Metabolic Control and Cardiovascular Risk Factors among Type 2 Diabetes in a Primary Care Clinic

Background: Prevalence of diabetes is escalating both globally as well as in Malaysia. With the epidemic of diabetes and its related morbidities and mortalities, health care professionals are facing an unprecedented challenges in controlling the disease. Objective: To determine the metabolic control and the cardiovascular risk factors among type 2 diabetic patients in a primary care setting. Method: This was a cross sectional study conducted in a primary care clinic in Selangor, Malaysia. Inclusion criteria were all type 2 diabetic patients aged 18 and above and were being followed-up for more than six months prior to the recruiting period in May 2009. The demographic data were obtained through faceto- face interview. Height, weight and blood pressure of the patients were taken during the day of data collection. The co-morbidities and laboratory results were obtained from the medical records. Results: Two-hundred patients were recruited. The mean age was 58.6 (SD=10.5) with 79.0% of the patients aged more than 50 years old. The majority of the patients were female (62.5%). One-tenth (11.5%) were smokers. More than half of the patients (64.0%) had co-morbid of hypertension and half of them (50.5%) had dyslipidaemia. A total of 72.5% of the patients had 3 or more cardiovascular risk factors. Less than one fifth of the patients had achieved the target of control for glycaemia, blood pressure, LDL and BMI. Those age 60 and above had significantly higher proportion of patients achieving fasting blood glucose control (p=0.033). Conclusion: The majority of type 2 diabetic patients had multiple cardiovascular risk factors (3 or more risk factors) and had not achieved the recommended goals in metabolic control.

A Clinical Audit on Diabetis Care in Two Urban Public Primary Care Clinics in Malaysia

Introduction: The incidence of diabetes mellitus (DM) is increasing globally and it is associated with significant morbidity and mortality. The importance of a better quality of diabetes care is increasingly acknowledged. Objective: This clinical audit was conducted to assess the quality of care given to type 2 DM patients in public primary care clinics. Methods: A clinical audit was conducted in two selected urban public primary care clinics, between April and June of 2005. The indicators and criteria of quality care were based on the current Malaysian clinical practice guidelines for type 2 DM. A structured pro forma was used to collect data. Results: A total of 396 medical records of patients with type 2 DM were included in this audit. Most of the patients had measurements of fasting blood glucose and blood pressure recorded in more than 90% of the visits over the previous one year.Twenty-seven percent of the patients had glycosylated haemoglobin (HbA1c) done every 6 months with a mean of 8.3%. Only 15.6% had HbA1c values less than 6.5%. Fifty percent had blood pressure controlled at 130/80 mmHg and below; and 13.0% had low density lipoprotein cholesterol values of 2.6mmol/L or less. The majority of the patients were overweight or obese. Conclusions: The quality of diabetes care in this study was found to be suboptimal. There is a gap between guidelines and clinical practice. Certain measures to improve the quality of diabetes care need to be implemented with more rigour

Silent cerebral infarction in hemodialysis patients: possible predictors for vascular events

We designed this study on hemodialysis [HD] patients to estimate the prevalence of silent brain infarction [SBI]; to evaluate the cardiovascular risk factors for SCI; and to investigate whether or not SCI is associated with clinical vascular events. Fifty HD patients who had no past history of stroke or TIA were included in this prospective study. We followed these patients for two years to record any vascular events related to cardiovascular or cerebrovacsular diseases. All patients underwent CT or MRI on the brain to define any silent brain infarcts. We investigated the prognostic role of SCI in cerebral, cardiac and vascular events by using Cox proportional hazards analysis. SCI was detected in 16 patients out of 50 HD patients with a percentage of 32%. During follow up period, vascular events were detected in ten patients after two years of follow up; six cerebral events; three cardiac events; and one death. The HD patients group with SCI had none significantly higher cerebral and cardiac morbidity than the group without SCI. Patients with SCI were significantly older than those without SCI and had significantly longer duration of HD. Furthermore, HD patients with SCI had significantly higher systolic and diastolic blood pressure than those without SCI. We could not find a difference between HD patients with SCI and those without SCI as regards other cardiovascular risk factor except for ischemic heart disease [IHD]. Using univariate analysis, we found that age, duration of HD, IHD and silent brain infarction were predictors of vascular events, whereas, duration of HD and SCI were predictors of cerebral events. By multivariate analysis, we found that SCI was a powerful independent predictor of cerebral and vascular events. We concluded that the presence of SCI is an independent risk factor for vascular events in HD patients

Reversible cortical blindness following successful surgical repair of two stab wounds in the heart

This report describes a case of cortical blindness that followed successful surgical repair of two stab wounds in the heart in a 29-year old Libyan man. The patient presented in a state of pre cardiac arrest [shock and low cardiac output status], following multiple chest stab wounds. Chest tube was immediately inserted. Surgery was urgently performed suturing the two wounds; in the root of the aorta and in the left ventricle, and haemostasis was secured. Cardiac arrest was successfully prevented. The patient recovered smoothly, but 24 hours later he declared total blindness. Ophtalmic and neurological examinations and investigations that included fundoscopy, Electroencephalograms [EEGs] and Computed Tomography Scans revealed no abnormalities, apart from absence of alpha waves in the EEGs. We diagnosed the case as cortical blindness and continued caring for the patient conservatively. Three days later, the patient regained his vision gradually and was discharged on the 7[th] postoperative day without any remarks