MO650EMPHYSEMATOUS PYELONEPHRITIS IN TYPE 2 DIABETES – CLINICAL PROFILE AND MANAGEMENT

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Dr Sanjay Bhat ◽  
Anupma Kaul ◽  
Priyanka Rai ◽  
Rohit Srivastav
Keyword(s):  
Glycosylated Hemoglobin ◽  
Left Kidney ◽  
Diabetic Patients ◽  
Emphysematous Pyelonephritis ◽  
Medical College ◽  
Poor Outcome ◽  
Microbial Profile ◽  
Disturbance Of Consciousness ◽  
Life Threatening ◽  
High Index Of Suspicion

Abstract Background and Aims Emphysematous pyelonephritis (EPN) is a rare but life-threatening acute suppurative infection of the kidney among diabetics. There is no current consensus on management of EPN. Method A prospective observational study was conducted at Department of General Surgery at RML institute of Medical sciences , Lucknow as well as at Eras Lucknow medical college, Lucknow from 2015-2018 to look for clinical, microbial profile and treatment outcome of diabetic patients with emphysematous pyelonephritis. Results A total of 76 Diabetic patients diagnosed with pyelonephritis were identified, of which 15 patients were diagnosed with EPN (26.3%). The mean age of the patients was 58.4±6.5 years. Mean duration of diabetes was 5.3 ± 3.3 years. 12 (82%) of the 15 patients with DM had a glycosylated hemoglobin A1C level higher than 7.5. Renal dysfunction at presentation was seen in 11 (73.3%) patients. Among the unilateral involvement, left kidney was more affected. Escherichia coli in 11 (73.3%), Klebsiella sp. in 1 (6.6%), Pseudomonas in 1 (6.6%), and 1 each with polymicrobial and fungal UTI respectively. Of 15 EPN patients, 13 (86.6 %) survived and 1 (6.6 %) expired. 2 of them underwent nephrectomy both survived. All patients with Stage I, II and IIIa EPN (n = 12) were managed with antibiotics with or without PCD. In EPN Stage IIIb/IV (n = 3), all the 3 (20 %) patients were managed with antibiotics and PCD and later 2 (13.3%) needed nephrectomy. Only time to diagnosis, altered sensorium, shock at presentation and thrombocytopenia were associated with poor outcome in EPN patients (P < 0.05) Multiple logistic regression tests showed shock (P = .04) and and disturbance of consciousness (P = .05) on hospital admission as being the independent factors for poor outcome. Conclusion EPN in diabetics needs high index of suspicion, timely diagnosis and good multidisciplinary approach with adequate antibiotics and surgical management for better patient outcomes.

scholarly journals Different Imaging Modalities for Evaluating Emphysematous Pyelonephritis (EPN); a Life Threatening Urological Emergency – A case report

2018 ◽  
Vol 20 (1) ◽  
pp. 63
Author(s):  
Rawnak Afrin ◽  
ABM Golam Mostofa ◽  
Shankar Kumar Biswas ◽  
Sadia Hossain ◽  
Sanowar Hossain
Keyword(s):  
Left Kidney ◽  
Lower Abdominal Pain ◽  
Tertiary Hospital ◽  
Renal Parenchyma ◽  
Ct Number ◽  
Emphysematous Pyelonephritis ◽  
Left Flank ◽  
Life Threatening ◽  
Urological Emergency ◽  
Contrast Ct

<p>Emphysematous pyelonephritis (EPN) is a severe necrotizing infection of the renal parenchyma; it causes gas formation within the collecting system, renal parenchyma, and/or perirenal tissues. In this reported case, a female patient of 40 years was admitted in a tertiary hospital with history of severe left flank pain, lower abdominal pain, fever, vomiting and scanty micturition for three days. Ultrasonogram showed-normal right kidney but left renal bed reveals extensive air obscuring visualization of left kidney with probe tenderness in left flank. Contrast CT scan of KUB shows larger left kidney with extensive air (CT number = -1000 HU) within the renal parenchyma, collecting systems and perinephric space. This case was diagnosed as EPN. After conservative treatment patient was improved significantly.</p><p>Bangladesh J. Nuclear Med. 20(1): 63-66, January 2017</p>

The Evaluation of Biochemical and Microbiological Parameters in the Diagnosis of Emphysematous Pyelonephritis

2017 ◽  
Vol 68 (6) ◽  
pp. 1285-1288
Author(s):  
Nicolae Grigore ◽  
Valentin Pirvut ◽  
Maria Totan ◽  
Dan Bratu ◽  
Sebastian Ioan Cernusca Mitariu ◽  
...  
Keyword(s):  
Biochemical Parameters ◽  
Biochemical Analysis ◽  
Renal Parenchyma ◽  
Diabetic Patients ◽  
First Line ◽  
Emphysematous Pyelonephritis ◽  
Gram Negative ◽  
Microbiological Parameters ◽  
Life Threatening ◽  
Etiologic Diagnosis

Emphysematous pyelonephritis (EPN) is a severe, necrotizing infection of the renal parenchyma, produced by gas-forming Gram-negative bacilli. Even though only few cases are reported in the literature, the disease is not so rare and can become life-threatening if the diagnose is not quick and the therapeutic messures efficient. The biochemical analysis are the first line diagnostic, indicating the severity of the infection. The aim of our study was to to evaluate the importance of biochemical parameters, as first line diagnosis and also of the microbiological parameters, as etiologic diagnosis, in severe renal infections produced by gas forming bacili mainly in diabetic patients, predominantly women, with obstructive nephrolithiasis.

scholarly journals Polyherbal antidiabetic drug: An approach to cure diabetes

2020 ◽  
Vol 11 (2) ◽  
pp. 2679-2683
Author(s):  
Ranjit Sidram Ambad ◽  
Gaikwad S B ◽  
Anshula G ◽  
Nandkishor Bankar
Keyword(s):  
Blood Glucose ◽  
Blood Sugar ◽  
Glycosylated Hemoglobin ◽  
Fasting Blood Glucose ◽  
Complete Recovery ◽  
Health Concern ◽  
Diabetic Patients ◽  
Medical College ◽  
The World ◽  
Animal House

In recent years, diabetes has become a major health concern. India is referred to as the diabetes capital of the world. There are plenty of chemical agents available to monitor and treat diabetic patients, but up to this date, no complete recovery from diabetes has been recorded. Many herbal plants with hypoglycemic properties are known from around the world as an alternative to these synthetic agents; which is a natural remedy to keep the blood sugar under control by consuming vegetables & herbs in our diet. Such medicinal plants & their herbal preparation with proven antidiabetic and related beneficial effects were used in the treatment of diabetes in rats. The effect of polyherbal drug Anti-hyperglycemic activity is studied in rats against alloxaninduced diabetes. This polyherbal drug consists of 16 antidiabetic plants. Disorders in diabetes-induced glucose metabolism have been shown to be regulated. The present study was conducted in the Dept. of Pharmacology and Dept. of Biochemistry at Central Animal House Facility of the SBH Govt Medical College, Dhule, in collaboration with Datta Meghe Medical College, (Datta Meghe Institute of Medical Sciences Sawangi, Meghe) Nagpur, Maharashtra, India. After the treatment, fasting blood glucose, plasma insulin and glycosylated hemoglobin (HbA1c) were determined in normal and experimental rats. Polyherbal mixture was seen to be an effective and safe method for management of diabetes which reduces blood sugar levels & shows positive effect in altering blood glucose levels. The herbal formulation could be lowering the insulin resistance, thereby normalizing the uptake of glucose by cells.

scholarly journals Emphysematous Pyelonephritis Caused by a Giant Fecaloma

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Mikael Abi Abdallah ◽  
Nehme Raad ◽  
Naim Yarak ◽  
Jean Paul Noujeim ◽  
Antoine Noujeim
Keyword(s):  
Septic Shock ◽  
Fecal Impaction ◽  
Routine Clinical Practice ◽  
Rapid Progression ◽  
Aggressive Treatment ◽  
Emphysematous Pyelonephritis ◽  
First Case ◽  
Threatening Condition ◽  
Life Threatening ◽  
High Index Of Suspicion

Emphysematous pyelonephritis (EPN) is a gas-producing necrotizing bacterial infection that involves the renal parenchyma and perirenal tissue. It is a life-threatening condition that requires a high index of suspicion, an early diagnosis and an aggressive treatment. Rapid progression to septic shock may occur. We report, to the best of our knowledge, the first case of obstructive EPN caused by a giant fecaloma. The patient was successfully treated with percutaneous drainage and broad-spectrum antibiotics, in addition to fecaloma evacuation using fleet enemas and oral laxatives. This shows how fecal impaction, a common pathology in routine clinical practice, can cause some serious complications if left untreated, including extrinsic ureteral compression.

scholarly journals Emphysematous pyelonephritis: non surgical treatment approach

2015 ◽  
Vol 14 (3) ◽  
pp. 305-307
Author(s):  
Kiran Kumar Singal ◽  
Neerja Singal ◽  
Bhaskar Gupta ◽  
Karun Puran Bhatti ◽  
Abhinav Gupta
Keyword(s):  
Diabetes Mellitus ◽  
Left Kidney ◽  
Medical Science ◽  
Severe Infection ◽  
Lumbar Region ◽  
Emphysematous Pyelonephritis ◽  
Patients With Diabetes ◽  
Life Threatening ◽  
High Doses

Emphysematous pyelonephritis is a severe infection characterized by the presence of gas within the renal parenchyma tissues. It is a life threatening complication of bacterial interstitial nephritis, and it mainly occurs in patients with diabetes mellitus. We report a case of a 37 year old female who complained of fever and pain in left lumbar region on admission. Her past medical history included uncontrolled type 2 diabetes mellitus. On USG (ultrasonography), left kidney swollen and show echogenic linear specs with dirty shadowing suggestive of air in pelvicalyceal system (PCS). She was treated with intensive antibiotic therapy in high doses. On repeat USG there was marked reduction in air shadow in kidney and patient improved clinically.Bangladesh Journal of Medical Science Vol.14(3) 2015 p.305-307

scholarly journals P1048EMPHYSEMATOUS PYELONEPHRITIS IN TYPE 2 DIABETES -CLINICAL PROFILE AND MANAGEMENT

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Dr Sanjay Bhat ◽  
Alok Srivastava ◽  
Nisar Ahmad ◽  
Priyanka Rai ◽  
R P Singh ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Obstructive Uropathy ◽  
Tertiary Care ◽  
Laboratory Data ◽  
Diabetic Patients ◽  
Care Hospital ◽  
Renal Abscess ◽  
Emphysematous Pyelonephritis ◽  
Duration Of Symptoms ◽  
Microbial Profile

Abstract Background and Aims Emphysematous pyelonephritis (EPN) is a rare but life-threatening acute suppurative infection of the kidney.60-70% are associated with uncontrolled diabetes mellitus (DM) with or without obstructive uropathy and superimposed with infection caused by gas-forming organisms. Conventional treatment of EPN is parenteral antibiotics with percutaneous or open surgical drainage and/or nephrectomy. There is no current consensus on management of EPN as to whether present day antibiotics alone good enough or is surgical intervention necessary and if surgical intervention required when should one go for nephrectomy. Method A prospective observational study was conducted at Tertiary care hospital, Lucknow from 2015-2018 to look for clinical, microbial profile and treatment outcome of diabetic patients with emphysematous pyelonephritis.The clinical features and laboratory data at the initial presentation, management and outcomes were analyzed .Contrast enhanced computerized tomography (CECT) was performed in case of suspected renal abscess and nonrecovering pyelonephritis Results A total of 76 Diabetic patients diagnosed with pyelonephritis were identified, of which 15 patients were diagnosed with EPN (26.3%) Renal papillary necrosis and renal abscess was seen in 1 and 3 patients, respectively. The mean age of the patients was 58.4 ± 6.5 years (age range 22-79 years). Pyelonephritis was more common among males. Duration of symptoms prior to hospitalization ranged from 16.34 ± 7.32 (range 8-32) days. Renal dysfunction at presentation was seen in 15 (100%) patients. Bilateral involvement was seen in 5 (33.3%) patients. Fever was the most common presenting symptom followed by dysuria. Urine and blood cultures were positive in 13 (88.3%) and 3 (20 %) patients respectively. Gram-negative bacilli were the most frequent organisms isolated, Escherichia coli in 11 (73.3%), Klebsiella sp. in 1 (6.6%), Pseudomonas in 1 (6.6%), and 1 each with polymicrobial and fungal UTI respectively. The fungus included Candida albicans managed with fluconazole. Good, moderate, and poor glycemic control was seen in 13 (12.3%), 16 (15.2%) and 76 (72.3%), respectively.Of 15 EPN patients, 13 (86.6 %) survived and 2 (13.3%) expired. 2 of them underwent Nephrectomy both survived.All patients with Stage I, II and IIIa EPN (n = 12) were managed with antibiotics with or without PCD. In EPN Stage IIIb/IV (n = 3), all the 3 (20 %) patients were managed with antibiotics and PCD and later 2 (13.3%) needed nephrectomy.Of different variable only altered sensorium and shock at presentation were associated with poor outcome in EPN patients (P &lt; 0.05) Conclusion EPN in diabetics needs good multidisciplinary approach with adequate antibiotics and surgical management as and well required for better patient outcomes.

scholarly journals PEFR, FEF25-75 and MVV In Type-1 Diabetic Male And Their Relationships With HbA1c

2013 ◽  
Vol 8 (1) ◽  
pp. 16-20
Author(s):  
Khan Mohammad Arif ◽  
Nasim Jahan ◽  
Nayma Sultana
Keyword(s):  
Glycemic Control ◽  
Lung Function ◽  
Glycosylated Hemoglobin ◽  
Cross Sectional Study ◽  
Diabetic Patients ◽  
Cross Sectional ◽  
Medical College ◽  
Control Serum ◽  
Apparently Healthy

Background: Diabetes mellitus is a chronic and debilitating disease. Its complications give rise to microvascular, macrovascular and neuropathic diseases which affect eyes, kidneys, heart, blood vessels and also lungs. So, there may be a relationship between type-1 diabetes and reduced lung function. Objectives: To observe PEFR, FEF25-75 and MVV and their relationship with HbA1c in type- 1 diabetic male in Bangladesh. Methods: This cross-sectional study was carried out in the Department of Physiology, Sir Salimullah Medical College, Dhaka between 1st January and 31st December 2009. A total 30 type-1 diabetic male subjects, age 18-30 years were taken as study group. Another 30 apparently healthy age, sex, BMI and socioeconomic status matched non-diabetic persons were also included as control. For assessment of lung function PEFR, FEF25-75 and MVV of all the subjects were measured by a digital spirometer. Again, to observe glycemic control serum blood glucose and glycosylated hemoglobin (HbA1c) levels of diabetic patients were also measured by usual laboratory technique. Data were analyzed by unpaired‘t’ test and Pearson’s correlation coefficient test. Results: PEFR (p<0.001), FEF25-75 (p<0.001), and MVV (p <0.001) were significantly lower in type-1 diabetic patients in comparison to those of apparently healthy non-diabetic male. Again, their PEFR (p < 0.05), FEF25-75 (p>0.05), and MVV (p<0.05) were negatively correlated with HbA1c. Conclusion: The lung functions were lower in type-1 diabetic male in comparison to those of non-diabetic counterpart and this reduction is mainly due to poor glycemic control. DOI: http://dx.doi.org/10.3329/jbsp.v8i1.16642 J Bangladesh Soc Physiol. 2013, June; 8(1): 16-20

Poor outcome of diabetic patients with coronary artery disease and coexisting heart failure

2008 ◽  
Vol 7 ◽  
pp. 19-19
Author(s):  
B PONIKOWSKA ◽  
E JANKOWSKA ◽  
K WEGRZYNOWSKATEODORCZYK ◽  
S POWIERZA ◽  
L BORODULINNADZIEJA ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Diabetic Patients ◽  
Poor Outcome ◽  
Artery Disease

High HBA1C Level Is Associated With Low Heamoglobin Level

2018 ◽  
Vol 3 (02) ◽  
Author(s):  
Mafooza Rashid ◽  
B. K. Gupta, Vinay Bharat ◽  
Abhishek Gupta ◽  
Zubair Rashid
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Glycosylated Hemoglobin ◽  
Good Control ◽  
Diabetic Control ◽  
Medical College ◽  
High Hba1c ◽  
Normal Controls

Background: The aim of the study was to compare the hemoglobin levels among normal controls (patients) and patients of TypeII diabetes with HbA1c levels below 7 % & above 7 %.and secondly to identify the undetected cases of anemia in TypeII diabetes. Materials & Methods - 50 patients of type 2 diabetes mellitus with their glycosylated hemoglobin levels less than 7 %, 50 patients of type 2 diabetes mellitus with their glycosylated hemoglobin levels more than 7 % attending the Medicine outpatient department of Subharti Medical College and Hospital will be the subjects for the study.50 age and sex matched controls will be selected randomly from Subharti Medical College and Hospital. Informed written consent will be taken from all the subjects. The study will be conducted from January 2016 to January. Result - We studied 50 cases with HbA1C>7(poor control),50 cases with HbA1C 5.6 to7 (good control) and 50 controls with HbA1C ≤5.6, we observed in cases with HbA1C>7 (poorly control) ,the mean HbA1C is 9.9±2 and mean Hb is 9.8±1.3 as compared to cases with HbA1C 5.6 to 7(good control) where mean HbA1C is 6±0.4 and Hb is 13±0.5,this clearly indicates that in cases HbA1C is more Hb levels are low and when HbA1C is less Hb levels are higher. Conclusion - In the present study we found negative correlation between HbA1c & Hb levels. As the value of HbA1c increases, as in cases of HbA1c >7(poor diabetic control), we found low Hb levels as compared to the cases with HbA1c <7(5.6-7) (good control).

scholarly journals Profile of Organophosphorus Poisoning

KYAMC Journal ◽  
2018 ◽  
Vol 9 (3) ◽  
pp. 133-135
Author(s):  
Joya Debnath ◽  
Arpan Kumar Basak ◽  
Md Zubaidur Rahman ◽  
Anujit Saha
Keyword(s):  
Organophosphorus Compound ◽  
Economic Status ◽  
Frequency Pattern ◽  
Major Health Problem ◽  
Major Health ◽  
The Public ◽  
Medical College ◽  
Phosphorus Poisoning ◽  
Life Threatening ◽  
The Government

Background : Self poisoning with organophosphate pesticides is a major health problem in world wide. Organophosphorus compound poisoning is a very common toxicological emergency encountered at Mirzapur in Tangail. It is particularly common among the rural agricultural worker's which comprise a substantial group of the population of this region.Objective: The objective of this study was to find out the incidence, frequency, pattern of poisoning, outcome and aetiological aspect of Organo phosphorus poisoning patient admitted in Kumudini Women's Medical college Hospital.Methods: A total 366 cases of OPC poisoning were analysed during 1 year from January 2015 to December 2015. The emphasis was given on age, sex, socio-economic status, occupation, motive of poisoning, types of compound consumed its quality, place, distance from referral place and the ultimate outcome.Results: Young population of rural background, particularly agricultural workers were the commonest patients (51.91%). The most common motive of poisoning was with a suicidal intent, both in males (27.59%) and females (66.39%). Financial crisis was one of the most common reasons analysed as the motive behind the poisoning (54.20%). Three hundred forty four Patients recovered and 22 were expired. The major cause of death in these cases was respiratory failure followed by multi-organ failure.Conclusion : Strict of the pesticide act and involving a new policy by the government to educate the public and youth in large about the dangerous, life threatening effects of Organophosphorus compound could help amelerioating the harmful effects of such poisoning.KYAMC Journal Vol. 9, No.-3, October 2018, Page 133-135

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