ABSTRACT
Background: Diabetes increases the risk of infection and the commonest amongst them are the ones involving the genitourinary tract. Diabetic patients are found to have an increase in the risk of developing urinary tract infection (UTI) by 60%. The study aimed to determine the causative pathogens and their antimicrobial pattern, identify risk factors associated in type 2 diabetic subjects having UTI. Methods: This was an observational study conducted in the medicine unit of a tertiary care hospital over a period of 8 months. A total of 619 (M:F 289:330) type 2 diabetic subjects were studied. History, clinical examinations, and the duration of diabetes were recorded in all patients at admission. Diabetes was diagnosed based on the WHO criteria. An immunoturbidimetric method was used to estimate glycosylated hemoglobin (HbA1C%). Diagnosis of UTI was made from midstream urine samples of patients if the urine cultures has >103 to >105 colony forming units (CFUs)/mL of a pathogen. Results: Among the 619 diabetic patients 220 patients had pus cells in urine but 72 patients had insignificant colony count. 90 (60.8%) patients were more than 60 years old, 48 (32.4%) were in the age group of 40-60 years and 10 (6.7%) were less than 40 years old. Among the 148 patients studied 52 (35.1%) were males and 96 (64.9%) were females. 116 (78.4%) had diabetes for more than 15 years and the rest had a duration lesser than 15 years. The HbA1C of patients with and without UTI were 10.2 ± 1.6 and 8.4 ± 1.3 respectively. Gram negative bacilli were isolated from 129 (87.2%) patients which included E. coli in 75 (50.7%), Klebsiella in 30 (20.3%), Pseudomonas species in 12 (8.1%) and Citrobacter in 12 (8.1%). Gram positive cocci were responsible for UTI in 15(10.1%) of subjects including Enterococcus in 13 (8.9%) and Staphylococcus in 2 (1.3%). Gram negative bacilli including E. coli, the Klebsiella species, pseudomonas and Citrobacter had good response to piperacillin-tazobactum, cefoperazone sulbactum, imipenam and amikacin. Gram positive cocci (Enterococcus and Staphylococcus) responsible for UTI showed good susceptibility to vancomycin (81 and 94% respectively) but a high resistance to ciprofloxacin and tetracyclines (68 and 57% respectively). Conclusions: Female gender, age and duration of diabetes were found to have increased risk factors for developing UTI in diabetes. Escherichia coli was the commonest organism causing UTI in diabetes which showed good response to piperacillin/tazobactum, cefoperazone-sulbactum, imipenam and amikacin.
ABSTRACT
A 31-year-old male born of a second degree consanguineous union was admitted with fatigue for 3 months. His past medical history was significant for recurrent renal stones from the age of 12 years. He was evaluated and diagnosed to have primary hyperoxaluria. He developed renal failure secondary to nephrolithiasis and is on hemodialysis for past 6 years. His younger brother also has renal failure secondary to nephrolithiasis. Examination showed hepatosplenomegaly. His hemoglobin was 8.9 g/dl (normocytic, normochromic), total white blood cell count 4900/μl, platelet count 1.1 × 109/L, erythrocyte sedimentation rate 88 mm in 1 h. Peripheral smear showed dimorphic anemia, anisopoikilocytosis, polychromasia and mild thrombocytopenia. He had normal blood sugars and altered renal function tests. Liver function tests showed only hypoalbuminemia. A bone marrow biopsy revealed extensive eosinophilic needle shaped crystalline structures arranged in radial pattern replacing normal hematopoietic cells [Figure 1a and b], which showed birefringence under polarized light [Figure 1c and d] consistent with calcium oxalate monohydrate crystals. Primary hyperoxaluria is an inherited disorder featured by the hyperoxaluria, calcium oxalate urinary lithiasis in childhood, nephrocalcinosis, and renal failure. Bone marrow oxalate deposition can be associated with variable degrees of cytopenias, leukoerythroblastic
ABSTRACT
Background: Hyponatremia is the most common electrolyte abnormality among the patients in medical wards as well as in the intensive care unit contributing to substantial morbidity and mortality. The most common cause of hyponatraemia in hospital inpatients is Syndrome of Inappropriate Anti Diuretic Hormone secretion (SIADH). This prospective observational study was designed to assess the clinical profile of SIADH. Aim: To assess the clinical profile of SIADH in medically ill patients. Methods: This was an observational study for 24 months conducted in a tertiary care hospital. Patients were assessed clinically to study the volume status, effects of hyponatremia on nervous system and find out various etiologies for SIADH. All patients underwent routine hemogram, blood biochemistry, serum electrolytes, thyroid function tests, morning serum cortisol estimation, plasma and urinary osmolality determination as well as urinary sodium estimation. Patients were diagnosed to have Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH) if they satisfied the Bartter and Schwartz criteria. Results: Among the eighty patients with euvolemic, hypoosmolal hyponatremia who were screened for SIADH, seven patients were excluded due to various reasons (hypothyroidism, Sheehan’s syndrome, Addison’s disease). The mean age of the patients was 64 ± 13 years. Among 73 patients included there were 33 (45.2%) male patients and 40 (54.8%) female patients. Severe hyponatremia (Na <110 meq/l) was detected in 33 patients (45%). Pulmonary causes were the most common cause of SIADH in this study seen in 25 (34.2%). The other causes were idiopathic in 20 (27.4%), neurological in 17 (23.3%), drug induced in 2 (2.7%), positive pressure ventilation in 5 (6.8%) and other infections in 4 (5.5%).The average rate of correction was 5 meq ± 1.5 in the first 24 hours. The overall mortality was found to be 7%. Conclusion: Hyponatremia due to SIADH is common among elderly patients with preponderance for female population. Majority of the patients in the present study were noticed to have an underlying respiratory cause as the etiology. Mortality in SIADH patients was related to the underlying cause rather than the severity of hyponatremia.
ABSTRACT
Transverse myelitis is one of the rare neurological complications of Varicella-Zoster Virus (VZV) infection in immuno-competent. We report a 26-year-old immuno-competent gentleman who developed virologically confirmed myelopathy caused by VZV which improved with steroids and acyclovir leaving no residual neurological deficits.