Correlation between microalbuminuria and hypertension in Type 2 diabetic patients

Hypertension is commonly found in patients with Diabetic Kidney Disease [DKD]. Microalbuminuria is the first clinical sign of involvement of kidneys in patients with type 2 diabetes. Uncontrolled hypertension induces a higher risk of cardiovascular events, including death, increasing proteinuria and progression to kidney disease. To determine the correlation between microalbuminuria and hypertension and their association with other risk factors in type 2 diabetic patients. One hundred and thirteen type 2 diabetic patients attending the diabetic clinic of Shaikh Zayed Postgraduate Medical Institute, Lahore, Pakistan were screened for microalbuminuria and raised blood pressure. The study was conducted from November 2012 to June 2013. Patients were divided into two groups. Group 1, those with normoalbuminuria [n=63] and Group 2, those having microalbuminuria [n=50]. Group 2 patients showed higher blood pressure values as compared to Group 1. The results were statistically significant and showed poor glycemic control as a contributing risk factor. The study concluded that there is high frequency of hypertension among type 2 diabetics but still much higher among those having microalbuminuria. So, early recognition of renal dysfunction through detection of microalbuminuria and to start treatment without any delay will confer future protection from end stage renal disease as well as hypertension and its complications in type 2 diabetic patients

Endobronchial rupture of pulmonary hydatid cyst followed by anaphylactic shock and full recovery

A 36 years old woman with a past history of multiple hydatid cysts in liver presented with dry cough and low grade fever. She was found to have a large hydatid cyst in the left lower lobe of lung which ruptured endobronchially. At the time of induction of anesthesia, the cyst ruptured and she went into anaphylactic shock and then cardiac arrest. She was successfully resuscitated and later on a partial pneumonectomy was done. She made an uneventful recovery. Although hydatid cyst is a globally prevalent disease and has a low mortality rate but a ruptured cyst has a relatively high mortality and morbidity in terms of dissemination of disease into other parts of body therefore a careful follow-up is required in case of rupture of the cyst

Prevalence of microvascular complications in newly diagnosed patients with type 2 diabetes

Microvascular complications are the major outcome of type 2 Diabetes Mellitus progression, which reduce the quality of life, incur heavy economic burdens to the health care system and increase diabetic mortality. The aims of this study were to assess the prevalence of microvascular complications among newly diagnosed type 2 diabetic patients and to analyze the association between these complications and poor glycemic control. This cross sectional hospital based study was carried out in Diabetic Clinic of Shaikh Zayed Postgraduate Medical Institute, Lahore Pakistan. The study was conducted from November 2011 to November 2012 among newly diagnosed type 2 diabetic patients. Relevant information of all patients was recorded with the help of a proforma. They were investigated for retinopathy, nephropathy and neuropathy. We have divided the patients into two groups: Group I with good glycemic control [HbA1c < 6.5] and group II with poor glycemic control [HbA1c > 6.5]. In group II microvascular complications were 89.8%. Neuropathy, nephropathy and retinopathy were present in 68.5%, 56.2% and 31.4% respectively. These similar percentages in Group I were 50%, 0% and 31% respectively and are significantly lower. The study showed that even in newly diagnosed type 2 diabetic patients who had poor glycemic control, frequency of microvascular complications is much higher as compared to those who had average glycemic control. Thus tight glycemic control does count even in newly diagnosed type 2 diabetics to prevent and minimize the occurrence of complications

Bernard-soulier syndrome and dengue fever: a rare association-case report

A 32-years-old pregnant woman who was a diagnosed case of Bernard Soulier Syndrome; which is a rare hereditary disorder of quafitative and quantitative platelet defect with tendency to bleed spontaneously, developed dengue fever which resulted in marked thrombocytopenia. She was continuously monitored and managed conservatively. Luckily, she made an uneventful recovery. But this may not be the case always, and constant vigilance is required while treating patients of congenital disorders of platelet function with acquired thrombocytopenia

Aids and its complications. A case report and review of the subject

Infection with HIV causes a spectrum of clinical problems beginning at the time of seroconversion [primary HIV] and terminating with full blown Acquired Immune deficiency Syndrome [AIDS] and death. This article describes the case of a 45-year-old gentleman who presented with 2 months history of fever and weight loss. He was diagnosed as a case of HIV on Elisa testing. He had extremely low CD 4 count and was suffering from opportunistic infections like Pneumocystis Carin ii Pneumonia [PCP]. The literature is reviewed on AIDS with a special focus on recent advances and highly active antiretroviral therapy

Pagophagia: a novel form of pica

This case report describes a 37 year old female with iron deficiency anemia due to heavy menstrual bleeding. She had a habit of compulsive ice eating called pagophagia, which is a mysterious form of pica. Pagophagia has been found to be associated with iron deficiency and resolves after a few weeks of iron therapy, well before the anemia is corrected. Our patient too responded to intravenous and oral iron and within a few weeks she gave up her ice eating habit. We discuss this case to introduce this interesting form of pica in the Pakistani setting

Tetanus - review of the subject

Tetanus is a serious bacterial disease that leads to stiffness of your jaw muscles and other muscles. It can cause severe muscle spasms, make breathing difficult and, ultimately, threaten your life. A cut, puncture wound, laceration or other wound can lead to a tetanus infection and toxin production in someone without immunity. Spores of the tetanus bacteria, Clostridium tetani, usually are found in the soil but can occur virtually anywhere. If deposited in a wound, the bacteria can produce a toxin that interferes with the nerves controlling your muscles. Treatment is available, but the process is lengthy and not uniformly effective. Tetanus may be fatal despite treatment. The disease is rare in the Western world and developed countries due to proper vaccination programmes and a very small number of those result in death. However, in our setup he number of cases and resulting deaths is far higher. The best defence against tetanus is prevention by regular vaccination and making people aware of this potentially lethal but preventable disease. A review is presented here to highlight the problem

Cutaneous manifestations in Type-1 and type-2 diabetes mellitus [a study profile of 200 patients]

Diabetes mellitus affects every organ system in the body. Cutaneous manifestations in diabetes are varied, approaching to 100%. We conducted a study at our center to determine the prevalence of skin abnormalities in type 1 and type 2 diabetes mellitus. Two hundred patients of diabetes mellitus were observed for cutaneous manifestations. Twenty one [10.5%] patients were suffering from type 1 diabetes mellitus and 179 [89.5%] patients were suffering from type 2 diabetes mellitus. Mean duration of diabetes mellitus was 7.1+/-0.89 years and 6.8+0.84 years in type 1 and type 2 diabetes mellitus respectively. Two hundred patients [116 [58%] patients were found to have cutaneous abnormalities. Among these patients 57 [49%] were male and 59 patients [50.86%] were female. Thirteen patients [11.2%] were suffering from type 1 diabetes mellitus and 103 patients [88.7%] were suffering from type 2 diabetes mellitus. No significant effect of type of diabetes mellitus was observed on skin lesions [p=0.12]. It is concluded that skin disease is quite common in diabetes mellitus and it is equally prevalent in type 1 and type 2 diabetes mellitus

Frequency and association of cutaneous manifestations of diabetes mellitus with HbA1c

Diabetes mellitus is the most common endocrine disorders associated with disturbed metabolism. Glycosylated haemoglobin [HbA1c] is one parameter of checking blood glucose control in diabetics over the past 3 months. We concluded a study to look for skin disorders due to diabetes mellitus and to see correlation between control of blood sugar [HbA1c] and cutaneous manifestations. It was a cross sectional study. The study was carried out from 1[st] January 2003 to 31[st] March 2003 in the Department of Medicine and Dermatology, Shaikh Zayed Hospital, Lahore. A total of 200 patients of diabetes mellitus admitted as inpatient and attending Outpatient Department of Medicine were studied. Patient`s history, dermatological and systemic examination were recorded. Their blood was collected for estimation of random blood sugar, complete blood count, blood urea, serum creatinine, serum electrolytes, serum lipid profile whereas HbA1c was determined by chromatographic method. Normal range of HbA1c was taken as 5-7%. HbA1c of > 7% was taken as high and HbA1c value of <7% was taken as normal. Of 200 patients, 116 [58%] patients were found to have cutaneous abnormalities, 127 [63.5%] patients had high HbA1c value and 73 [36.5%] patients had normal HbA1c value. In patients having high HbA1c value, 90 [70%] patients had cutaneous disorders. Among those patients who had normal HbA1c, value 26 [35.6%] patients had skin abnormalities. This correlation was found to be statistically significant [P <0.002]. Prevalence of cutaneous disorders in diabetes mellitus is 58%. Cutaneous manifestations are more common in patients who have overall poor glycemic control which in turn is reflected by high HbA1c, value [Normal= 5-7%]

Bronchial carcinoid - case report and review of the subject

Carcinoid tumours are rare entity but carcinoid syndrome is even more uncommon. These tumours arise from neuro-endocrine cells of the fore- mid- and hind-gut and produce a number of substances, the most important is serotonin. Bronchial carcinoid tumours are rare and account for 2.5% of all pulmonary tumours. Two cases of bronchial carcinoid are reported with different presentations and a review of the subject is discussed

Prevalence of hepatitis C in patients on maintenance haemodialysis

To find the prevalence of Hepatitis C in patients on maintenance haemodialysis. Design: A case control study. Place and Duration of Study: Haemodialysis unit at Sheikh Zayed Postgraduate Medical Institute, Lahore, Pakistan in December 1999. Patients and Fifty patients who were on maintenance haemodialysis were screened for anti HCV antibody. Fifty normal individuals who did not have any identifiable risk factors were also screened for anti HCV antibody. The relative risk and prevalence was calculated for the patients on maintenance haemodialysis. Sixty-eight% of the patients on maintenance haemodialysis were found to be positive for anti HCV antibody. Prevalence in normal individuals was 10% and relative risk for the patients on maintenance haemodialysis was 6.8. Hepatitis-C is endemic among patients on maintenance haemodialysis and prevalence is much higher in developing countries as compared to developed world

Frequency of anti - HCV antibodies in patients with lichen planus

To determine the frequency of anti-HCV antibodies, identify risk factors associated with HCV infection and to screen asymptomatic carriers in patients with lichen planus. Design: A prospective study. Place and Duration of Study: This study was carried out in the out patient department of Dermatology, Shaikh Zayed Hospital, Lahore, from October, 1999 to September, 2001. Subjects and A total of 184 clinically diagnosed cases of lichen planus [LP] were selected for the study. Blood samples of all the patients were tested for anti hapatitis C virus antibodies [anti-HCV Ab]. Polymerase chain reaction for hapatitis C virus was done in patients with positive anti-HCV Ab. Transcutaneous liver biopsy was performed in 7 patients with positive HCV-RNA. The histopathological results were evaluated using validated Metavir and Knodell scoring systems. Out of 184 LP patients, 43 [23.4%] were anti-HCV antibodies positive. Females were predominantly affected and male to female ratio was 1:5.1. Maximum positivity for anti-HCV was observed in age group 31-40 years [39.53%] followed by 41-50 years [25.58%]. Eighty-one% patients had history of dental treatment and 63% had received multiple injections for various ailments. Forty% patients had family history of jaundice while 26% had jaundice in the past. Ten out of 16 anti-HCV antibody positive patients, checked for HCV-RNA, had high levels of virus in blood. Transcutaneous liver biopsy done in 7 patients revealed underlying liver disease at various stages. Four patients treated with a-interferon and ribazole therapy for liver disease, showed marked improvement in their skin disease. A high prevalence of HCV infection was detected in patients with lichen planus. Patients with lichen planus should be screened for HCV carrier state