Frequency of hypomagnesemia in patients with uncontrolled type II diabetes mellitus

Objective: The objective of this study was to determine the frequency of Hypomagnesemia in patients with uncontrolled type II diabetes mellitus

Study Design: Cross-sectional study

Place and Duration of Study: Department of Medicine, PNS Shifa Naval Hospital Karachi, from Jul 2012 to Dec 2012 over a period of six months

Material and Methods: In this study, three hundred and twenty three patients of uncontrolled diabetes mellitus type-II on oral hypoglycemic agents for more than five years, presenting to medical OPD, were recruited. All patients fulfilled inclusion and exclusion criteria. Blood samples of all patients for serum HbA1c and serum magnesium levels were analyzed at the time of enrollment. Statistical analysis was done on SPSS 20

Results: Out of 323 patients, 243 [75.23%] were males and 80 [24.76%] were females with the age ranging from 40 - 65 years [mean age and SD 54.76 +/- 6.43]. Hypomagnesemia was found in 117 patients, without any significant difference in men and women [38.45% and 35.39% respectively]. The mean duration of diabetes was 12.5 years [ranging from 5 to 22 years]. By frequency test in SPSS-20, the highest frequency of hypomagnesemia [49.42%] is seen in [8.6-9.0] HbA1c group while lowest frequency hypomagnesemia [15.38%] is seen in [>10.0] HbA1c level group mean standard deviation and p-value calculated by Pearson correlation statistic in SPSS-20 for quantitative variables [HbA1c, Magnesium level]

Conclusion: Hypomagnesemia is frequent in poorly controlled type-II diabetes mellitus having increased level of HbA1c. So it may be prudent in clinical practice to periodically monitor plasma magnesium and HbA1c in type-II diabetes mellitus patients

Frequency of thyroid dysfunction during TFT in interferon and ribavirin therapy in patients with chronic hepatitis C

Objective: To determine the frequency of thyroid dysfunction among patients of chronic hepatitis C [HCV] infection receiving combination of interferon-alpha and ribavirin therapy

Study Design: Cross-sectional study

Place and Duration of Study: Department of Medicine, PNS Shifa Naval Hospital Karachi, from September 2012 to March 2013 over a period of six months

Patients and Methods: In this study, 170 diagnosed patients of chronic HCV [confirmed by anti-HCV and HCV RNA-positive] presenting to medical OPD with normal thyroid functions were recruited. All patients fulfilled inclusion and exclusion criteria. They were prescribed IFN-alpha 2b [3 million units subcutaneously 3 days a week] and oral preparation of antiviral drug ribavirin [800 to 1200 mg daily in divided doses according to weight]. At the end of 12 weeks of combination antiviral therapy, their thyroid profile was worked up. Serum TSH, free T4 and T3 levels were determined by chemiluminescence technique in chemical pathology lab of the hospital. Statistical analysis was done on SPSS 17

Results: Out of 170 patients, 83 [48.82%] were females and 87 [51.18%] were males with the age ranging from 22-46 years [mean +/- SD: 33.86 +/- 5.32]. After 12 weeks of antiviral therapy, thyroid functions were normal in 156/170 [91.76%] patients, whereas in 14/170 [8.24%] cases thyroid dysfunction was observed. Out of those patients having thyroid dysfunction, 10/14 [71.42%] were hypothyroid whereas 4/14 [28.58%] had hyperthyroidism

Conclusion: Managing patients of chronic HCV with combination antiviral therapy comprising IFN-alpha 2b and ribavirin can cause thyroid dysfunction. These patients should be monitored before and during treatment to avoid complications and poor compliance

Plasmapheresis versus intravenous immunoglobulins in guillain barre syndrome, the therapeutic outcomes

To compare the therapeutic outcomes of plasmapheresis with intravenous immunoglobulins [IVIG] for Guillain Barre syndrome. Randomized controlled trial. Medicine department; PNS Shifa Hospital Karachi from Jan 2011 to Jun 2012. Adult patients admitted to internal medicine department with the diagnosis of Guillain Barre Syndrome [GBS] fulfilling the inclusion and exclusion criteria were included after taking ethical approval and informed consent. They were randomly assigned to plasmapheresis and IVIG treatment groups. Their presenting features, investigations and management plan were followed over 6 months duration. Hughes disability scale for Guillain Barre syndrome was documented and compared at admission, 4 weeks, 12 weeks and 6 months by non-parametric tests via SPSS version 17. Total 36 patients [31 males and 5 females] were included. Mean age was 37 +/- 15 [18-70] years, mean duration of symptoms 11.6 +/- 12.7 days. Plasmapheresis and IVIG groups were comparable with respect to age and gender [p>0.05]. Significant improvement of mean disability score was observed in each group from baseline score [p<0.0005]. At specified intervals, comparison between the two groups in terms of mean improvement in disability scores showed significant improvement at 4 weeks [p<0.05] in IVIG group as compared to plasmapheresis group; however on further observation at 12 weeks and 6 months, mean improvement was comparable between two groups with no significant difference [p>0.05]. There was no significant difference in need for assisted ventilation between two groups [p>0.05]. Variants of GBS observed were AIDP [50%], AMAN [31%] and AMSAN [19%]. Our study suggests that both plasmapheresis and intravenous immunoglobulins are useful and effective modes of treatment for Guillain Barre Syndrome. Significant short term improvement was observed in the IVIG group at 4 weeks of treatment; however no significant difference in therapeutic outcome observed between the two groups on further follow up of 6 months. Thus focusing the need of further large scale regional studies to analyze various factors contributing to this short term but significant improvement with IVIG treatment observed in this study