Diabetes mellitus prediction; Serum lipids, ALT and fasting blood glucose: using serum lipids and ALT

The rapid change in lifestyles and dietary has led to a pandemic of diabetes mellitus. The diagnosis of diabetes mellitus sometimes requires 2 hr OGTT sampling. Recent evidence has shown that there are lipid related abnormalities associated with diabetes mellitus, so a consideration comes in fortheir utilization as a marker to support diabetes mellitus. [1] To correlate serum total cholesterol, triglycerides and ALT with fasting blood glucose [2]. To predict diagnosis of diabetes mellitus using above serum markers. Cross-sectional analysis, descriptive study. This study was carried out between Mar-2010 to Jan-2011 at the department of pathology, PNS RAHAT in collaboration with PNS SHIFA. A total of 251 subjects were screened for presence of glucose dysregulation. Based upon the results of fasting blood glucose, subjects were grouped as having normal glucose tolerance [NGT], impaired fasting glucose [IFG], and newly diagnosed diabetes mellitus [NDDM]. A comparison of lipids including triglycerides, total cholesterol and alanine aminotransferase [ALT] were made in the above groups to measure the differences between the above mentioned three groups. ALT, triglyceride and total cholesterol were correlated with results of fasting blood glucose through pearson's correlation. Later the performance of different cut-offs of triglycerides, total cholesterol and two mathematical models [[Factor-l=FBG [mmol/L] + triglycerides [mmol/L]] and [Factor-ll=FBG [mmol/L] + triglycerides [mmol/L] + total cholesterol [mmol/L]]] were evaluated for detecting diabetes mellitus against the gold standard 2 hr OGTT in 71 subjects. The results of triglycerides, total cholesterol and serum ALT between the three groups were as: [[Triglycerides: NGT =1.91, IFG =2, 10, NDDM= 2.75, p=0.003] [total cholesterol: NGT=5.03, IFG=5.19, NDDM=5.74, p=0.056] [ALT:NGT=28.47, IFG=27.95, NDDM=25.78, p=0.846]]. Most correlation was found between serum triglycerides and fasting blood glucose [r2=0.235, p<0.001]; while serum total cholesterol and ALT showed lesser correlations [[total cholesterol:r2= 0.172, P=0.007], [ALT:r2= 0.010, p= 0.877]]. While triglycerides demonstrated superiority in terms of sensitivity to total cholesterol for detection of diabetes mellitus, the factors incorporating lipids and glucose had the highest overall diagnostic efficiency. Triglycerides and total cholesterol levels rise from normoglycemic individuals to subjects having impaired fasting glucose and newly diagnosed diabetics. The inclusion of triglycerides and total cholesterol for diagnosis of diabetes mellitus improves the chances of for detection of diabetes mellitus

Association of blood lipid and glucose levels with carotid intima media thickness

To measure the differences in CIMT across groups based upon normal and higher levels of fasting glucose and lipids. This cross sectional study was carried out between January to June 2011 at department of radiology and pathology, PNS Rahat hospital Karachi. From a target population of patients presenting for fasting blood glucose measurement, a total 0f 201 subjects were short listed and consented after various exclusion. These patients were sampled for glucose and lipids after brief clinical evaluation. Later subjects underwent CIMT measurement in radiology department. Age showed moderate positive correlation with CIMT readings [r=0.493, p=0.000], while BMI[r=0.038, p=0.636], fasting blood glucose [r=0.038, p=0.646], triglyceride [r=0.179, p=0.029], and total cholesterol [r=0.221, p=0.007] showed lesser correlations. Patients with hyperglycemia had higher CIMT [[Group-1, Normolycemia, FBG 5.5mmol/L= 0.7180 +/- 0.147cm][p=0.028]]. Mean CIMT values among subjects with hypertriglyceridemia and hypercholesterolemia were higher than patients with normal triglycerides and cholesterol [[triglyceride:p=0.040] [total cholesterol: p=0.055]]. The carotid intima medial layers were found to be thicker in subjects having higher blood levels of fasting blood glucose, triglycerides and total cholesterol

Massive Rhinolith

Rhinolithiasis, a known yet uncommon clinical entity, usually presents as an incidental finding either in the otolaryngologist's office or on radiography performed for other reasons. A patient with left sided nasal obstruction and foul smelling discharge was diagnosed as having a massive rhinolith and because o f the sheer size o f stone it had to be partly delivered per orally under general anaesthesia

Reconstruction of lip defects with the Karapandzic technique

To study the use and effects of Karapandzic technique of lip reconstruction by long-term assessment. Design: A descriptive study. Place and Duration of Study: CMH Rawalpindi from January 1994 to January 2002. Subjects and Thirty seven consecutive patients who underwent Karapandzic technique of lip reconstructon with a minimum follow-up period of two years have been included. The variables assessed were hemorrhage, wound infection, flap necrosis, microstomia, reconstruction time, hospital stay and dynamic lip functions. Results drawn were analyzed. A total of 37 patients were included in the study. Thirteen [35%] patients were outdoor cases while 24 [65%] were in-patients. Average time of reconstruction was 40 minutes, which was done under general anesthesia in 21[57%] patients and under local anesthesia in 16 [43%] cases. Mean hospital stay of the indoor cases was 26 hours. There was no flap loss except for marginal necrosis in 04 [11%] patients. Wound infection and wound dehiscence was observed in 03 [08%] patients. Sensations were completely intact in 29 [78%] patients and aesthetically 28 [76%] patients gave normal look at the end of two years [2Y]. Twenty-seven [74%] patients had no change in speech and only one [3%] patient had unsatisfactory speech after 2 years. Varying degree of microstomia was observed in all the cases at immediate postoperative stage of one month but 35 [95%] patients showed gradual improvement with active mouth opening and stretching by prosthetic splints over 2 years. The Karapandzic technique of lip reconstruction is strongly recommended over the other techniques as it is a single stage, quick and safe procedure which gives cosmetically and functionally excellent results. Microstomia, occuring in early postoperative stage, shows gradual improvement on long-term follow-up