Effects of Different Dietary Approaches on Type 2 Diabetes Mellitus: A Review

Type 2 diabetes (T2D) is a metabolic disorder that occurs due to various etiologies including lifestyle. One of the significant contributors in causing Type-2 diabetes is diet. For high-risk individuals, diet is way more significant in causing Type-2 diabetes. This present study discussed several published papers comprising of various food categories and their effects on type-2 diabetes or its role in causing the disorder. The study revealed the advantages of functional foods and their role in the prevention of T2D. The study has elaborated the outcome of T2D due to consumption of fats, carbohydrates, protein, dietary fibres, red meat, fried food, common beverages like carbonated drinks, and a few other foods. The authors also reviewed T2D from the aspect of religion, region, specific lifestyles, smoking and drinking habit and body weight. Overall, the study has successfully drawn a map of the spectrum of dietary role in T2D including its prevention, increasing the risk of T2D, its causation and affecting the outcome of the disorder.

Is peripheral neuropathy a part and parcel of chronic hepatitis-c in south asian population?

Introduction: Management of chronic Hepatitis C and its complications is a major concern for physicians. Peripheral neuropathy is a disease affecting the nerves, and is one of the complications of Hepatitis C

Objective: The aim of this study is to determine the prevalence of peripheral neuropathy in chronic hepatitis-C patients. Study design and duration: The type of study is a cross-sectional study, which was conducted over a period of one month from 01-11-2015 to 30-11-2015

Setting: The study was conducted at a tertiary care hospital in Karachi, Pakistan

Sample size and procedure: The study population consisted of a random sample group of 139 Hepatitis C positive patients who presented to the Internal Medicine Department either via out-patient clinic or via emergency. After due informed consent, variable such as demographic data and type and degree of neuropathy were recorded. All the Hepatitis-C patients who presented to us during that time were evaluated clinically, serologically and electrophysiologically. Data Analysis: Data was analyzed using SPSS version 20

Results: Out of the total study population of n= 139 patients peripheral neuropathy was present in n= 77 [55.39%] of the patient population; n= 3 [2.15%] had sensory type of neuropathy, n=13 [9.35%] had motor neuropathy and n= 61 [43.88%] had mixed type of neuropathy

Conclusion: According to the results of our study there is a significant association of peripheral neuropathy with hepatitis C in patients in South Asian population as more than hald of the participants had some form of peripheral neuropathy.

Knowledge attitude and practices about management of vitamin D deficiency among doctors in Pakistan

Background: Hypovitaminosis D is a common health issue in Pakistan because of its high prevalence. The awareness and practices of doctors treating vitamin D deficiency needs to be highlighted, as it will help in managing this public issue

Objectives: To assess knowledge, attitude and practices for diagnosing and treating hypovitaminosis D among practicing doctors in Pakistan

Subjects and Methods: Clinicians from different cities of the Pakistan were participated for a cross-sectional descriptive questionnaire based study about their approach in treating vitamin D deficiency. Results were analyzed using SPSS version 20. Descriptive statistics were calculated

Results: One hundred eighty eight [188] practicing doctors from 21 different cities of Pakistan participated in the study. Majority [85.6%, n=161] prescribed vitamin D levels in patients of hypovitaminosis D. It is empirically treated by 101 [53.7%]. Most clinicians [84%, n=158] prescribe Cholecalciferol, 19 [10.1%] Alfacalcidol and 11 [5.9%] prescribe Calcitriol as a vitamin D supplement, while 155 [82.4%] prescribe a maintenance dose. The prescription form preferred by doctors is tablets by 49 [26.1%], capsule by 29 [15.4%], oral injections by 68 [36.2%] and intra-muscular by 42 [22.3%]. As a follow up tool, 84 [42.6%] clinicians order serum 25 [OH] D and serum calcium levels, 102 [54.3%] assess patients by improvement in clinical symptoms and 3 [1.9%] use both strategies for assessment. Nutritional advice was also given by most doctors

Conclusion: There is no uniform approach for diagnosing and treating hypovitaminosis D among practicing doctors in Pakistan. A great variability and gap is seen in prescription options, dosing frequency and duration. This highlights the importance of need for a national guideline regarding prophylaxis, diagnosis and treatment of vitamin D deficiency

Bidi smoking is injurious to health: a prospective study

Objective: To assess the extent of bidi smoking injurious effects in patients attending the department of community dentistry at the Institute of Dentistry LUMHS, Jamshoro , Civil hospital Hyderabad jointly with department of NeuroSurgery in SIMS/Services Hospital Lahore

Methods: The study was mainly carried out in dept of community dentistry civil hospital Hyderabad and SIMS/Services Hospital Lahore. The side effects of bidi smoking were recorded in both urban and rural population using data analysis and Non probability convenience for analysis

Results: A total 300 patients age 25 to 50 years include urban and ruler population visited in civil hospital Hyderabad were surveyed out of 300 patients male were 72.3%a and female was 27.3% Graph 1 show percentage of gender distribution. Injurious effects of bidi smoking like oral cancers, lung cancers, brain cancers, myocardial infarction, atherosclerosis, COPD and Cardiac failure were most commonly seen in bidi consumers as compare to non-consumers

Conclusion: Bidi smoking is mostly used in people in rural population and males are seen more widely a consumers of bidi smoking as proved by this study so, why it is known as poor man cigarette. Health education programs on smoking cessation should be arrange in this area, use of tobacco products in indoor location should be properly banned. It can be concluded that bidi smoking is cause of oral cancer, and bronchogenic carcinoma etc. Bidi smoking is mostly used in people rural population and males are seen more widely a consumer of bidi smoking as proved by this study. High taxes on tobacco products should be implanted. Television media and radio stations can also participate to stop advertising tobacco products

Role of serum procalcitonin in sepsis

Objective: Role of serum procalcitonin in sepsis

Study Design: Descriptive / Cross sectional study

Place and Duration of Study: This study was carried out at the Mamji Hospital Karachi from January 2013 to July 2014

Materials and Methods: The adult patients presented with short duration of fever, altered consciousness, bed sores, cough, increased frequency of urine, diarrhea and vomiting and abdominal pain. ESR, CRP and serum procalcitonin level were sent simultaneously with blood, sputum and urine cultures. The study was conducted in Mamji Hospital F. B. area, data was recorded in a preset proforma. The features like biodata, symptoms/signs, biochemical test and cultures reports were shown in tables. The data was analysed on SPSS version 15

Results: In this study total cases were 33. Males were 19[55%] and 14[45%] were females. The mean age was 47 +/- 19. With the age range from 28 to 68 years. Males were slightly more than females. The patients were divided into two groups according to the level of procalcitonin. Group I were those with raised procalcitonin level > 0.5 and group II were those with procalcitonin level < 0.5. The ESR and CRP were raised in every case. In Group I total number of cases were 27, pneumonias 06 cases, UTI06 cases, bacterial meningitis 05 cases, bacterial dysentery 05 cases, skin infection 04 cases and septic arthritis 01 cases. In group II total cases were 06, 02 cases were viral one is cytomegalovirus and other is Epstein-Barr virus, 01 cases was connective tissue disease and was diaganosed as systemic lupus erythematosus 01 case was wegner's granulomatosis, 01 case was bronchogenic carcinoma and 01 was peripartum cardiomyopathy. The culture report showed 08 cases were E coli, 6 cases were pseudomonas aeroginosa, 5 cases were staphylococcus aureus, 3 cases Enterobacter 03 cases and streptococcus pneumonia 02 cases

Conclusion: In cases with fever the early detection of high serum procalcitonin level will clearly differentiate between inflammatory conditions caused by bacterial rather non bacterial conditions

Central obesity as a risk factor for impaired glucose tolerance

Objectives: To examine the association of central obesity [measured as waist-to-hip ratio] with glucose intolerance, and to compare the mean fasting blood sugar and the mean random blood sugar levels of centrally obese and non- obese adults

Study Design: Analytical case-control study

Place and Duration of Study: This study was carried out at the Medical Wards and OPDs of Civil Hospital Karachi from June 2015 to December 2015

Materials and Methods: The subjects were selected by non-probability convenience. Based on their waist-to-hip ratio they were divided into centrally obese [group A] and non-obese [group B]. The cut-off point for waist-to-hip ratio was 1.0 for males and 0.85 for females. One hundred non-diabetic, healthy adults were included in each group. All the subjects underwent a 2 hour 75-gm oral glucose tolerance test. Fasting blood sugar and random blood sugar at two hours post-glucose challenge were measured

Results: Five individuals had blood sugar levels in the diabetic range and were excluded from the study. Impaired glucose tolerance was observed in fifteen out of 98 subjects in the centrally obese group and six out of 97 subjects in the non-obese group. This difference was statistically significant [p=0.04]. Statistically significant difference was also observed between the mean fasting blood sugar and the mean random blood sugar of the two groups [p<0.001 in both cases]. The odds ratio for a person with central obesity to have impaired glucose tolerance was estimated to be 2.74

Conclusion: There is a significant association between central obesity [waist-to-hip ratio] and glucose intolerance

Evaluation of upper right abdominal pain in patients of dengue fever

Objective: To Evaluate patients with upper Right abdominal pain in dengue fever

Study Design: Prospective descriptive study

Place and Duration of the Study: This study was conducted at Mamji Hospital Karachi between August 2012 to October 2014

Materials and Methods: The patients presented with confirmed dengue fever with upper right abdominal pain. The study was conducted in Mamji Hospital F.B area. The data was gathered and analysed on SPSS version 15

Results: Total cases were 113.Males were 62 [55%] and 51[45%] were females. The mean age was 27 +/- 9. With the range from 18 to 36 years. Males were slightly more than females. The causes of abdominal pain were acalculuscholicystitis in 57 cases[50%], hepatitis in 17 cases[15%], pancreatitis in 5 cases[4.4%] and no cause was detected in 34 cases[30%].Total leukocyte count was not high and thrombocytes were low in every case. SGPT was mildly[Less than 100]raised in 71 cases [63%], moderately raise [more than 200] in 27 cases [23%] and severely raised in 12 cases [10.6%][more than300] and in 03 cases [3%] the SGPT was normal. Ultrasound finding of acute acalculus cholecystitis were enlarged gallbladder with thickened wall in 57 cases [50%] while 9 cases [8%] had gall stones without inflammatory signs. Perihepatic fluid in 35 cases [31%]. Swollen pancreas were noted in 5 cases [4.4%].Amylase were raised in 13 cases [11.5%] and serum lipase were raised in 5 cases [4.6%]

Conclusion: The acalculuscholecyctitis is one of the commonest cause of upper abdominal pain in denguefever. It is also consider as an early sign of severeinfection

Comparison of laparoscopic and open appendectomy in terms of operative time, hospital stay and frequency of surgical site infection

To compare laparoscopic and conventional open appendectomy in terms of operative time, hospital stay and frequency of surgical site infection [SSI]. Quasi-experimental study. Combined Military Hospital, Quetta from 6[th] Jun 2010 to 1[st] Sep 2011 and Combined Military Hospital, Multan, Pakistan from 2[nd] Sep 2011 to 5[th] Jun 2012 over a period of 2 years. A total of 417 patients underwent appendectomy during this period. 137 patients underwent laparoscopic appendectomy [group A] while 280 patients had open appendectomy [group B]. The sample includes all patients who were operated upon, between the time-span of June 2010 to September 2011. A chi square-test was performed to compare the data for statistical significance. Mean operative time for group A was 79.21 +/- 23.42 minutes whereas in group B, the mean operative time was 41.49 +/- 20.86 minutes. Group A patients had a shorter hospital, 1 stay [3.6 +/- 1 day] but in group B, it was [5.2 +/- 3 days]. Seven patients [5.1%] developed surgical site infection [SSI] in group A and 34 patients [12.14%] developed postoperative SSI in group B [p < 0.05]. Laparoscopic appendectomy is superior to open appendectomy because of shorter hospital stay and lesser post-operative SSI, but requires longer operative time

Readmission to paediatric intensive care unit: frequency, causes and outcome

Readmission to intensive care units is considered to be an important quality indicator in ICU settings. This study was carried out at the paediatric intensive unit [PICU] and step down units of paediatric ward at the Aga Khan University Hospital, Karachi, Pakistan, to assess the frequency, common causes and outcome of patients readmitted in PICU within 48 hours after discharge from unit. During the study period, 1022 patients were admitted in PICU, out of which 24 [2.34%] patients required readmission. Male to female ratio was 1.2:1. The mean length of stay on paediatric floor before readmission was 24 hours. Fifteen [62%] patients were readmitted due to worsening of primary condition while 9 [38%] developed new problems. Respiratory problems accounted for 15 [62.5%] of readmissions, followed by cardiovascular 4 [16.5%] and sepsis related causes 3 [12.5%]. The mortality rate of readmitted patients was 21% [5/24] in this study as compared to overall PICU mortality of 122 [11.93%]

Thrombotic Microangiopathic Syndrome: A Novel Complication of Diabetic Ketoacidosis.

Thrombotic microangiopathic syndrome secondary to diabetic ketoacidosis is an under reported entity in children. We describe 2 girls who developed thrombotic thrombocytopenic purpura (TTP) and thrombocytopenia associated multi organ failure (TAMOF) in new onset diabetes. Both patients presented with classical findings of DKA and were intubated due to low GCS, admitted in PICU and managed according to DKA guidelines. Later on, both patients developed thrombocytopenia, acute kidney injury, and low hemoglobin along with evidence of microangiopathy on peripheral smear. One patient developed paraparesis while other patient had high LDH levels. The clinical diagnosis of TTP and TAMOF was made respectively. Both patients were treated with plasmapharesis and renal replacement therapy. Both gradually improved and were discharged.

Botulism in children: a diagnostic dilemma in developing countries

Botulism is a well-known disease of the neuromuscular junction. It is a rare but curable cause of paralysis in paediatric population. In addition to classical clinical signs and symptoms, the diagnosis of botulism requires laboratory confirmation of intoxication by various biological tests. These include demonstration of botulinum toxin in serum or isolation of the Clostridium botulinum from stool/gastric aspirates. However, it is not always possible to confirm intoxication due to unavailability of technical facilities, especially in resource limited countries like Pakistan. Under these circumstances, electrophysiological studies serve as an excellent diagnostic tool. These studies can provide quick diagnosis of botulism so that early administration of botulism immunoglobulin, if available, can reduce morbidity, mortality and length of stay in hospital. We report a case of botulism from Pakistan diagnosed on the basis of electrophysiological studies

Proteinuria in HIV positive patients; Determine the frequency at a tertiary care hospital in Karachi

To determine the frequency of proteinuria in HIV positive patients at a tertiary care hospital in Karachi. Cross-sectional. This study was carried out in lnfectious diseases wards and all medical wards of Civil Hospital Karachi, from Jan 201 1 to the Dec 2011. A total of 170 patients from infection diseases wards and all medical wards of Civil Hospital Karachi. Age more >12 years of either sex who were newly diagnosed cases of HIV based on positive HIV serology by ELlSA and Western blot in infection diseases ward were included. Patients having known kidney disease. urinary tract infection, serum creatinine more than 1.5 mg/dI, diabetes mellitus, high blood pressure and old diagnosed cases of HIV who have already taken or who are taking HIV infection treatment were excluded from this study. Spot urinary sample was taken to measure the proteinuria by urine dipstick. To minimize bias all specimen sent to same laboratory of the hospital. 170 newly diagnosed cases of HIV were included in this study. Gender distribution showed male preponderance [Male: Female = 6.4:1]. Majority of cases 120 [70.6%] had age between 26 - 50 years. Mean age of women was 30.3 +/- 7.4 years [min - max = 18 - 45 years] and for males was 34.3 +/- 9.6 years [min - max = 15 - 56 years]. Out of 170 HIV positive cases frequency of > 1+ protein in urine on urine dipstick analysis was found in 27 [15.9%] cases. Out 27 cases, 16 [59.3%] cases had age between 26-50 years [mean +/- SD =32 +/- 10.1 years, min - max = 18 - 55 years]. Proteinuria was high in increasing age groups. Proportion of proteinuria was high in married and depressed patients, out of 27 cases, 18 [66.7%] were married and 9 [33.3%] unmarried, Frequency of proteinurta was high in labor class, 11 of 27 [40.7%] were labors followed by house wife 6[22.3%], while 5 [18.5%] were private job holder. ln this study I found a high prevalence of proteinuria in HIV positive patients. Such subjects show male preponderance disiribution. We conclude that HIV positive patients should be screened for proteinuria and if they found to have proteinuria, they should be subjected to appropriate treatment to retard the progression of nephropathy and associated complications.

Elective tracheostomy in mechanically ventilated children

Tracheostomy is an important procedure in children requiring prolonged mechanical ventilation. We conducted a retrospective study to assess the frequency, indications, postoperative course and short-term outcome of elective tracheostomy in a Paediatric Intensive Care Unit [PICU] of Pakistan. Twenty-five patients underwent tracheostomy in last 5 years [2.2% of all PICU admissions]. Mean age of patients was 6 years and 60% were male. The most common indication for tracheostomy was prolonged mechanical ventilation secondary to neurological disease [60%], followed by upper airway obstruction [40%]. Major complications included accidental decannulation [20%] and tube obstruction [20%]. Three patients [12%] developed ventilator-associated pneumonia after tracheostomy change while persistent bacterial colonization of trachea was observed in 8 patients [32%]. Decannulation was achieved in 40% [10/25]. There was no mortality related to tracheostomy in this series

Pyogenic granuloma of scrotum case report and review of literature

Pyogenic granulomas are common, acquired, vascular lesions of the skin traumatically. We present adult patient who developed pyogenic granuloma on scrotum, only second case report in English literature

Acute necrotizing encephalopathy of childhood: a fatal complication of swine flu

Acute necrotizing encephalopathy of childhood [ANEC] is a rare condition characterized by the presence of multifocal symmetrical brain lesions involving mainly thalami, brainstem, cerebellum and white matter. ANEC is a serious and life threatening complication of simple viral infections. We present a case of a young child who developed this condition with classical clinical and radiological findings consistent with ANEC, secondary to swine flu [H1N1]. He needed ventilatory support and had profound motor and intellectual deficit on discharge. We report this case with aim of raising awareness about this fatal complication of swine flu which has become a global health care issue these days

Efficacy of pubovaginal sling using fascia lata for treatment of urodynamic stress incontinence in females

To evaluate results of pubovaginal sling surgery for the treatment of urodynamic stress incontinence in females. Descriptive study. This study was carried out in Pakistan Naval Services Shifa, Karachi and Armed Forces Institute of Urology, Rawalpindi from February 1997 to February 2004. Thirty two Pubovaginal sling operations using fascia lata were performed at Pakistan Naval Ship Shifa, Karachi and Armed Forces Institute of Urology, Rawalpindi in females having severe urodynamic stress incontinence. The inclusion criteria was women with stable bladder, having post void residual urine [PVRU] <100 ml and P det 720 cm of water. Patients with detrusor overactivity, impaired detrusor function and marked cystocele were excluded from the study. The procedure involves placing a band of sling material using fascia lata directly under the bladder neck, which acts as a physical support to prevent bladder neck and urethral descent during physical activity. All patients were evaluated postoperatively by clinical examination, PVRU, Peak flow rate on uroflowmetry and urodynamic assessment. Mean patients age was 46.5 years [range 27-68] and mean parity was 6 [range 0-10]. Follow up was completed in all 32 patients over a mean follow-up period of 26 months [range 3-38]. Overall success rate [completely cured and partially cured] was 84%. De. novo detrusor over activity was observed in 25% patients, while 2 patients underwent undo operation for urinary obstruction. Pubovaginal sling surgery is the first line surgical treatment for all types of urodynamic stress incontinence

Effect of obstructive disease in patients with non-cystic fibrosis bronchiectasis

Extensive research has been devoted to cystic fibrosis-related brochiectasis, compared with non-cystic fibrosis bronchiectasis but the latter is more common and results in significant morbidity and mortality. We assessed the relationship between pulmonary function test [PFT] findings and sputum bacteriology, blood gases, number of hospital admissions and mortality in patients with non-cystic fibrosis bonchiectasis [NCFB]. We conducted a retrospective review of 88 consecutive patients admitted with exacerbation of bronchiectasis over 5 years from 1996 to 2001. Demographic and clinical data collected included gender, age, pulmonary functions, arterial blood gases, sputum bacteriology during stable and exacerbation periods, and number of hospital admissions due to exacerbation of bronchiectasis. A comparison was made between patients having obstructive airway disease [OAD group] and patients with normal or restrictive pulmonary functions [non-OAD group]. OAD in patients with NCFB adversely affected clinical outcome. There was a significant increase in Pseudomonas colonization [60.3% vs. 16%; P<0.0003], hypercapnic respiratory failure [63.4% vs. 20%; P<0.0003], and mean number of admissions due to exacerbation [6 vs. 2; P<0.0001] in the OAD group as compared with the non-OAD group. Although mortality was increased in the OAD group, the difference was not statistically significant. Patients with NCFB who have OAD have a significantly higher rate of colonization with Pseudomonas aeruginosa [PSA], hypercapnic respiratory failure, a greater number of hospital admissions due to exacerbation of bronchiectasis, and a higher mortality compared with patients with restrictive or normal pulmonary functions

Effects of intravesical BCG therapy on superficial bladder cancer [recurrence and progression]

The present study was conducted to determine the efficiency of the intravesical BCG therapy on superficial bladder tumor recurrence and progression. 39 patients at AFIU Rawalpindi from Jan 1999 to Jan 2002. All patients with superficial bladder tumor were included in the study. Patients with Carcinoma Urinary Bladder were evaluated with Ultrasound Kidney and Urinary Bladder, examination under anaesthesia, cystoscopy, and histopathological examination. Sixteen patients with superficial bladder tumor were given BCG therapy two weeks after transurethral resection. This consisted of induction with six instillations at weekly intervals, followed by three monthly check cystoscopies. Control group [twenty three patients] underwent transurethral resection followed by check cystoscopy at three monthly intervals. Both recurrence rate and tumor progression was low [12.05% and 6.25% respectively] in BCG treated group, compared with higher tumor recurrence and tumor progression [65.25% and 26.10% respectively] in the control group. BCG instillation therapy in superficial bladder tumors significantly reduced the rate of tumor recurrence and tumor progression

Hypospadias: one stage repair

To evaluate the cosmetic and functional results of one stage repair of hypospadias, using parameatal based flip-flap urethroplasty. A prospective study from 1990 to 2002 at AFIU Rawalpindi, CMH Kohat, Jhelum, and Pano Aqil Cantt. And AK CMH Muzaffarabad. Fifty patients underwent one stage repair of hypospadias by parameatal based flip flap urethroplasty, using ventral penile and scrotal axial skin flap. The urethral meatus was subcoronal in 6 [12%], Distal penile in 32 [64%], proximal penile in 8 [16%] and penoscrotal in 4 [8%]. Some modifications and combinations were used to ensure better vascularity of the flaps; natural verticals slit meatus and reduce complications. An 8 Fr polythene feeding tube used as stent with its tip inside the urinary bladder was removed on 7th or 8th postoperative day. The mean follow up period was 12 to 36 months. We achieved good cosmetic and functional results in 86% patients. Urethrocutaneous fistula occurred in 3[6%] patients, meatal stenosis in 2 [4%], residual chordee in 1[2%] and disruption of repair due to flap necrosis in 1 patient. Only four patients required redo surgery for fistula, residual chordee and failed repair due to flap necrosis. Meatal stenosis responded well to regular dilatation with the cone tip of an ophthalmic ointment tube, twice daily for 2-4 weeks. Postoperatively the penis was straight with natural vertical slit meatus and good stream of urine. One stage parameatal based flip flap urethroplasty, with some modifications, give very good functional and cosmetic results in primary as well as salvage repair of hypospadias

Transurethral resection of prostate for BPH-Assessment by uroflowmetry

To assess the improvement in the urinary flow rate in patients with benign prostasic hypertrophy [BPH] following transurethral resection of prostate [TUR] [P] with the help of Uroflowmetry. It was a prospective study. This study was conducted at Armed Forces Institute of Urology [AFIU] Rawalpindi. 100 patients with BPH were included in the study. Patients were evaluated by digital rectal examination [DRE], ultrasound kidney, ureter and bladder [KUB] and Prostate size, PSA., Uroflowmetry preoperatively as well as post operatively at monthly interval for 03 months. There was significant improvement in the maximum flow rate with decrease in the time to maximum flow rate. There was also increase in the voided volume. In Conclusion, TUR [P] is the commonest method of treatment for BPH. Uroflowmetry is a simple, quick and easiest way to assess degree of obstruction and improvements in the flow rate postoperatively