well as its delivery. It complements and supplements in achieving students intended learning outcome and hence may contribute to overall learning quality in the long run.

Background: Diabetes mellitus (DM) and thyroid dysfunctions are the two most common endocrine disorders to come across in any clinical practice. Both thyroid hormones and insulin act antagonistically in metabolic pathways or cycles of cells. The aim of our study is to look for thyroid dysfunction in patients with type 2 DM and its correlation with insulin resistance (IR). Methods: A cross-sectional study was carried out among 80 newly diagnosed type 2 diabetic patients. Thyroid-stimulating hormone (TSH), free triiodothyronine, free thyroxine, and insulin were measured in fasting serum sample. Homeostasis model assessment for IR was calculated as per formula. Results: Among 80 diabetic patients, 20 were hypothyroid, 4 were hyperthyroid, and 56 were found to be euthyroid. IR was found to be significantly higher in hypothyroid as compared to euthyroid patients. A positive association was found between TSH and IR ( r = 0.230) among hypothyroid patients though association was not significant. In hyperthyroid patients, a strong negative correlation ( r = −0.94933) was found between TSH and IR, but no association was found among euthyroid patients. Conclusion: The inability to recognize the presence of thyroid hormone dysfunction may be one of the important causes of poor management of type 2 DM. Therefore, there is a need for routine assay of thyroid hormones in type 2 diabetic patients to improve the medical management as well as to reduce the morbidity in them.

Journal of Clinical and Diagnostic Research aims to publish findings of doctors at grass root level and post graduate students, so that all unique medical experiences are recorded in literature.

Background: Insulin resistance (IR) is the key pathophysiological defect that leads to the development of type 2 diabetes mellitus. The purpose of this study was to estimate serum magnesium level and insulin sensitivity indices among type 2 diabetes mellitus patients and to see an association between them. Methods: This study was carried out among 38 type 2 diabetic patients and forty age and sex matched controls. Serum fasting glucose, magnesium, insulin, urea, and creatinine levels were estimated. Insulin sensitivity indices, homeostasis model assessment for insulin resistance (HOMA-IR) and quantitative insulin sensitivity check index (QUICKI) levels were calculated as per formulae. Results: A highly significant low serum magnesium level was found in diabetic subjects as compared to the controls. Statistically significant high HOMA levels (>2.6) and low QUICKI levels (< 0.33) were found among the case group. An inverse, statistically significant correlation was found between serum magnesium and fasting insulin level. A highly statistically significant inverse correlation was found between serum magnesium and HOMA level, and a positive correlation was found between serum magnesium and QUICKI level, that is, serum magnesium level decreases with increase in IR. A strong association was also found between fasting serum insulin level and insulin sensitivity indices. Conclusion: This study showed a lower serum magnesium level in diabetic patients compared to control. A strong association was also found between serum magnesium level and insulin sensitivity indices. For proper management of type 2 diabetes, it may, therefore, be necessary to treat hypomagnesemia in these patients.

Purpose: Secondary hyperparathyroidism (SHPT) is one of the less recognized reasons of anemia in chronic kidney disease (CKD). In this study, we evaluated the role of SHPT as a cause of anemia and correlation of intact parathyroid hormone (iPTH) and hemoglobin (Hb) level in hemodialysis (HD) patients. Methods: This cross-sectional study was carried out in 63 individuals admitted in HD unit of the institute. Serum samples were collected and urea, creatinine, Hb, ferritin and iPTH levels were measured. Statistical analysis was carried out using the SPSS software (IBM, NY, USA). Results: Mean ± standard deviation for serum urea, creatinine, Hb, ferritin and intact PTH were 177 ± 15.52, 15.16 ± 2.28 mg/dl, 7.03 ± 2.26 g/dl, 654.7 ± 563.4 ng/ml, 539.18 ± 493.59 pg/ml respectively. A reverse correlation was found between intact PTH and Hb level. Conclusions: A variety of postulated pathophysiological mechanisms linking SHPT and anemia in CKD are discussed. An efficient control of parathyroid hormone hypersecretion may be required to achieve a better management of anemia in HD patients.