Peripheral arterial disease. [PAD] in type 2 diabetic patients

The increase in prevalence of type 2 diabetes and its complication is alarming. The incidence of diabetic foot ulcers due to peripheral arterial disease, which leads to foot amputations far too often, is unacceptably high especially in developing countries. This study has been conducted to find out frequency and degree of peripheral arterial disease in type 2 diabetics having foot ulcers at tertiary care settings in Abbottabad. This was a prospective descriptive study-being conducted at Northern Institute of Medical Sciences [NIMS] and Ayub teaching hospital Abbottabad from August 2009 to June 2010. Type 2 diabetics with non-healing foot ulcers lasting longer than then days, were selected for this study by non-probability purposive sampling method. All study subjects have undergone for palpation of peripheral arterial pulses in the lower limbs. Ankle-brachial index [ABI] is the ratio of the systolic blood pressure at the ankle to that in the arm Peripheral arterial disease [PAD] was considered to be present if ABI was less than 0.90. It was further graded as mild, moderate and severe according to ABI values between 0.70-0.90, 0.50-0.69 and less than 0.49 respectively, as per recommendations of American Diabetes Association. A total of 83 type 2 diabetics with foot ulcers were enrolled during eleven months period of this study. The mean age of study subjects was 53.68 +/- 9.51 years. There were 33 [39.75%] males and 50 [60.24%] females with M to F ratio of 1: 1.51. Mean duration of diabetes was 13.67 +/- 5.80 years [ranging from 9-23 years]. Majority 57 [68.67%] of our patients were obese having poor glycemic control. Peripheral arterial disease has been fond in 35 [42.16%] patients, out of them 18[51.42%] had mild PAD as their ABI values remained between 0.70-0.90, 15[42.85%] had moderate PAD due to their ABI values between 0.50- 0.69 and 2 [5.71%] had severe PAD as their ABI values lie below 0.49. Ankle-brachial index is a non-invasive, inexpensive and office-based diagnostic tool for peripheral arterial disease in type 2 diabetics having foot ulcers, Healthcare professionals must be trained about early referral and regular feet care of these patients

Porto-systemic encephalopathy [PSE]; study to evaluate common precipitating factors in patients with chronic liver disease

Porto-systemic encephalopathy [PSE] is a common medical emergency at our settings due to increased prevalence of chronic liver disease. To determine frequency of common precipitating factors in patients having porto-systemic encephalopathy [PSE] at tertiary care settings in Hyderabad. Descriptive case series study. Setting: Department of Medicine Isra University Hospital Hyderabad. Period: 1st April 2011 to 31st December 2011. A total 100 patients manifesting clinical features of PSE were included in this study by non-probability convenience sampling. The data was evaluated in statistical program SPSS version 16. As 100 patients with PSE were enrolled in the current study, out of these 96 patients have precipitating factors involved while only 4 patients have no such factors. Out of these 96 patients, 36 patients have only single risk factor found while in 64 cases multiple factors were implicated. Constipation, infections [except SBP] and renal impairment were noted in 36%, 24% and 22% respectively. Constipation, infections [except SBP] and renal impairment were the most common precipitating factors of porto-systemic encephalopathy in our study. Hence priority should be given to them in terms of hospital funds, medicines and human efforts