Association of Plasma Procalcitonin with Various Components of Metabolic Syndrome and Insulin Resistance in Urban Indian Population: A Novel Biomarker.

RATIONALE: Chronic low-grade inflammation is proposed as the keystone in pathogenesis of metabolic syndrome. The inflammatory biomarker Procalcitonin which is produced by adipose tissue, can serve as a biomarker for insulin resistant state present in metabolic syndrome. OBJECTIVES: To evaluate the association of plasma Procalcitonin (PCT) with components of metabolic syndrome (abdominal obesity, dyslipidemia, hypertension, and hyperglycemia) and with insulin resistance as compared to healthy controls. DESIGN: In this case-control study Plasma Procalcitonin was measured in patients with metabolic syndrome and compared to healthy controls. Its association was investigated with insulin resistance, individual components of metabolic syndrome, cardiovascular complications and microalbuminuria. RESULTS: Plasma Procalcitonin was significantly higher (mean 0.55 ± 0.60 ng/ ml, Median 0.156 ng/ml) in 53 patients with metabolic syndrome (n = 53) as compared to 26 healthy controls (p < 0.001). PCT significantly correlated with level of Insulin Resistance (p< 0.01), Waist Circumference, S. Triglycerides, S. VLDL (p < 0.05), fasting blood glucose (p < 0.01) and inversely with S.HDL (p< 0.05). PCT was significantly higher in patients with cardiovascular complication (n=16/53, z = -7.137) and in those with microalbuminuria (n=18/53, z = - 7.265) as compared to cases without complications. CONCLUSION: Raised plasma procalcitonin levels in the normal range are associated with insulin resistance and components of the metabolic syndrome (abdominal obesity, hypertriglyceridemia, high VLDL, low HDL and hyperglycemia), suggesting its role as a promising biomarker.

An unusual cause of hematuria.

Hematuria is a cardinal manifestation of renal disease and forms a cornerstone of nephrologic diagnosis. A systemic approach is required to delineate the source of hematuria to the kidney or urinary tract. We present the case of 14 years old boy who presented to us with history of passing red colour urine since 3 month not associated with pain who was subsequently diagnosed to have of Thin Basement Membrane Disease.

Hypoglycaemic and hypolipidaemic effects of low GI and medium GL Indian diets in type 2 diabetics for a period of 4 weeks: a prospective study.

This prospective study reports significant hypoglycaemic and hypolipidaemic effects in type 2 diabetic subjects who were provided the complete diet plan to be on low glycaemic index (GI) and low-medium glycaemic load (GL) Indian vegetarian snacks and mixed meals for 4 continuous weeks. Five millilitres of fasting blood sample drawn at weekly intervals for 4 weeks were analysed for blood glucose, HbA1c and lipid profile. Four weeks later mean blood glucose level of 173.6 mg% decreased to 137.8 mg%, HbA1c of 8% also decreased to 7.1% which reflected the blood glucose level during the study period and hence correlated well with the fall in blood glucose level. Triglyceride level of 244.5 mg% decreased to 164.7 mg% (p < 0.0001) and total cholesterol of 173.5 mg% decreased to 134.6 mg% (p < 0.0001). High-density lipoprotein cholesterol of 33 mg% increased to 39.8 mg% (p < 0.003), very low density lipoprotein (VLDL) cholesterol of 48.9 mg% decreased to 32.9 mg% (p < 0.0001) and low-density lipoprotein cholesterol of 90.1 mg% decreased to 64.3 (p < 0.009). This significant outcome can be improved further if compliance to low GI and low-to-medium GL diet is continued. This may achieve desired glycaemic control and that's limit oxidative stress.

Acute accidental exposure to chlorine fumes--a study of 82 cases.

Eighty-two patients were hospitalized following an accidental exposure to chlorine. All patients presented with dyspnoea and cough. The other symptoms included irritation of throat (53.6%), irritation of eyes (42.3%), headache (29.2%), abdominal pain (26.8%), vomiting (24.3%) and giddiness (9.7%). All of them had bronchospasm and 5 (6%) had cyanosis at the onset. An x-ray of the chest revealed patchy infiltrates in 3 (3.85%) and hilar congestion in 2 (2.44%). Pulmonary function tests showed an obstructive pattern in 27.4%, restrictive in 3.25% and mixed in 53.2%. Pulmonary functions were normal in 16.1% of the patients. Bronchoscopy revealed tracheobronchial mucosal congestion in all cases, hemorrhagic spots in 35.7%, erosions and ulcers in 12.5%. All patients were treated with oxygen, aminophylline, hydrocortisone and antibiotics. Haematemesis (n = 1) and pulmonary oedema (n = 2) developed 12 hours after the admission. Two other patients developed pneumonia 48 hours later. All patients recovered satisfactorily. On follow-up 16 patients had no sequelae after one year. Pulmonary functions were normal in 5 patients after 3 years of follow-up.

Hepatocellular failure in glycogen storage disorder type 3.

A case of a 21 years male patient with type 3 glycogen storage disorder diagnosed at necropsy, who died suddenly with hypovolemic shock following a massive upper gastrointestinal bleeding due to hepatocellular failure is reported. Salient features of GSD type 3 are briefly discussed.

Captopril--nifedipine interaction in hypertension.

Nifedipine, a calcium channel blocker exerts significant peripheral vasodilatory activity in hypertensive patients. It has been postulated that the antihypertensive effect of peripherally acting vasodilators is masked, by counter regulatory mechanism e.g. activation of renin-angiotensin aldosterone (RAA) axis. The present work was undertaken to study the effect of blockade of RAA axis using captopril, an angiotensin converting enzyme inhibitor on the blood pressure lowering activity of nifedipine. Pretreatment with captopril in a dose of 25 mg. bd was carried out for 4 weeks in one group of 10 patients before administering nifedipine 10 mg bd for 4 weeks. The other matched group of 10 patients received nifedipine alone in the same dose. It was observed that although captopril by itself had no appreciable effect on blood pressure in the dose used, it significantly enhanced the blood pressure lowering activity of nifedipine. It appears that counterregulatory mechanisms play an important role in determining the net antihypertensive effect of peripheral vasodilators.

ARDS in a case of vesicular mole with secondary hyperthyroidism.

Vesicular mole is best regarded as a benign neoplasia of the chorion with malignant potentials. In India, the prevalence is one in four hundred pregnancies. We present one such case who presented with thyrotoxicosis and pulmonary edema.

Neuroleptic malignant syndrome: an experience of four cases.

We report four cases of neuroleptic malignant syndrome occurring after administration of a typical antipsychotic haloperidol and a newer atypical antipsychotic clozapine. The management of these patients is discussed.

Traditional Indian snacks modified to attain low glycaemic index and confirmed suitable to be consumed without hyperglycaemic effect in type 2 diabetics.

The purpose of this study is to determine the glycaemic index of seven traditional Indian snacks modified in composition and preparation and to determine their glycaemic and insulinaemic response in type II diabetics. Blood glucose and insulin level at fasting, postprandial - 1 hour and 2 hours in ten normal healthy volunteers were analysed after oral administration of 50 g pure glucose and later at weekly intervals with each of the test snack. Area under curve was calculated and compared for pure glucose and each test snack to determine the glycaemic index. Each of the test snack was administered in ten type II diabetics and the glycaemic and insulinaemic response was determined at fasting, postprandial - 1 hour, 2 hours and compared with that of the normal volunteers. Changes in blood glucose and insulin levels (mean +/- SD) at fasting and two time Intervals in normal and diabetics were analysed using Student's paired 't' test, and between the two groups using Student's unpaired 't' test for each test snack. Sensory evaluation and satiety factor were obtained using five-point hedonic and visual assessment scale. Area under curve for each test snack was significantly lower (p < 0.001) than that of pure glucose and hence all the snacks are confirmed as having low glycaemic index which ranged from 31 to 47%. The significant rise at postprandial - 1 hour (p < 0.001) and fall at postprandial - 2 hours (p < 0.001) in blood glucose levels and sustained Insulin levels at postprandial - 2 hours was similar in normal and diabetics for each of the test snack. Sensory evaluation and satiety factor were similar for traditional and modified snacks. The seven modified traditional Indian snacks have low glycaemic index and do not have a hyperglycaemic effect in type II diabetics. Besides, their low glycaemic index status, high acceptability, and satiety factor makes these modified snacks most suitable for sustained consumption by type II diabetics and hence better glycaemic control.

Efficacy and tolerability of a combination of ofloxacin and tinidazole in the management of infectious diabetic foot ulcer.

The management of infectious diabetic foot ulcers is a major concern. Various treatment modalities are used. The efficacy and tolerability of a combination of ofloxacin and tinidazole in diabetic foot ulcer has been assessed in 60 patients in the present trial. The results are promising.