No abstract

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.

BACKGROUND Tuberculous meningitis (TBM) still remains an important cause of morbidity and mortality in India. Due to lack of early and timely diagnosis of TBM, the fatality rate remains high. OBJECTIVES To evaluate the role of Adenosine Deaminase (ADA) activity in the Cerebrospinal Fluid (CSF) in diagnosis of Tubercular meningitis in adults. MATERIAL AND METHODS The study included 100 patients who presented with sign and symptoms suggestive of meningitis. All the patients were admitted; detailed history and examination including neurological examination was done. CSF samples were taken along with other routine investigations. CSF analysis was done for sugar, protein, cells, and ADA. X-Ray Chest was done in all patients to find out the lung involvement. RESULTS Out of a total of 100 patients, 49 were diagnosed as TBM based on the clinical features and CSF analysis. The CSF showed pleocytosis of 10 to 500 cells/mm3 predominantly lymphocytes, protein >45mg/dl, sugar<40mg/dl or <40% of blood glucose concentration. The mean ADA activity was 12.54±3.91 U/L in patients with TBM. The sensitivity and specificity was 75.51% and 100% respectively when a cutoff value of ADA of 10U/l was used, with an accuracy of 88%. CONCLUSIONS ADA activity in the CSF is very important and rapid screening test that can help in the diagnosis of TBM. ADA activity is markedly higher in TBM.