Vitamin D, Bone Mineral Density and Serum IGF-1 Level in Non-ambulatory Children With Cerebral Palsy

OBJECTIVES

To compare serum 25-hydroxy vitamin D (25-OHD) status, bone mineral density and Insulin-like growth factor (IGF-1) level among children with cerebral palsy (CP) aged 1 to 8 years with age- and gender-matched controls.

METHODS

A cross-sectional study enrolled 30 children in each group: CP with epilepsy, CP without epilepsy, and healthy controls. Bone mineral density (BMD), serum 25-OHD levels, and serum insulin like growth factor (IGF)-1 levels were measured.

RESULTS

z-scores of BMD [-1.80 (1.03), -2.12 (0.85) vs -1.40 (0.90); P<0.01], 25-OHD levels [19.26 (8.28), 20.59 (8.92) Vs 26.79 (12.76) ng/mL; P<0.01] and IGF-1 levels [20.90 (6.42), 23.37 (8.11) vs 31.77 (11.21) ng/mL; P<0.01] were significantly low among children with CP with epilepsy, CP without epilepsy when compared to controls.

CONCLUSIONS

Children with CP with or without comorbid epilepsy were prone to vitamin D deficiency, low bone mineral density and growth hormone axis suppression with low IGF-1 levels.

Chemoradiation in locally advanced Ca Cx: Effect on NGAL levels

INTRODUCTION

Neutrophil gelatinase-associated lipocalin (NGAL) has been reported to be unregulated in many cancers and to suppress tumor suppressor genes like p53 leading to cell proliferation. Studies to report its relationship with carcinoma cervix (Ca Cx) are still scant.

MATERIALS AND METHODS

Serum NGAL levels were analyzed in 30 patients of histopathologically proven locally advanced Ca Cx at the time of diagnosis and 3 weeks after standard chemoradiation by enzyme-linked immunosorbent assay. These patients underwent either brachytherapy or supplementary external beam radiotherapy (EBRT) depending on the response of treatment. The results were analyzed statistically by applying Student's paired t-test.

RESULTS

No statistically significant difference (P > 0.05) was observed in patients of Ca Cx before and after treatment or when compared stage wise, histopathological grade wise, or response wise. But the levels were found to increase when duration of treatment was ≥8 weeks (P = 0.040) and to decrease significantly when duration of treatment was <8 weeks (P = 0.0052). The NGAL levels also increased significantly after treatment in patients who received EBRT and supplementary radiotherapy (P = 0.019) while the pre- and post-treatment difference in NGAL levels was not statistically significant in patients who received EBRT + intracavitary brachytherapy (P > 0.05).

CONCLUSION

As the duration as well as modality of treatment is quite important in Ca Cx, shorter duration associated with better results and lower NGAL levels, NGAL might prove to be a useful biomarker although further studies are needed to support the claim.

Status of Ischemia Modified Albumin in Athletes Before and After Moderate Exercise

Background:

Ischemia Modified Albumin (IMA) is considered as an early marker of ischemia. Its levels may be altered in any clinical condition where an ischemic event is involved. Skeletal muscle ischemia is associated with severe exercise but may also occur in moderate form of exercise.

Objective:

The levels of IMA were estimated before and after thirty minutes of moderate exercise in students undergoing athletic training.

Methods:

The present study was conducted on 120 young adult students undergoing athletic training program in the physical education department. All the subjects were healthy with normal body mass index and blood pressure. Their serum samples were collected before and after running for half an hour on the racing track and were analyzed for IMA colorimetrically and the data was subjected to appropriate statistical analysis.

Results:

The levels of IMA were found to be statistically significantly higher after exercise as compared to those before exercise (p = 0.005). The ratio of IMA to albumin (IMAR) was also found to be significantly higher after exercise as compared to that before exercise (p=0.000).

Conclusion:

It may be concluded that the skeletal muscle ischemia induced by moderate aerobic exercise is associated with an increased conversion of albumin to IMA.

Assessment of quality control system by sigma metrics and quality goal index ratio: A roadmap towards preparation for NABL

AIM

To study sigma metrics and quality goal index ratio (QGI).

METHODS

The retrospective study was conducted at the Clinical Biochemistry Laboratory, PGIMS, Rohtak, which recently became a National Accreditation Board for Testing and Calibration of Laboratories accredited lab as per the International Organization for Standardization 15189:2012 and provides service to a > 1700-bed tertiary care hospital. Data of 16 analytes was extracted over a period of one year from January 2017 to December 2017 for calculation of precision, accuracy, sigma metrics, total error, and QGI.

RESULTS

The average coefficient of variation ranged from 2.12% (albumin) to 5.42% (creatinine) for level 2 internal quality control and 2% (albumin) to 3.62% (high density lipoprotein-cholesterol) for level 3 internal quality control. Average coefficient of variation of all the parameters was below 5%, reflecting very good precision. The sigma metrics for level 2 indicated that 11 (68.5%) of the 16 parameters fall short of meeting Six Sigma quality performance. Of these, five failed to meet minimum sigma quality performance with metrics less than 3, and another six just met minimal acceptable performance with sigma metrics between 3 and 6. For level 3, the data collected indicated eight (50%) of the parameters did not achieve Six Sigma quality performance, out of which three had metrics less than 3, and five had metrics between 3 and 6. QGI ratio indicated that the main problem was inaccuracy in the case of total cholesterol, aspartate transaminase, and alanine transaminase (QGI > 1.2), imprecision in the case of urea (QGI < 0.8), and both imprecision and inaccuracy for glucose.

CONCLUSION

On the basis of sigma metrics and QGI, it may be concluded that the Clinical Biochemistry Laboratory, PGIMS, Rohtak was able to achieve satisfactory results with world class performance for many analytes one year preceding the accreditation by the National Accreditation Board for Testing and Calibration of Laboratories. Aspartate transaminase and alanine transaminase required strict external quality assurance scheme monitoring and modification in quality control procedure as their QGI ratio showed inaccuracy.

Is nitric oxide level affected in postmenopausal women with hypothyroidism?

AIM

To analyze serum levels of nitric oxide (NO), an indicator of cardiovascular health, in post-menopausal females with and without hypothyroidism.

METHODS

NO was analyzed colorimetrically in 30 newly diagnosed hypothyroid postmenopausal females and 30 postmenopausal females with normal thyroid profile. Results were compared and subjected to appropriate statistical analysis.

RESULTS

The levels of serum NO were found to be significantly decreased in postmenopausal females with hypothyroidism as compared to the levels in those with normal thyroid profile (P value < 0.05). A negative correlation of NO was observed with thyroid stimulating hormone whereas a positive correlation of NO was observed with free T3 (FT3), free T4 (FT4), T3 and T4 though it was statistically significant only for FT4 among postmenopausal females with hypothyroidism.

CONCLUSION

Postmenopausal hypothyroid females may be at a risk of compromised cardiovascular health as indicated by low NO levels. Regular monitoring and risk assessment is essential for timely intervention.

Chemotherapy: Impact on Anti-Müllerian Hormone Levels in Breast Carcinoma

INTRODUCTION

Anti-Mullerian Hormone (AMH) is a glycoprotein of the transforming growth factor-β (TGF-β) family that seems to reflect the continuous non-cyclical growth of small follicles and can be considered an indirect index of the size of the resting primordial follicle pool. Accordingly, AMH represents a marker of Ovarian Reserve (OR) and is particularly useful in demonstrating ovarian tissue damage induced by chemotherapy.

AIM

To evaluate and compare the levels of AMH in Breast Carcinoma patients before and after chemotherapy with age matched healthy controls and to assess whether AMH as a biochemical marker of the OR might improve prediction of chemotherapy related outcomes in these patients.

MATERIALS AND METHODS

The present study was conducted in the Department of Biochemistry in collaboration with Department of Radiotherapy, Pt. B.D. Sharma, University of Health Sciences, Rohtak between June 2013 and June 2014. The subjects were divided into two groups. A total of 30 female patients of confirmed diagnosis of breast carcinoma were enrolled in the study group (Group I). The enrolled breast cancer cases were further divided into subgroups (Group-IA=Prechemotherapy & Group-IB= Postchemotherapy). Thirty healthy age matched female volunteers were enrolled as controls (Group II). Serum levels of AMH were determined by the ultrasensitive anti-müllerian hormone/ müllerian inhibiting substance (US AMH/MIS) Enzyme Linked Immuno Sorbent Assay (ELISA).

RESULTS

There was a significant decrease in serum AMH levels in the both study group-IA and study group-IB as compared to control group-II (p<0.05 and p<0.001 respectively). The prechemotherapy (group-IA) serum AMH levels dropped significantly after chemotherapy (group-IB) (p<0.001).

CONCLUSION

AMH levels declined after chemotherapy indicates direct chemotherapy induced damage to the granulosa cells and growing follicles, reflecting decrease ovarian reserve and fertility.

Evaluation of cord blood ischemia modified albumin in normal pregnancies and pre-eclampsia

OBJECTIVE

Pre-eclampsia is associated with ischemia and increased oxidative stress, which may lead to modification of plasma albumin to ischemia modified albumin (IMA).

METHODS

IMA levels were estimated in cord blood of 30 newborns born to pre-eclamptic mothers and compared with 30 normal newborns. IMA was estimated colorimetrically and the results were compared statistically.

RESULTS

The levels of IMA were found to be significantly higher (p < 0.001) in newborns born to pre-eclamptic mothers (0.835 ± 0.02 ABSU) as compared to those born to normal mothers (0.325 ± 0.01 ABSU).

CONCLUSION

IMA may act as a marker of ischemia and oxidative stress in newborns delivered to pre-eclamptic mothers.

Immunocontraceptives: How far from reality?

Despite high expectations of safer, effective, economical, longer acting contraceptives, to date, there are no licensed contraceptive vaccines available in the market. Nevertheless, a role for vaccines undoubtedly exists as an aid to birth spacing and as a nonsurgical means of generating sterility. The research concerned in the area so far has been successful on the feline population, with room still for exhaustive studies on humans. The future of contraceptive vaccines holds great promise in terms of comfort, price, efficacy, rare complications, and possibly nonselective action on animal populations as well as on humans. This brief review deals with the basic aspects of immunocontraceptives along with the efforts done so far. There is a need for further research in aspects involving the rate of evolution of contraception resistance based on genetics, resistance phenotypes, or cross generation effects. Gonadotropin-releasing hormone and luteinizing-hormone have not been investigated in humans, as both reported impotency in animals; the follicle-stimulating hormone has been shown to cause oligospermia; zona pellucida has also not been studied in humans as it causes irreversible oophoritis, while the sperm has the potential for success in humans based on the data from immunoreproductive studies. Even as the position of the human chorionic gonadotropin vaccine looks hopeful, research on other possible targets continue with an eventual aim of discovering a vaccine that is more immunogenically effective.

Decrease in antioxidant status of plasma and erythrocytes from geriatric population

Background: Ageing is associated with an accumulation of free radical damage, which leads to physiological and clinical modifications. The study aims to find out the status of lipid profile, antioxidant enzymes, malondialdehyde in geriatric population.

Patients/methods: The study was conducted on 150 subjects (75 healthy control between the ages of 20–30 years and 75 elderly subjects between ages of 50–70 years as cases). The following parameters were analyzed using the standard reference methods: lipid profile, reduced glutathione, glutathione peroxidase, glutathione reductase, catalase, superoxide dismutase and malondialdehyde.

Results: The present study was conducted to estimate the oxidative stress parameters in geriatric population. Highly significant increase in total cholesterol (TC), triglyceride (TG), LDL-cholesterol (LDL-C), VLDL-cholesterol (VLDL-C), malondialdehyde, catalase and decrease in high density lipoprotein cholesterol (HDL-C), reduced glutathione, glutathione peroxidase, glutathione reductase, superoxide dismutase was observed in geriatrics when compared with their younger counterparts.

Conclusion: This study concluded that there is enhanced oxidative stress and decreased antioxidant defence in geriatrics as compared to younger subjects which could play an important role in ageing. Dyslipidemia has become one of the important risk factors for the increasing prevalence of cardiovascular diseases. There is lack of awareness on the relationship between blood lipids and the risk of cardiovascular diseases in geriatric population. The strategy of early prevention should be adopted against dyslipidemia.

Antioxidant Enzymes and Lipid Peroxidation in Type 2 Diabetes Mellitus Patients with and without Nephropathy

Background:

Oxidative stress has been considered to be a pathogenic factor of diabetic complications including nephropathy. There are many controversies and limited studies regarding the antioxidant enzymes in diabetic nephropathy.

Aim:

This study was to evaluate the levels of antioxidant enzymes and lipid peroxidation in Type-2 Diabetes Mellitus (DM) patients with and without nephropathy.

Materials and Methods:

The study included 90 age and sex matched subjects. Blood samples of all subjects were analyzed for all biochemical and oxidative stress parameters.

Results:

The malondialdehyde (MDA) levels and catalase (CAT) activity were significantly increased and reduced glutathione (GSH) levels and activities of glutathione peroxidase (GPx) and glutathione reductase (GR) were significantly decreased in Type-2 DM with and without nephropathy as compared to controls and also in Type-2 DM with nephropathy as compared to Type-2 DM without nephropathy. There were an excellent positive correlation of glycohemoglobin (HbA1c) with MDA and a good negative correlation of GPx with GSH in controls. There were positive correlations of GR, CAT, and superoxide dismutase (SOD) with MDA in Type-2 diabetes patients with nephropathy.

Conclusions:

Intensity of oxidative stress in Type-2 diabetic patients with nephropathy is greater when compared with Type-2 diabetic patients without nephropathy as compared to the controls.

Association of insulin like growth factor-1 (IGF-1) and thyroid hormones in patients of acute leukemia

BACKGROUND

For many years, several studies have demonstrated a relationship between insulin like growth factor-1 (IGF-1), thyroid hormones, and various malignancies. IGF-1 plays an important role in tumor proliferation in various malignancies. The relationship between IGF-1 and thyroid hormones is complex and not fully understood. Therefore we planned to evaluate the level of IGF-1 and thyroid hormones in patients of acute leukemia.

METHODS

The present study included 25 patients with acute leukemia (Acute Myeloid Leukemia, n = 16; Acute Lymphoid Leukemia n = 9, mean age 28.16 years). 25 age and gender matched healthy individuals were taken as control (mean age 27.17 years). In all the subjects, serum IGF-1 was measured by enzyme linked immunosorbent assay (ELISA), serum total triiodothyronine (T3), thyroxine (T4) by radioimmunoassay (RIA), thyroid stimulating hormone (TSH) by immunoradiometric assay (IRMA), and free T3 (FT3) and free T4 (FT4) by chemilluminiscence. These tests were done before starting of chemotherapy and either 6 to 8 weeks after chemotherapy or at the time of remission, whichever was earlier.

RESULTS

At the time of diagnosis, patients with acute leukemia showed a significantly increased level of IGF-1 as compared to controls (198.32 +/- 67.55 vs 160.64 +/- 45.96; p < 0.01). After 6 to 8 weeks of chemotherapy, patients with acute leukemia showed a significant decrease in the level of IGF-1 compared to the baseline values (198.32 +/- 67.55 vs 155.6 +/- 45.96; p < 0.01). Though FT3, FT4, total T3, and total T4 values in these patients were within the normal range, these values were still significantly higher compared to controls. TSH levels were significantly lower in patients at the time of presentation and the levels increased after chemotherapy.

CONCLUSIONS

The estimation of IGF-1 and thyroid hormones may be helpful in assessing the disease activity and predicting the response of chemotherapy.

Study of changes in antioxidant enzymes status in diabetic post menopausal group of women suffering from cardiovascular complications

BACKGROUND

In type 2 diabetic patients, persistence of hyperglycemia has been reported as a cause of increased production of oxygen free radicals (FR), which leads to oxidative stress (OS) and becomes the main factor for predisposition to the cardiovascular complications in diabetes. Diabetic postmenopausal women are prone to cardiovascular disease due to reduced production of estrogen which is a potent antioxidant and prevents oxidative stress (OS) in body. The study is being aimed to find out the status of antioxidant enzymes (AOEs) and malondialdehyde (MDA) in post-menopausal diabetic women.

METHODS

The study was conducted with a total of 70 cases, which included 35 Type 2 diabetic post-menopausal females (45 - 60 years) with diabetic CVD complication as the study group and 35 age matched type 2 diabetic postmenopausal females without CVD complication.

RESULTS

All diabetic post menopausal females with CVD had significantly higher levels of fasting plasma glucose (FPG), postprandial plasma glucose (PPPG), total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), very low density lipoprotein cholesterol (VLDL-C), catalase (CAT), and malondialdehyde (MDA) and significantly lower levels of HDL-C, reduced glutathione (GSH), glutathione reductase (GR), glutathione peroxidase (GPx), and superoxide dismutase (SOD) as compared to the levels of control subjects.

CONCLUSIONS

During menopause, reduced production of estrogen causes hypertriglyceridemia, hypercholesterolemia, and hyperlipoproteinemia whose oxidation causes the accumulation of FR in the cell, which precipitates OS. Also, type 2 diabetic subjects with CVD poor glycemic control and impaired AOEs result in increased oxidative injury by failure of protective mechanisms, which further leads to oxidative stress.

Diagnostic significance of adenosine deaminase, uric acid and C-reactive protein levels in patients of head and neck carcinoma

BACKGROUND

Carcinomas are considered to be associated with increased cellular proliferation under antigenic stimulation and inflammation. Therefore, the markers of increased cellular turnover such as adenosine deaminase and uric acid were estimated quantitatively along with markers of inflammation such as C-reactive protein in squamous cell carcinoma of head and neck region.

METHODS

The levels of adenosine deaminase, uric acid, and C-reactive protein were estimated in 50 patients of squamous cell carcinoma of head and neck region before starting any treatment and compared with their corresponding levels in 30 healthy age and gender matched controls. The patients were divided into four groups depending on their staging and their results were compared statistically and the coefficient of correlation was calculated using Pearson's formula.

RESULTS

The levels of adenosine deaminase, uric acid, and C-reactive protein were found to be significantly higher in patients of head and neck cancers as compared to the levels in controls (p < 0.001). The levels were also observed to rise with staging. A positive correlation was observed between adenosine deaminase and uric acid (r = 0.743, p < 0.001), adenosine deaminase and C-reactive protein (r = 0.648, p < 0.001) and also between C-reactive protein and uric acid (r = 0.712, p < 0.001).

CONCLUSIONS

Thus, estimation of adenosine deaminase, uric acid, and C-reactive protein can help in making the diagnosis and assessing the severity of disease in patients of head and neck carcinoma.

HbA(1c) levels in cardiovascular diseased patients without diabetes in a developing country

BACKGROUND

High levels of glycated hemoglobin (HbA(1c)) have been associated with Coronary Vascular Diseases (CVD) in diabetic patients. Recent studies have reported no association between elevated glycated hemoglobin (HbA(1c)) and incident cardiovascular disease (CVD) among women without diabetes. There are many controversial studies on topics such as "Glycated hemoglobin levels (HbA(1c)) have been associated with cardiovascular diseases (CVD) in the non-diabetic patients". Therefore, we planned this study.

METHODS

The present study was conducted on 50 age matched controls and 50 clinically diagnosed non-diabetic CVD patients of either gender. The study included 50 patients with myocardial infarction (MI) admitted to the ICCU ward of J.L.N. Medical College and Hospital, Ajmer (Rajasthan). The following information was recorded from admission sheets of non-diabetic CVD patients of either gender: history of diabetes, hypertension, and cigarette smoking; demographic indices; coronary heart disease and diabetes mellitus treatment; serum cholesterol; serum triglycerides (TG); high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C); fasting and non-fasting blood glucose levels and Glycated haemoglobin levels (HbA(1c)). Glycosylated hemoglobin (HbA(1c)) was measured by latex agglutination inhibition assay.

RESULTS AND CONCLUSIONS

The HbA(1c) levels in healthy controls (n = 50) and non-diabetic CVD subjects (n = 50) observed were 4.32 +/- 0.34% and 5.80 +/- 0.20%, respectively. HbA(1c) levels in these subjects were significantly higher than controls (p < 0.001). The HbA(1c) levels in non-diabetic CVD patients are higher in comparison to controls.

Plasma tocopherol levels: a preliminary reference range

Alpha-tocopherol level was measured spectrofluorometrically in 279 healthy volunteers to establish reliable reference values and to compare possible sex and age-related differences. In the present study, men had higher tocopherol levels than women (p<0.05) and older subjects had lower values. This study provides reference values for alpha-tocopherol that may assist it evaluating the anti-oxidant defense.

Plasma lipoperoxides: a preliminary reference range

We measured lipoperoxides, as malonaldehyde (MDA) by thiobarbituric acid reaction in serum from 80 male and 120 female volunteers to establish reliable reference values and to compare possible sex- and age- related differences. In the present study women had higher MDA concentration in serum than do men (p<0.05) and older subjects had higher values (p<0.05). These age related results support the suggestions that lipid peroxidation increases with increasing age.

Immunological assessment in patients of leukaemia

In the present study delayed cutaneous hypersensitivity response (DNCB test) and humoral response (by uantification of immunoglobulins) ware carried out in 20 cases of leukaemias. None of the cases was found to be anergic or immunodeficient. In remission also patients showed the normal response.

Lipid peroxidation in leukaemia

OBJECTIVE

Free radicals have been implicated in the pathogenesis of leukaemias, so the degree of lipid peroxidation was studied as a marker of disease activity in patients of leukaemia.

METHODS

Lipid peroxidation product malonyldialdehyde (MDA) was estimated in serum from 30 patients of leukaemia by thio-barbituric acid reaction before and after chemotherapy. There were 10 patients of acute myeloid leukaemia (AML), 5 with acute lymphocytic leukaemia (ALL), 15 with chronic myeloid leukaemia (CML) of which 10 were in chronic stable phase and 5 in blast crisis. Twenty healthy age and sex matched individuals served as control.

RESULTS

There was a significant increase in MDA levels in AML and ALL patients and serum MDA levels were higher in the active phase of disease than in remission. We observed a direct correlation between peripheral leucocyte counts and MDA levels. In CML, MDA levels were higher, more so in the patients who were in blast crisis. Patients of CML blast crisis who achieved remission showed a significant decrease in MDA levels as compared to those without remission.

CONCLUSION

We observed a significant increase in MDA levels in active phase of acute as well as chronic leukaemia than those in remission. The proposed mechanism for high MDA is that myeloid cells are a major source of superoxide and other oxygen metabolites which lead to lipid peroxidation. MDA estimation in leukaemia can be of help in detecting type of leukaemia, response of therapy, and to predict the chances of relapse.

Alpha tocopherol concentration in serum of critically ill patients

OBJECTIVE

Alpha tocopherol is the biologically and chemically active form of vitamin E and is the most abundant lipid-soluble antioxidant in humans protecting the cell membranes. Serum concentration of the antioxidant alpha tocopherol was measured in critically ill patients in whom the excessive generation of reactive oxygen species could compromise antioxidant defence mechanisms.

METHOD

Alpha tocopherol concentration in serum was measured spectrofluorometrically in critically ill patients admitted in intensive care unit and age matched healthy adults, patients with diabetes mellitus (DM) and chronic myeloid leukaemia (CML) served as control.

RESULTS

Alpha tocopherol levels were significantly lower in critically ill patients (p < 0.001) as compared to healthy control subjects and those in two other disease groups (DM, CML) in which reactive oxygen species are reported to be increased. Elderly patients and patients who stayed longer than 8 days had lower plasma concentration of vitamin E.

CONCLUSION

These findings indicate that antioxidant defence could be considerably compromised in these very sick patients and vitamin E supplementation may be beneficial in increasing their antioxidant reserve.

Vitamin E in intestinal fat malabsorption

This study was done on 5 patients suffering from tropical sprue (8-10 years' duration). Serum vitamin E level was significantly low in these patients. Cell-mediated immune mechanism assessed by using 2,4-dinitrochlorobenzene, a skin-sensitizing hapten, was also depressed. Polyneuropathy was also observed. Repletion of vitamin deficiency was associated with marked improvement in T-cell functions and neuropathy.

Adenosine-deaminase (ADA) activity in Psoriasis (A Preliminary Study)

Study of adenosine-deaminase activity 'in 23 patients hav-mg psoriasis compared with an equal number of healthy controls revealed significantly high ADA-activity in the psotiatic patients.