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.

Hepatitis E virus seroprevalence in pregnant women in Pakistan: maternal and fetal outcomes

Hepatitis E virus [HEV] is endemic in Pakistan. Although otherwise asymptomatic, HEV infection becomes fatal in pregnancy, with considerable maternal and fetal morbidity and mortality. We conducted a descriptive study from April to October 2015 in 10 tertiary care hospitals throughout Pakistan to determine maternal and fetal morbidity and mortality in HEV-positive pregnant women with acute jaundice or raised liver function tests. Twenty-one of 135 women were HEV positive and in 3rd trimester except for 1 in 1st trimester. Overall prevalence of HEV in pregnancy was 0.19%. Ten women were artificially induced, 3 had premature labour, 4 delivered spontaneously [full term], 3 died and there was 1 intrauterine death. One woman had a home abortion before coming to hospital. There were 7 perinatal infant deaths: 4 intrauterine, 3 stillbirths and 1 abortion. Maternal mortality was significantly associated with delivery, as 17 mothers who lived went into labour spontaneously or were artificially induced, whereas 3 women who continued their pregnancy and did not deliver, died. Case fatality rate of HEV infection in pregnancy was 14.2%

Phytochemical screening, antiglycation and antioxidant activities of whole plant of Boerhavia repens L. from Cholistan, Pakistan

Present study was aimed to explore a traditionally used indigenous medicinal plant Boerhavia repens [Nyctaginaceae family] of the Cholistan desert, Pakistan. Crude aqueous and methanolic extracts of the whole plant were investigated in vitro for preliminary phytochemical screening, antioxidant and antiglycation activities. Antioxidant activities were determined by total phenolic contents, 1,1-diphenyl-2-picrylhydrazyl [DPPH] free radical scavenging and inhibition of lipid peroxidation. For antiglycation activities browning production was noted and thiobarbituric acid [TEA] technique was used to determine glycation level. Boerhavia repens expressed considerable amounts of phytochemicals. Extract yield was found to be 4.59%-7.85% g/100g of dry matter with total phenolics ranging from 47.9- 190.77mg/GAE per g for aqueous and methanol extract respectively. Strong inhibitory effect was exhibited by methanolic extract in linoleic acid per oxidation system [86.11%, EC[50]=0.99mg/mL] and DPPH assay [88.65%, EC[50] =212.33 Lig/ml]. In term of browning maximum inhibition [81.50%] was exhibited by methanolic extract at 37°C at third week of incubation. Both extracts expressed significant [P>0.05] and comparable inhibition of glycation level. In conclusion, Boerhavia repens showed promising antioxidant and antiglycation activities validating its therapeutic potential

Burden and associated factors for caregivers of the elderly in a developing country

The elderly population in South Asia is growing. In Pakistan trained caregivers are scarce and culturally not acceptable. This study assessed the level of stress experienced by caregivers of the elderly and determined the association of care giving burden with different characteristics of the elderly. A cross-sectional, questionnaire based study was conducted using nonprobability purposive sampling. All consenting participants aged 60 years and above needing help with at least one activity of daily living or two instrumental activities of daily living were included. 350 participants were assessed for perceived care giver burden. Care providers were mostly female [68.9%]. Half [50.3%] of the caregivers had a positive score on a perceived care burden scale. Financial impact had a strong correlation [0.79] with perceived caregiver burden. Higher dependency levels of a physical and cognitive nature posed greater burden on caregivers. Behavioural issues of the elderly such as verbal abuse and difficulty sleeping were predictors of a higher caregiver burden. Caregiver burden is a significant issue for those caring for elderly family members in Karachi, Pakistan

Glycation pattern of captopril in diabetics

Captopril is a chemical which acts as vasodilator and angiotensin- I converting enzyme inhibitor. The present attempt is to study the glycation inhibition pattern of captopril in diabetics and normals. Experimental Study. This study was conducted at the Research Lab., Department of Biochemistry, University of Agriculture, Faisalabad from May 2006 to February 2007. The study was designed on blood plasma from apparently healthy non-diabetic and diabetic persons. Plasma samples with different concentrations of glucose and that of captopril were prepared, followed by incubation for 5 weeks at 37 °C temperature. Glucose was estimated by glucose oxidase method before and after dialysis. Glycation level was measured by TBA and Periodate assays. Increased glycation was observed from 1[st] to 3[rd] week of incubation while it decreased after 5[th] week due to the formation of advanced glycatiori end products. 10 mM concentration of captopril showed fairly good response to decrease glycation as compared to its other two concentrations. Highest concentration of captopril produced overall good enough of inhibition. Periodate borohydride appeared to be more reliable and sensitive glycation assay as compared to TBA

Knowledge of depression among community members and health care providers in two selected areas of district Rawalpindi

To determine the level of knowledge about depression in two selected areas of district Rawalpindi. Cross-sectional survey report. Union council Rehmatabad and mohalla Sultanpura, Rawalpindi, from June to December 2007. Strata of community were interviewed regarding the knowledge about depression using an indigenously developed questionnaire. To determine any association between difference of level of knowledge and different strata of community Chi-square [X][2] tests was applied at 5% level of significance and p-value less than 0.05 was considered significant. Most of the respondents [63%] thought that diabetes was the major health problem in our country. Most of participants thought that drug abuse and addiction [74.3%], adolescent emotional and behavioral problems [66.8%] followed by alcohol abuse [50.3%] and personality disorders [49.2%] were the common mental illnesses. Chi-square [X][2] statistics showed a highly significant association between difference of level of knowledge and the two strata of community i.e. health care providers and community members [p < 0.001]. People in the selected areas of district Rawalpindi had a poor knowledge about depression

introduction to general methodology for screening of medicinal plants

Screening of plants is essential to explore the presence of novel compounds and to investigate their biological activities. Once the presence of such compounds is suspected, they are generally isolated in order to have material available for further biological and toxicological test[1, 2]. It is a cumbersome, tedious and lengthy process that starts from the selection of suitable plant/s to find out their pure constituents.It involves a continued effort that might last from weeks to years and includes the following steps: 1.Correct identification of the plant with the aid of specialists [botanists]. 2. Collection and drying of the vegetable material; precautions need to be taken to avoid the formation of artifacts. 3. Preparation of extracts using different solvents; analysis of these extracts by different chromatographic methods. 4.Fractionation of the extracts by different preparative chromatographic techniques [column chromatography, centrifugal partition chromatography etc.]. 5. Purity control of the isolated products. 6. Structure elucidation of the constituents by combination of diverse spectroscopic techniques [UV/VIS, IR spectrophotometry, carbon and proton nuclear magnetic resonance, mass spectrometry, X-ray diffraction] and chemical techniques [hydrolysis, formation of derivatives, degradation reactions etc.]. 7. Synthesis or semi-synthesis of the natural product. 8. Modification of structure with a view to establish structure-activity relationships. 9. Pharmacological and toxicological testing

Sesame radiatum phytoestrogens stimulate spermatogenic activity and improve sperm quality in adult male Sprague Dawley rat testis / Fitoestrógenos sesame radiatum estimulan la actividad espermatogénica y mejoran la calidad del esperma en el testículo de ratas Sprague Dawley adulto de sexo masculino

Increasing concern has been expressed about the declining sperm count of humans and the potential environmental effects of both synthetic and natural estrogenic endocrine disruptors (EEDs) on human reproductive health in the last few decades. However, due to paucity of knowledge, we evaluate the chronic reproductive toxicity of sesame phytoestrogenic lignans on the male Sprague Dawley (SD) rats' testis. Thirty adult male SD rats weighing 150-200g were divided into three groups. Two treated groups received a daily dose of aqueous leaves extract of Sesamum radiatum at 14.0 mg/kg bw and 28.0mg /kg bw respectively via gastric gavage, while equal volume of normal saline was administered to the control group for six weeks. Seminal analysis and hormonal assay study were analyzed using SPSS software and P< 0.05 was considered statistically significant. The results showed significant (P< 0.05) body weight gains observed in all the animals with significant (P< 0.05) weight increase in their raw testicular weights compared to control. The relative testicular weight per 100g bw was significantly (P< 0.05) higher in control than treated. However, the weight gain was dose related with a reversal in their relative testicular weight. The cauda sperm count including the motility and morphology of the treated were significantly (P< 0.05) higher than control in a dose related manner. In addition, significant (P > 0.05) increases in testosterone and a significant decrease in FSH in the high dose (treated) compared to control. Sesame phytoestrogenic lignans improves spermatozoa quality in a dose related manner.

Una mayor preocupación se ha expresado en las últimas décadas por la disminución en la cantidad de espermatozoides de los seres humanos y los posibles efectos ambientales de disruptores endocrinos estrogénicos (DES) sintéticos y naturales sobre la salud reproductiva humana. Sin embargo, debido a la escasez de conocimientos, evaluamos la toxicidad crónica para la reproducción de fitoestrógenos lignanos del sésamo en el testículo de ratas Sprague Dawley (SD) macho. Treinta ratas macho adultas, de un peso de 150-200g se dividieron en tres grupos. Dos grupos de tratamiento recibieron una dosis diaria de extracto acuoso de las hojas Sesamum radiatum de 14,0 mg/kg de peso corporal y 28,0mg / kg de peso corporal, respectivamente, a través de una sonda gástrica, mientras que igual volumen de solución salina normal se administró al grupo control durante seis semanas. El análisis seminal y estudio de ensayo hormonal fueron analizados mediante el software SPSS y P <0,05 fue considerado estadísticamente significativo. Los resultados mostraron significativas (P <0,05) ganancias de peso corporal observados en todos los animales con un peso significativo (P <0.05), aumento de peso en su peso testicular bruto en comparación con el control. El relativo peso testicular por 100 g de peso corporal fue significativamente mayor (P <0,05) en control que en tratamiento. Sin embargo, el aumento de peso dosis se ha relacionado con un retroceso en su peso relativo testicular. La cantidad de espermatozoides, incluyendo la motilidad y morfología de los que recibieron tratamiento fue significativamente más alto que el control (P <0,05) en una dosis relacionados. Además, significativo aumento en los niveles de testosterona (P> 0,05) y una disminución significativa de FSH en la dosis alta (tratados), en comparación con el control. Fitoestrógenos lignanos del sésamo mejoran la calidad de los espermatozoides en una dosis adecuada.

Biodiversity and phylogenetic analysis of culturable bacteria indigenous to Khewra salt mine of Pakistan and their industrial importance

Culturable bacterial biodiversity and industrial importance of the isolates indigenous to Khewra salt mine, Pakistan was assessed. PCR Amplification of 16S rDNA of isolates was carried out by using universal primers FD1 and rP1and products were sequenced commercially. These gene sequences were compared with other gene sequences in the GenBank databases to find the closely related sequences. The alignment of these sequences with sequences available from GenBank database was carried out to construct a phylogenetic tree for these bacteria. These genes were deposited to GenBank and accession numbers were obtained. Most of the isolates belonged to different species of genus Bacillus, sharing 92-99 percent 16S rDNA identity with the respective type strain. Other isolates had close similarities with Escherichia coli, Staphylococcus arlettae and Staphylococcus gallinarum with 97 percent, 98 percent and 99 percent 16S rDNA similarity respectively. The abilities of isolates to produce industrial enzymes (amylase, carboxymethylcellulase, xylanase, cellulase and protease) were checked. All isolates were tested against starch, carboxymethylcellulose (CMC), xylane, cellulose, and casein degradation in plate assays. BPT-5, 11,18,19 and 25 indicated the production of copious amounts of carbohydrates and protein degrading enzymes. Based on this study it can be concluded that Khewra salt mine is populated with diverse bacterial groups, which are potential source of industrial enzymes for commercial applications.

Avaliou-se a biodiversidade e a importância industrial de bactérias indígenas da mina de sal Khewra, Paquistão. Efetuou-se a amplificação do 16S rDNA dos isolados por PCR empregando-se os iniciadores universais FD1 e rP1, e os produtos foram seqüenciados comercialmente. Essas seqüências de genes foram comparadas com outras seqüências disponíveis no GenBank a fim de encontrar seqüências relacionadas, construindo-se uma árvore filogenética para essas bactérias. Os genes foram depositados no GenBank obtendo-se os números de acesso. A maioria dos isolados pertenceu a diferentes espécies do gênero Bacillus, apresentando 92-99 por cento de identidade de 16S rDNA com a respectiva cepa de referencia. Outros isolados apresentaram alta similaridade com Escherichia coli, Staphylococcus arlettae e Staphylococcus gallinarum, com 97 por cento, 98 por cento e 99 por cento de similaridade de16S rDNA, respectivamente. A capacidade dos isolados produzirem enzimas industriais (amilase, carboximetilcelulase, xilanase, celulase e protease) foi verificada. Todos os isolados foram testados em placas quanto a degradação de amido, carboximetilcelulose, xilana, celulose e caseína. Os isolados BPT-5, 11, 18, 19 e 25 produziram grandes quantidades de enzimas degradadoras de carboidratos e proteínas. Conclui-se que a mina de Sal Khewra apresenta diferentes grupos de bactérias, que são fontes potenciais de enzimas industriais de aplicação comercial.

Vacuum assisted closure of laparostomy wounds a novel technique

Management of a laparostomy wound is contentious. Specific pathologies like severe intraabdominal sepsis, trauma requiring damage control, abdominal compartment syndrome, staged abdominal repair and other complex abdominal pathologies can be managed with a novel technique of Vacuum Assisted Closure dressing. This device applies sub-atmospheric pressure that leads to reduced bowel wall edema, bacterial count and inflammatory burden found in open abdominal wounds. This leads to a reduced need for frequent dressing changes, maintaining intact skin and improvement in fluid management. Controlled clinical studies are needed to establish the safety and effectiveness of this treatment strategy. We present our experience with this technique suggesting it to be safe and effective. A brief outline of the working of Vacuum Assisted Closure dressing is also presented

Clinical investigation of hypoglycemic effect of coriandrum sativum in type-2 [NIDDM] diabetic patients

The present study was designed to investigate clinically the hypoglycemic effect of Coriandrum sativum in Type-2 diabetes mellitus. After assaying fasting plasma and urinary glucose, 10 patients of type-2 diabetes mellitus with no previous medication, 10 patients of type-2 diabetes mellitus taking oral hypoglycemic agents with history of inadequate control and six control subjects were given low [2.5 g tid] and high [4.5 g tid] doses of powdered part, aqueous extract and alcoholic extract of Coriandrum sativum for 14 days. On 15[th] day blood and urine samples for glucose were taken. Based on results obtained it was found that Coriandrum sativum has significant hypoglycemic activity in high dose and can be successfully combined with oral hypoglycemic agents in type-2 diabetic patients whose diabetes is not controlled by these agents

Cerebro vascular accident in sickle cell disease

An 11-year-old Saudi female reported in pediatric outpatient department with complaint of weakness of left side of the body for last two days. The child was a known case of sickle cell disease and was diagnosed at an age of 6 months. Two other siblings were also sicklers. She had an episode of left sided hemiparesis 2 years back and on CT scan, diagnosis of cerebral infarct was made [Figure 1]. Exchange transfusion was done at that time. Patient recovered completely. She was receiving blood transfusion every 6-8 weeks. During summer vacations, she went to her native town and did not receive blood transfusion for about 13 weeks. She developed weakness on left side of the body. On examination, she was fully conscious and well oriented in time, place and person. She was pale and her vital signs were stable. On central nervous system examination, her speech was normal. No cranial nerve deficit was noted. Power in left upper limb was grade IV/V with normal reflexes. Power in left lower limb around hip and knee was grade IV/V and power around left ankle was grade II. Plantar extensor and plantar clonus was present in the left side. No signs of cerebeller lesion or meningial irritation were noted. Rest of the systemic examination did not reveal any abnormality. Her blood counts revealed hemoglobin 7.2 g/dl, platelets 203 x 109/l and total leukocyte count 13.5 x 109/l with differential showing neutrophils 51%, lymphocytes 45%, monocytes 2% and eosinophils 2%. Reticulocyte counts were 13%. Biochemistry profile revealed glucose, urea, creatinine, electrolytes, calcium, aspartate transaminase and alanin transaminase within normal range. Total bilirubin was 46.7 umol/l [normal range 0.0-24 umol/l]; out of this unconjugated bilirubin was 41 umol/l. Lactate dehydrogenase [LDH] levels were 1543 U/l [normal value 297-537 U/l]. CT scan of the brain revealed right temporo-parietal infarct. Her hemoglobin S was 83% on hemoglobin electrophoresis. Exchange transfusion was done as per protocol of this hospital and child was maintained on adequate hydration. Child was discharged from hospital after two weeks. She was advised physiotherapy for weakness of left lower limb and hyper-transfusion protocol in outpatient department regularly

Results of surgical procedures for brachial plexus injuries due to penetrating trauma

The incidence of brachial plexus injuries is on the rise primarily due to the increase in road traffic accidents and the upsurge of violence in our society in general. Inappropriate and poorly timed management can lead to disastrous consequences, not only for the individual but also for the society as a whole. Twenty four patients who received penetrating wounds resulting in damage to the brachial plexus are presented. The time lapse between injury and surgery, level and extent of disability, mode of evaluation and the surgical procedures performed are discussed. Exploration and repair was performed in patients who presented early and in those with total lesions without evidence of recovery. Muscle transfer was the mainstay in patients who presented late and in whom some muscle groups had been spared. The results of surgery have been encouraging although the period of follow-up is relatively short. It is concluded that with the judicious use of intact muscles, nerve repair and grafting in selected cases and extensive physiotherapy useful function can be achieved even in patients with extensive post ganglionic lesions

Characteristics of psychiatric hospital absconders

Absence of patients without leave is common in psychiatric hospitals causing anxiety to staff, relatives and the lay public. This study is an attempt to identify some of the characteristics of patients absconding from the Mental Hospital, Lahore over one year. Absconders were predominantly young males who were compulsorily admitted and diagnosed as cases of schizophrenia. They tended to be single and had history of frequent and a relatively longer period of hospitalisation. Police were more often involved in their admission. Reasons for absconding and implications for management of newly admitted psychiatric patients are discussed

Fracture fixation with industrial glues: an experimental study in animals

This experimental study was planned to try several industrial glues including Araldite, Epoxy, Epoxy steel ect. in holding together the fractured fragments of bones in 20 rabbits. The animals were sacrified after 4 weeks and tissues from fracture site were subjected to histological examination. The control group revealed good healing and callus formatioin as seen on x-ray while histological examination of callus showed normal response of bone healing. The experimental group exhibited rotation and angulation of bone fragments of x-ray examination. The histology of the fracture site in this group revealed foreign body giant cell reaction. This experimental study thus showed that the industrial glues have a very limited role in fracture management

Hepatic hydatid cyst Double line sign on ultrasound

Fifty four cases of hepatic hydatid cyst were examined on ultrasound during the 3 year study. On the basis of sonographic appearance and clinical symptoms, four groups of cysts were identified, uninfected, organizing, suppurative and degenerated. The study was carried out to describe some new features found in the 54 cases studied which include :1. "Double line" sign reflecting the pericyst and laminated members of the cyst; 2. Differentiating the organization hydatid cysts from cysts of other types; 3. Analysis of echogenic material between the daughter cysts previously described as matrix [cysts with abundant matrix may mimic solid lesion] and 4. some clues in differentiating suppurative hydatid cyst from an abscess

Rural eye surgery experience of a non-governmental organization [NGO] in Pakistan

We discuss the problem of curable blindness in Pakistan, and present our experience with a Non-Government Organization [NGO] by adopting a fundamentally different approach to ensure quality care in eye surgery, free of cost to the patient, in Pakistani villages. A three tier program, which is being implemented in some villages for the last three years, was followed in order to: a] increase the number of cataract extractions by operating in selected villages for six months, and thereafter by construction of small hospitals which operate throughout the year; b] ensure a high standard of safety by the use of fully equipped air-conditioned mobile and static operation theaters manned by permanently employed and adequately qualified and experienced surgical and ancillary staff, whose quality care through adoption of recognized techniques and proper closure of operation wounds allows immediate ambulation of the patient, and provides a basis for the future day-care surgery; and c] establish a referral system with a [Base Hospital] for complicated cases