Prevalence of Glucose Metabolism Disorder in Liver Cirrhosis and its Correlation with Risk Factors of Diabetes Mellitus: A Hospital-Based Cross Sectional Observational Study from New Delhi.

OBJECTIVES: Association between liver cirrhosis (LC) and glucose intolerance has been known since long. This study was carried out to (1) determine the proportion of LC patients having insulin resistance and glucose metabolism disorder (GMD) which includes pre-diabetes (pre-DM) and diabetes mellitus (DM) and (2) study the correlation between GMD and the presence of risk factors (RF) for DM in patients with LC. METHODS: 100 patients with LC admitted in medical wards were studied and tested with fasting plasma glucose (FPG), 2 hours post-75 gram oral glucose load plasma glucose (PPG), glycosylated hemoglobin (HbA1c) and fasting plasma insulin. They were also evaluated for the presence or absence of RF for DM and groups of LC patients with and without GMD were compared. RESULTS: Out of the 100 patients, 77% were males and 76% were between 30-59 years of age. Insulin resistance (IR) was found in 26% and GMD in 39% (pre-DM 13% DM 26%). Certain RF for DM like advanced age, positive family history (F/H) of DM, high body mass index (BMI), hypertension, high triglycerides, history of CAD/ CVA/ PVD showed positive correlation with the occurrence of GMD in LC; advanced age, hypertension and high triglycerides had a significant correlation with occurrence of IR. CONCLUSION: GMD was prevalent in about a third and IR in about a quarter of patients with LC. Traditional risk factors of DM increase the chances of an individual with LC having GMD. IR increased with advanced age, the presence of hypertension and high triglycerides and did not always predate GMD.

Biological reference interval of nitric oxide in health and disease.

OBJECTIVES: There is a need to develop reference interval of NO in health and disease. METHODS: Subjects aged between 25 and 55 years were drawn from a random sample of the north Indian population, based on defined inclusion and exclusion criteria. Measurement of NO was done based on principle of greiss reaction. RESULTS: Reference interval of NO in healthy individual of age group 25-55 years was 21 ± 13.3 µM/L (n=350), Premenopausal women of age group 25-35 years was 12.7 ± 4.9 µM/L (n=180), Postmenopausal women of age group 40-55 years was 10.3 ± 3.84 µM/L (n=100) and healthy pregnant females of age group 25-35 years was 70.9 ± 15.95 µM/L (n=330). In pathological state group, reference interval of NO in metabolic syndrome cases of age group 25-55 years was 19.4 ± 15.3 µM/L (n=100), coronary artery disease patient of age group more than 35 years was 17.6 ± 10.8 µM/L (n=160), pregnancy induced hypertension (PIH) of age group 25-30 years was 45.7 ± 7.2 µM/L (n=330), pre-eclampsia patient of age group 25-35 years was 39.8 ± 14.7 µM/L (n=200) and diabetic individuals of age group of more than 30 years was 15.5 ± 1.4 µM/L (n=50). CONCLUSIONS: The reference intervals presented may be used for various research purposes. Based upon our study, reference interval for NO levels of various disease states like MetS, CAD, diabetes, PIH showed lower levels of NO compared to their respective healthy group due to shared etiopathologies with decreased NO levels.

Interaction of iNOS Gene (C150T) Polymorphism and Endothelial Dysfunction in Pathophysiology of Metabolic Syndrome.

OBJECTIVE: To study the endothelial dysfunction by measuring Nitric Oxide and Endothelin-1, and inter-genotypic variation of inducible Nitric Oxide Synthase gene (C150T) polymorphism among the study subjects. METHODS: 50 diagnosed cases of metabolic syndrome as per International Diabetes Federation (IDF) criteria and 50 healthy volunteers as control were enrolled. Nitric Oxide, Endothelin were measured and PCR-RFLP was done to identify the iNOS gene C150T polymorphism and its effect on serum nitric oxide levels. RESULTS: Subjects with metabolic syndrome had lower NO levels (16.3 ± 10.3 vs 20.9 ± 11 µM, p = 0.032) and higher endothelin (2.68 ± 1.73 vs 1.98 ± 0.82 fmol/ml, p = 0.011). The frequency of mutant T allele (10% vs 9%) was higher in cases. Serum nitric oxide levels were lower in cases expressing the Mutant T allele as compared to wild type C allele. However, the differences were not statistically significant. CONCLUSIONS: The present study demonstrated that iNOS C150T polymorphism did not show significant association with metabolic syndrome. Serum nitric oxide levels could be influenced by factors other than genetic polymorphism of iNOS gene (C150T) which cause endothelial dysfunction in metabolic syndrome and associated co-morbidities.

First-Trimester Inflammatory Markers for Risk Evaluation of Pregnancy Hypertension.

Introduction: Hypertension in pregnancy is one of the potential causes of maternal and fetal morbidity and mortality. It complicates 7-10% of pregnancies. As of today, prediction of pregnancy hypertension is not possible. Aim and Objectives: Evaluation of pregnancy associated plasma protein-A (PAPP-A), free ß-human chorionic gonadotropin, tumor necrosis factor-α (TNF-α) and interferon gamma (INF-γ) in establishing a biomarker or combination of biomarkers for the early identification of pregnancy hypertension. Methodology: This prospective study was carried out in two phases. Phase I was a cohort study in which 2000 pregnant women were enrolled in their first trimester (11 + 0 to 13 + 6 weeks of gestation) and followed till delivery. Women who developed hypertension were compared with normotensive cohort (women who remained normotensive till term). Phase II was a case-control study. The women who were diagnosed with hypertension in phase I were cases and their controls were matched for gestational age and sample storage time from normotensive cohort population. Two additional proinflammatory markers TNF-α and INF-γ were evaluated in this case-control population. Results: Out of 2000 women, 199 women developed hypertension and 1454 women remained normotensive throughout their pregnancy. Among 199 hypertensive women, 151 (9.13%) cases had gestational hypertension, 45 (2.72%) had preeclampsia (PE) and 3 (0.18%) had eclampsia (E). First trimester mean arterial pressure (MAP) (p < 0.001) and body mass index (BMI) (p < 0.001) were found significantly higher in hypertensive women when compared with normotensive women. Maternal serum levels of PAPP-A (p < 0.001) were significantly low in hypertensive women as compared to normotensive women, while free ß-hCG (p = 0.59) was high, but the difference was not statistically significant. TNF-α (p < 0.001) and INF-γ (p = 0.014) both were high in hypertensive women. When all biomarkers were combined we found the positive predictive value (PPV) of 51.6% an negative predictive value (NPV) of 71.4%. Conclusion: Increased levels of proinflammatory cytokines suggest the role of underlying inflammation in pathogenesis of pregnancy hypertension, and low PAPP-A may be attributed to impaired implantation. Combining biomarkers may improve the prediction of pregnancy hypertension in the early stages of gestation. NPV of 71.4% depicts that if woman has all biomarkers in normal ranges during first trimester, she will have 71.4% chances of remaining normotensive during pregnancy.

Association of prothrombotic adipokine (plasminogen activator inhibitor-1) with TSH in metabolic syndrome: a case control study.

Background Metabolic syndrome (MetS) involves a cluster of cardiovascular risk factors, including abnormal lipids, insulin resistance and hypertension. The aim of the present study is to investigate associations between thyroid profile and the pro-thrombotic mediator, plasminogen activator inhibitor-1 (PAI-1), in MetS and identify associated biochemical markers. Materials and methods The present study was a case control study and consisted of 50 diagnosed cases of MetS and 50 healthy volunteers as controls. MetS cases were further divided into two groups based on the presence and absence of subclinical hypothyroidism (SCH). Data collected included demographic profile, clinical history and routine lab investigation. Special investigations included the thyroid function test and serum PAI-1 levels. Results The mean serum thyroid-stimulating hormone (TSH) levels were significantly higher in MetS cases as compared to controls (5.7 ± 1.2 mIU/L vs. 2.3 ± 1.6 mIU/L, p < 0.0001), although the mean triiodothyronine (T3) and thyroxine (T4) levels were comparable in two groups. The mean levels of serum PAI-1 were significantly higher in MetS cases as compared to controls(231 ± 87 ng/mL vs. 185 ± 96 ng/mL, p = 0.013). TSH and PAI-1 levels were positively correlated with various markers of MetS and negatively correlated with high-density lipoprotein (HDL). Conclusion The present study points towards the presence of thyroid dysfunction, in the form of subclinical hypothyroidism (SCH), in cases of MetS. In the presence of thyroid dysfunction, abnormal adipocytes may release adipokines, such as PAI-1, which lead to increased risk of thrombotic episodes in these patients. Hence, SCH should be appropriately managed.

Use of first-trimester placenta growth factor concentration to predict hypertensive disorders of pregnancy in a low-risk Asian population.

OBJECTIVE: To determine the value of placenta growth factor (PlGF) for predicting hypertensive disorders of pregnancy (HDP) in a low-risk population when used either alone or in combination with other markers. METHODS: A prospective observational cohort study was conducted among women with singleton pregnancy in the first trimester in New Delhi, India, between October 1, 2013, and September 30, 2016. First-trimester measures included maternal history, body mass index (BMI), mean arterial pressure (MAP), Doppler uterine artery pulsatility index, and serum levels of biomarkers (including PlGF). RESULTS: Among 1725 women, 208 (12.1%) developed HDP; 74 (35.6%) of these cases were early onset. Mean PlGF levels were significantly lower among cases than among controls (30.42 ± 10.22 vs 37.31 ± 13.28 pg/mL; P<0.001). As a biomarker for prediction of HDP, PlGF fared better than pregnancy-associated plasma protein A (PAPP-A): area under the curve 0.685 (95% confidence interval [CI] 0.620-0.750; P<0.001) versus 0.659 (95% CI 0.593-0.726; P<0.001). The highest odds ratio was found for MAP (8.369, 95% CI 5.752-12.215). The combination of PlGF, PAPP-A, BMI, MAP, and Doppler uterine artery pulsatility index provided an area under the receiver operating characteristic curve of 0.876 (95% CI 0.833-0.919; P<0.001). CONCLUSION: Combining PlGF concentration with biochemical and biophysical markers provided a good screening test for HDP during the first trimester.

Role of Sub Clinical Hypothyroidism in Association with Adiponectin Levels Causing Insulin Resistance in Metabolic Syndrome: A Case Control Study.

INTRODUCTION: Metabolic Syndrome (Met S) is reported to be associated with sub clinical hypothyroidism (SCH). The aim of our study is to evaluate the role of SCH in association with adiponectin levels causing insulin resistance in metabolic syndrome. MATERIALS AND METHOD: We recruited 100 study subjects; out of which 50 were cases of Met S, which were further divided into two groups based on presence and absence of SCH and 50 were healthy controls. Serum insulin, serum T3, T4, TSH were measured by chemiluminisence based immunoassay and serum adiponectin was measured by ELISA. RESULTS: Mean TSH levels were significantly higher in Met S cases as compare to control. Out of 50 cases of Met S, 22 (44 %) had SCH. Mean serum adiponectin were significantly lower in Met S cases as compare to control. On Pearson's correlation analysis, TSH showed significant positive correlation with HOMA-IR and negative correlation with adiponectin levels. Strong association was found on the likelihood of low levels of adiponectin in Met S cases. CONCLUSIONS: Met S cases showed insulin resistance and underlying SCH. SCH in Met S may cause altered adipocytes physiology which is associated with decreased release of insulin sensitising adiponectin which may lead to insulin resistance and future development of type II DM and associated co morbidities. Therefore, Met S cases should be screened for SCH and adiponectin levels thereafter. Also, our recommendation is SCH should be treated appropriately to attenuate insulin resistance and development of type II DM in Met S.

Raised TSH is associated with endothelial dysfunction in Metabolic Syndrome: A case control study.

INTRODUCTION: Endothelial dysfunction has been considered as one of the important factors in pathogenesis of Metabolic Syndrome (Met S). Subclinical hypothyroidism (SCH) has also been reported to be associated with Met S. The aim of our study is to evaluate the association of raised TSH with mediators of endothelial dysfunction in Met S with Subclinical hypothyroidism as compared to healthy controls. METHODS: Study population consisted of 100 subjects, out of which 50 were cases of Met S and 50 were healthy controls. Met S group were further divided into two, based on the presence & absence of SCH. Serum insulin, T3, T4, TSH were measured by chemiluminescence based immunoassay (CLIA). Serum nitric oxide (NO) levels were measured by Modified Griess's method and serum endothelin-1 (ET-1) levels were measured by ELISA. RESULTS: Out of 50 cases of Met S, SCH was diagnosed in 22. The mean serum TSH levels were significantly higher in Met S cases as compared to healthy controls (5.7 ± 1.2 µIU/mL vs. 2.3 ± 1.6 µIU/mL, P <0.0001). Mean serum NO levels were significantly lower in Met S cases as compared to healthy control (15.4 ± 10 µM vs. 21 ± 10 µM, p = 0.009). Mean serum ET-1 levels were significantly higher in Met S cases as compared to healthy controls (2.68 ± 1.7 fmol/mL vs. 2.1 ± 0.84 fmol/mL, p = 0.011). On Pearson's correlation analysis, TSH showed positive correlation with ET-1 (r = 0.341, p = 0.001) and negative correlation with NO (r = -0.331, p = 0.001). Binary logistic regression analysis showed that TSH, NO and ET-1 has significant odd's ratio for predicting Met S. CONCLUSION: Met S cases were screened for thyroid abnormalities and found to have 44% of SCH along with co-existing endothelial dysfunction. Raised TSH in SCH could cause endothelial dysfunction which may lead to Met S and associated co-morbidities. Present study gives new insight in linking endothelial dysfunction and raised TSH in Met S. Therefore, Met S cases should be screened for SCH and treated appropriately to attenuate endothelial dysfunction and associated comorbidities in Met S.

Early prediction of hypertension during pregnancy in a low-resource setting.

OBJECTIVE: To evaluate the role of maternal factors, biomarkers, and uterine-artery Doppler in the prediction of hypertension during pregnancy. METHODS: A prospective cohort study was performed between December 2012 and November 2014. All singleton pregnancies between 11 weeks and 13 weeks, 6 days of pregnancy were included. Patients had their body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters), mean arterial pressure, uterine-artery Doppler pulsatility index, and pregnancy-associated plasma protein A (PAPP-A) and free ß-human chorionic gonadotropin levels recorded. Any patients diagnosed with hypertension during follow-up were assigned to the case cohort; all other patients were assigned to the control group. RESULTS: Hypertension during pregnancy was observed in 198 (9.7%) of 2042 patients that attended follow-up. The mean BMI, mean arterial pressure, uterine-artery Doppler pulsatility index, and the PAPP-A level at study enrollment were all significantly correlated with the later development of hypertension (P<0.001 for all variables). The combined sensitivity, specificity, positive predictive value, and negative predictive value of using the investigated parameters to predict hypertension was 76%, 80%, 31%, and 93%, respectively. CONCLUSION: Patient BMI, mean arterial pressure, PAPP-A, and pulsatility index were found to be effective predictors of hypertension during pregnancy. Combining these predictors may be beneficial in selecting individuals for close monitoring and early intervention during pregnancy.

Effect of l-Arginine on Nitric Oxide Levels in Intrauterine Growth Restriction and its Correlation with Fetal Outcome.

The current management of intrauterine growth restriction (IUGR) being empirical and aimed at selecting a safe time for delivery. Acknowledging the beneficial effects of l-arginine on endothelial vasculature the present study was designed to evaluate efficacy of l-arginine on bioavailability of nitric oxide (NO) with respect to fetal outcome. With l-arginine supplementation, mean NO levels were significantly increased and a significant mild reduction in systolic/end-diastolic velocity ratio (S/D ratio) was observed on doppler blood flow study, also neonatal outcome improved and incidences of complications were lowered. A deficiency in NO may play an important role in the causation of asymmetric fetal growth restriction. l-Arginine can be used to increase maternal NO levels, enhancing birth weight and decreasing neonatal morbidity. The ideal candidate for arginine therapy according to our study would be IUGR cases with S/D ratio less than 4.96 ± 0.49 and NO levels below 33 µmol/L with minimum of 3 weeks duration of arginine supplementation.

Intergenotypic variation of endothelial dysfunction and inflammatory markers in eclampsia.

BACKGROUND: Cytokine imbalance and endothelial dysfunction are suggested to have a pivotal role in eclampsia. Pathophysiological processes are influenced by genetic factors and nitric oxide (NO) synthases seem to play important roles, although their role is still unclear. Endothelial NO synthase (eNOS) gene polymorphism may affect cytokine production. The aim of this study was to test the hypothesis that inflammatory cytokines impairs endothelium-dependent relaxation and NO production gets vitiated due to eNOs Glu298Asp gene polymorphism causing endothelial dysfunction in eclampsia. METHODS: This cross-sectional study included 100 women with eclampsia and 100 healthy pregnant women. Their blood samples were analyzed for NO (indirectly), and inflammatory cytokines and eNOS (Glu298Asp) gene polymorphism were determined by DNA extraction, followed by restriction fragment length polymorphism. RESULTS: Decreased NO metabolites and increased cytokines (tumor necrosis factor-α; interleukin-2, -6; and interferon-γ) levels were found in eclampsia (p < 0.001). Significant differences were found in genotype/allele distribution between the two groups. Occurrence of "T" allele frequency was found to be 0.27 among patients and 0.05 among controls (CI = 95%, OR = 0.7-0.9, p < 0.001). Significant negative correlation was seen between NO and cytokines levels (tumor necrosis factor-α and interferon-γ) in eclamptic women (p = 0.001). CONCLUSION: This study concluded that eclampsia is associated with decreased levels of NO and increased levels of circulating inflammatory cytokines, which might be contributed due to single-nucleotide polymorphism, pointing toward the role of endothelial and inflammatory components.

Endothelial nitric oxide synthase Glu298Asp (G894T) gene polymorphism in coronary artery disease patients with type 2 diabetes mellitus.

AIMS: Endothelial dysfunction is thought to be a significant risk factor for cardiovascular disease. This study determined the role of endothelial nitric oxide synthase (eNOS) Glu298Asp polymorphism and intergenotypic variation of plasma nitric oxide (NO) levels in coronary artery disease (CAD) patients with type 2 diabetes mellitus (DM). METHODS: This case-control study included 28 documented CAD patients with type 2 DM and 32 non-diabetic patients with CAD. Fifty healthy volunteers without any major cardiovascular risk factors served as controls. NO was estimated by modified Griess method. The eNOS gene polymorphism was studied by amplifying DNA by PCR and digesting with BanII restriction enzyme. Restriction fragment length polymorphism was studied by using a gel documentation system. RESULTS: The genotype frequencies for Glu298Asp (GT) genotype were 10.71% in diabetic CAD patients, 28.1% in non-diabetic CAD patients and 12% in controls. The T allele frequency was higher in the non-diabetic CAD group (14%) as compared with the diabetic CAD (5.4%) and control group (6%). NO level was significantly lower in non-diabetic CAD patients (10.25 mmol/L) but not in diabetic CAD patients (13.89 mmol/L) as compared to controls (16.78 mmol/L). CONCLUSION: Glu298Asp polymorphism is not the mediator of increased incidence of CAD in diabetic patients.

Naturally occurring core immune-escape and carboxy-terminal mutations\truncations in patients with e antigen negative chronic hepatitis B.

INTRODUCTION: Hepatocellular injury is often progressive in patients with hepatitis B e antigen negative chronic hepatitis B (HBeAg -ve CHB). There is scant data on association of core mutations occurring in patients with HBeAg -ve CHB with severity of liver disease. MATERIALS AND METHODS: Hundred and eighteen patients with chronic infection who were HBeAg negative, anti-HBe, and HBV DNA positive were enrolled. Precore and core regions were amplified, sequenced, and analyzed for precore, T helper, cytotoxic T lymphocytes (CTLs), B-cell epitope, and core carboxy-terminal region mutations. RESULTS: Majority of patients were infected with HBV genotype D: 96 (81%) [D1: 16, D2: 55 and D5: 25] followed by genotype A1: 15 (13%) and genotype C: 7 (6%) [C1: 5 and unidentified subgenotype C: 2]. Classical (A1896) as well as nonclassical precore region mutations were detected in 30 (25%) and in 9 (7.6%) patients, respectively. Core immune escape, core carboxy-terminal mutations and truncations were detected in 61 (52%), 11 (9.3%), and 14 (12%) patients, respectively. Three core immune escape mutations were significantly higher in patients with coexisting precore stop codon compared with patients without precore stop codon mutation, cT12S (43 vs. 8%, p < 0.001), cS21T (16 vs. 3.4%, p < 0.026), and cE77D (30 vs. 4.5%, p < 0.002). When frequency of core immune escape mutations was compared among CHB and decompensated patients, and cT12S: (27 vs. 10%, p < 0.05), cS21T (16 vs. 1.35%, p < 0.01), cT67P/N: (20 vs. 4%, p < 0.001), cE113D (11.37 vs. 1.35%, p < 0.05), and cP130T/Q (7 vs. 0%, p < 0.001) mutations were found to be significantly higher in decompensated patients. CONCLUSION: Core immune-escape mutations cT12S, cS21T, cT67P, cE113D, and cP130T/Q are significantly higher in decompensated liver disease patients and could influence the severity of liver disease in HBeAg -ve CHB patients.

Correlation of creatinine with TSH levels in overt hypothyroidism - a requirement for monitoring of renal function in hypothyroid patients?

OBJECTIVE: Renal function is influenced by thyroid status. Therefore, this study was done to determine the relationship between renal function and different degrees of thyroid dysfunction. DESIGN AND METHODS: Thyroid and kidney function tests were analyzed in 47 patients with overt (TSH ≥ 10.0 µIU/L) and 77 patients with subclinical hypothyroidism (TSH 6.0-9.9 µIU/L) in a cross-sectional study. These were compared with 120 age- and sex-matched euthyroid controls. RESULTS: Overt hypothyroid subjects showed significantly raised serum urea, creatinine and uric acid levels as compared to controls whereas subclinical hypothyroid patients showed significant increased levels of serum urea and creatinine levels. TSH showed significant positive correlation with creatinine and uric acid values and, fT4 had a negative correlation with uric acid in overt hypothyroidism. CONCLUSION: Hypothyroid state is associated with significant derangement in biochemical parameters of renal function. Hence the renal function should be regularly monitored in hypothyroid patients.

Interleukin-6 as a predictor of subclinical chorioamnionitis in preterm premature rupture of membranes.

PROBLEM: One of the major challenges faced by the clinicians in preterm premature rupture of the membranes (PPROM) is to correctly identify when a significant chorioamnionitis is evolving and decide timely delivery of the fetus. Measuring interleukin-6 levels in maternal serum can be useful for the identification of asymptomatic intrauterine infections in subjects with PPROM. METHOD OF STUDY: A total of 75 pregnant women, of which 45 pregnant women presenting with PPROM between 24 and 34 weeks gestation and 30 healthy pregnant women without PPROM, were included in the study. Serum IL-6 levels were determined by solid-phase sandwich enzyme-linked immunosorbent assay (Diaclone Research, Besancon, France). RESULTS: The mean serum IL-6 value at admission in the control group was 2.48 ± 2.7 pg/mL and in the study group was 11.86 ± 14.5 pg/mL (P = 0.001). Mean serum IL-6 concentrations at admission in subjects without histological chorioamnionitis were 3.98 ± 3.9 pg/mL and in those who had histological chorioamnionitis were 20.09 ± 16.8 pg/ml (P < 0.001). CONCLUSION: Maternal serum IL-6 levels were significantly elevated in subjects with PPROM with infectious morbidity as compared to those without infectious morbidity in the present study. There was a significant rise in maternal serum IL-6 levels with increased duration of rupture of membranes and with evidence of histological chorioamnionitis and funisitis in the placenta.

Association of endothelial dysfunction with endothelin, nitric oxide and eNOS Glu298Asp gene polymorphism in coronary artery disease.

The endothelial dysfunction has been implicated as a major event in the pathogenesis of atherosclerosis. Therefore, this study was planned to determine (a) role of endothelium-derived nitric oxide (NO) and endothelin as coronary artery disease (CAD) risk markers and (b) intergenotypic variation of endothelial nitric oxide synthase (eNOS) Glu298Asp polymorphism in CAD.The endothelin, NO and eNOS genotypes were determined in 60 patients with documented history of CAD. These were compared with 50 age- and sex- matched healthy controls. The genotype frequencies for eNOS gene polymorphism were determined by PCR and RFLP. The plasma endothelin in CAD patients was significantly higher (p< 0.001) whereas, the NO level in CAD group was significantly lower (p< 0.001) than the control group. The genotype frequencies for Glu298/Asp (Glu/Glu and Glu/Asp) genotypes were 75% and 25% in CAD subjects and 88% and 12% in control subjects, respectively. No Asp/Asp was found in any of the groups. The genotype frequencies differed significantly (p< 0.05) between the controls and cases. In conclusion, endothelin and NO may be used as markers of endothelial dysfunction in CAD. Asp allele might be a risk factor for CAD in the North Indian population.

Effect of integrated yoga practices on immune responses in examination stress - A preliminary study.

BACKGROUND: Stress is often associated with an increased occurrence of autonomic, cardiovascular, and immune system pathology. This study was done to evaluate the impact of stress on psychological, physiological parameters, and immune system during medical term -academic examination and the effect of yoga practices on the same. MATERIALS AND METHODS: The study was carried out on sixty first-year MBBS students randomly assigned to yoga group and control group (30 each). The yoga group underwent integrated yoga practices for 35 minutes daily in the presence of trained yoga teacher for 12 weeks. Control group did not undergo any kind of yoga practice or stress management. Physiological parameters like heart rate, respiratory rate, and blood pressure were measured. Global Assessment of Recent Stress Scale and Spielbergers State Anxiety score were assessed at baseline and during the examination. Serum cortisol levels, IL-4, and IFN-γ levels were determined by enzyme-linked immunosorbent assay technique. RESULT: In the yoga group, no significant difference was observed in physiological parameters during the examination stress, whereas in the control group, a significant increase was observed. Likewise, the indicators of psychological stress showed highly significant difference in control group compared with significant difference in yoga group. During the examination, the increase in serum cortical and decrease in serum IFN-γ in yoga group was less significant (P<0.01) than in the control group (P<0.001). Both the groups demonstrated an increase in serum IL-4 levels, the changes being insignificant for the duration of the study. CONCLUSION: Yoga resists the autonomic changes and impairment of cellular immunity seen in examination stress.

Intergenotypic variation of nitric oxide and inflammatory markers in preeclampsia: a pilot study in a North Indian population.

Cytokines appeared to contribute to the development of pathologic condition and eNOS gene polymorphism may affect cytokine production. The aim of this study was to evaluate cytokines pattern in preeclampsia and whether there is any relationship between gene and cytokines production and cytokine with disease severity. This cross-sectional study included 100 women with preeclampsia and 100 healthy pregnant women. Their blood samples were analyzed for nitric oxide (NO), inflammatory cytokines, and eNOS gene polymorphism. Decreased NO and increased cytokine (tumor necrosis factor-α, interleukin-2, and interferon-γ) levels were found in preeclampsia (p < 0.001). Significant differences were found in genotype/allele distribution between the two groups. A significant negative correlation was observed between NO and cytokine levels (tumor necrosis factor-α and interferon-γ) in the preeclamptic group (p = 0.001). We conclude that preeclampsia is associated with decreased levels of NO and increased levels of circulating inflammatory cytokines due to single nucleotide polymorphisms, pointing toward the role of endothelial and inflammatory components.

Oxidative stress and eNOS (Glu298Asp) gene polymorphism in preeclampsia in Indian population.

Oxidative stress causing widespread endothelial dysfunction has been proposed as a key factor involved in the development of preeclampsia (PE). With this background our objective was to study oxidative stress biomarkers like nitric oxide and malondialdehyde (MDA) and to correlate these markers with endothelial nitric oxide synthase (eNOS) (Glu298Asp) gene polymorphism. This cross-sectional study included 300 pregnant women diagnosed with PE and 200 women with normal pregnancy. Plasma NO and MDA levels were analyzed using student's t test and eNOS gene polymorphism was studied by performing polymerase chain reaction amplification and restriction length polymorphism and frequencies were distributed by using χ(2) analysis. The mean plasma levels of NO were significantly lower in study group while MDA levels were significantly higher in study group (P < 0.001). Genotypic and allelic frequency of eNOS gene in both groups was found to be significant (P < 0.05). The intergenotypic variation of NO and MDA levels was found to be significant (P < 0.001). We concluded that the plasma levels of NO are decreased while MDA levels are increased in subjects with PE and that might contribute to the pathophysiology of PE. As observed in this study Glu298Asp eNOS gene polymorphism showed significant association with PE.