This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Objective: To determine causative uropathogens and their antibiotic susceptibility pattern among Type-2 diabetics (T2D) with good and suboptimal glycemic control. Methods: A hospital based cross-sectional study was carried out in Peshawar from April–October, 2019. Four hundred consecutive T2D patients with symptomatic UTI or showing numerous pus cells on routine urinary examination attending outpatient clinic were included. As per the guidelines of the Clinical and Laboratory Standards Institute (CLSI), the urine samples collected were checked for identification of uropathogen by culture. Disc diffusion method was used to determined antimicrobial susceptibility. Results: Of the total (n=400) T2D patients, 205 (51.25%) showed microbial growth. Mean age of patients with UTI was 63.26 ±12.30 years. About two-third (63.9%) of the patients were females. Mean HbA1c was 8.80±2.20%. The frequency of patients with UTI was noticeably greater in the suboptimal glycemic control group 178(86.3%) compared to good control glycemic patients 27(13.7%). Significant mean difference in glycemic levels were observed (HbA1c = 5.86±0.48 and HbA1c = 9.25±2.02, respectively, P < 0.001). E. coli was the predominant pathogen isolated 120(71%), followed by Klebsiella pneumonia Spp (K. pn) 35(17.1%), Pseudomonas auregonosa (P. aeruginosa) 14(6.83%), Enterococcus 12 (5.85%) and Candida Spp were 2(0.98%). Both gram positive and negative-bacteria were highly susceptible to imipenem, meropenem, fosfomycin and nitrofurantoin. Conclusion: The frequency of UTI in diabetics was higher in female in comparison to male, and was significantly greater in the suboptimal glycemic control group. E. coli was the most typical isolate followed by K. pn. Imipenem, meropenem, fosfomycin and nitrofurantoin had high susceptibility profile against the isolated pathogens. doi: https://doi.org/10.12669/pjms.36.7.2881 How to cite this:Ahmad S, Hussain A, Khan MSA, Shakireen N, Ali I. Diabetes mellitus and urinary tract infection: Causative uropathogens, their antibiotic susceptibility pattern and the effects of glycemic status. Pak J Med Sci. 2020;36(7):---------. doi: https://doi.org/10.12669/pjms.36.7.2881 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background: Published studies have reported that acute kidney injury (AKI) and other kidney related manifestations are associated with COVID-19 and linked with poor outcome. This study aimed to determine the incidence, risk factors and outcomes of AKI in hospitalized COVID-19 patients. Methods: This retrospective study of 154 patients involved retrieving data from hospital records confirm COVID-19 infection admitted to the Northwest General Hospital & Research Center, Peshawar from 1st April to 31st July 2020. AKI was defined using Kidney disease. Improving Global Outcomes (KDIGO)” guidelines. Results: Incidence of AKI was 37.01%. Age, gender, intensive care (ICU) requirement, number of co-morbid, diabetes mellitus, coronary artery disease, chronic kidney disease, chronic obstructive airway disease (COAD), arrhythmias among comorbid and fever and shortness of breath among symptoms were found to be significantly differed between AKI and non-AKI patients. Numerous differences of laboratory results such as serum sodium, potassium, total leukocyte count, absolute lymphocyte count and platelets between both groups were observed (p<0.05). Inflammatory markers including lactate dehydrogenase (LDH), ferritin, d-dimer and C-reactive protein (CRP) were significantly raised in AKI group. Overall mortality was observed to be 38 (24.7%). Moreover, age, ICU requirement; COAD, creatinine, serum sodium, inflammatory markers (LDH, ferritin, d-dimers and CRP), total leukocyte count, absolute lymphocyte count, platelets and support requirement were significantly differed between survivors and non-survivors.  Mortality was significantly higher among AKI group, i.e., 52.6% compared to 8.2% in non-AKI group (p<0.001). Conclusion: AKI is common among hospitalized COVID-19 patients and is associated with mortality. In all, AKI patients less than half of the patients survived.

Objective: To find the correlation between serum vitamin B12 levels in metformin users among type-2 diabetics.Study Design: Cross-sectional Study.Place and Duration of Study: The study was carried out at the Department of Medicine of Combined Military Hospital, Peshawar, Pakistan from April 2021 to September 2021.Materials and Methods: Using a consecutive sampling technique, patients were selected from both outdoor and indoor medical health facility Blood tests were performed on all patients and serum vitamin B12 level was assessed, a level less than 200 pg/ml was considered deficient. The comparison was made among patients taking metformin and those not on metformin.Results: 148 patients were enrolled, consisting of an equal proportion of cases and controls i.e. 74 patients in each group, with a mean age of 44.09± 10.61 and 46.15± 10.64 respectively. Vitamin B12 deficiency was found more in metformin user group 34 (45.94%) than in patients not on metformin 11 (14.86%) (p<0.001). The odd ratio was 4.87 (95% CI is 2.22 – 10.69).Conclusion: Metformin users taking at least 1000mg daily of minimum one-year duration experienced significant reductions in blood vitamin B12 levels as compared to patients not using metformin. A serum vitamin B12 test needs to be performed on regular basis after every three months in type-2 diabetic patients taking metformin of more than 1 gram daily for more than a year.

Background: Acinetobacter spp. have been a primary cause of nosocomial infections worldwide, causing significant morbidity and mortality, especially in Pakistan. The purpose of this study was to investigate the trend of antimicrobial resistance over a 5-year period in a tertiary care hospital in Pakistan. Methods: A retrospective cross-sectional study regarding the occurrence and antimicrobial resistance of Acinetobacter spp. recovered from clinical specimens that were referred to the Pathology Laboratory of Northwest General Hospital, Peshawar. The data from 2014 to 2019 was recorded and analyzed by the laboratory. Sociodemographic characteristics and laboratory record data was analyzed using SPSS, version 25. A chi-square test was applied to see the significance. Results: Of 59 483 clinical samples, Acinetobacter baumannii strains were detected in 114 of them. The majority of the clinical samples were from blood (89.5%) followed by sputum (7.9%), wound swab (1.8%), and bone marrow (0.9%). A. baumannii has been found in 52 men (67.53%) and 28 women (75.67%), with an overall risk of 0.669 times. In 76 men (98.70%), sensitivity for ertapenem (99.1), colistin (96.49), and tigecycline (78.9%) were also observed which indicated the potential viability of these drugs to treat multidrug-resistant (MDR) Acinetobacter infections. The male-to-female risk ratio was 0.98 for colistin and 0.71 for amikacin. Conclusion: Increased frequency of MDR supports the need for continuous surveillance to determine the prevalence and evolution of MDR Acinetobacter spp. in Pakistan. Colistin, tigecyclines, and ertapenem remain the possible line of drugs to treat MDR Acinetobacter.