HbA1c - A predictor of dyslipidemia in type 2 Diabetes Mellitus.

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.

Atypical diffuse bilateral cystic lung changes secondary to erlotinib treatment in a patient with metastatic non-small cell lung carcinoma: A case report and literature review.

Erlotinib is a first-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) approved in the first-line treatment of advanced non-small-cell lung cancer (NSCLC) patients with sensitizing epidermal growth factor receptor (EGFR) mutations. The response rate to erlotinib is ~60% and the incidence of erlotinib-induced interstitial lung disease (ILD) is ~1-4%. The Response Evaluation Criteria in Solid Tumours (RECIST) tool is commonly used to assess response to erlotinib; however, evaluation of response and subsequent progression in the presence of atypical cystic lung changes may be challenging. We herein present a rare case of diffuse cystic lung changes secondary to erlotinib treatment in a patient with EGFR mutation-positive metastatic NSCLC. Challenges in assessing atypical tumour response to erlotinib, pitfalls in using RECIST and differential diagnosis of TKI-related ILD are discussed in detail.

Antibiotic susceptibility in commonly isolated pathogens from urinary tract infection in a cohort of subjects from low socioeconomic strata.

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.

Pattern Of Dyslipidaemia And Its Association With Hypovitaminosis D In Type 2 Diabetes Mellitus.

BACKGROUND: Macrovascular atherosclerosis is an important long-term complication of type 2 diabetes mellitus. Concurrent dyslipidaemia acts as an additional risk factor for these complications. Hypovitaminosis D has been associated with adverse cardiovascular events. These modifiable risk factors of cardiovascular disease are inter-related. In the presence of an increasing incidence of type 2 diabetes mellitus and its associated metabolic abnormalities and widespread vitamin D deficiency in Pakistan, this association needs to be investigated. The purpose of our study was to determine the pattern of dyslipidaemia and its association with low vitamin D levels in South Asian diabetics. METHODS: The study was designed as a quantitative cross-sectional study. It was conducted at the Department of Medicine, Sir Syed College of Medical Sciences and Hospital, Karachi from January to June 2014. A total of 168 adult consecutive patients with type 2 diabetes mellitus of both the genders were included. Data was collected and analysed using SPSS-20.0. The association of dyslipidaemia with vitamin D status was computed through Chi-square test. RESULTS: We found that dyslipidaemia is highly prevalent in patients with type 2 diabetes mellitus in Pakistan. High total cholesterol, LDL cholesterol and triglycerides show significant association with vitamin D deficiency. CONCLUSIONS: In order to decrease the development of diabetic complications aggressive management of hyperglycaemia and dyslipidaemia is required. Vitamin D supplementation may play a dual role in these situations.

Comparative effectiveness of ACC-deaminase and/or nitrogen-fixing rhizobacteria in promotion of maize (Zea mays L.) growth under lead pollution.

Lead (Pb) pollution is appearing as an alarming threat nowadays. Excessive Pb concentrations in agricultural soils result in minimizing the soil fertility and health which affects the plant growth and leads to decrease in crop production. Plant growth promoting rhizobacteria (PGPR) are beneficial bacteria which can protect the plants against many abiotic stresses, and enhance the growth. The study aimed to identify important rhizobacterial strains by using the 1-aminocyclopropane-1-carboxylate (ACC) enrichment technique and examine their inoculation effects in the growth promotion of maize, under Pb pollution. A pot experiment was conducted and six rhizobacterial isolates were used. Pb was added to 2 kg soil in each pot (with 4 seeds/pot) using Pb(NO3)2 at the rate of 0, 100, 200, 300, and 400 mg kg(-1) Pb with three replications in completely randomized design. Rhizobacterial isolates performed significantly better under all Pb levels, i.e., 100 to 400 Pb mg kg(-1) soil, compared to control. Comparing the efficacy of the rhizobacterial isolates under different Pb levels, rhizobacterial isolates having both ACC-deaminase and nitrogen-fixing activities (AN8 and AN12) showed highest increase in terms of the physical, chemical and enzymatic growth parameters of maize, followed by the rhizobacterial isolates having ACC-deaminase activity only (ACC5 and ACC8), and then the nitrogen-fixing rhizobia (Azotobacter and RN5). However, the AN8 isolate showed maximum efficiency, and highest shoot and root length (14.2 and 6.1 cm), seedling fresh and dry weights (1.91 and 0.14 g), chlorophyll a, b, and carotenoids (24.1, 30.2 and 77.7 µg/l), protein (0.82 mg/g), proline (3.42 µmol/g), glutathione S-transferase, peroxidase and catalase (12.3, 4.2 and 7.2 units/mg protein), while the lowest Pb uptake in the shoot and root (0.83 and 0.48 mg/kg) were observed under this rhizobial isolate at the highest Pb level (i.e., 400 Pb mg kg(-1) soil). The results revealed that PGPR significantly decreases the deleterious effects of Pb pollution and increases the maize growth under all Pb concentrations, i.e., 100-400 Pb mg kg(-1) soil. PGPR chelate the Pb in the soil, and ultimately influence its bioavailability, release and uptake. The PGPR having both ACC-deaminase and nitrogen-fixing abilities are more effective and resistive against Pb pollution than PGPR having either ACC-deaminase or nitrogen-fixing activity alone. The ACC enrichment technique is an efficient approach to select promising PGPR.

Nocturnal dipping is preserved in children with sleep disordered breathing regardless of its severity.

OBJECTIVE: Sleep disordered breathing (SDB) in adults has been associated with a loss of nocturnal dipping in blood pressure (BP) and heart rate, however, there have been limited studies in children. We measured BP non-invasively and continuously overnight in 105 children aged 7-12 with a range of severities of SDB and 36 non-snoring controls to examine nocturnal dipping profiles. STUDY DESIGN: Children with SDB were divided into three severity groups according to their obstructive apnea hypopnea index. Nocturnal dipping profiles across sleep stages were described both as a proportion of children exhibiting a ≥10% fall in systolic arterial pressure (SAP) and heart rate (HR) from wake to sleep and according to SAP sleep/SAP wake ratio as extreme dippers (ratio ≤ 0.8), dippers (ratio < 0.8 and ≤0.9), non-dippers (ratio < 0.9 and ≤1.0), and reverse dippers (ratio > 1.0). RESULTS: The mean fall in BP between wake and NREM 1/2, SWS, and REM sleep was not different between the groups and there were no differences between the dipping profiles of children in each group. CONCLUSIONS: SDB did not alter nocturnal dipping patterns of BP and HR compared to controls, a finding which may suggest that these young children have not been exposed to the effects of SDB long enough or that SDB severity was not great enough to affect nocturnal dipping profiles. However, further studies are required to determine if the elevated BP previously reported in this group of children will have long-term effects on the cardiovascular system.

Elevated blood pressure during sleep and wake in children with sleep-disordered breathing.

OBJECTIVE: Sleep-disordered breathing (SDB) in adults has been associated with elevated blood pressure (BP); however, the effects of severity of SDB on BP in children are uncertain. We addressed this issue by measuring BP noninvasively and continuously during sleep in children with a range of severities of SDB and in a group of nonsnoring control children. METHODS: A total of 105 children referred for assessment of SDB and 36 nonsnoring controls were studied. Routine polysomnography (PSG) was performed with continuous BP monitoring. Children were assigned to groups according to obstructive apnea/hypopnea index (OAHI). BP data were categorized as quiet awake (recorded before sleep onset), non-rapid eye movement sleep 1 and 2 combined, slow-wave sleep, and rapid eye movement sleep. RESULTS: BP during awake before sleep onset and during overnight sleep was elevated by 10 to 15 mm Hg in the 3 SDB groups compared with the control group; this finding was independent of SDB severity. BP during stable sleep (with respiratory events and movements excluded) was also elevated in the children with OSA compared with the control group. BP was elevated in rapid eye movement sleep compared with the non-rapid eye movement sleep, and heart rate was higher during wake state than in all sleep states. CONCLUSIONS: We recorded BP continuously overnight and found that SDB, regardless of the severity, was associated with increased BP during sleep and wake compared with nonsnoring control children. These findings highlight the importance of considering the cardiovascular effects of SDB of any severity in children, and the need to review current clinical management that focuses primarily on more severe SDB.

Acute cardiovascular changes with obstructive events in children with sleep disordered breathing.

STUDY OBJECTIVES: Obstructive apneas in adults are associated with acute changes in blood pressure (BP) and heart rate (HR) that may contribute to poor cardiovascular outcome. Children with sleep disordered breathing (SDB) are similarly at risk for cardiovascular complications. We aimed to test the hypothesis that BP and HR are augmented during obstructive events in children equivalent to levels reported in adults. DESIGN: Beat-by-beat mean arterial pressure (MAP) and HR were analyzed over the course of obstructive events (pre, early, late, and post-event) during NREM and REM sleep and compared using 2-way ANOVA with post hoc analyses. SETTING: Pediatric sleep laboratory. PATIENTS OR PARTICIPANTS: 30 children (15M/15F) aged 7-12 y referred for investigation of SDB INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: All children underwent overnight polysomnography with continuous BP recording. MAP and HR increased significantly from late to post event in both sleep states (mean +/- SEM, NREM: MAP, 74 +/- 3 to 93 +/- 3 mm Hg; HR, 76 +/- 2 to 97 +/- 2 bpm. REM: MAP, 76 +/- 3 to 89 +/- 3 mm Hg; HR, 76 +/- 2 to 91 +/- 2 bpm. P < 0.05 for all). NREM sleep state and arousal from sleep were significant independent predictors of the magnitude of cardiovascular change from late to post event (P < 0.05 for all). CONCLUSIONS: Children with SDB experience significant changes in HR and BP during obstructive events with magnitudes that are similar to levels reported in adults. These changes are more pronounced during NREM sleep and with arousal. These acute cardiovascular changes may have important implications for poor cardiovascular outcome in children with OSA as repetitive cardiovascular perturbations may contribute to the development of hypertension.

Central apnoeas have significant effects on blood pressure and heart rate in children.

Brief central apnoeas (CAs) during sleep are common in children and are not usually considered clinically significant unless associated with oxygen desaturation. CAs can occur spontaneously or following a movement or sigh. The aim of this study was to investigate acute cardiovascular changes associated with CAs in children. Beat-by-beat mean arterial pressure (MAP) and heart rate (HR) were analysed across CAs, and spontaneous and movement-induced events were compared using two-way analysis of variance with post hoc analyses. Fifty-three children (28 male/25 female) aged 7-12 years referred for investigation of sleep-disordered breathing (SDB) and 21 age-matched healthy controls (8 male/13 female) were studied. Children underwent routine clinical polysomnography with continuous blood pressure (BP) recordings. Movement-induced, but not spontaneous, CAs were more frequent in children with mild or moderate/severe obstructive sleep apnoea (OSA) compared with healthy controls (P < 0.05 for both). Movement-induced CAs were associated with significantly larger MAP and HR changes across the event compared with spontaneous CAs. The percentage changes in MAP and HR between late-event and post-event were significantly greater for movement-induced compared with spontaneous CAs (MAP 20.6 +/- 2.3 versus 12.2 +/- 1.8%, P < 0.01; HR 28.2 +/- 2.6 versus 14.7 +/- 2.5%, P < 0.001). This study demonstrates that movement-induced CAs are more common in children with OSA, and are associated with significantly greater changes in HR and BP compared with spontaneous CAs. These data suggest that movement-induced CAs should be considered when assessing the cardiovascular impact of SDB.

Oral lichen planus.

Lichen planus is a mucocutaneous dermatological disorder, with intraoral manifestation. Skin lesions prevail with oral mucosal lesions. Prevalence of lichen planus, as an oral pre-malignant lesion, is 1-2% population. Lateral border, dorsal tongue, gingiva, hard palate and vermilion border are common sites and lesions appear as reticular, plaque-like and papular intraoral types. Skin presents with pururitic, polygonal papules. Atrophic and erosive are the known intraoral pre-malignant types. A case report is presented, which responded well to steroid therapy.