Metabolic Syndrome in Adults with Nonalcoholic Fatty Liver Disease

Nonalcoholic fatty liver disease (NAFLD) is associated with insulin resistance, obesity, and other features of metabolic syndrome. It is identified as the most common cause of liver enzyme derangement. Lately, NAFLD has generated interest in exploring treatment options, including weight loss and dietary interventions. An association of NAFLD with metabolic syndrome has been suggested in contemporary literature. In this study, we attempted to look into the association of NAFLD with metabolic syndrome. In this study, 80 adult NAFLD patients were recruited from a tertiary care hospital. Among these, 42 were males and 38 females with a mean age of 44.46±13.146 years (range 18–82 years). Grades of fatty liver and presence or absence of metabolic syndrome were studied in this patient population. Patients who did not qualify for the criteria of metabolic syndrome were placed in Group 1 and those who fulfilled the stated criteria were considered in Group 2. There were 29 (36.25%) patients in Group 1 and 51 (63.75%) in Group 2. All the patients in Group 1 were having Grade I fatty liver whereas patients in Group 2 were found to having varying grades of fatty liver, with six patients having Grade III fatty liver. We found statistically significant difference in various parameters of study (liver enzymes, high-density lipoprotein (HDL), triglycerides, and blood pressure) between Group 1 and Group 2. Ultrasound evidence of a fatty liver should be considered as a predictor of metabolic syndrome, and these patients must be investigated for the different components of metabolic syndrome so as to have early diagnosis and intervention to alter development of long-term metabolic disorders and their inherent complications

Automobile Paint Reducer Induced Acute Kidney Injury: A Case Series

The various aspects of the automobile industry also carry with it the risk for occupational health hazards with it. Toluene has also evolved as a commonly used drug by substance abusers. Accidental exposure or self-poisoning with these substances has been reported in literature. These substances can also cause distal renal tubular acidosis (RTA), acute tubular necrosis, glomerulonephritis and interstitial nephritis, rhabdomyolysis and myoglobinemia. In this series, we report about three patients who developed renal manifestations because of organic solvents. Two of the three patients had ingested the paint reducer substance and the third one was addicted to sniffing the toluene based paint reducer. All the patients had in taken these substances s with suicidal intent and developed acute kidney injury (AKI) and severe metabolic acidosis. One of the patients had features of rhabdomyolysis as well. The third patient was a substance abuser and had inhaled higher than usual dose and developed severe and refractory acidosis and mild kidney injury and required Renal Replacement Therapy (RRT) for acidosis. All the patients eventually recovered their kidney functions and were doing well during their follow-up. Toluene based organic solvents lead to acute neurological symptoms, accompanied by severe metabolic alterations, organ injury and dysfunction. An association of the development of hypokalemic paralysis and metabolic acidosis with toluene intoxication has been observed. The management of acute toluene toxicity is mainly conservative, consisting of electrolytes correction, acid-base and fluid abnormalities and renal replacement therapy in severe AKI. Organic solvent exposure may result in acute tubular necrosis, rhabdomyolysis, RTA and AKI irrespective of the intake route. Clinical suspicion of organ dysfunction and failure and timely induction of supportive care leads to a good outcome

Does SARS-CoV2 infection increase hyperglycemia risk? Case series and review

Introduction   Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) has been observed to cause serious complications  and higher mortality in patients with type 2 diabetes mellitus (DM). Conversely, new-onset diabetes and metabolic complications of pre-existing diabetes (including DKA and hyperosmolarity) have also been seen in patients with COVID-19.   Materials and Methods   We report a  series of 7 patients with  mean age of 30.71+/-1.38 years. Our series included 2 female patients. None of our patients had any  underlying known comorbidity. All patients were RT PCR positive for SARS-Cov2.  All patients had lymphopenia at presentation and raised inflammatory markers. All patients received IV steroids (methylprednisolone)  for 5 days and subsequently oral. All patients improved with no major complication except one patient developed hyperglycemia on day 3 of institution of steroids. His Hba1c was suggestive of prediabetic status (6.1%). No other treatment related complication was observed.    Discussion   Given the capability of COVID-19 to trigger an intense inflammatory response, it has been challenging to disentangle whether hyperglycemia in COVID-19 is a cause or a consequence of severe disease. Some authors have hypothesized a potential diabetogenic effect of COVID-19, in addition to the well-recognized stress-induced hyperglycemia associated with critical illnesses. However, we observed that not all patients had hyperglycemia despite receiving steroids at the same dose and for the same duration.   Conclusion We postulate that the combination of SARS-CoV2 infection and steroids impairs the glucose metabolism resulting in hyperglycemia only in patients who have underlying risk factors for the same. &nbsp

Uric acid level and its correlation with glycemic control in diabetics with normal renal function

Introduction: Limited studies have evaluated the relationship between uric acid and diabetes mellitus (DM), with different studies reporting varying findings. We aimed to investigate the association between levels of uric acid and glycemic control in type 2 DM (T2DM) in our patient cohort. Materials and Methods: We analyzed 200 consecutive patients in the age group of 30–70 years suffering from T2DM with normal renal functions (glomerular filtration rate >60 ml/min/1.73 m2), after excluding patients taking medications for lowering uric acid levels or diuretics. Fasting blood glucose (FBG), random blood glucose (RBG), glycated hemoglobin (HbA1c), and serum uric acid levels were measured in all the patients. Results: The mean age of the study population was 55.25 ± 12.05 years. There was no statistically significant difference in mean age, FBG, RBG, serum uric acid, and HbA1c levels or between males and females in our study cohort. There was a statistically significant negative correlation (P < 0.05) between uric acid levels and HbA1c (r = −0.189) and FBG (r = −0.114). Conclusion: We report an inverse correlation between uric acid levels and glycemic control in diabetic patients with normal renal function, irrespective of gender

Paint-thinner-induced Acute Kidney Injury: A Case Series and Review

Occupational health hazards contribute significantly to the morbidity and mortality of workers in factories. Toluene has become a widely abused inhaled volatile drug. The spectrum of toluene-induced renal injury includes rhabdomyolysis, myoglobinemia, distal renal tubular acidosis (RTA), acute tubular necrosis, glomerulonephritis, and interstitial nephritis. We describe two patients with paint-thinner-induced kidney injury who were affected through different routes of exposure and recovered well, with one requiring dialysis support; the second patient, who had developed Type 1 distal RTA and mild kidney injury, was managed with conservative measures. Toluene can cause acute neurological symptoms, accompanied by severe metabolic alterations, as well as organ injury and dysfunction. A common association of the development of hypokalemic paralysis and metabolic acidosis with toluene intoxication was observed. Liver injury and rhabdomyolysis are also common. Vomiting, dehydration, tubular injury, and rhabdomyolysis are all possible additional causes of acute renal failure in toluene intoxication. Type 1 distal RTA, which is characterized by an inability to lower urine pH despite acidemia, results in hyperchloremic metabolic acidosis with hypokalemia. The management of acute toluene toxicity is largely conservative, consisting of correcting the electrolytes and the acid–base balance, fluid alterations, and renal replacement therapy in severe acute kidney injury. A clinical suspicion of organ failure and prompt supportive care leads to encouraging results. Adequate protective steps for workplaces involved in the use of such substances in confined spaces include prior risk assessment, using low-toxicity chemical products, ensuring adequate ventilation, safety training, and using appropriate personal protective equipment

Intravenous Albumin and Diuretic in Nephrotic Syndrome with Severe Edema: Our Experience and Literature Review : Albumin infusion

Background and Aim: Steroids are the mainstay of initial treatment in children with Idiopathic Nephrotic Syndrome (INS). The role of diuretics in children with NS is less clear in comparison to adults. In cases with severe or refractory edema, furosemide is often combined with albumin infusion (0.5 to 1 g/kg) to provide symptomatic relief. Methods: This study was a retrospective chart review of 17 patients with a diagnosis of Steroid Dependent Nephrotic Syndrome (SDNS) admitted for relapse of NS with severe edema who were resistant to diuretic therapy alone. The patients were treated as per unit protocol with an infusion of 100 ml intravenous albumin 20% over 4 hours and 2 doses (one in the morning at 10 AM and the other in the evening at 6 PM) of furosemide 1mg/kg for 3 days. Response to therapy and adverse events were evaluated. Results: The mean age of the study population was 10.58±1.5 years. All of the patients had severe edema and none of them had responded to intravenous diuretics alone. After co-administration of intravenous albumin infusion and furosemide, the mean weight loss per day per patient was 0.87±0.16 kg. Conclusion: A significant improvement was noted in all of the patients following co-administration of albumin and furosemide without any adverse events

Sodium-glucose co-transporter 2(SGLT2) inhibitors renal benefits and beyond

Background Diabetes is a disaease of Insulin insufficiency or resistance which implications on &nbsp;almost every organ and tissue of human body.&nbsp; It plays a direct or indirect role in causation or progression of many chronic conditions like Coronary Heart disease, Cerebrovascular accidents, Chronic Kidney disaease, limb amputation and so forth. It&nbsp; increases the risk and frequency &nbsp;of infections and delays the recovery as well. Management strategies include dietary management,exercise, Oral Antidiabetic drugs,Insulin formulations, pancreatic transplantation. The goal of these management strategies, usually employed in combination, is good glycemic control so as to avoid development of diabetic complications in the long run. Sodium-glucose co-transporter 2(SGLT2) inhibitors There are various classes of Oral Antidiabetic drugs(OAD) which form the basis of management of&nbsp; Diabetes Mellitus type 2 in particular as Type 1 Diabetes Mellitus invariably needs insulin for glycemic control. Sodium-glucose co-transporter 2(SGLT2) inhibitors are a class of OAD, approved by FDA for management of &nbsp;adults with type 2 diabetes.&nbsp;There are many&nbsp; SGLT2 inhibitors currently which can be used in patients with diabetes&nbsp; notably &nbsp;dapagliflozin, canagliflozin, empagliflozin.&nbsp; These oral antidiabetic drugs act by locking the SGLT2 transporters in proximal tubule of nephron and hence lead to glycosuria. They&nbsp; improve glycemic control, reduce body weight, and improve blood pressure control. Furthermore, evidence suggests that SGLT2 inhibitors&nbsp; have &nbsp;renoprotective, Cardiovascular and hypouricemic benefits among others. These benefits of SGLT2i slow progression of diabetic kidney disease. There is some evidence of increased risk of genitourinary fungal infections, Ketoacidosis and Fournier,s gangrene with use of SGLT2i. Conclusion Considering the added benefits of SGLT2i like renoprotection, weight loss, bP control, decreased CV morbidity and mortality with its use has provided &nbsp;an option of retarding the progression of Diabetic Nephropathy and improved survival of Diabetic patients. As more and more information with the experience of using this drug is published many unanswered questions about mechanism of these benefits and adverse events will be answered