Peripheral artery disease in type II diabetes

To determine the frequency of peripheral arterial disease [PAD] in type 2 diabetic patients. Cross-sectional observational study. Diabetes Clinic, Medical Unit III, Jinnah Postgraduate Medical Centre, Karachi, from January to June 2010. Three hundred and eighty seven [387] type II diabetic patients of either gender and any age were included in the study. Patients with a previous history of trauma to the arterial vasculature, pregnancy and those who underwent arterial graft procedures were excluded. Non-purposive convenient sampling technique was used to enroll patients in the study. PAD was diagnosed when ankle-brachial index [ABI] was less than 0.9. A p-value of less than 0.05 was considered statistically significant. Out of 387 studied patients, 128 were males [33.1%] and 259 were females [66.9%]. Mean age was 52.22 +/- 9.671 [22 -76] years in the entire cohort. Mean duration of diabetes was 9.38 +/- 6.39 years. PAD was detected in 152 [39.28%] of the total study subjects. Thirty-one of 128 male patients [24.22%] had PAD disease while 121 out of 259 female patients [46.71%] had evidence of PAD [p = 0.001]. Hypertension was a significantly associated factor [p = 0.002]. A high frequency of PAD was observed in the diabetic population particularly with hypertension and more prevalent in females

Effect of carvedilol on portal pressure estimated by hepatic vein doppler ultrasound waveform and damping index in cirrhotic patients

To assess the effect of Carvedilol in reducing portal pressure estimated non-invasively by studying Doppler ultrasound waveforms [DUS] and hepatic vein Damping Index [DI]. Quasi-experimental study. Department of Medical ICU in collaboration with Department of Radiology, JPMC, over a period of 6 months [June 1st to 30th November, 2008]. Of the enrolled 65 patients, 47 patients [33 males and 14 females] completed the study. The mean age was 47.4 years. Cirrhotic patients of Hepatitis B, C, D [delta], B and C combined, B and D combined with varying degrees of portal hypertension were included in the study. Cirrhotic patients with bronchial asthma, congestive heart failure, Insulin dependent Diabetes, portal vein thrombosis and hepatorenal syndrome were excluded from the study. The patients were examined by color flow Doppler of the right hepatic vein before and after administration of Carvedilol. Their waveforms and Damping Index [Dl] were recorded and compared by Wilcoxon signed ranks test through SPSS version 12.0. Responders were described as those showing a positive change in wave forms or a decrese of 0.10 or more in Dl. Of the 47 patients, 30 [63%] showed a positive response and 10 [21%] showed no favorable response to Carvedilol, while 7 [14%] patients showed deterioration. The mean Dl on DUS dropped from 0.62 to 0.41 in responders after treatment, while in the non-responders it ranged between 0.42 and 0.57. Ultrasonography Carvedilol reduced portal pressure of cirrhotic patients, as measured indirectly by the damping index of hepatic waveform by Doppler

Prevalence of bacterascites

This is a Hospital based prospective study carried out in Medical Unit-I, Department of Medicine, Jinnah Postgraduate Medical Centre, Karachi from June, 1993 to May, 1994, to find the prevalence of bacterascites in cirrhotic patients with ascites. 65 cirrhotic patients with ascites were selected. Aspiration of ascitic fluid of all patients was done. The fluid was sent for analysis, culture and sensitivity. The main laboratory indicators were polymorph count/mm3 and culture positive ascitic fluid. Patients with bacterascites were followed for 12 weeks. Prevalence of bacterascites was 8%. Twenty% patients of bacterascites developed spontaneous bacterial peritonitis [SBP] during 12 weeks follow up. Bacterascites does not require aggressive treatment. It usually resolves spontaneously