Diabetic nephropathy and its association with cardiac autonomic dysfunction

Diabetic nephropathy is one of the fore runners of almost all complications of diabetes. This is a preventable disease. It can lead to sudden deaths due to arrhythmias in nephropathic patients, which can be due to cardiac autonomic dysfunctions To establish an association of diabetic nephropathy with cardiac autonomic dysfunction by crosses sectional study. Materials and Study was conducted in the Diabetic Clinic of JPMC Ward - 7 from January 1993 to January 1994. Fifty [N= 50] diabetic patients were included in the study with a history of diabetes for more than five years. Thirty six [N = 36] were diabetic proteinuric patients while fourteen [N=14] were non proteinuric diabetes. Patients with severe ischemic heart disease patients and infections anywhere in the body were excluded. Patients were divided[a-e] in to five groups according to severity of protein excretion in 24 hours. They were than assessed for cardiovascular autonomic neuropathy. Four tests for autonomic dysfunctions for selected. 1. Valsalva manoeuvre 2. Systolic blood pressure change to standing 3. Heart rate variation to breathe tests. 4. Heart rate variation to standing Group A was non-nephropathic diabetics while from B to E, were uric diabetics in increasing severity. All autonomic tests showed increased abnormalities with degree of protein excretion. The tests were least abnormal in Group A while mostly abnormal in-group E, group B, C, D showed mostly borderline and abnormal responses. Autonomic abnormalities are increasingly seen with severe diabetic nephropathy, while least observed in non-nephropathic diabetes. This is of immense importance as cardiac arrhythmias and sudden death are encountered more frequently in cardiac autonomic disturbed patients

Role of keto-analogues in the conservative management of chronic renal failure

One hundred patients with chronic renal failure were studied for twenty months to see the effect of a low protein diet supplemented with ketoanalogues [Ketosteril]. Their protein intake was restricted to 0.6-0.8 gms [35 kcals]/kg bw/day. Eighty two patients reported improvement and experienced enhanced physical activity, mental alertness, improved appetite and sleep. There was no generalised weakness, wasting of muscles and weight loss. Of these 82 patients, 33 showed definite improvement as their blood urea nitrogen [BUN] decreased while in 49 BUN remained stable i.e. it neither decreased nor increased. Out of the remaining 18 patients who did not show any improvement, seven are on maintenance haemodialysis, three underwent renal transplantation, five expired while three were lost to follow up. It is concluded that a low protein diet supplemented with ketoanalogues [Ketosteril] can improve uraemic symptoms, improve rehabilitation status and can thus defer an early need for dialysis

Safety and efficacy of ciprofloxacin in the treatment of complicated urinary tract infections

One hundred patients with complicated urinary tract infection with significant colony counts were treated. The most common organism was Escherichia coli [86%], Pseundomonas aeruginosa [8%], Klebsiella [4%] and mixed infection with Escherichia coli and Proteus mirabilis [2%]. Most of the patients started showing improvement within 48 to 72 hours and complete recovery was achieved with 7 to 10 days with Ciprofloxacin 250 mg twice daily. A cure rate of 98% was achieved. Adverse effects were insignificant. There were no significant changes in the renal and liver function tests after the therapy. All the patients were followed up for a period of six months. Most of the patients with anatomical structural deformities were later on treated surgically. Since complicated UTI is a serious problem the safety and efficacy of only one drug with newer fluoroquinolones was studied