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Introduction Growth Differentiation Factor-15 (GDF-15) has emerged as a novel marker in gyne-cological cancers. But its suitability in clinical diagnostics is yet to be recognized. Materials and methods We sorted out eligible studies from multiple online databases like Pubmed, Cochrane, ClinicalTrials.gov, Google Scholar, Web of Science, Embase, Scopus, LILACS, and Opengrey. The terms used were ‘Growth Differentiation Factor-15’, ‘GDF-15’, ‘Macrophage Inhibitory Cytokine-1’, ‘MIC-1’, ‘Ovarian cancer’, ‘Ovarian carcinoma’, ‘Endometrial cancer’, ‘Endometrial carcinoma’, ‘Uterine cancer’, ‘Uterine Carcinoma’, ‘Cervical cancer’, ‘Cervical car-cinoma’, ‘diagnosis’, ‘sensitivity’, ‘specificity’, ‘prognosis’, and ‘outcome’. Of the full-text, potentially eligible records, six were found eligible for inclusion into our meta-analysis. Studies were selected only if the diagnosis was proven by pathology, cases recruited were those without any prior treatment, sufficient diagnostic accuracy data were present for GDF-15 in gynecological cancers, ethical approval was taken from Institutional Ethics Committee, and full-text material was available in English. Nonclinical research and animal studies were excluded. We took the assistance of the Rayyan QCRI software for the screening and selection process. We conducted the study following Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines and used Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) to assess the risk of bias. The protocol was registered at PROSPERO, registration number CRD42019130097. Results We extracted diagnostic accuracy data from the articles and evaluated the role of GDF-15 by pooling the sensitivity, specificity, and diagnostic odds ratio (DOR) and plotting a summary receiver operating characteristic (SROC) curve. Since there was heterogeneity across the studies, random-effects model was employed to carry out the integration. The meta-analysis showed that GDF-15 has a pooled DOR of 12.74 at 80.5% sensitivity and 74.1% specificity, with an area under the curve (AUC) of 0.84. Conclusion Our analysis suggests that GDF-15 may be a useful candidate marker to differentiate malignant from non-malignant tumors of the female reproductive system. Registration detail: PROSPERO, CRD42019130097.

Graphical abstract, Highlights • BLL had a significant direct correlation with abnormal neurobehavior. • Serum serotonin levels were significantly lower in children with high blood lead levels (BLL). • Serum serotonin and dopamine receptor expression were upregulated in children with high BLL. • Serum serotonin levels had significant negative association with adverse neurobehavior. • Dopamine receptor expression had significant positive association with adverse neurobehavior., Present study aimed to assess the alterations in neurotransmitter expression and its association with Blood Lead Level (BLL) and neurobehavioral pattern in children. 72 school going children were recruited. Blood lead levels were determined by Atomic Absorption Spectrophotometer. Neurobehavioral state was assessed by means of population specific scale i.e. CPMS (Childhood Psychopathological measurement Schedule). Serum serotonin and dopamine were estimated by ELISA, receptor and transporter gene expressions were assessed by quantitative real time PCR. Significant positive correlation was observed between Total CPMS score (i.e. adverse neurobehaviour) and BLL. Further, serum serotonin levels and dopamine receptor expression showed a negative and positive association with BLL, respectively. In similarity, serum serotonin levels showed a negative correlation and dopamine receptor expression had a significant positive correlation with total CPMS score. Environmental exposure to Lead (Pb) may result in significant alterations in the neurotransmitter levels which may be associated with neurobehavioral changes in the children exposed to Pb.

Acute kidney injury (AKI), characterised by fluid imbalance and overload, is prevalent in severe disease phenotypes of coronavirus disease 2019 (COVID-19). The elderly immunocompromised patients with pre-existing comorbidities being more risk-prone to severe COVID-19, the importance of early diagnosis and intervention in AKI is imperative. Histopathological examination of COVID-19 patients with AKI reveals viral invasion of the renal parenchyma and evidence of AKI. The definitive treatment for AKI includes renal replacement therapy and renal transplant. Immunosuppressant regimens and its interactions with COVID-19 have to be further explored to devise effective treatment strategies in COVID-19 transplant patients. Other supportive strategies for AKI patients include hemodynamic monitoring and maintenance of fluid balance. Antiviral drugs should be meticulously monitored in the management of these high-risk patients. We have focussed on the development of renal injury provoked by the SARS-CoV-2, the varying clinical characteristics, and employment of different management strategies, including renal replacement therapy, alongside the emerging cytokine lowering approaches.

Oral Squamous Cell Carcinoma (OSCC) is common preventable disease when diagnosed early, but mostly its progression follows transition from oral potentially malignant disorders (OPMDs) like Oral Submucous Fibrosis (OSF). However, it is difficult to predict possibilities of progression in these premalignant lesions hence, identification of molecular biomarkers would have major clinical impact in early diagnosis and better prognosis. In this context microRNA’s(miR’s) provide better opportunities in malignancy prediction and demarcation in OSF to OSCC transition as they perform key regulatory roles in many tumorigenic processes. Here, we computationally screened differentially expressed miR’s of OSCC and OSF from public databases followed by construction of protein interaction networks and enrichment analyses. The relevant miR’s were validated using qPCR of total 93 samplesincluding 34 OSCC, 30 OSF and 29 control blood and tissue samples. We identified significant down regulation of miR-133a-3p in OSCC compared to controls and interesting up-regulation compared to OSCC and control. miR-9-5p was up-regulated in OSF as well as OSCC and down-regulated in OSF compared to OSCC. Therefore, these two miR’s may serve as risk stratification biomarkers with validation in larger categorical datasets.

Background: Type 2 diabetes mellitus (T2DM) is an ever-growing epidemic in India, and poses significant morbidity, mortality, and socioeconomic burden. Introduction: Growth differentiation factor-15 (GDF15) is a stress-responsive cytokine, increased in T2DM patients compared to control subjects without the disease. We aimed to assess whether serum GDF15 and adipose tissue GDF15 expression can differentiate between obese pre-diabetes and T2DM and control populations. Methodology: We recruited 156 individuals including 73 type 2 diabetes, 30 pre-diabetes, and 53 healthy controls. Clinical history, anthropometric measurements and biochemical profiling were done. Insulin resistance indices were calculated following HOMA models. Serum GDF15 was measured by sandwich ELISA. Visceral adipose tissue (VAT) expression of GDF15 was observed in 17 T2DM patients and 29 controls using SYBR Green chemistry in RT-PCR using GAPDH as housekeeping gene. The data were analyzed on R programming platform using RStudio. Results: Serum GDF15 was significantly higher (p Conclusion: Hence, serum GDF15 is a biomarker for T2DM patients in our study population from Western India. However, larger prospective cohorts are necessary to validate this claim.

Background and Aims Metabolic syndrome (MS) is found to be prevalent in patients with mental illness including depression. Data is sparse on the role of lifestyle factors on MS in depression. Methods This study was aimed to assess correlates of MS in patients with depression. Methodology: Three hundred eighty-two patients with depressive disorders were assessed for the prevalence of MS by using modified National Cholesterol Education Program- Adult Treatment Panel-III criteria (NCEP ATP-III). Their illness severity, functionality, physical activity and nutritional habits were also assessed. Conclusions Majority of patients with depression (82.2%) were drug naive. One-fourth of the patients had metabolic syndrome (27.7%). Additionally, other 59% of patients had one or two metabolic abnormalities and one-third of patients were obese. Lower high density lipoprotein cholesterol level was the most common abnormality (65%), while abnormal blood pressure was the least common abnormality (18%). Significant correlates of MS were greater age, and age at onset of depression, greater illness duration, lesser physical activity and lower nutritional score. Conclusion Nearly one-fourth of patients with depression had MS; another three-fifth of patients had one or two metabolic abnormalities. MS was more commonly seen with sedentary lifestyle and poor nutritional habits. It calls for comprehensive assessment and timely management of cardiovascular risk factors as well as lifestyle factors in depression.

Introduction: Role of T cells in VAT inflammation is poorly characterised. Perforin deficiency is associated with autoimmune inflammatory diseases like Hemophagocytosis Lymphohistiocytosis,as also in context of type 1 DM pathogenesis. Data from animal models suggest that perforin deficiency leads to VAT inflammation1Objective: We hypothesized CD8+/perf+ and CD56+/perf+ cells to be decreased in type 2 DM as compared to healthy controls. The present study also explored the difference in activation of T/NK cells between two groups Methods: 2×2 cm omental tissue was obtained from subjects undergoing elective abdominal surgery. The sample was transported in RPMI solution and stored in -80 ℃. Processing involved thawing, incubation at 37.6 ℃ for 24 hours with type IV Collagenase (1 mg/ml, Sigma Aldrich) 1ml/g of tissue,centrifuge (32g for 10 min at 10℃). The resultant Stromal Vascular fraction (SVF) was suspended in phosphate buffer saline (PBS), passed through cell strainer to make single cell suspension. It was again centrifuged and tagged with CD markers of interest. Fc block was added and single cell solution with FACS fluid prepared. It was run in BD CANTO-2 flow cytometer as described2Results: Of seventeen samples analysed, twelve samples of type 2 diabetes subjects were compared with five healthy controls. All results are presented in median. The diabetics had higher HbA1c (8.1 % vs 6%), higher BMI (28 kg/m2 vs 24 kg/m2), hsCRP(2.1 mg/dl Vs 0.9 mg/dl) but there was no difference in HOMA-Ir (5 vs 5.2 mU/L/mg/dl). The percentage of CD4+ + CD8+ cells/g of VAT was similar in both cases and control (20 × 103 Vs 23× 103). CD8+/CD45+/perf+ and CD56+/CD45+/perf+ could not be identified in any of the samples. Although CD8+/CD45+/perf-- and CD56+/CD45+/perf-- cells were identified. Next, we analysed the same cells for cytotoxic activation by 107a. The percentage of 107a positivity was low in CD 8+ (7% and 4 % respectively in cases and control) and CD 56+ cells (10% and 9 % respectively in cases and control),Although clinically type 2 DM subjects were obese and had inflammation (i.e higher hsCRP), there was no difference in VAT activation of immune cells studied. Also, we could not delineate perforin in any of the samples. Conclusion: Taken together this work suggests VAT T cell immune milieu in human Type 2 DM is different from mouse model. It is neither characterised by perforin deficiency nor activation of T cell/NK cell. This study points towards the probability that, the role of T cell/NK cells in human VAT infiltration could be fundamentally different from mice models. Further studies should be focussed on functional characteristics of these cells and interaction with VAT macrophages. References 1. Xavier S. Revelo et al Diabetes 2015;64:90–103 2. Wetzels S et al J Vis Exp. 2018 Mar 6;(133):57319.

Background and study aims Although newer needle designs are thought to improve diagnostic outcomes of endoscopic ultrasound-guided fine-needle biopsy, there is limited evidence on their diagnostic performance. The aim of this meta-analysis was to provide a pooled estimate of the diagnostic performance and safety profile of Franseen and Fork-tip fine-needle biopsy needles. Patients and methods Computerized bibliographic search on the main databases was performed through March 2019. The primary endpoint was sample adequacy. Secondary outcomes were diagnostic accuracy, optimal histological core procurement, mean number of needle passes, pooled specificity and sensitivity. Safety data were also analyzed. Results Twenty-four studies with 6641 patients were included and pancreas was the prevalent location of sampled lesions. Overall sample adequacy with the two newer needles was 94.8 % (93.1 % – 96.4 %), with superiority of Franseen needle over Fork-tip (96.1 % versus 92.4 %, P Conclusion Our meta-analysis speaks in favor of use of newer biopsy needles as a safe and effective tool in endoscopic ultrasound-guided tissue acquisition.

OBJECTIVE: Acute lower respiratory infections are an important cause of morbidity and mortality in developing countries. Recent randomized trials of zinc supplementation for the prevention of acute lower respiratory tract infections have revealed discrepant findings. The main aim of this study was to evaluate the prevalence of zinc deficiency and the effect of zinc supplementation on respiratory infections. MATERIAL AND METHODS: A single center, prospective open-label interventional single-arm pre-post study of the effect of oral zinc supplementation in zinc deficient children aged 6 months to 5 years was done. A total of 465 healthy children of age 6 months to 5 years were enrolled in the study for estimation of the prevalence of zinc deficiency. Children having zinc deficiency were recruited to study the efficacy and safety of oral administration of 20 mg zinc for two weeks during a 6-month follow-up period. RESULTS: There were statistically significant differences between the zinc deficient and non-deficient groups according to modified Kuppuswamy categorization of family status and exclusive breast feeding. There was significant difference in the mid arm circumference between the zinc deficient and non-deficient groups (p

Ovarian cancer is a heterogeneous disease that influences women worldwide, is diagnosed at an advanced stage in most patients, and has no effective screening tests for initial detection. The incidence of this cancer is 225,500 diagnoses per year worldwide, and it is the leading cause of death in women with gynecological cancer. Most patients are diagnosed at an advanced stage and have a poor prognosis. Therefore, better management strategies are needed to improve outcomes for women with advanced ovarian cancer.

Objective: COVID-19 has emerged as a multi-system disease with the potential for endocrine dysfunction. We aimed to study the hormonal profile of hospitalized patients with COVID-19 at a tertiary care referral hospital at Jodhpur, India. Design: A hospital-based clinical study of endocrine profile of COVID-19 patients conducted from 15th May to 30th June 2020 after ethical approval. Measurements: Fasting blood samples for free thyroxine (T4), free tri-iodothyronine (T3), thyroid stimulating Hormone (TSH), serum prolactin; basal and 1 h post-intramuscular adrenocorticotropic hormone (ACTH) stimulated cortisol, interleukin-6 (IL-6), and high sensitivity C-reactive protein (hsCRP) were collected within 24 h of admission after written informed consent. All hormones and IL-6 were analyzed by chemiluminescent immunoassay. hsCRP was measured by immune-turbidimetric assay. Results: Of 235 patients studied, 14% had severe disease and 5.5% died. Adrenal insufficiency was present in 14%, most of whom had mild disease. A robust adrenal response was observed in those with severe disease. Basal and post-ACTH serum cortisol were significantly increased in severe disease or those who died compared to those who were mild or asymptomatic. Basal and post-ACTH serum cortisol showed a significant positive correlation with hsCRP but not with IL-6. Low T3 and low T4 syndrome were documented in 25% and 5%, respectively. Serum TSH and FT3 levels declined significantly from asymptomatic to severe category. Hyperprolactinemia was found in 21 patients. hsCRP showed a rising trend with disease severity while IL-6 did not. Conclusions: Endocrine dysfunction in the form of adrenal insufficiency, low T3, and low TSH syndrome and hyperprolactinemia were common COVID-19 hospitalized patients.

Hypocalcemia is a laboratory and clinical abnormality that is observed especially in neonates and paediatric patients. Laboratory hypocalcaemia is often asymptomatic but it can manifest as central nervous system irritability, paraesthesia, tetany (i.e. contraction of hands, arms, feet, larynx, bronchioles), seizures, and even psychiatric changes in children. Cardiac function may also be impaired because of poor muscle contractility. We report a unique case of an eleven year old male child who presented with chronic kidney disease associated with severe hypocalcemia, tonic-clonic seizures, hypovitaminosis D but normal electroencephalogram and electrocardiography. The child required prolonged intravenous calcium gluconate therapy to correct his ionised calcium levels.

Background: Routine zinc supplementation is a potential intervention for the prevention of acute lower respiratory infections in developing countries. However discrepant findings from recent randomized trials remain unexplained. Methods: Single centre, single arm, prospective non-randomized, open label interventional study, of effect of zinc supplementation in zinc deficient children aged 6 months to 5 years. 465 healthy children aged 6 months to 5 years were enrolled in the study. The primary outcome was the prevalence of serum zinc deficiency. Children having zinc deficiency were recruited for the study of effect of oral administration of zinc 20 mg for 2 weeks. The secondary outcomes were incidence and duration of acute upper respiratory and acute lower respiratory infections per child-year and side effects after giving zinc therapy. Results: There was significant difference in mid arm circumference in between zinc deficient and non-zinc deficient groups (p < 0.001). Also the number of episodes of acute upper respiratory infections (AURI) and mean duration of AURI and acute lower respiratory infections (ALRI) was significantly different in the two groups (p < 0.001). There was no significant difference in ALRI episodes in two groups. After zinc supplementation in zinc deficient children, there was significant decrease in the number of episodes and mean duration of AURI (p < 0.001) and ALRI (p < 0.001) in six months after supplementation as compared to preceding six months before supplementation. Conclusion: This study sheds light on the efficacy of short course prophylactic zinc supplementation in reducing the burden of ARI among zinc deficient children. Future studies should assess the effectiveness of delivering prophylactic zinc supplementation at scale, comparing the feasibility and cost benefit of short course and continuous regimens. Clinical Trial Number: As it was a Non Randomized observational single arm study, study was not registered. Only RCT needs to be registered. Funding Statement: This study was funded by All India Institute of Medical Sciences (AIIMS), Manuscript Jodhpur, India, as a part of Intramural project conducted in the department of Pediatrics, AIIMS Jodhpur. Declaration of Interests: We declare no competing interests. Ethics Approval Statement: The study was approved by Institutional Ethics committee of All India Institute of Medical Sciences, Jodhpur, India. The study was conducted in accordance with ICH-GCP and other applicable regulatory guidelines.

Polycystic ovarian syndrome (PCOS) is one of the commonest endocrine pathies in women of reproductive age. We aimed to establish cardiovascular (CVD) risk factors in pre-menopausal Indian women with PCOS. Methods and Results: Study included 150 women (100 PCOS and 50 controls) from reproductive age (25-45 years). Both study groups were examined and analysed for anthropometric, clinical and biochemical parameters. Observations were subjected to statistical analysis using the descriptive statistics, Pearson’s coefficient of correlation and Multiple regression analysis. PCOS women presented with central adiposity (Waist circumference (cms) - 85.82 ± 12.16 v/s 78.84 ± 9.66p Conclusion: Obesity, IR, high pro-thrombotic and pro-inflammatory factors in Indian PCOS women indicate strong CVD risk and could cause cardiovascular complications in later life. Key words: Dyslipidemia, fibrinogen, HDL2c, hs-CRP, Insulin resistance, PCOS, sd LDLc.

Inadequate methods may cause substantial loss not only in the quantity but also in quality of the product. This study aimed to determine the best method for making single cell suspension for isolation of RNA and flow cytometer analysis from cancer tissue. We compared two methods of tissue disruption used during RNA isolation and flow cytometer analysis. Mechanical tissue disruption method and enzymatic tissue digestion method are commonly used for making single cell suspension before RNA isolation and flow cytometer analysis. 20 resected tissue samples were dissociated into single cells by mechanical and enzymatic methods. Quality and quantity of isolated miRNA was graded by the ratio of 260/280 nm and by running gels. The results revealed that mechanical hand held tissue homogenizer showed better yield than enzymatic (719.12 ± 513.67 vs. 524.87 ± 388.18 ng/µl) and the quality 260/280 nm ratio was significantly better [2.15 ± 0.21 vs. 1.57 ± 0.23; 95% CI (0.402–0.730); p

Metabolic syndrome (MS) is found to be more prevalent in patients with psychiatric disorders including depression. This study aimed to assess the association of inflammatory and liver markers with cardiometabolic risk factors in patients with Depressive disorders. Prevalence of MS by using Modified NCEP ATP-III Criteria and liver enzymes and CRP were assessed in 382 patients with depressive disorders. MS prevalence was 27.7% and lower HDL level was the commonest metabolic abnormality. ALT, GGT, and CRP levels were positively correlated with weight and BMI. ALT, GGT, and CRP levels were significantly greater in patients with abnormal waist circumference, triglyceride levels and raised blood pressure, compared to patients with normal indices. Such association was not found with abnormal HDL cholesterol and hyperglycemia. Levels of GGT and CRP were significantly greater in patients with MS compared to patients without MS and CRP was significant predictor for MS. To conclude, one-fourth of depressed patients had MS. MS and metabolic abnormalities were associated with inflammatory marker and liver enzymes. Patients with depression should be regularly evaluated for cardiovascular risk factors, liver enzymes, and inflammatory markers.

The aim was to evaluate the CVD risk in type 2 diabetes mellitus subjects on diagnosis using the traditional lipid profile and apo-proteins B and A1 in correlation with serum insulin and IR. The study was conducted on 280 subjects (100 Controls and 180 type 2 DM subjects) who first reported to our OPDs. We analysed FBG, serum Insulin, HOMA – IR, Lipid profile and apo –B and A1. There was a female preponderance, obesity, hyperinsulinemia, insulin resistance (IR) and diabetic dyslipidaemia (hypertriglyceridemia and reduced HDLc). Correlative analysis of BMI showed significant correlation with SBP, lipid profile (except HDLc) and apo –B. Similarly correlative analysis of serum insulin and HOMA –IR showed significant correlation with FBG, lipid profile (except HDLc with HOMA –IR which was Non – significant) and apo –B. CVD risk ratios T. Chol./HDLc and apo –B/apo –A1 showed a significant association with serum insulin and HOMA – IR. Type 2 diabetics from Western Rajasthan, especially those with high BMI, are at increased risk of complications due to atherosclerosis. The positive association of the two CVD risk ratios with serum insulin and IR showed that type 2 diabetics’ risk of developing CVD increases with rise in serum insulin and IR.

Background: There is a gross dearth of correlative data for cardiovascular diseases. Aim: We aimed to explore the association of systolic and diastolic blood pressure with anthropometric and biochemical parameters of hypothyroid patients in order to establish any correlation that may exist and be useful in an early diagnosis and management against cardiovascular risk. Materials and Methods: The study included 100 healthy controls and 150 newly diagnosed hypothyroid patients. Subjects were evaluated anthropometrically and biochemically for fasting blood sugar, triiodothyronine, thyroxine, thyroid stimulating hormone, Insulin, C-peptide, lipid profile, apo-B and apo-A 1 . The results were statistically analysed using unpaired t-test and Spearman's coefficient of Correlation. Results: The hypothyroids had a female preponderance (73.3%) however; their biochemical profiles were comparable with those of male counterparts. They had raised Body Mass Index, hypertension, hyperinsulinemia, insulin resistance, raised C-peptide, dyslipidaemia with raised apo-B and reduced apo-A 1 and strong association of systolic and diastolic blood pressure with insulin, insulin resistance, C-peptide and Total cholesterol/HDLc (TC/HDLc). Conclusion: Strong association of hypertension with serum insulin, IR, C -peptide and TC/HDLc hints significant contribution towards cardiovascular risk in hypothyroid adults of Jodhpur.

Type V hypertriglyceridemia in children is a rare condition since it has often been associated with obesity, type II diabetes, metabolic syndrome and hormone therapy. We encountered a case of massive hypertriglyceridemia (1900 mg/dl) in a 6 years old boy with complains of acute pancreatitis but no physical manifestations. There was no family history of sudden cardiac death, father and younger male sibling were found to be normal. The mother however had hypertriglyceridemia. The child was managed by dietary changes, omega 3 capsules and low dose fenofibrate. On follow up showed there was reduction in lipid profile and lipoprotein electrophoretic pattern showed bands for VLDL and chylomicron indicating type V hyperlipidemia. Early diagnosis via screening for lipid profile of such patients and their family can improve prognosis and quality of life of these children.

Microalbuminuria is an established cardiovascular risk indicator in diabetes, hypertension and the general population. There is lack of information on MAU in healthy obese Indian adults and an ongoing debate whether obese adults deserve targeted identification and clinical intervention for MAU and prediabetes. We aimed to screen the healthy obese, young (group I) and middle aged (group II) adults for prevalence of MAU and prediabetes and study its association with Framingham risk score. The study included 50 healthy obese young (20-30 years) and middle aged adults (31-50 years), attending the outpatient clinic of Dept. of Medicine for a duration of 2 months (July-August). The patients were screened for fasting blood sugar, lipid profile and MAU. Of the total patients 28 % had MAU, 32.14 % of which had prediabetes and 33.33 % had diabetes whereas 10 % were normoglycemic. The group I patients had 50 % cases of MAU and group II had 25 % patients with MAU. Group II 63.63 % pre-diabetics. The values of MAU obtained were correlated with age, gender, body mass index, systolic and diastolic blood pressure, FBS, waist to hip ratio using Pearson's Coefficient (p

Cardiovascular disease (CVD) is the leading cause of mortality all over the world. However, majority of CVDs are caused by risk factors that can be controlled, treated or modified, such as hypertension, cholesterol, overweight/obesity, tobacco use, sedentary lifestyles and diabetes. Various environmental toxicants like Lead (Pb) are also important preventable causes of variation in CVDs as reported in different human populations [1]. Although important measures have already been implemented in a number of countries to reduce environmental Pb exposure which includes the use of unleaded gasoline, Pb free paints, solder of canned foods, and glazed ceramics used for storage and preparation of food, it is still a major environmental health hazard in specific communities and targeted high-risk populations [2]. Pb intoxication has been found to be associated with hypertension and promotes atherosclerosis in experimental animals [2, 3]. Hypertensive effects of Pb has also been documented in workers chronically exposed to high Pb levels [4]. Several epidemiological and clinical studies have found a link between chronic Pb exposure and elevated blood pressure [1]. Although a dose–response relationship between Pb exposure and blood pressure has also been reported however shape of the dose response relationship is not completely elucidated, especially at low levels of exposure. It is still not clear what should be the lowest level of Pb exposure that shall not be associated with Pb toxicity and its impact on blood pressure, although in the available studies there seems to be no evidence of a threshold effect [5]. The precise mechanisms explaining a hypertensive effect of low chronic exposure to environmental Pb are unknown. Muntner et al. [6] has reported an inverse association between estimated glomerular filtration rate and blood Pb level at Pb concentration below 5 μg/dl in general population studies, indicating that Pb-induced reductions in renal function could play a major role in hypertension. Enhanced oxidative stress, down-regulation of nitric oxide, stimulation of the renin-angiotensin system and soluble guanylate cyclase are among other potential mechanisms which could result in increased vascular tone and peripheral vascular resistance [5]. Metal-mediated formation of free radicals may enhance lipid peroxidation and changes in calcium and sulfhydryl homeostasis. Pb by promoting the production of reactive oxygen species, triggers a cycle of oxidative stress and inflammation in target tissues. Depletion of sulfhydryl reserves in cells provides an indirect mechanism for redox-inactive metals induced oxidative stress. These findings suggest a possible involvement of oxidative stress in the pathophysiology of Pb toxicity. Although oxidative stress is one of the important factor in the pathophysiology of Pb toxicity, it is not clear whether these alterations are the cause of the oxidative damage or a consequence of it. Increased expression and production of inflammatory markers in association with Pb exposure have also been reported in humans [2]. Most of the data available have been drawn from experimental studies and there are few cohort studies that evaluate the association of Pb with clinical cardiovascular outcomes in general population settings. The National Health and Nutrition Examination Surveys (NHANES) II and III showed a statistically significant increase in cardiovascular mortality with increasing blood Pb levels, although there was an overall decline in Pb levels in the US adults. Similarly the British Regional Heart study showed positive but non-significant association of coronary heart disease or stroke with elevated Pb levels. However, the unresolved issue is the impact of uncontrolled confounding and measurement error on the relative risk estimates in studies of Pb and clinical cardiovascular end points. Similarly the validity of occupational studies on Pb and cardiovascular mortality is limited by different methodological problems like bias of observations in occupationally exposed workers, which cannot be extrapolated to general population [5]. Various factors, both conventional and novel risk factors have been shown to be responsible for the morbidity and mortality of patients with cardiovascular diseases. No attention has so far been given to environmental toxicants and other trace elements such as Pb, which can exacerbate the disease condition. A prospective pro-atherogenic effect, even if modest compared to other conventional risk factors would have a significant impact in sensitive population groups. In view of this it becomes important to explore the precise role and mechanism of Pb in development of atherosclerosis and CVD.

Metabolic syndrome or MS as it is called is a compilation of most of the non-communicable disease components which is a life style disease with strong genetic predisposition, culminating in a morbid adulthood. The increasing number of subjects under the umbrella of MS is alarming. Diabetes mellitus, hypertension is the end result of this insulin resistance as it is sometimes called. Apart from genes, it also has strong inflammatory components that are responsible for early onset of MS. MS is marked by a gamut of inflammatory and non-inflammatory markers. If diagnosed early by screening the population, the percentage of florid cases of this debilitating syndrome can be brought down. Active intervention and constant monitoring of affected or predisposed young subjects will curtail the progress of MS and prevent full blown diabetes and hypertension, thus reducing cardiovascular complications, other morbidity and early mortality. Prevention is always better than cure.

Aim: We aimed to diagnose latent diabetic hypothyroid patients presenting with symptoms of metabolic syndrome (MS) based on the Adult Treatment Panel-III (ATP-III) guidelines. Background: Type 2 diabetes mellitus (DM) coexisting with thyroid disorders is difficult to manage. With an ever-increasing incidence of both these disorders and an increasing risk of secondary complications due to their coexistence, newer correlative studies are needed for the early diagnosis of these diseases. Subjects and Methods: The present study was conducted on 100 healthy controls and 150 newly diagnosed hypothyroid patients. The patients were selected based on symptomatology and thyroid function tests. They were then analyzed for body mass index (BMI), blood pressure, fasting blood sugar (FBS), fasting serum insulin, homeostatic model assessment-insulin resistance (HOMA-IR), lipid profile, and apolipoprotein B (apo-B) and apolipoprotein (apo-A 1 ). Statistical Analysis: Analysis was done using the Students t test and Spearman's coefficient of correlation. Results: For hypothyroid patients who presented with raised BMI, diastolic hypertension and dyslipidemia were further investigated for underlying latent diabetes. Of the total hypothyroid patients, 53.3% had raised FBS, 48% had diastolic hypertension, 86.6% had hypertriglyceridemia and 66.67% patients fulfilled three conditions for MS as per the ATP-III guidelines. There was highly significant correlation of serum insulin and HOMA-IR with lipid fractions and cardiovascular disease (CVD) risk ratios (total cholesterol/high-density lipoprotein cholesterol) and apo-B/apo-A 1 in hypothyroid patients. Conclusion: All hypothyroid patients should be closely watched for presence of DM and MS for prevention of atherogenic dyslipidemia, which may lead to CVDs. The estimation of serum insulin, apo-A 1 and apo-B, along with the traditional lipid profile may be useful in such patients.

Aim: We aimed at evaluating the cardiovascular disease (CVD) risk of thyroid disorder patients at diagnosis, using the traditional lipid profile, apo-B and apo-A1 in correlation with serum insulin and insulin resistance (IR) and C-peptide. Background: With an ever increasing incidence of CVD in most urban populations, there has been a demand for newer techniques that could help in the early detection of the risk of this disease complex. Materials and Methods: The present study was conducted on 100 healthy controls and 150 hypothyroid and 70 hyperthyroid patients, coming for the first time to our OPDs. The patients were selected on the basis of symptomatology and serum T3, T4, thyroid stimulating hormone (TSH) evaluations. They were then analyzed for body mass index (BMI), blood pressure (BP), serum insulin, homeostasis model assessment-insulin resistance (HOMA-IR), C-peptide, lipid profile and apo-B and -A1. Statistical analysis was done using Student's “t” test and Spearman's coefficient of correlation. Results: The hypothyroid patients presented with high BMI, diastolic hypertension, dyslipidemia, hyperinsulinemia, IR and raised serum C-peptide. There was highly significant correlation of serum insulin, HOMA-IR and C-peptide with lipid fractions and CVD risk ratios, T. chol/HDLc and apo-B/apo-A1, in hypothyroid patients. The hyperthyroid patients presented with systolic hypertension and a significant correlation of T. chol/HDLc with HOMA-IR. Hyperthyroid patients also had hyperinsulinemia, but reduced serum C-peptide levels. Conclusion: We conclude that the estimation of traditional lipid profile along with serum insulin, IR, C-peptide, apo-A1 and apo-B would not only help assess the thyroid status, but can also help in the early evaluation of a possible risk of CVD.