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Hypoglycaemia without Coma
Sir, — A hypertensive, illiterate, housewife, aged 60 years suffering from type 2 DM for last 10 years had been on chlorpropamide (250mg) at breakfast and glibenclamide (5mg) at dinner was admitted to the hospital with the history of abdominal pain and nausea for last two days. On examination, the patient had soft abdomen with the pulse rate 72/minute and BP 150/70mm Hg. On admission, the patient was advised the same antidiabetic regimen and diabetic diet along with enalepril (10mg) at breakfast while methyldopa (250mg) thrice daily. Next day, the patient had pain in the epigastric, left lumbar and left iliac fossa regions. Injection prochorperazine (12.5mg) and hyoscine-n-butyl bromide (20mg) were administered immediately while keeping rest of the treatment as such. On the third day, in the morning, the patient complained of vomiting six times and severe uneasiness. On examination, her extremities were cool, pulse rate 96/minute and BP 130/80 mm Hg. Having made a diagnosis of hypoglycaemia, a blood sample was drawn before administering 5% dextrose intravenously.
Blood analysis revealed plasma glucose 5mg/dl, serum urea 45mg/dl and serum creatinine 2.6 mg/dl. It can be mentioned that one month back, her plasma glucose (fasting) was 162 mg/dl, serum urea 32mg/dl and serum creatinine 1.9mg/dl.
On inquiry from the patient directly in the afternoon, it was learnt that the patient had been taking less than her prescribed diet for last one month including elimination of snacks in the afternoon and occasionally skipping breakfast and/or lunch for different social/religious rituals while taking antidiabetic drugs as usual. This presumably might have caused recurrent hypoglycaemia leading to lowering of set point for responding to hypoglycaemia. She did not take any food for successive two nights after admission on account of anorexia and nausea despite being on antidiabetic drugs and diet. On the preceding evening of hypoglycaemia, she drank about 250 ml milk only at dinner.
Biswajit Saha
Sr Dy Director, Durgapur Biswajit Saha
Steel Plant Hospital,
Durgapur 713205
Cadaver Dissection – Need to Cope the Inevitable Stressor
Sir, — The subject under ‘Current topic’ in the June 2006, issue of the JIMA fuel the healthy debate on the importance of dissection and also focuses attention on anxiety and its potent stressor effect on our young future doctors. It is important to acknowledge that even in this computer age, anatomists can proudly say that dissection room is one place where the dead teaches the living. In one interesting study1, students ranked the learning aids as follows (most to least useful) : atlases, cadavers, lectures, textbooks, bones, teaching assistants, models/cross-sections, case studies, computer programme, radiology, tutorials, video tapes. McGarvey et al2 suggest that the anatomy room is a positive learning experience for the large majority of students, however the first exposure to human cadaver dissection is a recognised potential stressor. A large proportion of students (up to 30%) report adverse physiological and psychological consequences of being introduced to this situation3. Better preparation and debriefing for coping with dissection is required4. Dissection room experience can be made less stressing for many students if there is a detailed description of the process provided in advance in a separate room. Students can watch the video too of the procedure as many times as required until they felt comfortable to face the “hands-on” scenario. State-Trait Anxiety Inventory (STAI) has been shown to have excellent psychometric properties for the assessment of anxiety in first year medicos. It was Freud who first proposed a critical role for anxiety in the aetiology of psychoneurotic and psychosomatic disorders. Perhaps, these approaches can reduce the likelihood of medicos engaging in avoidable coping strategies such as “denial”. Added standardised instructions may lead to increased confidence, skill and future compliance with physical examination and screening practices
References
1 Jones LS, Welsh MG, Terracio L — First year medical students’ views on computer programme “give us our teaching assistants”. FASEB J 1998; 12: 5635.
2 McGarvey MA, Farrell T, Conroy RM, Kandiah S, Monkhouse WS — Dissection: a positive experience. Clin Anat 2001; 14: 227-30.
3 Kiecolt-Glaser JK, Glaser R — Psychological influences on immunity. Psychosomatics 1986; 27: 621-4.
4 Horne DJ, Tiller JW, Eizenberg N, Tashevska M, Biddle N — Reactions of first-year medical students to their initial encounter with a cadaver in the dissecting room. Acad Med 1990; 65: 645-6 Satendra Singh*
Jyoti Sethi**
Sushma Sood***
Department of Physiology, Pt BD Sharma
PGIMS, Rohtak 124001
*Senior Resident
**Lecturer
***Professor and Head of the Department
Ivermectin — Antiscabies Chemotherapeutic Agent
Used in Masses
Sir, — Ivermectin can control outbreak of scabies in overcrowded or endemic areas. In one study (n=56) among both sexes aged one year and above presented with itching, rashes and urticaria, ivermectin was given in a single dose of 200mg/kg body weight orally. The outcome was recorded after 2 weeks. Disappearance of skin complaint was seen in almost all cases. One-third people had some abdominal discomfort, nausea, itching, while passage of worms was noted in half of the cases. Oral ivermectin is an effective chemotherapeutic agent and can be used in scabies, pediculosis and filarias as a mass chemotherapeutic agent.
Rakesh Chandra Chaurasia Lecturer, Department
of Pharmacology,
MLN Medical College,
Allahabad 211002
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