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Background: Insulin resistance can be broadly defined as subnormal biological response to normal insulin concentration. Insulin resistance (IR) is one of the major factors in the pathogenesis of sepsis. Aim: To study the Insulin Resistance as Prognostic Indicator in Severe Sepsis, Septic Shock and Multiorgan Dysfunction syndrome (MODS). Materials and Methods: A prospective observational study done at Intensive care unit of Department of Medicine, at the tertiary care health centre of Northern India, it was done between June 2016-to May 2017. Patients with age between 14 to 75 years and satisfying the criteria for severe sepsis, septic shock, MODS according to third international consensus 2016 guidelines was included in the study. Patients on statins and insulin, those who had chronic disease and who had CPR were excluded. Results: A total of 81 patients were enrolled. Mean of fasting blood glucose (FBG), fasting insulin level and insulin resistance of both groups were calculated and compared on Day 1 and Day of outcome. Out of 81 patients 42 were euglycemic (RBS<140 mg/dl) and 39 were hyperglycemic (RBS>140 mg/dl). Mean fasting insulin (13.36+4.95v/s 9.83+4.54) and insulin resistance (6.65+3.84v/s2.41+1.11) of hyperglycemic was found to be significantly (p<.01) higher than euglycemic group of patients. Of 39 hyperglycemic patients 30% (n=13) expired while out of 42 euglycemic patients 28.5% expired (n=12) showing mortality was higher in hyperglycaemic patients and the value was found to be non-significant. Conclusion: In patients of severe sepsis, septic shock and MODS stress induced hyperglycemia and insulin resistance are associated with increased mortality. IR is a good and easily estimated method for assessing, but it is not the appropriate indicator of mortality in patients with severe sepsis and organ failure as there are many other factors which come into interplay leading to poor prognosis. [ABSTRACT FROM AUTHOR]

Background: Hypothyroidism (both subclinical and overt) is associated with increased cardiovascular morbidity. About 3% hypertensive patients found to have hypothyroidism during the routine investigations. Objectives: To assess the effect of thyroid hormone replacement on the level of blood pressure in the cases of newly diagnosed subclinical hypothyroidism. Methods: Patients above the age of 15 years admitted to various wards (Indoor) or attending Endocrinology OPD at teriatary care health centre of north India were enrolled during the period of one year. The cases were divided into two groups, normotensive and hypertensive. Cases with subclinical hypothyroidism after evaluation were prescribed thyroxine replacement therapy to achieve euthyroid function. Each group followed periodically at 1 ½, 03 and 06 month with measurement of blood pressure and serum TSH, T3 and T4 level. Results: The prevalence of hypertension in cases of subclinical hypothyroidism in this study was 33.4 per 100 populations. There was no correlation between serum TSH level and blood pressure level in hypertensive group (p>0.05). In hypertensive group mean fall in blood pressure after thyroxine replacement therapy was systolic blood pressure 20.10±11.2 diastolic blood pressure 13.16±3.8 and in mean arterial pressure 15.2±4.7. With replacement of thyroxine hormone, the blood pressure was normalized in 47.4% (45 out of 95 cases) cases with elevated blood pressure. Conclusion: The effect of thyroxine replacement therapy in cases of hypertension with subclinical hypothyroidism on blood pressure was significant reduction in blood pressure after achieving normal thyroid function. [ABSTRACT FROM AUTHOR]

Abdominal obesity is one of the pivotal factors in defining the metabolic syndrome. Abdominal obesity is assessed by the various clinical surrogates among which waist circumference is considered to be simple, inexpensive & sensitive tool. But various controversies surround the exact cut offs and the ideal sites of waist circumference measurement, so in this review we discussed these issues. [ABSTRACT FROM AUTHOR]

SGLT2 inhibitors are a new class of anti-diabetic drugs recently approved by the FDA which act by a novel beta cell independent mechanism. Acute pancreatitis is a very rare adverse effect of this group of drugs, with only three cases described so far in medical literature. Our case describes the occurrence of diabetic ketoacidosis precipitated by acute pancreatitis in a middle aged diabetic individual who was recently started on therapy with Dapagliflozin. Timely diagnosis and management lead to complete recovery of the condition with no residual disabilities. This highlights the importance of awareness of this rare adverse effect associated with SGLT2 inhibitors to facilitate prompt detection, management and preventing morbidity [ABSTRACT FROM AUTHOR]

Background: Various autoimmune disorders are associated with pediatric-type-1 diabetes mellitus (DM), but are usually ill-defined and not usually suspected until the disease becomes advanced, and the prevalence of these autoimmune conditions is usually not very well defined in developing part of the world. Aim: To find out the prevalence of various autoimmune disorders associated with pediatric-type-1 DM. Materials and Methods: Total of 164 patients were screened (90 males and 74 females) during the study period of 1-year, patients were evaluated for the clinical signs, biochemical investigations and family history of autoimmune disorders in a tertiary health care center in western Uttar Pradesh. Results: Autoimmune thyroiditis was found to be most commonly associated with type-1 diabetes, followed by the celiac disease, and Graves' disease, others less commonly seen were pernicious anemia, juvenile rheumatoid arthritis and vitiligo. Conclusion: Autoimmune hypothyroidism was found to be significantly associated with type-1 diabetes, timely identification of these disorder are of paramount important for better glycemic control and to reduced the morbidity and mortality associated with the conditions. [ABSTRACT FROM AUTHOR]

Latent Autoimmune Diabetes of Adult (LADA) is an autoimmune form of diabetes mellitus characterised by onset in adulthood and slow progression of beta cell failure. It is commonly misdiagnosed as type 2 diabetes mellitus and treated with oral hypoglycaemic agents, ultimately resulting in delay of insulin initiation. Acute hyperglycaemic crisis in the form of diabetic ketoacidosis is a rare initial presentation of LADA with very few cases reported so far. We present the case of a 40 year old housewife with no past or family history of diabetes that presented with diabetic ketoacidosis and was subsequently discovered to be affected with LADA. [ABSTRACT FROM AUTHOR]

Rupture of the sinus of Valsalva (RSOV) is an uncommonly encountered condition. It can present with wider manifestations ranging from an asymptomatic murmur to cardiogenic shock. The case discussed in this report also had subaortic membrane which usually presents with subvalvular aortic stenosis, left ventricular hypertrophy, myocardial ischemia and sudden death. Corrective cardiac surgery was advised, but due to financial constraints, the patient could not be operated and he died. Here, the authors report for the first time an unusual presence of both RSOV and subaortic membrane and the patient presented with thromboembolic complication resulting from infective endocarditis.