Sudhakar S. Nayak

A new colorimetric method for the estimation of glycosylated hemoglobin

A new colorimetric method, based on the phenol sulphuric acid reaction of carbohydrates, is described for the determination of glycosylated hemoglobin. Hemolyzates were treated with 1 mol/l oxalic acid in 2 mol/l Hcl for 4 h at 100 degrees C, the protein was precipitated with trichloroacetic acid, and the free sugars and hydroxymethyl furfural in the protein free supernatant were treated with phenol and sulphuric acid to form the color. The new method is compared to the thiobarbituric acid method and the ion-exchange chromatographic method for the estimation of glycosylated hemoglobin in normals and diabetics. The increase in glycosylated hemoglobin in diabetic patients as estimated by the phenol-sulphuric acid method was more significant (P less than 0.001) than the increase observed by the thiobarbituric acid method (P less than 0.01). The correlation between the phenol-sulphuric acid method and the column method was better (r = 0.91) than the correlation between the thiobarbituric acid method and the column method (r = 0.84). No significant correlation between fasting and postprandial blood sugar level and glycosylated hemoglobin level as determined by the two colorimetric methods was observed in diabetic patients.

Urinary hydrogen peroxide: a probable marker of oxidative stress in malignancy

BACKGROUND Urinary hydrogen peroxide was postulated to be a biomarker of oxidative stress. We estimated urinary hydrogen peroxide along with other established parameters of oxidative stress in malignancies where oxidative stress is well documented. METHODS The oxidative stress markers tested were concentrations of erythrocyte glutathione, erythrocyte malonaldehyde (MDA) and plasma hydroperoxide, and activities of plasma glutathione-S-transferase (GST) and erythrocyte catalase. Urinary hydrogen peroxide was measured by a modified ferrous ion oxidation xylenol orange version-2 (FOX-2) method on a spot random sample of urine. RESULTS In healthy controls (n=10), erythrocyte glutathione concentration was 4.41+/-0.057mg/g of hemoglobin, plasma hydroperoxide was 2.5+/-0.07 micromol/l, erythrocyte MDA was 0.9+/-0.15 nmol/ml of packed cell suspension and erythrocyte catalase and plasma GST were 74.66+/-9.2/s/ml of packed cell suspension and 6.12+/-0.84 IU/l, respectively. In cancer patients (n=25), erythrocyte glutathione, plasma hydroperoxide and erythrocyte MDA were 9.32+/-0.42 mg/g of hemoglobin, 6.2+/-0.13 micromol/l and 2.3+/-0.27 nmol/ml of packed cell suspension, respectively; and activities of erythrocyte catalase and plasma GST were 151.04+/-6.5/s/ml of packed cell suspension and 10.9+/-0.36 IU/l, respectively. Urinary hydrogen peroxide concentration was 15+/-9.8 micromol/l in the healthy controls and 56.3+/-3.9 micromol/l in cancer patients. CONCLUSION Urinary hydrogen peroxide may be a marker of oxidative stress in malignancies.

Serum Apolipoproteins A and B, Lecithin: Cholesterol Acyl Transferase Activities and Urinary Cholesterol Levels in Nephrotic Syndrome Patients before and during Steroid Treatment

Serum apolipoproteins A (Apo-A) and B (Apo-B) and lecithin: cholesterol acyl transferase (LCAT) activities and 24-hour urinary cholesterol levels were estimated in 25 nephrotic children before and during steroid treatment with 4 weeks of daily prednisolone followed by another 4 weeks of alternate-day prednisolone. The patients with untreated nephrotic syndrome (NS) showed significant decrease in serum Apo-A and LCAT activities associated with significant increase in serum Apo-B and urinary cholesterol levels compared to healthy controls (n = 25). Serum Apo-A levels correlated directly and Apo-B levels inversely with the serum albumin concentrations. After a transient elevation, the serum Apo-A level returned to control range by 8 weeks of treatment accompanied by a gradual increase in serum LCAT activity and decrease in urinary cholesterol excretion. Though, the serum Apo-B level was decreased with treatment, it was still significantly high compared to the controls.

Diagnostic significance of estimation of serum apolipoprotein A along with α-fetoprotein in alcoholic cirrhosis and hepatocellular carcinoma patients

The serum apolipoprotein A (Apo A) and alpha-fetoprotein (AFP) were evaluated in histologically verified 30 cases of alcoholic cirrhosis and 18 cases of hepatocellular carcinoma (HCC). The latter were also divided into subgroups depending on the presence or absence of associated cirrhosis. Serum Apo A levels were found to be significantly decreased in cirrhotics (p less than 0.001) compared to controls and non-cirrhotic HCC patients. In 22 cases of alcoholic cirrhosis (AFP less than 10 ng/ml) and 12 cases of HCC (AFP greater than 600 ng/ml), the AFP levels itself were diagnostic, but in the remaining cases, AFP levels (100-600 ng/ml) were not able to differentiate between cirrhosis and malignancy. In this later group of patients with low pathological range of AFP, serum Apo A levels found to be significantly decreased in alcoholic cirrhotic patients (p less than 0.001) compared to HCC patients. Thus, estimation of Apo A levels may be helpful to interpret the AFP values at lower pathological range due to suspected liver pathology.

Serum apoproteins A and B and the lecithin: cholesterol acyl transferase activities in liver cirrhosis and hepatic coma patients

Serum apoproteins A and B and LCAT activities were estimated in 80 patients, 46 with posthepatic cirrhosis and 34 with alcoholic cirrhosis. The cirrhosis patients were also divided into compensated, decompensated, and hepatic coma subgroups. Apo-A and LCAT activities were significantly decreased in both cirrhotic groups without any significant difference between posthepatitic and alcoholic cirrhotic groups, while Apo-B was decreased in hepatic coma patients only. The decompensated cirrhosis patients showed lower Apo-A levels than the compensated cirrhosis patients and hepatic coma patients showed still lower levels compared to decompensated subgroup, while no significant decrease was observed in LCAT activities between compensated and decompensated cirrhosis patients. Apo-A level was correlated more significantly with serum albumin level than the LCAT activity. The study confirms that Apo-A level is highly related to the degree of liver injury and also suggests that this decrease may be mainly due to impaired liver synthesis and that the serum levels of Apo-A and Apo-B can be utilized in the differential diagnosis of chronic liver diseases.

Symptoms experienced by cancer patients and barriers to symptom management

Background: People living with cancer experience wide variety of symptoms. If symptoms are not managed well, it may hamper an individuals ability to continue his or her activities of daily life. Treatment of symptoms relieves suffering and improves the rate of recovery as well as the quality of life. Objectives: To assess the symptoms of suffering among cancer patients and to identify the perceived barriers to their symptom management. Materials and Methods: A cross-sectional study was carried out among 768 cancer patients selected by stratified sampling with a proportionate selection from each stratum. Data were collected from cancer patients by interview technique using structured validated questionnaire. Results: Majority of the samples (30.2%) belonged to the age group of 51–60 years, most of them were diagnosed with head and neck cancer (40.1%) and 57.7% had stage III disease. The majority of the patients studied had pain (77%), tiredness (96.5%), disturbed sleep (96.4%), weight loss (63.3%), and irritability (85.7%). Most of the patients had lack of appetite (89.4%), feeling of sadness (96.6%), worry (94.5%), and feeling of nervousness (82.8%). Majority of the patients had some misconception regarding symptoms, that is, increasing pain signifies disease progression (92.7%), medicine to control pain may weaken the immune system (89.9%) and pain is inevitable for cancer patients (78.5%). Seventy-seven percent of samples reported that the anxiety or depression is expected after the diagnosis of cancer. Conclusion: This study provides an overview of symptoms among cancer patients and barriers experienced by them.

Quality of life among cancer patients

Introduction: Cancer is a leading cause of death. People living with cancer experience a variety of symptoms. Quality of life (QOL) is a major concern of patients with terminal cancer. Symptoms affect their QOL. Management of symptoms improves distress and QOL. Objective: The objective of the study was to assess the QOL among cancer patients. Materials and Methods: A survey was conducted among 768 cancer patients selected by a convenient sampling technique. Data was collected from cancer patients by interview technique using structured and validated interviewed schedule. Results: Out of 768 cancer patients, 30.2% patients were in the age group of 51–60 years, majority with head–and-neck cancer (40.1%), and 57.7% had stage III disease. QOL of majority of patients was influenced by their symptoms. 82.3% of them had low QOL scores. Conclusion: Cancer patients experienced many symptoms that affected their QOL. There is a need to develop interventions for effective management of symptoms that will empower the patients to have a greater sense of control over their illness and treatment and to improve the QOL.

Effect of cigarette smoking on serum lipid, lipoprotein and apolipoprotein levels in hypertensives receiving β-adrenoreceptor blocking drugs

Both cigarette smoking and propranolol administration significantly alter plasma lipid profile. We examined the relationship of cigarette smoking and propranolol administration with fasting serum total cholesterol, triglyceride, lipoprotein cholesterol subfractions (high density, low density, and very low density), Apo-A, Apo-B and ratios obtained from these variables in 42 hypertensive patients. Significantly lower values of HDL cholesterol, Apo-A and HDL-C/total cholesterol and Apo-A/Apo-B ratios were observed in smokers taking propranolol than non-smokers not taking propranolol. Smokers who were not on propranolol also had significantly lower values as compared to non-smokers. These findings suggest that smoking may be the more significant factor responsible for alteration in lipid profile.

Clinical utility of estimation of serum apolipoproteins A and B in patients with chronic liver disease

The liver obviously has a central role in human lipoprotein metaboKsm (1-8). Apolipoprotein-A (Apo-A, Apo A-I + Apo A-II), the major apoprotein of high density lipoproteins (HDL) (9, 10) and Apolipoprotein-B (Apo-B), the major apoprotein of low density lipoproteins (LDL) (11, 12) are partially synthesized by liver cells (13-15). Apart from being important structural components of HDL and LDL, the Apo A-I also functions as the activator for lecithin: cholesterol acyl transferase (LCAT) (16, 17), a plasma enzyme c, atalysing the conversion of nascent HDL to mature HDL (18, 19) whereas Apo A-II acts as an inhibitor for LCAT (17) and Apo-B plays an important role in regulating cholesterol synthesis and degradation (20-22). Due to several extensive epidemiological studies, interest has focused in recent years on the relationship between coronary artery disease (CAD) and plasma levels of lipoproteincholesterol subfractions, Apo-A and Apo-B (23, 24). However, ~he recognition of an association between alcohol intake and CAD (25-28) has prompted several authors to study the alcohol induced hepatic changes leading to alterations in serum lipids and lipoproteins (29-33) and many studies have also report e fl altered serum Apo-A or Apo A-I (Apo-A/A-I) and Apo-B levels in various liver diseases (34-42). However, on reevaluating the results observed for serum Apo-A/A-I and Apo-B levels in various liver diseases, it becomes apparent that the serum ApoA/A-I and Apo-B levels can also be utilized for solving various clinical and biochemical problems pertaining to liver pathology. This review article tries tff highlight this new in~eresting role of serum Apo-A/A-I and Apo-B levels in the field of diagnostic hepatology and to suggest some of the future research work that can be carried out in this field.

β Blockers, lipids, and coronary atherosclerosis

Heroin addicts, AIDS, and aflatoxins R G Hendrickse, FRCP, and SM Maxwell, MB 1257 (3 Blockers, lipids, and coronary atherosclerosis A Ramani, MD, and others ......................... 1257 Surgical aspects of drug smuggling E Clifford, MB, and others ......................... 1258 Urinary catheters S L Stanton, FRCOG; D J Waghorn, MB, and others; CM Castleden, FRCP, and others ....... 1258 Sexual dysfunction among middle aged women Ruth Skrine, MRCGP; B M Goss, MRCGP ........ 1259 Death despite malaria prophylaxis E L C Ong, MRCP, and EM Dunbar, MRCP .... 1259 Clinical carpal scaphoid injuries J J Langham-Brown, FRCR ........................ 1259 Wheelchairs M A Tudor, MB; J B Young, MRCP ............... 1259 Psychiatric illness among British Afro-Caribbeans J Merrill, MRCPSYCH, and J Owens, MB ......... 1260 The need to make rugby safer J Piggot, FRCS ................................ ........ 1260 Hypoglycaemia in patients with insulin dependent diabetes I Sturgess, MRCP, and others ...................... 1260 Korner, nomenclature, and SNOMED BW Ellis,FRCS ....................................... 1261 Interview for medical student selection W F M Wallace, FRCP; D A Powis, PHD, and others ............ ...................... 1261 Achieving a balance P McDonald, FRCS, and A McIrvine, FRCS ..... 1261 Drug points Generalised chorea due to digoxin toxicity (L J M M Mulder and others); Neutropenia caused by intravenous immunoglobulin (R V Majer and P J Green); Purpuric rash associated with slow release morphine (R J Whiston and others); Gynaecomastia associated with captopril (HM Markusse and RH B Meyboom) ......... 1262 Points Griffiths on community care (B R W Lodge; M Warren); Transporting critically ill patients (P Meyer); Late life depression: undertreated? (H P Rosenvinge; Som D Soni); How informed is signed consent? (Diane E Wallis); Home visiting by consultants (D Brodie); Osteoporosis in elderly Chinese (EdithMC Lau); A slip ofthe knife (C Illingworth); Ammonia burns of the eye (O Wrong) ................................. 1263