New-onset hyperglycemia: a potential clue to detect early pancreatic cancer

Pancreatic adenocarcinoma has an incidence rate nearly equal to the mortality rate and this is mostly due to late symptom onset and diagnosis. Evidence has indicated that new-onset diabetes may be a manifestation of occult pancreatic carcinoma. Authors report the case of a young female who presented with new-onset severe hyperglycemia and superficial thrombophlebitis. She was subsequently diagnosed with pancreatic cancer confirmed by histopathology. Her glycemic status evaluated 6 months prior to her presentation during institutional health check-up was entirely normal. This case report will serve to emphasize that new-onset diabetes in certain patients could be a presenting feature of pancreatic cancer.Pancreatic adenocarcinoma has an incidence rate nearly equal to the mortality rate and this is mostly due to late onset of symptoms and delay in diagnosis. Early diagnosis of this cancer gives the opportunity for total resection of pancreas and creates hope for a full recovery. Compelling evidence now indicates that new-onset diabetes may be a manifestation of occult pancreatic carcinoma. Authors report a young female who presented with new-onset severe hyperglycemia and superficial thrombophlebitis. She was subse­quently diagnosed with pancreatic cancer confirmed by histopathology. Her glycemic status evaluated 6 months prior to her presentation during institutional health check-up was entirely normal. This case report will serve to emphasize that new-onset diabetes in certain patients could be a presenting feature of pancreatic cancer. (Clin Diabetol 2017; 6, 3: 115–117

Evaluating mild traumatic brain injury in adults: an emergency physician’s dilemma

Background: Mild traumatic brain injury (MTBI) is a common presentation in emergency departments across the globe. A controversy about the policy of evaluating them with CT scan and hospital admission or discharge and for these patients. This study is directed towards correlation of clinical profile with CT brain findings of the patients to predict the possibility of an intracranial lesion and need for early neurosurgical intervention.Methods: This prospective observational study was carried out in the Emergency Department (ED) of a tertiary care government medical college and hospital. All patients aged more than 12 years presenting to the ED with mild traumatic brain injury (MTBI) within 24 hours of injury in whom NCCT head (trauma protocol) was done during the Study. Descriptive and analytical statistics were applied. Multiple logistic regression analysis was used to identify factors related to different outcomes.Results: 178 patients with MTBI were enrolled in the study among which intracranial injuries were found by CT scan in 28 patients (15.7%). Odds of finding intracranial injuries were highest with the presence of post-traumatic vomiting, post traumatic amnesia (PTA), pre-existing alcohol use disorder, GCS≤14, focal neurological deficit and clinical signs of basal skull fracture. 2.8% patients required urgent neurosurgical intervention.Conclusions: Presence of post-traumatic vomiting, PTA, alcohol use disorder, GCS≤14, focal neurodeficit and signs of basal skull fracture in a MTBI patient should be considered as high-risk factors for significant intracranial injuries. 

Van Wyk-Grumbach syndrome: a rare presentation of a common endocrine disorder

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Nowo wykryta hiperglikemia: wskazówka umożliwiająca wczesne rozpoznanie raka trzustki

 W raku gruczołowym trzustki wskaźnik umieralności jest niemal równoważny ze wskaźnikiem zapadalno­ści, co jest spowodowanie głównie tym, że choroba długo przebiega bezobjawowo i zwykle zostaje późno wykryta. Wczesne rozpoznanie raka trzustki umożliwia całkowitą resekcję guza i daje nadzieję na zupełne wyleczenie. Dostępne obecnie dowody naukowe wskazują, że cukrzyca de novo może być manifestacją kliniczną utajonego raka trzustki. Autorzy opisują przy­padek młodej kobiety, która zgłosiła się z objawami ciężkiej hiperglikemii i zakrzepowym zapaleniem żył powierzchownych. Następnie u chorej rozpoznano raka trzustki, a rozpoznanie potwierdzono w badaniu histo­patologicznym. Wartość glikemii zmierzonej podczas rutynowych badań kontrolnych przeprowadzonych 6 miesięcy wcześniej mieściły się w granicach normy. Niniejszy opis przypadku zwraca uwagę na to, że u niektórych pacjentów nowo rozpoznana cukrzyca może być objawem wskazującym na obecność raka trzustki

Chronic inflammation in polycystic ovary syndrome: A case–control study using multiple markers

Background: Polycystic ovary syndrome (PCOS) is associated with insulin resistance and elevated risk of cardiovascular disease and diabetes. Chronic inflammation has been observed in PCOS in several studies but there is also opposing evidence and a dearth of research in Indians. Objective: To estimate chronic inflammation in PCOS and find its relationship with appropriate anthropometric and biochemical parameters. Materials and Methods: Chronic inflammation was assessed in 30 women with PCOS (Group A) and 30 healthy controls (Group B) with highly sensitive C-reactive protein (hsCRP), interleukin-6 (IL-6), tumour necrosis factor alpha (TNFα), and platelet microparticles (PMP). In group A, the relationship of chronic inflammation with insulin resistance, waist hip ratio (WHR) serum testosterone, and serum glutamate pyruvate transaminase (SGPT) were examined. Results: In group A, the hsCRP, TNFα, and PMP were significantly elevated compared to group B. However, IL-6 level was similar between the groups. In group A, PMP showed a significant positive correlation with waist-hip ratio and serum testosterone. IL-6 showed a significant positive correlation with insulin sensitivity and significant negative correlation with insulin resistance and serum glutamate pyruvate transaminase. Conclusion: PCOS is associated with chronic inflammation and PMP correlates positively with central adiposity and biochemical hyperandrogenism in women with PCOS. Key words: Polycystic ovary syndrome, Inflammation, C-reactive protein, Interleukin-6, Tumor necrosis factor, Microparticles

Myxedema Coma: A New Look into an Old Crisis

Myxedema crisis is a severe life threatening form of decompensated hypothyroidism which is associated with a high mortality rate. Infections and discontinuation of thyroid supplements are the major precipitating factors while hypothermia may not play a major role in tropical countries. Low intracellular T3 leads to cardiogenic shock, respiratory depression, hypothermia and coma. Patients are identified on the basis of a low index of suspicion with a careful history and examination focused on features of hypothyroidism and precipitating factors. Arrythmias and coagulation disorders are increasingly being identified in myxedema crisis. Thyroid replacement should be initiated as early as possible with careful attention to hypotension, fluid replacement and steroid replacement in an intensive care facility. Studies have shown that replacement of thyroid hormone through ryles tube with a loading dose and maintenance therapy is as efficacious as intravenous therapy. In many countries T3 is not available and oral therapy with T4 can be used effectively without major significant difference in outcomes. Hypotension, bradycardia at presentation, need for mechanical ventilation, hypothermia unresponsive to treatment, sepsis, intake of sedative drugs, lower GCS and high APACHE II scores and Sequential Organ Failure Assessment (SOFA) scores more than 6 are significant predictors of mortality in myxedema crisis. Early intervention in hypothyroid patients developing sepsis and other precipitating factors and ensuring continued intake of thyroid supplements may prevent mortality and morbidity associated with myxedema crisis

Role of Lipid, Protein-Derived Toxic Molecules, and Deficiency of Antioxidants behind the Pathogenesis of Diabetic Retinopathy (DR) in Type 2 Diabetes Mellitus

To determine the role of NADPH-oxidase mediated formation of different lipid, protein-derived molecules, and depletion of vitamin-C level in vitreous behind the endothelial dysfunction-induced vascular endothelial growth factor secretion and pathogenesis of diabetic retinopathy (DR) in type 2 diabetes mellitus (T2DM). Fourteen T2DM patients with mild non-proliferative diabetic retinopathy (MNPDR), 11 patients without diabetic retinopathy (DNR), 17 T2 DM subjects with high-risk proliferative diabetic retinopathy (HRPDR), and 5 healthy individuals without DM underwent vitreous analysis for estimation NADPH oxidase, lipid peroxide like malondialdehyde (MDA), 4-Hydroxy-noneal (HNE) and advanced lipoxidation end product (ALE) like Hexanoyl-lysine (HLY), protein carbonyl compound (PCC), Vitamin-C and concentration of vascular endothelial growth factor (VEGF) secretion following standard spectrophotometric methods and enzyme-linked immunosorbent assay (ELISA). Vitreous concentration of NADPH-oxidase, different protein and lipid-derived molecule, and VEGF were found to be significantly elevated among DNR and of DR subjects with different grades compared to HC subjects whereasthe vitamin-C level was found to be decreased among different DR subjects and DNR subjects in comparison to healthy individuals. Oxidative stress-mediated lipid and protein-derived biomolecules not only add important mediators in the pathogenesis of DR, but also accelerate the progression and severity of microangiopathy