ABSTRACT
To compare the efficacy of metformin in the treatment of gestational diabetes mellitus [GDM] with insulin and to compare the frequency of hypoglycaemia in neonates of the mothers treated with metformin and insulin. Randomized control trial to compare the efficacy of metformin with insulin in the treatment of GDM. Outpatient department and labour ward of Obstetric and Gynaecology department of Benazir Bhutto Hospital Rawalpindi from August 2012 to January 2013. A total of 110 pregnant ladies with GDM diagnosed after 20 weeks of gestation were included and divided into group A and group B with 55 patients in each group. Group A patients were treated with insulin and group B with metformin. Plasma fasting glucose and two hours postprandial glucose levels were determined on weekly basis for four weeks after starting the treatment to determine the efficacy of insulin and metformin. At birth plasma glucose levels of all the neonates were carried out two hourly, and more frequently depending upon the requirement, during first 24 hours in both the groups to determine neonatal hypoglycaemia. Fasting plasma glucose in group A and B were calculated as 5.96 +/- 0.58 and 5.76 +/- 0.46 mmol/L respectively [p=0.280], while two hours post-prandial plasma glucose levels were 7.34 +/- 0.48 and 7.28 +/- 0.58 mmol/L respectively [p=0.650]. Efficacy in group A was 78.18% and in group B was 70.91% [p=0.381] while frequency of neonatal hypoglycaemia was calculated as 61.54% in group A and 41% in group B [p=0.113]. The efficacy of metformin in treatment of gestational diabetes mellitus is similar as with insulin and the frequency of hypoglycemia in neonates of the mother treated with metformin and insulin is also similar
ABSTRACT
To determine the frequency of asymptomatic spontaneous bacterial peritonitis in patients of liver cirrhosis with ascites. Descriptive study. The study was conducted at indoor and outpatient departments of Medicine, Military Hospital, Rawalpindi, Pakistan from 29[th] February 2008 to 28th August 2008. One hundred and ninety five patients of liver cirrhosis with ascites were selected. To standardize the study; patients of both genders over 18 years of age, diagnosed with liver cirrhosis and ascites were included in the study after obtaining their informed consent. Patients with abdominal tenderness and fever, hepatic encephalopathy, intra-abdominal surgically treatable cause, with any co-morbid disease [hypertension and diabetes mellitus] or refusing to give consent were excluded from the study. Strict inclusion/exclusion criteria were observed to control the confounding variables. Diagnosis of spontaneous bacterial peritonitis was based on increased ascitic fluid absolute polymorphonuclear leukocyte [PMN] count [> 250 cells / mm[3]] and/or positive bacterial culture. Out of 195 patients, 10 patients [5%] had neutrocytic ascites [absolute neutrophil count > 250 cell/mm[3]]. Out of these 195 patients, three patients [1.5%] were found to have positive ascitic fluid culture. In our study the frequency of asymptomatic spontaneous bacterial peritonitis in patients of liver cirrhosis with ascites turned out to be 5% which is low. Therefore, analysis of ascitic fluid through diagnostic paracentesis should be reserved for inpatient or outpatient with clinically apparent new onset ascities or in cirrhotic patients with ascities whose general condition deteriorates