RAJIV GANDHI UNIVERSITY OF HEALTH SCEINECS,
KARNATAKA , BANGALORE.
PROFORMA FOR REGISTRATION OF SUBJECTS
1 Name of the candidate. Dr. K.P.LATHA
Address (in Block Letters). #25, 1ST CROSS, 3RDMAIN ROAD,
NAGARBAVI MAIN ROAD,
2 Name Of The Institution Kempegowda Institute of
3 Course Of Study and Subject M.D. in Biochemistry
4 Date of Admission to Course 31st MAY, 2007.
5 Title Of Topic SERUM LIPIDS AND LIPOPROTEIN (a)
LEVELS IN PSORIASIS.
6 Brief resume of the intended
6.1 Need for the Study Enclosed
6.2 Review of Literature Enclosed
6.3 Objectives of the Study Enclosed
7 Material and Methods
7.1 Source of Data
7.2 Method of collection of Enclosed
procedure ,if any)
7.3 Does this study require
Any investigations or Enclosed
Interventions to be
conducted on patients or
Other humans or animals?
If so, describe briefly.
7.4 Has ethical clearance
been Obtained from your Enclosed
institution in case of 7.3
8 List Of References Enclosed
9 Signature of the Candidate
10 Remarks of the Guide This study is undertaken to determine the
levels of lipids and lipoprotein (a) in
psoriatic patients which predicts the risk of
11 Name and Designation of
(in block Letters)
11.1 Guide Dr. A. S. ANIL KUMAR
Department of Biochemistry,
Kempegowda institute of Medical Sciences,
11.3 Co-Guide(if any) Dr. M.G.GOPAL
PROFESSOR & HEAD,
Department of Dermatology,
Kempegowda Institute of Medical Sciences,
11.5 Head of the Dr. K. L.MAHADEVAPPA
Department PROFESSOR & HEAD,
Department of Biochemistry,
Kempegowda Institute of Medical Sciences,
12 12.1 Remarks of the
Chairman & Principal
6.0 BRIEF RESUME OF THE INTENDED WORK:
6.1 NEED FOR THE STUDY:
The etiology of psoriasis is unknown, but genetic, metabolic and immunologic
mechanisms have been proposed(1). The loss of scale from the surface observed
in the course of psoriasis may be related to lipid disorders in epidermis and in
Studies have demonstrated that patients with psoriasis may have an increased
risk of noncutaneous diseases , including arterial and venous occlusive diseases.
Changes in plasma lipid and lipoprotein (a) [Lp (a)] composition may be the
reason for increased risk of atherosclerosis in psoriasis(3).
It has been suggested that increased reactive oxygen species (ROS) production
and deficient function of antioxidant system activities may be involved in the
pathogenesis of psoriasis(4).
Hence this study intends to determine the levels of serum lipids, lipoprotein (a)
and malondialdehyde levels in psoriatic patients.
6.2 REVIEW OF LITERATURE:
Psoriasis is a common chronic and recurrent inflammatory skin disease that can
occur due to abnormalities in essential fatty acid metabolism, lymphokine
secretion, free radical generation, lipid peroxidation and eicosanoid metabolism
and has been associated with increased frequency of cardiovascular events(5) .
Abnormalities in lipid metabolism have been considered to play an important
role in the pathogenesis of psoriasis and patients with psoriasis may have
increased risk of arterial and venous occlusive diseases(7) . Alterations in plasma
lipid and lipoprotein composition including a tendency toward an increase in
total cholesterol (TC), triglyceride(TG), low density lipoprotein cholesterol
(LDL-C) and decrease in high-density lipoprotein cholesterol (HDL-C) levels
suggest that psoriasis may be associated with the disorders of lipid
Increased lp(a) level may be a factor involved in occlusive vascular disorders in
patients with psoriasis and that patients with extensive and severe skin
involvement are more predisposed to relatively high lp(a) levels(2,3) .
Evidences suggest that chronic inflammation, a characteristic feature of
psoriasis, per se may play a role in the initiation and prognosis of dyslipidemia
and atherosclerosis(6) .
Inadequate antioxidant protection or excess ROS production results in oxidative
stress, contributing to the development of cutaneous diseases and disorders.
Increased ROS production during the inflammatory process in psoriasis, as a
result of insufficient antioxidant mechanisms, may result in increased lipid
peroxidation. ROS induced oxidation of polyunsaturated fatty acids in
biological systems results in the formation of lipid peroxidation products such
as malondialdehyde (MDA).Higher plasma levels of MDA has been reported
in psoriasis(4,5) .
6.3 OBJECTIVES OF THE STUDY:
1 To determine the serum lipid disturbances in psoriasis.
2 To assess the significance of lipoprotein (a) levels in psoriasis.
7. MATERIALS AND METHODS:
7.1 SOURCE OF DATA
The study will comprise cases of psoriasis visiting the inpatient and
outpatient department of Dermatology of Kempegowda Institute of
Medical Sceinces, Bangalore.
Age and sex matched healthy volunteers will serve as controls.
Study duration : January 2008 to May 2009.
Study design : Comparative study.
Sample design : Purposive sampling.
Total Number of Subjects : 60
Number of controls : 30
Number of Psoriasis cases : 30
Inclusion Criteria : Cases of Psoriasis in the age group
of 15-75 years.
Exclusion Criteria : Diabetes, hypertension, obesity,
family history of hyperlipidemia, renal
and liver failure, endocrine disorders,
taking systemic drugs especially lipid
lowering agents, smoking and alcohol
Blood and urine samples would be collected after an informed written
Data for the study will be collected from all those who fulfill the
inclusion and exclusion criteria on a purposive sampling using a pretested
structured questionnaire basis by obtaining a written informed consent.
The data collected will be analysed statistically by computing descriptive
statistics namely mean, standard deviation, range, chi-square test and any
significant difference between the mean values of study group and
control group will be tested using independent sample student t- test.
7.2 METHOD OF COLLECTION OF DATA:
Blood: 5 ml plain venous blood sample after overnight fasting will be
obtained by venepuncture. This will be followed by centrifugation and then
sample will be processed immediately after collection.
Urine: Overnight fasting urine sample will be collected in a clean dry
container and will be tested immediately.
1. Plasma glucose will be tested by Glucose Oxidase Method.
2. Plasma urea will be determined by Urease/ Glutamate
3. Plasma creatinine will be estimated by Jaffe’s Alkaline Picrate
4. Serum Total cholesterol will be estimated by enzymatic method.
5. Serum Triglycerides will be determined by enzymatic method.
6. Serum HDL- Chlolesterol by phosphotungstate method.
7. Serum VLDL-Cholesterol is calculated according to the formula:
VLDL=TG / 5.
8. Serum LDL- Cholesterol is calculated by Friedwald’s equation.
9. Total Ch/ HDL and LDL-C/HDL-C ratio will be determined.
10. Lipoprotein (a) will be determined by turbidimetric immunoassay.
11. The extent of oxidative stress will be evaluated by measuring
Thiobarbituric acid reaction that reflects Malondialdehyde
12. Urine albumin and Urine sugar will be determined by dipstick
7.3 Does the study require any investigations or interventions to be
conducted on patients or other humans or animals? If so, Please
Study does not include any animal experiments .The following investigations
will be carried in Psoriatic cases and healthy controls after taking informed
1. Plasma glucose
2. Blood Urea
3. Plasma Creatinine
4. Lipid Profile
Total Cholesterol/HDL – C ratio
6. Thiobarbituric Acid reacting substances (MDA levels are determined).
7. Urine albumin and Urine Sugar.
7.4 Has the Ethical clearance obtained from your institution in case of 7. 3.
8. LIST OF REFERENCES:
1. Nilgun Solak Tekin, Ishak Ozel Tekin, Figen Barut, Emine Yilmaz
Sipahi. Accumulation of oxidized low-density lipoprotein in psoriatic
skin and changes of plasma lipid levels in psoriatic patients. Mediators of
inflammation 2007; article ID 78454:5 pages.
2. Javidi Z, Meibodi N T, Nahidi Y. Serum lipids abnormalities and
psoriasis. Indian J Dermatol 2007; 52: 89-92.
3. Seckin D, Tokgozoglu L, Akkaya S. Are lipoprotein profile and
lipoprotein (a) levels altered in men with psoriasis? J Am Acad Dermatol
1994; 31: 445-449.
4. Kiyamet Baz, Burak Cimen M.Y, Aysin Kokturk,et al. Oxidant/
antioxidant status in patients with psoriasis. Yonsei Medical Journal
2003; 44(6): 987-990.
5. Vanizor Kural.B, Orem A, Cimsit G, et al. Evaluation of the atherogenic
tendency of lipids and lipoprotein content and their relationships with
oxidant- antioxidant system in patients with psoriasis. Clin chim acta
2003; 328(1-2): 71-82.
6. Mallbris L,Olof Akre, Fredrik Granath,et al. Psorisis- studies at
phenotype at onset and of associated Cardiovascular morbidity. Lotus
mallbris 2005; thesis.
7. Suleyman Piskin, Figen Gurkok, Galip Ekuklu, Mustafa Senol. Serum
lipids levels in Psoriasis. Yonsei medical journal 2003; 44: 24-26.