Association of adipocyte size and SREBP-1c in visceral and subcutaneous adipose tissue in non-obese type 2 diabetes mellitus.

OBJECTIVE: Non-obese type 2 diabetes seems to be common in India; hence the current study tried to understand the pathogenesis of diabetes in this group focusing on the role of adipocytes especially abdominal fat compartment. Comparison was made between non-obese subjects with newly detected diabetes and those without diabetes, in relation to levels of adipogenic factor and adipokines in pre-adipocytes and mature adipocytes respectively. RESEARCH DESIGN METHODS: Non-obese subjects (BMI-18-25 Kg/m2) were consecutively selected of whom 15 had newly-detected, treatment naïve type 2 diabetes (HbA1% ≥6.5) while 25 were control (HbA1c% ≤5.6). We examined the expression of adipocyte differentiation factor - SREBP-1c from preadipocytes and adipocyte specific adipokines- HMW isoform and total adiponectin, leptin, FABP-4, TNF-α and IL-6 from adipocytesisolated from abdominal visceral and subcutaneous adipose tissues (VAT and SCAT) by RT-PCR and as well as from serum by ELISA. Size of cultured adipocytes was measured in a fully automated imaging system microscope. RESULT: Both in SCAT and VAT, SREBP-1c and adiponectin had significantly lower expression along with increased mRNA level of inflammatory adipokinesdiabetes.Average adipocyte size and frequency of large(hypertrophied) adipocytes were comparatively higher in T2DM subjects and had significant negative correlation with SREBP-1c. HMW adiponectin level significantly reduced in the secretion from VAT and SCAT of T2DM subjects compared to control. CONCLUSION: Reduced expression of SREBP-1c in preadipocytes may lead to increased number of hypertrophied adipocytes in T2DM. Therefore, these dysfunctional hypertrophied adipocytes could cause imbalanced expression of insulin resistant and insulin sensitive adipokines.

Haemophagocytic lymphohistiocytosis in pregnancy and the postpartum period: A retrospective case series analysis.

Introduction: Haemophagocytic lymphohistiocytosis (HLH) is an extremely rare condition characterised by excessive immune activation leading to haemophagocytic activity and has seldom been reported in pregnancy. HLH manifests as relapsing fevers with features of multi- organ failure and has a high mortality. Methods: A retrospective case series analysis using national data from MBRRACE-UK maternal death reports (n=5) and case notes from patients diagnosed with HLH during pregnancy at New Cross Hospital, Wolverhampton (n=2) between 2012 and 2021. Results: A total of seven cases were included. Cases uniformly presented with fever and experienced prodromal illnesses consisting of lymphadenopathy, fevers, and malaise. Gestation at presentation ranged from 9/40 to 11 months postpartum. All patients had multiple cytopaenias. Other common features included elevated liver enzymes (n=5), hyperferritinaemia (n=5), splenomegaly (n=4), hypofibrinogenemia (n=4) and elevated soluble interleukin-2 receptor α (CD25) levels (n=3). Underlying causes were identified in four cases. Median time from presentation to diagnosis was 35 days. Bone marrow biopsy was diagnostic in a majority of cases. Corticosteroids and ciclosporin were the most frequently used treatments. In some cases early delivery by caesarean section or termination of pregnancy was necessary to permit maternal treatment. Progression to multi-organ failure resulting in maternal death occurred in five cases: two cases survived. Pregnancy outcomes were: livebirth at term (n=2), preterm livebirth (n=3), termination of pregnancy (n=1), and miscarriage (n=1). Of the surviving infants, one had bone marrow suppression with anaemia at birth and sensorineural deafness. Conclusions: Due to the rarity of the condition, diagnosis is often delayed. In view of the high mortality, clinicians should consider HLH early when reviewing pregnant patients with unexplained pyrexia and multi-organ dysfunction. Early involvement of haematology should be sought, as prompt diagnosis is crucial for meaningful attempts at curative therapy. Important treatment considerations include fetal viability, maternal condition and treatment toxicity.

Haemophagocytic lymphohistiocytosis (HLH) is an extremely rare and life threatening condition. It is a disorder where the body reacts to any stimulus which produces an excessive immune response causing severe inflammation and damage to multiple major organs. If not diagnosed and treated on time, it can lead to major organ failure and even death. HLH affecting pregnant women can be life threatening affecting both mother and the baby. Early diagnosis and treatment by specialist teams of doctors can help in improving the outcomes. Our case series aims to bring awareness about this serious disorder, so that it can be identified early and treated accordingly.

Association between growth differentiation factor 15 levels and gestational diabetes mellitus: A combined analysis.

Objective: Gestational diabetes mellitus (GDM) is a common glucose metabolism disease occurs in pregnancy that affects both maternal and neonatal health. Recently, increasing studies have attached importance to the relationship between growth differentiation factor 15 (GDF-15) and GDM, but the results were inconclusive. Therefore, we conducted a meta-analysis to examine the association between GDF-15 and GDM. Materials and methods: A systematical search was performed in Gene Expression Omnibus (GEO), PubMed and Google Scholar till Oct 27, 2022. We first calculated the mean and standard deviation of GDF-15 expression levels from the included eligible datasets and articles. Then, a meta-analysis was conducted to depict the difference in GDF-15 mRNA or GDF-15 protein expression between case and control groups by using conservative random effect model. Moreover, the potential publication bias was checked with the aid of Begg's test and Egger's test. Finally, sensitivity analyses were performed by changing the inclusion criteria. Results: In summary, 12 GEO datasets and 5 articles were enrolled in our study, including 789 GDM patients and 1202 non-GDM pregnant women. It was found that the expression levels of GDF-15 mRNA and GDF-15 protein in late pregnancy were significantly higher in GDM patients compared with non-GDM pregnant women, with the standard mean difference (SMD) and 95% confidence interval (95% CI) of 0.48 (0.14, 0.83) and 0.82 (0.32-1.33), respectively. Meanwhile, a slightly weakened association between GDF-15 protein levels and GDM was also observed in the middle pregnancy, with SMD (95% CI) of 0.53 (0.04-1.02). Conclusion: In all, our results suggested that the expression levels of GDF-15 were significantly higher in GDM patients compared with non-GDM pregnant women, especially in the late pregnancy.

The Manifestation of Anxiety as Repercussion of COVID-19: A Survey of Medical Practitioner's Opinion.

Anxiety is usually transient in nature, but if the symptoms are severe and persistent in the absence of stressor, then it is considered as anxiety disorder. Corona virus disease 2019 (COVID-19) which was declared as pandemic by World Health Organization in March 2020 affected the lives of human beings worldwide. A panic and anxious situation was created due to the outbreak of COVID-19. Medical health practitioners have been connected with the patients and hence can better speculate the psychology of human beings. The present study was designed to find out the manifestation of anxiety as repercussion of COVID-19 on the basis of opinion of medical practitioners. A survey was conducted among the medical practitioners from India and Bangladesh to find out the possibility of anxiety as after-effect of COVID-19 through questionnaires. Results of the study showed that 95% medical practitioners were in the view to have chances of anxiety with more possibility to have social anxiety and post-traumatic stress anxiety disorder as a consequence of COVID-19. Female and male genders have equal chances, whereas transgender have lesser chances to have anxiety disorders as a consequence of COVID-19. Population above 50 years age might have maximum chance of having anxiety as after-effect of COVID-19. The study concludes to have chances of anxiety as repercussion of COVID-19.

A study of serum growth differentiation factor 15 in Indian women with and without gestational diabetes mellitus in the third trimester of pregnancy and its association with pro-inflammatory markers and glucose metabolism.

The pathogenesis of gestational diabetes mellitus (GDM) is multifactorial and it shares many features with type 2 diabetes mellitus. Growth differentiation factor 15 (GDF-15), a member of transforming growth factor-ß superfamily, is expressed in a high amount in the placenta in addition to other organs. This cross-sectional study was performed to assess the difference of GDF-15 and pro-inflammatory cytokines between pregnant women with or without GDM, and to explore the possible association of GDF-15 with the parameters of dysglycemia (Serum insulin, HOMA-IR, fasting, 60 min, and 120 min post-75 gm oral glucose plasma glucose levels) and inflammation (IL-6 and TNF-α) in women with GDM at 24-28 weeks of gestation. Thirty-five women with GDM and 30 age-matched non-diabetic pregnant control (NDPC) subjects were recruited for the study. Mean serum GDF-15, IL-6, and TNF-α levels were significantly higher in GDM in comparison to the NDPC population. These differences persisted even after adjusting for the possible confounders like maternal age and BMI. GDF-15 level showed a positive correlation with parameters of dysglycemia (Serum insulin, HOMA-IR, fasting, 60 min, and 120 min post-75 gm oral glucose plasma glucose levels) but a variable correlation with the markers of inflammation. In conclusion, our study provides evidence that, in Indian women, serum GDF-15 level is higher in GDM in comparison to age-matched pregnant subjects without GDM in the early third trimester pregnancy. Moreover, in third trimester, GDF-15 level increases with increase in plasma glucose and insulin resistance.

Predictive factors for a good outcome following endoscopic sinus surgery.

The aim of this study was to establish if there are any symptoms which can predict increased patient satisfaction following Endoscopic Sinus Surgery (ESS) and whether these symptoms correlate with Lund-Mackay score on Computerised Tomography (CT). A prospective observational study was performed. Ninety-three consecutive patients who were offered ESS were recruited from an otolaryngology department in a UK Teaching Hospital. All patients had failed medical therapies for chronic rhinosinusitis (CRS), recurrent acute sinusitis and/or nasal polyposis. Patients were asked to complete a questionnaire pre-operatively and 12 months after surgery. Symptoms were assessed using a visual analogue scale. Endoscopic examination of the nose was performed pre and post-operatively. Lund-Mackay score was recorded for the pre-operative CT scan. Results were analysed using linear regression analysis and Pearson correlation coefficient. All symptoms improved after ESS (P < 0.001). However, a high pre-operative score for nasal discharge and olfactory disturbance were predictive of lesser improvement in symptom scoring (P < 0.001). Patients undergoing polypectomy with ESS demonstrated greater improvement in symptom score than those undergoing ESS with septoplasty or turbinate reduction surgery. There was no correlation between symptom score improvement and pre-operative Lund-Mackay score (r = 0.09). Patients who have high pre-operative symptom scores for nasal discharge and olfactory disturbance may gain less benefit from ESS, whilst those with nasal polyposis appear to perceive the greatest benefit. Increasing pre-operative Lund-Mackay score is not a predictor of a favourable operative outcome.