Serum cobalamin and dyslipidemia in type 2 diabetics

OBJECTIVE: To evaluate serum cobalamin with special reference to dyslipidemia in type 2 Diabetic subjects

STUDY DESIGN: Observational study

PLACE AND DURATION: Department of Medicine, Isra University Hospital and Consultant Clinics Hyderabad, Sindh from January 2014 to July 2014

METHODOLOGY: A sample of 107 type 2 diabetic subjects was selected according to inclusion and exclusion criteria. Cobalamin was measured on Roche Cobas e411 chemistry analyzer and blood lipoproteins by standard laboratory methods. Data was analyzed by SPSS version 21.0 using appropriate statistical test. P-value of

RESULTS: Cobalamin deficiency was noted in 51 [47.6%] of diabetics which has associated with dyslipidemia. Mean +/- SD of serum cobalamin in normal and reduced serum cobalamin groups were noted as 355+/-29.5 and 183+/-17.5 pg/ml respectively [p=0.0001]. Triglycerides, total cholesterol, HDLc, LDLc and VLDLc differed significantly in the normal and reduced cobalamin subjects

Lipoprotein sub fractions showed a negative correlation with serum cobalamin

CONCLUSION: Cobalamin deficiency is common in type 2 diabetics associated with dyslipidemia

Prevalence and risk factors of severe perineal injuries during childbirth in Saudi Arabia

Objectives: To estimate the prevalence and risk factors for obstetric anal sphincter injuries [OASIS] in Saudi Arabia using data in a tertiary care University Center

Design: A retrospective case-control study

Setting: King Khalid University Hospital, Kingdom of Saudi Arabia

Subjects: All women with third and fourth degree perineal tears over a 10-year period

Interventions: We conducted this study by creating an obstetric database compiled over a period of 10 years [2002-2012] screening all for third and fourth degree perineal tears and too control matched by the time of delivery and delivery team [midwife and obstetrician]

Main Outcome Measures: The prevalence of perineal injuries was calculated in cases and controls. Maternal and obstetric parameters were analyzed and compared between the two groups

Results: Of 31,665 vaginal deliveries, seventy-three patients [0.23 %, 95% Cl by the adjusted wald method: 0.18%-0.29%] had a recognized third [n=66] or fourth-degree [n=7] perineal tear. The following three variables were independently associated with OASIS on multivariate logistic regression models adjusting for potential confounders: primiparity [OR 3.32] instrumental delivery [OR 7.19] and episiotomy [OR 4.92]

Conclusion: The overall prevalence of third- and fourth-degree perineal tears in our population is low; avoidance of certain obstetric interventions including instrumental delivery and episiotomy may decrease such complications

Standard antituberculosis drug induced hepatotoxicity: Do the risk factors matter?

Objective: To determine the frequency of hepatotoxicity with standard antituberculosis drug therapy and its risk factors

Method: This prospective cohort study was conducted at Muhammad Medical College Hospital, Mirpurkhas and Liaquat University Hospital Jamshoro, from July 2007 to August 2008. A total of 350 cases of active pulmonary tuberculosis with normal pretreatment liver function test [LFT] were selected through probability sampling. Patients were started first line antituberculosis drug therapy [ATT]. The liver function derangement was monitored. If any hepatotoxicity noticed, the time duration for toxicity occurrence and time taken for normalization of LFT were recorded. ATT was altered as needed, with exclusion of toxic drug. Data were collected on proforma and analyzed by using SPSS version 10.0

Results: ATT induced hepatotoxicity developed in 91 [26%] patients with minor, moderate and severe alanine transaminase [ALT] rise noted in 48 [52.75%], 40 [43.95%] and 3 [3.3%] cases respectively. Hepatotoxicity for individual drugs were noted as; Isoniazid [INH] 53 [58.24%], rifampicin 32 [35.16%] and pyrazinamide [PZA] 6 [6.59%] [p=0.01]. Malnutrition, low albumin, acetaminophen, female sex, older age and low serum cholesterol were noted as the risk factors [p=0.05]

Conclusion: Hepatotoxicity occurs significantly with anti-TB drugs, usually reversible and rarely fulminant. It is more frequent in patients with malnutrition, low albumin, acetaminophen, female sex, older age and low serum cholesterol

Chloroquine resistant plasmodium falciparum

The study was conducted to determine the frequency of Chloroquine-resistant Plasmodium falciparum. This was a descriptive case series study conducted at Muhammad Medical College Mirpurkhas and Liaquat University Hospital Hyderabad/ Jamshoro, from January 2007 to December 2007. Total 160 patients with acute attack of fever were selected and studied who fulfilled the inclusion criteria. The WHO extended test was done by giving 25 mg/kg body weight of Chloroquine base over 3 days. The interpretation of the test was done as per criteria laid down by WHO. Out of one hundred sixty, 110 [68.75%] were males and 50 [31.25%] were females with ratio of 2.2:1. The age range 16-45 years with mean 28_12 years. Seventy one patients [44.375%] were Chloroquine sensitive. Chloroquine-resistance [CQR] Rl, Rll and both Rl Rll noted were 28.125%, 15.645% and 43.75% respectively. The CQR- R III was not observed in our study. In view of this situation, more organized and thorough studies must be conducted to elucidate the epidemiology, geographic-distribution and degree of Chloroquine resistance. And the local strategies be made to overcome this problem and to assess the need for changing the first line drug

Cardiac autonomic neuropathy [CAN] in type-1 diabetes, mellitus patients and its association with the duration of disease and glycemic control

To determine the frequency of Cardiac Autonomic Neuropathy [CAN] in type-1 Diabetes mellitus patients and its association with the duration of disease and glycemic control. Descriptive study. Department of Medicine, Liaquat University Hospital, Hyderabad/Jamshoro, from December, 2004 to April, 2005. Fifty patients of type-1 Diabetes Mellitus [DM] of >/= 10 years duration were selected. CAN was evaluated in terms of presence of resting tachycardia, loss of sinus arrhythmia and heart rate response to Valsalva maneuver by electrocardiogram [ECG]. An R-R variation with respiration of >15 beats per minute was taken normal, while 10-15 beats and <10 beats per minute were taken as borderline and definitive CAN respectively. QTc intervals were measured. Patients with HbA1c levels <7% were considered as well-controlled. The associations between CAN, the duration of diabetes and the diabetic control were determined. The mean age was 35.16 +/- 10.58 years with 32 males and 18 females. The mean values for the known duration of diabetes and HbA1c were 13 +/- 7.3 years and 9.36 +/- 2.5 mg/dl respectively. Definitive and borderline CAN were noted in 20% and 24% respectively. Variability of heart rate with respiration was significantly related to the duration but not to the control of the diabetes [p < 0.05]. QTc showed a significant correlation with the known duration of diabetes and heart rate variability with respiration [p < 0.05]. Most of the patients had uncontrolled glycemic status. Cardiac autonomic neuropathy is common in long standing type-1 diabetics. CAN resulted in prolonged QTc interval that may result in cardiac arrhythmias and even death. Intensive glycemic control improves the cardiac autonomic nerve functions

Diabetic foot ulcers; common isolated pathogens and in vitro antimicrobial activity

To determine common pathogens isolated in diabetic foot ulcers and in vitro antimicrobial activity. Muhammad Medical College Hospital, Mirpurkhas and Liaquat University of Medical and Health Sciences Jamshoro. 1st November 2007 to 30th June 2008. Pus samples for bacterial culture were collected from 60 patients admitted with diabetic foot infections. Anti-microbial susceptibility testing of aerobic isolates was performed by the standard disc diffusion method as recommended by the National Committee for Clinical Laboratory Standards. Microbroth dilution test was arranged for susceptibility of anaerobic organisms to metronidazole and amoxicillin/clavulanate. A vancomycin screen agar [6 micro g/ml] was used to detect vancomycin intermediate isolates of Staphylococci. Clinical grading and bacteriological study of 60 patients revealed, 44 [73.33%] patients had gram-negative organisms, and Pseudomonas aeruginosa was the most common. While 16 [26.66%] patients had gram-positive organisms and Staphylococci was the most common organism. Infection with anaerobes was observed in one patient [1.66%]. Both gram-positive and -negative organisms were seen in 8 [13.33%]. Pseudomonas aeruginosa and S.aureus exhibited a high frequency of resistance to the antibiotics tested. All the isolates were uniformly susceptible to fosfomycin, levofloxacin, amikacin and vancomycin. Pseudomonas aeruginosa, Staphylococcus aureus, Escherichia coli, Staphylococcus epidermidis and Proteus were the most common causes of diabetic foot infections in this study. And the rate of antibiotic resistance was 66.66% among the isolates. All the isolates were uniformly susceptible to fosfomycin, levofloxacin, amikacin and vancomycin

HBV vaccination; status in health care workers

The study was conducted to determine the HBV vaccination status in health care workers of Muhammad Medical College Mirpurkhas. This was a descriptive study carried out at Muhammad Medical College Mirpurkhas, From December 2007 to February 2008. Total 480 health care workers were included; both male and female. Vaccination status and other data were filled on preformed Questionnaire proforma, if vaccinated or not. And if vaccinated either complete or incomplete. Total 480 health care workers were studied, including 300 [62.5%] male and 180 [37.5%] females. The mean age was 34 +/- 8.7 and 36 +/- 9.3 years in vaccinated and non-vaccinated subjects respectively. A total of 255 [53.15%] were vaccinated, including 215 males and 40 females. A 225 [44.875%] patients were non-vaccinated including 85 males and 140 females. The prevaccination HBsAg status was checked and found negative in all the subjects. The frequency of vaccination was highest among house officer 55 [91.66%] and lowest in the sanitary workers 3 [11.5%]. The most common reason of not being vaccinated was non-affordability [high cost of vaccine]. We conclude that a substantial number of health care workers are not vaccinated. So it demands a need for a more aggressive approach to be vaccinated and vaccine must be cost effective

Frequency of skin manifestations in 120 type 2 diabetics presenting at tertiary care hospital

Objectives: to determine" the frequency of skin manifestations in patients with type 2 Diabetes mellitus"

Study design, place and duration: this was a descriptive case series study, carried out at Dep't of Medicine, Muhammad Medical College Hospital, Mirpurkhas and Liaquat University of Medical and Health Sciences, Jamshoro from November 2007 to April 2008

Subjects and Methods: one hundred and twenty type 2 diabetics; both male and female, were included in this study. All patients were asked about any skin problems they might have and subsequently all were examined regardless of their response. Age, sex, duration of diabetes, mode of treatment whether on oral hypoglycemic agents or insulin, and skin manifestations were noted

Results: age varied from 33 to 76 years [54 +/- 17 years] and known duration of diabetes varied from 10 to 27 years [15 +/- 9 years]. The overall prevalence of one or more skin disease was 96 [80%]. Diabetic dermopathy was seen in 36 [30%], rubeosis facies in 6 [5%], skin tags in 22 [18.33%], acanthosis nigricans in 7 [5.8%], eruptive xanthomas in 8 [6.66%], Vitiligo in 6 [5%], diabetic bullae in 8 [6.66%], diabetic xerosis in 6 [5%], lichen planus in 4 [3.33%], loss of hair in legs in 24 [20%], nail changes in 24 [20%], gangrenous diabetic foot in 29 [24%], thick skin in 60 [50%], and hyperhidrosis in 36 [30%] patients. Pruritis was noted in 48 [40%] patients. The skin infections were noted in 84 [70%] cases; including bacterial infections in 60 [50%], fungal infections in 20 [16.66%] and viral infections in 04 [3.33%] cases

Conclusions: we conclude that the skin is involved in diabetes quite often and whenever patients present with multiple skin manifestations; their diabetic status should be checked and controlled

Rising menace of multidrug resistant mycobacteria in pulmonary tuberculosis

Objective: the study was conducted to determine the rising menace of multidrug resistant mycobacteria in pulmonary tuberculosis

Subjects and methods: this prospective study was conducted in the Department of Medicine, Muhammad Medical College Mirpurkhas, from May 2007 to July 2008. Sixty cases of pulmonary tuberculosis were selected for multidrug resistant tuberculosis [MDR-TB] study that fulfilled the inclusion criteria. Pulmonary specimens consisted of 2-5 ml, early morning sputa and bronchial washings were sent for the ZN staining [AFB] and culture and drug sensitivity on culture-media. MDR-TB was defined as simultaneous resistance of an isolate to isoniazid and rifampicin

Results: drug culture and sensitivity revealed that 22 [36.66%] were sensitive to all the five first-line drugs, while 38 [63.33%] showed one or other type of drug resistance, including 7 [11.66%] resistant to single drug, 15 [25%] resistant to two drugs, 10 [16.66%] resistant to three drugs, while 6 [10%] were resistant to all the first-line drugs. Primary drug resistance was noted in 3 [5%]. Resistance to isoniazid, rifampicin, streptomycin, ethambutol and pyrazinamide was seen in 32 [53.33%], 28 [46.66%], 24[40%], 20 [33.33%], and 18 [30%] respectively

Conclusions: in view of this increasing level of drug resistance, more organized national strategy against tuberculosis is needed. MDR-TB was most commonly seen in chronic cases/ drug defaulters, and it is a major threat to the tuberculosis control measures

Frequency of cardiac autonomic neuropathy in patients with type 2 diabetes mellitus reporting at a teaching hospital of Sindh

To determine the frequency of Cardiac Autonomic Neuropathy [CAN] in patients with type 2 Diabetes mellitus. Study Design: Descriptive study. Place and Duration of Study: Department of Medicine, Liaquat University Hospital, Jamshoro, Hyderabad from December 2004 to April 2005. Patients with type 2 Diabetes Mellitus [DM] of at least 10 years duration were selected. CAN was evaluated in terms of presence of resting tachycardia, loss of sinus arrhythmia and heart rate response to Valsalva maneuver by ECG. A R-R variation with respiration of > 15 beats per minute, 10-15 beats per minute and <10 beats per minute were taken as normal, borderline CAN and definitive CAN, respectively. QTc intervals were measured. The association between CAN, diabetic control and duration of diabetes were determined. The mean age was 53.62 +/- 8.30 years, with male to female ratio of 1:1. Mean values for known duration of diabetes and HbA1c were 14 +/- 3.5 years and 11.36 +/- 3.6 mg/dl respectively. Definitive and borderline CAN was noted in 30% and 40% patients respectively. Variability of heart rate with respiration was significantly related to duration but not to the control of diabetes [p < 0.05]. QTc showed a significant correlation with the known duration of diabetes and heart rate variability with respiration [p < 0.05]. Most of the patients had very bad glycemic status as evidenced by HbA1c. CAN is common in long-standing diabetics, specifically those treated with oral hypoglycemic agents than those with insulin. Intensive glycemic control is associated with a better cardiac autonomic nerve functions