THE MAJOR HISTOCOMPATIBILITY COMPLEX: A REVIEW

One of the important components of the immune system, the major histocompatibility complex (MHC) molecules allow T-lymphocytes to detect cells, such as macrophages, B-lymphocytes, and dendritic cells that ingest infectious microorganisms or the self-cells infected with microorganism. On being engulfed a microorganism, macrophage partially digests it and displays peptide fragments of the microbe on its surface, bound to MHC molecules and the T-lymphocyte recognizes the foreign fragment attached to the MHC molecule and binds to it, lead to stimulation of an immune response. The MHC molecule presents peptides from its own cell (self-peptides) in healthy self-cells to which T-cells do not normally react.Keywords: MHC, B Cells, T Cells, Antigen Processing.Â

CARDIOVASCULAR RISK IN PATIENTS WITH MILD TO SEVERE SUBCLINICAL HYPOTHYROIDISM

ABSTRACTObjective: Cardiovascular risk as suggested by its name refers to altered lipid profile and C-reactive protein. It is associated with hypothyroidismdue to the effect of abnormal concentrations of thyroid hormones in the cardiovascular system and increased the risk of atherosclerosis. Subclinicalhypothyroidism is associated with cardiac abnormalities is not well-documented. C-reactive protein one of the markers of inflammation, considered tobe the predictor of cardiovascular diseases. It may be helpful in the assessment of future developments of cardiovascular abnormalities in subclinicalhypothyroidism.Methods: Recently diagnosed 71 subclinical hypothyroidism patients were enrolled in the study and compared with 63 healthy individuals.Patients were divided into two groups on the basis of thyroid stimulating hormone (TSH) concentration. Thyroid profile (TSH, free thyroxine,triiodothyroinine) and C-reactive protein were estimated by enzyme-linked immunosorbent assay. Total cholesterol (TC), triglycerides (TG), and highdensitylipoprotein-cholesterolwereinvestigatedin the studypopulation bya spectrophotometricmethod,and low-densitylipoprotein-cholesterol(LDL-C)wasmeasuredbythe Friedewaldformula.Results and Conclusion: Altered lipid profile, as well as higher concentrations of C-reactive protein, was observed in subclinical hypothyroidismpatients as compared to controls. Higher concentration of TC, TG, and LDL was observed in subclinical hypothyroidism patients while theconcentration of high-density lipoprotein was lower in patients with subclinical hypothyroidism. The elevated concentration of C-reactive proteinwas also observed in the patient group. Patients having TSH >10 µIU/ml have a higher risk of developing cardiovascular disease compared to patientshaving TSH <10 µIU/ml and increasing concentration of C-reactive protein along with LDL-C may progress to cardiac abnormality.Keywords: Subclinical hypothyroidism, C-reactive protein, Dyslipidemia, Cardiovascular risk

SCOPE OF INFLAMMATORY MARKERS IN SUBCLINICAL HYPOTHYROIDISM

Subclinical hypothyroidism (SCH) and inflammatory diseases are now a day's one of the most popular topics of research. Previous studies have shownthat the patients with SCH have increased levels of triglycerides and signs of low-grade inflammation (raised C-reactive protein levels). Disordermight be a risk factor for the development of cardiovascular and other inflammatory diseases. However, there is still some controversy concerning theinflammatory impact of SCH. Treating patients with thyroid stimulating hormone values of <10 mIU/L is not compelling, except in pregnant women.Fortifying the association between SCH and inflammation and a better understanding of research data may provide a more compelling argument forfuture treatment.Keywords: Thyroid stimulating hormone, C reactive protein, interleukin-6, inflammatio

ROLE OF MAGNESIUM IN POSTMENOPAUSAL WOMEN WITH OSTEOPOROSIS AND OSTEOPENIA

ABSTRACTObjective: Osteoporosis is quite common in elderly people, especially in post-menopausal women. The role of Magnesium, an important cation alongwith calcium for bone formation, is not very well-studied in osteoporosis as well as osteopenia group.Methods: Total 68 post-menopausal women 48-75 years of age group, were included in this study. In which, 33 women were having osteoporosiswhile rest 35 were from osteopenia. The differentiation between osteoporosis and osteopenia were done with the bone mineral density usuallyexpressed in T score and Z score. Serum total calcium, ionized calcium, serum phosphate, serum alkaline phosphatase, and serum magnesium wereestimated in post-menopausal women.Results: Significant results were obtained in various parameters. In osteopenic women, the mean values of total calcium (8.25±1.25 vs. 9.29±0.62)and ionized calcium (4.22±0.51 vs. 4.64±0.31) were significantly (<0.001) higher. The serum concentration of alkaline phosphatase (159.87±37.11 vs.137.21±33.29) was significantly higher (<0.01) in osteoporosis group. The serum concentration of magnesium (1.95±0.44 vs. 2.22±0.42) was lowerin osteoporosis group, and the result was statistically significant (<0.05).Conclusion: In post-menopausal women, osteoporosis is characterized by a lower concentration of magnesium. Hypomagnesemia may result ininflammatory disorders which have an existing relationship with bone loss. The dietary intake of magnesium supplement may be useful in reducingthe adverse effect of osteoporosis.Keywords: Osteoporosis, Post-menopause, Osteopenia, Hypomagnesemia

ASSESSMENT OF URIC ACID IN POST-MENOPAUSAL OSTEOPOROTIC WOMEN

ABSTRACTObjective: Osteoporosis is a quite common in post-menopausal women due to estrogen deficiency. Uric acid (UA) concentration has found somecontroversial association with bone mineral density (BMD). Hence, the role of UA may be beneficial to know due to the sign and symptoms presentedby osteoporosis patients.Methods: A total of 79 post-menopausal women were recruited without having a previous history of osteoporosis or the secondary osteoporosis.Their BMD was estimated by estimating T-score and Z-score at the tibia and radius level. Total calcium ionized calcium, serum phosphate, alkalinephosphatase (ALP), and UA level were estimated by a colorimetric method.Results and Conclusions: There were 38 women having osteoporosis and remaining 41 with pre-osteoporosis or osteopenia. Significant resultswere obtained between these groups. Total calcium and ionized calcium were higher is osteopenic group and the result highly significant (<0.001).Serum concentration of phosphate and ALP were significantly (<0.01) higher in the osteoporotic group. The UA level was significantly higher(<0.001) in the osteoporotic women. There were positive association (standardized β=0.265, p=0.018) serum UA and ALP in the study group. Inconclusion, post-menopausal women with pre-osteoporosis as well as osteoporosis are characterized by elevated concentration of UA. The role ofUA in bone loss disorder could not be neglected as hyperuricemia may give rise to several other life-threatening diseases associated with this, incoming future.Keywords: Osteoporosis, Osteopenia, Uric acid, Bone mineral density

ASSESSMENT OF CARDIOMETABOLIC RISK FACTORS AMONG LOCAL POPULATION OF NATIONAL CAPITAL REGION

  Objective: In view of marked accentuations in cardiometabolic diseases in developing countries such as India, we aimed to conduct a cross-sectional study analyzing the prevalence of cardiometabolic risk factors in local population of Ghaziabad.Methods: The study is descriptive, random sample survey, and cross-sectional study. The study was carried out at Santosh Medical College, Ghaziabad, on 350 participants between the age group 18-70 years. After taking the informed consent, they were included in the study. The variables recorded were clinical history, all risk factors of cardiovascular disease including blood pressure, body mass index, waist circumference, blood sugar and serum lipid levels, cigarette use, and dietary habit.Result: Our study shows that the high prevalence of multiple risk factors in a general population with as many as 70% of the participants had metabolic syndrome. Among individually studied groups, obesity was the most common followed by dyslipidemia then diabetes and hypertension and the least prevalent was smoking. Females were more commonly affected than males by dyslipidemia and obesity, probably due to physical inactivity coupled with unhealthy diet and lifestyle.Conclusion: There is the higher prevalence of cardiometabolic risk factors among the population making the individuals prone to associated spontaneous coronary artery dissection and their predisposition. Therefore, timely detection of cardiometabolic factors and appropriate interventions may be of prime concern

ASSESSMENT OF METABOLIC SYNDROME: ROLE OF SERUM FERRITIN

ABSTRACTObjective: The aim of the study is to explore the association between serum ferritin level and metabolic syndrome and its components.Methods: Serum ferritin level and metabolic syndrome and its components were measured among 100 study subjects with respect to 25 healthycontrols at Santosh Medical College and Hospital, Ghaziabad. Fasting and post-prandial blood sugar level was estimated by using glucose oxidaseperoxidase(POD)method.Totalcholesterol,triglycerides,andhigh-densitylipoproteincholesterolwereestimatedbyusing cholesteroloxidase(CHOD)-PODmethod,glycerol-3-phosphateoxidase-phenolaminophenazone method, and Phosphotungustate/CHOD-PODmethod,respectively.Low-densitylipoproteincholesterolwasestimatedbyusing Friedewald'sequation. Serum concentrationof ferritinwasestimatedbyusing MicroELISAtestkit.Cases and controlswerecomparedusing Chi-squaretestand unpairedStudent's t-testand p valueswerecalculated.Results: Significant relationship was observed between serum ferritin level and components of metabolic syndrome. Body mass index, blood sugarlevel, and lipid profile were significantly (<0.05) different between the groups. Serum concentration of creatinine and urea was not significantly(>0.05) different between the groups. Serum ferritin level was elevated in case group with metabolic syndrome and this difference was extremelysignificant (<0.01) between the groups.Conclusion: Serum ferritin, key regulator of iron homeostasis, can be used as indicator of progressing risk of metabolic syndrome.Keywords: Dyslipidemia, Ferritin, Insulin resistance

Female sterilization failure, consequences and further contraception: a review of cases over ten years

Objective: To study the socio-demographic profile and etiological factors responsible for failure of tubal ligation. Their outcome and further adopted methods of contraception.Methods: This was a retrospective observational study done in a tertiary care centre from January 2009 to December 2018. All cases who came with sterilization failure were reviewed including their demographic patterns, previous methods used and the contraception choices adopted after procedural failure.Results: Over a period of ten years, out of a total of 157 cases of sterilization failure 43.33% (n=68) were laparoscopic interval ligation, 42.60% (n=67) were laparoscopic ligation with termination of pregnancy, 10.20% (n=16) were sterilization done along with lower segment cesarean section and 1.9% (n=3) were mini-laparotomy (minilap) done in postpartum period. Only 63.05% (n=99) got repeat sterilization procedure done despite previous failure. Out of 157 cases, in 50.9% (n=80) recanalization was found, tuboperitoneal fistula was responsible in 5.7% (n=9) women, slipped fallope ring was found in 5.7% (n=9) women, wrong application of fallope ring was seen in 1.9% (n=3) and 35.6% (n=56) did not opted for religation.Conclusion: Failures of sterilization procedures do exist especially in laparoscopic ligation. Counseling prior to adoption of this method, risk of failure and other noninvasive options of contraception must be discussed.

SELECTIVE ESTROGEN RECEPTOR MODULATORS; ROLE OF SIDE CHAIN IN ACTIVITY MODULATION

Selective estrogen receptor modulators (SERMs) are a class of molecules that activate estrogen receptors (ER), impacting differently on differenttissues. Upon binding to ER, the ligand-receptor complex may present various conformations due to the presence of two different kinds of ERs. Fewof these ligands show estrogenic effects, whereas others will inhibit the action of estrogens. Researchers are working in the direction to generatethe SERMs that have a desirable estrogen-like effects on the various sites i.e., bones, improving lipid profile, reduce hot flushes, but do not act likeestrogens in unwanted ways i.e., causing breast cancer, uterine endometrial proliferation. Given the comprehensive nature of this article, it is not ourintention to revisit many of the issues relating to SERMs, which have already been covered in detail. Rather this article focuses on the aspect thatligand-mediated structural perturbations in and around the ligand binding pocket, contributed by the side chain effects lead to receptor antagonism.Adjusting the balance of these effects may provide a novel strategy for designing of improved SERMs. In the light of this, the article will provide anoverview of the SERMs and their structural diversity.Keywords: Ligand and estrogen receptor, Side chain of selective estrogen receptor modulators, Selective estrogen receptor modulators, Mechanismof action

Fresh frozen plasma utilization pattern in tertiary care hospital of North Western India

Background: Fresh Frozen Plasma (FFP) is mainly used in treatment of coagulation derangements; trauma emergencies. It is the most inappropriately used blood component. Since the guidelines for FFP use in a clinical setting are not well defined, this study aims at defining the appropriateness of use of FFP in the light of its risks and adverse effect. Audit of institute FFP usage with specific aim of assessing appropriate use, based on clinical indications and laboratory parameters in requisition form.Methods: Retrospective analysis of 10,753 FFP supplied in 3072 patients from June 2016 to December 2016 in SMS Hospital, Jaipur, Rajasthan, India was done in Department of Immunohaematology and Transfusion Medicine, SMS Hospital, Jaipur, Rajasthan, India. Detailed analysis of clinical indication, INR value, specialty, age, gender of patient was done.Results: 10,753 FFP was supplied to 3072 Patients. 6990 FFP was supplied to 1995 males. 3763 FFP was supplied to 1077 females. Clinical use of FFP for medical and surgical conditions was highest seen in Blood Cancers (13%) and Cardiosurgery (22.3%). 15.2% was available from Emergency Department. 1.9% of FFP was returned back. Patients with Deranged Coagulation Profile (DCP) require maximum transfusion (49.3), Bleeding patients (37.6%), DIC (3.3%). FFP used for plasmapheresis (2.6%). No information available about diagnosis (7.2%) was available from Emergency Department.Conclusions: FFP is most inappropriately used blood component (39.57%) and should be used judiciously. Regular audit of blood components serves as tool for accomplishment of quality tools and to understand clinical transfusion practices