Glycemic control with four way model approach in rural area patients

Background: It is very important to keep the Glucose levels under control continuously and without any holidays. Type 2 diabetes is increasingly common in the industrialized world. Tight glycemic control attempts to rigidly glucose control levels (A1c: 6.5% -7.0% or lower). Maintaining tight glycemic control is lifesaving. Proper counselling, proper nutrition and if regular exercise is done it can result is good glycemic control.Methods: In the present study a total of 350 diabetic patients were selected out of which only 208 participants were eligible for study. Inclusion criteria in the study were 1) Age: men and women between age group 30 years to 70 years and 2) Type 2 Diabetes mellitus with HbA1c between 8 to 10%. Exclusion criteria in the study were 1) Type 1diabetes mellitus, Pre-existing renal, hepatic or cardiac disease, Hba1c >10%. A quadriad was established between patients, personal health worker, dietician and doctor.Results: Participants had regularly followed up and were divided randomly into cases (n = 112) and controls (n = 96). Patient were followed up as per study design it was observed that at the end of 3 months period mean FBS (case group 168.2±26.4 control group 200.8±38.3 p value <0.001) , Mean PPBS (case group 204.8±53.0 control group 271.0±45.5 p value <0.001) and Mean Hba1c (case group 8.7±0.5 control group 8.9±0.6 p value .003) in cases was significantly lower than control group.at the end 6 months it was observed that the mean cholesterol, mean triglyceride, mean LDL and mean VLDL was significantly lower in the cases compared to controls.Conclusions: A systematic approach and close monitoring that increased the adherence to medication, diet, and counselling would help in better glycemic control and prevent long term complication.

Lobectomy for congenital lobar emphysema, experience of two centers in Pakistan

Objective: To assess outcome of lobectomy in congenital lobar emphysema in pediatrics group of patients

Methods: This retrospective study was conducted in Department of Thoracic Surgery Nishtar Hospital Multan and Services Hospital Lahore from October 2003 to December 2015.All the patients of pediatric group who underwent lobectomy for congenital lobar emphysema were included in study. Demographic data, operative findings outcome of the procedure in terms of post operative complications and 30 days morbidity and mortality were recorded .All the patients presented with respiratory distress. Standard lobectomy was performed and bronchial stump was buttressed with surrounding lymph nodes, pericardial or pleural flap

Results: Of these 41 study cases, 30 [73.2%] were boys while 11 [26.8%] were girls and male to female ratio was 2.72: 1. Mean age of our study cases was 3.32 +/- 1.59 months [with age range; 15 days to 7 months]. Mean age of the boys was noted to be 3.38 +/- 1.52 months while that of girls was 3.18 +/- 1.84 months [p = 0.405]. Of these 41 study cases, left upper lobectomy was performed in 27 [65.9%] patients, right middle lobectomy in 11 [26.8%] patients, left lower lobectomy in 2 [4.9 %] patients and right upper lobectomy in 1 [2.4%] patients. Out of 41 patients 8 [19.5%] were preoperatively on ventilator. Out of 8 ventilated patients one had left sided chest intubation which was malpositioned and was in the lung parenchyma. Morbidity was superficial wound infection in 2 [4.9%] patients and post lobectomy empyema in 2 [4.9%] patients who required prolonged tube thoracostomy, antibiotics and chest physiotherapy. Mortality was recorded in 1 [2.4%] patient who was preoperatively on ventilator and had misplaced chest tube. That patient died on the 3rd post-operative day due to respiratory failure secondary tolung parenchymal injury

Conclusion: Our study results support surgical management of congenital lobar emphysema as Lobectomy was found to be safe, reliable and effective in these children presenting with respiratory distress due to lobar emphysema. There were no significant morbidities in these patients and clinical outcomes were satisfactory and surgical management is reported to be treatment of choice in pediatric patients with CLE

Olfactory tract transection reveals robust tissue-level plasticity by cellular numbers and neurotrophic factor expression in olfactory bulb.

Nervous system lesions are characterized by the loss of neuronal numbers and types. The neurotrophic factor levels in an injured tissue reflect their potential for regeneration. This hypothesis was investigated in olfactory bulb (OB), where olfactory tract was surgically transected disrupting neuronal migration and turnover. The effects were followed with quantification of mitral cells and three neurotrophic factors mRNA levels for 6 weeks. The neuronal numbers decreased by 3rd- and 4th-week in transected OBs followed by their restoration, comparable with that of controls at 5th- and 6th-week. The endogenous levels of three neurotrophic factors – (brain derived neurotrophic factor, insulin growth factor-1 and fibroblast growth factor-2) using qPCR showed increase at 2nd-week by 136-, 8- and 2-fold respectively. Also, there was a significant increase in specific neurotrophic factors at 5th-week and 6th-weeks. The results propose a temporal link between deployment of neurotrophic factors and the plausible restorative events for mitral cell numbers in OB.

Correlation of triceps skin fold with BMI in age matched men: anthropometric analysis

To study the thickness of the triceps subcutaneous fat measured by the caliper anthropometry, in age matched individuals having different body mass indices; and to determine if there is any correlation between the thickness of subcutaneous fat with that of the body mass index [BMI]. Cohort prospective. This study was conducted at Anatomy Dept, Nishtar Medical College, Multan from August 2010 to December 2010. Observations were made on 260 healthy men of 20-50 years of age. Regression analysis and Pearson's correlation coefficient were computed and are statistically significant [p < 0.05-0.01]. The results reveal that the triceps skin fold fat was very strongly correlated [range = 0.88 to 0.96] in all age groups. While in case of BMI it good in Groups I and II. On the other hand Age and BMI show little correlation with that of triceps muscle area. The results are statistically significant p value being 0.05 to .01. The study reflects some limitations of triceps anthropometry in estimating obesity but still has value in assessing nutritional status in special circumstances like refugee camps, schools

Alendronate a promising/ multi aspect drug in the management of ostoeoporosis

Recently, osteoporosis is regarded as a major health concern due to increase in its incidence, associated morbidities and mortalities. Among antiresorptives, alendronate which is a bisphosphonate is FDA [Food and Drug Administration] approved drug of choice for postmenopausal and glucorticoid induced osteoporosis. It has been also recommended for the prevention of bone loss in perimenopausal women. Currently, it has been also viewed as a treatment option in osteoporotic males. Several clinical trials have highlighted the significant role of alendronate in the management of osteoporosis. Although it was proved to be a safe drug for long time periods but very recently some studies have reported the risk of low energy subtrochanteric and diaphyseal femoral shaft fractures in the chronic users of alendronate. The current review is undertaken to elaborate the different aspects related to this drug in the scenario of osteoporosis management

Evaluation of breast feeding practices

The best first food for babies is breast milk. This study was conducted to assess the percentage of population having knowledge regarding benefits of breast feeding, exclusive breast feeding and ratio of mothers practicing it. This observational study was carried out from January 2008 to June 2008, in the vicinity of Isra University Hyderabad. A sample of 285 women who attended the Gynaecology antenatal clinics, living in the vicinity of Isra University, also lady doctors working there were enrolled by convenient sampling. A pre-designed questionnaire was filled by interviewing these women. The data collected was statistically analyzed and percentages recorded. Breast feeding was practiced in 278[97.54%] of the study population and only 7[2.45%] women did not practice it. 130[44.56%] of women were knowing about benefits of breast feeding and 155[54.38%] were not aware about the benefits. Among those knowing about the benefits, only 3.2% were fully aware, 67% were feeding for health of babies and 29.8% for prevention from diseases. Information regarding exclusive breast feeding was collected, 198 [68.70%] were practicing it and 87 [31.29%] were not exclusively feeding their babies. Time duration of breast feeding noticed that 28 [9.82%] of mothers feed their child for <6 months but most of women 104 [36.49%] for 2 years and some of them even feed for >2 years. Breast feeding is well practiced in this community but the ratio of exclusive breast feeding is low. Mothers have poor knowledge of benefits of breast feeding

Left main disease - patient profile

Background: left main coronary artery [LMCA] disease is a potentially lethal disease that can be effectively treated if it is recognized early. The aim of our study was to define the demography of patients with left main disease among those undergoing angiography at our center

Methods: the profile of 180 patients, who were found to have left main disease out of a total of 1111 consecutive patients undergoing coronary angiography, was studied retrospectively. Obstructive left main disease was defined as >/= 50% diameter stenosis on angiogram. All patients having atheromatous involvement of left main coronary artery from plaques to total occlusion were included

Results: the overall incidence of left main disease was 16.2%, however, if only obtrusive lesion lesions were considered it was 4.5%. Mean age was 58.9 years. 41.6% [75] were smokers and 50% were hypertensive Diabetes is prevalent in the majority of this patient, being 67.2%, but the incidence of obstructive disease is not increased. Obstructive left main disease is seen in 34.7% among male smokers against 21.6% in nonsmokers

Conclusion: left main disease appears to be related to increasing age. Diabetes is the commonest prevalent risk factor in this patient population. Among male smokers obstructive left main disease prevalence is higher than nonsmokers

Role of wound classification in predicting the outcome of diabetic foot ulcer

To compare the effectiveness of Wagner and University of Texas [UT] classification systems of diabetic foot ulcers in directing appropriate therapy and possibly predicting outcomes. A total of 383 patients with foot ulcer were seen. Details of socio-demographic and clinical profiles of 200 patients were completely available. Patients were assessed and classified into different grades and stages according to Wagner's and UT classification systems. Their duration of healing was recorded. The outcome endpoints were defined as complete healing, major or minor amputations, or expired. Out of the 200 subjects, 65% were males and 35% were females. Mean age in males was 53.04 +/- 10.33 years and in females was 51.14 +/- 9.94 years. Average duration of treatment in males was 109.68 +/- 82.26 days and in females was 85.10 +/- 61.97 days. Forty five percent of the subjects had neuropathic ulcers. Median healing time increased with increase in Wagner grade and UT grade and stage. The higher the UT grade and stage at the time of presentation, the less the chances of ulcer to heal within the study period. Our study has shown that grading and staging of diabetic foot ulcer affects and predicts the outcome. Amputation rates increase with increase in grade. Addition of stage to grade in UT classification helps further on assessing the severity of wound at the time of presentation and shows better association with the outcome