Diabetes mellitus; incidence of chronic hepatitis C patients

Hepatitis C virus [HCV] is a major cause of chronic liver disease, cirrhosis and hepatocellular carcinoma [HCC]. HCV infection and type 2 diabetes are two common disorders with a high impact on health worldwide. There is growing evidence to support the concept that HCV infection is a risk factor for developing type 2 Diabetes Mellitus. Both insulin resistance and diabetes can adversely affect the course of chronic hepatitis C, and lead to poor response to antiviral therapy and increased incidence of Hepatocellular carcinoma. The objective of the study was to assess the frequency of type 2 Diabetes mellitus in newly diagnosed chronic hepatitis C patients presenting in Allied hospital Medical unit II during six month period. Cross sectional study. Medical unit-II, Allied Hospital, Faisalabad. 01-08-2009 to 28-02-2010. All newly diagnosed patients of chronic hepatitis C on the basis of PCR for HCV-RNA were included in the study. Fasting and two hours postprandial blood sample were tested. Diabetes Mellitus was labeled as per slandered. Out of 180 patients with CHC 19 [10.6%] were found to have Diabetes mellitus while 161[89.4%] were non-diabetics. There is close association in the development of type 2 diabetes mellitus in patients with chronic hepatitis C

Diversity of presentations in decompensated chronic liver disease due to HCV

Background: An estimated 170 million people worldwide suffer from HCV infection. Chronic hepatitis C virus [HCV] infection is often a clinically silent infection presenting many years after with complications related to decompensation, so

Objective: To emphasize the role of early detection and intervention in preventing complications of HCV related chronic liver disease

Materials And Methods: Newly diagnosed decompensated chronic liver disease [CLD] due to HCV infection presenting to respective hospitals during 2010

Study design: observational multicentre study

Results: Out of 340 new cases of decompensated chronic liver disease due to hepatitis C virus. 190 [56%] were females and 150 [54%] were male. In terms of presentation, patients were having overlapping symptoms and signs like ascites, jaundice, upper GI bleed and encephalopathy. 220 [64.7%] had clinical ascites, 70 [20.5%] had spontaneous bacterial peritonitis, 130[38.2%] had altered conscious level and150 [44.1%] had upper GI bleed. It was inferred from history that 170[50%] patients with Hepatitis C were detected while being investigated for complaints other than liver disease. Other presentations included jaundice in 10[2.9%] 50 [14.7%] with previous upper GI bleed, 80 [23.5%] with CLD, 10 [2.9%] with epigastric discomfort and 20 [5.8%] had altered conscious level. 235 [69.1%] with Child's Score B and 105[30.4%] with Child's Score C

Conclusion: Majority of patients become aware only when complications set in. Early detection and interventions should be stressed because the available treatment options for the complications are beyond the reach of majority of patients and don't have a permanent solution

Serum vitamin D deficiency, a new epidemic

Vitamin D deficiency has profound adverse effects on health. Serum calcium, phosphorus and even alkaline phasphatase cannot predict underlying vitamin D deficiency. 1. To determine the frequency of vitamin D deficiency in outpatient private clinic 2. To determine the relation of vitamin D deficiency with the presenting symptom of bone or body aches. To see the relation of its deficiency to the serum calcium, alkaline phosphate and phosphate levels. Descriptive study. One of the local private clinic. 800 patients who presented to the clinic due to any ailment, having presenting complains with bone or body aches or not, were included in this study. The duration of study was 7 months from June to December 2008. The study showed among total 33% [n=264] were male and 67% [n=536] were female. 33 patients [4.1%] were below age of 20 years, 364 patients [45.2%] were having age between 20-40 years, 252 [31 .5%] were between 41 -60 years, 1 43 [1 7.8%] were between 61 -80 years and only 8 patients [1%] were above 80years. Over all vitamin D present in sufficient amount [>30 ng/ml] in only 4 patients [0.5%], reaming patients [n=796, 99.5%] were deficient in vitamin D were further divided into those who were having deficiency [serum level <20 ng/ml] [n=636, 79%] and insufficiency [serum level between 21-29 ng/ml] [n=160, 20%]. All the deficient patients were having normal serum calcium and phosphate levels and only 33 patients were having modestly raised serum alkaline phosphate. Among the sample only 318 [39.7%] were having bone or body aches as a presenting feature while remaining 482 [60.3%] were having no pains. More ever pain has got insignificant relation to any level of serum vitamin D level [p-value=0.201], however younger deficient patients were having lesser chance of bone or body aches as compared to age more then 60 year [p-value<0.001]. Vitamin D deficiency is more prevalent in our community, as compared to published data, targeting young population. Vitamin D supplementation should be planned to decrease its varied and multidimensional ill effects on health

Effect of vitamin d replacement in patients of fibromyalgia

Fibromyalgia is a common condition characterized by long-term, body-wide pain and tender points in joints, muscles, tendons, and other soft tissues. It is a chronic pain disorder that is difficult to treat. Recently Vitamin D has shown promising impact in the treatment of this disorder. To see the therapeutic role of vitamin D replacement in patients of fibromyalgia. Prospective study. Multicentre, Three private clinics. Out of 223 patients presenting with body aches and pains over the course of six months [January to June 2008], 100 patients [96 females and 4 males] between 20 to 50 years of age fulfilled the American College of Rheumatology [ACR] criteria of fibromyalgia and were included in the study. Using standard proforma, frequency of complaints other than ACR criteria were also documented.All of them were on some form of pain medication by various general practitioners/ consultants for more than three months but their symptoms were persistent. After informed consent, their serum vitamin D3 [25OHD3] level was requested as the cost of investigation was to bear by patients themselves. Patients were then replaced with vitamin D with an expected target of > 50 ng/ml and followed for 6 months duration. Supplementation with calcium in a dose of 1000mg/day was also done. In this study 83% of patients were having vitamin D between 11-20 ng/ml[mean =13 +/- 2], 11% between 5-10 ng/ml [mean=7 +/- 1] and 6% were below 5ng/ml [table-2]. There were four male patients, all [100%] with age distribution of 41-50 year and all were deficient in vitamin D [<20ng/ml]. Among 96 female patients 80[76.8%] were having level between 11-20 ng/ml, 10 [9.6%] between 5- 10ng/ml and 6 [5.7%] were below 5 ng/ml. After replacement with vitamin D achieving expected target serum levels >50ng/ml. Improvement in ACR criteria of fibromyalgia syndrome consisting of widespread musculoskeletal pains and 11 out 18 tender points was improved in more than 76% of the patients. Improvement in the associated conditions was also observed e.g. restless legs in 91.3% chronic fatigue in 97.6%. Similarly 85% reported relief from muscle spasm and 65% from tingling. There was also improvement in neuropsychiatric conditions like depression 71%] and anxiety 46.8%. Moreover, improvement in cognitive function like concentration and forgetfulness was also reported by 69.8% and 67.7% respectively [Table-4]

Diabetes mellitus; prevalence of high blood cholesterol, obesity, smoking and physical activity in urban population of Faisalabad

To estimate the prevalence of diabetes high total cholesterol obesity smoking and physical activity in urban population of Faisalabad. The project was limited to population based screening for above mentioned variables using WHO criteria. Study was conducted by holding numerous screening camps in different urban areas over the course of two years. People age 20 years or above were included in the study. Total 5349 people, 58% males [3102] and 42% females [2247] were screened for diabetes and high blood cholesterol. Body mass index was calculated by measuring height in meter square and weight in kilograms. People were interviewed for smoking and physical activity and relevant data was entered in the designed proforma. Within the chosen age range, total prevalence of diabetes was 16% and among them 11% were previously diagnosed and 5% were unaware of their diabetes [newly diagnosed]. Cholesterol was high [>/= 200 mg/dl] in 48% males and 34% females. 9.2% of the males were found to be obese [BMI>30] in comparison to 14.3% of females whereas 36.26% of males and 36.84% of females were overweight [BMI >/= 25 to 29.9 kg/m[2]]. The prevalence of smoking was 38.8% in males and 1.2% in females respectively. In daily routines only 6.8% of the males were doing the physical exercise [30 minutes exercise five days a week or equivalent] whereas among females it was 1.9%. Diabetes and metabolic syndrome in adults is now a global health problem, and the population of developing countries like Pakistan are facing this menace especially in the urban areas where it is on the rise with each passing day

Stroke; frequencies of intra-cerebral bleed, cerebral infarction and sub-arachnoid haemorrhage

To find out the frequency of major categories of stroke [i.e. cerebral infarction, intra cerebral hemorrhage and sub-arachnoid hemorrhage]. A descriptive study. Medical unit III Allied Hospital Faisalabad from January 2005 to June 2005. 112 patients were enrolled after taking verbal consent. After complete physical examination and investigations a sample size of 100 patients was calculated using 5% level of significant and margin of error as 5%. This study revealed frequency distribution of various categories of stroke as cerebral infarction 62 cases [62%], cerebral haemorrhage 30 cases [30%] and sub-arachnoid haemorrhage 8 cases [8%] out of 100 cases in total. Intra-cerebral bleed has got a higher trend in Asia than in western countries and is more common in female gender while cerebral infarction is more common in males and its frequency although the highest among the major categories of stroke in Asia but relatively less as compared to that in western countries

Predictive value of blood glucose as an independent risk factor for progression/ mortality in acute coronary syndrome

This study was designed to assess the prognostic significance of hyperglycemia in Acute Coronary Syndromes. Most studies that have examined this fact before were performed in patient with Acute Myocardial Infarction. [4, 18]. There were 320 patients admitted in M.U.III, Allied Hospital, Faisalabad between July 2006 and December 2006. Patients were divided according to history of Diabetes Mellitus and further according to whether they had blood glucose more than 198 mg/dl. Other cardiac risk factors, medications and interventions were analyzed and multivariate logistic regression was used to determine the influence of blood glucose on progression/ Mortality. About 122 patients were lost in follow up and 198 patients were followed for 2 months. In patients without history of diabetes, glucose levels were 198mg/dl in 136 patients [Group 1] and > 198 mg/dl in 24 patients [Group 2]. Of those with diabetes glucose levels were 198 mg/dl in 27 patients [Group 4]. Compare with Group 1 patients, the odds ratios [95% confidence interval] for in hospital progression/mortality among those in Group 2, 3 and 4 were 2.64 [1.32 to 4.52; p = .001], 1.63 [98 to 3.52; p = .035], and 1.88 [1.29 to 3.45; p = .012], respectively. These groups also have greater 2 months progression/mortality. Hyperglycemia in ACS is associated with worse prognosis in patients without diabetes. This finding signifies the underlying need for aggressive glucose management in these situations and perhaps more vigorous screening strategy for early recognition of diabetes. diagnosis of diabetes, was an independent predictor of in-hospital and 2 month morbidity and mortality. [9,24,36]. Setting and Study Population: Allied Hospital, Punjab Medical College is a tertiary care hospital with 1500 beds and all state of the art modern facilities. Implications of elevated blood glucose were studies in 300 patient admitted to M.U. III during July

Frequency of hepatitis c virus in patients with decompensated cirrhosis of liver in Faisalabad

To assess the frequency of Hepatitis C viruses in patients with decompensated cirrhosis of liver at a tertiary care hospital. It is a descriptive study conducted at Medical unit-Ill Allied Hospital Faisalabad from January 2005 to June 2005. 112 patients were enrolled after taking verbal consent. After complete physical examination and investigations a sample size of 100 patients was calculated using 5% level of significance and margin of error as 5%. In a total of 100 patients 66 were Hepatitis C virus positive, 20 patients were found to be Hepatitis B virus positive. 9 patients were both Hepatitis B and C virus positive, 5 patients were found negative on virus screening with Elisa method. Hepatitis C virus is the most common cause of decompensated liver disease. It is the need of the hour to create more awareness and to launch educational campaigns regarding the modes of spread and prevention against Hepatitis C virus and to increase the compliance of Hepatitis B virus vaccination