Effect of Vitamin D supplementation on reduction in levels of HbA1 in patients recently diagnosed with type 2 Diabetes Mellitus having asymptomatic Vitamin D deficiency

Objective: To study the effect of Vitamin D supplementation on reduction in level of HbA1 in patients recently diagnosed with diabetes mellitus Type II having asymptomatic Vitamin D deficiency

Methods: This randomized control trial was conducted at East Medical Ward Mayo Hospital Lahore for 6 months from January 01 2016 to June 30, 2016. 114 Patients were included through non probability purposive sampling technique. Informed consent and demographic information was collected. Patients were divided in two groups by randomization through tossing a coin. GroupA patients received Metformin tablet alone at 500 mg after dinner and Group-B patients were treated with same dosage of Metformin along with oral vitamin D at 200,000 ILJ monthly for three months. Blood sample was obtained at baseline, 3 months and 6 months of initiation of therapy. All samples were sent to the laboratory for complete blood count, blood sugar fasting, serum calcium, serum phosphorous, serum alkaline phosphatase, HbA1c and serum 25 Hyroxy Vitamin D [S-25[OH] D] levels and iPTH. Data entry and analysis was done by using SPSS 20

Results: The mean age of patients in metformin group was 42.37+/-4.59 years while mean age of patients in combination group was 43.33+/-4.86years. Males were 45.6% and females were 54.4% in metformin group while in combination group, 36.8% were males1 and 63.2% were females'. At baseline, in metformin group, mean Vitamin D level was 17.09+/-1.73mg/dl and in combination group, mean Vitamin D level was 16.49+/-n D was 29.04+/-3.96mg/dl. At baseline, 1[st] and 2[nd] visit, in metformin group, mean HbA1c was 7.59+/-0.47%, 7.46+/-0.25% and 7.30+/-0.29%. At baseline, 1[st] and 2[nd] visit, in combination group, mean HbA1c was 7.71 +/-0.19%, 7.57+/-0.21% and 7.43+/-0.26%. The difference was insignificant [p>0.05] at baseline while significant on later follow-ups [P<0.05]

Conclusion: Vitamin D supplementation improved the glycemic control but substantial reduction in HbA1c was statistically insignificant in both groups

Association of progression of pulmonary fibrosis with severity of liver cirrhosis

Background: it has been found that frequency of pulmonary fibrosis increases in patients with cirrhosis of liver. We hypothesized that as the stage of cirrhosis advances, the frequency of pulmonary fibrosis should increase. We used child's pugh classification to stage the cirrhosis of liver

Material and Methods: fifty five patients of age range 16 to 80 years, both males and females having established cirrhosis of Fiver on ultrasonography, regardless of etiology, visiting the outpatient and inpatient department for treatment were selected. Patients were divided into three groups according to child's criteria i.e. group A, group B, and group C. HRCT of chest was performed on patients in all three groups to look for pulmonary fibrosis

Results: 27 [49%] patients were found to have pulmonary fibrosis on HRCT. The frequency of pulmonary fibrosis in different groups of child's classification was also assessed and it was found that class C and class B, are affected more than A

Conclusion: pulmonary fibrosis progresses with severity of liver cirrhosis

Assessment of severity of esophageal varices by splenic index in cirrhotic patients

Objective: to determine the relationship between the splenic index and the severity of esophageal varices in cirrhotic patients

Material and Methods: fifty patients who had coarse echotexture of liver on abdominal ultrasound and clinically .palpable spleen were selected. Splenic index was calculated using abdominal ultrasound as a product of longitudinal length and transverse width across the hilus of the spleen. These patients were then subjected to upper gastrointestinal endoscopy and esophageal varices were noticed and severity was assessed using grades from 0-3

Results: relationship was observed between the splenic index and the severity of esophageal Varices

Conclusion: splenic index can be a useful noninvasive method to determine the severity of esophageal varices in patients suffering from hepatic cirrhosis

Frequency of pulmonary fibrosis in patients with cirrhosis of liver

Background: Cirrhosis of liver and pulmonary fibrosis both are chronic inflammatory disorders. Mediators of chronic inflammation include both cytokines and interleukins. The mediators produced during process of fibrosis in liver reach pulmonary circulation which comes first during the pathway; so these mediators should lead to fibrosis in lungs as well

Material and Methods: 55 patients of age range 16 to 80 year, both males and females having established cirrhosis of liver on ultrasonography, regardless of etiology, visiting the outpatient and inpatient departments for treatment of liver disease were selected. High Resolution Computerized Tomography [HRCT] Scan of chest was performed on each patient to look for pulmonary fibrosis

Results: Out of 55 patients 27 [49%]were found to have pulmonary fibrosis on HRCT

Conclusion: Cirrhosis of liver is associated with pulmonary fibrosis in up to 50% of the patients

Efficacy of pre-operative injection Mitomycin-C in prevention of pterygium recurrence

To determine the recurrence rate of pterygium with four weeks preoperative injection mitomycin-C using bare sclera technique. An interventional case series. This ongoing study was started in November 2005 at eye department of combined military hospital Kharian, Pakistan. Ninety one eyes of 87 patients have been so far enrolled in the study. Cases between 20 to 50 years of age, of either sex, with primary and recurrent pterygia were included. The subjects were first given 0.1 ml injection mitomycin-C 0.15 mg/ml into the body of pterygium. Four weeks later, pterygium surgery was performed using bare-sclera technique. The subjects are being followed up for at least one year to detect any recurrence. Out of 91 cases, 16 [17.58%] cases have been followed up for 12 months, 19 [20.87%] for 9 months, 21 [23.07%] for 6 months, 17 [18.68%] for 3 months and 18 [19.78%] for less than 3 months. Recurrence has not been encountered in any of these cases so far. Initial results show that pterygium surgery with pre-operative injection mitomycin-C appears to be an effective form of treatment for prevention of pterygium recurrence. Further follow up and multi-centric studies are required for final conclusion