Jaundice Heralding the Onset of Thyrotoxic Crisis.

Thyrotoxic crisis is a life threatening medical condition that requires urgent diagnosis and treatment. Because of the wide variety of presenting symptoms, its diagnosis can be difficult in some cases and a high index of suspicion is required for diagnosis. We present a case of 53 year old patient who presented with fever, jaundice and passage of loose stools. Upon investigations other etiologies for hepatic injury were ruled out and she was found to be in thyrotoxic crisis causing liver injury.

Association of Fasting Plasma Glucose and Serum Lipids in Type 2 Diabetics.

Dyslipidemia is a significant morbidity associated with diabetes and cardiovascular disorders. The present study was undertaken to assess the lipid profile of type 2 diabetic and age-gender matched healthy subjects and its association, if any, with fasting plasma glucose. Clinically diagnosed diabetic subjects were recruited for the study. The fasting plasma glucose and lipid profiles were analyzed for 99 diabetic and 101 healthy volunteers. The blood samples were analyzed for fasting plasma glucose, total cholesterol, triglycerides, high density lipoprotein-cholesterol, low density lipoprotein-cholesterol and very low density lipoprotein-cholesterol. Correlation analysis of lipid profile with fasting plasma glucose and calculation of risk ratio was done. The levels of high density lipoprotein-cholesterol and low density lipoprotein-cholesterol were found to be significantly low in diabetics and subjects with lower low density lipoprotein-cholesterol were on statins. Inspite of lower lipid values, the risk ratio for diabetics was significantly higher. The correlation analysis indicated significant difference in relationship between fasting plasma glucose, lipid parameters and risk ratios in the two groups. Diabetics with lower high density lipoprotein-cholesterol and higher total cholesterol present with a higher risk ratio pointing to need of non-statin high density lipoprotein-raising medications decreasing their predisposition to cardiovascular disorders. The study highlights the altered pattern of correlation of lipid profile with fasting plasma glucose in diabetics and their increased risk of cardiovascular disorders. The dyslipidemia in the form of triglyceridemia and significantly low high density lipoprotein-cholesterol in diabetics point towards the need of non-statin high density lipoprotein-raising medications.

Circulatory adipocytokines and lipid profile variations in type-2 diabetic subjects: desirable side-effects of antidiabetic drugs.

AIM: Inspite of availability of a variety of drugs to treat type 2 diabetes, little is known about their effects on other systems. Normalization of glucose metabolism by these drugs may consequently affect the secretory function in adipocytes. Secretory adipocytokines like adiponectin and leptin are emerging as novel therapeutic targets for type 2 diabetes mellitus (T2DM). The present study was undertaken to analyze the effects of commonly used Oral Hypoglycemic Agents (OHAs) alone, or in combination with other drugs and/or insulin on circulatory adiponectin and leptin levels, lipid profile, and blood pressure in diabetic subjects. METHODS: The study was undertaken at IRSHA and Bharati Vidyapeeth Medical College and Hospital, MS, India. Clinically diagnosed T2DM subjects and age, gender matched healthy controls were recruited. Fasting blood was collected from each subject and the blood samples were analyzed for circulatory adipocytokines and lipid parameters using commercial kits. RESULTS: Serum adiponectin levels were significantly increased while leptin significantly decreased in diabetic men (p<0.05) and women (p<0.001) on OHA, as compared to healthy controls. Triglyceride levels significantly decreased (p<0.05) in diabetic men, however, they remained unchanged in women despite same drug treatment. Serum HDL and LDL levels (p<0.001) were significantly lower in diabetic women as compared to healthy women. Systolic (p<0.05) and diastolic (p<0.001) blood pressure was significantly high in diabetic men but remained unchanged in women. CONCLUSIONS: Frequently used OHAs significantly improve circulatory levels of adipocytokines. Selecting best treatment option for each patient is a key, and 2012 European Association for the Study of Diabetes (EASD) and ADA guidelines recommend diabetes treatment to be individualized depending on various socioeconomic and lifestyle factors. We recommend regular analysis of circulatory adipocytokines in T2DM patients to help clinicians select the best treatment option to normalize levels of these important therapeutic targets.

Acute organophosphorus poisoning complicated by acute coronary syndrome.

We report a case of 30 year old alcoholic male admitted with vomiting, drowsiness, limb weakness and fasciculations after alleged history of consumption of 30 ml of chlorpyriphos insecticide. He had low serum cholinesterase levels. With standard treatment for organophosphorus poisoning (OPP), he improved gradually until day 5, when he developed neck and limb weakness and respiratory distress. This intermediate syndrome was treated with oximes, atropine and artificial ventilation. During treatment, his ECG showed fresh changes of ST elevation. High CPK & CPK-MB levels, septal hypokinesia on 2D echo suggested acute coronary syndrome. Coronary angiography was postponed due to his bedridden and obtunded status. The patient finally recovered fully by day 15 and was discharged. Acute coronary syndrome is a rare occurrence in OP poisoning. The present case thus emphasises the need for careful electrocardiographic and enzymatic monitoring of all patients of organophosphorus poisoning to prevent potential cardiac complication which can prove fatal.