PRE DIABETES IN YOUNG MEDICAL STUDENTS

Introduction: A study was conducted among students of a public medical college in Lahore, Pakistan to determine proportion of pre diabetic students (Blood sugar levels between 100 mg/dl - 125 mg/dl, accord- Waseem M.1 Fourth Year MBBS Student Sheikh Khalifa Bin Zayed Al-Nahyan Medical College, Lahore Bokhari F.A.2 Assistant Professor, Department of Physiology, Sheikh Khalifa Bin Zayed Al-Nahyan Medical College, Lahore Jalal M.A.3 Fourth Year MBBS Student Sheikh Khalifa Bin Zayed Al-Nahyan Medical College, Lahore Zahra Z.4 Fourth Year MBBS Student Sheikh Khalifa Bin Zayed Al-Nahyan Medical College, Lahore Khalid M.5 Fourth Year MBBS Student Sheikh Khalifa Bin Zayed Al-Nahyan Medical College, Lahore Aman M.6 Fourth Year MBBS Student Sheikh Khalifa Bin Zayed Al-Nahyan Medical College, Lahore ing to American Diabetes Association) and its relation with body mass index, family history of Diabetes, die-tary habits, socioeconomic status and physical activity. Methods: A cross sectional survey was conducted at Sheikh Zayed Medical Complex in February 2013 on medical students of either gender. Data was collected on a validated questionnaire. Fasting blood sugar lev-els of 65 students (enrolled after taking informed con-sent) were taken by trained co investigators through standardized glucose meter. Results: A total of 65 medical students (43 males and 22 females) enrolled in this study. Their ages ranged from 18 to 23 years (mean age 20.56 ± 0.97 years). No student was found to be pre diabetic. Fasting blood sugar level in male participant with a family historyof diabetes was significantly higher (85 ± 6.228 vs. 79.857 ± 6.602, P = 0.016). Conclusion: In this study, no student was found to be pre diabetic, though male participants with a family history of diabetes had higher fasting blood sugar levels. However, a larger study sample is required so that any significant finding may be shown, if it exists. Data on prevalence of pre-dia-betes in youth in South Asia is scarce. The high incidence of diabetes in developing countries un-derlines the need to explore prevalence of pre dia-betes in the younger population. Key Words: Pre diabetes, Impaired Fasting Glucose (IFG).

Outcomes Associated with Treatment of Hyperthyroidism with Radioiodine; A Single Center Retrospective Study

Background: Hypothyroidism and hyperthyroidism are prevalent conditions with potentially crippling health consequences that globally affect all populations. Hyperthyroidism is overproduction and persistent release of thyroid hormones that can be stratified into a number of subtypes with varying magnitudes and treatment outcomes. Despite of decades of treatment of hyperthyroidism with radioiodine, the success of treatment is still debatable and influenced by many factors. Objective: To determine outcomes associated with treatment of hyperthyroidism with radioiodine. Methods: All patients screened for thyroid disease at King Abdullah Medical City, Makkah in between 2012-17 were included in the analysis (N = 353). Eighteen questions were used to assess the presence or absence of symptoms associated with hyperthyroidism. 251 out of 353 patients were found eligible for screening with thyroid-stimulating hormone, free triiodothyronine (fT3) and free thyroxin (fT4). On the basis of laboratory analysis, 73 patients were eligible for the differing RAI therapeutic regimens. Treatment outcomes were assessed 6 months after the patients received RAI therapy, at which time they were classified as being hypothyroid, euthyroid, or hyperthyroid. Results: Females were predominantly affected by hyperthyroidism (75.2%) compared with males (24.8%). However, males were significantly more likely than females to have Graves’ ophthalmopathy (p < 0.01), anxiety (p < 0.05), and insomnia (p < 0.05). A total RAI dose of ≤15 mCi was effective in eliminating most hyperthyroidism: ≤12 mCi, 26/29 = 89.7%; 12.1–15 mCi, 28/30 = 93.3%. Using bivariate analysis, the association of treatment effectiveness with each of the symptoms and comorbidities revealed significant correlations only for diabetes mellitus (rho = −0.428, p < 0.001). Conclusions: Our data suggests that radioiodine remains an effective option of treating hyperthyroidism in most of the patients who qualify for it.

The Bell Jar_ Shattered: Exploration of creativity through a psychiatric lens

Aristotle’s theory of melancholia hypothesized for the first time that individuals who possess any form of genius are prone to depression more than the average person. The list of examples supplementing Aristotle’s theory is by no means exhaustive. Extensive medical research has also been done to establish this connection. We will briefly review our understanding of the relationship between creativity and mental illness. We will discuss the insights provided by the life and works of American poet, novelist and short story writer Sylvia Plath. Sylvia Plath extensively chronicled her struggle with lifelong depression in her semi-autobiographical novel 'The Bell Jar'.

Visual Inspection with Acetic Acid-an Acceptable Option in Screening of Cervical Cancer.

Objectives| To evaluate the accuracy of Visual Inspection with Acetic Acid (VIA) and Papanicolaou (Pap) smear as screening tests for cervical carcinoma and compare it with cervical biopsy as a gold standard. Methods| This was a cross-sectional study conducted at Gynae Unit 3 Services Institute of Medical Sciences from Jan 2016 to December 2016. All the married patients between 18 to 64 years of age were included in the study. Every patient underwent VIA, Pap smear and colposcopic directed biopsy from aceto white area as well as from 2:00 clock and 5:00 clock position. We determined the sensitivity, specificity, positive and negative predictive values of VIA, Pap smear and both tests and compared them with histopathology of biopsy specimen. Results| 476 women were screened in the study. Out of these, 110 (23.10%) patients were VIA positive and 40 (8.40%) patients were positive with Pap smear. Thirty seven (7.77%) patients were positive on both VIA and Pap smear. A total of 43 (9.03%) patients had cervical pre-malignancy on biopsy. The sensitivity of VIA and pap was 97.67%, 94.87% while specificity was 84.29% and 99.31%respectively (p=0.001). The PPV of VIA and pap was 38.18% and 92.5 %( p=0.00) while NPV was 99.7% and 99.5% respectively. The sensitivity and specificity of both tests combined was 94.59% and 99.54% while the PPV and NPV was 94.59% and 99.54% respectively. Diagnostic accuracy of VIA was 85.5%. Conclusion| VIA has high sensitivity and NPV which makes it an effective screening test for cervical carcinoma in developing countries like Pakistan. Pap smear can be combined to VIA positive cases to improve its specificity.

Thyroid Hormones Pattern in Preeclampsia.

Objectives: To assess thyroid hormones pattern in preeclampsia in third trimester, in our Pakistani population (Punjab). Methods| It was a Comparative cross- sectional study. Thyroid hormones; namely thyrotropin (TSH), Total triiodothyronine (tT3), free triiodothyronine (fT3), Total thyroxine (tT4) and free thyroxine (fT4) were evaluated by enzyme linked immunoassay (ELISA) in 17 diagnosed preeclamptic subjects with 16 number of matched normotensive pregnant subjects. Data was entered in the form of a questionnaire and analyzed by using version SPSS 17. Results| In this study the mean TSH concentration was 100% higher in preeclamptic subjects as compared to normotensive pregnant subjects, whereas Mean of tT3, tT4, fT3 and fT4were lower when compared between healthy normotensive pregnant and preeclamptic women but no significant difference was seen between both the groups. Conclusion| This study shows statistically non-significant increase in TSH levels and decrease in total and free T3 and T4 levels of PE as compared to the normotensive pregnant subjects.

Dermotraction as a Simple and Effective Technique for Fasciotomy Wound Closure.

Background| Fasciotomy is the best treatment option of acute compartment syndrome, but it results into large wounds which are difficult to manage. Different techniques have been utilized to manage the fasciotomy wounds which have their respective merits and demerits. This study was conducted to evaluate yet another novel technique which requires skin stapler and Prolene #1 sutures. Methods| This descriptive cases series was done using non-probability convenient sampling technique from January 2015 and June 2017 at Department of Orthopedics Surgery, King Edward Medical University / Mayo Hospital, Lahore. We included 24 fasciotomy wounds. They were managed with Dermotraction technique. We excluded patients with vascular injury. All wounds were successfully closed within an average time of seven days. The procedure was found to be cost effective, easy to execute and with minimal complications. Results| Amongst the total 13 patients, all were males of age ranging from 14 to 45year with mean age of 28.46±9.97. Majority, 10 patients (77 %) had acute compartment syndrome of leg and each patient managed with two fasciotomy wounds (N= 20). All fasciotomy wounds were closed with serial traction technique and the average time of closure was 07 days ranging from 3 days to 17 days 8.61±2.63. Conclusion| We concluded from the study that dermotraction technique has good outcome in fasciotomy wound closer and healing and it is a cost effective.

Efficacy and Safety of Intrauterine Balloon Tamponadeversus Uterovaginal Roll Gauze Packing in Patient Presenting with Primary Postpartum Hemorrhage after Normal Vaginal Delivery.

Objective| To compare the effectiveness and safety profile of intrauterine balloon tamponade with uterovaginal roll gauze packing among patient of primary postpartum hemorrhage after normal vaginal delivery. Duration of Study| This study was conducted in the Department of Obstetrics & Gynaecology, of a Tertiary Care Hospital, Lahore from December 2015 to November 2016. Patients and Methods| In this Randomized controlled trial,212 patients of age range 20 to 40 years who presented with postpartum hemorrhage after a normal vaginal delivery (NVD) those who did not responded to medical treatment were included. Cases of PPH due to perineal, cervical or vaginal tear, episiotomy, retained placenta, coagulation disorder, secondary PPH and PPH with normal vaginal delivery after previous cesarean section were excluded from this study. Subjects were randomly assigned to either intrauterine balloon tamponade or uterovaginal roll gauze packing. Intrauterine packing (IP) was removed after 24 hours and balloon tamponade after 24 hours of insertion. Antibiotic coverage was also given to prevent intrauterine infection. All females were kept under observation in ward. Effectiveness was labeled if bleeding was stopped within 15 minutes after uterovaginal packing or balloon tamponade (BT) and patient remain hemodynamically stable and if no complications occur after applying or removing balloon tamponade or intrauterine packing safety was labeled. Data was analyzed by SPSS version 20.2.Frequencies and percentage of complications were calculated along with rate of successful cessation of bleeding were calculated. Result| Mean age group of woman in whom balloon tamponade and intrauterine packing was used was 29.22+6.52 and 29.05+ 6.802 years. Mean gestational age of woman in BT and IP group and was 39.95+1.304 and 38.98+ 1.428 years. Mean blood loss in woman in BT and IP group was 600.28+ 25.338 and 669.21+70.176 ml. Efficacy of group BT was 78(73.6%) and in IP was 63(59.4%).Safety of BT group was 97(91.51%) and IP group was 55(51.88%). Treatment of balloon tamponade was more effective and safe than intrauterine packing in female presented with PPH after normal vaginal delivery (p < .05). Conclusion| This study concluded that balloon tamponade is an effective and safe method than intrauterine packing for the management of PPH after normal vaginal delivery.

Gender Differences in Nutritional Quality of Life of Young and Old Adults.

Background: Healthy eating is essential for individuals’ physical as well as psychological wellbeing. Women’s focus on achieving thin ideal physique and men’s aspiration for muscular body is likely to impact their food intake and consequently Nutritional Quality of Life (NQoL). Moreover, NQoL varies across different age groups owing to the varying nutritional needs with increasing age. Investigating NQoL across gender and age has useful implications for health counseling and practice. Objectives| To investigate differences in nutritional quality of life among gender and different age groups. To investigate gender and age group differences in knowledge of nutritional value of food. Methodology| A descriptive cross-sectional research was conducted. The sample consisted of 200 participants i.e., 100 younger adults between age range of 18-23 years and 100 older adults between age range of 40-60 years. Gender of participants was equally represented in both age groups. Nutritional Quality of Life (NQoL) Instrument and a self-developed Nutritional Knowledge Questionnaire were administered on the sample to collect data. Results| Mean age of younger adults was 19.17 ± 1.18 and for older adults it was 48.17 ± 5.20. Findings showed that women scored significantly higher on psychological factor and social impact whereas men scored significantly higher on food impact and self-efficacy impact of NQoL. Moreover younger adults scored higher on self-efficacy than older adults and older adults scored higher on food impact, social impact, psychological factor and physical functioning than younger adults. Also interaction of gender and age was significant regarding knowledge of nutritional value of food; older women and younger men had more knowledge of nutritional value of food than younger women and older men. Conclusions| There were significant differences in nutritional quality of life. Also knowledge of nutritional value of food varied across gender and age groups.

Dietary Intake Pattern Associated with General and Central Obesity Among Professional Drivers of Multan, Pakistan.

Background: Obesity among professional drivers is a considerable issue. The study focuses on the dietary intake pattern of the professional drivers in order to assess their general and central obesity. Methodology| A cross-sectional study of 197 professional drivers was carried out for public transport and loader vehicles. Convenient sampling technique was adopted for data collection. Dietary pattern of the drivers and its association with their body mass index (BMI), and waist circumference (WC) were focused. Along with descriptive statistics and percentages, chi-square test and two-sample t-test were used to analyze the data. Results| The mean BMI of the participants was 25.48 (+4.21) Kg/m2 and WC was 93.48 (+ 11.01) cm, respectively. There is significant association between dietary pattern and obesity among the professional drivers (χ2 = 7.90, p-value< 0.05 for general obesity and χ2 = 8.13, p-value < 0.01 for central obesity). Majority of the drivers regularly eat three times a day and they eat mostly outside their home indicating one of the major factor of obesity (both general and central). Conclusion| The study with professional drivers reveals that dietary intake behaviour is associated with obesity and the professional drivers should be careful about their dietary pattern especially while taking meals outside their homes.

Effect of Production of Multiple Keloids on Health of the Animal

Keloids are fibrous tumors developed in the process of wound healing. Keloids are found solely in human species, and not in animals. Keloid animal model has been developed by the authors. Now authors want to investigate if multiple keloids can be produced in one animal without causing any untoward effects on the health of that animal. Objective | To find out effect of production of multiple keloids on health of the animal. Methodology| The study was Quasi-experimental trial and settings were Experimental Research/Pathology Laboratories, University of Health Sciences, Lahore. The duration was 12 months. Two rabbits were taken; one as control, and other as interventional. In interventional rabbit eight keloids were produced, four on each ear, using Mannan & Hannan technique. Results | Eight keloids were produced in one animal without causing any untoward effects on the health of that animal. Conclusion| Multiple keloids can be produced in one animal without causing any untoward effects on the health of that animal.