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Glycemic control is critical in the perioperative setting, especially in diabetic patients. The consequences of surgical tension and anesthesia on blood sugar levels are distinct, and should be considered in order to maintain optimal glycemic control. Each stage of surgery presents its own set of challenges in terms of keeping glucose levels within the target range. Furthermore, there are some surgical conditions that necessitate specific glucose management protocols. Authors hope to highlight the most crucial factors to consider when developing a perioperative diabetic regimen, while still allowing for specific adjustments based on sound clinical judgement. Overall, by carefully managing glycemic control in perioperative patients, we may be able to reduce morbidity and mortality while improving surgical outcomes.

Disseminated intravascular coagulation (DIC) is life threatening disease it’s often associated with sepsis, which require ICU management. In individuals with sepsis, the risk of DIC is especially high, DIC affects 30 to 50 percent of these individuals. Also it affects only about ten percent of patients with solid tumors, trauma, or obstetric emergencies. Hematological malignancies, aneurysms, and liver diseases can also cause the disease, the treatment for DIC focuses on resolving the underlying problem that led to this condition in the first place. As a result, antibiotics for severe sepsis, delivery in the case of placental abruption, and exploratory surgical intervention in the case of trauma are the pillars of DIC treatment, Patients with active bleeding or a high risk of bleeding, as well as those who require an invasive surgery, should consider platelet and plasma transfusions. Other anti-coagulant drugs can also be used. Prothrombin complex concentrates should only be administered in an emergency, due to their possible dangers. Recombinant human soluble thrombomodulin rhTM it was developed and licensed for clinical usage in Japan in 2008, and it’s one of the novel treatments for DIC. Anti-Xa agents, Synthetic protease inhibitors, and antithrombin are another options for treatment. In this article we will be making overview of the disease, it’s etiology an what’s the current management options.

Bacterial cystitis accounts for the majority of urinary tract infection (UTI). It is frequently found in young, otherwise healthy females showing no signs of anatomical or physiological urinary tract defects. Among young women who have experienced an episode of acute bacterial cystitis, 25% to 50% develop recurrent episodes. Individuals with recurrent cystitis episodes have a greater susceptibility to urogenital colonization with uropathogens that thrive by adhering to uroepithelial cells. Further, there is an increased likelihood of infection with an antibiotic resistant uropathogen due to previous antimicrobial therapy for recurring infections. At each step of the pathogenesis, different host genetic, biologic, and behavioral factors, and bacterial factors interact and influence susceptibility to recurrent cystitis. Behavioral factors like sexual intercourse, use of spermicidal contraceptives and history of recurrent cystitis are major independent risk factors for recurrent cystitis infections. In post-menopausal women without comorbidities, estrogen depletion is mainly responsible for increased susceptibility to recurrent cystitis. Certain strain-specific bacterial virulence determinants may also contribute to recurrent cystitis by providing a selective advantage. Phenotypically, recurrent cystitis is categorized as reinfection or bacterial persistence. Majority of recurrent cystitis cases seen in men occur due to structural or functional abnormalities of the urinary bladder which allows same pathogens from the same site in the bladder to cause recurrences due to bacterial persistence. The concept of ‘uncomplicated’ and ‘complicated’ recurrent cystitis is used for classification of recurrent cystitis cases, similar to UTIs. Uncomplicated recurrent cystitis comprises cases occurring in young, healthy, nonpregnant women, mainly due to uropathogenic Escherichia coli. Due to the unique spectrum of host-bacterial interactions in the urinary tract, the distinction between complicated and uncomplicated recurrent cystitis is not straightforward. ‘Complicating’ factors such as structural, obstructive, neoplastic, functional, and neurological abnormalities of the urinary tract, systemic conditions including pregnancy, and certain demographic factors are attributed in the development of complicated recurrent bacterial cystitis.