A cross-sectional descriptive study of clinical autonomic dysfunction in diabetic peripheral neuropathy

Background: Adults having type 2 diabetes mellitus satisfying inclusion and exclusion criteria will be included. Consent of those who fit into inclusion criteria taken. 100 patients were analysed on the basis of history, clinical presentations, investigations. Patients presenting with signs and symptoms of neuropathy were accessed by nerve conduction studies (NCV), autonomic testing, heart rate variation with deep breathing, blood pressure response to standing. Arterial blood gas analysis, and CT /MRI also done. Methods: 100 patients of type 2 diabetes were taken and study of autonomic dysfunction was done for 3 months across tertiary health care centre. Results: Out of 100 diabetic patients under study 54 patients (54%) had diabetic neuropathy. Out of these 54, distal sensory motor neuropathy- most common (77%), sensory neuropathy- 24%. Axonal neuropathy was more prevalent than demyelinating neuropathy. Out of 100, 51 (51%) patients have autonomic neuropathy. Peripheral neuropathy was most common complication in which distal sensory motor polyneuropathy were common. Most common symptom of autonomic neuropathy was postural dizziness followed by erectile dysfunction. Conclusions: Most common complication of type 2 DM is neuropathy. Most common neuropathy was distal sensory motor polyneuropathy whereas most common symptom of diabetic neuropathy was postural dizziness. Other autonomic dysfunction was change in blood pressure and heart after standing.

Evaluation of spot urinary albumin - creatinine ratio as a screening tool in the prediction of pre-eclampsia in early pregnancy: a pilot study

Background: Pre-eclampsia is one of the leading causes of maternal and perinatal morbidity and mortality in India. Objective of this study was to establish whether a spot urinary albumin/creatinine ratio (ACR) measured between 18-28 weeks of gestation can predict subsequent pre-eclampsia in asymptomatic pregnant women.Methods: A prospective observational study involving 50 registered antenatal cases visiting the obstetrics outpatient department between 18-28 weeks of singleton pregnancy with nil proteinuria upon dipstick measurement were included. ACR was determined from random single midstream urine sample. Statistical analysis was performed using Chi square test and Student’s t-test.Results: Of the study group, 10 patients had high ACR value, with 8(80%) developed pre-eclampsia and 2(20%) remained normotensive. ACR had a sensitivity of 80%, specificity 97.56%, positive predictive value of 88.89%, diagnostic accuracy of the test being 94.12%.Conclusions: The spot urinary protein creatinine ratio is a reliable predictor for pre-eclampsia in pregnancy.

Meningitis due to Rhodotorula glutinis in an HIV infected patient.

Rhodotorula spp, though considered a common saprophyte, recently has been reported as causative agent of opportunistic mycoses. We present a case of meningitis in an immunocompromised human immunodeficiency virus infected patient who presented with longstanding fever. He was diagnosed as a case of chronic meningitis. Diagnosis was confirmed by cell cytology, India ink preparation, Gram staining and culture of cerebrospinal fluid (CSF) sample. CSF culture grew Rhodotorula glutinis. Therapy with amphotericin B was successful in eliminating the yeast from CSF and the patient was discharged after recovery.

Rare presentation of leucocytosis.

We present the case of a 44 years man who presented to us with persistent leucocytosis. Following relevant investigations, we diagnosed him to have Chronic Neutrophilic Leukaemia (CNL); a rare haematological disorder. Ten months later, he remains non-responsive to standard line of treatment.