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Objective: To determine the frequency of dyslipidemia and its types in adult diabetics of Karachi. Study Design: Cross Sectional, Observational study. Setting: Diabetic Outpatient Clinic in JPMC, Karachi. Period: January 2019 to June 2019. Material & Methods: 248 adult diabetics presenting in diabetic outpatient clinic in JPMC, Karachi selected by non-purposive convenient sample technique. Diagnosed diabetics who were not on any lipid lowering therapy were included in the study. Non diabetics and those diabetics who are already on lipid lowering drugs were excluded. After relevant information is taken the lipid profile of the participants was done with a 12 hours fasting and the data was secured on a pre-designed performa. The results were analyzed on SPSS. Results: Among the 248 diabetics that presented 88(35.4%) were males and 160(64.5%) were females. The prevalence of dyslipidemia is 85.9% (213 diabetics had dyslipidemia). High triglycerides were present in 52.4% (130), high LDL in 28.2% (70) and low HDL in 175(70.6%). [P=0.000]. At least one dyslipidemic factor was deranged in 81(32.7%), two in 102(41.1%) and 3 in 30(12.1%) persons. In males, 53 out of 88(60.2%) were dyslipidemic, and in females all had dyslipidemia (100%). [P = 0.000]. Hypertriglyceridemia was present in 38(43.1%) males and 92(57.5%) females [P=.021], High LDL in 21(23.8%) males and 49(44%) females [P=.163], while low HDL was present in 16(22%) males and 159(99%) females [P=.000]. Conclusion: Dyslipidemia is highly prevalent in our population. Female diabetic patients had relatively higher triglycerides than men.

Background: Polycystic ovary syndrome (PCOS) is the most frequent pathology among women of reproductive age characterized by menstrual irregularities, hyperandrogenism and polycystic ovaries on ultrasound. Evidence suggests that high androgen levels are the fundamental factor in the pathogenesis of PCOS. The objectives of the present study was to determine serum free testosterone levels in polycystic ovarian syndrome patients, and observe its correlation with clinical hyperandrogenism. Patients and methods: This cross-sectional study was conducted at Jinnah Allama Iqbal Institute of Diabetes and Endocrinology Lahore, Pakistan from 15th May 2019 to 15th November 2019. The study included 140 patients of PCOS diagnosed as per Rotterdam criteria. Serum testosterone levels were determined in these patients by ELISA method. Ferriman-Gallwey (FG) score was used to assess severity of clinical hyperandrogenism in the form of hirsutism. Patients were categorized into three groups, mild (FG score 8-15), moderate (FG score 15-25) and severe (FG score >25). Correlation between clinical (hirsutism) and biochemical hyperandrogenism (serum free testosterone levels) was assessed using Fisher exact test. Data was analyzed using SPSS version 25. Results: Biochemical hyperandrogenism in the form of raised free testosterone levels was present in 46 (32.9%) PCOS patients. Out of 12 patients having Ferriman Gallwey score >25, 10 (83.3%) had biochemical hyperandrogenism. Out of 70 patients having Ferriman Gallwey score 15-25, 22 (31.4%) had biochemical hyperandrogenism whereas out of 58 patients having Ferriman Gallwey score 8-15, only 14 (24.1%) patients had biochemical hyperandrogenism. Conclusion: Prevalence of biochemical hyperandrogenism in PCOS patients in our studied population was significantly low when compared to the population studied worldwide making it less reliable as diagnostic tool in this part of the world. Also there was significant positive correlation between free testosterone levels and degree of hirsutism which means that diagnostic accuracy of free testosterone in PCOS patients is considerably high in those having clinical hyperandrogenism.

Patients with inflammatory bowel disease (IBD) have numerous risk factors for low bone mineral density (BMD). We aimed to study the prevalence of low BMD in IBD and the factors associated with it. BMD was measured by radial quantitative ultrasound, and clinical and biochemical characteristics were compared in prospectively enrolled patients and healthy age and gender-matched controls. Chi-square test, t test for independent samples, analysis of variance (ANOVA), Mann–Whitney U test and Kruskal–Wallis H tests were used as appropriate for univariate analysis to compare the characteristics between patients with and without abnormal BMD. Binary logistic regression analysis was done to determine the factors associated with low BMD in IBD patients. One hundred and six patients (Crohn’s disease [CD] = 35, ulcerative colitis [UC] = 71) and 55 controls were included. Low BMD was equally prevalent in CD, UC and controls (42.9%, 36.6%, 36.4% respectively, p = 0.791). Serum calcium and vitamin D were significantly lower in IBD patients compared to controls (p

Objectives: To determine the association of low serum vitamin D levels with poor glycemic control and obesity in type 2 diabetic patients. Study Design: Descriptive Cross Sectional study. Setting: Sakina Institute of Diabetes and Endocrine Research Centre (SIDER), Shalamar Hospital Lahore. Period: 1st June to 31th august 2017. Material & Methods: After applying strict exclusion criteria, about 450 patients with known type II diabetes were enrolled in the present study and their HBA1C and fasting vitamin D levels were measured. Patients were divided into two groups, group 1 with poor glycemic control (HBA1C>8%) and group 2 with good glycemic control (HBA1C 23 were having suboptimal Vitamin D levels (p value

Background The standard treatment of displaced femoral neck fracture is arthroplasty. THA is reportedly superior to BHA in terms of hip pain, function and reoperation rate. On the other hand THA has a higher rate of dislocation. Total hip replacement with dual mobility cup increases the range of motion and reduces the chances of dislocation. The aim of this study is to compare the functional outcome, rate of dislocation, complications and mortality between BHA and THA with dual mobility cuff for the treatment of displaced neck of femur fracture. Patients and method This is a non-commercialized retrospective cohort study conducted at our tertiary care level 1 trauma centre. Patients of age group 60 years and above who underwent hip arthroplasty (BHA or THA with dual mobility implant) between 2015 and 2017 for displaced neck of femur fracture with a complete follow up for one year were included. Both groups were assessed for postoperative surgical complications including dislocation, fracture, surgical site infection, and medical complications, one-year mortality and functional outcome were analysed via Harris Hip Score (HHS) at the latest follow up. Results Overall 104 patients were included in the study out of which 77 patients underwent BHA while 27 underwent THA with dual mobility cup. Baseline characteristics were found to be similar in both groups. Mean pre-op HHS for bipolar group was found to be 71.01 while for THA with dual mobility cup group it was 73.52 with the difference being statistically insignificant (P = 0.12). Mean post-op HHS for bipolar group was noted to be 68.82 whereas for THA with dual mobility cup group it was 76.81. The difference was found to be statistically significant with a P-value of, Highlights • The standard treatment of displaced femoral neck fracture is arthroplasty. • Total Hip Arthroplasty is reportedly superior to Bipolar Hemiarthroplasty in terms of hip pain, function and reoperation rate. • Total Hip Arthroplasty has a higher rate of dislocation rate than Bipolar Hemiarthroplasty. • Total Hip Arthroplasty with Dual mobility cup increases the functional outcome and reduces the chances of dislocation.

Background Hip fractures usually occur in old aged patients with osteoporotic bone. Management of hip fractures in old aged patient is aimed to ambulate patient immediately and to restore the pre-operative ambulation. Proximal femur replacement is an effective treatment option in elderly patient with osteoporotic bones. It allow immediate weight bearing and early return to preoperative ambulatory status and minimizes the chances of systemic complication associated with prolong bed rest associated with internal fixation. This study is aimed to review the outcome of the patients whom underwent proximal femur replacement as primary treatment for the patient with comminuted intertrochanteric and sub trochanteric fracture. Patients and method This is a study conducted in our university hospital which is a tertiary-care level-1 trauma center. A retrospective analysis of 21 patients who underwent proximal femur replacement for comminuted intertrochanteric and sub trochanteric fracture, age more than 60 years during the period from April 2011 to March 2018 was conducted. Data collected included: age, gender, comorbidities, mechanism of injury, type of fracture, functional outcome (calculated via Harris Hip Score) and one year mortality. Results The mean age of the patients was 74.05(range 64–91) years, out of which 13 (61.8%) were female and 8 (38.0%) were male. The mean follow up was 32.6(8–91 months).Immediate post-operative ambulation status was full weight bearing (FWB) in 17 patients (80.9%) of the patients while three patients (19.0%) had non-weight bearing (NWB) due to associated co-morbidities. The mean preoperative Harris Hip score was 68.0, while the mean postoperative Harris Hip score was 66.5 at last follow up. Post operatively one patient (4.7%) developed pulmonary embolism, one patient developed dislocation. One patent (4.7%) died of sepsis from implant infection at 8 months after surgery Conclusion Primary Proximal femoral replacement in a viable option in old aged patients with poor bone quality who developed intertrochanteric and subtrochanteric fracture. According to our study, with mortality rate comparable to that of primary fixation, yet with the added advantage of immediate post op ambulation and reduced incidences of decubitus ulcers, atelectasis and DVT., Highlights • Management of hip fractures in old aged patient is aimed to ambulate patient immediately. • Proximal femur replacement is an effective treatment option in elderly patient with osteoporotic bones. • Proximal femur replacement allows immediate weight bearing and early return to preoperative ambulatory status.

Background The first case of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was diagnosed in Wuhan, China, in 2019. By the first half of 2020, coronavirus disease 2019 (COVID-19) turned into a global pandemic. Objectives The aim of this study is to describe the clinical and demographic characteristics including comorbidities and their outcomes among patients hospitalized with COVID-19 in four tertiary care hospitals across Lahore. This retrospective study was conducted at Fatima Memorial Hospital, Sir Ganga Ram Hospital, Lahore General Hospital, and Jinnah Hospital, all in Lahore, Pakistan, from May 1, 2020, to June 30, 2020. The sample size was 445, which was derived using the convenient sampling method. Clinical outcomes during hospitalization included the requirement of invasive positive pressure ventilation, need for renal replacement therapy (RRT), and death. Data regarding demographics, baseline comorbidities, important vital signs on reporting, and initial workup with results were also collected. Results A total of 445 patients' data were studied, of whom 291 (65.4%) were male patients and 154 (34.6%) female patients. The median age was 54 years (interquartile range [IQR]: 24). The most common comorbidities were hypertension (HTN) (195; 43.8%) followed by diabetes mellitus (DM) (168; 37.8%) and cardiovascular disease (CVD) (61; 13.7%). The median length of hospital stay was eight days (IQR: 3). Of the total patients, 137 (30.7%) were treated in intensive care unit settings, 40 (9%) received invasive mechanical ventilation, 40 (9%) patients had acute kidney injury, 38 (8.5%) received RRT, and 37 (8.3%) died. It was seen that more patients who were either diabetic or hypertensive received invasive mechanical ventilation as compared to those who did not have these comorbidities. The most common radiological finding on chest X-ray was the classical ground-glass appearance of COVID-19, which was found in 318 (71.4%) patients. Conclusions Patients with one or more underlying comorbidities had poor clinical outcomes compared to those with no comorbidities, with the most vulnerable group being patients with chronic kidney disease, DM, HTN, and CVD in descending order.

To study the clinical and biochemical profiles across the different ranges of impaired fasting glucose (IFG) based on American Diabetes Association (ADA) and World Health Organization (WHO) criteria. A cross-sectional study was conducted on 149 subjects, of which 63 belonged to group 1 (IFG = 100–110 mg/dl) and 86 to group 2 (IFG = 111–125 mg/dl). Basic anthropometric and clinical examinations were done for all subjects. Data was collected from patient by a questionnaire, which included the history of hypertension and diabetes and other comorbidities and complications. Biochemical profiles including Fasting Plasma Glucose (FPG), Oral Glucose Tolerance Test (OGTT), HbA1c, Fasting insulin levels and Fasting Lipid Profile were measured. Assessment of insulin resistance and beta cell function was done by Homeostasis Model Assessment (HOMA). Data were analysed using SPSS software version 15 and p

Appropriate doses of fluoride (F) have therapeutic action against dental caries, but higher levels can cause disturbances in soft and mineralized tissues. Interestingly, the susceptibility to the toxic effects of F is genetically determined. This study evaluated the effects of F on the liver proteome of mice susceptible (A/J) or resistant (129P3/J) to the effects of F. Weanling male A/J (n = 12) and 129P3/J (n = 12) mice were housed in pairs and assigned to two groups given low-F food and drinking water containing 15 or 50 ppm F for 6 weeks. Liver proteome profiles were examined using nano-LC-ESI-MS/MS. Difference in expression among the groups was determined using the PLGS software. Treatment with the lower F concentration provoked more pronounced alterations in fold change in liver proteins in comparison to the treatment with the higher F concentration. Interestingly, most of the proteins with fold change upon treatment with 15 ppm F were increased in the A/J mice compared with their 129P3/J counterparts, suggesting an attempt of the former to fight the deleterious effects of F. However, upon treatment with 50 ppm F, most proteins with fold change were decreased in the A/J mice compared with their 129P3/J counterparts, especially proteins related to oxidative stress and protein folding, which might be related to the higher susceptibility of the A/J animals to the deleterious effects of F. Our findings add light into the mechanisms underlying genetic susceptibility to fluorosis.

Introduction Hypogonadism is characterized by clinical and biochemical evidence of testosterone deficiency. Low testosterone levels have been reported in patients with type 2 diabetes mellitus (T2DM), which can predispose to coronary artery disease (CAD). It has been proposed that diabetic men with proven CAD have lower androgen levels than patients with normal coronary arteriograms. We conducted this study with the objective to determine the frequency of hypogonadism in patients with diabetes mellitus and its relationship with CAD. Materials and Methods It was a comparative cross-sectional study conducted at a tertiary care hospital. We recruited a total of 108 patients, divided into two groups, 54 patients in each arm of the study. Group A comprised patients with CAD, whereas group B consisted of diabetic patients without CAD. Hypogonadism was defined on the basis of erectile dysfunction clinically and total testosterone levels biochemically. CAD was diagnosed on the basis of findings of coronary angiography. Fasting blood samples were drawn and evaluated for fasting plasma glucose, HbA1c, fasting lipid profile, thyroid-stimulating hormone (TSH), serum prolactin, blood urea, serum creatinine, liver function tests (LFT), total testosterone, luteinizing hormone (LH), and follicle‑stimulating hormone (FSH) levels. Hypogonadism among two study groups was compared using chi-square and serum testosterone level was compared using independent t-test with p < 0.05 considered as statistically significant. Results There were 108 subjects in the study with the mean age of 54.4 ± 4.29 (range: 22 to 68) years. The mean duration of T2DM was 12.6 ± 8.2 years. The mean BMI of patients with and without CAD was 25.7 ± 2.37 and 26.9 ± 4.21 kg/m2, respectively. There was no significant difference in waist circumference and obesity between both the groups (p-value > 0.05). Fasting plasma glucose and HbA1c in both groups were not significantly different. Testosterone levels and erectile dysfunction score were found lower in T2DM with CAD compared to T2DM patients without CAD, although this difference was not statistically significant (p-value: 0.051). The majority of the subjects with hypogonadism in both groups had a hypogonadotrophic hypogonadism (39/42, 92.9% versus 16/20, 80.0%). No statistically significant difference was seen in serum levels of LH and FSH between the study groups. The frequency of hypogonadism was found higher in the group with CAD (72.2%, 39/54) as compared with T2DM patients without CAD (37.03%, 20/54; p-value = 0.000). Conclusion Testosterone deficiency is a significant problem of males with T2DM. Patients with CAD have markedly low levels of testosterone as compared with patients without any CAD.

The brain undergoes ionizing radiation exposure in many clinical situations, particularly during radiotherapy for brain tumors. The critical role of the hippocampus in the pathogenesis of radiation-induced neurocognitive dysfunction is well recognized. The goal of this study is to test the potential contribution of non-targeted effects in the detrimental response of the hippocampus to irradiation and to elucidate the mechanisms involved. C57Bl/6 mice were whole body (WBI) or partial body (PBI) irradiated with 0.1 or 2.0 Gy of X-rays or sham irradiated. PBI consisted of the exposure of the lower third of the mouse body, whilst the upper two thirds were shielded. Hippocampi were collected 15 days or 6 months post-irradiation and a multi-omics approach was adopted to assess the molecular changes in non-coding RNAs, proteins and metabolic levels, as well as histological changes in the rate of hippocampal neurogenesis. Notably, at 2.0 Gy the pattern of early molecular and histopathological changes induced in the hippocampus at 15 days following PBI were similar in quality and quantity to the effects induced by WBI, thus providing a proof of principle of the existence of out-of-target radiation response in the hippocampus of conventional mice. We detected major alterations in DAG/IP3 and TGF-β signaling pathways as well as in the expression of proteins involved in the regulation of long-term neuronal synaptic plasticity and synapse organization, coupled with defects in neural stem cells self-renewal in the hippocampal dentate gyrus. However, compared to the persistence of the WBI effects, most of the PBI effects were only transient and tended to decrease at 6 months post-irradiation, indicating important mechanistic difference. On the contrary, at low dose we identified a progressive accumulation of molecular defects that tended to manifest at later post-irradiation times. These data, indicating that both targeted and non-targeted radiation effects might contribute to the pathogenesis of hippocampal radiation-damage, have general implications for human health.

Background: Diabetes Mellitus (DM) is a serious worldwide health concern. Pakistan is among the top 10 countries with the highest prevalence of diabetes in the world with estimates reaching as high as 21.6% in adults aged 30–79 years. HbA1C is the most useful diagnostic tool to assess the control and progression of disease and related complications. However, the predictors of good and bad control are not well established in our population. Objective: 1). To assess the level of A1C control among type 2 diabetic patients. 2). To find out factors which can predict uncontrolled A1C. Study Design: Retrospective observational study. Setting: Among type 2 diabetes mellitus patients attending the outpatient of Diabetes Endocrine and Metabolic Centre (DEMC) of Lahore General Hospital, Lahore. Period: June 2012 to Feb 2014. Material and methods: Total of 809 patients were randomly selected to assess A1C in this population. At the same time, we assessed other factors associated with uncontrolled A1C. Chart review of the included patients was done using a data collection sheet, structured for this purpose. Patient demographic data was gathered. Specific information including complications and laboratory results (HbA1C, Triglycerides (TG), Dyslipidemias) was collected. Diabetes complication data was obtained clinically and through laboratory workup. The outcome was calculated. Patients with A1C of

Background: Stroke is a leading cause of disability and the second principal cause of death in the world. The aim of this study was to analyze different characteristics in stroke patients in Medical Unit 1 of Lahore General Hospital, which is biggest referral hospital for Neurology patients in Punjab, to identify the risk factors and help in targeting prevention in our patients. Study Design: Descriptive study. Setting: Lahore General Hospital, Lahore. Period: January 2016, including data from January to November 2015. Methods: The demographic data, clinical manifestations, risk factors, side of weakness, cranial nerves involved, neurological weakness and Glasgow Coma Scale, duration of stay in hospital and outcome were included in the data. For the comparison between categorical variables Chi-square test was used. For other variables, t-test was used. Results: A total of 235 patients with stroke, age 20 to 105 (mean ±SD= 58±14.6) were included. 127 (54%) had Ischemic stroke (IS) and 100 (42.6%) had hemorrhagic stroke (HS). 127 (54%) were men and 108 (46%) were women. 17.9% of the patients with IS and 21.7% of the patients with HS died (OR 0.65 95% CI 0.48-0.89). Hypertension, diabetes and dyslipidemia were the most common risk factors. Conclusion: Burden of stroke is high in Pakistan. Mean age of patients with stroke is less. Hypertension, diabetes, dyslipidemia and smoking are highly prevalent and hypertension is the most common. Ischemic strokes are more common, mortality of intra-cerebral hemorrhage is higher.

Objective Although many studies worldwide explained the risk factors for developing Diabetic Foot Ulceration (DFU), little has been done to assess medical factors in DFU formation and link them in patients of Pakistan. This study aimed to link the DFU with different risk factors. Methods This descriptive cross-sectional retrospective study was conducted in Diabetes Endocrine and Metabolic Centre / Post Graduate Medical Institute / Lahore General Hospital. Data of all patients presenting between July 2017 to June 2018 were analyzed for risk factors. Analysis was done on SPSS version 21. Results Total of 3301 patient were seen during this period, out of which 2052 patient data was picked up as it was complete in respect to the information needed. Middle age, Male gender, Type 2 diabetes, and Hypertension, were insignificantly co-related. High waist circumference, Comorbidity like Neuropathy, Dyslipidemia, Greater body mass index, Poor compliance with Medication and type of medication used (combination of oral and injectable) were found statistically significant predictor for DFU. However retinopathy was not found to be a risk factor of DFU. This result was statistically significant. Conclusion Factors like obesity, waist circumference, combination of oral along with injectable therapies, neuropathy, dyslipidemia, retinopathy and poor compliance with medication were statistically significant and can be strongly linked with diabetic foot ulcer. Middle age, Male gender, Type 2 diabetes, and Hypertension were insignificantly co-related. However, further studies are needed in larger population to support these findings.

Background: Alopecia is the medical term that refers to the loss of hair. It comes in a variety of patterns and has a number of causes. A host of factors has been found to be associated with its occurrence. For severe cases, hair transplantation may consequently be required. Our main objectives in this study were to perform profiling of alopecia, to determine the role of nutritional deficiency, stress and endocrine imbalance in alopecic population of Pakistan and to elucidate the reasons for seeking hair transplant. Methods: This was a cross sectional, interview-based survey carried out at five dermatological clinics and hair transplantation centers located in Clifton Area and dermatological clinics of Liaquat National, Jinnah Postgraduate Medical Center and Civil Hospital, Karachi from April – May 2012. Non-random convenience sampling was employed. Around 400 individuals of both sexes with Alopecia were approached, of which 330 consented (response rate = 82.5%). Domains included BMI, stress (using a questionnaire), endocrine abnormality and grade of alopecia (via Hamilton’s/Ludwig’s Scales and trichometric index). Results: Patients’ mean age was 39 ± 14 years. Grade 3 was the most common grade of alopecia, seen in 114 (34.5%) patients. The most repeated trichometric indices were 95% and 85%. Further interview revealed that many of the hair loss patients were overweight (37.6%), moderately prone to stress (79.4%) and had endocrine imbalance (30%). 21.5% patients wanted physical improvement through transplantation. Conclusion: Our study results indicate that stress may be a major player in triggering alopecia, and although we were unable to prove a role for nutritional deficiencies and endocrine dysfunctions, these factors have been reported to play an important role in previous studies. However, large studies involving a greater sample/geographical size are needed in order to further elucidate their effects on alopecia in this particular population.

The study was performed to estimate the association of hypertension and dyslipidaemia with increasing body weight and obesity in Type II diabetics of Lahore, Pakistan. An observational study was conducted by enrolling 2708 obese diabetics from four diabetes care centres of Lahore, Pakistan. Data was collected for a period of 7 months. Associations were estimated using chi-square, binary and multinomial logistic regression. Data suggested that blood pressure, systolic and diastolic, exhibited continual increase with increasing body weight and obesity class in diabetes patients with 41.8% increase in the prevalence of hypertension in obesity class III subjects (OR; 1.91, p=0.02). Likewise, triglycerides and total cholesterol exhibited continual increase in their mean values with increasing obesity, i-e., an overall increase in the prevalence of dyslipidaemia of 27.2% in obesity class 3 subjects (OR; 1.94, p=0.29). Taken together, this data suggested that hypertension is potentially associated with increasing obesity in diabetics, while dyslipidaemia demonstrated plausible association only with obesity class 3.