Association of Low Serum Magnesium Levels in Type 2 Diabetes Mellitus with &without Hypertension

Background: Diabetes Mellitus is a widespread metabolic abnormality that constitutes a most important physical dilemma in the world. Hypomagnesaemia accelerates the rate of diabetic complications. Objective: To analyze the association of magnesium levels in DM (Type 2 Diabetes Mellitus) with and without complication of Hypertension. Design: It was a comparative analytical study. Setting: This research was carried out in medicine department, Peoples Medical College Hospital, Nawabshah from March 2016 to February 2017. Samples: 245 patients with Type 2 DM after fulfilling the selection criteria were included, out of them 123 with hypertension and 122 without hypertension. Methods: After a short-lived consultation, all the subjects were categorized for variable analyses like age, gender, Type 2 DM with and without hypertension, duration of diabetes and presence of hypomagnesaemia. Joint National Committee (JNC 8) classification of Hypertension was applied to collect data. Blood samples were drawn for research purpose in fasting state for serum magnesium level analyses on the basis of hypertension and without hypertension. Results: In 245 diagnosed Type 2 diabetic patients, 160 were males and 85 were females. Out of them, 123 were hypertensive while 122 were non hypertensive. Normal magnesium was present in 120 (48.97%) and low magnesium was present in 125 (51.02%) patients overall. A decreased serum level of magnesium was observed in 52.04% hypertensive subjects with diabetes and 50% non-hypertensive subjects with diabetes. Conclusion: Frequency of decreased serum magnesium is widespread in T2DM with and without hypertension.

Frequency of Low Vitamin D3 Levels in Subjects with Parkinson’s Disease. A Study Conducted at PMCH, a Tertiary Care Hospital, Nawabshah

Background: Lack of serum vitamin D3 is related to PD (Parkinson’s disease). Currently a valid place for vitamin D3 deficiency in Parkinson disease (PD) has been anticipated. The aim of present research was to evaluate insufficiency of D3 (vitamin) in subjects with PD (Parkinson’s disease). Many of physiological functions connected with higher risk of illness are maintained by vitamin D, which also plays significant task in pathogenesis of calcium homeostasis and skeletal ailments. It forecasts hazard of persistent ailments like malignancy, CVS conditions, and T2DM. Continuous insufficiency of this vitamin may lead to PD. Method: This was a cross sectional study. Conducted at People’s Medical College Hospital, Nawabshah during period of Jan. 2014-Dec. 2016, the sample size of 243 subjects clinically diagnosed as PD was enlisted. Inclusion criteria were all male and female subjects aged >50 years, clinically diagnosed Parkinson’s disease enlisted in research. Results: In 151 (62.1%) subjects, vitamin D3 levels were <30 ng/ml while in 92 (37.9%) subjects, vitamin D3 values were normal (30 - 150 ng/ml) (p = 0.000). Conclusion: Considerably low levels of vitamin D3 were seen in Parkinson’s disease. Our information sustains a legitimate part of vitamin D insufficiency in PD.

Vitamin D3: Association of Low Vitamin D3 Levels with Semen Abnormalities in Infertile Males

Background: Insufficiency of vitamin D is one of the utmost general health issues all over the globe, including Pakistan;incompatible data are present on the possible relationship among serum vitamin D values and quality of semen. Objective: Lack of Vitamin D in body is related with a higher risk of various health problems including infertility. In our setup no such type of study had been conducted in the past on the relationship among serum vitamin D levels and infertility. This study was aimed to investigate male subjects with infertility and serum levels of vitamin D. Methods: This study was cross-sectional and performed on 243 male subjects who attended the clinic for evaluation of infertility from January 2016 to December 2017. Mean age of patients was 31.94 years with standard deviation of 7.52 years. The mean age of controls was 32.2 years with SD 8.42 years, age ranged between 20 years as minimum to 46 years as maximum. The minimum vitamin D level was 7.00 ng/dl while maximum 130 ng/dl, mean was 26.20 and standard deviation was 22.06 ng/ml. Levels of vitamin D were significantly low in (67%) male subjects with infertility. The mean vitamin D level of controls was 49.40 with SD of 35.98 ng/ml. 28% of controls had also vitamin D levels below the normal range, which indicates the prevalence of vitamin D deficiency in general population here in our setup. The participants were divided according to WHO (World Health Organization) 2010 criteria along with corresponding healthy control subjects. A questionnaire for evaluation of infertility in male subjects was filled by all the contestants. Results: Levels of vitamin D were significantly low in (67%) male subjects with infertility. While 28% of controls had also vitamin D levels below the normal range. Infertile male subjects with low or no sperm count were found insufficient for vitamin D in comparison to healthy control subjects. Conclusion: It was concluded from the results of current study that low levels of vitamin D are related with abnormal male reproductive function, the severity of that was subject to the amount of vitamin D insufficiency.

Non Alcoholic Fatty Liver Disease: Assessment of Lipid Profile Estimation in Different Grades of Fatty Liver on Ultrasound

Background: Non Alcoholic Fatty Liver Disease (NAFLD) is common hepatic disorder which is recognized as a great health problem causing different diseases worldwide. To determine non-alcoholic fatty liver and assess the relation of fasting total lipids with different grades of fatty liver (NAFLD) subjects diagnosed through ultrasound. By identifying the risk factors of Lipid Profile and NAFLD, the health care provider can properly manage it, even awareness specific for patients and community as general being launched to diminish the morbidity and mortality by this study. Methods: This cross-sectional research carried out at Medicine Department of PMCH, Shaheed Benazirabad. This study comprises 300 subjects of NAFLD. Patients who attended the medicine department with abdominal complains after examination consultant advised ultrasound. The ultrasound performed in Radiology department, patients with findings of fatty liver selected, and history taken from all the patients with special regard to alcoholism. Fasting lipid profile done in all patients included in present study. The blood samples collected from a vein and immediately sent to the laboratory. Results: This present study enlisted total 300 patients out of them 203 (67.7%) belonged to male gender and 97 (32.3%) were females. A ratio of 2.1:1 observed in male and female subjects. There were 176 (58.7%) patients in grade I, while 82 (27.3%) patients in grade II and 42 (14%) patients in grade III. The cholesterol value was abnormal in 186 (62%), while normal in remaining 114 (38%) patients. Triglycerides were abnormal in 152 (50.7%) while in 148 (49.3%) patients were normal. HDL in 155 (51.7%) patients was abnormal while 145 (48.3%) patients had normal values. Low density lipoprotein value in 117 (39%) patient was abnormal and 183 (61%) patient normal. Very low-density lipoprotein in 117 (39%) patients was abnormal and 183 (61%) patient normal. The mean age and SD of patients in present study was 46.83 ± 8.82, with minimum 30 years and maximum age 65 years respectively (p value 0.000). The mean and SD of total cholesterol value was 154.66 ± 58.88 mg/dl (p value 1.000), TG 180.98 ± 96.46 mg/dl (p value 0.974), HDL-C 32.13 ± 5.88 mg/dl (p value 0.000), LDL-C 116.41 ± 41.002 mg/dl (p value 0.000), and VLDL-C was 43.47 ± 34.34 mg/dl (p value 0.000). Conclusions: In current study, variable changes in lipid profile observed amongst NAFLD (non-alcoholic fatty liver disease) patients who diagnosed on ultrasound. Early diagnosis and treatment of non alcoholic fatty liver with abnormal lipids can prevent from long-term complication of fatty liver.

Vitamin D: Level of Vitamin D3 in AFB Positive PTB Patients in Initial Diagnostic Phase

Background: A relationship among vitamin D and pulmonary tuberculosis. Objective: To conclude the occurrence of Vitamin D insufficiency in subjects suffering from pulmonary TB. Design: This was a cross sectional study. Setting: Current study was performed at department of medicine, Peoples Medical College Hospital Nawabshah starting from January 2017 to December 2017. Samples: 385 AFB positive subjects of pulmonary tuberculosis after achieving the criteria of selection were recruited. Material and Methods: After a brief discussion, the patients were characterized for variable evaluation such as age, gender, sputum AFB and duration of disease and presence of low vitamin D levels. Sputum AFB criterion was used for Data collection. Fasting blood samples were collected for analysis of vitamin D levels in all subjects of AFB positive pulmonary tuberculosis. Results: In 385 diagnosed patients with smear positive PTB, 273 (70.9%) males and 112 (29.1%) were female. Vitamin D levels were within normal or sufficient range in 134 (34.8%), below normal range in 251 (65.2%) cases (insufficient in 09.56% (24/251) and deficient in 90.43% (227/251) cases). Conclusion: Decreased levels of vitamin D were common in subjects with AFB smear Positive PTB cases.

Assessment of Serum Magnesium Level in Type 2 Diabetes Mellitus with Diabetic Foot Ulcers (Grade I and II) at Nawabshah, Pakistan

Diabetes Mellitus is a metabolic disorder increasing morbidity and mortality worldwide, which needs exact identification and proper management. Aim of this study was to analyze the serum Mg (magnesium) level in patients with Type 2 Diabetes Mellitus with grade I & II diabetic foot ulcers. This descriptive cross sectional study was conducted at Medicine Department, PMCH Nawabshah from June 2015 to December 2016. A total of 110 Type 2 Diabetes Mellitus with foot ulcer patients, 51 with grade I and 59 with grade II out of total were included by purposive sampling. After consultation, subjects were categorized as gender, age, Type 2 DM and foot ulcer duration, foot ulcer grading and grouping for analyses. Wagner’s classification of diabetic foot ulcers used to analyze the data and blood samples were collected for research purpose in fasting state for serum Magnesium level analyses. Out of 110, 67 (65.5%) males and 43 (34.5%) females were reported with Type 2 diabetic patients. Hypomagnesaemia was reported in 59% patients out of total, 24 found with grade I and 38 found with grade II from the studied subjects. P value &le;0.000 was in the studied population in relation to hypomagnesaemia. In conclusion, Hypomagnesaemia is common in Type 2 Diabetes Mellitus patients with grade I & II foot ulcers. As the duration of Diabetes along with duration of diabetic foot ulcer in Grade I and II increases, the level of serum magnesium decreases. As the duration of Diabetes Mellitus increases, the severity of complications might also increase.

Frequency of Various Risk Factors in HCV Positive Patients in Initial Diagnostic Phase

Viral hepatitis C is a type of illness, which is transmitted to patients by different methods in world. Here we will identify the different common risk factors for transmission of viral hepatitis C in our setup. Aim of study was to determine frequency of various risk factors in HCV positive patients. This study was cross sectional and conducted Department of Medicine PMC Hospital at Nawabshah. Duration of this study was one year from April 2016 to March 2017. After taking informed written consent, 243 diseased persons with positive anti Hepatitis C Antibodies were incorporated in this research. Frequency of variables i.e. Hepatitis C virus risk factors and different other demographic results was collected on preformed proforma. In total of 243 subjects there were 165 (67.9%) male and 78 (32.1%) females respectively. Most of the subjects have more than one risk factor. 19 (7.8%) had history of blood and blood products transfusion. IV drug abuse was detected in 08 (3.3%). Homosexuality and heterosexuality were observed in 14 (5.8%) and 12 (4.9%) subjects respectively. History of dental procedure was seen in 31 (12.8%). 228 (93.8%) had history of needle pricking in different ways. History of different surgical procedures was observed in 33 (13.8%). Calculated Mean and Standard Deviation for age was 39.2 ± 10.3 years. It was concluded that proper implementation of precautionary measures should be carried out for every human being to reduce burden of HCV illness in far near future.

Association of Hypomagnesemia in Type 2 Diabetic Patients with and without Peripheral Neuropathy

Background: Diabetes Mellitus is a wide-ranging metabolic disorder, which constitutes a most important physical condition dilemma in the world. Hypomagnesaemia accelerates the rate of diabetic complications. Objective: To analyze the association of serum magnesium (Mg) in Type 2 Diabetes Mellitus with and without complication of peripheral neuropathy. Design: A cross sectional study. Setting: This research was carried out in medicine department, Peoples Medical College Hospital Nawabshah from May 2016-April 2017. Sample Size: Total 271 patients of both genders with Type 2 DM with and without peripheral neuropathy, each group after fulfilling the selection criteria were included. Material and Methods: After a short-lived consultation, the subjects were categorized for variable analyses like sex, age, Type 2 Diabetes Mellitus with and without peripheral neuropathy, duration of diabetes mellitus and presence of hypomagnesaemia. Clinical examination with monofilament was applied for diagnosis of peripheral neuropathy. Blood samples for magnesium analysis were collected in fasting condition. Results: In 271 diagnosed patients of Type 2 diabetes mellitus, 180 male and 91 were females. Peripheral neuropathy was observed in 136 subjects out of them 94 males and 42 were females. While 135 were without peripheral neuropathy out of them 86 males and 49 were females. Normal magnesium was seen in 119 (43.91%) and low magnesium was present in 152 (56.09%) patients overall. A decreased serum level of magnesium was observed in 56.09% diabetic subjects with peripheral neuropathy and 50% subjects with diabetes without peripheral neuropathy. Conclusion: Frequency of hypomagnesaemia is common in subjects with in Type 2 DM with and without peripheral neuropathy.

Spontaneous Bilateral Pneumothorax with Recurrent Pneumothorax: A Case Report

Aim: To report a rare case of spontaneous bilateral pneumothorax with recurrent pneumothorax. Background: Spontaneous bilateral pneumothorax is medical and surgical emergency. It is presence of free air in the bilateral pleural spaces. It rarely occurs at any age but usually young age without apparent precipitating etiology in healthy subjects without any existing pathology. Case Report: In present case, a non smoker, uneducated, young housewife was received in emergency in critical condition and admitted in Intensive Care Unit directly, Peoples Medical university Hospital, Nawabshah, and Sindh, Pakistan. She felt difficulty in breath and after few moments she complained chest pain on right side of chest. They rushed in emergency in Peoples Medical University hospital and diagnosed as case of pneumothorax and at the same time her symptoms started worsening and she developed central cyanosis. In emergency chest X-ray was done showing bilateral pneumothorax, patient developed respiratory distress, emergency bilateral chest intubation was done and due to SO2 drop. Patient was kept on mechanical ventilation. After 24 hours she was weaned off and she was vitally in stable state and shifted in medical department and after 2 weeks she was discharged well. After 3 days of discharge she again came in emergency X-ray shown right sided recurrent pneumothorax, chest intubation done and she was referred to Oojha Institute of Chest Diseases, Karachi, Pakistan for further management and Pleurodesis. Conclusion: Bilateral spontaneous pneumothorax is medical and surgical emergency, diagnosis is thru clinical history, examination of chest and X-ray chest. Prompt diagnosis and management with chest intubation bilaterally and supportive treatment may decrease the morbidity in these critical cases.

Spontaneous Subcutaneous Emphysema with Pneumo-Mediastinum: A Case Report

Aim: To report a rare case of Spontaneous subcutaneous emphysema and pneumo-mediastinum Introduction: Spontaneous subcutaneous emphysema and pneumo-mediastinum may be defined as the presence of free gas or air in the subcutaneous tissue or mediastinal structures without an apparent precipitating cause. It most commonly occurs in adolescent in good physical health group devoid of severe existing lung pathology. Case Report: In our case, a middle aged married housewife was referred to Department of Medicine, Peoples Medical University Hospital Nawabshah, Sindh, Pakistan, by her local GP for the worsening of her condition due to development of acute neck pain, difficulty in breathing, eating and swallowing (mainly for solid foods) with swelling of neck. She was not complaining of any respiratory symptoms. The chest and neck radiographs showed subcutaneous emphysema and pneumo-mediastinum, there was no any evidence of air leakage from esophagus. She was subsequently put on free fluids, light diet, antibiotics, analgesia and other supportive measures along with close observation. After three days of admission, her clinical symptoms were alleviated to a great extent. She was discharged well from hospital after four days. Conclusion: Spontaneous subcutaneous emphysema with pneumo-mediastinum is medical and surgical emergency. Diagnosis may be made by routine chest X-rays and CT scan of the chest. Prompt diagnosis and immediate management may affect the morbidity and mortality outcomes in this condition.