Context: A complex dysregulation of glucose homeostasis, Diabetes Mellitus (DM) is an iceberg disease with an ever-rising global (8.5%, 2018) and national prevalence (7.3% - ICMR-INDIAB study, 2017) amidst adults. Besides the micro and macrovascular complications, in virtue of diverse mechanisms that downplay the immune system culminating in an array of infections especially UTIs are commoner in routine diabetic clinics. The spectrum of UTI ranges from asymptomatic bacteriuria (ASB) to serious complications such as emphysematous pyelonephritis, renal abscesses that are encountered frequently among Diabetics than the general population. The risk stratification and varying modalities of presentation of UTIs in diabetics in contrast with non-diabetics are being studied. Methods and Material: A prospective comparative cross-sectional study was conducted in 250 adult consenting participants with equal diabetics and non-diabetics with culture-proven UTI, at the Department of Internal Medicine in a tertiary care hospital of National Capital Territory (NCT) of India, after fulfilling appropriate criteria. Alongside socio-demographic details and vitals parameters, glycaemic status assessment and relevant investigations were done in either group. Results: Mean age of the participants was 52.18 ± 9.06 with age and gender being reasonably distributed in both the groups. Fever ( P <0.01), dysuria ( P <0.01), urgency ( P <0.01) and urinary frequency ( P <0.01) found frequently among non-diabetics wherein vomiting ( P <0.01) and incontinence ( P <0.01) relatively commoner among diabetics. E. coli, Klebsiella sp., were the most common organisms in both groups with Proteus sp., and Pseudomonas sp., higher among diabetics. Severe infection and Pyelonephritis were frequent (AOR 2.64, 95% CI- 2.01-3.27, P <0.05) among diabetics. Antimicrobial sensitivity patterns were not significantly different among both groups. Conclusions: Primary care physicians are to be acquinted with the possibility that UTI in diabetics could exhibit relatively lesser symptoms or more severe forms of UTI at presentation and less favorable outcomes. Further validation from a larger cohort of diabetics is warranted in terms of symptomatology, diagnostic approach, and sensitivity patterns.
Introduction: Calcium plays an important role in the pathogenesis of ischemic cell damage. Intracellular calcium accumulation leads to neuronal damage by triggering the cycle of cytotoxic events. In this study, the association of serum calcium levels with clinical severity of ischemic stroke as defined by the National Institute of Health Stroke Scale (NIHSS) score was evaluated. Materials and Methods: After obtaining ethical approval from the institutional ethics committee, data was collected from 60 ischemic stroke patients, who were divided into two groups of 30 patients each: group 1 with serum ionized calcium less than 4.5 mg/dl and group 2 with serum ionized calcium levels more than 4.5 mg/dl. The stroke severity in the two groups was assessed using the NIHSS score. Results: The severity of ischemic stroke according to the NIHSS score was greater in patients with low serum ionized calcium levels compared to the severity of ischemic stroke in patients with normal serum ionized calcium levels. Conclusion: Serum ionized calcium certainly plays a role in the pathogenesis of ischemic stroke by influencing the cycle of cytotoxic events that result in ischemic cell death. This study showed that the severity of ischemic stroke was greater in patients with low serum ionized calcium levels compared to patients with normal serum ionized calcium levels.
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