Study of cytomorphological features of thyroid lesions and its correlation with thyroid function tests.

Background: Fine needle aspiration cytology along with ultrasound and assessment of thyroid function status remains the mainstay of evaluation of thyroid swellings. According to the guidelines put forth by American Thyroid Association, serum estimation of TSH should be part of initial assessment of thyroid swellings. Present study aims to assess the cytomorphological features of various thyroid lesions, classify them in different categories based on The Bethesda System of Reporting Thyroid Cytology and correlate them with thyroid hormone status of patients. Methods: 165 cases of thyroid lesions were subjected to FNAC, smears were categorised according to The Bethesda System of Reporting Thyroid Cytopathology and cases were also assessed for T3, T4, TSH hormone levels. Results: On interpretation of FNAC non-neoplastic lesions outnumbered the neoplastic lesions and Colloid goitre accounted for the majority of the cases (40.6%). Among the neoplastic lesions, follicular neoplasms were most common. Cytologically majority of the lesions belonged to category II (benign) as per the Bethesda System. On evaluation of thyroid function majority of the cases (69.1%) were euthyroid and were interpreted as either colloid goitre or adenomatoid nodule, whereas most patients of lymphocytic thyroiditis presented with either hypo or hyperthyroidism. Majority of malignant cases also turned out to be hypothyroid (9/12 Cases). None of the malignant case presented with hyperthyroidism. Conclusions: Thyroid cytology proves to be a reliable, simple and cost-effective first line diagnostic procedure. FNAC together with thyroid function test can be used for early and accurate diagnosis of various thyroid lesions, and reduces unnecessary intervention.

Cord Blood Iron Status In Maternal Iron Deficiency Anaemia.

Background: Iron deficiency (ID) and iron-deficiency anaemia (IDA) during pregnancy continue to be of worldwide concern.The purpose of this study was to determine the effect of maternal iron status on neonatal iron status and anthropometric characteristics.Methodology: A total of 86 pregnant women aged between 19 and 31 years delivering singleton live births at term gestation (37-41weeks) were included in the study. The pregnant women were divided into three groups according to their pre-delivery haemoglobin (<11gm/dl) and serum ferritin concentration (<12ng/dl) levels. Analysis of maternal and cord blood for estimation of haemoglobin level and serum ferritin was performed. Weight, length and head circumference of neonates was also recorded. Results: Amongst the pregnant women, 32.6% were anaemic and 17.4% were iron deficient. Neonatal haemoglobin and neonatal serum ferritin was significantly different (p<0.001) across 3 groups suggesting that maternal anaemia affected the iron status including iron stores of the newborn. Neonatal haemoglobin and neonatal serum ferritin had a significant positive correlation with maternal iron status. However no significant correlation was found between maternal iron status and neonatal anthropometric parameters except in case of neonatal birth weight which had a significant positive correlation with maternal haemoglobin levels. Conclusion: This study showed that maternal iron deficiency anaemia has an adverse effect on iron status of their newborns. Thus effective strategies are urgently needed to control maternal anaemia in the developing world.

Bone turnover markers in women can predict low bone mineral density.

Background: Morbidity and mortality associated with osteoporosis continues to be high in India due to late diagnosis. This study aims to find the difference in the levels of bone turn over markers in premenopausal and postmenopausal women, in order to assess whether these markers can be used as predictors of low bone mineral density which can develop in later life. Methods: Study was conducted on 350 women aged 30-65 years. Women were classified into premenopausal and postmenopausal groups based on their menstrual history. Serum samples were analyzed for osteocalcin and telopeptide-C. Student’s t-test and logistic regression are used for statistical confirmations. Results: Levels of these markers (ng/ml) were found to be lower in premenopausal women (Osteocalcin = 9.0 ± 1.0; telopeptide-C = 0.270 ± 0.099) than in postmenopausal women (Osteocalcin = 9.8 ± 1.7; telopeptide-C = 0.490 ± 0.135) and this difference was found to be significant (P <0.001) for both the markers. In both the groups, telopeptide-C made significant contribution to prediction of low BMD [(Premenopausal group - odds ratio (OR) = 2.9; 95% confidence interval (95%CI) = 1.3-6.5 and postmenopausal group - OR = 9.6; 95%CI = 6.0-13.23) but osteocalcin could not (premenopausal group - OR = 0.91; 95%CI = 0.58-1.42 and postmenopausal group - OR = 0.87; 95%CI = 0.54-1.4)]. In premenopausal women increase in telopeptide-C by a unit increased chance of developing low BMD by 2.9 times while in postmenopausal women increase in telopeptide-C by a unit increased chance of developing low BMD by 9.6 times. Conclusion: Women with higher levels of telopeptide-C need to be identified at an early stage as it provides with an early warning of the possibility of future development of osteoporosis so that preventive measures can be taken timely.

Correlation Of Bone Turnover Markers With Age, BMI And Serum Oestradiol In Pre And Postmenopausal Urban Women.

Abstracts: Background: Rapid bone loss occurs in women after menopause due to hormonal factors that lead to an increased susceptibility to fractures. This study was done to find out the correlation of osteocalcin and telopeptide-C with age, body mass index (BMI) and oestradiol in premenopausal and postmenopausal women. Methodology: Study was conducted on 350 women aged 30–65 years who were classified into premenopausal and postmenopausal groups. Serum samples were analysed for oestradiol, osteocalcin and telopeptide-C. Pearsons correlation was used for statistical confirmations. Results: Osteocalcin was found to be correlated with age (r= +0.56, p<0.001), BMI (r= -0.39, p<0.001), oestradiol (r= -0.21, p<0.01) and telopeptide-C (r= +0.18, p<0.05) in postmenopausal women but no correlation was found in premenopausal women. Telopeptide-C was found to be correlated with age (r= +0.39,p<0.001), BMI (r= -0.29,p<0.001) and oestradiol (r= -0.48,p<0.001) in postmenopausal women; in premenopausal women it was found to be correlated with BMI (r= -0.30,p<0.001) and oestradiol (r= -0.29,p<0.001). Conclusion: Inverse correlation of Telopeptide-C with BMI and serum oestradiol in premenopausal and postmenopausal women suggests that their increased bone turnover was linked to low BMI and oestrogen deficiency.

Asymptomatic bacteriuria & obstetric outcome following treatment in early versus late pregnancy in north Indian women.

Background & objectives: Asymptomatic bacteriuria during pregnancy if left untreated, may lead to acute pyelonephritis, preterm labour, low birth weight foetus, etc. Adequate and early treatment reduces the incidence of these obstetric complications. The present study was done to determine presence of asymptomatic bacteriuria (ASB) and obstetric outcome following treatment in early versus late pregnancy. Methods: A prospective cohort study was conducted at a tertiary care teaching hospital of north India. Pregnant women till 20 wk (n=371) and between 32 to 34 wk gestation (n=274) having no urinary complaints were included. Their mid stream urine sample was sent for culture and sensitivity. Women having > 105 colony forming units/ml of single organism were diagnosed positive for ASB and treated. They were followed till delivery for obstetric outcome. Relative risk with 95% confidence interval was used to describe association between ASB and outcome of interest. Results: ASB was found in 17 per cent pregnant women till 20 wk and in 16 per cent between 32 to 34 wk gestation. Increased incidence of preeclamptic toxaemia (PET) [RR 3.79, 95% CI 1.80-7.97], preterm premature rupture of membrane (PPROM)[RR 3.63, 45% CI 1.63-8.07], preterm labour (PTL) [RR 3.27, 95% CI 1.38-7.72], intrauterine growth restriction (IUGR)[RR 3.79, 95% CI 1.80-79], low birth weight (LBW) [RR1.37, 95% CI 0.71-2.61] was seen in late detected women (32-34 wk) as compared to ASB negative women, whereas no significant difference was seen in early detected women (till 20 wk) as compared to ASB negative women. Interpretation & conclusions: Early detection and treatment of ASB during pregnancy prevents complications like PET, IUGR, PTL, PPROM and LBW. Therefore, screening and treatment of ASB may be incorporated as routine antenatal care for safe motherhood and healthy newborn.