Prevalence of Thyroid Dysfunction in Newly Diagnosed Rheumatoid Arthritis Patients.

INTRODUCTION: Rheumatoid arthritis (RA) is associated with various autoimmune disorders, including thyroid dysfunction. However, local data studying the prevalence of thyroid dysfunction in newly diagnosed RA patients are limited. METHODS:  This case-control study was conducted between January 2019 to December 2020 in the Internal Medicine Department of Liaquat University of Medical and Health Sciences. The study group of 400 newly diagnosed patients with RA was enrolled in the study. Another 400 patients without the diagnosis of RA, adjusted for age and gender, were enrolled in the study as a control group and their thyroid functions were compared. RESULTS: Patients with RA had more participants with thyroid dysfunction compared to patients without RA (25.25% vs. 11.5%; p-value: 0.00001). In addition, more patients with RA had concomitant primary hypothyroidism compared to the control group (7.75% vs. 2.5%; p-value: 0.0007). Furthermore, patients with RA also had a higher prevalence of subclinical hypothyroidism (13.0% vs. 5.5%; p-value: 0.0002). CONCLUSION: Our study indicates that thyroid dysfunction is significantly prevalent in patients with RA. Based on our findings, it is suggested that management and follow-up of RA patients should include the screening of thyroid auto-antibodies and thyroid dysfunction.

Prevalence of Thyroid Dysfunction in Patients With Hepatitis C.

INTRODUCTION: Hepatitis C has been linked to a multitude of autoimmune disorders, including rheumatoid arthritis, thyroid disease, cryoglobulinemia, immune thrombocytopenic purpura, systemic lupus erythematosus, and Sjögren's syndrome. In this study, efforts were made to draw a parallel between hepatitis C and thyroid dysfunction. METHODS: This case-control study was conducted between June 2020 and March 2021 in the gastroenterology ward of a tertiary care hospital. We enrolled 300 hepatitis C-positive patients in this study through consecutive convenient non-probability sampling. In addition, 300 patients without hepatitis C were signed up as a control group. Blood sampling for thyroid function tests was conducted via phlebotomy from the cubital vein and the samples were dispatched to the laboratory for further study. RESULTS: The control group had more euthyroid patients as compared to patients with hepatitis C (74.6% vs. 89.6%; p-value: <0.01). Hepatitis C patients had more cases of primary hypothyroidism compared to the control group (10.6% vs. 4.6%; p-value: 0.005). Similarly, patients with hepatitis C had a higher prevalence of subclinical hypothyroidism compared to the control group (6.0% vs. 1.3%; p-value: 0.002). CONCLUSION: Hepatitis C patients have a high frequency of thyroid dysfunction, particularly primary hypothyroidism and subclinical hypothyroidism. Therefore, it is important to ensure regular screening for early prognosis and avoid treatment modalities that are known to cause thyroid abnormalities.

Uropathogens Antimicrobial Sensitivity and Resistance Pattern From Outpatients in Balochistan, Pakistan.

Objective To determine the pattern of microbes responsible for urinary tract infections and their susceptibility to different antibiotics. Method This is a cross-sectional study conducted at Quetta, Pakistan. The urine samples of 400 patients were collected and sent for culture and sensitivity analysis. The results were recorded on an excel datasheet. Descriptive statistics were used to describe the data. Results Out of 400 urine samples, 266 samples were culture positive for microorganisms. The most common organism on analysis was Escherichia coli 123/266 (46.24%) followed by Staphylococcus saprophyticus 59/266 (22.18%) and Klebsiella pneumonia 49/266 (18.42%). Gram-negative microorganisms were most susceptible to fosfomycin, cefoperazone/sulbactam, and meropenem. Gram-positive microorganisms were most susceptible to fosfomycin, cefoperazone/sulbactam, meropenem, and amoxicillin/clavulanate. High rates of resistance in E. coli were observed to most commonly prescribed broad-spectrum antibiotics; ceftriaxone (64.35%), cefotaxime (76.54%), ceftazidime (49.43%), cefepime (53.44%), levofloxacin (71.26%), and amoxicillin/clavulanate (70.31%). E. coli was the major multidrug-resistant organism. Conclusion High rates of antibiotic resistance and multi-drug resistance were revealed in this study due to the widespread and injudicious use of broad-spectrum antibiotics. Thus, it is highly recommended to regulate the pharmacies. Physicians should judiciously prescribe antibiotics and practice the culture and sensitivity of urine samples rather than blind prescription. Continued surveillance on uropathogens prevalence and resistance, new and next-generation antibiotics, and rapid diagnostic tests to differentiate viral from bacterial infections is the need of time.

Vitamin D Deficiency and Associated Risk Factors in Muslim Housewives of Quetta, Pakistan: A Cross-Sectional Study.

Background Vitamin D (Vit-D) plays a central role in calcium homeostasis and maintains skeletal integrity. Housewives in Quetta, Pakistan are at increased risk of vitamin D deficiency (VDD). They spend a greater part of their day in cleaning, washing, cooking, managing daily groceries, and other household chores. Thus, little time is left for self-care and outdoor activities. They wear hijab and have very little exposure to sunlight. In addition, their diet is deficient in Vit-D-rich food items, rendering them at high risk of VDD. Fear of getting tanned, melasma, and preference for a fair complexion further limit their sun exposure. This study evaluates the prevalence of VDD in housewives and determines its various risk factors to recommend screening guidelines for VDD. Methods A cross-sectional study was performed between November 2020 and April 2021 and recruited housewives aged >18 from the outpatient department of a tertiary care hospital in Quetta. Informed consent was obtained from all participants. VDD was defined as a serum 25(OH)-D level <20 ng/mL (50 nmol/L). Sociodemographic variables and information about the dietary habits, perception, attitudes towards sunlight, and daily duration of sunlight exposure were collected. Mean and standard deviation (SD) were calculated for continuous variables and counts, and proportions were calculated for categorical variables like education, age. Univariate and multivariate logistic regression analyses were performed to determine the risk factors and associations of VDD. Data were analyzed by SAS/STAT software (version 9.4). Results Among 151 housewives, 58.9% of housewives had VDD. VDD group had a higher proportion of females aged 18-30 years and a lower proportion of graduates. The reported use of Vit-D supplements was much lower in the VDD group compared with the non-deficient group, 38.2% versus 71.0 %, P-value <0.001. History of fragility fractures was reported by 10.1% of housewives in the VDD group compared to 4.8% in the non-deficient group, P-value: 0.03. Around 77.5% of housewives in the VDD group spent 15 minutes or less outdoors versus 51.6% in the non-deficient group; 55.1% of housewives in the VDD group reported that they never consumed milk versus 17.7 % in the non-deficient group, P-value <0.00001. In the univariate logistic regression model, housewives with an 11-12th grade of education had 4.80-fold higher odds of VDD compared to those who had undergraduate or graduate degrees (OR: 4.80, 95 % CI: 1.07-21.45). Housewives who never consumed milk had 9.72-fold (95 % CI: 3.69-25.58) higher odds of VDD compared to those who consumed milk on daily basis. Odds of VDD were 3.61-fold (95% CI: 1.06-12.31) higher in those who never consumed fish as compared to those who ate fish at least 1-2 days/week. In multivariate logistic regression, age group 18-30 (OR: 17.07, 95% CI: 1.18-246.86), and never consuming milk (OR: 7.33, 95 % CI: 1.99-26.89) were independently associated with VDD. Conclusion VDD is highly prevalent (58.9%) in housewives of Quetta. It is the need of time to increase awareness regarding the health benefits, sources, and deficiency symptoms of Vit-D. Our study revealed VDD in housewives irrespective of education and income. Dietary supplementations were greater predictors of VDD. Daily sun exposure should be encouraged, and food items should be fortified with Vit-D. Recommendations for Vitamin D screening would be a good step, especially in Muslim housewives.

Association Between Diabetic Retinopathy and Carotid Intima-Media Thickness.

Introduction Patients with diabetes having advanced stage of diabetic retinopathy (DR) may predict future risk of coronary artery disease. To predict cardiovascular outcomes carotid intima-media thickness (CIMT) is utilized in diabetic patients. The aim of our study was the evaluation of the relationship between retinopathy and CIMT as two valuable non-invasive methods for early detection of micro- and macrovascular complication of diabetes. Methods This comparative cross-sectional study was conducted in the internal medicine ward of tertiary care hospital in Pakistan from November 2020 to January 2021. Three hundred patients with type 2 diabetes mellitus and 300 control subjects were enrolled in the study after taking informed consent. Ophthalmological examination was done to screen patients for DR. CIMT was evaluated by a Doppler ultrasound for both carotid arteries. Results Carotid artery intimal thickness was more in patients with retinopathy compared to patients without retinopathy in both right (0.77 ± 0.16 vs. 0.66 ± 0.12; p-value: <0.0001) and left carotid artery (0.77 ± 0.15 vs. 0.65 ± 0.11; p-value: <0.0001). Conclusion In our study, there was a correlation between DR and CIMT. Screening for DR, which may be a potential early marker for complications, may help detect patients at risk of various macro and microvascular complications.

Comparison of Iron Profile in Patients With and Without Coronary Heart Disease.

Introduction Atherosclerosis is considered a major cause of coronary artery disease (CAD). Pathogenesis of atherosclerosis involves the oxidation of low-density lipoprotein (LDL) within the lysosomes of macrophages. Ferritin and iron have pro-oxidant properties, and ferritin is an independent positive determinant of oxidized LDL level. In this study, we will determine the association between ferritin and serum iron levels and CAD. Methods This case-control study was conducted in the cardiology unit of a tertiary care hospital in Pakistan from December 2020 to April 2021. After taking informed consent, 400 patients with a confirmed diagnosis of CAD were enrolled. Another set of 400 patients without a history of CAD were included in the control group. A blood sample of 5 ml was drawn and sent to the laboratory to test for ferritin, serum iron, and total iron-binding capacity (TIBC). Ferritin, serum iron, and iron-binding capacity were compared between the case and control groups.  Results Serum ferritin was significantly higher in patients with CAD compared to patients without CAD (921.21 ± 201.21 ug/L vs. 101.21 ± 92.21 ug/L; p-value: <0.0001). Serum TIBC was significantly lower in patients with CAD compared to patients without CAD (302.12 ± 101.75 umol/L vs. 362.12 ± 82.16 umol/L). Conclusion Patients with raised levels of ferritin should consult a physician to manage their ferritin levels since they are at a greater risk of CAD. Treatment ranges from lifestyle changes to pharmacological therapy, thus reducing the overall risk and normalizing the ferritin levels.