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Objective: To determine association of Serum Uric Acid levels (SUA) in subjects suffering Systemic Blood Pressure and to determine its association with systolic and diastolic blood pressure. Study Design: Cross Sectional Study. Setting: Department of Faculty of Medicine and Allied Medical Sciences, Isra University, Hyderabad, Sindh, Pakistan. Period: January 2018 to September 2019. Material & Methods: 150 diagnosed cases of systemic hypertension and 150 controls were selected though non-probability purposive sampling according to inclusion and exclusion criteria. 2 ml venous blood was taken, centrifuged and sera were used for uric acid. Data was saved in a pre-structured Performa. Statistical software (SPSS v 21.0, IBM, Incorporation, USA) of data variables was analyzed at 95% CI (P = 0.05). Results: Serum uric acid in controls was 2.93±0.72 compared to cases 4.25±1.44 mg/dl (P=0.0001). Hyperuricemia was observed in 58 (38.6%) cases compared to 23 (15.3%) controls. Uric acid shows strong positive association with Systolic BP (r= 0.52*, p=0.0001) and Diastolic BP (r= 0.46**, p=0.0001). Conclusion: We found hyperuricemia in 58 (38.6%) of systemic hypertension cases. Systolic and Diastolic Blood pressure show positive association with uric acid. [ABSTRACT FROM AUTHOR]

Objective(s): Causality of occurrence of metformin-associated lactic acidosis (MALA) is a clinical problem. Currently, there is no drug available to prevent MALA. The present study was conducted to evaluate the protective effect of Berberine (BBR) against MALA in induced diabetic rat model. Materials and Methods: A sample of 75 healthy male Wistar rats was randomly selected according to inclusion and exclusion criteria. 75 male Wistar rats were randomly divided into a control and 4 experimental groups. Streptozotocin (STZ) in citrate buffer (pH 4.5) at a dose of 45 mg/kg was injected for induction of diabetes mellitus and rats achieving fasting blood glucose >250 mg/dl were included. Blood samples were collected 18 hr after the last dose of metformin and berberine. Ethical approval was taken before the study was conducted. Staistix 10.0 (USA) software was used for data analysis. Results: Berberine decreased MALA. Metformin, metformin + BBR 50 mg/kg bwt, and metformin + BBR 100 mg/kg bwt showed serum lactate as 1.87±0.4 mmol/lL, 1.62 ± 0.44 mmol/l and 1.47± 0.45 mmol/l, respectively (P=0.0001). Insulin resistance and liver enzymes were improved in BBR treated rats. Conclusion: The present study reports berberine protects against MALA in streptozocin-induced diabetes mellitus. [ABSTRACT FROM AUTHOR]

Objectives: To determine superoxide dismutase (SOD), glutathione peroxidase (GPX), and malondialdehyde (MDA), uric acid and serum bilirubin in healthy adult smokers. Study Design: Case control study. Place and Duration: Liaquat University of Medical and Health Sciences Hospital. Hyderabad, Sindh from December 2013 - July 2014. Subjects and Methods: 77 smokers and 50 healthy controls were selected through non-probability purposive sampling. Blood glucose, lipids, MDA, antioxidant enzymes (SOD & GPX), serum bilirubin and uric acid (UA) were measured. Data was analyzed on Statistic software 8.1 by student's t test and Chi square test. The significant p-value was taken at ≤ 0.05. Results: Anti-oxidant enzymes (SOD & GPX), blood lipids, lipid per oxidant marker; the MDA, bilirubin and UA showed statistically significant differences between smokers and controls (p<0.001). Total blood lipids and lipid sub fractions were elevated in smokers. MDA in smokers was 3.17±0.91 μmol/ml compared to 1.15±0.61 μmol/ml (p=0.001) in controls. Smokers showed reduced SOD, GPX, serum bilirubin and UA, was significant (p=0.0001) in comparison to controls. Conclusion: Cigarette smoke is a significant source of oxidative stress. Smoking increases malondialdehyde and reduces superoxide dismutase, glutathione peroxidase, uric acid and bilirubin. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate serum cobalamin with special reference to dyslipidemia in type 2 Diabetic subjects. Study Design: Observational study Place and Duration: Department of Medicine, Isra University Hyderabad, Sindh from January 2014 to July 2014. Methodology: A sample of 107 type 2 diabetic subjects was selected according to inclusion and exclusion criteria. Cobalamin was measured on Roche Cobas e411 chemistry analyzer and blood lipoproteins by standard laboratory methods. Data was analyzed by SPSS 21.0 (IBM, Incorporation, USA) using student t and Chi square tests for continuous and categorical variables respectively. P-value of ≤ 0.05 was taken significant. Results: Cobalamin deficiency was noted in 51 (47.6%) of diabetics and cobalamin deficiency was associated with dyslipidemia. Mean ± SD of cobalamin in normal and reduced cobalamin groups were noted as 355±29.5 and 183±17.5 pg/ml respectively (p=0.0001). Triglycerides, total cholesterol, HDLc, LDLc and VLDLc differed significantly in the normal and reduced cobalamin subjects (p<0.001). Lipoprotein sub fractions showed a negative correlation with serum cobalamin (p≤0.02). Conclusion: Cobalamin deficiency is common in type 2 diabetics and is associated with dyslipidemia. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate Vitamin D in Pulmonary tuberculosis and normal healthy adults. STUDY DESIGN: Case control study. PLACE AND DURATION: Department of Medicine, Isra University Hospital Hyderabad, from January 2013-June 2014. SUBJECTS & METHODS: A sample of 209 diagnosed pulmonary tuberculosis patients was selected through non-probability purposive sampling according to inclusion and exclusion criteria. After taking informed written consent from the participants, Vitamin D was measured by ARCHITECT I 1000 system for estimation of 25-OH-D3. . The data was recorded on a pre-structured proforma, and analyzed on SPSS version 21.0. The significant p-value was taken at ≤ 0.05. RESULTS: The mean ±S.D serum level of 25-hydroxyvitamin D3 in cases and controls were 27.1±9.7 and 36.8±8.1 (ngdl-1) respectively (p=0.0001). The 25-hydroxyvitamin D3 levels as low as 6 ng/dl were observed in pulmonary tuberculosis subjects. The normal, insufficiency and deficiency of 25-hydroxyvitamin D were observed in 37(33%), 16 (14.2%) and 59 (52.6%) in cases respectively compared to controls as 57 (58.7%), 21(21.6%) and 19 (19.5%) respectively. CONCLUSION: Patients with pulmonary tuberculosis are significantly Vitamin D deficient. Vitamin D supplements may be prescribed, however further studies are warranted. [ABSTRACT FROM AUTHOR]

Objectives: The present study aims to evaluate the serum cobalamin in Helicobacter pylori (H. pylori) infected patients. Study Design: Case control study. Place and Duration: Department of Medicine, Isra University Hospital Hyderabad from March 2013-April 2014. Methodology: A sample of 109 subjects including Helicobacter pylori positive subjects and controls were selected according to study criteria. Centrifugation of blood was performed at 4000 rpm for 10 minutes and sera were stored at -20°C. Blood sera were used for H. pylori serological testing. Blood counting was performed on hematoanalyzer. Cobas e411 analyzer was used for detection of cobalamin. 64 kD H. pylori antigens was detected by ELISA. The data was entered into SPSS version 21.0. (IBM, Incorporation, USA) A 2-tailed p-value of ≤0.05 was considered significant for statistical analysis. Results: Of total 109, 54.1% (n=59) were H. pylori seropositive cases and others were controls i.e. 45.9% (n=50). Cases and controls showed cobalamin levels of 290±49.3 vs. 351±32.9 pg/ml respectively (p=0.0001). Red blood cell indices were found to show statistically significant difference between cases and controls (p=0.001). Conclusion: Serum cobalamin deficiency was noted in both Helicobacter pylori positive and controls, however deficiency was more pronounced in Helicobacter pylori positive subjects. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The aim of this study was to determine the frequency of skin lesions in type 2 diabetes patients. PATIENTS AND METHODS: A cross-sectional study was conducted at Muhammad Medical College Hospital Mirpukhas, Sindh from July 2008 to December 2009. The sample size comprised of 1270 type 2 diabetes patients. The patients were examined by a physician to determine the presence of diabetes mellitus-related skin lesions, skin infections and skin lesions caused by treatment. The data were collected on preformed proforma. Age, sex, duration of diabetes, mode of treatment, whether on oral hypoglycemic agents or insulin were noted. A multivariate logistic regression model was used to estimate the adjusted odds ratio (OR) for having diabetes related skin lesions. All data was analyzed by SPSS-10.0 for Windows (Chicago, IL. USA). The chi-square and student t-test were used as test of significance for qualitative and quantitative variables respectively. A p-value of <0.05 was considered statistically significant. RESULTS: The mean age of patients was 52±11 years, 768 (60.47%) were female and 502 (39.62%) were male. The mean duration of the diabetes was 19±7 years and mean HbAlc was 11.8±3g/dl. Oral hypoglycemic agents were used by 913 (81.88%) patients, insulin by 164 (12.91%) and both were used by 193 (15.19%). The skin lesions were observed 851 (67%). The most common lesion was diabetic dermopathy (28.34%), but different types of skin infections were seen in 42.6% of patients and thus forming the most common lesion. The third most common manifestation was pruritis (28.05%) and the least common was the perforating dermatoses (0.78%). The HbA1c was higher in patients suffering from diabetic foot ulcer and fungal infection than those without having these infections (10.34±1.67 and 11.5±1.4 vs.9.7±1.6 and 8.9±1.6, respectively) (p<0.05). CONCLUSION: This study shows that skin lesions are common in patients with type 2 diabetes mellitus. Therefore, frequent skin evaluation of the diabetic patients is warranted. [ABSTRACT FROM AUTHOR]

Objective: The present study aimed to evaluate the current trends of drug resistance patterns of Acinetobacter baumannii infection in blood transfusion-dependent thalassemia patients., Study Design: This study was a cross sectional study, conducted at the Liaquat University of Medical and Health Sciences, Jamshoro/Hyderabad, Sindh, Pakistan from October 2014 to January 2016., Subjects and Methods: Of 921 blood samples, A. baumannii strains were isolated from 100 blood samples. Blood samples were processed for the isolation, identification, and drugs sensitivity as per the Clinical and Laboratory Standards Institute. A. baumannii strains were identified by microbiological methods and Gram's staining. API 20 E kit (Biomeriuex, USA) was also used for identification. Data were analyzed on Statisti × 8.1 (USA)., Results: Mean ± standard deviation age was 11.5 ± 2.8 years. Nearly 70% were male and 30% were female ( P = 0.0001). Of 921 blood transfusion-dependent thalassemia patients, 100 (10.8%) patients showed growth of A. baumannii . Drug resistance was observed against the ceftazidime, cefixime, cefepime, imipenem, meropenem, amikacin, minocycline, tigecycline, and tazocin except for the colistin., Conclusion: The present study reports drug-resistant A. baumannii in blood transfusion-dependent thalassemia patients. National multicenter studies are recommended to estimate the size of the problem., Competing Interests: There are no conflicts of interest.

Background: Pulmonary tuberculosis (PTB) is a chronic granulomatous disease caused by Mycobacterium tuberculosis . The present study determined the serum human enolase-2 (ENO-2), high-sensitive C-reactive protein (hs-CRP), and serum cholesterol levels as biological marker of disease activity and treatment response in smear-positive drug-naïve PTB., Materials and Methods: This case-control study was done in the Department of Medicine, Liaquat University of Medical and Health Sciences (LUMHS), Jamshoro/Hyderabad, Sindh, from January 2015 to April 2016. Thirty-five sputum smear-positive drug-naïve PTB patients and thirty controls were studied. MTB culture and drug sensitivity were performed at the Diagnostic and Research Laboratory of LUMHS. Serum ENO-2, hs-CRP, and serum cholesterol were estimated at baseline, 3 rd and 6 th month of antituberculosis (TB) therapy., Results: Serum ENO-2 and hs-CRP were found raised in PTB compared to controls and showed decrease of 13% and 21.55%, 19.6% and 31.5% at 3 rd and 6 th month, respectively ( P = 0.0001). Serum ENO-2 revealed positive correlation with hs-CRP ( r = 0.734, P = 0.0001), and serum cholesterol revealed negative correlation with ENO-2 and hs-CRP ( r = -0.509, P = 0.0001) and ( r = -0.566, P = 0.0001), respectively., Conclusion: The present study reports the baseline ENO-2 and hs-CRP were raised, and serum cholesterol was low in smear-positive PTB patients and the ENO-2 and hs-CRP were reduced by anti-TB drug therapy., Competing Interests: There are no conflicts of interest.

Objective: To evaluate the QTc-interval, heart rate variability and postural hypotension in predicting cardiac autonomic neruopathy (CAN) in type 2 diabetes mellitus (DM) patients, Methods: The comparative cross-sectional study was conducted in the Department of Medicine, Muhammad Medical College Hospital, Mirpurkhas, Sindh, from September 2008 to December 2009. A total of 186 type-2 diabetes mellitus patients with a QTc value of > 440 ms were studied. The QT interval was measured on electrocardiographic (ECG) recordings. The patients with HbA1c levels < or = 7% were considered as well-controlled. A cut-off of 5 years was selected for the known duration of diabetes. The longest and shortest R-R intervals on ECG, and heart rate variability (HRV) were determined. An HRV of less than 20 beats per minute was accepted as CAN. The relationship of postural hypotension (PH) and heart rate variability to the duration and control of diabetes were also evaluated. The relationship of cardiac autonomic neuropathy with diabetes control was also determined. Data was analysed using SPSS 10.0 (Chicago, Illinosis, USA). The comparison of differences in means was calculated by the student t-test and the difference in proportions was compared by the Chi-square test. A p-value of < 0.05 was considered significant., Results: The mean age was 47 +/- 13 years, and the mean duration of diabetes was 13 +/- 7 years. All cases had QTc prolongation with mean 0.52 +/- 0.19. Median QTc intervals were 0.590 (range. 0.515-0.780) and 0.631 (range 0.530-1.869) for males and females respectively. Cardiac autonomic neuropathy manifestations were prominent in diabetics of +/- 5 years when compared with patients for < 5 years (p < 0.003). The postural hypotension difference increased while the heart rate variation decreased with the duration of diabetes (p < 0.002). The PH on standing was significantly related with the control (p < 0.002) as well as the duration of diabetes (p < 0.002). Heart rate variation with respiration was significantly related to the duration (p < 0.005), but not to the control (p = 0.59) of diabetes. QTc showed a significant correlation with the duration of diabetes, postural hypotension and heart rate variation with respiration (p < 0.005, p < 0.013, p < 0.004) respectively., Conclusions: Prolonged QTc interval, heart rate variation and postural hypotension are relatively easy, quick and inexpensive methods to measure cardiac autonomic neuropathy.

Objective: To determine the resistance patterns of mycobacterium tuberculosis (MTB) isolates among category I and II patients of pulmonary tuberculosis., Methods: This cross sectional study was conducted at the Department of Medicine, Liaquat University of Medical and Health Sciences Jamshoro, from November 2008 to September 2009. Patients were divided into category I and II. The sputa were collected, stained with Ziehl-Nielsen (Z-N) staining and ultimately inoculated on Lowenstein-Jensen (L-J) media for six weeks. Out of 890 pulmonary tuberculosis (PTB) patients, the growth was obtained in 285 cases. The Drug sensitivity testing (DST) for Isoniazid (INH), Rifampicin (RIF), Ethambutol (EMB) Pyrazinamide (PZA) and Streptomycin (SM) were performed. The data was analyzed on SPSS 10.0. A p-value of <0.05 was taken as significant., Result: Out of 285 cases, 176 (61.75%) were male and 109 (38.24%) female. The mean age was 37 +/- 19.90 years. The DST showed drug sensitive and drug resistant isolates in 80 (28.05%) and 205 (71.92%) cases respectively (p=0.001). The drug resistant tuberculosis (DR-TB) rates for individual drugs; INH, RIF, EMB, PZA and SM were 51,22%, 15.4%, 13.33%, 9%12, and 3.85% respectively (p=0.03). The MDR-TB isolates were detected in 120 (42.10%) cases, including 5 (5.88%) in category I and 115 (57.50%) in category II patients (p=0.0001)., Conclusion: Drug resistant and multidrug resistant tuberculosis was observed mainly in category II patients. However, primary MDR was also observed in category I patients and reflects dissemination of MDR cases within the community.

Accidental or intentional Isoniazid poisoning may manifest within half to three hours as intractable seizure, acidosis, and coma. Single high dose of pyridoxine was used as an antidote with good response as reported earlier. Ingestion of more than 80 mg/kg body weight produces severe central nervous system symptoms and a dose of 125 mg/kg is potentially lethal if not promptly treated. We report a case of suicidal attempt with use of Isoniazid, who developed grand mal seizures and was controlled with diazepam and symptomatic treatment.

Background: Malaria is usually associated with reduced blood cell counts & mild to moderate thrombocytopenia is a common association of malaria. The cause of thrombocytopenia is poorly understood, but the immune-mediated lysis, sequestration in the spleen and dyspoietic processes in the marrow with diminished platelet production have all been postulated. This study was conducted to evaluate thrombocytopenia in the patients suffering from acute Plasmodium falciparum malaria., Methods: This descriptive case series study was conducted at a tertiary care hospital, Liaquat University of Medical & Health Sciences Jamshoro, over a one-year period. A total of 370 Plasmodium falciparum positive on peripheral blood film were studied. Full blood counts were determined by using automated Coulter analyzer. Thick & thin smears were stained with Giemsa stains and studied by haematologist. Data was analyzed using the SPSS version 10.0., Results: Out of 370 patients, 260 were male & 110 were female, with M:F ratio of 2.36:1. Mean age was 34 +/- 1.7 years (range 16-53 years). Haemoglobin values were 12.7 +/- 1.4g% and white blood cells counts were found 12600 +/- 450/microL. Out of 370, 114 (30.81%) had normal platelet counts, and 256 (69.18%) had thrombocytopenia (p < 0.05). The mild, moderate and severe thrombocytopenia were found in 39 (10.5%), 180 (48.6%) and 37 (10%) respectively (p < 0.05)., Conclusions: We found high frequency of mild to moderate thrombocytopenia in the Plasmodium falciparum malaria. Finding of thrombocytopenia is of diagnostic help as it raises the suspicion of malaria.

Objective: To determine the frequency of Cardiac Autonomic Neuropathy (CAN) in type-1 Diabetes mellitus patients and its association with the duration of disease and glycemic control., Study Design: Descriptive study., Place and Duration of Study: Department of Medicine, Liaquat University Hospital, Hyderabad/Jamshoro, from December, 2004 to April, 2005., Methodology: Fifty patients of type-1 Diabetes Mellitus (DM) of >or=10 years duration were selected. CAN was evaluated in terms of presence of resting tachycardia, loss of sinus arrhythmia and heart rate response to Valsalva maneuver by electrocardiogram (ECG). An R-R variation with respiration of >15 beats per minute was taken normal, while 10-15 beats and <10 beats per minute were taken as borderline and definitive CAN respectively. QTc intervals were measured. Patients with HbA1c levels<7% were considered as well-controlled. The associations between CAN, the duration of diabetes and the diabetic control were determined., Results: The mean age was 35.16+/-10.58 years with 32 males and 18 females. The mean values for the known duration of diabetes and HbA1c were 13+/-7.3 years and 9.36+/-2.5 mg/dl respectively. Definitive and borderline CAN were noted in 20% and 24% respectively. Variability of heart rate with respiration was significantly related to the duration but not to the control of the diabetes (p<0.05). QTc showed a significant correlation with the known duration of diabetes and heart rate variability with respiration (p<0.05). Most of the patients had uncontrolled glycemic status., Conclusion: Cardiac autonomic neuropathy is common in long standing type-1 diabetics. CAN resulted in prolonged QTc interval that may result in cardiac arrhythmias and even death. Intensive glycemic control improves the cardiac autonomic nerve functions.

Objective: To determine the frequency of Cardiac Autonomic Neuropathy (CAN) in patients with type 2 Diabetes mellitus., Study Design: Descriptive study., Place and Duration of Study: Department of Medicine, Liaquat University Hospital, Jamshoro, Hyderabad from December 2004 to April 2005., Methodology: Patients with type 2 Diabetes Mellitus (DM) of at least 10 years duration were selected. CAN was evaluated in terms of presence of resting tachycardia, loss of sinus arrhythmia and heart rate response to Valsalva maneuver by ECG. A R-R variation with respiration of > 15 beats per minute, 10-15 beats per minute and <10 beats per minute were taken as normal, borderline CAN and definitive CAN, respectively. QTc intervals were measured. The association between CAN, diabetic control and duration of diabetes were determined., Results: The mean age was 53.62+/-8.30 years, with male to female ratio of 1:1. Mean values for known duration of diabetes and HbA1c were 14+/-3.5 years and 11.36+/-3.6 mg/dl respectively. Definitive and borderline CAN was noted in 30% and 40% patients respectively. Variability of heart rate with respiration was significantly related to duration but not to the control of diabetes (p < 0.05). QTc showed a significant correlation with the known duration of diabetes and heart rate variability with respiration (p < 0.05). Most of the patients had very bad glycemic status as evidenced by HbA1c., Conclusion: CAN is common in long-standing diabetics, specifically those treated with oral hypoglycemic agents than those with insulin. Intensive glycemic control is associated with a better cardiac autonomic nerve functions.