Comparison of metformin and repaglinide monotherapy in the management of newly diagnosed diabetes mellitus type 2: a prospective study

Background: Diabetes Mellitus Type 2 (DMT2), which is characterized by the raised blood sugar level due to insulin resistance in body cells, has now become global epidemic. This study was aimed to compare the efficacy of metformin and repaglinide monotherapy in patients with newly diagnosed DMT2. Methods: This randomized comparative prospective study was performed in a tertiary care hospital of Lahore. 108 Patients’ enrollment was made via simple random sampling technique and a developed inclusion and exclusion criteria. Patients were divided into metformin and repaglinide groups via lottery method. Self-designed proforma was applied for data collection. Data analysis was done in SPSS version 25.0. Results: There was no significant difference in the means of pretreatment (p=0.08) and posttreatment (p=0.10) fasting blood sugar levels between two groups, while significant differences between the means of pretreatment and posttreatment fasting blood sugar levels within metformin group (p=0.02) and repaglinide group (p=0.01) were noted. Likewise, there was no significant difference in the means of pretreatment (p=0.07) HbA1C levels of two groups; however, significant difference was observed in the means of posttreatment (p=0.04) HbA1C of two groups. Moreover, significant differences were also seen between the means of pretreatment and posttreatment HbA1C levels in both metformin group (p=0.03) and repaglinide group (p=0.01). Conclusions: This study suggests that although both metformin and repaglinide are effective in the new-onset T2DM managementz; however, reduction in fasting blood sugar level and HbA1c was more in repaglinide group.

Correlation of glycated hemoglobin with serum uric acid levels among type 2 diabetic patients: a cross-sectional study

Background: Diabetes Mellitus Type 2 (DMT2) is one of the commonest disorders of endocrinology which is characterized by the raised blood glucose level due to insulin resistance in body cells. This study was aimed to determine the correlation between the glycated hemoglobin (HbA1c) and serum uric acid (SUA) in patients with DMT2. Methods: This cross-sectional study was conducted in a tertiary care hospital of Lahore. 73 Patients’ recruitment was made via convenient sampling technique and a developed inclusion and exclusion criteria. Self-structured proforma was used for data collection. Data analysis was done in SPSS version 25.0. Results: From total patients, 40 (54.79%) were women while 33 (45.21%) were men. Means of different variables like age, HbA1c, and serum uric acid level were 54.98 years with standard deviation (SD) of ±11.67 years, 7.90 with SD of ±1.85%, and 7.51 with SD of ±0.81 respectively. 32 (43.83%) patients had good glycemic control whereas 41 (56.17%) patients had poor glycemic control. The frequencies of hyperuricemia and normal SUA in study population were 35 (47.94%) and 38 (52.06%) respectively. The means of the HbA1c across gender had statistically significant difference. Difference in the means of the SUA level, across gender and between patients with hyperuricemia and normal SUA level, was also statistically significant. Moreover, correlation between the HbA1c and SUA was positive and statistically significant. Conclusions: In a nutshell, this study suggests that increase in SUA level, worsen the glycemic control by raising glycated hemoglobin level among patients with DMT2.

Association between serum uric acid level and microalbuminuria among type 2 diabetic patients: a cross-sectional study

Background: Diabetic nephropathy is common and its advancement is affected by different factors and one of them, serum uric acid has crucial role in the progression of kidney injury. The objective of this study is the determination of the association of serum uric acid level with the microalbuminuria among type 2 diabetic patients. Methods: This cross-sectional study was performed in a tertiary care hospital of Rawalpindi, among 108 patients for 8 months from March 2021 to October 2021. Patients’ recruitment was done by the inclusion and exclusion criteria and convenient sampling technique. Data was obtained via a self-designed proforma. Descriptive and inferential statistics were applied for data analysis. P<0.05 was taken as statistically significant Data analysis was performed by SPSS version 25.0. Results: From total study population, 60 (55.55%) were females, whereas, 48 (44.45%) were males. The means of age for the study population and serum uric acid were 48.98±15.67 years and 7.12±0.91 respectively. The overall frequencies of hyperuricemia and microalbuminuria were 41 (37.96%) and 33 (30.55%) respectively. The frequency of hyperuricemia was higher among older age group, women, and patients with microalbuminuria. The associations of serum uric acid level with the age group, gender, and albuminuria were significant statistically. Conclusions: Correlation between the serum uric acid levels and albuminuria is statistically significant. Serum uric acid levels have statistically significant relationship with age and gender as well. Serum uric acid level was higher among older age group, females, and patients with microalbuminuria.

Impact of diet on attention-deficit hyperactivity disorder in a tertiary care hospital of Rawalpindi

Background: Attention-deficit hyperactivity disorder (ADHD) is a prevalent neuropsychiatric disorder of children that affects almost all aspects of the life. The role of diet in the management of the ADHD is understudied in Pakistan. This study aimed to assess the impact of different types of diet on the symptoms of ADHD among the children with ADHD. Methods: This descriptive cross-sectional study was conducted among 58 children with ADHD in Rawalpindi. Ethical approval and informed consent were obtained. Patients’ recruitment was done via developed criteria and Convenient sampling technique. Descriptive statistics and one-way ANOVA were used to determine the difference of ADHD severity among various frequencies of different included foods via Conner Parent rating scale-revised short form. Data analysis was performed by SPSS version 25.0. Results: The difference in hyperactivity index, impulsivity, and learning problems score on CPR-RS among various frequencies of carbohydrate, protein rich and fat foods, was statistically significant and with the increase intake of carbohydrate and protein rich foods, the score on CPR-RS of hyperactivity index, impulsivity, and learning problems also goes up. Whereas, with the increase intake of fat rich foods, the score of hyperactivity index, impulsivity, and learning problems goes down. Conclusions: In short, the high intake of carbohydrate and protein rich foods, increase the severity of the symptoms of ADHD, while, high intake of fat rich foods decreases the severity of the symptoms of ADHD among children.

Impact of breastfeeding on the intelligence quotient of the children of Rawalpindi, Pakistan

Background: Breastfeeding impacts the children physical and mental growth and development. The impact of breastfeeding on intelligence quotient (IQ) of children is under-researched in Pakistan. This study aimed to determine the impact of breastfeeding on the intelligence quotient among children of Rawalpindi, Pakistan. Methods: This comparative cross-sectional was performed among 88 children of the Rawalpindi. Patients’ enrolment in the study was done via non-probability convenient sampling and developed inclusion and exclusion criteria. Ethical approval and informed consent were taken. Intelligence quotient was calculated through Wechsler intelligence scale for children (WISC). Data analysis was done via descriptive and inferential statistics by statistical package for the social sciences (SPSS) version 25. Chi square test was used to assess the variables association. P value less than 0.05 was set as statistically significant. Results: The overall mean score on WISC of intelligence quotient was 106 with SD of ±39, whereas, mean score of intelligence quotient for breastfed children was 112 with SD of ±32 and mean score of intelligence for children who were on formula milk was 100 with SD of ±36. The association between the type of milk and intelligence quotient (p=0.003) and association between duration of breastfeeding and intelligence quotient (p=0.04) was statistically significant. Conclusions: Children who had been on breastfeeding had better IQ. Furthermore, children who were breastfed for longer duration had even better IQ than children who were on breastfeeding for shorter duration.

Laparoscopic cholecystectomy: the treatment of choice for cholelithiasis in infancy and childhood

Twelve consecutive laparoscopic cholecystectomies [LC] were performed between January 1994 and October 1996 at King Khalid University Hospital. In all patients the indication for cholecystectomy was symptomatic gallstones. Among the 12 children, six had sickle cell disease. The operating time ranged between 65 and 135 minutes [mean=89 +/- 21.06]. There was no major morbidity or mortality. The average duration of postoperative parenteral analgesia [pethidine hydrochloride] required was 0.47 +/- 0.19 day [ranged between 0.3 and one day]. The average postoperative stay was 1.67 +/- 0.44 days [ranged between 1 and 2.5 days]. In conclusion, LC is safe, effective and the preferred approach for cholelithiasis in children, with the advantages of short postoperative analgesia requirement, shorter hospitalization, and therefore, an early return to normal daily activities

Evaluation of serum calcium in Mosul laboratories

Serum calcium has been estimated among 16 controls and compared with that from patients, using three methods, Cresophthalin complex method and Trender method and Permanganate titration method, Cresophthalin complex method is considered to be the best method for the determination of serum calcium, because of it's specificity and accuracy. The evaluation of serum calcium among patients showed, that 15 are normocalcemic, 20 patients are hypocalcemia and 15 patients are with hyperalcemia. From cases of hypercalcemia, 8 patients had malignancy, [5 with metastasis to bones, 3 were without metastasis to bones]. 3 patients had Multiple Myeloma. Where as the other 3 patients had primary hyperparathyroidism and another patient had hypercalcemia due to over use of vitamin D

management of esophageal strictures in children

During a 10-year period from 1982 to 1992, 36 children and infants were treated for esophageal stricture. The severity of the stricture was indicated by the degree of feeding intolerance manifested by delays in growth and development and confirmed by fluoroscopy and endoscopy. Their ages ranged from one month to seven years. During the first eight years, the initial treatment was the conventional use of Savory dilators. Balloon dilatation was applied in all patients with esophageal stricture during the last two years. According to the etiology of the stricture, patients were divided into three groups. Group A: [seven patients] due to peptic esophagitis following persistent gastroesophageal reflux [GER]. Group B : [15 patients] following ingestion of corrosive material. All had severe strictures; two had stomach outlet obstruction in addition. Group C : [14 patients] following repair of esophageal atresia. There was no mortality; however, overall morbidity was 5.5%, as one patient had esophageal perforation during the initial esophageal dilatation and one patient developed anastomotic leak

Midline cervical cleft

Three patients with midline cervical cleft are reported. To our knowledge, this rare condition has not been described previously in Arab children. A description of the lesion, its management and a review of the literature are given

experience of modified soave procedure in King Khalid University Hospital

A modification of the original Soave procedure is described in this paper. Eight patients within the age range 6 months to 14 years at the time of presentation were operated upon. Three of those were referred after trial of conservative treatment for constipation to exclude or confirm Hirschsprung's disease; in five, transverse colostomy had already been performed. There was no operative mortality but three patients had postoperative complications; namely anal stenosis and subacute intestinal obstruction

Gastric transposition for oesophageal replacement in childhood

Two infants who presented with long-gap oesophageal atresia and tracheo-oesophageal fistula were initially treated in King Khalid University Hospital by division of the fistula, gastrostomy and cervical oesophagostomy. A year later the whole stomach was used to replace the oesophagus. One patient had herniation of the small bowel into the chest months after surgery, through the old oesophageal hiatus. This required surgical intervention. Both patients showed a normal growth and developmental pattern over the 2 years following surgery. Gastro-oesophageal reflux has not been a problem in either patient

Protein loss during isolated ultrafiltration patients with chronic renal failure

Six hypertensive overhydrated maintenance dialysis patients [4 women, 2 men] were treated with isolated ultrafiltration and sequential dialysis for 1 to 3 months. Two to 5.5 liters of fluid were removed each time in 2-4 hours of isolated ultrafiltration. Haemoglobin concentration and haematocrit increased in proportion to the volume of fluid extracted. Serum protein concentration increased to a lesser extent indicating protein loss during ultrafiltration. The ultrafiltrate contained 0.432 +/- 0.084 g/Liter of immunognobulins. The proportion of filtered IgA relative to its plasma concentration was highest and that of IgG lowest, probably due to differences in the shapes of their molecules

Volvulus of the sigmoid colon in a child

Volvulus of the sigmoid colon, which is common in certain groups of adults and in certain ethnic groups, is extremely rare in infancy and childhood. The clinical features and the radiological appearances may not distinguish the condition from other causes of an acute abdomen. We report this condition in a Saudi child in whom laparotomy and simple reduction of the volvulus proved satisfactory