Assessment of neutrophil and platelet-to-lymphocyte ratio as inflammatory markers in type 2 diabetes mellitus patients

Background: Diabetes mellitus (DM), metabolic disease, and its prevalence are increasing in India. DM causes micro- and macrovascular complications. Inflammation is one of the contributing factor in the pathophysiology of DM. Aims and Objectives: This study aimed to evaluate neutrophil and platelet-to-lymphocyte ratio (PLR) in T2DM patients. Materials and Methods: This study was carried out in Biochemistry Department, Lt. B.R.K.M Government Medical College, Chhattisgarh, India. In this study, 150 type 2 DM patients were considered as cases and 150 normal subjects were considered as controls. Baseline data was collected from subjects. All subjects underwent physical and clinical examination. Fasting and post prandial venous blood samples were collected. FBS, PPBS, renal profile (urea, creatinine and uric acid) were estimated in serum sample. EDTA samples were used for complete blood count (CBC). Neutrophil-to-lymphocyte ratio (NLR) and PLR ratio were calculated from CBC values. HbA1c was estimated using whole blood sample. Blood pressure and BMI were recorded. Results: In this study, mean age of 61.2±4.0 years, systolic blood pressure 136.2±14.4 mmHg, diastolic blood pressure 100.1±12.5 mmHg, BMI 28.1±2.6 (kg/m2), FBS 180.7±22.3 mg/dL, PPBS 289.3±33.2 mg/dL, HbA1c 8.1±0.7%, serum urea 39.1±8.3 mg/dL, creatinine 1.1±0.2 mg/dL, uric acid 7.1±2.0 mg/dL, lymphocytes 18.3±3.0%, NLR 8.1±3.1, and PLR 20.3±7.1 were significantly increased in cases than controls. Conclusion: Elevated ratios of NLR and PLR may serve as markers of inflammation in T2DM. These are inexpensive and helpful to assess the inflammatory status in T2DM

Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio are useful markers of inflammation in polycystic ovary syndrome?

Background: Polycystic ovary syndrome (PCOS) is a heterogeneous metabolic disorder characterized by hyperinsulinemia, abnormal lipid levels, altered hormonal milieu such as elevated androgen levels, and chronic anovulation. PCOS is one of the important reasons for infertility. PCOS is the most common cause of irregular menstruation with diverse clinical manifestations affecting women of reproductive age. Aims and Objectives: The present study aimed to examine systemic inflammatory markers that can be detected in complete blood count, such as neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR), in patients with PCOS and to compare them with healthy women. Materials and Methods: This case–control study was conducted in the Department of Obstetrics and Gynecology, Akash Institute of Medical Sciences and Research Centre, Devanahalli, Bengaluru, Karnataka. After following the inclusion and exclusion criteria, a total of 160 subjects were included. Among them, 80 were PCOS patients as cases and 80 were healthy women as controls. A detailed clinical and gynecological history was obtained from all subjects. Women presenting gynecology OPD in the group of 15–45 years with irregular menstrual cycles were included in the study. The diagnosis of PCOS was done according to the Rotterdam criteria, diagnosis of PCOS requires the presence of at least two of the following three symptoms: (1) oligomenorrhea/polymenorrhea; (2) biochemical hyperandrogenism (Ferriman–Gallwey scores of ≥8) or the presence of clinical hyperandrogenism; and (3) detection of polycystic ovaries in an ultrasonographic examination (≥12 follicles, 2–10 mm in size). Under aseptic conditions, venous blood samples were collected from all the subjects to assess the hormones such as follicle-stimulating hormone (FSH), luteinizing hormone (LH), inflammatory markers, white blood cells, neutrophils (N), lymphocytes (L), and platelets. NLR and PLR were calculated. Lipid profiles were obtained in the fasting state. Results: In the present study, BMI 24.5±4.1 kg/m2, total cholesterol 160.1±24.2 mg/dL, triglyceride 99.1±28.1 mg/dL, LDLC 99.1±25.1 mg/dL, LH 8.4±3.8 mIU/mL, LH/FSH ratio 1.2±0.91, lymphocytes 16.30±4.69, NLR 5.73±1.91, and PLR 17.01±7.13 were significantly increased in PCOS cases and HDLC 39.7±6.2 mg/dL and FSH 6.1±1.1 mIU/mL were decreased in PCOS cases compared to healthy controls. Conclusion: The study concludes that increased inflammatory markers such as NLR and PLR in PCOS cases compared to the age-matched individuals in the control group, suggesting the presence of chronic low-grade inflammation in PCOS cases of early reproductive age

Study of prevalence of non alcoholic fatty liver disease in type 2 diabetes mellitus patients and variations in liver function tests, lipid profile and mean platelet volume in patients with fatty liver in comparison with patients without fatty liver

Background: Type 2 diabetes mellitus (T2DM) patients potentially are at risk of developing non-alcoholic fatty liver disease. The aim of the study is to determine the prevalence of NAFLD among T2DM patients, diagnosed by ultrasonography of liver, to study the age & sex incidence of NAFLD and to compare the liver function tests, lipid profile and mean platelet volume (MPV) between individuals with NAFLD and without NAFLD.Methods: Total of 97 type 2 diabetes mellitus ambulatory patients were selected for the study. Among them 62 were males (63.9%) and 35 were females (36%). 78 healthy subjects were selected as controls. Their age ranged between 27 to 75 years. Serum was used for the estimation of FBS, PPBS, total bilirubin, direct bilirubin, AST, ALT, ALP, GGT, total protein, albumin, total cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). EDTA blood was used for the estimation of MPV. Fatty liver was diagnosed on ultrasound based on the echogenicity and size of the liver.Results: In this study, liver size & echotexture, liver enzymes such as AST, ALT, ALP and GGT, serum cholesterol, TGL and LDLC were found to be statistically significantly increased in T2DM patients when compared to controls. T2DM patients were divided in to two groups; group 1 included patients with NAFLD and group 2 included patients without NAFLD. Liver size, AST, ALT, ALP, GGT, Cholesterol and TGL were significantly increased in group 1 patients when compared to group 2 patients (P value<0.05). Elevation of MPV was found to be more in group 1 patients than group 2 patients ranging between 12.1±3.0 and 10.2±0.9 respectively.Conclusions: Early detection and optimum control of diabetes mellitus is important to minimize the effect of diabetes on liver. Hence, assay of serum levels of hepatic enzymes and USG abdomen to detect NAFLD should be done in all patients with T2DM as preliminary diagnostic tests.

Apelin 13 and Blood Pressure, Is there any Association in Pre-eclampsia? - A Case-control Study

Introduction: Pre-eclampsia is a pregnancy specific disorder, characterised by the onset of hypertension and proteinuria. Preeclampsia is the leading cause of maternal, perinatal morbidity and mortality. The exact cause of pre-eclampsia is not known clearly and needs to be explored. Aim: To evaluate the maternal serum apelin 13 levels among pre-eclampsia and healthy pregnant women and also, to find the association between apelin 13 and blood pressure. Materials and Methods: A case-control study was conducted between Department of Biochemistry and Department of Obstetrics and Gynaecology, RL Jalappa Hospital and Research Centre, Kolar, Karnataka, India. After approval from the Institutional Ethics Committee and written informed consent from study subjects, a total of 270 pregnant women were recruited for this study. Among them, 135 pre-eclamptic women were considered as cases and 135 normotensive healthy pregnant women served as controls. According to the pre-eclampsia severity, cases were grouped into mild (n=47) and severe preeclampsia (n=88). Blood samples were collected from all the study subjects and was analysed for apelin 13 by Enzyme Linked Immunosorbent Assay (ELISA) method. Maternal and foetal adverse outcomes were recorded. Results were expressed as mean±Standard Deviation (SD). Categorical variables were expressed in percentages. Spearman’s correlation was applied and p<0.05 was considered significant. Results: The mean gestational age was 36.66±3.69 weeks which was, significantly low in pre-eclamptic women compared with healthy pregnant women. BMI (26.94±3.81 kg/m2 ), systolic (157.82±15.14 mmHg), diastolic (101.68±11.02 mmHg) and Mean Arterial Pressure (MAP) (120.20±11.12 mmHg), pulse rate (88.14±5.82 bpm), Aspartate Transaminase (AST) (25.25±12.49 IU/L) and Alanine Transaminase (ALT) (19.01±10.95 IU/L) were significantly increased in pre-eclamptic women when compared with control group. Mean maternal serum apelin 13 (341.44±218.63 pg/mL) concentrations were significantly lower in pre-eclampsia compared with healthy pregnant women. Maternal serum apelin 13 concentrations were negatively correlated with Systolic Blood Pressure (SBP) (r = -0.196), Diastolic Blood Pressure (DBP) (r = -0.172) and MAP (r =-0.204). Adverse maternal outcomes such as epigastric pain 75 (55.55%), oedema 62 (45.92%) and persistent headache 35 (25.92%) were higher in pre-eclamptic group. Additionally, adverse foetal outcomes were more in preeclamptic cases including significantly decreased birth weight (2.40±0.65), babies requiring Neonatal Intensive Care Unit (NICU) admission were 54 (40%), preterm birth (≤37 wks) in 50 (37.03%), Respiratory Distress Syndrome (RDS) 31 (22.96%), Small for Gestational Age (SGA) in 4 (2.96%) and Intra Uterine Death (IUD) in 11 (8.14%) babies. Conclusion: It was concluded from the present study that there was low maternal serum apelin 13 concentrations in pre-eclampsia and had negative correlation with blood pressure, suggesting its potential role in the pathophysiology of pre-eclampsia

Evaluation of thyroid hormone levels in chronic kidney disease patients

We attempted in this study to determine the thyroid hormone levels in 45 adult chronic kidney disease (CKD) patients and 45 ageand sex-matched healthy subjects as controls. The serum thyroid hormone levels were measured by a radioimmunoassay. Serum concentrations of creatinine, urea, electrolytes and total proteins and albumin were measured as well. There was a significant decrease in the levels of serum total T3, total T4 and total protein and albumin levels in CKD patients when compared with the controls. There was a significant increase in the level of thyroid stimulating hormone in the CKD patients compared with the controls. Our study suggests that CKD leads to significant changes in the thyroid hormone levels, which need to be interpreted carefully in these patients

Study of prevalence of non alcoholic fatty liver disease in type 2 diabetes mellitus patients and variations in liver function tests, lipid profile and mean platelet volume in patients with fatty liver in comparison with patients without fatty liver

Background: Type 2 diabetes mellitus (T2DM) patients potentially are at risk of developing non-alcoholic fatty liver disease. The aim of the study is to determine the prevalence of NAFLD among T2DM patients, diagnosed by ultrasonography of liver, to study the age &amp; sex incidence of NAFLD and to compare the liver function tests, lipid profile and mean platelet volume (MPV) between individuals with NAFLD and without NAFLD.Methods: Total of 97 type 2 diabetes mellitus ambulatory patients were selected for the study. Among them 62 were males (63.9%) and 35 were females (36%). 78 healthy subjects were selected as controls. Their age ranged between 27 to 75 years. Serum was used for the estimation of FBS, PPBS, total bilirubin, direct bilirubin, AST, ALT, ALP, GGT, total protein, albumin, total cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). EDTA blood was used for the estimation of MPV. Fatty liver was diagnosed on ultrasound based on the echogenicity and size of the liver.Results: In this study, liver size &amp; echotexture, liver enzymes such as AST, ALT, ALP and GGT, serum cholesterol, TGL and LDLC were found to be statistically significantly increased in T2DM patients when compared to controls. T2DM patients were divided in to two groups; group 1 included patients with NAFLD and group 2 included patients without NAFLD. Liver size, AST, ALT, ALP, GGT, Cholesterol and TGL were significantly increased in group 1 patients when compared to group 2 patients (P value&lt;0.05). Elevation of MPV was found to be more in group 1 patients than group 2 patients ranging between 12.1±3.0 and 10.2±0.9 respectively.Conclusions: Early detection and optimum control of diabetes mellitus is important to minimize the effect of diabetes on liver. Hence, assay of serum levels of hepatic enzymes and USG abdomen to detect NAFLD should be done in all patients with T2DM as preliminary diagnostic tests.