Prevalence of microalbuminuria with relation to glycemic control in type-2 diabetic patients in Karachi

Diabetes is one of the most common endocrine disorders characterized by hyperglycaemia. Diabetic nephropathy is a consequence of long standing diabetes. The prevalence of microalbuminuria predicts progression to diabetic nephropathy. The present study was conducted to determine the prevalence of microalbuminuria in relation to duration of diabetes, BMI, Serum Creatinine and HbA1c in an ethnic group of Type 2 diabetes mellitus residing in Karachi. This cross-sectional descriptive study was carried out in a community diabetic centre, located at Garden East Karachi from July to December 2007. One hundred known Type 2 diabetic patients with age 30- 70 years were included in the study. Informed consent and a structured questionnaire of each patient were recorded. Fasting venous blood and morning urine sample was collected for analysis of creatinine, HbA1c and microalbuminuria respectively. Statistical analysis was done using SPSS version 13.0. Pearson correlation was applied to observe association of microalbuminuria with different parameters. All p-values <0.05 were considered as statistically significant. Microalbuminuria had a highly significant correlation with duration of diabetes, serum creatinine [p<0.001], HbA1c [p<0.05] and BMI [p<0.024]. A strong correlation exists between age and serum creatinine [r=0.73]. The present study found an early onset of microalbuminuria in the selected community which could be due to poor glycaemic control [high HbA1c>7%] or heredity factors. Screening for microalbuminuria and HbA1c test should be done in both newly and already diagnosed Type 2 diabetic patients as an early marker of renal dysfunction and glycaemic control

Morgagni Hernia in childhood

Three hundred and twenty five infants and children with congenital diaphragmatic hernia have been managed at the Hospital for sick children, Great Ormond Street, [GOS], London since January 1950 to January 1994. Twenty four of this series had the uncommon anterolateral hernia of Morgagni and are the subject of this study. Twenty infants and children presented with respiratory and gastrointestinal symptoms, while in four the diagnosis was incidental. Eight infants and children presented acutely with respiratory and gastrointestinal system. The diagnosis was made using plain chest x-ray and upper gastrointestinal contrast studies. Three children had normal chest x-ray. Angiography was performed in two patients for cardiac defects and this also confirmed the herniation of the left ventricular diverticulum into the abdomen. A further patient required operative splenoportogram because of suspected portal vein thrombosis and to plan shunt procedure. Eleven children had formal repair of the diaphragmatic defect A hernial sac was present in 16. Four children had malrotation. The operative findings were herniation of the small and large bowel, left lobe of the liver, omentum, spleen, stomach, diverticulum of the left ventricle and segment of the right lung. One patient had bilateral hernia. Postoperative complications occurred in eight patient's and were adhesive small bowel obstruction in 4, pleural effusion in 2, pericardial effusion in 2, wound infection in 2, recurrent hernia in one, impaired right diaphragmatic motility in one, and portal hypertension in another. There was no mortality

Choledochal cyst: a comprehensive review

The term choledochal cyst refers to a congenital lesion of the biliary tree [either intrahepatic or extrahepatic] characterised by dilatation which may be cystic or, less commonly, fusiform in appearance. More recently defined, choledochal cyst is a conglomerate of congenital cystic dilatation of the common bile duct, anomalous arrangement of the pancreaticobiliary ductal system and lack of sphincter function at the junction of the common bileduct and pancreatic duct