Determine the diagnostic accuracy of HbA1C for detection of diabetes mellitus by taking fasting blood sugar as gold standard

Background: HbA1c is now formally endorsed in many countries as a diagnostic test for [type 2] diabetes as well as for monitoring, although some debate still continues regarding its applicability for diagnosis

Objective: The objective of the study was to: Determine the diagnostic accuracy of HbA1C for detection of diabetes mellitus by taking fasting blood sugar as gold standard. Study Design: Cross Sectional Study [Validation]. Setting: Medical department, Allied Hospital, Faisalabad. Duration of Study: 6 Months Duration from 25-02-2015 to 25-08-2015

Methodology: A total of 145 cases with more than 40 years of age of either gender were enrolled in the study. Informed consent was taken from each participant of the study from medical department, Allied Hospital, Faisalabad. Information was collected by trainee researcher and comprised age, Gender, address and contact number, HbA1C and Fasting Blood Sugar. HbA1C and Fasting blood sugar was measured by drawing 3cc blood from a peripheral vein after antiseptic measures and sent to pathology laboratory, Allied Hospital, Faisalabad where it was reported by Pathologist. All the information was collected on Performa by Principal Investigator

Results: In our study, 71.72% [n=104] were between 40-60 years while 28.28% [n=41] had >60 years of age, mean +/- sd was calculated as 56.75 +/- 6.45 years, 52.41% [n=76] were male and 47.59% [n=69] were females, frequency of diabetes mellitus on gold standard was recorded as 26.21% [n=38] while 73.79% [n=107] had no findings of the morbidity. Diagnostic accuracy of HbA1C for detection of diabetes mellitus by taking fasting blood sugar as gold standard was calculated for sensitivity, specificity, positive predictive value, negative predictive value and accuracy rate as 78.95%, 83.17%, 62.15%, 91.75% and 82.07% respectively

Conclusion: We concluded that the diagnostic accuracy of HbA1C at cutoff point more than 6.15% for detection of diabetes mellitus by taking fasting blood sugar as gold standard is high and this modality can be used in our population

Acute ischemic stroke; correlation between higher total cholesterol level and high barthel index score in patients

Among all deaths, 40-50% are due to vascular events and out of these 10% are due to stroke. More than 66% of the global stroke occurrence is in developing countries, where the average age of patients with stroke is 15 years less than in developed countries. Objectives: To determine the correlation between higher total cholesterol level and high Barthel Index score[estimate of functional daily independent activity level] in patients with acute ischemic stroke. Design: Cross sectional study. Period: May 2013 to Apr 2014. Setting: Medical Units of DHQ and Allied Hospital, Faisalabad. Methodology: Sample size of 200 patients was collected and patients were included through Consecutive [non-probability] sampling technique. All patients underwent CT scan Brain from the radiology department of the hospital to determine the respective changes [hypo dense area] of the ischemic stroke. Fasting serum cholesterol was measured in all patients after an overnight fast of 12 hours. Then patients were assessed by using Barthel Index score [BI]. The data was analyzed by using SPSS version 16.0. Spearman Rank correlation coefficient was calculated to BI score in patients with ischemic stroke. Results: The mean age of the patients was noted as 61.76+/-11.55 years. In this study 55.50% were males and 44.50% patients were females. The mean total cholesterol value of patients was noted as 251.58+/-71.15 mg/dl. Out of 200 patients, 111[55.5%] patients had high cholesterol [>200mg/dl] whereas 89[44.5%] patient had low cholesterol of[<200mg/dl].In statical analysis the results showed that the mean value of total Barthel index score was 57.50+/-19.52. The study results described that 51.50% patients had high Barthel index score [>53] whereas 48.50% patients had low Barthel index score [<53]. Spearman correlation coefficient was calculated between high TC and high BI score as r= 0.641. This value was statistically significant i.e. p-value=0.000*. Conclusions: With the help of this study, we found a significant positive relationship between high TC and high BI score inpatients presented with ischemic stroke. Now we can better prognosticate the functional outcome of ischemic stroke in our patients.

Frequency of silent myocardial ischemia in type 2 diabetic patients having cardiovascular autonomic neuropathy

Introduction: Early detection of silent myocardial ischemia plays an important role in prevention of sudden cardiac death and acute myocardial infarction. The studies regarding the frequency of silent myocardial ischemia in diabetic patients having cardiovascular autonomic neuropathy are few so we planned this study to determine the frequency of silent myocardial ischemia among patients with diabetic cardiovascular autonomic neuropathy in our population

Objectives: To determine the frequency of silent myocardial ischemia in type 2 diabetic patients having cardiovascular autonomic neuropathy

Study Design: Cross-Sectional study

Place and Duration of Study: Medical Departments of Allied Hospital and Aziz Fatimah Hospital Faisalabad from 01-08-2013 to 31-01-2014

Methods: This study included 91 type 2 diabetic patients with cardiovascular autonomic neuropathy. All the patients had ECG done. Those who had normal ECG underwent ETT, to determine if there was any silent myocardial ischemia which was described as frequency distribution table. The data was collected on specially designed performa

Results: Total 91 patients were included in the study. Silent myocardial ischemia was present among 35 [38.5%] patients while 56 [61.5%] did not have silent myocardial ischemia. The mean age of the patients was 52.99 + 7.00 years [range 41-71years]. 57 [62.6%] patients were male and 34 [37.4%] patients were female. ECG was positive for ischemia among 25 [27.5%] patients and ETT was positive for ischemia among 10 [11%] patients

Conclusion: The frequency of the silent myocardial ischemia is high among patients with diabetic cardiovascular autonomic neuropathy, so every diabetic patient with cardiovascular autonomic neuropathy should be screened for ischemic heart disease

Comparison of electrocardiography with echocardiography in terms of concurrence of results in the diagnosis of left ventricular hypertrophy

Introduction: Left ventricular hypertrophy, common in hypertension, is an adaptive state of the heart to increase in wall stress. LVH has important prognostic implications for patients with hypertension. In detection of LVH, Echocardiography is considered to be superior to electrocardiography in patients with hypertension

Objectives: To compare the findings of electrocardiography with echocardiography in terms of concurrence of results in the diagnosis of left ventricular hypertrophy

Study Design: Cross - sectional study

Place and Duration of Study: Medical Department of Allied Hospital and PINUM Faisalabad from 14-02-2014 to 13-08-2014

Material and Methods: A total of 88 patients were included in this study. After detailed history and examination, all patients had first ECG and then echocardiography

Results: Mean age of the patients was 50.85+6.3 year. Out of 88 cases, 55 patients [62.5%] were male while remaining 33 patients [37.5%] were female. Mean height of the patients was 1.69+0.10 meter, mean weight was 66.1+9.86 kg and mean BMI was 23.38+1.20. Out of 88 cases, 67 cases were positive on echocardiography and 39 cases were positive on electrocardiography [ECG]. Out of these 39 cases 37 cases were true positive, 2 cases were false positive

Conclusion: The results show that electrocardiogram has low sensitivity and low NPV for detecting LVH as compare to echocardiography. These findings are relevant for physiological LVH and should not be extrapolated to detection of hypertrophic cardiomyopathy. In clinical practice, echocardiography alone should be used to exclude LVH

Comparison between role of honey dressing and oxoferin [tetrachlorodecaoxide] dressing in the management of infected wounds in diabetic amputated limbs

Introduction: Diabetic ulcer is a very common entity encountered in the general surgical practice. The problem needs keen interest and meticulous wound care for its management to prevent serious complications of these infected and gangrenous ulcers

Objective: The objective of the study was to compare the efficacy of honey dressing and oxoferin [tetrachlorodecaoxide] dressing in the management of infected wounds in diabetic amputated limbs

Study design: Randomized clinical trial

Setting: Surgical Unit-IV of Districted head quarter hospital Faisalabad

Subjects and Methods: The total sample size comprises of 98 patients were divided into two groups A and B. Group A was treated with honey dressing while group B was treated With oxoferin [tetrachlorodecaoxide] dressing. Area of the wounds to be dressed was measured in two largest dimensions and noted in cm. Sterile gauzes soaked in commercially available tube packed honey and oxoferin [tetrachlorodecaoxide] solution were applied over the wounds. Outcome of the both methods were assessed by measuring of the size of the wound at presentation and then after one week

Results: Significant decrease in wound size in oxoferin group was in 24 patients [49%] and in honey group was in 11 patients [22.4%]

Conclusion: Although the clinical experience detailed in this study showed better results to oxoferin as compare to honey dressing, more quality randomised controlled trials are needed to provide evidence to encourage the use of honey in wound care

Chronic hepatitis C virus infection; association with type 2 diabetes mellitus

[1] To seek the association between chronic HCV infection and type 2 diabetes, mellitus. [2] To verify the effect of age, sex, socioeconomic status, obesity and presence of cirrhosis on the association of chronic HCV infection. Case control study. DHQ Hospital, Faisalabad. The subjects were divided into two groups. One was with positive anti-HCV antibody on ELISA method and other was without liver disease and negative for anti-HCV. Both the groups contained 500 subjects each and were selected according to the inclusion and exclusion criteria. After a brief interview regarding age, residence, family history of diabetes, socioeconomic status, both the groups underwent weight and height measurements. The body mass was calculated according to the formulae. Ultrasonography of abdomen was done of all the patients of study groups to assess the liver status. Chi - square test was applied to see the association and then odds ratio was calculated to check the strength of association. Diabetes mellitus was detected in 174 patients [34.8%] out of 500 patients in the group Aas compared to 30 patients [6%] out of 500 patients in the group B. having chi-square value of 127.69 and significance of 0.000 with HCV +/ HCV- Odds ratio 0.120 and 95% C 10.079-0.181. There is strong association between HCV infection and type 2 diabetes mellitus. Severity of Liver Disease was strong associated factor

Prevalence of H. pylori

Acid peptic disease is a world wide problem among all the age groups and both sexes. Duodenal ulcer is common as compared to gastric ulcer. Its prevalence being 4:1 in USA and UK and 5:1 in Pakistan. Etiology of peptic ulcer is almost certainly multi-factorial. Basic paradigm for ulcer disease is the imbalance between the digestive activity of acid and pepsin and the protective mechanism in place to resist mucosal digestion. Over the past few years a new line of thought has been evolved after isolating spiral campylobacter like organism from antral biopsy specimens. H pylori is now considered to be an important if not the only causative agent of gastritis and peptic ulcer disease. The dictum; No acid - No ulcer summarized the pathogenesis of peptic ulcer disease but new dictum seems to be; No H. pylori -No ulcer, as over 90% of Duodenal ulcer and 70% of Gastric ulcer patients are infected by H. Pylori. Aim of the study was to evaluate the prevalence of H. pylori among duodenal ulcer patients at Faisalabad District and its suburbs. Descriptive Study. From Mar 2008 to Oct 2008. 50 patients [40 males, 10 females] belonging to Faisalabad District and surrounding areas with upper gastrointestinal symptoms of acid peptic disease and endoscopy proved duodenal ulcer were subjected to gastric antral mucosal biopsies for evaluation of the H. Pylori status with the help of unease test and histological examination of biopsy specimen. Epigastric pain was the most frequent symptom 90%. [46 out of 50 patients]. 92% showed evidence of H. pylori infection. Maximum incidence of H. pylori was recorded in age group IV [46-55 years]. Maximum number of patients was skilled workers [35 out of 50] 70%. 80% of the patients belonged to lower and middle class. Percentage of H. pylori positivity was 89.1% and 84.34%. Acceptance of contributory role and high prevalence rate of H. pylori instigates us for addition of antimicrobial treatment to the conventional treatment with H2 Blockers and PPls which is cost effective and alter the course of the disease

Bacteriology of spontaneous bacterial peritonitis

Cirrhosis is a major cause of mortality worldwide and is the most common non neoplastic cause of death among hepatobiliary and digestive diseases. Ascites is often among the first signs of de-compensation in patients with chronic liver disease. Spontaneous Bacterial Peritonitis [SBP] [with out any source of infection] occurs in 30% of patients with ascites. Common causative organisms include escherichia coli, pneumococcus, Klebsiella and anaerobes. It has a 25% mortality and recurs in 70% of patients within a year. To determine the pathological agents causing SBP in patients with liver cirrhosis. Descriptive study. Medical Ward Allied and K.M. Hospitals Faisalabad. From 17 Nov 2004 to 15 May 2005. Fifty patients of either sex having cirrhosis of liver and ascites were included according to the criteria i.e ascitic fluid leukocyte count of >500 cells/L or >250 PMN, while results of bacterial cultures of ascitic fluid were pending. Out of 5 0 patients, 27 [54%] were males and 23 [46%] females. Mean age of whole the population was found to be 51 +/- 12.49] yrs. Classical spontaneous bacterial peritonitis was present in 27 patients and Culture Negative Neutrocytic Ascites [CN NA] in 23[46%] patients. Out of 50 patients, 27[54%] samples of ascitic fluid showed positive culture reports. E Coli was isolated in 9[18%] cases. Klebsiella pneumoniae in 6 [12%], streptococcus pneumoniae 4 [8%], staphylococcus aureus 2 [4%], pseudomonas aeruginosa 2 [4%]. Acinobacter 2 [4%] and proteus mirabilis 2 [4%]. E. Coli is the commonest organism followed by klebsiella pneumoniae

Diagnostic role of endoscopy; an experience at Faisalabad

To see the usefulness of Endoscopy in patients with various gastrointestinal manifestations. Prospective study. Department of medicine and gastroenterology Allied Hospital Faisalabad January 2005 to July 2005, This study was conducted on 500 patients presented to us with various gastrointestinal manifestations of either sex and between 13-70 years. 260 patients were Males and 237 were Females. Most common indication was epigastric pain. 60.4% of the patients had organic lesion. Endoscopy was maximally positive in inpatients [91.86%]. Most common lesion was in stomach i.e. gastritis. Collectively ulcerative lesions came out to be 27.30%. Diagnostic yield of Endoscopy is undoubtedly very high if the patient selection is done in a meticulous way