Frequency and risk factors associated with hypomagnesaemia in hypokalemic type-2 diabetic patients.

OBJECTIVE: To determine the frequency and factors associated with hypomagnesaemia in hypokalemic type-2 diabetic patients presenting at Civil Hospital, Karachi. STUDY DESIGN: A cross-sectional study. PLACE AND DURATION OF STUDY: Department of Medicine and Diabetic Clinic of Civil Hospital and Dow Medical College, Karachi, from November 2010 to May 2011. METHODOLOGY: A total of 358 adult type-2 diabetics with hypokalemia were selected for this study. With aseptic measures, venous blood was collected for serum magnesium, potassium, HDLc, LDLc Triglyceride (TGs) and glycosylated hemoglobin (HbA1c) from each subject after an overnight fasting and was analyzed on Roche Hitachi 820 Photo Spectrometry. The data was analyzed on SPSS version 17 to determine the factors associated with hypomagnesaemia like duration of diabetes, Body Mass Index (BMI), diabetic nephropathy, HDLc, LDLc Triglyceride (TGs) and glycosylated hemoglobin (HbA1c) level. RESULTS: Mean age of study population was 55.62 ± 9.9 years. Most of them (n=228, 63.7%) were males. Out of the 358 subjects, 198 (55.3%) had hypomagnesaemia. There was significant association between hypomagnesaemia with duration of diabetes, Body Mass Index (BMI), diabetic nephropathy, HDLc, LDLc Triglyceride (TGs) and glycosylated hemoglobin (HbA1c) level. CONCLUSION: Hypomagnesaemia is very common in type-2 diabetic hypokalemic patients. Therefore, it should be routinely sought by the clinicians. Early recognition and subsequent treatment of hypomagnesaemia may help in better glycemic control, may delay the chronic complications and decrease the mortality in diabetic hypokalemic patients.

Inpatient management of type 2 Diabetes Mellitus: Does choice of insulin regimen really matter?

OBJECTIVE: To assess inpatient management of non-critically ill type 2 diabetics with different insulin regimen. METHODS: We reviewed the medical records of all non-critically ill type 2 diabetic patients more than 18 years of age in medical department of civil hospital Karachi and Dow University of Health Sciences from January 2011 to December 2012. We collected the data from case records in data collection sheets that fulfill the inclusion criteria and divided the study subjects into three groups according to insulin regimen they received. RESULTS: A total of 416 patients were analyzed out of which 220 were male. Subjects were divided into three groups according to insulin regimen they received. Majority were put on sliding scale of insulin (44.7%), while 33.1% and 22.1% subjects received basal bolus and pre-mixed insulin regimen respectively. Patients treated with basal bolus regimen had greater improvement in glycaemic control with short duration of hospital stay as compared to other two groups. The mean hyperglycaemic events were higher in sliding scale group while mean hypoglycaemic events were higher in basal bolus group. CONCLUSION: In non-critically ill type 2 diabetic patients the basal bolus regimen is superior to sliding and pre-mixed insulin regimen. Sliding scale should be discouraged in non-critically ill type 2 diabetic patients.

Frequency, characteristics and risk factors of carotid artery stenosis in ischaemic stroke patients at Civil Hospital Karachi.

OBJECTIVE: To determine the frequency and characteristics of carotid artery stenosis in acute ischaemic stroke patients and to assess the significance of common risk factors for carotid stenosis in these patients. METHOD: One hundred consecutive patients admitted with acute ischaemic stroke were included in the study. The relevant history, physical examination and laboratory investigations were done as per the Performa. Doppler ultrasound was performed during the hospitalization to find out carotid artery stenosis. Statistics analysis was done with SPSS v 14. RESULTS: Out of one hundred (100) patients, sixty one (61%) were males and thirty nine (39%) were females. Thirty nine patients (39%) were found to have carotid artery stenosis, all of them on the ipsilateral side corresponding to the ischaemic lesion. Eleven (11) of these patients had stenosis on the contra lateral side as well. The presence of stenosis was significantly correlated with older age and the presence of multiple risk factors. Majority (52%) of the lesions were severe to critical as determined by Doppler peak systolic velocity. Fifty nine (59%) were non calcified. CONCLUSION: Carotid artery stenosis is strongly associated with ischaemic stroke. Doppler studies are recommended for the high risk patients for the primary as well as secondary prevention of ischaemic stroke.

Vitamin D deficiency in fibromyalgia.

OBJECTIVE: To check the Vitamin D levels in patients diagnosed as fibromyagia in our population. METHODS: Study was done at Medical OPD of Civil Hospital Karachi, from January to March 2009. Female patients diagnosed as Fibromyalgia according to American College of Rheumatology (ACR) criteria and exclusion of systemic illness on examination, and normal reports of blood CP, ESR, serum calcium, phosphate and Alkaline Phosphatase, were asked to get Vitamin D levels in their serum. Vitamin D deficiency is defined as <20 ng/ml, Vitamin D insufficiency 21-29 ng/ml and Vitamin D sufficiency equal or >30 ng/ml. RESULT: Forty female patients were included in the study. The mean age was 37.65 +/- 11.5 years. Mean Vitamin D level was 17.41 +/- 5.497 ng/ml. Thirty two (80%) of patients had Vitamin D deficiency, mean levels of 15.855 +/- 4.918 ng/ml and 8(20%) had Vitamin D insufficiency, mean levels of 23.64 +/- 2.39 ng/ml. Patients with vitamin D deficiency and age less than 45 years were 22 (68.75%), had mean vitamin D level 16.87 +/- 4.48 ng/ml whereas in age ranging from 46-75 years were 10 (31.25%) had mean vitamin D level 16.09 +/- 6.45 ng/ml. CONCLUSION: Vitamin D deficiency is frequently seen in patients diagnosed as fibromyalgia and nonspecific musculoskeletal pain in our population. Although the sample size of the study is small, but the figures are so alarming that it is an eye opener towards the need of a population based study, including normal population as well as those presenting with musculoskeletal pain.