Russell’s Viper Envenomation-associated Acute Kidney Injury in Children in Southern India.

Objectives: To determine the frequency and risk factors of acute kidney injury in children with Russell’s viper envenomation using Acute Kidney Injury Network definition and classification system. Methods: A prospective observational study recruiting 61 subjects managed as per the National Snakebite Protocol. Results: 45.9% of envenomed children had acute kidney injury. The median (IQR) of the maximum serum creatinine level during hospitalization was 2 (1.3-4.8) mg/dL. The distribution of stages 1, 2 and 3 of acute kidney injury was 32.1%, 17.9% and 50% respectively. Dialysis was required in 35.7% of the children with acute kidney injury. Conclusions: Acute kidney injury is common with Russell’s viper envenomation. Native treatments and bleeding manifestations were associated with acute kidney injury in our patient population.

Identification of mistakes and their correction by a small group discussion as a revision exercise at the end of a teaching module in biochemistry.

Background. Graduate medical students often get less opportunity for clarifying their doubts and to reinforce their concepts after lecture classes. The Medical Council of India (MCI) encourages group discussions among students. We evaluated the effect of identifying mistakes in a given set of wrong statements and their correction by a small group discussion by graduate medical students as a revision exercise. Methods. At the end of a module, a pre-test consisting of multiple-choice questions (MCQs) was conducted. Later, a set of incorrect statements related to the topic was given to the students and they were asked to identify the mistakes and correct them in a small group discussion. The effects on low, medium and high achievers were evaluated by a post-test and delayed post-tests with the same set of MCQs. Results. The mean post-test marks were significantly higher among all the three groups compared to the pre-test marks. The gain from the small group discussion was equal among low, medium and high achievers. The gain from the exercise was retained among low, medium and high achievers after 15 days. Conclusion. Identification of mistakes in statements and their correction by a small group discussion is an effective, but unconventional revision exercise in biochemistry.

Increased protein carbonylation and decreased antioxidant status in anemic H. pylori infected patients: effect of treatment

Collective evidences suggest the causal association of Helicobacter pylori infection with iron deficiency anemia. Generation of free radicals against this bacterium can lead to turbulence in oxidative-antioxidative system. This study was undertaken to evaluate the marker of oxidative protein injury, protein carbonylation, and total antioxidant status in anemic H. pylori-infected patients and to observe the alteration in them after treatment for 1 month with oral ferrous sulfate and anti-H. pylori therapy. Twenty anemic H. pylori-infected patients were randomly divided into 2 groups. The H. pylori-infected patients in Group I received both iron supplementation and anti-H pylori therapy, whereas patients in Group II received only the iron supplementation. Fifteen healthy volunteers served as controls. All the study parameters were estimated after 1 month of the treatment. Protein carbonylation and total antioxidant status were estimated using colorimetric method. Hematologic parameters were evaluated using Sysmex-K-100 automated cell counter. In anemic H. pylori-infected patients, the protein carbonyls [PCOs] were significantly increased, whereas the total antioxidant status, iron, hemoglobin, and ferritin levels were significantly decreased compared with the controls. In Group I, while the PCOs level decreased significantly, there was a significant increase in the total antioxidant status, iron, hemoglobin, and ferritin levels after 1 month. No significant alterations were noted in the levels of PCOs, total antioxidant status, iron, hemoglobin, or ferritin in Group II patients after 1 month of the treatment. The findings from this study indicate that treatment for both anemia and H. pylori infections is required for lowering the oxidative stress markers, which synergistically bring about an appropriate correction of anemia soon in these patients

Inflammation and oxidative stress in hypothyroids: Additive effects on cardiovascular risk.

Cardiovascular disease is one of the major complications of hypothyroidism which is one of the most common endocrine disorders in India. In the present study, we have analyzed the link among oxidative stress, C reactive protein which is an inflammatory marker and the cardiovascular lipid risk factors in hypothyroid patients which has not been analyzed before. Sixty seven untreated hypothyroid patients were recruited consecutively for the study. Their ultrasensitive C reactive protein level and oxidative stress profile were measured apart from various lipid risk factors of cardiovascular disease. Ultra sensitive C reactive protein was significantly correlated with increased lipid risk factors of cardiovascular disease, thyroid stimulating hormone level and indices of oxidative stress in these patients. Low grade inflammation in hypothyroidism plausibly acts as the link between higher oxidative stress and the underlying cardiovascular risk among hypothyroid patients.

Sympathovagal imbalance in thyroid dysfunctions in females: Correlation with thyroid profile, heart rate and blood pressure.

The aim of the study was to investigate the role of spectral analysis of heart rate variability (HRV) for assessing the type and degree of sympathovagal imbalance (SVI) and their link to cardiovascular morbidities in thyroid dysfunctions. Forty-five female subjects (15 control subjects and freshly diagnosed untreated 15 hypothyroid and 15 hyperthyroid patients) were recruited for the study. Thyroid profile, body mass index (BMI), basal heart rate (BHR), blood pressure (BP) and spectral indices of HRV (TP, LFnu, HFnu and LF-HF ratio, mean RR, SDNN and RMSSD) were assessed in all the three groups. LF-HF ratio was correlated with thyroid profile, BMI, BHR and BP. SVI was more prominent in hyperthyroid (P<0.001) compared to hypothyroid (P<0.05) subjects. LF-HF ratio was correlated with thyroid profile in both hypo and hyperthyroid subjects; but correlation with BHR and BP was significant only in hyperthyroidism. Though the SVI was found to be due to both vagal withdrawal and sympathetic activation, especially in hyperthyroidism, contribution by vagal inhibition was prominent. Vagal inhibition contributes significantly to SVI in thyroid dysfunctions, especially in hyperthyroidism. As the present study indicates poor cardiovascular health due to vagal inhibition in patients suffering from thyroid dysfunctions, attempt should be made to improve vagal tone especially in hyperthyroid subjects to attain a stable sympathovagal and cardiovascular homeostasis.

rotein glycation, insulin sensitivity and pancreatic beta cell function in high-risk, non-diabetic, first degree relatives of patients with type 2 diabetes.

Insulin resistance and impaired beta cell function are widely recognized as features of type 2 diabetes. But it is still debated whether insulin resistance or beta cell dysfunction constitutes the primary abnormality. This study was done to evaluate the impact of family history of type 2 diabetes on insulin resistance, beta cell function and glycation of proteins. A total of 30 healthy subjects with a positive family history of type 2 diabetes and thirty two healthy age-matched subjects without any family history of type 2 diabetes were enrolled in this study. Fasting glucose, post prandial glucose, fasting plasma insulin, fructosamine and glycated hemoglobin were evaluated in both the study groups. The mean fasting glucose, fasting Insulin and HOMA-IR were significantly higher among the first-degree relatives of type 2 diabetics, but there was no alteration in HOMA-B. The levels of both glycated hemoglobin and fructosamine were significantly increased in the test group when compared with controls. In conclusion the results from the present study suggest that Indian subjects with family history of type 2 diabetes are associated with insulin resistance and enhanced glycation of proteins, but with no evidence of beta cell defect.

Altered oxidant-antioxidant status in non-obese men with moderate essential hypertension.

BACKGROUND: Although a wide number of experimental evidences are available regarding oxidant-antioxidant disturbance in hypertension, clinical data supporting it is lacking in men in early stages of hypertension. AIMS: The objective of the study was to evaluate oxidative status and antioxidant activities in males with stage I essential hypertension. MATERIALS AND METHODS: Thirty hypertensives and 21 normotensives were included in the study. Protein carbonyl, reduced glutathione, glutathione peroxidase, catalase and fasting glucose were assessed in both the groups. STATISTICAL ANALYSIS: Results were analyzed by student's 't' test and linear regression analysis test. RESULTS: Plasma protein carbonyl and glutathione peroxidase were significantly increased and catalase and GSH were significantly reduced in the hypertensive group compared to normotensive subjects. There was a significant negative correlation between glutathione peroxidase and catalase in the test group. CONCLUSIONS: The data from the present study indicates an alteration in oxidant-antioxidant status in non-obese men in early stages of essential hypertension.

Antioxidant response to oxidative stress induced by smoking.

Oxygen free radicals have been hypothesized to play a pivotal role in the deleterious effects of smoking on health. The present study was undertaken to examine the oxidant and antioxidant system among smokers and nonsmokers. Fourteen smokers and 11 nonsmokers were enrolled for this study. The protein carbonyl levels in smokers were found to be significantly higher than in nonsmokers. The levels of plasma ascorbic acid, free sulfhydryl group, and erythrocyte reduced glutathione were lower in smokers compared to nonsmokers. In smokers the erythrocyte activities of both glutathione peroxidase and catalase were decreased when compared to that in nonsmokers. The data from the study reemphasizes the presence of oxidative stress in smokers. The concomitant decrease in the activities of both catalase and glutathione peroxidase found in the erythrocytes of smokers raises rational grounds for expressing concern over the increased susceptibility towards oxidative stress in these subjects.

Nonenzymatic glycation of plasma proteins in smokers.

Glycation is known to play a key role in complications of many pathophysiological processes. The present study was carried out to assess whether there are abnormalities of nonenzymatic glycation of proteins in smokers. Fourteen current smokers and 10 healthy nonsmokers were enrolled for the present study. Fasting plasma glucose, insulin, fructosamine and total plasma glycated proteins were evaluated. A significant rise in the mean levels of fructosamine and total plasma glycated proteins were found in smokers when compared with controls. Significant difference in insulin values was observed between these two groups. When Pearson's correlation analysis was performed, no significant correlation was found between fasting plasma glucose with either fructosamine or total plasma glycated protein levels. These data suggest an increased glycation of proteins in smokers independent of glucose concentration.

An evaluation of thyroid hormone status and oxidative stress in undialyzed chronic renal failure patients.

Chronic renal failure (CRF) patients on prolonged dialysis have been found to have significant alteration in their thyroid status, but little is known about the same in undialyzed CRF patients. Oxidative stress has been implicated as the key player in altering the levels of thyroid hormone in euthyroid sick syndrome. This study was performed to evaluate the levels of oxidative stress and thyroid status in undialyzed CRF patients. A case control study was performed on 20 undialyzed CRF patients and 20 control subjects. There was a significant decrease in the levels of T3, T4, total protein and albumin levels in CRF patients when compared to control. There was a significant increase in the level of malondialdehyde and total antioxidant status in CRF patients when compared with control subjects. The present study confirms oxidative stress along with altered thyroid status in CRF patients.

Effect of smoking on lipid profile and lipid peroxidation in normal subjects.

The aim of the present study was to assess the association between smoking and the alteration in plasma concentration of lipid profile and lipid peroxides. Fourteen smokers and 11 age matched control were enrolled. Plasma levels of fasting cholesterol, triglycerides, lipoprotein cholesterol and malondialdehyde were estimated. In smokers the levels of total cholesterol, LDL cholesterol, Non-HDL cholesterol and MDA were significantly elevated when compared with the controls. The atherogenic index as indicated by various risk ratios were also found to be increased in smokers as compared to controls. These findings indicate that current smokers are at a pro- atherogenic state and as in other countries, in India smokers require particular attention in terms of public health interventions.

Effect of anti-Helicobacter pylori therapy on outcome of iron-deficiency anemia: a randomized, controlled study.

BACKGROUND: Helicobacter pylori infection may play a role in iron-deficiency anemia. METHODS: In 52 patients with iron-deficiency anemia, H. pylori status was determined using rapid urease test and histology. H. pylori -positive patients were randomly assigned to receive anti- H. pylori treatment either immediately (Group I) or after a delay of one month (Group II); in addition, all patients received oral ferrous sulfate for three months. Patients testing negative for H. pylori (Group III) received only oral ferrous sulfate. Hematological parameters were tested every month. RESULTS: Of 52 patients, 32 (61.5%) had H. pylori infection. At the end of one month, median increase in hemoglobin level was lower in Group II than in Groups I and III (1.1 g/dL vs. 3.6 g/dL and 1.9 g/dL, respectively; p=0.025), as were that in serum iron (19 mcg/dL vs. 55.5 mcg/dL and 41 mcg/dL; p=0.019). During the second month, after H. pylori infection in Group II had been treated, median increase in hemoglobin in this group was comparable to those in Groups I and III (3.7 g/dL vs. 2.5 g/dL and 2.5 g/dL. CONCLUSION: In patients with iron-deficiency anemia, presence of H. pylori infection is associated with a poorer response to oral iron therapy, which improves with treatment for H. pylori infection.

Oxidative stress and protein glycation in patients with chronic obstructive pulmonary disease.

Several studies have indicated the presence of increased oxidative stress as a critical feature in the pathogenesis of chronic obstructive pulmonary disease (COPD). Another biochemical complication leading to pathogenesis is protein glycation. The nexus between oxidative stress and protein glycation in various pathological conditions is being unraveled. Increased oxidative stress can lead to enhanced protein glycation by a process of auto-oxidative glycation. No information is available in the literature regarding protein glycation among COPD patients. Eleven non-diabetic COPD patients were included in the study and equal number of age and sex-matched healthy individuals were enrolled as controls. The whole-blood reduced glutathione was found to be less among the patients while lipid peroxides and fructosamine were elevated in comparison to control. The present study confirmed oxidative stress and enhanced protein glycation among the COPD patients. Antioxidant therapy may be considered as part of the treatment regimen for COPD patients.

Small group discussion followed by presentation as a revision exercise at the end of a teaching module in biochemistry.

BACKGROUND: We evaluated the effect of student-dominated small group discussion followed by faculty-moderated presentation as a revision exercise after completion of a teaching module in biochemistry. We assessed the understanding of graduate medical students on the topic and the gain in retention of information, if any, after 15 days. METHODS: Small group discussions involving 11-12 students in each group were conducted on 12 application-oriented problems in 'amino acid metabolism'. A group leader among the students helped to conduct the discussions. While two-thirds of the problems were taken up after the discussion during faculty- or student-moderated interactive presentations, the remaining were not. The effects on low-, medium- and high achievers were evaluated by a pre-test and post-test with multiple choice questions immediately after the session. A subjective feedback was also obtained. To test short-term memory, a post-test with the same multiple choice questions was conducted after 15 days. RESULTS: The exercise was effective and equally beneficial for low-, medium- and high achievers. The gain was maximum when faculty moderated the presentation session. The students' retention of their gain after 15 days was complete. All the students wanted more such sessions in future. CONCLUSION: Student-dominated small group discussion followed by a faculty-moderated presentation is an effective, revision exercise for undergraduate medical students.