Sukriti Kumar

Assessment of insulin sensitivity/resistance.

Insulin resistance is one pretty troublesome entity which very commonly aggravates metabolic syndrome. Many methods and indices are available for the estimation of insulin resistance. It is essential to test and validate their reliability before they can be used as an investigation in patients. At present, hyperinsulinemic euglycemic clamp and intravenous glucose tolerance test are the most reliable methods available for estimating insulin resistance and are being used as a reference standard. Some simple methods, from which indices can be derived, have been validated e.g. homeostasis model assessment (HOMA), quantitative insulin sensitivity check index (QUICKI). For the clinical uses HOMA-insulin resistance, QUIKI, and Matsuda are suitable, while HES, McAuley, Belfiore, Cederholm, Avignon and Stumvoll index are suitable for epidemiological/research purposes. With increasing number of these available indices of IR, it may be difficult for clinicians to select the most appropriate index for their studies. This review provides guidelines that must be considered before performing such studies.

Pituitary stalk interruption syndrome: Case report of three cases with review of literature.

Pickardt syndrome (Pickardt-Fahlbusch syndrome) is a rare congenital syndrome characterized by tertiary hypothyroidism caused by the interruption of the portal veins between hypothalamus and adenohypophysis. Typical features of this syndrome are tertiary hypothyroidism with low thyroid stimulating hormone, hyperprolactinemia and other pituitary hormone deficiencies. Pituitary stalk interruption syndrome is characterized by a triad of thin or interrupted pituitary stalk, aplasia or hypoplasia of the anterior pituitary and absent or ectopic posterior pituitary (EPP) seen on magnetic resonance imaging (MRI). It is a congenital anomaly of pituitary whose exact prevalence is unknown. In some cases, it is restricted to EPP or pituitary stalk interruption. We are presenting the case history along with MRI finding of three childrens who presented with short stature and delayed puberty.

Diabetes mellitus: Trends in northern India

Diabetes mellitus is becoming a global health issue with more than 80% diabetics living in developing countries. India accounts for 62.4 million diabetics (2011). Indian Council of Medical Research India Diabetes Study (ICMR-INDIAB) study showed highest weighted prevalence rate in the north India among all studied regions. Diabetes in north India has many peculiarities in all aspects from risk factors to control programmers. North Indians are becoming more prone for diabetes and dyslipidemia because rapid westernization of living style and diet due rapid migration to metropolitan cities for employment. North Indian diabetes is plagued with gender bias against females, poor quality of health services, myths, and lack of disease awareness compounded with small number of prevention and awareness programmers that too are immature to counteract the growing pandemic.

Oxidative stress determined through the levels of antioxidant enzymes and the effect of N-acetylcysteine in aluminum phosphide poisoning.

Introduction: The primary objective of this study was to determine the serum level of antioxidant enzymes and to correlate them with outcome in patients of aluminum phosphide (ALP) poisoning and, secondly, to evaluate the effect of N-acetylcysteine (NAC) given along with supportive treatment of ALP poisoning. Design: We conducted a cohort study in patients of ALP poisoning hospitalized at a tertiary care center of North India. The treatment group and control group were enrolled during the study period of 1 year from May 2011 to April 2012. Interventions: Oxidative stress was evaluated in each subject by estimating the serum levels of the enzymes, viz. catalase, superoxide dismutase (SOD) and glutathione reductase (GR). The treatment group comprised of patients who were given NAC in addition to supportive treatment (magnesium sulfate and vasopressors, if required), while in the control group, only supportive treatment was instituted. The primary endpoint of the study was the survival of the patients. Measurements and Results: The baseline catalase (P = 0.008) and SOD (P < 0.01) levels were higher among survivors than non-survivors. Of the total patients in the study, 31 (67.4%) expired and 15 (32.6%) survived. Among those who expired, the mean duration of survival was 2.92 ± 0.40 days in the test group and 1.82 ± 0.33 days in the control group (P = 0.043). Conclusions: This study suggests that the baseline level of catalase and SOD have reduced in ALP poisoning, but baseline GR level has not suppressed but is rather increasing with due time, and more so in the treatment group. NAC along with supportive treatment may have improved survival in ALP poisoning.

Prognostic Factors in Patients Hospitalized with Diabetic Ketoacidosis

Background Diabetic ketoacidosis (DKA) is characterized by a biochemical triad of hyperglycemia, acidosis, and ketonemia. This condition is life-threatening despite improvements in diabetic care. The purpose of this study was to evaluate the clinical and biochemical prognostic markers of DKA. We assessed correlations in prognostic markers with DKA-associated morbidity and mortality. Methods Two hundred and seventy patients that were hospitalized with DKA over a period of 2 years were evaluated clinically and by laboratory tests. Serial assays of serum electrolytes, glucose, and blood pH were performed, and clinical outcome was noted as either discharged to home or death. Results The analysis indicated that significant predictors included sex, history of type 1 diabetes mellitus or type 2 diabetes mellitus, systolic blood pressure, diastolic blood pressure, total leukocyte count, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, blood urea nitrogen, serum creatinine, serum magnesium, serum phosphate, serum osmolality, serum glutamic oxaloacetic transaminases, serum glutamic pyruvic transaminases, serum albumin, which were further regressed and subjected to multivariate logistic regression (MLR) analysis. The MLR analysis indicated that males were 7.93 times more likely to have favorable outcome compared with female patients (odds ratio, 7.93; 95% confidence interval, 3.99 to 13.51), while decreases in mean APACHE II score (14.83) and serum phosphate (4.38) at presentation may lead to 2.86- and 2.71-fold better outcomes, respectively, compared with higher levels (APACHE II score, 25.00; serum phosphate, 6.04). Conclusion Sex, baseline biochemical parameters such as APACHE II score, and phosphate level were important predictors of the DKA-associated mortality.

Thyroid functions and serum lipid profile in metabolic syndrome

Background Thyroid hormones are known to affect energy metabolism. Many patients of metabolic syndrome have subclinical or clinical hypothyroidism and vice versa. To study the correlation of thyroid profile and serum lipid profile with metabolic syndrome. Method It is a hospital based cross sectional case-control study carried out in tertiary care health center, we studied thyroid functions test and serum lipid profile in 100 metabolic syndrome patients according to IDF criteria and a similar number of age, gender and ethnicity matched healthy controls. Result We found that serum HDL was significantly lower (p < 0.001) in cases (41.28 ± 8.81) as compared to controls (54.00 ± 6.31). It was also found that serum LDL, VLDL, triglyceride levels and total cholesterol were found to be significantly higher (p < 0.001) in cases than controls. Serum TSH levels of subjects in cases group (3.33 ± 0.78) were significantly higher (p < 0.001) than that of controls (2.30 ± 0.91) and significantly lower levels of T4 (p < 0.001) in the patients of metabolic syndrome (117.45) than in controls (134.64) while higher levels of T3, although statistically insignificant in the patients of metabolic syndrome. Conclusion Thyroid hormones up-regulate metabolic pathways relevant to resting energy expenditure, hence, obesity and thyroid functions are often correlated.

Wolfram syndrome: A rare mimic of type 1 diabetes mellitus

Wolfram syndrome is a rare autosomal recessive disorder characterized by a constellation of disorders also known as diabetes insipidus, diabetes mellitus (DM), optic atrophy, and deafness. Patients present with DM and optic atrophy in the first decade, diabetes insipidus and sensorineural deafness in the second decade, and renal outflow tract anomalies and other neurological manifestations later in life. We report a case of a 14-year-old boy who was diagnosed with insulin-dependent DM and subsequently discovered to have optic atrophy, sensorineural hearing loss, and cardiovascular defect with a positive family history. Such cases need to be evaluated thoroughly with respect to Wolfram syndrome and its associated anomalies.

Nonnutritive sweeteners: Pros and cons

Nonnutritive sweeteners (NNSs) are the substances having an intense sweet taste with no or very low calories and are used as substitutes for simple sugars for reduction of energy intake. The consumption of NNSs is increasing at an alarming rate because of the ever evolving pandemic of obesity and Type 2 diabetes mellitus. NNSs have various positive and negative metabolic consequences on the health of the consumers. There are misconceptions and myths regarding the use of NNSs for which various professional bodies have issued guidelines. However, the overall long-term effects of the NNSs are still an area of debate and discussion.

Acute viral encephalitis clinical features and outcome: Experience from a tertiary center of North India

Background: Acute viral encephalitis (AVE) is an unconscious state that either accompanies or follows a short febrile viral illness and is characterized by a diffuse and nonspecific brain insult manifested by the combination of coma, seizures, and decerebration and frequently results in delayed neurological deficit. Aim and Objective: To evaluate the clinical features and the outcomes of patients presenting with AVE. Materials and Methods: The patients presenting with AVE with serologically confirmed viral parameters were consecutively recruited from the department of medicine/neurology from a tertiary care center of Lucknow, Uttar Pradesh, India. These patients were then subjected to detailed clinical examination, laboratory examination, and radiological assessment. The modified Rankin Scale (mRS) was calculated at the time of discharge and after 1 month of follow-up. Results: One hundred and eight patients were diagnosed with AVE over a period of 2 years. The mean age of the patients of AVE was 28.97 ± 16.7 years. The most common complaints were fever (100%), headache (94.4%), and altered mental state (92.5%). Out of the 108 patients, Japanese encephalitis (JE) was the most common etiology followed by herpes simplex virus (HSV) encephalitis. Of the total number of patients, 27 died, 9 were diagnosed with JE, 4 with hematopoietic stem cell (HSC) encephalitis, 5 with miscellaneous group, and 11 with the nonspecific group of viral encephalitis (NSAVE). The mRS at discharge was <3 in 44 patients and >3 in 35 patients with AVE. After 1 month, mRS was <3 in 57 patients and >3 in 22 patients with AVE. Conclusion: In this study, JE meningitis was the leading cause of AVE followed by NSAVE and HSV encephalitis. The outcome in cases with AVE can be fatal or more disabling than other etiologies and prompt diagnosis and supportive care remain the backbone of treatment.

A case of dengue fever complicated by acute transverse myelitis

Dengue infection is now known to have varied neurological complications, involve central as well as peripheral nervous system. Only few isolated cases of acute transverse myelitis (ATM) have been reported. In this paper, we report a case of a 15-year-old female who developed acute onset quadriparesis following a dengue virus infection. Magnetic resonance imaging of the spinal cord disclosed signal-intensity abnormalities from C2 to T3. A diagnosis of ATM was considered. Because of the very rapid involvement of upper cervical cord, respiratory paralysis ensues. The patient condition necessitated her to be put on mechanical ventilation. Intravenous methylprednisolone was also given, but eventually patient expired.