Effect of Vitamin D supplementation on reduction in levels of HbA1 in patients recently diagnosed with type 2 Diabetes Mellitus having asymptomatic Vitamin D deficiency

Objective: To study the effect of Vitamin D supplementation on reduction in level of HbA1 in patients recently diagnosed with diabetes mellitus Type II having asymptomatic Vitamin D deficiency

Methods: This randomized control trial was conducted at East Medical Ward Mayo Hospital Lahore for 6 months from January 01 2016 to June 30, 2016. 114 Patients were included through non probability purposive sampling technique. Informed consent and demographic information was collected. Patients were divided in two groups by randomization through tossing a coin. GroupA patients received Metformin tablet alone at 500 mg after dinner and Group-B patients were treated with same dosage of Metformin along with oral vitamin D at 200,000 ILJ monthly for three months. Blood sample was obtained at baseline, 3 months and 6 months of initiation of therapy. All samples were sent to the laboratory for complete blood count, blood sugar fasting, serum calcium, serum phosphorous, serum alkaline phosphatase, HbA1c and serum 25 Hyroxy Vitamin D [S-25[OH] D] levels and iPTH. Data entry and analysis was done by using SPSS 20

Results: The mean age of patients in metformin group was 42.37+/-4.59 years while mean age of patients in combination group was 43.33+/-4.86years. Males were 45.6% and females were 54.4% in metformin group while in combination group, 36.8% were males1 and 63.2% were females'. At baseline, in metformin group, mean Vitamin D level was 17.09+/-1.73mg/dl and in combination group, mean Vitamin D level was 16.49+/-n D was 29.04+/-3.96mg/dl. At baseline, 1[st] and 2[nd] visit, in metformin group, mean HbA1c was 7.59+/-0.47%, 7.46+/-0.25% and 7.30+/-0.29%. At baseline, 1[st] and 2[nd] visit, in combination group, mean HbA1c was 7.71 +/-0.19%, 7.57+/-0.21% and 7.43+/-0.26%. The difference was insignificant [p>0.05] at baseline while significant on later follow-ups [P<0.05]

Conclusion: Vitamin D supplementation improved the glycemic control but substantial reduction in HbA1c was statistically insignificant in both groups

Role of vitamin D in reducing number of acute exacerbations in chronic obstructive pulmonary disease [COPD] patients

Background and Objective: Chronic obstructive pulmonary disease [COPD] is characterized by chronic incompletely reversible poor airflow and air trapping and usually this debilitating disorder limits the outside activities of the patients depriving them of sunlight which is a rich source of Vitamin D. The objective of this study was to determine the effect of vitamin D supplementation in reducing number of acute exacerbation in COPD patients

Methods: This randomized control trial was conducted at East Medical Ward Mayo Hospital Lahore from January to December 2015 as exacerbations of COPD are season dependent. Diagnosis was confirmed by performing Pulmonary Function Tests [PFTs]. Basic demographical information was obtained and baseline PFTs of the patient was done. Only Group A patients was treated with oral vitamin D intake of 2000 IU daily for 6 months. Vitamin D level was measured at 0, 2, 4, and 6 months and exacerbation of COPD, FEV1 and FVC was measured weekly. Both the groups were given standard treatment for exacerbation of COPD. Spirometry was repeated at each visit. Blood samples were collected every 2 months for vitamin D. Supplementation was stopped if vitamin D level exceeded 100ng/ml

Results: The mean age of the patients was 46.28 +/- 8.83 years, the male to female ratio was 1.8:1. The mean 25[OH] level at baseline was 24.08 +/- 2.58 and at 6th month was 29.60 +/- 8.74. The mean FVC at baseline was 77.83 +/- 5.49 and at 6th month was 91.34 +/- 5.52. The exacerbation at baseline was present in all 120[100%] patients and at 6th month was reduced to 4[3.3%]

Conclusion: Vitamin D supplementation has significant effect in reducing number of acute exacerbation in COPD patients when it is given for prolonged period

Wet mount microscopy a better diagnostic tool for bacterial vaginosis screening than gram staining

To compare Wet smear and Gram staining for Clue cells in screening Bacterial Vaginosis [BV] in a clinical setting where laboratory facilities are not readily available. Cross-Sectional .This study was conducted in the Department of Microbiology, Basic Medical Sciences Institute Jinnah Postgraduate Medical Center Karachi. High vaginal swabs [HVS] were collected from Gyne and Obstetric Department of Jinnah Postgraduate Medical Centre, Karachi, from Jan 2005 to Feb 2007. One hundred and fifty high vaginal swabs [HVS] were collected from married females with or without complain of vaginal discharge. BV was diagnosed on the basis of clinical Amsel's criteria BV was diagnosed. Subsequently, clinical diagnosis was compared with laboratory based diagnosis for each woman. Two methods used were Wet Mount and Gram Staining. Out of total 150 cases, 100 females were complaining of vaginal discharge and after clinical assessment by Amsel's criteria 34 [34%] were diagnosed as cases of BV. Fifty females as [as controls] were those who were not complaining of any discharge. But among this group 8 [16%] were discovered to be suffering from BV. With the help of wet mount, the clue cells were visualized in 61 [40.7%] cases, while by Gram staining 54 cases [36.0%] were seen. BV screening is important as it affects both groups of females with or without complains of discharge. For easier recognition of clue cells, which are an excellent predictor of BV, wet mount is better as compared to Grams staining method

review of uterine cancers

Review of uterine neoplasms to evaluate the frequencies of different morphological types of uterine cancers and to compare the results with different age groups and the findings of other workers. Observational and comparative study. This study was conducted at the Department of Pathology, Basic Medical Science Institute, JPMC, Karachi from January 2002 to December 2011. A total of 927 cases of neoplastic lesions of the uterine corpus, received over a period of 10 years at the department of Pathology, Basic Medical Science Institute, JPMC, Karachi were reviewed. A total of 98 [9.45%] were uterine cancers including 82 [83.67%] carcinomas and 16 [16.32%] sarcomas. Adenocarcinoma was the commonest finding [66/98], followed by squamous cell carcinoma [10/98] and endometrial stromal sarcomas [7/98]. The mean age of uterine carcinomas was 51.48 years and of sarcomas was 41.87 years. Grade III Adenocarcinoma presented at relatively late ages [mean age 60.71 years] than grade II [mean age 56.37 years] and grade I [mean age 47.02 years]. Sarcomas were found to be of relatively high frequency in our study [16.32%]. Leiomyosarcoma [LMS] and endometrial stromal sarcoma [ESS] tend to occur at younger age than carcinosarcomas. Mean age of uterine carcinoma was found to be 51.48 years and of sarcomas 41.87 years. Grade I adenocarcinoma is more common in younger age groups than grade II and III adenocarcinoma. Finally the LMS and ESS are more frequent than malignant mixed mesodermal tumors [MMMT]

Histopathological study of 209 cases of early abortions

Determining the frequencies of various histological abnormalities of chorionic villi in cases of spontaneous abortions for better understanding of etiology and pathogenesis of the abortions. Cross sectional study. This study was conducted at the Department of Pathology Dow Medical College, Dow University of Health Sciences [DUHS] Karachi from January 2009 to December 2010. A total of 209 cases were included in this study from January 2009 to December 2010 and studied for the following variables e.g. age, date of last menstrual period [if given], period of amenorrhea [if available], history of previous abortions. This information was obtained from surgical pathological registers, request cards and copies of reports. The slides and paraffin blocks of cases coded as Abortions were collected from the files of Surgical Pathology of Department of Pathology Dow Medical College DUHS. The paraffin blocks were sectioned and stained with hematoxylin and eosin. A total of 209 cases of Abortions were studied. In order to find the commonest age group of abortions, the maternal age of the patients were divided into 5 groups with less than 20 years to more than 35 years. Maximum numbers of abortions were encountered in maternal age group of 31-35 years with 85 cases [40.66%] and minimum number of abortions seen in maternal age of< 20 years with 16 cases [7.65%]. Regarding the gestational period, it was provided in 117 cases. A maximum number of 45 cases [38.46%] were seen during 8-12 weeks of gestation and a minimum number of 10 cases [8.5%] were noted between 16-20 weeks. In the remaining 92 cases gestational period was assessed by estimation of presence / absence of nucleated RBCs in chorionic villi according to Salafia et-al. Histological changes found in the chorionic villi were classified into 3 types according to Rushton's classification. This included hydropic change of the villi [type-I] fibrotic change [type-II] and normal honey combed appearance [type-III]. Out of the 209 cases of abortions, 104 cases belonged to type-I, 81 cases classified as type-II and 24 cases as type-III. It is of empirical value that products of conception should be studied in detail then just to confirm that pregnancy was established. This is of significant importance in patients with recurrent and habitual abortions, so as to establish a probable cause and to manage future pregnancies

Vitamin-E: anti-ulcer activity; beyond the antioxidant functions

To evaluate the anti-ulcer activity of vitamin-E on caecal ulcerogenicity of Diclofenac sodium in Albino rats. A prospective experimental study Department of Anatomy, Basic Medical Sciences Institute, Jinnah Post Graduate Medical Centre Karachi during 2003. Diclofenac sodium and Vitamin-E were administered to Albino Rats separately and simultaneously at a dose of 2 mg/kg body weight [for each drug] orally once daily for two weeks. These animals were sacrificed, Caeca were identified and removed, opened along mesenteric border and examined under dissecting microscope for dilatation of the blood vessels, blood streaks and hemorrhagic areas. The caeca were fixed in 10% formalin, Embedded in paraplast, 4 um thick sections were cut on rotary microtome, stained with Haematoxylin and eosin stains. The histomorphological Features of caecal mucosa were compared with those in the control animals and analyzed statistically. The study revealed that simultaneous use of vitamin-E administration with [NSAIDs] produced Anti-ulcer activity in caecal ulcers of albino Rats. The results suggest that vitamin-E produced anti-ulcer activity in Caecal ulcers of albino rats

Urinary tract infections [UTI] among females caused by staphylococcus saprophyticus

Staphylococcus saprophyticus is a uropathogen frequently isolated from young female outpatients presenting with uncomplicated urinary tract infections[1]. Antibiotic resistance in uropathogen is increasing worldwide in out patients as well as hospitalized patients[2]. Cross-sectional study. The urine specimens were obtained from Nephrology, Urology and gynecology/ Obstetric and outpatient departments of JPMC, Karachi for three years. They were processed in the Department of Microbiology, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi from May 2003 to May 2005. The proper and necessary records of the patient were maintained, then the samples were processed by the standard methods. Blood agar plates and MacConkey's agar plates were used for culture. The biochemical tests were done by using different sugar media, TSI, Simon citrate agar, urease, indole and MRVP tests. Out of 175 urinary pathogens isolated from female patients complaining from symptoms of UTI, 28 [16%] yielded Saprophyticus predominantly in pure culture and in high counts. In the age group of 18-28 years, this organism was found in 10 [36%], while in the age group of 29-39 years it was found in 8 female patients i.e. it was 28%. Hence it is observed that as the age advances staph saprophyticus becomes a rare finding so it is not a common organism in elderly males as well as females of all ages. But the sensitivity pattern must be seen to commonly use antimicrobial agents for proper and timely therapy

Comparison of methods for diagnosing bacterial vaginosis

To determine the laboratory method that best predicts Bacterial Vaginosis. Descriptive Observational study. This study was conducted in the Department of Microbiology, Sindh Medical College [DUHS] and Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi from Jan. 2005 to Feb. 2007. A total of 150 randomly selected women were included in this study from OPD of various tertiary care hospitals and family planning clinics of the city. In this study we compared and calculated the sensitivity, specificity and predictive value of positive and negative tests for wet mount, Gram stained vaginal smears and Gardnerella vaginalis [G.vaginalis] cultures with clinical sign Amsel's criteria [Gold standard], for the diagnosis of bacterial vaginosis [B.V]. We diagnosed 54 [36%] cases of bacterial vaginosis by Gram's staining method, 61 [41.7%] cases by Wet Mount method, and 42 [28.0%] cases by Amsel's criteria and 47 [31.3%] cases by culturing. Amsel's criteria were comparable with other laboratory tests for diagnosis of BV. Culture was laborious, expensive and least sensitive method

Seroprevalence of toxoplasmosis [by detecting IgM antibiodies] in women with repeated abortions

To determine seroprevalence of Toxoplasmosis in women with repeated abortions in our local population. Prospective Cross-sectional study. This study was conducted in the Department of Microbiology Basic Medical Sciences Institute [BMSI] Jinnah Postgraduate Medical Centre [JPMC] Karachi from April 2006 to May 2008. Sera from 130 pregnant and post-aborted women with history of repeated abortions [group A] and 50 pregnant women with no history of abortion [group B - as controls] were analyzed for Toxoplasma IgM antibodies by ELISA technique to see the prevalence of toxoplasmosis. 24% of women of group A and 14% of women of group B were seropositive for toxoplasma IgM antibodies. Most of the cases with toxoplasmosis have had their abortions in the first trimester. Gradual increase in Toxoplasma antibody positivity with increasing gravida was observed. Women with negative serological status are at risk of acquiring a primary infection during pregnancy, hence education regarding preventive measures should be provided to them and every pregnant woman may be advised for Toxoplasma IgM antibodies investigation

Role of h.pylori eradication therapy in alleviation of symptoms in H. pylori positive nonhljlcerjjyspepsia patients

Abstract: To establish the role of anti H. pylori eradication therapy in alleviation of symptoms in H. pylori positive non-ulcer dyspepsia [MUD] patients

Material and Methods: This clinical trial was carried out in the Medical unit II and Medical Special unit of the Services Hospital, Lahore during the period from 2003 to 2004.100 patients with the symptoms of dyspepsia without having evidence of peptic ulcer on upper Gl endoscopy were included in the study. Out of these 100 patients 33 were found H. pylori negative on first endoscopy and histopathology, whereas, the remaining number of 67 was completed by confirmation of H. pylori eradication in initially positive cases. Post treatment six weeks follow up was performed to confirm outcome

Results: The H. pylori eradication therapy did not show statistically significant improvement in symptoms of NUD patients

Conclusion: Routine H. pylori eradication has little role in the alleviation of symptoms in patients with NUD