Association of obesity with hormonal imbalance in infertility: a cross-sectional study in north Indian women.

Hormones play an important role in the development and regulation of reproductive function and the menstrual cycle of women. Extremes of body weight tend to affect the homeostasis of the hypothalamo-pituitary-gonadal axis. This cross-sectional study was carried out in 113 women (57 with primary infertility and 56 with secondary infertility) in the age group 20-35 years, presenting for hormonal evaluation of infertility in a tertiary care hospital. After preliminary clinical evaluation, anthropometric indices (height, weight, BMI, waist circumference and waist hip ratio) were measured in all subjects. Fasting blood sample drawn on second/third day of menstrual cycle was analysed for serum luteinizing hormone, follicle stimulating hormone (FSH), prolactin and thyroid stimulating hormone (TSH). Serum FSH levels showed a significant positive correlation with indicators of central obesity (waist circumference and waist hip ratio in both the study groups). In primary infertility, significant positive correlation was also observed between serum FSH levels and other markers of obesity like body weight, hip circumference and BMI. In secondary infertility, serum prolactin and serum TSH levels demonstrated a significant positive correlation with body weight and BMI. Obesity is associated with hormonal derangements which are responsible for infertility. In overweight women with infertility, weight loss should be considered as a first line treatment.

Role of Serum Interleukin-6 and C-reactive Protein in Early Prediction of Severe Acute Pancreatitis.

Background: Early prediction of severity is an important goal in acute pancreatitis (AP), to identify 20% of patients who are likely to have a severe course. Such patients have an expected mortality of 15-20% and may benefit from early admission to high dependency or intensive care units, with parenteral or nasojejunal feeding and prophylactic antibiotics. In severe AP (SAP), multiorgan dysfunction accounts for most of early deaths. Aims: The aim of this article is to assess the role of serum interleukin (IL)-6 and serum C-reactive protein (CRP) in early prediction of severity of AP. Materials and Methods: This observational analytical study was conducted in the Department of General Surgery and Department of Biochemistry in our hospital in 62 patients as per inclusion and exclusion criteria. Results: IL-6 on day 1 and day 2 as well as CRP on day 2 was 100% sensitive but IL-6 on day 1 and day 2 had a maximum specificity of 88.37% among them when compared with a specificity of 81.4% of CRP on day 2. Though CRP on day 1 also had a specificity of 88.37%, its sensitivity was 89.47%. Conclusion: IL-6 and CRP together appear to be a promising marker for assessing the severity of AP within 48 h. We recommend to do IL-6 and CRP in patients with AP, which can help in predicting severity of the disease in patients.

Lipoprotein (a)--lipid profile and apolipoprotein B in children of young parents with coronary artery disease.

OBJECTIVE: To evaluate lipoprotein(a), apolipoprotein B and lipid profile in children of young parents with coronary artery disease. DESIGN: Analytical observational study. SETTING: Tertiary care hospital. MATERIAL: The study included 80 children (9-18 years) out of which 40 were children of young parents (one or both) with established coronary artery disease (CAD), while the other 40 were children of parents with no evidence of CAD (controls). All were evaluated for fasting blood glucose, lipid profile, apolipoprotein B and lipoprotein (a) - Lp(a). Two sample 't' test was applied for analysis of continuous variables between study & control group. RESULTS: The study group children had significantly higher levels of total serum cholesterol (p = 0.004), LDL cholesterol (p = 0.002), lipoprotein a (p = 0.001) as compared to children of the control group. A significant difference in apolipoprotein B levels (p = 0.044) was observed in children in the adolescent age group (14-18 years). Both systolic and diastolic blood pressures were significantly higher without any significant difference being observed for weight and body mass index between the two groups. CONCLUSION: Higher levels of pro-atherogenic factors in children with family history of premature CAD indicate that the combined effects of "nature and nurture" are responsible for development of accelerated atherosclerosis especially in Indians. Tracking of Lp(a) levels from childhood may be a better option than detecting other elements of dyslipidemia which are not fully expressed until middle age.

Modification of Jaffe's kinetic method decreases bilirubin interference: A preliminary report.

The negative interference of bilirubin on serum creatinine determined by the kinetic alkaline picrate (Jaffe) reaction is the unresolved problem. Though high performance liquid chromatography and gas chromatography with mass spectroscopy have been proposed to be gold standards for creatinine estimation but they are not readily available in most of the clinical chemistry laboratories due to economic and technical constraints. Most of the present day analyzers use Jaffe's kinetic method without deproteinization. Though enzymatic methods are now routinely used as most accurate method but they are not acceptable due to cost constraints. Hence this study was planned to find out a possible solution to the problem of bilirubin interference by a minor modification in the commonly used Jaffe method so that it is amenable for use on the currently used analyzers.

Effect of soy proteins Vs soy isoflavones on lipid profile in postmenopausal women.

Soy isoflavones and soy proteins are being considered as possible alternatives to postmenopausal hormone replacement therapy. This study was undertaken to evaluate effects of these two preparations on symptoms and lipid profile in postmenopausal women. The study was done in 75 postmenopausal women with FSH levels = 30 mIU/ml. These women were randomly divided into 3 groups (n=25). Study group I was given soy proteins 30gm/day containing 60 mg soy isoflavones. Study group II was given soy isoflavones (60 mg/day). The control group was given casein protein 30 gm/day. The menopausal symptoms were assessed by Kupperman Index. Fasting blood samples were analyzed for serum lipid profile, apolipoprotein A1 and B, Leutenizing Hormone (LH) and Follicle-Stimulating Hormone (FSH) at the beginning of therapy, 4 and 12 weeks after initiation of therapy. A highly significant improvement in postmenopausal symptoms was observed in both the study groups. A highly significant improvement was seen in serum lipid profile and Apolipoprotein A1 and B in women taking soy proteins whereas women taking soy isoflavones demonstrated significant improvement in serum triglycerides only. Both soy proteins and soy isoflavones are helpful in alleviating postmenopausal symptoms but soy proteins offer a greater health advantage due to their beneficial effect on serum lipid profile.

Evaluation of Reproductive Outcome in Infertile Hypothyroid Women on Thyroxine Therapy.

INTRODUCTION: Thyroid dysfunction is associated with increased risk of infertility. Serum thyroid stimulating hormone (TSH) screening in all women seeking infertility care is recommended and hypothyroid infertile women should be treated with thyroxine until the preconception serum TSH level is <2.5 mU/l.[1] However, insufficient evidence exist to determine if thyroxine therapy improves fertility in subclinical hypothyroid women who are trying to conceive naturally. OBJECTIVES: The objective is to study the effect of thyroxine therapy on reproductive outcome in infertile women with clinical and subclinical hypothyroidism (SCH). MATERIALS AND METHODS: The study is a descriptive cohort study with 72 subjects. Women between 20 and 40 years of age with primary or secondary infertility with hypothyroidism were studied and thyroid profile including free T3, T4, TSH, and thyroid antibodies were done. Thyroxine was given to clinical, subclinical hypothyroid subjects depending on TSH levels such that serum TSH levels are maintained < 2.5 mU/L. Serial thyroid function test was done every 6 weeks until the optimal levels were reached. Once normal TSH levels were reached subjects were followed up for 6 months. Reproductive outcome was analyzed in two groups. Group A included hypothyroid infertile women who conceived and Group B included those who did not conceive following thyroxine therapy. RESULTS: Thirty-eight out of 72 subjects (54%) conceived during thyroxine treatment (Group A) of which 4 cases had miscarriage. Maximum infertile women in Group A (20/38) conceived between 6 and 12 months (52.6%) of thyroxine therapy. Significant decrease was observed in mean TSH levels over a period of 6 months (P < 0.001). The infertility period until pregnancy in Group A reduced significantly from 5.2 ± 1.8 years to 0.5 ± 0.8 years after thyroxine treatment (P = 0.001). CONCLUSION: Thyroxine therapy enhances fertility in infertile women with clinical and SCH.

Impact of Vitamin D Supplementation on Semen Quality in Vitamin D-Deficient Infertile Males with Oligoasthenozoospermia.

INTRODUCTION: Male factor contributes to almost 50% cases of infertility. There is evidence of the effect of serum vitamin D on male fertility by helping in spermatozoa maturation and initiating acrosomal reaction. In India, vitamin D deficiency has been documented to be in the range of 50-90% among all the age groups. OBJECTIVE: To study the levels of vitamin D and the impact of vitamin D supplementation in vitamin D-insufficient/deficient infertile males with oligoasthenozoospermia. MATERIAL AND METHODS: This study is a longitudinal observation study. Infertile men with either oligozoospermia or asthenozoospermia with vitamin D levels < 30 ng/ml were enrolled. Vitamin D and calcium supplementation was given, and semen and hormone parameters were assessed at the end of 3 and 6 months. RESULT: There is significant improvement in the mean sperm concentration and progressive sperm motility in infertile males with oligoasthenozoospermia after 6 months of vitamin D supplementation (p value < 0.001). The overall clinical pregnancy rate in the study was 8.33% after vitamin D supplementation (p value 0.24). CONCLUSION: Vitamin D supplementation plays a crucial role in regulating male fertility.

Influence of menopause on biochemical markers of endothelial dysfunction-A case-control pilot study in North Indian population.

OBJECTIVE: Menopause, an estrogen deficient state, is known to increase the cardiovascular risk. Lipid changes accompanying menopause account for only few cases of coronary artery disease (CAD). Endothelium-dependent nitric oxide-mediated vasodilatory mechanisms are also known to play a role in development of coronary artery disease, but studies in menopausal women are very few. This study was hence undertaken to see if nitric oxide (NO)-cyclic guanidine monophosphate (c-GMP) pathway is influenced by menopause. DESIGN: This study was a hospital-based case-control study involving 100 women in age group 40-55 years. Of these, 50 women were postmenopausal and 50 were premenopausal. Women with known risk factors for CAD were excluded. Fasting blood samples from these women were collected and analyzed for estradiol levels, lipid profile, apolipoprotein B, plasma nitric oxide, c-GMP and platelet nitric oxide using standard kits and reagents. Statistical analysis was done on SPSS and two-tailed p-value <0.05 was considered significant. RESULT: Postmenopausal women had significantly lower estradiol, plasma NO, and c-GMP levels as compared to premenopausal women (p<0.05). Cholesterol, low-density lipoprotein (LDL) cholesterol and apolipoprotein B (apo-B) levels were higher and HDL levels were lower in postmenopausal as compared to premenopausal women (p<0.05). Plasma NO showed a significant positive correlation with estradiol, HDL levels and negative correlation with apo-B levels. CONCLUSION: Menopause tends to downregulate NO-c-GMP pathway resulting in endothelial dysfunction. The mechanism may be directly through estrogen receptors or indirectly through potentiation of dyslipidemia.

Dyslipidemia in pregnancy may contribute to increased risk of neural tube defects -a pilot study in north Indian population.

Neural tube defects are congenital structural abnormalities of the brain and vertebral column resulting from improper or non-timely closure of the neural tube. Prevalence of neural tube defects is reported to be higher among women with diabetes mellitus and obesity. This study was designed to investigate the relation between the presence of dyslipidemia in antenatal patients and the risk of fetal neural tube defects. The present study was an observational, cross-sectional study involving 129 pregnant women in 16 to 18 weeks gestation period. Of these, 80 women had normal pregnancies and 49 were clinically high-risk cases for neural tube defects. Fasting blood samples were analyzed for blood sugar and lipid profile by enzymatic assay and alpha-fetoprotein levels using Enzyme Immunoassay. Alpha-fetoprotein (AFP) values were converted to Multiples of Median (MoM) appropriate for the gestational age. Based on AFP values, women were labeled as screen negative (AFP <2 MoM, n= 102) and screen positive (AFP > 2 MoM, n =27). Screen positive women were further evaluated by ultrasound and 21 women were found to carry a neural tube defects positive pregnancy. Statistical analysis was done on SPSS software. Body weight of the women showed a significant positive correlation with serum triglycerides, plasma sugar and AFP MoM values. A significant difference was observed in serum cholesterol levels (p= 0.038), triglycerides (p=0.001) and plasma sugar levels (p=0.002) between normal women and those with neural tube defects positive pregnancy. The Odds ratio for neural tube defects risk in dyslipidemic cases was 24.23 (CI 4.73 - 148.60) with a relative risk of 12.12. Dyslipidemia especially hypertriglyceridemia was found to be significantly associated with fetal neural tube defects.

Biochemical markers of liver and kidney function are influenced by thyroid function-a case-controlled follow up study in Indian hypothyroid subjects.

Thyroid hormones regulate the renal hemodynamics and basal metabolic rate of most cells. This hospital-based case-control study was done to evaluate the changes in biochemical markers of liver and kidney function in hypothyroid subjects before and after treatment. The study included 176 subjects randomly selected from Thyroid clinics. Serum T(3), T(4), TSH, Liver and Kidney Function tests were analysed using standard kits. Forty-six hypothyroid patients were re-evaluated 6 weeks after thyroxine substitution therapy. Hypothyroid subjects (n=80) showed significantly raised serum creatinine and uric acid levels as compared to euthyroid subjects (n=96). After 6 weeks of thyroxine replacement, serum creatinine and uric acid decreased significantly and were comparable to euthyroid group. A positive correlation of ALT, AST, uric acid, protein and albumin with TSH levels (p<0.05) and negative correlation of serum T(4) levels with ALT, AST, proteins (p<0.05) was observed in the hypothyroid group. Hypothyroidism results in reversible impairment of hepatorenal function.

Leptin and its metabolic interactions: an update.

Obesity results from an abnormal accumulation of fat in the white adipose tissue. Recent research utilizing genetic models of obesity in rodents has implicated a major role of leptin as a controller of obesity. Leptin is a 167-amino acid peptide hormone encoded by the obesity gene (ob), which is secreted by adipocytes and plays an important role in regulating food intake, energy expenditure and adiposity. Leptin receptors (OB-R) are expressed in the central nervous system mainly in afferent satiety centres of hypothalamus and in peripheral organs such as adipose tissues, skeletal muscles, pancreatic beta-cells and liver, thus indicating the autocrine and paracrine role of leptin in energy regulation. In human beings, a highly organized circadian pattern of leptin secretion is observed with peak levels in the midnight probably resulting from cumulative hyperinsulinemia of entire day. Leptin has a dual role in weight maintenance. Leptin reflects total body adipose tissue mass whereas in conditions of negative and positive energy balance, the dynamic changes in plasma leptin concentration function as a sensor of energy balance and influence the efferent energy regulation pathways. Many effects of leptin on metabolism are mediated by interaction with Insulin and also by synergistic action with cholecystokinin. Besides physiological roles, leptin may influence pathological conditions like obesity-associated atherosclerosis, oxidative stress and cancers. The purpose of the present review is to summarize the important aspects of the biology, actions, and regulation of leptin and to serve as an update of new information.

Study of genetic, metabolic and inflammatory risk factors in patients of acute ischemic stroke.

Stroke is the third leading cause of death and foremost cause of disability. Based on studies in CAD patients, a focus has been shifted on genetic and inflammatory markers as risk factors for stroke besides deranged lipid profile. The present study was aimed to ascertain the role of Lipoprotein (a), C-Reactive protein (CRP) levels and lipids in patients of ischemic stroke. The study was done in 82 subjects including 40 Computerized Tomography (CT) proven patients of ischemic stroke and 42 age and sex matched controls. Complete biochemical parameters including lipid profile were carried out on autoanalyzer using standard kits and reagents. Lipoprotein (a) [Lp(a)] was determined by immunoturbidimetric assay. Atherogenic indices (Total cholesterol/ HDL, LDL/HDL and Lipid Tetrad Index) were calculated using these lipid parameters. The CRP levels were measured semi-quantitatively by latex agglutination test method. Out of 40 stroke patients, 38 had abnormalities in lipid profile (As per ATP III guidelines). A significant difference was seen in serum cholesterol, LDL cholesterol and atherogenic indices between the patients and controls. The difference in CRP levels in cases and control subjects was highly significant (4.78±0.72 mg/dl vs 0.76 ±0.70, p<0.001). 96.5% of patients with raised CRP had abnormal lipid levels also. CRP levels in stroke patients showed significant correlation with total cholesterol and LDL (p<0.001), Lp (a) (p=0.002) and atherogenic indices (p<0.05). Raised CRP levels in stroke patients were significantly associated with large territory infarcts, severe disability and poor functional outcome (p<0.05).Genetic [Lp(a)], metabolic (deranged Lipid profile) and inflammatory factors (CRP) together are instrumental in causing cerebrovascular arteriosclerosis leading to ischaemic stroke and can be used as important markers to identify patients at risk of severe stroke and to institute aggressive preventive strategies.

Study of Effect of Vitamin D Supplementation on the Clinical, Hormonal and Metabolic Profile of the PCOS Women.

INTRODUCTION: Insulin resistance is one of the most common features of polycystic ovary syndrome, and some studies suggest that vitamin D deficiency may have role in insulin resistance. OBJECTIVE: To study the effect of vitamin D supplementation on the clinical, hormonal and metabolic profile of the PCOS women. STUDY DESIGN: Randomized, placebo-controlled, interventional, double-blind study. MATERIALS AND METHODS: PCOS women were evaluated and enrolled after considering inclusion and exclusion criteria. They were randomized by block randomization with sealed envelope system done in two groups. In the study group (n = 25), patients were supplemented with vitamin D 60,000 IU weekly for 12 weeks, whereas control group (n = 25) was given placebo weekly for the same period. Both the groups were compared pre- and post-supplementation for variables like clinical profile, biochemical profile and metabolic profile. Statistical analysis was performed by the SPSS program for Windows, version 10.1 (SPSS, Chicago, IL). RESULT: In the study (n = 50), PCOS patients were enrolled; 34 patients (68%) were vitamin D deficient (≤20 ng/ml) out of which 10 patients (29%) were severely deficient (<10 ng/ml). Twelve patients (24%) were vitamin D insufficient showing high prevalence of vitamin D deficiency in the PCOS women. The difference in mean serum fasting glucose pre- and post-supplementation of vitamin D in study group was found to be statistically significant with p value of 0.041. There was significant difference seen in insulin resistance (IR) (2.38 ± 4.88-1.00 ± 0.58, p = 0.003), serum fasting insulin (10.34 ± 20.00-5.00 ± 3.25, p = 0.021), and increase in insulin sensitivity determined by QUICKI (0.37 ± 0.04-0.394 ± 0.009, p = 0.001) after supplementation with vitamin D. CONCLUSION: The study concluded that there was a beneficial effect of vitamin D supplementation on ovulatory dysfunctions and blood pressure. Post-supplementation, there were decrease in insulin resistance and increase in insulin sensitivity. In the study decreased serum fasting insulin level and fasting blood sugar after vitamin D supplementation suggest underlying role of vitamin D in glucose homeostasis.

Role of neuropeptides in appetite regulation and obesity--a review.

Obesity represents the most prevalent nutritional problem worldwide which in the long run predisposes to development of diabetes mellitus, hypertension, endometrial carcinoma, osteoarthritis, gall stones and cardiovascular diseases. Despite significant reductions in dietary fat consumption, the prevalence of obesity is on a rise and is taking on pandemic proportions. Obesity develops when energy intake exceeds energy expenditure over time. Recently, a close evolutionary relationship between the peripheral and hypothalamic neuropeptides has become apparent. The hypothalamus being the central feeding organ mediates regulation of short-term and long-term dietary intake via synthesis of various orexigenic and anorectic neuropeptides. The structure and function of many hypothalamic peptides (neuropeptide Y (NPY), melanocortins, agouti-related peptide (AGRP), cocaine and amphetamine regulated transcript (CART), melanin concentrating hormone (MCH), orexins have been characterized in rodent models The peripheral neuropeptides such as cholecystokinin (CCK), ghrelin, peptide YY (PYY3-36), amylin, bombesin regulate important gastrointestinal functions such as motility, secretion, absorption, provide feedback to the central nervous system on availability of nutrients and may play a part in regulating food intake. The pharmacological potential of several endogenous peripheral peptides released prior to, during and/or after feeding are being explored. Long-term regulation is provided by the main circulating hormones leptin and insulin. These systems implicated in hypothalamic appetite regulation provide potential targets for treatment of obesity which could potentially pass into clinical development in the next 5 years. This review summarizes various effects and interrelationship of these central and peripheral neuropeptides in metabolism, obesity and their potential role as targets for treatment of obesity.

Variation in Different Lipoprotein Fractions if Estimated by Different Methodologies.

BACKGROUND: Determining the levels of lipids and lipoprotein fractions is important in assessing the risk of coronary artery disease. The levels of total cholesterol, triglycerides and high-density lipoproteins are determined directly by enzymatic assays. In the case of low-density lipoproteins and very-low-density lipoproteins, Friedewald's formula has been in use since 1972. According to the formula, the level of very-low-density lipoprotein is equal to that of triglycerides divided by five, while that of low-density lipoprotein cholesterol is equal to the total cholesterol level minus the concentrations of high-density and very-low-density lipoproteins. The determination of low-density lipoprotein by this equation involves three independent lipid analyses, each of which may introduce errors. Besides, other lipoproteins, like intermediate-density lipoproteins and chylomicrons, are not accounted for. This study was done to compare the values of low-density and very-low-density lipoproteins by Friedewald's formula and to determine the values of high-density and low-density lipoproteins by homogenous assays with electrophoretic separation of lipoproteins. METHODS AND RESULTS: Sixty adult patients with triglyceride levels of less than 400 mg/dL were evaluated. The level of low-density lipoprotein was measured enzymatically, using cholesterol esterase, after selective micellary solubilization of low-density lipoprotein cholesterol by a non-ionic detergent. High-density lipoprotein cholesterol was estimated similarly, after binding anti-human ss-lipoprotein antibody to low-density lipoprotein, very-low-density lipoprotein and chylomicrons. Electrophoretic separation of serum lipoproteins was done on agarose gel, and the bands scanned by a densitometer using a 570-nm filter. The values of low-density and very-low-density lipoproteins were also calculated using Friedewald's formula, following the spectrophotometric assay of serum cholesterol and triglycerides. Using the paired t-test, we found that the values of low-density lipoprotein as calculated by Friedewald's formula were significantly different from those determined by direct assays (p < 0.001) and electrophoresis (p < 0.001). Further, the values determined by direct assay and electrophoresis did not differ significantly (p = 0.53). The high-density lipoprotein cholesterol values as determined by direct assay and electrophoresis differed significantly (p < 0.001) from each other. The level of very-low-density lipoprotein as calculated by Friedewald's formula was significantly different from that estimated by electrophoresis (p < 0.001). CONCLUSION: Though Friedewald's equation is widely used in the case of triglyceride levels below 400 mg/dL, the values arrived at are erroneous if there are alterations in intermediate-density lipoproteins, as reported in diabetes mellitus, chronic renal failure, coronary heart disease and certain other disorders. This study shows that even at low triglyceride levels, the calculated values of various lipoproteins differ from those measured by direct spectrophotometric and electrophoretic assays.

Effects of short-term hormone replacement on atherogenic indices in Indian postmenopausal women.

Indian ethnicity by itself is a strong risk factor for development of CAD in Indian postmenopausal women due to lower HDL levels as compared to Whites and women of oriental origin. We evaluated and compared the short-term effects of menopause, estrogen replacement therapy and combined estrogen and progestin replacement therapy on various atherogenic indices. 40 postmenopausal women, both surgical and natural (20 each) were selected. 10 surgical postmenopausal women were given 0.625 mg conjugated estrogens daily for 6 months and 10 natural postmenopausal women were given 0.625 mg conjugated estrogen with 2.5 mg medroxyprogesterone acetate daily. 20 women were included in the control group and given placebo. Fasting venous blood samples were analyzed for extended lipid profile and calculated atherogenic indices before starting the therapy and after 1,3 and 6 months. LDL and Apolipoprotein B increased (p<0.05) and those of Apolipoprotein A1 and HDL decreased in the control groups. In both the study groups levels of serum cholesterol and LDL decreased (p<0.05) and those of HDL and Apolipoprotein A1 increased (p<0.01). LDL/HDL, Apo B/ApoA1, Total Cholesterol/HDL decreased significantly (p<0.05) in both the study groups compared to the control groups. The effect of estrogen alone was more significant as compared to combination therapy. Log Triglycerides (TG)/HDL ratio showed a decrease in women on estrogen alone but the difference was not significant. Our study confirms that short term HRT has a favorable effect on atherogenic indices in Indian postmenopausal women.

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.

Serum Homocysteine and Total Antioxidant Status in Vitiligo: A Case Control Study in Indian Population.

BACKGROUND: Oxidative stress is considered as an initial pathogenic event in melanocyte destruction. These free radicals are scavenged by antioxidants, whose sum of activity in serum is measured by total antioxidant status (TAS). In addition, homocysteine (Hcy) may mediate melanocyte destruction via increased oxidative damage. However, previous studies investigating these parameters in vitiligo provide equivocal results. AIMS: To study and compare serum Hcy and TAS levels in vitiligo patients with controls and also to correlate these parameters with the various disease characteristics. The present study further looked into any correlation between serum Hcy and TAS in vitiligo. MATERIALS AND METHODS: A case control study was conducted on 82 vitiligo patients and 83 controls aged 18-45 years after excluding factors which could potentially alter serum Hcy or TAS levels. Disease characteristics were studied and blood samples were obtained for measuring serum Hcy and TAS levels. RESULTS: TAS levels were lower in vitiligo patients than controls (1.79 ± 0.51 vs. 2.16 ± 0.63 mmol/L; P < 0.001) and had a negative correlation with disease activity (r = -0.410, P < 0.001). However, serum Hcy levels were comparable between vitiligo patients (18.68 ± 9.90 µmol/L) and controls (20.21 ± 13.39 µmol/L) (P = 0.406). No significant correlation was found between serum Hcy and serum TAS levels. CONCLUSIONS: Serum TAS may be further investigated to establish its role as biomarker for vitiligo since its levels also correlate with disease activity. However, serum Hcy may not be a reliable marker in Indian population probably because of differences in dietary habits.

Evaluation of Role of GnRH Antagonist in Intrauterine Insemination (IUI) Cycles with Mild Ovarian Hyperstimulation (MOH): A Prospective Randomised Study.

AIMS AND OBJECTIVE: To evaluate the role of GnRH antagonist in prevention of premature LH surge and increasing pregnancy rates in IUI cycle with mild ovarian hyperstimulation (MOH). STUDY DESIGN: Prospective parallel, randomised controlled study. MATERIAL AND METHODS: Couples diagnosed with unexplained, male factor subfertility and with one or both tubes patent were randomised to receive either a GnRH antagonist (study group) or no intervention (control group). All women were treated with clomiphene citrate (D3-D7) followed by HMG. A GnRH antagonist was added when one or more follicles of 16 mm diameter or more were visualised in the study group. When at least one follicle reached a size of ≥18 mm, ovulation was induced by hCG injection. A single IUI was performed 36 h later. The primary outcome was premature LH surge and pregnancy rate. The secondary outcomes were the amount of gonadotropins used, duration of use of GnRH antagonist and incidence and severity of OHSS. RESULTS: A total of seventy patients attending the infertility clinic in the outpatient department of Obstetrics and Gynecology, of a tertiary care centre, were recruited in the study which was carried out from August 2011 to March 2013. The study group included 34 women and 36 in the control arm. The incidence of premature LH surge was significantly lower in the antagonist group as compared to the control group 2.9 vs. 13.9 %, with a p value of <0.001. The clinical pregnancy rates were similar in both the groups 8.8 vs. 11.1 %, p value being 1.000. The amount of gonadotropins used in GnRH antagonist group was lower than in control group but not statistically significant. Duration of GnRH antagonist was 1.85 ± 0.61 days in the study group. CONCLUSION: The delayed administration of GnRH antagonists in MOH with IUI cycles when follicle size is ≥16 mm is beneficial in terms of preventing the occurrence of premature LH surge but with no improvement in pregnancy rates.

Correlation of Vitamin D Levels in Term Normotensive and Pre-eclamptic Patients in Labor.

OBJECTIVE: To evaluate maternal vitamin D levels in term normotensive and preeclamptic patients in labor and to assess additional factors such as maternal and cord blood levels of calcium, phosphorus, parathormone, and alkaline phosphatase and associated factors such as BMI, birth weight, and mode of delivery. METHOD: This was a case control study carried out in Department of Obstetrics and Gynaecology, ESIC-PGIMSR, New Delhi, India from August 2012-April 2014. A total of 100 patients were divided into two equal groups (control and study groups of 50 each). Control group had women with singleton uncomplicated, term normotensive pregnant women in labor while the study group composed of term preeclamptic women in labor. Blood samples were drawn for vitamin D, serum calcium, serum phosphorus, serum alkaline phosphatase, and serum parathormone levels during first stage of labor, and subsequently, their levels were evaluated in cord blood also. RESULTS: All the enrolled patients had vitamin D deficiency pointing toward a universal prevalence of this micronutrient deficiency in antenatal patients. We found more incidence of severe vitamin D deficiency (90 %) in preeclamptic patients as compared to normotensive patients (62 %). Also preeclamptic group had lower median vitamin D levels (3.9 ng/ml) when compared to normotensive group (9 ng/ml). Similarly, all the neonates were found to be vitamin D deficient as assessed by their cord blood levels. Neonates born to preeclamptic mothers had lower median cord blood vitamin D levels (4.4 ng/ml) when compared to those born to normotensive mothers (7.25 ng/ml). The mean maternal calcium levels followed trends observed in vitamin D levels with preeclamptic patients having consistently lower calcium levels (mean value of 8.50 ± 0.80 mg/dl) when compared to normotensive patients (mean value of 8.89 ± 0.56 mg/dl). Preeclamptic group was found to have more number of patients (58 %) with higher BMI when compared to normotensive group (32 % of patients). A slightly more incidence (36 %) of low birth weight babies is being born to preeclamptic mothers as compared to normotensive mothers (34 %). Significantly a more number of patients (36 %) with vitamin D levels below 15 ng/ml underwent cesarean section when compared to only 9 % of patients having vitamin D level above this level. CONCLUSION: Preeclampsia is indeed associated with lower vitamin D levels, and its pathophysiology involves vitamin D and calcium metabolism.