BackgroundMusculoskeletal manifestations of diabetes in the upper limb are well recognized. No data has been available in this regard from Pakistan. Our aim was to find out the frequency of upper limb musculoskeletal abnormalities in diabetic patients.MethodsThis was an observational study in which type 2 diabetes patients attending our diabetic clinic were enrolled along with age and gender matched controls. Data was analyzed on SPSS 16.ResultsIn total, 210 Type 2 diabetics (male 34.3%, female 65.7%) and 203 controls (male 35%, female 65%) were recruited. The mean age was 50.7± 10.2 years in diabetic group as compared to 49.5±10.6 years in the control group. The frequencies of hand region abnormalities were significantly higher in the diabetic subjects as compared to the controls (20.4%, p-value <0.001). Limited joint mobility (9.5% vs 2.5%), carpal tunnel syndrome (9% vs 2%), trigger finger (3.8% vs 0.5%), and dupuytren’s contracture (1% vs 0%) were found more frequent as compared to controls (all p-values <0.05). In the shoulder region of diabetic subjects, adhesive capsulitis and tendonitis was found in 10.9% and 9.5% respectively as compared to 2.5% and 2% in control group [p- value <0.001]. A weak but positive relationship was observed between age and duration of diabetes with these upper limb abnormalities. However, no correlation was found between the frequencies of these abnormalities with control of diabetes.ConclusionA higher frequency of upper limb musculoskeletal abnormalities was observed in Type 2 diabetic patients as compared to control group.

Background and Objective:Urinary tract infection is one of the commonest infections seen in clinical practice. Lack of compliance and unjustified antibiotic prescriptions has resulted in bacterial resistance and is proving as a major challenge in the management of these infections. Our aim was to identify the sensitivity pattern of commonly used antibiotics against urinary tract infections so as to suggest an improvised line of action against bacteria causing urinary tract infections’.Method:This was a hospital based cross sectional study extended over a period of four months. Patients were recruited from outpatients department of a tertiary care hospital in an industrial area of Karachi. Adult patients with symptomatic and documented UTI in urine detailed report (pus cells >10) were enrolled after informed consent. A clean catch midstream urine was collected for culture and sensitivity testing using the standard microbiological procedure. Data is analyzed on SPSS 16.Results:A total of 184 samples were collected in 4 months. The Male to Female ratio was 1:2 (n=58/126) with mean age 48.5±12 years. 83(45.6%) patients were between 45-60 years. Most common isolated pathogen was Eschericia coli 108(59%) followed by staphylococcus aureus 30(16.4%) and Klebsiella 20(11%). 55(30%) pathogens showed sensitivity to 4-6 antibiotics, 22(12%) strains to 7-9 antibiotics, 33(18%) were sensitive to ≤3 drugs and in 3(1.6%) patients resistance to all antibiotics is seen. The more resistant pathogens were sensitive to intravenous antibiotics alone.Conclusion:In this low socioeconomic cohort with UTI nearly half the isolated pathogens has shown resistance to most of the commonly used antibiotics recommended in the guidelines especially the floxacin group probably because of its unwarranted use. Therefore, a revised line of management should be developed locally in accordance with the susceptibility pattern of the urinary pathogens to avoid further resistance as well as morbidity of the patient.

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Objective: This study was aimed to determine the predictive value of HbA1c in detecting dyslipidemia in patients with Type-2 Diabetes Mellitus. Methods: A total of 142 consecutive patients of Type-2 diabetes mellitus were recruited in this study after informed consent. The study was conducted for 6 months from January 2019 – June 2019 in Creek General Hospital, Korangi, Creek, Karachi. Demographic data and detailed history was taken. A complete systemic examination was done for any complications or co-morbids present and related investigations were performed including Fasting lipid profile (CHO, TG’s, HDL, LDL, CHO/HDL), serum HbA1c, Creatinine and ECG. Data is analyzed on SPSS 16 for mean, frequencies and correlations. Pearsons Chi square test is used for analyses of Correlation Results: In a total of 142 Type-2 diabetic patients 39(27.5%) were Males and 103(72.5%) were females with a male to female ratio of 1: 2.6. Mean age was 54.9yrs ± 10.7SD. Mean duration of diabetes was 7.37yrs ±5.64 SD years. Mean BMI is 26.8 ± 3.67kg/m2. 27(19.01%) patients had HbA1c ≤ 7% whereas 115(80.9%) had >7%. 81(57.04%) patients had dyslipidemia. HbA1c exhibited direct correlations with BMI, cholesterol, TG’s and LDL and inverse correlation with HDL with significant P value of <.05. TG’s were found significantly higher in females when compared with male patients. In addition, Metabolic syndrome also showed a strong correlation with increasing HbA1c levels especially in female gender (P0.001). Conclusion: The results of our study indicates that HbA1c can be used not only as a useful biomarker of long-term glycaemic control but also a good predictor of lipid profile. doi: https://doi.org/10.12669/pjms.36.6.2000 How to cite this:Kidwai SS, Nageen A, Bashir F, Ara J. HbA1c – A predictor of dyslipidemia in type 2 Diabetes Mellitus. Pak J Med Sci. 2020;36(6):---------. doi: https://doi.org/10.12669/pjms.36.6.2000 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background: Smoking and smokeless tobacco use is the major cause of death and disease in South Asia, the use of gutka has surpassed that of smoking in this region thus, acting as a major contributor to oral and esophageal cancer especially in the younger population. Authors have designed this study to explore the knowledge, apptitude and practice regarding smoking and gutka use in a lower socio-economic cohort and observe the impact of education, income and type of profession on the users.Methods: This cross sectional descriptive survey is conducted in Creek General Hospital, Korangi, Karachi. The study design is non-probability convenience. A questionnaire is used to quantify the frequency of smoking-related knowledge-attitude-practice, knowledge and attitude about tobacco-related disease and, smoking cessation-related thoughts and practice. Data is analysed in SPSS 16.Results: A total of 250 subjects participated in this descriptive study, 133 subjects (22% females and 62.6% males) were found addicted to smoking or smokeless tobacco product with stress, seeking pleasure and peer pressure being the most convincing factor to initiate their habit.90% of the users want to stop using the substance of abuse and 80 have at least once tried to quit the habit.Conclusions: This study shows a direct relationship between level of education and socioeconomic status with use of addictive substance. It also resulted in identifying the desire to quit in our cohort and need for formulating a plan specifically for the target population to focus not only to remove the cause, but also to empower them to take responsibility for their own well being.

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Down’s syndrome (DS, Trisomy 21) with a prevalence of 1:8,000 live births is considered the most common genetic chromosomal disorder, with an extra full or partial copy of chromosome 21. In addition to physical and mental developmental delays and disabilities being a challenge to this disorder, vulnerability of DS patients to a variety of autoimmune diseases like diabetes, thyroid disorders and celiac disease is also well established suggesting impaired immune response especially cell mediated immunity. In the last 3 decades, a few cases of Systemic Lupus Erythematosis (SLE) have been identified and reported internationally, this case report adds to this rare association and also endorses the need to carefully evaluate and investigate the DS individuals for the presence of connective tissue disorders especially if there is already an existing autoimmune disorder like diabetes, celiac or thyroid disorder.

Objectives: To study the latest trend of cardiometabolic risk factors in diabeticsin a low socioeconomic group. Design: Cross sectional observational. Place and duration:Three tertiary care hospitals of Karachi. June 2013 – Dec 2014. Methods: 824 type II adultdiabetic patients of both genders were included. History was taken regarding diabetes, ischemicheart disease, hypertension, and cerebrovascular accidents. Blood pressure and BMI wasrecorded. Investigations were done for dyslipidemia. SPSS 16 was used for means, frequenciesand proportions. Results: There were 276 males (33%) and 548 females (67%) with a meanage of 52 years (±9.67). Mean duration of diabetes was 9.36 years (± 6.39). Hypertension waspresent in 375 (45%) diabetics of which males were 124(33%) and females were 251(66.6%).Frequency of hypertension in total diabetic males is 45% (125) and in females 45.6 %( 140).Ischemic heart disease was present in 105 patients (12.7%) in which males were 45(42.8%) andfemales were 60(57.1%). The male percentage of ischemic heart disease was 16.3% (45) of thetotal males and females 11 %( 40). Stroke was found in 19 patients (2.3%) equally distributed inboth genders. Mean Body mass Index was 28.02 (+/- 5.31) with 135 (16.3%) being overweightand 529 (64.2%) obese. Dyslipidemia was present in 250 (42.3%) out of 591 patients. Smokinghistory taken in 614 patients showed that 73 (11.8%) were smokers and/or chewed tobacco.Out of a total of 595 patients, 372 (62.5%) patients had metabolic syndrome. Conclusion:There is a strong association and high prevalence of cardiovascular risk factors in diabetics ina low socioeconomic group. Factors such as hypertension, dyslipidemia, obesity, and smokingfurther multiply the cardiovascular risk ratio in diabetics.