ABSTRACT
Emphysematous pyelonephritis is a rare, severe, necrotizing renal parenchymal infection characterized by gas accumulation in kidney(s) with or without involving surrounding tissues. Patients with diabetes mellitus are the usual sufferers. Here we describe a case history of a young Bangladeshi diabetic lady who presented with dysuria, fever and abdominal pain. Investigations confirmed left sided emphysematous pyelonephritis. She responded to and recovered with intravenous antibiotics.
ABSTRACT
Background: ST-segment depression in ECG is a common finding during paroxysmal supraventricular tachycardia. The exact mechanism and etiology of this ST-segment depression is not always evident. In this study we have tried to evaluate the significance of ST-segment depression during supraventricular tachycardia. Methods: Hospitalized patients for elective electrophysiological study with previous (EPS) history of supraventricular tachycardia with or without ST-segment depression were evaluated clinically, by coronary angiogram and EPS. Data were analyzed by appropriate statistical methods and comparison made between groups with ST-segment depression (Group A) and without ST-segment depression (Group B). Results: Total number of patients was 66. Equal number of patients (33) was in each group. The mean age of patients was 43.8 years. There was female predominance (M:F ratio 2:3). The mean heart rate during supraventricular tachycardia was 161 beats/min. Age, sex, coronary artery disease risk factors and heart rate during an episode of supraventricular tachycardia did not have any significant influence on ST-segment depression. Significant coronary artery disease was found in two patients in Group A and one patient in Group B. Electrophysiological study revealed that Atrio ventricular reentry tachycardia (AVRT) and AV nodal reentry tachycardia (AVNRT) were present in 28 (42.4%) and 38 (57.6%) cases respectively. Patients of group A exhibit AVRT significantly more than patients of group B.The sensitivity of ST-segment depression in correctly diagnosing coronary artery disease (CAD) was 66.7% while the specificity was 50.8%. The sensitivity of ST-segment depression in correctly differentiating AVRT was 83.3% while the specificity was 66.7%. The positive predictive value (PPV) and Negative predictive value (NPV) of the test were 75% and 76.9% respectively. Conclusion: ST-segment depression during episode of supraventricular tachycardia is a poor indicator of coronary artery disease. Presence of ST-segment depression can differentiate AVRT from AVNRT. However, >2 mm ST-segment depression was proved to be an excellent predictor of AVRT.
ABSTRACT
Background: Diabetic ketoacidosis (DKA) is one of the most common acute complications of diabetes mellitus (DM). DKA is a recognised presenting feature of type 1 DM, but it commonly complicates previously diagnosed diabetic patients of all types, specially if they get infection or discontinue treatment. Objective: To describe the precipitating causes of DKA. Materials and Methods: This cross-sectional study was done from September to November, 2010 in Bangladesh Institute of Research & Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM). Diagnosed DKA cases were evaluated clinically and by laboratory investigations for identification of precipitating causes. Results: Out of 50 patients, 28 were female. Mean age was 38.3 years. Forty patients (80%) were known diabetics and 10 (20%) were detected diabetic first time during this admission. Severe DKA cases were less common. Infection (20, 40%) was the commonest precipitating cause followed by noncompliance (14, 28%). In 7 (14%) cases no cause could be identified. Other less common causes included acute myocardial infarction, acute pancreatitis, stroke and surgery. Conclusion: Infection and noncompliance were the major precipitants of DKA. So, it is assumed that many DKA cases might be prevented by proper counselling regarding adherence to medication and sick days’ management.