Visual outcome after phacoemulsification with lens implant in diabetic and non-diabetic patients; A comparative study.

OBJECTIVE: To compare the visual outcomes of phacoemulsification surgery with intraocular lens (IOL) in persons with and without diabetes at end of follow-up. METHODS: This was a comparative, cross sectional, observational study with Non-probability, purposive sampling. After approval from "Research Ethical Committee of Isra Post-graduate Institute of Ophthalmology Karachi, 92 patients with cataract in one eye were selected. Patients were divided into two groups. Group A consisted of 48 diabetics and group B consisted of 44 non- diabetics with or without diabetes in the age group ≥ 30 years were included. Patients with small Pupil, Pseudo exfoliation Syndrome, Diabetic Retinopathy, and positive history of Uveitis, Glaucoma, and Macular Degeneration were excluded. Data analysis was performed by SPSS Version 20.0. RESULTS: Best Corrected Visual Acuity (BCVA) in diabetic patients improved from 0.813 ± 0.181 Log MAR pre operatively to 0.183 ± 0.143 after the period of six months post-operatively. Corresponding results in non-diabetics were 0.66 ± 0.31 and 0.08 ± 0.092 Log Mar (P value = 0.001). If WHO criteria was considered, 87.5% diabetics and 92% non-diabetics achieved normal vision (Log Mar 0 to 0.5; ≥ 6/12,) on the first post-operative day. Remaining 12.5% diabetics and 8% non-diabetics achieved moderate vision (0.6 to 1 Log MAR) on first post-operative day improving to normal vision within a week. CONCLUSION: Visual outcomes in diabetics after phacoemulsification with intra ocular lens implant is almost as good as that in non-diabetic patient if the diabetics have no retinopathy and have good glycemic control.

An assessment of knowledge, attitude and practices (KAP) towards diabetes and diabetic retinopathy in a suburban town of Karachi.

OBJECTIVE: To assess the Knowledge, Attitude and Practices (KAP) towards diabetes and diabetic retinopathy in the general population of Bin Qasim Town (BQ), Karachi. METHODS: An observational, cross-sectional study was approved by Research Ethical Committee of Al-Ibrahim Eye Hospital. It included every third household by stratified sampling in each Union Council of (BQ) Town, in the months of May to July 2013. The interview Questionnaire included 43 questions, of qualitative and quantitative aspects, which were awarded 56 scoring points. SPSS version 20.0 was used to analyze the data. RESULTS: Six hundred ninety two adults one from each household were interviewed. Of the total respondents, 271 (39.2%) had diabetes. Lowest mean knowledge score (5.28 ± 6.09) was seen in illiterate respondents. Male's Mean Knowledge score (7.61 ± 6.600) was better than female's (5.46 ± 6.21) with P <0.001. Over all mean score of Attitudes towards diabetes was 5.43 ± 2.57. It was higher (6.62 ± 2.03) in diabetic respondents as compared with non-diabetic respondents (4.70 ± 2.59) with p < 0.000. In Practice module majority of the respondents (69.9%) did not exercise, 49% took high caloric snacks between meals and 87% ate outside home once a month, 56.8% diabetics visited ophthalmologist for routine eye examination; but only 9.2% asked for retinal examination. CONCLUSION: Lack of knowledge of diabetes was found in the surveyed community, more marked in females, illiterate and the individuals not having diabetes.

Effects of garlic on dyslipidemia in patients with type 2 diabetes mellitus.

BACKGROUND: Garlic (Allium Sativum) has been used in herbal medicine for centuries for various ailments. In recent years garlic has been the focus of serious medical and clinical attention because of beneficial effects on several cardiovascular risk factors like reduction of serum lipids, blood pressure and plasma viscosity. There is also wide spread belief among general public that garlic has beneficial effects on cardiovascular system. The purpose of present study was to evaluate the effects of garlic on one of the major cardiovascular risk factors i.e. dyslipidemia in patients with type 2 diabetes mellitus. METHOD: This 12 week randomized, single-blind, placebo controlled study was conducted on Type 2 diabetic patients with newly diagnosed dyslipidemia (n=70). Patients were selected from Diabetic OPD of Jinnah Post Graduate Medical Centre, Karachi and were divided into two groups each comprising of 35 patients, they were given tablet garlic (Garlex-Bosch Pharmaceuticals) 300 mg (containing 1.3 % allicin) twice daily and identical placebo tablets respectively. Both groups were given diet and exercise plan. RESULTS: After 12 weeks the garlic treated group (n = 33) had a significant reduction in total cholesterol (-28 mg/dl, - 12.03 % P= <0.001), LDL - C (-30 mg/dl, - 17.99 % P=<0.001) while the placebo treated group ( n=32) had a non significant decrease in total cholesterol (- 2 mg/dl, - 0.9 % p= ns) and LDL-C (-3 mg/dl, -1.6 % p=ns). HDL cholesterol was significantly increased in patients treated with garlic (3.35 mg/dl, 8.81% P= <0.05) compared with placebo group (0.62, 1.6% P= n.s) but there was no significant difference in triglyceride was observed between two groups. CONCLUSION: This study suggests possible small short term benefits of garlic on dyslipidemia in type 2 diabetic patients. Garlic significantly reduced serum total cholesterol and LDL cholesterol and moderately raised HDL cholesterol as compared to placebo. Controlled Clinical Trials of longer duration are needed to assess the long term benefit of garlic on vascular and circulatory disease processes.

Comparison between duration dependent effects of Simvastatin and Gemfibrozil on dyslipidemia in patients with type 2 diabetes.

OBJECTIVE: To observe the duration dependent effects of two important classes of lipid lowering drugs i.e. simvastatin and gemfibrozil in type 2 diabetic patients with dyslipidemia in Pakistani population. METHODS: Seventy type 2 diabetic patients with newly diagnosed dyslipidemia were enrolled and were divided randomly into two groups each, with 35 patients. Group I patients was given tablets Simvastatin 20 mg once daily and group II patients received tablet Gemfibrozil 600 mg twice daily. The study period comprised of 12 weeks. Fasting lipid profile and fasting blood sugar was analyzed on week 0 (day of inclusion), week 6 and week 12. RESULTS: At week 12 simvastatin decreased serum LDL cholesterol by 36.97 percent (P < 0.001). In contrast gemfibrozil did not reduce it significantly with a reduction of only 1.33 percent (P = N.S). Simvastatin reduced serum total cholesterol and serum triglyceride by 29.88 percent (P < 0.001) and 21.78 percent (P < 0.001) respectively and increased serum HDL cholesterol by 16.67 percent (P < 0.001). While gemfibrozil decreased serum total cholesterol by 9.14 percent (P < 0.001) and serum triglyceride by 30.84 percent (P < 0.001). Gemfibrozil raised serum HDL cholesterol levels by 18.08 percent (P < 0.001). CONCLUSION: Significant changes were observed in all lipid parameters with both simvastatin and gemfibrozil with regard to duration of treatment. Simvastatin was found to be more effective in lowering serum total cholesterol and LDL cholesterol levels in comparison to gemfibrozil, which was found to be more effective in lowering serum triglyceride and elevating serum HDL cholesterol levels. Both of these drugs were well tolerated and none of the patients exhibited any significant adverse effects. Both can be given as monotherapy in patients with type 2 diabetes mellitus and abnormal lipid profile.