Vitamin D deficiency and hypertension in type 2 diabetic Iraqi patients

Objective: Vitamin D[3] deficiency has been defined as serum 25-hydroxyvitamin D[3][25-[OH]D[3]] levels below 30 ng/ml and it is common among patients with type 2 diabetes mellitus [T2DM]. Laboratory studies indicate that 1,25-[OH]D[3] suppresses renin expression and vascular smooth muscle cells proliferation, then decreases blood pressure. The aim of the present study is to demonstrate the association between 25-[OH]D[3] level and the risk of blood pressure, and its relation with T2DM and body mass index [BMI]

Method: This study was conducted at Al-Hussein Medical City/Al-Hussein Teaching Hospital, Karbala, Iraq. All samples, 30 apparently healthy subjects as control, N = 30 and 90 patients [equal number of male and female] with T2DM [50 obese with hypertension [G1] and 40 non-obese without hypertension [G2]], were randomly selected from diabetic patients who had attended the diabetic consultation unit from November 2012 to June 2013 with age ranged between 23 and 75 years. Measurement of 25-[OH]D[3], fasting blood glucose, triglyceride, total cholesterol and high-density lipoprotein cholesterol [HDL-C] levels in addition to blood pressure and BMI were calculated in all samples

Results: The results showed that serum 25-[OH]D[3] was significantly decreased in G1 and G2 groups [16.8 +/- 8.8 ng/ml, 19.5 +/- 9.7 ng/ml, respectively], compared with control group [36.0 +/- 9.4 ng/ml] at P < 0.001, and 68% of female vs. 57% of male underwent this deficiency. Also 25-[OH]D[3] had negative correlation with blood pressure, fasting blood sugar, triglycerides and BMI in diabetic patients in G1 at P < 0.0001 and it had positive significant correlation with HDL-C in G1 and G2 groups

Conclusion: It can be concluded that T2DM, systolic and diastolic blood pressure levels correlates significantly with lower concentration of 25-[OH]D[3], which suggested that clinical experiences should be taking into account the protective effect of vitamin D in decrease hypertension, which reflects risk factors in diabetic patients with hypertension that leads to metabolic syndrome and then to cardiovascular diseases

case report of congenital insensitivity to pain and anhidrosis

Congenital insensitivity to pain with anhidrosis [CIPA] is a rare disorder characterized by episodes of fever and pain insensitivity despite the fact that all other sensory modalities remain intact or minimally impaired. Other clinical features are self-mutilated behaviour, mental retardation and anhydrosis. We present a case first time from Pakistan, 9- and 4-year-old brother and sister respectively, diagnosed as CIPA clinically with the above-mentioned clinical characteristics.

South African Hypertension Practice Guideline 2014 : Review Article

Outcomes : Extensive data from many randomised; controlled trials have shown the benefit of treating hypertension (HTN). The target blood pressure (BP) for antihypertensive management is systolic 140 mmHg and diastolic 90 mmHg; with minimal or no drug side effects. Lower targets are no longer recommended. The reduction of BP in the elderly should be achieved gradually over one month. Co-existent cardiovascular (CV) risk factors should also be controlled. Benefits : Reduction in risk of stroke; cardiac failure; chronic kidney disease and coronary artery disease. Recommendations : Correct BP measurement procedure is described. Evaluation of cardiovascular risk factors and recommendations for antihypertensive therapy are stipulated. Lifestyle modification and patient education are cornerstones of management. The major indications; precautions and contra-indications are listed for each antihypertensive drug recommended. Drug therapy for the patient with uncomplicated HTN is either mono- or combination therapy with a low-dose diuretic; calcium channel blocker (CCB) and an ACE inhibitor (ACEI) or angiotensin receptor blocker (ARB). Combination therapy should be considered ab initio if the BP is ? 160/100 mmHg. In black patients; either a diuretic and/or a CCB is recommended initially because the response rate is better compared to an ACEI. In resistant hypertension; add an alpha-blocker; spironolactone; vasodilator or ?-blocker

Diurnal fluctuation of the heat fluxes over the Northern Arabian Sea

The sea surface hourly meteorological parameters that were recorded at five time series stations under the North Arabian Sea Environment and Ecosystem Research [NASEER] programme [1992-1994] were used to study the heat fluxes including; momentum, latent, sensible and moisture heat fluxes as well as the net heat gain and total heat loss over the northern Arabian Sea. The study is the part of research on the formation and distribution of northern Arabian Sea water mass. The momentum or wind stress fluxes during the January 1992 and December 1994 were quite large in both the components of eastward [0.188 N m -2] and northward [0.148 N m -2]. During the August 1992, the east and north components were negative indicated direction of momentum from southwest with values under 0.1 N m-2. The data recorded during the March of 1993, have the visible diurnal variational pattern. The average of sensible heat fluxes during January 1992 was 76 Wm -2, while in the August of 1994 was 71 Wm -2. The results of evaporation indicated the similar pattern of diurnal variation as observed for the data of latent heat fluxes. During the January 1992 cruise, minimum evaporation is computed in the early morning and maximum after 1100 hours. However, during the December 1994, minimum evaporation was observed after sunrise and maximum near to sun set. The mean of the Net Heat Gain during the January 1992 was 138 Wm -2 while, in the August 1992, mean of the area was computed as 96 Wm -2. The Net Heat Gain values depicted that in the entire area of observation, heat was lost from sea surface to the atmosphere

Emerging bacterial resistance patterns in febrile neutropenic patients: experience at a tertiary care hospital in Pakistan

To look at the clinical presentations, spectrum and site of isolation of the organisms, sensitivity patterns of the organisms and the antibiotic prescribing practices for the treatment of febrile neutropenic patients at our hospital. The data were collected retrospectively from the records of all neutropenic patients with an absolute neutrophil count [ANC] of less than 500/ml admitted during the period of 3 years from August 1999 to July 2002 at AKUH. Out of the total of 404 patients, 65% had hematological malignancies and around half of them had leukaemia, 86% of the patients presented with fever. A total of 124 bacterial organisms were isolated from 96 patients among which 47% were gram positive and 53% were gram negative organisms; 16.1% of the patients had septicaemia. Coagulase Negative Staphylococci [CoNS] were the most common gram positive and E coli was the most commonly isolated gram negative organism. Most of the gram positive organisms were isolated from blood [67%]. There was emerging resistance to all commonly used antibiotics including imipenem, cloxacillin, vancomycin and amikacin. The average duration of neutropenia was 6.4 days. The mortality rate was 6%. There is increasing trend of gram negative organisms developing resistance to commonly used antibiotics. Gram positive bacteria including Enterococcus spp. and CoNS are also showing emerging resistance to vancomycin

Bronchial Asthma; assessment of patient`s awareness level about different aspects of their disease

Objectives: To assess the patients level of understanding of their disease and their experience in the management offered to them

Introduction: Bronchial Asthma is a common episodic disorder of all ages. Successful management depends on active and continuous interaction between the clinician and a well-educated patient. Detailed interview of patients ware carried out on different; aspects of their experience of the management and to assess the level of understanding of their disease. This would highlight the common deficiencies in the management in our own setup. Study Design: Observational; study. Period: From January to December 2003, Setting: Al-Shifa Medical Center Faisalababd

Materials and Methods: Any patient with a diagnosis of Bronchial Asthma and using MDI device was assessed for the competency of diagnosis. A specially trained nurse interviewed the eligible patients on a prescribed performa. The physician checked all the information before making a detailed clinical examination. Patients below the age of 16 or over the age of 60, seriously sick patients and COPD were excluded

Results: 192 patients were enrolled in this study. There were 112 males and 80 females. 66% incriminated allergy to something, 75% blamed upper respiratory tract infection, 54% recognized exercise as the precipitating event, 33 attributed it to emotions, only 8% recognized menses as the factor, 54% related it with environmental change or specific environment, 41% related it with change in season or through some particular season, 68% called it dust allergy, 12.5% recognized pets and chemicals as the culprit, 8% incriminated work place environment and 16.7% could recall some specific drug as the cause of their attack of asthma. One patient could connect more than one stimulus to his or her attack. Only 52%, 44% and 32% of patients knew the mode of action and the difference between the three most commonly used drugs i.e. aminophyllines and steroids respectively 92% did not have a rescue prescription for their acute severe attack our had any concept of it. 79% gauged the severity of their attack of acute severe Asthma on the basis of perceived severity of symptoms and 58% on frequency of symptoms. Only 29% could recognize bouts of cough as a symptom of Asthma. Only 8% of patients were objectively tested by measuring PFR at the clinics of their doctors and only half of them were doing it at home

Conclusion: Well-educated patients can do a lot in modifying their treatment. This study speaks loudly of the inadequacies in our management. More emphasis on different aspects of patient education is the only way to improve our standard of Asthma care

Genetic and physical evidence for plasmid in Shigella species specifies one or more function essential for O-antigen

Shigella species are invasive enter bacteria that cause dysentery a sever form of diarrhea. The ability to invade epithelial cells is essential for virulence in a prototype Shigella species. It has shown here t that clinical isolates of Shigella dysenteries were investigated. GEB 937 lacked a small plasmid 4.3 kb [plasmid pSA1], exhibited reduce invasiveness for Hep-2 cells, and failed to produce the somatic antigen. The transfer of this plasmid into Escherichia coil MM294 confirmed the conclusion that pSAl encodes one or more function involved in O-antigen [lipopolysaccharide] biosynthesis and bacterial virulence. A plasmid of similar size as detected in all of the other strain of Shigella species examined