A Rare Presentation of Wilson Disease: A Case Report

Wilson Disease results from autosomal recessive mutation in ATP7B gene which leads to reduced formation of ceruloplasmin protein in the body that acts as a copper transporter. Due to its deficiency, there is the build-up of copper in the liver and brain among other organ systems and it leads to the development of various clinical abnormalities but commonly presents either as hepatic dysfunction and/or cirrhosis in young patients with movement disorder. Here we present a case that presented with hypoglycemia and hypothermia in absence of any infection, drug abuse or metabolic abnormality. He was later diagnosed as Wilson disease. Wilson Disease is mostly thought of hepatic /neurological disease. Contrary to this Wilson’s disease is a multisystem disease affecting multiple organ system including, kidneys, endocrine system and musculoskeletal system and can present with manifestations of above-mentioned systems

Socio-Demographic and Clinical Factors Associated with Poor Glycemic Control among Patients of Type-2 Diabetes Mellitus Presenting at a Tertiary Healthcare Facility

Objective: To identify socio-demographic and clinical factors associated with poor glycemic control in type-2 diabetes mellitus patients at a tertiary healthcare facility. Methodology: This cross-sectional study was conducted at Outpatient department of Medicine, Pakistan Institute of Medical Sciences, Islamabad, Pakistan, from February 2022 to July 2022, included 246 known type-2 diabetes patients of both genders, aged 18 to 75, with at least three consecutive days of fasting blood glucose (FBG) measurements. We assessed socio-demographic and clinical characteristics and classified glycemic control according to ADA guidelines: FBG between 80-130 mg/dl as good control and FBG above 130 mg/dl as poor control. We recorded the prevalence of good and poor glycemic control and compared them based on various socio-demographic and clinical factors. Results: Among 246 patients, 152 (61.8%) were male, with a mean age of 46.47±11.55 years and a mean BMI of 23.13±5.01 kg/m². The mean diabetes duration was 9.18±7.50 years, and 132 (53.7%) patients had a disease duration > 5 years. Diabetes-related complications were present in 156 (63.4%) patients. Poor glycemic control was found in 137 (55.7%) patients. Significant associations with poor glycemic control were observed for age (p<0.001), educational status (p<0.001), BMI (p=0.002), residential status (p=0.013), family history of diabetes (p<0.001), diabetes duration (p<0.001), and current diabetes medications (p=0.001). Conclusion: A majority (55.7%) of type-2 diabetes patients in our study had poor glycemic control. Factors such as increasing age, BMI, education level, residential status, family history of diabetes, longer disease duration, and current diabetes medications were significantly associated with poor glycemic control

Frequency of Missing Dose of Anti-Diabetic Medications and its Impact on Blood Glucose Levels Among Patients of Diabetes Mellitus

Objective: To determine the frequency of missed medications and its association with glycemic control among patients of diabetes mellitus. Methodology: This cross-sectional study was conducted at the Outpatient Department of Medicine, Pakistan Institute of Medical Sciences, Islamabad, Pakistan, from January 2022 to June 2022. Patients with type-1 or type-2 diabetes mellitus who visited the outpatient department and had a disease duration of at least six months were included in the study. Participants might be either gender and ranged in age from 18 to 70. Along with sociodemographic information, characteristics of diabetes mellitus were recorded including fasting and postprandial blood glucose levels, kinds of DM, drugs used, and family history of DM. All patients' frequency of missing diabetic mellitus prescription doses was also assessed. Results: In a total of 230 patients of DM, 148 (64.3%) were male. The mean age was a 45.00±12.48 year. Family history of diabetes was present in 113 (49.1%) patients. There were 215 (93.5%) patients who had type 2 DM while remaining 15 (6.5%) were type-1 DM. Mean duration of DM was 7.63±7.6 years. It was found that 105 (45.7%) patients were using both oral and insulin. It was noted that 30 (13.0%) patients were missing their DM medications daily, 43 (18.7%) most frequently, 21 (9.1%) frequently and 54 (23.5%) missed their DM medications/dosages occasionally. It was observed that statistically significant differences existed for blood glucose parameters and frequency of missed medications (p<0.0001). Conclusion: Vast majority of diabetes mellitus patients were found to miss their anti-diabetic medications. Missed medication frequency was significantly linked with higher blood glucose levels