Newly Diagnosed Anemia in Admitted Diabetics, Frequency, Etiology and Associated Factors

Objective: To determine the frequency of newly-diagnosed anemia in diabetics admitted to the Internal Medicine Department and its etiology and contributing factors. Study Design: A cross-sectional, analytical study. Place and Duration of Study: Department of Internal Medicine, Sir Syed Trust Hospital and College of Medical Sciences, Karachi, from July 2011 to December 2012. Methodology: Adult diabetic patients first diagnosed as having anemia upon hospital admission during the specified duration were included. Patients with active bleed, acute renal impairment, critical illness, pregnancy and previously diagnosed anemia were excluded. Etiology and risk factors of anemia were determined in each case on the basis of history, clinical findings and relevant laboratory investigations i.e. complete blood picture, red cell indices, iron profile, renal function tests, urine and stool examination. Association of anemia was determined using chi-square and t-tests with p-value < 0.05 taken as significant. Results: One hundred and thirty patients [34 males and 96 females] were included. Mean age was 51 +/- 12.4 years, with mean BMI of 25.4 +/- 5.2 kg/m2, mean duration of diabetes of 7.6 +/- 5.5 years and mean glycated haemoglobin [HbA1c] 8.47 +/- 1.58%, with 75% diabetics having unsatisfactory glycemic control. Mean haemoglobin was 11.6 +/- 1.96 g/dl. Anemia was present in 63% diabetics [18 males and 64 females]. It was normocytic in 59.8%, microcytic in 37.8% and macrocytic in 2.4%. Chronic Kidney Disease [CKD] was present in 44%, iron deficiency in 23%, mixed etiology in 6%, vitamin B-12 deficiency in 2% and thalassemia minor in 1% cases. Statistically significant association of anemia was found with poor glycemic control [p=0.002], dietary restriction for red meat [p < 0.001], history of blood loss [p < 0.001], gastrointestinal disorders [p < 0.001], CKD [p < 0.001] and retinopathy [p=0.011]. Conclusion: Anemia in two out of every three diabetics in this study points to need for haematological screening in all diabetics presenting to healthcare facility. In addition to chronic kidney disease, dietary iron and vitamin deficiency, glycemic control, presence of CKD, retinopathy and gastrointestinal disorders need to be evaluated and rectified. Key Words: Anemia. Chronic kidney disease. Diabetes mellitus. Dietary iron. Glycemic control. Retinopathy. Vitamin B-12.

study of 30 cases of renal amyloidosis

To determine the clinicopathological features of renal amyloidosis. Patients And A total number of thirty cases were included in two year study. Diagnosis was based on renal biopsy and Congo red staining. There was 18 [60%] male and 12 [40%] female patients. Age range was 20 - 70 years and maximum number was found between 40 - 50 years. Out of 30 cases tuberculosis was present in 10 [33.3%], leprosy in 6 [20%], bronchiectasis and rheumatoid arthritis in 4 [13.3%], chronic osteomyelitis in 3 [10%], ankylosing spondylitis in 2 [6.7%] and multiple myeloma in 1 [3.3%] case. Proteinuria was present in all cases. Generalised edems found in 26 [86.6%], hypertension in 17 [56.6%], hematuria in 10 [33.3%], hepatosplemngely in 5 [16.6%] patients. Tuberculosis was the commonest cause of secondary renal amyloidosis

Role of keto-analogues in the conservative management of chronic renal failure

One hundred patients with chronic renal failure were studied for twenty months to see the effect of a low protein diet supplemented with ketoanalogues [Ketosteril]. Their protein intake was restricted to 0.6-0.8 gms [35 kcals]/kg bw/day. Eighty two patients reported improvement and experienced enhanced physical activity, mental alertness, improved appetite and sleep. There was no generalised weakness, wasting of muscles and weight loss. Of these 82 patients, 33 showed definite improvement as their blood urea nitrogen [BUN] decreased while in 49 BUN remained stable i.e. it neither decreased nor increased. Out of the remaining 18 patients who did not show any improvement, seven are on maintenance haemodialysis, three underwent renal transplantation, five expired while three were lost to follow up. It is concluded that a low protein diet supplemented with ketoanalogues [Ketosteril] can improve uraemic symptoms, improve rehabilitation status and can thus defer an early need for dialysis

Safety and efficacy of ciprofloxacin in the treatment of complicated urinary tract infections

One hundred patients with complicated urinary tract infection with significant colony counts were treated. The most common organism was Escherichia coli [86%], Pseundomonas aeruginosa [8%], Klebsiella [4%] and mixed infection with Escherichia coli and Proteus mirabilis [2%]. Most of the patients started showing improvement within 48 to 72 hours and complete recovery was achieved with 7 to 10 days with Ciprofloxacin 250 mg twice daily. A cure rate of 98% was achieved. Adverse effects were insignificant. There were no significant changes in the renal and liver function tests after the therapy. All the patients were followed up for a period of six months. Most of the patients with anatomical structural deformities were later on treated surgically. Since complicated UTI is a serious problem the safety and efficacy of only one drug with newer fluoroquinolones was studied

Role of recombinant human erythropoietin in predialysis patients of chronic renal failure

Experience with erythropoietin in the treatment of anaemia in predialysis patients is limited. This study was designed to investigate the efficacy, safety and impact of recombinant Human Erythropoietin [r-HU EPO] in the treatment of anaemia in predialysis chronic renal failure patients. The study included 19 patients and the treatment was administration of 50 I.U /kg r-HU EPO subcutaneously twice a week. The dose was reduced to 25 I.U/kg when the Hb level reached between 10-11 gm /dl and stopped when it went above 11 gm/dl. No side effects occurred during the period of study. The study concluded that r-HU EPO therapy improves anaemia in predialysis patients and doses not accelerate the progress to end stage renal disease