High sensitivity C-reactive protein levels across spectrum and severity of coronary artery disease

Background: C-reactive protein (CRP) is an acute-phase reactant protein synthesized by the liver in response to acute\ud stress in a wide range of acute and chronic inflammatory conditions. In healthy subjects and patients presenting with\ud coronary artery disease (CAD), elevated levels of CRP has repeatedly been demonstrated to predict future cardiovascular\ud events.\ud Methods: We measured high sensitivity C-reactive protein (hs-CRP) levels in 382 consecutive patients with CAD and 60 healthy controls by immunoturbidimetry method. Risk factors like hypertension, diabetes mellitus, dyslipidaemia,smoking, obesity and family history of premature CAD were assessed.\ud Results: The mean age of patients with CAD was 53.5±11.8 years (303 males) and that of control group was 50.83±8.07(28 males). The patient group had significant higher concentration of mean hs-CRP levels when compared\ud with the healthy control group (1.8±1.9 mg/L vs 0.35±1.1 mg/L, p<0.001). The mean hs-CRP levels of unstable angina\ud (USA) and myocardial infarction (MI) patients was higher than chronic stable angina (CSA) patients (p<0.05). Based\ud on the disease severity, we found a significantly higher hs-CRP levels in patients of triple vessel disease when compared\ud to patients with single vessel disease (p=0.01).\ud Conclusions: Elevated serum hs-CRP levels provide a useful marker for cardiovascular risk which, when combined\ud with traditional risk factors, may help improve global risk prediction. Our study showed a significant contribution of\ud hs-CRP to coronary risk prediction with better discrimination

Ultrasound bone mineral density of Os Calcis - its relationship with bone mineral markers and 25(OH) vitamin D in endemic fluorotic and non-fluorotic villages

Objectives: To study the relationship between the nutritional status, serum bone mineral markers, 25 hydroxy vitamin D [25(OH)D] levels and ultrasound bone mineral density (USBMD) of Os Calcis in subjects living in endemic fluorotic and non-fluorotic villages. Methods: Subjects from fluorotic (n=57) and non-fluorotic (n=79) villages were studied for their dietary habits, biochemical parameters of bone mineral markers, 25(OH)D levels and correlated with stiffness index (SI) measured using Achilles ultrasound bone densitometer. Results: Dietary calcium intake in both the villages is far below the recommended daily allowances (RDA) by Indian Council of Medical Research (ICMR), India for Indian population. The 25(OH)D correlated positively with energy intake (r=0.7; p<0.001); dietary calcium (r= 0.5; p<0.001); and negatively with phytate/calcium ratio (r=0.2; p<0.001), in subjects in fluorotic villages. No similar correlation was observed among subjects from non-fluorotic villages. For comparable levels of serum calcium, subjects in non-fluorotic villages were more osteopenic than the fluorotic counterparts. USBMD did not correlate with 25(OH)D in the fluorotic and non-fluorotic subjects. Conclusions: The dietary calcium intake among subjects from fluorotic and non-fluorotic villages is less than the RDA suggested by ICMR. The 25(OH)D levels of both these villages were in the vitamin D insufficiency range. USBMD does not correlate with the 25(OH)D status of an individual and it should not be used for screening osteoporosis in areas endemic for fluorosis

Clinical applications of glycosylated haemoglobin

Glycosylated haemoglobin (HbA1c) has been in use since 1980s as the 'gold standard' for monitoring glycaemic control and as a predictor of diabetic complications. Even though several conditions, such as, haemolytic anaemia (lowers HbA1c) and aplastic anaemia (raises HbA1c) tend to confound and interfere with HbA1c measurement, in most circumstances HbA1c is a valid and reliable index of glycaemic status. Recently, HbA1c has also been recommended as a diagnostic test for diabetes mellitus by the American Diabetes Association (ADA); HbA1c offers logistical advantages over the conventional oral glucose tolerance test as it requires a non-fasting random sample. In this article the history of discovery of HbA1c, biochemical processes behind its formation, its assay techniques, various factors influencing HbA1c, importance of standardization of its assay so as to make the results reported from different laboratories much more comparable are critically reviewed. This review also provides an update on the optimal HbA1c targets, its reliability in control of diabetic complications, limitations of test results and its importance in control of diabetes patients and their complications, various cut-off values obtained in studies performed both in India and worldwide and its role as a surrogate marker of metabolic syndrome, among others

Indices of insulin resistance in paediatric obesity

Background: Paediatric obesity is associated with insulin resistance (IR), which increases risk of type 2 diabetes mellitus (T2DM) and cardiovascular diseases (CVD). Hyperinsulinaemic-euglycaemic clamp and minimal-model analysis frequently sampled intravenous glucose tolerance test (FSIVGTT) are used to assess IR, which are invasive, complex and expensive. Objective: To assess IR using the derived indices namely, homeostasis model assessment of insulin resistance (HOMAIR), fasting glucose-to-insulin ratio (FGIR), quantitative insulin-sensitivity check index (QUICKI), in obese children. Methods: Fifty obese children (cases) and 50 apparently healthy age-and gender- matched non- obese children (controls) were studied. Obese children with body mass index (BMI; Kg/m2) greater than 95th percentile and nonobese children with BMI between 5th to 95th percentile were included in the study. Results: Obese children had higher fasting insulin levels, HOMA-IR (p<0.001), FGIR (p<0.001) and QUICKI (p<0.001) when compared to controls; fasting blood glucose levels were comparable (p=0.170). A statistically significant correlation was observed between serum insulin and BMI, between insulin and all the derived indices and between the derived indices and BMI (p<0.001). HOMA-IR had more area under the curve (0.760) followed by FGIR (0.721) when compared to QUICKI (0.240). Conclusions: Obese children were normoglycaemic with IR. HOMA-IR was found to be a stronger predictor of IR when compared to FGIR and QUICKI in obese children

Acute renal failure in falciparum malaria: Clinical characteristics, demonstration of oxidative stress, and prognostication

In this prospective study, we aimed to assess the clinical characteristics of acute renal failure (ARF), determine oxidative stress, as well as to predict the outcome in patients with severe falciparum malaria (FM). The study included a total of 75 subjects; there were 25 adult patients with acute severe FM and ARF, 25 adult patients with uncomplicated FM without ARF, and 25 age- and sex-matched healthy subjects who served as controls. In patients with severe FM and ARF (n = 25), renal failure was non-oliguric in 28% and oliguric in 72%. The average duration of renal failure was 10.53 ± 4.0 days. Sixty percent recovered and 40% died. All patients with non-oliguric presentation recovered. The mean serum malondialdehyde (MDA) levels were 0.82 ± 0.43 μmol/L, 2.97 ± 1.11 μmol/L, and 6.86 ± 2.62 μmol/L, respectively, in healthy con-trols, in patients with uncomplicated FM, and in those with severe FM with ARF. The Acute Physiology Age and Chronic Health Evaluation II (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score, and the Acute Tubular Necrosis-Individual Severity Index (ATN-ISI) score were all significantly higher in the expired group (19 ± 5.49) when compared to the survivor group (14.4 ± 3.15) (P = 0.014). Kaplan-Meier survival analysis showed that survival was low in patients with delayed hospitalization and longer duration of symptoms. Also, we observed a high occurrence of acute respiratory distress syndrome and central nervous system involvement among the patients who expired

Body iron status and association with hyperinsulinaemia and hyperandrogenism in non-obese Indian women with polycystic ovarian syndrome

Background: Increased body iron stores, insulin and androgen levels have been reported in obese women with polycystic ovarian syndrome (PCOS). However, the status of iron and the influence of hormonal profile on iron status in non-obese women with PCOS has not been studied. The present study was thus designed to determine the iron status and hormones insulin and testosterone levels and their association with body iron status in non-obese women patients with PCOS. Methods: The present study included 33 non-obese women diagnosed as PCOS based on National Institutes of Health consensus 1990 criteria and 31 age-matched healthy women as controls. Height, weight, body mass index, fasting plasma glucose, iron status markers i.e., serum ferritin, iron, total iron binding capacity, insulin and testosterone levels were determined. Results: A significant increase in hormones insulin and testosterone levels (p<0.001) was found in patients with PCOS in comparison with controls. Similarly, a significant increase in serum ferritin levels was observed in PCOS patients compared to controls (p<0.05). A significant positive correlation was observed between serum insulin and testosterone levels (p<0.05). Similarly, a positive association was observed between serum testosterone and ferritin levels [p=0.007 odds ratio (OR) 7.0(1.715-28.568)]. Conclusions: The present study demonstrates that body iron stores, as reflected by serum ferritin concentrations, are increased even in non-obese PCOS patients. Androgen excess is associated with increased body iron stores in these patients with the possible additive effects of hyperinsulinaemia, through its perpetuating effect on increased androgens and iron-sparing effect of reduced menstrual losses

Prevalence of thyroid disorders and metabolic syndrome in adult patients with rheumatoid arthritis

Background: The clinical association between rheumatoid arthritis (RA) and hypothyroidism is important as both these conditions are associated with metabolic syndrome (MetS) which in turn makes the patients more prone for cardiovascular disease. Material and methods: In this cross-sectional study, the prevalence of thyroid disorders and MetS were studied in 54 consecutive adult patients with RA (mean age 46.0±10.4 years; 48 females) and 54 age - and gender-matched healthy control subjects. Results: The prevalence of thyroid disorders was higher in patients with RA than in control subjects; however, this difference was not statistically significant [19/54 (35.2%) Vs 12/54 (22.2%); p=0.201]. Nine patients with RA already known to have hypothyroidism were receiving levothyroxine treatment. Among the remaining RA patients (n=45), a significantly higher prevalence of autoimmune thyroid disease (AITD) (10/45 Vs 4/54; 2=4.437, p=0.045) and subclinical hypothyroidism with anti-thyroid peroxidase (anti-TPO) antibody positivity (4/45 Vs 0/54; 2=5.002, p=0.040) were observed compared with healthy control subjects. The prevalence of MetS was higher in patients with RA than in control subjects; however, this difference was not statistically significant [31/54 (57.4%) Vs 25/54 (46.3%); p=0.336]. Conclusions: A significantly higher prevalence of AITD and subclinical hypothyroidism with anti-TPO antibody positivity in patients with RA suggests that these patients would benefit from screening for AITD. The co-existence of hypothyroidism and RA reiterates the need for monitoring and early identification of cardiovascular risk factors in patients with RA