Vitamin D[3] in newly diagnosed pulmonary tuberculosis patients: a comparative case control study

Objective: To evaluate Vitamin D in Pulmonary tuberculosis and normal healthy adults

Study design: Case control study

Place and duration: Department of Medicine, Isra University Hospital Hyderabad, from January 2013- June 2014

Subjects and methods: A sample of 209 diagnosed pulmonary tuberculosis patients was selected through non-probability purposive sampling according to inclusion and exclusion criteria. After taking informed written consent from the participants, Vitamin D was measured by ARCHITECT I 1000 system for estimation of 25-OH- D[3]. The data was recorded on a pre-structured proforma, and analyzed on SPSS version 21.0. The significant p-value was taken at

Results: The mean +/-S.D serum level of 25-hydroxyvitamin D[3] in cases and controls were 27.1+/-9.7 and 36.8+/-8.1 [ngdl[-1]] respectively [p=0.0001].The 25-hydroxyvitamin D[3] levels as low as 6 ng/dl were observed in pulmonary tuberculosis subjects. The normal, insufficiency and deficiency of 25-hydroxyvitamin D3 were observed in 37[33%], 16 [14.2%] and 59 [52.6%] in cases respectively compared to controls as 57 [58.7%], 21[21.6%] and 19 [19.5%] respectively

Conclusion: Patients with pulmonary tuberculosis are significantly Vitamin D deficient. Vitamin D supplements may be prescribed, however further studies are warranted

Malondialdehyde, blood lipids and antioxidant activity in newly diagnosed type 2 diabetics

Objective: To determine malondialdehyde, blood lipids and anti oxidants in newly diagnosed type 2 diabetic patients

Study design: Observational, comparative study

Place and duration: Department of Medicine, Liaquat University of Medical and Health Sciences Hospital from February 2013- May 2014

Subjects and methods: 97 newly diagnosed type 2 diabetics and 50 healthy controls were selected through non-probability purposive sampling according to inclusion and exclusion criteria. Blood samples were collected after 8-12 hours of fasting. Fasting blood glucose level, lipid and lipoprotein levels were measured by Cobas e411 analyzer. Malondialdehyde [MDA], Superoxide dismutase [SOD] and Glutathione peroxidase [GPX] were measured by Diagnostics kit. Zinc and ascorbic acid were measured by using Centronic GmbH-Germany Kit. Albumin, bilirubin, and uric acid were measured on Hitachi Chemistry analyzer. Data was analyzed on SPSS version 21.0. The significant p-value was taken at

Results: MDA, blood lipids and anti oxidant mechanisms showed significant differences between diabetics and healthy controls. Total blood lipids and lipid sub fractions were elevated in diabetics compared to controls. MDA was raised 5.16+/-0.91 vs. 2.16+/-0.62 micro mol/l in diabetics and controls respectively [p=0.0001]. The SOD, GPX, Ascorbic acid, Zinc, albumin, uric acid and bilirubin were reduced in diabetics [p<0.001]

Conclusion: Diabetes mellitus is characterized by free radical formation, lipid peroxidation, altered blood lipids and reduced anti oxidant mechanisms. An increase in malondialdehyde and reduction of antioxidant mechanisms may contribute to secondary complications

Serum cobalamin and dyslipidemia in type 2 diabetics

OBJECTIVE: To evaluate serum cobalamin with special reference to dyslipidemia in type 2 Diabetic subjects

STUDY DESIGN: Observational study

PLACE AND DURATION: Department of Medicine, Isra University Hospital and Consultant Clinics Hyderabad, Sindh from January 2014 to July 2014

METHODOLOGY: A sample of 107 type 2 diabetic subjects was selected according to inclusion and exclusion criteria. Cobalamin was measured on Roche Cobas e411 chemistry analyzer and blood lipoproteins by standard laboratory methods. Data was analyzed by SPSS version 21.0 using appropriate statistical test. P-value of

RESULTS: Cobalamin deficiency was noted in 51 [47.6%] of diabetics which has associated with dyslipidemia. Mean +/- SD of serum cobalamin in normal and reduced serum cobalamin groups were noted as 355+/-29.5 and 183+/-17.5 pg/ml respectively [p=0.0001]. Triglycerides, total cholesterol, HDLc, LDLc and VLDLc differed significantly in the normal and reduced cobalamin subjects

Lipoprotein sub fractions showed a negative correlation with serum cobalamin

CONCLUSION: Cobalamin deficiency is common in type 2 diabetics associated with dyslipidemia

Vitamin B[12] deficiency with megaloblastic anemia: an experience at tertiary care hospital of Sindh

OBJECTIVE: To determine frequency of Vitamin B12 deficiency in subjects with anemia and elevated mean corpuscular volume

STUDY DESIGN: Cross sectional study

PLACE AND DURATION: Department of Medicine, Liaquat University and Isra University Hospital Hyderabad from January 2011 to August 2013

METHODOLOGY: A sample of 113 subjects was selected according to inclusion and exclusion criteria. Serum vitamin B12 deficiency was defined as per standard criteria. Blood samples were analyzed on Sysmex KX 21 hematology analyzer. Continous variables were analyzed by ANOVA and Tukey-Cramer test while categorical variables by Chi-square test

The association between variables was analyzed by Pearson`s correlation. A p-value of

RESULTS: Of 113 subjects, 37 [32.7%] were male and 76 [67.2%] female, mean+/-SD age was 34.48+/-6.71 years and 89.3% [n=101] were anemic. Mean hemoglobin, hematocrit and RBC counts were found as 11.3 g/dl, 33.1% and 3.0 million/µL respectively. Of total 113 subjects, vitamin B[12] deficiency was noted in 65 [57.5%]; further subdivided as borderline and definitive deficiency in 19.4% and 37.9% respectively. Mean corpuscular volume as high as 139 fl and vitamin B[12] levels as low as <30pg/ml were found. Pancytopenia was noted in 11 [9.7%] with severe vitamin B[12] deficiency [<100pg/ml]. Significant negative correlation was found between vitamin B[12] and mean corpuscular volume [r=-0.79, p=0.0001]. Peripheral blood film revealed anisocytosis, poikilocytosis, megaloblasts and hypersegmented neutrophils

CONCLUSION: Vitamin B12 deficiency is prevailing and is a major contributing factor of megaloblastic anemia

Knowledge, attitudes and practices of general practitioners towards diabetes mellitus in Hyderabad, Sindh

Objectives: To ascertain the knowledge, attitude and practice of general practitioners towards diabetes mellitus

Study Design: Cross sectional study

Duration of Study: From July 2009 to October 2009

Place of the study: The cases were collected from various areas of Hyderabad like Latifabad, Qasimabad, Hussainabad, Pretabad and Tando Jam, Hosrri

Material and Methods: One hundred general practitioners were selected in this study were excluded. A written questionnaire was filled by each doctor that included the 4 questions of each domain of knowledge, practice and attitudes. The knowledge was assessed by levels of blood glucose, random and fasting, practices assessed by treatment options and attitudes by advising to their patients for obesity, diet and pregnancy. The frequencies were taken of known or unknown

Results: out of 100 participants 35 belonged to periphery and 65 to major areas of Hyderabad. The mean +/- SD age was 41+/- 3.5 years and means +/- SD duration of practice was 10.4+/- 5.7 years. Each doctor had seen 10 diabetic patients per day. Out of 100 doctors, 55 answered correctly and 45 were poor to all domain

Conclusion: This study explored the knowledge, attitudes and practices regarding diabetes in Hyderabad among general practitioners and identified the need for improvement in managing diabetes. Awareness and education regarding diabetes is recommended to improve the health-care services provided by general practitioners

Standard antituberculosis drug induced hepatotoxicity: Do the risk factors matter?

Objective: To determine the frequency of hepatotoxicity with standard antituberculosis drug therapy and its risk factors

Method: This prospective cohort study was conducted at Muhammad Medical College Hospital, Mirpurkhas and Liaquat University Hospital Jamshoro, from July 2007 to August 2008. A total of 350 cases of active pulmonary tuberculosis with normal pretreatment liver function test [LFT] were selected through probability sampling. Patients were started first line antituberculosis drug therapy [ATT]. The liver function derangement was monitored. If any hepatotoxicity noticed, the time duration for toxicity occurrence and time taken for normalization of LFT were recorded. ATT was altered as needed, with exclusion of toxic drug. Data were collected on proforma and analyzed by using SPSS version 10.0

Results: ATT induced hepatotoxicity developed in 91 [26%] patients with minor, moderate and severe alanine transaminase [ALT] rise noted in 48 [52.75%], 40 [43.95%] and 3 [3.3%] cases respectively. Hepatotoxicity for individual drugs were noted as; Isoniazid [INH] 53 [58.24%], rifampicin 32 [35.16%] and pyrazinamide [PZA] 6 [6.59%] [p=0.01]. Malnutrition, low albumin, acetaminophen, female sex, older age and low serum cholesterol were noted as the risk factors [p=0.05]

Conclusion: Hepatotoxicity occurs significantly with anti-TB drugs, usually reversible and rarely fulminant. It is more frequent in patients with malnutrition, low albumin, acetaminophen, female sex, older age and low serum cholesterol

Frequency of skin manifestations in 120 type 2 diabetics presenting at tertiary care hospital

Objectives: to determine" the frequency of skin manifestations in patients with type 2 Diabetes mellitus"

Study design, place and duration: this was a descriptive case series study, carried out at Dep't of Medicine, Muhammad Medical College Hospital, Mirpurkhas and Liaquat University of Medical and Health Sciences, Jamshoro from November 2007 to April 2008

Subjects and Methods: one hundred and twenty type 2 diabetics; both male and female, were included in this study. All patients were asked about any skin problems they might have and subsequently all were examined regardless of their response. Age, sex, duration of diabetes, mode of treatment whether on oral hypoglycemic agents or insulin, and skin manifestations were noted

Results: age varied from 33 to 76 years [54 +/- 17 years] and known duration of diabetes varied from 10 to 27 years [15 +/- 9 years]. The overall prevalence of one or more skin disease was 96 [80%]. Diabetic dermopathy was seen in 36 [30%], rubeosis facies in 6 [5%], skin tags in 22 [18.33%], acanthosis nigricans in 7 [5.8%], eruptive xanthomas in 8 [6.66%], Vitiligo in 6 [5%], diabetic bullae in 8 [6.66%], diabetic xerosis in 6 [5%], lichen planus in 4 [3.33%], loss of hair in legs in 24 [20%], nail changes in 24 [20%], gangrenous diabetic foot in 29 [24%], thick skin in 60 [50%], and hyperhidrosis in 36 [30%] patients. Pruritis was noted in 48 [40%] patients. The skin infections were noted in 84 [70%] cases; including bacterial infections in 60 [50%], fungal infections in 20 [16.66%] and viral infections in 04 [3.33%] cases

Conclusions: we conclude that the skin is involved in diabetes quite often and whenever patients present with multiple skin manifestations; their diabetic status should be checked and controlled

Rising menace of multidrug resistant mycobacteria in pulmonary tuberculosis

Objective: the study was conducted to determine the rising menace of multidrug resistant mycobacteria in pulmonary tuberculosis

Subjects and methods: this prospective study was conducted in the Department of Medicine, Muhammad Medical College Mirpurkhas, from May 2007 to July 2008. Sixty cases of pulmonary tuberculosis were selected for multidrug resistant tuberculosis [MDR-TB] study that fulfilled the inclusion criteria. Pulmonary specimens consisted of 2-5 ml, early morning sputa and bronchial washings were sent for the ZN staining [AFB] and culture and drug sensitivity on culture-media. MDR-TB was defined as simultaneous resistance of an isolate to isoniazid and rifampicin

Results: drug culture and sensitivity revealed that 22 [36.66%] were sensitive to all the five first-line drugs, while 38 [63.33%] showed one or other type of drug resistance, including 7 [11.66%] resistant to single drug, 15 [25%] resistant to two drugs, 10 [16.66%] resistant to three drugs, while 6 [10%] were resistant to all the first-line drugs. Primary drug resistance was noted in 3 [5%]. Resistance to isoniazid, rifampicin, streptomycin, ethambutol and pyrazinamide was seen in 32 [53.33%], 28 [46.66%], 24[40%], 20 [33.33%], and 18 [30%] respectively

Conclusions: in view of this increasing level of drug resistance, more organized national strategy against tuberculosis is needed. MDR-TB was most commonly seen in chronic cases/ drug defaulters, and it is a major threat to the tuberculosis control measures