Association of Metabolic Dysfunction-Associated Steatotic Liver Disease/Non-alcoholic Fatty Liver Disease With Type 2 Diabetes Mellitus: A Case-Control Study in a Tertiary Care Hospital in Pakistan.

Background Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder characterized by high blood sugar levels, insulin resistance, and relative insulin deficiency. Metabolic dysfunction-associated steatotic liver disease (MASLD) is the term used to describe fatty liver (steatosis) in individuals without a history of significant alcohol intake. MASLD is progressively known as the leading cause of chronic liver disease. Dietary factors, a significant risk factor for developing T2DM and cardiovascular disease, also contribute to MASLD development. The risk of developing MASLD increases with age, particularly in patients with diabetes mellitus. This risk is notably elevated among South Asians due to their higher incidence of insulin resistance and metabolic syndrome. Importantly, MASLD is acknowledged as a component of the metabolic syndrome, with insulin resistance playing a central role in its development. Objective To determine the association between MASLD and T2DM in patients presenting at a tertiary care hospital in Pakistan. Methodology This case-control study was conducted for one year in a tertiary care hospital in Gujranwala, Pakistan. A total of 380 patients were enrolled through convenient sampling and were analyzed according to two groups: those with diabetes (case) and those without diabetes (control). All participants were assessed for serum aspartate transaminase (AST) and alanine transaminase (ALT) levels and underwent abdominal ultrasound to determine hepatic fibrosis. A diagnosis of MASLD was made only in the presence of hepatic steatosis with AST and ALT values of more than 40 IU. The odds ratio (OR) was calculated, and stratified analysis was conducted according to gender, age, and BMI. A p-value of ≤0.05 was considered statistically significant. Results In our study, 55.53% of patients were male, while 44.47% were female. The average BMI (±SD) of the patients was 23.66±3.08 kg/m2. Among the cases group, the MASLD was noted in 91 (47.9%) patients, while among the controls group, the MASLD was noted in 64 (33.7%) patients with a statistically significant OR of 1.810 (1.19-2.74). Conclusion In conclusion, MASLD is significantly associated with T2DM, regardless of gender and BMI of patients. We recommend screening T2DM patients for the presence of MASLD at regular intervals to prevent hazardous consequences of MASLD in adult populations, particularly those with features of metabolic syndrome. Further larger-scale studies investigating the impact of T2DM on MASLD are required to reduce morbidity and decrease disease burden, especially in prevalent areas.

Berardinelli-Seip Congenital Lipodystrophy - A Case Report and Review of Literature.

Berardinelli-Seip Congenital Lipodystrophy (BSCL), also known as congenital generalised lipodystrophy, is a genetic disorder where there is an absolute deficiency of adipose tissue. It affects the development of adipocytes and ultimately leads to an inability to store fat in adipocytes. It is extremely rare. Most of the cases reported are from Africa and North America. Only a handful of cases have been reported in the world. The aim of this case report is to highlight the significance of this rare metabolic disorder, which should be considered whilst managing young patients with severe insulin resistance. We present a case of a young Asian child with an increasing need for insulin for his diabetes. He was previously managed on the lines of type 1 diabetes mellitus and his insulin requirements kept on increasing. Diagnosis on the basis of genetic studies was not possible due to the non-availability of the test in Pakistan. BSCL is an infrequent condition leading to several cardiometabolic complications. Timely diagnosis can lead to better management and prevention of complications. Keywords: Insulin resistance, Lipodystrophy, Acanthosis nigricans, Hypertriglyceridemia, Genetic disease.

Acute pancreatitis secondary to hypertriglyceridaemia caused by undiagnosed type 2 diabetes.

In some patients undiagnosed diabetes may present with metabolic complications of diabetes as their initial presentation. Suboptimal glycaemic control in diagnosed and undiagnosed diabetes can cause hypertriglyceridaemia which can cause pancreatitis. In patients presenting with pancreatitis where common causes of pancreatitis are excluded hypertriglyceridaemia should be considered as a cause and hence their lipid profile should be evaluated. If hypertriglyceridaemia is confirmed, then such a patient should be screened for diabetes. We present three cases presenting to hospital with pancreatitis secondary to hypertriglyceridaemia. Hypertriglyceridaemia in all three were secondary to undiagnosed and uncontrolled type 2 diabetes. Early treatment of hypertriglyceridaemia can prevent morbidity and mortality. Diagnosing type 2 diabetes in this context can result in optimisation of glycaemic control, and hence improve hypertriglyceridaemia and reduce the risk of recurrent attacks of pancreatitis.

Quality Of Sleep And Its Associated Factors Among Diabetics And Non Diabetics.

BACKGROUND: Diabetes mellitus is the metabolic state which has shown a persistent global rise in numbers. It is therefore necessary to closely assess all aspects of this state. Sleep quality and diabetic control have a relation where both can affect each other. Therefore, we aim to study the quality of sleep and factors affecting it in our diabetic population. The objective of the study was the identification of quality of sleep and factors affecting it in the diabetic and non diabetic adult population. METHODS: In this comparative cross sectional study quality of sleep was evaluated in all the patients through the Pittsburgh Sleep Quality Index. Statistical analysis was conducted with the SPSS-23. RESULTS: The total number of study participants were 250 adults (18 years and above), where 125 were diabetics, while 125 were non diabetics. In Diabetic group, the total number of patients with impaired sleep was 65 (52%). In non-diabetic group, impaired sleep was found in 70 (56%) individuals. The mean age of diabetics was 55.2±11.6 years and non-diabetics was 37.23±12.017 years. Prevalence of restless leg syndrome and depression among diabetics was 33 (26.4%) and 30 (24.0%) respectively and in nondiabetic was 20 (16.0%) and 63 (50.4%). Impaired sleep quality was associated with the use of cell phones before going to bed (p-value: 0.01) and watching television until late at night in both groups. Impaired sleep is seen more commonly in uncontrolled DM (RR:1.462 and CI: 0.531 to 4.025). CONCLUSIONS: Impaired sleep and uncontrolled DM has a direct relation and the prevalence of Restless leg syndrome (RLS) is higher in Diabetics. Addressing the factors impairing sleep can improve sleep quality and have beneficial effects on the sufferers from this metabolic state.

Thyrotoxic Periodic Paralysis.

Thyrotoxic periodic paralysis is an uncommon disorder characterized by hypokalaemia, thyrotoxicosis and paralysis, most commonly seen in South Asian males. Aim of our case series is to highlight the significance of this reversible cause of patients presenting with neuromuscular paralysis. We present case series of 1 Asian and three Caucasian patients with thyrotoxic periodic paralysis who came with neuromuscular weakness secondary to thyrotoxicosis. All made a swift and uneventful recovery with no recurrence. Thyrotoxic periodic paralysis (TPP) is an infrequent condition having recurrent episodes of muscle weakness as main feature. Hypokalaemia is a common finding seen in these patients. Resolution of the attacks is achieved with correction of hypokalaemia and hyperthyroidism.

Meningoencefalitis bacteriana. Hospital Pediátrico "José Luis Miranda". Cuba. 2007-2012 / Bacterial meningoencephalitis. Pediatric Hospital "José Luis Miranda". Cuba. 2007-2012

Se realizó un estudio de tipo no experimental, descriptivo, transversal en el Hospital Pediátri-co Universitario "José Luís Miranda", provincia de Villa Clara, Cuba; durante el período 2007 ­ 2012. Se trabajó con la totalidad de la población de estudio, la que estuvo integrado por 56 casos interpretados mediante el método diagnóstico del Síndrome Neurológico Infec-cioso: meningoencefalitis bacteriana, cuyos participantes fueron seleccionados a partir de las Tarjetas de Declaración Obligatoria (EDO). Los datos fueron recopilados mediante la revi-sión de documentos (historias clínicas) y procesados mediante estadísticas descriptivas. El 42,86% de los pacientes correspondió a niños menores de 1 año; así mismo el 21,43% resultó causado por meningococo y una cifra similar por neumococo. Se observó un predominio del género masculino; la etiología fue mayoritariamente neumocóccica y meningocóccica; los síntomas más frecuentes fueron fiebre, cefalea y vómitos escasos; así como la complicación más importante observada resultó el fallecimiento de algunos pacientes.

A non-experimental, descriptive, cross-sectional study was carried out at the "José Luís Miranda" University Pediatric Hospital, in the province of Villa Clara-Cuba, during the period 2007 ­ 2012. The total population of the study was composed of 56 cases interpreted by the diagnostic method of Infectious Neurological Syndrome: bacterial meningoencephali-tis, whose participants were selected from the Obligatory Declaration Cards (ODC). The data was collected by reviewing documents (medical records) and these were processed using descriptive statistics. 42.86% of the patients were children under one year of age; likewise, 21.43% was caused by meningococcus and a similar number by pneumococcus. A predomi-nance of the masculine gender was observed. The etiology was mostly pneumococcal and meningococcal, the most frequent symptoms were fever, headache and poor vomiting; as well as the most important complication observed was the death of some patients.

Caracterización clínico- epidemiológica de la infección por condiloma acuminado. Poli-clínico Universitario "Marta Abreu". Abril 2011-diciembre 2012 / Clinical-epidemiological characterization of infection by condyloma acuminatum. Poli-clínico Universitario "Marta Abreu". April 2011-December 2012

Fue efectuado un estudio descriptivo, longitudinal y prospectivo, en el Policlínico Universi-tario "Marta Abreu ", en la ciudad de Santa Clara, provincia Villa Clara, Cuba, en el período comprendido desde abril del 2011 hasta diciembre del año 2012, con el objetivo de caracteri-zar la relación clínico-epidemiológica en pacientes portadores de la infección por condiloma acuminado. Los pacientes que acudieron a la consulta dermatológica del policlínico, tres mil trescientos cincuenta y cuatro (3 354), representaron el universo y la muestra tomada estuvo integrada por 49 afectados con diagnóstico clínico de condiloma acuminado, la cual estuvo determinada a través del método de muestreo de conveniencia. Se obtuvo la información del cuestionario (Anexo I); aplicado a los pacientes con diagnóstico clínico de condiloma acumi-nado, del Departamento de Estadísticas, las Historias Clínicas Individuales y Entrevistas, revistas científicas y de las fuentes actualizadas del internet. El condiloma acuminado, llama-do por lo general verruga genital o verruga venérea, es considerado como la ITS más frecuen-te y ocupa el segundo lugar en importancia tras el VIH/SIDA. Según el estudio realizado, la infección por condiloma acuminado predominó en las edades entre 20 y 29 años; sexo mas-culino e inicio las relaciones sexuales en edades tempranas a los 15 o 17 años; uso eventual del condón y múltiples parejas sexuales en el año. Predominó el tratamiento tópico a través de la podofilina al 25% y la evolución fue insatisfactoria.

A descriptive, longitudinal and prospective study was carried out at the Policlínico Universi-tario "Marta Abreu", in the city of Santa Clara, province of Villa Clara, Cuba, in the period from April 2011 to December 2012. It aimed to characterize the clinical-epidemiological relationship in patients with condyloma acuminatum infection. Three thousand three hundred fifty four (3 354) patients who were attended in the dermatological consultation represented the universe; the sample taken of 49 affected patients with clinical diagnosis of condyloma acuminatum was determined through the method of convenience sampling. The information was collected from the questionnaire(Annex I) applied to patients with a clinical diagnosis of condyloma acuminatum, from the Department of Statistics, Individual Clinical Stories and Interviews, scientific journals and updated Internet sources. The condyloma acuminatum (usually called genital wart or venereal wart) is considered the most frequent STI and ranks second in importance after HIV / AIDS. Infection by condyloma acuminatum in the ages between 20 and 29 years, male sex, initiation of sexual relations at an early age at 15 or 17 years old, eventual use of the condom, and multiple sexual partners in the year predominated according to the study conducted. Topical treatment with podophyllin at 25% predominated and the evolution was unsatisfactory.