Prevalence of peripheral arterial disease in type 2 diabetics in Pakistan.

OBJECTIVES: To observe the prevalence of peripheral arterial disease (PAD) and associated factors among people with type 2 diabetes in Pakistan. METHODS: A multicenter cross-sectional study was carried out at eight centers in all the provinces of Pakistan on people with type 2 diabetes. History of symptoms related to Peripheral arterial disease were noted and anthropometric measurements were recorded. Ankle brachial index (ABI) was measured using Doppler ultrasound; patients with ABI < 0.9 were classified as having low ABI. RESULTS: There were 830 patients in the study, (49% males and 51% females). Females were younger and had a higher body mass index (BMI) (p < 0.001). The prevalence of peripheral arterial disease was 31.6% with a 95% CI of 28.4% to 34.8%. There was no significant difference in the proportion of low ABI between males (30%) and females (33%) (p = 0.29). Patients with low ABI were found to have significantly higher BMI (p = 0.02) and waist circumference (p = 0.001). The most common symptom in the patients with low ABI was pain on walking (84%), followed by numbness of the feet (64%). There was a significant difference in the reporting of all the symptoms (p < 0.05) except for numbness of the feet (p = 0.57) as compared to patients with normal ABI. No association was found between low ABI and duration of diabetes mellitus or cigarette smoking. There was no significant association between cardiovascular conditions and low ABI. CONCLUSION: Peripheral arterial disease is common among people with type 2 diabetes in Pakistan and needs to be properly evaluated by the medical professionals as early diagnosis can help prevent future complications.

Frequency of the metabolic syndrome in type 2 diabetic subjects attending the diabetes clinic of a tertiary care hospital.

OBJECTIVE: To determine the frequency of the metabolic syndrome in patients with type 2 diabetes mellitus wiho attended the diabetes clinic of Liaquat National Hospital, Karachi. METHOD: A descriptive study was conducted at the diabetes clinic of Liaquat National Hospital from June 2004 to December 2004. We enrolled 233 subjects with type 2 diabetes mellitus. Frequency of metabolic syndrome was estimated according to the criteria proposed by National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III), with adoption of the Asian criteria for abdominal obesity and recently proposed International Diabetes Federation (IDF) diagnostic criteria for metabolic syndrome. RESULTS: There were 233 patients with type 2 diabetes mellitus in whom 49.8% were men and 50.2% were women. Mean age was 49.9 years. By applying NCEP-ATP III criteria, metabolic syndrome was found in 79.7% type 2 diabetics, (45.5% women and 34.3% men), by applying IDF criteria, metabolic syndrome was identified in 68.1% of type 2 diabetics (43.7% women and 24.4% men). CONCLUSION: In our study the frequency of the metabolic syndrome was found significantly high, especially in women and at a relatively young age of 49.9 years.

Pattern of stroke in type 2 diabetic subjects versus non diabetic subjects.

BACKGROUND: Diabetes mellitus is a well-recognized risk factor for ischaemic stroke. Stroke in diabetic patients is different from stroke in non-diabetics from several perspectives. There is no local study on this topic. This is the first study from Pakistan, in which pattern of stroke in diabetics have been described and compared with non-diabetics. The object of this study was to compare pattern of stroke in diabetic subjects with non-diabetics. METHODS: This is a prospective comparative cross sectional study, carried out at Liaquat national hospital, Karachi, neurology department from October to March 2006. Fifty patients were enrolled in diabetic group and 50 in non-diabetic. Clinical features, risk factors and stroke patterns were identified. RESULTS: Mean age was 59.5 (+/- 11.82) in diabetics and 60.4 (+/- 14.8) in non diabetics. There was slight preponderance of male patients in non diabetic group. Out of 50 diabetic patients, 44 (88.0%) had ischaemic stroke and 6 (12.0%) had intracerebral haemorrhage. In non-diabetics, 29 (58.0%) had ischaemic stroke while 21 (42.0%) had intracerebral haemorrhage. On further analysis of ischaemic stroke, cortical infarcts (CI) was found in 22, sub cortical infarcts (SCI) in 14, brainstem in 5 and cerebellar in 2 diabetic patients. CI was also the commonest subtype of ischaemic stroke in nondiabetics. CONCLUSION: Patterns of stroke in diabetics are different from non-diabetics. Ischaemic stroke is more prevalent than hemorrhagic strokein diabetics. Sub cortical infarcts are more common in diabetics than non diabetics (p = 0.04).

Lithium-induced nephrogenic diabetes insipidus.

We report a case of a 43 year-old female who presented with lithium-induced nephrogenic diabetes insipidus. This patient had history of bipolar disorder for which she had been taking lithium carbonate for last 16 years. Appropriate work up was done and she was diagnosed with nephrogenic diabetes insipidus, secondary to lithium toxicity, and was managed accordingly.

An adult with Morquio syndrome.

We report a case of a 25-year-old male who came to endocrine clinic to get medical certificate so as to claim as the shortest man of the world. He was evaluated for short stature and eventually diagnosed with type-IV mucopolysaccharidosis (MPS) or Morquio syndrome.