Effect of Glycemic Control on the Clinical and Laboratory Profile of UTI in Patients with Diabetes Mellitus

Introduction: Urinary Tract Infection is the commonest infection in the patients of Diabetes Mellitus. Glycemic control, which is a major goal in the management of DM, may have an effect on their clinical profile and investigations. In this study, we compared the clinical and laboratory profile of UTI in patients of DM having good glycemic control with those having poor glycemic control. Material and Methods: This was a prospective observational study in the patients admitted in Department of General Medicine in a tertiary care centre in Central India between January 2017 and September 2018. A total of 100 consecutive patients of DM with culture positive UTI were included in the study. Results: Out of the 100 patients, 44% were males and 56% were females; 10% had Type 1 DM and 90% had Type 2 DM; and 57% had good glycemic control, whereas 43% had poor glycemic control. Patients on Oral Hypoglycemic Agents had better glycemic control (68.1%) than those on Insulin (26.3%) [P = 0.002]. 'Adherence to treatment' (85.9%) and 'regular follow up' (71.9%) were attributes of patients with good control [P < 0.001]. Commonest symptom seen was Dysuria (62%). Urinary incontinence (15%) [P = 0.001] and renal angle tenderness (14%) [P = 0.03] were significantly commoner in the poor glycemic control group. Escherichia coli was the commonest isolate in urine culture (70%). E.coli and other Gram Negative Bacilli were most susceptible to Aminoglycosides (72% and 83%) whereas Gram Positive Cocci were most susceptible to Nitrofurantoin (100%). Resistance to Ampicillin was uniformly high. Conclusion: Glycemic control was better in those patients who adhered to treatment and had regular follow-up. Urinary incontinence and renal angle tenderness were associated with poor glycemic control. E.coli was the commonest isolate and Amikacin, Ceftriaxone and Nitrofurantoin were the most useful antibiotics

Encephalopathy: An Unusual Neurological Manifestation Following Snakebite.

Encephalopathy following snakebite is infrequent. Neurotoxicity due to snakebite is well-known with varied presentation and fatality. We report a case of young male presenting with respiratory failure and neuromuscular paralysis, who later developed diffuse encephalopathy, convulsions and right-sided hemiparesis. Toxic effect of venom can be a possible cause for this rare presentation.