Association of Hypertension with Non-HDL Cholesterol in Patients with Type 2 Diabetes Mellitus.

OBJECTIVE: To determine the association of hypertension with Non-HDL Cholesterol (Non-HDL.C) among patients with type 2 diabetes mellitus. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY:  Shifa Foundation Community Health Centre, Shifa International Hospital, Islamabad, from January to December 2019. METHODOLOGY:  This study comprised of 214 patients with type 2 diabetes. Detailed history, examination, anthropometric measurements, fasting lipid profiles and blood glucose levels were recorded for all patients. Non-HDL.C was determined in all patients by subtracting HDL Cholesterol (HDL.C) from total Cholesterol (Total.C). Association of hypertension with Non-HDL.C was analysed using Chi-square Fisher Exact test for qualitative data and post-stratification t-test for quantitative data. Correlation of rising levels of Non-HDL.C with Total.C, LDL.C, Triglycerides, HDL.C and fasting blood sugar was analysed using ANOVA. SPSS version 23 was used for statistical analysis. RESULTS: Non-HDL.C was raised in 169 (78.97%) patients with type 2 diabetes. However, there was no significant difference in the mean Non-HDL.C among patients with hypertension and without hypertension (156.35 +38.52 mg/dl versus 156.81 +45.82 mg/dl; p = 0.936). Furthermore, there was no significant difference in the Total.C, LDL.C, Triglycerides and the number of patients with raised Non-HDL.C among both groups. Increasing values of Non-HDL.C correlated significantly to Total.C, LDL.C and Triglycerides (p <0.001). CONCLUSION: Hypertension had no significant association with Non-HDL.C in patients with type 2 diabetes. However, the raised level of Non-HDL.C in majority of type 2 diabetic patients in addition to significant correlation with Total.C, LDL.C and Triglycerides necessitates its screening irrespective of the blood pressure status. Key Words: Non-HDL cholesterol, Dyslipidemia, Diabetes, Hypertension.

Outcome of early use of non-invasive positive pressure ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease.

OBJECTIVE: To determine the outcome of early use of non-invasive positive pressure ventilation (NIPPV) in Pakistani patients with acute exacerbation of chronic obstructive pulmonary disease. METHODS: This descriptive study was conducted at Shifa International Hospital Islamabad from April 2015 to January 2017. A total of 120 patients with acute exacerbation of chronic obstructive pulmonary disease receiving NIPPV alongside standard therapy were included in the study. The patients were clinically assessed before starting on NIPPV. The parameters of respiratory rate, pH and paCO2 were monitored and NIPPV was given for six hours to evaluate clinical outcomes and analyze the factors predicting failure (requirement of mechanical ventilation and mortality). Frequency and percentages were calculated for qualitative variables while Mean and Standard Deviation for quantitative variables. Chi-square and t-test were used to see differences in pre and post NIPPV arterial blood gases. RESULTS: Patients' mean age was 58.88±10.09 years. Males were 88 (73.3%) and females were 32 (26.7%). The mean respiratory rate was 24±1.45 per minute before and 17.96±1.35 per minute after NIPPV (p < 0.00001). The mean pH before NIPPV was 7.27±0.04 and afterwards 7.38±0.02 (p < 0.00001). The mean pCO2 was 61.87±9.60 mm of Hg before and 57.46±6.79 mm of Hg after NIPPV (P < 0.0003). Twenty Four (20%) patients required invasive ventilation of which 19 (15.8%) patients could not survive. CONCLUSIONS: There was remarkable improvement in the arterial blood gases after NIPPV. However, the high mortality rate and significant number of COPD patients requiring mechanical ventilation necessitates further investigation into our population.

Association of Impaired Fasting Glucose with Hypertension.

OBJECTIVE: To evaluate the association of impaired fasting glucose (IFG) with hypertension in Pakistani population. STUDY DESIGN: A cross-sectional, analytical study. PLACE AND DURATION OF STUDY: Shifa Community Health Centre, Islamabad from December 2016 to July 2017. METHODOLOGY: One hundred and eighty-seven hypertensive patients were included in the study, using consecutive sampling technique. Demographic, anthropometric, and laboratory data of the patients were recorded. Continuous variables were expressed as mean + SD and categorical variables as numbers and percentages. Differences among males/females and between hypertensive patients with normal, impaired fasting glucose and diabetes for risk factors were analysed, using independent sample t-test, ANOVA and chi-square test using SPSS version 24. RESULTS: The mean age of patients was 52.98 +11.22 years. Females were 69.9% and males 30.1%. The total frequency of IFG in patients with hypertension was 42.6% and new onset diabetes 12.5% showing its close association with hypertension. There was no significant difference between males and females for risk factors (age, BMI, blood pressure, total cholesterol, LDL-cholesterol, and HDL-cholesterol) except for more education, smoking, and high triglyceride in males. There was no significant difference among hypertensive patients with normal, impaired fasting glucose and diabetes for risk factors (gender, BMI, blood pressure, total cholesterol, LDL-cholesterol, triglycerides, HDL-cholesterol and family history) except for smoking. CONCLUSION: The significant association of impaired fasting glucose with hypertension necessitates early screening for impaired fasting glucose.