Perception of diabetic patients regarding basal bolus insulin injections and outcome of its use

Objective: To assess the perceptions regarding basal bolus insulin injections and the changes in blood glucose levels and glycosylated hemoglobin [HbA1c] before and after 3 months of such treatment in diabetic patients. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Endocrinology, Liaquat National Hospital, Karachi, from December 2014 to March 2015

Methodology: A total of 222 diabetic patients started on basal bolus insulin injection were enrolled and asked to answer 17 questions. Those with complications of diabetes were excluded. Fasting blood glucose [FBS], random blood glucose [RBS] and HbA1c levels were checked initially, and after 3 months of getting basal bolus insulin. Paired t-test and chi-square test were used for determining p-value with significance at p < 0.05

Results: Majority [n=217, 97.7%] of the patients were previously taking other insulins. Before starting this treatment, the mean FBS was 260.5 +/- 52.2 mg/dl, RBS was 385.5 +/- 47.61 mg/dl and HbA1c was 12.76 +/- 1.92%. After 3 months of treatment, FBS improved to 117.9 +/- 14.2 mg/dl, RBS was 156.7 +/- 17.09 mg/dl and HbA1c was 7.72 +/- 4.41% [p < 0.001]. Two hundred and sixteen [97.3%] patients believed that basal bolus insulin was started as their diabetes worsened; 157 [70.70%] thought that their blood glucose control would improve with the use of this form of insulin. One hundred and ninety four [87.4%] had fear of needle injections. Perceptions regarding hypoglycemia with this form of insulin were observed in 157 [70.7%]. One hundred and twenty seven [84.1%] of the females and 51 [71.8%] of the males thought that the basal bolus insulin regimen was too expensive [p=0.032]

Conclusion: There were many misconceptions in patients who were started on basal bolus insulin. Marked improvement in blood glucose levels and HbA1c were observed after the use of this regimen

Presentations and outcome of thyroiditis from a tertiary care hospital of Karachi

Objective: To assess the clinical presentations and short-term outcomes of patients with thyroiditis presenting to a tertiary care hospital in Karachi, Pakistan

Study Design: Case series

Place and Duration of Study: Department of Endocrinology, Liaquat National Hospital, Karachi, from June 2014 to February 2015

Methodology: Patients between 18 and 70 years of age with acute onset of thyroiditis confirmed on thyroid scan or clinical judgment presenting to the outpatient services were included in the study. Pregnant females, psychiatric patients and patients having other chronic illnesses were excluded from the study

Results: A total of 26 patients with thyroiditis attended the endocrine clinic. Mean age of patients was 41.2 +/- 11.12 years. There were 18 [69.2%] females. Clinical presentations were fever [65.4%], tender neck [23.1%], goiter [19.2%], localized tenderness in neck and palpable lymph nodes [26.9%]. Major symptoms reported were: sore throat [69.2%], weight loss [38.5%], upper respiratory tract infection, thyroid pain, tremor, sweating and fever of unknown origin in 26.9% cases. All the patients had raised Erythrocyte Sedimentation Rate [ESR]. Low Thyroid Stimulating Hormone [TSH] < 0.4 mlU/L was seen in 88.5% and 57.7% had raised Free T4 > 1.8 ng/dL. Complete recovery was seen in 88.5% patients while 11.5% had early hypothyroidism

Conclusion: Fever and sore throat were the main presenting features of thyroiditis patients. ESR was raised in all patients. A majority of patients had complete recovery with appropriate management; however, few cases developed hypothyroidism

Mobile phone intervention to improve diabetes care in rural areas of Pakistan: a randomized controlled trial

To determine the effect of mobile phone intervention on HbA1c in type-2 Diabetes Mellitus [DM] patients living in rural areas of Pakistan. Randomized controlled trial. Department of Endocrinology, Liaquat National Hospital, Karachi, from December 2013 to June 2014. A total of 440 patients in intervention and control groups were enrolled. All patients between 18 - 70 years of age, residing in rural areas of Pakistan, HbA1c >/= 8.0% and having personal functional mobile phone were included. The intervention group patients were called directly on mobile phone after every 15 days for a period of 4 months. They were asked about the self- monitoring blood glucose, intake of medications, physical activity, healthy eating and were physically examined after 4 months. However, the control group was examined initially and after 4 months physically in the clinic and there were no mobile phone contacts with these patients. Patients in intervention group showed improvement [p < 0.001] in following diet plan from 17.3% at baseline to 43.6% at endline, however, the control group showed insignificant increase [p=0.522] from 13.6% at baseline to 15.9% at endline. Intervention group [RR = 2.71, 95% CI = 1.18 - 6.40] showed significant positive association with normalization of HbA1c levels. The relationship was adjusted for age, gender, socio-economic status, ethnicity, education, hypertension, medication, BMI, diet, LDL levels and physical activity. Dietary restriction and low LDL levels also showed significant associations with reduced HbA1c levels on multivariate analysis. Mobile phone technology in rural areas of Pakistan was helpful in lowering HbA1c levels in intervention group through direct communication with the diabetic patients. Lowering LDL and following diabetic diet plan can reduce HbA1c in these patients and help in preventing future complications

Trichobezoar and gastric polyps: a rare association

A 10 year old female child presented with upper abdominal pain and huge abdominal mass in epigastrium extending to both hypochondria and umbilical regions. Investigations revealed a trichobezoar with gastric polyps. At operation, a large trichobezoar occupying almost whole of the stomach was removed along with gastric polyps. Biopsy suggested hyperplastic polyps