Prevalence of microalbuminuria with relation to glycemic control in type-2 diabetic patients in Karachi

Diabetes is one of the most common endocrine disorders characterized by hyperglycaemia. Diabetic nephropathy is a consequence of long standing diabetes. The prevalence of microalbuminuria predicts progression to diabetic nephropathy. The present study was conducted to determine the prevalence of microalbuminuria in relation to duration of diabetes, BMI, Serum Creatinine and HbA1c in an ethnic group of Type 2 diabetes mellitus residing in Karachi. This cross-sectional descriptive study was carried out in a community diabetic centre, located at Garden East Karachi from July to December 2007. One hundred known Type 2 diabetic patients with age 30- 70 years were included in the study. Informed consent and a structured questionnaire of each patient were recorded. Fasting venous blood and morning urine sample was collected for analysis of creatinine, HbA1c and microalbuminuria respectively. Statistical analysis was done using SPSS version 13.0. Pearson correlation was applied to observe association of microalbuminuria with different parameters. All p-values <0.05 were considered as statistically significant. Microalbuminuria had a highly significant correlation with duration of diabetes, serum creatinine [p<0.001], HbA1c [p<0.05] and BMI [p<0.024]. A strong correlation exists between age and serum creatinine [r=0.73]. The present study found an early onset of microalbuminuria in the selected community which could be due to poor glycaemic control [high HbA1c>7%] or heredity factors. Screening for microalbuminuria and HbA1c test should be done in both newly and already diagnosed Type 2 diabetic patients as an early marker of renal dysfunction and glycaemic control

Intermediate and long term outcome of patients after device closure of ASD with special reference to complications

Device closure of Secundum atrial septal defect [ASD] is an accepted mode of treatment in selected patients with a suitable defect. The major initial concern over the long term outcome has been erosions and more recently development of aortic regurgitation. Objective was to assess the intermediate and long term outcome of patients with device closure of ASD with special reference to complications. Two hundred and four patients with significant Secundum ASD, 16 months to 55 years [median 8 years] were considered for transcatheter closure with the Amplatzer septal occluder from October 1999 to April 2009 with follow up examinations at 1, 3, 6, and 12 months and thereafter at yearly interval. Device closure of ASD was done successfully in 202/204 patients. The immediate [first 24-hour] major complications included device embolization [n=4], pericardial effusion [n=1] and 2:1 heart block [n=1]. At a mean follow up of 4.9 years [90 days to 9.6 years, median 5.3 years] complete closure was documented in all patients. Two patients [1%] had developed mild aortic regurgitation. A trial fibrillation occurred in 3 adult patients [1.5%] at a mean of 2 weeks post procedure with complete recovery within 6 months. There were no late embolizations, erosions or thromboembolic events on long term follow up. Device closure of secundum ASD using Amplatzer septal occluder is safe and effective in intermediate and long term follow up with extremely low mortality rate. The risk of development of aortic regurgitation or atrial fibrillation is also very low

National Polio Day Campaign in a squatter settement through medical students

To provide maximum polio vaccination coverage to under-five [<5] year children of a squatter settlement through Ziauddin Medical University [ZMU] medical students. ZMU has established a Primary Health Care Program in a squatter settlement, which is predominantly inhabited by migrants from North Western Province of Pakistan and Afghanistan. The total population is approximately 20,000 and the proportion of <5 year children is nearly 19%. ZMU started Oral Polio Vaccination [OPV] campaigns from 1996; up to 1999. The OPV campaigns were confined to the National Immunization Days [NIDs]. A different strategy of "door-to-door" OPV services by medical students was undertaken in 1997. In December 1999 the polio vaccination coverage of <5-year children was evaluated through cluster sampling. This paper describes the steps for improving OPV coverage in Sikanderabad. The estimated number of <5 year children in the area is 4,600. In a cluster sample survey after the 1999 NID campaign out of 620 under 5 year children living in 429 households, 529 [85%] received OPV, with a 95% CI for OPV coverage of 82 to 88%. The coverage before the campaigns initiated by ZMU was 52%. The results indicate that the polio coverage of <5-year children has risen with the change in strategy. Door-to-door coverage strategy with the help of medical students proved effective in providing vaccination. No case of suspected poliomyelitis has been reported from the area since October 1999