Serum iron, Folate, Ferritin and CD4 Count in HIV Seropositive Women.

HIV infects cluster of differentiation 4 (CD4) T-lymphocytes, monocytes and macrophages resulting in decreased number and function of CD4 cells, changes that affect both cell mediated and humoral immunity. Hematological abnormalities are a common complication of human immune virus (HIV) infection and these abnormalities increase as the disease advances. Anemia is the most common haematological abnormality in HIV seropositive patients and its incidence is strongly associated with the progression of the disease. The aim of present study was to assess the haematological profile of HIV seropositive women and compare them with CD4 count. Two hundred seropositive females (age 18-25 years) attending antiretroviral therapy clinic were selected. Routine gynaecological and haematological investigations were carried out, study samples were drawn and serum iron, folate and ferritin were analysed by chemiluminiscence and CD4 count was determined by using flow-cytometry. Anemia was prevalent in seropositive women especially in those with low CD4 levels. Serum folate and ferritin levels were significantly lower in females with lower CD4 levels. Serum iron levels were higher at low CD4 levels. The mean CD4 count in HIV seropositive anaemic women were lower as compared to non anaemics suggesting that anaemia improves with higher CD4 cell counts. Plasma folate and ferritin levels are sensitive predictor of anaemia in early HIV infections and these patients should have a regular monitoring of their folate and ferritin levels especially with lower CD4 levels.

Glycohemoglobin levels with severity of periodontitis in non-diabetic population.

BACKGROUND: Periodontal disease is closely related to type 2 diabetes and is an important complication of diabetes. There are few studies about the relationship the glycohemoglobin levels with severity of periodontitis in non-diabetic population. We therefore planned this study to evaluate the glycohemoglobin levels with severity of periodontitis in non-diabetic population. METHODS: This study was conducted on 50 age and gender matched subjects in each of the three groups (according to the grades of mobility in periodontitis), a total of 150 non-diabetic periodontitis patients (Grade 1, Grade 2, and Grade 3 mobility) and 50 non-diabetic periodontitis patients with Grade 0 mobility (controls), in collaboration with the Department of Periodontics of Dental College and Department of Biochemistry, PGIMS, Rohtak, Haryana. After obtaining informed consent, fasting venous blood samples of all the non-diabetic periodontitis patients of all grades were collected aseptically for HbA1c, plasma glucose, and serum C-reactive protein (CRP) estimation. RESULTS: A total of 150 non-diabetic periodontitis patients (Grade 1, Grade 2, and Grade 3 mobility) and 50 age and gender matched controls participated in the study. There was no significant difference in fasting plasma glucose and postprandial plasma glucose in non-diabetic periodontitis patients with Grade 1, Grade 2, and Grade 3 mobility as compared to controls, non-diabetic periodontitis patients with Grade 1 mobility as compared to Grade 2, non-diabetic periodontitis patients with Grade 1 mobility as compared to Grade 3 and non-diabetic periodontitis patients with Grade 2 mobility as compared to Grade 3. Glycohemoglobin and serum C-reactive protein levels were significantly increased in non-diabetic periodontitis patients with Grade 1, Grade 2, and Grade 3 mobility as compared to controls, non-diabetic periodontitis patients with Grade 1 mobility as compared to Grade 3 and non-diabetic periodontitis patients with Grade 2 mobility as compared to Grade 3. The difference of serum C-reactive protein levels were significant. However, glycohemoglobin levels were non-significant between non-diabetic periodontitis patients with Grade 1 and Grade 2 mobility. CONCLUSIONS: The evidence of association between periodontitis and increased glycohemoglobin increases attention to the diagnosis and treatment of periodontitis, consequently improving the patient's oral health and prevention of occurrence in future diabetes. An understanding of these correlations is important to allow dental health care providers to inform patients with periodontitis of their increased risks and to counsel such patients to seek additional medical assessment or intervention as indicated.

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.

Case series: CSF LDH, proteins and electrolyte levels in patients of acute lymphocytic leukemia.

BACKGROUND: Central nervous system (CNS) involvement is common in hemoncologic diseases especially in patients with acute lymphocytic leukemia (ALL). Currently available modalities have limitations in diagnosing CNS involvement in early stages of disease and have a limited prognostic value. Raised cerebrospinal fluid (CSF) total lactate dehydrogenase (LDH) levels can predict CNS involvement in patients with various neurological disorders including CNS leukemia. METHODS: This study was conducted in 23 consecutive freshly diagnosed patients of ALL without any previous CNS disease. Analysis of CSF was done for total LDH, proteins and electrolytes in all the patients before the start of chemotherapy and when the patients were in remission or 6 weeks after chemotherapy whichever was earlier. Twenty-three age and sex matched controls were also studied to set the normal reference range. The results were analyzed statistically by Student's t test and coefficient of co-relation between CSF LDH and protein in patients with raised CSF LDH at the time of presentation was also calculated. RESULTS: CSF LDH was increased in 4 out of 6 patients with signs and symptoms of CNS involvement (Group A) and 3 of these patients also had increased CSF protein levels. 2 out of 17 patients without signs and symptoms of CNS involvement (Group B) had both elevated CSF LDH and protein levels. The increased levels came down to normal reference values after chemotherapy except in one Group A patient in whom CSF LDH remained high. However, no significant change in CSF electrolytes was noted in these patients. CONCLUSION: Raised CSF LDH and CSF protein levels may indicate CNS involvement in patients with ALL.

Effect of imatinib therapy with and without turmeric powder on nitric oxide levels in chronic myeloid leukemia.

Nitric oxide (NO) is involved in different stages of malignancies. Increased levels of NO have been reported in different leukemias. Imatinib is the preferred drug for the treatment of chronic myeloid leukemia (CML). Turmeric powder contains curcumin which has anti-leukemic property and also decreases NO synthesis. This study was conducted on fifty patients of CML divided into two groups, group A receiving imatinib alone and group B receiving turmeric powder along with imatinib for six weeks. Nitric oxide levels were estimated in these patients before and after receiving therapy and were analyzed statistically. Nitric oxide levels were found to be significantly decreased in both the groups, but more significantly in group B after receiving the respective treatments. Thus, curcumin acts as an adjuvant to imatinib in decreasing the NO levels and may help in the treatment of CML patients.

Piperacillin-tazobactum plus amikacin versus ceftazidime plus amikacin as empirical therapy for Fever in neutropenic patients with hematological malignancies.

Infections are one of the main cause of death in cancer patients particularly when granulocytopenia is present. A number of drugs have been used for the treatment of neutropenic patients with fever. Most published literature has shown piperacillin-tazobactum in combination with amikacin to be significantly more effective than ceftazidime plus amikacin in empirical treatment of febrile episodes in patients with neutropenia. In view of the reported literature we have tried this combination in our febrile neutropenic patients with haematological malignancies at PGIMS Rohtak. It was an open randomized trial. Patients were divided into two groups of 20 each. In the first group (group A) piperacillin-tazobactum (4 + 0.5 g 6 hourly) with single daily dose of amikacin 20 mg/kg was given. In the second group (group B) ceftazidime 40 mg/kg every 8 hourly with single daily dose of amikacin 20 mg/kg was given. The most common site of infection was blood followed by urinary tract, respiratory tract and oral cavity. 13 (65%) patients in group A and 12 (60%) patient in group B showed clinical success. In our study however in our patients a better response was seen in patients with piperacillin-tazobactum + amikacin (65% vs. 60%). So it is recommended that piperacillin-tazobactum + amikacin should be given in febrile neutropenic patients with haematological malignancies.

Role of granulocyte colony stimulating factor (G-CSF) in chemotherapy induced neutropenia.

BACKGROUND: In the past decade, there have been many clinical trials investigating the potential benefits of adjunctive therapy with colony stimulating factors (CSFs) both to ameliorate or prevent profound neutropenia and its potentially life threatening consequences. Neutropenia is the most common dose limiting side effects of cytotoxic chemotherapy. We decided to study the effect of same in our patients coming to haematology clinic. AIMS AND OBJECTIVES: To see the effect of G-CSF on severity of neutropenia following chemotherapy in patients of haematological malignancies and to see the effect of G-CSF on duration of hospitalization, documented infections and duration of fever as compared to control group in patients with neutropenia following chemotherapy in haematological malignancies. MATERIAL AND METHODS: Thirty patients of acute leukemia were prospectively studied. Patients were given G-CSF 24.hours following chemotherapy induced neutropenia and following parameters were observed. (a) median time to ANC recovery (b) incidence and duration of fever (c) duration of hospitalization following chemotherapy (d) incidence of documented infections. The patients were given G-CSF until the neutrophil count was >1000/ml for 3 days or maximum of 7 days. RESULTS: Mean age was 29.33 +/- 14 years in G-CSF group and 27.53 +/- 13.75 in control group. Mean duration of neutropenia was 11.4 days (p < 0.05) in G-CSF group and 15.8 days in control group. Mean duration of fever was 8.2 days in G-CSF group and 13.53 days in control group (p < 0.05). Mean duration of hospital stay was 21.33 days in G-CSF group and 25 days in control group (p > 0.05). CONCLUSIONS: The study demonstrates that G-CSF administration is efficacious in chemotherapy induced neutropenia by decreasing the duration of neutropenia and duration of fever.

Cefepime versus ceftazidime as empirical therapy for fever in neutropenic patients with haematological malignancies.

An open randomized comparative study was conducted to evaluate the efficacy of Cefepime (2 gm iv. 8 hr.) vs. ceftazidime (2 gm iv. every 8 hr.) in empirical therapy of febrile neutropenic patients. A total of 40 eligible febrile episodes were randomized to be treated with study regimen. Twenty febrile episodes were treated with cefepime and 20 were treated with ceftazidime. The two groups were comparable in terms of age, sex, height, underlying neoplasm, number of pretherapy neutrophils, duration of neutropenia. The overall therapeutic success rate of cetepime group (60%) was comparable to that of ceftazidime group (55%). The results of this study suggest that cefepime is an effective and safe agent in empirical therapy of febrile episode in neutropenic patient and its efficacy is comparable with that of ceftazidime.

Alteration in lipid profile in patients of chronic myeloid leukemia before and after chemotherapy.

BACKGROUND: Chronic myeloid leukemia (CML) is a myeloproliferative disorder of pleuripotent hematopoietic progenitor cells characterized by excessive proliferation and accumulation of granulocytes and occasionally red blood cells and platelets. METHODS: We examined 30 newly diagnosed and proved cases of CML admitted in medical wards or attending a clinical hematology clinic. In addition to routine hematological investigations, lipid profile was done in all the patients at the time of presentation, 4-6 weeks after the start of chemotherapy and 6 months after the chemotherapy even if some of the patients were not in remission. RESULTS: Total serum cholesterol, HDL-cholesterol and LDL-cholesterol concentrations increased significantly after chemotherapy whereas serum triglyceride and VLDL-C cholesterol concentrations did not increase significantly. Also, lipid concentrations were correlated with disease activity. An inverse correlation was found with spleen size and total serum cholesterol, HDL-cholesterol and LDL-cholesterol. Serum triglyceride and VLDL-C concentrations were inversely related to the hemoglobin concentrations. There was no correlation of total cholesterol and LDL-cholesterol concentrations with hemoglobin. We found from the present study that low lipid concentrations are associated with poor prognosis of the disease. CONCLUSION: We suggest that the estimation of lipid profile may be helpful in evaluating the response to chemotherapy in CML patients.

Plasma concentrations of lipid peroxidation products in children with acute leukaemia.

Acute leukaemia is the most common childhood malignancy. The cause of leukaemia is not known in most of the cases and of late free radicals have been implicated in the pathogenesis of leukaemia. The degree of lipid peroxidation was studied in the present study as a marker of disease activity in 15 patients of acute lymphoblastic leukaemia and 20 healthy age and sex matched individuals served as control. Serum malonaldehyde (MDA) levels were increased in leukaemia and were higher in the active phase of disease as compared to those in remission, Hence, serum MDA estimation in leukaemia can be of help in diagnosis and to predict the chances of relapse.

Role of oxygen free radicals in shock.

AIMS OF THE STUDY: To study lipid peroxidation, magnesium levels (Mg) in plasma and red cells (RBC), superoxide dismutase (SOD) and catalase (CAT) activities in the plasma and RBC of shock patients. METHODOLOGY: Twenty five patients with clinically defined septic shock and 30 healthy volunteers were selected for the study to study the parameters of oxidative stress. RESULTS: Septic shock patients had higher activities of plasma and RBC SOD and CAT activities as compared to control. Also, plasma Mg and malonaldehyde (MDA) levels were higher in shock patients as compared to controls. While, RBC Mg levels were similar in two groups. CONCLUSIONS: The finding of increased concentration of MDA, Mg, SOD and CAT in sepsis implicates oxygen free radicals in the pathophysiology and free radical scavengers may have a role in organ preservation.

Glutathione levels in health and sickness.

We speculate that the glutathione (GSH) status of human subjects could be an indicator of health and functional age. In this regard, in a study in which, 80 young and 40 elderly healthy individuals were selected as control. We also studied 145 patients with chronic illnesses namely, ischaemic heart disease, diabetes, preeclampsia, cataract, chronic renal failure and leukaemia (age 52 +/- 8.6 years). We observed that all the subjects had high malonadildehyde and low glutathione levels as compared to control. These early observations support the hypothesis that oxidative stress may have an important aetiological rule and antioxidants a potential therapeutic role.

Oxidative stress after acute myocardial infarction: effect of thrombolytic treatment.

OBJECTIVE: Treatment with thrombolysis plays a crucial role in salvaging the myocardium in myocardial infarction (MI) patients, but reperfusion of ischaemic areas may itself be associated with reperfusion injury mediated by free radical induced oxidation. Hence the present study was planned to evaluate oxidative stress in patients receiving thrombolytic therapy during MI and to compare them with those not receiving thrombolysis. METHODS: Thiobarbituric acid reactive substance (TBARS) was used as a marker of lipid peroxidation in 30 patients after acute MI. Thirteen were treated by intravenous thrombolysis and 17 served as control. Also, vitamin E levels were estimated in these patients. RESULTS: Patients treated with thrombolysis showed a fall in vitamin E and increase in TBARS within first hours. The decrease in vitamin E was independent of a change in cholesterol. However, the levels were similar at 72 hours. CONCLUSION: The results indicate increased free radical production after MI and reperfusion also increases in free radical production and antioxidants may have a part in improving thrombolytic reperfusion of ischaemic myocardium.

Serum vitamin E in chronic myeloid leukaemia.

OBJECTIVE: Experimental evidence suggests that free radicals can participate in tumour promotion and malignant conversion and free radical scavengers like alphatocopherol act as first line of defense against peroxidation of polyunsaturated fatty acids. The present study was planned to estimate serum vitamin E levels in patients of chronic myeloid leukaemia (CML). METHODS: Serum vitamin E levels were estimated in 25 CML patients before and after the treatment. Twenty five age and sex matched healthy individuals served as control. RESULTS: Mean serum vitamin E levels were significantly decreased in CML patients before starting the treatment as compared to control. Also, vitamin E levels increased significantly after the treatment, but, remained lower than the control. CONCLUSION: Vitamin E levels were lower in CML patients as compared to control and the levels increased significantly after treatment in these patients. This could be due to decrease in oxidative stress due to decrease in tumour load.

Lymphocyte glutathione levels in acute leukemia.

The current interest in the clinical significance of the glutathione estimation in leukemia is due to its widespread effect on the cell constituent and cell function of the hematopoietic system. It helps and protects the cells against free radicals and reactive oxygen products. The present study was conducted to estimate glutathione levels in lymphocytes of 20 patients with acute leukemia before and after chemotherapy to observe the relation of glutathione level to response to chemotherapy. Twenty age and sex matched healthy volunteers served as control. In acute myeloid leukemia, the levels were almost double than that of controls (P<0.001). In acute lymphoid leukemia they were 2.5 times of the control. Lymphocyte glutathione levels was higher in active phase of disease than in remission. Lymphocyte glutathione level could act as a marker of leukemic activity and may help to predict onset of relapse. But, it is not only the determinant of response to chemotherapy.