A Rare Case of P63-Negative Sinonasal Nut Midline Carcinoma in the Elderly.

A nuclear protein in testis (NUT) midline carcinoma arises from squamous cells and is often located in the head, neck, and lungs. This report focuses on the negative p63 mutation and older age at the diagnosis of a NUT carcinoma, which has significant prognostic implications. A 62-year-old patient presented initially with a three-year history of recurring frontal headaches, intermittent nasal bleeding, and a sensation of a nasal cavity mass. An incisional biopsy revealed a poorly differentiated NUT carcinoma in the left maxillary sinus. A functional endoscopic sinus surgery was performed, but the cancer recurred. As a result, a total maxillectomy was performed, and the patient was declared cancer-free with no evidence of residual disease. This is a rare instance of a p63-negative midline NUT cell carcinoma (NCC) in an elderly patient, which could potentially contribute to a more favourable prognosis and longer survival compared to other reported cases. LEARNING POINTS: Molecular analysis of a NUT carcinoma and age at diagnosis may serve as a potential means for predicting patient prognosis in cases of midline NCC.Each patient should receive careful monitoring and a personalised treatment strategy based on their molecular studies. Surgical resection, along with a combination of radiotherapy and chemotherapy, has the potential to improve overall survival rates.In line with the commonly observed relationship between increased p63 mutation and poorer survival rates, a negative p63 expression in squamous cell carcinomas may indicate a more favorable prognosis. This hypothesis highlights the importance of further research to validate these findings.

Acute Kidney Injury Complicating Wasp Stings: A Report of Two Cases and Literature Review.

Acute kidney injury could occasionally complicate wasp stings. We describe two such cases. The first one developed acute kidney injury as a result of rhabdomyolysis and hemolysis, whereas the other patient developed acute kidney injury as part of multiorgan dysfunction syndrome resulting from shock and rhabdomyolysis. Both remained dependent on intermittent hemodialysis for a short period of time before recovering spontaneously. These cases highlight different pathophysiological processes leading to acute kidney injury, and the importance of timely diagnosis to achieve favourable clinical outcomes.

Comparison of prilocaine/lidocaine cream with piroxicam gel for reducing pain during cannulation of arteriovenous fistula for adults undergoing haemodialysis: A randomized crossover clinical trial.

BACKGROUND: Pain is a traumatic experience for most patients on hemodialysis. In this trial, we compared prilocaine/lidocaine cream with piroxicam gel for pain reduction during arteriovenous fistula needling. METHODS: This randomized double-blind crossover clinical trial was done at dialysis unit of a tertiary care hospital from June to August 2022. Adult patients, aged 18-75 years, on maintenance hemodialysis through an arteriovenous fistula were selected randomly. Pain severity during needling of fistula was assessed during initial two hemodialysis sessions without application of any drug. Patients were then randomized into two groups receiving 5% prilocaine/lidocaine cream or 0.5% piroxicam gel 1 h before the next two hemodialysis sessions. After a 7-day washout period, patients crossed over to other groups for another two hemodialysis sessions. Pain was assessed on all these occasions. Primary outcome was reduction in pain with each intervention. RESULTS: There were 32 patients aged 46.44 ± 11.58 years. Pain intensity was 6.69 ± 0.58, 3.13 ± 1.28, and 4.55 ± 1.95 without any medication, prilocaine/lidocaine cream and piroxicam gel respectively. There was greater pain reduction with prilocaine/lidocaine cream than piroxicam gel (3.56 ± 1.35 vs 2.14 ± 1.78; p = 0.001). Local redness with prilocaine/lidocaine cream was reported by one (3.13%) patient, whereas no side effects were seen with piroxicam gel (p = 1.000). CONCLUSION: Prilocaine/lidocaine cream provides better pain relief than piroxicam gel during arteriovenous fistula needling.

Clinical Determinants of Frailty in End-stage Renal Disease.

This cross-sectional analytical study was carried out to determine the frequency of frailty in patients on haemodialysis and to identify predictive clinical parameters. Patients were selected using convenience sampling. Exclusion criteria included acute kidney injury, non-compliance to hemodialysis, limited physical mobility due to cerebrovascular or rheumatological diseases, acute infections and unwillingness. Frailty was assessed using a short physical performance battery (SPPB). Handgrip strength and triceps skin fold thickness were also measured. There were 79 patients enrolled in the study with mean age of 51.86± 14.85 years, including 44 (55.70%) males. The median SPPB score was 8 (4-11). Frailty was observed in 51 (64.56%) patients. SPPB score had significant correlation with handgrip strength (R2= 0.309; p<0.001) and triceps skin fold thickness (R2= 0.060; p=0.030). On univariate analysis, increasing age, female gender, triceps skin fold thickness and hand grip strength were predictive of frailty. However, only increasing age (p<0.001) was predictive of frailty in multivariate analysis. Key Words: Haemodialysis, Physical performance, Renal replacement therapy.

Glycolysis: The Next Big Breakthrough in Parkinson's Disease.

Parkinson's disease (PD) is a common neurodegenerative disease characterized by the death of dopaminergic neurons. Its pathogenesis comprises defects in the physiological pathway of mitophagy and mutations in the genes involved in this process's regulatory mechanism. PD manifests itself with multiple motor and non-motor symptoms, and currently, there are multiple pharmacological treatments, and unconventional non-drug treatments available. The mainstay of Parkinson's disease treatment has centered around directly manipulating neural mechanisms to retain high dopamine levels, either by exogenous administration, increasing intrinsic production, or inhibiting the breakdown of dopamine. In this review, we highlight a new potential biochemical modality of treatment, treating PD through glycolysis. We highlight how terazosin (TZ), via PGK1, increases ATP levels and how enhanced glycolysis serves a neuroprotective role in PD, and compensates for damage caused by mitophagy. We also discuss the role of quercetin, a bioactive flavonoid, in preventing the development of PD, and reversing mitochondrial dysfunction but only so in diabetic patients. Thus, further research should be conducted on glycolysis as a protective target in PD that can serve to not just prevent, but also alleviate the non-dopaminergic signs and symptoms of PD.

Correlation Of Caregivers' Strain With Patients' Disability In Stroke.

BACKGROUND: Stroke results in serious long-term disability in fifty percent of the survivors, making them dependent on others for activities of daily living. Our study aims to study the effect of this dependence on care-givers. Cross sectional study. METHODS: It was a cross sectional study conducted at Combined Military Hospital Peshawar from September to November 2020. Self-administered questionnaires were used to interview 96 patients with stroke and their caregivers selected through convenience sampling technique. Barthel Index was used to measure disability among patients, whereas Modified Caregivers Strain Index (M-CSI) was used for the caregivers. An association between the two scores was analyzed through Pearson's coefficient of correlation (r) and linear regression. RESULTS: Mean ages of the patients and their caregivers were 66.13±11.32 and 36.32±13.71 years respectively. Median score of Barthel index was 1.00 (interquartile range 0.00- 9.75). Mean M-CSI score was 17.31±5.04. There was significant negative correlation between Barthel Index and M-CSI (R=0.542, p<0.001). No significant association was found between duration of stroke and history of recurrent stroke with Barthel Index (p=0.399 and p=0.527 respectively). CONCLUSIONS: Greater the dependence of patients for activities of daily living on their caregivers, higher is the level of strain among the latter. There is dire requirement of social support and rehabilitation centers to address the physical and mental needs of both the patients and their care providers.

Comparison Of Vascular Calcification And Mineral Bone Disease In Non-Dialysis (CKD4/5ND) Vs Dialysis Dependent (CKD5D) Patients.

BACKGROUND: Chronic kidney disease (CKD) has been a highly prevalent medical condition in all parts of the world affecting the haemostasis of the body in number of ways. Epidemiological data suggest that no region of the world has been spared from this condition and both developing and developed countries equally share the burden of this disease. Objective was to compare the vascular calcification and mineral bone disease in non-dialysis vs dialysis patients suffering from chronic kidney disease at a tertiary care hospital of Pakistan. It is a Comparative study, conducted at the Department of nephrology Pak Emirates Military Hospital Rawalpindi. Four months from November 2020 to February 2021. METHODS: A total of 310 cases were included in the study, which were diagnosed as chronic kidney disease in nephrology department by a consultant nephrologist on basis of National Kidney Foundation/Kidney Disease Outcome Quality Initiative (NKF/KDOQI) 2002. They were divided into two equal groups by block randomization. Group I had the patients who were not dependent on dialysis (CKD4/5ND) while group II had dialysis dependent patients. Abdominal aorta, mitral and tricuspid valves were assessed to look for vascular calcification. Calcium, phosphate and parathyroid hormone levels were done to assess the mineral bone profile. RESULTS: Out of 310 patients, 192 (61.9%) patients were males and 118 (38.1%) were females. Ninty-eight (31.6%) had evidence of vascular calcification while 212 (68.4%) did not have vascular calcification. 147 (47.4%) had hypocalcaemia, 167 (53.8%) had hyperphosphatemia while 98 (31.6%) patients had raised Parathyroid hormone levels. Regression analysis revealed that vascular calcification and abnormal mineral bone profile was significantly present more among patients who were dependent on dialysis (p-value<0.05). CONCLUSIONS: Bone mineral disease and vascular calcification were consistent findings among patients suffering from chronic kidney disease. Patients who were dependent on dialysis were more prone to develop these complications as compared to those who were not dependent on dialysis.

COVID-19 pandemic and antimicrobial resistance in developing countries.

A wide range of antimicrobial agents were touted as potential remedies during the COVID-19 pandemic. While both developed and developing countries have recorded an increase in the use of antimicrobial drugs, use and misuse have occurred to a far greater degree in developing countries. This can have deleterious consequences on antimicrobial resistance, especially when various developing countries have already reported the emergence of various drug-resistant organisms even before the pandemic. Telemedicine services, societal and cultural pressures, and bacterial co-infections can predispose to overwhelming antimicrobial prescriptions. The emergence of new multidrug resistance species is a major concern for the developing world especially since health services are already overburdened and lack the diagnostic capabilities and basic amenities for infection prevention and control. This can lead to outbreaks and the rampant spread of such microorganisms. Improper waste management and disposal from hospitals and communities establish freshwater runoffs as hubs of various microorganisms that can predispose to the rise of multidrug-resistant species. Microplastics' ability to act as vectors for antibiotic-resistant organisms is also particularly concerning for lower-middle-income countries. In this review, we aim to study the impact of antimicrobial use during the COVID-19 pandemic and antimicrobial resistance in lower middle-income countries, by understanding various determinants of resistance unique to the developing world and exploring solutions to combat the problem.

Psychological Burden amongst Caregivers of Patients on Maintenance Haemodialysis.

Long-term caregiving is a difficult job, risking mental health of involved individuals. This study was planned to document magnitude of the problem at Pak Emirates Military Hospital, Rawalpindi, with an aim to improve quality of life in caregivers and patients alike. From January to June 2019, caregivers accompanying haemodialysis patients were selected using consecutive sampling technique. Those unwilling were excluded. Psychological burden was assessed using Zarit Burden Interview (ZBI) questionnaire. There were 98 caregivers, including 71 (72.45%) males and 27 (27.55%) females, aged 33.13 ± 9.98 years. There was little/ no burden in 27 (27.55%) caregivers; 52 (53.06%) had mild to moderate, 18 (18.37%) had moderate to severe and 3 (3.06%) had severe psychological burden. Mean ZBI score was 30.00 ± 12.57. Males had lower scores than females (28.01 ± 11.18 vs. 35.22 ± 14.65, respectively; p= 0.026). Gender of caregivers significantly predicted ZBI scores; while their age, job status, education, monthly income and duration of caregiving did not. Key Words: Caregivers, Chronic kidney disease, Haemodialysis, Long-term care, Psychological burden.

Is COVID-19 Fatality Rate Associated with Malaria Endemicity?

COVID-19 (coronavirus disease 2019) is a disease caused by the coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). COVID-19 has yielded many reported complications and unusual observations. In this article, we have reviewed one such observation: an association between malaria endemicity and reduced reported COVID-19 fatality. Malaria-endemic regions have a significantly lower reported COVID-19 fatality rate as compared to regions where malaria is non-endemic. Statistical analyses show that there is a strong negative correlation between the reported SARS-CoV-2 fatality and endemicity of malaria. In this review, we have discussed the potential role of CD-147, and potential malaria-induced immunity and polymorphisms in COVID-19 patients. Noteworthy, the results may also be due to underreported cases or due to the economic, political, and environmental differences between the malaria endemic and non-endemic countries. The study of this potential relationship might be of great help in COVID-19 therapy and prevention.

Association of Inflammatory Markers with Mortality in COVID-19 Infection.

OBJECTIVE: To evaluate the association of serum ferritin, lactate dehydrogenase, and C-reactive protein at admission with in-hospital mortality in COVID-19 infection; and to determine best predictive cut-offs. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Department of Medicine, Combined Military Hospital, Peshawar Cantt; Pakistan from March to June 2020. METHODOLOGY: Admitted patients with SARS-CoV-2 detectable by polymerase chain reaction (PCR) were included. Patients with suggestive radiological findings but negative PCR for SARS-CoV-2, those with incomplete data or those leaving against medical advice were excluded. Serum C-reactive protein, ferritin and LDH levels were tested on admission. SARS-CoV-2 viral load was checked on nasopharyngeal samples. Disease severity was assessed using World Health Organization guidelines. RESULTS: There were 238 patients, aged 41.18 ± 16.74 years. Disease was mild in 157 (65.97%), moderate in 36 (15.13%), and severe in 45 (18.91%) cases. Twenty-two (9.24%) patients died in the hospital. Serum C-reactive protein, ferritin and lactate dehydrogenase levels were elevated in 122 (51.26%), 83 (34.87%) and 184 (77.31%) patients, respectively; more frequently amongst patients with moderate/severe disease or mortality. Areas under receiver operating characteristic curves  and 95% confidence intervals for serum C-reactive protein, ferritin and LDH were 0.909 (0.854-0.964), 0.915 (0.835-0.995) and 0.863 (0.785-0.942), respectively. C-reactive protein ≥45.5 mg/L had sensitivity 86.36% and specificity 88.89%; serum ferritin ≥723 ng/ml had sensitivity 95.45% and specificity 86.57%, and lactate dehydrogenase ≥428.5 U/L had sensitivity 90.91% and specificity 80.56% for predicting mortality. CONCLUSION: Levels of the three inflammatory markers at admission can predict mortality in COVID-19 infection. Key Words: Coronavirus, Inflammation, Mortality, Outcome, Pakistan.

COVID-19 and Anxiety amongst Doctors: A Pakistani Perspective.

OBJECTIVE: To assess anxiety in Pakistani doctors in context of COVID-19 pandemic and evaluate possible causes. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Departments of Nephrology, Combined Military Hospital Peshawar and Combined Military Hospital Malir, Karachi, during March 2020. METHODOLOGY: Doctors working in different parts of Pakistan were approached online through snowball sampling technique. Those with history of psychiatric disorders were excluded. They were administered a questionnaire including Seven-item Generalised Anxiety Disorder Scale (GAD-7). Reasons why they felt anxious were also explored. RESULTS: Responses from 431 doctors, including 238 (55.2%) males, were evaluated. Most of them were younger than 30 years (286; 66.4%), in training (335; 77.7%), and working in public hospitals (347; 80.5%). Mild, moderate and severe anxiety was seen in 120 (27.8%), 103 (23.9%) and 42 (9.7%) doctors, respectively. Median score on GAD-7 was 6 (interquartile range = 3 - 11). Lady doctors had higher scores than males (7 vs. 5; p=0.024). No significant differences in scores were found amongst doctors from different workplaces or of different professional status. A greater proportion of females had anxiety as compared to males (67.9% vs. 56.3%; p=0.014). Frequency of anxiety was not different amongst doctors of different professional status, types of workplace and amongst different age groups. Commonest reasons for anxiety were lack of personal protective equipment (83.8% doctors); and the fear that they could spread infection to family members (79.8% doctors). CONCLUSION: COVID-19 pandemic has had a major impact on the psychological well-being of doctors. Greater attention needs to be paid towards lady doctors to ensure their mental well-being. Key Words: Anxiety disorders, Pandemic, Personal protective equipment, Workforce.

Agreement Between Two Nutritional Assessment Scores as Markers of Malnutrition in Patients with End-stage Renal Disease.

Background Malnutrition is directly related to morbidity and mortality in end-stage renal disease. This should be picked up using simple techniques. Methods Adult patients on maintenance haemodialysis were included using a consecutive sampling technique. Compliance was assessed from attendance register (minimum 75% attendance for good compliance). Hypoalbuminemia signified malnutrition. Blood samples for measurement of haemoglobin, serum albumin, calcium and phosphate levels were drawn from the dialyser tubing at the start of the first of the two haemodialysis sessions for each patient. Height and weight were recorded at the end of the first haemodialysis session for each patient. Mini Nutritional Assessment Questionnaire and Council on Nutrition Appetite Questionnaire were administered in direct face-to-face interviews during two consecutive dialysis sessions. Results There were 116 patients aged 53.46± 14.39 years. Majority were males (83.6%) and on twice a week haemodialysis (69.0%). Malnutrition was present in 30 (25.9%) patients. Serum albumin had a significant relationship with both haemoglobin (R = 0.399; p < 0.001) and serum phosphate levels (R = 0.253; p = 0.006) but not body mass index (R = 0.028; p = 0.769). Mean Mini Nutritional Assessment and Council on Nutrition Appetite scores were 19.45± 5.10 and 26.76± 6.28, respectively. Based on Mini Nutritional Assessment scores, 31 (26.7%) patients were malnourished, 59 (50.9%) were at risk of malnutrition, and 26 (22.4%) had normal nutritional status. Council on Nutrition Appetite scores were low in 65 (56.0%) patients, indicating risk of weight loss in next six months. Serum albumin had significant correlation with Mini Nutritional Assessment scores (R = 0.381; p < 0.001) and Council on Nutrition Appetite scores (R = 0.290; p = 0.002). Slopes of linear regression for Mini Nutritional Assessment and Council on Nutrition Appetite scores were not statistically different (p = 0.202). Conclusions Mini Nutritional Assessment and Council on Nutrition Appetite scores had a similar correlation with serum albumin levels. Either of the two could be used for evaluation of malnutrition in end-stage renal disease.

Ultrasound Guided Tunnelled Cuffed Catheter Placement Without Fluoroscopic Guidance By Anatomical Landmarks; Accuracy And Safety.

BACKGROUND: Chronic kidney disease is a growing disease with high morbidity and mortality. Haemodialysis remains the most common option available for all those not planning for renal transplantation. Vascular access is the most important aspect of haemodialysis. Though not recommended but central venous catheters remain the most common vascular access in starters on haemodialysis. There is a growing trend towards placement of tunnelled cuffed catheters (TCC). Tunnelled cuffed catheters placement requires fluoroscopic guidance which is not available in all centres. The rationale of this study was to describe safety and accuracy of a catheter placement technique not dependent on fluoroscopic guidance for resource limited settings. METHODS: Dialysis dependent patients of a single hospital without long term vascular access were selected over a period of 15 months after getting informed written consent. A new technique was described in which depth of catheter was estimated by superficial anatomical and ultrasound guided measurements for TCC placement which were checked by conventional chest radiography post procedure. RESULTS: A total of 209 catheters were placed over a period of 15 months, 189 males and 30 females. Various sites were used predominantly right Internal jugular vein (IJV) (85.6%). Overall success rate was 97.1% (98.3% males, 90% females, p=0.08). Right IJV was successful 98.9%, left IJV 87.5% (p<0.001). Multiple thrombosed/stenosed veins were associated with higher failure rate (p<0.001). CONCLUSIONS: Tunnelled cuffed catheters can be placed successfully and safely in right IJV under ultrasound guidance using anatomical landmark measurement technique without fluoroscopic guidance.

Tumor protein 53 mutations mapping to its tertiary structure with in-silico prediction of neoepitopic vaccine candidates in bone tumors.

OBJECTIVE: Mapping of tp 53 mutations in bone cancers present in COSMIC database to its secondary and tertiary structure with in silico prediction of newly formed HLA binding epitopes as candidates for synthetic peptide vaccine. Mutations in bone cancers present in COSMIC database were listed and manually induced in wt p53 FASTA sequence. Wt p53 secondary structure was predicted. Template identified and tertiary structure of wt p53 was modelled in Cn3D followed by individual mutations mapping onto this model. HLA class I binding affinity was determined for mutated sequences to determine any newly binding peptide sequences. 62 missense mutations were identified. After predicting secondary structure, template was identified as PDB ID 1MZR for tertiary structure modelling. Mutations were highlighted that showed most of mutations in DNA binding region of tp 53 tetramer. Wt p53 had 19 HLA class I binders whereas in 62 mutated sequences we identified 18 neobinders not present in wt sequence. Neoepitopes identified serve as candidates for individualized anti-cancer peptide vaccine therapy.

The impact of hypertension on lipid parameters in type 2 diabetes.

OBJECTIVE: To study the effect of hypertension on lipid levels in patients with type 2 diabetes mellitus. METHODS: This prospective, observational study was conducted at 1 Mountain Medical Battalion, Bagh, Azad Kashmir, from May 2012 to April 2015, and comprised adult type 2 diabetics. Patients already on lipid-lowering agents, hypothyroidism, nephrotic syndrome, unwilling patients and those who had serum triglycerides>4.5mmol/l were excluded. Blood pressure was measured twice in sitting position. Amongst hypertensive patients, blood pressure <140/90mmHg reflected good control. Serum total cholesterol, triglyceride and high-density lipoproteins were measured using enzymatic calorimetric method. Friedewald equation was used to calculate low-density lipoprotein levels.Subjects were divided into three groups: those without hypertension; those with hypertension but good blood pressure control; and hypertensives with poor blood pressure control. SPSS 20 was used for data analysis. RESULTS: Of the 322 patients, 129(40.06%) were women and 193(59.94%) were men. The overall mean age was 51.42±10.93 years. Hypertension was seen in 144(44.72%) patients. Blood pressure was well controlled in 46(31.94%) hypertensive patients. Among patients without hypertension and those with good or poorly controlled blood pressure, the mean values for serum total cholesterol were 181.08± 32.05, 186.87± 39.00, 185.33± 35.55 mg/dl, triglycerides were 172.57±80.53, 187.61±81.42, 183.19±74.34 mg/dl, high-density lipoproteins were 40.54±12.36, 37.06±8.80, 40.15±12.35 mg/dl and low-density lipoproteins were 105.79±29.73, 110.81±31.66, 106.56±35.16 mg/dl. The number of patients with abnormalities of total cholesterol was 44(26.83%), 13(28.26%), 33(29.46%), triglycerides was 83(50.61%), 30(65.22%), 66(58.93%), high-density lipoproteins was 119(72.56%), 39(84.78%), 93(83.04%) and low-density lipoproteins was 90(54.88%), 29(63.04%) and 59(52.68%), respectively. CONCLUSIONS: Hypertension did not worsen diabetic dyslipidaemia.

Diagnostic Accuracy of Clinical Methods for Detection of Diabetic Sensory Neuropathy.

OBJECTIVE: To determine the accuracy of clinical methods for detection of sensory neuropathy as compared to biothesiometry. STUDY DESIGN: Cross-sectional analytical study. PLACE AND DURATION OF STUDY: 1 Mountain Medical Battalion, Azad Kashmir, from October 2013 to September 2014. METHODOLOGY: Patients with type 2 diabetes were enrolled by convenience sampling. Exclusion criteria included other identifiable causes of neuropathy, extensive ulceration of feet, amputated feet, those on treatment for neuropathy and unwilling patients. Average of 3 vibration perception threshold values measured with a biothesiometer on distal hallux was calculated. Ten gm monofilament was used to examine touch sensation over dorsal surfaces of great toes. Vibration sensation was checked over the tips of great toes using 128Hz tuning fork. Ankle jerks were checked bilaterally. RESULTS: Neuropathy (vibration perception threshold > 25 volts) was present in 34 (21.12%) out of 161 patients and 93 (57.76%) were symptomatic. Measures of diagnostic accuracy for monofilament, tuning fork and ankle jerks were: sensitivity 41.18%, 55.88% and 64.71%; specificity 92.91%, 93.70% and 80.31%; positive predictive value (PPV) 60.87%, 70.37% and 46.81%; negative predictive value (NPV) 85.51%, 88.81% and 89.47%; and, diagnostic accuracy 81.99%, 85.71% and 77.02%, respectively. Values for any 1 positive sign, any 2 positive signs or all 3 positive signs were: sensitivity 35.29%, 14.71% and 32.35%; specificity 81.89%, 93.70% and 99.21%; PPV 34.29%, 38.46% and 91.67%; NPV 82.54%, 80.41% and 84.56%; and, diagnostic accuracy 72.05%, 77.02% and 85.09%, respectively. CONCLUSION: Clinical methods are high accurate and specific diagnosis in picking up symmetric sensory neuropathy in patients with type 2 diabetes, particularly when multiple signs are combined.

Frequency of depression in type 2 diabetes mellitus and an analysis of predictive factors.

OBJECTIVE: To determine frequency of depression in patients with diabetes mellitus type 2 and to identify predictive factors. METHODS: The observational study was carried out at 1 Mountain Medical Battalion, Bagh, Azad Kashmir, Pakistan, from June 2013 to May 2014, and comprised type 2 diabetic patients who were not using anti-depressants and did not have history of other psychiatric illnesses. Demographic data, duration of diabetes, presence of hypertension and type of treatment were recorded and body mass index was calculated. Patient Health Questionnaire-9, translated into Urdu, was administered during face-to-face interviews. Scores >5 indicated depression, which was classified into different grades of severity using standard cut-off values. RESULTS: Of the 133 patients, 51(38.35%) were depressed. Depression was mild in 34(26%), moderate in 12(9.6%), moderately severe in 4(2.9%) and severe in 1(0.7%) patient. On univariate binary logistic regression, female gender (odds ratio=3.07; 95% confidence interval = 1.43, 6.59), lesser education (odds ratio = 0.90; 95% confidence interval 0.84, 0.97) shorter duration of diabetes (odds ratio=0.87; 95% confidence interval = 0.80, 0.96) and higher body mass index (odds ratio=1.41; 95% confidence interval = 1.05, 1.25) were significantly associated with depression. Only shorter duration of diabetes (odds ratio=0.90; 95% confidence interval = 0.82, 0.99) remained significant after adjustment for confounders. Age, level of education, glycaemic control and type of treatment did not predict depression. CONCLUSIONS: A significant proportion of type 2 diabetics were depressed. Shorter duration of diabetes reliably predicted depression in these patients.

Frequency of Poor Adherence to Antihypertensive Treatment and an Analysis of Clinico-demographic Correlates.

This observational study is aimed to determine the frequency of poor compliance to antihypertensive treatment and to identify predictive demographic factors. One hundred and six hypertensive patients, on treatment for more than three months, were enrolled. Demographic characteristics (age, gender, level of education, duration of hypertension and area of residence) were recorded. Number of antihypertensive as well as total medicines, presence of any co-morbid conditions, possible side effects to treatment and financial source for obtaining medications were also enquired. Blood pressure was measured and body mass index was calculated. Compliance was assessed with 4-Item Morisky Medication Adherence Scale. Poor compliance (scores ≤ 2) was present in 31 (29.25%) patients. Systolic and diastolic blood pressures were higher in poorly compliant patients. Patients with co-morbid conditions were more likely to have poor compliance (OR=4.238; 95% CI 1.161, 15.468). Other variables did not have a significant association with compliance to treatment. Poor compliance is fairly common in hypertensive patients and should be looked after for more so in patients with co-morbid conditions.