No abstract

No abstract

Background: Preeclampsia is a hypertensive disorder of pregnancy affecting multiple systems and characterized chiefly by hypertension and proteinuria in a previously normotensive and non proteinuric women. The main underlying cause for its pathophysiology is an imbalance between the physiological vasoconstrictor and vasodilator molecules in circulation leading to maternal endothelial dysfunction. Hydrogen sulphide (H2S) is a physiological vasodilatory gasotransmitter which plays an important role in the development of hypertension and proteinuria in preeclampsia. Aims and Objectives: The aim of this study was to determine the serum level of hydrogen sulphide and spot urinary protein levels in preeclampsia cases and compare it with age matched controls which were normal pregnant women and to find any correlation, if exists, between these two parameters. Materials and Methods: Serum level of H2S and spot urinary protein level were measured in one hundred pregnant women with preeclampsia and the values were compared with age matched controls. Results: The mean serum H2S level was 32.31 ± 12.62μmol/L in patients which was significantly lower (p<0.001) when compared to controls where mean was 114.50 ±20.35μmol/L. The mean spot urinary protein level was found to be 11.83 ± 5.06 mg/dl in preeclampsia cases which was significantly higher (p<0.001) than in controls where it was 7.18 ± 2.38 mg/dl. A negative correlation was found between the serum level of H2S and both the systolic BP (r=-0.725, p<0.001) and diastolic BP (r= - 0.639, p<0.001) in preeclampsia patients.A negative correlation was also observed between the serum levels of H2S and spot urinary protein in preeclampsia (r=-0.541, p<0.001). Conclusion: The present study has elucidated that the serum levels of hydrogen sulphide decreases and the spot urinary protein levels increases in preeclampsia when compared to normal pregnant women and hydrogen sulphide shows a negative correlation with both systolic and diastolic BP in preeclampsia. This study also demonstrates that,there exists a negative correlation between the serum H2S level and spot urinary protein level in preeclampsia patients.

Background: Pre-analytical phase is the major source of errors in a clinical biochemistry laboratory. Aims and Objectives: The study aims to determine the quality of laboratory performance in the pre-analytical phase using quality indicators (QI) specified by the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) Working Group on Laboratory Errors and Patient Safety and sigma metric scale for both the inpatient and outpatient samples received in the clinical biochemistry laboratory. Materials and Methods: All samples and requisition forms received in the laboratory were examined before analysis. The percentages of the seven QI were calculated. The frequency, percentage, and defects per million rates of each pre-analytical error were calculated. Sigma value was obtained using an online sigma calculator. The laboratory performance was then categorized by the IFCC-based performance levels and sigma-based values. Results: Out of 30,546 samples received during a period of 6 months, pre-analytical errors occurred in 2.8% of them. The highest number of pre-analytical errors was due to hemolysis (29.9%). The outpatient samples showed a desirable to optimum performance with a good sigma value. There were more errors and lower quality-based performance, in the case of inpatient samples. Errors were highest in September at the start of the study followed by a gradual decrease over the next 5 months. Conclusion: The laboratory performance in the pre-analytical phase was found to be favorable and consistent with the international specifications.

A 50-year-old woman with no known premorbid illnesses was presented to the emergency room with sudden onset of severe upper abdominal pain, fatigue, nausea and vomiting for one day. There was no history of intake of NSAIDs, alcohol, spicy food, or history of peptic ulcer disease. Consent was taken from the patient.Patient was conscious, co-operative but in agony due to the severe pain in abdomen. General examination was unremarkable and vital signs were stable. Abdominal examination revealed tenderness in the epigastric region. Systemic examination was otherwise unremarkable. The patient was admitted to the surgical ward and evaluated for suspected causes of acute upper abdominal pain.Investigations: An emergency ultrasonography of the abdomen was performed that showed only mild hepatomegaly. Serum amylase and lipase levels were elevated (Serum Amylase-69 IU/l Serum Lipase-318 IU/l). Other salient biochemical investigations revealed random blood sugar of 100 mg/dl, serum sodium 103 mEq/l\l, serum potassium 5.3 mEq/l, serum urea of 54 mg/dl, serum creatinine of 2.2 mg/dl, serum calcium 10 mg/dl. Complete haemogram obtained with peripheral smear were within normal limits.A provisional diagnosis of acute pancreatitis with acute kidney injury was made and the patient was managed conservatively with no feeds administered orally. Intravenous fluids, proton pump inhibitors and anti spasmodic medications were administered along with parenteral tramadol to alleviate acute abdominal pain despite patient having abnormal renal function test. However, despite improvement in the patient's amylase and lipase levels and creatinine levels within the subsequent three to four days, the patient complained to have persisting abdominal pain. Repeat biochemical investigations three days after admission revealed serum sodium of 110 mEq/l, serum potassium of 5.1 mEq/l, serum creatinine-1.5 mg/dl. An internal medicine opinion was sought in view of persisting hyponatremia despite optimal hydration with parenteral fluids. Repeat systemic examination was consistent with previous findings and revealed only mild epigastric tenderness. However, a meticulous general examination revealed blackish hyperpigmentation of the palms, soles, and mucus membranes [Table/ Fig-1]. On reviewing the history, the patient had claimed to have noticed these skin changes since the last one year. She also gave history of salt craving, malaise, fatigue, anorexia, mild bouts of self-limiting pain in abdomen and occasional vomiting after food intake that she ignored. Examination of vital signs revealed postural hypotension with a drop in the systolic blood pressure by 20 mmHg from the baseline in recumbent position.In view of the persisting acute severe epigastric pain, progressive hyperpigmentation, postural hypotension and persisting hyponatremia with hyperkalemia despite adequate hydration, a diagnosis of hypocortisolism was considered.The serum cortisol levels estimated at 8 am was 29.5 ng/ml (normal range -49.9-249.9 ng/ml) and serum Adrenocorticotrophic (ACTH) ...