NDSP-10: The Cardiometabolic Risk Profile with Various Degrees of Dysglycemia in Younger and Older Adults: Findings from the Second National Diabetes Survey of Pakistan 2016-2017.

Background: To assess and compare the cardiometabolic risk profile of the Pakistani population between younger (<45 years) and older adults (≥45 years). Methods: This is a substudy of a nationally representative community-based epidemiological second National Diabetes Survey of Pakistan (NDSP) 2016-2017. Out of 12,486 individuals approached, 10,834 participants agreed to be included (response rate 87%). Cardiovascular risk factors assessed were obesity, central obesity, hypertension, diabetes, hyperlipidemia, and tobacco use. Participants were stratified into young adults (<45 years) and older adults (≥45 years) and was subcategorized into four groups that is, diagnosed diabetes mellitus (DM), undiagnosed DM, prediabetes, and without diabetes. Results: Around 14.3% were prediabetes, 8.8% were undiagnosed DM, and 24% were diagnosed diabetes. Most participants in dysglycemic (prediabetes, undiagnosed DM, and diagnosed DM) groups were females and were from rural regions. Cardiovascular disease (CVD) risk factors were more noted in dysglycemic states, compared with without diabetes. Overall CVD risk profile was worse in males in both age categories, although the accumulation of four or five CVD risk factors at one point was more predominant in females in either age group. Conclusion: Overall, the preponderance of CVD risk factors, such as overweight, obesity, central obesity, tobacco use, ex-tobacco uses, and dyslipidemia, were substantially more prevalent in dysglycemia groups of young adults (<45 years) compared with older adults (≥45 years). Early and targeted intervention in young may prevent poor CVD outcomes as they age.

Psychometric Analysis for fear of COVID-19 Scale (FCV-19S) and its association with depression in patients with diabetes: A cross sectional study from a Tertiary Care Centre in Karachi, Pakistan.

BACKGROUND AND AIMS: To assess the psychometric properties of the Fear of COVID-19 (FCV-19S) scale and to determine its associated factors among the Pakistani patients with diabetes. METHODS: This observational study was conducted in 24-h helpline service, a department of Baqai Institute of Diabetology and Endocrinology (BIDE). Study duration was from August to September 2020. The target population was registered adult patients with type 2 diabetes aged >16 years. Baseline demographic details were obtained from hospital management system of BIDE. Forward-backward translation method was used to translate the existing Fear scale (FCV-19S). Symptoms of depressive disorder were assessed through Patient Health Questionnaire (PHQ9). RESULTS: Total of 380 participants with mean age 51.93 ± 12.03 years contributed in the study. Three factors loading and item correlation of fear COVID-19 explained 96% of total variance having unidimensional Cronbach's alpha of 0.881. All demographic indicators that showed significance in univariate model were included in multivariate model. Females had more fear for COVID-19 compared to males (OR = 1.73, 95% CI (1.15-2.6)), whereas current smokers had also showed 4 times more fear than non-smokers (OR = 4.19, 95% CI (1.18-14.83). Depression assessed by PHQ9 showed maximum fear of COVID-19 in participants with moderate depression. CONCLUSION: FCV-19S had adequate psychometric properties for assessing effects of pandemic in people with diabetes attending tertiary care center.

Toxoplasmosis in an Immunocompetent Patient.

Toxoplasmosis is an obligate intracellular, food borne parasite disease with variable clinical presentation. Although the neurological presentation of toxoplasmosis in immunocompetent patients is uncommon, broad differential diagnosis should be kept in consideration when attending to similar patients. Twenty years old man with no known co-morbid conditions presented with fever and unilateral limb weakness for three weeks. It increased gradually, associated with altered level of consciousness for the last five days, diagnosed as acute toxoplasmosis. MRI Brain showed multiple ring enhancing lesions in frontal, parietal and temporal lobes. Serology for toxoplasmosis denoted raised IgM levels 36IU/mL (cut off value > 18IU/mL). This case report describes the clinical presentation and management of neurological toxoplasmosis in immunocompetent patient. Early diagnosis and prompt management can resolve the symptoms at an earlier stage.

Vitamin D for the treatment of painful diabetic neuropathy.

OBJECTIVE: To assess the effect of high-dose vitamin D in patients with painful diabetic neuropathy. METHODS: A single intramuscular dose of 600 000 IU vitamin D was administered, and the effects on metabolic parameters and neuropathic pain assessed over 20 weeks. RESULTS: 143 participants with predominantly type 2 diabetes, aged 52.31±11.48 years, with a Douleur Neuropathique 4 (DN4) score (3.0±1.8), total McGill pain score (21.2±14.9), and Short Form McGill Pain Questionnaire (SFMPQ) score (2.1±0.9), were enrolled. The baseline 25-hydroxyvitamin D (25(OH)D) level was 31.7±23.3 ng/mL and 58 (40.5%) patients showed evidence of vitamin D deficiency (25(OH)D<20 ng/mL). Intramuscular administration of vitamin D resulted in a significant increase in 25(OH)D (46.2±10.2 ng/mL, p<0.0001) and a reduction in positive symptoms on the DN4 (p<0.0001), total pain score (p<0.0001), and SFMPQ (p<0.0001). CONCLUSIONS: Treatment with a single intramuscular dose of 600 000 IU of vitamin D in patients with painful diabetic neuropathy is associated with a significant decrease in the symptoms of painful diabetic neuropathy. TRIAL REGISTRATION NUMBER: BIDE-12/2014.

Differences in various biochemical and clinical parameters with respect to family history of Non Communicable Diseases in fourth year MBBS students of Karachi, Pakistan.

OBJECTIVE: To observe the differences of various biochemical and clinical parameters with respect to Family History (FH) of Non-communicable Diseases (NCDs) in fourth year Bachelor of Medicine, Bachelor of Surgery (MBBS) students. METHODS: This observational study was conducted at Baqai Institute of Diabetology & Endocrinology from December 2013 to January 2014. Total 50 medical students from Dow University of Health Sciences (DUHS) participated in the study. Statistical Package for Social Sciences (SPSS) version 13 was used to analyze the data. For cross tabulation and mean comparison z-test and t test were applied. RESULTS: Out of 50 subjects, there were 26 (52%) females. Mean age of the study population was 21.56 ± 0.90 years. Mean serum cholesterol levels with positive FH of NCDs was significantly higher than negative FH of NCDs (p=0.005). Mean value of low density lipoprotein (LDL) of positive family history of NCDs was found higher than those with negative FH (p=0.006) being statistically significant. The insulin levels in subjects with positive FH of NCDs were higher than subjects with negative FH of NCDs (p=0.685). However, serum leptin and plasma renin showed no significant difference with the negative FH of NCDs being higher compared to positive FH of NCDs (p=0.068) and (p=0.884) respectively. However, Waist circumference, Body mass index and central obesity in subjects with positive FH of NCDs shows increasing trend but no statistically significant difference (p > 0.05) was observed. CONCLUSION: In our study of various biochemical and clinical parameters with respect to FH of NCDs, Serum Cholesterol and LDL levels were observed higher and statistically significant.