Prediction of Preterm Delivery among Low-risk Indian Pregnant Women: Discriminatory Power of Cervical Length, Serum Ferritin, and Serum Alpha-fetoprotein.

Background: Around 80% of preterm births (PTBs) occur spontaneously. Various biomarkers are being evaluated to assess the possible role of chorioamniotic inflammation in PTBs. Aim: The aim of this study was to establish the accuracy of serum bio-markers( cut off values of ferritin and alpha-fetoprotein [AFP] at midtrimester) along with cervical length [CL] assessment to predict preterm delivery among low-risk women. Methods: Three hundred low-risk pregnant women attending the antenatal clinic of a tertiary health care facility were included and underwent CL measurement during mid-trimester by transvaginal ultrasonography and their serum levels of ferritin and AFP were recorded. All were followed up till delivery. Results: Receptor-operated characteristic curves for ferritin, AFP, and CL were constructed. Area under curves and Youden Index calculated for each marker were very low (<0.5) which is statistically considered very poor for a screening test. Conclusion: Serum ferritin and AFP together with CL measurement in the second trimester of pregnancy had poor discriminatory value in predicting preterm delivery among low-risk asymptomatic pregnant women.

Variations of Adipokines and Insulin Resistance in Primary Hypothyroidism.

INTRODUCTION: Hypothyroidism is a common concern in endocrinology practice, which plays a significant role in metabolic and development processes. Obesity, hyperlipidaemia and hypertension may complicate hypothyroidism. Recent studies have shown that cytokines like leptin and adiponectin, secreted by adipose tissue and exert their endocrinal functions by modulating appetite, obesity and insulin sensitivity in conjunction with thyroid hormones. Interrelation between thyroid hormone, insulin resistance and adipokines are not yet clear. AIM: To estimate serum leptin, adiponectin and insulin resistance in patients with hypothyroidism and to compare with control subjects and measure the relation between the mean value of one variable with others. MATERIALS AND METHODS: Forty primary hypothyroidism patients and forty age and sex matched controls were selected for the study with informed consent. Fasting serum Thyroid Stimulating Hormone (TSH), leptin, adiponectin, glucose and insulin were estimated. Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) was evaluated from fasting plasma glucose and serum insulin levels. Statistical analysis was carried out using SPSS version 17.0. Unpaired t-test and regression analysis were used to compare and determine the dependence, p<0.05 was considered significant. RESULTS: Serum TSH, leptin, adiponectin HOMA-IR were significantly higher (p<0.05) in patients with hypothyroidism (10.37±4.10, 10.97±0.60, 31.09±4.07, 3.64±0.40) than controls (2.41±2.09, 10.37±0.12, 33.32±1.44, 2.36±0.35). Regression analysis showed that leptin was significantly (p=0.054) dependent on adiponectin but not on others. CONCLUSION: Increased oxidative stress by hypothyroid mediated leptin secretion and increased insulin resistance can down-regulate the adiponectin secretion and future complications. Serum estimation and correction of imbalance of adipokines in hypothyroidism can prevent severe consequences.

Alteration of micronutrient status in compensated and decompensated liver cirrhosis.

Decompensation followed by death is the most serious outcome in patients suffering from cirrhosis of the liver. Alteration of trace elements may play a vital role in the process of decompensation. To examine the change in status of trace elements during the decompensation process, we analysed the zinc, copper, iron, magnesium, bilirubin and albumin levels in the serum of compensated (n = 34) and decompensated (n = 31) liver cirrhosis patients and compared them with healthy control group (n = 36) by post hoc ANOVA. We observed significant alteration in the selected micronutrients in the diseased group relative to healthy controls (P < 0.05). Moreover, mean serum zinc and iron levels were significantly lower with a higher level of serum copper in decompensated cirrhosis group than in compensated group (P < 0.05). However, no significant decrease of serum magnesium was found between the two diseased groups. Our findings imply that the trace elements like zinc, copper and iron might exert important contributory roles in decompensation process in liver cirrhosis and hence, may be utilized as important biomarkers for these patients. Furthermore, we propose that replacements of those micronutrients at an early stage can delay or prevent the severe outcomes like hepatic encephalopathy, gastrointestinal bleeding, severe jaundice or ascites in these patients.

Comparison of urinary and serum CA 19-9 as markers of early stage urothelial carcinoma.

OBJECTIVES: Although the glycoprotein group tumor marker CA 19-9 has been detected in both serum and urine of bladder cancer patients, information about their comparative role in screening of low grade transitional cell carcinoma (LGTCC) and high grade transitional cell carcinoma (HGTCC) is rare. MATERIALS AND METHODS: In this study we measured both the urinary and serum levels of CA 19-9 in 35 LGTCC and 20 HGTCC patients by ELISA and determined the cut off value of both urinary and serum CA 19-9 levels by receiver operator characteristic curve (ROC) for both patient groups. Odds ratio (OR) for CA 19-9 was analyzed with its range at 95% confidence interval to analyze the role of this tumor marker as a screening parameter for both of these cancer types. RESULTS: For urinary CA 19-9 the OR was 20.16 with an interval of 4.91-82.71 whereas for the serum CA 19-9 it was 7.5 with an interval of 2.28-24.62. CONCLUSIONS: From these data we suggest that urinary CA 19-9 is a better screening parameter with optimum sensitivity and specificity than its serum counterpart for diagnosis of low grade and early stages of transitional cell carcinoma of urinary bladder. Furthermore, it can be suggested that urinary CA 19-9 can be used as better prognostic marker for LGTCC than its serum counterpart.

Comparison of Urinary and Serum CA 19-9 as Markers of Early Stage Urothelial Carcinoma

Objectives Although the glycoprotein group tumor marker CA 19-9 has been detected in both serum and urine of bladder cancer patients, information about their comparative role in screening of low grade transitional cell carcinoma (LGTCC) and high grade transitional cell carcinoma (HGTCC) is rare. Materials and Methods In this study we measured both the urinary and serum levels of CA 19-9 in 35 LGTCC and 20 HGTCC patients by ELISA and determined the cut off value of both urinary and serum CA 19-9 levels by receiver operator characteristic curve (ROC) for both patient groups. Odds ratio (OR) for CA 19-9 was analyzed with its range at 95% confidence interval to analyze the role of this tumor marker as a screening parameter for both of these cancer types. Results For urinary CA 19-9 the OR was 20.16 with an interval of 4.91-82.71 whereas for the serum CA 19-9 it was 7.5 with an interval of 2.28-24.62. Conclusions From these data we suggest that urinary CA 19-9 is a better screening parameter with optimum sensitivity and specificity than its serum counterpart for diagnosis of low grade and early stages of transitional cell carcinoma of urinary bladder. Furthermore, it can be suggested that urinary CA 19-9 can be used as better prognostic marker for LGTCC than its serum counterpart. .

Changes in biochemical contents of expressed breast milk on refrigerator storage.

To determine the biochemical integrity of refrigerated breast milk for 96 hours at 4C, a longitudinal observational study done with fresh milk samples. It is found that there were significant changes in pH, serum albumin and lactose concentrations in breast milk though within normal range.

Elevated level of carbonyl compounds correlates with insulin resistance in type 2 diabetes.

INTRODUCTION: Recent periodicals direct that reactive carbonyl compounds are formed due to existing oxidative stress in type 2 diabetes mellitus, which further nonenzymatically react with proteins and lipids to form irreversible advanced glycation end products (AGE) and advanced lipoxidation end products (ALE). In type 2 diabetes mellitus, insulin resistance plays a pivotal role in hyperglycaemia. In this study, we tried to fi nd the relation between insulin resistance and carbonyl stress. MATERIALS AND METHODS: Forty-seven patients of type 2 diabetes mellitus (age 51 ± 5.06 years) were selected and fasting plasma glucose, serum insulin, total carbonyl compounds, HbA1c, thiobarbituric acid reacting substances (TBARS) and Trolox equivalent antioxidant capacity (TEAC) were estimated using standard protocols. Homeostatic model assessement of insulin resistance (HOMA-IR) was evaluated from fasting plasma glucose and serum insulin levels. RESULTS: We found highly significant correlations of carbonyl compounds with HOMA-IR, fasting plasma glucose and glycated haemoglobin (HbA1c). Correlations of lipid peroxidation end product, TBARS were not so significant. CONCLUSION: Findings from this study indicate that the level of carbonyl compounds can be a biomarker of insulin resistance in type 2 diabetes mellitus.