Safety and efficacy of Empagliflozin in Pakistani Muslim patients with type 2 diabetes (SAFE-PAK); a randomized clinical trial.

BACKGROUND: Sodium-Glucose-Co-Transporter 2 (SGLT2) inhibitor (Empagliflozin) is an effective drug in controlling blood glucose through predominantly glycosuria. Glycosuria increases the risk of genitourinary infections in diabetes. This study was aimed to establish the safety and efficacy of Empagliflozin (Group-A) versus standard care (Group-B) in Pakistani Muslim individuals with type 2 diabetes. METHODS: A multicenter, randomized clinical trial was conducted in five cities across Pakistan from July 2019 to August 2020. Patients of both genders aged 18-75 years, body mass index (BMI) ≤ 45 kg/m2, glycosylated hemoglobin (HbA1c) 7-10% (53 mmol/mol to 86 mmol/mol) and treatment-naive to Empagliflozin were included. Treatment was given for 24 weeks, and allocation was done through randomization. RESULTS: Out of 745 screened patients, 333 met the eligibility criteria, and a total of 244 (73.3%) patients were enrolled. More hypoglycemic events were reported in the standard care group, whereas positive urine culture, fungal infection, dehydration, and hypotension occurrence were comparable between the two groups. The 6 months mean HbA1c reduction was significant in both groups; (Group-A: 0.91 ± 0.15; p < 0.001 vs. Group-B2: 0.79 ± 0.14; p < 0.001). Efficacy comparison at 6 months revealed a significant reduction in weight and systolic blood pressure (SBP) in Group A only (Group-A: 1.4 ± 0.4 kg; p < 0.002 vs. Group-B: 0.01 ± 0.5 kg; p < 1.00), (Group-A: 5.1 ± 1.7 mmHg; p < 0.012 vs. Group-B: 2.3 ± 1.7 mmHg; p < 0.526). CONCLUSIONS: Empagliflozin was a safe drug compared to standard care in Pakistani Muslim patients with diabetes. It was as effective as standard care in the clinical setting but achieved glycemic control by reducing weight and SBP in type 2 diabetes patients. TRIAL REGISTRATION: This study was registered in the NIH US National Library of Medicine clinical trials registry at Clinicaltrials.gov with the registration number: NCT04665284 on 11/12/2020.

Asymptomatic urinary tract infections and associated risk factors in Pakistani Muslim type 2 diabetic patients.

BACKGROUND: One of the leading long-term complications of type 2 diabetes mellitus (T2DM) includes renal dysfunction and urinary tract infections (UTI) which are considered to be prevalent in uncontrolled diabetes. Moreover, physiological factors like age, gender, duration of diabetes, other diabetic complications like neuropathy, autonomic neuropathy and glycosuria are also considered as predisposing factors for increased prevalence of UTI in diabetes which can be symptomatic or asymptomatic. METHODS: This was a cross-sectional, multi-centre study including diabetic patients from 12 clinical sites spread across major cities of Pakistan. The inclusion criteria were adult Pakistani population of age between 18 to 75 years both genders and suffering from T2DM irrespective of duration. A detailed clinical history of the past 3 months was recorded and, biochemical investigations of blood samples were conducted. Urine culture analysis performed identified the type of pathogen present and was done only for asymptomatic patients. RESULTS: A total of 745 type 2 diabetic patients were initially screened, out of 545 patients considered for final analysis 501 (91.92%) were negative and the rest 44 (8.08%) had positive urine culture. Female gender had a significantly higher proportion of positive urine culture (77.27%, p-value< 0.001). Body mass index and mean age had insignificant distribution among the two groups of positive and negative urine culture, with age 40-59 years having higher proportion (70.45%) in the positive group. Escherichia coli was detected in most of the positive samples (52.3%). All bacterial samples were found resistant to Ciprofloxacin. CONCLUSION: Diabetic Pakistani muslim female patients are identified to be at high risk of suffering from asymptomatic UTI and age more than 40 years is an important risk factor. Escherichia coli was the most common causative organism among people living in this geographical area.

NDSP 06: Prevalence and risk factors for obesity in urban and rural areas of Pakistan: A study from second National Diabetes Survey of Pakistan (NDSP), 2016-2017.

OBJECTIVE: To study the pattern and prevalence of obesity in a large representative sample of Pakistani population aged 20 years and above. METHODOLOGY: This study is a sub analysis of the second National Diabetes Survey of Pakistan (NDSP) 2016-2017, a large community-based epidemiological survey carried out from February 2016 to August 2017 in all 4 provinces of Pakistan. An estimated sample size of 10,834 people was calculated using a multistage sampling technique. Out of 213 clusters, Twenty-seven clusters were selected from all four provinces of Pakistan. Households were identified and selected members of every 10th household were advised to come to the campsite after an overnight fast. All the study participants underwent anthropometric measurements including height, weight, and waist circumference by using standardized techniques and oral glucose tolerance tests were done. Data were analyzed on the statistical package for social sciences (SPSS), version 20. RESULTS: Overall weighted prevalence of generalized obesity was 57.9% (42% in males and 58% in females) and central obesity 73.1% (37.3% in males and 62.7% in females) as per WHO Asia pacific cutoffs. The highest prevalence of generalized obesity was found in Punjab 60%, followed by Khyber, Pakhtunkhwa 59.2%. Moreever, highest prevalence of abdominal obesity was observed in Baluchistan 82.1%, followed by Punjab 73.3%. Obesity (generalized and abdominal) was found significantly associated with diabetes, hypertension, and dyslipidemia. CONCLUSION: The prevalence of obesity is at epidemic proportions in Pakistan, calling for urgent lifestyle intervention strategies to prevent and manage this important cardiometabolic risk factor.

Spatial and temporal variations in the atmospheric concentrations of "Stockholm Convention" organochlorine pesticides in Kuwait.

The study reports fortnightly atmospheric concentrations of organochlorine pesticides concomitantly measured at an urban, "industrial" and a remote location over a twelve month period in Kuwait to examine seasonal variability and urban-rural concentration gradients. The average±SD (and range) of the ΣOC concentrations measured throughout the study period in decreasing order were urban, 505±305 (range, 33-1352) pgm-3, remote, 204±124 (4.5-556) pgm-3, and "industrial" 155±103 (8.8-533) pgm-3. The concentrations of most OCs measured in this study, except for DDT and its metabolites, were higher at urban locations relative to their concentrations at remote location, in line with the literature on POPs regarding urban conurbations being sources of industrial chemicals. The most abundant pesticides measured throughout this study were dieldrin, pentachlorobenzene, hexachlorobenzene, ΣDDTs, ΣHCHs, and oxychlordane. Hexachlorobenzene concentrations were generally higher than those of pentachlorobenzene and are both strongly negatively correlated with temperature (p<0.05) at all sampling locations. Mean summertime concentrations were higher for hexachlorocyclohexanes, chlordanes, dieldrin, and DDT isomers, except for pp-DDT. This may suggest that concentrations of these compounds may be driven by temperature.

Seasonal variations in the atmospheric concentrations of polychlorinated biphenyls in Kuwait.

The spatial and temporal variations in the atmospheric concentrations of PCBs were concomitantly measured at several sites over a twelve-month period in Kuwait to examine seasonal variability and urban-rural concentration gradients using two sampling methods. The annual mean (and range) of ∑PCB concentrations measured using high volume samplers was 10.8 (1.2-32) pg m-3 at the remote site and 39.4 (1.1-128) pg m-3 at the urban site. The median concentrations of ΣPCBs at the urban location (30.3 pg m-3) was significantly higher (p < 0.001) than that measured at the remote location (8.6 pg m-3) consistent with the view that urban centers are an important net source of these compounds to the environment. Passive sampler derived concentrations across the country showed a uniform distribution except at a few locations in the vicinity of suspected sources where elevated concentrations were measured. As with active sampling data, the concentrations measured using passive samplers were higher in urban areas (range, 4-78 pg/m3) compared to remote sites (range, 2.2-17 pg/m3). The concentrations measured at some urban sites correlated extremely well with mean temperature during the deployment period whereas temperature correlations with measured concentrations were negative at remote and semi-rural sites suggesting that air-surface exchange maybe a key driving mechanism of the current levels of PCBs in Kuwait.

Bacteriology Of Diabetic Foot In Tertiary Care Hospital; Frequency, Antibiotic Susceptibility And Risk Factors.

BACKGROUND: Diabetic foot being one of the frequent and disabling complications of diabetes. In view of widespread regional variation in causative organisms and antimicrobial susceptibility, the current study aimed to determine frequency of causative organisms, their antimicrobial susceptibility and associated risk factors. METHODS: This descriptive cross-sectional study was conducted in 6 months' duration at dept. of Medicine; PIMS Hospital Islamabad. Type 2 Diabetes mellitus patients with diabetic foot ulcer were enrolled after informed consent. Patients already receiving antibiotics, having no growth on culture and >3 weeks' duration of ulcer were excluded. Sample from wound was sent for culture and sensitivity. Antibiotic susceptibility testing identified the susceptible and resistant strains of organisms. RESULTS: Among 114 patients (66.67% males and 33.33% females); mean age was 55.11±11.96 years. Staphylococcus aureus was identified in 46%, E. coli in 28%, Pseudomonas in 6%, Klebsiella in 3.5% and other organisms in 17%. 92% of S. aureus was sensitive to Vancomycin and 67% to Clindamycin. Amongst E. coli, 81% showed sensitivity to Imipenem, 69% to Aminoglycosides and 31% to Quinolones. Glycaemic control was unsatisfactory in 65.8%. Peripheral vascular disease was found in 46% patients and sensory neuropathy in 94%. CONCLUSIONS: Staphylococcus aureus was the most frequent isolate amongst gram positive organisms while E. coli amongst gram-negatives. Vancomycin is suggested to be the drug of choice for gram positive and Imipenem for gram negative organisms. Appropriate antimicrobial therapy according to susceptibility patterns would reduce the morbidity and emergence of multidrug resistant organisms in diabetic foot infections.

Depression In Type-2 Diabetic Patients Presenting To A Tertiary Care Hospital In Pakistan.

BACKGROUND: Diabetes affects almost every system including mental health. When depression and diabetes coexist, the outcome is even worse. This study was conducted to find the prevalence of comorbid depression in diabetic patients and its association with diabetic control. METHODS: This was a descriptive cross sectional observational study conducted in the department of general medicine of Pakistan Institute of Medical Sciences, Islamabad from March to September 2014. A total of 223 adult diabetic patients 30-60 years of age were enrolled. Becks Depression score (BDI) and HDRS (Hamilton Depression Rating Score) of each patient was calculated. Patients were stratified into various categories based on their demographics, depressions scores and diabetic control (by means of HbA1C). Percentages, frequencies and means were calculated accordingly using SPSS-16. RESULTS: Out of a total of 223 patients, 55.6% were females while the rest (44.4%) were males. The mean age of the patients was 51 years. Majority of the patients were uneducated (35.9%). Eighty-seven% were married, Mean BMI, duration of diabetes and HbA1C were 27 Kg/m2, 8.3 years±6.1 years and 8.15±2.13% respectively. Mean BDI and HDRS were 9.97±9.42 and 6.27±6.74 respectively. 25.6% and 21.1% of the patients had at least some degree of depression when assessed by BDI and HDRS score respectively.. CONCLUSIONS: Depression is common in diabetic patients especially females, uneducated, have social issues like widows, those having long standing diabetes and those who have uncontrolled blood sugars.

Sources and levels of endocrine disrupting compounds (EDCs) in Kuwait's coastal areas.

The sources and levels of endocrine disrupting compounds in Kuwait's coastal areas were investigated. Phthalates, alkylphenols and estrogens were measured in the inflows and outflows of three sewage treatment plants as well as in the seawater and sediments from the sewage impacted coastal areas. Phthalate levels in the inflow of the treatment plants ranged from 8.9 to 78.3µg/l; alkylphenols from 0.7 to 279ng/l and estrogens from 30 to 368ng/l. On average, the treatment plants removed about 80% of these compounds. The outflows, however, contained significant levels of all three classes of compounds. The seawater from the sewage impacted area also contained detectable levels of these compounds. Sediment samples from these locations contained elevated levels of phthalates (ranging from 2145 to 15,722µg/kg) and lower levels of alkylphenols (ranging from 2.49 to 15.14µg/kg) and estrogens (ranging from 4.1 to 214µg/kg, dry wt.).

Prevalence of diabetes and its correlates in urban population of Pakistan: A Cross-sectional survey.

OBJECTIVE: To determine the prevalence of diabetes mellitus and its associated risk factors in urban population. METHODS: The cross-sectional study was carried out at four union councils of Rawalpindi, Pakistan, from May to September 2014, and comprised members of the general public.A questionnaire was administered to obtain information about demographic characteristics and risk factors. Anthropometric and blood pressure measurements were obtained from the participants. Venous blood samples were taken for measuring glycated haemoglobin. SPSS 20 was used for data analysis. RESULTS: Of the 404 participants, 181(44.8%) were men and 223(55.2%) were women. The overall mean age was 42.3±13 years. Overall prevalence of diabetes was 133(32.9%) and that of pre-diabetes was 151(37.4%). The prevalence of diabetes was 203(50.3%) in 50-65 years age group and 143(35.4%) among obese subjects. Diabetes was significantly associated with increasing age (35-49 years (p<0.05); 50-65 years (p<0.01), positive parental (p<0.05) and sibling (p<0.05) history of diabetes, hypertension (p<0.01) and central obesity (p<0.05). CONCLUSIONS: The prevalence of diabetes and pre-diabetes was very high. Prevalence increased with increasing age and body mass index. Major independent risk factors were increasing age, central obesity, and family history of diabetes and hypertension.

Spatial and temporal distributions of polycyclic aromatic hydrocarbons in the Northern Arabian Gulf sediments.

Surficial sediment samples were collected from 25 locations within Kuwait Bay and outside the Bay, in the Northwestern Arabian Gulf, to access recent polycyclic aromatic hydrocarbon pollution in Kuwait. Time trends in the depositional history of PAHs to this portion of the Arabian Gulf was reconstructed from the analysis of a dated sediment core. Intersite differences in concentration exist although these differences were not statistically significant (p=0.08). However, organic carbon normalized concentrations within Kuwait Bay were 4 times higher than the average concentrations outside the Bay and were shown to be statistically significant (p<0.001). The sedimentary record showed that ΣPAHs concentration fluctuated between 12 and 25ngg-1 before 1970. Concentrations then increased sharply to a maximum of 45ngg-1 around the late 1970s and early 1980s followed by an exponential decrease in concentration to pre-1970 "background" concentrations of between 12 and 25ngg-1.

Clinico-microbiological study and antibiotic resistance profile of mecA and ESBL gene prevalence in patients with diabetic foot infections.

Diabetic foot infections (DFIs) constitute a major complication of diabetes mellitus. DFIs contribute to the development of gangrene and non-traumatic lower extremity amputations with a lifetime risk of up to 25%. The aim of the present study was to identify the presence of neuropathy and determine the ulcer grade, microbial profile and phenotypic and genotypic prevalence of the methicillin-resistance gene mecA and extended spectrum ß-lactamase (ESBL)-encoding genes in bacterial isolates of DFI in patients registered at the Pakistan Institute of Medical Sciences (Islamabad, Pakistan). The results indicated that 46/50 patients (92%), exhibited sensory neuropathy. The most common isolate was Staphylococcus aureus (25%), followed by Pseudomonas aeruginosa (P. aeruginosa; 18.18%), Escherichia coli (16.16%), Streptococcus species (spp.) (15.15%), Proteus spp. (15.15%), Enterococcus spp. (9%) and Klebsiella pneumoniae (K. pneumoniae; 3%). The prevalence of the mecA gene was found to be 88% phenotypically and 84% genotypically. K. pneumoniae was shown to have the highest percentage of ESBL producers with a prevalence of 66.7% by double disk synergy test, and 100% by the cefotaxime + clavulanic acid/ceftazidime + clavulanic acid combination disk test. P. aeruginosa and K. pneumoniae had the highest (100%) proportion of metallo ß-lactamase producers as identified by the EDTA combination disk test. The overall prevalence of ß-lactamase (bla)-CTX-M, bla-CTX-M-15, bla-TEM, bla-OXA and bla-SHV genes was found to be 76.9, 76.9, 75.0, 57.7 and 84.6%, respectively, in gram-negative DFI isolates. The prevalence of mecA and ESBL-related genes was found to be alarmingly high in DFIs, since these genes are a major cause of antibiotic treatment failure.

Clinical experience with insulin detemir in patients with type 2 diabetes from the near East countries.

INTRODUCTION: This study aimed at determining the clinical safety and efficacy of insulin detemir (IDet) in combination with oral anti-diabetic drugs (OADs) in type 2 diabetes (T2D) patients from four Near East Countries (Israel, Jordan, Pakistan and Lebanon). METHODS: This prospective observational study included T2D patients previously on OADs and newly diagnosed patients initiating IDet with or without OADs, at the discretion of physicians. Safety objectives included evaluation of hypoglycemia and adverse drug reactions (ADRs) from baseline to Week 24. Efficacy outcomes included baseline to Week 24 changes in glucose control parameters (glycated hemoglobin [HbA1c], fasting plasma glucose [FPG] and post-breakfast post-prandial plasma glucose [PPPG]). Change in body weight during this period was also assessed. RESULTS: A total of 2,155 patients (mean ± SD: age 57.1 ± 11.0 years, BMI 29.4 ± 5.1 kg/m(2), average diabetes duration 9.2 ± 5.4 years) were included. IDet dose at baseline was 0.20 ± 0.09 U/kg titrated up to 0.34 ± 0.14 U/kg by Week 24. From baseline to Week 24, the total number of hypoglycemic episodes increased from 1.30 to 1.37 events/patient-year, while major hypoglycemic episodes decreased from 0.15 to 0.02 events/patient-year. A total of 9 ADRs were reported, of which one event was a serious ADR. Statistically significant improvements in glucose control were reported from baseline to Week 24 (HbA1c: 9.6 ± 1.6% vs. 7.6 ± 1.1%; FPG: 201.5 ± 59.5 mg/dL vs. 124.9 ± 31.6 mg/dL; PPPG: 264.2 ± 65.7 mg/dL vs. 167.2 ± 36.8 mg/dL; all p < 0.0001). Body weight did not change significantly after 24 weeks of IDet therapy. CONCLUSION: IDet therapy in combination with OADs improved glycemic control without increasing the risk of hypoglycemia or weight gain.

Seasonal variations in the atmospheric concentrations of polybrominated diphenyl ethers in Kuwait.

The study reports fortnightly atmospheric concentrations of PBDEs concomitantly measured at an urban and a remote location over a twelve-month period in Kuwait to examine seasonal variability and urban-rural concentration gradients. The annual mean (and range) of ∑PBDE concentrations was 32 (3-208) pgm(-3) at the remote site and 57 (0.3-445) pgm(-3) at the urban site. Although not statistically significant, the median (29 pg m(-3)) and mean (57 pg m(-3)) concentrations at the urban location were higher than those measured at the remote location (18 and 29 pg m(-3) respectively), consistent with the view that urban centers are an important net source of these compounds to the environment. Although Clausius-Clapeyron plots showed statistically significant correlations (p<0.05) with temperature for low molecular weight congeners (BDEs 28, 47, 100), correlations with the ΣPBDE concentrations were not significant at both urban and remote sites. The seasonal variations in ΣPBDE concentrations were not markedly different at the urban location, but the median summer ΣPBDE concentration at the remote location was significantly higher than winter median ΣPBDE concentrations. The absence in seasonality at the urban location may be due to ongoing primary emissions in urban areas.

Utility of 99mTc-labelled antimicrobial peptide ubiquicidin (29-41) in the diagnosis of diabetic foot infection.

PURPOSE: Detection of osteomyelitis beneath a diabetic foot ulcer is imperative for proper management; however, accurate and noninvasive diagnosis of osteomyelitis remains a challenge. Ubiquicidin 29-41 (UBI 29-41) is a synthetic antimicrobial peptide fragment reported to be highly infection-specific. (99m)Tc-UBI 29-41 has recently been reported to be a promising radiotracer for infection imaging. The aim of this prospective study was to evaluate the utility of (99m)Tc-UBI 29-41 scintigraphy in diabetic patients with suspected osteomyelitis of the foot. METHODS: Included in the study were 65 patients with type 2 diabetes mellitus and foot ulcer and with clinical suspicion of osteomyelitis . Each patient had a three-phase bone scan and a (99m)Tc-UBI scan at 30 and 60 min after injection. The scan was considered to be consistent with osteomyelitis when the (99m)Tc-UBI 29-41 uptake was concordant with the (99m)Tc-MDP uptake. It was considered negative for osteomyelitis if there was no uptake of (99m)Tc-UBI 29-41 or if (99m)Tc-UBI 29-41 accumulated in an area not concordant with the abnormal uptake of (99m)Tc-MDP on the bone scan. In the latter case a diagnosis of soft-tissue infection was made. Bone infection was confirmed by bone biopsy/culture and by clinical and radiological follow-up. RESULTS: Final analysis was done in 55 patients. Osteomyelitis was confirmed in 37 patients, and 18 patients were free of bone infection. (99m)Tc-UBI 29-41 was positive in all 37 patients and with the bone scan as the reference for the bone identified all osteomyelitic foci (68 in total). (99m)Tc-UBI 29-41 was negative for osteomyelitis in all 18 patients, and 17 of these patients were diagnosed with soft-tissue infection ((99m)Tc-UBI 29-41 accumulation without concordant abnormal uptake on bone scintigraphy). The sensitivity, specificity and accuracy of (99m)Tc-UBI 29-41 scan in combination with three-phase bone scan for the diagnosis of osteomyelitis in diabetic foot was 100 %. Accuracy for soft-tissue infection was also 100 %. Maximum accumulation of the (99m)Tc-UBI 29-41 with maximum target to background activity was observed in the infectious foci at 30 min after injection. CONCLUSION: Tc-UBI 29-41 may be a useful agent for the accurate diagnosis of bone infection in diabetic foot because of the high accuracy demonstrated in this pilot study. It was able to differentiate between bone and soft-tissue involvement effectively in combination with a bone scan.

Polybrominated diphenyl ethers (PBDEs) in soils along a rural-urban-rural transect: sources, concentration gradients, and profiles.

This study reports concentrations of PBDEs in surface soil samples collected along a 140 km transect across Kuwait to assess the role of urban centers as sources of persistent organic pollutants to the surrounding environment. The ΣPBDE concentrations varied by a factor of ~250 and ranged from 289 to 80,078 pgg (-1)d.w. The concentrations of PBDEs in Kuwait City were significantly higher (p<0.01) than those collected from sites outside the city supporting the hypothesis that urban centers are sources of PBDEs. The congener profiles were dominated by BDE-209, accounting for 93% of the PBDEs in the soil samples. The concentrations of all congeners (except BDE-209) were highly correlated with percent organic carbon (%OC) (p>0.05) when the data from Kuwait City was omitted from the analysis. These findings suggest that soil concentrations outside the urban centers were close to equilibrium with the atmosphere.

Polybrominated diphenyl ethers in three commercially important fish from the northwestern Arabian Gulf: occurrence, concentration, and profiles.

Polybrominated diphenyl ethers (PBDEs) were measured in three species of fish (yellowfin seabream [Acanthopagrus latus, a predatory fish]; Klunzinger's mullet [Liza klunzingeri, a pelagic fish]; and large-scaled tonguesole [Cynoglossus arel, a demersal fish]) collected from two sites in the northwestern part of the Arabian Gulf, a marginal sea of the tropical Indo-Pacific Ocean. Concentrations of ΣPBDEs ranged from 11 to 57 ng g(-1) lipid weight (lw) for mullet, 5.0-38 ng g(-1) lw for tonguesole, and 2.8-48 ng g(-1) lw for seabream in Kuwait Bay, whereas in the open gulf, concentrations ranged from 6.0 to 160 lw for mullet, 8.3-190 lw for tonguesole, and 7.1-62 for lw for seabream. The congener composition in all species from both sites was dominated by BDEs 47, 99, and 100, which together constituted approximately 90% of the congeners detected. Although no statistically significant intersite differences were found, ΣPBDEs concentrations in mullet were significantly higher than those in seabream (p = 0.01). However, no significant differences existed between mullet and tonguesole (p = 0.28) or between tonguesole and seabream (p = 0.06). ΣPBDE concentrations were negatively correlated with fish mass for all species; however, the correlations were statistically insignificant, suggesting a growth dilution effect.

Prevalence and risk factors for diabetes mellitus in a selected urban population of a city in Punjab.

OBJECTIVE: To estimate the prevalence of diabetes mellitus (diagnosed and undiagnosed), impaired fasting glucose and possible risk factors for diabetes mellitus among Pakistani population. METHODS: This cross sectional study was performed in Rawalpindi which is one of the cities in Northern Punjab of Pakistan in July 2008. An area was selected in Rawalpindi city, with mixed population representative of almost all provinces with different socioeconomic groups. Three hundred and thirteen houses were selected through systematic random sampling technique and fasting blood glucose was obtained and subjects were labeled to have diabetes according to WHO criteria of diagnosing diabetes mellitus. The statistical analysis was performed by using Stata version 10. RESULTS: There were 1091 respondents who were selected after cleaning the data, among them 293 were males and 798 were females. Of the total 15.41% of the males and 12.31% of females were found to have diabetes mellitus. Thus making a total prevalence of 13.14%. Impaired fasting glucose (IFG) was found in 5.14% males and 5.78% females making a total prevalence of 5.61%. Over all (DM & IFG) was found to be 20.55% in males and 18.09% in females. The main risk factors identified were obesity, family history, hypertension and increasing age. CONCLUSION: There is an increased prevalence of Type 2 diabetes in Pakistan and main risk factors identified were obesity, overweight, family history of diabetes mellitus, and hypertension.

Frequency of patients with diabetes taking proper foot care according to international guidelines and its impact on their foot health.

OBJECTIVE: To determine the frequency of people with diabetes, practicing proper foot care according to International Guidelines and its impact on their foot health. METHODS: This cross sectional study was conducted on 100 people with diabetes in General Medicine Out Patients Department of Pakistan Institute of Medical Sciences, Islamabad from January to May 2007. Patients were enquired about their foot care practices. Patients following more than 70% of American Diabetes Association (ADA) guidelines for foot care were labeled as practicing "Proper foot care". Foot examination of included patiehts was also performed and foot care practices were compared with examination findings. RESULTS: Mean age of included patients was 51.57 + 10.72 years. Only six (6%) patients were found to be practicing proper foot care. There were statistically significant correlations between proper foot hygiene and frequent foot washing, fungal foot infections and foot drying practices, and ingrowing toe nails and improper nail trimming. Corns and callosities and ingrowing toe nails were associated with inappropriate foot wear. It was also found that proper foot care practice was related with foot care education. CONCLUSIONS: This study demonstrated that very few patients with diabetes were practicing proper foot care according to the ADA Guidelines. High risk behaviours were common which could lead to preventable foot complications.

Polycyclic aromatic hydrocarbons in indoor air and dust in Kuwait: implications for sources and nondietary human exposure.

This study reports concentration of polycyclic aromatic hydrocarbons (PAHs) in indoor air and dust samples collected from 24 homes in Kuwait. Mean SigmaPAHs in indoor air ranged from 1.3 to 16 ng/m(3) with a geometric mean of 5.6 ng/m(3), whereas the dust concentrations varied over three orders of magnitude, from 3 to 2920 ng/g, with a geometric mean of 165 ng/g. The low-molecular-weight tricyclic and tetracyclic PAHs dominated the air profile constituting approximately 70-90 % of the measured compounds, with phenanthrene (51%), fluorene (13 %), fluoranthere (8 %), and pyrene (7 %) being the major contributors. The PAH profile in dust was dominated by the high-molecular-weight PAHs, with three compounds (benzo[a]pyrene, benzo[k]fluoranthene, and benzo[b]fluoranthene) contributing approximately 60% of the average SigmaPAHs measured in the samples. Indoor-to-outdoor (I/O) ratios for individual compounds were <1 for the majority of compounds, suggesting that there were no significant indoor sources for these compounds in these homes. Using the measured concentrations in air and dust, together with estimates of inhalation and inadvertent dust ingestion rates for children and adults, estimated human nondietary exposure on a BaP(equiv) basis were 547 pg/kg body weight/day and 205 pg/kg body weight/day for children and adults, respectively. Exposure from dust ingestion contributes about 42% of nondietary intake of SigmaPAHs in children, but only 11% for adults. The threefold difference in exposure estimates between children and adults in this study supports previous reports that children are at greater risk from pollutants that accumulate indoors.

Frequency of the metabolic syndrome in adult type 2 diabetics presenting to Pakistan Institute of Medical Sciences.

OBJECTIVE: To determine the frequency of metabolic syndrome in both genders, in a limited adult type 2 diabetic population presenting to Pakistan Institute of Medical Sciences, Islamabad. METHODS: This was a cross sectional study conducted in a tertiary care teaching hospital. During the six months of study period, 106 adult type 2 diabetics were examined and evaluated for the presence of metabolic syndrome according to the ATP-III criteria. Asian standards for the waist circumference were used. RESULTS: Out of 106 patients, 91 (85.8%) had metabolic syndrome of whom 95% were females. Abdominal obesity was present in 91% females and 86% males. Low HDL levels were present in all females and 83% males. Seventy eight percent females and 63% males had elevated levels of triglycerides. Hypertension was present in 68% and 73% females and males respectively. CONCLUSION: This study showed a very high prevalence of the metabolic syndrome in type2 diabetic population. Females were more affected than males in all respects.