Comparison of Apple Cider Vinegar and Metformin Combination with Metformin Alone in Newly Diagnosed Type 2 Diabetic Patients: A Randomized Controlled Trial

Objective: This study aims to compare the effect of metformin monotherapy with the combination therapy of metformin and apple cider vinegar on the parameters of Body Mass Index and glycemic control of recently diagnosed type 2 diabetes mellitus patients. Methods: A total of 126 patients were enrolled in this open-label randomized controlled trial, divided into two parallel arms: Group I (Metformin 750 mg alone per day) and Group II (Metformin 750 mg+Apple Cider Vinegar 2 tablespoons per day) and assessed for weight, Body Mass Index, Fasting Blood Sugar and Hemoglobin A1c after which the post-treatment values of the aforementioned parameters were compared between the two groups. Informed consent from all patients and ethical approval from the institutional ethics board was obtained. A p-value of <0.05 was considered significant. Results: All the parameters underwent a significant reduction in the pre and post intra group comparison of each group (p-value<0.001). Moreover, a significant difference was found in the post-treatment comparisons of the Fasting Blood Sugar (p-value<0.001) and HbA1c (p-value=0.04) in between the two groups. However, no significant difference was obtained in the post-treatment comparisons of weight and Body Mass Index in between the two groups. Conclusion: Apple Cider Vinegar in combination with Metformin appears to be more effective in improving glycemic control versus Metformin monotherapy.

Ocular malignant tumors. Review of the tumor registry at a tertiary eye hospital in central Saudi Arabia

To present the epidemiologic profile and magnitude of ocular malignant tumors [MT] representative of the Saudi population from the Tumor Registry [TR] at King Khaled Eye Specialist Hospital [KKESH]. This study evaluated the demographic information, clinical features including tumor laterality, ocular tissue of origin, and diagnosis of patients from the TR registry between 1983 and 2012 at KKESH, Riyadh, Kingdom of Saudi Arabia. The incidence of MT among Saudi adults [>/= 15 years old], and children [<15 years old] was estimated. The TR recorded 4,146 neoplasms [2,509 [60.5%] benign tumors, and 1,637 [39.5%] MT]. The incidence of MT in children was 3.6 per million/year [M/Y], and 2.4/M/Y for adults. Retinoblastoma [Rb] [n=763, 91%] was the most common ocular malignancy in children. In adults, the most common MT was squamous cell carcinoma [SCC] [n=363, 45.8%], basal cell carcinoma [BCC] [n=186, 23%], uvealmelanoma [n=94, 11.9%], sebaceous gland carcinoma [n=54, 6.8%], lymphomas [orbital, adnexal] [n=46, 5.8%], and others [n=53, 6.8%]. The Rb [7.7/M/Y in <5 years old Saudi children] was less frequent than that reported in some Gulf countries, but higher than that reported from the West. The SCC was less frequent in countries with comparable sun exposure than in other continents, but the incidence remained unchanged over 3 decades. There was a significant increase in BCC between 1983-1992 and 2003-2012. The rates of all cancers remained stable over 3 decades except BCC, which showed a significant rise

Effects of Ramadan fasting and physical activity on glucose levels and serum lipid profile among type 2 diabetic patients

To assess the effect of fasting and physical activity on blood pressure, fasting glucose, cholesterol, triglyceride, high density and low density lipoproteins among diabetic type 2 patients. Seventy five patients who had three visits [last ten days of Shabann [visit 1], Ramadan [visit 2] and Shawwal [visit 3]] were included in the study. Physical measurements, clinical measurements and 12 hours fasting blood sample were taken, along with an interview for demographic information and physical activity on each visit. The samples were analyzed for 1] Glucose, 2] Cholesterol, 3] Triglyceride, 4] Uric Acid, 5] HDL-C, and 6] LDL-C. The mean weight of the patients decreased significantly from 71.43 kg to 69.41 kg from visit 1 to visit 2. Mean systolic blood pressure also decreased significantly from 124.25 mm/Hg to 119.86 mm/Hg while. Mean triglyceride level decreased from 239.095mg/L to 207.07 mg/L from visit 1 to visit 2 and it kept decreasing to 159.25 mg/L till third visit. Mean LDL value increased from 104.12 mg/L to 112.64 mg/L from visit one to visit two and then further increased to 119.0 mg/L on the third visit. Ramadan fasting is safe for diabetes type II patients and is associated with weight loss and improvement in the overall diabetic control. Furthermore, the physical activities could reduce the body weight, waist measurement, systolic blood pressure, triglyceride and HDL

General practitioners' awareness and management of common psychiatric disorders: a community-based survey from Karachi, Pakistan

This study assessed the knowledge and management of common psychiatric disorders by general practitioners [GPs] in Karachi, Pakistan, Structured interviews were carried out in 2009 with 360 GPs selected by cluster random sampling. Patients with psychiatric disorders were estimated to be up to 10% of the daily caseload according to 71.8% of doctors. Two-thirds of GPs were unaware of the ICD-10 diagnostic criteria for depression and anxiety disorders. Benzodiazepines were the most recognized category of medication [75.3%] and were the most commonly used medication for all mental health conditions. Fewer GPs were familiar with selective serotonin reuptake inhibitors [35.1%] or tricyclic antidepressants [20.2%]. Lack of time and patients financial constraints were reported to be barriers to care. Most GPs [69.2%] had not received any recent medical education about mental health problems. Gaps in GPs' knowledge about the management of mental disorders have implications for the rational use of psychotropic medications in primary care

Retinopathy: variable clinical spectrum and postendarterectomy changes

The Carotid Artery Insufficiency Retinopathy [CAIR] is an uncommon sign of carotid artery obstruction. It is mainly found in patients with complete occlusion or severe obstruction of Internal Carotid Artery [ICA]. Retinopathy is caused by progressive and chronic hypoxia to ocular tissues. The purpose of the study is to describe the variable presentation of CAIR in patients with internal carotid artery stenosis and to asses the resolution of retinopathy in patients who had carotid endarterectomy. Records of the patients with confirmed internal carotid artery stenosis were reviewed. Patients' demographic data and way of presentation to ophthalmologist was recorded. Associated systemic vascular diseases were also recorded on the proforma. Records of the patients with confirmed internal carotid artery stenosis were reviewed. Thirteen eyes of 10 patients were included in study with male to female ratio of 9:1. Patients' clinical presentation ranged from scattered blot haemorrhages to ocular ischemic syndrome. Patients presented with retinopathy at different stages. The presentation of retinopathy varied from scattered blot haemorrhages to ocular ischemic syndrome. Endarterectomy resolved CAIR in 2 out of 3 patients, with one patient having bilateral resolution. CAIR should be suspected if retinopathy is unilateral. On the other hand patients with asymptomatic Carotid artery stenosis should be examined for signs of ocular ischemia. All patients with CAIR should be investigated for cardiovascular diseases. Endarterectomy in selected patients can resolve CAIR

Use of continuous low pressure suction on chest drain in thoracic surgical unit

To assess the merits and demerits of continuous Low Pressure Suction applied to the chest drain in both preoperative and postoperative thoracic patients. Department of Cardiothoracic Surgery, Postgraduate Medical Institute, ady Reading Hospital Peshawar from Jan 2005 to March 2005. It was a prospective study carried out over the period of three months to assess the benefits of Low Pressure Suction. Patients with Chest trauma, inflammatory disease of the lung and pleura, carcinomas and postoperative patients were included in the study. Patients with multiple trauma and moribund patients were excluded from the study. Postoperative patients were given priority for suction beds. The suction applied to the chest drain ranged from -05 to -20 KPa. It was continuously applied to the chest drain 24hrs a day and 7 days a week and only interrupted at the time of bottle change or patients going to toilets. A total of 180 patients were included in the study, which were divided into two groups depending upon the availability of suction beds. Group I: Included those patients who were put on Continuous Low Pressure Suction. Group II: Included those patients who were not put on Continuous Low Pressure Suction because lack of suction beds. Ninety patients were included in group I and similar number of patients into group II. In group I out of 90 patients 40 were non-operative and 50 were operative. In group II out of 90 patients 55 were non-operative while 35 were operative. Out of operated patients [total 85] full lung expansion was achieved in 42 [84%] in group I and 25 [71.4%] in group II while partial lung expansion was achieved in 08 [16%] in group I and 10 [28.6%] patients in group II. Out of non-operated patients [total 95] full expansion was achieved in 35 [87.5%] in group I and 42 [76.4%] in group II while partial expansion was achieved in 05 [12.5%] patients in group I and 13 [23.6%] in group II. Out of 5 partial expansions in group I suction had to be discontinued in 2 patients because of increasing air leak. Continuous low pressure suction helps to decrease the need for surgery in patients following chest trauma, inflammatory lung disease and decreases morbidity in postoperative patients

Collapse therapy in 21 century an experience of 50 cases

To observe the various indications of thoracoplasty and evaluate their management and outcome. Study Design: An observational descriptive study. Place and Duration: Department of Cardiothoracic Surgery, Postgraduate Medical Institute, Lady Reading Hospital from July 2001 to January 2004. Subjects and During two and a half years study period fifty patients needed thoracoplasty. M: F ratio was 36:14. Aged distribution was 23 - 57 with a mean age of 36.3 years. Indications for surgery were tubercular or parapenumonic empyema in 25[50%] patients, post lobectomy space infection, and broncho pleural fistula [BPF] in 10[20%], destroyed lung with hemoptysis in 8[16%], post pneumonectomy space infection in 4[8%] and upper lobe hemoptysis with poor PFTs in three [6%] cases. A standard subperiosteal extra pleural paravertebral surgical technique was used in all cases. Out of 50 cases 28 [56%] required full thoracoplasty and 22[44%] cases underwent partial thoracoplasty. Postoperatively all patients had a single chest drain on suction for 7 days. Both the drain and stitches were removed after 2 weeks and patients were advised to attend out patient department for follow-up. Patients symptoms index showed remarkable improvement. 100% improvement was needed in patients regarding chest pain, fever, cough, weight loss, hemoptysis and ATT. Postoperative complications were noted in 10 [20%] cases. Four patients had wound infection, 2 had wound dehiscence, residual space in 3 and restricted shoulder mobility in one. There was 1[2%] mortality. This patient had borderline pulmonary functions and had to be ventilated for ventilatory failure. With the persistent problem of pulmonary tuberculosis in the developing countries, thoracoplasty is still an operation of continued relevance for space obliteration in cachectic patients, and as collapse therapy for bleeding lungs with poor PFTs. Most patients are definitively and rapidly cured with limited sequelae

Early surgery for pulmonary tuberculosis

The purpose of our study was to analyze current indications for surgery in tuberculosis and evaluate the outcome of early surgical intervention. Department of Cardiothoracic Surgery, Postgraduate Medical Institute, Lady Reading Hospital, Peshawar from June 2000 to July 2004. Total number of cases was 132; M: F 105: 27. Age range was 20 to 79 years. Mean age was 48.4 years. The indications for surgical intervention included 5 cases of pulmonary aspergillioma, 9 cases of pneumothorax; 3 cases of pulmonary nodes and masses without histological diagnosis, 15 cases bronchiectasis, 12 cases of massive hemoptysis and 82 cases of pleural empyema while six patients with multi drug-resistant tuberculosis required surgical intervention. The techniques utilized included lobectomy in 45 cases, pleural drainage in 20 cases, segmented pulmonary resection in 32 cases, surgical procedures on the chest wall in 17 cases, pneumonectomy in 10 cases, decortication in 8 cases. In 22 cases two or more procedures were performed on the same patient. In 26[19.6%] cases various complications were noted of which wound infection was the most frequent. There was a mortality rate of 3.3% [4 cases]. Surgical treatment is indicated for the complication of TB and management of MDR TB. Early surgery is beneficial in patients whose disease is still localized and who can tolerate resection surgery; of particular importance is a healthy opposite lung, on which the patient would be dependent during and immediately after surgery

Henoch-Schonlein purpura associated with gastric helicobacter pylori infection

This is a case report of a 40 year old patient with Henoch-Schonlein Purpura, who presented with upper abdominal pain, retrosternal burning and palpable purpura over the lower limbs. His upper GI Endoscopy revealed erythematous lesions in the body of stomach and more severe antral gastritis, which was later on proved to be due to Helicobacter Pylori [H. Pylori]. The patient was started on anti-H.Pylori treatment with omeprazole, clarithromycin and amoxicillin and responded very well, with remission of symptoms. H.Pylori infection was the most probable cause of Henoch-Schonlein purpura in this patient