Evaluation of CRP/Albumin Ratio in Polycystic Ovarian Syndrome.

Background: Polycystic ovarian syndrome is a common endocrine disorder among women of reproductive age. It is characterized by menstrual abnormalities, hyperandrogenism and polycystic ovaries and can lead to many complications. Studies have postulated the role of inflammation in the pathophysiology of PCOS. As acute phase reactants often serve as markers of inflammation, this study aimed to evaluate the role of inflammatory markers in women with PCOS and healthy controls. Material and Methods: A total of 60 participants were enrolled; 30 cases of PCOS and 30 age matched healthy controls. Peripheral venous blood was collected for assessment of CRP, serum albumin, serum total testosterone, serum fasting insulin and fasting blood glucose, following which statistical analysis was done. Results: The CRP/albumin ratio was found to be significantly higher in women with PCOS as compared to healthy controls along with serum total testosterone and HOMA-IR. Correlation between CRP/albumin ratio and the levels of serum total testosterone and insulin resistance was found to be non-significant. Conclusion: An elevated CRP/albumin ratio in cases of PCOS compared to healthy controls supports the hypothesis of inflammation playing a key role in the pathophysiology of PCOS. CRP/albumin ratio can serve as a cheaper biochemical marker of the disease subject to further validation studies to establish its use in Indian population.

Effect of Preoperative Oral Carbohydrate Intake on Perioperative Hyperglycemia in Indian Patients Undergoing Hip Fracture Fixation.

Objective: Preoperative fasting leads to a catabolic state aggravated by surgical stress. This leads to poor patient outcomes. This study aimed to determine the effect of preoperative oral carbohydrate administration on perioperative hyperglycemia and patient comfort. Methods: This prospective, randomized study was conducted on 60 adult American Society of Anesthesiologist I/II patients undergoing hip fracture fixation after obtaining institutional ethical committee clearance. Patients were randomly kept conventionally fasted before surgery (group F, n = 30) or were given oral carbohydrate 2 h before surgery (group C, n = 30). Under all aseptic precautions, a combined spinal epidural block was administered, and surgery was allowed. The primary outcome was blood glucose, and secondary outcomes included incidence of postoperative hyperglycemia, insulin level, blood urea, hunger, thirst, and anxiety. Results: Blood glucose levels were not statistically different between the two groups at baseline (T0; P=0.400), immediately after surgery (T1; P=0.399) and 24h after surgery (T2; P=0.619). The incidence of postoperative hyperglycemia was significantly higher in group F than in group C (P=0.045) at T2. Insulin levels, blood urea levels, and hunger scores were also not statistically different between the groups. The thirst and anxiety scores were lower at T0 and T1 in group C. Conclusion: Preoperative oral carbohydrate administration does not prevent perioperative increases in blood glucose levels. However, it reduces the incidence of perioperative hyperglycemia and decreases perioperative thirst and anxiety, thereby improving the quality of perioperative patient care.

Gene expression of iron transporters, markers of vascularization and structural integrity in placenta of mothers with and without anemia.

OBJECTIVE: To compare the mRNA expression of placental iron transporters (TfR-1 and FPN), markers of placental vascularization (VEGF and sFLT1) and marker of structural integrity (LMN-A) in term women with and without iron deficiency anemia. MATERIALS AND METHODS: A total of 30 pregnant women were enrolled; 15 cases of iron deficiency anemia (Hb 7-10.9 gm/dL) and 15 gestational age matched healthy controls (Hb ≥ 11 gm/dL). Peripheral venous blood was collected for assessment of hemoglobin levels and serum iron profile. Placental tissue was used for assessing the mRNA expression of TfR-1, FPN, VEGF, sFLT-1 and LMN-A via real time PCR. RESULTS: Placental expression of TfR-1, VEGF and LMN-A was increased in pregnant women with anemia compared to healthy pregnant controls. Placental expression of sFLT-1 was decreased in pregnant women with anemia compared to healthy pregnant controls. There was no change in the placental expression of FPN. CONCLUSION: The increased expression of TfR-1, VEGF and LMN-A in cases of iron deficiency anemia are most likely to be compensatory in nature to help maintain adequate fetal iron delivery. WHAT DOES THIS STUDY ADDS TO THE CLINICAL WORK: Compensatory changes in the placenta aimed at buffering transport of iron to the fetus are seen in pregnant women with anemia compared to healthy pregnant controls.

Children with severe acute malnutrition have high rates of bone resorption: A cross-sectional comparative study.

Malnutrition in under-5 children (i.e., children younger than age 5 years) remains a major public health problem. Because of the reductive adaptation in children with severe acute malnutrition (SAM), changes in bone health are often subtle. We hypothesized that children with SAM have higher rates of bone resorption than bone formation, which can be assessed using bone turnover markers. In this cross-sectional comparative study, we evaluated the status of bone turnover markers, serum osteocalcin and serum tartrate-resistant acid phosphatase-5b (TRAP-5b) in under-5 children with SAM. Thirty children (6-59 months) with SAM (defined as per World Health Organization criteria) were enrolled as cases and another 30 children (age and sex matched) with normal nutritional status (weight for height -1 standard deviation [SD] to +1 SD) were enrolled for comparison of bone turnover markers. Serum TRAP-5b concentrations were significantly higher in children with SAM compared with children with normal nutritional status (mean [SD] 22.6 [15.3] vs. 11.3 [9.6], P = .009), whereas serum osteocalcin concentrations were comparable between the 2 groups (mean [SD] 40.6 [17.9] vs. 36.0 [12.5], P = .344). Frequency of hypocalcemia and vitamin D deficiency were also significantly high in children with SAM (P < .05). An inverse correlation was found between serum calcium and serum osteocalcin (r = -0.383, P < .05). Our results indicate that children with SAM have a higher bone resorption rate than children with normal nutrition status indicating compromised bone health.

PINK1 and oxidative stress in lean and obese patients with type 2 diabetes mellitus.

AIM: To compare mRNA [messenger RNA] expression of PINK1 in whole blood and the levels of biomarkers of Oxidative Stress (mitochondrial DNA [mtDNA] content & Total Antioxidant status [TAS]) in newly diagnosed lean and obese patients with T2DM. METHODS: Newly diagnosed patients of T2DM were enrolled in this study. The patients were divided into two groups of 30 patients each, lean (BMI < 18.5 kg/m2) and obese (BMI > 25 kg/m2). mRNA expression of PINK1 & mtDNA content was measured by real time PCR. Serum TAS was measured using a commercially available kit. RESULTS: There was a 1.78-fold decrease in mRNA expression of PINK1 in obese group compared to the lean group. Mean mtDNA content was 300.82 ± 169.66 in the obese group and 332.78 ± 147.07 in the lean group (p = 0.06). Mean levels of TAS was 5.39 ± 2.28 µM Trolox Equivalents in the obese group and 3.85 ± 3.33 µM Trolox Equivalents in the lean group (p = 0.001). CONCLUSION: The T2DM patient with obesity had greater OS than the lean patients. Thus, there is a compensatory increase in antioxidants in obese patients with T2DM. Our findings also suggest that decreased levels of PINK1 in obese group are unable to protect the mitochondria against OS leading to decreased mtDNA content. Does it also result in beta cell dysfunction or contribute to insulin resistance in obese patients with T2DM needs to be explored.

Differential Expression of Suppressor of Cytokine Signaling and Interferon Gamma in Lean and Obese Patients with Type 2 Diabetes Mellitus.

Background: The model of obesity-induced insulin resistance has long been used to explain the development of type 2 diabetes mellitus (T2DM) in obese individuals (body mass index (BMI) > 25 kg/m2), but this model failed to explain the development of the disease in lean individuals (BMI < 18.5 kg/m2). Defects in the insulin signaling pathway have been postulated to play a role in these patients, particularly in suppressors of cytokine signaling (SOCS) proteins, which are involved in the downregulation of insulin transduction. The expression of SOCS is also known to be induced by cytokines such as interferon gamma (IFN-γ). It is still not clear whether these pathways operate differently in lean versus obese patients with T2DM. Therefore, this pilot study was designed to study the expression of SOCS1, SOCS3, and IFN-γ in lean and obese patients with T2DM. Objectives: The levels of IFN-γ in serum and the messenger RNA (mRNA) expression of SOCS (SOCS1 and SOCS3) and IFN-γ genes in whole blood in lean and obese patients with T2DM. Methods: Sixty newly diagnosed T2DM patients (not on any pharmacotherapy) were enrolled and divided into 2 groups of lean (BMI < 18.5 kg/m2) and obese (BMI > 25 kg/m2) patients (n = 30 per group). Serum IFN-γ was measured by enzyme-linked immunosorbent assay (ELISA), and mRNA expression of IFN-γ, SOCS1, and SOCS3 was measured by real-time polymerase chain reaction (PCR) using the ∆∆ Ct method. Results: Serum IFN-γ levels were 10.83 ± 5.81 pg/mL in the lean group and 9.35 ± 5.14 pg/mL in the obese group (P = 0.02). Fasting serum insulin levels were 16.07 ± 8.39 µIU/mL in the lean group and 27.11 ± 4 .91 µIU/mL in the obese group (P = 0.001). There was a 3.16-fold increase in mRNA expression of IFN-γ and a 1.3-fold increase in mRNA expression of SOCS1 in the lean group compared to the obese group. mRNA expression of SOCS3 was similar in both groups. Conclusions: The level of IFN-γ increased at both transcriptional and translational levels, and mRNA expression of SOCS1 was higher in the lean group than in the obese group. The SOCS protein is a known negative regulator in insulin signaling pathways. Thus, our findings and available scientific literature suggest that IFN-γ might impair the insulin signaling pathway to a greater extent in lean patients than in obese patients via induction of SOCS1. This signaling pathway could be a major contributing factor to hyperglycemia in lean patients with T2DM compared with obese counterparts. This suggests that different therapeutic approaches to these groups might be of greater benefit in the treatment of T2DM.

Quality Indicators for Evaluating Errors in the Preanalytical Phase.

Objective The aim of this study was to study the incidence of preanalytical errors in the clinical chemistry laboratory attached to a tertiary care hospital. Design and Methods The study was conducted in a clinical chemistry laboratory using the samples and forms received for analysis. Five hundred random samples were analyzed using a predefined set of quality indicators (QIs) over a period of 3 months. The incidence of each preanalytical error was described as a percentage of the total samples analyzed in the study. Statistical Analysis Individual QIs were assigned values as 0 and 1 and were used to assess each sample; 0 if the error was present, and 1 if absent. The incidence of each preanalytical error was described as a percentage of the total samples analyzed in the study. Result Out of the 500 samples observed, 138 samples were error free, while 21 samples had the maximum number of errors, that is, 6. The error committed most often was the omission of provisional diagnosis being mentioned on the requisition form. No preanalytical error was observed for QIs: selecting the appropriate blood collection vial or storage of sample. Conclusion This study confirms that error rate in the preanalytical phase is high and vastly ignored. Errors committed here may be overlooked, given the large number of samples received in the clinical laboratory of a tertiary center. To reduce these errors, the laboratory should provide training to all workers involved in the preanalytical phase. Daily or weekly QI scores should be recorded to assess and rectify shortcomings, thereby improving patient care.

Role of repeat procalcitonin estimation at 48 hours for outcome in pregnancy associated sepsis: a prospective observational study

Objectives@#We assessed whether repeat procalcitonin (PCT) estimation has a role in detecting organ dysfunctions and mortality in pregnancy associated sepsis (PAS). @*Methods@#The study included 85 pregnant, post-abortal, and postpartum women with PAS, diagnosed using the quick Sequential Organ Failure Assessment criteria. Median interquartile range PCT levels were documented at admission and 48 hours later. Statistical comparisons were performed between the groups with non-severe and severe (≥1 organ failure) PAS, and between the survivor and mortality groups. The relationship between PCT and the number of organ failures was also assessed. @*Results@#Most of the subjects with PAS were young and in the postpartum period (mean age 26 years; postpartum 55%). Sixteen (19%) patients died due to PAS. Sixty-two patients (74%) had severe PAS at presentation. Bacteria were isolated on culture in 64% of the subjects. PCT levels at admission were higher in patients with severe PAS than in those who did not have severe PAS. At 48 hours, this difference was significant (P=0.014; severe PAS 2.23 ng/mL vs. non-severe PAS 0.20 ng/mL). Furthermore, the number of organ failures increased at 48 hours. The PCT levels were significantly higher in the mortality group than in the survivors’ group at admission (8.31 ng/mL vs. 1.72 ng/mL), and the difference increased further at 48 hours (9.54 ng/mL vs. 1.37 ng/mL). @*Conclusion@#Repeat PCT estimation at 48 hours could complement the clinical findings and enhance the prognostic value for PAS.