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Akram M, Handelsman DJ, Qayyum M, Kennerson M, Rauf S, Ahmed S, Ishtiaq O, Ismail M, Mansoor Q, Naseem AA, Rizvi SSR. Genetic analysis of failed male puberty using whole exome sequencing. J Pediatr Endocrinol Metab 2022; 35:1410-1421. [PMID: 36103668 DOI: 10.1515/jpem-2022-0254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/29/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Although at least 598 genes are involved in the development of the hypothalamo-pituitary-testicular (HPT) axis, mutations in only 75 genes have so far been shown to cause delayed puberty. METHODS Six male patients with failed puberty, manifested as absence of pubertal changes by 18 years of age, underwent whole exome sequencing of genomic DNA with subsequent bioinformatics analysis and confirmation of selected variants by Sanger sequencing. Genes having plausibly pathogenic non-synonymous variants were characterized as group A (previously reported to cause delayed puberty), group B (expressed in the HPT-axis but no mutations therein were reported to cause delayed puberty) or group C (not reported previously to be connected with HPT-axis). RESULTS We identified variants in genes involved in GnRH neuron differentiation (2 in group A, 1 in group C), GnRH neuron migration (2 each in groups A and C), development of GnRH neural connections with supra-hypothalamic and hypothalamic neurons (2 each in groups A and C), neuron homeostasis (1 in group C), molecules regulating GnRH neuron activity (2 each in groups B and C), receptors/proteins expressed on GnRH neurons (1 in group B), signaling molecules (3 in group C), GnRH synthesis (1 in group B), gonadotropins production and release (1 each in groups A, B, and C) and action of the steroid hormone (1 in group A). CONCLUSIONS Non-synonymous variants were identified in 16 genes of the HPT-axis, which comprised 4 in group A that contains genes previously reported to cause delayed puberty, 4 in group B that are expressed along HPT-axis but no mutations therein were reported previously to cause delayed puberty and 8 in group C that contains novel candidate genes, suggesting wider genetic causes of failed male puberty.
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Affiliation(s)
- Maleeha Akram
- Department of Zoology, Wildlife and Fisheries, Pir Mehr Ali Shah Arid Agriculture University Rawalpindi, Rawalpindi, Pakistan
| | - David J Handelsman
- The ANZAC Research Institute (ARI), University of Sydney, Concord, NSW, Australia
| | - Mazhar Qayyum
- Department of Zoology, Wildlife and Fisheries, Pir Mehr Ali Shah Arid Agriculture University Rawalpindi, Rawalpindi, Pakistan
| | - Marina Kennerson
- The ANZAC Research Institute (ARI), University of Sydney, Concord, NSW, Australia
| | - Sania Rauf
- Department of Zoology, Wildlife and Fisheries, Pir Mehr Ali Shah Arid Agriculture University Rawalpindi, Rawalpindi, Pakistan.,Department of Biosciences, University of Wah, Quaid Avenue, Wah Cantt, Pakistan
| | - Shahid Ahmed
- Department of Endocrinology, Military Hospital, Rawalpindi, Pakistan
| | - Osama Ishtiaq
- The Endocrinology and Diabetes Department, Shifa International Hospitals Ltd, Islamabad, Pakistan
| | - Muhammad Ismail
- Institute of Biomedical and Genetic Engineering (IBGE), Islamabad, Pakistan
| | - Qaisar Mansoor
- Institute of Biomedical and Genetic Engineering (IBGE), Islamabad, Pakistan
| | - Afzaal Ahmed Naseem
- Department of Zoology, Wildlife and Fisheries, Pir Mehr Ali Shah Arid Agriculture University Rawalpindi, Rawalpindi, Pakistan
| | - Syed Shakeel Raza Rizvi
- Department of Zoology, Wildlife and Fisheries, Pir Mehr Ali Shah Arid Agriculture University Rawalpindi, Rawalpindi, Pakistan
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Ahmed I, Raja UY, Wahab MU, Rehman T, Ishtiaq O, Aamir AH, Ghaffar T, Raza A, Kumar S, Sherin A, Masood F, Randhawa FA, Asghar A, Khan S. Efficacy and safety of combination of empagliflozin and metformin with combination of sitagliptin and metformin during Ramadan: an observational study. BMC Endocr Disord 2022; 22:247. [PMID: 36224542 PMCID: PMC9560019 DOI: 10.1186/s12902-022-01168-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 09/19/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Management of diabetes during fasting is a clinical challenge. Sodium glucose co-transporter -2 inhibitors (SGLT2i) are considered safe with a low risk of hypoglycemia. However, studies on SGLT2i are scarce. This study was designed to compare the efficacy, safety, and tolerability of empagliflozin with metformin during Ramadan in comparison with sitagliptin and metformin. METHODS It was a prospective, observational study, conducted at 11 different sites all across Pakistan on an outpatient basis during Ramadan (May 2021-June 2021). including 132 patients, 88 who received metformin and sitagliptin, and 44 patients who received metformin and empagliflozin. RESULTS Patients of the SGLT-2i group experienced similar symptomatic hypoglycemic episodes (15.9%) as the sitagliptin group. There was an improvement in blood sugar levels after the use of SGLT-2i (RBS 181 ± 64 before Ramadan vs 162 ± 53 after Ramadan). HbA1c also improved after the use of SGLT-2i before and after Ramadan (7.2 ± 0.8 vs 6.9 ± 0.9 for Metformin + Empagliflozin and 7.8 ± 1.5 vs 7.6 ± 1.6 for Metformin and sitagliptin). Weight and BMI improved after the use of SGLT-2i (BMI 36.5 ± 4.8 before Ramadan and 33.7 ± 2.4 after Ramadan). There were no reported cases of urinary tract infection in the empagliflozin group. CONCLUSION SGLT-2 inhibitors combined with metformin for patients with diabetes during Ramadan fasting is as effective, safe and well tolerated as DPP4 combined with metformin.
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Affiliation(s)
- Ibrar Ahmed
- Lady Reading Hospital, Soekarno Rd, PTCL Colony, Peshawar, House No 6A, Street 2, Akbar Town Danishabad, Near Academy Hostel, Peshawar, Khyber Pakhtunkhwa Pakistan
| | - Umar Yousaf Raja
- Shifa International, Pitras Bukhari Road, Sector H-8/4, Islamabad, Pakistan
| | - Muhammad Umar Wahab
- Umer Diabetes and Foot Clinic, Malak shafait plaza, Mauza Mahal kot, Hathial, Main Murree Rd, Bhara Kahu, Islamabad, Pakistan
| | - Tejhmal Rehman
- Shifa International, Pitras Bukhari Road, Sector H-8/4, Islamabad, Pakistan
| | - Osama Ishtiaq
- Shifa International, Pitras Bukhari Road, Sector H-8/4, Islamabad, Pakistan
| | - A. H. Aamir
- Hayatabad Medical Complex, Phase-4 Phase 4 Hayatabad, Peshawar, Khyber Pakhtunkhwa Pakistan
| | - Tahir Ghaffar
- Hayatabad Medical Complex, Phase-4 Phase 4 Hayatabad, Peshawar, Khyber Pakhtunkhwa Pakistan
| | - Abbas Raza
- Shaukat Khanum Hospital, 153-E, Shah Noor Park (adjacent Clinix Pharmacy Head Office), Main Multan Road, Lahore, Pakistan
| | - Suresh Kumar
- Bolan Medical, Brewery Rd, Quetta, Balochistan Pakistan
| | - Akhtar Sherin
- KMU Institute of Medical Sciences, KIMS, Phase 2, KDA, Khyber Pakhtoonkhwa, Phase 2 Kohat Development Authority (KDA), Kohat Development Authority, KohatKohat, Khyber Pakhtunkhwa Pakistan
| | - Faisal Masood
- Alkhaliq Hospital, Nishtar Rd، Al Rahim Colony, Multan, Punjab Pakistan
| | | | - Ali Asghar
- Liaquat National Hospital, National Stadium Rd, Liaquat National Hospital, Karachi, Karachi City, Sindh Pakistan
| | - Sehrish Khan
- Liaquat National Hospital, National Stadium Rd, Liaquat National Hospital, Karachi, Karachi City, Sindh Pakistan
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Kamin M, Khan SA, Raja UY, Ishtiaq O, Malik A, Rehman T, Wahab MU. Efficacy and Safety of Dulaglutide in Type 2 Diabetes Patients in Endocrinology Clinics of Islamabad, Pakistan. Indian J Endocrinol Metab 2021; 25:456-461. [PMID: 35300442 PMCID: PMC8923314 DOI: 10.4103/ijem.ijem_402_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 10/18/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Our objective was to ascertain the efficacy and safety of once weekly Dulaglutide among patients with Type 2 diabetes of Pakistani origin. METHODS This prospective cohort study was conducted at the Endocrinology Clinics of Shifa International Hospital, Islamabad and Umar Diabetes and Foot Care Centre, Islamabad, Pakistan during the period from July 2020 to December 2020. Dulaglutide at the dose of 1.5 mg once weekly was initiated in patients with BMI >28 and suboptimal glucose control in the background of Type 2 Diabetes who were also taking one or more of oral anti-diabetic and/or insulin therapy. RESULTS Mean age of patient cohort (n = 148) was 49.51 years (SD +/- 12.15) with 53.5% (n = 85) having type 2 diabetes for a duration of over 10 years. Mean weight was 93.2 kg at baseline with end of study mean weight being 90.7 kg. Mean HbA1c at baseline was 9.2%, which improved to 8.05% at the end of study. The main side-effects were nausea in 32%, vomiting in 8%, and diarrhea in 7% with 19% discontinuation rate due to cost and side-effects. CONCLUSION Dulaglutide as a therapy demonstrated favorable HbA1c and weight reduction in obese type 2 diabetes patients of Pakistani origin.
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Affiliation(s)
- Matiullah Kamin
- Department of Endocrine, Bolan University of Medical and Health Sciences, Quetta, Pakistan
| | - Sajjad Ali Khan
- Department of Endocrine, Aga Khan University Hospital, Karachi, Pakistan
| | - Umar Yousaf Raja
- Department of Endocrine, Shifa International Hospital, Islamabad, Pakistan
| | - Osama Ishtiaq
- Department of Endocrine, Shifa International Hospital, Islamabad, Pakistan
| | - Asmara Malik
- Department of Community Medicine, National University of Medical Sciences, Karachi, Pakistan
| | - Tejhmal Rehman
- Department of Endocrine, Shifa International Hospital, Islamabad, Pakistan
| | - Muhammad Umar Wahab
- Department of Diabetes, Umar Diabetes and Foot Care Clinic and Umar Diabetes Foundation, Islamabad, Pakistan
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Raashid K, Ishtiaq O, Kamin M, Rehman T, Khan SA, Raja U, Shah FH. Weight and Body Mass Index for Predicting Thyroxine Dose in Primary Hypothyroidism. Cureus 2021; 13:e15031. [PMID: 34136323 PMCID: PMC8200257 DOI: 10.7759/cureus.15031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background The treatment of primary hypothyroidism with thyroxine is weight-based or body mass index (BMI)-based. However, significant variation in the dose and the consequent delay in achieving euthyroid state is observed along the spectrum of patient body weights. Objectives To determine the weight and BMI-based dosing of thyroxine in primary hypothyroidism to achieve euthyroidism. Material and methods It was a retrospective review of the patient records conducted in the department of endocrinology, Shifa International Hospital, Islamabad, from July 1, 2014, to June 30, 2019 (five-year period). Patients with clinical and biochemical hypothyroidism were enrolled and initiated on thyroxine replacement to achieve euthyroid status. A total of 504 patients were included in the study. Results The mean age was 44.5 ±13.6 standard deviation. Females were 83.5%. The mean dose of thyroxine to achieve euthyroid status was 107.7 ± 39.3 mean standard deviation mcg/day, i.e. 1.4 (0.5) mcg/kg/day. Euthyroid status was achieved in 264 (52.4%) of patients at three months. The mean TSH level after treatment was 2.09 (1.2) mU/L. The linear regression model showed that BMI and weight are independent predictors of the required thyroxine dose (R and Rsquare values are .274 and 0.075 for BMI and .319 and .102 for weight, respectively (P-value <.0001). There was no impact of age, gender, height, and duration of disease on achieving euthyroid at six months after treatment (P values: .85, .394, .827, and .105, respectively). Conclusion The optimum dose in primary hyperthyroidism can be determined with body weight and BMI-based calculations.
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Affiliation(s)
- Kashif Raashid
- Endocrinology and Diabetes, Shifa International Hospital, Islamabad, PAK
| | - Osama Ishtiaq
- Endocrinology and Diabetes, Shifa International Hospital, Islamabad, PAK
| | - Matiullah Kamin
- Endocrinology and Diabetes, Shifa International Hospital, Islamabad, PAK
| | - Tejhmal Rehman
- Endocrinology and Diabetes, Shifa International Hospital, Islamabad, PAK
| | - Sajjad Ali Khan
- Department of Medicine, Section of Diabetes and Endocrinology, Aga Khan University Hospital, Karachi, PAK
| | - Umar Raja
- Endocrinology, Shifa International Hospital, Islamabad, PAK
| | - Fazal H Shah
- Medicine, Tehsil Headquarters (THQ) Hospital, Bhakkar, PAK
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Zameer R, Kamin M, Raja U, Wahab MU, Ishtiaq O, Raashid K, Ahmed N, Rehman A. Effectiveness, Safety, and Patient Satisfaction of Liraglutide in Type 2 Diabetic Patients. Cureus 2020; 12:e9937. [PMID: 32864274 PMCID: PMC7449611 DOI: 10.7759/cureus.9937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Kamin M, Ishtiaq O, Raashid K, Wahab MU, Khan SA, Raja U. The Outcomes of Dapagliflozin Use in Real-Life Clinical Settings in Endocrinology Clinics of Islamabad, Pakistan. Cureus 2020; 12:e8565. [PMID: 32550088 PMCID: PMC7294883 DOI: 10.7759/cureus.8565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 06/11/2020] [Indexed: 01/10/2023] Open
Abstract
Introduction Dapagliflozin is a member of a novel class of drugs (sodium-glucose cotransporter-2 inhibitors) used to treat type 2 diabetes mellitus and licensed in Pakistan in 2017. This retrospective observational study evaluated the effects of dapagliflozin on glycated hemoglobin (HbA1c) concentrations in patients treated at endocrinology clinics in Islamabad, Pakistan. The secondary objectives included assessing the effects of dapagliflozin on weight reduction and blood pressure control and to determining its safety. Methodology Patients with type 2 diabetes who were treated with dapagliflozin were identified by screening the electronic medical records at tertiary care hospitals in Islamabad. Data were collected at the first visit and at follow-up. Categorical variables were recorded as frequencies and percentages and compared by McNemar's tests, and continuous variables were recorded as means and standard deviations and compared by paired sample t-tests. Results Mean HbA1C concentration was significantly lower at follow-up than at the first visit (7.57%±0.98% vs. 9.07%±2.07%, respectively; p<0.001). Bodyweight (85.09±15.92 kg vs. 87.07±16.11 kg, respectively; p<0.001) and diastolic blood pressure (80.34±7.12 mmHg vs. 82.34±9.61 mmHg, respectively; p<0.001) were also significantly lower at follow-up than at the first visit, whereas systolic pressure showed a marginally significant reduction (123.5±16.57 mmHg vs. 126.83±19.97 mmHg, p=0.048). Conclusion This first observational study of patients in Pakistan treated with dapagliflozin found that HbA1c concentration, weight, and blood pressure were reduced after initiation of dapagliflozin treatment.
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Affiliation(s)
- Matiullah Kamin
- Endocrinology, Shifa International Hospital, Islamabad , PAK
| | - Osama Ishtiaq
- Endocrinology, Shifa International Hospital, Islamabad, PAK
| | - Kashif Raashid
- Endocrinology, Shifa International Hospital, Islamabad, PAK
| | - Muhammad Umar Wahab
- Endocrinology, Umar Diabetes and Footcare Clinic, Islamabad, PAK
- Diabetology, Umar Diabetes Foundation, Islamabad, PAK
| | | | - Umar Raja
- Endocrinology, Shifa International Hospital, Islamabad, PAK
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Raza SA, Aamir AH, Jawa A, Qureshi FM, Ahmad I, Khan KM, Khan K, Naseer N, Islam N, Ishtiaq O, Mahar SA. Expert Opinion: Use of sodium glucose co-transporter type-2 inhibitors in South Asian population -The Pakistan perspective. J PAK MED ASSOC 2019; 69:555-563. [PMID: 31000862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Sodium-glucose co-transporter type 2 inhibitors (SGLT 2- i)are increasingly being used in the management of type 2 diabetes mellitus (T2DM). With the novel insulinindependent glycosuric action, these agents help to attain glycaemic goals by lowering HbA1c and fasting blood glucose. In addition, these agents improve metabolic control in diabetes and ameliorate comorbidities like obesity and hyper tension. Beneficial effec ts on cardiovascular outcomes have been a key attraction for physicians. These agents are used alone or in combination with oral antidiabetic agents and insulin to attain glycaemic and metabolic targets. A major disadvantagewith these agents is the increased risk for genital andurinary infections. When used in appropriate settings, there is no additional increased risk of hypoglycaemia or volume depletion with these agents. Available evidence suggests good efficacy and safety of these agents in diabetes management. The easy and convenient oncedaily dosing should be customized according to patient needs and glycaemic profiles.
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Affiliation(s)
- Syed Abbas Raza
- Shaukat Khanum Cancer Hospital and Research Center. Johar Town, Lahore, Punjab. Pakistan
| | - A H Aamir
- Hayatabad Medical Complex Peshawar. Pakistan
| | - Ali Jawa
- Wilshire Cardiovascular and Endocrine Center of Excellence WILCARE Lahore
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Aamir AH, Ul-Haq Z, Mahar SA, Qureshi FM, Ahmad I, Jawa A, Sheikh A, Raza A, Fazid S, Jadoon Z, Ishtiaq O, Safdar N, Afridi H, Heald AH. Diabetes Prevalence Survey of Pakistan (DPS-PAK): prevalence of type 2 diabetes mellitus and prediabetes using HbA1c: a population-based survey from Pakistan. BMJ Open 2019; 9:e025300. [PMID: 30796126 PMCID: PMC6398762 DOI: 10.1136/bmjopen-2018-025300] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES We conducted a Pakistan-wide community-based survey on the prevalence of type 2 diabetes using glycated haemoglobin (HbA1c) as the screening test. The aim was to estimate diabetes prevalence across different demographic groups as well as all regions of Pakistan. DESIGN, SETTINGS AND PARTICIPANTS Multistaged stratified cluster sampling was used for the representative selection of people aged ≥20 years, residing in 378 sampled clusters of 16 randomly selected districts, in this cross-sectional study. Eligible participants had blood drawn for HbA1c analyses at field clinics near to their homes. The oral glucose tolerance test (OGTT) was conducted on a subsample of the participants. Overall and stratified prevalence of type 2 diabetes and its association with risk factors were estimated using logistic regression models. MAIN OUTCOME MEASURES Prevalence of prediabetes and type 2 diabetes. RESULTS Of 18 856 eligible participants the prevalence of prediabetes was 10.91% (95% CI 10.46 to 11.36, n=2057) and type 2 diabetes was 16.98% (95% CI 16.44 to 17.51, n=3201). Overall, the mean HbA1c level was 5.62% (SD 1.96), and among newly diagnosed was 8.56% (SD 2.08). The prevalence was highest in age 51-60 years (26.03%, p<0.001), no formal education (17.66%, p<0.001), class III obese (35.09%, p<0.001), family history (31.29%, p<0.001) and female (17.80%, p=0.009). On multivariate analysis, there was a significant association between type 2 diabetes and older age, increase in body mass index and central obesity, positive family history, and having hypertension and an inverse relation with education as a categorical variable. On a subsample (n=1027), summary statistics for diagnosis of diabetes on HbA1c showed a sensitivity of 84.7%, specificity of 87.2% and area under the receiver operating characteristic curve 0.86, compared with OGTT. CONCLUSIONS The prevalence of type 2 diabetes and prediabetes is much higher than previously thought in Pakistan. Comprehensive strategies need to be developed to incorporate screening, prevention and treatment of type 2 diabetes at a community level.
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Affiliation(s)
- Azizul Hasan Aamir
- Department of Diabetes, Endocrinology and Metabolic Diseases, Hayatabad Medical Complex, Peshawar, Pakistan
| | - Zia Ul-Haq
- Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Pakistan
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Saeed A Mahar
- Endocrinology, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | | | - Ibrar Ahmad
- Endocrinology Ward, Lady Reading Hospital, Peshawar, Pakistan
| | - Ali Jawa
- Endocrinology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Aisha Sheikh
- Endocrinology, Aga Khan University, Karachi, Pakistan
| | - Abbas Raza
- Endocrinolgy, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Sheraz Fazid
- Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Zahid Jadoon
- Hayatabad Medical Complex Department of Ophthalmology, Epidemiology, Peshawar, KP, Pakistan
| | - Osama Ishtiaq
- Endocrinology, Shifa College of Medicine, Islamabad, Pakistan
| | - Nauman Safdar
- Social Work, Social and Health Inequalities Network, Islamabad, Islamabad, Pakistan
| | - Hussain Afridi
- Department of Diabetes, Endocrinology and Metabolic Diseases, Hayatabad Medical Complex, Peshawar, Pakistan
| | - Adrian H Heald
- The School of Medicine and Manchester Academic Sciences Centre, University of Manchester, Manchester, UK
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Farooq MU, Mushtaq F, Naeem Z, Iqbal S, Naseem S, Ishtiaq O. Dietary habits and practices of type-2 diabetic patients in a tertiary care centre of Islamabad, Pakistan. J PAK MED ASSOC 2018; 68:825-830. [PMID: 29885196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To determine the relation between food intake and diabetes control. METHODS This cross-sectional study was carried out at Department of Medicine and Endocrinology, Shifa International Hospital, Islamabad, Pakistan, from July 2016 to February 2017, during which type-2 diabetes patients were interviewed using a structured questionnaire. Demographics, intake of high glycaemic index foods consumed in each food group, and general dietary practices were assessed by means of number of meals per day and adherence to the dietary plan. Glycated haemoglobin A1c values were recorded as well. SPSS 21 was used for data analysis. RESULTS Of the 180 patients, 100(55.6%) were taking three meals a day. Besides, 108(60%) had an income >Rs50,000. Moreover, 127(70.6%) patients were not aware of the type of diabetes, while 117(65%) patients had high glycated haemoglobin levels. Furthermore, 148(82.2%) made a change in diet following diabetes diagnosis, while 168(93.3%) had recommended food available in their house, and 65(36.1%) followed a strictly-recommended dietary schedule. A statistically significant association was found between the consumption of different desserts/sweets and glycated haemoglobin levels (p=0.008) followed by fruit intake like mangoes (p=0.004) and grapes (p=0.02). CONCLUSIONS There is a need to educate diabetics regarding diet management in terms of glycaemic index of foods.
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Affiliation(s)
| | - Fahad Mushtaq
- Shifa College of Medicine, ShifaTameer-e-Millat University, Islamabad
| | - Zoha Naeem
- Shifa College of Medicine, ShifaTameer-e-Millat University, Islamabad
| | - Safa Iqbal
- Shifa College of Medicine, ShifaTameer-e-Millat University, Islamabad
| | - Sajida Naseem
- Shifa College of Medicine, ShifaTameer-e-Millat University, Islamabad
| | - Osama Ishtiaq
- Shifa International Hospitals Ltd Islamabad, Pakistan Shifa College of Medicine, ShifaTameer-e-Millat University, Islamabad, Pakistan
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Noon MJ, Khawaja HA, Ishtiaq O, Khawaja Q, Minhas S, Niazi AK, Minhas AMK, Malhi UR. Fasting with diabetes: a prospective observational study. BMJ Glob Health 2016; 1:e000009. [PMID: 28588932 PMCID: PMC5321331 DOI: 10.1136/bmjgh-2015-000009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 07/08/2016] [Accepted: 07/12/2016] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To determine the proportion of diabetic patients who develop adverse glycaemic events when fasting regularly. DESIGN Prospective observational study conducted at a tertiary care hospital in South Asia. Five hundred and twenty-three patients were assessed for eligibility, and 150 were included in the final analysis. Diabetic patients over 18 years of age who were willing to fast regularly and make a chart of their daily blood sugar levels were included in the study. The main outcome measures were hypoglycaemic and hyperglycaemic events. Frequencies and percentages were calculated for quantitative variables, while mean±SD were documented for qualitative variables. Relative risk was calculated as a measure of association. RESULTS Of a total of 150 individuals, 10% experienced hypoglycaemia, while 3.3% reported hyperglycaemic episodes. Only 8.7% of the participants discontinued one or more fasts; however, none of them required hospitalisation. There is a negative association between a visit to a physician by diabetic patients before they begin to fast regularly and the risk of developing hypoglycaemia (relative risk 0.73). CONCLUSIONS Many diabetic patients who fast regularly are at high risk of adverse glycaemic events. Most diabetics do not consult their physicians before fasting to adjust medications and lifestyle. Various strategies should be planned and implemented for the awareness and education of such patients to avoid adverse glycaemic events and subsequent complications.
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Affiliation(s)
- Muhammad Jawad Noon
- Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | | | - Osama Ishtiaq
- Department of Endocrinology, Shifa International Hospital, Islamabad, Pakistan
| | | | - Sana Minhas
- Shifa International Hospital, Islamabad, Pakistan
| | - Asfandyar Khan Niazi
- Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
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Pathan F, Latif ZA, Sahay RK, Zargar AH, Raza SA, Khan AKA, Siddiqui NI, Amin F, Ishtiaq O, Shrestha D, Somasundaram N, Kalra S. Update to South Asian consensus guideline: Use of newer insulins in diabetes during Ramadan Revised Guidelines on the use of insulin in Ramadan. J PAK MED ASSOC 2016; 66:777-778. [PMID: 27339590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This guidance is an update to the South Asian Consensus Guideline: Use of Insulin in Diabetes during Ramadan, published in the Indian Journal of Endocrinology and Metabolism in 2012. A five country working group has collated evidence and experience to suggest guidelines for the safe and rational use of insulin degludec (IDeg) and insulin degludec aspart (IDegAsp) during Ramadan. The suggestions contained herewith are based on the pharmacokinetic and pharmacodynamics properties of these novel insulins.
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Affiliation(s)
- Faruque Pathan
- Department of Endocrinology, Shaukhat Khanum Cancer Hospital and Research Center, Lahore, Pakistan
| | | | | | | | - Syed Abbas Raza
- Shaukhat Khanum Cancer Hospital and Research Center, Lahore, Pakistan
| | | | | | - Feroz Amin
- Department of Endocrinology, Shaukhat Khanum Cancer Hospital and Research Center, Lahore, Pakistan
| | - Osama Ishtiaq
- Department of Endocrinology, Shifa International Hospital, Islamabad, Pakistan
| | - Dina Shrestha
- Department of Endocrinology, Norvic International Hospital, Kathmandu, Nepal
| | | | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana, India
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Azad K, Mohsin F, Zargar AH, Zabeen B, Ahmad J, Raza SA, Tayyeb S, Bajaj S, Ishtiaq O, Kalra S. Fasting guidelines for diabetic children and adolescents. Indian J Endocrinol Metab 2012; 16:516-518. [PMID: 22837907 PMCID: PMC3401747 DOI: 10.4103/2230-8210.97998] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Fasting during the month of Ramadan, the ninth month of Islamic lunar calendar, is obligatory for all healthy adult and adolescent Muslims from the age of 12 years. Fasting starts from early dawn (Sohur/Sehri) till sunset (Iftar). During this period one has to abstain from eating and drinking. Islam has allowed many categories of people to be exempted from fasting, for example, young children, travelers, the sick, the elderly, pregnant, and lactating women. According to expert opinion, patients with type 1 diabetes (type 1 DM) who fast during Ramadan are at a very high risk to develop adverse events. However, some experienced physicians are of the opinion that fasting during Ramadan is safe for type 1 DM patients, including adolescents and older children, with good glycemic control who do regular self-monitoring and are under close professional supervision. The strategies to ensure safety of type 1 diabetic adolescents who are planning to fast include the following: Ramadan-focused medical education, pre-Ramadan medical assessment, following a healthy diet and physical activity pattern, modification in insulin regimen, and blood glucose monitoring as advised by the physician.
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Affiliation(s)
- Kiswhar Azad
- Paediatrics, BIRDEM and Ibrahim Medical College, Dhaka, Bangladesh
| | - Fauzia Mohsin
- Paediatrics, BIRDEM and Ibrahim Medical College, Dhaka, Bangladesh
| | - Abdul Hamid Zargar
- Department of Endocrinology, Advanced Center for Diabetes and Endocrine Care, Srinagar, India
| | - Bedowra Zabeen
- Paediatrics, BIRDEM and Ibrahim Medical College, Dhaka, Bangladesh
| | - Jamal Ahmad
- Rajiv Gandhi Centre for Diabetes and Endocrinology, J. N. Medical College, Aligarh Muslim University, Aligarh, India
| | - Syed Abbas Raza
- Endocrinologist, Shaukat Khanum Cancer Hospital and Research Center, Lahore, Pakistan
| | - Samin Tayyeb
- Paediatrics, BIRDEM and Ibrahim Medical College, Dhaka, Bangladesh
| | | | - Osama Ishtiaq
- Endocrinologist, Shifa International Hospital, Islamabad, Pakistan
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Siddiqi SS, Singh SK, Khan SA, Ishtiaq O, Pathan MF, Raza SA, Khan AKA, Zargar AH, Bantwal G. Guidelines regarding management of adrenal insufficiency in the Holy month of Ramadan. Indian J Endocrinol Metab 2012; 16:519-521. [PMID: 22837908 PMCID: PMC3401748 DOI: 10.4103/2230-8210.97999] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Adrenal insufficiency is a life-threatening event, so it is recommended for patients with known adrenal insufficiency to be properly educated regarding sick-day management. In the month of Ramadan, people refrain from eating and drinking during daylight hours. It is very important for patients with adrenal insufficiency, who wish to keep a fast, to be well aware of the disease, the suitable drug to be used for that particular period, warning signs, sick-day management, physical activity, and dietary limits. This article describes guidelines for the sick-day management of patients with adrenal insufficiency, in the month of Ramadan.
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Affiliation(s)
- Sheelu S. Siddiqi
- Rajiv Gandhi Center for Diabetes and Endocrinology, J.N. Medical College, Aligarh Muslim University, Aligarh, India
| | - S. K. Singh
- Department of Endocrinology and Metabolism, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Shakeel Ahamad Khan
- Department of Medicine, J.N. Medical College, Aligarh Muslim University, Aligarh, India
| | - Osama Ishtiaq
- Department of Endocrinology, Shifa International Hospital, Islamabad, Pakistan
| | | | - Syed Abbas Raza
- Department of Endocrinology, Shaukhat Khanum Cancer Hospital and Research Center, Lahore, Pakistan
| | | | - Abdul Hamid Zargar
- Department of Endocrinology, Advanced Center for Diabetes and Endocrine Care, Srinagar, India
| | - Ganapathy Bantwal
- Department of Endocrinology, St John's Medical College, Bangalore, India
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Pathan MF, Sahay RK, Zargar AH, Raza SA, Khan AKA, Ganie MA, Siddiqui NI, Amin F, Ishtiaq O, Kalra S. South Asian Consensus Guideline: Use of insulin in diabetes during Ramadan. Indian J Endocrinol Metab 2012; 16:499-502. [PMID: 22837903 PMCID: PMC3401743 DOI: 10.4103/2230-8210.97992] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A person with diabetes mellitus (DM) has every right to perform the ritual of fasting during Ramadan. In daily practice we come across both type 1 and type 2 DM who wish to fast. This Consensus Statement describes the pre-Ramadan assessment, planning, prescription, management, and monitoring of patients on insulin, who wish to fast.
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Affiliation(s)
| | | | - Abdul Hamid Zargar
- Department of Endocrinology, Advanced Center for Diabetes and Endocrine Care, Srinagar, India
| | - Syed Abbas Raza
- Department of Endocrinology, Shaukhat Khanum Cancer Hospital and Research Center, Lahore, Pakistan
| | | | | | | | - Firoz Amin
- Department of Endocrinology, BIRDEM, Dhaka, Bangladesh
| | - Osama Ishtiaq
- Department of Endocrinology, Shifa International Hospital, Islamabad, Pakistan
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana, India
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Abstract
In the month of Ramadan, patients with thyroid diseases, most of the time, do not need treatment adjustments and can fast safely without any health hazards. Patients with hypothyroidism taking thyroxine can take their tablets on an empty stomach at bedtime instead of half an hour before Sehr. Patients with hyperthyroidism, on methimazole/carbimazole can continue their dose in once or twice daily regimes, while those on propylthiouracil need to be switched. Hyperthyroid patients with severe symptoms should start treatment immediately and can avoid fast for few days after a consultation with their religious scholar.
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Affiliation(s)
- Syed A. Raza
- Shaukhat Khanum Cancer Hospital and Research Center, Lahore, Pakistan
| | | | | | | | - Jamal Ahmad
- Rajiv Gandhi Centre for Diabetes and Endocrinology, J. N. Medical College, Aligarh Muslim University, Aligarh, India
| | | | - Kishwar Azad
- BIRDEM and Ibrahim Medical College, Dhaka, Bangladesh
| | - Manash Baruah
- Department of Endocrinology, Excel Hospitals, Guwahati, India
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Bashir MI, Pathan MF, Raza SA, Ahmad J, Khan AKA, Ishtiaq O, Sahay RK, Sheikh A, Zargar AH. Role of oral hypoglycemic agents in the management of type 2 diabetes mellitus during Ramadan. Indian J Endocrinol Metab 2012; 16:503-507. [PMID: 22837904 PMCID: PMC3401744 DOI: 10.4103/2230-8210.97994] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
It is obligatory for all adult Muslims to observe fast during the holy month of Ramadan, but sick individuals including those with diabetes mellitus are exempted from the duty of fasting. Specific medical advice must be provided to individual patients concerning the potential risks they must accept if they decide to fast. Any alteration in medications deemed necessary to provide an effective and safe antidiabetic regimen should be instituted well before the start of Ramadan. Diet-controlled patients and those well controlled on insulin sensitizers have low risk of hypoglycemia and may safely fast with some modification in the timing of the doses. Newer generation sulfonylureas (gliclazide MR and glimepiride) have reasonable safety profile during Ramadan fasting and are economical options for a large number of diabetics worldwide, especially in the developing countries; older, long acting sulfonylureas like glibenclamide and chlorpropamide should be avoided during fasting. Oral DPP-IV inhibitors are important substitutes to sulfonylureas for patients with diabetes mellitus during fasting owing to their glucose-dependent mechanism of action, efficacy, and tolerability. This group of drugs causes a moderate A1c reduction, are weight neutral, and have a very low risk of hypoglycemia. Short-acting insulin secretagogues are an option in the subset of fasting diabetic patients who have predominantly post-prandial hyperglycemia.
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Affiliation(s)
| | | | - Syed Abbas Raza
- Department of Endocrinology, Shaukhat Khanum Cancer Hospital and Research Center, Lahore, Pakistan
| | - Jamal Ahmad
- Rajiv Gandhi Centre for Diabetes and Endocrinology, Faculty of Medicine, J. N. Medical College, Aligarh Muslim University, Aligarh, India
| | - A. K. Azad Khan
- President, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Osama Ishtiaq
- Department of Endocrinology, Shifa International Hospital, Islamabad, Pakistan
| | - Rakesh K. Sahay
- Department of Endocrinology, Osmania Medical College, Hyderabad, India
| | - Aisha Sheikh
- Section of Endocrinology, Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan
| | - Abdul Hamid Zargar
- Advanced Center for Diabetes and Endocrine Care, Srinagar, Jammu and Kashmir, India
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Abstract
Majority of physicians are of the opinion that Ramadan fasting is acceptable for well-balanced type 2 patients conscious of their disease and compliant with their diet and drug intake. Fasting during Ramadan for patients with diabetes carries a risk of an assortment of complications. Islamic rules allow patients not to fast. However, if patient with diabetes wish to fast, it is necessary to advice them to undertake regular monitoring of blood glucose levels several times a day, to reduce the risk of hypoglycemia during day time fasting or hyperglycemia during the night. Patient with type 1 diabetes who fast during Ramadan may be better managed with fast-acting insulin. They should have basic knowledge of carbohydrate metabolism, the standard principles of diabetes care, and pharmacology of various antidiabetic drugs. This Consensus Statement describes the management of the various diabetic emergencies that may occur during Ramadan.
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Affiliation(s)
- Jamal Ahmad
- Rajiv Gandhi Centre for Diabetes and Endocrinology, J. N. Medical College, Aligarh Muslim University, Aligarh, India
| | | | - Mohammed Abdul Jaleel
- Department of Medicine, Bangalore Diabetes Hospital, Vasanthanagar, and AJ Diabetes Care and Polyclinic, BTM Layout, India
| | - Farah Naaz Fathima
- Department of PSM, St. John's Medical College, and Hospital, Bangalore, India
| | - Syed Abbas Raza
- Department of Endocrinology, Shaukhat Khanum Cancer Hospital and Research Center, Lahore, Pakistan
| | | | - Osama Ishtiaq
- Department of Endocrinology, Shifa International Hospital, Islamabad, Pakistan
| | - Aisha Sheikh
- Section of Endocrinology, Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan
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Ishtiaq O, Qadri AM, Mehar S, Gondal GM, Iqbal T, Ali S, Janjua NZ. Disposal of syringes, needles, and lancets used by diabetic patients in Pakistan. J Infect Public Health 2012; 5:182-8. [PMID: 22541266 DOI: 10.1016/j.jiph.2012.02.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2011] [Revised: 02/10/2012] [Accepted: 02/16/2012] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To assess the use, handling and disposal of insulin injection equipment by diabetic patients in Pakistan. METHODS We conducted a cross-sectional study at diabetic clinics in five tertiary centers in Pakistan. All diabetic patients (type 1/type 2) who were on insulin for more than 1 month, were included. An Urdu (local language)-translated questionnaire was used to collect information on insulin administration equipment, the site and frequency of needle use, insulin syringe/pen/lancet disposal, sharing of needles and knowledge about diseases that are spread by sharing contaminated needles. RESULTS Of 375 patients, 58% were female. The mean (SD) duration of diabetes was 12.3 (7.3) years, and the duration of insulin use was 4.4 (4.3) years. The majority of the patients used syringes (88.3%) for insulin administration. Additionally, the majority of the patients disposed of used devices (syringes, 92%; pens, 75%; and lancets, 91%) in the household garbage collection bin. About half of the patients (n=185) reported being educated by their physicians about the disposal of sharps. Those who were educated by a physician (adjusted odds ratio (adjOR): 0.36; 95%CI: 0.16-0.81) or could read/write English (adjOR: 0.32; 95%CI: 0.11-0.92) were less likely to dispose of syringes and needles in the household garbage. CONCLUSION The common disposal of sharps in the household garbage has implications for disease transmission. Education on the safe disposal of sharps may improve the disposal practices.
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Ishtiaq O, Waseem S, Haque MN, Islam N, Jabbar A. Remission of Grave's disease after oral anti-thyroid drug treatment. J Coll Physicians Surg Pak 2010; 19:690-3. [PMID: 19889263 DOI: 11.2009/jcpsp.690693] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 07/10/2008] [Accepted: 07/02/2009] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate remission rate of anti-thyroid drug treatment in patients with Grave's disease, and to study the factors associated with remission. STUDY DESIGN A cross sectional study. PLACE AND DURATION OF STUDY The Endocrine Department of the Aga Khan University Hospital, Karachi from 1999 to 2000. METHODOLOGY Seventy four patients of Grave's disease were recruited who were prescribed medical treatment. Grave's disease was diagnosed in the presence of clinical and biochemical hyperthyroidism along with anti-microsomal (AMA) and anti-thyroglobulin antibodies (ATA) and thyroid scan. These patients were prescribed oral anti-thyroid drugs using titration regime and followed at 3, 6, 12 and 18 months. Patients were categorized into two groups: "remission group" and "treatment failure group" and results were compared using a chi-square test, t-test and logistic regression model with significance at p < 0.05. RESULTS A majority of the patients were females (62.6%, n=46). During the follow-up period of 18 months, 41.9% patients went into remission. Univariate analysis showed that the initial free T4 level was significantly different (p < 0.05) in patients in remission and treatment failure groups. Multivariate analysis showed only initial free T4 level was a significant predictor of outcome. Positive AMA patients (n=27) had higher treatment failure (odds ratio: 2.55: 95%, CI 0.69 - 9:31), although the difference was not statistically significant (p = 0.13). CONCLUSION Remission rates with oral anti-thyroid agents is markedly high. Patients should be offered alternate treatment options to those who do not enter remission during a period of 12-18 months of treatment, those who develop relapse, and those who have aggressive disease on initial presentation.
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Affiliation(s)
- Osama Ishtiaq
- Department of Medicine, The Aga Khan University Hospital, Karachi.
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20
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Ishtiaq O, Haq MU, Rizwan A, Masood MQ, Mehar S, Jabbar A. Etiology, functional status and short term outcome of patients with pituitary lesions. An experience from a developing country. J PAK MED ASSOC 2009; 59:839-843. [PMID: 20201177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To describe the etiology, functional status and short term outcome of patients with pituitary lesions (PL). METHODS Brain or pituitary MRI reports of 3753 patients were analyzed for PL over the period of 2000 to 2007, done at the Aga Khan University Hospital (AKUH), Karachi, Pakistan. MRIs with reported PL and all those ordered by Endocrinologists with or without pituitary abnormalities, were included in the analysis. This made a total of 338 (9%) MRI reports. PL were defined as pituitary tumors, cysts, haemorrhage, hypoplasia; and empty sella. Patients with these PL, were analyzed for symptoms, hormonal profile and short term outcome in the hospital retrospectively. RESULTS In the analysis of 338 MRI reports, 23% had normal pituitary gland on MRI examination. Hypogonadotrophic hypogonadism was the commonest (38.5%) endocrine abnormality seen with normal pituitary MRI, followed by hypopituitarism (5.1%). Most common PL identified were macroadenoma (38.7%), empty sella (16.5%) and microadenoma (12.7%). Patients with macroadenoma had 58% of non-functional tumours while 19.1% had hypopituitrism, 17.6% had acromegaly and 17.5% had prolactinoma. Majority of these lesions were causing headache and visual symptoms (42.7%) and were treated with surgery (75.5%). Patients with microadenoma included 39.5% prolactinomas, 18.6% cushing disease, 14% acromegaly, 4.7% hypogonadotrophic hypogonadism and 2.3% hypopituitrism. Majority of these lesions were treated with drugs and 37.3% were treated with surgery. In empty sella patients, 32% patients had endocrine abnormalities among which 21.4% had hypopituitrism, 2% had hypogonadotrophic hypogonadism, and only 6% patients had normal endocrine workup. A significant number of patients (62.5%) never had endocrine hormonal checkup. CONCLUSION Although PL are less common entities (9% in 3,753 reports) but they are associated with significant endocrinal abnormalities and need prompt treatment. Empty sella, which is not considered as a distinct abnormality, is also associated with significant endocrine deficiencies.
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Affiliation(s)
- Osama Ishtiaq
- Department of Endocrinology, The Aga Khan University Hospital, Karachi, Pakistan
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Ishtiaq O, Iqbal M, Zubair M, Qayyum R, Adil M. Outcome of cardiopulmonary resuscitation - predictors of survival. J Coll Physicians Surg Pak 2008; 18:3-7. [PMID: 18452659 DOI: 01.2008/jcpsp.0307] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 06/21/2007] [Accepted: 12/27/2007] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess the outcomes of patients undergoing cardiopulmonary resuscitation (CPR). DESIGN A cross-sectional study. PLACE AND DURATION OF STUDY Shifa International Hospital, Islamabad from January 2005 to December 2005. PATIENTS AND METHODS Data were collected retrospectively of all adult patients who underwent CPR. Clinical outcomes of interest were survival at the end of CPR and survival at discharge from hospital. Factors associated with survival were evaluated using logistic regression analysis. RESULTS Of the 159 patients included, 55 (35%) were alive at the end of CPR and 17 (11%) were discharged alive from the hospital. At the end of CPR, univariate logistic regression analysis found the following factors associated with survival: cardiac arrest within hospital as compared to outside the hospital (odds ratio = 2.8, 95% CI = 1.27-6.20, p-value = 0.01), both cardiac and pulmonary arrest as compared to either cardiac or pulmonary arrest (odds ratio = 0.37, 95%CI = 0.19- 0.73, p-value = 0.004), asystole as cardiac rhythm at presentation (odds ratio = 0.47, 95%CI = 0.24-0.93, p-value = 0.03), and total atropine dose given during CPR (odds ratio = 0.78, 95%CI = 0.62-0.97, p-value = 0.02). In multivariate logistic regression, cardiac arrest within hospital (odds ratio = 2.52, 95%CI = 1.06-5.99, p-value = 0.04) and both cardiac and pulmonary arrest as compared to cardiac or pulmonary arrest (odds ratio = 0.44, 95%CI = 0.21-0.91, p-value = 0.03) were associated with survival at the end of CPR. At the time of discharge from hospital, univariate logistic regression analysis found following factors that were associated with survival: cardiac arrest within hospital (odds ratio = 8.4, 95%CI = 1.09-65.64, p-value = 0.04), duration of CPR (odds ratio = 0.91, 95%CI = 0.85-0.96, p-value = 0.001), and total atropine does given during CPR (odds ratio = 0.68, 95%CI = 0.47-0.99, p-value = 0.05). In multivariate logistic regression analysis cardiac arrest within hospital (odds ratio = 8.69, 95%CI = 1.01-74.6, p-value = 0.05) and duration of CPR (odds ratio = 0.92, 95%CI = 0.87-0.98, p-value = 0.01) were associated with survival at discharge from hospital. CONCLUSION In-hospital cardiopulmonary arrest was associated with better clinical outcomes as compared to outside hospital arrest. Public education is needed to improve clinical outcomes in patients who need CPR outside hospital.
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Affiliation(s)
- Osama Ishtiaq
- Department of Medicine, Shifa College of Medicine, Islamabad, Pakistan.
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Iqbal M, Ishtiaq O, Akhtar A, Chaudery Y, Khizar B. Empysematous gastritis--a case report with literature review. J PAK MED ASSOC 2006; 56:605-7. [PMID: 17312654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Emphysematous gastritis is a condition characterized by gas within the wall of the stomach and associated, systemic toxicity. We are reporting to our knowledge the first case of emphysematous gastritis in a 76 year old female from Islamabad, Pakistan. She was admitted with five day history of upper abdominal discomfort and vomiting. Diagnosis of emphysematous gastritis was made on CT scan. She was treated successfully with conservative management including IV antibiotics and few sessions of dialysis, and was discharged home within two weeks.
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Ishtiaq O, Baqai HZ, Anwer F, Hussain N. Patterns of pancytopenia patients in a general medical ward and a proposed diagnostic approach. J Ayub Med Coll Abbottabad 2004; 16:8-13. [PMID: 15125172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
BACKGROUND There has been little systematic study on the clinical spectrum of pancytopenia. This study was done to describe the etiology, presentation and outcome of patients with pancytopenia presenting in a general medical ward. METHODS Hundred patients with pancytopenia were included in the study from October 2001 to October 2002. Patients on cancer chemotherapy were excluded. Blood counts, bone marrow examinations and trephine biopsies were performed according to standard methods. RESULTS In all cases, megaloblastic anemia constituted the largest group (n = 39), and also seen in conjunction with hemolytic anemia and septicemia. Hypersplenism secondary to portal hypertension (cirrhosis) was the second most common diagnosis (n = 19). Aplastic anemia, septicemia and myelodysplasia were other common causes. Two patients were the suspected cases of viral hemorrhagic fever. Thirteen (13%) patients expired. Absolute neutrophil count (ANC) less than 500/microliter was seen in 14 (14%) patients, among which 6 (15.3%) had megaloblastic anemia, 3 (37.5%) had aplastic anemia, and 2 (40%) had myelodysplasia. Eleven patients with platelet counts < or = 10 x 10(9)/L, 6 (54.5%) presented with bleeding; and 2 of these 8 had aplastic anemia and 1 patient with megaloblastic anemia. MCV values > 100 fL and > 110 fL were more frequent in patients with megaloblastic anemia with most prominent anisopoikilocytosis, microcytosis and fragmented RBCs. Macrocytosis was noted in 35 (89.7%) patients with megaloblastic anemia and 12 (63.1%) with hypersplenism, 4 (50%) with aplastic anemia. Hypersegmented neutrophils were noted in the blood films of 36 (92.3%) patients with megaloblastic anemia. CONCLUSION Megaloblastic anemia, hypersplenism and aplastic anemia are the common causes of pancytopenia in our study.
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Rashid E, Ishtiaq O, Gilani S, Zafar A. Comparison of store and forward method of teledermatology with face-to-face consultation. J Ayub Med Coll Abbottabad 2003; 15:34-6. [PMID: 14552246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
BACKGROUND To compare the accuracy of store and forward method of teledermatology with the traditional face-to-face consultation. METHODS The comparison was done between Institute of Dermatology King Edward Medical College Lahore that served as teledermatology center and Dermatology Department of Pakistan Institute of Medical Sciences Islamabad from where patients were selected. Telmedpak provided the technical support. Thirty three patients were selected from outpatient department of PIMS and images were taken using a digital camera. Images were stored in computer and were sent to Institute of Dermatology via e-mail for Teleconsultation along with a short history and examination findings. Diagnosis of consultant after face-to-face consultation was then compared with the image based diagnosis that is after teleconsultation. RESULTS In 81% of the cases the diagnosis on face-to-face consultation was same (p < 0.05) while in 18% of the cases the two diagnoses differed. In 9% (n = 3) of the cases, image resolution was not good but out of these three, diagnosis was same in two and differed in one case. CONCLUSION This study concludes that store and forward method of teledermatology is reliable and can provide a means of increasing access to dermatological care in rural and under-served areas.
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Affiliation(s)
- Eanas Rashid
- Pakistan Institute of Medical Sciences (PIMS), Islamabad.
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Ishtiaq O, Zahid M, Baqai H, Umer M, Shoaib A, Bashir K. Hypocellular myelodysplastic syndrome presenting as megaloblastic anemia. J Ayub Med Coll Abbottabad 2002; 14:29-30. [PMID: 12476862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
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