Changing haematological parameters in dengue viral infections

Dengue Fever is the most common arboviral disease in the world, and presents cyclically in tropical and subtropical regions of the world. The four serotypes of dengue virus, 1, 2, 3, and 4, form an antigenic subgroup of the flaviviruses [Group B arboviruses]. Transmission to humans of any of these serotypes initiates a spectrum of host responses, from in apparent to severe and sometimes lethal infections. Complete Blood count [CBC] is an important part of the diagnostic workup of patients. Comparison of various finding in CBC including peripheral smear can help the physician in better management of the patient. This cross sectional study was carried out on a series of suspected patients of Dengue viral infection reporting in Ittefaq Hospital [Trust]. All were investigated for serological markers of acute infection. Out of 341 acute cases 166 [48.7%] were confirmed by IgM against Dengue virus. IgG anti-dengue was used on 200 suspected re-infected patients. Seventy-one [39.5%] were positive and 118 [59%] were negative. Among 245 confirmed dengue fever patients 43 [17.6%] were considered having dengue hemorrhagic fever on the basis of lab and clinical findings. Raised haematocrit, Leukopenia with relative Lymphocytosis and presence atypical lymphocytes along with plasmacytoid cells was consistent finding at presentation in both the patterns of disease, i.e., Dengue Haemorrhagic fever [DHF] and Dengue fever [DF]. Changes in relative percentage of cells appear with improvement in the symptoms and recovery from the disease. These findings indicate that in the course of the disease, there are major shifts within cellular component of blood.

Insulin deficiency among newly diagnosed type 2 diabetics

Any patient above the age of 40 years, coming with the symptoms of diabetes is labelled as type 2 diabetic. If insulin levels are included in the protocol for initial investigations of diabetic patients, they can be differentiated as having insulin deficiency or insulin resistance. They can thus be treated accordingly. This study was conducted to see the prevalence of insulin resistance and insulin deficiency in newly diagnosed type 2 diabetics. This study was conducted on 75 newly diagnosed diabetic subjects, and 75 control subjects for comparison. Fasting serum insulin was assayed by ELISA and HOMA-IR index was calculated. The diabetic subjects with fasting hyperglycaemia and serum insulin level below 20 micro IU/ml and HOMA-IR index below 3.5 were grouped as insulin deficient [Group-A], and the diabetic subjects with fasting insulin level above 20 micro IU/ml and HOMA-IR index above 3.5 were grouped as insulin resistant [Group-B]. Twenty-eight percent subjects were found to have insulin level below 20 micro IU/ml while 72% subjects had insulin resistance. When gender was taken into consideration, it was seen that 18.7% males had fasting insulin level of 6.98 +/- 0.737 micro IU/ml and 9.3% females had fasting insulin level of 5.21 +/- 0.885 micro IU/ml while 32% males and 40% females had insulin resistance. The mean age of male subjects with insulin resistance was significantly higher compared to the male subjects with insulin deficiency. Mean weight and body mass index of the male and female subjects having insulin resistance was significantly higher than their respective control groups and also higher than the subjects with insulin deficiency. Pearson coefficient of correlation was calculated for fasting serum insulin level with age and BMI. A significant positive correlation was observed between fasting serum insulin and age of females with insulin resistance. A considerable number of persons who develop diabetes after 40 years of age but are not insulin resistant. Twenty-eight percent subjects have relative insulin deficiency, and 72% subjects have insulin resistance.

Effect of body mass index on serum leptin levels

Background: Leptin is product of ob gene, an adipose tissue derived hormone that plays a key role in the regulation of body fat mass by regulating appetite and metabolism while balancing energy intake and energy expenditure. The objective of the study was to evaluate possible association between serum leptin levels and Body Mass Index [BMI] of gender in adult age group. Methods: Two-hundredseventy subjects aged 20–50 years were randomly selected from general population of Abbottabad. The subjects were grouped on the basis on BMI [89 normal, 92 overweight, and 89 obese]. After complete evaluation, demographic data was recorded and BMI. Non-fasting venous blood samples were drawn to measure serum leptin and serum glucose levels. The data were analysed using SPSS-15 calculating mean, percentage, independent t-test and chi-square test. Correlation and regression curve analysis wer obtained, and p and r values were calculated. Results: Serum leptin levels and differences betwee genders were significant in all body mass indices. For normal BMI group the mean values for leptin were 2.6 +/- 1.5 ?g/ml in men, and 17.3 +/- 10.2 ?g/ml for women. For Group-2 mean leptin levels in men were 9.9 +/- 6.8 ?g/ml and in women were 34.8 +/- 13.6 ?g/ml. For Group-3 BMI comprising obese subject mean values for men were 21.3 +/- 14.2 ?g/ml and for women were 48.21 +/- 21.2 ?g/ml [p<0.001]. Conclusion: A progressive increase in serum leptin concentration was observed with an increase in BMI. Significant difference between leptin concentrations in either gender was found in normal, overweight and obese subjects. Keywords: Serum leptin levels, weight gain, BMI

Effect of abdominal obesity on fasting blood glucose levels in type-2 diabetes mellitus patients treated with oral hypoglycemic agents

Objective: to observe the effect of abdominal obesity on fasting blood glucose levels in T2DM patients who are on treatment with oral hypoglycemic agents

Material and Methods: the study included 55 T2DM patients, who were taking oral hypoglycemic drugs for the last 3 to 5 years. Abdominal obesity was assessed by measuring waist circumference. Fasting blood glucose levels were measured in all patients

ResuIts: according to our observation there were 41.81% non-obese, 23.63% overweight and 34.54% obese T2DM patients. The obese T2DM patients had significantly higher mean fasting blood glucose level as compared to nun-obese and overweight T2DM patients [p<0.001]. Overweight T2DM patients though had higher mean fasting plasma glucose levels as compared to non-obese T2DM patients but it was not significant

Conclusion: Abdominal obesity is associated with significantly higher fasting blood glucose levels in T2DM patients who are on treatment with oral hypoglycemic agents

Effect of silymarin on serum levels of alt and GGT in ethanol induced hepatotoxicity in albino rats

Alcoholic liver disease is a worldwide health problem. At least 80% of heavy drinkers have been reported to develop steatosis, 10-35% alcoholic hepatitis, and approximately 10% liver cirrhosis. The objective of this study was to determine the effect of silymarin on the levels of serum ALT and GGT in ethanol induced hepatotoxicity in albino rats. This study was an experimental Randomised Control Trial [RCT], and was conducted at the experimental research laboratory of University of Health Sciences, Lahore, from January 2007 to December 2007. Eighteen male albino rats of 6-8 weeks age, weighing 150-200 gm each were divided into 3 groups of 6 rats each. Group A served as control, Group B was given ethanol at a dose of 0.6 ml [0.5 gm]/100 gm/day and group C was given ethanol and silymarin at a dose of 0.5 gm/100 gm/day, and 20 mg/100 gm/day respectively for 8 weeks. At the end of the experiment, each animal was euthenised with chloroform. Blood was drawn from each animal by cardiac puncture for liver function tests [ALT and GGT]. After taking blood sample, each euthenised animal was sacrificed and then its liver was removed for gross and histological examination. The mean values of serum alanine-aminotransferase [ALT] in groups A, B and C were 28.16 +/- 7.13, 82.33 +/- 10.89 and 49.66 +/- 6.12 U/L respectively, whereas, the mean values of gamma-glutamyl transferase [GGT] in groups A, B and C were 27.33 +/- 3.05, 79.33 +/- 4.37 and 45.66 +/- 1.85 U/L respectively. ANOVA showed significant [p<0.05] difference in mean value of these serum enzymes among groups. Post Hoc test, using the Tukey honestly significant difference [HSD] showed that there was significant [p<0.05] increase in mean value of ALT and GGT in group B as compared to group A and C. This test also showed that there was significant [p<0.05] decrease in mean value of these enzymes in-group C as compared to group B. Silymarin tends to normalise liver function test in alcoholic liver disease

Study of lipoprotein patterns as an atherogenic factor in T2DM patients and their FDRS

The present study was carried out to determine the lipoprotein patterns as an atherogenic factor in T2DM [Type 2 Diabetes Mellitus] patients and their FDRS [First Degree Relatives]. In various previous studies it has been reported that hyperinsulinemia and hyperlipidemia frequently coexist in T2DM patients which indicate that the diabetic state it self is associated with atherogenic lipid disorders. The present study included 26 Type 2DM [T2DM] patients and 21 apparently healthy First Degree Relative [FDRs] of T2DM patients. Twenty three age matched control not related to diabetics were also included in the study. The BMI in male patients and FDRs were significantly higher as compared to controls but no significant difference was seen among the BMI of female FDRs. Fasting plasma glucose [FPG] levels of T2DM patients were significantly higher but no significant difference was observed among the FDRs and controls. FPG did not show any significant correlation with the BMI in diabetic patients, FDRs and controls. The lipid profile of patients showed no significant difference, except the mean LDL-Chol of female patients was significantly higher as compared to female controls. HDL-Chol of males FDRs was significantly lower as compared to male controls. LDL-Chol of female FDRs was significantly lower than the female controls. No significant difference was observed in the total cholesterol and the triglycerides level of the patients of T2DM and FDRs but those cases in which pre-beta band appear upon lipoprotein electrophoresis had significantly higher triglyceride levels as compared to those patients in which pre-beta band did not appear. Lipoproteins of the T2DM patients and FDRs group were found to be highly disturbed as compared to the control group and they show a trend of developing atherogenic states in future

Antioxidant status in coronary heart disease [CHD] patients with type 2 diabetes mellitus

The present study was carried out to see the levels of vitamin C, vitamin E and total antioxidant [AO] in Coronary Heart Disease [CHD] patients with and without Type-2 Diabetes Mellitus [T2DM]. In various previous studies it has been reported that, diabetes, hypertension and smoking are risk factors for CHD and all risk factors were common in these patients. Serum was tested from 80 CHD patients and 21 healthy controls, matched for age, height, and weight. No significant difference was seen between the age, height and weight of the subjects and controls. CHD patients were mostly male, smokers, over 40 year of age and belonging upper class families. The mean plasma glucose was significantly higher [p<0.05] in CHD patients having T2DM as compare to CHD patient with out T2DM. Risk factors for CHD, like diabetes, hypertension and smoking were common in these patients. No significant difference was seen in vitamin C level of patients of CHD. Vitamin E level was significantly [p < 0.05] low among the CHD patients as compared to controls and a significant [p < 0.05] decrease in mean vitamin E level was observed among smoker CHD patients as compared to non-smoker CHD patients. But no significant difference in vitamin C and vitamin E levels of CHD patients with diabetes and hypertension were observed when compared with CHD patients having no such complaints. The CHD patients' total antioxidant level was significantly [p < 0.05] decreased as compared to controls. The total AO [Vit. C and E] were not significantly higher in CHD patients with hypertension and diabetes as compared to those patients of CHD having no hypertension and diabetes

Extra intestinal manifestations of irritable bowel syndrome

Objectives: This study was done to assess the frequency of extra intestinal features present in patients with irritable bowel syndrome

Design and place of study: It was an observational study conducted in out-patient Department of Medicine, Shaikh Zayed Hospital, Lahore affiliated with Federal Postgraduate Medical Institute, over a period of two years from January 2005 to December 2006

Subject and methods: The patients fulfilling the Rome II criteria of IBS were included in the study. A check list of extra intestinal symptoms was administered to all the patients

Results: A total of 63 patients were included in the study. There were 41 men and 22 women [male to female ratio of 1.86: I] with the age range from 18 to 61 years [mean of 33 .09 +/- 8.5 SD]. The mean duration of disease was 2.78 years. Urinary symptoms like frequency and urgency were present in almost one third of patients. These symptoms were more frequent in men [47%] than in women [33%]. The most common non-specific pain was chronic headache [62%] followed by fibromyalgia [43%] and non-specific chest pain [37%] of all cases. All of these non-specific pain symptoms were more common in women. Dysmenorrhoea [45%] was the commonest genitourinary symptom in women while impotence and premature ejaculation each were seen in 7% of men. As a group sexual and genital symptoms were more common in women than men

Conclusion: Majority of the IBS patients along with intestinal symptoms also suffers from extra intestinal complaints. Therefore, these patients should be actively screened for the presence of these extra intestinal complaints so that a timely multidisciplinary intervention may prevent further prolongation of their misery

Insulin resistance syndrome in type - 2 diabetes mellitus patients

Objective: To find out the presence or absence of insulin resistance syndrome [lRS] in type-2 diabetes mellitus patients

Material and Methods: The study included 55 TZDM patients [34 male and 21 female], who were already taking oral anti diabetic drugs for the last 3 - 5 years. Obesity or weight gain in TZDM patients aggravates metabolic disturbances along with increased insulin resistance. The five variables in TZDM patients were studied as per recommendations of the United States National Cholesterol Education Program Adult Treatment Panel-Ill [ATP-Ill], to find out the presence or absence of insulin resistance syndrome [IRS] in TZDM patients. The TZDM patients who had shown the presence of three or more variables out of five 2 were considered to have IRS

Results: 32 [58.18%] TZDM patients [20 male and 12 female] had IRS. The T2DM patients with lRS had significant [p<0.001] increase in mean blood glucose levels, waist circumference, triglyceride levels and in systolic and diastolic blood pressure. The mean HDL Cholesterol was significantly [p<0.001] decreased in TZDM patients with IRS as compared to TZDM patients without IRS

Conclusion: An increase in waist circumference in TZDM patients will increase the prevalence of insulin resistance syndrome

Uric acid profile in patients with chronic nonspecific musculoskeletal pain

The present study was undertaken to determine the uric acid profile in patients with unexplained chronic musculoskeletal complaints, and to establish any possible causal role for altered uric acid profile in such patients. Method: A comparative study of 36 patients and 36 controls of both sexes and ages between 25-60 years was carried out at Shaikh Zayed Hospital, Lahore from November 2001-May 2002. Patient included were those who had at least 4-24 weeks duration of complaints. Uric acid profile for serum uric acid, uric acid excretion, uric acid clearance and total uric acid production was done. Additional tests included renal functions test, liver function test, cardiac enzymes, haematology and serology to exclude other underlying causes of complaints. Mean serum uric acid levels were higher in patients as compared to controls [p=0.05], with 9 [25%] patients showing hyperuricemia. Uric acid clearance [female patients 5.86+0.42 ml/min, female controls 8.06+0.24 ml/min] and daily uric acid excretion [female patients 412.38+28.52 mg/24 hours, female controls 487.79+18.64 mg/24 hours] in female patients was significantly lower than control females [P=0.034 and P<0.001 respectively]. Twenty patients [55.55%, 3 males and 17 females] were classified as under excretors of uric acid, while there were no under excretors in the control group [p<0.001]. We conclude that abnormalities of uric acid profile, particularly under excretor status may be an underlying biochemical abnormality in a significant number of patients. Female patients appear more predisposed to abnormal uric acid profile such as hyperuricemia and under excretor status