Frequency of infantile pyloric stenosis and ocular abnormalities in Turner's syndrome in Bahawalpur city

Turner's syndrome is one of the most common of all chromosomal abnormalities. Pyloric stenosis is the most common pediatric surgical disorder of infancy that requires surgery for associated emesis.4 Ocular abnormalities are common in Turner's syndrome, but are under estimated and often neglected. The study that was hospital - based observational, was conducted from September 1[st], 2005 to August 31, 2011 in the Al-Noor Hospital Yazman [Bahawalpur] in collaboration with ophthalmology department, Bahawal Victoria Hospital Bahawalpur. Laboratory investigations including electrolytes, blood gas analysis, and osmolality were done in pathology department, Quaid-e-Azam Medical College Bahawalpur. Frequency of pyloric stenosis in infants from 0 - 6 months 64.95% and infants 6 - 12 months is 35.09%, the ocular abnormalities amblyopia 19%, strabismus 23%, phoria only 43.5%, epicanthus 10%, hypertelorism 3%, ptosis 1%, nystagmus 0.5%. There is a high frequency of ocular abnormalities and pyloric stenosis in infants with karyotype XO. Timely diagnosis may save from devastating effects of ocular complications leading to blindness and life threatening alkalosis due to pyloric stenosis in infants below one year of age

Hyperuricaemia and the risk of ocular complications in tuberculous patients during therapy

Objective: To determine the risk of ocular complications due to hyperuricaemia in tuberculous patients during therapy. Material and Methods: The study was canducted in chest ward and eye ward BVH, Bahawalpur in collaboration with Department of Chemical Pathology, QMG, Baharvalpur from July 2009 to July 2011 One thousand and fifty tuberculous patients [850 males and 200 females, aged 18 - 70 years] receiving four standard drugs i.e; rifampicin. pyrazynamide, ethambutol, and isoniazid, were included in the study. Approved and fixed dose combination of four drugs of proven bio equivalency was used Serum uric acld and creatinlne levels were estimated on fujly automated chemistry analyzer SELECTRA-XL [Merck Diagnostics] using Merck reagents. before the commencement of treatmenl. Ophthalmic examination of all the patients included in the study was also done by funduscopy and on slit lamp before starling therapy. At 8-1 2 weeks after commencement of therapy serum uric acid and crealinine levels were measured along with fundoscopic and slit lamp examination on all patients under srudy subjects to diagnose any ocular complication by an ophthalmologist. Results: All patients study subjects had hyperuricaernia [mean=9.60 mg/dl +/- 3.4 SD] and ncrmal creatinine. Syrnploms of visual blurring from the corneal haze or foreign body sensation due to epithelial breakdown were found in 86% of study subjects. Uveitis was found in 2 percent of the patients. Scleritis and Episcleritis was seen in 4% of the patients. Corneal deposits of urates were found in 0.5% subjects whiie conjuntiual urate crystals were found in 8.5% of the subjecls Conclucian: Hyperuricaemia is an important risk factor for ocular complications and starts almost after 8-12 weeks of cornmcncement of antituberclosis treatment. If it is left undiagnosed, sight-threatening effects can occur

Frequency of retinopathy in adult diabetics in Bahawalpur city

To determine the frequency of diabetic retinopathy in adult diabetic population of Bahawalpur city. A cross-sectional population based study was carried out to determine the frequency of diabetic retinopathy among adult diabetics of Bahawalpur City from January 2009 - June 2010 at Ophthalmology Department Bahawal Victoria Hospital, Bahawalpur and Department of Pathology, Quaid-i-Azam Medical College, Bahawalpur. Two thousand sixty diabetics [males=1090, females = 970] aged 18 - 55 years [mean age = 38 years] were included in the study who were residing in Bahawalpur for last 3 years. Anthropometric measurements including weight, height and waist measurement were obtained using standardized techniques. Blood pressure was recorded in the sitting position in the right arm to the nearest 2 mm Hg with a mercury sphygmomanometer. A fasting blood sample was taken after ensuring 8 hours of overnight fasting for estimation of plasma glucose. According to ADA criteria, patients having fasting plasma glucose > 99 mg/dl were considered to have impaired glucose level and OGTT was performed. Those having fasting plasma glucose level >/= 125 mg/dl were considered diabetic. For retinal studies, pupils were dilated in both eyes. The four fields taken were stereoscopic picture of the macula, disc and superior temporal and inferior temporal quadrants. Color photography [35 mm] was used because of better clarity and the stereo effect. The frequency of diabetic retinopathy in study subjects was found to be 34.5%. Occurrence of diabetic retinopathy shows a positive correlation with duration of diabetes. Frequency of diabetic retinopathy in Bahawalpur City is 34.5% and hyperglycemia, BMI, obesity, hypertension and dyslipidemia are direct association with diabetic retinopathy

Prevalence of impaired glucose tolerance among obese teenagers

Obesity has been accompanied by an increase in the prevalence of type-2 diabetes among adolescents. We determined the prevalence of impaired glucose tolerance in a cohort of 100 obese teenagers. Department of Medicine, BV Hospital, Bahawalpur. From January 2005 to January 2007. All subjects underwent a two-hour oral glucose-tolerance test [1.75 mg of glucose per kilogram of body weight], and glucose levels were measured fasting and during the first 30 minutes after the ingestion of glucose. Impaired glucose tolerance was detected in 21 percent of the 100 obese adolescents [11 to 19 years of age]; silent type-2 diabetes was identified in 4 percent of the obese adolescents. After the body-mass index had been controlled for, insulin resistance was greater in the affected cohort and was the best predictor of impaired glucose tolerance. Impaired glucose tolerance is highly prevalent among adolescents with severe obesity, irrespective of ethnic group. Impaired oral glucose tolerance was probably associated with insulin resistance

Intervention of insulin resistance at two stages in the evolution of type 2 diabetes

The purpose of this study was to compare the impact of treating insulin resistance with a thiazolidinedione drug before versus at the onset of diabetes on as per diagnosed by glucose levels and funduscopy. The study was conducted in Medical OPD, BVH, BWP from January 2001 to January 2007. One hundred twenty six non-diabetic young women who were 18-30 year old, with a history of GDM in the prior 4 year and a total glucose level on a 75-g oral glucose tolerance test [oGTT] above the median for women with gestational diabetes mellitus [GDM]were randomized to troglitazone [early intervention], 400 mg/d, or placebo [later intervention]. Women who developed diabetes were placed on open-label troglitazone. Glucose tolerance, insulin resistance, and funduscopy were measured at randomization, at the diagnosis of diabetes, and 8 months post trial to determine the long-term impact of the two treatments strategies on glucose levels and eye. During a mean follow-up of 4.3 year between baseline and post-trial tests, glucose tolerance [oral glucose tolerance test, P<0.04] and insulin resistance [P< 0.02] worsened more in women randomized to late intervention [n= 69] than to early intervention [n = 57]. Among women in the late intervention group who developed diabetes, retinopathy and cataract deteriorated significantly during development of diabetes on placebo and then did not change significantly [P >0.50] during treatment with troglitazone and post-treatment washout. In high-risk women, amelioration of insulin resistance can stabilize glycemia at the time diabetes develops. These findings highlight the role of insulin resistance in the genesis of progressive evolution of type 2 diabetes and successful treatment of insulin resistance in young, nondiabetic women with recent GDM lowered endogenous insulin requirements and stabilized pancreatic-cell function, thereby preventing type 2 diabetes in later life

Microalbuminuria: incidence in patients of diabetes mellitus at Bahawalpur

To determine the incidence of microalbuminuria in patients of diabetes mellitus.[type 1 and type 2] at Bahawalpur. Comparative, cross-sectional study. Bahawal Victoria Hospital, from September 99 to December. 02. 120 patients [Males=52; Females=68, aged 10-80 years]; with DM [Type 1 or 2] were included in the study. Detection of proteinuria was done by dry chemistry system using Medi-Test [Combi 10-Macherey-Nagel]. Proteinuria was confirmed by repeated testing and by measuring urinary protein excreted in 24 hours. Patients with proteinuria were not screened for microalbuminnuria. Screening for microalbuminuria was done on spot urine samples by dry chemistry systems using Micral -Test [Roche Diagnostic]. If the urine was positive for albumin, the test was repeated on two further occasions, over the next few weeks; if on two of three tests raised, 24- hour collection of urine was done to measured the albumin excretion rate [AER]. If AER was increased monitoring at each review visit was done. Funduscopy of all study subjects was done. Blood pressure was recorded on each visit and if raised, treatment with an ACE inhibitor was started; Baseline GFR was measured. If AER was normal on two of three occasions, AER was re-measured at the next review appointment. Out of 120 diabetics studied, 43.33% were males and 56.67% were females. Fifty percent of the females with DM and 29.1% of the males had microalbuminuria. Twenty [16.7%] of the diabetics had type 1 DM, out of them 50% had microalbuminuria. The duration of diabetes did not affect the incidence of microalbuminuria. Hundred [83.3%] of the studied patients had type 2 DM, 45% of this group was found to have microalbuminuria. Neither the incidence of proteinuria nor that of microalbuminuria was affected by the duration of diabetes. Fifty eight of the diabetics studied were hypertensive. 48.2% of hypertensive diabetics had microalbuminuria and 24.1% proteinuria. Incidence of microalbuminuria [73.9% and 72.72% of patients with type 1 and type 2 diabetes respectively] was common in diabetics with age ranging between 40-69 years. Incidence of microalbuminuria is high on our setup, reflecting poor glycaemic control

Estrogen replacement therapy for depression in perimenopausal women

To determine the effect of a four-week course of oral estrogen therapy on depression in aging women. Quasi experimental. The OPD, Bahawal Victoria Hospital, Bahawalpur, from September 2000 to January 2004. Forty-two depressed women [aged 42-57] who were either perimenopausal [n=20] or postmenopausal [n=22] received open label treatment with oral estrogen tablets[1.25mg/day] for 4 weeks. The Montgomery-Asberg Depression Rating Scale and the Beck Depression Inventory were used to assess depressive symptoms, the Greene Climacteric Scale was used to assess menopause-related symptoms, and the Clinical Global Impression[CGI] was used to assess global clinical improvement in these women at baseline and after treatment. Remission of depression was defined as a score <10 on the Montgomery-Asberg Depression Rating Scale and a score < 2 on the CGI at week 4. The women who completed the study had a median Montgomery-Asberg Depression Rating Scale score of 20 [range= 15-32] at study entry and 11.50 [range= 10-31.0] at week 4 [z = -3.43, p<0.01]. This improvement was consistent with that reported by the women themselves on the Beck Depression Inventory [rs=0.86, n=20, p<0.01]. The improvement measured by CGI scores was also significant [p<0.01]. Remission of depression was noted in 5 of the 40 women [after 1 year] who completed the study. Anti-depressant response was not associated with severity or subtypes of depression at study entry or with concomitant improvement in menopause-related symptoms. Perimenopausal and postmenopausal women benefit from short-term use of estrogen therapy. Antidepressant effect of estrogen therapy is independent of improvement in menopause-related symptoms

Effect of pregnancy on diabetic nephropathy and retinopathy

To determine whether pregnancy worsens renal function in women with diabetic nephropathy and the effect of pregnancy on diabetic retinopathy. Design: Cross-sectional analytical study. Place and Duration of Study: The study was conducted in OPD, Bahawal Victoria Hospital, Bahawalpur from September 1997 to June 2003. Subjects and Thirty-five patients [aged 20-36 years] identified with diabetic nephropathy and moderate to severe renal dysfunction[creatinine [Cr] > 1.4 mg/dl] at pregnancy onset by retrospective chart review. Alterations in glomerular filtration rate [GFR] were estimated. An equal number of non-pregnant premenopausal type I diabetic women with similar degrees of renal dysfunction served as controls for non-pregnant rate of decline of renal function and potential contributing factors. Student's t-test and repeated measures analysis of variance were analyzed. Mean serum Cr rose from 1.8 mg/dl prepregnancy to 2.5 mg/dl in the third trimester. Renal function was stable in 27%, showed transient worsening in pregnancy in 27%, and demonstrated a permanent decline in 45%. Proteinuria increased in pregnancy in 79%.Exacerbation of hypertension or pre-eclampsia occurred in 73% and 71% of these showed acceleration of disease during the pregnancy. All the patients had diabetic retinopathy, though proliferative retinopathy was diagnosed and treated in only 54.5.% prepregnancy. The retinopathy progressed, requiring laser therapy, in 45.4%. Macular edema was noted in 6 of the patients. Other diabetic complications included peripheral and autonomic neuropathy in 8 patients. Pregnancy induced progression is seen in the decline of renal functions. Patients with diabetic nephropathy were found to have a > 40% chance of accelerated progression of their disease as a result of pregnancy. Forty-five% of the patients had permanent decline in GFR in association with pregnancy