Thyroid hormones reference ranges during each trimester of normal pregnancy subjects in Andhra Pradesh, South India

Background: The Thyroid hormones normal levels are very much essential for fetal neural development and good pregnancy outcome. Thyroid insufficiency during pregnancy may be associated with adverse obstetric outcome and fetal neurodevelopmental deficits. The main objective of the study is to estimate and establish the reference ranges of thyroid hormones as it varies from place to place and inter dependent on the iodine levels as the American Thyroid Association strongly recommends to refer to population defined trimester-specific reference ranges.Methods: A longitudinal study was conducted at obstetric clinic, Kakinada city, Andhra Pradesh over a period of 18 months. The total number of normal pregnancy subjects included in this study was 126. Thyroid hormones estimation was done by Competitive electrochemiluminescence (T3 and T4) and Sandwich electrochemiluminescence (TSH) at Thyorocare Laboratory. Only 47 subjects were having all three trimester thyroid hormone levels estimated during each trimester and were followed up to full term. The 2.5th and 97.5th percentiles were calculated as the reference intervals for thyroid hormone levels during each trimester.Results: The thyroid hormone levels during first, second and third trimesters median with reference intervals - Total Triiodothyronine (T3) : 163(100.2-230), 168(121-219.2), 168(110.2-222.6) ng/dl ,Total Thyroxine (T4) : 8.4(4.05-16.64) , 10.2(4.09-18.7), 11.2(3.8-16.7) μg/dl and Thyroid Stimulating Hormone (TSH ):2.52(1.6-7.9) 3.01(1.28-7.6) 3(1.5-8.4) μIU/mlConclusions: The trimester-specific reference intervals and median for thyroid hormones during normal pregnancy have been established for pregnant South Indian women in Andhra Pradesh by full term follow-up during pregnancy using 2.5th and 97.5th percentiles and median

Thinking beyond low-density lipoprotein cholesterol: strategies to further reduce cardiovascular risk

Several large statin trials and meta-analyses have demonstrated a reduction in low-density lipoprotein cholesterol (LDL-C) and cardiovascular morbidity and mortality. Some trials have also highlighted the significance of residual cardiovascular risk after treatment of LDL-C to target levels. This reflects the complex nature of residual cardiovascular risk. This residual risk is partially due to low HDL-C and high triglycerides (TG) despite achievement of LDL goals with statin therapy. The NCEP ATP III guidelines reported that low HDL-C is a significant and an independent risk factor for coronary heart disease (CHD) and is inversely related to CHD. Epidemiologic studies have also shown a similar inverse relationship of HDL-C with CHD. High-density lipoprotein cholesterol (HDL-C) may directly participate in the anti-atherogenic process by promoting efflux of cholesterol of the foam cells of atherogenic lesions. Many studies have demonstrated multiple anti-atherogenic actions of HDL-C and its role in promoting efflux of cholesterol from the foam cells. The residual risk by increased TG with or without low HDL-C can be assessed by calculating non–HDL-C and a reduction in TG results in decreased CHD

The significance of lipid profile and positive troponin-I in predicting cardiac event

Background: Diagnosis of acute cardiac event in the early stage of its onset is important in the treatment process. The development of highly sensitive and specific immunoassays for myocardial proteins such as cardiac troponin-I had made it possible. However troponin indicates cardiac events only after its onset or after cardiac tissue necrosis. Traditionally such high risk subjects were identified using lipid profiles. The identification of subjects with high risk of developing cardiac event in the future is more significant as it will provide time to prevent such incidents.Methods: In this retrospective study data of the 250 patients presented to the emergency department with symptoms of cardiac ischemia who underwent both troponin-I and lipid profiles tests were compared with the lipid profiles of 100 normal healthy subjects (controls). The troponin-I was detected quantitatively when a specimen contains troponin-I above the 99th percentile (TnI >0.3 ng/ml). The total cholesterol, high density lipoproteins cholesterol, very low density lipoproteins cholesterol and triacylglycerol levels were also analyzed and low density lipoprotein cholesterol level was calculated using Friedewald’s formula.Results: Patients with chest pain and positive troponin-I test (with confirmed cardiac event) were found to have significantly elevated levels of total cholesterol, triacylglycerols, low density lipoprotein cholesterol level and significantly reduced high density lipoproteins cholesterol levels when compared to the patients who experienced only chest pain with (negative troponin-I) and healthy controls.Conclusions: An acute cardiac event is best diagnosed by highly sensitive and specific positive troponin-I test (by quantitative method). However, traditional lipid profile levels still can be used in screening the populations to identify those subjects with high risk of developing cardiac event, in those centres where troponin-I test facility is unavailable.

The interaction between clopidogrel and proton pump inhibitors (PPI): is there any clinical relevance?

The potential interaction between clopidogrel and proton pump inhibitors (PPI) in patients with acute coronary syndrome (ACS) raises serious concerns for cardiologists. However, in patients on this combination of drugs, there is no conclusive evidence of an increase in adverse cardiovascular events. From pharmacologic and pharmacodynamic perspectives, there is a real interaction between clopidogrel and PPIs because of the competitive inhibition of CYP2C19 isoenzyme which is required for biotransformation of clopidogrel to its active metabolite. The consequent decrease in the availability of this active metabolite leads to attenuation of antiplatelet efficacy of clopidogrel. In several observational trials, it was shown that decreased antiplatelet effect of clopidogrel due to PPIs may translate into poor cardiovascular outcomes. However, an incomplete RCT (COGENT) and a post hoc analysis of two large trials (PRINCIPLE-TIMI 44 and TRITON-TIMI 38 trial) showed no significant adverse cardiovascular events with this combination. Caution is however needed in patients who are hypometabolizers of clopidogrel putting them at a higher risk of adverse coronary events. Since 3% of patients are likely to be hypometabolizers of clopidogrel, routine combination of clopidogrel and PPIs should be avoided. There is a heightened awareness of this interaction following multiple advisory warnings. At the same time, one should not withhold PPIs in patients who are at a high risk of developing gastrointestinal (GI) bleeding. In these patients, selected choices of PPI such as pantoprazole may be helpful and for low risk patients, serious consideration should be given to H2 receptor antagonists or antacids. Therefore, while not compromising the cardioprotective effect of antiplatelet agents, the gastroprotective benefit of PPI should be strongly considered in patients who need both. Health care providers should remain alert to more outcome data. Future researchers will need to demonstrate the safety of coadministration of PPIs and clopidogrel and trials should be powered to detect major adverse cardiovascular events and facilitate risk stratification based on genetic polymorphism

Fine mapping and sequence analysis reveal a promising candidate gene encoding a novel NB-ARC domain derived from wild rice (Oryza officinalis) that confers bacterial blight resistance

Bacterial blight disease of rice caused by Xanthomonas oryzae pv. oryzae (Xoo) is one of the most serious constraints in rice production. The most sustainable strategy to combat the disease is the deployment of host plant resistance. Earlier, we identified an introgression line, IR 75084-15-3-B-B, derived from Oryza officinalis possessing broad-spectrum resistance against Xoo. In order to understand the inheritance of resistance in the O. officinalis accession and identify genomic region(s) associated with resistance, a recombinant inbred line (RIL) mapping population was developed from the cross Samba Mahsuri (susceptible to bacterial blight) × IR 75084-15-3-B-B (resistant to bacterial blight). The F2 population derived from the cross segregated in a phenotypic ratio of 3: 1 (resistant susceptible) implying that resistance in IR 75084-15-3-B-B is controlled by a single dominant gene/quantitative trait locus (QTL). In the F7 generation, a set of 47 homozygous resistant lines and 47 homozygous susceptible lines was used to study the association between phenotypic data obtained through screening with Xoo and genotypic data obtained through analysis of 7K rice single-nucleotide polymorphism (SNP) chip. Through composite interval mapping, a major locus was detected in the midst of two flanking SNP markers, viz., Chr11.27817978 and Chr11.27994133, on chromosome 11L with a logarithm of the odds (LOD) score of 10.21 and 35.93% of phenotypic variation, and the locus has been named Xa48t. In silico search in the genomic region between the two markers flanking Xa48t identified 10 putatively expressed genes located in the region of interest. The quantitative expression and DNA sequence analysis of these genes from contrasting parents identified the Os11g0687900 encoding an NB-ARC domain-containing protein as the most promising gene associated with resistance. Interestingly, a 16-bp insertion was noticed in the untranslated region (UTR) of the gene in the resistant parent, IR 75084-15-3-B-B, which was absent in Samba Mahsuri. The association of Os11g0687900 with resistance phenotype was further established by sequence-based DNA marker analysis in the RIL population. A co-segregating PCR-based INDEL marker, Marker_Xa48, has been developed for use in the marker-assisted breeding of Xa48t

Knowledge, Attitude and Practice of food safety among the residents of an urban slum- A cross-sectional study

Introduction: Food safety refers to limiting the presence of those hazards whether chronic or acute, that may make food injurious to the health of the consumer. Ensuring food safety is the responsibility of everyone involved with handling and preparation of food. Objective: To assess the knowledge, attitude and practices of food safety among the women inmates of the households located in an urban slum. Methodology: A cross-sectional study was conducted among the women involved in food preparation in YSR colony, an urban slum located adjacent to a private medical college in Visakhapatnam with a sample size of 121. The data was collected by interviewing the study subject using a pre-designed, pretested questionnaire. Results: Only 35.5% of the women were having good knowledge of food safety. 54.5% of them were having favourable attitude towards food safety and 57% of them were having good practice of food safety. The Spearman’s rank correlation test showed positive correlation between scores of knowledge and scores of attitude of the women of food safety (r=.241 ; p= 0.008) and between scores of attitude and scores of practice of the women participants and their correlation was found to be statistically significant ( r=.826 ; p < 0.001). Conclusion: Most of the women residents’ knowledge, attitude and practices towards ‘WHO Five keys for Food safety’ is abysmally low and the gaps have to be plugged for promoting nutrition and ensuring a healthy society

Comparison of Palatal Rugae Pattern among North Indian, South Indian and Chinese Students of Manipal University

Aims: To compare the palatal rugae pattern for possible differences between North Indian, South Indian and Chinese students of Manipal University, Manipal. To determine the rugae length, shape, direction, unification and number of the primary rugae. Materials and Method: The study sample consisted of 50 diagnostic study models of 25 males and 25 females within the age group of 15-23 years that were available in the department and were free from palatal defects. These cases were further segregated into 10 cases of each of North Indian, South Indian and Chinese groups and their dental casts were analyzed. Results: There were no significant differences in any parameter when compared between the sexes in the three groups. The difference in length among 3 groups was not statistically significant. The most common rugae shapes observed were wavy and curved. The North Indian group had a predominantly curved rugae shape while the South Indian and Chinese groups had wavy rugae. The rugae direction observed was mostly forward. Most of North Indians and South Indians had forward rugae and Chinese group had both types. Conclusion: The present study indicated that the rugae patterns of the Chinese group are significantly different from the two Indian groups and can hence be used for group identity