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.

Oxidative stress and total antioxidant status in acute leukemia at diagnosis and post remission induction phase

This study evaluated the activity of superoxide dismutase [SOD1], glutathione reductase [GR] and total antioxidant status [TAS] in the hemolysate and sera of patients with acute leukemia [AL] at diagnosis, post remission induction phase and in healthy controls. However, total antioxidant status and glutathione reductase activities normalized after remission induction phase in acute myeloid leukemia [AML] only whereas levels of SOD were reduced but not achieved the normal level in acute lymphoblastic leukemia [ALL]. TAS activity showed no difference in either sex among any subtype of acute leukemia but glutathione reductase level was significantly higher in female ALL patients. Activity of SOD was elevated in T-cell ALL and acute myelomonocytic leukemia however; no significant difference in the activity of GR and TAS was noted. Levels of antioxidant were reduced insignificantly in patients who achieved complete remission

Vitamin D levels in patients of acute leukemia before and after remission-induction therapy

To determine the levels of 25-hydroxyvitamin [25[OH]D3] in patients with acute leukemia and the effect of remission-induction chemotherapy. This study was case control, all newly diagnosed patients of acute leukemia between the age of one to sixty years and residents of Pakistan were enrolled and evaluated. Those who were unwilling or unable to provide written informed consent were excluded. All selected patients [n=86] were grouped in to acute myeloid leukemia [AML] and acute lymphoblastic leukemia [ALL]. AML was further categorized as A1 before remission-induction [n=17] and B1 after remission induction [n=13], ALL was further categorized as A2 before remission-induction [n=31] and B2 after remission induction [n=25]. The 25-hydroxyvitamin [25[OH]D3] levels were measured in the sera of all patients [before and after remission-induction] by one step delayed chemiluminescent micro particle immunoassay [CMIA].We compared 25[OH]D3 levels in all patients before and after the remission-induction chemotherapy. A total of 86 patients were analyzed, in which 60 patients were male. Mean age was 24.39 years [range, 1 to 60 years]; the mean levels of 25[OH]D in group A1 [n=17] was 17.70 +/- 3.2 ng/ml, in group B1 [n=13] 14.06 +/- 2.4 ng/ml, 19.07 +/- 7.08 ng/ml in group A2 [n=31], while 10.59 +/- 3.9 ng/ml found in group B2 [n=25]. 25[OH]D3 insufficiency was evident subnormal in majority of patients with acute leukemia and 25[OH]D3 were further reduced after remission-induction as compared to untreated group, difference was statistically significant when compared with each group

Wandering ascaris coming out through the abdominal wall

A rare case of ascaris coming out through the anterior abdominal wall is reported here. A 40-year-old female had undergone dilatation and curettage by a quack. On the second day she presented with presented with features of peritonitis. She was explored. Resection anastomosis of the ileum was done for multiple perforations of the ileum. Patient developed a fistula in the anterior abdominal wall which was draining bile-colored fluid. On the 12[th] postoperative day a 10-cm-long worm was seen coming out through the fistulous tract which was found to be Ascaris lumbricoids. Ascaris lumbricoids can lead to many complications ranging from worm colic to intestinal obstruction, volvulus, peritonitis, pancreatitis, cholangiohepatitis, liver abscess and many more. Worm has been reported to come out through mouth, nostrils, abdominal drains, T-tubes etc. But ascaris coming out through the anterior abdominal wall is very rare hence reported here

Molecular epidemiology of β-thalassemia in Pakistan: Far reaching implications.

Background: β -Thalassaemia, an autosomal recessive hemoglobinopathy, is one of the commonest genetically transmitted disorders throughout the world. Collective measures including carrier identification, genetic counseling and prenatal diagnosis are required for preventing β-thalassemia. Aim: To achieve this objective, Identification of the spectrum of genetic mutations, especially for various ethnic backgrounds in Pakistan. Therefore, we designed a cross sectional prospective study to identify the frequency of various gene mutations in different ethnic groups of Pakistan. Materials and Methods: Over a 5-year period, DNA from 648 blood samples {including specimens of chorionic villus sampling (CVS)} were analyzed for the twelve most common β-thalassemia mutations found in the Pakistani population by a Multiplex amplification refractory mutation system (ARMS). Each sample was analyzed for the mutation as well as the normal gene, appropriate with negative and positive controls, and reagent blanks. Results: Out of 648 samples mutations were identified in 640 (98.75%) samples by multiplex ARMS. 8 common β-thalassemia mutations were identified in 8 different ethnic groups accounting for 93.9% of the β-thalasemia alleles. Conclusions: Based on the outcome of this study a cost effective proposal is formulated for detection of β-thalassemia mutations.

Seropositivity of hepatitis C, hepatitis B and HIV in chronically transfused beta -thalassaemia major patients

The purpose of this study was to determine the frequency and trend of transfusion transmitted infections [TTI] in chronically transfused beta-thalassaemia major [TM] patients with reference to the duration of transfusions. A cross-sectional study was done on 160 beta-TM patients and 5517 healthy blood donors to find out the prevalence of HCV, HBV and HIV infections. Out of 160 patients, 21 cases [13.1%] were anti-HCV positive, 2 [1.25%] were HBsAg positive. HIV antibodies were not detected in any sample. However, 109 [1.9%] and 104 [1.8%] of 5517 blood donors were positive for HCV and HBV respectively. No donor showed HIV antibodies. Anti-HCV was positive in 9/111[8.4%] thalassaemics [< 10 years of age] while 11/49 [22%] [> 10 years of age] showing significant difference [p = 0.005] among the two groups. For the past 10 - 12 years the screening of blood has reduced the magnitude of the disease significantly as shown by the trend in two age groups. Further improvements need to be done to implement uniform screening throughout the country

JAK2V617F mutation in chronic myeloid leukemia predicts early disease progression

To determine the association of JAK2V617F mutation along with BCR-ABL translocation or Philadelphia chromosome in chronic myeloid leukemia with early disease progression to advanced stages [accelerated phase or blast crisis] and poor outcome. Case series. National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, from February 2008 to August 2009. All the newly diagnosed cases of BCR-ABL or Philadelphia positive CML were tested for JAK2V617F mutation by Nested PCR. Demographic data, spleen size, hemoglobin levels, white blood cell and platelet counts were recorded. Independent sample t-test was used for age, haemoglobin level and spleen size. Fisher's exact test was applied to compare disease progression in JAK2V617F mutation positive and negative cases. Out of 45 newly diagnosed cases of CML, 40 were in chronic phase, 01 in accelerated phase and 04 in blast crisis. JAK2V617F mutation was detected in 12 [26.7%] patients; 09 [22.5%] in chronic phase, none in accelerated phase and 03 [75%] in blast crisis. During a mean follow-up of 8 months, 03 patients in chronic phase transformed in blast crisis and 02 into accelerated phase. Overall 08 out 0f 11 [73%] JAK2V617F positive patients either had advanced disease or showed disease progression. Only 2 of 20 [10%] available patients, negative for the mutation, showed disease progression by transforming into blast crisis [p < 0.001]. No statistically significant difference was seen in the age, spleen size, haemoglobin levels, white blood cells and platelets counts in JAK2V617F positive patients. JAK2V617F mutation was detected in 26.7% cases of chronic myeloid leukemia. A significant proportion of them showed early disease progression

Distribution of hepatitis C virus genotypes, hepatic steatosis and their correlation with clinical and virological factors in Pakistan

Background: Due to the inherently unstable nature of HCV, various genotypes have been identified. Steatosis is a histological feature in the progression of HCV-associated liver disease and has been shown to alter the host lipid metabolism. Objective: Assess the distribution of HCV genotypes in the two provinces of Pakistan, and determine the association of hepatic steatosis with altered clinical and virological factors in chronic HCV patients. Methods: One hundred twenty six chronic HCV patients (steatosis in 49 patients) were enrolled for qualitative analysis by PCR. Out of 126 ELISA and PCR positive samples, 119 (48 with hepatic steatosis) chronic HCV patients (mean age 42.0±13.3 years, mean body mass index (BMI) 24.2±4.1) were proved positive after PCR-based detection. Biochemical and virological factors such as HCV genotype, or glucose, in 119 CHC patients were determined and compared between patients with and without hepatic steatosis. Results: Out of 126 samples, 119 were HCV positive, where 58 (48.7%) were genotype 3a, 24 (20.2%) were 3b, 12 (10.1%) were 1a, eight (6.7%) were 2a, six (5.0%) were 1b, and one (0.8%) was 4. Furthermore, seven (5.9%) had a co-infection and three (2.5%) were untypable. BMI (p=0.004), genotype 3a (p<0.001), and triglycerides (p=0.002) were significantly associated with steatosis. It is noteworthy that cholesterol (p=0.281), glucose (p=0.305), lowdensity lipoprotein (p=0.101), high-density lipoprotein (p=0.129), alanine amino transferase (p=0.099), aspartate transaminase (p=0.177), bilirubin (p= 0.882), and age (p=0.846) showed non-significant association. Conclusion: Genotype 3a is the predominant genotype in Pakistan. Hepatic steatosis is quite frequent feature in HCV patients and strongly correlates with BMI, genotype 3a, and triglyceride contents in patients infected with HCV.

Triglyceride profile in dyslipidemia of type 2 diabetes mellitus

To evaluate ratios of serum triglycerides and cholesterol levels which may indicate postprandial lipid handling and to assess their role as prospective markers of dyslipidaemia in type 2 diabetes mellitus. Comparative, observational study. Bismillah Taqee Hospital, Karachi from July 2002 till December 2003. The study comprised 160 subjects, including 83 known type 2 diabetics [45 males, 38 females] and 77 age-matched controls [45 males, 32 females]. Fasting blood samples were analysed for serum triglycerides and total cholesterol, using automated chemistry analyzer. HDL-C was determined by precipitation method and LDL-C and VLDL-C were estimated by Friedewalds formula. LDL/HDL ratio and TG/HDL ratios were also calculated. The mean values for male and female diabetics were compared with that for the male and female non-diabetics respectively and tested for significance by paired t-test. Serum triglycerides and VLDL were raised in both male and female diabetics. No significant differences were observed in levels of serum total cholesterol, LDL, HDL and the LDL/HDL ratio. The mean value of the TG/HDL ratio for male diabetics was higher than that for the male non-diabetics [p=0.39]. A statistically significant difference was found in the TG/HDL ratios for the female diabetics and non-diabetics [p < 0.05]. In this study, type 2 diabetics showed marked hypertriglyceridaemia and raised TG/HDL ratio. The dyslipidaemia of diabetes predisposes to development of coronary heart disease and, therefore, evaluation of the TG:HDL ratio may provide a good tool to monitor and manage the lipid abnormalities in diabetics

Arteriovenous thrombosis in chronic renal failure patients receiving renal replacement therapy

To determine the frequency of thrombotic complications and to identify factors associated with arteriovenous thrombosis in patients of chronic renal failure receiving renal replacement therapy. A descriptive study. The study was carried out at Sindh Institute of Urology and Transplantation [SIUT], Karachi, from May 2003 to December 2003. Of the 3000 patients evaluated, 61 End Stage Renal Disease [ESRD] patients on regular dialysis, having recent renal transplant, were selected for the study after informed consent. These patients had arteriovenous thrombosis with temporary central lines thrombosis and vascular access problems. Cases of congenital or acquired thrombotic disorders, e.g. with malignancy, DIG, liver disease, systemic lupus erythematosus or other immunologic diseases, pregnancy or women using oral contraceptives, were excluded. Similarly, patients taking any type of anticoagulant therapy during the preceding one week were not included in the study. Findings were recorded in a structured questionnaire. Laboratory analysis was done after clinical and radiological evaluation. Thrombophilia screening included antithrombin, protein C, protein S deficiencies and lupus anticoagulant. Forty-seven out of 61 patients selected were positive for thrombophilia screening with protein C deficiency in 26.2%, protein S deficiency in 16.3%, antithrombin in 5%, lupus anticoagulant in 13.1% and combined deficiency was observed in 16.3%. Of the 3000 patients, 61 with frequency of 2% were found to be deficient in one or had combined deficiency of these. Thus, the study of ESRD patients presenting with arteriovenous thromboembolism emphasizes the need to reconsider the perception that this clinical entity is rare and requires further studies

effect of breast feeding on plasma cholecystokinin in neonates

this prospective study was conducted to evaluate the effect of breast-feeding on cholecystokinin in neonates. this study was conducted in King Abdul-Aziz University Hospital. Plasma concentration of cholecystokinin [CCK] was estimated in 41 neonates [19 boys, 22 girls]. The study was done in the neonates on the third day after delivery. Serum CCK was estimated by radioimmunoassy. it was found that CCK rises immediately after breast feeding and declines 10 minutes later. CCK rises immediately after breast-feeding and declines 10 minutes later

Application of fibrin glue in maintaining post operative haemostasis in a thrombocytopenic patient: a novel approach case report

Here we report a case of chronic refractory autoimmune thrombocytopenic purpura [ITP] who presented with severe persistent thrombocytopenia, 3 months history of incisional hernia with aggravating symptoms. Considering the potential danger of acute obstruction, with its disastrous consequences, surgery was performed under cover of fibrin glue and hernia was repaired without any excess post operative bleeding

Determination of pesticide residues in fruits and vegetables in Islamabad market.

Pesticide residues in fruits and vegetable from Islamabad market, Pakistan were determined by GLC using Perkin Elmer Autosystem equipped with 63NECD and capillary column. Dimethoate was determined in the quantity of 0.032 mg kg-1 in apple, 0.110 mg kg-1 in banana, 0.004 mg kg-1 in brinjal, 1.80 mg kg-1 in cauliflower and 0.13 mg kg-1 in arvi, fenvalerate 0.010 mg kg-1 in apple and chlorpyrifos 0.004 mg kg-1 in brinjal. The importance of these pesticide residues with reference to human health is also briefly discussed.

Predictive value of MCV/RBC count ratio to discriminate between iron deficiency anaemia and beta thalassemia trait

Two forms of hypochromic microcytic anaemia i.e. iron deficiency and beta-thalassaemia trait are common in our society. This study reports the prevalence of iron deficiency anaemia and beta-thalassaemia trait and predictive value of MCV/RBC count ratio to discriminate between two. Venous blood was taken from 299 students of Karachi Medical and Dental College and Ziauddin Medical University in Na2 EDTA and analyzed by semi-automated Sysmex K-1000 haematology analyzer. MCV/RBC count ratio was used to discriminate between iron deficiency and beta-thalassaemia trait and > 14% was marked as iron deficiency. Hb electrophoresis was used as gold standard test for confirmation. Serum iron and TIBC was performed to confirm iron deficiency anaemia. Iron deficiency was found in 9% while beta-thalassaemia was seen in 3% students. MCV/RBC count ratio showed a positive predictive value of 91%. In areas where iron deficiency anaemia and beta-thalassaemia trait are common, MCV/RBC count ratio can be used to screen out beta-thalassaemia trait

Plasma adrenaline and noradrenaline in children with Reye's syndrome

This study aimed to estimate the plasma level of both adrenaline and noradrenaline in children with Reye's syndrome. Plasma adrenaline and noradrenaline was assayed in eleven children [seven males and four females with age ranged between two years and eleven years] with biopsy proven Reye's syndrome. The median age at which children were presented was 5.8 years. The mean adrenaline level was found to be 611.7 pg/ml compared with 83 pg/ml for the controls. The mean noradrenaline level was 1538.9 pg/ml compared with 372.3 pg/ml for the controls. This study revealed that both adrenaline and noradrenaline increased in children with Reye's syndrome and discussed the cause of the these changes

Pemphigus: epidemiological survival characteristics of 72 patients

From 1st October, 1991 to 30th September, 1992 an observational study was conducted on pemphigus patients presenting to the department of dermatology, Mayo Hospital, Lahore in order to document the epidemiological and survival characteristics. A total of 72 pemphigus patients were recorded. Thirty eight of these were already known to have the disease while 34 were seen for the first time. A majority of patients[76%] were from lower socioeconomic class. Pemphigus vulgaris was the most common type, accounting for 83% of the total patients, with female to male ratio of 4.4:1. Most of the patients were in third and fourth decades of life. Eight patients[11%] complained of exacerbation during summer and three [4%] had history of photosensitivity. In two patients disease relapsed at the site of trauma. Eleven deaths [15% mortality] occurred during this period either due to the disease itself or disease related complications

role of gastrin in infantile hypertrophic pyloric stenosis

The serum gastrin level was estimated in eighteen children with infantile hypertrophic pyloric stenosis at the time of pyloromyotomy. We also estimated the gastrin level in a control group. It was found that there was no significant difference of gastrin level between the two group. It was also found that serum gastrin in the neonatal period is higher than serum gastrin of normal adultsThe widespread use of maternal ultrasonography has resulted in an increasing number of newborns diagnosed with obstructive uropathy [O.U]. Over the past 4 years, 39 neonates had been referred for evaluation of their prenatally detected O.U. thirty-four were males. Mean time of prenatal ultrasound examination was 32 +/- 2 weeks of gestation. Postnatal evaluation consisted of ultrasonography, voiding cystourethrography, excretory urography and radionuclide renal scan to assess the differental function and document the severity of obstruction. One infant died at 2 days of age. In the remaining 38 patients, surgery was needed in 34 of them. The excellent postoperative clinical and radiological status of these patients further advocates early intervention when feasible