Adnan Muhammad | PMAS Arid Agricultural university.Rawalpindi,Pakistan (original) (raw)

Papers by Adnan Muhammad

Background: Rapid blood glucose estimation is required to prescribe treatments and to make dose a... more Background: Rapid blood glucose estimation is required to prescribe treatments and to make dose adjustments in diabetic patients. However, measuring plasma glucose levels is time consuming. Therefore, the use of glucometers has greatly increased. Objectives: To measure the correlation between capillary and venous blood glucose levels. Methods: Seventy patients with type 2 diabetes mellitus (T2DM) were enrolled in the present study and informed written consent was obtained from all participants. Demographic characteristics and clinical information was noted. Capillary and venous glucose levels were determined. Statistical Package for Social Sciences version 21 was used for data analysis. Results: Mean age of patients was 52 ± 12 years. It included 29% men; 71% women; 9% smokers; and 90% poor. Mean venous glucose was 11.73 ± 4.64 mmol/L and mean capillary glucose 12.57 ± 5.21 mmol/L. These findings demonstrated a significant intermethod mean difference of 0.84 mmol/L (P < 0.001). Inter-glucose difference was not significant at glucose levels near normal. However, it increased gradually with rise in glucose measurements and was significant at elevated glucose levels. Both concordance correlation coefficient and intraclass correlation coefficient demonstrated positive correlation and more consistency between glucose estimations. A Bland and Altman plot presented excellent agreement between glucometrically and photometrically determined glucose levels. Conclusion: A positive correlation coefficient showed strong association between capillary and venous glucose measurements.

Introduction: Double burden of malnutrition, i.e. coexistence of under nutrition (underweight) an... more Introduction: Double burden of malnutrition, i.e. coexistence of under nutrition (underweight) and obesity, is getting high among populations in both developed and developing countries and has been observed at national and household levels. The present study was designed to estimate the double burden of underweight and obesity among undergraduate students. Material and Methods: This cross sectional study was conducted from April 2012 to September 2012, by PMRC Research Centre, FJMC Lahore. By using non probability convenient sampling method, a total of 456 volunteers of both genders aged 17-24 years were recruited from Punjab University, MAO College and Kennard College. A comprehensive questionnaire was used to collect the data from 173 males and 283 females. Weight (kg) and height (m) were measured to calculate body mass index (kg/m 2). BMI classification criteria for overweight and obesity in adults (Asia Pacific) was used to know the weight status. The circumferences of waist (inches) and hip (inches) were measured to calculate waist-hip ratio. The abdominal obesity was defined as waist circumference ≥35 inches in males and ≥32 inches in females and waist-hip ratio ≥0.90 in males and ≥0.85 in females. The data was analyzed using Statistical Package for Social Sciences (SPSS-20). Results: The means for age were 19.1±2.7 years in males and 20.9±1.8 years in females. The overall prevalence of underweight, normal-weight and overweight was 25.7%, 52.6% and 21.8%, respectively. The double burden of underweight and overweight was more common in males and less common in females. The powerful tool to find abdominal obesity was waist-hip ratio (42.5%), followed by waist circumference (38.4%). The abdominal obesity was more commonly seen than general obesity. The means for weight, height, waist circumference and waist-hip ratio were significantly different in both genders (p-value <0.001). According to waist-hip ratio, abdominal obesity was more prevalent in females than males (53.4% vs. 24.9%). Conclusion: The urbanization, nutrition shift and sedentary lifestyle are the reasons for double burden of underweight and obesity in undergraduate students. Regular exercise and balanced diet is the key to prevent obesity related morbidity. Health education programs are highly recommended at college and university level.

Background: Considering the fact that Pakistan is amongst the countries with very high neonatal m... more Background: Considering the fact that Pakistan is amongst the countries with very high neonatal mortality rates, we conducted a research study to determine the possible causes and characteristics of neonates presenting dead to the emergency department of tertiary public health care facilities of Pakistan using verbal autopsies. Methods: A descriptive case series study was conducted in emergency department/pediatrics ward/neonatal ward/ nursery unit of ten tertiary care public health facilities, situated in seven major cities of Pakistan from November, 2011 to June, 2013. Precoded verbal autopsy proforma was used to collect information regarding cause of death, family narratives and other associated risks accountable for pathway to mortality. Results: We identifi ed 431 neonates presenting dead to the emergency department (238 males and 193 females). Sepsis (26.7%), birth asphyxia (18.8%) and persistent pulmonary arrest (17.2%) were main primary causes of brought death. Around 72% brought dead neonates were referred from doctors/health care facilities and more than 28% caregivers mentioned that they were not informed about the diagnosis/ailment of their deceased newborn. Conclusions: Findings of our study suggest that infectious disease remains the main primary cause of neonatal mortality. Underweight in newborns (64%) was estimated as a leading associated risk. Delays in referrals to respective health care facility enlightened the concern of substandard prerequisites of neonatal care that could be one of the major contributing risk factor of high mortality rates.

Background: Rapid blood glucose estimation is required to prescribe treatments and to make dose a... more Background: Rapid blood glucose estimation is required to prescribe treatments and to make dose adjustments in diabetic patients. However, measuring plasma glucose levels is time consuming. Therefore, the use of glucometers has greatly increased. Objectives: To measure the correlation between capillary and venous blood glucose levels. Methods: Seventy patients with type 2 diabetes mellitus (T2DM) were enrolled in the present study and informed written consent was obtained from all participants. Demographic characteristics and clinical information was noted. Capillary and venous glucose levels were determined. Statistical Package for Social Sciences version 21 was used for data analysis. Results: Mean age of patients was 52 ± 12 years. It included 29% men; 71% women; 9% smokers; and 90% poor. Mean venous glucose was 11.73 ± 4.64 mmol/L and mean capillary glucose 12.57 ± 5.21 mmol/L. These findings demonstrated a significant intermethod mean difference of 0.84 mmol/L (P < 0.001). Inter-glucose difference was not significant at glucose levels near normal. However, it increased gradually with rise in glucose measurements and was significant at elevated glucose levels. Both concordance correlation coefficient and intraclass correlation coefficient demonstrated positive correlation and more consistency between glucose estimations. A Bland and Altman plot presented excellent agreement between glucometrically and photometrically determined glucose levels. Conclusion: A positive correlation coefficient showed strong association between capillary and venous glucose measurements.

ABSTRACT… Background: Diabetic retinopathy is the optical complication that may lead to impaired ... more ABSTRACT… Background: Diabetic retinopathy is the optical complication that may lead to impaired vision. It is one of the most prevalent but preventable blinding disease. Its early diagnosis is prerequisite for the prevention of the visual loss and blindness associated with diabetic complication. Objective: To estimate frequency of eye examination and various types of retinopathy; and to find the association between diabetic retinopathy and its risk factors. Methods: The cross sectional study was conducted from Apr-Sep 2012 by PMRC Research Centre, FJMC, Lahore. Using non probability convenient sampling, eighty known type II diabetics were recruited. Venous blood was drawn for plasma glucose level (GOD-PAP) and glycosylated hemoglobin (Ion-Exchange Resin). Arterial blood pressure was measured using digital apparatus (Oscillometric method). Visual acuity was tested by Snellen's chart and dilated fundus examination was done to screen diabetic retinopathy. Data was analyzed using Statistical Package for Social Sciences (SPSS-20). Results: The study included 41% males and 59% females. Mean age was 51±9 (33-67) years. Diabetics who never screened for retinopathy were 54.3%; and who examined during last year as per IDF guidelines were 25.7%. The frequency of bilateral and unilateral NPDR was 22.5% and 5%, respectively. The occurrence of NPDR was slightly higher in left eye, whereas PDR was more prevalent in right eye. The visual acuity was equal or better than 6/12 in better eye of 80% study participants; and was 6/18-6/36 in better eye of 20% participants. DR was significantly associated with longer duration of diabetes (p-0.010), poorly controlled diabetes (p-0.044) and hypertension (p-0.006). Odd ratios (95% CI) showed that duration of diabetes ≥20 years , glycosylated hemoglobin ≥7.5 %, Systolic blood pressure ≥140 mm/ Hg and diastolic blood pressure ≥90 mm/Hg had 3-5 times higher risk of retinopathy. Conclusion: Majority of patients were neither knew nor referred for eye examination. Strict control of diabetes and hypertension may prevent or delay diabetic retinopathy. Policy Message: Annual eye examination must be prescribed by the physician/ diabetologist. An education and awareness program for diabetics and community based survey is highly recommended.

Objectives: To see the effects of age, gender and diabetes on serum lipid levels. Study type, set... more Objectives: To see the effects of age, gender and diabetes on serum lipid levels. Study type, settings and duration: Cross sectional analytical study conducted at PMRC Research Centre, Fatima Jinnah Medical College, Lahore from Jun-Dec 2011. Materials and Methods: One hundred type 2 diabetes mellitus and equal numbers of gender matched healthy controls were randomly selected for the study. After an overnight fasting, blood specimens were drawn for lipid profile where total cholesterol, high density lipoprotein cholesterol and triglycerides were measured by standard enzymatic endpoint methods and LDL-cholesterol by Friedweld's formula. Statistical analysis was done using SPSS-15. Results Odd ratios of age for total cholesterol (OR 1.198); high density lipoprotein cholesterol (OR 1.144); and low density lipoprotein cholesterol (OR 1.576) revealed that subjects aged 45 years or more had greater risk of having deranged lipid levels. Female gender had higher high density lipoprotein cholesterol (p 0.000); and triglycerides (p 0.001). Odd ratios of men for total cholesterol (OR 0.775); high density lipoprotein cholesterol (OR 0.183); and low density lipoprotein cholesterol (OR 0.683) illustrated that men were significantly less prone to dyslipidemia than women. Odd ratio of diabetes for high density lipoprotein cholesterol (OR 1.802) suggested that diabetics had 1.8 times more risk of having low high density lipoprotein cholesterol. Conclusions: Diabetic females over 45 years of age have significantly high chances of having disturbed or high lipid profile. Policy message: All persons in general and diabetics in particular over the age of 45 years should be screened for dyslipidemia and informed using behavior change communication to prevent disease complications.

Background: Rapid blood glucose estimation is required to prescribe treatments and to make dose a... more Background: Rapid blood glucose estimation is required to prescribe treatments and to make dose adjustments in diabetic patients. However, measuring plasma glucose levels is time consuming. Therefore, the use of glucometers has greatly increased. Objectives: To measure the correlation between capillary and venous blood glucose levels. Methods: Seventy patients with type 2 diabetes mellitus (T2DM) were enrolled in the present study and informed written consent was obtained from all participants. Demographic characteristics and clinical information was noted. Capillary and venous glucose levels were determined. Statistical Package for Social Sciences version 21 was used for data analysis. Results: Mean age of patients was 52 ± 12 years. It included 29% men; 71% women; 9% smokers; and 90% poor. Mean venous glucose was 11.73 ± 4.64 mmol/L and mean capillary glucose 12.57 ± 5.21 mmol/L. These findings demonstrated a significant intermethod mean difference of 0.84 mmol/L (P < 0.001). Inter-glucose difference was not significant at glucose levels near normal. However, it increased gradually with rise in glucose measurements and was significant at elevated glucose levels. Both concordance correlation coefficient and intraclass correlation coefficient demonstrated positive correlation and more consistency between glucose estimations. A Bland and Altman plot presented excellent agreement between glucometrically and photometrically determined glucose levels. Conclusion: A positive correlation coefficient showed strong association between capillary and venous glucose measurements.

Introduction: Double burden of malnutrition, i.e. coexistence of under nutrition (underweight) an... more Introduction: Double burden of malnutrition, i.e. coexistence of under nutrition (underweight) and obesity, is getting high among populations in both developed and developing countries and has been observed at national and household levels. The present study was designed to estimate the double burden of underweight and obesity among undergraduate students. Material and Methods: This cross sectional study was conducted from April 2012 to September 2012, by PMRC Research Centre, FJMC Lahore. By using non probability convenient sampling method, a total of 456 volunteers of both genders aged 17-24 years were recruited from Punjab University, MAO College and Kennard College. A comprehensive questionnaire was used to collect the data from 173 males and 283 females. Weight (kg) and height (m) were measured to calculate body mass index (kg/m 2). BMI classification criteria for overweight and obesity in adults (Asia Pacific) was used to know the weight status. The circumferences of waist (inches) and hip (inches) were measured to calculate waist-hip ratio. The abdominal obesity was defined as waist circumference ≥35 inches in males and ≥32 inches in females and waist-hip ratio ≥0.90 in males and ≥0.85 in females. The data was analyzed using Statistical Package for Social Sciences (SPSS-20). Results: The means for age were 19.1±2.7 years in males and 20.9±1.8 years in females. The overall prevalence of underweight, normal-weight and overweight was 25.7%, 52.6% and 21.8%, respectively. The double burden of underweight and overweight was more common in males and less common in females. The powerful tool to find abdominal obesity was waist-hip ratio (42.5%), followed by waist circumference (38.4%). The abdominal obesity was more commonly seen than general obesity. The means for weight, height, waist circumference and waist-hip ratio were significantly different in both genders (p-value <0.001). According to waist-hip ratio, abdominal obesity was more prevalent in females than males (53.4% vs. 24.9%). Conclusion: The urbanization, nutrition shift and sedentary lifestyle are the reasons for double burden of underweight and obesity in undergraduate students. Regular exercise and balanced diet is the key to prevent obesity related morbidity. Health education programs are highly recommended at college and university level.

Background: Considering the fact that Pakistan is amongst the countries with very high neonatal m... more Background: Considering the fact that Pakistan is amongst the countries with very high neonatal mortality rates, we conducted a research study to determine the possible causes and characteristics of neonates presenting dead to the emergency department of tertiary public health care facilities of Pakistan using verbal autopsies. Methods: A descriptive case series study was conducted in emergency department/pediatrics ward/neonatal ward/ nursery unit of ten tertiary care public health facilities, situated in seven major cities of Pakistan from November, 2011 to June, 2013. Precoded verbal autopsy proforma was used to collect information regarding cause of death, family narratives and other associated risks accountable for pathway to mortality. Results: We identifi ed 431 neonates presenting dead to the emergency department (238 males and 193 females). Sepsis (26.7%), birth asphyxia (18.8%) and persistent pulmonary arrest (17.2%) were main primary causes of brought death. Around 72% brought dead neonates were referred from doctors/health care facilities and more than 28% caregivers mentioned that they were not informed about the diagnosis/ailment of their deceased newborn. Conclusions: Findings of our study suggest that infectious disease remains the main primary cause of neonatal mortality. Underweight in newborns (64%) was estimated as a leading associated risk. Delays in referrals to respective health care facility enlightened the concern of substandard prerequisites of neonatal care that could be one of the major contributing risk factor of high mortality rates.

Background: Rapid blood glucose estimation is required to prescribe treatments and to make dose a... more Background: Rapid blood glucose estimation is required to prescribe treatments and to make dose adjustments in diabetic patients. However, measuring plasma glucose levels is time consuming. Therefore, the use of glucometers has greatly increased. Objectives: To measure the correlation between capillary and venous blood glucose levels. Methods: Seventy patients with type 2 diabetes mellitus (T2DM) were enrolled in the present study and informed written consent was obtained from all participants. Demographic characteristics and clinical information was noted. Capillary and venous glucose levels were determined. Statistical Package for Social Sciences version 21 was used for data analysis. Results: Mean age of patients was 52 ± 12 years. It included 29% men; 71% women; 9% smokers; and 90% poor. Mean venous glucose was 11.73 ± 4.64 mmol/L and mean capillary glucose 12.57 ± 5.21 mmol/L. These findings demonstrated a significant intermethod mean difference of 0.84 mmol/L (P < 0.001). Inter-glucose difference was not significant at glucose levels near normal. However, it increased gradually with rise in glucose measurements and was significant at elevated glucose levels. Both concordance correlation coefficient and intraclass correlation coefficient demonstrated positive correlation and more consistency between glucose estimations. A Bland and Altman plot presented excellent agreement between glucometrically and photometrically determined glucose levels. Conclusion: A positive correlation coefficient showed strong association between capillary and venous glucose measurements.

ABSTRACT… Background: Diabetic retinopathy is the optical complication that may lead to impaired ... more ABSTRACT… Background: Diabetic retinopathy is the optical complication that may lead to impaired vision. It is one of the most prevalent but preventable blinding disease. Its early diagnosis is prerequisite for the prevention of the visual loss and blindness associated with diabetic complication. Objective: To estimate frequency of eye examination and various types of retinopathy; and to find the association between diabetic retinopathy and its risk factors. Methods: The cross sectional study was conducted from Apr-Sep 2012 by PMRC Research Centre, FJMC, Lahore. Using non probability convenient sampling, eighty known type II diabetics were recruited. Venous blood was drawn for plasma glucose level (GOD-PAP) and glycosylated hemoglobin (Ion-Exchange Resin). Arterial blood pressure was measured using digital apparatus (Oscillometric method). Visual acuity was tested by Snellen's chart and dilated fundus examination was done to screen diabetic retinopathy. Data was analyzed using Statistical Package for Social Sciences (SPSS-20). Results: The study included 41% males and 59% females. Mean age was 51±9 (33-67) years. Diabetics who never screened for retinopathy were 54.3%; and who examined during last year as per IDF guidelines were 25.7%. The frequency of bilateral and unilateral NPDR was 22.5% and 5%, respectively. The occurrence of NPDR was slightly higher in left eye, whereas PDR was more prevalent in right eye. The visual acuity was equal or better than 6/12 in better eye of 80% study participants; and was 6/18-6/36 in better eye of 20% participants. DR was significantly associated with longer duration of diabetes (p-0.010), poorly controlled diabetes (p-0.044) and hypertension (p-0.006). Odd ratios (95% CI) showed that duration of diabetes ≥20 years , glycosylated hemoglobin ≥7.5 %, Systolic blood pressure ≥140 mm/ Hg and diastolic blood pressure ≥90 mm/Hg had 3-5 times higher risk of retinopathy. Conclusion: Majority of patients were neither knew nor referred for eye examination. Strict control of diabetes and hypertension may prevent or delay diabetic retinopathy. Policy Message: Annual eye examination must be prescribed by the physician/ diabetologist. An education and awareness program for diabetics and community based survey is highly recommended.

Objectives: To see the effects of age, gender and diabetes on serum lipid levels. Study type, set... more Objectives: To see the effects of age, gender and diabetes on serum lipid levels. Study type, settings and duration: Cross sectional analytical study conducted at PMRC Research Centre, Fatima Jinnah Medical College, Lahore from Jun-Dec 2011. Materials and Methods: One hundred type 2 diabetes mellitus and equal numbers of gender matched healthy controls were randomly selected for the study. After an overnight fasting, blood specimens were drawn for lipid profile where total cholesterol, high density lipoprotein cholesterol and triglycerides were measured by standard enzymatic endpoint methods and LDL-cholesterol by Friedweld's formula. Statistical analysis was done using SPSS-15. Results Odd ratios of age for total cholesterol (OR 1.198); high density lipoprotein cholesterol (OR 1.144); and low density lipoprotein cholesterol (OR 1.576) revealed that subjects aged 45 years or more had greater risk of having deranged lipid levels. Female gender had higher high density lipoprotein cholesterol (p 0.000); and triglycerides (p 0.001). Odd ratios of men for total cholesterol (OR 0.775); high density lipoprotein cholesterol (OR 0.183); and low density lipoprotein cholesterol (OR 0.683) illustrated that men were significantly less prone to dyslipidemia than women. Odd ratio of diabetes for high density lipoprotein cholesterol (OR 1.802) suggested that diabetics had 1.8 times more risk of having low high density lipoprotein cholesterol. Conclusions: Diabetic females over 45 years of age have significantly high chances of having disturbed or high lipid profile. Policy message: All persons in general and diabetics in particular over the age of 45 years should be screened for dyslipidemia and informed using behavior change communication to prevent disease complications.