Comparison of Reproductive Hormonal Profile and Sexual Performance Satisfaction among Type-2 Diabetes Mellitus and Controls.

OBJECTIVE: To evaluate reproductive hormonal profile among three groups with varying sexual performance satisfaction (erectile dysfunction) with or without type-2 diabetes (T2DM). STUDY DESIGN: Comparative cross-sectional analysis. PLACE AND DURATION OF STUDY: Department of Pathology, PNS Hafeez Hospital, Islamabad, from January to December, 2018. METHODOLOGY: One hundred and twenty-one subjects including T2DM and age-matched controls were segregated into three groups based upon their sexual performance satisfaction. These groups were evaluated by one-way ANOVA for various anthropometric, glycemic indices and reproductive hormones and free androgen indices (FAI). A general linear model (GLM) was utilised using HbA1c and FAI as dependent variable with sexual performance satisfaction as fixed and quantitative CRP and urinary albumin creatinine ratio (UACR) as random variables to evaluate diabetes complication and inflammation on sexual performance. RESULTS: Comparison between three groups suggested a rising trend for FAI as: FAI: {Non-satisfied (n=43):41.78 (95%CI:36.67-46.90)}, {Just satisfied (n=38):48.81(95%CI: 42.96-54.66)}, {Satisfied (n=40):51.86 (95%CI:45.27-58.44)}, [p=0.041]. GLM model evaluation suggestion that for any particular degree of reported ED, HbA1c demonstrated a higher trend from non-satisfied subjects to satisfied subjects with inflammation following a rise with HbA1c levels, identifying inflammation as more related with worsening diabetes than with sexual performance satisfaction. FAI levels were higher among subjects who showed no erectile dysfunction than subjects with less satisfied groups with both inflammation (qCRP) and nephropathy (UACR) causing across the group decline for FAI among all ED groups. CONCLUSION: Sexual performance satisfaction and FAI decline with rise in HbA1c. Moreover, subjects having nephropathy or higher inflammation (qCRP) were found to have lower FAI and ED, both in controls and T2DM.

Comparison of retinal nerve fiber layer thickness between normal population and patients with diabetes mellitus using optical coherence tomography.

OBJECTIVE: To compare the difference in peripapillary Retinal Nerve Fibre Layer (RNFL) thickness between normal population and Type-II diabetic patients without diabetic retinopathy using Spectral Domain Optical Coherence Tomography (SD OCT). METHODS: This cross sectional study was carried out at PNS Shifa Naval Hospital, from May 2017 to November 2017. Out of 200 eyes, 100 eyes were of normal individuals and 100 eyes were of Type-II diabetic patients without diabetic retinopathy. Both groups were age and gender matched. Average RNFL thickness, along with RNFL of each quadrant of individuals was noted using SD OCT, and compared between two groups. RESULTS: Mean age of study population was 44.63 ± 4.30 years. Mean axial length was 23.46 ± 0.59 mm. Mean peripapillary RNFL thickness was 126.98 ± 10.07 µm in Group-A (normal individuals), and 120.77 ± 5.41 µm in Group-B (Type-II diabetics). Difference in mean RNFL thickness, as well as RNFL thicknesses of each quadrant was statistically significant between both groups (p-value < 0.001). CONCLUSION: Diabetic patients have thin RNFL as compared to normal individuals, and must be taken in account while making diagnosis of any disease based on thinning of RNFL.

Diagnostic accuracy of cerebrospinal fluid adenosine deaminase in detecting Tuberculous Meningitis.

OBJECTIVE: To determine diagnostic accuracy of Cerebro Spinal Fluid (CSF) Adenosine De-Aminase (ADA) in detecting Tuberculous Meningitis (TBM) keeping CSF Polymerase Chain Reaction (PCR) for Mycobacterium Deoxy Ribonucleic Acid (DNA) as gold standard. METHODS: This cross sectional validation study was conducted at Department of General Medicine of PNS Shifa Naval Hospital Karachi, Pakistan from Oct 2015 to Mar 2017 for a total duration of one and a half year. One hundred and thirty six patients were included. The diagnosis of TBM was based clinically on symptoms like fever, headache, altered mental state and signs of meningeal irritation with CSF findings of increased proteins, low glucose and lymphocytic pleocytosis. Lumbar puncture was done and approximately 4ml of CSF sample was withdrawn for analysis. Diagnosis of TBM was confirmed by doing CSF PCR test for mycobacterium tuberculosis DNA. RESULTS: Total 136 patients were enrolled in this study. Mean age in our study was 47.09±12.80 years, whereas frequency and percentages of male and female patients was 102 (75%) and 34 (25%) respectively. The diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value of CSF ADA level in detecting TBM was 71.32%, 84.21%, 95.45%, 98.97% and 53.85% respectively. CONCLUSION: The study concludes that diagnostic accuracy of CSF ADA in detecting TBM is high which is proposed as an investigation to differentiate it from other causes of meningitis in places where PCR test is not available.

Comparison of corneal morphological characteristics between diabetic and non diabetic population.

OBJECTIVE: To compare corneal morphological parameters between diabetics and age matched non-diabetic control subjects and to evaluate the correlation of these parameters in relation to duration of diabetes mellitus (DM), glycemic status and severity of diabetic retinopathy.(DR). METHODS: This cross sectional comparative study was conducted at the Department of Ophthalmology, PNS Shifa Karachi from February 2016 to January 2017. Patients with ages between 10 to 80 years of either gender who were diagnosed to have DM were recruited in the study. Control group comprised of age matched healthy volunteers who did not have DM. Corneal morphological parameters (CED, Average cell size, CV of cell size and hexagonality) was evaluated in each subject with non-contact specular microscope and findings were endorsed on a pre devised proforma. RESULTS: Data of 298 eyes (149 diabetic patients and 149 healthy controls) was evaluated. Mean corneal endothelial cell density (CED) of diabetic population was 2494.47 ± 394.10 cells/mm2, while mean CED of control group was 2574.46 ± 279.97 cells/mm2 [p = 0.04]. Between group differences in mean average cell size, CV of cell size and hexagonality was statistically not significant. Analysis of corneal endothelial parameters among subgroups of patients with no DR, with NPDR and PDR did not show statistically significant difference. Moreover, patients with diabetes of more than 10 years duration had significantly lower CED (p <0.01) and larger average cell size (p= 0.03). Duration of DM was significantly correlated with type of DR, HbA1c level, CED, polymegethism and hexagonality. CONCLUSION: Mean corneal endothelial cell density (CED) was found to be significantly lower in diabetic population as compared to healthy controls.

Comparison of serum lipid profile in Type-2 Diabetics with and without retinopathy in Pakistani population.

OBJECTIVE: To compare serum cholesterol, TG, HDL-C and LDL-C concentrations between type-2 Diabetes mellitus (DM) patients with retinopathy and without retinopathy and to study association between various modifiable risk factors of Diabetic retinopathy (DR). METHODS: The study included 300 patients with type 2 DM; 140 of them were without DR (Group-I) and 160 were with DR (Group-II). Serum total cholesterol, LDL-C, HDL-C, and TG levels were determined. SPSS 17.0 for windows was used for statistical analysis. RESULTS: Overall, mean age of study population was 48.86 ± 5.62 years. Subjects with DR were older (P < 0.018), had higher fasting plasma glucose (P < 0.01) and higher HbA1c (P <0.01) concentrations compared with those without DR. Analysis of serum cholesterol, LDL-C, HDL-C and TG among subgroups of patients with no DR, with NPDR and PDR showed statistically significant difference (p <0.01). There was strong positive correlation of severity of DR with BSF, HbA1c, serum LDL-C, total cholesterol and TG. CONCLUSION: The serum cholesterol, TG, HDL-C and LDL-C concentrations were found to be significantly deranged in patients with DR as compared to those without DR.