JAGRATI GUPTA

Spleenic abscess is a rare entity, with a reported frequency of 0.05-0.7%.Its reported mortality is still high, up to 47%, and has the potential to reach 100% among patients who do not receive antibiotic treatment. It is more common in the presence of infection at different primary sites, especially endocarditis or in cases of ischemic infarcts that are secondarily infected. Immunosuppression and trauma are well-known risk factors. Recently, intravenous drug abusers and alcoholics have shown an increased incidence compared to other high-risk groups. However, encountering this entity in general population is uncommon. Clinical examination and laboratory findings are not constant; thus, imaging is a necessary tool for establishing the diagnosis, with a choice between ultrasound and computed tomography. If untreated, the mortality reaches almost 100%. Treatment includes conservative measures and surgical interventions. Spleenectomy has been the preferred approach in most centers. More recent studies have suggested the use of advanced and alternative options, including laparoscopic surgical and percutaneous interventions. Changing trends, in view of the importance of immunological role of spleen, have emphasized more on spleen preserving protocols, especially in children and young patients, and in cases of solitary abscess with a thick wall. Conducted a literature review by analysis of various high-risk groups, presentation, diagnosis and treatment of splenic abscess and have presented a case report here. Spleenic abscess is an infrequent clinical entity and carries a very high mortality in the untreated cases. Pathognomic clinical features of left hypochondrial pain, splenomegaly, fever and leucocytosis are present in only one - third of the cases. Diagnosis is mostly done by imaging, either Abdominal Sonography or CT Scan. So far no prospective study has been done to rationalize the management, probably due to paucity of cases. Antibiotics alone or with percutaneous drainage under imaging control are successful in many cases. Failed aspirations and splenic abscesses with concomitant pathologies need spleenectomy. Spleenectomy and complete removal of the source of the infection is still the mainstay of treatment. Detailed review of the available literature of the clinical problem and various methods of treatment of spleenic abscesses are discussed in this article.

Objectives: To determine the level of serum uric acid level in diabetics and pre diabetics individuals. To compare the level of serum uric acid , FPG , HBA1C in pre diabetics and diabetics. Results: There was a significant relation between prediabetics who were younger in age compared to diabetics (almost a decade younger). The gender distribution was identical between the two groups. 53% had complaint <1 year.39% had isolated HTN; 9% had IHD whereas 19% had both. The diabetics had HbA1c significantly higher than prediabetics. Although proportionately more prediabetics had raised creatinine levels, but the difference was not significant. The difference of mean uric acid wrt HbA1c was not significant, although people with lower HbA1c values had a higher uric acid levels. The difference was not significant wrt uric acid levels with FBS values in prediabetics. The difference was not significant, although people with lower PPBS had higher uric acid levels in prediabetics. There was a significant relation of lower uric acid mean values for people with elevated HbA1c over 7g% amongst diabetics. There was no significant relation, although mean uric acid levels were raised for people with FBS<110 amongst diabetics. There was no significant relation but uric acid levels were higher in people with PPBS <140 amongst diabetics Conclusion: Younger age in India is predisposed to prediabetes and diabetes. Often patients are silent, without symptoms and detected only by investigations, so investigations for prediabetes and diabetes should be mandatorily routine. Lower uric acid levels have correlation with impaired glycemic control and should be part of check ups for metabolic syndromes. Hypertension and heart disease commonly coexist with diabetes and should be tackled together. Uric acid monitoring should have a role in guiding glycemic goals