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Preanalytical errors constitute about 40–65% of laboratory errors, of which 60% are due to hemolysis. This leads to imprecise reporting and misinterpretation of the actual concentration of analytes.Hence the aim of this study was to estimate the extent of different degrees of interference by visible hemolysis. 25 hemolysed samples along with their fresh unhemolysed sample were studied. Hemolyzed serum was mixed with unhemolyzed serum in predefined serial ratios from 100%, 70%, 50%, 30% and 10% to achieve different grades of hemolysis. Each dilution was analysed for BUN, creatinine, uric acid, phosphorus, Na, K, total protein, amylase, lipase, LDH, tacrolimus and methotrexate. Percentage difference of each dilution of the hemolyzed sample as compared to the unhemolyzed sample was calculated and considered acceptable only if less than TEa. It was observed that Percentage difference of BUN, creatinine, amylase and lipase in all dilutions of hemolyzed samples were within TEa while phosphorus, Na, K, total protein and LDH were beyond the acceptance criteria. Hence It was concluded that it may be safe to analyse a hemolysed sample for BUN, creatinine, amylase, lipase, tacrolimus and methotrexate while uric acid may be estimated in a moderately hemolysed sample. Phosphorus, sodium, potassium, total protein and LDH must never be analyzed in any hemolysed sample.

Lead exposure is increasingly becoming an important risk factor for osteoporosis. In adults, approximately 80–90 % of absorbed lead is stored in the bones. These bone lead deposits are released into the blood during periods of enhanced bone resorption like menopause, forming a potential endogenous source of lead exposure. Postmenopausal women are at a higher risk for bone lead release because of hormonal and age related changes in bone metabolism. Estrogen deficiency is associated with increase in osteoclasts number and activity leading to both the early and late form of osteoporosis. Hence, high blood lead level coupled with concomitant environmental exposure exposes women in this age group to lead related adverse outcomes like hypertension, reduced kidney and neurocognitive functions as well as increased risk of atherosclerosis and cardiovascular mortality. A few studies have also identified coexisting variates like ethnicity, occupation, residence, education, smoking, alcohol medications, water etc. as significant determinants of bone and blood lead in women, thus increasing the magnitude of postmenopausal bone changes. Hence, interventions focused on reducing the intensity of bone resorption during menopause will help decrease exposure to endogenous lead. This would play a significant role in decreasing the morbidity and mortality associated with menopause. Also, identification of modifiable factors that prevent bone lead release will reduce the risk of chronic lead exposure and improve the health outcomes of post-menopausal women.

Lead is a naturally occurring toxic metal whose widespread use has resulted in extensive environmental contamination and human exposure. It has become a significant public health problem and according to WHO estimates, accounts for 9.8% of idiopathic intellectual disability, 4% of ischaemic heart disease, and 5% of the global burden of stroke.

Cognitive impairment is a progressive disorder that affects the ageing population. With the increase in the mean age of our population, it is becoming a public health problem. Homocysteinemia has been implicated in cognitive impairment. Whilst it is modulated by vitamins B12 and folate, it acts through MMPs 2 and 9. To assesses the relationship of cognitive impairment with homocysteine, B12, folate and MMPs 2 and 9, so as to detect cases of mild cognitive impairment which are potentially reversible, blood samples were drawn from 73 enrolled subjects, with and without cognitive impairment on basis of Montreal cognitive assessment (MoCA) score < 25 or ≥ 25, respectively. Homocysteine, B12, folate and MMPs2 and 9 were estimated. Correlation between MoCA score and these parameters was elucidated. After adjusting for age and gender, homocysteine was the only significant independent predictor of MoCA score. Cut-off of homocysteine for prediction of MoCA < 25 was derived at 13.5 µmol/L(PPV = 59.6%; NPV = 79.2%). The equation derived for calculation of MoCA score from homocysteine is: MoCA score = 32.893 + [(− 0.223)(homocysteine in μmol/L)]. Homocysteine > 13.5 μmol/L predicts low MoCA (< 25) with 84.8% sensitivity and 50% specificity. Hence, patients with an Hcy > 13.5 μmol/L should be administered B12 and folate to reduce homocysteine, a modifiable risk factor of cognitive decline. Also, a novel equation for calculating MoCA score from homocysteine has been derived. Using this derived equation to calculate MoCA score, it may be possible to identify asymptomatic subjects with early cognitive impairment.

Interest in cardiovascular biomarkers in primary prevention has increased manifold because of the advances in genetic and molecular research. Also, the Indian population is particularly prone to CAD, especially premature CAD, and traditional risk factors have failed to explain this high incidence. Currently two strategies are being followed to improve the management of CAD-search for novel biomarkers and the use of combination of multiple biomarkers. This has lead to the emergence of several novel clinically useful biomarkers that have improved the diagnosis and treatment of CAD and also helped to identify patients susceptible to this disease. The newer biomarkers for CAD have been classified according to the varied pathophysiology of the disease. Some emerging biomarkers include (a) small dense LDL- marker of plaque formation (b) Lp-PLA2 as a vascular specific inflammatory marker (c) oxidized LDL and myeloperoxidase as markers of oxidative stress (d) heart type fatty acid binding protein (FABB) as a marker of myocyte injury and apoptosis (e) marker for myocyte stress- soluble ST2 and (f) Cystatin C as a marker with extra cardiac involvement. We studied the association of two novel risk biomarkers, cystatin C and small dense LDL (sdLDL) with the presence and severity of CAD in patients [less than or equal to] 45 years with normal kidney function. Cystatin C was significantly raised and mean LDL particle size significantly reduced in CAD patients as compared to controls. sdLDL was significantly associated with the severity of CAD, while cystatin C was not. Both cystatin C and sdLDL emerged as independent risk factors, however, of the two, sdLDL was a more sensitive predictor of CAD events. Hence, we suggest, that while assessing the risk of CAD in younger age group patients, measurement of cystatin C and sdLDL may be considered along with the traditional lipid tests. Thus, in future, the risk management for CAD may shift from a single marker to a \"multimarker approach.\"

The current epidemic affecting Indians is coronary artery disease (CAD), and is currently one of the most common causes of mortality and morbidity in developed and developing countries. The higher rate of CAD in Indians, as compared to people of other ethnic origin, may indicate a possible genetic susceptibility. Hence, Lp(a), an independent genetic risk marker for atherosclerosis and cardiovascular disease assumes great importance. Lp(a), an atherogenic lipoprotein, contains a cholesterol rich LDL particle, one molecule of apolipoprotein B-100 and a unique protein, apolipoprotein (a) which distinguishes it from LDL. Apo(a) is highly polymorphic and an inverse relationship between Lp(a) concentration and apo(a) isoform size has been observed. This is genetically controlled suggesting a functional diversity among the apo(a) isoforms. The LPA gene codes for apo(a) whose genetic heterogeneity is due to variations in its number of kringles. The exact pathogenic mechanism of Lp(a) is still not completely elucidated, but the structural homology of Lp(a) with LDL and plasmin is possibly responsible for its acting as a link between atherosclerosis and thrombosis. Upper limits of normal Lp(a) levels have not been defined for the Indian population. A cut off limit of 20 mg/dL has been suggested while for the Caucasian population it is 30 mg/dL. Though a variety of assays are available for its measurement, standardization of the analytical method is highly complicated as a majority of the methods are affected by the heterogeneity in apo(a) size. No therapeutic drug selectively targets Lp(a) but recently, new modifiers of apo(a) synthesis are being considered.

Small dense (sd) LDL is a significant independent risk factor for premature coronary artery disease (CAD). Unfortunately, its estimation is not popular, due to the limited availability of specialized equipment, high cost and time-consuming technique. Non-HDL is a calculated, single index measure of all atherogenic apolipoprotein-B containing lipoproteins. This study aimed at identifying non-HDL as a superior surrogate marker of sdLDL cholesterol in a young Indian population. 161 healthy subjects < 45 years were tested for lipid profile, apolipoproteins A1 and B, and sdLDL particle size. sdLDL particles showed negative correlation with non-HDL (r = − 0.283, p < 0.001), LDL (r = − 0.195, p = 0.013) and apoB/apo A1 (r = − 0.175, p = 0.026), the significance being greatest with non-HDL. ROC showed AUC for non-HDL, LDL and apoB/apo A1 as 0.704, 0.686, and 0.596 respectively. For LDL < 130 mg/dL, sdLDL showed a more significant negative correlation with non-HDL (r = − 0.291, p < 0.001) as compared with apoB/apoA1 (r = − 0.172, p = 0.037). For triglycerides < 200 mg/dL, sdLDL particle size showed higher significant negative correlation with non-HDL (r = − 0.213, p = 0.015) than with LDL (r = − 0.176, p = 0.045) while for triglycerides between 200 and 400 mg/dL, significant negative correlation was observed only with non-HDL (r = − 0.372, p = 0.043). Hence, our study suggested that non-HDL is a superior surrogate marker of sdLDL particle size as compared to LDL and apoB/A1 ratio in a young healthy Indian population and should be used for optimum assessment of dyslipidemias and CAD risk.

Coronary artery disease (CAD) affects Indians 5–6 years earlier than in the west, is diffuse and malignant, and poses a heavy burden on India’s developing economy. Traditional risk factors have failed to explain this high incidence of premature CAD and hence this study investigated the association of two novel risk biomarkers, cystatin C and small dense LDL (sdLDL) with the presence and severity of CAD. Cystatin C and sdLDL were estimated in 204 CAD patients ≤45 years of age and compared with 161 age-matched healthy controls. The traditional lipid profile parameters, i.e., cholesterol, LDL, HDL, triglycerides, apolipoproteins A1 and B, and Lp(a) were also measured in both groups. Cystatin C was significantly raised and mean LDL particle size significantly reduced in CAD patients as compared to controls. 62.7 % of CAD patients showed pattern B while 37.3 % patients showed pattern A. Of the traditional lipid tests, only HDL and apolipoprotein A1 showed a significant decrease in the CAD group. sdLDL was significantly associated with the severity of CAD, while cystatin C was not. Both cystatin C and sdLDL emerged as independent risk factors, however, of the two, sdLDL was a more sensitive predictor of CAD events. Cystatin C and mean LDL particle size are significantly and independently associated with the presence of CAD events in patients ≤45 years with normal kidney function. Hence, these novel risk biomarkers can be useful tools in reducing the morbidity and mortality associated with CAD in the productive Indian workforce.

Context: The purpose of this study was to evaluate and compare the centering ability and canal transportation of TruNatomy, OneCurve, and Jizai file systems to assess their performance in oval-shaped canals using cone-beam computed tomography imaging. Materials and Methods: Forty-two fully formed single-rooted mandibular premolars were selected with a buccolingual canal size 2–2.5 times the mesiodistal size at 5 mm from the apex, with 0°–10° canal curvature with a 5–6 mm radius, at 5 mm from the apex. The teeth were divided into three groups (n = 14) and prepared with TruNatomy, OneCurve, and Jizai files based on the manufacturer's instructions. Cone-beam computed tomographic images were taken before and after instrumentation. The canal transportation and centering ability was calculated at 3, 6, and 9 mm from the apex in both mesiodistal and buccolingual directions. Statistical Analysis: Intergroup comparison was done using Kolmogorov–Smirnov test. Intragroup comparison was done using Freidman test. A comparison of categorical variables was done using the Chi-square test. Results: The results obtained did not present any statistically significant difference between the three groups, with TruNatomy and OneCurve showing relatively lesser canal transportation and better centering ratio when compared to the Jizai file system. Conclusions: It can, therefore, be concluded that all three systems used in the study are capable of safely preparing root canals with minimal errors.

Subjective evaluations are critical for assessing the perceptual realism of sounds in audio-synthesis driven technologies like augmented and virtual reality. However, they are challenging to set up, fatiguing for users, and expensive. In this work, we tackle the problem of capturing the perceptual characteristics of localizing sounds. Specifically, we propose a framework for building a general purpose quality metric to assess spatial localization differences between two binaural recordings. We model localization similarity by utilizing activation-level distances from deep networks trained for direction of arrival (DOA) estimation. Our proposed metric (DPLM) outperforms baseline metrics on correlation with subjective ratings on a diverse set of datasets, even without the benefit of any human-labeled training data.