Introduction: Diabetic ketoacidosis (DKA) is a complication of hyperglycemia. Through this study we plan to study the clinical features of DKA and precipitating factors responsible for DKA in type 1 and type 2 diabetes. Methods: This cross-sectional observational study was conducted in the emergency department of a tertiary care hospital in Sukkur, Pakistan from August 2019 to February 2020. Symptoms and precipitating factors were noted in a self-structured questionnaire. Results: Out of 71 patients, 19 (26.7%) patients had type 1 diabetes mellitus and 52 (73.3%) patients had type 2 diabetes mellitus. The most common clinical symptom was nausea and vomiting (57.7%), followed by pain in abdomen (42.2%) and dehydration (42.2%). We found that the most common precipitating factors were infections (69.0%) and non-compliance to treatment (53.5%). Among various infections, people commonly presented with pneumonia (38.7%) and urinary tract infection (30.6%). Conclusion: Diabetic ketoacidosis presents with vague symptoms such as nausea, vomiting, and pain in abdomen. Characteristic findings of DKA such as Kussmaul breathing was present in limited patients. Infections in diabetic patients should be carefully monitored as they are the most common precipitating factors for DKA.
Introduction Coronavirus disease 2019 (COVID-19) primarily affects the pulmonary system and presents itself as shortness of breath, fever, and cough. However, it may affect other systems as well, including the nervous system. This study aimed to determine the frequency of neurological symptoms in COVID-19 patients and its association with the severity of the disease. Methods This cross-sectional study was conducted at a public sector tertiary care teaching hospital in Karachi, Pakistan, from April to July 2020. All patients with positive polymerase chain reaction (PCR) tests were included, except those with pre-existing neurological and psychiatric conditions. Results The most common neurological symptom was dizziness (17.5%), followed by headache (15.7%). Three (2.6%) patients had a stroke. Nine (7.8%) participants had a taste impairment, and another nine (7.8%) had a smell impairment. There was no significant difference in the frequency of neurological symptoms when severe and non-severe disease was compared. Conclusion Neurological symptoms are frequent in COVID-19. Care should be taken to identify them early. COVID-19 should be suspected in patients presenting with neurological abnormalities and should be included in the differential diagnosis to prevent further virus transmission.
Both type 1 and type 2 diabetes mellitus have been associated with vitamin D deficiency. Diabetic ketoacidosis, which is a complication of type 1 and, rarely, type 2 diabetes, is also found to be associated with vitamin D levels. This review discusses studies on the correlation between diabetic ketoacidosis and vitamin D levels. Studies show that vitamin D deficiency is associated with the occurrence of diabetic ketoacidosis. Diabetic ketoacidosis is also found to affect vitamin D levels. The possible explanation of diabetic ketoacidosis affecting vitamin D levels is the inactivity of the 1-alpha-hydroxylase enzyme and an increase in the renal excretion of vitamin D binding proteins. The presence of vitamin D receptors on pancreatic beta cells explains the role of vitamin D in the causation of diabetic ketoacidosis.
Introduction Urinary tract infections (UTIs) are common in low socioeconomic country like Pakistan. There are various factors responsible for UTI, one major factor being diabetes. This study aims to compare diabetic and non-diabetic patients, for gender association, symptoms, and organisms, with UTI. Methods This cross-sectional study was conducted in the medicine ward of tertiary care hospital in Pakistan from January 2019 to December 2019. For urine analysis, freshly voided 5-10 ml of clean midstream urine specimens was collected in a sterile container. Samples were sent to the lab immediately, A colony count of ≥10 5 CFU/ml was considered for the diagnosis of UTI. Culture was done if UTI was diagnosed. Results The overall incidence of UTI in participants of the diabetic group was significantly higher than those in the non-diabetic group (13.67% vs 6.40%; P=0.004). Escherichia coli was the most common organism in both the diabetic and non-diabetic groups (60% vs 72%; P=0.73). Frequency of Klebsiella was considerably higher in the participants of diabetes but it was not significant (23.3% vs 11.1%; P=0.29). Conclusion UTI was significantly higher in the diabetic population compared to the non-diabetic population. Since diabetes is prevalent in Pakistan, care of diabetes should include reducing the risk factors for UTI.
Introduction Angiotensin-converting enzyme inhibitors (ACEi) induced cough is still the greatest challenge in the continued utilization of ACEi for management of hypertension. The clinical pattern and related risk factors predisposing patients to ACEi-induced cough have not been studied in Pakistani hypertensive patients as yet. Hence, this study was conducted. Methods In this prospective, observational study individuals of both genders, of age 18 years or more, known cases of hypertension, taking ACEi, and having a chronic cough (>14 days) without any respiratory etiology were included. Their demographic and clinical characteristics were recorded. All data were managed using SPSS for Windows version 20.0 (IBM Corp., Armonk, NY). Results Enalapril was the most frequently prescribed ACEi (n=58; 47.2%) in patients with ACEi-induced cough followed by captopril (n=28; 22.7%), lisinopril (n=23; 18.7%), and ramipril (n=14; 11.4%). Higher body mass index (p=0.002), smoking (p=0.008), and longer time from the start of ACEi to the occurrence of cough (p=0.04) were the significant determinants of ACEi-induced cough. There were 33 (26.8%) participants who planned to request their physician to prescribe them an alternate medication due to their cough. Conclusions Enalapril was the most commonly ACEi prescribed among patients with ACEi-induced cough. Higher BMI, smoking, and longer time from the start of ACEi to the occurrence of cough related to ACEi-induced cough.
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