Knowledge attitude and practices about management of vitamin D deficiency among doctors in Pakistan

Background: Hypovitaminosis D is a common health issue in Pakistan because of its high prevalence. The awareness and practices of doctors treating vitamin D deficiency needs to be highlighted, as it will help in managing this public issue

Objectives: To assess knowledge, attitude and practices for diagnosing and treating hypovitaminosis D among practicing doctors in Pakistan

Subjects and Methods: Clinicians from different cities of the Pakistan were participated for a cross-sectional descriptive questionnaire based study about their approach in treating vitamin D deficiency. Results were analyzed using SPSS version 20. Descriptive statistics were calculated

Results: One hundred eighty eight [188] practicing doctors from 21 different cities of Pakistan participated in the study. Majority [85.6%, n=161] prescribed vitamin D levels in patients of hypovitaminosis D. It is empirically treated by 101 [53.7%]. Most clinicians [84%, n=158] prescribe Cholecalciferol, 19 [10.1%] Alfacalcidol and 11 [5.9%] prescribe Calcitriol as a vitamin D supplement, while 155 [82.4%] prescribe a maintenance dose. The prescription form preferred by doctors is tablets by 49 [26.1%], capsule by 29 [15.4%], oral injections by 68 [36.2%] and intra-muscular by 42 [22.3%]. As a follow up tool, 84 [42.6%] clinicians order serum 25 [OH] D and serum calcium levels, 102 [54.3%] assess patients by improvement in clinical symptoms and 3 [1.9%] use both strategies for assessment. Nutritional advice was also given by most doctors

Conclusion: There is no uniform approach for diagnosing and treating hypovitaminosis D among practicing doctors in Pakistan. A great variability and gap is seen in prescription options, dosing frequency and duration. This highlights the importance of need for a national guideline regarding prophylaxis, diagnosis and treatment of vitamin D deficiency

Lack of uniformity in screening, diagnosis and management of gestational diabetes mellitus among health practitioners across major cities of Pakistan

Objective: To determine knowledge, attitude and practice [KAP] regarding management of Gestational Diabetes Mellitus [GDM] among Health Care Providers in major cities of Pakistan

Methods: A knowledge, attitude and practice [KAP] questionnaire based study was conducted in major cities in Pakistan from health care providers in public and private hospitals and clinics. Questionnaires were provided to the health care providers regarding screening, diagnosis and management of patients with GDM. Data analysis was done using IBM SPSS 20

Results: A total of 210 doctors took part in the study. 55[26%] reported using fasting blood glucose as screening test for GDM whereas 129[61.4%] respondents used Oral Glucose Tolerance based WHO criteria for diagnosing GDM. Thirty six [17%] and 98[46.7%] doctors referred their patients to Gynecologists. For treating GDM, 64[30.5%] doctors prescribed insulin [NPH/Regular, 70/30 Mix]. 112[53.5] doctors used combination of capillary glucose by glucometer and plasma blood glucose tests for monitoring of glycemic control of patients with GDM

Conclusion: There is lack of agreed screening tests and criteria for diagnosis and management of GDM patients. Doctors need to be educated to follow evidence based diagnostic and management guidelines so that GDM patients can be effectively managed. Recently released South Asian Federation Societies and Pakistan Endocrine Society guidelines could be much needed consensus guidelines for doctors to apply in their daily practice to improve GDM diagnosis and treatment

simple integrated primary health care based model for detection of diabetic retinopathy in resource-limited settings in Pakistani population

Objective: To find out prevalence of Diabetic Retinopathy in general population of three districts in Pakistan

Methods:A community based cross-sectional survey was conducted in three large districts of Pakistan namely Rawalpindi in Punjab, Peshawar in Khyber Pakhtoonkhwa and Hyderabad in Sindh between January 2013 and August 2015. Lady Health Workers identified individuals at high risk for diabetes based on predefined criteria. High risk population was tested for dysglycemia. Fundoscopic evaluation for evidence of DR was performed in all individuals with a random blood glucose >190mg/dl. Individuals with the evidence of DR were referred to affiliated tertiary care ophthalmology departments

Results:A total of 42,629 individuals reported at the project sites and 63% [n=26,859] were female. Fifty one percent [n=21,989] individuals met high risk criteria. Out of these 21,989 individuals, dysglycemia was found in 3,869 [17.6%]. Fundoscopy showed evidence of DR in 1,042 [27%] individuals. Amongst high risk population, dysglycemia was significantly more common in females as compared to males. The frequency of DR in dysglycemic patients was comparable across both gender groups

Conclusion:The prevalence of DR in Pakistani population is alarmingly high. This preventable cause of blindness is largely undiagnosed in our population and a simple integrated model based on primary health care facilities can help identify and treat a large population of DR patients

Causes of short stature in Pakistani children found at an Endocrine Center

Background and Objective: Short stature is defined as height below 3[rd] centile. Causes of short stature can range from familial, endocrine disorders, chronic diseases to chromosomal disorders. Most common cause in literature being idiopathic short stature. Early detection and management of remedial disorders like malnutrition and vitamin D deficiency, Endocrine disorders like growth hormone deficiency and hypothyroidism can lead to attainment of expected height. Pakistani data shows idiopathic short stature as the most common cause of short stature. Our study aimed at detecting causes of short stature in children/adolescents at an Endocrine referral center

Methods: A retrospective study was conducted at WILCARE Center for Diabetes, Endocrinology and Metabolism, Lahore on 70 well-nourished children/adolescents. The patients had been evaluated clinically, biochemically and radiologically as needed. Biochemical testing included hormonal testing as well to detect endocrine causes. Data was entered and analyzed in SPSS 20.0

Results: Leading cause of short stature in our population was Growth Hormone [GH] deficiency seen in 48 out of 70 [69%] patients. Second most common endocrine abnormality seen in these patients was Vitamin D deficiency [44 out of 70 patients [63%]]. Primary hypothyroidism; pan-hypopituitarism and adrenal insufficiency were other endocrine causes. The weight for age was below 3rd percentile in 57 [81%] patients, with no association with other major causes

Conclusion: Growth hormone and Vitamin D deficiency constitute one of the major causes of short stature among well-nourished children with short stature in Pakistan