Relation of elevated serum ferritin levels to hypothyroidism in children with beta-thalassemia major

Background: The commonest form of thyroid dysfunction, seen in thalassaemics, is subclinical hypothyroidism due to abnormalities of the thyroid gland which, leads to insufficient production of thyroid hormones. However, the frequency of hypothyroidism varies depending on the region, quality of management and treatment protocols. Aim: This study was conducted with the aim of investigating the frequency of hypothyroidism in children with beta-thalassemia major and to study its correlation with serum ferritin. Material and methods: A case-control study was carried out in the OPD, Medical College, Kolkata. It included 100 children with Beta–Thalassemia major as cases. Hundred age and gender matched healthy controls were also included in the study. Results: The weight and height of the cases lagged behind those of the control group. Compared to the control group, the mean level of thyroid hormones (both T3 and T4) and Hemoglobin levels were significantly reduced while those of TSH and Serum Ferritin were significantly increased. Out of 100 cases, 64 were euthyroid, 34 and 2% had subclinical and clinical hypothyroidism respectively. No case of secondary hypothyroidism was detected. Our results showed no association between Serum ferritin levels and the frequency of hypothyroidism among studied patients. Conclusion: Thyroid dysfunction in thalassemia may start early in life, hypothyroidism is not clinically observed in most thalassemia major patients. Therefore, thyroid function should be followed on regular basis when other iron over load associated complications occurs. Regular follow-up for early detection and timely treatment of such complications could improve the quality of life of these patients

Relation of elevated serum adenosine deaminase levels to glycated hemoglobin and serum uric acid in type 2 diabetes mellitus

Background: Adenosine deaminase (ADA) is suggested to be an important enzyme for modulating the bioactivity of insulin, but its clinical significance in Type 2 diabetes mellitus is not yet established. The present study was undertaken to evaluate serum ADA activity and serum uric acid levels in patients of Type 2 DM. It is widely reported that immunological imbalance is one of the key factors associated with the metabolic disturbances in type 2 diabetes mellitus. Aims: The present study aimed to evaluate the serum Adenosine Deaminase level and to correlate ADA levels with Blood Glucose and HbA1c levels in Type-2 Diabetes Mellitus patients. Material and Method: It is a case control study. The subjects included in this study were divided into 3 groups. Group I consisted of 50 normal healthy individuals who served as controls with no history of DM. Group II consisted of 50 patients of Type 2 Diabetes Mellitus both males & females in the age group of 40-65 years on oral hypoglycemic drugs with HbA1c <7%. Group III consisted of 50 patients of Type 2 Diabetes Mellitus both males & females in the age group of 40-65 years on oral hypoglycemic drugs with HbA1c >7 %. Serum levels of fasting blood sugar, HbA1c, ADA and uric acid were estimated in all the subjects under study. Results: All the three parameters, FBS, HbA1c, ADA and serum uric acid levels were found to be increased in the patients of Type 2 DM as compared to controls. The mean serum uric acid levels showed a bell shaped relation with glycemic control. Conclusion: From the present study, it is concluded that there is an increase in serum ADA levels with increase in HbA1c levels. It was found that the serum uric acid levels increased with increasing levels of HbA1c <7% and then decreased with further increasing levels of HbA1c >7% (a bell-shaped relation)

Serum triacylglycerol: A putative early biomarker of disease severity of Type 2 diabetes mellitus compared to microalbuminuria

499-504Poorly controlled type 2 diabetes mellitus progresses to several complications including nephropathy. While glycated hemoglobin demarcates severity, urinary microalbumin indicates renal involvement. Considering nephropathy is a late manifestation of the disease, here, we explored whether serum triacylglycerol (TAG) can be used as an early disease severity biomarker. About 100 Type 2 diabetes mellitus patients were recruited and categorized as moderate (n=43) and severe (n=57) based on glycated haemoglobin (8%) level. Duration of the disease, BMI, systolic and diastolic BP, fasting and Post Prandial plasma glucose, glycated haemoglobin, serum lipid profile and urinary microalbumin were measured. Results obtained were compared between the groups and correlated. Taking glycated haemoglobin as reference, receiver operating characteristic curves were constructed for serum triacylglycerol and urinary microalbumin excretion to check their efficacy as classifier of disease severity. Significant differences (P <0.001) were recorded for plasma glucose, glycated haemoglobin, triacylglycerol and microalbuminuria but not for other parameters. Significant association (P <0.001) of glycated haemoglobin was displayed with triacylglycerol (r=0.67), fasting (r=0.0.71) and Post Prandial (r=0.82) plasma glucose and urine microalbumin levels (r=0.54). Serum triacylglycerol and urinary microalbumin levels also showed significant correlation (P <0.001, r=0.44). ROC curve analysis showed better performance of triacylglycerol (AUC=0.97) than microalbuminuria (AUC=0.88) to demarcate severity of diabetes. The results indicate that serum triacylglycerol is a better classifier of Type 2 diabetes mellitus than urinary microalbumin level, and may help in early assessment of the disease progression