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Objectives: To determine the frequency of undiagnosed hypertension among the diabetic patients with micro vascular complications. Method: This is a descriptive case series conducted at Department of Medicine, Ghurki Trust Teaching Hospital, in this six month stud which enrolled 213 patients between 18-60 years from March 28, 2021 to September 28, 2021, having diabetes with microvascular complications. These patients were not previously diagnosed as hypertensives. Patient was diagnosed as hypertensive if SBP or DBP was ≥140 or ≥90 mmHg respectively. The frequency of undiagnosed hypertension was noted and compared across various subgroups of patients. Results: The mean age of the patients was 49.3±9.7 years. The mean BMI of these patients was 28.3±3.5 Kg/m2 and 67 (31.5%) patients were obese. The mean duration of disease was 8.2±3.9 years. Majority (62.4%) of the patients had diabetic retinopathy while 37.6% patients had diabetic nephropathy. Undiagnosed hypertension was observed in 42 (19.7%) patients with diabetic micro vascular complications. The frequency of undiagnosed hypertension was significantly higher among obese as compared to non-obese patients (28.4% vs. 15.8%; p-value=0.032). There was no statistically significant difference in the frequency of undiagnosed hypertension across various subgroups based on patient’s age (p-value=0.750), gender (p-value=0.902), type of micro vascular complication (p value=0.783) and duration of diabetes (p-value=0.763). Conclusion: In the present study, a substantial proportion of patients with diabetic micro vascular complications suffered undiagnosed hypertension which is alarming and advocates routine blood pressure monitoring of such patients so that timely identification and anticipated management of underlying hypertension may improve the outcome of such cases in future clinical practice. doi: https://doi.org/10.12669/pjms.41.1.9715 How to cite this: Qureshi SS, Amer W, Mueez M, Farok M, Shehzad SK. Frequency of undiagnosed hypertension among diabetic patients with micro vascular complications. Pak J Med Sci. 2025;41(1):210-213. doi: https://doi.org/10.12669/pjms.41.1.9715 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: This study was aimed to compare the body mass index (BMI) and waist-to-hip ratio (WHR) in their ability to predict type 2 diabetes risk in a large prospective cohort of men and women in Pakistan. Methods: This was a case-control study conducted at Diabetic and medical OPD of GTTH. Anthropometric measures including BMI and WHR were analyzed. Student’s t-test, Chi-squared test along with Cramer’s V value, was applied to evaluate association between variables. Receiver operating curve (ROC) was used to assess anthropometric measures. Results: The study included 804 diabetics and 396 non-diabetics between 30–60 years of age. Comparing the BMI parameters it was found that 717 (89·2%) in diabetic group were overweight or obese (p-value < 0·001). On comparing the WHR, 97·9% diabetics had increased WHR (p-value <0·001). Both BMI & WHR were further compared using ROC curve which found out that WHR had an area under ROC of 0·720 & BMI has 0·680, suggesting that WHR is more better predictor of diabetes as compared to BMI. Conclusions: Both BMI and WHR were strong discriminators of T2DM but WHR was found superior according to ROC value. Family history is significantly associated in patients with diabetes. doi: https://doi.org/10.12669/pjms.35.5.759 How to cite this:Qureshi SS, Amer W, Kaleem M, Beg BM. Adult anthropometry in Type 2 diabetic population: A case-control study. Pak J Med Sci. 2019;35(5):1284-1289. doi: https://doi.org/10.12669/pjms.35.5.759 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.

This study was aimed to compare the body mass index (BMI) and waist-to-hip ratio (WHR) in their ability to predict type 2 diabetes risk in a large prospective cohort of men and women in Pakistan. This was a case-control study conducted at Diabetic and medical OPD of GTTH. Anthropometric measures including BMI and WHR were analyzed. Student's t-test, Chi-squared test along with Cramer's V value, was applied to evaluate association between variables. Receiver operating curve (ROC) was used to assess anthropometric measures. The study included 804 diabetics and 396 non-diabetics between 30-60 years of age. Comparing the BMI parameters it was found that 717 (89.2%) in diabetic group were overweight or obese (p-value < 0.001). On comparing the WHR, 97.9% diabetics had increased WHR (p-value <0.001). Both BMI & WHR were further compared using ROC curve which found out that WHR had an area under ROC of 0.720 & BMI has 0.680, suggesting that WHR is more better predictor of diabetes as compared to BMI. Both BMI and WHR were strong discriminators of T2DM but WHR was found superior according to ROC value. Family history is significantly associated in patients with diabetes.

This work examines the behaviour of flow and heat transmission in the presence of hybrid nanofluid in thermal radiation, heat generation, and magnetohydrodynamics. The hybrid state in this model is represented by two different fluids, TiO (titanium dioxide) and Ag (silver). The enclosure is wavy and slanted, with curving walls on the left and right. The finite difference approximation method was utilized to resolve the fundamental equations after they were non-dimensionalized, which are further reduced to a fourth-order bi-harmonic equation and are numerically solved based on the biconjugate gradient-stabilized approach method. The simulations are performed with various Rayleigh numbers, Hartmann numbers, an inclination angle of the enclosure, radiation parameters, heat generation parameters, inclination angle of the magnetic field, and volume fraction of hybrid nanoparticles. The streamlines, isotherms, and average Nusselt number contours are used to depict the thermo-fluid patterns. The findings show that the average Nusselt number relies on and increases as rises. The investigation’s findings demonstrated that the transfer of heat on the heated bottom wall significantly increases with the Rayleigh number (Ra = 10 and 10 ). At a cavity inclination of 45°, interesting multi-vortex structures are observed. The results of this study may enhance the effectiveness of solar collectors, heat exchangers, and other similar systems that depend on convective heat transfer in nature.

Abstract Introduction/Objective Introduction: Patients with advanced chronic kidney disease (CKD) often require phosphate binders to manage elevated serum phosphorus levels due to phosphorus-restricted diets being insufficient. This study aimed to assess the safety and efficacy of sevelamer in lowering serum phosphorus and improving the serum lipid profile in a hemodialysis patient. Methods/Case Report A prospective study was conducted on a 59-year-old hemodialysis man with CKD. Sevelamer was administered orally as 800 mg tablets, with the dosage adjusted based on washout serum phosphorus levels (WSPL). Blood samples were collected every two weeks before dialysis, and all samples were analyzed using standard clinical laboratory methods. Sevelamer treatment resulted in a significant reduction in serum phosphorus levels from 6.9 mmol/l to 4.3 mmol/l. No major adverse events were observed during the trial period, and there was no evidence of negative consequences associated with sevelamer therapy. Additionally, sevelamer treatment led to a decrease in hemoglobin levels to 10.5 g/dl and a substantial reduction in total cholesterol concentration from 5.22 mmol/l to 4.26 mmol/l. Results (if a Case Study enter NA) NA Conclusion Conclusion: Sevelamer, a non-absorbable aluminum and calcium-free phosphate binder, effectively lowered serum phosphorus levels in dialysis patients while improving lipid profiles. It was well tolerated with no instances of hypercalcemia and resulted in significant reductions in intact parathyroid hormone (PTH) and total and LDL cholesterol. Sevelamer may serve as a valuable therapeutic option for managing hyperphosphatemia in patients with CKD.

Background Residency programs have been impacted by the Coronavirus disease 2019 (COVID-19) pandemic. In this study we aim to investigate and evaluate the impact of the pandemic on residents as well as residency training programs. Methods This was a cross-sectional study including a survey of 43 questions prepared on Google forms and electronically distributed among a convenience sample of residents training at a tertiary center in North Jordan during the COVID-19 pandemic. Data were collected in the period between October 30th and November 8th of 2020. The survey included questions that addressed the impact of the pandemic on residents’ health as well as training programs. The study participants included residents in training at KAUH in 2020 and were stratified according to the type of residency program (surgical residents (SRs) and non-surgical residents (NSRs)). Statistical methods included descriptive analysis, Chi-square or Fisher’s exact test, Mann Whitney U test, and Cramer’s V and r statistics as measures of effect sizes. Results Of all 430 residents, 255 (59%) responded to the survey. A total of 17 (7%) of residents reported being infected with COVID-19 and a significant difference was reported between SRs and NSRs (10% vs 4%, V = .124 “small effect” (95% CI; .017–.229), p  = 0.048). Approximately, 106 (42%) reported a decrease in the number of staff working at the clinic and 164 (64%) reported limited access to personal protective equipment during the pandemic. On a 4-point Likert scale for the feeling of anxiety, the median was 2 (2–3 IQR) in the NSRs group, vs 2 (1–2 IQR) in the SRs groups, with the NSRs being more likely to feel anxious (r = 0.13 “small effect” (95% CI; 0.007–0.249), p  = .044). Similarly, the proportion of residents who reported feeling anxious about an inadequacy of protective equipment in the work area was significantly greater in the NSRs group (90.3% vs 75.2%; V = .201 “small effect” (95% CI; .078–.313), p  = .001), as well as the proportion of residents who reported feeling increased stress and anxiety between colleagues being also significantly higher in the NSRs group (88.1% vs 76%; V = .158 “small effect” (95% CI; .032–.279), p  = .012). Conclusion The burden of the ongoing pandemic on the mental health status of residents is very alarming and so providing residents with psychological counseling and support is needed. Also, critical implications on the flow of residency training programs have been noticed. This necessitates adapting and adopting smart educational techniques to compensate for such limitations.

To review the indications and clinical profile of neonatal admissions at King Abdullah University Hospital in Jordan. We conducted a cross-sectional review of all neonates admitted to the neonatal intensive care unit between September 2016 and September 2018. Collected data include demographic characteristics, indications for admission, morbidities and mortality, and discharge outcomes. Findings were reported among term and preterm infants. A total of 1444 infants were admitted during the study period of whom 1332 (92.2%) were inborn and 612 (42.4%) were term neonates. Of the 832 preterm infants, 545 were late preterm (34-36 6/7 gestation) and 125 had very low birth weight (˂ 1500 grams); 925 (64%) were born by cesarean section. Respiratory failure of the newborn (41.2%) and prematurity (33.3%) were the main indications for admission among the whole cohort. Maternal prolonged premature rupture of membranes (PROM) was observed in nearly half the admissions of term infants. Hypoxic ischemic encephalopathy (3.2% vs 0.7%, p 0.01) and congenital anomalies (5% vs 1.2%, p 0.03) were more common in term infants. The rate of bronchopulmonary dysplasia was 39% among <28-week and 28% among <32-week premature infants. Sepsis was encountered in 59 infants. The overall mortality rate was 3.8%. Prematurity was the main predisposing factor for mortality (Adjusted OR: 9.9, 95% CI: 3.5, 27.6). The majority of neonatal admissions at our institution are term and late preterm infants delivered by cesarean section. Prematurity, respiratory failure of the newborn, and suspected sepsis due to maternal PROM are the leading causes of admission. The mortality rate is within WHO target to achieve Sustainable Development Goal 3. Population-based studies are needed to make better conclusions that represent the whole Jordanian population. A revisit for the indications of cesarean deliveries may help to improve the neonatal outcomes.

Apart from the Buongiorno model, no effort was ably accomplished in the literature to investigate the effect of nanomaterials on the Oldroyd-B fluid model caused by an extendable sheet. This article introduces an innovative idea regarding the enforcement of the Tiwari and Das fluid model on the Oldroyd-B fluid (OBF) model by considering engine oil as a conventional base fluid. Tiwari and Das’s model takes into account the volume fraction of nanoparticles for heat transport enhancement compared to the Buongiorno model that depends significantly on thermophoresis and Brownian diffusion impacts for heat transport analysis. In this paper, the thermal characteristics of an Oldroyd-B nanofluid are reported. Firstly, the transformation technique is applied on partial differential equations from boundary-layer formulas to produce nonlinear ordinary differential equations. Subsequently, the Keller-box numerical system is utilized to obtain final numerical solutions. Copper engine oil (Cu–EO) and molybdenum disulfide engine oil (MoS2–EO) nanofluids are considered. From the whole numerical findings and under the same condition, the thermodynamic performance of MoS2–EO nanofluid is higher than that of Cu–EO nanofluid. The thermal efficiency of Cu–EO over MoS2–EO is observed between 1.9% and 43%. In addition, the role of the porous media parameter is to reduce the heat transport rate and to enhance the velocity variation. Finally, the impact of the numbers of Reynolds and Brinkman is to increase the entropy.

ABSTRACT Objective: To determine the frequency of cerebral venous sinus thrombosis (CVST) among the patient with headache presenting from high altitude (HA). Study Design: Cross-sectional study. Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi, from 24th Apr 2018 to 24th Jan 2019. Methodology: The sample population comprised of patients presenting with the headache, living at a height of 3000-8200 meter above sea level. CT-scan brain, MRI brain and MRV brain was performed on all the cases. Carotid Doppler, d-dimers, thrombophillic screen, autoimmune profile, EEG and other relevant investigations were performed of all the cases diagnosed with CVST. Age, altitude, total time spent at HA and acclimatization were correlated with the presence of CVST among the patients of headache at HA. Results: Out of 60 patients reporting with headache from HA, 9 had presence of CVST on the relevant neuroimaging. Among these cases of CVST 2 had secondary polycythemia, 1 had protein C deficiency and 1 had protein S deficiency. Poor acclimatization had a significant relationship with the presence of CVST when logistic regression was applied. Conclusion: Cerebral venous sinus thrombosis should be considered a possibility while evaluating the causes of headache among the patients reporting from high altitude. Special attention should be given on acclimatization process for the people who are ascending to high altitude.

The optimal management of cancer in patients with severe heart failure is not defined. This issue is particularly challenging when a diagnosis of limited-stage small cell lung cancer (SCLC) is made incidentally in the context of evaluating patient for candidacy for cardiac transplantation. Limited-stage SCLC is typically managed on a curative therapeutic paradigm with combined modality approach involving chemotherapy and radiation. Even with excellent performance status and good organ function, the presence of severe cardiomyopathy poses significant challenges to the delivery of even single modality approach with chemotherapy or radiotherapy, let alone the typical curative combined modality approach. With mechanical left ventricular devices to provide cardiac support, treatment options for cancer in the setting of advanced heart failure may be improved. Here we discuss the therapeutic dilemma involving a patient with severe cardiomyopathy and left ventricular assistant device (LVAD) who was found to have limited-stage SCLC during the evaluation process for cardiac transplantation.