Low levels of vitamin D[3] in people of Karachi - needs to be readdressed

Objective: The aim of this study is to see the frequency of vitamin D and its impact on the sample population

Study Design: Descriptive / cross sectional study

Place and Duration of Study: This study was conducted at Trauma and General Hospital, Karachi from January 2014 to June 2015

Materials and Methods: 205 patients were included in the study. Participants were assessed according to predesigned questionnaire. All patients were subjected to have complete blood count, serum calcium, phosphorous, albumin, alkaline phosphatase, SGPT, vitamin D and parathyroid hormone levels along with X-rays of hip joint and femur

Results: Out of total 205 patients, 12.7% were males and 87.3% were females. Mean age was 41.32 +/- 15.225 years. 5.9% had normal levels of Vitamin D[3], while 60.5%, 27% and 6.5% showed mild, moderate and severe deficiency. Serum calcium and phosphorous were deficient in 20.4% and 31.9% respectively. Serum alkaline phosphatase and parathyroid hormone were normal in most of the participants. The deficiency of Vitamin D[3] was mostly due to reduced sun exposure and excessive clothing [86.8%] while 8.3% showed malabsorption. This deficiency caused bone pains, and muscle pains in 55.6%, and 17.6% respectively. But none of the patient had any fracture

Conclusion: Levels of Vitamin D[3] are low in most of the people of Karachi but without any gross deformity. It is advisable to readdress the daily requirement of vitamin D bring the awareness among people regarding sun exposure and daily use of vitamin D supplements

Decompensated cirrhosis; thyroid hormone levels in patients

Objective: The objective of the study is to find out, the levels of thyroid hormones in serum of the patients having decompensate cirrhosis and to determine the frequency of signs and symptoms of thyroid dysfunctions in such patients. Study design: Prospective descriptive study. Setting: All medical wards of Civil Hospital and Ojha campus, Dow University of Health Sciences, Karachi, Pakistan. Period: May 2013 to January 2015

Methodology: 76 patients having decompensated liver cirrhosis with various presentations, which were fulfilling the inclusion and exclusion criteria and were admitted in medical wards during the study period, were included in this study. Detailed history and examination of each case was performed. Thyroid hormone levels were performed along with other relative laboratory investigations and the results were obtained

Results: Out of 76 patients 58 patients had low serum T3 levels, whereas 18 had normal T3 levels. 65 patients had normal T4 levels and 11 had low serum T4 levels. The TSH levels were found normal in 74 patients and two patients had raised TSH levels

Conclusion: It is concluded that T3 levels is low in cirrhotic patients but at the same time T4 and TSH levels remains normal in majority of cases and the patients remain euthyroid. As far as the clinical scenario is concern, no significance was found in the frequency of sign and symptoms of thyroid dysfunction. Most of the patients did not show signs and symptoms of hyper and hypothyroids

Hepatic overlap syndrome: glass of autoimmune mimicry - half empty and half filled

Objective: To unfold the iceberg entity of hepatic overlap syndrome among patient with established chronic liver diseases

Methodology:Forty-one patients were referred from the remote areas of Sindh province during March 2008 to August 2010 to Department of Internal Medicine at Civil Hospital, Karachi, Pakistan. These patients were unresponsive to the treatment[s] being prescribed. The complete biochemical, clinical, serological and histopathological profiles of these patients was assessed. The Chazouilleres criterion was used to diagnose the overlap syndrome cases [according to which an AIH-PBC overlap syndrome would be accepted when 2 out of 3 criteria each of AIH or PBC is fulfilled]. Data were analyzed through SPSS version 16.0. Frequencies and means were calculated. Serological markers were correlated against biopsy patterns by Pearson's, Cramer's V test, Mantel-Haenszel Test to measure the odd of getting the particular biopsy pattern and 2- sided significance level <0.10 was taken as significant

Results: Out of 41 patients, 23 had AIH or PBC [56.09%] and the other 18 [43.90%] were having CLD secondary to Wilson's disease [9 patients], fatty liver [4 patients], Hepatitis B [3 patients] and hepatitis C [2 patients]. Further workup in 23 patients showed that 10 out of 23 were having AIH/PBC overlap. Fatigue was the most common clinical symptom among Overlap syndrome patients [80%]. 3 patients were having Hashimoto's thyroiditis and one male was diagnosed with SLE

Conclusion: We emphasize and recommend for detail investigations to consider such entity for autoimmune chronic liver disease, where initial laboratory investigations do not support the exact diagnosis among CLD patients. Since no work has been done so far on overlap syndrome in our set up, we suggest multicentre prevalence surveys to develop proper treatment guidelines for Indo-Pakistan population