Study of Association of Leptin and Insulin Resistance Markers in Patients of PCOS.

Polycystic ovary syndrome (PCOS) is a common endocrinological disorder among women of the reproductive age group with long term sequelae which include diabetes mellitus, hypertension and CAD. The present study was conducted to evaluate the association of leptin-an adipokine playing an important role in carbohydrate metabolism and markers of insulin resistance among women with PCOS. Sixty diagnosed cases of PCOS as per Rotterdam criteria were enrolled in this study after informed written consent. Insulin resistance was estimated using the homeostatic model assessment-insulin resistance (HOMA-IR). HOMA-IR was calculated as the product of the fasting plasma insulin value (mU/ml) and the fasting plasma glucose value (mg/dl), divided by 405 and HOMA ß was calculated as 360 × [insulin]/([glucose] - 63) % (glucose in mg/dl). Estimation of serum leptin levels was done by ELISA using leptin ELISA kit from (DRG). A positive correlation of serum leptin levels was observed with markers of insulin resistance. Multiple regression analysis with HOMA-IR as dependent variable demonstrated a statistically significant contribution of fasting insulin levels. This study highlights the role of leptin in alterations in carbohydrate metabolism in patients with PCOS.

Assessment of oxidative stress and inflammatory process in patients of multiple myeloma.

Multiple myeloma is a disseminated malignancy of monoclonal plasma cells that accounts for 15 % of all hematological cancers. The present study was conducted to evaluate the role of inflammation and oxidant-antioxidant dynamics in the etiology of this disease. The study population comprised of 20 cases of multiple myeloma and 20 healthy controls. The parameters evaluated were serum malondialdehyde (MDA), superoxide dismutase (SOD) and ferritin levels. The serum MDA levels were 1.9 ± 0.96 nmol/ml in cases as compared to 0.98 ± 0.55 nmol/ml in the controls. Similarly, a statistically significant difference was noted in the SOD and ferritin levels between the cases and controls (93.2 ± 23.8 vs. 210.1 ± 190.5 U/ml and 285.8 ± 216.4 vs. 131.8 ± 30.1 ng/ml respectively). Our study highlights the imbalance in the oxidant-anti oxidant mechanism and the role of smoldering inflammation in the etiology of multiple myeloma.

HDL-A molecule with a multi-faceted role in coronary artery disease.

BACKGROUND: High density lipoprotein cholesterol (HDL-C) is popularly known as "good cholesterol" due to its ability to protect against atherosclerosis. High density lipoprotein (HDL) is best known as a key player to promote efflux of cholesterol from cells and promote reverse cholesterol transport (RCT) which decreases the accumulation of foam cells in arterial walls. Several roles of HDL discovered recently include anti-oxidant effect, anti-inflammatory role, and anti-thrombotic role, all of which potentiate the athero-protective role of HDL. METHOD: Relevant articles published in this field in various books, journals and on the websites of PubMed Central and National Library of Medicine were assessed to create a literature review article. RESULT: Besides reverse cholesterol transport, the antioxidant and anti-inflammatory properties of HDL may also play a major role in protection against development of atherosclerosis. Two different scales define the atheroprotective effects of HDL-quantity of HDL-C (measured in mg/deciliter or mmol/L) is inversely correlated with cardiovascular risk, the other is the quality or 'functionality' of HDL. CONCLUSION: The changes in HDL composition (primarily in protein components-apolipoproteins, paraoxonase etc.) can occur under pathological conditions and can affect the functionality of HDL. Thus, treatment alternatives to elevations in HDL-C must also involve strategies to maintain or enhance functionality of HDL. This literature review article discusses about the various athero-protective roles of HDL and the effects of changes in composition on its function.

Periodic paralysis: An unusual presentation of drug-induced hyperkalemia.

Hyperkalemia is a life-threatening electrolyte abnormality. The most common cause of hyperkalemia includes renal disease and ingestion of medications. Drug-induced hyperkalemia may develop in patients with underlying renal impairment, disturbed cellular uptake of potassium load, excessive ingestion or infusion of potassium-containing substances. We report a case of "drug-induced severe hyperkalemia" presenting as periodic paralysis. A 67-year-old diabetic and hypertensive woman presented to emergency department with the complaint of intermittent episode of inability to walk for the past 5 days. Each episode lasted for 15-20 minutes and was associated with breathlessness and restlessness. There was no family history of periodic paralysis and drug history revealed that the patient was onolmesartan 20 mg per day (for past 2 years), perindopril 4 mg per day (for past 16 months), and torsemide 10 mg/day. On examination patient was found to be conscious, alert, and afebrile. Vitals were normal. Examination of cardiovascular and respiratory system did not reveal any significant finding. Blood report of the patient showed serum K+ level 8.6 mmol/l. All other investigations were within normal limits. A diagnosis of drug-induced hyperkalemia was made. Patient responded well to the symptomatic treatment. To the best of the author's knowledge, this is the first case report of drug-induced hyperkalemia presenting as periodic paralysis.

Integrative role of neuropeptides and cytokines in cancer anorexia-cachexia syndrome.

BACKGROUND: The cachexia anorexia syndrome is a complex metabolic syndrome associated with cancer and some other palliative conditions characterized by involuntary weight loss involving fat and muscle, weight loss, anorexia, early satiety, fatigue, weakness due to shifts in metabolism caused by tumour by-products and cytokines. Various neuropeptides like Leptin, neuropeptide Y, melanocortin, agouti-related peptides have been known to regulate appetite and body weight. METHOD: A comprehensive literature search was carried out on the websites of Pubmed Central (http://www.pubmedcentral.nih.gov/), National Library of Medicine (http://www.ncbl.nlm.nih.gov) and various other net resources. RESULT: Data from observational studies shows that various cytokines (TNF-α, IL-6 and IL-1) are associated with metabolic changes resulting in cachexia in cancer patients. These cytokines may mimic the action of various neuropeptides resulting in anorexia, various metabolic effects resulting from enhanced catabolic state and weight loss. CONCLUSION: There is a need to understand and explore the role of various neuropeptides and cytokines in the pathophysiology of cancer-anorexia syndrome so that therapeutic measures may be designed for effective palliative care.

Vitamin D as a predictor of insulin resistance in polycystic ovarian syndrome.

INTRODUCTION: Polycystic Ovary Syndrome (PCOS) is the most common endocrinological disorder in women in the reproductive age group. The salient features of this condition include hyperandrogenic features, infertility and insulin resistance among others. Mechanisms behind these features are a matter of debate. Vitamin D has been implicated lately in the etiology of many disorders. The aim of our study was to assess the role of vitamin D as an etiological and predictive factor in PCOS. MATERIALS AND METHODS: The study comprised 60 proven cases of PCOS diagnosed on the basis of Rotterdam criteria. The parameters assessed include HOMA-IR, vitamin D besides the routine anthropometric and biochemical parameters. RESULTS: The study population was divided into 3 groups according to vitamin D status. Insulin resistance was most severe in the sub group with vitamin D deficiency. Multiple regression analysis established the role of vitamin D as the best predictor of insulin resistance in our study. CONCLUSION: Vitamin D has an important role in the pathogenesis of insulin resistance in PCOS.