24.dr mayank shukla.cdr BACKGROUND Cerebrovascular disease is one of the most frequently occurring and signicant neurological disorders among the [1,2]adult population . WHO denes stroke as "the rapidly developing clinical symptoms &/or signs of focal (at times global) disturbance of cerebral function, with symptoms lasting more than 24 hrs or leading to death with no apparent [3]cause other than that of vascular origin" . Majority of patients aged ≥65 years with stroke develop dementia and disability worldwide: about 25% of stroke patients develop dementia (4).Prolactin is a polypeptide hormone (molecular mass 21500 KD) that is synthesized in and secreted from specialized cells [5]of the anterior pituitary gland, the lactotrophs . Normal serum prolactin levels vary between 5 and 25 ng/ml for females while in males the normal prolactin levels range from 2 to 18 ng/mL. [6] Inammation and hypercoagulability are linked to the pathogenesis of atherosclerosis and i ts c l in ical manifestations such as coronary or peripheral artery disease and stroke [7]. Platelet activation and aggregation have been shown to play an important role in the pathophysiology of atherosclerosis and thrombosis in acute and chronic arterial [1,8] disease. Prolactin induces expression of P-selectin in the platelet and augment of adenosine diphosphate-induced platelet aggregation leading to thrombosis in acute coronary syndromes mainly in acute MI, also there was an association [9]between high prolactin level and stroke. AIM AND OBJECTIVES : 1) To evaluate correlation between Serum Prolactin and Acute Ischemic Stroke. 2) To nd out correlation between clinical severity of Acute ischemic Stroke and level of Serum Prolactin. MATERIALS AND METHOD : This is an observational, case control study which was conducted on 50 patients diagnosed with acute ischemic stroke admitted in ICU, Neurology and Medicine ward in Geetanjali Medical College and Hospital, Udaipur. 50 controls were also included in the study with unrelated ailments. The study was conducted from June 2018 to December 2018.Data of patients were collected by detailed history, clinical examination, investigations and diagnosis conrmed by MRI or CT Brain. Apart from routine investigations, serum prolactin estimation was done. The severity of stroke was assessed as per Glasgow Coma Scale (GCS). Selection of cases: Inclusion criteria: Patients with Acute Ischemic Stroke >18 years of age. Exclusion criteria: Patients with the history of coronary artery disease, peripheral arterial disease, venous infarcts ,epilepsy, metabolic and endocrine diseases, chronic renal failure, hepatic failure, malignancies, autoimmune and collagen tissue diseases, Pregnant females and Lactating women, history head trauma, previous intracranial surgical procedures and hemorrhagic stroke, platelet dysfunction and/or abnormal platelet counts, bone marrow diseases and hematological conditions that may lead to suppression of bone marrow, use of various drugs that have effects on bone marrow or prolactin metabolism such as anti- psychotics, hormone treatments, prolactin metabolism disorders like pituitary adenoma and prolactinoma and HIV- AIDS patients. Selection of controls:Patients with unrelated illess >18 years of age were selected and exclusion criteria included acute ischemic stroke patients and rest same as for cases. RESULTS : With equal number of cases and controls, i.e. 50 in each group. Mean age of 100 patients was 59.06±13.32 years.The mean age group in cases was 60.56±13.53 years and in control was 57.56±13.06 years.Mean blood uric acid level in cases was 4.98±1.45 and in control was 4.36±1.45 mg/dl, this difference was statistically signicant at p value of <0.05.The correlation between serum uric acid levels and severity of stroke was not statistically signicant. The Serum Prolactin level in mild and moderate GCS score is 42.28 and 42.72 ng/ml respectively. However, the Serum Prolactin level of patients with severe GSC score is lower i.e. 33.27 ng/ml as compared to others. For cases Pearson's correlation between serum uric acid level and age was 0.348 which is statistically signicant. (P<0.05) Table 1. Age and Serum Prolactin Level CORRELATION BETWEEN SERUM PROLACTIN LEVEL AND ACUTE ISCHEMIC STROKE Original Research Paper Dr. Mayank Shukla Resident, Department Of General Medicine, Geetanjali Medical College And Hospital, Udaipur, Rajasthan, India X 11GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS General Medicine BACKGROUND- In this study, we determined serum prolactin level in patients with acute stroke and assessed its relationship with disease severity. METHOD- This is an observational, case control study on patients diagnosed with acute ischemic stroke in Geetanjali Medical College and Hospital, Udaipur.50 cases and 50 controls were included in the study.Serum prolactin level along with other blood routine tests were done. RESULTS- The mean age group in cases was 60.04±2.04 years and in control was 48.76±2.399 years. Male preponderance was seen in both cases and control.Mean serum prolactin level in cases was 39.678±5.488 and in control was 9.998±0.942 ng/ml, this difference was statistically signicant at p value of <0.05. The correlation between serum uric acid levels and severity of stroke on basis of GCS score was not signicant. CONCLUSION- This study concludes that Serum prolactin level can be used as pathological biomarker in patients of acute ischemic stroke but of severity of disease cannot be predicted by its levels. ABSTRACT KEYWORDS : Prolactin, Stroke VOLUME-9, ISSUE-3, MARCH-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra Dr. Syed Javed* Associate Professor, Department Of General Medicine, Geetanjali Medical College And Hospital, Udaipur, Rajasthan, India *corresponding Author Age group Case Mean Serum Prolactin Control Mean Serum Prolactin <20 0 6.88 21-30 27.7 8.245 31-40 26.38 13.445 41-50 21.398 10.773 12 X GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS Table 2. GCS and Serum Prolactin in cases - The relationship between the GCS Score and outcome is the basis for a common classication of acute traumatic brain injury: Severe - GCS 3 to 8, Moderate - GCS 9 to 12 and Mild - [12]GCS 13 to 15. Table 3. DIFFERENCE BETWEEN CASES AND CONTROLS DISCUSSION : A stroke can be dened as a sudden onset of a neurological decit that is due to a focal vascular cause. Stroke is an important cause of mortality and long term morbidity. Serum prolactin has been described as cause of increased in vivo and in vitro platelet aggregation and these processes are [10]thought to contribute to the pathophysiology of stroke. In our study, mean serum prolactin level in cases was 39.678±5.488 and in control was 9.998±0.942 ng/ml, this difference was statistically signicant at p value <0.05. In the study of Tam et al., (2016) the mean serum prolactin for the case group with standard deviation was 117.26±83.52 whereas, the mean serum prolactin with standard deviation for the control group [11]was 11.99±5.25 which was higher than the current study . Tripathi et al. (2016) found that the patients of ischemic stroke were having higher serum prolactin level as compared to the controls. Mean prolactin level in ischemic stroke patients was [13]11.8 ng/ml and control group was 6.6 ng/ml (p value < 0.01) . The correlation between severity of stroke based on GCS score and uric acid levels was not statistically signicant in our study (p value >0.05). CONCLUSION : Serum prolactin can be used as pathological biomarker in patients of acute ischemic stroke. However the levels do not correlate with severity of the disease. REFERENCES : 1. Gawaz M, Langer H, May AE. Platelets in inammation and atherogenesis. Journal of Clinical Investigation. 2005; 115:3378–84. 2. Fateh-Moghadam S, Htun P, Tomandl B, Sander D, Stellos K, Geisler T, Langer H, Walton K, Handschu R, Garlichs C, Daniel WG. Hyperresponsiveness of platelets in ischemic stroke. Thrombosis and haemostasis. 2007;97(06):974-8. 3. Hatano S. Experience from a multicentre stroke register: a preliminary report. Bulletin of the World Health Organization. 1976;54(5):541. 4. Llibre J, Valhuerdi A, Fernandez O. prevalence of stroke and Associated Risk factors in Older Adults in Havana city and Matanzas Provinus, Cuba (10/66 Population-Based study) MEDICC Review. 2010;12:20–24. 5. BERN HA. The comparative endocrinology of prolactin. Recent Prog Horm Res. 1968;24:681-720. 6. Majumdar A. Mangal NS. Hyperprolactinemia. J Hum Reprod Sci. 2013 Jul- Sep; 6(3): 168–175. 7. Tohgi H, Suzuki H, Tamura K, Kimura B. Platelet volume, aggregation, and adenosine triphosphate release in cerebral thrombosis. Stroke. 1991 Jan;22(1):17-21. 8. Nieswandt B. Ruggeri ZM. Platelets In Atherothrombosis. Nature medicine. 2002 Nov;8(11):1227-34. 9. Ben-Jonathan N, Hugo ER, Brandebourg TD, LaPensee CR. Focus on prolactin as a metabolic hormone. Trends in Endocrinology & Metabolism. 2006 Apr 1;17(3):110-6. 10. Wallaschofski H, Kobsar A, Sokolova O, Eigenthaler M, Lohmann T. Co- activation of platelets by prolactin or leptin-pathophysiological ndings and clinical implications. Hormone and metabolic research. 2004 Jan;36(01):1-6. 11. Tam AA. Kaya C. Baser H. Ersoy R. Cakr B. Mean platelet volume in patients with prolactinoma. Arch. Endocrinol. Metab. 2016;60(4). 12. Ghelichkhani P, Esmaeili M, Hosseini M, Seylani K. Glasgow Coma Scale and FOUR Score in Predicting the Mortality of Trauma Patients; a Diagnostic Accuracy Study. Emergency. 2018;6(1). 13. Tripathi SK, Kamble P and Muddeshwar MG. Serum Prolactin Level in Patients of Ischemic stroke. International Journal of Contemporary Medical Research. 2016. 3(12). VOLUME-9, ISSUE-3, MARCH-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra 51-60 50.814 10.286 61-70 29.454 7.207 >70 45.419 10.685 No. of Patients Percent Mean Serum Prolactin Mild 24 48 42.28 Moderate 11 22 42.72 Severe 15 30 33.27 cases(n=50) controls(n=50) P value Age 60.04±2.04 48.76±2.399 <0.05 Sex Male 30 29 0.8388 Female 20 23 prolactin level 39.678±5.488 9.998±0.942 <0.05