Spurious Hyperphosphatemia in a Case of Multiple Myeloma

A 50 year old male was admitted in our hospital with anemia and impaired renal function. He was subsequently found to have extremely elevated serum phosphate level (24 mg/dL, reference interval: 2.5–4.5 mg/dL) with normal serum calcium when assayed on a Beckman Coulter AU 480^® analyser. Clinico-biochemical discrepancy led to the suspicion of spurious hyperphosphatemia. Serum total protein was grossly elevated with gross reversal of albumin to globulin ratio. Serum electrophoresis revealed a large M band and was confirmed as Ig G-Kappa type on immunofixation. Subsequently a bone marrow aspiration biopsy confirmed the diagnosis of multiple myeloma. The patient serum was then reassayed for phosphate on a Vitros^® 250 Dry Chemistry platform and the result was within normal reference interval. Paraproteinemias are a common cause of analytical interference in clinical biochemistry laboratories and as multilayered film technology platforms like Vitros^® assay most routine analytes on a protein free filtrate they are unaffected by paraprotein interference. Clinically discordant patient results should always be interpreted keeping such interferences in mind.     

Comparison Between Serum hsCRP and LDL Cholesterol for Search of a Better Predictor for Ischemic Heart Disease

Acute myocardial Infarction is one of the major causes of morbidity & mortality in world and atherosclerosis is the major cause of ischemic heart disease. In order to determine the better clinical marker of atherosclerosis, we estimated serum low-density lipoprotein (LDL-C) and high sensitivity C-reactive protein (hsCRP). Hundred patients of myocardial infarction and 100 controls irrespective of age and sex were studied for these parameters over a period of 2 years. The statistical analysis showed that the serum hsCRP was significantly raised in myocardial infarction cases than controls (P < 0.01) but LDL-C was not (P > 0.05). We conclude that the serum hsCRP has better predictive value for risk of atherosclerosis.     

The effect of culture and belief systems on students’ academic buoyancy

Increasingly, learner motivation is implicated in student failure at universities. This has led to intense research into internal or external variables that might buoy resilience to failure. This research investigates the impact of strong cultural connectedness and strong belief systems on the academic buoyancy of international students studying at an Australian University. For this purpose, we surveyed 102 tertiary students at a Sydney university. Results demonstrate that, in the event of academic failure, students’ academic buoyancy remains high if they have support through strong cultural connections and from their belief systems. We further endeavored to identify if academic buoyancy was fed by intrinsic or extrinsic motivation. This research contributes to the understanding of the sources of strengths available to international students from primarily collective cultures studying overseas. There are implications for educational practice in terms of identifying students ‘at high risk’ if they are unable to draw strengths from cultural connections and belief systems.     

Extracting Fuel Efficiency Information From the Car Dashboard Display An Application of Interpolation Technique

We discuss an application of interpolation of curves to extract fuel efficiency information of cars. Input data is taken from the mileage meter in the dashboard display of cars equipped with such a facility. This is also an application of harmonic mean.     

Hepcidin and Ferritin: Important Mediators in Inflammation Associated Anemia in Systemic Lupus Erythematosus Patients

Systemic Lupus Erythematosus is an autoimmune disease with female preponderance. Anemia is found in 50% of Systemic Lupus Erythematosus patients. This is a cross sectional case control study with 30 female Systemic Lupus Erythematosus patients having inflammation associated anemia (Hemoglobin < 10.0 gm/dl) and 30 age matched controls with the aim to measure serum hepcidin and ferritin levels, correlate and study their role as homeostatic regulators of iron metabolism and utility as markers. Serum transferrin, ferritin, iron, total iron binding capacity, hsCRP, liver enzymes and renal parameters were analyzed by using automated analyser. Hepcidin levels were estimated by Sandwich-ELISA method. There was significant decrease in Iron (p < 0.0001), Iron Binding capacity (p < 0.0001), Transferrin (p < 0.0001) in patients, and a significant increase in inflammatory markers: hs-CRP (p < 0.0001), ESR (p < 0.0001) compared to controls. Significant increase in both Hepcidin (p < 0.0001) and Ferritin (p < 0.0001) was observed in patients with significant positive correlation (r = 0.711) with each other. Additionally, ferritin and hepcidin significantly positively correlated with hs-CRP and ESR (r = 0.526, 0.735); (r = 0.427, 0.742) respectively. Negative correlation with hemoglobin, iron, total iron binding capacity and transferrin with hepcidin (r = ? 0.80, ? 0.307, ? 0.553, ? 0.584) and ferritin (r = ?0.722, ? 0.22, ? 0.654, ? 0.728) was observed respectively. On ROC analysis both hepcidin and ferritin has sensitivity of 96.7%, specificity of 100% at cut-off values of 110 and 49 respectively. AUC of hepcidin was 0.993 and ferritin was 0.978. We have established a positive linear correlation between Hepcidin and Ferritin levels in disease activity and the changes correlated with the inflammatory state and anemia in patients, making them important mediators and potential markers of inflammation associated anemia.     

Positive influence of Methotrexate-Hydroxychloroquine combination on the expression of GM-CSF receptor on neutrophils of synovial fluid in rheumatoid arthritis

Granulocyte Macrophage Colony Stimulating Factor (GM-CSF) has been inducted as a mediator of inflammation in rheumatoid arthritis. Methotrexate combination therapy forms an important component of the treatment regimen in rheumatoid arthritis. The present study was undertaken to evaluate the influence of Methotrexate-Hydroxychloroquine (MTX-HCQ) combination and Sulfsalazine- Hydroxychloroquine (SSZ-HCQ) combination on the expression GM-CSFR in neutrophils isolated from synovial fluids. 15 cases of confirmed rheumatoid arthritis patients who presented at the hospital for surgical correction of joint deformities were selected for the study. Neutrophils isolated from the synovial fluids were used as the source of the receptor for quantitation on an enzyme immunoassay (EIA). The EIA was developed and standardized in our laboratory for quantification of the GM-CSF R. The findings are suggestive of the fact that the administration of MTX-HCQ combination has positive influence on the expression of the GM-CSF R on neutrophils as against SSZ-HCQ combination. The physiological basis of this increase needs further investigation.     

Infantile Tremor Syndrome Persistence in Era of Development: An Old Story

Infantile tremor syndrome is seen worldwide more commonly in the developing countries. Although various protein energy malnutrition awareness programme being run in many of these countries including India yet there is persistence of this disease. Here we present a case of 13 month old female child who visited RAPCC paediatrics OPD of Govt. Wenlock Hospital Mangaluru with history of respiratory distress, fever, tremor in limbs and loss of milestones. On examination she had pallor, hyper pigmentation in axilla and toes. Investigatory findings showed megaloblastic erythroid hyperplasia, hemoglobin- 1.6 g % and CT scan of brain showed central atrophic changes.     

A specific colorimetric assay for Dapsone in biological fluids

The original Bratton and Marshall method for sulfanilamide assay has been modified for differential assay of Dapsone even in the presence of other diazotisable compounds. The property of Dapsone diazo derivative to precipitate out upon its coupling with N-(1-naphthyl) ethylene diamine has been taken advantage to differentiate this sulphone from that of other diazotisable compounds. The present assay method also enables one to assay free DDS and its acid labile metabolites in biological samples even in the presence of other diazotisable compounds. The use of the organic solvent to extract the azo colour complex renders greater sensitivity and specificity for DDS assay.     

Increasing Glucose Concentrations Interfere with Estimation of Electrolytes by Indirect Ion Selective Electrode Method

The estimation of electrolytes like sodium (Na⁺), potassium (K⁺) and chloride (Cl⁻) using direct and indirect ion-selective electrodes (ISE) is a routine laboratory practice. Interferents like proteins, triglycerides, drugs etc. are known to affect the results. The present study was designed to look into the effect of increasing glucose concentrations on estimation of Na⁺, K⁺ and Cl⁻ by direct and indirect ISE. Pooled sera was mixed with glucose stock solution (20 g/dL) prepared in normal saline to obtain glucose concentrations ranging from ~100 to ~5000 mg/dL. Na⁺, K⁺ and Cl⁻ levels were estimated by direct and indirect ISE analyzers and results were statistically analysed using ANOVA and Pearson’s correlation. Similar experiment was also performed in 24 h urine sample from healthy subjects. Significant difference was observed between Na⁺ and Cl⁻ measurements by direct and indirect ISE, with indirect ISE values being consistently higher than direct ISE. Besides this, significant difference was observed amongst Na⁺ and Cl⁻ values from baseline values obtained by indirect ISE at glucose concentrations ≥2486 mg/dL. However, no such difference was observed with direct ISE. Na⁺ and Cl⁻ estimation by indirect ISE showed significant negative correlation with glucose concentration, more so, above ~2000 mg/dL. K⁺, however, showed no significant difference with varying glucose. Similar results were observed in 24 h urine samples with a significant difference observed amongst Na⁺ and Cl⁻ values at ≥2104 mg/dL glucose. Thus we conclude that high glucose concentrations interfere significantly in estimation of Na⁺ and Cl⁻ by indirect ISE in serum as well as urine.

Electronic supplementary material

The online version of this article (doi:10.1007/s12291-015-0522-0) contains supplementary material, which is available to authorized users.     

Protective effect of<Emphasis Type="Italic">Bacopa monniera L.</Emphasis> on cytarabine induced biochemical changes in chick embryo

Bacopa monniera, a medicinal plant distributed throughout India. Cytosine arabinoside (1-β-arabinofuranosylcytosine; Ara-C) is the most important antimetabolite chemotherapeutic drug used for acute leukemia. In this study we examined the chemoprotective property of an ethanolic extract of Bacopa monniera on biochemical changes in chick embryo. CA caused biochemical changes in a concentration and time dependent manner in amniotic fluid, liver and heart tissues. Ethanolic extract of BM given to chick embryo at doses of 2, 4, 6 mg per egg. There is significant decrease in biochemical levels of glucose, protein, urea, uric acid, creatinine and inorganic phosphorus. Enzymatic activities of alkaline phosphatase, lactate dehydrogenase, serum glutamate oxaloacetate transaminase, serum glutamate pyruvate transaminase and malatedehydrogenase were also decreased with dose dependent manner in amniotic fluid, liver and heart tissues.