Evaluating the association between maternal vitamin D deficiency and preeclampsia among Indian gravidas.

OBJECTIVE: The association between vitamin D deficiency and devastating preeclampsia is still debated. In this present study, our aim is to evaluate whether a statistically significant association exists between vitamin D deficiency and preeclampsia in Indian gravidas. As to the best of our knowledge, no study of this context with such a large sample size is done in the Indian population till now. METHOD: A case-control study was performed in the year 2015-2019 where we enrolled 1000 pregnant women with preeclampsia admitted either in labor or for induction of labor in the study group and 1000 pregnant women without preeclampsia either in labor or admitted for induction of labor at term gestation in the control group. Serum 25-hydroxyvitamin D [25 (OH)] D levels of both the groups were measured through the radioimmunoassay method and analyzed. In both the groups, samples were collected equally across all the seasons of the year to avoid confounding by seasonal variation of vitamin D. Primary outcome measures the association of vitamin D deficiency and preeclampsia. While secondary outcome measures the correlation between levels of vitamin D deficiency with the severity of preeclampsia. RESULT: A significantly low mean vitamin D level was seen in preeclamptic women (11.0 ± 7.1 ng /ml) compared to normotensive (31.4 ± 1.7 ng/ml) with p < .001. We observed approximately 11 fold increased odds of having preeclampsia in vitamin D deficient women (OR: 11.308; 95 % CI 7.5982-14.0097). Moreover, we observed that as vitamin D level decreases, the severity of preeclampsia increases (p < .001). CONCLUSION: Compared with normotensive women, preeclamptic women had a significantly low level of vitamin D, suggesting a significant association between vitamin D deficiency and preeclampsia.

Cross-sectional study of the prevalence of polycystic ovary syndrome in rural and urban populations.

OBJECTIVE: To assess the prevalence and risk factor profile of polycystic ovary syndrome (PCOS) in Haryana, India. METHODS: A large-scale cross-sectional study was conducted among women of reproductive age in Haryana between December 2015 and May 2017. A random multi-stage stratified sampling method was adopted. PCOS screening was based on questionnaires. Blood samples for hormonal analysis were collected from those with probable and definitive PCOS cases. Women with menstrual irregularities (MI), hyperandrogenism (HA), and polycystic ovaries (PCO) (Rotterdam criteria) were included. Females with thyroid disease, hyperprolactinemia, and adrenal hyperplasia were excluded. RESULTS: Among total 2400 women screened, 94 (4.21%) had PCOS. The PCOS phenotypes were 30% clinical HA (hirsutism, H), 64% biochemical HA, 35% PCO, 16% H+MI, 10% MI+PCO, 52% MI+HA, 14% PCO+H, and 19% PCO+H+HA. Overall, 67 (71%) of the women with PCOS resided in urban regions and 27 (29%) in rural regions. CONCLUSION: Among the women with PCOS, a considerably higher proportion resided in urban regions of Haryana. The difference may be attributed to lifestyle and dietary factors. Ignoring PCOS may put women at risk of serious long-term health consequences that are difficult to manage. Lifestyle changes and continuous surveys should be promoted for better management.

Levels of neutrophil gelatinase-assosciated lipocalin in patients with head and neck squamous cell carcinoma in Indian population from Haryana state.

AIM: To study the levels of neutrophil gelatinase associated lipocalin (NGAL) in head and neck squamous cell carcinoma (HNSCC). METHODS: This was a non randomized case control study conducted at Department of Biochemistry, in collaboration with Regional Cancer Center over a period of one year. The study population included 50 adult newly diagnosed HNSCC patients reporting in outpatient department at Regional Cancer Center and compared with 50 healthy controls. NGAL was estimated by ELISA technique. Student t test and χ2 test were applied for comparison of means of study groups. Correlations between groups were analyzed using Pearson correlation coefficient (r) formula. RESULTS: Patients with HNSCC exhibited significantly increased levels of NGAL (P < 0.05) as compared to healthy controls (978.88 ± 261.39 ng/mL vs 34.83 ± 7.59 ng/mL). Out of 50, 26 patients (52%) were in stage IV, 21 (42%) in stage III, 1 (2%) patient in stage II and 2 (4%) patients were in stage I. Metastasis was absent in 98% patients and mean NGAL levels were highest in these patients but P value was not significant. Mean NGAL levels were highest in stage IV [1041.54 ± 222.15 ng/mL (stage IV) vs 1040 ± 0.00 ng/mL (stage I); 900 ± 0.00 ng/mL (stage II) and 1031.90 ± 202.55 ng/mL (stage III)] and χ2 test was highly significant (P < 0.001). Thirty-six patients (72%) were having moderately differentiated HNSCC and mean NGAL levels were maximum in patients with well differentiated HNSCC (1164 ± 315.64 ng/mL vs 1013.33 ± 161.19 ng/mL in moderately differentiated and 890 ± 11.55 ng/mL in poorly differentiated) and the results were also highly significant (P < 0.001, χ2 test). CONCLUSION: The present work demonstrates a potential role of NGAL as cancer biomarker and its use in monitoring the HNSCC progression.

Biomarkers in Preeclamptic Women with Normoglycemia and Hyperglycemia.

The present study was planned to assess IGF-1, leptin and cholinesterase levels in maternal blood of both normoglycaemics and hyperglycaemics preeclampsia. Twenty five normotensive pregnant women at the time of delivery were selected in as group I and sub grouped according to blood glucose less than or more than 85 mg/dL as I A (<85mg/dL) and I B (>85mg/dL). Study group (group II, n=25) comprised of preeclamptic women and was further divided into group II A (<85mg/dL) and group II B (>85mg/dL). Routine biochemical investigations along with IGF-1, leptin and cholinesterase levels were analyzed in maternal and cord blood of preeclamptic and normotensive pregnant women. Serum IGF-1 levels were significantly lower in preeclamptic women and more so in those with hyperglycemia. Cord blood IGF-1 levels were nearly doubled in hyperglycemic preeclamptics as compared to normoglycemic preeclamptics. Leptin levels were higher in preeclamptic women and more in hyperglycemic preeclamptics. Cholinesterase levels were lowered in preeclamptic mothers and higher in hyperglycemics. Cord blood cholinesterase levels were reduced in preeclamptics, more so in hyperglycaemics as compared to group I. Diet recommendation, avoidance of excessive weight gain and healthy life style, exercise and nutritional interventions may be beneficial in these women.

Status of leptin in MBCR-ABL p210 positive chronic myeloid leukemia patients before and after imatinib therapy: a conflicting scenario.

BACKGROUND: Chronic myelogenous leukemia (CML), a myeoloproliferative disorder, is characterized by the presence of the fusion gene BCR-ABL in hematopoietic cells. Leptin, considered a link between cancer and obesity, has been reported to be actively involved in hemopoiesis and pathophysiology of CML. There are few and conflicting reports about the status of serum leptin levels and recently alteration in leptin has been reported due to imatinib mesylate. METHODS: Leptin and CRP were estimated in 30 (male: 20; female: 10) newly diagnosed and confirmed MBCR- ABL p210 positive CML patients before and after 3 months of therapy by commercial enzyme linked immunosorbent assays. Leptin levels were compared with 30 (male: 20; female: 10) age matched healthy controls accounting for the differences due BMI and gender. RESULTS: Leptin/BMI ratio was significantly raised in both male and female chronic phase patients as compared to controls (p < 0.001, p = 0.048) and accelerated phase patients as compared to controls (males, p < 0.001; females, p < 0.001). The normal gender difference and dependence on BMI was lost in patients. In patients, who failed to achieve hematological baseline, leptin/BMI was higher only in male patients (p = 0.012). Leptin/BMI also correlat- ed with TLC and blast percentage (TLC, R2 = 0.412, p = 0.001; Blast %, R2 = 0.408, p < 0.001). There was no correlation between leptin and CRP levels. Levels decreased significantly after complete hematological remission in both males and females (p = 0.001, p = 0.028). Levels after 3 months of imatinib therapy were significantly higher than controls in all patients not in remission (males, p < 0.001; females, p = 0.018) but only in male patients in re- mission (p = 0.002). CONCLUSIONS: Leptin levels were increased in CML patients. The findings suggest a possible role of leptin in patho- genesis of CML or disease progression independent of inflammatory state or reactionary rise. Imatinib itself may increase leptin levels, and, as leptin plays an active role in the pathophysiology of CML, this conflicting scenario needs further investigation. Alterations in leptin need to be investigated cautiously accounting for confounding and differences due to BMI and gender.

Effect of imatinib on male reproductive hormones in BCR-ABL positive CML patients: A preliminary report.

Multiple animal studies, few clinical case reports and one study have observed decreased testosterone production and gynaecomastia as adverse effect of imatinib therapy. We have prospectively studied testosterone, LH and FSH levels at baseline and at 6 months of imatinib treatment in 34 newly diagnosed male BCR-ABL positive CML patients. While none of the patients had gynaecomastia at 6 months, the proportion of patients with low testosterone level increased significantly from 11.8% at baseline to 58.8% (p < 0.001) and those with high LH and FSH increased significantly from 26.4% and 23.5% to 82.4% and 76.4%, respectively (p < 0.001 and p < 0.001). Serum testosterone levels decreased significantly (p = 0.002) and serum LH and FSH levels increased significantly at 6 months of imatinib therapy (p = 0.001 and p = 0.003) in comparison to baseline levels. The findings document the effect of imatinib on testosterone levels in adult CML patients much before than reported earlier.

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.

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.