Dyslipidaemia in Newly Diagnosed Diabetic Patients with and without Microalbuminuria

To determine the association of dyslipidemia in newly diagnosed diabetic patients with and without microalbuminuria. Cross sectional study. The study was conducted from December 2009 to July 2011 at Medical Unit 1, Pakistan Railway Hospital, Islamic International Medical College [IIMC] Rawalpindi. A cross sectional study was carried out in Medical Unit 1 Pakistan Railway Hospital Rawalpindi. The newly diagnosed diabetic patients i.e. the patients who have not yet been given any treatment, of both genders, without overt-proteinuria were included in the study. A proforma was filled indicating their bio-data, history and clinical examination and laboratory investigations which included fasting blood glucose, urinary albumin and lipid profile. If albumin was negative with dipstick, a sample of urine was sent for microalbuminuria. Frequency of dyslipidaemia in patients with and without microalbuminuria was determined. Out of the 317 newly diagnosed diabetic patients screened for microalbuminuria, 43 patients [13.5%] had microalbuminuria while 274 patients [86.6%] did not have microalbuminuria. Out of these patients with microalbuminuria, 58.8% [i.e 24] of patients had dyslipidaemia. Among microalbuminuria negative patients only 36% [i.e101] of patients had dyslipidaemia. The dyslipidemia, occurs more frequently in newly diagnosed diabetics who have micro-albuminuria than those without micro-albuminuria

Frequency of latent tuberculosis among diabetics and non-diabetics

To determine the frequency of latent tuberculosis among diabetics and non-diabetics. Adescriptive cross sectional study. At Unit II, Department of Medicine, Benazir Bhutto Hospital, Rawalpindi from October 1,2009 to March 30,2010. Across sectional study was carried out in MUM, BBH Rawalpindi. All patients, male and female, both diabetic and non diabetic, above the age of 18 years, presenting in Out-Patient department for regular check up or follow up were included in the study. Mantoux test was carried out in all patients to find out the frequency of latent tuberculosis in diabetics and non diabetics. A total of 286 patients were initially inducted in the study. However by the end of study, 20 patients dropped out as they lost follow up. So 256 patients were finally included in the study. Amongst them 131 were diabetics i.e., 51.2% and 125 were non diabetics i.e., 48.8%. One hundred and seventeen were male i.e., 45.7% and 139 were female i.e., 54.3%. Mantoux test was carried out in all patients both diabetic and non diabetic. Out of 256 patients Mantoux test was positive in 33 patients i.e., 14.8%. Among diabetics Mantoux test was positive in 27 patients i.e., 10.5%. While among non diabetics Mantoux test was positive in 11 patients i.e., 4.3%, with a p value of .008.This shows that latent tuberculosis is more common in diabetics than non diabetics. Latent tuberculosis is more common in diabetics than non diabetics. Treatment of latent TB in diabetics may have a beneficial impact on TB control

Headache: a useful clinical feature in detecting serious underlying cause

To examine the utility of clinical features in detecting serious underlying causes of headache in patients presenting to an emergency room. Descriptive Observational Study. Pakistan Railway Hospital spanning over a period of one year from July 2010 to June2011. Medical records of the patients attending the Emergency Room with headache as the major complaint were studied. 312 patients presented to ER with a complaint of headache. Of these 7.7% [n=24] had malignant headache and 92.3% [n=288] had benign headache. One hundred and ninety six patients [62.8%] were women and 116 [37.2%] were men. In males there were 86.2% patients with benign headache and 13.8% with malignant headache. While in females 94.9% had benign and 4.1% malignant headache. Ninety percent of patients had altered consciousness at presentation proved to have malignant cause for their headache. This figure was 91% for limb weakness, 100% for papillary and gaze abnormalities, 89% for extensor plantar response, and 85% each for papilledema and neck rigidity. Females present at younger age with headache and tend to have benign than malignant headache in majority of cases. Males present at relatively older age and tend to have malignant than benign headache in majority of cases. Younger patients presenting with headache usually have benign and elderly patients usually have malignant illness as the cause of their headache. With a good history and thorough physical examination Imaging like CT Scan and MRI can be avoided

Hepatic cirrhosis; its etiology and complications

To determine etiology and complications in the patients suffering from cirrhosis of liver in Railway Hospital. Descriptive study. At Medical Unit II, IIMC-T, Pakistan Railway Hospital, Rawalpindi from March 2004 to July 2007. Patients suffering from cirrhosis of liver on the basis of clinical and ultrasonographic findings were included in the study. All other patients of liver disease without evidence of cirrhosis were excluded. Data of the patients regarding the etiological factors and complications of cirrhosis were recorded onaproforma. Out of 141 patients, 56% were males and 44% were females. The mean age was 48.67 years. Most of the patients had HCV infection [61%] followed by HBV infection [20.56%]. Co-infection with HBV and HCV was 3.54%. 3.54% had alcoholic cirrhosis while 5% had post-surgical biliary cirrhosis. Only 2.12% had Wilson's disease and 4.25% were cryptogenic. Most common presentation was simple ascites [33.33%], next was variceal bleeding [27.65%]. Spontaneous bacterial peritonitis was present in 7.8%, hepatic encepha-lopathy in 15.6%, hepatorenal syndrome in 2.12%, generalized bleeding tendency in 3.54% and 5% of cases developed hepatocelluar carcinoma. HCV infection was most common etiology while simple ascites was most common presentation. Emphasis should be on prevention of hepatitis B and C infections through public awareness programmes

Frequency of clinically visible diabetic retinopathy among indoor diabetic patients in a teaching hospital of Rawalpindi

To determine the frequency of diabetic retinopathy among indoor diabetic patients. To document the effect of duration, type, control of diabetes, gender and concurrent hypertension on severity of retinopathy in our local population. Detailed ophthalmic evaluation of indoor diabetic patients in Pakistan Railways Hospital Rawalpindi was performed. History of duration, type of diabetes, control, treatment and hypertension was recorded. Thorough ophthalmic examination was performed including fundus evaluation with maximum mydriasis using direct and indirect ophthalmoscopy and superfield lens fundus assessment under high magnification. Out of 4725 patients admitted, 789 were diabetics. 171 diabetics presented to ophthalmology department. Non-proliferative diabetic retinopathy [NPDR] was seen in 25.14% and proliferative diabetic retinopathy [PDR] in 11.11% of cases. Advanced diabetic eye disease was seen in 3.8% of patients [included in PDR cases]. Retinopathy was more frequent in cases with longer duration, type 1 diabetes, poor control, male gender and concurrent hypertension [with poor diabetic control]. Hypertension in the presence of good diabetic control did not adversely affect the retinopathy. On comparing the presence and severity of retinopathy between 10 years duration of diabetes, a statistically significant difference was found [p 0.0005]. Comparing the same between type 1 and type 2 diabetes, the difference was statistically significant [p 0.006] while comparison between good and poor control of diabetes yielded a difference that was statistically significant [p 0.0495]. Gender comparison revealed male preponderance but the difference was not statistically significant [p 0.739]. Among the diabetic admissions seen, 36.25% of patients had the changes of diabetic retinopathy. Significantly greater frequency of retinopathy was seen in cases with longer duration, type 1 and poor control of diabetes. Hypertension in the presence of poorly controlled diabetes affected the retinopathy adversely. Developing countries require aggressive screening and control strategies for diabetes to prevent microvascular complications