Treatment gap and barriers to access mental healthcare among women with postpartum depression symptoms in Pakistan.

Background and Objectives: Postpartum depression (PPD) is prevalent among women after childbirth, but accessing mental healthcare for PPD is challenging. This study aimed to assess the treatment gap and barriers to mental healthcare access for women with PPD symptoms living in Punjab, Pakistan. Methods: A multicenter cross-sectional study was conducted in five populous cities of Punjab from January to June 2023 by administering the questionnaire to the women using stratified random sampling. A total of 3,220 women in first 6 months postpartum were screened using the Edinburgh Postnatal Depression Scale. Of them, 1,503 women scored thirteen or above, indicating potential depressive disorder. Interviews were conducted to explore help-seeking behavior and barriers to accessing mental healthcare. Descriptive statistics along with nonparametric tests (e.g., Kruskal-Wallis, Mann-Whitney U) were used and group differences were examined. Scatter plot matrices with fitted lines were used to explore associations between variables. Classification and regression tree methods were used to classify the importance and contribution of different variables for the intensity of PPD. Results: Only 2% of women (n = 33) with high PPD symptoms sought mental healthcare, and merely 5% of women (n = 75) had been in contact with a health service since the onset of their symptoms. 92.80% of women with PPD symptoms did not seek any medical attention. The majority of women, 1,215 (81%), perceived the need for mental health treatment; however, 91.23% of them did not seek treatment from healthcare services. Women who recently gave birth to a female child had higher mean depression scores compared to those who gave birth to a male child. Age, education, and birth location of newborn were significantly associated (p  <  0.005) with mean barrier scores, mean social support scores, mean depression scores and treatment gap. The results of classification and regression decision tree model showed that instrumental barrier scores are the most important in predicting mean PPD scores. Conclusion: Women with PPD symptoms encountered considerable treatment gap and barriers to access mental health care. Integration of mental health services into obstetric care as well as PPD screening in public and private hospitals of Punjab, Pakistan is critically needed to overcome the treatment gap and barriers.

Assessment of health-related quality of life among patients with obesity, hypertension and type 2 diabetes mellitus and its relationship with multimorbidity.

Obesity, hypertension (HTN) and type 2 diabetes (T2D) are among the multifactorial disorders that occur at higher prevalence in a population. This study aims to assess the health-related quality of life (HRQoL) of patients with obesity, HTN and T2D individually and in the form of multimorbidity. A questionnaire-based cross-sectional study was conducted among the patients in 15 private clinics of Punjab, Pakistan. A stratified random sampling technique was used to collect the data from patients with obesity, HTN and T2D or their comorbidity. A total of 1350 patients responded by completing the questionnaire. The HRQoL of these patients was assessed using the EQ-5D-5L questionnaire (a standardized instrument for measuring generic health status). Statistical analysis was performed using chi-square test, Mann-Whitney U test, and Kruskal-Wallis test. Multivariate linear regression model was used to model the visual analogue scale (VAS) score. In total, 15% of patients had combined obesity, HTN and T2D; 16.5% had HTN and T2D; 13.5% had obesity and HTN and 12.8% had obesity and T2D. Only 15.8% of patients had obesity, 14.3% had HTN, and 12% had T2D. Mann Whitney-U test gave the statistically significant (p = <0.001) HRQoL VAS score55.1 (±23.2) of patients with the obesity. HRQoL VAS scores of patients with obesity were found to be higher when compared to patients with both T2D 49.8 (±15.4) and HTN 48.2 (±21). Diagnosis of one, two and three diseases showed significant results in VAS with all variables including gender (p = 0.004), educational level (p = <0.001), marital status (p<0.001), residence (p = <0.001), financial situation (p = <0.001) and monthly income (p = <0.001). The most frequently observed extremely problematic dimension was anxiety/ depression (47%) and the self-care (10%) was the least affected. Patient HRQoL is decreased by T2D, HTN, and obesity. The impact of these diseases coexisting is more detrimental to HRQoL.

Prevalence, Clinical Characteristics, and Clinical Outcomes of New-onset Diabetes Mellitus among COVID-19 Patients in Developing and Developed Countries: A Systematic Review.

Diabetes mellitus (DM) is linked to poor clinical outcomes and high mortality in Coronavirus patients. The primary objective of this systematic review was to determine the prevalence, clinical features, glycemic parameters, and outcomes of newly diagnosed diabetes in individuals with COVID-19 in developing and developed countries. By searching PubMed, Medline, Scopus, Embase, Google Scholar, and PakMediNet databases, an online literature search was conducted from March 2020 to November 2021. Guidelines for reporting systematic reviews and meta-analyses (PRISMA) were used. There were 660 publications found, of which 27 were original studies involving 3241 COVID-19 patients were selected. In the COVID-19 patients with new-onset diabetes, mean age was 43.21±21.00 years. Fever, cough, polyuria, and polydipsia were the most frequently reported symptoms, followed by shortness of breath, arthralgia, and myalgia. The developed world reported (109/1119) new diabetes cases (9.74%), while the developing world reported (415/2122) (19.5%). COVID-19 new-onset diabetic mortality rate was 470/3241 (14.5%). Key Words: COVID-19, New onset diabetes mellitus, SARS-CoV-2, Prevalence, Clinical outcomes, Developing countries, Developed countries.

Efficacy and safety of combination of empagliflozin and metformin with combination of sitagliptin and metformin during Ramadan: an observational study.

BACKGROUND: Management of diabetes during fasting is a clinical challenge. Sodium glucose co-transporter -2 inhibitors (SGLT2i) are considered safe with a low risk of hypoglycemia. However, studies on SGLT2i are scarce. This study was designed to compare the efficacy, safety, and tolerability of empagliflozin with metformin during Ramadan in comparison with sitagliptin and metformin. METHODS: It was a prospective, observational study, conducted at 11 different sites all across Pakistan on an outpatient basis during Ramadan (May 2021-June 2021). including 132 patients, 88 who received metformin and sitagliptin, and 44 patients who received metformin and empagliflozin. RESULTS: Patients of the SGLT-2i group experienced similar symptomatic hypoglycemic episodes (15.9%) as the sitagliptin group. There was an improvement in blood sugar levels after the use of SGLT-2i (RBS 181 ± 64 before Ramadan vs 162 ± 53 after Ramadan). HbA1c also improved after the use of SGLT-2i before and after Ramadan (7.2 ± 0.8 vs 6.9 ± 0.9 for Metformin + Empagliflozin and 7.8 ± 1.5 vs 7.6 ± 1.6 for Metformin and sitagliptin). Weight and BMI improved after the use of SGLT-2i (BMI 36.5 ± 4.8 before Ramadan and 33.7 ± 2.4 after Ramadan). There were no reported cases of urinary tract infection in the empagliflozin group. CONCLUSION: SGLT-2 inhibitors combined with metformin for patients with diabetes during Ramadan fasting is as effective, safe and well tolerated as DPP4 combined with metformin.

Microbiological and antimicrobial pattern of diabetic foot ulcers (DFUs) at a tertiary care center in North East, Punjab.

OBJECTIVE: To determine the pattern of antimicrobial sensitivity of common microorganisms isolated from diabetic foot infections. METHODS: The cross-sectional study was conducted from January to August 2019 at the Diabetes and Footcare Clinic, Mayo Hospital, Lahore, Pakistan, and comprised deep-seated tissue samples from the ulcer bed that were tested for culture and sensitivity. Antimicrobial susceptibility was determined in accordance with Clinical and Laboratory Standards Institute guidelines. Data was analysed using SPSS 26. RESULTS: There were 389 bacterial isolates collected from 201 patients who had a mean age of 53.05±10.70 years. . Of the isolates, 238(61.11%) were gram-negative and 151(38.89%) were gram-positive organisms. Methicillin-resistant Staphylococcus aureuswas found in 62(64.58%) isolates. CONCLUSIONS: Early identification of diabetic foot infections can help in timely initiation of empirical treatment and prevention of unwanted amputations.

Pharmacological Primary Prevention of Diabetes Mellitus Type II: A Narrative Review.

The evolving epidemic of type 2 diabetes mellitus has challenged health-care professionals. It stands among the leading causes of mortality in the present world. It warrants new and versatile approaches to improve mortality and the associated huge quality-adjusted life years lost to it once diagnosed. A possible venue to lower the incidence is to assess the safety and efficacy of various diabetes prevention strategies. Diet and exercise have a well-developed role in the prevention of weight gain and, ultimately, diabetes mellitus type II in high-risk individuals. However, high-risk individuals can also benefit from adjunct pharmacotherapy. In light of this information, we decided to conduct a systematic review of randomized controlled trials. This article summarizes the evidence in the literature on the pharmacological prevention of diabetes in high-risk individuals.

Effectiveness of intralesional steroid injections with dilatation in corrosive oesophageal strictures - A Randomized Control Trial

OBJECTIVE: To compare the improvement of dilatation among patients receiving intralesional steroid injection with dilatation versus dilatation alone for the management of corrosive ooesophageal strictures. METHODS: The randomized controlled trial was conducted at Mayo Hospital, Lahore, Pakistan, from November 10, 2014, to November 10, 2015, and comprised patients of either gender aged 15-50years who had corrosive ooesophageal stricture. They were randomised into 2 groups by using the lottery method. In the dilatation group, only endoscopic dilation was done, while in the combination group, intralesional triamcinolone injection was injected followed by dilatation. Follow-up endoscopic dilatation was done every two weeks. Data was analysed using SPSS 21. RESULTS: There were 60 patients randomised into two groups of 30(50%) each. The overall mean age was 32.58±10.58 years and the male-to-female ratio was 1.7:1. At baseline, in dilatation group, the mean stricture length was 23.30±2.28cm while in combination group, it was 24.23±3.06cm. In dilatation group, the mean stricture length was 11.20±3.09cm while in combination group, it was 5.33±3.09cm (p=0.0001).. CONCLUSIONS: oesophageal Combination group was more effective than the dilatation-alone group.

Presence of pre-diabetes in Helicobacter pylori positive versus Helicobacter pylori negative patients having dyspepsia.

Pre-diabetes is a state of intermediate hyperglycaemia. Helicobacter (H) pylori infection is an established risk factor for pre-diabetes. This comparative cross-sectional study was done in Mayo Hospital Lahore from November 2015 to August 2016 in which 270 patients underwent upper gastrointestinal endoscopy with antral biopsy. An oral glucose tolerance test was done half to one hour after endoscopy. Patients were diagnosed having pre-diabetes according to American Diabetic Association criteria. Cases were divided into Group A and B based on the presence or absence of histopathological evidence of H. pylori respectively. Comparison was done to see the occurrence of pre-diabetes in H. pylori positive versus helicobacter negative dyspeptic patients. Results showed that 79 (58.52%) in Group-A and 62 (45.93%) in Group-B had pre-diabetes while remaining 56 (41.48%) in Group-A and 73 (54.07%) in Group-B had no findings of this morbidity, p value was calculated as 0.03 showing a significant difference. It was concluded that H. pylori infection is significantly associated with pre-diabetes.

Efficacy of high dose Allopurinol in reducing left ventricular mass in patients with left ventricular hypertrophy by comparing its efficacy with Febuxostat - a randomized controlled trial.

OBJECTIVE: : To determine the efficacy of high-dose allopurinol in reducing left ventricular mass in patients with left ventricular hypertrophy by comparing its efficacy with febuxostat.. METHODS: The randomised controlled interventional study was conducted at Mayo Hospital, Lahore, Pakistan, from April to December 2015, comprising patients with left ventricular hypertrophy on echocardiography. They were randomly divided into two equal groups, with Group A receiving allopurinol and Group B receiving febuxostat. Primary endpoint was reduction in left ventricular mass and left ventricular mass index as calculated by echocardiography. Patients were followed at third and sixth month of enrolment to detect regression. Patients were investigated for eosinophil's count, urine for micro albuminuria and renal function tests to monitor side effects of allopurinol. SPSS 20 was used for data analysis. RESULTS: There were 76 patients divided into two groups of 38(50%) each. Mean reduction in left ventricular mass between baseline and at six months in Group A and Group B was 35.474±13.54 and 21.921±3.33 respectively (p=0.0001) while mean reduction in left ventricular mass index between baseline and at six months was 17.26±4.36 and 17.63±21.07 respectively (p=0.0001). Greater improvement was observed in Group A.. CONCLUSIONS: Allopurinol was found to be more effective than febuxostatin reducing the left ventricular mass and left ventricular hypertrophy independent of blood pressure.

Efficacy of Vitamin D supplementation in achieving an early Sputum Conversion in Smear positive Pulmonary Tuberculosis.

OBJECTIVE: To determine the efficacy of Vitamin D supplementation in achieving an early sputum conversion in vitamin D deficient smear positive pulmonary tuberculosis patients. METHODS: This randomized clinical trial was done at Mayo hospital Lahore from November 2015 to August 2016. One hundred twenty patients with sputum smear positive pulmonary tuberculosis were selected and randomized to Group-A (taking anti-tuberculous therapy (ATT) only) and Group-B (taking ATT with Vitamin D supplementation). Four doses of100,000 IU of Vitamin D injection intramuscularly were given after every 14 days during intensive-phase. Sputum examination was repeated at 2nd, 4th, 6th, 8th, 10th and 12th weeks. Efficacy of treatment in terms of early sputum conversion between both groups was tested using Chi square and independent sample t-test was applied to compare mean values of serum vitamin D before and after treatment. P-value ≤ 0.05 was considered as significant. RESULTS: The mean age of patients was 37.18±6.81 years in Group-A and 39.02±7.56 years in Group-B. There were 63 (52.50%) males and 57 (47.50%) females. The mean serum Vitamin D was 17.07±1.44 in Group-A and 17.23±2.37 in Group-B at baseline and at 12th week, the levels were 21.77±2.23 in Group-A and 29.24±0.72 in Group-B. In Group-A, 7 (11.7%) patients showed positive sputum examination and in Group-B, only one (1.7%) patient had positive sputum examination at 12th week. The difference was statistically significant (p-value= 0.028). CONCLUSION: Four doses of intramuscular vitamin D given after every 14 days corrected vitamin D deficiency and improved the rate of sputum smear conversion in patients of pulmonary tuberculosis.

Efficacy of oral vitamin D on glycated haemoglobin (HbA1c) in type 2 diabetics having vitamin D deficiency - A randomized controlled trial.

OBJECTIVE: To study the efficacy of oral vitamin D in improving glycaemic control of patients with type 2 diabetes by reducing glycated haemoglobin levels. METHODS: This randomised control trial was carried out at Mayo Hospital, Lahore, from February 5 to August 5, 2016, and comprised type 2 diabetes patients aged 40-70 years visiting the outpatient clinics. They were randomly divided into two groups by using the lottery method. Group A received oral vitamin D along with metformin and group B received metformin only. Blood samples of both the groups were tested for glycated haemoglobin at three months to assess the change. SPSS 21 was used for data analysis. RESULTS: There were 140 patients divided into two groups of 70(50%) each. Mean age in Group A was 54.80±8.55 years and 58.40±7.98 years in Group B. No significant difference was seen in glycated haemoglobin levels at baseline (p>0.05). However, after 3 months post-treatment the levels significantly differed (p<0.05) in favour of Group A. CONCLUSIONS: Vitamin D supplementation had a significant effect in lowering glycated haemoglobin level in patients with type 2 diabetes.

Evaluation of educational environment for postgraduate residents using Post Graduate Hospital Educational Environment Measure.

The objective of this study was to determine the level of educational environment among residents working in our hospital using Post graduate hospital educational environment measure (PHEEM). This cross-sectional study was conducted at services hospital, Lahore. All the Post-graduate residents (PGR's) working at Services hospital, Lahore were asked to fill a proforma having 2 parts: Bio-data and PHEEM. Out of 110 PGR's, 87 completed questionnaires, of which majority labelled education environment into level 3 (71%). Overall mean PHEEM score calculated was 90.49 ±15.44. Maximum score was found for teaching subscale followed by autonomy and social support subscale. Highest mean score was found for neurology (104) department and lowest for anaesthesia (72 ± 9.19). General surgery, internal medicine, paediatric medicine and gynaecology gave mean score of 90, 92, 93 and 89 respectively. There was non-significant difference in terms of PHEEM score when stratified for gender, year of residency and marital status.

Comparison of metformin and pioglitazone in achieving sustained virological response in chronic hepatitis C patients with insulin resistance: A quasi-experimental study.

OBJECTIVE: To compare metformin and pioglitazone with standard interferon and ribavirin in achieving sustained virological response in chronic hepatitis C patients. METHODS: This quasi-experimental, comparative, interventional study was conducted at Mayo Hospital, Lahore, Pakistan, from January 2015 to March 2016, and comprised chronic hepatitis C patients who had insulin resistance. The patients were divided evenly in three groups. Group A had patients treated with interferon 3 million units, three times in a week and ribavirin 400mg three times in a day. In addition to interferon and ribavirin, group B was treated with metformin, and group C received pioglitazone. Polymerase chain reaction was done at the completion of 24 and 48 weeks to assess the end treatment and sustained virological response, respectively. SPSS 20 was used for data analysis. RESULTS: Of the 138 patients, there were 46(33.3%) in each group. The mean age of the patients in group A was 36.83±9.65 years, in group B was 37.72±10.00 years and in group C it was 38.07±8.85 years. Overall, there were 70(50.72%) males and 68(49.28%) females. At the end of 24 weeks, polymerase chain reaction exhibited that in group A, the score was <100 in 28(60.9%) and >100 in 18(39.1%) patients. In group-B, it was <100 in 39(84.8%) and >100 in 7(15.2%) patients. In group-C, it was <100 in 31(67.4%) and >100 in 15(32.6%) patients. The sustained virological response was considerably higher in group B (p=0.003). CONCLUSIONS: Sustained virological response with standard therapy with metformin gave high-end response as compared to other groups.

Frequency of Type-2 diabetes mellitus in Nephropathic patients and comparison of mean magnesium levels in Nephropathic patients with and without Type-2 diabetes mellitus.

OBJECTIVE: The objective of this study was to determine the frequency of Type 2 diabetes mellitus (T2DM) in patients with nephropathy (i.e. Chronic Kidney Disease Stage 1 to 3) and to compare the mean magnesium levels in diabetic nephropathic patients and non-diabetic nephropathic patients. METHODS: This cross-sectional study was conducted in department of Medicine, Mayo Hospital Lahore from August 2014 to February 2015. Using non-probability purposive sampling 200 nephropathic (Chronic Kidney Disease Stage 1 to 3) patients were selected. Patients were assessed for T2DM and divided in two groups on the basis of presence or absence of DM. Magnesium levels were recorded in both groups. Percentages, mean, standard deviation and unpaired t-test was used to assess the data. SPSS was used for analysis of information. RESULTS: Total number of cases were 200, 43.5% (n=87) out of them were between 25-50 years of age while 56.5% (n=113) patients were between 51-70 years. The Mean+SD was calculated to be 51.38+11.51 years. The male patients were 48.5 %(n=109) while 51.5 %(n=91) were females. The frequency of DM in patients with nephropathy was 25.5% (n=51). Comparison of mean magnesium levels in nephropathic patients with and without diabetes was done. The results showed nephropathic patients having diabetes had 1.54+0.301 mg/dL magnesium levels while cases without diabetes had 1.92+0.313 mg/dL levels of magnesium, p value was calculated as 0.001 showing a significant difference between the two groups. CONCLUSION: The frequency of diabetes mellitus is higher among patients with nephropathy while on comparison of mean magnesium levels, nephropathic patients with diabetes had significant lower levels of magnesium as compared to without diabetes.

Effect of Vitamin D supplementation on reduction in levels of HbA1 in patients recently diagnosed with type 2 Diabetes Mellitus having asymptomatic Vitamin D deficiency.

OBJECTIVE: To study the effect of Vitamin D supplementation on reduction in level of HbA1 in patients recently diagnosed with diabetes mellitus Type II having asymptomatic Vitamin D deficiency. METHODS: This randomized control trial was conducted at East Medical Ward Mayo Hospital Lahore for 6 months from January 01 2016 to June 30, 2016. 114 Patients were included through non probability purposive sampling technique. Informed consent and demographic information was collected. Patients were divided in two groups by randomization through tossing a coin. Group-A patients received Metformin tablet alone at 500 mg after dinner and Group-B patients were treated with same dosage of Metformin along with oral vitamin D at 200,000 IU monthly for three months. Blood sample was obtained at baseline, 3 months and 6 months of initiation of therapy. All samples were sent to the laboratory for complete blood count, blood sugar fasting, serum calcium, serum phosphorous, serum alkaline phosphatase, HbA1c and serum 25 Hyroxy Vitamin D (S-25(OH) D) levels and iPTH. Data entry and analysis was done by using SPSS 20. RESULTS: The mean age of patients in metformin group was 42.37±4.59 years while mean age of patients in combination group was 43.33±4.86years. Males were 45.6% and females were 54.4% in metformin group while in combination group, 36.8% were males' and 63.2% were females'. At baseline, in metformin group, mean Vitamin D level was 17.09±1.73mg/dl and in combination group, mean Vitamin D level was 16.49±1.56mg/dl. The difference was insignificant (p>0.05). On 2nd visit, combination group mean Vitamin D was 29.04±3.96mg/dl. At baseline, 1st and 2nd visit, in metformin group, mean HbA1c was 7.59±0.47%, 7.46±0.25% and 7.30±0.29%. At baseline, 1st and 2nd visit, in combination group, mean HbA1c was 7.71±0.19%, 7.57±0.21% and 7.43±0.26%. The difference was insignificant (p>0.05) at baseline while significant on later follow-ups (P<0.05). CONCLUSION: Vitamin D supplementation improved the glycemic control but substantial reduction in HbA1c was statistically insignificant in both groups.

Profile of hepatic involvement in dengue infections in adult Pakistani population.

OBJECTIVES: To estimate the range of hepatic involvement in dengue infections by assessing clinical and biochemical profile of adult dengue infected patients. METHODS: Serologically confirmed 220 adult cases of dengue infections admitted to Mayo hospital from June 2013 to November 2013 were classified as having dengue fever, dengue haemorragic fever and dengue shock syndrome. The frequency and range of bilirubin, liver enzymes derangement and presence of liver enlargement in each group was calculated and further stratified according to age and gender. Patients with positive viral serology, chronic liver disease, malaria and typhoid were excluded from the study. RESULTS: About 60% of DHF patients had hepatomegaly compared to 40% of DF patients. Liver dysfunction was more common in DF compared to DHF (38.15 vs 18.6%). Hyperbilirubinemia was noted in 40 (18.2%) patients, 28 (12.7%) in DF and 12(5.5%) in DHF. The mean serum bilirubin was higher in DHF [0.87+0.33] compared to DF [0.74+0.27]. Bilirubin was higher in male patients and in younger (<20 years) age group. ALT was elevated more frequently in male patients in age group of 31-40 years and in DF patients as compared to DHF [72(32.7% vs 40(18.2%)]. The mean serum ALT level was 103.7 U/l in DHF and 69.2U/l in DF. AST was raised in all DHF patients as compared to DF in which 40% patients had normal AST levels. Alkaline Phosphate was high in all DHF patients with a mean of 278.7. It was raised in most of the DF patients as well and majority of patients were in age group of 31-40 years. CONCLUSION: Liver involvement is very common in dengue infections and is not limited to elevation of transaminases only. Bilirubin and Alkaline phosphatase are also raised in considerable number of patients. Therefore in adults with fever, jaundice, hepatomegaly and altered liver function tests, the diagnosis of dengue infection should be strongly considered in areas where dengue infection is endemic. List of abbreviations:DF: Dengue Fever DHF: Dengue Hemorrhagic Fever DSS: Dengue Shock Syndrome DIC: Disseminated intravascular coagulation ALT: Alanine transaminase AST: Aspartate aminotransferase.

Burnout among gynaecological residents in Lahore, Pakistan: A cross-sectional survey.

OBJECTIVE: To determine the prevalence of burnout among gynaecological residents and factors associated with it. METHODS: This cross-sectional study was performed at the University Medical and Dental College, Faisalabad, Pakistan, from March to April 2016, and comprised female medical students. Participants were divided into groups on the basis of their ABO blood groups and on body mass index criteria. Blood groups were determined by simple conventional slide method. Blood pressure was estimated by manual auscultatory technique with a mercury sphygmomanometer. Data was analysed usingSPSS20. RESULTS: Of the 102 participants, 57(55.9%) were satisfied after choosing gynaecology as career. It was found that emotional exhaustion and depersonalisation were significantly higher among residents working in government institutions than private institutions (p<0.05). Those having more than 2 years of post-graduate experience had significantly higher depersonalisation than those with lesser experience (p=0.016). Also, working for 50-60 hours/week and feeling dissatisfied with the specialty were associated with significantly higher emotional exhaustion and depersonalisation (p<0.05). CONCLUSIONS: Burnout was highly prevalent among gynaecological residents.

Role of Vitamin D in reducing number of acute exacerbations in Chronic Obstructive Pulmonary Disease (COPD) patients.

BACKGROUND AND OBJECTIVE: Chronic obstructive pulmonary disease (COPD) is characterized by chronic incompletely reversible poor airflow and air trapping and usually this debilitating disorder limits the outside activities of the patients depriving them of sunlight which is a rich source of Vitamin D. The objective of this study was to determine the effect of vitamin D supplementation in reducing number of acute exacerbation in COPD patients. METHODS: This randomized control trial was conducted at East Medical Ward Mayo Hospital Lahore from January to December 2015 as exacerbations of COPD are season dependent. Diagnosis was confirmed by performing Pulmonary Function Tests (PFTs). Basic demographical information was obtained and baseline PFTs of the patient was done. Only Group A patients was treated with oral vitamin D intake of 2000 IU daily for 6 months. Vitamin D level was measured at 0, 2, 4, and 6 months and exacerbation of COPD, FEV1 and FVC was measured weekly. Both the groups were given standard treatment for exacerbation of COPD. Spirometry was repeated at each visit. Blood samples were collected every 2 months for vitamin D. Supplementation was stopped if vitamin D level exceeded 100ng/ml. RESULTS: The mean age of the patients was 46.28±8.83 years, the male to female ratio was 1.8:1. The mean 25(OH) level at baseline was 24.08±2.58 and at 6th month was 29.60±8.74. The mean FVC at baseline was 77.83±5.49 and at 6th month was 91.34±5.52. The exacerbation at baseline was present in all 120(100%) patients and at 6th month was reduced to 4(3.3%). CONCLUSION: Vitamin D supplementation has significant effect in reducing number of acute exacerbation in COPD patients when it is given for prolonged period.

Glycaemic Control Of Type 2 Diabetic Patients During Ramazan Fasting.

BACKGROUND: Among five main pillars of Islam Fasting is one of the key elements, all healthy adult Muslims have to observe fast from dawn till dusk during the holy month of Ramadan. According to a 2009 demographic study, Islam has 1.57 billion believers, making up 23% of the world population of 6.8 billion, and is growing by 3% per year. EPIDIAR (epidemiology of diabetes and Ramadan) study showed that 43% patients with type 1 and 79% patients with type2 diabetes observe fast during the month of Ramadan. Whereas those people who are suffering from diabetes and are fasting may be at risk of adverse outcomes and the risks may rise with longer fasting periods. Ideal management of diabetic patients who wish to fast during Ramadan needs to be done to avoid the complications. The purpose of this study was to observe the effect of fasting on glycaemic control in type 2 diabetic patients during the month of Ramadan. METHODS: This was an observational cross sectional study; it was conducted at outpatient department Jinnah institute of diabetes and endocrinology Jinnah hospital Lahore during the month of Ramadan. Patients were advised to monitor blood sugar levels for two days before and after three meals (lunch, breakfast and dinner) before Ramadan and then during Ramadan blood sugar levels were monitored for four days in first Ashra before and two hours after Sehari, for four days at noon during second Ashra and then for four days pre and two hours after Iftar in last Ashra of Ramadan. Patients were educated Pre-Ramadan about glucose monitoring and drug dosage adjustments were done along with dietary counselling. RESULTS: Blood glucose levels two days before and during Ramadan fell within range of mean glucose level of 150-187 mg/dl showing no extreme fluctuations in blood glucose levels only one patient reported symptomatic and biochemical hypoglycaemia severe enough to break the fast at noon. CONCLUSIONS: We concluded that in Ramadan fasting, type 2 diabetic patients with proper education, dietary counselling and drug dosage adjustments glycaemic control can remain in safe acceptable range preventing any life-threatening complication.

HBA1C AS AN INDIRECT MARKER OF HYPERTRIGLYCERIDEMIA IN TYPE-2 DIABETES MELLITUS.

BACKGROUND: Diabetes is usually accompanied by dyslipidaemia, and among these triglyceride levels are related to the insulin resistance in type 2 diabetes. HbAlc which is an indicator of diabetes control can depict the severity of hypertriglyceridemia. The objective of this study was to determine the correlation between HbAlc and Triglyceride levels in type 2 Diabetes mellitus. METHODS: A sample of 150 diabetic patients fulfilling the inclusion and exclusion criteria were selected for this cross-sectional study. Patient included were type 2 Diabetes Mellitus with HbAlc >7. Patients with history of cardiovascular disease, taking lipid lowering medications, smoker and history of cerebral stroke were excluded. HbAlc and triglyceride levels were noted .Study patients were further stratified on the basis of severity of HbAlc and Triglyceride values. The correlation between HbAlc and Triglyceride levels were established with Pearson Correlation. RESULTS: Among total number of 150 patients 44% (n=70) were male and 50.3% (n=80) were female. The correlation of HbAlc with Triglyceride as estimated by Pearson Correlation was positive (p=0.033, r=0.033) and statistically significant. CONCLUSIONS: In type 2 diabetes mellitus there is a predictable relationship between Triglycerides and HbAlc.