Role of Cod Liver Oil in Preventing Myocardial Infarction.

INTRODUCTION: Omega-3 fatty acids have for long been shown to reduce the incidence of cardiovascular (CV) diseases. Omega-3 fatty acids mainly exist in the form of eicosapentaenoic acid (EPA) and docosahexaenoic acid in fish oils. Cod liver oil is found to have a high concentration of these omega-3 fatty acids. This study aims to explore the benefits of using cod liver oil in reducing the incidence of myocardial infarction (MI) among at-risk patients.  Method: This open-label placebo-controlled two-arm interventional study was conducted in the internal medicine and cardiology unit of tertiary care hospital between January 2018 to January 2021. During this period, 870 patients at risk of CV events were enrolled in the study after obtaining informed consent. The study group received 415 mg cod liver oil daily, in addition to their current treatment, in a bottle without label and the control group received no additional treatment to their standard treatment. Patients were followed up for 12 months or till the development of MI. RESULT: Patients treated with cod liver oil had comparatively fewer incidences of MI; however, the difference was not significant (p-value: 0.09). Furthermore, the difference was non-significant for both fatal and non-fatal MI. The relative risk for total MI incidence was 0.70 (0.44-1.10). CONCLUSION: According to our study, adding cod liver oil to the diet does not play a major role in reducing the risk of MI. Further large-scale studies are needed to understand the role of cod liver oil in reducing the risk of CV events, including MI.

Prevalence and Causes of Hyperuricemia in Children.

Introduction  There are various factors responsible for hyperuricemia in children, however, there is extremely limited local data available. In this study, we aim to determine the causes and risk factors associated with hyperuricemia. This study will assist pediatric consultants to identify children who might be at risk of hyperuricemia and manage them accordingly. Methods This study was conducted in pediatric outpatient departments of various tertiary care hospitals from January 2018 to December 2019. Five thousand (n = 5000) children of either gender between the age group of 1-14 years, were enrolled in the study after informed consent from their parents. Uric acid levels were assessed by using the UASure blood uric acid monitoring handheld device. Results  In our study, n = 1301 (26.02%) children had hyperuricemia. Hyperuricemia was more common in male compared to females (65.49% vs. 34.51%; p-value <0.00001) and in older children (9 ± 2 years vs. 7 ± 3; p-value <0.00001). In hyperuricemia patients, the most common disorder was gastroenteritis (23.98%), followed by respiratory infection (23.14%) and asthma (15.45%). Conclusion  Hyperuricemia in children is very prevalent in the local setting. Patients with pre-existing conditions like congenital heart disease, asthma, epilepsy, and cancers should routinely be screened for hyperuricemia and managed accordingly to avoid long-term complications associated with hyperuricemia.

Evaluation of the role of maternal serum high-sensitivity C-reactive protein in predicting early pregnancy failure.

Maternal serum high-sensitivity C-reactive protein (HSCRP) was evaluated in predicting spontaneous abortion in spontaneous pregnancies presenting with threatened spontaneous abortion. Seventy-one cases of threatened spontaneous abortion (group A) and 71 asymptomatic controls (group B), matched for gestational and maternal age, body mass index and smoking status, were included. Maternal serum samples were evaluated for HCG, progesterone, pregnancy-associated plasma protein-A (PAPP-A) and HSCRP using standard bio-assays. No difference was observed in ultrasound measurements, and median progesterone maternal serum level was significantly lower (P < 0.05) in group A compared with group B. In group A, the median of all ultrasound and maternal serum parameters was significantly lower (P < 0.01) compared with group B. The median gestational sac diameter, volume and median HSCRP and PAPP-A levels were significantly increased (P < 0.05) in group A, with a normal outcome compared with group B, probably owing to the inflammatory reaction associated with intrauterine bleeding. In group A patients destined to abortion, the gestational sac development and corresponding protein synthesis fell before the fetal heart activity stopped; in spontaneous pregnancies, maternal serum HSCRP did not provide additional information for the management of threatened spontaneous abortion but warrants further research in assisted reproduction pregnancies.

Oxygen-linked S-nitrosation in fish myoglobins: a cysteine-specific tertiary allosteric effect.

The discovery that cysteine (Cys) S-nitrosation of trout myoglobin (Mb) increases heme O2 affinity has revealed a novel allosteric effect that may promote hypoxia-induced nitric oxide (NO) delivery in the trout heart and improve myocardial efficiency. To better understand this allosteric effect, we investigated the functional effects and structural origin of S-nitrosation in selected fish Mbs differing by content and position of reactive cysteine (Cys) residues. The Mbs from the Atlantic salmon and the yellowfin tuna, containing two and one reactive Cys, respectively, were S-nitrosated in vitro by reaction with Cys-NO to generate Mb-SNO to a similar yield (∼0.50 SH/heme), suggesting reaction at a specific Cys residue. As found for trout, salmon Mb showed a low O2 affinity (P50 = 2.7 torr) that was increased by S-nitrosation (P50 = 1.7 torr), whereas in tuna Mb, O2 affinity (P50 = 0.9 torr) was independent of S-nitrosation. O2 dissociation rates (koff) of trout and salmon Mbs were not altered when Cys were in the SNO or N-ethylmaleimide (NEM) forms, suggesting that S-nitrosation should affect O2 affinity by raising the O2 association rate (kon). Taken together, these results indicate that O2-linked S-nitrosation may occur specifically at Cys107, present in salmon and trout Mb but not in tuna Mb, and that it may relieve protein constraints that limit O2 entry to the heme pocket of the unmodified Mb by a yet unknown mechanism. UV-Vis and resonance Raman spectra of the NEM-derivative of trout Mb (functionally equivalent to Mb-SNO and not photolabile) were identical to those of the unmodified Mb, indicating that S-nitrosation does not affect the extent or nature of heme-ligand stabilization of the fully ligated protein. The importance of S-nitrosation of Mb in vivo is confirmed by the observation that Mb-SNO is present in trout hearts and that its level can be significantly reduced by anoxic conditions.

Soluble Flt-1 and PlGF: new markers of early pregnancy loss?

Recent data have indicated a relationship between placental oxygen and angiogenic protein levels in the first trimester of normal pregnancies. Our objective was to investigate if maternal serum levels of angiogenic factors Soluble vascular endothelial growth factor (VEGF) receptor 1 (sFlt-1), soluble Endoglin and placental growth factor (PlGF) are altered in women with symptoms of threatened miscarriage (TM) and if they are predictive of a subsequent miscarriage. Blood samples were collected at 6-10 weeks from women presenting with TM (n = 40), from asymptomatic controls (n = 32) and from non- pregnant women in their luteal phase (n = 14). All samples were assayed for serum level of sFLT-1, PlGF, sEndoglin and HSP70 using commercial ELISAs. Samples were analysed retrospectively on the basis of pregnancy outcome. TM group included 21 women with a normal pregnancy outcome and 19 with subsequent complete miscarriage. The latter subgroup had significantly lower mean maternal serum (MS) sFlt-1 (83%, P<0.001) and PlGF (44%, P<0.001) compared to those with a normal pregnancy outcome. Asymptomatic control pregnant women had similar MS levels of sFlt-1 and PlGF compared to the TM patients with a normal outcome. The mean MS sFlt-1 (>10 fold) and MS PlGF (∼2 fold) levels were significantly (P<0.001) higher in control pregnant women compared to the non-pregnant group in the luteal phase of the menstrual cycle. Soluble Endoglin was not altered in the normal pregnant women compared to non pregnant women, although lower in the TM subgroup with a subsequent miscarriage (∼25%, P<0.001) compared to TM with a live birth. There was no significant difference in the mean MS HSP 70 levels between the different groups. This study shows that sFlt1 and PlGF MS levels are increased by several folds in early pregnancy and that MS sFlt-1 and MS PlGF are markedly decreased in threatened miscarriage patients who subsequently have a miscarriage suggesting these proteins are sensitive predictive markers of subsequent pregnancy loss.