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

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