Hypoadiponectinemia is associated with increased insulin resistance, dyslipidemia and presence of type 2 diabetes in non obese central Indian population

Background: Accumulating evidence suggests that adiponectin, a major adipocyte secretory protein, has insulin-sensitizing and anti-atherogenic properties and protects against later development of type 2 diabetes. We investigated the association of adiponectin with insulin resistance, blood lipids and type 2 diabetes in non obese central Indian population.Methods: Anthropometric and biochemical parameters were measured in 149 (81 male and 68 female) newly diagnosed non obese type 2 diabetic patients and 157 (85 male and 72 female) age and body mass index (BMI) matched controls.Results: Adiponectin level (p<0.0001) was significantly lower in the diabetic group than in non diabetic control. In an age, gender and BMI adjusted model, adiponectin level was significantly negatively correlated with waist circumference, waist to hip ratio, systolic blood pressure, fasting insulin, homeostasis model assessment-insulin resistance (HOMA-IR) (p= 0.0034), HbA1C, total cholesterol, LDL-cholesterol, and triglycerides (p<0.0001) and positively correlated with HDL-cholesterol (p =0.0014) in non obese type 2 diabetic group. However, there was no significant correlation between adiponectin and glucose in this study. In stepwise linear regression analysis, adjusted for potential confounder, significant inverse association was observed between serum adiponectin level and HOMA-IR (p = 0.0001). In multivariate logistic regression model, adjusted for age, gender, BMI, waist circumference, and waist-hip ratio, lower adiponectin was independently associated with the presence of type 2 diabetes (p<0.0001).Conclusions: Lower adiponectin levels in non obese type 2 diabetic patients were significantly related to the increased insulin resistance, dyslipidemia, and presence of type 2 diabetes, independently of overall and abdominal adiposity, thereby suggesting a direct link between adiponectin and carbohydrate and lipid metabolism in human.

Role of Resistin, Adiponectin, Glutamic Acid Decarboxylase (GAD) Auto-Antibodies, HbA1c, Lipoproteins, Periodontal Parameters In Periodontitis And Their Correlation With Diabetes Mellitus

Background: The link between periodontal disease and type 2 diabetes Mellitus (T2DM) has been suggested through a number of clinical and epidemiological studies. Several studies have shown that the prevalence, incidence and severity of periodontitis is increased in the presence of diabetes. Thus, diabetes is considered to be a risk factor for gingivitis and periodontitis. Methods: For this study newly diagnosed type 2 diabetic and periodontitis patients are selected. BMI of all patients is calculated by using the formula weight in Kg/m2. Brief clinical history, Blood pressure, dietary habit and information on physical activity are taken before entry of all patients. Results: Resistin, adiponectin, glutamic acid decarboxylase (GAD) auto-antibodies, HbA1c, lipoproteins, periodontal parameters and blood sugar have significant role in periodontitis with diabetes mellitus. Conclusion: Diabetes mellitus is a systemic disease with several major complications affecting both the quality and length of life. One of these complications is periodontal disease (periodontitis). Periodontitis is much more than a localized oral infection. Recent data indicate that periodontitis may cause changes in systemic physiology. The interrelationships between periodontitis and diabetes provide an example of systemic disease predisposing to oral infection, and once that infection is established, the oral infection exacerbates systemic disease.

Comparative Study of Serum Calcium and Magnesium in Pre-eclamptic Pregnancies in Third Trimester and its Comparison with Healthy Normotensive Nonpregnant and Pregnant Women and to Evaluate their role in Pregnancy-induced Hypertension.

Background: Despite numerous studies, the etiology of preeclampsia has not been fully elucidated. The study of serum calcium and serum magnesium is gaining ground in the pathophysiology of hypertension. Objective: A comparative study of serum calcium and serum magnesium in women with pre-eclamptic pregnancy and its comparison with healthy normotensive nonpregnant women and healthy normotensive pregnant women in third trimester. Materials and methods: Serum calcium and serum magnesium were measured in 52 women with pre-eclampsia in their trimester of pregnancy as patients group, and in 73 healthy normotensive nonpregnant women and 65 healthy normotensive pregnant women as control groups with similar maternal and gestational ages. Pre-eclamptic group was further divided into two subgroups mild (n = 36) and severe pre-eclampsia (n = 16). This is the case-control hospital based study carried in the Department of Biochemistry, MGM Medical College and associated MY Hospital, Indore, Madhya Pradesh. Results There were no significant differences among the three groups in age and body mass index (BMI) (p > 0.05) but significantly higher differences in gestational age, systolic and diastolic blood pressure was observed (p < 0.001). When comparison of serum calcium and serum magnesium between healthy normotensive nonpregnant women (9.87 ± 0.6 mg/dl, 2.60 ± 0.3 mg/dl) and healthy normotensive pregnant women was done, the levels were lower in the healthy normotensive pregnant women (9.34 ± 0.49 mg/dl, 2.36 ± 0.13 mg/dl) with statistically higher significant difference (p < 0.001). Lower mean values of serum calcium and serum magnesium were found in pre-eclamptic women (8.82 ± 0.93 mg/dl, 1.74 ± 0.24 mg/dl) than those of healthy normotensive nonpregnant women (9.87 ± 0.6 mg/dl, 2.60 ± 0.3 mg/dl) and healthy normotensive pregnant women (9.34 ± 0.49 mg/dl, 2.36 ± 0.13 mg/dl) in third trimester with statistically higher significant differences (p < 0.001). As compare to mild pre-eclamptic pregnant women (9.07 ± 0.8 mg/ dl, 1.77 ± 0.24 mg/dl), the levels of serum calcium and serum magnesium in severe pre-eclamptic pregnant women (8.25 ± 0.97 mg/dl 1.65 ± 0.24 mg/dl) was lower and the difference was significantly higher (p < 0.001). Conclusion: These findings support the hypothesis that hypocalcemia and hypomagnesemia are possible etiologies of pre-eclampsia and levels of calcium may be more important than magnesium.

The study of lipid profile, LP (a) and electrolytes with oxidative stress, total protein and albumin in nephrotic syndrome.

Nephrotic syndrome is characterized by heavy proteinuria, hypoalbuminemia, hyperlipidemia associated with peripheral edema. Recent observation revealed that serum albumin plays an important role in the host defense mechanism as it is one of the important antioxidants. Oxidative damage by free radicals has been implicated in kidney injury, especially in nephrotic syndrome (NS). Therefore, this study was carried out to investigate oxidant and lipoprotein (a) status with protein and electrolytes in nephrotic syndrome patients. The blood samples were analyzed for quantitation of malondialdehyde as index of lipid peroxide, total antioxidant capacity, lipid profile, lipoprotein (a), electrolytes, total protein and albumin. Significantly increased levels of serum lipid peroxide, lipoprotein (a) LDL, VLDL, Tcholand decreased levels of serum total antioxidant capacity and total protein and albumin were noticed in the patients with nephrotic syndrome as compared to control subjects. Electrolytes are variable Na was increased and potassium was decreased. However, significant positive correlation in lipid peroxide with lipoprotein (a),and total protein and albumin with total antioxidant capacity were observed.

Evaluation of serum lactate dehydrogenase and gamma glutamyl transferase in preeclamptic pregnancy and its comparison with normal pregnancy in third trimester.

Background: Preeclampsia affects about 5-8% of all pregnancies and is a major cause of maternal, fetal and neonatal mortality and morbidity. Evidences prove that endothelial cell and altered endothelial cell function play an important role in the pathogenesis of preeclampsia. Therefore serum lactate dehydrogenase (LDH) and serum gamma glutamyl transferase (GGT) are the useful biochemical markers reflecting the severity of the occurrence of preeclampsia. The objective was to determine serum lactate dehydrogenase (LDH) and serum gamma glutamyl transferase (GGT) as biochemical markers in preeclamptic pregnant women and its comparison with normal pregnant women in third trimester. Methods: This is the case-control hospital based study carried in the Department of Biochemistry M.G.M. Medical College and associated M.Y. Hospital. Indore (M.P.). Normal pregnant women (n=48), women with preeclampsia (n=53) were included in the study. Both the groups were in their third trimester and of same age and same gestational age. Preeclamptic group was further divided into two subgroups mild (n=36) and severe (n=17) preeclampsia. Results: There were no significant differences among the three groups in age and body mass index but significantly higher differences in gestational age, systolic and diastolic blood pressure was observed. Higher values of serum lactate dehydrogenase (LDH) were found in mild and severe preeclamptic women than those of normal pregnant women in third trimester but the values of serum LDH was significantly elevated in severe preeclamptic women when comparison was done between mild and severe preeclamptic women. Serum GGT was significantly higher among all the groups. Conclusion: Elevated levels of serum LDH and serum GGT indicates the tissue damage related to endothelial vascular damage and are the main cause of the occurrence of preeclampsia.

Assessment of nutritional status in hyperthyroidism patients.

Introduction: Hyperthyroidism often referred to as overactive thyroid, is a type of thyrotoxicosis, a hypermetabolic clinical syndrome which occurs when there are elevated serum levels of T3 and/or T4. There are very less studies on the nutritional deficiencies related to hyperthyroidism. Methods: Quantitative determination of Thyrotropin (TSH), triiodothyroinine (T3) and tetraiodothyronine (T4) was analyzed along with nutritional analysis of dietary nutrients like carbohydrate, proteins, fat, vitaminA, B1, B2, C, niacin, etc. Biostatistical analysis and correlations were analyzed by using Graph Pad prism software. Results: The mean intake of nutrients in Hyperthyroid and control groups are: Carbohydrate (147.9 ± 41.89 g, 218.3 ± 100.0 g), Thiamin (0.567 ± 2.850 mg, 1.051 ± 0.470 mg), Riboflavin (0.590 ± 0.341 mg, 1.121 ± 0.415 mg), Niacin (7.560 ± 2.346 mg , 11.59 ± 3.571 mg), pyridoxine (0.066 ± 0.262 mg , 0.317 ± 0.627 mg), Vitamin B1 (0.087 ± 0.205 μg, 0.199 ± 0.306 μg), Folacin (130.0 ± 36.57 μg , 143.4 ± 57.29 μg) and the mean values of all these nutrients were not optimum as recommended by ICMR. Conclusion: We should all be aware of the nutritional deficiencies encountered in hyperthyroidism and hence we can provide considerable support by eliminating adverse influences and normalizing the nutritional status by including multivitamins , antioxidants, etc. along with daily antithyroid drugs.

Estimation of RBC membrane and serum lipid composition in central Indian sickle cell disease population with and without pulmonary hypertension.

Aim: This study is designed to estimate and examine the relation between the levels of RBC membrane and serum lipids in central Indian sickle cell disease population with and without Pulmonary Hypertension .Methods: This study was carried out on central Indian sickle population at the Dept.of Biochemistry at MGM medical college & M.Y. hospital, Indore. From june 2011 to October 2012. Plasma Lipid concentrations were determined in 135 Sickle cell disease (SCD) patients, out of this 65 patients had sickle cell disease with Pulmonary Hypertension (SCD-PH) and 80 normal healthy matched individuals (controls). Study group comprises of both male and females in the age group of 18-56 years. Weight , height, waist hip ratio and blood pressure were recorded. All the blood samples were analyzed to determine the serum lipid concentration and RBC membrane lipid composition. Results: The body mass index and the systolic blood pressure of SCD with Pulmonary Hypertension (27.87 ± 4.68, 128.60 ± 22.49 mmHg) and without pulmonary hypertension (25.87 ± 4.68, 125.23 ± 15.89 mmHg ) were higher when compared with controls (24.67 ± 5.18, 119.15 ± 13.03 mmHg). The SCD with PH population (1.21 ± 0.07) and SCD without PH (1.09 ± 0.04) subjects showed significantly higher levels of RBC membrane cholesterol compared with controls (0.84 ±0.01). The trends of decreased serum cholesterol and normal high-density lipoprotein(HDL) levels in SCD patients were noted as compared with controls and these levels are statistically significant. The low-density lipoprotein cholesterol (LDL) was also significantly lower in SCD-PH and SCD when compared with control subjects. Interestingly serum Triglyceride levels are highly elevated in SCD-PH (208.43±.56.97) when compared with SCD (132.34±8.97) and controls (141.43±26.98). Elevated TGL concentrations are positively correlated with haemolytic markers (Lactate dehydrogenase and Total Bilirubin, (r=0.326 and r=0.468,P<0.001)). On a prospective screening of SCD population we found that around one third total population are with elevated tricuspid regurgetant jet velocity (TRJV) of 2.5m/s or higher. Conclusion: Our study data suggests that there is a relationship between RBC membrane and serum lipids in SCD population. Significant increase in RBC membrane cholesterol and decreased phospholipids in sickle cell disease play an important role in the fluidity and structural stability of the membrane and possibly in the Hemolysis and sickle shape of RBC. In pulmonary hypertension except the elevated levels of TGL remaining serum lipids are equal to the normal SCD population. This indicates the relation between TGL and vascular dysfunction in SCD.

Assessment of nutritional status in hyperthyroidism patients.

Background: Hyperthyroidism often referred to as overactive thyroid, is a type of thyrotoxicosis, a hypermetabolic clinical syndrome which occurs when there are elevated serum levels of T3 and/or T4. There are very less studies on the nutritional deficiencies related to hyperthyroidism. Methods: Quantitative determination of Thyrotropin (TSH), triiodothyroinine (T3) and tetraiodothyronine (T4) was analyzed along with nutritional analysis of dietary nutrients like carbohydrate, proteins, fat, vitaminA, B1, B2, C, niacin, etc. Biostatistical analysis and correlations were analyzed by using Graph Pad prism software. Results: The mean intake of nutrients in Hyperthyroid and control groups are: Carbohydrate (147.9 ± 41.89 g, 218.3 ± 100.0 g), Thiamin (0.567 ± 2.850 mg, 1.051 ± 0.470 mg), Riboflavin (0.590 ± 0.341 mg, 1.121 ± 0.415 mg), Niacin (7.560 ± 2.346 mg , 11.59 ± 3.571 mg), pyridoxine (0.066 ± 0.262 mg , 0.317 ± 0.627 mg), Vitamin B1 (0.087 ± 0.205 μg, 0.199 ± 0.306 μg), Folacin (130.0 ± 36.57 μg , 143.4 ± 57.29 μg) and the mean values of all these nutrients were not optimum as recommended by ICMR. Conclusion: We should all be aware of the nutritional deficiencies encountered in hyperthyroidism and hence we can provide considerable support by eliminating adverse influences and normalizing the nutritional status by including multivitamins , antioxidants, etc. along with daily antithyroid drugs.

Attenuation of Serum Ferritin and Iron Burden by Intake of Antioxidants in Beta Thalassemia Major.

It has been anticipated that iron and ferritin burden in patients with beta thalassemia major is associated with enhanced free radical formation and blemished antioxidant defense system. The goal of study was to scrutinize impact of serum iron, total iron binding capacity (TIBC), ferritin and erythrocyte catalase in patients with beta thalassemia major. 140 beta thalassemia major patients were studied before and after supplementation of antioxidants for one month, and status was compared with 140 age and sex matched healthy controls. A significant elevation was found in the levels of serum iron and ferritin (P<0.001) with concomitant decrease in erythrocyte catalase (P<0.001) in patients when compared with controls. After one month supplementation of antioxidants, catalase was elevated significantly (P<0.001) and marginal rise in serum TIBC concentration increased marginally while iron and ferritin were decreased marginally (P>0.05) when compared with controls and baselines values. Beta thalassemia major children receive multiple blood transfusions, and are at risk of secondary iron overload induced oxidative stress. These effects may be help to minimize with supplementation of antioxidants.

Oxidative stress with homocysteine, lipoprotein (A) and lipid profile in diabetic nephropathy.

Diabetic nephropathy is the single most common disorder leading to renal diseases. Reactive oxygen species (ROS) play a major role in the development of diabetic nephropathy. Nephrotic syndrome is often manifesting in progression of diabetic nephropathy. Therefore, this study was carried out to investigate oxidant and antioxidant status in diabetic nephropathy patients. The blood samples were analyzed for quantitation of malondialdehyde as index of lipid peroxide, vitamin C, total antioxidant capacity, homocysteine, lipoprotein (a) and lipid profile. Significantly increased levels of serum total cholesterol, triglycerides, low density lipoprotein, malondialdehyde as index of lipid peroxide, lipoprotein (a), homocysteine (p<0.001) and decreased levels of serum total antioxidant capacity, total protein, albumin, high density lipoprotein & plasma vitamin C (p<0.001) were noticed in the patients with diabetic nephropathy as compared to control subjects.

Comparative study of NBT reduction method for estimation of glycated protein (serum fructoseamine) with glycated hba1c estimated on DCA 2000+analyzer (immunoagglutination inhibition).

Glycated protein estimation is a diagnostic tool, used for the long term and short term monitoring of the glycemic status of diabetic patients. The present study is designed to compare and correlate modified NBT reduction method for the estimation of Glycated protein (serum fructosamine) with HbA1c estimated on DCA+2000 Analyzer. Glycated protein (serum fructosamine) reduces Nitro Blue Tetrazolium (NBT) reagent in alkaline medium to tetrazinolyl radical NBT+ which forms a highly colored monoformazen compound, absorbance of which is directly proportional to the concentration of glycated protein (serum fructosamine) present in the sample and is recorded as ΔA/min. The results of modified NBT were then compared with HbA1c estimated by immunoagglutination inhibition method. Correlation coefficient between HbA1c with serum fructosamine was found to be r = 0.739 using Schimadzu CL-750 spectrophotometer and r = 0.731 using colorimeter. Results of this study were found to be statistically significant P<0.001. Hence this method could be used for routine monitoring of blood glucose control in diabetics as HbA1c estimation.

Oxidized LDL and paraoxanase status in ischemic stroke patients.

Stroke is the leading cause of mortality and long term disability among adults in industrialized countries. Oxidative stress is an independent risk actor by inducing production of oxygen free radicals in ischemic stroke. Because a relationship may be associated between ox-ldl and paraoxanase, the aim of this study was to investigate the association between ox-ldl and paraoxanase in ischemic stroke patients by determining whether ox-ldl is a useful marker for monitoring oxidative stress in ischemic stroke patients. Our study included 100 patients of ischemic stroke and 100 controls. Compared with controls ox-ldl was significantly raised in stroke patients and Paraoxanase activity was low. Our findings suggest that there is a significant association between raised plasma ox-ldl and decrease activity of Paraoxanase with age indicating that plasma ox-ldl may reflect oxidative stress in ischemic stroke patients.