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Background: Levosimendan is an effective calcium sensitizer with complementary mechanisms of action: calcium sensitization and opening of adenosine triphosphate-dependent potassium channels, both on the sarcolemma of the smooth muscle cells in the vasculature and on the mitochondria of cardiomyocytes. Levosimendan has a long-acting metabolite with a half-life of approximately 80 h. There have been a few small studies on this drug regarding right ventricular function. In view of this, we investigated the effect of levosimendan on right ventricular function in patients with coronary artery disease. Methods: This was a prospective, randomized, double-blind study on 50 patients with coronary artery disease and severe left ventricular dysfunction (left ventricular ejection fraction ≤35%) undergoing elective off-pump coronary artery bypass. Results: Levosimendan had an inotropic effect on right ventricular myocardium and a vasodilatory effect on blood vessels. It caused a decline in pulmonary vascular resistance (p < 0.018), right ventricular systolic pressure (p < 0.001), and pulmonary artery systolic pressure (p < 0.001), and improved right ventricular diastolic function as shown by the decrease in right ventricular Tei index (p < 0.001), right ventricular end-diastolic pressure, and the ratio of early diastolic tricuspid inflow to tricuspid lateral annular velocity (p < 0.006). However, we found no beneficial effects on intensive care unit or hospital stay (p = 0.164, p = 0.349, respectively) nor a mortality benefit. Conclusions: Levosimendan has salutary effects on right ventricular function in patients with severe left ventricular dysfunction undergoing coronary artery bypass, in terms of improved hemodynamic parameters. [ABSTRACT FROM AUTHOR]

Background: Euthyroid state is preferred for cardiovascular system. The most common cause of cardiovascular disease is atherosclerosis. Studies have suggested anti-atherosclerotic effect of thyroid hormone but some recent clinical trials have failed to show an association between thyroid function and cardiovascular events, indicating that the relationship between thyroid hormone and atherogenesis is still not conclusive. Methods: Study was conducted on 90 premenopausal females in each group with subclinical hypothyroidism, overt hypothyroidism and healthy controls. Patients were ruled out for cardiovascular disease or any other condition which would have influenced the parameters under study. After overnight fasting, 6 mL venous blood sample was collected. hs-CRP, PAI-1, APC levels were estimated by ELISA and NO levels by modified Griess method. Results: We found that APC levels were significantly decreased and PAI-1, hs-CRP and NO levels were significantly increased in patients with overt hypothyroidism as compared to controls. APC levels were and PAI-1were not significantly different whereas hs-CRP and NO levels were significantly increased in patients with subclinical hypothyroidism as compared to controls. Conclusion: Premenopausal females are generally considered to be at lower risk of cardiovascular disease because of protective action of estrogen but chances of cardiovascular disease due to atherosclerosis increase in females with overt hypothyroidism, which represents a potential hypercoagulable, inflammatory state with endothelial dysfunction. Females with subclinical hypothyroidism also have higher preponderance of atherosclerotic risk factors like endothelial dysfunction and inflammatory state. So, we suggest early screening of risk factors of atherosclerosis in premenopausal females with hypothyroidism. [ABSTRACT FROM AUTHOR]

Normal level of thyroid hormones is important for normal hepatic function and thyroid dysfunction may modulate metabolic function of liver. The purpose of this study is to determine whether liver function is associated with subclinical and overt hypothyroidism. Thyroid and liver function tests were evaluated in 47 patients with overt (TSH ≥10.0 mIU/L) and 77 patients with subclinical hypothyroidism (TSH 6.0-9.9mIU/L) and compared with 120 age-matched euthyroid controls. Subjects with overt hypothyroidism had significantly raised serum ALT, AST, ALP and total protein levels as compared to controls whereas subclinical hypothyroid patients had significantly increased levels of serum ALT, ALP and total protein. Further, TSH showed significant positive correlation with AST and ALP values whereas fT3 and fT4 had a negative correlation with AST in overt hypothyroidism. Thus, overt hypothyroid state is associated with significant derangement in biochemical parameters of liver function. Hence, liver function should be regularly monitored in hypothyroid patients. [ABSTRACT FROM AUTHOR]

The association between overt hypothyroidism (OH) and altered lipid profile is well known, however the significance of dyslipidemia in subclinical hypothyroidism (SCH) remain controversial. Therefore, this study was conducted to determine any association between lipid profile and different degrees of thyroid dysfunction. Thyroid and lipid profile parameters were analysed in 58 patients with overt (TSH = 10.0 μIU/L and/or abnormally low fT4 and fT3 levels) and 87 patients with subclinical hypothyroidism (TSH 6.0-9.9 μIU/L with normal fT4 and fT3 levels) in this case-control study. These were compared with 100 age- and sex-matched euthyroid controls. It was found that only mean serum level of total cholesterol in patients with SCH was significantly high from that in controls (p=0.045). Other lipid parameters did not show any statistical significance. Whereas patients with OH had statistically significant higher levels of total cholesterol (p<0.001), triglyceride (p<0.05), LDL-C (p<0.001) and VLDL-C (p<0.05). There was also an increase in HDL-C in both SCH and OH group though not significant statistically. In conclusion, lipid profile is not much deranged in SCH whereas OH is a major cause of secondary dyslipidemia which may lead to increased risk of coronary artery disease. Therefore, thyroid hormone replacement would be most beneficial in patients with OH instead of SCH. However, patients with SCH should be monitored for deterioration of thyroid function and dyslipidemia at regular intervals. [ABSTRACT FROM AUTHOR]

Gestational Diabetes Mellitus (GDM) exposes women to a higher risk for development of type 2 diabetes mellitus in later years of life. Newborns of mothers with GDM are at increased risk for acute perinatal complications including hypoglycaemia, jaundice and being large for gestational age. One of the mechanisms underlying glucose metabolism in pregnancy are a group of substances, which includes leptin and adiponectin, produced mainly in the adipose tissue; in this paper we analyze the role of these mediators in women with GDM. This case control study was performed in 90 females (30 GDM patients and 60 control subjects without GDM) referred to a tertiary care hospital. Blood samples were analyzed for fasting blood glucose, leptin and adiponectin. Leptin and Adiponectin were analyzed using ELISA technique. In our study, the levels of fasting blood glucose were statistically significantly higher (p=0.000) in gestational diabetes patients as compared to controls. There was statistically significant positive correlation between blood glucose and leptin (p = 0.000, r = 0.585). There was statistically significant negative correlation between blood glucose and adiponectin(p = 0.000, r = -0.661). An amplification of the low-grade inflammation already existing in normal pregnancy may lead to increase in leptin and decrease in adiponectin. These factors may play a role in development of gestational diabetes mellitus. Further studies are required for establishing them as a marker for gestational diabetes mellitus. [ABSTRACT FROM AUTHOR]

Introduction: Down Syndrome (trisomy 21) provides an interesting natural model to study atherosclerosis, since these individuals appear to be protected from plaque formation. Methodology: We assessed the lipid levels, and superoxide dismutase (SOD) activity in 32 clinically diagnosed children of Down syndrome and 34 children matched for age and sex as controls. Results: SOD activity was found to be significantly higher (p=0.004) in children with Down Syndrome (mean=313.7 IU/ml) than in controls (mean140.2 IU/ ml). Significantly higher levels of serum triglyceride (154.7 mg/dl) and VLDL (33.9 mg/dl) were observed in Down Syndrome as compared to healthy controls (119.6 mg/dl and 23.9 mg/dl respectively; p<0.05 for each). However, the two groups did not show any significant difference in levels of serum HDL-C, LDL-C. Conclusion: The raised antioxidant activity of SOD, because of over expression of genes situated non chromosome 21, probably offers some protection against the development of atherosclerosis despite the occurrence of dyslipidemia. [ABSTRACT FROM AUTHOR]