Precipitating factors for diabetic ketoacidosis

To determine the frequency of various precipitating factors for Diabetic Ketoacidosis [DKA]. This descriptive, cross-sectional study based on purposive sampling method was conducted at Medical ward VI, Islamabad Hospital, Pakistan Institute of Medical Sciences, Islamabad from 15[th] July 2005 to 14[th] January 2006. Forty Two patients of type 2 diabetes mellitus who at the time of admission had diabetic ketoacidosis were analyzed to sort out the precipitating factor by history, physical examination and investigations both laboratory and radiological. Out of 42 patients 19 [45%] were male while 23 [55%] were female. 21 [50%] had infection, 11 [26.19%] were non-compliant to the treatment, 09 [21.40%] had other co-morbidity [stroke, acute pancreatitis etc] as precipitating factor while one [2.3%] had his first presentation of diabetes mellitus as diabetic ketoacidosis. A mortality of 7.15% was recorded in the study. Infection, non-compliance to treatment and comorbid conditions are the major precipitating factors for diabetic ketoacidosis

sweet foot relation of glycemic control with diabetic foot lesions

Introduction: diabetes mellitus has become an epidemic in the past several decades, owing to the advancing age of the population. The average delay of 4-7 yrs in diagnosing type 2 diabetes mellitus translates into approximately 20% of patients of type 2 diabetes having some evidence of microvascular or neurological diabetic complications at the time of diagnosis

Material and Method: Design: descriptive observational study

Setting: out door and indoor patients in P.I.M.S, Islamabad, Pakistan visiting during May to June 7th, 2004 i.e.5 weeks

Patient Selection: all patients with diagnosed diabetes mellitus eligible to be included in the study

Measurements included: 1] glycosylated Hb. 2] Proteinuria by dipstick. 3] Retinal changes by fundoscopy; 4] Skin lesions 5] Neuropathy such as loss of sensations on self reported history and examination clinically

Results: out of a total of 36 patients, males were 39% [n = 14], females 61% [n = 22]. Mean age at the time of diagnosis was 42 yrs [15 yrs - 56yrs]; mean age at presentation to us was 53 yrs [25-69 yrs]; mean duration of diabetes was 15 yrs [I month - 5yrs]. Of these patients 94% [n = 34] were taking some form of treatment which included oral hypoglycemics in 94% [n = 32] and oral and parentral drugs i.e. insulin in 6% [n = 2]. Of those taking treatment 56% [n = 20] had controlled diabetes mellitus [DM] while 44% [n = 16] were having uncontrolled DM at presentation. Mean value of glycosylated haemoglobin [Hb] was 8.2% [6 - 16.6%]

Conclusion: incidence of diabetes foot lesion strongly correlates with poor glycemic control which is in itself best manifested by levels of glycoslated haemoglobin

Effect of typhoid fever on thrombocytes

This study was carried out to evaluate the effect of typhoid fever on platelet count. A total of 175 patients were admitted with suspected typhoid fever. We picked up only those 46 cases in which either blood culture was positive for Salmonella, or Widal test was positive in high titres. 29 percent of these patients showed a significant decrease in their platelet counts regardless of WBC count. This is important to remember since many viral and bacterial infections and also a number of drugs can cause thrombocytopaenia. The platelet count increased to normal values as the fever settled