Correlation of HbA1c levels in late pregnancy with maternal and perinatal outcome in patients with gestational diabetes mellitus

Background: Estimation of HbA1c in gestational diabetes mellitus patients is not being recommended by any societies/guidelines as studies regarding the role of HbA1c for monitoring of euglycemic control and predicting the maternal and perinatal outcomes in GDM patients (unlike overt diabetes) are conflicting and sparse.Methods: This was a prospective study with an aim to evaluate the role of HbA1c estimation in late pregnancy (early and late third trimester) for prediction of pregnancy outcomes in GDM patients. 53 patients with GDM (diagnosed before third trimester) were recruited for the study. HbA1c levels were estimated in late pregnancy (at 28-32 weeks and again repeated at 37 - 39 weeks or at the time of delivery). Correlation of HbA1c levels in third trimester with maternal and perinatal outcome was studied in patients with gestational diabetes mellitus and cut off taken was 5.8%.Results: Of the total 53 patients 54.7% had HbA1c levels <5.8% and 45.3% had HbA1c ≥5.8% done at 28-32 weeks. Also when HbA1c levels done at 37-39 weeks POG/ at the time of delivery, 52.8% patients had <5.8% and 47.2% had HbA1c ≥5.8%. Approximately one-fourth of the patients had HbA1c ≥ 5.8% even with normal blood sugar levels (euglycemic) control. There was statistically significant increased incidence of polyhydramnios, LGA (large for gestational age babies) and increased mean birth weight in patients with HbA1c ≥ 5.8%, done in late pregnancy. However there was no statistically significant difference in the incidence of preterm labour, gestational hypertension or preeclampsia, urinary tract infections, vulvovaginal infections, caesarean deliveries and postpartum haemorrhage in patients with HbA1c ≥5.8% compared to patients with HbA1c <5.8%.Conclusions: The study revealed that in patients of GDM with HbA1c levels ≥5.8% done in third trimester was statistically significantly associated with increased incidence of polyhydramnios, large for gestational age babies and increased mean birth weight when compared to patients with HbA1c <5.8%

Cardiac troponin I as mortality predictor in acute exacerbation of chronic obstructive pulmonary disease

Background: Comorbidities are important determinants of outcome and quality of life of patients with chronic obstructive pulmonary disease (COPD). The risk of cardiovascular events in COPD patients is three to five-fold high. COPD is often associated with right ventricular hypertrophy and pulmonary hypertension. Various studies have associated levels of cardiac troponin I (cTnI) with severity and duration of acute exacerbation of COPD (AECOPD). The objective of the present study was to assess the usefulness of serum cTnI as mortality predictor in AECOPD patients.Methods: An observational, prospective and non interventional study was conducted in 50 patients with AECOPD admitted in the pulmonary medicine emergency or ward of a tertiary care hospital of Northern India. AECOPD was diagnosed according to Global Initiative for chronic obstructive lung disease guidelines. cTnI levels were estimated within 24 hours of admission by method based on chemiluminiscence along with routine investigations. Levels ≥ 0.01ng/ml were taken as positive. The patients were followed up for 30days for outcome in terms of mortality and morbidity. Data was entered and analyzed by SPSS package and two sided p values<0.05 were considered statistically significant.Results: The serum cTnI was found to be positive in 34% of patients with AECOPD. The in- hospital mortality was significantly low in patients having cTnI <0.01ng/ml as compared to patients with cTnI ≥0.01ng/ml. The patients with cTnI levels ≥0.01ng/ml had significantly higher mean PaCO2 levels and higher requirement for invasive or noninvasive ventilation during hospital stay as compared to patients having cTnI <0.01ng/ml (p=0.04 and 0.016 respectively).Conclusions: Levels of cTnI≥0.01ng/ml may be considered as a biomarker to predict mortality in AECOPD patients

Study of patients with liver dysfunction during pregnancy and their maternal and perinatal outcomes

Background: Liver dysfunction in pregnancy can be associated with maternal and perinatal morbidity and mortality, therefore early recognition and timely management is of paramount importance to improve the outcome. The studies related to liver dysfunction in pregnancy and its outcome are sparse from this part of India and are retrospective in nature, so present study was planned.Methods: A total of 80 pregnant patients with liver dysfunction were enrolled as per the inclusion criteria after taking informed consent. Patients were investigated depending on the symptoms and pregnancy related complications with an aim to know the probable cause of liver dysfunction. Maternal and perinatal outcomes were noted in these patients.Results: Intrahepatic cholestasis of pregnancy was the most common cause of deranged liver function tests (71.3%) followed by HELLP syndrome (21.3%), viral hepatitis (6.3%) and AFLP (1.3%) respectively. The most common maternal complication seen was preterm labour (33.8%) followed by thrombocytopenia (11.3%), postpartum hemorrhage (7.5%), vaginal wall hematoma (7.5%) and coagulopathy (3.8%). 2 patients (2.5%) required ICU admission and both patients expired due to fulminant hepatic failure. The most common fetal complication was prematurity (33.8%). Intrauterine fetal demise occurred in 10% of the patients and there were 12.5% perinatal deaths observed in our study.Conclusions: The commonest cause of liver dysfunction in our study was IHCP (71.3%) followed by HELLP syndrome (21.3%). In spite of multidisciplinary approach, liver dysfunction during pregnancy was associated with high maternal and perinatal morbidity and mortality

Association of vitamin D deficiency during pregnancy with preeclampsia and eclampsia

Background: Vitamin D was considered important for bone and calcium. Historically thought to be important for bone and calcium metabolism but recent studies have redefined its role. There is some evidence now that low levels of Vitamin D are associated with the risk of preeclampsia but more studies are needed to prove the same. This study was done to determine whether vitamin D deficiency is an independent risk factor for preeclampsia/eclampsia.Methods: In this prospective case control study vitamin D levels were estimated in 92 women divided into two groups. Group 1(n = 42) included pregnant women with preeclampsia/eclampsia and group 2(n = 50) included uncomplicated pregnant women admitted in labour ward for delivery. The frequency of risk factors for preeclampsia/eclampsia were compared in two groups. Statistical analysis was done using the multivariate logistic regression analysis.Results: Almost 100% women in both groups had low vitamin D levels. Mean serum 25(OH)D levels were significantly less in Group 1(6.7236ng/ml) as compared to group 2(9.8862 ng/ml, p = 0.004). 83.3% of women in group 1 had severe deficiency (25(OH)D levels <10 ng/ml) compared to 68% women in group 2. All women (100%) in group 1 had vitamin D deficiency (<20 ng/ml) as compared to 92% in group 2 but this was not statistically significant.Conclusions: Although mean serum 25(OH)D levels were significantly less in preeclampsia/eclampsia group, prevelance of vitamin D deficiency was not significantly different in pregnant women with preeclampsia/eclampsia as compared to women who did not have preeclampsia/eclampsia

Evaluation of high risk screening protocol for detection of overt hypothyroidism in pregnancy

Background: Overt hypothyroidism is a known cause of feto-maternal morbidity. Many large-scale studies do not support the identification and treatment of sub-clinical hypothyroidism. Hence, we need a screening protocol that will identify all cases of overt hypothyroidism. The present study aimed to evaluate the high-risk screening protocol for detection of overt hypothyroidism during pregnancy.Methods: Authors performed a prospective observational study for detection of thyroid dysfunction in 604 pregnant women in a tertiary care hospital setting. Detailed demographic, medical and obstetric history was noted and baseline serum thyrotropin (TSH) level and urinary iodine levels were checked. Reflex testing for thyroid peroxidase antibody was done in women diagnosed to have hypothyroidism. The enrolled women were then grouped as high risk if any of the high-risk criteria provided by ATA was positive.Results: The study population was iodine sufficient with median urinary iodine (MUI) level of 255µg/l. Overall 32.2% women (n=201) were found to be hypothyroid (TSH >2.5mIU/L), 0.8% women (n=5) were hyperthyroid. Overt hypothyroidism was seen in 3.8% women (n=23), all of whom were in the high-risk group as per the ATA guidelines. This co-relation was highly significant (likelihood ratio 24.94; P 0.05.Conclusions: High risk screening protocol is highly sensitive for detection of overt hypothyroidism and provides the best therapeutic payoff

Metabolic Syndrome: a challenging health Issue in highly urbanized Union Territory of north India

<p>Abstract</p> <p>Objectives</p> <p>1. To determine the prevalence of Metabolic Syndrome in adults aged 18 years and above in Chandigarh, India. 2. To determine the socio-demographic factors associated with MS. 3. To determine the agreement between IDF (International Diabetes federation definition) and ATP-III (National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults criteria).</p> <p>Methods</p> <p>In a community based cross-sectional study, total 605 subjects aged 18 yrs and above were studied using multistage random sampling.</p> <p>Results</p> <p>Prevalence of Metabolic Syndrome was estimated by using IDF and ATP-III criteria. By IDF, Metabolic Syndrome was found in 287 (47.4%) subjects and it was more prevalent among females 171 (59.6%) as compared to males 116 (40.4%). By applying ATP-III overall prevalence was less i.e. 233 (38.5%) but again its prevalence was more among females 141 (44.8%) than males 116 (39.5%). Higher socioeconomic status, sedentary occupation and high body mass index were significantly associated with Metabolic Syndrome.</p> <p>Conclusions</p> <p>Metabolic Syndrome is a major health problem in the region and proper emphasis should be given on its prevention and control.</p

Modulation of Trehalose Dimycolate and Immune System by Rv0774c Protein Enhanced the Intracellular Survival of Mycobacterium smegmatis in Human Macrophages Cell Line

Mycobacterium tuberculosis Rv0774c protein was reported previously to express under stress conditions. Therefore, Rv0774c gene was cloned and expressed in Mycobacterium smegmatis, a surrogate host, to determine its role in bacterial persistence and immune modulation in natural environment. The bacterial colonies expressing Rv0774c (Ms_rv0774c) were larger, smoother, more moist, and flatter than the control ones (Ms_ve). Enhanced survival of Ms_rv0774c after treatment with streptomycin was observed when compared with control. The cell envelope of Ms_rv0774c was demonstrated to have more trehalose di-mycolate (TDM) and lesser amount of mycolylmannosylphosphorylheptaprenol (Myc-PL) in comparison to control. Higher intracellular survival rate was observed for Ms_rv0774c as compared to Ms_ve in the THP-1 cells. This could be correlated to the reduction in the levels of reactive NO and iNOS expression. Infection of macrophages with Ms_rv0774c resulted in significantly increased expression of TLR2 receptor and IL-10 cytokines. However, it lowered the production of pro-inflammatory cytokines such as IL-12, TNF-α, IFN-γ, and MCP-1 in Ms_rv0774c infected macrophages in comparison to the control and could be associated with decreased phosphorylation of p38 MAPK. Though, predicted with high antigenicity index bioinformatically, extracellular in nature and accessible to host milieu, Rv0774c was not able to generate humoral response in patient samples. Overall, the present findings indicated that Rv0774c altered the morphology and streptomycin sensitivity by altering the lipid composition of M. smegmatis as well as modulated the immune response in favor of bacterial persistence

Interplay among the Variants of One Carbon Metabolism, Methylenetetrahydrofolate Reductase Polymorphisms and Lung Cancer

Introduction: Folates perform an integral task in DNA synthesis, methylationand repair. Methylenetetrahydrofolate Reductase (MTHFR) potrays a key part in the metabolism of folate and regulates the equilibrium between the various forms of folate for DNA synthesis and DNA methylation. MTHFR irrevocably transforms 5,10 methylenetetrahydrofolate to 5-methyltetrahydrofolate, the principal circulating folate and the carbon donor for remethylation processes. MTHFR is vastly polymorphic in the general population. Materials and Methods: It was a case-control study conducted during March 2010 to September 2011 in the Department of Pulmonary Medicine in collaboration with the Department of Biochemistry at Government Medical College and Hospital, Chandigarh, to see whether any association exists between the variants of one carbon metabolism, MTHFR polymorphisms (C677T and A1298C), and lung cancer. Twenty biopsy proven lung cancer patients and 20 age and sex matched cancer-free controls were selected. Results: The mean serum folate in cases was higher (12.84 ng/mL±7.527 ng/mL) as compared to controls (4.46 ng/ mL±1.346 ng/mL), suggesting that high levels of serum folate are associated with lung cancer. There was no significant variance in the levels of vitamin B12 and plasma homocysteine between cases and controls. No MTHFR polymorphism C677T was seen in the blood and the bronchial biopsy samples of all cases as well as blood samples of all the controls. The MTHFR polymorphism A1298C was present in the blood as well as bronchial biopsy samples of cases as well as blood of controls. Thus, in the present study, there was no relation of this polymorphism with lung cancer. Conclusion: Polymorphisms in MTHFR may contribute to lung cancer. More research on the basis of cellular and molecular mechanisms of lung cancer is urgently needed to aid in understanding of pathogenesis of the disease