Prevelance, risk factors and outcomes of hypoglycemia in elderly diabetic patients

To estimate the clinical outcomes of hypoglycemia in elderly diabetic patients, its associations with the different antidiabetic drugs and some predisposing factors or comorbid conditions. Both type 1 and type 2 diabetic patients with age 60 years or above fulfilling Whiple's criteria for hypoglycemia were included in this study. They were collected from the medical unit Hayatabad Medical Complex Peshawar from November 2010 to July 2011. The patient's history, clinical examination and investigations were recorded on a proforma. Patients with abnormal CNS findings on CT or MRI scan and those who didn't give any partial or complete response to the IV glucose, were excluded from the study. Eighty five patients with mean age of 75+6 years were included in this study. The average hospital stay was 10 days. Sixty-five percent [n=55] of these patients were using sulfonylureas, 20% [n=17] were using metformin alone and in combination, while 25% [n=21] were using insulin [combination of regular and intermediate acting]. Impaired renal function in 40% [n=34], impaired liver functions in 20% [n=17] and neglected elderly in 30.6% [n=26] were the most common predisposing factors. Diabetic treatment related hypoglycemia is more severe in the elderly population with a poor prognosis. Sulfonylureas are the most frequently associated drugs with poorer outcomes. Predisposing factors like impaired renal functions, liver functions and neglected elderly increase the frequency of hypoglycemia. HbA1c is not a good predictor of hypoglycemia in elderly population

Stroke and its relationship to risk factors

Stroke is a medical emergency and can cause permanent neurological damage, complications, and death. This trial was conducted to study the risk factors for stroke in our set up. This observational study was conducted in Department of Medicine, Saidu Teaching Hospital Swat, from January 2006 to December 2006. Eighty-eight patients, 62 males and 26 females with stroke were included in the study. History, general physical and neurological examination was recorded. Relevant investigations were performed, risk factors noted and the outcome studied after one week. Out of 88 patients, 62 were males and 26 females with age range of 45-95 years [Mean 65.9+9.15]. Cerebral infarction constituted 50%, intra-cerebral hemorrhage 29.5% and subarachnoid hemorrhage 11.3%. Hypertension was the most common risk factor 68 [75%] followed by diabetes mellitus 48 [54.5%], ischemic heart disease 32 [36.3%], hyperlipidaemia 12 [13.6%], smoking [13.6%] and valvular heart disease 6 [6.8%]. Most of these patients on presentation were semi-comatosed [50%], few were comatosed [29.5%] or alert [20.5%] at presentation. The outcome of these patients was recorded after a week of presentation and it showed mortality in 24 [27.2%]. There was no improvement in 22 [25%], 30 [34%] partially improved while complete recovery occurred in 12 [13.6%]. Mortality rate in stroke is 27.2% in our set up. The main risk factors for stroke are hypertension, diabetes mellitus, ischaemic heart disease, hyperlipidaemia and smoking. These can be modified by proper health education

role of branch chain amino acids [aminoleban] in the management of hepatic encephalopathy

To find out the efficacy of branch chain amino acids [Aminoleban] in the reversal / improvement of hepatic encephalopathy due to chronic liver disease [CLD] presenting with grade 3 and 4 hepatic coma. This descriptive study was carried out at the Department of Medicine, Saidu Teaching Hospital, Swat from 1st July 2005 to 31st December 2005. Patients meeting the criteria were enrolled by nonprobability convenient sampling method. Aminoleban was administered, transfusing two consecutive infusions [500 ml each] daily for 3 consecutive days only. The changes in the mental state were evaluated on day 1, 2 and 3 following Aminoleban therapy. A total of 50 patients [30 males and 20 females] with mean age of 51.3 years were recruited. The duration of CLD was 1-2 years in 25 patients [50%], 2-5 years in 15 patients [30%] and >5 years in 10 patients [20%]. Forty patients [80%] had first episode of hepatic encephalopathy. Complete reversal of hepatic encephalopathy was observed in 25 patients [50%] at end of 3rd day and there was no change in the grade of the coma in 15 patients [30%]. Grade of coma aggravated in 10 [20%] patients. Majority of non-responders [n=10] were having >5 years of duration of CLD. The parentral use of branch chain amino acids [Aminoleban] is reasonably effective treatment modality in the reversal of first episode of hepatic encephalopathy especially with shorter duration of CLD