Plasma homocysteine and total antioxidant status in diabetic chronic kidney disease and diabetic renal allograft recipients: effect of folic acid therapy.

Indian population is usually deficient in folic acid. Aim was to study the plasma homocysteine and antioxidant status in type 2 diabetics and healthy individuals before and after folate therapy. Methods: This study was done in four groups of 25 cases each. These included: type 2 diabetics with end stage diabetic chronic kidney disease (CKD) (group A); diabetic renal allograft recipients with normal and stable graft function (group B); uncomplicated type 2 diabetics (group C); and age and sex matched healthy controls (group D). The serum homocysteine and total antioxidant status (TAS) were measured at baseline and after 4 weeks of folate therapy. Results: The plasma homocysteine levels were 18.163.80, 16.150.66, 12.480.82 and 23.361.61 mol/L in group A, B, C and D respectively. The homocysteine levels were significantly low in all diabetic groups when compared to healthy controls. The plasma homocysteine were significantly elevated in stage 5 diabetic CKD and diabetic renal transplant recipients as compared to uncomplicated diabetics. After four weeks of folate therapy, there was a significant decrease of homocysteine in all the groups. The mean values of TAS were 1.42 0.18, 1.49 0.18, 1.17 0.06 and 1.60 0.86 pg/ml in group A, B, C and D respectively. There was no significant correlation between diabetic groups and healthy controls. No change was observed in TAS levels after folate therapy. Conclusions: Our results show significant hyperhomocysteinemia in healthy Indians. Plasma homocysteine were significantly low in all diabetic groups as compared to healthy individuals. We suggest supplementation of Indian diet with folic acid.

An unusual case of complete heart block with triplet pregnancy.

A young primigravida presented at 36 weeks of gestation with complete heart block and triplet pregnancy. She underwent a lower segment cesarean section, and was managed successfully. The patient remained asymptomatic and did not require antiarrhythmic drugs or pacing.

Azathioprine versus sulfasalazine in maintenance of remission in severe ulcerative colitis.

BACKGROUND: Azathioprine is useful as a steroid-sparing drug in patients with ulcerative colitis. Its role as monotherapy in the maintenance of disease remission has not been evaluated. METHODS: In this prospective, randomized, open-label study, 25 patients with severe ulcerative colitis received either azathioprine (2.5 mg/Kg/day; Group A, n = 12) or sulfasalazine (6 g/day; Group B, n = 13). All patients received oral corticosteroids in a tapering dosage schedule initially. Treatment failure was defined as either disease relapse or drug withdrawal because of adverse effects. RESULTS: Five of 12 patients in Group A and 8 of 13 patients in Group B had sustained remission during the stipulated study period of 18 months (p = ns). Two patients in Group A had to stop azathioprine because of adverse effects (bone marrow suppression and acute pancreatitis). In Group A, all patients who had treatment failure developed it in the first half of the study while in Group B treatment failure occurred in both halves. CONCLUSIONS: The relapse rate of ulcerative colitis on maintenance therapy with azathioprine or sulfasalazine is comparable; there was a trend towards earlier treatment failure with azathioprine.