Mediators of energy homeostasis in hyperthyroidism

ABSTRACT Objective: The aim of this study was to assess the effect of hyperthyroidism and its treatment on body weight and composition, insulin resistance, and mediators of appetite and energy homeostasis, namely ghrelin, leptin, adiponectin, and fibroblast growth factor 21 (FGF21). Subjects and methods: Thirty-five adult patients (27 female and 8 male, aged 39.63 ± 9.70 years) with overt hyperthyroidism were evaluated for leptin, ghrelin, adiponectin, and FGF21 levels; insulin resistance; and body composition using DEXA both at baseline and a minimum of two months following normalization of serum thyroxin on carbimazole treatment. Comparison of means between the baseline and post treatment values was performed by the paired t test for normally distributed parameters and by the Wilcoxon signed-rank test for non-normally distributed data. Results: Hyperthyroidism correction resulted in an increase in weight from 51.15 ± 8.50 kg to 55.74 ± 8.74 kg (P < 0.001), paradoxically accompanied by a decrease in insulin resistance as measured by HOMA-IR from 1.35 (1.02-1.72) to 0.73 (0.52-0.93) ( P < 0.001). Correction of hyperthyroidism was also associated with a decrease in FGF21 from 58 (55-64) to 52 (47-58) pg/mL ( P < 0.001) and in leptin levels from 17 (7-36) to 11 (4.6-28) ng/mL ( P = 0.03). Conclusion: Despite lower body weight, thyrotoxicosis is associated with insulin resistance. High levels of thermogenic hormones, leptin, and FGF21 were observed in thyrotoxicosis and may be partly responsible for the excessive heat production typical of this condition.

Laparoscopic donor nephrectomy in unusual venous anatomy - donor and recepient implications

ABSTRACT Objectives Laparoscopic donor nephrectomy is now a commonly performed procedure in most of renal transplantation centers. However, the suitability of laparoscopy for donors with abnormal venous anatomy is still a subject of debate. Materials and methods Between August 2007 and August 2014, 243 laparoscopic donor nephrectomies were performed in our institution. All donors were evaluated with preoperative three-dimensional spiral computed tomography (CT) angiography Thirteen (5.35%) donors had a left renal vein anomaly. A retrospective analysis was performed to collect donor and recipient demographics and perioperative data. Results Four donors had a type I retroaortic vein, seven had type II retroaortic vein and a circumaortic vein was seen in three donors. The mean operative time was 114±11 minutes and mean warm ischemia time was 202±12 seconds. The mean blood loss was 52.7±18.4mL and no donor required blood transfusion. Mean recipient creatinine at the time of discharge was 1.15±0.18mg/dL, and creatinine at six months and one year follow-up was 1.12±0.13mg/dL and 1.2±0.14mg/dL, respectively. There were no significant differences in operative time, blood loss, warm ischemia time, donor hospital stay or recipient creatinine at 6 months follow-up, following laparoscopic donor nephrectomy in patients with or without left renal vein anomalies. Conclusion Preoperative delineation of venous anatomy using CT angiography is as important as arterial anatomy. Laparoscopic donor nephrectomy is safe and feasible in patients with retroaortic or circumaortic renal vein with good recipient outcome.

Pharmacognostical Standardization and HPTLC Fingerprint of Alstonia Scholaris Linn. Bark.

There is increasing global interest in herbal and other forms of traditional medicines. Herbs have long been an important source of numerous effective drugs. As per World Health Organization recommendations, there is a need for investigation of traditional medicinal plants for their potential therapeutic efficacy. The bark of Alstonia scholaris (L.) R. Br. (Family: Apocynaceae) locally known as ‘Sapthaparni’ or ‘Satwid’, is reported to have anticancer, antihelminthic, antidiarrhoeal, antiasthamatic, antimalarial etc. The present work embodies the study carried out for quality control of herbal drugs which comprises of macroscopy, microscopy, physicochemical properties, phytochemical analysis, fluorescence analysis and HPTLC fingerprint. The anatomical markers present were found to be stone cells, sclereids, cork cells, fibers and prismatic crystals of calcium oxalate. Methanol soluble extractive value was found to be higher than Water, Ethanol and Petroleum ether soluble extractive values. Preliminary phytochemical analysis revealed the presence of tannins, alkaloids, steroids, amino acids, fats, fixed oil, glycosides, proteins, starch and flavonoids. A unique HPTLC fingerprint for A. scholaris (L.) R. Br. bark was developed. Results of the present study on pharmacognostical and phytochemical investigation of A. scholaris (L.) R. Br. bark will be helpful in developing standards for quality, purity and sample identification of this plant.

Physical and chemical characteristics of carambola (Averrhoa carambola L.) fruit at three stages of maturity.

The fresh fruits of carambola (Averrhoa carambola L.) are used in jelly making, for garnishing salads and to prepare drinks. In some Asian countries, the green mature fruit is relished and consumed fresh and used in pickle preparations. In the present work the physical and chemical properties of carambola fruits were studied at different maturity stages. The fruits were characterized for physical properties like length, diameter, fresh weight, dry weight and moisture content. The fruits were also analyzed for soluble protein, total sugars, reducing sugars, ascorbic acid, oxalic acid, amino acid, pectin and chlorophyll. The composition of fruit varied widely during maturation. The length, diameter, fresh weight and dry weight increased as fruit mature and ripen. The pH of the fruit increased with maturity. The contents of reducing sugars, total sugars, soluble protein, amino acid and oxalic acid increased with maturity. Total chlorophyll content increased from young to half ripe fruit but in full ripe fruit it decreased significantly.