Impact of diabetes mellitus on nerves

Background: Involvement of the peripheral and autonomic nervous systems is probably the most common complication of diabetes. The main symptoms of diabetic polyneuropathy include negative symptoms (those related to nerve fiber loss or dysfunction) such as numbness and weakness, and positive symptoms (those related to abnormal function of surviving nerve fibers) such as tingling and pain.Methods: This was a cross-sectional study held in diabetic clinic of Nishter hospital, Multan, Pakistan. The study included any diabetic patients showing symptoms of neuropathy.Results: There were total of 140 in this study. This study included 85% of male and 15% of female. Most common symptoms of diabetic neuropathy were pain (70%) and tingling (70%) followed by numbness in 65% of patients. There were 28 patients in 5 years duration of diabetes, 35 people in 6-10 years duration, 21 patients in 11-15 years duration, and 14 patients in 20+ years duration.Conclusions: Neuropathy due to diabetes is crippling especially when pain is the prominent symptoms. Autonomic symptoms like constipation and lightheadedness are discomforting for the patients. The most commonly used screening test is vibrating tuning fork test which is east to perform is clinical setting and is not time consuming. Diabetic patients need to take special care of

Types and clinical presentation of stroke

Background: Stroke is one of the leading causes of mortality and morbidity worldwide. In this study, authors worked on clinical presentation and types of stroke. The two main types of strokes are ischemic and haemorrhagic. Brain infarction is caused by decrease blood flow due to either narrowing of artery or complete obstruction to blood flow owing to embolism. While haemorrhage is caused by rupture of artery or aneurysms leading to accumulation of blood in the brain parenchyma.Methods: Cross sectional study of group of patients in Nishtar hospital Multan, Pakistan who presented with variety of neurological symptoms who were subsequently diagnosed as non-traumatic stroke. All patients were subjected to a detailed history and thorough clinical examination and investigations after obtaining informed consent.Results: Of 122 patient, 66 patients were male and 56 were female. Ischemic stroke was more common: present in 76 patients as compared to 46 patients with hemorrhagic stroke. Hypertension was present in 40.9% of ischemic stroke and 27.8% of hemorrhagic strokes. Most of the patients (67.2%) had altered sensorium at presentation followed by hemiplegia in 39.3 % of patients.Conclusions: Prevalence of ischemic strokes is higher than that of haemorrhagic stroke. Hypertension is associated with both types of these strokes. Moreover, hyperglycaemia and high blood pressure are common in early phase of stroke. Vomiting in stroke favors haemorrhagic stroke

Clostridium difficile Peritonitis: An Emerging Infection in Peritoneal Dialysis Patients

Recently, the incidence of Clostridium difficile- (C. difficile-) associated infection has increased significantly in hospital and ambulatory care settings in parallel to the increasing use of inappropriate antibiotics. According to the CDC, approximately 83,000 patients who developed C. difficile experienced at least one recurrence and 29,000 died within 30 days of the initial diagnosis. Patients on dialysis (particularly peritoneal dialysis) are predisposed to this infection due to an inherent immunocompromised state and transmural translocation of the bacteria due to the close association of gastrointestinal tract and peritoneal cavity. C. difficile infection in peritoneal dialysis patients is problematic from two aspects: (1) because dialysis patients are immunocompromised, the infection can be devastating and (2) infection directly interferes with their renal replacement therapy. In this article, we present a case of peritoneal dialysis (PD)-related peritonitis caused by C. difficile-associated diarrhea and colitis. In this patient, the peritonitis was caused by transmural translocation of the enteric bacteria. While the peritoneal fluid culture did not grow the organism (possibly because of prior empiric broad-spectrum antibiotics use), the positive PCR on stool analysis suggested C. difficile-related peritonitis, along with the rapid clinical improvement induced by C. difficile-directed therapy (metronidazole) and discontinuation of broad-spectrum antibiotics. The patient was successfully treated with metronidazole without PD catheter removal. C. difficile infection is common and frequently internists are the first contact with such patients. This article highlights C. difficile infection in a PD patient and raises awareness of this infection in dialysis patients