Abdoul Hamide

Oxidative stress and protein glycation in primary hypothyroidism. Male/female difference

Oxidative stress (OS) has recently been documented in hypothyroidism, a disease more prevalent in women. In general, OS is reported to be more prevalent in males. However, the effect of gender on OS and protein glycation in hypothyroidism has not been addressed. Blood samples from 37 recently diagnosed primary hypothyroid patients were collected before initiation of thyroxine therapy. Serum glucose, thyroid and lipid profiles were estimated. Glutathione (GSH), malondialdehyde (MDA), protein carbonylation (PCO) and fructosamine levels were analysed. GSH was found to be lower, whereas MDA, fructosamine and PCO levels were higher in male than in female patients. Level of MDA was significantly correlated with fructosamine, protein carbonyls, cholesterol, low-density and high-density lipoprotein cholesterol, triglyceride and GSH in hypothyroid patients. We found OS to be more prevalent in male hypothyroid patients. The positive association of MDA with fructosamine indicates that enhanced lipid peroxidation could be a plausible contributor for accelerated glycation of protein. Considering the negative influence of OS on health, extra attention should be paid to male hypothyroid patients in spite of the low prevalence of this disease in them.

Quality of life and its determinants in people living with human immunodeficiency virus infection in puducherry, India.

Context: With anti-retroviral therapy (ART) for human immunodeficiency virus infection (HIV) coming into picture, quality of life (QOL) has gained importance. Knowledge on the factors affecting QOL would be helpful in making important policy decisions and health care interventions. Aims: The aim of this study is to assess the quality of life of people living with HIV (PLWH) and to identify the factors influencing their QOL. Materials and Methods: The study was done among 200 PLWH attending a tertiary care hospital, and three Non Governmental Organizations at Puducherry, India, from November 2005 to May 2007. QOL was assessed using HIV specific World Health Organization Quality Of Life scale (WHOQOL-HIV) – BREF questionnaire which has six domains (physical, psychological, level of independence, social relationships, environment and spirituality/religiousness/personal belief). Social support and stigma were measured using “Multidimensional Scale of Perceived Social Support” and “HIV Stigma Scale,” respectively, using Likert Scale. Factors influencing QOL were identified using backward stepwise multiple linear regression with the six domain scores as the dependent variables. Results: Male: Female ratio was 1:1 and 58% were in early stage of the disease (stage I/II). Psychological and SRPB (Spirituality Religiousness and Personal Beliefs) domains were the most affected domains. All the regression models were statistically significant (P<0.05). The determination coefficient was highest for the social relationship domain (57%) followed by the psychological domain (51%). Disease stage and perceived social support significantly influenced all the domains of WHOQOL. Younger age, female gender, rural background, shorter duration of HIV, non-intake of ART and greater HIV related stigma were the high risk factors of poor QOL. Conclusion: Interventions such as ART, family, vocational and peer counseling would address these modifiable factors influencing QOL, thereby improving the QOL of PLWH.

Association of thyroid stimulating hormone and coronary lipid risk factors with lipid peroxidation in hypothyroidism.

Abstract Background: Hypothyroidism is the second most prevalent disorder in India and most cases require lifelong treatment. Disordered myocardial function is one of the complications of overt hypothyroidism. Dyslipidemia and lipid peroxidation are two biochemical derangements of hypothyroidism and both have been found to be associated. Still uncertainty remains regarding the origin of lipid peroxidation in this clinical condition. Besides, thyroid stimulating hormone or thyrotropin at a higher concentration can induce secretion of inflammatory cytokines and decrease the antioxidant status. Methods: Hence, we analyzed the association of lipid risk factors and thyrotropin in hypothyroidism with the extent of lipid peroxidation. A total of 42 primary hypothyroid patients volunteered to give fasting blood samples prior to therapy for the analysis of oxidative stress, thyroid and lipid profiles. Results: Oxidative stress was confirmed by the increased levels of malondialdehyde and protein carbonylation and decreased levels of reduced glutathione. Simple correlation analyses revealed the association of lipid peroxidation with both thyrotropin and lipid risk factors. Partial correlation analyses showed that thyrotropin and lipid risk factors mutually influence their association with the higher malondialdehyde levels in these patients. Conclusions: Hyperthyrotropinemia may be considered not only as an index of the severity of hypothyroidism but also of the extent of the associated lipid peroxidation. Clin Chem Lab Med 2008;46:674–9.

The spectrum of mucocutaneous manifestations during the evolutionary phases of HIV disease: an emerging Indian scenario.

Third world countries, including India, lack sophisticated investigations to assess the progression of HIV disease. Hence, this study was undertaken to determine the clinical mucocutaneous markers of HIV disease and to establish its relationship with the stage of the disease. This was an observational institutional study of 75 patients with mucocutaneous disorders and HIV infection recruited over a period extending from September of 1996 to June of 1998. The patients with mucocutaneous lesions were staged according to the Centers for Disease Control classification system for HIV infection (1986). The most frequent mode of acquisition of HIV infection was heterosexual contact (96%). The patients were broadly categorized into two groups. The AIDS group was comprised of patients who were in group IV and the early HIV infection group included patients in group II and III; none were detected in group I. Forty‐eight cases belonged to the AIDS group, and 27 belonged to the early HIV infection group. A total of 207 dermatoses were diagnosed and grouped as fungal, viral, bacterial, or miscellaneous. The common mucocutaneous disorders in order of frequency observed in this study were: candidiasis, dermatophytosis, herpes simplex, oral aphthae, xerosis/ichthyosis, scabies, HPV infection, molluscum contagiosum, and psoriasis. Xerosis/acquired ichthyosis and giant molluscum contagiosum were characteristically seen in group IV of HIV disease, whereas oral candidiasis, oral aphthae, papular dermatitis of HIV, and psoriasis were early warning signs. The mean number of dermatoses per patient in group IV was 3.15; in group III, it was 2.41; and in group II, it was 1.5. There was a statistically significant difference between the early HIV infection group and AIDS group with regard to number of dermatoses. Apart from syphilis and human papilloma virus infection, the treatment outcomes were satisfactory.

Activation of NF-κB in lymphocytes and increase in serum immunoglobulin in hyperthyroidism : Possible role of oxidative stress

This study evaluated oxidative stress, serum IgM and IgG, and nuclear factor (NF)-kappaB signaling in lymphocytes of hyperthyroidism patients. GSH content in lymphocytes was significantly lower and serum malondialdehyde, IgM and IgG levels were significantly higher in hyperthyroidism as compared to controls. In lymphocytes, the NF-kappaB signaling pathway was studied by western blot analysis of p65 and p-IkappaBalpha. Density of p-IkappaBalpha and p65 (in nuclear fraction) was significantly higher in hyperthyroidism as compared to controls. The density of p-IkappaBalpha and p65 had significant positive correlation with serum malondialdehyde level and negative correlation with lymphocyte GSH level in hyperthyroid cases. The serum IgG and IgM levels were correlated significantly with density of p-IkappaBalpha and p65. As immunoglobulin production is regulated by the NF-kappaB pathway, we conclude that the oxidative stress-induced activation of the NF-kappaB pathway might play a role in the rise of serum immunoglobulin level in hyperthyroidism.

Acute demyelinating encephalitis due to Abrus precatorius poisoning--complete recovery after steroid therapy.

Introduction. Poisoning from Abrus precatorius is attributed to a toxalbumin (abrin) that acts by inhibiting protein synthesis and rarely can cause immuno-mediated demyelination. We report a case of abrin poisoning with demyelination. Case report. A 19-year-old man presented with a history of ingesting crushed Abrus precatorius seeds following a family quarrel. He developed vomiting, abdominal pain, and bloody diarrhea, followed by a seizure and an altered sensorium. Magnetic resonance imaging (MRI) of the brain showed demyelination in the bilateral-medial temporal lobes. The patient was treated with supportive care, and intravenous methylprednisolone followed by oral prednisone, and recovered fully. Discussion. Abrin is an immuno-modulator that may cause immune-mediated demyelination. We report the clinical course of a patient with demyelination after abrin poisoning, treated with corticosteroids, and document his clinical recovery. Conclusion. Demyelination is a rare complication of Abrus precatorius poisoning. In our case, the demyelination was demonstrated by MRI. Although our patient appeared to recover completely following methylprednisolone therapy, the suggestion that methylprednisolone or other corticosteroids might be useful in treating this demyelination needs experimental verification and clinical validation before concluding that it is a beneficial therapy.

Plasma ferritin and indices of oxidative stress in Helicobacter pylori infection among schoolchildren.

Objective: Iron deficiency is one of the most common causes for anemia in Indian children. The present study was performed to evaluate the prooxidant status and ferritin levels in Helicobacter pylori–infected schoolchildren. Methods: The present study included healthy controls (control group), H pylori–infected children (group I), and H pylori–uninfected children with iron deficiency (group II). Group I was further subdivided into group Ia and Ib, depending on the presence or absence of iron deficiency, respectively. Serum levels of protein carbonyls, malondialdehyde (MDA), ferritin, total protein, and albumin were evaluated and compared among study groups. Results: In H pylori–infected schoolchildren, serum MDA and protein carbonyls were significantly increased and ferritin levels were significantly decreased compared with the controls and group II. In group I, irrespective of presence and absence of iron deficiency, MDA and protein carbonyls were significantly increased compared with group II. In anemic H pylori–infected schoolchildren, levels of serum total protein were significantly decreased compared with healthy controls. In H pylori–infected patients, MDA was found to have a significant negative correlation with ferritin levels and total protein by partial correlation analysis. Conclusions: An increased level of oxidative stress was found in H pylori–infected schoolchildren. Furthermore, the findings from the present study indicate that prolonged oxidative stress may enhance protein degradation in children.

Gelatinous transformation of bone marrow in acquired immunodeficiency syndrome

Sir, The focal or diffuse deposition of extracellular gelatinous material in bone marrow along with accompanying fat cell atrophy and marrow hypoplasia is collectively known as gelatinous transformation of bone marrow (GMT). A relatively uncommon condition, GMT has been described in a variety of disorders associated with chronic wasting like starvation, anorexia nervosa and chronic infections. It has of late been recognised in patients with acquired immunodeficiency syndrome (AIDS). The gelatinous material is histochemically mucopolysaccharides rich in hyaluronic acid. The deposition of this material and the subsequent alteration in the marrow microenvironment is detrimental to erythropoiesis, which may lead to peripheral haematological abnormalities. We report the presence of GMT in four patients with AIDS who also had moderate to severe anaemia. All four patients were HIV-positive males. The ages of the patients ranged from 22 to 37 years. The presenting complaint was fever of a duration ranging from 15 days to 5 months and cough. All patients also had a significant history of weight loss. The loss of weight ranged from 30 to 70% within a period of 3–6 months. One patient presented with altered sensorium. On examination, all patients were found to be emaciated and had moderate to severe pallor. Two patients had lymphadenopathy, cervical in one and mediastinal and abdominal in the other, both of which were diagnosed on fine needle cytology as tuberculous lymphadenitis with many acid-fast bacilli. The patient who presented with altered sensorium was diagnosed with cryptococcal meningitis. The fourth patient had oral candidiasis. None of the patients had received anti-retroviral therapy nor had they taken any native medicine. Anaemia was seen in all four patients with haemoglobin ranging from 5.2 to 8.6 g/dL. In addition, two patients had leucopaenia and one of them also had thrombocytopaenia. The haematological findings are summarised in Table 1. Peripheral smear showed normocytic normochromic red cells. Differential leucocyte count showed neutrophilic preponderance with toxic changes. Bone marrow aspiration and biopsy was carried out in all four patients. The indications were pyrexia of unknown origin with cytopaenia in two patients, disseminated infection in one and suspected lymphoma in the other. Aspirates of bone marrow were difficult to obtain in general. In one, gelatinous metachromatic seromucinous material was seen focally, with a few entrapped haematopoietic cells. Bone marrow biopsy was hypocellular in three cases and normocellular in one. Microscopically, with H&E stain, most of the GMT lesions could be easily discerned on lowpower magnification because of their low cell content. On higher magnification, haematopoietic cells and fat cells in the lesions were reduced in number, and many fat cells also were shrunken. The hypocellular spaces were filled with amorphous gelatinous substances (Fig. 1). The gelatinous material was amphophilic to pale pink in color and appeared mucoid. It was seen focally in one and diffusely in three cases and was graded subjectively into grade 1, 2 and 3, depending on the extent of deposition and replacement of marrow spaces. One case showed grade 1 deposit, two cases were grade 2, and one case was grade 3. Histochemical evaluation showed the material to be positive for periodic acid-Schiff. The extracellular material was also strongly positive for alcian blue at pHs of 2.5 and 1.0. Haematopoietic elements immediately adjacent to the areas of gelatinous transformation showed hypoplasia with a few atypical megakaryocytes. Reticulin content was also TABLE 1 Haematological profile of the four patients with GMT

Tetanus caused by human bite of the finger.

A case of generalized tetanus after human bite of the finger is reported. The patient recovered with institutional care. We propose that secondary invasion by Clostridium tetani is the cause for infection. It could be prevented by immediate tetanus prophylaxis, thorough debridement, and primary repair of the wound.

Hyperhomocysteinemia, Insulin Resistance and High HS- CRP Levels in Prehypertension.

BACKGROUND Pre-hypertension refers to blood pressure in the range of 120 to 139 mm of Hg / 80 to 89 mm of Hg and its prevalence is increasing in India. Previous studies have documented the increase in homocysteine, C-reactive protein and insulin resistance and their role in the development of hypertension. In recent years much attention has been focused on subjects with prehypertension, as the risk for development of cardiovascular disease is higher in these subjects compared to those with normal blood pressure. OBJECTIVES To evaluate the serum homocysteine, hs-CRP level and insulin resistance in subjects with prehypertension. MATERIALS AND METHODS Sixty prehypertensives and 32 normotensives were recruited according to Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of blood pressure (JNC 7) guidelines. Serum homocysteine, vitamin B12, folate, insulin, hs-CRP and lipid profile were analysed. Independent t-test was carried out to compare two groups and pearson correlation analyses were carried out between various parameters with systolic blood pressure (SBP) and diastolic blood pressure (DBP). RESULTS Cardiovascular risk factors like serum homocysteine, insulin resistance and inflammatory marker hs-CRP were significantly increased in prehypertensives. Total cholesterol, TG, LDL-C and VLDL-C were significantly increased when compared to normotensives. Serum homocysteine correlated positively and vitamin B12 and folate negatively with Systolic Blood Pressure. CONCLUSION The present study concludes that the established cardiovascular risk factors, homocysteine, insulin resistance, and hs-CRP which have roles in the etiopathogenesis of hypertension, were elevated in subjects with prehypertension. Thus, early detection and life style modification may reduce the risk or delay the onset of hypertension and other cardiovascular complications.