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Objective: To investigate the impact of sitagliptin and vildagliptin on hemodynamic and metabolic parameters in type 2 diabetic patients
Study Design: A comparative randomized clinical trial
Settings: Outdoor patient of diabetic clinic of Sheikh Zayed medical College/ Hospital Rahim Yar Khan. Duration: Six months, July to December 2017
Methodology: Overall 120 type 2 diabetic patients with dyslipidemia and mild to moderate hypertension were randomized at diabetic clinic for treatment with sitagliptin and vildagliptin respectively for a period of 12 week. Body weight, BMI, blood pressure and serum lipid profile were analyzed pre and post treatment by using SPSS 16
Results: There was significant improvement in HbA1C after 12 weeks treatment with sitagliptin[8.1+/-2.2 to 6.8+/-3.5]vildagliptin[8.5+/-3.1 to 6.4+/-4.2] with in group. However no significant changes were observed between groups [p-0.64]. This improvement in glycemic control was further accompanied by reduction in blood pressure within groups i.e. systolic [152+/-12.2 to 130.2+/-9.8 vs142+/-15.5 to 122+/-12.4] diastolic [90.5+/-8.4 to 80.4+/-6.5 vs 93+/-9.4 to 82.5+/-10.6]. When comparison was done between two groups in terms of blood pressure it found to be non-significant [p=0.82 and p=0.77]. Serum lipid profile also improved significantly with in groups but non significantly between groups i.e. total cholesterol [265+/-14.5 to 202+/-17.2 vs 255+/-14.82 to 210+/-14.5 p=0.12] triglycerides [210+/-20.5 to182+/-27.2 vs 192+/-32.5 to 148+/-42.55 p=0.37]LDL-cholesterol [152+/-14.4 to120+/-20.6 vs 158+/-15.4 to 110+/-9.5 p=0.86] HDL-cholesterol[42.4+/-3.5 to 47.4+/-3.8 vs 44+/-2.8 to 49+/-2.2 p=0.21] However no significant changes were recorded in terms of body weight and body mass index[BMI] within and between both study groups
Conclusion: DPP-4 inhibitors [sitagliptin andvildagliptin] significantly improved hemodynamic and metabolic parameters in type 2 diabetic patients
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Background: Pharmacology is one of the most progressive and constantly changing basic medical science subject. The current curriculum of pharmacology lacks uniformity. Lectures, tutorials and practical classes are the common methods of teaching. The scientific and integrated curriculum and innovative teaching methodology fulfils the academic objectives
Objective: To know the students satisfaction and effectiveness of current teaching methods and curriculum in pharmacology. Methodology: This cross-sectional survey was conducted in Pharmacology Department, Sheikh Zayed Medical College, Rahim Yar Khan, from1stNovember to30th November 2017. A set of questionnaire was distributed among the 140, MBBS students of 3rd yearwho have studied pharmacology. Students were instructed to tick the best possible option of each question on the basis of their own perceptions. Analysis of data was done using SPSS version in 20. Descriptive analysis was used to assess different variables in the study
Results:140 students of 3rd year MBBS class participated in this study. Male students were 59 and 81 were female students with mean age of 21.5+/-1 with minimum age of 19 and maximum age of 24 years old. All students answered the questions and gave their opinion. Regarding the current teaching methodologies, 66.4% students were satisfied with current teaching methodology in comparison with 23.5 % who were not satisfied and 10% has no idea
Conclusion: In present study, overall students were satisfied with current teaching curriculum and they were of the view that integrated teaching should be added to the curriculum and teaching should include problem based learning, small group discussion, self-directed learning and bed side teaching in pharmacology
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Background and Objective: NAFLD affecting up to 30% of the population globally. Drug treatment option are limited with disappointing results. The dietary supplementation in the form of green tea is another option. Our objective was to investigate the effect of Green tea extract [GTE] supplementation on varioi parameters in non-alcoholic fatty liver disease [NAFLD] patients
Methods: This study was conducted Dept. of Medicine of Sheikh Zayed Medical College/Hospital, Rahii Yar Khan from 15 April 2016 to 15 July 2016. Eighty overweight, non diabetic and dyslipidemic patients c NAFLD, diagnosed on the basis of ultrasound and aminotransferases level were randomized for treatmer with capsule GTE SOOmg [n=40] and capsule placebo [n=40] twice a day for twelve weeks. Anthropometri parameters, liver enzymes, inflammatory markers and liver ultrasound imaging were estimated by SPSS-1 pre and post treatment
Results: As compared to placebo, GTE caused a significant improvement in body weight [29.5+/-3.8 t 27.2+/-3.2 kg/m[2] p=0.03], BMI [86+/-10.5 to 80+/-12.4 kg p=0.026], HOMA-IR [4.32+/-2.25 to 3.16+/- 1.6 p=0.0081 lipid profile [i.e. TC: 242.5+/-20.5 to 215.4+/-18.6 mg/dl p=0.005; TG:175+/-22.6 to 145+/-18 mg/dlp=0.003 LDL-C: 155+/-12.5 to 140+/-16.7 mg/dl p=0.011; HDL-C: 36.8+/-6.7 to46.4+/-5.8 mg/dl p =0.001, Aminotransferase: [i.e. ALT: 70.4+/-15.8 to 52.8+/-12.2 IU/L p=0.04; AST:65.8+/-12.4 to 44.3+/- 8.5U/L p =0.002] and Inflammator] markers [hs-CRP: 3.14+/-0.58 to 2.18+/-0.32 p =0.023Adiponectin: 8.46+/-1.02 to 10.55+/-3.42microg/ml p =0.003; GTE also caused a 67.5% regression of fatty liver changes on ultrasound as compared to placebo which is 25% only
Conclusion: GTE therapy resulted in significant improvement in metabolic, chemical, inflammatory and radiological parameters of non-alcoholic fatty liver disease patients who were non-diabetic and dyslipidemic
Subject(s)
Humans , Female , Male , Adult , Middle Aged , Tea/drug effects , Ultrasonography , TransaminasesABSTRACT
Background and Objective: Increased neutrophil lymphocyte ratio [NLR] is a marker as well as predictor of various cardiac and non cardiac disorders. Our aim was to assess the relationship between NLR and different level of glycemic control in type 2 diabetic patients
Methods: An observational study was conducted at diabetic clinic of Sheikh Zayed Medical College/ Hospital, Rahim Yar Khan from September 2016 to February 2017 in which 330 type 2 diabetic patients were randomly divided in to three groups based upon diabetes control according to ADA criteria. Patients in group A with HbA1c /= 9 %[ worst control]. Patients were assessed in terms of complete blood count and C - reactive protein
Results: As compared to excellent control [Group A] patients with worst control [Group C]showed a high leukocyte count [p .001], high neutrophil count [P .003] and lower lymphocyte count [P 0.44] while patients in poor control [Group B]did not differ significantly. Similarly value of NLR was also significantly higher in worst control [Group C] as compared to poor control[Group B] and excellent control [Group A] diabetes [4.3+/-2.8, 2.7+/-1.0 and2.0+/-0.5[p.001]. NLR were found independent predictor of worst diabetes control [OR: 1.809, 95% CI: 1.459-2.401] along with fasting blood sugar [OR: 0.938, 95% CI: 0.995-0.982] and CRP [OR: 1.020, 95% CI: 1.003-1.028]
Conclusion: Increased NLR level is associated with elevated HbA1c and poor glycemic control in patients of type 2 diabetes mellitus. It can be used as a disease monitoring tool during the follow up of diabetic patients
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Background: hypothyroidism is one of the common complications among beta thalasemia
Objective: to determine the frequency of hypothyroidism in patients of beta thalassemia major in Thalassemia center, Rahim Yar Khan
Methodology: study design: Single center cross-sectional study. Place and duration of study: This study was carried out in "Thalassemia Center", Sheikh Zayed Hospital, Rahim Yar Khan over a period of one year from 1[st] January to 31[st] December 2015. This study was carried out on 144 patients of thalassemia major aged 5-16 years. The data was collected regarding demographic variables, serum ferritin, T4 and TSH and duration of transfusion. The data was entered and analyzed by using SPSS version 19
Results: hypothyroidism was found in 45 [31.2%] patients. Of these, 42 [93.3%] had sub clinical hypothyroidism [normal T4 level with elevated TSH] whereas only 3 [6.7%] patients has overt hypothyroidism [decreased T4 level with elevated TSH]. Frequency of hypothyroidism has significant association with patient's age and duration of transfusion
Conclusion: sub clinical hypothyroidism occurs in a significant proportion of thalassemia major patients. Frequency of hypothyroidism has significant association with age and duration of transfusion. Regular follow-up of thalassemic patients to detect and timely treat such complication could improve the quality of life of these patients
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Objective: To determine the effect of Vildagliptin in non-alcoholic, fatty liver disease patients with dyslipidemia
Methods: A randomized placebo controlled trial was conducted at outpatient clinic of Medical Unit-I of Sheikh Zayed Medical College/Hospital, Rahim Yar Khan, in which fifty eight patients of NAFLD with dyslipidemia were divided in to two, case and control groups. The case group was given tablet Vildagliptin 50mg twice a day for twelve weeks and control group was given placebo in same way. Body weight, body mass index [BMI], lipid profile, liver enzymes and ultrasound finding of fatty liver were assayed before and after treatment
Results: After 12 weeks treatment of vildagliptin there was significant improvement in following parameters. Body weight and BMI decreased significantly from 88 +/- 11 to79 +/- 12 kg [p0.036] and 30 +/- 4 to 27 +/- 5 kg/m2 [p 0.005] respectively. Notable reduction in the value of TC, TG and LDL-C [TC: 252 +/- 24 to 220 +/- 20mg/dl [p 0.031]; TG: 190 +/- 24 to115 +/- 22 mg/dl [p 0.005]; LDL-C 160 +/- 15 to 145 +/- 13mg/dl [p 0.004]. HDL-C level increased significantly from 29 +/- 5to45 +/- 4 mg/dl [p 0.001].There was remarkable reduction in aminotransferases level [ALT: 78 +/- 17 to 48 +/- 14IU/L [p 0.036]. AST: 63.3 +/- 13 to41 +/- 11IU/L [p 0.002]. There was overall 65.5% improvement in fatty liver grading on ultrasound with vildagliptin while non significant effects were seen in placebo group in all of the above parameters
Conclusion: Vildagliptin exhibited beneficial effects in non-alcoholic fatty liver disease, Nondiabetic patients with dyslipidemia
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Obesity, dyslipidemia and hypertension are major risk factors for cardiovascular disease and its associated complications. To evaluate the beneficial effects of sitagliptin and metformin in non-diabetic dyslipidemic and hypertensive patients. A prospective randomized clinical trial was conducted on 70 newly diagnosed dyslipidemic patients with BMI >/= 25 and blood pressure >/= 130/80 at outpatient clinic of medical unit-1 of sheikh medical college /hospital Rahim Yar Khan. They were divided in to three groups each containing 35 patients; First group served as a healthy control while second and third study groups were given tablet sitagliptin 50mg and tab metformin 850mg respectively twice a day for twelve weeks. After three months treatment with sitagliptin and metformin there was significant reduction in body weight [Sitagliptin 6.5% vs Metformin 7.65%] and BMI [Sitagliptin 2.2% vs Metformin 2.8%] with p
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Objective: To determine the frequency and severity of acute toxicity of pelvic radiotherapy for gynecological cancer
Study Design: A case series
Place and Duration of Study: Department of Oncology, The Aga Khan University Hospital, Karachi, from March 2011 to June 2012
Methodology: A total of 99 patients with histologically proven uterine and cervical cancer, receiving radiation therapy, were enrolled into the study after informed consent on justification of inclusion and exclusion criteria. Patients were evaluated for the frequency and severity of pelvic radiotherapy's side effects according to toxicity criteria based on RTOG/EORTC and CTC version 2 criteria at the start, during and at the end of treatment. The data was analyzed by using SPSS version 16
Results: Out of the 99 enrolled patients, 58 [58.6%] had uterine and 41 [41.4%] had cervical cancer. Mean age was 54.54 +/- 10.29 years. Thirty-five [35.4%] patients received chemotherapy with RT. Mean RT dose was 60.72 +/- 7.15 Gy. The most common gastrointestinal adverse effect was diarrhea in 64 [64.6%] followed by proctitis in 55 [55.5%], nausea in 33 [33.3%] and vomiting in 16 [16.2%] patients. Grade [G] 1 was the most frequently observed severity. The most common hematological toxicity was anemia in 37.8% [n=31/82] [[G1=18 [21.9%], G2=11 [13.4%], G3=2 [2.4%]] followed by thrombocytopenia in 22.8% [21/92] [[G1=16 [17.3%], G2=2 [2.1%], G3=3 [3.2%]] and neutropenia in 21 [21.2%] [[G1=12 [12.1%], G2=5 [5%], G3=3 [3%], G4=1 [1%]]. Urinary toxicity was observed in 49 [49.5%] patients. On stratification, chemotherapy and higher RT dose were strong predictor of increased hematological and upper gastrointestinal toxicity [p < 0.05] and age > 60 years for diarrhea [p < 0.05]
Conclusion: The frequency and severity of acute toxicity of pelvic radiotherapy in women with gynecologic cancers was found intermediate to high
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To determine the frequency of clinical features of Celiac disease [CD] and Celiac crisis in children. Case series. Paediatrics Unit, Sheikh Zayed Medical College and Hospital, Rahim Yar Khan, from September 2009 to September 2010. Forty children aged between 4 to 13 years of either gender, presenting with complaints of recurrent diarrhea, abdominal distention, severe emaciation and dehydration were included. The information about breast feeding, weaning diets, age of introduction of wheat diets, onset of diarrhea, characteristics and frequency of stools, growth, vaccination status, symptoms in 1st degree relatives, restriction of Gluten diet in the past and anthropometric measures were recorded. Serological tests against anti-Tissue Transglultaminase [anti-tTG] antibodies were obtained in all cases. Upper gastrointestinal endoscopies were performed and multiple biopsies were taken from distal parts of duodenum. Among the forty children, twenty four [60%] were females and 16 were males [40%]. The mean age was 6.35 +/- 2.83 years. Thirty five [87.5%] parents were cousins. Breast feeding was not exclusively given and the Gluten containing weaning diets were given as early as 3.5 months of age. Thirty [75%] children presented with typical sign and symptoms of CD. Celiac crisis presented with profuse diarrhea, severe dehydration; abdominal distention; pedal edema, carpopedal spasm due to tetany; wasted muscles; head drop and inability to stand. The serum TtG antibodies in thirty-eight cases [95%] were above the cut off level of 7u/ml ranging from 35-99 u/ml. The histopathology of specimens from distal duodenum revealed lesions of M3 type in thirteen [32.5%] and M2 type in eighteen cases [45%]. All cases recovered and improved on follow-up after strict adherence to gluten-free diet [GFD]. Majority of children with Celiac disease presented with typical symptom, while Celiac crisis was characterized by severe dehydration, weakness and calcium deficiency signs. Most were the product of consanguineous marriages and were given Gluten - containing weaning foods as early as the 4th month of life
Subject(s)
Humans , Male , Female , Child , Diarrhea , Emaciation , Dehydration , Biopsy , GlutensABSTRACT
Background: Neonatal mortality and morbidity is always a great concern for clinicians and public health experts. Objectives: To determine the disease pattern and outcome in neonatal unit of Sheikh Zayed Hospital, Rahim Yar Khan
Patients and Methods: This prospective study was conducted in the neonatal unit of Sheikh Zayed Medical College /Hospital, Rahim Yar Khan from 1[st] January to 31[st] December 2010. The data of all the neonates admitted during the study period was analyzed regarding diagnosis, outcome [discharge, discharge on request, left against medical advice, death] and death cases were evaluated in detail regarding sex of patient, place of delivery and mode of delivery
Results: A total of 17150 patients were admitted in pediatric unit of which 4214 [24.6%] were neonates. Birth asphyxia was the commonest cause of admission in 1610 [38.2%] patients, followed by prematurity and low birth weight 1052 [24.9%], sepsis 631 [14.9%], congenital malformations 435 [10.3%], neonatal jaundice 225 [5.3%], meconium aspiration syndrome 181 [4.3%] and miscellaneous 80 [1.91%]. Total Paediatric deaths were 1651 with neonatal deaths 1030 [24.4%] while post-neonatal deaths were 621 [4.8%]. Main bulk of mortality was observed in first 7 days of life in 794 [77%]. The commonest cause of mortality was prematurity with its complications in 470 [45.6%] deaths, followed by birth asphyxia 302 [29.3%] and sepsis 191 [18.5%]. Of the total expired patients 405 [39.3%] were delivered in Sheikh Zayed Hospital, 385 [37.4%] at home, while 240 [23.3%] in private clinics and hospitals
Conclusion: Birth asphyxia, prematurity, low birth weight, sepsis, and congenital malformation are the main causes of neonatal admissions, while common causes of mortality are prematurity followed by birth asphyxia and sepsis. Solid and sustainable policies need to formulated and implemented to avoid the various preventable causes of neonatal morbidity and mortality