Background: Alcoholic liver disease (ALD) is most prevalent in Sikkim where its consumption is a common practice and accepted socially. Materials and methods: Fifty male patients and normal healthy groups were taken for the study. Direct and total bilirubin, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase (ALP), and reduced glutathione along with the relationship with age group and ethnicity were assessed. Results and conclusion: Biochemical parameters such as direct (1.6 ± 1.0) and total bilirubin (2.9 ± 1.5), aspartate aminotransferase (68.7 ± 1.629), alanine aminotransferase (29.8 ± 6.5), ALP (1.4 ± 3.4), gamma-glutamyl transferase (1.18 ± 8.4) were observed to be increased and oxidative stress markers like glutathione was decreased in patients with alcoholic liver disease. Highest number of patients with the disease were between 36 and 46 years (44%) of age and in Kiratis (40%). This is a first attempt to study the ALD based on age group and ethnicity. Various programs should initiated to prevent alcohol abuse.

Background: Lead is the toxic heavy element in the environment. Human exposure to lead and its compounds occurs mostly in lead-related occupations such as car repair, battery manufacturing and recycling, refining, smelting. Lead is a highly poisonous metal affecting almost every organ in the body. Lead inhibits necessary enzymes required for heme synthesis, and this results in increased levels of delta-aminolevulinic acid (δ-ALA) excretion through urine. Aim: To estimate the urinary δ-ALA acid levels in garage workers as an index of lead exposure. Materials and methods: This is a cross-sectional study in Mumbai from different suburban localities. The study was done on 72 garage workers of age group between 18 years and 50 years with their brief history related to lead exposure. Their urine samples were analyzed for δ-ALA by Ehrlich method. Results: According to our observation, it was found that out of 72 urine samples 19 samples (26.38%) have urinary δ-ALA levels below reference value (<5 mg/L), while 53 samples showed increased urinary δ-ALA levels (73.61%); out of these, 45 workers (84.90%) fall in the moderate-to-high exposure level category (5 or >5 to 20 mg/L), 8 workers (15.09%) fall in the dangerous—very high exposure level category (20 or >20 to 40 mg/L). Conclusion: The prevalence of lead exposure among our study population is 73.61%. Clinical significance: We conclude that there is high prevalence of lead exposure in garage workers in Mumbai, and necessary precautions need to be taken to avoid it.

Background: Diarrhea, vomiting, and excessive sweating are common features of tuberculosis (TB) infection and have been described as possible cause of loss of water and electrolyte fluid–electrolyte and acid–base derangement frequently encountered in TB and have been found to be a major factor for development of acute renal failure. In view of this associated water and electrolytes derangement and cytochemical changes in TB, this study was undertaken to evaluate common electrolytes status in patients with TB from that of normal healthy individuals. Objectives: The objective of this study was to evaluate the imbalance of some electrolytes like serum sodium, potassium, chloride, and bicarbonate among patients infected with mycobacterium TB in comparison with the normal healthy individuals at BRIMS Teaching Hospital, Bidar. Materials and methods: This was observational study conducted among the patients attending department of pulmonary medicine at BRIMS Teaching Hospital, Bidar. Demographic data and serum electrolytes levels were analysed among those diagnosed with TB patients and compared with normal individuals. Results: Fifty normal individuals (group I) and 50 newly diagnosed TB patients (group II) were included in the study. In the newly diagnosed TB patients, there was a significant (p < 0.001) decrease in sodium and potassium levels and increase in chloride and bicarbonate values compared with normal control group. The odds of having hyponatremia and hypokalemia among the newly diagnosed TB patients were 2.57 and 0.92, respectively, as compared to normal healthy individuals. Conclusion: Our results revealed that the electrolyte imbalance was significantly associated with the newly diagnosed TB patients as compared to the normal healthy individuals. Because of the high incidence of the electrolyte disturbances in TB patients, close monitoring and aggressive management are mandatory.

Introduction: Acne vulgaris, a common dermatological disorder, is often associated with excess sebum production. Studies indicate acne and serum lipid profile pathophysiology and its association need further exploration. This study was done to evaluate the relationship and association between plasma lipid profile and acne. Materials and methods: A case–control study with group I containing 100 patients with acne vulgaris and group II containing 100 age- and gender-matched healthy volunteers as the control group. The lipid profile parameters were estimated in the cases and controls. Results: Serum total cholesterol, triglyceride, HDL, and LDL levels were measured. The predominant acne grade was grade II. Total cholesterol, triglyceride, and LDL levels were statistically higher than in the healthy control (significant with p < 0.05), whereas HDL level was insignificant. When lipid profiles between male and female were compared, there were no significant differences in both sexes between acne patients and controls. Total cholesterol, triglyceride, and LDL levels in patients with mild, moderate, and severe acne patients were statistically significant and correlated with the severity of acne. Conclusion: Acne patients are more frequently associated with altered lipid profile parameters, particularly with both moderate and severe acne. This deranged lipid parameters provide a new route for further exploration in the pathogenesis and also treatment aspects of acne vulgaris.

Introduction: Police officers are facing enormous stress due to unpredictable working hours, irregular diet, disrupted sleep patterns, and different types of physical and mental disorders. The present study was conducted to evaluate the risk factors for the development of cardiovascular disorders, metabolic syndrome (MetS), and diabetes mellitus in police officers. Materials and methods: The study included a total of 800 participants (400 policemen and 400 controls). Along with questionnaire, biochemical, and anthropometric measurements were included in the present study. Statistical analysis: SPSS was used for statistical analysis. Results and conclusion: Present study reported increased risk factors like dyslipidemia, hypertension, obesity, and diabetes mellitus, which are predisposing factors for the development of cardiovascular disease (CVD) and MetS.

Commonly the reference values used in most of the laboratory are based on the western population. These usually do not have similarity with the Indian population; this is seen especially in case of the lipid profile. Clinicians all over the world use these reference values to interpret the results obtained in patients, it should correctly impersonate the defined population having close comparison with the patient coming for investigation.¹ There is no well documented evidence for the establishment of reference levels for lipids parameters for the Indian population, so there is a need for large scale study on lipid profile of Indian population.² Materials and methods: This is a cross-sectional study, including 200 subjects in total (according to CLSI guidelines). We analyzed total cholesterol, triglycerides, HDL-cholesterol by standard methods and, LDL-cholesterol was calculated using Friedewald's formula. Results: Median values and ranges (2.5–97.5th percentile) in mg/dL for fasting and nonfasting total cholesterol (TC), triglycerides (TG), HDL-C, VLDL, LDL-C were: 116–239 (189), 38.8–172.4 (84), 30.9–72 (48), 7.7–42 (17.2), 59.5–177.0 (124.6), 119.9–255.1 (189), 43.9–278.6 (120), 25.5–67.1 (44), 8.7–55.7 (24.6), 50.8–178.6 (118.6), respectively. After grouping them according to age and sex, we observed that HDL-C was significantly wider in females compared to males, TC was not significantly wider, but TG was higher in males. In the age group 39–48 years TC, TG, HDL-C and LDL-C in males were higher as compared to females of that age group. Conclusion: Reference ranges are wider as compared to western standard, which is due to variation in diet, ethnicity, environment, etc. Hence this can be considered as the reference interval for this study population, further study is needed in a larger population.

Background: Obesity has emerged as one of the most serious public health concerns in the twenty-first century. Currently, bariatric surgeries are considered to be the only successful, long-term therapy available for weight loss in morbid obese subjects. Recent research has focused on sleeve gastrectomy (SG) as a “cure” for comorbid conditions like diabetes mellitus. Materials and methods: This hospital-based prospective study was conducted in 50 morbid obese subjects with type 2 diabetes mellitus (T2DM) aged 20–40 years to evaluate glycemic indices and insulin resistance before and after SG at 9 and 12 weeks. Fasting plasma glucose was estimated using the glucose oxidase peroxidase method and serum insulin by the electrochemiluminescence method in automated analyzers. Insulin resistance was calculated using the homeostatic model assessment of insulin resistance (HOMA-IR) calculator. Data analysis was done using SPSS ver. 18 employing the ANOVA and Tukey's post hoc test. Results: A total of 50 cases were included in the study (19 women, 31 men; aged 20–40 years; duration of diabetes <10 years). Fasting plasma glucose and HOMA-IR decreased significantly (p < 0.05) at 9 and 12 weeks follow-up after SG. Conclusion: The present study conducted in morbid obese patients with T2DM highlights the fact that SG procedure showed early beneficial effects on the glycemic status as well as an improvement in the insulin sensitivity rather than an increased insulin secretion. Clinical significance: The improved glycemic status in this study along with an understanding of the underlying mechanisms could not only provide an insight into the pathophysiology of “diabesity” but also assist in the development of a better therapeutic approach for long-term remission of diabetes in obese patients.

Asymmetric dimethylarginine (ADMA) is now well established as a major risk factors for cardiovascular disease (CVD) impact upon endothelial function by decreasing nitric oxide (NO°) bioavailability. Asymmetric dimethylarginine, an endogenous analog of L-arginine, is able to inhibit the activity of endothelial-nitric oxide synthase (eNOS), promoting endothelial dysfunction. Prediabetes is characterized by a reduced endothelium-dependent vasodilation and increased ADMA levels. Asymmetric dimethylarginine is strongly associated with micro- and macrovascular diabetic complications. Asymmetric dimethylarginine activity is strongly correlated with CVD in prediabetes. Materials and methods: This study was a cross-sectional, descriptive type of study. In total, 815 participants were involved in this study, out of which 250 suffered from type II diabetes and 265 were prediabetic patients. 290 controls were involved from hospital OPD. Biochemical parameters including fasting plasma sugar, postprandial plasma sugar (after 2 hours of 75 g oral glucose), fasting lipid profile (serum total cholesterol (TC), low-density lipoprotein (LDL) cholesterol, triglycerides (TG), high-density lipoprotein (HDL) cholesterol, very low-density lipoprotein (VLDL) cholesterol) were done by enzymatic methods. The quantitative sandwich enzyme immunoassay technique was used to determine plasma ADMA level by using commercially available enzyme-linked immunosorbent assay. Results: The level of ADMA in prediabetes was 0.55 ± 0.11 and of type II diabetes was 0.70 ± 0.14 compared with controls (0.41 ± 0.14). p value was <0.05, which was significant. In the present study, there was a significant increase in serum TC, TG, LDL, VLDL, TG/HDL, and LDL/HDL ratio compared with those of normal healthy subjects, while HDL was significantly decreased in prediabetic as compared to normal healthy subjects. Conclusion: The current study shows that increased ADMA levels can indicate the risk of CVD in prediabetic stage. Prediabetes people are under risk of CVD and type II diabetes. Individuals who are prediabetic are at risk of CVD and type II diabetes. The evaluation of the ADMA levels may improve the early diagnosis of CVD of prediabetes.

Introduction: Infertility is one of the major health concerns among women of reproductive age group. Food habits and sedentary life style has lead to obesity among young women. With obesity, the incidence of infertility is on the raise in the last decade. Imbalance of sex hormones like FSH, LH, prolactin, estrogen, progesterone and testosterone contributes to the female infertility. Obesity also plays a significant role on reproductive system contributing to female infertility. The adipokines secreted from adipose tissue also to be evaluated to understand its role on infertility. Adipokines, like adiponectin, leptin, resistin and visfatin secreted from adipocytes, influence the reproductive organs via various mechanisms. So it is essential to evaluate the adipokines and sex hormones for better understanding of infertility and hence help in the treatment of infertility. Aim: To estimate the levels of fasting blood sugar, triglyceride, total cholesterol, HDL, LDL, VLDL, insulin, insulin resistance, FSH, LH, testosterone, prolactin, leptin, adiponectin, visfatin and resistin among infertile women and compare with fertile women of reproductive age group. Materials and methods: Fifty women with unexplained infertility were included as cases and fifty fertile women in reproductive age were included as controls. Results: BMI, waist/hip ratio, insulin, insulin resistance was significantly high in cases than controls. FSH, LH, prolactin, testosterone was high in cases compared to controls. Adiponectin was low in cases than controls, whereas leptin, visfatin and resistin was high in cases than controls. Conclusion: Sex hormones have influence on adipokines indicating role of adipokines in infertility.

Background: Elevated serum levels of pancreatic enzymes are frequently observed in end-stage renal disease (ESRD) in the absence of pancreatic diseases. Aim: Evaluate the prevalence of elevated pancreatic enzymes in patients on maintenance hemodialysis (HD) and compare it with healthy controls. Materials and methods: Serum amylase (SA) and serum lipase (SL) levels were evaluated in 20 patients on maintenance HD (group I) and compared with levels in 25 healthy controls (group II). Results: In group I, hyperamylasemia and/or hyperlipasemia were found in 14 (70%) patients. Abnormal levels of both SA and SL simultaneously were noted in 7 (35%); however, hyperamylasemia and hyperlipasemia only were noted, respectively, in 11 (55%) and in 10 (50%) patients. There was a significant moderate positive correlation between SA and serum creatinine (103.8 ± 50.6 vs 89.9 ± 20.9; r = 0.48; p = 0.029), and between SL and serum creatinine (61.2 ± 40.1 vs 89.9 ± 20.9; r = 0.47; p = 0.034) in group I. Mean SA values were significantly higher in group I in comparison with group II: 103.8 ± 50.6 vs 64.1 ± 31.5 U/L; p = 0.005, and mean SL values were significantly higher in group I in comparison with group II: 61.2 ± 40.1 vs 31.8 ± 17.7 U/L; p = 0.002. Conclusion: Our results indicate that elevated serum levels of pancreatic enzymes in ESRD patients on maintenance HD is slight but frequently occurs. There is a general agreement that reduced glomerular filtration rate would be the cause. The occurrence of hypothetical concomitant pancreatic damage has been suggested and the complex hemodynamic, biochemical, and physiological alterations in uremia were speculated to cause an excessive release of pancreatic enzymes.

Background and aim: Metabolic syndrome (MS) is a constellation of atherosclerotic risk factors and identifies patients who are at high risk for diabetes mellitus and cardiovascular disease (CVD). The interrelationship between gamma glutamyl transferase (GGT), obesity, and other metabolic disturbances raises the possibility that elevated GGT levels can help predict the risk of CVD in patients with MS and was proposed as a component of MS. Materials and methods: Patients with type 2 diabetes mellitus, presenting with central obesity, were enrolled as cases if they satisfied criteria for diagnosis of MS. Serum GGT levels were measured in cases as well as age- and gender-matched controls to assess the significance of difference, if any. Results: On analysis, we found an important association between serum GGT levels and MS, as shown by a significant difference in the levels of GGT in cases as compared to controls and the range of area under curve (AUC) for GGT was 0.648–0.827. Conclusion: Gamma glutamyl transferase may play a role in early diagnosis of MS with a high predictive value for both MS and risk for CVD, due to its association with insulin resistance. It is independent of other confounding factors. Due on its wide availability, simplicity, and universal standardization, GGT has the potential to be considered in algorithms for MS. Clinical significance: Including a raised GGT in the criteria for MS could increase its predictive nature for CVD. Considering the CVD risk, primary prevention may be emphasized in patients of MS with high GGT values.

Aim: The study aims at evaluating the glycated hemoglobin and serum sialic acid as risk factors in patients with myocardial infarction, who are nondiabetic. Materials and methods: This is a case-control study performed on the population of north coastal Andhra Pradesh. All the subjects got admitted to King George Hospital/Andhra Medical College which is a major referral hospital to the people of north coastal Andhra Pradesh. One hundred subjects participated in the study, of which 50 had myocardial infarction and are nondiabetic, and the rest are controls who never had myocardial infarction. Glycated hemoglobin and serum sialic acid levels were estimated, and results analyzed for the association. Statistical analysis was done using SPSS software. Results: Glycated hemoglobin and serum sialic acid levels are significantly increased in patients with myocardial infarction who are nondiabetic. Conclusion: Persistent hyperglycemia levels not surmounting to diabetes can be a significant risk factor in the development of myocardial infarction. Clinical significance: This study helps us to identify the role of persistent hyperglycemia not mounting to diabetes as a significant cardiovascular risk factor.

Gilbert' syndrome (GS), most common hereditary cause of unconjugated hyperbilirubinemia due to polymorphisms in uridine diphosphate glucuronosyltransferase (UGT) enzyme, was first described by Augustin Nicolas Gilbert and Pierre Lereboullet in 1901. It becomes apparent around adolescence and often precipitated by prolonged fasting, intercurrent illness, or strenuous exercise. Gilbert's syndrome has an excellent prognosis and does not require any treatment. But recent studies have shown that patients with GS are more susceptible to enhanced toxicity of several drugs using UGT enzyme in their metabolism. Also, hyperbilirubinemia is protective due to its anti-inflammatory, anti-oxidant, and anti-cancer properties, particularly in colon cancer. In India, followers of different religious practice a ritualistic prolonged fastings, which can predispose susceptible cases of GS to unconjugated hyperbilirubinemia. We report a rare case of GS unmasked by ritualistic prolonged fasting of Chhath Puja in Bihar to increase awareness about it among medical fraternity and patients.