Central obesity as a risk factor for impaired glucose tolerance

Objectives: To examine the association of central obesity [measured as waist-to-hip ratio] with glucose intolerance, and to compare the mean fasting blood sugar and the mean random blood sugar levels of centrally obese and non- obese adults

Study Design: Analytical case-control study

Place and Duration of Study: This study was carried out at the Medical Wards and OPDs of Civil Hospital Karachi from June 2015 to December 2015

Materials and Methods: The subjects were selected by non-probability convenience. Based on their waist-to-hip ratio they were divided into centrally obese [group A] and non-obese [group B]. The cut-off point for waist-to-hip ratio was 1.0 for males and 0.85 for females. One hundred non-diabetic, healthy adults were included in each group. All the subjects underwent a 2 hour 75-gm oral glucose tolerance test. Fasting blood sugar and random blood sugar at two hours post-glucose challenge were measured

Results: Five individuals had blood sugar levels in the diabetic range and were excluded from the study. Impaired glucose tolerance was observed in fifteen out of 98 subjects in the centrally obese group and six out of 97 subjects in the non-obese group. This difference was statistically significant [p=0.04]. Statistically significant difference was also observed between the mean fasting blood sugar and the mean random blood sugar of the two groups [p<0.001 in both cases]. The odds ratio for a person with central obesity to have impaired glucose tolerance was estimated to be 2.74

Conclusion: There is a significant association between central obesity [waist-to-hip ratio] and glucose intolerance

Low levels of vitamin D[3] in people of Karachi - needs to be readdressed

Objective: The aim of this study is to see the frequency of vitamin D and its impact on the sample population

Study Design: Descriptive / cross sectional study

Place and Duration of Study: This study was conducted at Trauma and General Hospital, Karachi from January 2014 to June 2015

Materials and Methods: 205 patients were included in the study. Participants were assessed according to predesigned questionnaire. All patients were subjected to have complete blood count, serum calcium, phosphorous, albumin, alkaline phosphatase, SGPT, vitamin D and parathyroid hormone levels along with X-rays of hip joint and femur

Results: Out of total 205 patients, 12.7% were males and 87.3% were females. Mean age was 41.32 +/- 15.225 years. 5.9% had normal levels of Vitamin D[3], while 60.5%, 27% and 6.5% showed mild, moderate and severe deficiency. Serum calcium and phosphorous were deficient in 20.4% and 31.9% respectively. Serum alkaline phosphatase and parathyroid hormone were normal in most of the participants. The deficiency of Vitamin D[3] was mostly due to reduced sun exposure and excessive clothing [86.8%] while 8.3% showed malabsorption. This deficiency caused bone pains, and muscle pains in 55.6%, and 17.6% respectively. But none of the patient had any fracture

Conclusion: Levels of Vitamin D[3] are low in most of the people of Karachi but without any gross deformity. It is advisable to readdress the daily requirement of vitamin D bring the awareness among people regarding sun exposure and daily use of vitamin D supplements

Frequency of hypomagnesemia in patients with diabetes mellitus at civil hospital Karachi

Objective: To determine frequency of hypomagnesemia in diabetic patients presenting at Civil Hospital Karachi

Study Design: Cross-sectional study

Place and Duration of Study: This study was conducted at a Diabetic Clinic in National Institute of Diabetes and Endocrinology [NIDE], Karachi from January to June 2016

Materials and Methods: All patients > 12 years of age of either sex, diagnosed cases of diabetes mellitus [either Type I or Type II] of > 5 years duration and have given consent for participation in the study were included. Patients with acute pancreatitis and have history of alcoholism [such conditions results in reallocation of the magnesium from extracellular to intracellular space], occurrences of diarrhea, regurgitating and nasogastric suction, ostomies and gastrointestinal fistulas [conditions which result gastrointestinal magnesium loss] and patients receiving diuretics, chemotherapeutic agents [cisplatin], antimicrobials [amphotericin B, aminoglycosides, pentamidine, capreomycin. vancomycin, and foscarnet], immunosuppressants [tacrulimus and cyclosporine], and proton-pump inhibitors, [as all these drugs results in renal loss of magnesium] were excluded

Results: The average age of selected patients with diabetes mellitus was 46.81 +/- 6.8 years. Of 350 patients, 203 [58%] were female and 147 [42%] were male; 176 [50.3%] patients had diabetes for >/= 7years; 269 [76.9%] patients had type II diabetes and 275 [78.6%] had uncontrolled diabetes. The mean serum magnesium level was 1.48 +/- 0.36 mg/dl and the frequency of hypomagnesemia was 227 [64.9%] cases

Conclusion: It is concluded from this study that the frequency of hypomagnesemia was 64.9% among study population

Awareness about the baseline blood glucose levels, risk factors and complications among diabetic patients attending OPD of national institute of diabetes and endocrinology, Karachi

Objective: To evaluate awareness among diabetic patients attending OPD of National Institute of Diabetes and Endocrinology, Karachi, about the baseline blood glucose levels, Risk factors and Complications

Study Design: Cross-sectional study

Place and Duration of Study: This study conducted at the OPD of National Institute of Diabetes and Endocrinology [NIDE], at OJHA campus of Dow University of Health Sciences, Karachi from January to March 2016 in Karachi

Materials and Methods: Adult, age 18 years and above, cases of diabetes were recruited from OPD of National Institute of Diabetes and Endocrinology [NIDE], at OJHA campus of Dow University of Health Sciences, Karachi. Data was collected using a structured questionnaire which was translated into local language i.e. Urdu. SPSS was used for statistical analysis

Results: A total of 100 participants completed the interview out of which 53% were male and 47% were female. Mean age of the participants was 49.3 +/- 10.7 years. Regarding the knowledge about target blood glucose levels, only 39% of the participants correctly identify the fasting blood glucose level while only 26% correctly answered random blood glucose levels. Overall mean score of knowledge and awareness was 40%. Male had better knowledge then female. Mean score for male was 50% compared to 30% among female. This difference was statistically significant p-value <0.05. Over all 45% of the participants were found to have poor knowledge scores, 35% had acceptable while only 20% had acceptable knowledge scores

Conclusion: This study found that there is low level of awareness among the patients attending diabetic outpatient clinics of NIDE. This indicates gaps in the patient care which needs attention. There is need to integrate patient education regarding glycemic targets, risk factors, complications and self-care as essential component of care through different channels of communication

Sequential organ failure assessment [SOFA]score as a predictor of outcome in patients admitted in a medical ICU

Objective: To assess the efficacy of Sequential Organ Failure Assessment score [SOFA] as a determinant of outcome in critically ill medical patients

Study Design: Prospective observational cohort study

Place and Duration of Study: This study was conducted at Medical ICU of Civil Hospital Karachi from June 2014 to December 2014

Materials and Methods: The study was conducted on 152 patients admitted in the Medical ICU. The SOFA score was calculated on admission and thereafter daily until ICU discharge or death. The primary outcome measure was ICU mortality. The initial SOFA score, the SOFA scores at 48 and 72 hours, the mean and highest SOFA scores and the trend of SOFA score during the initial 48 hours were correlated with mortality

Results: The overall ICU mortality rate was 35.5 % [n=54]. Patients with an initial SOFA score of /= 10 had a mortality rate of 88.2 %. The SOFA scores at 48 and 72 hours also showed significant association with mortality. The mortality rates of patients having a score of /=10 at 48 and 72 hours were 91.3% and 93.8% respectively. A sharp rise in mortality was seen when the Highest SOFA score during the entire ICU stay exceeded 7. Patients having a mean SOFA score of greater than 5 had a mortality rate of 66.7% regardless of length of stay. Univariate Logistic Regression Analysis revealed that the Highest SOFA score had closest correlation with mortality followed by Mean SOFA score, SOFA at 48hours, and SOFA at 72 hours. The biggest area under the receiver operating characteristic curve [AUROCC] was seen for the Highest SOFA score followed by SOFA at 72 hours, Mean SOFA score and SOFA at 48hours. Analysis of the changes in SOFA score during the first 48 hours depicted a mortality rate of 54.9% when the score increased, 27.6% when the score decreased and 23.3% when it did not change

Conclusion: The serial evaluation of SOFA score proved to be a convenient and efficient tool to predict mortality in the critically ill ICU patients

Frequency and risk factors associated with hypomagnesaemia in hypokalemic type-2 diabetic patients

To determine the frequency and factors associated with hypomagnesaemia in hypokalemic type-2 diabetic patients presenting at Civil Hospital, Karachi. A cross-sectional study. Department of Medicine and Diabetic Clinic of Civil Hospital and Dow Medical College, Karachi, from November 2010 to May 2011. A total of 358 adult type-2 diabetics with hypokalemia were selected for this study. With aseptic measures, venous blood was collected for serum magnesium, potassium, HDLc, LDLc Triglyceride [TGs] and glycosylated hemoglobin [HbA1c] from each subject after an overnight fasting and was analyzed on Roche Hitachi 820 Photo Spectrometry. The data was analyzed on SPSS version 17 to determine the factors associated with hypomagnesaemia like duration of diabetes, Body Mass Index [BMI], diabetic nephropathy, HDLc, LDLc Triglyceride [TGs] and glycosylated hemoglobin [HbA1c] level. Mean age of study population was 55.62 +/- 9.9 years. Most of them [n=228, 63.7%] were males. Out of the 358 subjects, 198 [55.3%] had hypomagnesaemia. There was significant association between hypomagnesaemia with duration of diabetes, Body Mass Index [BMI], diabetic nephropathy, HDLc, LDLc Triglyceride [TGs] and glycosylated hemoglobin [HbA1c] level. Hypomagnesaemia is very common in type-2 diabetic hypokalemic patients. Therefore, it should be routinely sought by the clinicians. Early recognition and subsequent treatment of hypomagnesaemia may help in better glycemic control, may delay the chronic complications and decrease the mortality in diabetic hypokalemic patients

frequency causative organisms and their sensitivity to the commonly used antibacterial agents in cases of urinary tract infections

Frequency causative organisms and their sensitivity to the commonly used antibacterial agents in cases of urinary tract infections. Observational study This study was conducted at Medical Wards of Civil Hospital Karachi from 1st November 2010 to 30th April 2011. This study consisted of 415 patients were selected for urine culture and sensitivity from medical O.P.D. and hospitalized patients in medical wards. Detailed history was taken from all the patients with special regard to symptoms and duration of UTI. Inclusion criteria were that all patients who had symptoms of urinary tract infection like frequency of micturition by day and night, painful voiding [dysuria], suprapubic pain and tenderness, hematuria, smelly urine, urgency, loin pain or swelling and patients who had more than 6 pus cells in urine D/R examination. Urine samples from OPD patients were randomly assigned to different reputable clinical pathological laboratories including pathological laboratory of Civil Hospital, Karachi, for urine culture and sensitivity. 415 patients 265[63.8%] were females and 150[36.2%] were males. 415 urine samples who were subjected to urine culture and sensitivity examination. Only 200 [48.2%] samples were found to had infection i.e. significant growth of 105 of microorganism/ml or more, while 142 [34.2%] samples did not show growth of any organism, and 73 [17.6%] samples showed growth between 104 and 105 of microorganism/ml . E. Coli 49.5% is the commonest organism causing UTIs in outpatients as well as in hospitalized patients. The second commonest organism in OPD is Klebsiella 16%, while in hospitalized patients it is Pseudomonas. The antibiotics susceptibility of the isolated organisms during the study and shows the percentage of sensitivity of the isolated organisms. E. coli the most common organism isolated showed high resistance pattern to ampicillin, amoxicillin, and co-trimoxazole 62%, 60%, 70%, respectively. E. coli the most common organism isolated showed a high sensitivity pattern to amoxicillin/clavulanic acid 85%, pipemidic acid 80%, norfloxacin 85%, ofloxacin 92%, ciprofloxacin 90%, tobramicin 98%. Generally a higher percentage of the organisms isolated were sensitive to all these antibiotics except amoxicillin/clavulanic acid which had a high resistance pattern to Pseudomonas 77%. Escherichia coli is still the commonest organism causing urinary tract infection, in outpatients as well as in hospitalized patients