Pakistan Journal of Medical & Health Sciences

Diabetic Foot- A New Era of Diagnosis and Prevention

Tue, 15 Apr 2025 00:00:00 +0000

Background: Diabetic foot ulcers (DFU), a common complication of long-term diabetes, significantly reduce quality of life, increase morbidity and mortality, and place a heavy burden on individuals and healthcare systems. It is require a multidisciplinary approach to treatment.
Aim: To overview the standards in diabetic foot prevention and care.
Methods: We searched for materials for this work in the Pubmed and Google Scholar databases using the keywords: "Diabetic foot", "diabetic wounds", "diabetic neuropathy"and analyzed the selected materials.
Results: DFU significantly reduce the quality of life and are a major burden for individuals and healthcare systems. Effective care involves specialists across various fields to address the complex causes and improve outcomes.
Conclusion:There are currently many published standards for the care and examination of the feet of patients with diabetes, which are presented in the following review. It is important to remember the cause of the pathophysiology of DFU and effectively treat diabetes, maintaining the patient in normoglycemia, and also examine your feet and actively look for the first signs of diabetic
ulcers.
Keywords: Diabetic foot, diabetic wounds, neuropathy, vascular disease

Assessment of Liver and Renal Function Tests among patients with typhoid fever in Motta General Hospital, Northwest Ethiopia: A Comparative Cross-Sectional Study

Tue, 15 Apr 2025 00:00:00 +0000

Background: Typhoid fever remains an important cause of morbidity and mortality in developing countries with poor hygienic conditions and limited access to safe drinking water. It primarily has an impact on the liver and the kidney organs which causes liver and renal function test to be affected. And now, this study was to evaluate liver and renal function tests in typhoid fever patients at Motta General Hospital Northwest Ethiopia, May to December 2023.
Method: Hospital-based comparative cross-sectional study was conducted in Motta General Hospital on 90 typhoid fever patients and 90 control groups were selected by convenience sampling technique. Data was analyzed by SPSS version 26 after collecting all clinical and laboratory data. Statistical significance was defined as a p-value < 0.05.
Result: The average age of the typhoid fever cases was 32.23± 13.48 years, and control subject was 32.62±7.708. Serum aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, total bilirubin, direct bilirubin and creatinine values were significantly higher among typhoid fever patients than control groups.
Conclusion: Typhoid fever appeared to significantly affect liver function tests (ALT and AST, ALP, TB and DB) and renal function tests (creatinine) compared to controls. Abnormal liver and renal functions tests in typhoid fever is more common with patients presenting in 2nd and 3rd week of illness.
Keywords: Typhoid fever, Liver function tests, Renal function tests

Iron deficiency anemia and its effect on HbA1c levels in patients above 30 years

SUMIT CHANDRA KANOJIA, SWATI SINGH, ADREENA MITTAL, ANISH PATEL, HINA KAUSAR — Tue, 15 Apr 2025 00:00:00 +0000

Background: Iron deficiency contributes 50% of the anemic burden worldwide. Glycated hemoglobin (HbA1c) is an irreversible product formed due to slow non-enzymatic catalysis of the β-chain of matured hemoglobin (Hb). The glycemic status of the patients with diabetes is monitored through HbA1c for the three months period. IDA is associated with blood loss, hemolysis, hemoglobinopathies, red cell abnormalities, and myelodysplastic disease. IDA also can elevate the turnover of red blood cells, which can increase the glycation of hemoglobin and lead to higher HbA1c concentrations.
Aim: To establish a relationship between the levels of HbA1c And Iron Deficiency Anemia.
Methods: Total 5ml of Venous blood was collected from patients above 30 years under aseptic conditions and distributed in EDTA and plain vial for serum. Blood samples from participants were sampled in 10ml Vacutainer tubes (Becton Dickinson, Franklin Lakes, NJ) containing EDTA and plain tubes (Becton Dickinson) for hematological analysis and serum separation respectively. The plain vial serum was used for estimation of serum ferritin levels. Complete Blood Count (CBC) and HbA1c estimation were performed using the EDTA samples. Biochemical analyses were performed by Sysmex-350 five-part auto analyzer. Results were systematically entered into a master chart in which were also cross referenced to clinical and other pertinent patient data. The data was then analyzed statistically for interpretation.
Results: There was a statistically significant difference when comparing hemoglobin (Hb) levels and mean corpuscular volume (MCV) between the control and study groups. Before treatment, every subject in the study group had Hb ≤13.0 g/dL (p13.0 g/dL. In this study, by the end of treatment in the study group, hemoglobin values showed a statistically significant increase where the percent of patients with hemoglobin >13.0 g/dL was found in 10% and basal mean hemoglobin value of patients was detected to be improved from 6.82±0.32g/dL to 12.66±0.42 (p90%, comparable to controls, indicating adequate resolution of iron deficiency anemia (p<0.001).
Conclusion: The evidence shows that iron supplementation has a strong beneficial effect on hemoglobin levels and reverses microcytic anemia in patients with anemia. All subjects in the study group showed low level of Hb and microcytic hypochromic mild anemia suggesting iron deficiency anemia before treatment. Significant uptick of Hb and MCV values on intervention —a quintessential hematological response. This emphasizes the need for early detection and proper treatment of anemia to bring back normal hematological parameters to improve general health.
Keywords: Anemia, IDA, Glycated Hemoglobin, microcytic, iron deficiency

Management of childhood acute diarrhea with Probiotics in Ambulatory Care (MIRACLE)

AGHA SHABBIR ALI, ZEESHAN HASSAN — Tue, 15 Apr 2025 00:00:00 +0000

Background: Probiotics are widely regarded as effective in the management of acute diarrhea.
Aim: To document usage of probiotics in children presenting with acute diarrhea at outpatient clinics across Pakistan, while also evaluating caregiver satisfaction with various aspects of their use.
Methods: This national, observational, multicentre study was conducted in outpatient settings as a non-interventional analysis of therapeutic practices. A prospective design with a single follow-up was used and general practitioners and paediatricians were randomly selected to participate. The study included children aged ≥1 month to under ≤5 years who presented with acute diarrhea in ambulatory care.
Results: Of the 1,130 children enrolled at the initial visit, 1,072 returned for follow-up. Probiotics were prescribed to 98.6% of these children. The most commonly recommended probiotics were Bacillus clausii (73%), followed by Saccharomyces boulardii (17%) and Lactobacillus species (6%). Caregiver satisfaction was high, with 94.3% (n=1,011) expressing approval of the
prescribed treatment. Physicians observed that probiotics were primarily effective in reducing the loose consistency of stools. Practical Implication: The use of ORS is widespread though not universal and should be further promoted. Probiotic use is widely prevalent. However, there is the room for increasing awareness on usage of probiotics both at primary health care level and at caregiver level. In this study the prescribed probiotics reduced diarrheal symptoms within 3.3 days and improved stool consistency in more than 86% of the cases.
Conclusion The exact proportion of probiotic prescriptions alongside other antidiarrheal treatments for children with acute diarrhea remains unclear. However, findings from this registry highlight that a significant rate of probiotic prescriptions is closely linked to high caregiver satisfaction with the treatment. The MIRACLE study represents an important step toward fostering awareness and building confidence in the use of probiotics for managing acute diarrhea in the general paediatric population of Pakistan.
Keywords: Acute diarrhea, Probiotics, Modified Vesikari Score, Bacillus clausii, caregiver Satisfaction

Comparison of Efficacy of 50% Salicylic Acid Versus Cryotherapy in the Treatment of Plantar Warts

Tue, 15 Apr 2025 00:00:00 +0000

Aim: To find the comparison of efficacy of 50% salicylic acid versus cryotherapy in the treatment of plantar warts.
Methods: Total 85 patients with plantar warts were presented in this study. We divided patients in two groups. 43 patients of group A received 50% salicylic acid and 42 patients received cryotherapy in group B. Outcomes were compared.
Results: We found that both treatments were effective in treatment of plantar warts while salicylic acid showed good outcomes as compared to cryotherapy but statistically insignificant.
Conclusion: The findings demonstrate that both treatments are similarly effective in achieving wart clearance, with salicylic acid showing a slightly higher, though not statistically significant.
Keywords: Plantar warts, salicylic acid, cryotherapy.

The Relationship between Epigenetics and Lifestyle in Homosexuality

HÜSEYIN ÇAKSEN — Tue, 15 Apr 2025 00:00:00 +0000

Homosexuality is a pattern of sexuality in which sexual behavior and thinking are directed towards people of the same sex. Although the Ibrahamic religions of Islam, Christianity, and Judaism prohibit homosexuality and teach that such behavior is sinful, male homosexuality, in particular, has been reported in many different cultures and historical eras. Lut1 (Alayhi As-Salam [AS]), nephew of the Prophet Ibrahim2 (AS), was sent as a prophet to the cities of Sodom and Gomorrah in the 22nd-20th centuries before Christ. Male homosexuality was very common in the tribe to which Lut (AS) was sent as a prophet. Lut (AS) conveyed the commands of Allah to people in order to make them give up homosexuality and make them follow him. Because the people continued their bad habits despite all the warnings of Lut (AS), Allah sent down torment on them. Allah turned (the cities) upside down, and rained down on them brimstones hard as baked clay, spread, layer on layer1,3. To the best of our knowledge, this is the first documented report of homosexuality in human history.