Hypoglycemia; experience in diabetics

Hypoglycemic symptoms are a very common experience for diabetics ranging from an innocent increased appetite to dreadful unconsciousness. This study was designed to assess the patient's awareness about the symptoms, experience of individual symptoms and their ability to recognize and to respond accordingly. All diabetic patients were assessed for the awareness of different symptoms of hypoglycemia, their experience of individual symptoms in last six months and ability of the patient and family members to recognize and to respond accordingly to these symptoms on a prescribed proforma with the help of trained staff. We had 1260 new cases of DM during the study period with valid diagnosis and taking either sulphonylurea or Insulin who were enrolled in the study. 280 patients had no idea of the symptoms. 564 patients knew no more than three symptoms. Palpitation and sweating were the most commonly known 80% and experienced 65% symptoms. Hunger and epigastric discomfort were the next best known 73% and experienced 58% symptoms. Loss of consciousness was the next in the list in terms of knowledge 52% and experience 23%. Coldness of body 28%, severe weakness 24%, blurred vision 12%, abnormal behavior 12% and altered consciousness 6% were the next in the list of experience. Early morning headache, night terror and frequent awakening were the least known 3% and recognized1% symptoms. Abnormal behavior and altered consciousness were not known to any patient as a symptom. Of those who knew or experienced the symptoms, eating anything available was the most common response, only 35% responded by eating rapidly available food items like sugar, honey, candies, beverages, fruit juice or jams. 3% of patients even resorted to taking diet colas initially and only later took other food after waiting for some time. In the event of patient getting unconscious, 80% of the times attendants did not consider hypoglycemia initially at home at first such experience. Patient must be properly educated about these symptoms before prescribing these agents and shall be repeatedly evaluated at each visit. Failing to recognize early and mild symptoms may lead to a terrifying experience

Amoebic liver abscess; incodence and outcome

Amoebic liver abscess is a common infection in third world countries like ours due to poor sanitary arrangements. It presents with severe pain and high grade fever and if not diagnosed and treated promptly, may lead to complications and mortality. To estimate the incidence, need for aspiration and treatment outcome. Case series study. At respective consultations centers in Faisalabad. From 1[st], January, 2007 to 31[st] December 2008. All patients suspected of the diagnosis of liver abscess whether presenting to physicians or surgeon were referred for ultrasonography for the confirmation of the diagnosis. Basic biodata, coexisting medical or surgical diseases and relevant investigation were recorded, and patient was assessed for the need to aspirate the abscess. After initial treatment patients were reassessed for the need to aspirate the abscess on third, tenth and twentieth day both clinically and ultrasonically. We had 188 cases in the study. There were 128 [68%] males and 60 [32%] females. Majority, 156 [76.6%], of the abscesses were single, 40 [21%] had double and 4 [2%] had three abscesses. 166 [83%] were situated in the right lobe, 28[15%] in the left lobe and 4 [2%] had abscess in both lobes. 16 [9%] were aspirated at presentation due to their size or position. Only 4 [2%] were aspirated at first follow-up on third day due to non resolution of pain or fever or increase in size. All the patients who were not lost from follow up responded to standard treatment of metronidazole. Amoebic liver abscess is a common diagnosis in our setup. Patients presents with right upper quadrant pain and fever. Clinical background and ultrasonogram give a reasonable suggestion about amoebic etiology. If initial aspiration is not indicated due to size larger than 5cm. or proximity to surface or nonresolution of symptoms or lesion in left lobe, conservative treatment with oral or intravenous metronidazole is successful