Endocrinology, Diabetes, and Metabolism Commons^™

Association Of Depression With Treatment Outcomes In Type 2 Diabetes Mellitus: A Cross-Sectional Study From Karachi, Pakistan, Saman I. Zuberi, Ehsan U. Syed, Junaid A. Bhatti

Section of Diabetes, Endocrinology and Metabolism

Background: To assess the associations of depression with glycemic control and compliance to self-care activities in adult Patients with Type 2 Diabetes Mellitus. Methods: This cross-sectional study was conducted at a tertiary-care hospital in Karachi (Aga Khan University Hospital). Equal numbers of depressed and non-depressed Patients were consecutively recruited from the diabetic clinic. Information on demographic and clinical characteristics was collected in face-to-face interviews and from medical records. Hospital Anxiety Depression Scale (HADS) was used to measure depression. Associations of depressed status (HADS >= 8) with poor glycemic control (Hemoglobin A1c level >= 7%) and compliance to self-care activities were …

Anxiety And Depression Among Outpatients With Type 2 Diabetes: A Multi-Centre Study Of Prevalence And Associated Factors., Ali Khan Khuwaja, Saima Lalani, Raheem Dhanani, Iqbal Syed Azam, Ghazala Rafique, Franklin White

Department of Family Medicine

Background: Anxiety and depression contribute to poor disease outcomes among individuals with diabetes. This study aimed to assess the prevalence of anxiety and depression and to identify their associated factors including metabolic components among people with type 2 diabetes. Methods: We conducted a cross-sectional, multi-center study in four out-Patient clinics in Karachi, Pakistan. In all, 889 adults with type-2 diabetes were included in this study. Anxiety and depression were measured by using the Hospital Anxiety and Depression Scale (HADS). Multivariable analysis using multiple logistic regression was carried out to evaluate the combined effect of various factors associated with anxiety and …

Self-Glucose Monitoring And Glycaemic Control At A Tertiary Care University Hospital, Karachi, Pakistan, Khurshid Khowaja, Humaira Waheed

Section of Diabetes, Endocrinology and Metabolism

OBJECTIVE: To explore the association between Self Monitoring of Blood Glucose (SMBG) levels and improved glycemic control (HbA1c level) among type 2 diabetic patients, receiving oral hypoglycaemic agents and insulin, and to ascertain the factors influencing SMBG.

METHOD: Using Comparative cross sectional study design five hundred Type 2 diabetes patients through convenient sampling between 30-70 years were interviewed through a structured questionnaire in year 2006 and 2007 at AKUH Ambulatory setting. These 500 subjects were divided as 250 in case (doing SMBG) and 250 in control (not doing SMBG) groups.

RESULTS: We identified that HbA1c value was maintained at good …

Imminent Epidemic Of Diabetes Mellitus In Pakistan: Issues And Challenges For Health Care Providers, Waris Qidwai, Tabinda Ashfaq

Department of Family Medicine

No abstract provided.

A Doppler-Based Evaluation Of Peripheral Lower Limb Arterial Insufficiency In Diabetes Mellitus, Riffat Shaheen, Saba Sohail

Department of Radiology

Objective: To determine the frequency, level and flow patterns of lower limb arterial insufficiency in diabetic patients on Doppler ultrasound study.
Study Design: Cross-sectional study.
Place and Duration of Study: Radiology Department, Civil Hospital, Karachi, from February 2007 to September 2008.
Methodology: One hundred adult diabetic patients with suspected peripheral vascular insufficiency irrespective of gender were included. Demographic data, presenting complaints, treatment history, and level of HbA1c were recorded. Doppler evaluated arterial status and ankle brachial index (ABI) were recorded on proforma. Statical analysis were done on SPSS version 12.
Results: The mean HbA1c was 8.4 ± 1.4gm/dl, a majority …

Etiology, Functional Status And Short Term Outcome Of Patients With Pituitary Lesions. An Experience From A Developing Country, Osama Ishtiaq, Mansoor Ul Haq, Azra Rizwan, Mohammad Qamar Masood, Saeed Mehar, Abdul Jabbar

Section of Diabetes, Endocrinology and Metabolism

OBJECTIVE: To describe the etiology, functional status and short term outcome of patients with pituitary lesions (PL).

METHODS: Brain or pituitary MRI reports of 3753 patients were analyzed for PL over the period of 2000 to 2007, done at the Aga Khan University Hospital (AKUH), Karachi, Pakistan. MRIs with reported PL and all those ordered by Endocrinologists with or without pituitary abnormalities, were included in the analysis. This made a total of 338 (9%) MRI reports. PL were defined as pituitary tumors, cysts, haemorrhage, hypoplasia; and empty sella. Patients with these PL, were analyzed for symptoms, hormonal profile and short …

Fight Against Chronic Diseases (High Blood Pressure, Stroke, Diabetes And Cancer) In Pakistan; Cost-Effective Interventions, Mohammad Wasay, Abdul Jabbar

Department of Medicine

No abstract provided.

Vitamin D Deficiency In Ambulatory Patients, Lubna M Zuberi, Aysha Habib, Naeemul Haque, Abdul Jabbar

Section of Diabetes, Endocrinology and Metabolism

OBJECTIVE: To determine the frequency of subclinical vitamin D deficiency in an ambulatory care setting.

METHODS: This was an observational study which measured 25 vitamin D levels in medical clinic patients. Patients with chronic renal failure, known osteomalacia and rickets were excluded. A total of 119 patients were evaluated. They were divided in three diagnostic categories based on their serum 25 vitamin D levels. Those with levels below 8 ng/ml were categorized to have severe deficiency, levels between 8 - 20 ng/ml as moderate deficiency and levels of 21-35 mg/ml as mild deficiency.

RESULTS: Of 119 patients, 92% had vitamin …

Hyponatraemia: Etiology, Management And Outcome, Aasima Yawar, Abdul Jabbar, Naeem Ul Haque, Lubna M Zuberi, Najmul Islam, Jaweed Akhtar

Section of Diabetes, Endocrinology and Metabolism

OBJECTIVE: To determine the etiology of hyponatraemia, the treatment instituted and the outcome of treatment in a tertiary care hospital setting.

STUDY DESIGN: Case series.PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi, between January and June 2004.

METHODOLOGY: Case records of 220 patients admitted to the medical service were identified through computerized hospital patients' data. All patients (3) 15 years with a sodium level on admission of (2) 130 mmol/litre were included. The records of those patients were reviewed for relevant demographic, clinical and laboratory data, in addition to the diagnosis, treatment and outcome of hospitalization. The …

Does Choice Of Therapy Save Costs And Improve Outcomes In Hyperthyroid Patients, Lubna M Zuberi, Safia Awan, Najmul Islam, J. Akhter, Abdul Jabbar

Section of Internal Medicine

OBJECTIVE: To compare cost of treating hyperthyroidism with antithyroid medications (ATD) versus radioactive iodine (RAI). As secondary outcome we also analyzed data in terms of remission rates.

METHODS: This was a retrospective comparative analysis of hyperthyroid patients treated with ATD or RAI from January 2000 to December 2005. Cost of ATD, TSH. FT4, doctors visits; thyroid technetium scan and RAI treatment were calculated for the duration of treatment and for one year of follow-up after remission.

RESULTS: A total of 143 patients were included, with an average duration of follow-up of 32 months. Mean age was 41 +/- 15.5 years …

Vitamin B12 Deficiency Common In Primary Hypothyroidism, Abdul Jabbar, Aasma Yawar, Sabiha Waseem, Najmul Islam, Naeem Ul Haque, Lubna Zuberi, Ataullah Khan, J. Akhter

Section of Diabetes, Endocrinology and Metabolism

OBJECTIVE: To assess the prevalence and clinical features of B12 deficiency in hypothyroid patients and to evaluate clinical response in symptoms to B12 replacement therapy.

METHODS: One hundred and sixteen hypothyroid patients from our endocrine clinic were evaluated for signs and symptoms of vitamin B12 deficiency. Laboratory parameters including Haemoglobin (Hb), MCV, Vitamin B12 levels and presence of anti thyroid antibodies were analyzed. Patients with low B12 levels were treated with parenteral intramuscular vitamin B12 monthly, and monitored for improvement of symptoms.

RESULTS: A total of 116 patients (95 females and 21 males) were evaluated. Forty six (39.6%) hypothyroid patients …

An Audit Of The Quality Of Care Indicators For The Management Of Diabetes In Family Practice Clinics In Karachi, Pakistan, Raheem H Dhanani, Mohammad Mustafa Qureshi, Ali Khan Khuwaja, Badar Sabir Ali, Riaz Qureshi

Department of Family Medicine

BACKGROUND: Management of diabetes is a painstaking and careful approach. This study was aimed to evaluate the quality of care for the management of diabetes provided by family practitioners to their patients having diabetes. This is a retrospective audit of medical records conducted in a tertiary care teaching hospital of private sector in Karachi for one month.

METHODS: For this study, 150 medical records of patients with type 2 diabetes that visited family practice clinics for their diabetes care were examined. A total of 88 patient's medical records were selected and analyzed who attended the studied clinics for at least …

Pregnancy Outcome In Primiparae Of Advanced Maternal Age, Ilse Delbaere, Hans Verstraelen, Sylvie Goetgeluk, Guy Martens, Guy De Backer, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Objective: To investigate the impact of maternal age on singleton pregnancy outcome, taking into account intermediate and confounding factors.

Study design: In this population-based retrospective cohort study, perinatal data of primiparous women aged 35 years or more ( n = 2970), giving birth to a singleton child of at least 500 g, were compared to data of primiparous women aged 25–29 years old ( n = 23,921). Univariate analysis was used to assess the effect of maternal age on pregnancy outcomes. The effects of intermediate (hypertension, diabetes and assisted conception) and confounding factors (level of education) were assessed through multivariable …

Cost Of Diabetes Care In Out-Patient Clinics Of Karachi, Pakistan, Liaquat A. Khowaja, Ali K. Khuwaja, Peter Cosgrove

Community Health Sciences

Background: Diabetes Mellitus (DM) is a growing epidemic and the cost of treating diabetes is largely increasing. The objective of this study was to estimate the cost-of-illness of DM among attendees of out-patient clinics in Karachi, Pakistan. This is the first study conducted from a societal perspective to estimate the cost of managing diabetes in Pakistan.Methods: A prevalence-based 'Cost-of-Illness' study for diabetes care was conducted in six different out-patient clinics of Karachi, Pakistan from July to September 2006. A pre-tested questionnaire was administered to collect the data from 345 randomly selected persons with diabetes.Results: The annual mean direct cost for …

Fine Needle Aspiration Cytology Of Thyroid Nodule: Diagnostic Accuracy And Pitfalls, Saeed A. Mahar, Akhtar Husain, Najmul Islam

Section of Diabetes, Endocrinology and Metabolism

Background: To evaluate the utility of FNAC in patients with Thyroid Nodule.

Methods: Records of all patients treated surgically for thyroid nodule(s) at Aga Khan University Hospital from January 2000 to December 2004 were reviewed. The patients who had pre operative FNAC as first line of the evaluation and the final post operative histopathology report available were included in the study.

Results: 125 patients (90 female 35 male) had thyroid surgery. The cytological diagnosis was made according to following categories: Benign, Follicular lesion, Malignant and Inadequate sampling. Among 63 "Benign cases", 57 were benign and 6 turned out …

Clinical Presentation Of Thyroid Cancer Patients In Pakistan--Akuh Experience, L M. Zuberi, A Yawar, N Islam, A Jabbar

Section of Diabetes, Endocrinology and Metabolism

Objective: To asses the clinical presentation of patients with thyroid cancer, their preferred diagnostic work-up and preferred surgical procedure.

Methods: A retrospective chart review of patients that underwent partial or total thyroidectomy for thyroid cancer at AKUH between 1989 and 2002. SPSS was used to analyze data. Pearson's chi square and likelihood ratios used to calculate tests of significance.

Results: A total of 97 patients were included in this review. Solitary thyroid nodule was the initial presentation in three. Majority (58.7%) presented with "neck swelling" or enlarging goiter. One out of every 3 patients showed evidence of lymph …

Clinical Features And Outcome Of Surgery In 30 Patients With Acromegaly, A Chandna, N Islam, A Jabbar, L Zuberi, N Haque

Section of Diabetes, Endocrinology and Metabolism

Objective: To assess the surgical outcome of hypophysectomy in acromegalic patients, differences in response to surgery in micro and macroadenoma and the development of associated hormonal deficiency after surgery.

Methods: Retrospective analysis of charts of acromegalic patients who were operated upon at Aga Khan University Hospital, Karachi, was done. Information regarding presentation, laboratory data, radiological assessment, details of surgery and postoperative outcome was recorded. Surgical outcome was classified depending on the degree of disease control after surgery as biochemical cure, remission and treatment failure.

Results: Out of 30 patients, eighteen (60%) were males and 12 (40%) females with …

Dietary Practices And Beliefs Of Patients With Chronic Liver Disease, S H. Badruddin, S M. Jafri, A Ahmed, S Abid

Section of Diabetes, Endocrinology and Metabolism

Objective: To study of the dietary practices and beliefs of patients suffering from chronic liver disease.

Setting: Two private tertcary care hospitals.

Method: Fifty patients presenting to the Gastroenterology Clinics at the Aga Khan University Hospital and Baqai Hospital, with compensated liver disease and no other co-morbid condition which required dietary modifications, were enrolled in the study. Patients were interviewed regarding their current dietary practices using an open-ended questionnaire.

Results: The mean age of the patients was 48 years and the majority were in relatively poor nutritional status. Four had BMI's < 18; 58% had Hb < 12 g/dl and 36% had albumin levels < 3 gm/dl. The percentage of patients avoiding various foods is as follows: meats 72%, fats and oils 64%, salt 42%, spices 34%, milk and milk products 28%, rice 20%.

Conclusion: The most commonly cited reason for avoiding a …

Gestational Diabetes In A Developing Country, Experience Of Screening At The Aga Khan University Medical Centre, Karachi, Khalid S. Khan, Javaid H. Rizvi, Rahat N. Qureshi, Rauf Mazhar

Department of Obstetrics & Gynaecology

In order to determine the prevalence of glucose intolerance in pregnancy, 1267 consecutive women attending the antenatal clinic of the Aga Khan University Medical Centre were subjected to a 75 g glucose challenge followed 2 hr later by plasma glucose determination irrespective of gestation on the first antenatal visit. The test was repeated at 28-32 weeks of gestation if the patients had an abnormal initial screen at less than 28 weeks gestation and a normal glucose tolerance test on diagnostic follow-up and for those who had a risk factor for gestational diabetes and a normal initial screen at less than …