Feto-maternal outcomes and Glycemic control in Metformin versus insulin treated Gestational Diabetics

Objective: To evaluate and compare feto-maternal outcomes and glycemic control in metformin versus insulin treated gestational diabetics

Methods: The study was conducted in 2010-2012 as a part of M. Phil at Civil hospital, Lyari General Hospital and Mamji Hospital in Karachi. After written informed consent, 71 GDM diagnosed females with WHO criteria were enrolled. They were divided into two groups. Group-A, 32 females were given oral metformin 500 mg TDS while Group-B, 39 females were given insulin 0.8-0.9 mg/kg/day in two divided doses subcutaneously. Patients were followed till term. Feto-maternal outcomes were evaluated in 25 patients in each group who completed the study

Results: When groups were compared, newborns in Group-B were significantly more in weight [p=0.01], Significant numbers of babies were delivered after 38 weeks of pregnancy in Group-B [P=0.021]. There were two intrauterine deaths and significantly higher HbC at term in Group-B. [P=0.03]. FBS at term was nonsignificant [p=0.079] and there was more number of cesarean sections due to feto-maternal disproportion in Group-B [28% vs.2%]. Results analyzed for glycemic control before and after the treatment revealed that FBS was statistically less in Group-A [p=0.00] whereas for Group-B the value of FBS and HbCwas statistically high. [p=0.002 a 0.04 respectively]

Conclusion: Metformin has produced better effects on feto-maternal outcomes and glycemic control in comparison to Insulin in GDM

Frequency of hypovitaminosis D and its associated risk factors in newly diagnosed pulmonary tuberculosis patients

Objective: To find out the frequency of hypovitaminosis D and its associated risk factors in newly diagnosed pulmonary tuberculosis patients prior to administration of standard anti tuberculosis therapy

Methods: This cross-sectional study was carried out in Ojha Institute of Chest Diseases-DUHS. After approval from BASR and following written informed consent eighty newly diagnosed, as per WHO criteria, tuberculosis patients were enrolled. Prior to the initiation of anti tuberculosis therapy, the serum vitamin D level was determined by 25-OH Vitamin D kit using the chemiluminescent immunoassay [CLIA] method. A cut off value of >30 ng/mL of serum vitamin D was taken as normal whereas a range between 10-30 ng/ mL and <10 ng/mL were considered insufficient and deficient respectively. Frequency of socio-demographic associated risk factors of hypovitaminosis D was also determined

Results: Out of eighty newly diagnosed tuberculosis patients 33 [41.25%] were males and 47[58.75%] were females with their ages ranging from 18-50 years. 54 patients [26 male and 28 female patients] were smokers. BMI of all the patients was found to be less than the normal ranges. Hypovitaminosis was present in all the cases. Vitamin D insufficiency was found in 49 participants [20 male and 29 female] whereas 31 patients [13 male and 18 female] were found to be vitamin D deficient

Conclusion: Prevalence of serum vitamin D level derangement is very high in newly diagnosed patients with pulmonary tuberculosis in our local setting which necessitates administration of adjuvant vitamin D along with standard anti tuberculosis therapy

Effects of diet and metformin on placental morphology in gestational diabetes mellitus

Objective: To evaluate the effects of diet control and Metformin on placental morphology in gestational diabetes mellitus [GDM]

Methods: After written informed consent 62 GDMs were enrolled. According to WHO criteria, 30 cases of GDMs with blood sugar level <130 mg/dl, were assigned Group B [2000-2500Kcal/day and 30 minute walk thrice weekly were kept on diet control and 32 cases of GDM with blood sugar level >130 mg/dl, assigned Group C were kept on diet with tablet Metformin, [500mg TDS] Finally 25 normal pregnant females were kept in Group A as control. After delivery placentae were preserved and evaluated for morphology

Results: Heavy placentae with abundant villous immaturity, chorangiosis and syncytial knots in group B and fibrinoid necrosis and calcification in group C were seen. In group B versus A placental and cord width while in Group C versus A only cord width in gross morphology showed significant results. In group B versus A villous immaturity, chorangiosis, infarction and syncytial knots in light microscopy were present; similarly in B versus C placental width, chorangiosis and syncytial knots showed significant results, while in C versus A results were non-significant

Conclusion: Metformin produced beneficial effects on placental morphology being comparable to normal control in contrast to diet group

Association between serum total testosterone and body mass index in middle aged healthy men

To determine correlation of serum total testosterone with body mass index [BMI] and waist hip ratio [WHR] in healthy adult males. A cross sectional study was conducted on 200 nonsmoker healthy males [aged 30-50 years] university employees. They were selected by convenience sampling technique after a detailed medical history and clinical examination including BMI and Waist Hip Ratio [WHR] calculation. Blood sampling was carried out to measure serum total testosterone [TT] using facilities of Chemiluminescence assay [CLIA] technique in Dow Chemical Laboratory. Independent sample T test was used for mean comparisons of BMI and WHR in between low and normal testosterone groups. [Subjects having < 9.7 nmol/L of total testosterone in blood were placed in low testosterone group and subjects having = 9.7 nmol/L of total testosterone in blood were placed in normal testosterone group]. Correlation of testosterone with BMI and WHR was analyzed by Pearson Correlation. Mean [ +/- SD] age of the subjects included in this study was 38.7 [ +/- 6.563] years mean [ +/- SD] total testosterone was 15.92 [ +/- 6.322]nmol/L. The mean [ +/- SD] BMI, and WHR were 24.95 [ +/- 3.828] kg/m[2] and 0.946 [ +/- 0.0474] respectively. Statistically significant differences were observed in the mean values of BMI and WHR for the two groups of testosterone. Significant inverse correlation of serum total testosterone with BMI[r = -0.311, p = 0.000] was recorded in this study. However testosterone was not significantly correlated with waist/hip ratio. [r = -0.126, p = 0.076] Middle age men working at DUHS who have low level of serum total testosterone are more obese than individuals with normal total testosterone level

Placental histology in diet and insulin treated gestational diabetics

To observe and compare placental histology for hypoxic changes in diet plus exercise alone versus dietplus exercise and insulin treatment in patients with Gestational Diabetes Mellitus [GDM]. Comparative / analytic study. The study was conducted in Lyari General Hospital and Mamji Hospital after approval from the Institutional Review Board [1KB] and Ethical Committee of Dow University of Health Sciences from Jan 2010- Jan 2011. After written informed consent, 30 patients were diagnosed to have GDM with RBS between 126-129 mg/dl were given diet control plus exercise therapy [Group A]. 39 GDM patients with RBS greater than 130 mg/dl were kept on diet plus exercise and insulin [Group B]. After delivery placentae were collected from 25 patients in each group. Histological slides of placentae were prepared and parameters of hypoxia such as villous immaturity, villous fibrinoid necrosis, syncytial knots, chorangiosis, calcification etc. were observed and compared between the two groups using light microscope. Results were evaluated by SPSS 16 using student t- test and chisquare test. Statistically non-significant results were obtained for the hypoxic parameters. However numerically more calcification was found in Group A while villous immaturity, villous fibrinoid necrosis and syncytial knots were present more in Group B. Histological examination of placentae showed presence of hypoxic features in both Group A and Group B patients with more propensities in diet plus exercise and insulin treated GDM group

Assessment of risk factors for gestational diabetes mellitus

Background: Gestational diabetes is a condition due to glucose intolerance that occurs in the few of the mothers during gestation. The pathophysiology originates as a result of increased placental hormones which have strong diabetogenic effect. It is strongly associated with multiple problems in mother and the baby and can even leads to unexplained fetal deaths in the end trimesters. So it is important to diagnose and treat females who are at greater risk than the others for developing gestational diabetes mellitus

Objective: To access the high risk factors associated with the development of gestational diabetes mellitus in 75 GDM diagnosed females

Methods: After screening and diagnoses 75 GDM patients [Diabetic, Group B] and 25 normal healthy patients [Control, Group A] in Lyari General and Mamji Hospital were enrolled in the study. Their detailed history was taken regarding occupation, parity, history of abortions, still births, preterm births and family history of diabetes. Parameters including age, weight, fasting and random blood sugar level and glycated hemoglobin were recorded in a predesigned data form. The results were evaluated using SPSS 16

Results: Statistically significant difference was found between the mothers of diabetic and normal control group as regards the weight, age [p-value=0.01 and p=0.03] and family history of diabetes [p-value=0.00]. Non-significant differences were found in the maternal occupation, parity, abortions, still births and pre-term births between the two groups

Conclusion: Advance maternal age, weight and familial association of diabetes are the risk factors associated with the development of gestational diabetes

Effects of insulin on placental, fetal and maternal outcomes in gestational diabetes mellitus

To observe the effects of exogenous insulin on placental, fetal and maternal outcomes in Gestational Diabetes Mellitus [GDM]. After screening and diagnoses [WHO criteria] 30 GDM patients[Group A] were kept on diet control and 39 GDM [Group B] who did not achieve glycemic targets were added subcutaneous insulin. Term placental weight, size, shape, consistency, fibrinoid necrosis, hemorrhages, cord color, length of the cord, completeness of membranes, weight and condition of baby and mode of delivery were assessed in 25 patients in each group. Placental weight, cord width and baby weight were found to be more in Group B, than Group A and were statistically significant with p value 0.005, 0.02 and 0.003 respectively. Ten patients in group A and 17 patients in group B had cesarean deliveries. Exogenous insulin produces significant effects on the placental, fetal and maternal outcomes in patients with GDM

Infrastructure, inventory, human resource of mother and child health centers of Lahore and its impact on maternal health services

It is a common observation that there is load on tertiary care facilities which is logical outcome of under utilized primary level. For identification, quantification and gauging of these gaps current study was conducted at MCH Centers of City District Government Lahore. It was cross-sectional descriptive study conducted at City District Government, Lahore. 18 MCH centers were selected by randomization technique at each town. The current study depicted that 44.44% centers were not having any telephone, fax, generator and ambulance service. While at 11.11% centers the post of dai are vacant. It was also found the 27.78% centers were not delivering service of IUD and inject able family planning services. It was also found that 88.89% of centers had the approved furniture, equipment and linen but in majority of cases it was non functional conditions. It was also found that 83.33% MCH Centers were lacking oxygen cylinder, artery forceps and tooth forceps. 88.89% MCH centers were not having vaginal retractors and dressing seizers. Umbilical Tape, Casco Vaginal Speculum, weighing machine were absent at 100% MCH centers. First aid box was present at 17 94.44% MCH Centers. Examination Couch, almirah, towel stand, iron bed and overalls were available at 88.89% of the MCH Centres but mostly they were in poor condition. Office chair, delivery couch, bed sheet and table cloth were available in all MCH Centres while bench, bucket, towel stand and durries were available in 94.44 MCH Centres. The preceding lines depict that although majority of centers have got sanctioned equipment and furniture but they are non functional and due to this fact this chain of MCH Centers for Maternal Health Services are not delivering up to the mark. Investment in the form of financial resources determines the success or failure of any setup

Breast self examination - awareness and practices among lady health workers

To find out the awareness and practices regarding breast self examination [BSE] among the lady health workers of Tehsil Arifwala, district Pakpatan, Punjab. This cross sectional study was conducted in July 2011. 300 LHW's fulfilling the inclusion criteria were selected through consecutive sampling technique. Information was collected regarding awareness and practices of BSE through interviews on questionnaire covering all variables. The BSE practices of LHW's were determined on the basis of two criteria: 1. Number of BSE steps performed [categorized as 'average' for performing >2 steps and 'below average' for performing one or two steps]. 2. Interval of BSE [categorized as 'correct' for regular monthly interval and 'incorrect' for >1 month interval]. Data was entered and cleaned using Epi Data 3.1 and analyzed using Epi Info 3.5.1 Mean age of participants was 32.06 +/- 7.8 years. Majority were married [79%], rural dwellers [64.3%], had job experience up to 5 years [55.3%] and were educated above middle [53.7%]. Majority 280 [93.3%] were aware of breast self examination but only 80 [28.5%] were practicing it. Out of 80 who were performing BSE, 34 [12.1%] were practicing BSE at correct interval and only 46 [16.4%] were practicing average steps. Significant relationship was found between the age and awareness while higher levels of job experience had a significant relationship with BSE practice. The awareness level of LHW's regarding BSE was relatively high as compared to their practices of BSE. As a LHW has direct link with the community, there is a need to organize training courses for LHW's regarding correct BSE practices. Special emphasis should be paid to timeliness and steps of the procedure so that she can provide proper information to community for early detection of breast cancer.