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.

… 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.

Objectives: To compare pregabalin with duloxetine in terms of mean reduction in pain score, in the management of patients with painful diabetic neuropathy. Study Design: Randomized Controlled Trial. Setting: Department of Medicine, FMU & Affiliated Hospitals, Faisalabad. Period: 1st March, 2020 to 3rd March 2021. Material & Methods: A total of 180 patients with known diabetics of at least 5 years duration, 18 to 75 years of age were included. Patients with ischemic pain or other types of pain not related to diabetes such as arthritic pain or phantom pain secondary to amputations, CRF & CLD were excluded. Group A received 150mg of Pregabalin at night before sleeping and was increased to 150mg twice daily after 02 week if VAS pain score reduction was found to be less than 50% from baseline. Group B received 60mg Duloxetine at bed time and it was increased to 120mg after 04 weeks if the VAS pain score was less than 50% after 04 weeks. The patients were again assessed after another 04 weeks to assess VAS Pain Score reduction. The primary outcome is pain as assessed by the Visual Analogue Score (VAS) at the end of 04 weeks from start of medications. Results: Age range in this study was from18 to75 years with mean age of 40.87±13.67 years. The mean age of patients in pregabalin group was 38.80 ± 13.01 years and in duloxetine group was 41.07 ± 13.85 years. Majority of the patients 34 (56.67%) were between 20 to 40 years of age. Mean reduction in pain in pregabalin group was 1.63 ± 1.07 while in duloxetine group was 3.23 ± 1.38 (p-value =0.0001). Conclusion: This study concluded that duloxetine had significantly greater pain reduction than pregabalin in the management of patients with painful diabetic neuropathy.

Objectives: To assess the frequency of acute exacerbation of chronic obstructive pulmonary disease in patients taking low dose azithromycin prophylaxis. Study Design: Cross Sectional study. Setting: Department of Medicine, Independent University Hospital, Faisalabad. Period: 01-07-2017 to 30-06-2018. Material & Methods: 100 patients having diagnosis of COPD according to the operational definition were selected from medical opd of hospital after consent of patients. All patients were given tablet azithromycin 250mg thrice weekly for 12 months, then these patients were followed up for episodes of exacerbations in one year. All patients were properly instructed to report in any change in their symptoms. Any episode of acute exacerbation was noted. There was no conflict of interest. Results: Frequency of acute exacerbation of chronic obstructive pulmonary disease was seen in 70 out of 100(70%) patients taking low dose azithromycin prophylaxis. In female patients frequency of acute exacerbation was high as compared to male patients. i.e. 62.9% vs. 37.1%. Frequency of acute exacerbation was higher in patients whose duration of disease was longer. i.e. 7-10 years followed by patients whose duration of disease was 4-6 years (28.6%) and 1-3 years (25.7%). Presence of acute exacerbation was significantly associated with decline in lung functions. Highest frequency of acute exacerbation was seen in patients who had 3-4 episodes. Conclusion: Results of this study showed a high frequency of acute exacerbation of COPD even with the prophylaxis of low dose azithromycin. However literature reported effectiveness of low dose azithromycin for acute exacerbation in patients of COPD. So further study in the form of randomized trail is needed to prove the efficacy of azithromycin.