Study of Association of Serum Prolactin Levels with Insulin Resistance in Type 2 Diabetes Mellitus Patients.

Objective: Prolactin (PRL) regulates glucose metabolism and insulin sensitivity. The study aimed to evaluate the role of PRL in glucose homeostasis and its association with insulin resistance in patients with diabetes mellitus (DM). Methods and Materials: This cross-sectional, observational study included 100 patients (25-60 years) with T2DM. Primary information including demographics, anthropometric measurements, and biochemical measures (complete blood count, glucose parameters, liver and kidney function test, lipid profile, thyroid function test, serum fasting insulin levels, serum PRL levels) was collected. Results: A total of 100 patients, 50 men and 50 women (25 premenopausal and 25 postmenopausal), were enrolled in this study. The correlation between serum cholesterol and PRL was found to be statistically non-significant (P = 0.129) in men and significant (P = 0.041) in women. There was an inverse relationship between fasting plasma glucose and serum PRL levels in both men (r = -0.88; P < 0.0001) and women patients (r = -0.768; P < 0.0001). Negative correlation between postprandial plasma glucose and PRL was found to be statistically significant (r = -0.398; P = 0.048) in postmenopausal women. The comparison in both men and women indicated an inverse correlation between serum PRL and glycated haemoglobin levels. There was a significant negative correlation between homeostasis model assessment-estimated insulin resistance (HOMA-IR) and PRL levels in both men (r = -0.362; P = 0.039) and women patients (r = -0.362; P = 0.003). Homeostasis model assessment of ß cell function (HOMA-ß), which directly correlates with residual pancreatic beta cell function, was positively correlated with prolactin levels, irrespective of gender and menopausal status of female subjects. Conclusion: Serum PRL levels correlate with improved glycaemic control.

Study of Significance of Serum Lactate Kinetics in Sepsis as Mortality Predictor.

Introduction: Sepsis is one of the leading causes of death worldwide. Serum lactate is being used in sepsis for diagnostic and prognostic purposes for years now. In this study, we shed light over a novel use of lactate in form of various clearance parameters to determine mortality in septic patients at the 28th day. Materials and methods: In our study, 200 patients with sepsis were included using quick sequential organ failure assessment (qSOFA) score and their lactate levels were measured at the time of admission (0 hour) and 24 hours after admission. Lactate clearance parameters (absolute and relative lactate clearance, lactate clearance rate) were calculated. All patients were followed up for a period of 28 days to determine the outcome, and data analysis was done accordingly. Results and conclusion: Our study showed that higher SOFA score, qSOFA score, and serum lactate levels were associated with increased 28th-day mortality. Low absolute, relative lactate clearance and lactate clearance rate were also associated with poor outcomes. The best cutoffs to predict poor outcomes were serum lactate level at 24 hours ≥4 mmol/L and relative lactate clearance ≤40.3% with good sensitivity and specificity. How to cite this article: Chaudhari M, Agarwal N. Study of Significance of Serum Lactate Kinetics in Sepsis as Mortality Predictor. Indian J Crit Care Med 2022;26(5):591-595.

Evaluation of lipoprotein (a) [Lp(a)] and lipid abnormalities in patients with newly detected hypertension and its association with severity of hypertension.

Introduction: Hypertension remains the major preventable cause of cardiovascular disease (CVD). Lipoprotein (a) is seen to be associated with established essential hypertension and contributes to atherogenesis or to thrombogenesis or both. Aim: Correlation between lipoprotein (a) [Lp(a)] and lipid abnormalities in patients with newly detected hypertension and its association with severity of hypertension. Methods: It was a cross-sectional observational study carried out at PGIMER, DR. RML Hospital, New Delhi, India. Estimation of serum Lp (a) and lipid parameters along with routine laboratory investigations were carried out in 100 newly diagnosed cases with hypertension and compared with age and sex matched 50 healthy normotensive controls. Result: Amongst 100 cases the mean systolic and diastolic blood pressure was 160.68 ± 19.75 mmHg and 84.44 ± 4.32 mmHg respectively. The mean serum Lp (a) in cases was 34.03 ± 7.55 mg/dl as compared to 24.13 ± 4.41 mg/dl in controls (p < 0.0001). 62% of cases as compared to 12% of controls had elevated serum Lp (a) levels. Apart from that, the levels of Lp (a) and lipid parameters increased significantly with higher stage of disease (p < 0.0001). Approximately 8% of cases had left ventricular hypertrophy as compared to 1% of control. Similarly, 18% of cases had Non-alcoholic fatty liver disease as compared to 4% of controls. 5% of cases had retinopathy as compared to nil in controls. 4% of cases had microalbuminuria as compared to nil in controls. Conclusion: It was observed that newly detected hypertension is associated with major derangements of Lp (a) and lipid parameters. We also concluded that end organ involvement is significantly higher in newly detected hypertensives as compared to normotensive subjects and it was attributed to be due to lipid abnormalities observed in the group.

Rare complications of chicken pox in immunocompetent children: Acute respiratory distress syndrome.

Chickenpox is a highly contagious disease caused by varicella zoster virus. Fever and papulovesicular rash are hallmarks of this disease. These manifestations are self-liming and complete recovery is seen in most cases. We report two cases of chickenpox infection where the rare and atypical manifestations of acute respiratory distress syndrome with pleural effusion were seen.

Association of Serum Ferritin Levels with Metabolic Syndrome in India: a Cross-Sectional Study.

Background: Metabolic syndrome is a known risk factor for various diseases including coronary artery disease and is associated with subclinical-inflammation. Various inflammatory markers have been evaluated in metabolic syndrome. However, the data evaluating serum ferritin in metabolic syndrome is sparse. The current study aims to evaluate the correlation between serum ferritin and metabolic syndrome. Materials and methods:This cross-sectional study included 100 subjects with metabolic syndrome and 50 gender matched healthy controls. Results:The mean age (SD) in study and control groups was 52.34 (7.64) and 48.36 (9.16) years, respectively. Majority were females in both groups (60% vs 52%). The mean (SD) HbA1c amongst study vs control was 8.26 (2.33) vs 5.10 (0.51); <0.0001. Mean (SD) serum iron and hsCRP were significantly higher in the study group (115.50 ±42.6 vs 65.741±9.16; p<0.001) and (6.33±4.87 vs 3.45±3.5; p<0.007) respectively. Mean serum ferritin level was significantly higher in the study group (123.9 vs 59.02; p<0.0001). A statistically significant correlation was found between serum ferritin and waist hip ratio, triglyceride, BMI and HOMA IR (r=0.49, p<0.0001; r=0.50, p<0.0001; r=0.47, p<0.0001 and r=0.54, p<0.0001 respectively). An inverse correlation was found between serum ferritin and serum HDL levels (r=-0.46, p<0.0001). Even after adjusting for age, serum ferritin levels were found to be significantly associated with metabolic syndrome Coeff (95% CI) -65.6 (-84.23, -46.98); p<0.0001. Conclusion:Significantly higher levels of serum ferritin were found in metabolic syndrome, and a significant correlation with its components was seen. Therefore, serum ferritin may be used as a marker of inflammation for an early intervention.

Leukocytoclastic vasculitis: An uncommon adverse effect of a common drug.

A hypertensive elderly male on amlodipine presented with a palpable purpuric rash on both legs followed by shoulder, buttocks, and back with foot ulcer, which was found to be leukocytoclastic vasculitis on skin biopsy. The patient recovered completely on discontinuation of amlodipine and short-term steroid.

A Rare and Lethal Complication of Oral Warfarin Therapy.

How to cite this article: Mahto SK, Sheoran A, et al. A Rare and Lethal Complication of Oral Warfarin Therapy. Indian J Crit Care Med 2019;23(4):197-198.

A rare cause of nodular skin lesions with fever in an immunocompetent individual.

Histoplasmosis is a fungal disease caused by the dimorphic fungus Histoplasma capsulatum. It is endemic to many parts of the world but is rarely seen in India. The fungus usually affects the immunocompromised patients and is rarely reported in immunocompetent hosts. We hereby report a case of the nodular skin lesion with fever lesion that finally turned out to have cutaneous histoplasmosis, from a non-endemic region of northern India and that too in an immunocompetent.

What is in N A M E?

An interesting and rare case of name syndrome is reported here. A young patient presented with stroke (left side hemiperesis due to cardiac embolic stroke) and cutaneous lesions. Further investigations revealed that left atrial myxoma was the cause of cardioembolic stroke. Skin lesions were also present which included, nevi, ephelides and neurofibroma hence diagnosis of "NAME SYNDROME" was made.

Asymptomatic giant pheochromocytoma.

An interesting case of pheochromocytoma is being presented which remained asymptomatic despite attaining a size of 16 x 11 cm. On intensive investigations, it was found to be a dopamine secreting tumour with certain features in favour of malignancy. The case was successfully operated and advised regular follow up.