ABSTRACT
Objective: The objective of this study is to determine the pattern dyslipidimia in patients of Type 2 diabetes mellitus
Study Design: Cross-sectional study
Place and Duration: This study was carried out in General Medicine department of Peoples Medical University and Hospital Nawabshah and Civil Hospital Karachi, from June 2011 to July 2012
Methodology: This study consisted of seventy patients. Detailed history was taken from all the patients with special regard to increased thirst and frequent urination, increased hunger, weight loss, fatigue, blurred vision, slow-healing sores or frequent infections and an areas of darkened skin. Inclusion criteria were that all patients after counseling for study and taking written consent were included in this study >35 years of age with either sex admitted in general medicine ward through outpatient department and diagnosed as case of DM type 2 on the basis of history, clinical examination and investigations. Exclusion criteria included patients on dialysis, patients on lipid lowering agents, patients with acute complication of diabetes mellitus such as diabetic keto-acidosis, patients suffering from hypothyroidism, nephritic syndrome, type 1 DM and HTN, lacticacidosis and hypoglycemia. Results were prepared with the help of tables and graphs. Data was analyzed through SPSS software
Results: Out of 70 patients included in this study 46 were men [65.8%] and 24 patients were female [34.2%]; with male to female ratio of 1.9:1. There was wide variation of age ranging from a minimum of 35 year to 75 year. The mean age was 48.65+7.8 years. Mean total serum cholesterol was 196.04 +/- 44.02mg/dl, mean serum triglycerides was 193.04 +/- 108.64 mg/dl , mean high density lipoprotein 29.28 +/- 8.48mg/dl, mean low density lipoprotein 125.24 +/- 39.68mg/dl and mean very low density lipoprotein was 31.28 +/- 8.48 mg/dl. Total cholesterol was abnormal [>200mg/dl] in 56[80%] patients out of 70[ 21[87.5%] were females and 35 [76.1%] were males], Triglycerides was abnormal [>150mg/dl] in 62[88.5%] patients [ 22 [91.66 %] were females and 40 [86.95%] were males], high density lipoprotein was abnormal [< 35 mg/dl] in 51[72.8%] patients[ 18[75%] were females and 33[71.73%] were males], LDL was abnormal [>130 mg/dl] in 40[57.1%] patients [ 17 [70.83%] were females and 23[50%] were males] and VLDL was abnormal [> 30 mg/dl] in 47[67.14%] patients [19[79.16%] were females and 28[60.86%] were males]
Conclusions: We conclude that dyslipidemia is common among type 2 diabetic patients. Males are more prone to suffer from this complication. Patterns of dyslipidemia found more commonly were decreased HDL levels, increased LDL and Triglycerides levels. There is a need for early detection and treatment of this problem to prevent type 2 diabetic complications
ABSTRACT
To determine the frequency of various neurological and psychiatric symptoms associated with B12 deficiency. Observational and descriptive study. The study was conducted on patients presenting to the neurology clinics and inpatients who were admitted through the emergency department at Aga khan University Hospital Karachi, from 1 st July 2011 to March 2012. 150 patients of either gender and age more than 18 years. Detailed history was taken from all the patients with special regard to anemia. Inclusion criteria were that patients above 18 years of age of either sex with low serum B12 levels. Patients having any type of neurological tumors, major ischemic stroke, major intracranial haemorrhage, patients on neuroleptic medications and any evidence of toxin induced neuropathy were excluded. All patients underwent for specific investigation complete blood count, serum B12 levels [derived by Radio Assay method [RIA]. Further investigations Nerve Conduction Studies / Electromyography and CT Scan / Magnetic resonance Imaging of the Brain / spinal cord were carried out as and when required, depending on the clinical scenario. There were 69 [46%] males and 81 [54%] females. Female to male ratio was 1:0.8. The age ranged between 18 to 90 years with the mean age of 45.7+ 5.6. Out of 150 patients 107 patients [71.3%] had severe vitamin B 12 deficiency while 43 [28.7%] had mild to moderate deficiency. Neurological manifestations which were observed included; Memory was impaired in 13 [8.7%] of the patients. Dysarthia, along with other cerebellar signs [Nystagmus and dysdiadochokinesia] was present in 9 patients [6%]. 4 patients [2.7%] sought medical attention regarding their abnormal gait and their neurological examination revealed extensor planter responses and hyperreflexia. Cranial nerve examination revealed Anosmia in 2 [1.3%] and upper motor neuron facial weakness in 1 [0.66%] patients. Motor weakness was found in 2 patients [1.3%], and spasticity in 2 [1.3%] patients. 5 patients [3.3%] had sensory complains and were found to have impaired pain and touch perception. Proximal muscle weakness in one patient while another patient had asymmetric muscle weakness and rest of the patients had normal muscle power. None of the patient had autonomic dysfunction. In six neuropsychiatric problems were commonly seen in vitamin B12 deficient people. In these patients depression was observed in 16%, agitation 12.7%, memory impairment 8.7%, cerebellar signs and dysarthria 6%, sensory symptoms 3.3% and gait abnormality and hyperreflexia and extensor planters 2.7%. Various Neuropsychiatric problems are associated with vitamin B12 deficiency and the most common Neuropsychiatric illness found in these patients were depression, agitation, and memory impairment