FREQUENCY OF DIABETIC NEPHROPATHY IN DIABETIC PATIENTS VISITING TERTIARY CARE HOSPITAL

Background; The incidence of diabetes mellitus (DM) and diabetic nephropathy (DN) have risen rapidly in the past few decades and have become an economic burden to the healthcare system in Pakistan, So this study was done to determine the frequency of diabetic nephropathy in diabetic patients visiting tertiary care hospital. Material and methods: One hundred eleven consecutive patients with diabetes mellitus presenting to diabetic OPD were included in this cross-sectional study. After brief history and previous medical record review, blood pressure readings were taken, 24hour urine and blood samples were obtained from study participants and were sent to Nishtar hospital lab, free of cost, for detection of albumin in urine sample, HbA1c and fasting blood sugar levels in blood sample. Statistical analysis was performed by entering data in SPSS version 20. Results; Among these 111 diabetic patients, 51 (45.9%) were male diabetic patients and 60 (54.1%) were female patients. Mean age of our study cases was 50.16 ± 6.43 years while mean duration of diabetes was 6.34 ± 2.64  years. Majority of patients 70 (63.1%) were untreated for the diabetes while only 41 (36.9%) had controlled diabetes. Mean fasting blood glucose level was found to be 206.62 ± 31.56 mg/dl. Of these patients, 20 (18%) had history of smoking while 80 (72.1%) had history of hypertension. Nephropathy was present in 30 (27%) of our study cases. Microalbuminurea was seen in 20 (18%) of our study cases while Macroalbuminurea was present in 10 (9%) of our study cases. Conclusion; In our study, very high frequencies of diabetic nephropathy have been observed. Diabetic Nephropathy was significantly associated with increasing age, prolonged disease duration, poor glycemic control, poor compliance with treatment and hypertension. Majority of the diabetic patients were having uncontrolled diabetes and poor compliance with the treatment which emphasizes towards well directed awareness campaigns among targeted population. Proper treatment and well controlled diabetes can help to decrease long term complications in such patients

HYPOTHYROIDISM IN WOMEN HAVING MENSTRUAL PROBLEMS AT A TERTIARY CARE HOSPITAL

Background; Menstrual disorders frequently affect the quality of life of adolescents and young adult women, especially those who suffer dysmenorrhoea and heavy menstruation. Different studies have associated thyroid dysfunction with menstrual problems. This study was conducted to document the frequency of hypothyroidism in women with menstrual problems. Objective; To determine frequency of hypothyroidism in women having menstrual problems at a tertiary care hospital.  Material and methods; All the study cases (227) who meet inclusion and exclusion criteria of my study were taken from OPD of the Department of Gynecology and Obstetrics, Nishtar Hospital Multan.  Once registered, 5 ml venous blood sample was taken and sent to the central laboratory of the Nishtar Hospital Multan for serum TSH and T4 levels by a pathologist having minimum 5 years experience after post-graduation.   Hypothyroidism was determined on laboratory report after serum analysis for TSH and T4. Data was analyzed by using SPSS Version 20. Results; Mean age of our study cases was noted to be 24.08± 4.65 years. Of these 227 study cases, 134 (59 %) were married while 93 (41%) were unmarried. Mean body mass index (BMI) of our study cases was 22.31 ± 2.70 kg/m2 , 160 (70.5%) were normal weight, 51 (22.5%) were overweight and 16 (7%) were obese. Secondary amenorrhea was noted in 25 (11%), oligomenorrhea in 42 (18.5%),  polymenorrhea in 16 (7%), heavy menstrual bleeding in 59 (26%) and irregular menstrual bleeding in 85 (37.5%). Mean serum TSH level of our study cases was 4.85 ± 0.91 mIU/L while mean T4 level was noted to be 86.90 ± 38.81 nmol/L and hypothyroidism was noted in 176 (77.5%) of our study cases. Overt hypothyroidism was noted in 75 (33 %) and subclinical hypothyroidism in 101 (44.5%) of our study cases. Conclusion; Very high frequency of hypothyroidism was noted in women having menstrual problems in our study. Hypothyroidism was significantly associated with residential status, obesity, poor socioeconomic status, level of education and type of menstrual problem. Subclinical hypothyroidism was more prevalent as compared with over hypothyroidism. Our study results suggest that women presenting with menstrual problems must be screened for thyroid hormones for proper management of these patients. Keywords; Hypothyroidism, Menstrual problems, subclinical hypothyroidism, overt hypothyroidism