Background: Diabetes mellitus is associated with significant morbidity andmortality worldwide and Pakistan is no exception. Objectives: To determine the morbidity andmortality in patients admitted with Diabetes Mellitus in a teaching hospital of Pakistan, throughretrospective analysis of admission and patient file records. Study Design: Retrospectivelyanalyzed. Setting: Independent University Hospital, a Teaching Hospital, Faisalabad. Period:1st January 2016 to 31st December 2017. Patients and Methods: Data included age, gender,total numbers of admissions and those due to Diabetes Mellitus, the indications for admissions,presenting symptoms and method of diagnoses in diabetic patients, mortality rates and causesof death. Data obtained were analyzed using chi square. Results: Out of 10490 medicaladmissions, 5706 (54.4%) were males and 4784 (45.6%) females. Diabetes was detected in 1450(13.8%) patients [810 (55.9%) males, 640 (44.13%) females]. The mean age of diabetic patientswas 53.6+16.1 years (range 18 – 94 years). Poor glycemic control (29%) and diabetic footsyndrome (23.4%) were the most common reasons for admission in diabetic cases. The overallmortality rate among medical admissions was 21.8%, with diabetes accounting for 6.7% deaths.Within the cohort of diabetic cases, mortality was 15.9%, with significantly higher mortalityin those aged > 65 years (p < 0.05). The most common causes of death in diabetic caseswere cerebrovascular disease and complications associated with the diabetic foot syndrome,accounting for 26.1% and 21.7% of deaths respectively; the least common causes of death indiabetic patients were pulmonary tuberculosis, meningitis, malaria and hepatic encephalopathyaccounting for 4.4% of deaths. Conclusions: Cerebrovascular disease was the most frequentcause of mortality among admitted diabetic patients with diabetic foot syndrome (a preventablecomplication) as the second most frequent cause of mortality. Increased screening for diabetesmellitus morbidities in the clinic and community settings and adequate health education isrequired to reduce morbidity and mortality associated with diabetes mellitus.

Hemodialysis adversely affects many dimensions of the patients. So this study was carried out to assess the impact of hemodialysis on livelihood of the patients. Objectives: To study the socio-economic characteristics of Hemodialysis (HD) dependent patients, to explore the impact of hemodialysis on the livelihood of the patients, and to suggest some suitable policy measures. Study Design: Cross sectional study. Setting: At Dialysis Center of DHQ Hospital Faisalabad, Punjab, Pakistan. Period: May 2018 November 2018. Material & Methods: Multistage sampling technique was used, at 1st step a public sector dialysis center was selected through simple random sampling and then 109 adult patients were conveniently selected and interviewed through self-designed interview schedule. Data analysis and interpretation was executed using (SPSS version 24). Multiple linear regression was applied to study the relevant significance of predicting variables and to check the impact of different variables on respondent’s livelihood (response variable). Conclusion: It was found that due to rigorous schedule of HD most of the respondents were unable to perform their economic, social and religious activities; also they were depending on their caregivers for their routine activities. Resultantly, lower SES (socio-economic) has a negative effect on health in patients with undergoing dialysis involving fewer personal resources and lower levels of social support to deal with stress imposed by HD. Hence HD was negatively affecting their livelihood, so there is dire need to address these problems of HD dependent segment.

Objective: To determine the frequency of extra articular manifestations in Rheumatoid Arthritis patients at independent university hospital Faisalabad. Study Design: Cross Sectional study. Setting: Rheumatology Division of Internal Medicine Independent University Hospital Faisalabad. Period: January 2019 to December 2019. Material & Methods: Consecutive Three hundred and twenty-three adult patients of either sex, of age between 20-60 years with baseline RA fulfilling the 2010 criteria of American College of Rheumatology. Extra articular manifestations were assessed. Chi square test was used to compare the frequency of extra articular manifestations among different disease duration, age groups, seropositivity and disease score. A p-value ≤ 0.05 was considered statistically significant. Results: 323 patients with RA were assessed in this study. Extra articular manifestations were assessed according to clinical presentation. 15.2% (49) patients were found to have lung involvement with predominant interstitial lung disease. Rheumatoid nodules were found in 9.9% (32) patients. 3rd most common extra-articular manifestation was sicca syndrome, seen in 3.7% (12) patients followed by neurological 2.2% and cardiac was 1.5%. Other extra-articular manifestations were seen in 2.8% of patients. Conclusion: it is very important to assess the extra articular manifestations in rheumatoid arthritis. Early assessment and early intervention can decrease the disease morbidity and mortality.

… Background: Diabetes mellitus is associated with significant morbidity and mortality worldwide and Pakistan is no exception. Objectives: To determine the morbidity and mortality in patients admitted with Diabetes Mellitus in a teaching hospital of Pakistan, through retrospective analysis of admission and patient file records. Study Design: Retrospectively analyzed. Setting: Independent University Hospital, a Teaching Hospital, Faisalabad. Period: 1 st January 2016 to 31 st December 2017. Patients and Methods: Data included age, gender, total numbers of admissions and those due to Diabetes Mellitus, the indications for admissions, presenting symptoms and method of diagnoses in diabetic patients, mortality rates and causes of death. Data obtained were analyzed using chi square. Results: Out of 10490 medical admissions, 5706 (54.4%) were males and 4784 (45.6%) females. Diabetes was detected in 1450 (13.8%) patients [810 (55.9%) males, 640 (44.13%) females]. The mean age of diabetic patients was 53.6+16.1 years (range 18 -94 years). Poor glycemic control (29%) and diabetic foot syndrome (23.4%) were the most common reasons for admission in diabetic cases. The overall mortality rate among medical admissions was 21.8%, with diabetes accounting for 6.7% deaths. Within the cohort of diabetic cases, mortality was 15.9%, with significantly higher mortality in those aged > 65 years (p < 0.05). The most common causes of death in diabetic cases were cerebrovascular disease and complications associated with the diabetic foot syndrome, accounting for 26.1% and 21.7% of deaths respectively; the least common causes of death in diabetic patients were pulmonary tuberculosis, meningitis, malaria and hepatic encephalopathy accounting for 4.4% of deaths. Conclusions: Cerebrovascular disease was the most frequent cause of mortality among admitted diabetic patients with diabetic foot syndrome (a preventable complication) as the second most frequent cause of mortality. Increased screening for diabetes mellitus morbidities in the clinic and community settings and adequate health education is required to reduce morbidity and mortality associated with diabetes mellitus.