Cutaneous manifestations of diabetes mellitus type 2: prevalence and association with glycemic control

Objective: To determine the frequency and pattern of skin disorders in patients with type 2 diabetes mellitus and their association with glycemic control in our diabetics

Methods: This descriptive, cross-sectional study was conducted at departments of Medicine and Dermatology, Sir Syed College of Medical Sciences and Hospital, Karachi from 1[st] January to 30[th] June 2014. Adult patients belonging to both genders having diabetes mellitus type 2 with cutaneous manifestations were included. After taking the informed consent, demographic details, duration of diabetes, mode of treatment for diabetes, types of footwear, foot care and glycemic profile were documented

Results: In 203patients [41% male and 59% female], mean age was 50 +/- 11 years and mean duration of diabetes 8.5 +/- 7 years. Mean HbA1c was 8.6 +/- 1.5 with 68% patients having unsatisfactory glycemic control. Most frequently observed skin disease was bacterial infections [26%], followed by fungal infections [22%], acanthosis nigricans [20%], diabetic foot [16%], nail changes [16%], acrochordons [10%], diabetic dermopathy [9%], necrobiosis lipoidica [9%], viral infections [8%] pruritus [8%] and xanthelasma [8%]. There was significant association of unsatisfactory glycemic control with bacterial infections [p = 0.037] and fungal infections [p = 0.023]. Females especially had a higher frequency of association with acanthosis nigricans [p = 0.030]

Conclusion: Patients with type 2 DM have high frequency of infections especially bacterial and fungal. Other manifestations like acanthosis nigricans and diabetic foot are comparatively less common

Obesity and hypertension in female medical students; frequency and risk factors

OBJECTIVE: To determine the frequency and risk factors of obesity and hypertension in female medical students

STUDY DESIGN: Descriptive cross sectional study

SETTING: Department of Medicine, Sir Syed College of Medical Sciences and Hospital Karachi

STUDY DURATION: 3 months [March 2014 to June 2014]

MATERIAL AND METHODS: Total 307 female medical students were included after ethical approval

Students with systemic illness, diabetes mellitus and taking corticosteroids were excluded

Demographic details obtained, followed by anthropometric measurements; height, weight, waist circumference and body mass index [BMI]. Students were classified as underweight, at risk, overweight, obesity grade I and obesity grade II as per WHO criteria for Asians. Blood pressure of each student was measured at two occasions. Outdoor activity time, screen time, sedentary time, dietary preferences, sleep hours and family history documented. Data analyzed via SPSS version 17 with significant p-value < 0.05

RESULTS: Among 307 students, obesity was found in 34% [25.4%obesity grade I and 8.8% obesity gradeII]. Hypertension was found in 4.88 %. There was significant association between hypertension and obesity [12 % obese hypertensiveversus 1.9 % non obese hypertensive students]

35 % students had higher waist circumference that was associated with hypertension. Excessive use of soft drinks, diet drinks, meat, dairy products, chocolates, oversleep on weekends and daily screen time >2 hours were found to be associated with obesity

CONCLUSION: Higher prevalence of obesity and obesity related hypertension in younger age group needs to be addressed. Those with obesity should be screened for the presence of hypertension at younger age. Waist circumference should be considered in addition to BMI while screening for obesity, and evaluation of its risk factors in Asians.Creating awareness and timely intervention in terms of dietary modification, adequate physical activity and sleep hours thus reducingthe screen time and sedentary time may help in controlling obesity and its complications among our young generation. Weight loss must be the first line of therapy in obesity related hypertension among younger obese population

Dermatological manifestations of obesity

To determine the frequency of various cutaneous manifestations in patients with obesity and correlate these skin changes with the grades of obesity. The study was conducted at Departments of Medicine and Dermatology, Sir Syed College of Medical Sciences and Hospital Karachi from 1[st] January 2014 till 30[th] June 2014. Patients belonging to both sexes and different age groups having body mass index [BMI] >/=25kg/m[2] with cutaneous manifestations of obesity were enrolled. Patients with skin changes secondary to other systemic illnesses, pregnancy and drugs were excluded. After an informed consent, demographic details, height and weight were documented. A clinical dermatological diagnosis was established after a detailed history and examination. Appropriate investigations were performed where required. 196 patients, 76 males [39%] and 120 females [61%] completed the study. Mean age was 43.6 +/- 10.8 years, age range being 19-70 years. Mean BMI 34 +/- 4.73 kg/m[2] [range 25-50], grade I obesity in 75 [38%] and grade II obesity in 121 [62%] cases. The most common finding observed was acanthosis nigricans [49%], followed by striae [17%], fungal infections [15%], acrochordons [12%], viral infections [11%], hirsutism [11%] and bacterial infections [7.5%]. Other less common associations included: xanthomas, corns, plantar hyperkeratosis and acne. Acanthosis nigricans and viral infections were significantly more among females; corn and callus among males. Obesity grade II was significantly associated with acanthosis nigricans, viral infections, hirsutism, striae and stasis dermatitis. Obesity is commonly associated with a wide range of dermatological manifestations like acanthosis nigricans, striae, hirsutism, skin infections. Other less common associations include: xanthomas, corns, plantar hyperkeratosis and acne

Newly diagnosed hepatitis-b and hepatitis-c during surgical pre-operative assessment of patients from lower socioeconomic class; frequency, risk factors and vaccination status

OBJECTIVE: To see the frequency of newly diagnosed Hepatitis-B and Hepatitis-C cases during pre-operative surgical assessment of patients from lower socioeconomic class and to study the possible risk factors

STUDY DESIGN: Descriptive Cross Sectional study

SETTING: Department of Surgery, Sir Syed College of Medical Sciences and Hospital, Karachi

STUDY DURATION: From July 2012 to July2013

MATERIAL AND METHODS: Total 107 patients [>18 years] of both genders from lower socioeconomic class planned for elective surgical procedure were included after ethical approval. Previously diagnosed cases of Hepatitis-B and C were excluded. After history and clinical examination, Hepatitis-B and Hepatitis-C serology was performed [ELIZA technique]. History of blood transfusion, previous dental or surgical procedures, intravenous injections, intravenous drug abuse, tattooing, piercing, circumcision, shaving by barbers, unprotected sex and Hepatitis-B vaccination status obtained. Data was analyzed by SPSS version 17

RESULTS: Among 107 cases [42% males and 58% females] with mean age 39+14 years, Hepatitis-B infection was present in 6[6%] cases, Hepatitis-C in 11[10%] and Hepatitis-B and C serology was negative in 90 [84%] cases. Frequency of Hepatitis-B was 3% [in males] versus 9% [in females]; Hepatitis-C 6.4% [in males] versus 15.5% [in females]. Among those with Hepatitis-B or C, history of previous surgical procedure present in 47% cases [vs. 21% in Hepatitis-B and C negative cases], dental procedure in 29.4% [vs. 7.7 %], intravenous injections in 94% [vs. 43%], intravenous drug abuse in 5.8% [vs. 0 %], blood transfusion in 35% [vs. 12%], tattooing in 0% [vs. 2%], unprotected sex in 5.8% [vs. 1%], piercing in 64.7% [vs. 39%], circumcision by barbers in 83.3%of males [vs. 80%], shaving by barbers in 66.6% of males [vs. 27%]. Hepatitis-B and C was found to be associated with history of blood transfusion, intravenous injections, dental procedures, shaving by barbers, piercing and intravenous drug abuse [p< 0.05]. Clinical stigmata of liver disease were present in 3% cases. Among all cases 9% were previously vaccinated for Hepatitis-B

CONCLUSION: Preoperative determination of Hepatitis viral markers is a good clinical practice to limit transmission from asymptomatic carriers and to diagnose new cases. Pakistan has high prevalence of Hepatitis-B and C and poverty and low literacy rate are the main determinants of its spread. Those who are negative for Hepatitis-B should be encouraged to get vaccinated

There is need for measures to create awareness about preventive measures and affective control of transmission of Hepatitis-B and C in community as well as at health care facilities

Effects of Ramadan fasting and physical activity on glucose levels and serum lipid profile among type 2 diabetic patients

To assess the effect of fasting and physical activity on blood pressure, fasting glucose, cholesterol, triglyceride, high density and low density lipoproteins among diabetic type 2 patients. Seventy five patients who had three visits [last ten days of Shabann [visit 1], Ramadan [visit 2] and Shawwal [visit 3]] were included in the study. Physical measurements, clinical measurements and 12 hours fasting blood sample were taken, along with an interview for demographic information and physical activity on each visit. The samples were analyzed for 1] Glucose, 2] Cholesterol, 3] Triglyceride, 4] Uric Acid, 5] HDL-C, and 6] LDL-C. The mean weight of the patients decreased significantly from 71.43 kg to 69.41 kg from visit 1 to visit 2. Mean systolic blood pressure also decreased significantly from 124.25 mm/Hg to 119.86 mm/Hg while. Mean triglyceride level decreased from 239.095mg/L to 207.07 mg/L from visit 1 to visit 2 and it kept decreasing to 159.25 mg/L till third visit. Mean LDL value increased from 104.12 mg/L to 112.64 mg/L from visit one to visit two and then further increased to 119.0 mg/L on the third visit. Ramadan fasting is safe for diabetes type II patients and is associated with weight loss and improvement in the overall diabetic control. Furthermore, the physical activities could reduce the body weight, waist measurement, systolic blood pressure, triglyceride and HDL

survey to assess the female sexual harassment in the higher educational institutes of Karachi

To determine the nature and frequency of the exposure of female students to sexual harassment at higher educational institutes; and explore the adverse effects of sexual harassment on the victims and coping strategies implied by them. Sexual harassment, whether at workplace, educational institution, street or leisure is a problem gaining increasing recognition in every society. Despite the widespread nature of the problem, there are still considerable misunderstandings as well as differences of opinion concerning whether particular situations or behaviours are sexually harassing in nature or not. The victim may feel threatened, humiliated, harassed, and would interfere with the performance, satisfaction, commitment, and undermine security, or create an intimidating environment. This study was conducted in ten institutes which included six medical, three engineering and one general colleges/universities of Karachi from January 6 to September 30, 2009. A total 480 female students were conveniently selected from ten different educational institutes, and were provided a self administered questionnaire with their consent. The identify of all the study subjects was kept secret. Out of total 480 female students, 460 i.e. 96% returned the filled questionnaire. Among them, 65% reported of sexual harassment of various degrees / levels irrespective of their residential area, appearance and attire. These females were harassed by the fellow students [37%], faculty [32%], and strangers [64%] who included patients, attendants, visitors and passerby. Although almost all of the participants [98%] wanted a punishment for the harassers, yet they [78%] were reluctant to disclose the name/ identity of those perpetrators because of the fear of exploitation, social taboo, further embarrassment, adverse consequences, and career obstacles. Many females were the victim of sexual harassment in various forms. There is a need to sensitize the society; and mass awareness programs should be carried out through variety of media

Diabetic patients; awareness about life style modifications

To assess awareness about the role of lifestyle changes in the management of diabetes among diabetics. Diabetic clinics of Jinnah Postgraduate Medical Centre and Kidney Centre. Karachi. From April 7, 2008 to August 31, 2008. Cross Sectional. Convenient. Sample Size: 200 diabetic patients. A total of 200 diabetics were interviewed. Their mean age was 48.8 years. Of these 92 [46%] were males and 108 [54%] were females. Diabetes was under control of 38% and 57% were taking regular treatment. Education sessions were attended by only 11%, counseling for lifestyle modification was done with 16%, 30% followed diet chart and 18% of the study participants were doing regular / irregular exercise. Majority of them [68%] needed social and family support to cop up the disease. There was a lack of awareness about the role of lifestyle changes in the management of diabetes among these diabetic patients. There is a need of health education programs for diabetics and general public

Unusual presentation of addison's disease

Addison's disease usually presents with non-specific symptoms like fatigue, nausea, vomiting, hyperpigmentation and generalized weakness. These symptoms are most often ignored or misinterpreted with other more common diseases. This is the major reason that this disease is under-diagnosed. Therefore, to establish a diagnosis, high index of suspicion is needed. We are reporting a case of six years old boy who presented with recurrent episode of severe hypoglycemia, so much so that he was receiving regular IV fluids including dextrose water and normal saline. While walking he was supported by his parents all the time because of recurrent attacks of fall due to extreme degree of hypoglycemia and subsequent weakness. His blood sugar was in the range of 40-90mg/dl, as a result, he was hospitalized several times. He was already worked up to exclude insulinoma before presenting to our institute. Eventually he was diagnosed as having Addison's disease

Henoch-Schonlein purpura associated with gastric helicobacter pylori infection

This is a case report of a 40 year old patient with Henoch-Schonlein Purpura, who presented with upper abdominal pain, retrosternal burning and palpable purpura over the lower limbs. His upper GI Endoscopy revealed erythematous lesions in the body of stomach and more severe antral gastritis, which was later on proved to be due to Helicobacter Pylori [H. Pylori]. The patient was started on anti-H.Pylori treatment with omeprazole, clarithromycin and amoxicillin and responded very well, with remission of symptoms. H.Pylori infection was the most probable cause of Henoch-Schonlein purpura in this patient

Clinical profile of 100 cases of liver abscess

One hundred patients with liver abscess were studied for clinical features and complications. They were diagnosed by radiography, ultrasonography, serology and by needle aspiration. A variety of interesting clinical, haematological and ultrasonographic findings were observed. Literature on liver abscess was reviewed and results compared

Serodiagnosis of amoebic liver abscess by IHA method

Serological test based on IHA [Indirect Haemagglutination Method] was performed in 100 cases of hepatic abscess. The test was 100% sensitive and 94% specific. The cut off point of antibody titer between normal population and patients with invasive amoebiasis was 1:128. Antibody titer in amoebic liver abscess was 1:5242 +/- 2795. A significant [P<0.001] correlation was found between total leucocyte count and antibody titer