Unveiling the spectrum: A cross-sectional exploration of hirsutism causes in women.

Background and Objective: Hirsutism is a common endocrine disorder and its etiology varies from benign and idiopathic disorders to serious malignant diseases. Hirsutism creates negative impact on quality of life and considerable effects on fertility. Our objective was to determine the various causes of hirsutism in women presenting at two endocrine clinics. Method: This cross-sectional study was conducted at Baqai Institute of Diabetology and Endocrinology, Karachi and at Jinnah hospital, Lahore from August 2020 to December 2021 women between 12-45 years of age with complains of hirsutism were included in the study. Severity of Hirsutism was evaluated using modified Ferriman-Gallwey score (FG). Patients with modified FG score of 8 or more were considered having hirsutism. Results: The study had 113 patients with a mean age of 15.50+7.29 years with 89% having moderate hirsutism (FG score 16-25). Polycystic ovaries was the most common cause of hirsutism. Common sites for hirsutism included back (83%), arms (74%), buttocks (70%), and upper abdomen (47%). High BMI (p-value <0.01) and high Dehydroepiandrosterone levels were positively associated with the severity of hirsutism (p-value of 0.006.). Conclusion: The various causes of hirsutism identified were polycystic ovaries, followed by idiopathic, thyroid dysfunction, congenital adrenal hyperplasia, and hyperprolactinemia; therefore, all women presenting with hirsutism should be evaluated for potential serious and curable etiologies, before embarking on a treatment plan.

Linear Growth and Final Height in People With Type 1 Diabetes: A Study From Karachi, Pakistan.

Objective In this study, we aimed to determine the linear growth and final height in children/adolescents with type 1 diabetes mellitus (T1DM) at a tertiary care hospital. Methodology This observational study was conducted at the Baqai Institute of Diabetology and Endocrinology (BIDE), Baqai Medical University, Karachi, Pakistan. All children/adolescents diagnosed with T1DM of either gender aged between 8-18 years visiting the outpatient department of BIDE were included after obtaining informed consent. A predesigned questionnaire was developed to record data. The Centers for Disease Control and Prevention (CDC) growth chart was plotted and growth velocity was checked every six months to observe the linear growth. The final height was compared with the targeted height of the respective participants. Results A total of 66 people participated in the study (24 males and 42 females); among them, the mean age at diagnosis was 11.17 ± 4.77 years, and the duration of diabetes [median (IQR)] at the first visit was one year (0-3). The mean age at menarche was noted to be 13.56 ± 1.41 years. The overall height [standard deviation score (SDS)] at the first visit was -0.62 ± 2.58 and it was -1.34 ± 0.94 at the last visit; the overall weight at the first visit (SDS) and at the last visit was -1.23 ± 2.77 and -1.14 ± 1.25 respectively. Furthermore, the overall mid-parental height was 160.9 5 ± 10.28 cm, and 50% of males and 85.7% of females achieved genetic target height with a significant difference between them (p = 0.002). Conclusion A large number of people with TIDM were not able to achieve their target height. Therefore, it is imperative to monitor metabolic control along with monitoring of growth in young people with T1DM.

Predicting the risk of type 2 diabetes through anthropometric indices in Pakistani adults- A sub-analysis of second National diabetes survey of Pakistan 2016-2017 (NDSP-07).

BACKGROUND AND AIM: Excess adiposity is associated with an increased risk of diabetes. Amongst the various measures of adiposity, the most appropriate one to predict the risk of diabetes remains debatable. Therefore, the aim of this study was to compare the ability of body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) in predicting type 2 diabetes mellitus (DM) among Pakistani adults. SUBJECTS AND METHODS: This was the sub-analysis of a large population based Second National Diabetes Survey of Pakistan (NDSP) 2016-2017. With this survey, 10834 individuals were recruited and 4788 individuals fulfilled the inclusion criteria for this sub-analysis (subjects with missing anthropometric details were excluded). Participants were categorized into two groups; subjects with type 2 DM and subjects without DM. Data of participants was collected via pre-designed detailed questionnaire. Clinical and anthropometric measurements were measured using standardized techniques. RESULTS: Out of 4788 individuals, 3085(64.4%) were non-DM subjects and 1703(35.6%) were type 2 DM subjects with mean age of 39.78 ±â€¯13.79 and 50.38 ±â€¯11.33 years, respectively. Logistic regression analysis revealed a significant association of WC with type 2 diabetes after adjustment for possible confounders. Area under the curve (AUC) of WC was found higher than AUC of BMI and WHR. CONCLUSION: The findings from second NDSP (2016-2017) demonstrated that WC is a better marker than WHR and BMI in predicting type 2 DM for Pakistani population.

NDSP 06: Prevalence and risk factors for obesity in urban and rural areas of Pakistan: A study from second National Diabetes Survey of Pakistan (NDSP), 2016-2017.

OBJECTIVE: To study the pattern and prevalence of obesity in a large representative sample of Pakistani population aged 20 years and above. METHODOLOGY: This study is a sub analysis of the second National Diabetes Survey of Pakistan (NDSP) 2016-2017, a large community-based epidemiological survey carried out from February 2016 to August 2017 in all 4 provinces of Pakistan. An estimated sample size of 10,834 people was calculated using a multistage sampling technique. Out of 213 clusters, Twenty-seven clusters were selected from all four provinces of Pakistan. Households were identified and selected members of every 10th household were advised to come to the campsite after an overnight fast. All the study participants underwent anthropometric measurements including height, weight, and waist circumference by using standardized techniques and oral glucose tolerance tests were done. Data were analyzed on the statistical package for social sciences (SPSS), version 20. RESULTS: Overall weighted prevalence of generalized obesity was 57.9% (42% in males and 58% in females) and central obesity 73.1% (37.3% in males and 62.7% in females) as per WHO Asia pacific cutoffs. The highest prevalence of generalized obesity was found in Punjab 60%, followed by Khyber, Pakhtunkhwa 59.2%. Moreever, highest prevalence of abdominal obesity was observed in Baluchistan 82.1%, followed by Punjab 73.3%. Obesity (generalized and abdominal) was found significantly associated with diabetes, hypertension, and dyslipidemia. CONCLUSION: The prevalence of obesity is at epidemic proportions in Pakistan, calling for urgent lifestyle intervention strategies to prevent and manage this important cardiometabolic risk factor.

Relationship between diabetic retinopathy and diabetic nephropathy; A longitudinal follow-up study from a tertiary care unit of Karachi, Pakistan.

OBJECTIVE: To determine the development and progression of diabetic retinopathy in subjects with diabetic nephropathy. METHODOLOGY: This retrospective longitudinal follow up study was conducted in outpatient department of Baqai Institute of Diabetology and Endocrinology (BIDE), a tertiary care diabetes unit of Karachi Pakistan, from January 2005 to December 2016. Type 2 diabetic subjects with newly diagnosed diabetic nephropathy (DN) and sex-age matched controls were identified from the electronic database of the institute, Health Management System (HMS). Subjects with type 1 diabetes, gestational diabetes and subjects with diabetic retinopathy (DR) at the baseline of both DN and non-DN group were excluded from the study. Statistical analyses were conducted by using SPSS version 20. RESULT: Out of 3056 type 2 diabetic subjects, 2389 were with DN and 667 were without DN. The incidence of retinopathy was found to be 21.7 per 1000 person years. The incidence rate ratio (IRR) of 2.57 (1.92-3.43) showed that retinopathy was significantly higher in subjects with DN as compared to subjects without DN. Kaplan-Meier survival plot confirmed that subjects with DN had a worse diabetic retinopathy-free survival than subjects without DN. CONCLUSION: Diabetic nephropathy is an independent risk factor for the development and progression of diabetic retinopathy.

Relationship of C-peptide levels to duration of Type 1 diabetes - A study from Sindh, Pakistan.

OBJECTIVE: To determine the relationship of C-peptide levels with duration of type 1 diabetes mellitus. METHODS: This prospective study was conducted at Baqai Institute of Diabetology and Endocrinology (BIDE), Baqai Medical University (BMU), Karachi-Pakistan from December 2013 to December 2015. A total of 184 subjects were recruited during the study period, 100 in Group-A and 84 in Group-B. Subjects clinically diagnosed with type 1 diabetes Mellitus (T1DM) were categorized into two groups based on duration of diabetes: Group-A (with ≤1-year duration of diabetes) and Group-B (with >1-year duration of diabetes). Ninety-nine of the 100 enrolled subjects in Group-A were diagnosed as having T1DM, with one subject who presented at 11.9 years of age and diagnosed with T2DM excluded from this study. Blood samples were drawn for biochemical parameters. Data for baseline characteristics and clinical parameters (HbA1c and C-peptide) were obtained from hospital management system of BIDE. RESULTS: Fifty-seven (57.6%) subjects in Group-A, and 39 (46.4%) in Group-B were males. Mean±SD duration of diabetes (years) was 0.64±0.6 (range 0-1) in Group-A, and 7.65±5.5 (range 1-23) in Group-B. Family history of T1DM and T2DM was 1(1%) and 27(27.3%) in Group-A, and 8(9.52%) and 21(25%) in Group-B, respectively. Twenty-one (21.2%) subjects presented in diabetic ketoacidosis (DKA) in Group-A and 18(21.4%), in Group-B. Mean±SD for HbA1c was non-significantly higher in Group-A 11.12±2.31 compared to Group-B 10.42±1.45. Mean±SD for C-peptide was 1.91±1.53 ng/mL (0.60±0.481 nmol/L) in Group-A, and 1.82±1.01 (0.57±0.32 nmol/L) in Group-B (p=0.984). CONCLUSION: The study found that subjects with longer duration of T1DM had non-significantly decreased C-peptide levels compared to a group in which C-peptide was measured at or soon after diagnosis. Furthermore, C-peptide levels in many subjects with longer duration were higher than expected in classic T1DM.

Clinical Presentation and Frequency of Metabolic Syndrome in Women With Polycystic Ovary Syndrome: An Experience From a Tertiary Care Hospital in Pakistan.

INTRODUCTION: Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting women of reproductive age. The aim of this study was to determine the variations in the clinical presentation and frequency of metabolic syndrome (MetS) in women with PCOS. METHODS: This cross-sectional study was conducted at the Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan, from April 2019 to March 2020. Women attending the endocrine clinic who satisfied the Rotterdam criteria of PCOS and agreed to participate in the study were included. Detailed personal and family history of menstrual cycle, hirsutism, diabetes, hypertension, dyslipidemia and obesity was noted along with measurement of vitals, anthropometric measures and calculation of the body mass index. Physical examination performed for signs of hyperandrogenism, insulin resistance and biochemical and hormonal evaluation was also carried out in recruited participants. Statistical analysis was done using the Statistical Package for the Social Sciences (SPSS) version 20 (IBM Corp., Armonk, NY). RESULTS:  A total of 153 participants with mean age of 27.2±8.13 years were included in this study. Regarding clinical presentation, menstrual irregularity (oligomenorrhea 39.85%, amenorrhea 38.9%), followed by hirsutism 52.3%, was the most common presentation. Polycystic appearance of ovaries was noted in 33.3% of our study participants. MetS was identified in 46.4% participants (obesity was noted at the highest frequency at 82.4% followed by dyslipidemia at 56.2%). CONCLUSION:  We observed a high frequency of MetS in females presenting with PCOS. There is a need to evaluate women with PCOS for various components of MetS to prevent potential complications.