Association of ADIPOQ C-11377G [rs266729], TNF-alpha G-308A [rs1800629] and TNF-alpha G-238A [rs361525] single nucleotide polymorphisms with type 2 diabetes mellitus in Pakistani population

Objective: to determine the frequencies of adiponectin [ADIPOQ] C-11377G, tumor necrosis factor-alpha [TNF-alpha] G-308A and TNF-alpha G-238A single nucleotide polymorphisms [SNP] and their association with serum levels in Pakistani T2DM and healthy population

Study Design: Case control study

Place and Duration of Study: Military Hospital, Rawalpindi, Army Medical College and Institute of Biomedical and Genetic Engineering, Islamabad, Pakistan, from June 2012 till 2014

Methodology: cases [n=539] and controls [n=250] comprising of T2DM and healthy subjects, respectively, belonging to Pakistani Punjabi Rajput ethnicity were genotyped for SNPs. Serum adiponectin, TNF-alpha, insulin, blood sugar fasting [BSF], lipid profile, body mass index [BMI], and insulin resistance [IR] was determined and correlated with genotypes

Results: serum TNF-alpha was significantly higher and adiponectin was lower in T2DM than healthy controls [p < 0.003 and 0.0001, respectively, Mann-Whitney U-test]. The frequency of ADIPOQ CC, GC and GG was 340 [63.1%], 167 [31%] and 32 [5.9%] in T2DM patients. ADIPOQ -11377 SNP was not significantly associated with T2DM [OR = 1.116 [95% CI 0.81- 1.53], p = 0.27- Fisher's exact test]. Genotypes deviated from Hardy-Weinberg equilibrium. Minor alleles of TNF-alpha G-308A and TNF-alpha G-238A were not found in either groups

Conclusion: frequency of ADIPOQ -11377 risk allele is low and does not functionally affect the serum adiponectin levels; hence, ADIPOQ C-11377G SNP is not a risk factor for T2DM in Pakistani Punjabi Rajput patients. Moreover, TNF-alpha G-308A and TNF-alpha G-238A SNPs are not prevalent in this ethnic group

Demographic features of donors and causes of blood donor deferral at armed forces institute of transfusion, Rawalpindi

Objective: To determine the demographic features and causes of donor deferral in blood donors

Study Design: Descriptive study

Place and Duration of Study: Conducted at the Armed Forces Institute of Transfusion [AFIT] for a period of 1 year from Jun 2012 to May 2013

Material and Methods: Donors with ages ranging from 18-60 years who reported to the blood bank were incorporated in this study. A comprehensive history was taken from all the potential donors through a structured proforma. A detailed general physical examination was done by the appointed doctor at the blood bank. Furthermore, laboratory testing of the blood samples of potential donors was done. On this basis, donors were accepted or deferred

Results: The commonest cause of the donor deferral was hepatitis C [HCV] [28.6%], the second leading cause was anaemia [24%] and the third leading cause was hepatitis B [HBV] [16.8%]. Syphilis was also a major cause of donor deferral causing the rejection of 10.4% donors

Conclusion: The donor deferral rate is 7.3% and the leading course of donor deferral are chronic infections like hepatitis C and B and diseases like anaemia

Students' perception of educational environment at army medical college, rawalpindi: assessment by dreem [dundee-ready education environment measure]

To assess the students' perception of educational environment of Army Medical College, Rawalpindi, Pakistan and to determine gender difference in this perception. A survey-based study. Army Medical College, Rawalpindi, Pakistan from Jan 2012-June 2012. Dundee Ready Education Environment Measure [DREEM] questionnaire was administered to 805 1[st] year to 5[th] year MBBS students of AM College, after written and informed consent. DREEM total and subscores were calculated according to Likert scale. Comparison was made for responses of male and female students as well as among students of each class by student's t test and ANOVA. Valid responses were 647 out of 805 [response rate = 80.17%]. The education climate was rated as more positive than negative determined by overall DREEM scores [mean 116.57 +/- 24.96]. Students perceptions of learning, teachers, academic self-perception, atmosphere and social self-perception were determined by sub scales and responses were found to be more on the positive side though sub scores of academic perception were highest [19.32 +/- 5.25] and those of social self-perception were lowest [15.42 +/- 3.85]. There was no statistical difference in perception of male and female students [p = 0.12]. The sub scores were significantly higher in 1[st] year students but all other classes had almost similar scores [p = 0.06] on ANOVA and post hoc tukey's test. Army Medical College as an institution has a positive education environment where most of the students feel positive about education climate, learning environment, teachers, their own academic achievements, institutional atmosphere and their social well-being

Correlation of inflammatory markers with type 2 diabetes mellitus in Pakistani patients

To study the levels of inflammatory markers in Type 2 Diabetes Mellitus Pakistani patients and determine their correlation with the disease. This cross sectional study was conducted at Military Hospital, Rawalpindi, and Centre for Research in Experimental and Applied Medicine [CREAM], Army Medical College, Rawalpindi, Pakistan from June 2011-June 2012. We determined the levels of Erythrocyte Sedimentation Rate [ESR], Total Leukocyte Count [TLC], Interleukin 6 [IL-6] and Tumor Necrosis Factor- alpha [TNF- alpha] in 72 patients with Type 2 Diabetes Mellitus [T2DM] and 40 healthy controls. The levels were correlated with age, duration of the disease, Body Mass Index [BMI], lipid profile and insulin resistance. ESR, TLC, IL-6 and TNF- alpha were found to be significantly higher in T2DM patients. There was also statistically significant difference in BMI, fasting blood sugar, insulin resistance and dyslipidemia [except LDL] between diabetic and control group. All inflammatory markers except TNF- alpha were positively correlated with insulin resistance. Only TNF- alpha was found to be correlated to duration of the disease. Both TLC and Serum insulin were positively correlated to BMI. Inflammatory markers were not correlated to dyslipidemia. This is the first study reporting levels of cytokines in Pakistani diabetic patients and healthy controls. There is augmented inflammation in T2DM in Pakistani patients which plays role in higher insulin resistance in these patients. TNF- alpha levels increases with longer duration of the disease. Levels of inflammatory markers are not correlated to BMI, dyslipidemia or increasing age

Effect of acacia nilotica leaves extract on hyperglycemia, lipid profile and platelet aggregation in streptozotocin induced diabetic rats

Background: To consider new hypoglycaemic, anti-hyperlipidaemic and anti-platelet aggregation sources, aqueous methanol extract of Acacia Nilotica [AN] leaves was investigated in streptozotocin induced diabetic rats. Methods: Diabetes mellitus was induced in 90 out of 120 male albino rats by administering 50 mg/Kg bodyweight [bw] streptozotocin intraperitonealy, and was confirmed by measuring fasting blood glucose level >200 mg/dL on 4th post-induction day. The rats were equally divided into 4 groups, A [normal control], B [diabetic control], C [diabetics rats treated with plant extract] and group D [diabetics rats treated with glyburide]. The rats of group C and D were given single dose of 300 mg/Kg bw, AN extract, and 900 µg/Kg bw glyburide respectively for 3 weeks. Blood glucose levels were measured by glucometer, platelet aggregation by DiaMed method, ß-thromboglobulin and insulin by ELISA technique, and lipid components were measured by enzymatic calorimetric method. Results: Significant differences [p<0.05] were noticed in blood glucose, serum insulin, platelet aggregation and triglyceride levels in diabetic rats treated with AN extract and glyburide as compared to diabetic controlled rats. A significant difference [p<0.05] in ß-thromboglobulin and LDL levels was also noticed in rats treated with glyburide than the diabetic controlled rats. The levels of fasting blood glucose, ß-thromboglobulin and platelet aggregation were significantly reduced [p<0.05] in diabetic rats treated with glyburide than AN extract treated rats. Conclusions: Administration of AN leaves extract showed hypoglycaemic and anti-platelet aggregation activity in diabetic rats as that of glyburide. Keywords: Acacia Nilotica, Hypoglycemia, Streptozotocin

Correlation of serum alanine aminotransferase and aspartate aminotransferase levels of liver histology in chronic hepatitis C

To assess the correlation of serum alanine aminostransferase and aspartate aminotransferase levels to severity of disease on liver biopsy in patients of chronic hepatitis C. Descriptive study. Department of Gastroenterology of Military Hospital, Rawalpindi, from January 2006 to February 2007. One hundred and seven diagnosed non-cirrhotic chronic hepatitis C adult patients were included. Serum alanine aminotransferase and aspartate aminotransferase levels were determined. Knodell histopathological Index was determined on liver biopsy. The correlation and regression value between serum alanine aminotransferase levels and liver histology and serum aspartate aminotransferase and liver histology in chronic hepatitis C patients was determined using Pearson correlation analysis. Patients of chronic hepatitis C had raised serum alanine aminostransferase and levels with the mean baseline level of 93 International units per liter [IU/L] with a range of 13-383 IU/L. Serum aspirate aminotransferase levels were also elevated with mean baseline level of 59.65 IU/L ranging from 18-370 IU/L. On liver biopsy based on Knobell histopathologicalIndex, 47.7% of patients had mild, 39.9% IU/L had moderate and 13.1% had severe disease. There was significant association between serum alanine aminostransferase levels severity of the disese on liver biopsy [p<0.03] with weak positive correlation between the two [r=0.217]. There was also significant association between serum aspartate aminotransferase levels and severity of the disease on liver biopsy [p<0.001] with weak positive correlation between the two [r=0.32]. The serum alanine aminostransferase and serum aspartate aminotransferase levels do not indicate the severity of the disease on liver biopsy in chronic hepatitis C patients

Effects of combined interferon alpha and ribavirin therapy on thyroid functions in patients with chronic hepatitis C

To determine the frequency of thyroid dysfunction in patients of chronic hepatitis C during treatment with interferon alpha-2b and ribavirin therapy. A cohort study. Army Medical College and Military Hospital, Rawalpindi, from February 2006 to January 2007. One hundred and sixty seven non-cirrhotic chronic hepatitis C patients were grouped into treatment group [n=107] and control group [n=60] awaiting treatment. Baseline serum[s.] Alanine Transferase [ALT] and S. Aspartate Transferase [AST] were measured by IFCC method. Serum Thyroid Stimulating Hormone [S. TSH], serum free thyroxine [S. Free T4] and serum total triiodothyronine [S.T3] level were determined by chemiluminescence. Study group patients underwent 24 weeks IFN and ribavirin therapy and were followed-up for thyroid dysfunction at weeks 0, 12 and 24. Control group patients underwent the same tests at weeks 0, 12 and 24. Statistical analysis was done on SPSS 15. Out of 107 patients of treatment group, 20 patients [18.69%] developed thyroid dysfunction. Females were at higher risk with Relative Risk [RR] of 11.25 and Attributable Risk [AR] of 91%. Hypothyroidism was more common than hyperthyroidism. Interferon-alpha and ribavirin therapy induces thyroid dysfunction in chronic hepatitis C patients. Hypothyroidism was more common. Females are at a higher risk of developing thyroid dysfunction

Efficacy of combined interferon alpha and ribavirin therapy in patients of chronic hepatitis C

This study was carried out to determine the efficacy of combined interferon alpha and ribavirin therapy in patients of chronic hepatitis C. This study was conducted at Military Hospital Rawalpindi and Army Medical College, Rawalpindi from January 2006 to Feb 2007. One hundred and sixty seven non cirrhotic chronic hepatitis C patients were studied. The patients were grouped into study group [n=107] and control group [n=60]. The patients had persistently raised serum aminotransferase [ALT], positive HCV antibodies by 3[rd] generation ELISA, positive HCV RNA by polymerase chain reaction. Study group patients had positive histopathological findings on liver biopsy on basis of Knodell histopathological index [HPI]. At weeks 0, 12 and 24, blood samples were taken for the assay of serum alanine transferase [ALT] and serum, aspartate transferase [AST] levels in both the groups. Study group patients underwent 24 weeks Interferon and Ribavirin combination therapy and subsequently followed up for the response to treatment by the assay of HCV RNA by polymerase chain reaction at weeks 24. Control group included the patients without treatment plan but they also underwent screening for the same liver function tests. Patients of chronic hepatitis C [80 males and 27 females] had age range 18-48 years. After 24 weeks of INF and ribavirin therapy, 86% patients showed favourable response to treatment manifested by negative HCV RNA polymerase chain reaction. Treatment with Interferon and ribavirin combination therapy for 24 weeks produces significant virological response in patients of chronic hepatitis C at the end of treatment