Vivian D’Souza

A comparative study on oxidative stress and antioxidant status in ischemic stroke patients with and without diabetes

The study was conducted to find out the extent of lipid peroxidation and antioxidant status in ischemic stroke patients (ISPs) with and without diabetes. Malondialdehyde (MDA) was studied as a marker of lipid peroxidation. Glutathione (GSH), uric acid and ceruloplasmin were estimated to study the antioxidant potential of ISPs. Significantly higher levels of MDA were found in both the groups of ISPs and the increase in MDA was more in ISPs without diabetes. GSH levels were decreased significantly in both the groups of ISPs and maximum decline was found in ISPs with diabetes. Uric acid levels were significantly increased in both the groups of ISPs. Ceruloplasmin levels were increased significantly in ISPs without diabetes, whereas its levels were slightly decreased in ISPs with diabetes. A negative correlation was found between MDA and the antioxidants GSH, uric acid and ceruloplasmin in ISPs with diabetes. This study suggests that there is an association between ischemic stroke and increased oxidative stress and the antioxidant potential is impaired in both the groups of ISPs with and without diabetes.

Utility of C-terminal Telopeptide in Evaluating Levothyroxine Replacement Therapy-Induced Bone Loss

Background Levothyroxine (LT4) therapy has shown to have effects on bone metabolism though its deleterious effect on bone remodeling is debatable. This study was aimed at assessing the diagnostic utility of the bone remodeling marker C-terminal telopeptide (CTx) in detecting early bone loss. Materials and Methods In this case–control study, 84 premenopausal women of 30–45 years of age were selected. Out of them, 28 were recently diagnosed of hypothyroidism (not on LT4), 28 were on LT4 replacement therapy (100–200 μg/day) for more than five years, and 28 had euthyroid. Plasma CTx levels were estimated. Bone mineral density (BMD) was measured by quantitative ultrasound (QUS) method. Pearsons coefficient of correlation and ANOVA were used for statistical analysis. Results CTx was most elevated in LT4-treated group (0.497 ± 0.209 ng/mL). It showed a significant negative correlation with T-score and Z-score of BMD values. In the treatment group of more than 150 μg/day, CTx showed significantly negative correlation with TSH (r = –0.462, P = 0.047). Conclusion LT4 therapy induces bone loss in hypothyroid patients. CTx levels can measure such bone loss along with BMD. Regular monitoring of CTx with adjustment in LT4 doses may help delay osteoporosis induced by prolonged LT4 replacement therapy.

Inherent suppression of thyroid stimulating hormone in newly diagnosed dyslipidemic patients - indication for use of thyromimetics?

BACKGROUND Dyslipidemia triggers a sequel of metabolic derangements such as insulin resistance, hyperglycemia and oxidative stress via vicious cycle. Dyslipidemia is characterised by elevation of plasma cholesterol, triglycerides (TGs), or both, or a low level of high-density lipoprotein (HDL) which in turn can progress to atherosclerosis a forerunner for ischemic heart disease (IHD). Dyslipidemia is seen even in subclinical hypothyroid patients. OBJECTIVES The aim of the study was to look for thyroid & glycemic abnormalities in dyslipidemic patients and compare it with euthyroid, normolipidemic group. MATERIALS AND METHODS Thirty primarily dyslipidemic patients and 30 euthyroid normolipidemic subjects aged 25-55 years were tested for fasting plasma glucose (FPG), fructosamine, lipid profile, thyroid hormones - T3, T4 and thyroid stimulating hormone (TSH). The values were compared with those of age matched euthyroid normolipidemic control group. RESULTS The dyslipidemic pool showed small but significant decrease in the TSH levels with comparable T3, T4 levels as compared to euthyroid group. The group also had significantly higher FPG, total cholesterol (TC), triglycerides (TG), low density lipoprotein (LDL) levels and lower high density lipoprotein (HDL) levels as compared to the euthyroid normolipidemic group. The plasma fructosamine levels were similar in both the groups. The observed results reflected a picture of subclinical hyperthyroidism in dyslipidemic patients. CONCLUSION The observations of the present study preclude a need to assess the thyroid status in patients of primary dyslipidemia as both conditions per se have an increased risk of cardio vascular diseases. A subclinical hyperthyroid state may essentially be helpful in maintaining the lipid metabolism. The prevailing mild hyperthyroid status also makes it important to reconsider the accuracy of long term glycemic indicators like fructosamine and possibly glycated haemoglobin in these patients. Upon establishment of their efficacy and safety, thyromimetics may have a role in the treatment of dyslipidemia.

Do Premenopausal Hypothyroid Women on Levothyroxine Therapy Need Bone Status Monitoring

BACKGROUND Suppressive doses of levothyroxine therapy are reported to reduce bone mineral density (BMD) in women. Data on bone changes in premenopausal hypothyroid women with replacement therapy are limited. Hence, this study was undertaken to evaluate bone changes in this group using bone markers and BMD. MATERIALS AND METHODS A hospital-based case–control study including 75 premenopausal women aged 30–45 years was conducted. The subjects were categorized based on their thyroid function and history into three groups of 25 euthyroid, 25 newly diagnosed hypothyroid, and 25 hypothyroid women on 100–200 μg of levothyroxine for a minimum of 5 years. The bone changes were evaluated and compared among the groups biochemically by estimating their plasma osteocalcin and serum calcium and phosphorus and radiologically by measuring their BMD by quantitative ultrasonography. Statistical analysis was conducted by using analysis of variance, Tukey’s test, and Pearson’s correlation using IBM SPSS Statistics 20. RESULTS Levels of plasma osteocalcin, serum calcium, and serum phosphorus in patients on long-term levothyroxine therapy were significantly higher than those in newly diagnosed hypothyroid women and in the euthyroid group. BMD showed definite features of osteopenia (T-score: −2.26 ± 0.5) among the women in the treatment group, while it was well within the normal range in the newly diagnosed and euthyroid women. A significant correlation was found between the osteocalcin levels and T-score. CONCLUSION Hypothyroid women on long-term levothyroxine therapy showed signs of increased bone turnover and increased resorptive changes, though not frank osteoporosis. Hence, it may be important to evaluate the bone status of patients on levothyroxine for >5 years.

Enhancement of myeloperoxidase activity in WBCS in oral cancer patients treated with Granulocyte Macrophage Colony Stimulating Factor (GM-CSF)—A pilot study

In a pilot study with five oral cancer patients undergoing radiotherapy (RT) three were given Granulocyte Macrophage Colony Stimulating Factor (GM-CSF) as a protective agent to reduce the mucosal inflammation during radiotherapy. The myeloperoxidase (MPO) enzyme activity in WBC was quantitated. The three patients showed a significant increase in the MPO activity when compared with two untreated controls indicating the efficacy of GM-CSF as a protective agent. It is suggested that further detailed studies with larger number of patients would be useful.