Evaluation of Serum Lipoprotein (a) Levels and Novel Lipid Indices in Patients with Chronic Kidney DiseaseA Case-control Study

Introduction: Majority of Chronic Kidney Disease (CKD) patients are more likely to die of cardiovascular complications, before reaching End Stage Renal Disease (ESRD). Although there are many risk factors contributing to pathogenesis of cardiovascular disease in CKD subjects, dyslipidemia represents one of the modifiable risk factors. American Heart Association has recommended that CKD patients should be classified in the highest risk group for developing cardiovascular events. Kidney Disease: Improving Global Outcome (KDIGO) recommends, these patients should be evaluated for dyslipidemia and for treatment to reduce the risk of cardiovascular events. Aim: To evaluate serum Lipoprotein (a) {Lp(a)} levels and assess the significance of novel lipid indices in non dialysis patients of CKD. Materials and Methods: This analytical case-control study was conducted from January 2016 to June 2016 at Government Stanley Medical College and Hospital, Chennai, Tamil Nadu, India. It included 70 non dialysis CKD subjects and 70 healthy control subjects, adhering to inclusion and exclusion criteria. Fasting Blood Samples (FBS) were collected and analysed for: Fasting blood glucose, Fasting Lipid Profile, Serum Lp(a). Serum Lp(a) was estimated by immunoturbidimetry method and lipid profile by enzymatic method. Estimated Glomerular Filtration Rate (eGFR) was calculated using Modification of Diet in Renal Disease (MDRD) formula and staging of CKD subjects was done, based on KDIGO guidelines. Novel lipid indices were calculated using appropriate formula. Statistical analysis of the tabulated data was done using Social Sciences of the Statistical Package (SPSS) software. Results: There were significant differences in the levels of FBS, Triglycerides (TG), Lp(a) between controls and non dialysis CKD subjects (p<0.001). Among Lipid Indices, Atherogenic Index of Plasma (AIP) and Lipid Tetrad Index (LTI) values were significantly higher in CKD subjects compared to controls (p<0.001), but there was no significant difference was seen in Atherogenic Coefficient (AC), Castelli’s Risk Index-I (CRI-I) and CRI-II values. AIP and LTI showed significant positive correlation with Lp(a). LTI had the highest Positive Predictive Value (PPV) (77.8%) and Negative Predictive Value (NPV) (72.7%); AIP had PPV of 65.3% and NPV of 66.2%. Conclusion: The present study concludes that, among lipid indices, AIP and LTI are the most suitable for assessment of atherogenicity in non dialysis CKD. In developing countries like India, owing to high cost of tests like Serum Lp(a), novel lipid index AIP can serve as a cost-effective screening tool for monitoring cardiovascular disease risk in CKD patients.

Serial quantification of CRP and total leukocyte count as a complementary tool in neonatal sepsis

Early detection and appropriate treatment of newborn sepsis reduce mortality and morbidity. A rapid, inexpensive laboratory approach is needed to assess newborn sepsis, even though blood culture is the gold standard for diagnosis. To compare serial CRP and Total Leukocyte Count (WBC) with blood culture, this study aimed to evaluate the role of newborn sepsis. A total 148 neonates with clinical symptoms of sepsis were included .CRP was measured by quantitative immuno turbidimetric method andotal leukocyte count (WBC) was measured by automated cell counter. CRP1 and WBC1 were measured within 6 hours of clinical symptoms. CRP2 and WBC2 were measured after 48 hours of clinical symptoms. Sensitivity, specificity, PPV, NPV of CRP1 and CRP2,WBC 1and WBC 2 were compared with culture positive and negative sepsis.CRP 2 showed high sensitivity 96% and high NPV95% with significant p value <0.0001. WBC2 has high sensitivity (90.57%) and NPV (91%) with significant p value <0.0001. CRP 1 has sensitivity 83%and NPV 82.3%, with p value < 0.001.WBC1 has lowest sensitivity (62.2%) and NPV (71.4%) compared to all other parameters. Serial CRP and WBC measurements are useful in the diagnosis of neonatal sepsis. Measurement of CRP and Total Leukocyte Count (WBC) after 48 hours of clinical symptoms were considered promptly for diagnose neonatal sepsis.

Development of New Glass Composite Membranes and their Properties for Low Temperature H2/O2 Fuel Cells

A new glass electrolyte formed by constant amounts of titanium oxide (TiO2) and various amount of phosphotungstic acid (PWA) doped P2O5-SiO2 is prepared using the sol-gel process. The structural formation is confirmed by Fourier infrared spectroscopy (FTIR) and from thermogravimetric and differential thermal analysis (TG/DTA) measurements, the glasses display good thermal stability. Further characterisation is undertaken by N2 adsorption/desorption measurements, proton conductivity and hydrogen permeability analyses and a H2/O2 fuel cell test is also performed. The glass materials with large pores and specific surface area are suitable for use as the electrolyte in H2/O2 fuel cells. The effect of TiO2 processing with constant amount of PWA in phosphosilicate glasses, is investigated and discussed. The hydrogen permeability is 1.57x10(-11) mol cm(-1) s(-1) Pa(-1) at 110 degrees C for 0.8 mm thick glass; a power density of 46.3 mW cm(-2) at 125 mA cm(-2) and a current density of 175 mA cm(-2) is obtained (T=28 degrees C, relative humidity).