Cutaneous manifestations of diabetes mellitus type 2: prevalence and association with glycemic control

Objective: To determine the frequency and pattern of skin disorders in patients with type 2 diabetes mellitus and their association with glycemic control in our diabetics

Methods: This descriptive, cross-sectional study was conducted at departments of Medicine and Dermatology, Sir Syed College of Medical Sciences and Hospital, Karachi from 1[st] January to 30[th] June 2014. Adult patients belonging to both genders having diabetes mellitus type 2 with cutaneous manifestations were included. After taking the informed consent, demographic details, duration of diabetes, mode of treatment for diabetes, types of footwear, foot care and glycemic profile were documented

Results: In 203patients [41% male and 59% female], mean age was 50 +/- 11 years and mean duration of diabetes 8.5 +/- 7 years. Mean HbA1c was 8.6 +/- 1.5 with 68% patients having unsatisfactory glycemic control. Most frequently observed skin disease was bacterial infections [26%], followed by fungal infections [22%], acanthosis nigricans [20%], diabetic foot [16%], nail changes [16%], acrochordons [10%], diabetic dermopathy [9%], necrobiosis lipoidica [9%], viral infections [8%] pruritus [8%] and xanthelasma [8%]. There was significant association of unsatisfactory glycemic control with bacterial infections [p = 0.037] and fungal infections [p = 0.023]. Females especially had a higher frequency of association with acanthosis nigricans [p = 0.030]

Conclusion: Patients with type 2 DM have high frequency of infections especially bacterial and fungal. Other manifestations like acanthosis nigricans and diabetic foot are comparatively less common

Dermatological manifestations of obesity

To determine the frequency of various cutaneous manifestations in patients with obesity and correlate these skin changes with the grades of obesity. The study was conducted at Departments of Medicine and Dermatology, Sir Syed College of Medical Sciences and Hospital Karachi from 1[st] January 2014 till 30[th] June 2014. Patients belonging to both sexes and different age groups having body mass index [BMI] >/=25kg/m[2] with cutaneous manifestations of obesity were enrolled. Patients with skin changes secondary to other systemic illnesses, pregnancy and drugs were excluded. After an informed consent, demographic details, height and weight were documented. A clinical dermatological diagnosis was established after a detailed history and examination. Appropriate investigations were performed where required. 196 patients, 76 males [39%] and 120 females [61%] completed the study. Mean age was 43.6 +/- 10.8 years, age range being 19-70 years. Mean BMI 34 +/- 4.73 kg/m[2] [range 25-50], grade I obesity in 75 [38%] and grade II obesity in 121 [62%] cases. The most common finding observed was acanthosis nigricans [49%], followed by striae [17%], fungal infections [15%], acrochordons [12%], viral infections [11%], hirsutism [11%] and bacterial infections [7.5%]. Other less common associations included: xanthomas, corns, plantar hyperkeratosis and acne. Acanthosis nigricans and viral infections were significantly more among females; corn and callus among males. Obesity grade II was significantly associated with acanthosis nigricans, viral infections, hirsutism, striae and stasis dermatitis. Obesity is commonly associated with a wide range of dermatological manifestations like acanthosis nigricans, striae, hirsutism, skin infections. Other less common associations include: xanthomas, corns, plantar hyperkeratosis and acne

Obesity and hypertension in female medical students; frequency and risk factors

OBJECTIVE: To determine the frequency and risk factors of obesity and hypertension in female medical students

STUDY DESIGN: Descriptive cross sectional study

SETTING: Department of Medicine, Sir Syed College of Medical Sciences and Hospital Karachi

STUDY DURATION: 3 months [March 2014 to June 2014]

MATERIAL AND METHODS: Total 307 female medical students were included after ethical approval

Students with systemic illness, diabetes mellitus and taking corticosteroids were excluded

Demographic details obtained, followed by anthropometric measurements; height, weight, waist circumference and body mass index [BMI]. Students were classified as underweight, at risk, overweight, obesity grade I and obesity grade II as per WHO criteria for Asians. Blood pressure of each student was measured at two occasions. Outdoor activity time, screen time, sedentary time, dietary preferences, sleep hours and family history documented. Data analyzed via SPSS version 17 with significant p-value < 0.05

RESULTS: Among 307 students, obesity was found in 34% [25.4%obesity grade I and 8.8% obesity gradeII]. Hypertension was found in 4.88 %. There was significant association between hypertension and obesity [12 % obese hypertensiveversus 1.9 % non obese hypertensive students]

35 % students had higher waist circumference that was associated with hypertension. Excessive use of soft drinks, diet drinks, meat, dairy products, chocolates, oversleep on weekends and daily screen time >2 hours were found to be associated with obesity

CONCLUSION: Higher prevalence of obesity and obesity related hypertension in younger age group needs to be addressed. Those with obesity should be screened for the presence of hypertension at younger age. Waist circumference should be considered in addition to BMI while screening for obesity, and evaluation of its risk factors in Asians.Creating awareness and timely intervention in terms of dietary modification, adequate physical activity and sleep hours thus reducingthe screen time and sedentary time may help in controlling obesity and its complications among our young generation. Weight loss must be the first line of therapy in obesity related hypertension among younger obese population

Hoffman syndrome; rare presentation of hypothyroidism

Hypothyroidism may present with various systemic manifestations including hypothyroid myopathy as a recognized feature. It is characterized by muscle weakness, pain, stiffness, and cramps along with elevated muscle enzymes and thyroid stimulating hormone levels.One of the rare presentations of hypothyroidism is Hoffman Syndrome characterized by myopathy along with muscle pseudohypertrophy and raised muscle enzymes. We report a case of Hoffman syndrome that showed significant clinical and biochemical response to thyroid hormone replacement

This case report highlights the clinical features, diagnostic approach and management of Hoffman syndrome. This signifies that early diagnosis and appropriate management improves outcome and prognosis. There have been few such cases reported worldwide and we report this rare case from Pakistan