comparative analysis of the association of chronic inflammation versus no inflammation on the nutritional status of patients on chronic maintenance hemodialysis

To assess the association of chronic inflammation on the nutritional status of patients on Chronic maintenance hemodialysis. This cross-sectional comparative study was performed at department of Medicine Fauji Foundation Hospital Rawalpindi. Patients having chronic renal failure who were on regular maintenance hemodialysis for more than 6 months were included in the study. Ultrasound examination was done to confirm the presence of renal parenchymal disease and shrunken kidneys. The level of C-reactive protein was measured as indicator of inflammation and serum albumin, cholesterol level, mid-arm circumference, triceps skin fold thickness, subscapular skin fold thickness and body mass index [BMI] were used as the assessment tools to evaluate the influence of inflammation on the nutritional status in patients. Patient in two groups with positive or negative CRP were compared regarding the effects of inflammation on nutritional parameters. Out of 30 patients, 13 [43.3%] had evidence of inflammation with positive CRP and a mean BMI of 19.2 +/- 3.3 whereas the CRP negative group had a mean BMI of 24.9 +/- 1.5. Regarding nutritional parameters, Triceps Skin Fold Thickness, Subscapular Skin Fold Thickness, mid-arm circumference and serum albumin were also statistically low in CRP positive patients although serum cholesterol levels did not differ significantly in our study. The CRP positive patients therefore were malnourished as compared to the CRP negative group. Patients with end stage renal disease on chronic dialysis with evidence of inflammation are more at risk of malnutrition. Although there is no standardized strategy for the treatment of chronic inflammation in these patients so far but this area needs further research to improve outcome in these patients

Disposal of syringes, needles, and lancets used by diabetic patients in Pakistan

To assess the use, handling and disposal of insulin injection equipment by diabetic patients in Pakistan. We conducted a cross-sectional study at diabetic clinics in five tertiary centers in Pakistan. All diabetic patients [type 1/type 2] who were on insulin for more than 1 month, were included. An Urdu [local language]-translated questionnaire was used to collect information on insulin administration equipment, the site and frequency of needle use, insulin syringe/pen/lancet disposal, sharing of needles and knowledge about diseases that are spread by sharing contaminated needles. Of 375 patients, 58% were female. The mean [SD] duration of diabetes was 12.3 [7.3] years, and the duration of insulin use was 4.4 [4.3] years. The majority of the patients used syringes [88.3%] for insulin administration. Additionally, the majority of the patients disposed of used devices [syringes, 92%; pens, 75%; and lancets, 91%] in the household garbage collection bin. About half of the patients [n = 185] reported being educated by their physicians about the disposal of sharps. Those who were educated by a physician [adjusted odds ratio [adjOR]: 0.36; 95%CI: 0.16-0.81] or could read/write English [adjOR: 0.32; 95%CI: 0.11-0.92] were less likely to dispose of syringes and needles in the household garbage. The common disposal of sharps in the household garbage has implications for disease transmission. Education on the safe disposal of sharps may improve the disposal practices

Mediastinal tuberculosis presenting with sternal osteomyelitis and discharging sinus

Involvement of the mediastinum and sternal bone leading to osteomyelitis is a very rare presentation of tuberculosis even in countries where tuberculosis is endemic like Pakistan. Frank presentation as discharging sinus is even more uncommon. We describe a case where a patient presented with constitutional symptoms of fever, loss of appetite, significant weight loss and an erythematous tender lesion over the sternum with a discharging sinus without any features of pulmonary tuberculosis. The case was initially not diagnosed by routine laboratory tests and the lesion was just considered as a boil until presented to tertiary care hospital as discharging sinus. Plain Radiographs showed lytic lesion on the inner aspect of sternum and histopathology of the aspirate from the lesion confirmed the presence of epithelioid granulomas and acid fast bacilli on staining. Patient responded very well to 12 months of antituberculosis treatment

Risk of development of chronic kidney disease in patients with type 2 diabetes having metabolic syndrome

To measure the relation of creatinine clearance in type-2 diabetic patients with different components of metabolic syndrome and to quantify the relationship of frequency of incident CKD with increasing number of metabolic syndrome components while controlling for age, gender and duration of diabetes. Cross-sectional descriptive study. Diabetes Clinic, Fauji Foundation Hospital, Rawalpindi, from January to August 2006. Patients having type-2 Diabetes for more than 5 years were enrolled. Information regarding age, gender, duration of diabetes, type of diabetes, treatment taking, complete fasting lipid profile, fasting blood glucose, Body Mass Index [BMI], 24 hours urinary proteins and creatinine clearance, co-existent risk factors like hypertension and ischemic heart disease was taken. Patients were divided into groups having one to all five metabolic syndrome traits. Progressive increase in the metabolic syndrome traits was compared with decline in creatinine clearance. Pearson correlation test and multiple logistic regression were applied to determine correlation with significance at 'r' and 'p'