Subclinical-hypothyroidism: a pathology in evolution

Subclinical-hypothyroidism is identified as suboptimal thyroid hormonal production associated with mild TSH [thyroid stimulating hormone] elevation. Though several non-thyroidal illness in the later stages, medications and dietary supplements may resemble SCH [subclinical-hypothyroidism], but mild persistent subnormal thyroidal pathologies are usually termed as SCH. This review briefly describes the various cardiovascular risk associations with subclinicalhypothyroidism and attempts to provide an insight into the risk and benefit association, which a patient faces once treated for SCH

Association of metabolic risks with subclinical hypothyroidism: a cross-sectional analysis

Objective: To compare lipid parameters, HbA1c, uric acid and albumin creatinine ratio [UACR] among subjects having euthyroidism, Sub-Clinical Hypothyroidism [SCH] and overt hypothyroidism

Methods: This comparative cross-sectional analysis was carried out from Dec-2015 to Oct-2016 in collaboration between PNS HAFEEZ hospital and department of chemical pathology and endocrinology, Armed Forces Institute of Pathology, Rawalpindi. Biochemical parameters including lipid indices, HbA1c and UACR were compared between euthyroidism [TSH: 0.5 to 4.0 mIU/L, n=163], subclinical hypothyroidism [TSH: 4.0 to 10 mIU/L, n=16] and overt hypothyroidism [TSH:>/= 10.0 mIU/L, n=9]

Results: LDL-cholesterol, non-HDL-cholesterol and UACR results were as: [[Euthyroid: 2.66 +/- 0.73], [SCH: 2.68 +/- 0.51] and [Overt hypothyroidism: 3.23 +/- 0.59], p-value=0.063], [[Euthyroid: 3.49 +/- 0.64], [SCH: 3.35 +/- 0.59] and [Overt hypothyroidism: 4.01 +/- 0.30], p-value=0.033] and [[Euthyroid: 2.48 [95% CI: 1.63-3.33]], [SCH: 2.27 [95% CI: 0.37-4.90]] and [Overt hypothyroidism: 14.95 [95% CI: 10.71-19.14]], [p-value< 0.001]]. Results for total cholesterol, triglycerides and HDL-cholesterol though increased in overt hypothyroid group were not found to be statistically significant

Conclusion: LDL-cholesterol, non-HDL-cholesterol and UACR increased from euthyroid subjects to overt hypothyroidism group. However, these changes were found to be more subtle in the subclinical hypothyroid subjects than cases with overt hypothyroidism

Biochemical changes in subjects with fatty liver: Is there a link?

Objective:To evaluate the biochemical markers including serum triglycerides, ALT, and fasting plasma glucose in detection of fatty liver disease

Methodology:This cross-sectional analysis was carried out at the department of radiology and pathology, PNS Rahat hospital,Karachi between March-2010 to February-2011.Sixty-two subjects with an ultrasonographic diagnosis of fatty liver were compared with thirty-seven subjects with normal ultrasound for fatty liver, after excluding all other abnormalities on history and examination. The comparison included measurement of biochemical abnormalities including fasting blood glucose, triglycerides, total cholesterol and alanine transaminase [ALT]

Results:The results of fasting blood glucose[[Fatty liver group=7.06 +/- 3.51mmol/L][Without fatty liver disease=5.12 +/- 0.56 mmol/L] [p = 0.002]], serum triglycerides [[Fatty liver group=2.56 +/- 1.33 mmol/L ] [Without fatty liver disease=1.68 +/- 0.97 mmol/L ] [p = 0.001]] and ALT[[Fatty liver group=36.37 +/- 18.12 IU/L] [Without fatty liver disease=28.15 +/- 13.95 IU/L] [p = 0.026]] were significantly higher in subjects with fatty liver disease. The Receiver Operating Curve [ROC] analysis showed fasting blood glucose and serum triglycerides to have the most area under the curve [AUC] as 0.747 [95% CI: 0.647-0.847] and 0.731[95% CI: 0.622-0.840]; while the other parameters have AUCs as: Serum ALT-0.650 [95% CI: 0.532-0.767] and total cholesterol-0.509 [95% CI: 0.389-0.629]

Conclusion: Hyperglycemia and hypertriglyceridemia are associated with an ultrasonographic diagnosis of fatty liver. Raised transaminase levels in subjects with fatty liver disease also suggest underlying hepatocyte damage

Changes in P-wave amplitude and axis after treatment of chronic obstructive pulmonary disease exacerbation

To compare the change in P-wave amplitude and axis before and after 24 hours of the treatment of chronic obstructive pulmonary disease exacerbation.Quasi-experimental study. Department of medicine, PNS Shifa Karachi from Dec-2010 to June-2011 [six months]. A total of 93 subjects were included in the study. Their pre-treatment and post treatment ECGs were evaluated by measuring P-wave amplitudes in leads II and aVF and P-wave axes were calculated. The differences in terms of changes in P-wave amplitude and axis were compared. Mean age of patients was 53.09 +/- 7.20 years. Before treatment P-wave amplitude in lead II was 2.36 +/- 0.34 mm and after treatment it was 1.73 +/- 0.29 mm [p < 0.001]. P-wave amplitude in lead aVF before treatment was 2.446 +/- 0.334 mm while after treatment it was 1.556 +/- 0.329 mm [p < 0.001]. P-wave axis before treatment was 72.67[degree] +/- 4.67[degree] and after 24 hours of treatment it was 63.75[degree] +/- 3.95[degree] [p < 0.001]. Sigruficant changes in terms of reduction of P-wave amplitude and left ward rotation of P-wave axis occur after effective treatment of acute exacerbation of COPD. These findings provide valuable objective evidence in evaluating patient's response to treatment and recommended to be used in clinical practice

Complexation of beta-sitosterol with tris [dibenzylideneacetone] dipalladium and its anti-microbial activity

Beta-sitosterol is a naturally occurring plant sterol [phytosterol] present in many fruits and vegetables. Scientific research has proven that beta-sitosterol is helpful in maintaining the proper functioning of our body. Previously we described the complexation of beta-sitosterol with trace metals [Mahmood et al., 2013]. Trace metals after the formation of complex unable to absorb in the body and hence eliminated out from the body thus reducing metal toxicity [Marsha, 1996]. The present article describes the complexation of beta-sitosterol with Palladium [Pd] metal. Palladium is a toxic metal and due to polluted and hazardous environment traces of this metal can be transferred into the body, which is harmful for human health. Our aim is to make Pd-sterol complex so that this toxic metal [Pd] does not absorb in the body and hence excreted out from the body in the complex form. In order to form this complex beta-sitosterol [Ib] is reacted with Tris [dibenzylideneacetone] dipalladium or [Pd[2] [DBA][3]] [Ia] in 2:1 ratio in an inert atmosphere and dimethylformamid [DMF] added as a solvent. The resulting complex [Pd[2] [DBA][3].[beta-sitosterol] [Ic] was identified by various spectroscopic techniques such as IR, Mass and [1]H-NMR. This new organo metallic complex [Ic] also showed significant antibacterial and antifungal activity. The present work revealed that Pd-sterol complex does not only reduce metal toxicity but also helpful in minimizing bacterial and fungal infections present in the body. Our research also concluded that we must take plenty of fruits and vegetables in our diet so that natural plant sterol such as beta-sitosterol can enhance our defense mechanism and maintain other functions of our body

Chemical and antimicrobial studies on the essential oil from Salvia santolinifolia Boiss

In view of the reputation of genus Salvia in folklore medicine and its abundance in our region, the chemical composition and antimicrobial activity of essential oil from S. santolinifolia Boiss was analyzed. Chemical analysis, using gas chromatography and gas chromatography mass spectrometry, retention indices and C-13 nuclear magnetic resonance spectroscopy has resulted in identification of 116 constituents, comprising about 97% of the total constituents. Out of these 116, 78 constituents are hitherto unreported from this source. The species belongs to alpha-pinene chemotype. In antibacterial assay, gram negative gastropathogens [Shigella boydii, S. flexneri, S. dysenteriae. Vibrio cholera]; causative agent of urinary tract infection [Proteus mirabilis and P. vulgaris] and pneumonia [Klebsiella pneumoniae] were found sensitive to this essential oil while Corynebacteria species and Staphylococcus epidermidis were significantly inhibited in antibacterial assay against gram positive bacteria. Clinical and Laboratory Standards Institute protocol was used for determining antimicrobial activity. Thus the essential oil from this species can be utilized as potential chemotherapeutic agent