Objectives: To determine the prevalence of asymptomatic cardiac autonomic neuropathy and its association with risk factors among patients with Type-2 diabetes mellitus (T2DM) Methods: The present case-control study was conducted at Department of Medicine, Civil Hospital, Dow University of Health Sciences (DUHS), Karachi, Pakistan during the period September` 2016 to May` 2017. After taking informed consent, subjects from both genders, 72 healthy controls and 72 clinically diagnosed T2DM diabetic patients, age between 30-65 years were selected by non-probability sampling technique. After taking medical history and demographics, Cardiac Autonomic Neuropathy (CAN) was identified by using Ewing`s cardiac autonomic reflex tests (CARTs) and association of risk factors was also investigated. Results: Severe CAN was identified in 13.9% of T2DM patients while in none of the healthy controls. HR response to deep breathing test was most sensitive (sensitivity= 90%) among all tests. The most common symptoms were Numbness (75.9%) and constipation (69%), resting heart rate and diabetes duration was significantly associated with DCAN. Conclusions: CAN was highly prevalent in diabetic population that may lead to nephropathy and retinopathy in future. It is highly recommended to use sensitive and simple CARTs in clinics for early detection and early treatment of CAN. doi: https://doi.org/10.12669/pjms.37.4.3675 How to cite this:Naz T, Memon NN, Afzal K, Shakir A. Noninvasive exploration of Cardiac Autonomic Neuropathy by heart rate and blood pressure variability analysis in Type 2 Diabetic patients. Pak J Med Sci. 2021;37(4):---------.  doi: https://doi.org/10.12669/pjms.37.4.3675 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.

Objectives:To compare thyroid hormone levels in apparently healthy individuals and un-dialyzed chronic renal failure patients in local population. Study Design: Crosssectional, descriptive, observational study. Setting: OPD patients in BMSI Biomedical Science Institute of Medical Jinnah Medical Karachi. Period: June 2010 to December 2010 in BMSI JPMC, Karachi. Methods: Ninety individuals including 30 healthy control and 60 patients of chronic renal failure were included in this study. Individuals were grouped based on severity of diseases (stages) as healthy (control) group and the diseased group. Patients with un-dialyzed CRF on conservative management, GFR < 60 ml/mint/1.73m 2 , age between 20 to 60 years in both sexes were included in this study. Patients already taking thyroxine or antithyroid drugs, history of thyroid surgery and neck radiation and patients on maintenance haemodialysis were excluded. Measurement of thyroid hormone levels were done through Radio Imune Assay (RIA) method and GFR by Cock Craft Gualt formula. Results: Serum FT 3 significantly low in patients with CRF of stage III 1.27±0.12, stage IV 1.04±0.09 vs 2.80±0.09 in controls, p=0.001. TSH was significantly high in patients of CRF as compared to control 4.41±0.87 and 3.3±0.34 vs 1.97±0.16, P=0.001. No significant difference was seen in serum FT 4 levels . Conclusion: In local population thyroid hormone level of FT3 declines with the severity of Glomerular Filtration Rate as compare to healthy individuals. However, TSH level increases with this severity as also reported in other countries. Additionally, FT3 level is helpful for early detection and prevention of complications. Local population need awareness to prevent CRF by reporting to hospital before stage 3.

Objectives: To compare thyroid hormone levels in apparently healthy individualsand un-dialyzed chronic renal failure patients in local population. Study Design: Crosssectional,descriptive, observational study. Setting: OPD patients in BMSI Biomedical ScienceInstitute of Medical Jinnah Medical Karachi. Period: June 2010 to December 2010 in BMSIJPMC, Karachi. Methods: Ninety individuals including 30 healthy control and 60 patients ofchronic renal failure were included in this study. Individuals were grouped based on severity ofdiseases (stages) as healthy (control) group and the diseased group. Patients with un-dialyzedCRF on conservative management, GFR < 60 ml/mint/1.73m2, age between 20 to 60 years inboth sexes were included in this study. Patients already taking thyroxine or antithyroid drugs,history of thyroid surgery and neck radiation and patients on maintenance haemodialysis wereexcluded. Measurement of thyroid hormone levels were done through Radio Imune Assay (RIA)method and GFR by Cock Craft Gualt formula. Results: Serum FT3 significantly low in patientswith CRF of stage III 1.27±0.12, stage IV 1.04±0.09 vs 2.80±0.09 in controls, p=0.001. TSHwas significantly high in patients of CRF as compared to control 4.41±0.87 and 3.3±0.34 vs1.97±0.16, P=0.001. No significant difference was seen in serum FT4 levels. Conclusion: Inlocal population thyroid hormone level of FT3 declines with the severity of Glomerular FiltrationRate as compare to healthy individuals. However, TSH level increases with this severity as alsoreported in other countries. Additionally, FT3 level is helpful for early detection and preventionof complications. Local population need awareness to prevent CRF by reporting to hospitalbefore stage 3.