Testosterone and DHEA Levels in Osteoporosis in Males Above The Age Of 60 Years

Background: A cross sectional study in which 100 male patients of 60 years and above were evaluated for Osteoporosis. Methods: Out of enrolled 100 men above 60 years suspected of Osteoporosis, 46 % is diagnosed as Osteoporosis, 32% as Osteopenia and 22% were observed to be normal based on BMD T-Score value. Results: The average level of Total Testosterone and DHEA in entire suspected osteoporosis patients were 2.74 ± 1.04 ng/ml and 1.45 ± 1.08 μg/ml respectively. The level across Osteoporotic cases (n=46), the average Total Testosterone and DHEA were 2.20 ± 0.77 ng/ml and 1.55 ± 0.91 μg/ml respectively. Abnormally low serum testosterone ( <2.0 ng/ml as per society of andrology) were found in 19 (41%) cases out of 46 osteoporotic men compared with normaltestosterone level men. Testosterone deficiency was seen in 39 (84%) cases of osteoporosis. This study has shown that the men with low testosterone levels had decreased BMD T-scores across entire cases (p<0.001). The men with decreased DHEA level also had decreased BMD T-scores BMI was inversely associated with testosterone and DHEA levels. It was found that decreased plasma testosterone had a 14 fold higher risk for decreased BMD compared with their peer with normal testosterone level. Age and BMD has shown significant association with testosterone levels (p<0.001).In this study, the incidence of osteoporosis increases with advancing age. Conclusion: There was significant decline in Testosterone and DHEA with advancing age and more over decrease in BMD value indicates the pathogenesis of osteoporosis in the patients. But still further study with large sample size is needed to clearly identify the role of testosterone in osteoporosis.

Evaluation of lipid peroxidation product, nitrite and antioxidant levels in newly diagnosed and two months follow-up patients with pulmonary tuberculosis.

This case-control study followed by a longitudinal cohort study was undertaken to evaluate the level of lipid peroxidation product malondialdehyde (MDA) and nitrite as an indirect measurement of nitric oxide vis-à-vis the levels of antioxidants vitamin C and vitamin E in pulmonary tuberculosis. Fifty-six sputum smear-positive cases of pulmonary tuberculosis based on Ziehl-Neelsen (ZN) staining and 50 healthy controls without any systemic disease were included in this study. Thirty-five cases were longitudinally followed up with standard antituberculosis chemotherapy (ATT) for two months. Serum levels of malondiadehyde (MDA), nitrite, and plasma levels of vitamins C and E were measured. The mean serum MDA level was significantly higher (8.1 +/- 1.61 nmoles/ml) in PTB patients before commencement of ATT as compared to healthy controls (3.45 +/- 1.7 nmoles/ml) (p=0.0001) and decreased significantly after 2 months of ATT (3.84 +/- 1.28 nmoles/ml) (p=0.0001). The mean serum nitrite level (47.19 +/- 18.44 micromol/l) was significantly elevated before ATT compared to healthy controls (32.89 +/- 11.94 micromoles/l) and decreased significantly after 2 months of ATT (27.71 +/- 11.97 micromoles/l) (p=0.0001). The mean plasma levels of vitamins C (0.88 +/- 0.33 mg/dl) and E (0.79 +/- 0.24 mg/dl) in PTB patients before commencement of ATT were lower than healthy controls (1.42 +/- 0.38 mg/dl) and (1.35 +/- 0.35 mg/dl), respectively (p=0.001). There was a significant increase in vitamin C levels after 2 months of ATT (1.19 +/- 0.40 mg/dl) compared to before ATT (0.83 +/- 0.31 mg/dl) (p=0.0001), but no significant change in mean plasma vitamin E level before and after 2 months on ATT was found. Elevated malondialdehyde and nitrite levels with concomitant depressed vitamin C and E levels are indicative of lipid peroxidation and oxidative stress. The decrease in levels of malondialdehyde and nitrite with subsequent increase in vitamin C levels after two months of follow-up indicate a good response to treatment with standard ATT. Hence, the extent of oxidative stress in PTB can be evaluated by analyzing lipid peroxidation product, antioxidant and nitric oxide levels.

Comparative study of cerebrospinal fluid adenosine deaminase activity in patients with meningitis.

Cerebrospinal fluid (CSF) adenosine deaminase (ADA) activity in tubercular meningitis (TBM) patients (n=20), non-tubercular meningitis (NTBM) patients (n=10) and non-tubercular non-meningitis (NTBNM) cases (n=15) were measured by the method based on Berthlot's reaction. The mean CSF ADA activity in TBM (13.62 +/- 8.45 IU/L) was found to be significantly higher as compared to NTBM (6.51 +/- 2.41 IU/ L, p<0.001) and NTBNM (2.35 +/- 1.16 IU/L, p<0.0001) respectively. The sensitivity and specificity of CSF ADA activity was 85.0% and 88.0% respectively at cut-off value of 6.97 IU/L to diagnose tubercular meningitis. The specificity and sensitivity of CSF ADA for TBM was found to be 85.0% and 70.0% as compared to NTBM and 85.0% and 100.0% as compared to NTBNM. We propose that estimation of that ADA activity in CSF of TBM patients, using a cut off value 6.97 IU/L can diagnose differentially tubercular meningitis. Since, most developing countries have the dubious distinction of having higher prevalence and incidence of tubeculosis and lack of well equipped laboratory services for proper diagnosis of tubercular meningitis, measurement of CSF ADA activity can be a better and reliable approach for the rapid diagnosis and management of tubercular meningitis vis a vis other types of meningitis.

Diagnostic utility of adenosine deaminase (ADA) activity in pleural fluid and serum of tuberculous and non-tuberculous respiratory disease patients.

Adenosine deaminase activity (ADA) was assayed in pleural fluid and serum of 42 subjects with pleural effusion. Twenty-nine of them had TB pleural effusion and the remaining 13 had pleural effusion due to non-TB respiratory diseases. Serum adenosine deaminase activity were also measured in 32 pulmonary tuberculosis patients without pleural effusion and equal numbers of healthy controls without systemic diseases for comparative analysis. The patients attending the medicine out-patient department (MOPD) of the B. P. Koirala Institute of Health Sciences, Dharan, Nepal were taken as study subjects. Serum and pleural fluid ADA activities were assayed spectrophotometrically by the method of Guisti and Gallanti. The mean serum ADA activity was significantly increased in patients with tubercular pleural effusion (34.53 +/- 10.27 IU/l) compared to pulmonary tuberculosis patients without pleural effusion (26.54 +/- 4.76 IU/l), (p = 0.004), those with non-TB respiratory disease (16.71 +/- 5.16 IU/l), (p = 0.0001) and healthy controls (15.53 +/- 4.4 IU/l) (p = 0.0001). The mean ADA in the pleural fluid of tubercular pleural effusion patients (90.29 +/- 54.80 IU/l) was significantly higher compared to those with non-TB respiratory disease (24.43 +/- 9.28 IU/l) (p = 0.0001). Using the lowest cutoff value for enzyme activity in the serum of patients with TB pleural effusion (25 IU/l), a test sensitivity of 72.41% and specificity of 81.53% were obtained. Using the lowest cutoff value for enzyme activity in pleural fluid of patients with TB pleural effusion (45 IU/l) the sensitivity and specificity for diagnosis were 76.10% and 100%, respectively. Therefore, the measurement of ADA in tubercular pleural effusion has a utility in the diagnosis of tuberculosis when other clinical and laboratory tests are negative.