Öz
Clinical details supplemented with results obtained from investigations are essential for arriving at the appropriate diagnosis for managing patients. In recent times, the use of biomarkers is taking centre stage for diagnostic specificity. Biomarkers are measurable indicators of normal biological, pathological or pharmacological responses that can lead to therapeutic intervention. Biomarkers have diagnostic and/or prognostic significance in clinical medicine.
The Strategic Advisory Group of Experts on In-Vitro Diagnostics (SAGE IVD) of the World Health Organization (WHO)1 recently published a comprehensive list of essential diagnostic tests for communicable (malaria, tuberculosis, human immunodeficiency virus, hepatitis B and C, human papilloma virus etc) and non-communicable diseases (diabetes mellitus, ischemic heart disease, chronic kidney disease, cancer screening etc), which are applicable at all tiers of the health care system. The WHO has taken giant strides in ensuring optimal and cost-effective health care on a global basis. This is commendable.
Three articles in this issue of the journal focus on another potential biological material for testing and other biomarkers of diseases that hold some promise in diagnosis and treatment: The first is the manuscript by Lasisi et al which reported that the levels of biochemical abnormalities in the saliva of patients with chronic kidney disease correlated significantly with the serum levels. Thus saliva is being recommended as a useful alternative to blood for monitoring patients with chronic kidney injury undergoing dialysis. The ease of obtaining saliva and the avoidance of the pain of venesection are immediate reasons why the use of this biological specimen appears favourable. It is very likely that this specimen may be found useful in other clinical situations. The second manuscript by Ajani et al focused on leptin and its association with obesity and glycaemic control. Leptin is a gene product that regulates food intake and energy metabolism. In their study, serum leptin levels were significantly higher in obese type 2 diabetic patients when compared with non-obese diabetic patients and normal individuals. The authors also reported an inverse relationship between leptin levels and glycaemic control which may suggest a potential therapeutic role. The third manuscript is the study by Akinpelu and colleagues which compared adiponectin levels in pre eclamptic and normotensive pregnant women. The authors observed that the pre-eclamptic group had significantly higher levels of adiponectin; again another useful diagnostic marker in obstetrics.
These innovative studies need to be acknowledged and their diagnostic/therapeutic values appraised. However, replication of these findings in more studies involving larger samples are needed before widespread use can be recommended. In addition, the psychometric properties must be such that the accuracy of diagnosis is not compromised. One can speculate at this stage that the addition of these biomarkers (adiponectin and leptin) will strengthen clinical use in preeclampsia and diabetes respectively while saliva becomes a specimen of choice for assessing biochemical changes after dialysis.
A. Ogunniyi
Editor-in-Chief
Referanslar
World Health Organization. First-ever WHO list of essential diagnostic tests. http:// www.who.int/medical_devices/diagnostics/Selection_in-vitro_diagnostics/en/ (accessed May 18, 2018).