Phenotypic and metabolic dichotomy in obesity: clinical, biochemical and immunological correlates of metabolically divergent obese phenotypes in healthy South Asian adults

<p><b>INTRODUCTION</b>Metabolic heterogeneity among obese individuals is thought to translate into variations in cardiovascular risk. Identifying obese people with an unfavourable metabolic profile may allow preventive strategies to be targeted at high-risk groups. This study aimed to identify clinical, biochemical and immunological differences between insulin-sensitive and insulin-resistant obese subgroups, to understand the population-specific pathophysiological basis of the adverse cardiovascular risk profile in the latter group.</p><p><b>METHODS</b>Cardiovascular risk indicators, including anthropometric parameters, blood pressure, acanthosis nigricans area, and related biochemical, endocrine and inflammatory markers, were determined in 255 healthy South Asian volunteers aged 18-45 years, with a 2:1 ratio of obese/overweight to normal-weight individuals. Lifetime atherosclerotic cardiovascular disease (ASCVD) risk was also calculated.</p><p><b>RESULTS</b>Body mass index (BMI) and insulin sensitivity-based tertiles independently showed incremental trends in waist-hip ratio, skinfold thickness, acanthosis nigricans area, blood pressure, serum lipids, hepatic enzymes, adipokines, inflammatory markers and ten-year ASCVD risk. The anthropometric, biochemical and inflammatory parameters of obese insulin-sensitive and obese insulin-resistant groups differed significantly. Extreme group analysis after excluding the middle tertiles of both insulin resistance and BMI also showed significant difference in anthropometric indicators of cardiovascular risk and estimated lifetime ASCVD risk between the two obese subgroups.</p><p><b>CONCLUSION</b>Obese insulin-sensitive individuals had a favourable metabolic profile compared to the obese insulin-resistant group. The most consistent discriminative factor between these phenotypic classes was anthropometric parameters, which underscores the importance of clinical parameters as cardiovascular risk indicators in obesity.</p>

Active case detection among household contacts of multi drug resistant tuberculosis patients in a tertiary care setting

Close contacts of multi drug resistant tuberculosis patients are expected to be at increased risk of developing the disease and therefore need screening on priority basis to have an effective TB control program. Active household contact screening is an effective and cheaper way to detect and treat MDR-TB at its early stages. To determine active TB cases among household contacts of MDR-TB patients in a tertiary care setting. Descriptive study, conducted at PMRC TB Research Centre in collaboration with Institute of Chest Medicine, King Edward Medical University/Mayo Hospital, Lahore from November 2012 to December 2013. Patients suffering from MDR-TB and seeking treatment from Institute of Chest Medicine were selected as index patients. Their contacts [spouses, children, parents, siblings and other relatives] underwent sputum smear microscopy. Those found positive for AFB were subjected for MTB RIF assay by GeneXpert to determine rifampicin resistance. Data was analysed using IBM Statistics SPSS version 20.0. A total of 692 contacts of 112 MDR-TB patients were studied. Among them, 374[54%] were males and 318[46%] female. Seventeen contacts were found smear positive and of these 15[88%] were also confirmed as MTB by GeneXpert. Four [23%] contacts were rifampicin resistant. Of the affected contacts, majority were sisters [23.5%]. Active TB was detected in contacts of patients having MDR-TB with few also showing rifampicin resistance. TB screening should be done in all contacts of TB patients, especially those having drug resistance

Type 1 and type 2 diabetes mellitus: are they mutually exclusive?

<p><b>INTRODUCTION</b>With advancement in the understanding of the pathogenesis underlying diabetes mellitus (DM), the boundary between type 1 and type 2 DM (T1DM and T2DM) does not seem to be as clear cut as previously thought. This study was designed to test the possibility of overlap between the spectra of immune-mediated DM and insulin resistance.</p><p><b>METHODS</b>To test for the possibility of overlap, we looked for autoantibodies typical of T1DM in patients with classical T2DM, and insulin resistance in patients with T1DM. Autoantibodies against islet cell antigen, glutamic acid decarboxylase-65 and insulinoma-associated antigen-2 were tested in 82 patients with T2DM and 27 patients with T1DM. The patients had been diagnosed on clinical criteria using standard laboratory techniques. Clinical parameters of diagnostic importance were noted, and homeostatic model assessment of insulin resistance (HOMA-IR) was calculated using fasting insulin and fasting blood glucose ratio.</p><p><b>RESULTS</b>Autoantibodies against one or more beta cell antigens were detected in 12.19% of patients clinically diagnosed to have T2DM, and insulin resistance (HOMA-IR > 2.5) was diagnosed in 37.03% of patients with T1DM. It was not possible to identify any combination of clinical or biochemical markers that could predict autoantibody positivity in T2DM patients. T1DM patients with insulin resistance had a significantly higher body mass index than their insulin-sensitive counterparts (p = 0.02).</p><p><b>CONCLUSION</b>Autoantibodies against beta cell antigens are detectable in insulin-resistant T2DM patients, and insulin resistance may be present in relatively overweight T1DM patients. No differentiating clinical features that might predict autoantibody positivity in T2DM patients were found.</p>

Postural hypotension in male diabetics with autonomic cardiovascular dysfunction and impotence

Objective: to find out frequency of postural hypotension in male diabetics with autonomic cardiovascular dysfunction and impotence

Material and Methods: a total of 200 male diabetic patients, attending Diabetes Management Centre Services Hospital Lahore, were enrolled in the study. All the diabetic patients between ages 14-60 years, having fasting blood sugar level more than 126 mg/di, were included. A detailed history was taken and all patients underwent relevant physical examination; blood pressure was taken in supine and standing position and investigations like random blood sugar levels were checked. The diagnosis of autonomic cardiovascular dysfunction was documented by heart rate response to Valsalva maneuver. The ratio of longest R-R to shortest R-R is< 1.2 during Valsalva in patients with autonomic cardiovascular dysfunction. The postural hypotension in diabetic patients was calculated after recording the postural drop in all the patients. Before assessing blood pressure variation with postural change, 20 min supine rest was mandatory

Results: the age range was from 14-60 years. The percentage of patients with postural drop was 32 percent in the presence of parasympathetic dysfunction. The mean age of patients with parasympathetic dysfunction was 50.65+/-5.53 years

Conclusion: postural hypotension does not seem to be a good marker for autonomic neuropathy. The proportion of patients having postural hypotension in the presence of parasympathetic dysfunction was not significant in the study population. However significant correlation of postural hypotension with duration of diabetes was found

Prevalence of congestive gastro and doudenopathy in patients with portal hypertension

The aim of this study was to determine the prevalence of congestive gastropathy/ duodenopathy in portal hypertension. A cross sectional study of 100 patients with portal hypertension undergoing upper gastro-intestinal endoscopy in Medical Unit IV was carried out in which their history, clinical and endoscopic examination was done. Congestive gastropathy was seen in 88% of the patients, while congestive duodenopathy was seen in 19% of the patients. The study data analysis leads to the conclusion that the congestive gastropathy can by included as one of the common complications of advanced liver cirrhosis

Association of progression of pulmonary fibrosis with severity of liver cirrhosis

Background: it has been found that frequency of pulmonary fibrosis increases in patients with cirrhosis of liver. We hypothesized that as the stage of cirrhosis advances, the frequency of pulmonary fibrosis should increase. We used child's pugh classification to stage the cirrhosis of liver

Material and Methods: fifty five patients of age range 16 to 80 years, both males and females having established cirrhosis of Fiver on ultrasonography, regardless of etiology, visiting the outpatient and inpatient department for treatment were selected. Patients were divided into three groups according to child's criteria i.e. group A, group B, and group C. HRCT of chest was performed on patients in all three groups to look for pulmonary fibrosis

Results: 27 [49%] patients were found to have pulmonary fibrosis on HRCT. The frequency of pulmonary fibrosis in different groups of child's classification was also assessed and it was found that class C and class B, are affected more than A

Conclusion: pulmonary fibrosis progresses with severity of liver cirrhosis

Comparison of efficacy of topical glycerin trinitrates with capsaicin in painful diabetic neuropathy

Objective: to compare the efficacy of topical glycerin triturates with capsaicin in painful diabetic peripheral neuropathy

Material and Methods: this quasi experimental study was conducted in Diabetes Management Centre Medical Unit-IV Services Hospital, Lahore over a period of six months from 01-06-2008 to 30-11-2008. Sixty-two patients of diabetes mellitus having symptoms of neuropathy were included in this study and were divided into two groups of thirty one patients each: .In group A topical capsaicin cream was applied twice a day for thirty minutes for the period of seven days aft he strength of 0.075% w/w. In group B glycerin triturate cream was applied twice a day for thirty minutes for the period of seven days at the strength of 2% w/w. After seven .days of treatment, intensity of numbness and par aesthesia and tissue perfusion were again assessed using visual analogue scale and Perl scan respectively. Perl scan and visual analogue chart assessment were repeated after the seven days wash out period and patients were .crossed over to the other treatment group. Numbness and para aesthesia were reassessed at the end of last treatment on visual analogue chart and Perl scan were repeated as well for tissue perfusion

Results: the age of the patients in group .A. was49:90+/-8.06 years and in group B were 49.58+/-6.62 years. In group A, the efficacy of GTN in peripheral neuropathy was 38.7% as compared to capsaicin which was only 19.3%. Similar results were seen in group B, in which efficacy of GTN in peripheral neuropathy was 51.6% as compared to capsaicin that was 29%.The overall results when combined in both the groups showed a response to capsaicin in 15 [24.2%] patients only versus 28 [45.2%] to GTN. This difference was statistically significant [p=0.02356]

Conclusion: there is a significant difference in efficacy of topical glycerin triturates and capsaicin in the management of diabetic peripheral neuropathy. GTN cream, a well-tolerated drug, provides significant improvement in painful diabetic neuropathy

Non invasive assessment of liver fibrosis in chronic liver disease

Background: Chronic hepatitis C [CMC] infection leads to necroinflammation which causes fibrosis and ultimately cirrhosis in 20% of cases. Liver biopsy is recommended for assessment of hepatic fibrosis and is thought to be the gold standard. Recurrent bouts of hepatocellular necrosis in CMC infection cause episodic rise in aminotransferases especially alanine aminotransferase [ALT]. ALT levels decrease as fibrosis advances and AST levels tend to exceed ALT. This results in increase in AST/ALT ratio >1.0, which can be used as non-invasive marker of hepatic fibrosis and cirrhosis, thus reducing the number of liver biopsies performed in patients with AST/ALT ratio >1.0

Objectives: To assess the accuracy of serum aminotransferases [AST/ALT] ratio for determining the severity of hepatic fibrosis in patients with chronic hepatitis C, considering histopathological findings as gold standard

Study Design: Cross sectional survey

Setting: Medical unit 4, Services Institute of Medical Sciences [SIMS]/ Services Hospital, Lahore

Duration: The study was completed over a period of 6 months; from 15th October, 2008 to 15th April, 2009

Subject and Methods: Seventy HCV positive with detectable RNA by Polymerase Chain Reaction, fulfilling the criteria were selected. AST and ALT levels were measured in [IU/L]. Upper limit of both AST and ALT was taken as 40 IU/L. AST/ALT ratio was calculated as under; AAR = AST [IU/L], ALT [IU/L] All these patients also underwent percutaneous liver biopsies and then histopathologist staged biopsy for fibrosis according to Ishak/Knodell criteria

Results: AST/ALT ratio of more than 1.0 was associated with severe fibrosis/ cirrhosis [F4- f6]

Conclusion: Study showed that AAR more than 1.0 has significant association with severe fibrosis and identifies CMC patients with marked fibrosis/ cirrhosis, and its application can decrease the need for performing liver biopsies for staging

Frequency of rectal varices in cirrhotic patients

Background: Most cirrhotic patients develop esophageal varices, with a lifetime incidence as high as 80-90%. Approximately 20% - 30% of cirrhotic patients with esophageal varices develop an episode of esophageal hemorrhage, which has a high mortality of nearly 20 30% with each episode of bleeding

Objectives: To determine the frequency of rectal varices in cirrhotic patients with esophageal varices

Study Design: Cross-sectional survey

Setting: Study was carried out in the Department of Medicine, Unit-4, Services Hospital, Lahore

Duration of Study With Dates: Study was carried out over a period of six months from 18-02- 2009 to 17-08-2009

Subjects and Methods: Total 150 patients were recruited in this study fulfilling the inclusion criteria. Per-rectal proctoscopy was performed in those patients who had esophageal varices and presence or absence of rectal varices documented

Results: Mean age of the patients was 45.5±8.6. 119 [79.3%] were male and 31 [20.7%] were females. Rectal varices were present in 70 patients [46.7%]. Out of total of 31 female patients included, rectal varices were present in 13 patients [41.9%] and were absent in the remaining 18 patients [58.1%]. As far as the male patients are concerned, out of the total 119 patients, rectal varices were present in 57 patients [47.8%] and absent in the remaining 62 patients [52.2%]

Conclusion: Rectal varices are common in patients with portal hypertension. In patients with portal hypertension, and lower Gl bleeding, the possibility of rectal varices should be considered

Frequency of pulmonary fibrosis in patients with cirrhosis of liver

Background: Cirrhosis of liver and pulmonary fibrosis both are chronic inflammatory disorders. Mediators of chronic inflammation include both cytokines and interleukins. The mediators produced during process of fibrosis in liver reach pulmonary circulation which comes first during the pathway; so these mediators should lead to fibrosis in lungs as well

Material and Methods: 55 patients of age range 16 to 80 year, both males and females having established cirrhosis of liver on ultrasonography, regardless of etiology, visiting the outpatient and inpatient departments for treatment of liver disease were selected. High Resolution Computerized Tomography [HRCT] Scan of chest was performed on each patient to look for pulmonary fibrosis

Results: Out of 55 patients 27 [49%]were found to have pulmonary fibrosis on HRCT

Conclusion: Cirrhosis of liver is associated with pulmonary fibrosis in up to 50% of the patients

Use of serum aspartate aminotransferase levels and platelet count to predict hepatic fibrosis in chronic hepatitis C

Background: Chronic hepatitis C [CHC] induces inflammation, resulting in fibrosis. Liver biopsy is the gold standard for assessing histology. Progressive fibrosis results in portal hypertension, splenomegaly, thrombocytopenia and decreased clearance with rise of the enzyme serum aspartate aminotransferase [AST] levels. To amplify this difference in AST and platelet counts in fibrosis, AST-platelet-ratio-index [APRI] was devised using noninvasive serum markers, suggesting that its application may decrease the need for liver biopsy

Material and Methods: Cross sectional descriptive study done in sixty patients of HCV positive state fulfilling the criteria were selected. AST levels [IU/L] expressed as a ratio of upper limit of normal [ULN] taken as 40, were divided by platelet counts[x10[9]/L] and multiplied by 100 to calculate APRI = AST/40 / Platelet count x100 Liver biopsies were then staged by histopathologist for fibrosis according to Ishhaq/revised Knodell criteria

Results: APRI of less than 1.5 was associated with absent or minimal fibrosis F0-F2],whereas values greater than these showed marked fibrosis/ cirrhosis [F3-F6], [p.0001]

Conclusion: Study showed that APRI has significant association with fibrosis and identifies CHC patients with minimal as well as marked fibrosis, and its application may decrease the need for performing liver biopsies for staging

Role of salt intake in the management of cirrhotic Ascites

Background: The purpose of study was to determine the role of salt intake in the management of ascites. Ascites is the most common complication of cirrhosis. Dilutional hyponatremia is present in most of patients with ascites. It is due to excess in antidiuretic hormone which occurs due to decrease in effective arterial volume. Water free salt intake tends to maintain the circulatory volume by drawing the fluid from third space, hence inhibiting ADH. It also increases the response of diuretics by increasing the filtered load of sodium. On the other hand, strict salt restriction and diuretics worsen the hyponatremia and make ascites refractory to treatment

Objective: To determine the role of salt intake in the management of ascites in cirrhotic patients

Methods: It was an interventional experimental study. This study was conducted in Services Hospital, Lahore. Sixty cirrhotic patients with ascites were randomized into two groups to undergo treatment with diuretics and salt restriction during the day. One group [A] was advised salt intake at night with over night fluid restriction, and the other group observed 24 hour salt restriction. The comparison was done in respect to average reduction in weight and abdominal girth over 9 days

Results: The average reduction in weight [p=0.011] and abdominal girth [p=0.003] was significantly more in patients taking salt at night. Moreover these patients also maintained their serum sodium levels [p=0.00001] and majority of them did not need increase in the dose of diuretics or therapeutic ascitic tap

Conclusion: Correction of dilutional hyponatremia by water free salt intake to improve the response of diuretics, gives a safe and effective option for the management of ascites

Use of serum aspartate aminotransferase levels and platelet count to predict hepatic fibrosis in chronic hepatitis C

Background: Chronic hepatitis C [CHC] induces inflammation resulting in fibrosis. Liver biopsy is the gold standard for assessing histology. Progressive fibrosis results in portal hypertension, splenomegaly, thrombocytopenia and decreased clearance with rise of the enzyme serum aspartate aminotransferase [AST] levels. To amplify this difference in AST and platelet count in fibrosis, AST-platelet-ratio-index [APRI] was devised using noninvasive serum markers, suggesting that its application may decrease the need for liver biopsy

Patients and Methods: Cross sectional descriptive study done insixty HCV positive patients fulfilling the criteria. AST levels [IU/L] expressed as a ratio of upper limit of normal [ULN] taken as 9 40, were divided by platelet count [x10 /L] and multiplied by 100 to calculate APRI = [[AST/40]/Platelet Count] x 100. Liver biopsies were then staged by histopathologist for fibrosis according to Ishaq /revised Knodell criteria

Results: APRI of less than 1.5 was associated with absent or minimal fibrosis [F0-F2], whereas values greater than these showed marked fibrosis/ cirrhosis [F3-F6] [p=0.0001]

Conclusion: Study showed that APRI has significant association with fibrosis and identifies CHC patients with minimal as well as marked fibrosis and its application may decrease the need for performing liver biopsies for staging

Topical therapy for neuropathic diabetic foot ulcers

Background: Healing is slow in neuropathic diabetic foot ulcers, using conventional medical treatment. This delayed wound healing is caused mainly by the pressure damages of weight bearing, and sometimes by a tight dressing, on the painless ulcer

Material and Methods: In our study, we used the dehydrating action of ethyl alcohol to reduce the oedema in the tissue compartments of the foot. This, in turn, reduced pressure on fool micro-vasculature. For this purpose, 60 diabetic subjects with neuropathic infection were rule out. After maximizing diabetic control, they were divided into two comparable groups

Results: Group A [n:30] patients were treatment with a commonly prescribed broad spectrum antibiotic [tablet ofloxacin 400 mg 12 hourly], and their wounds were dressed daily. In group B[n=30], ulcerated feet were soaked for 20 minutes in a solution of 0.025 L tincture of iodine [U.S.P] in one L of 75% ethyl alcohol. This process was repeated 8 hourly, and the wounds were left open with out any dressing. No systemic antibiotic was used in this group of patients. Time for complete wound healing was compared in the two groups

Conclusion: Results showed significantly faster wound healing 2.83 weeks vs 5.8 weeks [p=0.001] with the used of the proposed therapy, suggested this to be a better treatment option in neuropathic foot ulcers

Role of clinical diagnosis to ascertain the type of stroke

Background: Cerebrovascular Accident or stroke is a major cause of morbidity and mortality all over the world, including Pakistan. Determination of type of stroke either hemorrhagic or infarct is important for start of any treatment. This study was carried out to compare clinical diagnosis of stroke with Computed tomography [CT] scan findings in ascertaining the type of stroke [hemorrhagicor infarct]

Methods: This study was carried out at Medical unit 3, Services Hospital, Lahore from July 2003 to December 2003 and December 2004 to April 2005. Sixty patients admitted to our ward for stroke lasting more than 24 hours, with at least unilateral motor weakness affecting face and/or arm and/or leg were included in the study. Clinical diagnoses of type of stroke i.e. hemorrhage or Infarct was made using a clinical parameter, with specific emphasis on speed of onset, presence or absence of vomiting, headache and altered state of consciousness. CT scan brain was used as a gold standard in all patients to confirm the diagnosis. The results were compared on case to case basis with CT diagnosis

Results: The study included 60 patients, 44 with ischemic stroke and 16 with hemorrhagic CVA Out of these 60 patients; clinical diagnosis correlated with CT findings in 46 patients [76.66%] whereas in 14 patients [23.33%], CT findings contradicted our clinical suspicion. Clinical accuracy was 84% [37/44] in case of ischemic stroke and 56% [9/16] in hemorrhagic stroke

Conclusion: The study has shown that although clinical evaluation of acute stroke can be made in most cases but CT scan is mandatory for excluding hemorrhage before start of treatment

Can vascular pathology in cerebral and coronary fields predict peripheral artery disease in a cohort of diabetic patients?

Background: Diabetes mellitus, a metabolic disorder of absolute or relative insulin deficiency, is characterized by micro and macro-vascular complications. This process of vascular pathology proceeds at a uniform rate throughout the body. Eventually it may be manifested as atherosclerotic changes in cerebral, coronary and peripheral arteries Variables like central adiposity, altered metabolism, elevated blood pressure, proteinuria causes resistance

Methods: A retrospective cross-sectional study was carried out on 4482 diabetic patients attending the [Diabetes Management Center] Services Hospital, Lahore. Known determinates of past vascular disease PVD were assessed. An artery disease index was formulated by the presence or absence of lower limb pulses

Results: Past history of OVA was significantly associated with PVD with a p-value of 0.002. Similarly past history of M1 [p=0.000], hypertension [p=0.000], proteinuria [p=0.000] were all significantly present in patients with PVD. There was lack of association between cigarette smoking [p= 0.463] and PVD

Conclusion: Past hlstay o! CVA and MI, Hypertension and Protienuria are all significantly present in Diabetic patients with Peripheral Vascular disease

effect of age and lipid profiles on peripheral vascular disease in a cohort of diabetic patients

Background: Vascular disease Games the maximum mortality and morbidity burden in diabetic patents. Peripheral vascular disease is generally considered to be similar in its etiology and pathology to vascular disease in other tissue fields and its risk factors are also believed to be a part of larger atherogenic vascular picture

Methods: The study was conducted on a cohort of individuals suffering from Diabetes MelIitus registered at the [The Diabetes Management Center]. A total of 1160 cases were selected on the basis of presence or absence of peripheral artery disease with an aim to study the prevalence of peripheral vascular disease In diabetic and ascertain if total cholesterol, age and duration of diabetes play a role in the development of peripheral vascular disease

Results: Our study showed that presence of peripheral vascular disease in diabetics is significant; associated with increased age, increased duration of diabetes, history of intermittent claudication, delayed wound healing and Increased area of skin ulcers. There is no significant difference in total cholesterol level, LDL HDL, and triglyceride levels amongst those diabetics that developed PVD than those who did not The role of genetic susceptibilities leading to altered metabolism with due contribution by environmental factors may come to light by further analysis of other variables involved In artery disease picture

Conclusion: Presence of peripheral vascular disease in diabetics is significantly associated With Increased age Increased duration of dIabetes and history of intermittent claudication, delayed wound heating and increased area of skin ulcers. There is no significant difference in total cholesterol level LDL HDL and triglycerides levels amongst those diabetics that developed PVD than those who did not

Anthropometric measurements as a determinant and predictor of peripheral vascular disease in cohort of diabetic patients

Background: Diabetes leads to a dysmetabolic state in the body. A cluster of bio chemical and anthropometeric factors have been found to cause pro inflammatory state in vascuIar endothetium. The role of anthropomeric measures in development of atherosclerosis in patients with cardiovascular disease has been extensively studied. The aim of this study is to assess the influence of these factors in peripherai vascular disease

Materials and Methods: Queries were run on a cohort of diabetic patients and anthropometric measurements were made. Peripheral vascular disease was assessed by presence or absence of pulses

Results: The factors found to be significantly different in patients with peripheral vascular diseases versus those without peripheral vascular disease include waist circumference and waist Hip ratio, diastolic, systolic blood pressure and delayed wound healing

Conclusion: Distribution of adipose tissue and its possible endocrine control plays a significant role in subsequent development of vascular Injury and atherosclerosis in Diabetics

Helicobacter pylori-role in decompensation of patient with HCV positive chronic liver disease

Background: H. Pylori is prevalent in the developing world and is implicated in the pathogenesis of acid peptic disease and liver disorders. As patient with CLD may present with symptoms of acid peptic disease, a study was conducted to see if there is any correlation between H. Pylori and liver disorders

Methods: It was a prospective cross-sectional study of 60 patients, anti-HCV positive, who presented to Medical Unit-lll of Services Hospital, Lahore from March to August 2005. They were divided into groups as patients with compensated and de-compensated liver disease. All of them were tested for H. Pylon antibodies by Immunoassay

Results: Five patients [16.6%] of the compensated group were H. Pylori positive whereas 16 patents [53.3%] in the decompensated group were positive

Conclusion: There is a possible association between Helicobacter Pylori and progression of chronic Ever disease

Can vascular pathology in cerebral and coronary fields predict peripheral artery disease in a cohort of diabetic patients?

Objective: To find out whether peripheral artery disease followed the same pattern, set of risk factors and indicators as macro vascular disease in the coronary arteries and cerebral arteries disease

Study design: This was a randomized cross sectional retrospective analysis

Place and duration: Study was carried out at The Diabetes Management Center at The Services Hospital Lahore, during June 1999 to June 2001

Patients and methods: A total of 580 patients were selected from the diabetic data base that had absent pulsations in the any of the four arteries of the lower limbs. Another set of 580 diabetics with presence of pulsations in all the arteries of the lower and upper limbs was randomly selected to match the cases

Results: Diabetics with peripheral vascular disease had a significant positive history of past CVA and past MI

Conclusion: Presence of peripheral vascular disease is significantly associated with presence of history of past CVA and past MI, raised systolic BP, diastolic BP, and mean BP and increased proteinurea