Diagnostic strategies for subclinical hypothyroidism

The aim of this study is to delineate laboratory diagnostic strategies for subclinical hypothyroidism in patients who are clinically symptomatic but may have a normal thyroid profile. Tri — iodothyronine (T₃), thyroxine (T₄), thyroid stimulating hormone (TSH) and anti thyroid peroxidase antibodies (anti-TPO) were estimated on fasting blood samples from 99 patients using electrochemiluminescence methods on ELECSYS 1010 (Roche). 74% of study subjects had elevated anti-TPO levels.61% patients had subclinical hypothyroidism. 45 of the 61 subclinical hypothyroid patients had elevated anti-TPO levels (73%). This is an important finding suggesting an autoimmune etiology for subclinical thyroid dysfunction with a higher risk of developing overt hypothyroidism.     

Malnutrition-inflammation-atherosclerosis syndrome in Chronic Kidney disease

Chronic kidney disease is becoming a major health problem globally and in India an alarming number of about 8 million people are suffering from this disease. Patients undergoing hemodialysis have a high prevalence of protein-energy malnutrition and inflammation. As these two conditions often occur concomitantly in hemodialysis patients, they have been referred together as ‘malnutrition-inflammation-atherosclerosis syndrome’ to emphasize the important association with atherosclerotic cardiovascular disease. The three factors related to the pathophysiology in these patients are dialysis related nutrient loss, increased protein catabolism and hypoalbuminemia. Inflammation in Chronic Kidney disease is the most important factor in the genesis of several complications in renal disease. Pro-inflammatory cytokines like IL-1 and TNF-alpha play a major role in the onset of metabolic alterations in Chronic Kidney disease patients. Atherosclerosis is a very frequent complication in uremia due to the coexistence of hypertension, hyperhomocysteinemia, inflammation, malnutrition and increased oxidative stress, generation of advanced glycation end products, advanced oxidation protein products, hyperlipidemia and altered structural and functional ability of HDL. LDL-cholesterol, apolipoprotein (A), apolipoprotein (B), and Lp(a) are also associated with atherosclerosis. Studies have now provided enormous data to enable the evaluation of the severity of malnutrition-inflammation-atherosclerosis syndrome as well as effective monitoring of these patients.     

Immuno-Modulatory Effect and Therapeutic Potential of <Emphasis Type="Italic">Brugia malayi</Emphasis> Cystatin in Experimentally Induced Arthritis

Helminths are known to modulate host’s immune system and understanding this modulation can help in identification of novel therapeutic agents for autoimmune diseases. In this study, we have assessed the immune-modulatory activity and the therapeutic effect of Brugia malayi recombinant cystatin (rBmCys) in methylated BSA (mBSA) induced arthritis using rodent model. Administration of rBmCys has suppressed the severity of mBSA-arthritis in mastomys by reducing paw swelling and other clinical disease parameters as evident from significantly decreased arthritic index. The anti-arthritic effect of rBmCys was also confirmed by decreased histopathological score for synovitis, bone erosion and fibrosis in the tissue sections of paws. Further, this therapeutic effect of cystatin was found to be associated with significantly decreased production of IFN-γ and TNF-α and increased release of IL-4 and IL-10 cytokines. These results implied that rBmCys treatment has alleviated mBSA-induced arthritis and thus can be a promising alternative agent for the treatment of arthritis.     

Role of oxidative stress and antioxidants in aetiopathogenesis and management of oral submucous fibrosis

Lipid peroxidation product, malonaldehyde (MDA) and antioxidants were estimated in plasma and erythrocytes of 34 cases of oral submucous fibrosis (OSMF) of different grades with equal number of healthy controls to evaluate the association of reactive oxygen species (ROS) and OSMF. While plasma MDA was found to be significantly higher in patients (3.3±0.4 nmole/ml, P<0.001) as compared to controls (2.4±0.5 nmole/ml), plasma beta carotene and vitamin E levels were found to be decreased significantly in patients (81.7±14.3 μg/100 ml, P<0.001; 9.3±0.9 mg/L, P<0.01 respectively) with respect to healthy controls (110±20.8 μg/100 ml and 10.1±1.2 mg/L). The decrease in beta-carotene and vitamin E was found to be more significant in OSMF grade II and III than in grade I. After 6 weeks of oral administration of beta-carotene and vitamin E, patients showed increase in plasma level of these two antioxidants along with decrease in MDA level associated with clinical improvement.     

Estimation of Ischemia Modified Albumin (IMA) Levels in Patients with Acute Coronary Syndrome

Myocardial ischemia produces free radicals that catalyze a series of oxidative reactions that damage healthy tissues. The N-terminal sequence of albumin is one of the proteins modified by these highly reactive oxygen species and forms the ischemia modified albumin (IMA). This study involves investigations undertaken in different study groups to assess the levels of IMA. Mean serum IMA levels (U/mL) in patients with ST-segment elevated myocardial infarction (92.1 ± 10.6), non-ST-segment elevated myocardial infarction (87.3 ± 5.95) and unstable angina (UA) (88.9 ± 6.16) were significantly higher than non-cardiac chest pain (77.9 ± 6.69) and also healthy subjects (54.7 ± 17.2) (p < 0.001). IMA is a highly sensitive marker and has a high predictive value, which might prove the usefulness of this biomarker for early detection of myocardial ischemia. These data indicate a possible role of the IMA test in the early triage of patients with chest pain.     

A validated instrument measuring students' perceptions on plastinated and three-dimensional printed anatomy tools

Due to the modernization of the medical curriculum and technological advancements, anatomy education has evolved beyond cadaveric dissection alone. Plastination techniques, three-dimensional (3D) modeling, and 3D printing technologies have progressively gained importance. However, there are limited valid and reliable surveys to evaluate students' perceptions of these new anatomy tools. Hence, this study aimed to develop a validated instrument to measure students' learning satisfaction, self-efficacy, humanistic values, and perceived limitations of plastinated and 3D printed models. A 41-item survey (five-point Likert scale, 1 = strongly disagree to 5 = strongly agree) was administered to Year 1 undergraduate medical students following a randomized controlled crossover study that evaluated plastinated and 3D printed cardiac and neck models. Ninety-six responses were received, and a factor analysis was performed with the Kaiser–Meyer–Olkin sampling adequacy of 0.878. The confirmatory factor analysis yielded a 4-factor, 19 items model that had a good fit with the latent constructs of $x$² (147) = 211.568, P < 0.001, root mean square error of approximation = 0.068, root mean square residual = 0.064, comparative fit index = 0.946, and Tucker Lewis index = 0.937. The Cronbach's alpha for the individual factors ranged from 0.74 to 0.95, indicating good internal consistency. This demonstrated a psychometrically valid and reliable instrument to measure students' perceptions toward plastinated and 3D printed models.