Correlation between HbA1c and lipid profile in diabetes: a primary health concern in Aseer, Saudi Arabia

Background: Type 2 diabetes mellitus (T2DM) presently affects 537 million adults globally. It has a high prevalence in the Saudi population (31.6%), ranking 2nd highest in the Middle East and 7th worldwide. T2DM is characterized by insulin resistance and hyperglycemia, causing the glycation of hemoglobin, plasma proteins, tissue proteins, and their receptors. The high insulinemic state leads to dyslipidemia. These biochemical alterations can cause complications like atherosclerosis, coronary artery disease, angina, myocardial infarctions, and hypertension. Considering the high prevalence of diabetes in the Saudi population and the lack of studies conducted at primary health care (PHC) centers in Saudi Arabia, this study was done to investigate the status of diabetes control in T2DM patients and propose appropriate measures to prevent the development of future complications. Method: This cross-sectional study recruited 191 known T2DM patients presenting at the PHC center in the Al Qabil locality of Aseer province of Saudi Arabia. The patient's demographic and glycemic and lipid profile data were recorded and statistically analyzed. Results: T2DM was more prevalent in males. T2DM patients were found to be obese, and 52% had coexisting hypertension. Patients had deranged glycemic profiles and dyslipidemia despite taking hypoglycemic agents. Hyperglycemia and dyslipidemia were significantly higher in people with diabetes having HbA1c > 7. HbA1c is correlated with dyslipidemia, and dyslipidemia is linked considerably with obesity. Conclusion: T2DM patients must be regularly followed up to ensure drug compliance, explained about foreseen medical complications, and motivated to adopt lifestyle modification measures to control their weight, BP, and blood glucose

PRE-ANALYTICAL VARIABLES IN CLINICAL CHEMISTRY: TRAINING MEDICAL UNDERGRADUATES THROUGH CASE BASED DISCUSSION

Background: Pre-analytical variables in clinical chemistry are factors prior to the biochemical analysis of samples affecting laboratory test results accounting for 32-75% of errors leading to misdiagnosis, decreased quality of medical care services and wastage of monetary resources. Aim: To educate first year medical undergraduates about pre-analytical variables through case based discussion and lecture method of teaching and assess the gain in knowledge by these methods. Methods and material: Two batches of medical students namely A (N=50) and B (N=52) were assessed for their background knowledge on the topic using an MCQ based questionnaire (pre-test). Batch A and B were taught through didactic lecture and case based discussion respectively. Post-test questionnaire was conducted to test the gain in knowledge of both batches. Delayed post-test was conducted after 2 weeks to assess retention of knowledge amongst students. Results: Pre-test scores of Batch A and B were not significantly different indicating that both batches had similar background knowledge of topic. Post-test scores vs. pre-test scores were significantly higher in both batches implying that both batches benefitted from their respective teaching sessions. But post-test score of Batch B was significantly higher than that of Batch A indicating higher gain of knowledge through case based discussion. Delayed post-test score was also significantly higher in Batch B vs. A implying better retention of knowledge through case based discussions. Conclusion: Topic ˜Pre-analytical variables in clinical chemistry must be included in undergraduate medical curriculum. Case based discussion could be an effective module for teaching the same. Key words: Case based discussion; Didactic lecture; Medical students; Medical education; Pre-analytical variables

PRE-ANALYTICAL VARIABLES IN CLINICAL CHEMISTRY: TRAINING MEDICAL UNDERGRADUATES THROUGH CASE BASED DISCUSSION

Background: Pre-analytical variables in clinical chemistry are factors prior to the biochemical analysis of samples affecting laboratory test results accounting for 32-75% of errors leading to misdiagnosis, decreased quality of medical care services and wastage of monetary resources. Aim: To educate first year medical undergraduates about pre-analytical variables through case based discussion and lecture method of teaching and assess the gain in knowledge by these methods. Methods and material: Two batches of medical students namely A (N=50) and B (N=52) were assessed for their background knowledge on the topic using an MCQ based questionnaire (pre-test). Batch A and B were taught through didactic lecture and case based discussion respectively. Post-test questionnaire was conducted to test the gain in knowledge of both batches. Delayed post-test was conducted after 2 weeks to assess retention of knowledge amongst students. Results: Pre-test scores of Batch A and B were not significantly different indicating that both batches had similar background knowledge of topic. Post-test scores vs. pre-test scores were significantly higher in both batches implying that both batches benefitted from their respective teaching sessions. But post-test score of Batch B was significantly higher than that of Batch A indicating higher gain of knowledge through case based discussion. Delayed post-test score was also significantly higher in Batch B vs. A implying better retention of knowledge through case based discussions. Conclusion: Topic ˜Pre-analytical variables in clinical chemistry must be included in undergraduate medical curriculum. Case based discussion could be an effective module for teaching the same. Key words: Case based discussion; Didactic lecture; Medical students; Medical education; Pre-analytical variables

Etiopathogenesis of aplastic anemia in children: a case control study

Background: Aplastic anemia is not an infrequent clinical syndrome that we encounter. In about two thirds of cases of aplastic anemia it is not possible to identify any likely cause. Aim of the study was to study the role of organochlorine compounds, Parvovirus B19, Hepatitis viruses B and C and HIV I and II in causation of aplastic anemia in children.Methods: 25 children of bone marrow biopsy proved aplastic anemia and 25 age Matched controls were investigated for the presence of Parvovirus B19, Hepatitis viruses B and C, HIV I and II and for increased levels of organo-chlorines in blood and bone marrow. ELISA technique to detect antibodies against Parvovirus B19 (IgM), HCV (IgG), HbsAg, HIV I and II was used. Gas chromatography was used to measure blood levels of organo-chlorine compounds α, β, γ, δ HCH, p-p DDE.Results: out of 25 children of aplastic anemia 5 cases (20%) were IgM ELISA positive against Parvovirus B19, 6 cases (24%) were positive for IgG antibody against HCV and 1 case (4%) was Australia antigen positive. 14 cases (56%) showed increased levels (>mean±2SD) of organochlorine compounds α, β, γ, δ HCH, p-p DDE. None of the cases were positive for HIV I and II. None of the controls were positive for Parvovirus B19 (IgM) neither for HCV (IgG). Multiple factors (>1) were positive in 4 cases (16%). 5 cases (20%) didn’t have any positivity for studied factors. 22 cases (88%) of aplastic anemia children were >5 years of age. 21 cases (84%) belonged to rural areas. 11 cases (44%) presented in the month of March and April. Parvovirus B19 was more prevalent (80% cases) in the older age group of children (8-12years).Conclusions: Majority of virological agents contribute to non-severe aplastic anemia. Significant association was found between very severe and severe aplastic anemia with organochlorine compounds. However larger community based studies are needed to correlate this

Association between serum uric acid and HbA1c in patients with type 2 diabetes mellitus: A case control study in Indian population

Background and Aim: Uric acid is a pro-oxidant molecule that might be implicated in increasing oxidative stress and insulin resistance in type 2 diabetes mellitus patients. Hence, the aim of the study was to assess serum uric acid and HbA1c level (an indicator of glycemic control) in these patients and speculate the association between the two. Methods: 40 newly diagnosed cases of Type 2 diabetes mellitus (20 males and 20 females) with age ranging between 35-70 years were statistically compared against 40 age and sex-matched healthy subjects with respect to their uric acid and HbA1c levels. Demographic data like the height and weight of patients was also recorded and statistically compared. Results: No statistical difference in age, height and weight were observed in type 2 diabetes cases vs. controls indicating that the groups were comparable. HbA1c and uric acid levels of males and females with type 2 diabetes mellitus were significantly higher in comparison to normal males and females(controls). Correlation analysis showed a positive and significant correlation between HbA1c and uric acid levels in male and female cases of type 2 diabetes mellitus Conclusion: Uric acid might have a role in the development or worsening of type 2 diabetes mellitus. However, further studies are required with a larger sample size to clearly establish the relationship between uric acid and glycemic control in type 2 diabetes mellitus since studies in the literature have shown conflicting results and hence the understanding of the etiopathogenesis of type 2 diabetes mellitus remains poorly understood with respect to uric acid. Keywords: type 2 diabetes mellitus; uric acid, HbA1c; etiopathogenesis; correlation

Association between serum uric acid and HbA1c in patients with type 2 diabetes mellitus: A case control study in Indian population

Background and Aim: Uric acid is a pro-oxidant molecule that might be implicated in increasing oxidative stress and insulin resistance in type 2 diabetes mellitus patients. Hence, the aim of the study was to assess serum uric acid and HbA1c level (an indicator of glycemic control) in these patients and speculate the association between the two. Methods: 40 newly diagnosed cases of Type 2 diabetes mellitus (20 males and 20 females) with age ranging between 35-70 years were statistically compared against 40 age and sex-matched healthy subjects with respect to their uric acid and HbA1c levels. Demographic data like the height and weight of patients was also recorded and statistically compared. Results: No statistical difference in age, height and weight were observed in type 2 diabetes cases vs. controls indicating that the groups were comparable. HbA1c and uric acid levels of males and females with type 2 diabetes mellitus were significantly higher in comparison to normal males and females(controls). Correlation analysis showed a positive and significant correlation between HbA1c and uric acid levels in male and female cases of type 2 diabetes mellitus Conclusion: Uric acid might have a role in the development or worsening of type 2 diabetes mellitus. However, further studies are required with a larger sample size to clearly establish the relationship between uric acid and glycemic control in type 2 diabetes mellitus since studies in the literature have shown conflicting results and hence the understanding of the etiopathogenesis of type 2 diabetes mellitus remains poorly understood with respect to uric acid. Keywords: type 2 diabetes mellitus; uric acid, HbA1c; etiopathogenesis; correlation

Improving Academic Performance of Medical Undergraduates: Impediments and Solutions

Introduction: Medical undergraduates selected for studying medicine through exceedingly competitive pre- medical entrance tests are highly intellectual and hardworking, yet many students perform poorly in internal examinations perhaps because the initial exposure to medical education is tense and uninteresting. This study aims to find out probable reasons that could affect optimalacademic performance of first year medical students. Methodology: First year medical students of 3 consecutive academic batches were asked to fill a feedback form comprising of questions (regarding their opinion for inclusion of clinically oriented teaching and how often they read a topic prior to and after a lecture). Students were also asked to mention the problems affecting their academic performance. Results: 95.6-98.1% of students wanted clinically oriented teaching. 1.9-10.3% of students read a topic in advance (either always or most of the times) but the percentage of students who never or sometimes read the topic in advance was alarmingly very high (89.7-98.1%). 20.8-25.4% of students read the topic for lecture (either always or most of the times) on the same day after the lecture but the percentage of students who never or sometimes read the topic on the same day after the lecture was quite high(74.6-79.2%). Conclusion: Inclusion of clinically oriented classes and integration of clinical and non-c1inica1 subjects might enhance students' academic performance by evoking interest in subjects to read a topic before and after lecture. Provision for adequate hostels, personal counselling and repeated motivation which is frequently ignored by educators might also help

Markers of Oxidative Stress in Pregnant Womenwith Sleep Disturbances

Objective: The quality and duration of sleep is impaired during pregnancy. Our study aimed to determine whether maternal sleep deprivation occurring during the second and third trimester of pregnancy could alter fetal well-being with respect to birth weight and APGAR score by altering the inflammatory status and oxidative stress in the mothers. Methods: Sleep adequacy was assessed using the Pittsburgh Sleep Quality Index (PSQI). We investigated the inflammatory status and oxidative stress at term in the blood of pregnant subjects with and without sleep deprivation by measuring the levels of protein-bound sialic acid (PBSA), high-sensitivity C-reactive protein (hsCRP), malondialdehyde (MDA) and protein carbonyl (PCO). Homocysteine (Hcy) and its vitamin determinants were also measured. Fetal outcome with respect to birth weight and APGAR score were compared between study subjects. Results: A significant increase was observed in the levels of hsCRP, PBSA, Hcy, MDA, and PCO, in the sleep-deprived group when compared to the control group. Fetal outcome at birth showed a significant difference between the cases with high sleep deprivation and those with low sleep deprivation. Conclusion: Sleep deprivation in pregnancy leads to an increase in the inflammatory parameters, oxidative stress, and Hcy levels. Fetal outcome at birth was affected more in mothers with high sleep deprivation than those with low sleep deprivation. Follow-up in these babies are needed to reveal any differences in their growth and development

Markers of Oxidative Stress in Pregnant Womenwith Sleep Disturbances

Objective: The quality and duration of sleep is impaired during pregnancy. Our study aimed to determine whether maternal sleep deprivation occurring during the second and third trimester of pregnancy could alter fetal well-being with respect to birth weight and APGAR score by altering the inflammatory status and oxidative stress in the mothers. Methods: Sleep adequacy was assessed using the Pittsburgh Sleep Quality Index (PSQI). We investigated the inflammatory status and oxidative stress at term in the blood of pregnant subjects with and without sleep deprivation by measuring the levels of protein-bound sialic acid (PBSA), high-sensitivity C-reactive protein (hsCRP), malondialdehyde (MDA) and protein carbonyl (PCO). Homocysteine (Hcy) and its vitamin determinants were also measured. Fetal outcome with respect to birth weight and APGAR score were compared between study subjects. Results: A significant increase was observed in the levels of hsCRP, PBSA, Hcy, MDA, and PCO, in the sleep-deprived group when compared to the control group. Fetal outcome at birth showed a significant difference between the cases with high sleep deprivation and those with low sleep deprivation. Conclusion: Sleep deprivation in pregnancy leads to an increase in the inflammatory parameters, oxidative stress, and Hcy levels. Fetal outcome at birth was affected more in mothers with high sleep deprivation than those with low sleep deprivation. Follow-up in these babies are needed to reveal any differences in their growth and development