Visceral Adiposity Index: A Simple Tool For Assessing Risk Of Type 2 Diabetes Mellitus.

BACKGROUND: The prevalence of type 2 diabetes mellitus (T2DM) has increased recently in Pakistan. Visceral adiposity index (VAI) appears to be a better predictor for metabolic syndrome associated with insulin resistance. VAI has been shown to be linearly and positively associated with diabetes mellitus (DM) in many populations. It is, however, uncertain whether VAI could be associated with T2DM in the Pakistani adult population.. METHODS: This is a cross-sectional study of 300 outpatients with a newly diagnosed T2DM. Subjects were recruited from Lady Reading Hospital, Pakistan, during the period from April, 2020 to January, 2021. For all study subjects, anthropometric measurements were performed. Blood samples were collected for the assessment of high-density lipoproteins (HDL-C), triglycerides (TGs), glycated hemoglobin (HbA1c), and random blood glucose. RESULTS: Participants with high VAI showed poor glycemic control. The number of patients with poor glycemic control increased across the VAI quartiles. VAI showed significant correlations with TGs (r=0.715, p=<0.001), total cholesterol (TC) (r=0.256, p=<0.001), low density lipoprotein (LDL-C) (r=0.154, p=0.007), uric acid (r=0.205, p=0.019), duration of diabetes (r=0.171, p=0.033), TSH (r=0.163, p=0.007), and random blood glucose (r=0.195, p=0.019). CONCLUSIONS: Our data suggest that VAI is significantly and positively correlated with the risk factors of DM such as random blood glucose, uric acid and TSH. The findings of the study do not imply a significant direct association between VAI and DM among the Pakistani adult population. Prospective-large scale studies can help inform an effectiveness of VAI for the prediction of the risk of T2DM among Pakistani population.

Bacteriological Profile And Antibiotic Susceptibility Patterns In Diabetic Foot Infections, At Lady Reading Hospital, Peshawar.

BACKGROUND: Diabetic foot ulcer is one of the common complications of diabetes and is also the major cause of hospitalization across the world. To treat it properly, bacteriological profile is important to institute appropriate treatment. This study is done with the objective to determine the microbiological profile and antibiotic susceptibility patterns of organisms isolated from diabetic foot ulcers in Lady Reading Hospital, Peshawar Pakistan. METHODS: This cross-sectional study was conducted from January to June 2019. Swab samples were collected from 114 patients with diabetic foot infections and inoculated on appropriate media. Antibiotic susceptibility tests were done by Kirby Bauer disk diffusion method. RESULTS: E. coli were predominately isolated in the study, with ESBL in 41.6% of the cases. Strains of Pseudomonas with MDR and XDR were isolated in 21.8% and 6.25% of the patients respectively. Majority of Gram-positive isolates were Staphylococcus aureus, those were MRSA in 76.6% of samples. The commonly involved sites of DFU were the toes and forefoot, and the main causes were blister formation or trauma. Most of the patients were identified to have risk factors such as peripheral neuropathy, peripheral arterial disease, over weight and poorly controlled diabetes. CONCLUSIONS: In our study, Gram negative aerobes were predominantly isolated in the diabetic foot infections. A significant number of MDR isolates were also observed. Lack of awareness about DFU and inappropriate use of broad-spectrum antibiotics may be the main cause of increase in the frequency of MDR isolates.

Using Thypro 39 Scale For Predicting The Quality Of Life In Hypothyroid Patients At Lady Reading Hospital.

BACKGROUND: Thyroid disorders are the second most common of the endocrine diseases. With regards to Hypothyroidism, it has a slow indolent course over the years, before its diagnosis. Most of the patient, on adequate treatment with biochemical euthyroid status, have generalised symptoms that affect their quality of life. Several tools to assess quality of life in thyroid disorders have been validated and recommended for use for those patients in clinical follow ups. ThyPRO 39 is one of a recently developed thyroid-specific quality of life (QoL) questionnaires applicable to patients with benign thyroid disorders (BTD). The purpose of this study was to predict the thyroid-related quality of life (QoL) instrument ThyPRO 39 in patients with Hypothyroidism, who were rendered euthyroid with thyroid replacement therapy prior to the administration of study tool and to assess the internal reliability of this scale in our population. METHODS: A sample of 52 patients undergoing maintenance treatment for Hypothyroidism who visited the outpatient Endocrinology clinics at Lady Reading Hospital was studied. They were interviewed for their baseline demographic details and details on ThyPRO 39 questionnaire were recorded after a written informed consent. The data was entered and analysed using SPSS 25. The Internal reliability of the ThyPRO 39 scale was assessed for multi-item scales using Cronbach's alpha coefficient. RESULTS: The ThyPRO 39 scale demonstrated good response across the whole range of QoL aspects in patients with hypothyroidism. Internal reliability for ThyPRO 39 scale was satisfactory. Cronbach's Alpha in our study was 0.928, which was comparable to the results of other studies. CONCLUSIONS: We suggest implementing this measurement tool as a patient-reported outcome in clinical studies in our indigenous population and further more to utilise it as a screening tool for QoL in clinical management of Hypothyroidism in our routine medical consultations.

The characteristics and pattern of care for the type 2 diabetes mellitus population in the MENA region during Ramadan: An international prospective study (DAR-MENA T2DM).

AIMS: We aimed to describe the characteristics and care of participants with diabetes during Ramadan in the Middle East and North Africa (MENA). METHODS: In this prospective, observational study, we analysed the number of fasted days, number of participants fasting, glycemic control, rate of hypoglycemic events, and lifestyle patterns for participants with T2DM during Ramadan 2016. RESULTS: The population included 1749 participants with T2DM. The mean (SD) duration of fasting was 27.7 (5.0) days, and 57.3% of participants fasted for the full duration of Ramadan. Following Ramadan, a significant improvement in HbA1c, FPG, and PPG was observed (p < 0.0001). Confirmed hypoglycemia increased significantly from before to during Ramadan (incidence: 4.9% vs. 10.4%, p < 0.001; adverse events: 0.11 vs. 0.22 events/month/participant, p < 0.001) and was dependent on the treatment regimen. Severe hypoglycemia incidence was 0.2% before versus 0.9% during Ramadan (p = 0.031), whereas adverse events remained comparable (0.01 events/month/participant; p = 0.154). Most participants (97.4%) reported lifestyle changes during Ramadan. CONCLUSIONS: This prospective study is the first to describe the characteristics and care of participants with T2DM during Ramadan in MENA, and can be utilized in the development of evidence-based care to ensure the safety of participants who fast.

Feasibility, relevance and effectiveness of teaching and assessment of ethical status and communication skills as attributes of professionalism.

OBJECTIVE: To examine the feasibility and effectiveness of teaching and assessing professionalism in a developing country. METHODS: The pre-intervention and post-intervention study was conducted from January to August 2012 and comprised 7 workshops of three days each that were held at four teaching hospitals of Khyber Pakhtunkhwa province in Pakistan. Overall, there were 10 Objective Structured Clinical Examination stations and 10 written scenarios. After the pre-test, workshop was held on various aspects of professionalism which was considered 'intervention', and it was followed by a post-test similar to the pre-test at the end of day 3. Stata 12 was used for all statistical analyses. RESULTS: There were 136 postgraduate residents in the study. The correlation between Objective Structured Clinical Examination stations and written exam for pre-test was 0.42 (p<0.001), while for post-test the correlation was 0.17(p=0.046). Correlation between pre-test written and post-test Objective Structured Clinical Examination stations was 0.23 (p=0.001), but the correlation between pre-test Objective Structured Clinical Examination stations and post-test written was not significant (p>0.05).The standardised effect size for the adjusted regression was 0.37 for both comparisons (p<0.001).Mean pre-test scores were 38.13+/-13.13% vs. 76.50+/-14.4%for the post-test score (p<0.001). CONCLUSIONS: Although post-test scores increased significantly both for the Objective Structured Clinical Examination stations and the written scenarios, the former has shown a higher reliability compared to the written test. Furthermore, teaching and assessment of professionalism was found relevant, effective and feasible in resource-constrained countries. Teaching and assessment of professionalism has become globally relevant and is recommended to be included in the curricula of medical institutions.

Erectile dysfunction and type 2 diabetes mellitus in northern Pakistan.

OBJECTIVE: To determine the frequency of erectile dysfunction in married male Type-2 diabetic patients. METHODS: The cross-sectional observational study was carried out at the Endocrinology, Diabetes and Metabolic Diseases Unit Hayatabad Medical Complex, Peshawar, from July 2011 to Apr 2012, comprising 217 male married Type-2 diabetic patients. Serum samples were assayed for blood glucose, lipid profile and glycated haemoglobin A1c. Body mass index and waist-to-hip ratio was calculated. Erectile dysfunction was assessed by Sexual Health Inventory for Men questionnaire. SPSS 18 was used for statistical analysis. RESULTS: A total of 217 patients were initially interviewed. The mean age was 43.1 +/- 8.160 years. The frequency of drectile dysfunction increased with age, duration of patients and increased body mass index. Overall, 6 (2.8%) patients had no erectile dysfunction, 37 (17.1%) had mild, 82 (37.8%) mild to moderate; 47 (21.7%) moderate; and 45 (20.7%) severe. Higher HbAlc levels and atherogenic dyslipidaemia were associated with erectile dysfunction. CONCLUSION: Poor glycaemic control was associated with increased erectile dysfunction risk. Duration of diabetes, older age, increased body mass index are associated with increased incidence of the condition in patients with diabetes. Intensive lifestyle changes in the beginning can add to the better management of Type-2 diabetes and prevention of erectile dysfunction.

Diabetic foot infections and their management in a tertiary care hospital.

BACKGROUND: Diabetic foot is a common complication of diabetes world over. We conducted this study to determine common microbiological pathogens in Diabetic Foot Infections (DFI) at a tertiary care hospital and their management. METHODS: In this observational study deep wound swabs of all admitted diabetic patients were taken, pathogens isolated, antibiotic used and its response depending on complete resolution of symptoms and biochemical markers were recorded. Data were analysed on SPSS-11. RESULTS: A total of 114 cases were recorded. Sixty-eight (59%) cases had ulcers on forefoot, 28 (25%) mid-foot and 18 (16%) hind-foot. One hundred and four pathogens were isolated from wound swabs after debridement. Commonest pathogen isolated was Staphylococcus aureus (52, 46%) followed by E. coli (11, 10%), MRSA was found in 10 (9%) cases, streptococcus in 6 (5%) and pseudomonas in 5 (4%) cases. Polymicrobial infection was also seen in a few cases. Surgical intervention included superficial debridement in 88 (77%) cases, toe amputation/forefoot amputation in 19 (17%) cases, and below/above knee (major) amputation in 7 (6%) cases. Commonest antibiotic used was Cefoperazone/Sulbactam in 43 (38%) cases, alone or in combination, followed by Ceftraixone 36 (33%) cases. Linezolid was used for MRSA. Ninety-four (82%) patients responded to treatment and- were recorded as 'cured'. CONCLUSION: Diabetic Foot ulcers often present with serious foot infections. Commonest pathogens are Staph. aureus, E. coli, Pseudomonas spp. and MRSA. Treatment was effective with Cefoperazone/Sulbactam and Ceftraixone. MRSA was treated successfully with Linezolid.