Use of Troponin I as a Biochemical Marker for Diagnostics of Asphictic State in Mechanical Asphyxia

The purpose of the study was to determine the quantitative content of the biochemical marker of myocardial damage (subunits of the troponin complex: Troponin I) in the blood as a diagnostic criterion for asphyxia in mechanical asphyxia. Materials and methods. To determine the presence of asphyxia, the quantitative content of Troponin I in the blood of 12 dead people was studied and analyzed, among which violent death was observed in 7 cases and non-violent – in 5 cases. The study for biochemical detection of Troponin I used a method based on enzyme-linked immunosorbent assay followed by statistical processing of the results using the MedStat package. Results and discussion. Among the biochemical markers for the diagnosis of asphyxia in hanging and aspiration asphyxia, the most indicative is the determination of the quantitative content of Troponin I in the blood, which is also used in clinical practice to substantiate the diagnosis of cardiac pathology. Therefore, it is important to conduct a differential diagnosis of changes in quantitative indicators of biochemical markers depending on the cause and genesis of death. During the study of the quantitative content of Troponin I in the blood of those who died of mechanical asphyxia (hanging, aspiration asphyxia), it was found that the content of troponin I is from 140 ng/ml to 170 ng/ml. The quantitative content of Troponin I in the blood of those who died of acute and chronic coronary heart disease (control group) is from 10.1 ng/ml to 120 ng/ml. The average value of the quantitative content of Troponin I in two samples was found: in the blood of those who died of mechanical asphyxia – 156 ng/ml±4.4 ng/ml; in the blood of those who died of acute and chronic coronary heart disease – 45.62 ng/ml±22.4 ng/ml. The study revealed a difference in quantitative indicators of biochemical markers depending on the cause and genesis of death, found that the quantitative content of Troponin I in the blood of the dead from mechanical asphyxia (hanging, aspiration asphyxia) compared with the quantitative content of Troponin I in the blood of the dead with chronic coronary heart disease is higher, at the level of significance p=0.008. Conclusion. Thus, in the course of research, the feasibility of using changes in quantitative indicators of the biochemical marker Troponin I to determine the asphyxiation in violent death (mechanical asphyxia) and differential diagnosis in cases of non-violent death (acute and chronic coronary heart disease) was proved, which significantly increases efficiency and reliability of forensic medical examinations

Technology Updates in Male Infertility Management

Background: Technologies are replacing manpower many fields including medical field. Several devices have been marketed for replacing/reducing manpower in the medical field including male infertility. Here we reviewed several technologies that developed in male infertility. Review: Computer assisted sperm analysis (CASA), Automatic assessment of biochemical marker of seminal plasma, B-mode ultrasound, and automatic sperm cryopreservation can be applied routinely. Several updates i.e. automatic histopathology assessment, ultrasound strain elastography, magnetic resonance imaging (MRI) stronger than 3.0 T, Artificial intelligence for predicting the presence of sperm in azoospermia cases, automatic sperm selection, and automatic intracytoplasmic sperm injection (ICSI) need more studies before their application. Summary: Prudent choice based on valid studies is needed in order to give a comprehensive management to patient with male infertility without using useless technology.

ADIPOCYTE FATTY ACID BINDING PROTEIN (A-FABP) AS A NOVEL BIOCHEMICAL MARKER OF DIABETIC RETINOPATHY

Introduction: Diabetes mellitus is acomplex metabolic disorder associated with increased risk of microvascular and macrovascular disease characterized by chronic hyperglycaemia resulting from defect in insulin secretion, insulin action, or both. Diabetic retinopathy (DR) causes visual impairment as a result of long term accumulated damaged to the small blood vessels in the retina.Adipocyte fatty acid binding protein(AFABP), been suggested as a third adipokine, in addition to leptin and adiponectin. AFABP might have a role in the proliferation of endothelial cells, as well as in angiogenesis. A-FABP levels were determined in subjects witout diabetes mellitus, with type 2 diabetes mellitus without DR and with DR at admission in order to investigate a possible association of A-FABP to the increased risk of incidence of DR. Material and methods: This study was done on non-diabetic (n=25) and Type 2 diabetes subjectswith(n=25) and without retinopathy (n=25) who visited HAHC hospital. Blood glucose (fasting and post prandial), glycated hemoglobin(HbA1c), urea, creatinine, uric acid, total protein, serum albumin,serum electrolytes (sodium, potassiumand chloride), totalcholesterol,triglyceride, high density lipoprotein(HDL), low density lipoprotein (LDL), very low density lipoprotein (VLDL) and and AFABP were measured . Result: The mean values of blood glucose (fasting and post prandial),HbA1C,urea, creatinine , TG, LDL VLDL and AFABP were higher in diabetic subjectswith diabetic retinopathy in comparison to diabetic subjects without retinopathy and subjects without diabetes mellitus and were highly significant statistically.(p<0.01). The mean value of HDL was lower in diabetic subjects with diabetic retinopathy in comparison to diabetic subjects without retinopathy and subjects without diabetes mellitus and was highly significant statistically. Conclusion:The study helps in associating AFABP as an early biochemical marker for identifying onset of diabetic retinopathy in subjects with diabetes mellitus at an early stage.

Serum lactate dehydrogenase level in pre-eclampsia and its correlation with maternal and fetal outcome

Background: Hypertensive disorders are the most common medical disorders during pregnancy. It increases maternal and perinatal morbidity and mortality. The incidence is 7 to 10%. Identifying high risk patients and close monitoring can reduce the complications. Lactate dehydrogenase is a useful biochemical marker and can be used to evaluate maternal complications like Disseminated intravascular coagulation (DIC), HELLP syndrome (Haemolysis, elevated liver enzymes and lowered platelets), pulmonary edema, renal failure and fetal complications like Fetal growth restriction (FGR) APGAR score ≤7 at 5 min and Neonatal intensive care unit (NICU) admissions. The objective of this study was to estimate serum Lactate dehydrogenase levels (LDH) in pre-eclampsia patients and study the correlation between increased LDH levels and maternal and fetal outcome.Methods: It was a prospective study from October 2015 to May 2017 at M. S. Ramaiah medical college and hospitals, Bangalore.Results: The incidence of maternal and foetal complications was increased with higher serum LDH levels. With serum LDH >than 600 IU/l the incidence of HELLP syndrome, DIC, pulmonary edema was statistically significant. It also correlated with increased creatinine levels and decreased platelets with p value<0.001. The foetal complications including FGR NICU admission and Apgar score <7 at 5 min was statistically significant. The liver enzymes and serum creatinine correlated with increased LDH levels.Conclusions: Maternal and foetal complications are increased with raised LDH levels, and it can be used as a biochemical marker to achieve a better outcome.

Biochemical Aspects in Sera of Iraqi Patients with Trigeminal Neuralgia

Trigeminal Neuralgia (TN) is one of the most commonly painful cranial neuralgia characterized by paroxysmal attacks as short lasting facial pain along the trigeminal nerve branches. The aim of the present study is to innovate a biochemical relationship between (melatonin, GALNT12 and Zn) and TN and also to examine the biochemical action of tegretol (carbamazepine) as a treatment on the above biochemical parameters. Blood samples were collected from fifty four (54) trigeminal neuralgia patients diagnosed by magnetic radiation image (MRI). Patients were classified into four groups: G3 (40- 70) years composed of (12) diagnosed male (without treatment), G4 (48- 75) years composed of (12) diagnosed female (without treatment), G5 (34- 76) years composed of (15) male under treatment with tegretol (200 mg /daily) and G6 (49-65) years composed of (15) female under treatment with tegretol (200 mg/ daily). Patients were compared with healthy subjects (have approximately the same range of age) as control groups: G1 composed of (15) males (43-70) years and G2 composed of (15) females (50-55) years. The present study is the first reporting that melatonin is a novel biochemical marker in Iraqi patients with TN (with significant and highly significant decrease in males and females respectively compared with healthy subjects). Also it is the first reporting that GALNT12 and Zn are novel biochemical markers in Iraqi patients with TN (with highly significant decrease in both genders compared with healthy subjects). The present study is the first highlighting and dealing with the biochemical action of tegretol (carbamazepine) on melatonin, GALNT12 and Zn by submitting unique and novel mechanisms. Finally the present study confirms the specific role of tegretol (carbamazepine) on postmenopausal women regarding melatonin, and GALNTI2 by focusing on its interaction with female sexual hormones.

Pulmonary Embolism Detection in COVID-19 Patients

Background: A clinically important impact of Coronavirus Disease 2019 (COVID-19) is the increased likelihood of thromboembolism, mainly pulmonary embolism (PE). To screen for these complications a biochemical marker, D-dimer, is usually done. There is a plethora of research validating the use of D-dimer cutoff levels in non-COVID-19 patients, however less so in the COVID-19 population. Aim: To determine the number of suspected COVID patients with D-dimer ≥ 0.5 and PE reported on CTPA. Methods: Non-interventional single-centre retrospective clinical correlational study. Patient cohort was patients admitted with suspected COVID-19 over a 5-week period. N=690. Results: 76.5% of suspected COVID-19 patients were PCR positive. 40% of these patients had a CTPA completed with 19% reported to have a PE. 52% of patients had a D-dimer value ≥ 0.5 10.6% patients had a PE with a D-dimer ≥ 0.5. Conclusion: Nationally, hospitals are adopting existing D-dimer cut off levels to rule out PEs, however this leads to a large proportion of admitted COVID-19 patients having possibly unnecessary computed tomography pulmonary angiogram. This study highlights that majority of patients with D-dimers above the cut off level have negative PEs and contributes to the notion that standard D-dimer cutoffs are insufficiently accurate to be used as a standalone test in diagnosis in the context of an underlying SARS-CoV-2 infection.