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Background: With the advent of multimodality treatment approach, the number of cancer survivors is increasing which push us further to increase our knowledge on potential sites which could be exploited for the survival benefit of the patients. Insulin resistance has long been known to be a risk factor in various malignancies including breast, colon and endometrium. Insulin, a member of the family of growth factors that includes insulin-like growth factors IGF 1, IGF II, exerts mitogenic effects on normal and mitogenic breast epithelial cells acting via insulin and IGF 1 receptor. Insulin resistance leads to overexpression of the above-mentioned receptors and malignant transformation of cells. Aim of the study: To assess the prevalence of insulin resistance in non-diabetic carcinoma breast patients and to document fasting insulin levels in the same cohort of patients. Materials and methods: This was a prospective study conducted in the Department of General Surgery, Government Stanley Medical College in 2018. This study included all patients diagnosed as carcinoma breast, who was a non-diabetic. The relevant details collected included a clinical, radiological, pathological and biochemical profile of patients with carcinoma breast. Results: In our study, the majority of the patients had T3 lesion, with an almost equal incidence of T2. The incidence of T1 lesion was almost nil, which might indirectly indicate the lack of identification of carcinoma breast at an earlier stage in spite of widespread screening tests and campaign. In our study, the prevalence of insulin resistance was 17.2%. Five patients out of 29 of our study group had fasting insulin levels > 25µIU/L and found to have insulin resistance, with blood glucose levels within normal range. Conclusion: The study stated that insulin resistance which is considered a risk factor for many cancers, including carcinoma breast, might be prevalent in patients with normal glucose levels and in the absence of any symptoms. Screening them may be useful in identifying this cohort of patients and Princess Beulah, Vignesh. A study on fasting insulin levels in non-diabetic carcinoma breast patients. IAIM, 2019; 6(3): 194- 200. Page 195 treating them with tailored insulin resistance lowering agents like metformin which was found to have anti tumourigenic activity, as well as complete pathological response.
RESUMO
Background: Acute pancreatitis has widely variable clinical and systemic manifestations spanning the spectrum from a mild, self-limiting episode of epigastric pain to severe, life-threatening, multiorgan failure. Since the morbidity and mortality of Acute Pancreatitis differ markedly between mild and severe disease (mild < 5% vs severe 20–25%), it is very important to assess severity as early as possible. Various scoring systems like APACHE II scoring, RANSON scoring and BISAP have been used to asses Severity in Acute Pancreatitis. Aim and objective: To assess the accuracy of BISAP scoring system vs RANSON scoring system in predicting Severity in an attack of acute pancreatitis. Materials and methods: In this study, 60 in-patients presenting with features of acute pancreatitis Government Stanley Medical College General Hospital from November 2016 to September 2017 had been studied. It was a perspective and a retro prospective study. BISAP score and Ranson’s score was calculated in all such patients based on data obtained within 48 hours of hospitalization. Results: According to Atlanta Revised criteria, 30 patients had mild pancreatitis, 20 patients had moderately severe pancreatitis, 10 patients had severe pancreatitis. Of the 60 patients, 37 patients had Ranson's score less than or equal to 3. 23 patients had a score of more than 3.Of the 60 patients, 39 patients had a BISAP score less than or equal to 3, 21 patients had a score more than 3. Conclusion: From this study, we can conclude that the BISAP scoring system is not inferior to Ranson’s scoring system in predicting the severity of acute pancreatitis. BISAP scoring system is very simple, cheap, easy to remember and calculate. BISAP scoring system accurately predicts the outcome in patients with acute pancreatitis. Moreover, the values in BISAP score are instantaneous and there is no time delay. Ranson’s score takes a minimum of 24 hours.