Association of hyperuricemia with metabolic syndrome

Uric acid levels are often increased in subjects with metabolic syndrome but it is unclear whether it plays a causal role or it is a marker for metabolic syndrome. To find the association of hyperuricemia with various components of metabolic syndrome. The cross sectional analytical study was carried out in Sir Ganga Ram Hospital, Lahore, Pakistan. Total 600 subjects of both genders aged 30-70 years were recruited in the study. Demographic, clinical and biochemical variables were recorded by using a questionnaire. Fasting blood sample was used to estimate plasma glucose, serum lipid profile and uric acid. The cut-off for hyperuricemia was serum uric acid level >/=7.0 mg/dl for males and >/=5.7 mg/dl for females. Metabolic syndrome was diagnosed if subjects had any 3 of the 5 criteria described as per ATP III guidelines. The data was analyzed using SPSS Version 20. The study included 216 [36%] males and 384 [64%] females with mean age 47 +/- 10 years. Out of total 447 subjects, 62 [13.9%] with metabolic syndrome had hyperuricemia. Whereas 62 [75.6%] subjects out of total 82 subjects with hyperuricemia had metabolic syndrome. Different parameters of metabolic syndrome were statistically correlated with hyperuricemia but none showed significant correlation. Chi square and Wald Statistic [Logistic regression algorithm] showed that by using G-to-S [general to specific] approach hyperuricemia was significantly associated with female gender but did not show any association with metabolic syndrome. There was no association present between metabolic syndrome and hyperuricemia; therefore uric acid levels might not be important in the diagnosis of metabolic syndrome

Prevalence of shisha smoking in college, university and madarsa students aged 20-25 years in Pakistan

To estimate the prevalence of shisha smoking, its trends and associated factors in college, university and madarsa students aged 20-25 years in Pakistan. This survey was done on 7582 subjects belonging to 71 institutions from five cities and Federal Capital Islamabad, using a population based sample. Data was collected using cluster sampling from public/private colleges, universities and madarsas. After taking informed consent, about 10% students from each speciality including both genders were collected using a structured self administered questionnaire designed in Urdu and English. Variables included age, gender, socio-economic status, habits, trends, knowledge and perceptions about shisha smoking. The study was approved by Institutional Review Board. Data was analyzed on SPSS version 15 and chi square was used for statistical significance. Out of 71 educational institutions, 43 were public and 28 private including 8 madarsas. There were 2971 students from professional and 4174 from non-professional institutions. Overall prevalence of shisha smoking was 19.7% [n=1410] being more common in males [29.8%] than females [10.4%] Students started smoking shisha at 17-18 years age [57.2%] and almost 75% started this habit in year 2009-2010. The highest prevalence of shisha smoking was seen in Federal Capital Islamabad [28.1%], and lowest in Peshawar [11.2%]. The shisha smoking was more in professional and private educational institutions [p<0.000] with almost 29% students using it in engineering colleges and none using it in madarsas [alma/alia courses]. The trend was highest in students belonging to high socio-economic status [30.7%] and those already smoking cigarettes [74.1%] Pleasure seeking was the commonest reason for smoking shisha [7.1%] and almost 11% students were influenced by their friends. Shisha cafe's were site used by most smokers and majority preferred double apple or mint flavor. Almost a quarter [23.8%] students smoked shisha just for enjoyment and 12.1% thought that it is less harmful than cigarette smoking. Almost 20% students in colleges and universities are smoking shisha. Majority thinking shisha to be harmless or less harmful than cigarette smoking indicating that knowledge about adverse effects of shisha smoking is tremendously low in this educated youth of our country. Shisha should be subjected to the same regulation as cigarettes and other tobacco products and public should be educated about its harmful effects

Knowledge, attitude and practices of dentists about hepatitis B and C infection in Lahore

To assess the knowledge, attitude and practices of dentists of public and private sector in Lahore about Hepatitis B and C infection. This cross-sectional analytical study was conducted on private dental practitioners and public sector dental surgeons working in hospitals of Lahore. Private sector dentists of Lahore working in Shahdara, Badami Bagh, Mughalpura, Baghbanpura, Gulberg, Shadman, Mozang, Feroz pur Road, Model Town, Multan Road, Johar Town and Tohkher Niaz Baig were selected for the study. In the public sector hospitals, dental surgeons were selected from Demont Morency Dental College and Hospital, Mayo Hospital, Services Hospital, Govt. Mozang Hospital, Jinnah Hospital, Lahore General Hospital, Mian Munshi Hospital, Sheikh Zaid Hospital, Railway Hospital, Wapda Hospital and Combined Military Hospital by using convenient sampling technique. A self-administered, close- ended questionnaire was used and information was gathered about their knowledge, attitude and practices for HBV/HCV infection and its prevention. Data was entered in the SPSS-13 computer program. Frequency and percentages were calculated for different segments and comparison between the two groups was performed by using z-test for proportion. p-value

Thyroid status and urinary iodine levels in women of endemic goiter area

To determine the thyroid function tests and urinary iodine levels in women belonging to goiter endemic area. Descriptive study conducted in women of goiter endemic area in Saggian Lahore. Saggian Lahore is a goiter endemic area. A total of 293 women between the ages of 18-45 years residing in the area were clinically screened for goiter. Of them 73 women having goiter were recruited for the study. Information regarding demographic profile clinical presentation and physical examination of the goiter was recorded on a questionnaire. The goiter size was graded according to WHO, UNICEF and the International Council for the Control of Iodine Deficiency Disorder. About 5ml of blood sample was drawn from each women and run for thyroid function tests i.e. T3 T4 and TSH using Elisa kits [Human scientific Co. Germany]. Urinary iodine was checked by chemical method. Mean age of 73 women was 28.5 years. Marital status showed that 48[65.7%] were married and 25[34.3%] were unmarried. Visible diffuse goiter was seen in 56[77%] cases. Pressure symptoms as cough and shortness of breath was seen in 30[41%] and 31[42.5%] women respectively. Among the 73 women 24.6% [18 cases] took treatment for goiter. Adverse pregnancy outcome secondary to goiter was seen in 58% [28 cases] out of 48 married women. Thyroid function tests result showed that 72% [53 cases] were euthyroid, 18% [13 cases] were hypothyroid, and 10% [7 cases] were hyperthyroid. Urinary iodine levels showed that 99% women were iodine deficient. Thyroid functions do not indicate iodine deficiency in all cases of goiter, therefore, Urinary iodine levels need be estimated while investigating goiter cases. Policy message: Iodine deficiency should be diagnosed and treated on priority basis

Association of insulin resistance with obesity in children

Insulin resistance is the primary metabolic disorder associated with obesity. Little is known about its role as a determinant of the metabolic syndrome in obese children. To assess the association of insulin resistance with metabolic syndrome in obese and non obese children. Study type and settings: Cross sectional analytical study conducted among children of ten Municipal Corporation high schools of Data Ganj Buksh Town Lahore. A total of 46 obese and 49 non obese children with consent were recruited for the study. Fasting blood glucose, serum insulin, high density lipoprotein cholesterol, triglycerides, cholesterol, non HDL-cholesterol LDL cholesterol were measured using standard methods. Data were analyzed by using statistical software SPSS-Version 15. A total of 95 children 49 obese and 46 non obese were recruited for the study. A significant association of serum triglyceride [p<0.001], high density lipoprotein cholesterol [p<0.001], fasting blood glucose [p<0.001], and insulin levels [p<0.001], was seen between the two groups. For each component of metabolic syndrome, when insulin resistance increased so did odds ratios for cardio metabolic risk factors. Insulin resistance was seen in 34.7% children. Metabolic syndrome was found in 31.6% children reflecting that obese children are at high risk for metabolic syndrome and have low HDL-cholesterol and high triglycerides levels

Prevalence of dyslipidemia in patients with type-2 diabetes mellitus

The dyslipidaemia associated with type-2 diabetes is associated with raised plasma triglycerides, low high-density lipoprotein cholesterol, high low-density lipoprotein cholesterol and very low-density lipoprotein cholesterol levels and is a risk factor of cardiovascular disease. To assess the lipid abnormalities in patients with type-2 diabetes. A cohort study carried out at Diabetic Clinic of PMRC Research Centre, FJMC, Lahore, Pakistan. Eight years case records of type-2 diabetic patients seen at the research centre from 1999-2006 were reviewed. The research centre is a specialized centre for diagnosing and treating diabetes mellitus. All the patients were recruited for their follow up check up and laboratory investigations for dislipidemia. Adult treatment panel III guidelines for dyslipidaemia were followed. A 12 hours fasting blood sample was collected from each patient for serum total cholesterol, triglycerides, low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], and glucose as well as glycosylated hemoglobin [HbA1c] by using standard methods at Biochemistry laboratory of the research centre. LDL-C/ HDL-C ratios, Very low-density lipoprotein cholesterol [VLDL-C] and body mass index was calculated after anthropometery body mass index [BMI] >/= 25 was considered as overweight while >/= 30 obese. HbA1c<6.1 was considered as poor glycemic control. Data was analyzed by using statistical software SPSS-15. a total of 1200 type-2 diabetes were seen in 8 years. There was poor glycemic control, in 87.5% subjects judged on blood HbA1c levels. These patients had higher total cholesterol, LDL-C and low HDL-C levels in blood. The percentage of patients with high, borderline and near optimal risk LDL-C was 62.7, 26.9 and 10.4% respectively, while HDL-C >40mg/dl were seen in 67%. Raised VLDL-C [above 40 mg/dl] was seen in 32.9% cases. The group with high LDL and VLDL is at risk of developing cardiovascular disease. Hypertriglyceridaemia was found in 55% and hypercholesterolaemia in 45.4% cases. Obesity as indicated by body mass index was found in 53.7% patients. Statistically significant association of hypercholesterolemia, hypertriglyceridemia, hypo HDL cholesterolemia and VLDL-C was found with advancing age while only hypertriglyceridemia and VLDL-C showed a positive association with duration of diabetes. A significant association of hyperglycemia [raised HbA1c] was seen with hypertriglyceridemia and high LDL-C along with high body mass index i.e. obesity. Hypertriglyceridemia, high LDL-C and VLDL-C, low HDL-C levels and obesity were the pattern of dyslipidemia found in our diabetic population

Role of alanine transaminase as an indicator of non alcoholic fatty liver patients with type-2 diabetes mellitus

This study was carried out to see the role of Alanine transaminase [ALT] as an indicator of Non Alcoholic Fatty liver disease [NAFLD] in patients having Type-2 Diabetes Mellitus. This was a descriptive study carried out al PMRC FJMC Lahore. A total of 63 diabetic cases that were diagnosed on ultrasonography as nonalcoholic fatty liver were recruited in this study. Demographic profile of the patients were recorded and all were subjected to lab investigation which included random blood glucose, serum triglycerides and liver function tests including viral marker of the hepatitis. Fatty liver was more prevalent in female patients 47 out of 63 [74.6%] and is more common above 40 years of age, median age being 46 years. The duration of disease was prolonged with median of 6 years. It is seen that 28/63 [44.5%] were hypertensive, 31% had hyperlipidemia and 9.5% were having ischemic heart disease. Majority of patients 28 out of 63 [44.5%] had hepatomegaly. The liver enzymes results showed that 12 of the 63 [19%] were positive for hepatitis B and C and had ALT level raised with mean of 63.00 +/- 40.66. While, among the other 51 patients without hepatitis B and C ALT level were within normal range in 36 [71%] of the cases. While in rest of 29%%15 out of 51 they were only mildly elevated. Thus showing that ALT has no role as an indicator of fatty liver. Alanine transaminase is not an indicator of NAFLD and mild elevation can be due to the metabolic disturbances in type-2 diabetic patients. It is therefore, suggested that ultrasound graph is a good tool to detect the NAFLD in its early stage

Risk factors for syphilis and HIV infection in pregnant women attending a tertiary care public sector hospital

Syphilis, a sexually transmitted disease which seemed to have disappeared or had been controlled over the years, has now been re-emerged as a major public health problem in many communities. It can complicate the pregnancies with serious consequences. Appropriate treatment of pregnant women often prevents such complications. To study the frequency of syphilis in pregnant women attending a tertiary care public sector hospital, and see the positivity for HIV/AIDS among syphilis positive women. This cross sectional and interventional study was conducted among pregnant women attending Sir Ganga Ram hospital for antenatal care at PMRC Research Centre, Fatima Jinnah Medical College, Lahore. Blood samples from 2000 women were collected after taking consent. The blood was tested for syphilis by Treponema Pallidum Haemagglutination.History of the subjects for risks factors was also taken. Syphilis positive women were further screened for human immunodeficiency virus positivity. The treponemal antibodies were detected in less than one percent [9] pregnant women. The highest positivity was observed among age group of 21-26 years. Women in third trimester were significantly more infected with syphilis. Risk factors included husband's history with frequent traveling and drug abuse. All husbands of syphilis positive women were also positive. All syphilis positive women and their husbands were negative for Human immunodeficiency virus /Acquired immune deficiency syndrome. Less than 1% of pregnant women were infected with syphilis, and most of the spouses of these positive women were either travelers or drug addicts. Screening for syphilis should continue in pregnant cases and high risk individuals

Syphilis screening: outcome and interventions at an antenatal clinic

Syphilis, a sexually transmitted disease which seemed to had been controlled over the years, has now been re-emerged as a major public health problem in many communities. It can complicate the pregnancies with serious consequences. While appropriate treatment of pregnant women often prevents such complications. To study the frequency of syphilis in pregnant women coming to a public sector hospital and see the pregnancy outcome of positive mothers and disease transmission in neonates. This cross sectional and interventional study was conducted at PMRC Research Centre, Fatima Jinnaha Medical College, Lahore among pregnant women attending Sir Ganga Ram hospital for antenatal care. Blood samples from 2000 women were collected after taking consent from them. The blood was tested for syphilis by using Treponema pallidum haemagglutination assay. Infected mothers were administered intramuscularly with 2.4 million units of benzathine benzylpenicillin [penicillin G] after testing for hypersensitivity and followed for delivery outcomes such as abortion, miscarriage, intrauterine growth restriction, low birth weight, preterm delivery and still birth. Neonates born to infected women were examined for signs of congenital syphilis including non immune hydrops, jaundice, skin rash, pseudo paralysis and running nose along with blood test for either infection. Medical and reproductive histories were also obtained from women and recorded on a proforma. The treponemal antibodies were detected in 9[0.45%] pregnant women. The highest positivity was obtained among age group of 21-26 years. There was no statistically significant difference of acquiring infection among women of different age, education, and socioeconomic backgrounds. Women in third trimester were significantly more infected with syphilis. Out of 9 couples 3 refused treatment, 1 received only one dose of penicillin, 2 received two doses while only three couples completed all doses. Delivery outcome included one abortion, two preterm deliveries and none of the neonate had sign of congenital syphilis. Only one couple consented for blood sampling of their neonate which was positive for syphilis and was referred to pediatrician. Only 9[0.45%] of pregnant women were infected with syphilis, which can seriously complicate pregnancy and result in spontaneous abortion, and preterm delivery. Screening for syphilis in pregnant women is recommended to detect infected woman who requires treatment to prevent further transmission of this disease to new born

Parasitic infestation in children of district Vehari: an underdeveloped area of Pakistan

To determine parasitic infestation among children of rural and urban areas of district Vehari. Children Complex Hospital, at District Headquarter Hospital Vehari and PMRC Research Center, Nishtar Medical College, Multan, Pakistan. A cross-sectional study was done in 2006 where 500 children aged 1-10 years presenting with anaemia and malnutrition were studied. Demographic information included residential area [rural/urban], gender, socio-economic status, hygienic conditions, source of drinking water were recorded on a questionnaire. Parents were interviewed, while stool and blood samples of children were collected for parasites and to determine anemia. Parasites were found in 140[28%] children and anemia in 236[47%]. Prevalence of protozoa 102 [20.4%] was greater than intestinal helminthes 38 [7.6%]. The most common protozoa was Entamoeba histolytica 101 [20.2%] and in nematodes, Hymenolepis nana was seen in 28 [5.6%], Ancylostoma duodenale [hook worm] in 5 [1%], Ascaris lumbricoides [round worm] in 3 [0.6%] and Taenia saginata [tape worm] in 2 [0.4%]. Diarrhoea was seen in 254 [50.8%] cases, constipation in 191 [38.2%], abdominal pain in 245 [49%], anorexia in 181 [36.2%] and abdominal distension in 86 [17.2%] children. Rural children were significantly more infected with parasites, 81 cases [32.27%] compared with urban children 59 cases [23.69%] [p<0.05] and same was for poor children 81 [34.9%] compared with middle income 57[21.8%] [p<0.05]. Infected cases with poor hygienic conditions [77 cases 35.2%] were more infected than those with satisfactory 62 [24.4%] and good hygiene 1[3.7%]. Worm infestation was common 84[35.9%] in those using drinking water from hand pumps compared to those obtaining drinking water from government water supply 47[23.9%] and water filtration plant 9[13.%], a significant difference in infection due to poor quality drinking water was observed[p<0.05]. Worm infestation and anemia were inter related and 85 [60.7%] children with anaemia had parasites against 55 [39.3%] who were not anaemic [p<0.05]. Poor sanitation, hygiene and source of drinking water have appeared as major contributors towards parasitic infestation. Ent.histolytica was the most common protozoal infection found compared to helminths. Use of clean drinking water and good hygienic practices should be instituted throughout the country

Antenatal screening of women for hepatitis B and C in an out-patient department

To determine frequency of hepatitis B virus [HBV] and hepatitis C virus [HCV] and its clinical manifestation in pregnant women. A cross-sectional descriptive study. Pregnant women visiting the Gynaecology and Obstetrics out patient's department of Sir Ganga Ram Hospital Lahore for antenatal check-ups from October 2006 to March 2007 were screened for hepatitis B and C. Immune- chromatography was used for initial screening and diagnosis was confirmed by ELISA technique. Data collection included maternal age, parity, symptoms or past history of jaundice, fatigue, tiredness, insomnia, depression, dyspepsia, fever, anorexia and pale stool. Risk factors investigated include past history of some surgical procedures, the dental visit, blood transfusion, tattooing, hospitalization and history of injection. Among the screened population, 7.3% out of 2439 ladies were positive for anti HCV and 2.2% for HBsAg while dual infection with HBV and HCV was observed in 0.08%. Symptoms observed in hepatitis B patients were fatigue [90%], depression and pale stool [70%], anorexia [60%], jaundice [57.2%], fever [56.4%] and dyspepsia [51.2%]. In hepatitis C antibody positive patients fatigue was the main symptom [95.7%] followed by pale stool [84.5%] and depression [80.2%]; 63.3% had insomnia, 59.1% had anorexia, 50.7% had fever, 50.7% had jaundice and 43.6% had dyspepsia. Past history of blood transfusion was reported by 32.3% patients, surgery by 42.2% and tattooing was observed in 0.70%. One or more tooth extraction was reported by 50.2% subjects, and 49.25% had history of repeated injections. The frequency of sero-positivity for HBsAg and HCV among pregnant women is alarming. These sero-positive mothers are not only predisposed to chronic consequences of hepatitis, but also are a continuous threat to their off springs and care providers. Hence, there is a direct need for further epidemiological studies and to take measures for prevention and control of the disease

Prevalence of hepatitis-C antibodies amongst nursing staff working in a tertiary care hospital

To determine the prevalence of HCV infection amongst nursing staff working in a tertiary care hospital. Simple descriptive study of prevalence. Nursing staff of Nishtar Hospital Multan. 152 senior nursing staff working in all wards of Nishtar Hospital Multan. Diagnosis of HCV infection was made by detection of antibodies to HCV in serum [ACON Hepatitis C Virus Rapid Test Strip, Serum]. Those nurses whose test was positive by the above technique, underwent second generation Elisa testing for Hepatitis C to confirm the diagnosis [Cobas Core Anti-HCV EIA]. Study was conducted upon 152 nursing staffs working in different wards of Nishtar Hospital Multan, which is a tertiary care hospital. These 152 staff nurses were checked for anti-HCV and only 3 cases were positive [1.97%] and 149 negative [98.03%]. Study shows that the prevalence of HCV infection among nursing staff is 1.097%, which is low as compared to other studies but higher in comparison to the general population of Multan [0.27%]. It is recommended that both private and public health care systems to increase the awareness. The health care workers should strictly follow appropriate preventive measures

Plasma vitamin A, carotene, serm total protein and albumin levels in the school age children and young adults of Multan city

Purpose of this study was to estimate the severity and extent of vitamin A deficiency and to find whether it constitutes a significant public health problem. This study included 446 school children aged 5-17 years and 210 young adults aged 18-22 years of Deeni Madaras. All students were male, normal and apparently healthy. The schools and students of Multan city were selected randomly. It was observed that majority of the children belonged to poor socioeconomic class. In these subjects dietary intake of milk, meat and eggs per week was very low and in many cases the consumption of these commodities was once per month. Intake of other dairy products like butter and butter oil was also not found in many cases. However, consumption of leafy vegetables was common to some extent. Clinical examination showed that none of the children had visual or skin disturbances. To assess the malnutrition, serum total protein and serum albumin were measured in all subjects. Low levels of serum total proteins were found in 52.4% children of age 5-11 years, in 26.6% children of age 12-17 years and in 21.0% young adults of age 18-22 years. Low levels of serum albumin were found in 28% children of age 5-11 years, 37% children of age 12-17 years and in 35% young adults of age 17-22 years. Low or subclinical plasma vitamin A levels were noticed in 81.5% children of age 5-11 years, in 6% children of age 12-17 years and in 12.5% young adults of age 18-22 years. Low or subclinical plasma carotene levels were observed in 64% children of age 5-11 years, in 16% children of age 12-17 years and in 20% young adults of age 18-22 years. This study has shown that clinical features of vitamin A deficiency are not visible in our children, however subclinical deficiency is present which must be corrected for adequate growth and development

Effect of gram on blood sugar

The effect of wheat bread and whole gram on postprandial blood glucose levels was studied in 25 healthy individuals and 25 diabetic patients. The values of blood glucose levels obtained were compared with blood glucose levels after glucose load. Blood glucose levels decreased after gram meal more than wheat bread and glucose in both healthy and diabetic subjects