Insulin resistance (IR) is a major factor in the pathogenesis of sepsis. Critically ill patients with multi-organ dysfunction syndrome (MODS), diagnosed as per modified Acute Physiology and Chronic Health Evaluation II (modified APACHE II) score criteria and admitted to the medical ward in our hospital, were assessed for IR and beta cell function by using the homeostasis model assessment A (HOMA-A) and HOMA-B models, respectively. Of 80 consecutive patients, 60 were followed up to day 7; 16 patients died and 4 did not agree to follow up. The mean value of IR in all the 80 patients studied on the day 1 of hospitalization was 6.67 +/- 10.65. The initial high values of serum insulin and IR were significantly reduced (p < 0.05) as these patients recovered from their critical illness. Of those who died, the first day mean insulin levels were high (13.80 +/- 14.72 micro/ml as well as IR 5.14 +/- 6.76 values), but they had statistically low beta cell function (46.45 +/- 433.64%) as compared to those who recovered (227.60 +/- 430.36%; p < 0.05). This suggests that, beta cell overexhaustion occurs in critically ill patients, because it was required to overcome the prevailing state of IR and has more bearing in patients having less than 4 organ failures. beta cell failure ensued from the onset in those who were more moribund and had more than four organs failing or those who died. IR and beta cell function are reliable indicators of the state of severity of critical illness, and they corroborated with mortality in patients with MODS.
Aim: To determine the relationship of carotid plaque, intima media thickness (IMT), resistivity index (RI) and pulsatility index (PI) and prevalence of different risk factors with acute ischemic stroke and stroke subtypes in both diabetic and non-diabetic subjects. Materials and methods: 80 cases of acute ischemic strokes and 40 healthy controls were included in the study. The plaque, IMT, RI and PI were measured by carotid duplex ultrasound. Results: 31 subjects were Type 2 diabetic, 54 hypertensive while 25 were both diabetic and hypertensive. 23 cases (28.75%) had lacunar stroke (LACI), 32 (40%) stroke involving partial anterior circulation(PACI), 10(12.5%) stroke in posterior circulation (PACI) and 15(18.75%) stroke involving total anterior circulation(TACI) respectively. The mean IMT (0.88 ± 0.19mm), RI(0.76 ± 0.05) and PI(1.71 ± 0.19) of patients and mean IMT (0.6±0.09mm), RI (0.61 ± 0.06) and PI (1.53 ± 0.11) of controls were statistically significant (p-0.000). The mean values of IMT, PI and RI were significantly higher in diabetics (IMT-0.90 ± 0.16 VS 0.64 ± 0.11, p-0.013; PI-1.76 ± 0.20 VS 1.49 ± 0.09, P-0.000 and RI-0.76 ± 0.04 VS 0.59 ± 0.06, P-0.000) and similarly the mean values for IMT, PI and RI in hypertensives as compared to controls (IMT-0.88 ± 0.16 vs 0.65 ± 0.10, P-0.006; PI1.69 ± 0.18 vs 1.49 ± 0.09, P-0.000 and RI 0.76 ± 0.04 vs 0.59 ± 0.06, P-0.000). The mean IMT, PI and RI were increased significantly in smokers compared to controls (IMT-0.93 ± 0.20 vs 0.63 ± 0.06, P-0.000; PI-1.82 ± 0.22 vs 1.49 ± 0.09, P-0.000 and RI-0.77 ± 0.04 vs 0.59 ± 0.06, P-0.000). Type 3 plaque accounted for 27 (56.2%) cases and Type 2 plaque 12 (25%) cases. The total number of plaques in patients as compared to controls were significantly more (P-0.0034) and the mean plaque area was 46 mm2 for cases and 20 mm<sup>2</sup> for control (P-0.0001). TACI was the most common type of ischemic stroke seen in DM (60%), HTN (66.6%) and smokers (66.7%). Plaques (73.3%), IMT (0.90 ± 0.12), PI(1.72 ± 0.14) and RI (0.76 ± 0.13) were more commonly associated with TACI subtype. On multivariate analysis using ANOVA, the mean PI was highly significant (0.000) in relation to types of plaque. Summary and Conclusions: IMT, RI, PI and plaque type are useful diagnostic parameters for acute ischemic stroke and its subtypes. They can be used as noninvasive tools for predicting and preventing ischemic stroke in smokers as well as subjects with DM and hypertension
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