Role of leptin and dyslipidemia in chronic kidney disease

Chronic kidney disease [CKD] patients are at an increased risk of cardiovascular complications and plasma leptin level is elevated in cardio renal syndrome. We wanted to explore leptin levels in patients with different stages of CKD and find its association with risk of cardiovascular disease. This cross-sectional study was conducted in Nephrology Department of Jinnah Post Graduate Medical Centre [JPMC] from January 2014 to September 2014. Group I comprised of controls [GFR=116+/-8.3, n = 44] acquired from general population, CKD patients were grouped as II, III and IV respectively with GFR; 85.77+/-9.9 [n = 42], 53.84+/-9.9 [n=42] and 20.22+/-8.4 [n = 42].CKD patients with any inflammatory disease, Diabetes Mellitus and on steroid therapy were excluded. Serum leptin, lipid profile and C reactive proteins [CRP] were measured. Leptin and CRP levels increased significantly with progression of CKD. High density lipoproteins [HDL] to low density lipoproteins [LDL] ratio was significantly high in control as compared to CKD groups [p<0.001]. A positive correlation of leptin was observed with CRP and HDL/LDL ratio [r= 0.994,p<0.001 and r=-0.403 p<0.001] respectively. Hyperleptinemia observed with progression of CKD contributed to pathogenesis of cardiovascular disease by decreasing HDL/LDL ratio

Influence of body mass index and polycystic ovarian syndrome on ICSI/IVF treatment outcomes: a study conducted in Pakistani women

Background: obesity may establish a crucial barrier for effective fertility treatment in polycystic ovary syndrome [PCOS] females

Objective: to compare results of intra-cytoplasmic sperm injection [ICSI] in females with and without polycystic ovarian syndrome and further appraise the effect of obesity in PCOS females

Materials and Methods: a cross-sectional study from June 2015 to July 2016 included non-PCOS and PCOS [recognized by Rotterdam criteria] females who underwent ICSI. The PCOS were further stratified into non-obese and Obese according to the South Asian criteria for body mass index. Results were categorized on the basis of beta-human chorionic gonadotropin [beta-hCG] and transvaginal scan into non-pregnant [beta-hCG <25 mIU/ml], preclinical abortion [beta-hCG >25 mIU/ml with no fetal cardiac activity] and clinical pregnancy [beta-hCG >25 mIU/ml with fetal cardiac activity on transvaginal scan]. In addition, reproductive outcomes; implantation rate, clinical pregnancy rate and miscarriage rate among obese and non-obese PCOS and non-PCOS patients were compared

Results: our results revealed 38.5% clinical pregnancy rate in non-PCOs females, 23.8% in non-obese PCOS females whereas 26.4% in obese PCOS. Preclinical abortions were found to be highest [31.5%] in non-obese PCOS females and were the lowest [26.2%] in non-PCOS females. In non-PCOS group and non-obese PCOS females 35.4% and 44.6%, respectively, failed to become pregnant

Conclusion: the success after ICSI in terms of number of clinical pregnancies was more in non-PCOS patients as compared to PCOS. Increase in body mass index reflected a negative impact on the reproductive outcome in PCOS patients

Soluble transferrin receptor, ferritin index in Pakistani population

Inflammation affects the reliability of ferritin. The serum level of transferrin receptor protein [sTfR] represents true demand of iron in the body. This study attempts to identify levels of sTfR and correlate the trends of sTfR/ferritin index with BMI in the population of Karachi. 132 gender matched volunteers between the ages of 20-60 years were recruited for this cross-sectional study. BMI was calculated using the formula: [weight in kg / height in m2]. Following groups were made according to South Asian criteria of BMI; Group A: normal weight [18.0-22.9 kg/m[2]], Group B: overweight [23.0-24.9 kg/m[2]], Group C: obese [>25.0 kg/m[2]]. Serum ferritin, sTfR and CRP levels were determined using ELISA kits. Statistical comparisons were performed using Mann Whitney U and Spearman's rank correlation, where p<0.05 was considered significant. The results identified increased in TIBC, sTfR, ferritin and CRP in obese as compared to normal weight individuals [p<0.001]. sTfR/ferritin ratio was 0.822 which signifies increased risk of acute myocardial infarction in group C. Serum iron [r=-0.359,p=0.004] showed negative correlation with BMI while serum ferritin [r=0.237,p< 0.001] and sTfR [r=0.263,p= 0.036] levels were positively associated to BMI. This study highlights a novel finding that sTfR is most likely a better clinical measure of iron status in inflammatory conditions as its expression is effected by erythropoiesis and not by inflammation. Risk of Acute myocardial infarction can also be predicted by increased sTfR/ferritin ratio

Anti mullerian hormone: ovarian response indicator in young patients receiving long gnrh agonist protocol for ovarian stimulation

Objective: Anti Mullerian hormone [AMH] is gaining place as ovarian marker, chiefly in infertility assistance

We explored its correlation with oocytes retrieval after long GnRH agonist protocol for stimulation, in younger and older infertile population

Methods: This retrospective analysis compiled data of 166 females, receiving ICSI treatment from June 2014 to March 2015. Serum FSH, LH, Estadiol, AMH and antral follicle count were assessed. Outcomes were measured as good [5 to 19 oocytes] and bad responders

Results: Higher discriminatory power of AMH [AUROC; 0.771; p < 0.05] was seen in comparison to FSH [0.692; p < 0.05] and AFC [0.690; p < 0.01]. AMH reported strongest association with oocyte retrieved [odds ratio of 15.06]

Subgroup analysis reported 68.6 % risk of bad response with AMH levels of less than 1.37ng/ ml. This association was observed more significant in young infertile patients <35 year of age [=0.245; p=0.012] versus older population >35 year [r=0.169; p>0.05

Conclusion: Our study reaffirms that serum AMH correlates well with oocytes retrieved, particularly in females younger than 35 years. We suggest incorporation of AMH in baseline assessment of infertile females, who are falsely advised to postpone interventions based on their age and normal FSH levels

Students' perception of educational environment at Aga Khan University Medical College, Karachi, Pakistan

Objective: To assess educational environment in Aga Khan University Medical College [AKUMC] by Dundee Ready Educational Environmental Measure [DREEM] scale

Methods: A cross-sectional survey of students at the AKUMC with simple random sampling was carried out from June 2014 till March 2015. Responses in five subscales were used to calculate DREEM scores

Results: The average DREEM score was 125.77 +/- 16.8 with a reliability of 91.3%. With regards to subscales, on the 12-item students' perceptions of learning [PoL] subscale, the maximum score was 48; 11 items of students' perceptions of teachers [PoT] had a maximum score of 44; students' academic self-perceptions [ASP] identified by 8 items showed maximum score of 32; students' perceptions of atmosphere [PoA] with 12 items obtained maximum score 48 and students' social self-perceptions [SSP] subscale of 7 items had a maximum score of 28

Conclusion: Students perceived a positive learning environment at AKUMC Karachi

Increased Body Mass Index may lead to hyperferritinemia irrespective of body Iron stores

Objective: Obesity causes subclinical inflammation which results in the secretion of various bioactive peptides that are key players in metabolic regulation of iron homeostasis. We sought to establish correlation of one such peptide [ferritin] with marker of subclinical inflammation [CRP] in various BMI

Methods: Total 150 subjects between the ages of 20-60 years were included in the cross-sectional study conducted at Basic Medical Sciences Institute, Jinnah Post Graduate Medical Centre, Karachi, Pakistan. Body Mass Index [BMI] was calculated by weight [kg] /height [m[2]]. The given values were used as reference for Group A: normal weight [18.0-22.9 kg/m2], Group B: overweight [23.0-24.9 kg/m2], Group C: obese [>25.0 kg/m2] according to South Asian criteria. Serum Iron, Total Iron Binding Capacity, serum Transferrin Saturation, serum Ferritin and C-reactive protein were measured by commercially available kits. ANNOVA with Tukey's minimum significant difference and Spearman Rho correlation were used considering p<0.05 significant

Results: The results identified an increased serum Ferritin and CRP in obese versus lean subjects [p < 0.001]. BMI showed significantly positive correlation with serum CRP [r = 0.815; p-value < 0.01] and Ferritin [r = 0.584; p-value < 0.01]. However, serum Iron levels and Transferrin saturation decreased in obese versus normal weight individuals [p < 0.001]

Conclusion: This integrated new data reveals that individuals with high BMI had high levels of Serum Ferritin despite low levels of iron with high levels of C- reactive protein.This might be caused due to inflammatory conditions prevailing in the presence of increased adipose tissue

Role of fetuin-A in insulin resistance in type 2 diabetes mellitus

To determine the role of fetuin-A in triggering insulin resistance and leading to development of type 2 diabetes. A cross sectional, case control study was conducted at Basic Medical Sciences Institute [BMSI], Jinnah Post Graduate Medical Centre [JPMC]. Time duration of the study was from February 2012 to September 2013. A total of 150 subjects were included by random sampling out of which 50 were known type 2 diabetics, 50 were having impaired fasting glycaemia [IFG] and 50 were normal healthy individuals. Detailed history taking, clinical examination and body mass index [BMI] calculation were done. Laboratory investigations included serum fasting glucose, measured by glucose oxidase method and serum insulin and serum fetuin-A levels that were measured by ELISA method. Insulin resistance was calculated by Homeostatic model assessment, [HOMA IR]. Statistical analysis was done by using SPSS Version 16. We observed that serum fetuin-A levels were significantly higher in known type 2 diabetics as compared to impaired fasting glycaemics and controls [p<0.01]. Serum insulin and HOMA IR were also significantly elevated in known type 2 diabetics when compared to impaired fasting glycaemics and healthy individuals [p<0.01]. Body mass index was also significantly higher in known type 2 diabetics and impaired fasting glycaemics when compared to controls [p<0.01]. Our findings suggested that higher serum fetuin-A levels have a possible role in promoting insulin resistance and development of diabetes mellitus type 2

Life style trends in a group of known hypertensives: a questionnaire based survey

To evaluate the frequency of daily life trends in known hypertensive patients attending a hypertensive clinic regularly. Cross sectional study. Jinnah Medical and Dental College Hospital Korangi, Karachi from July 2007 to August 2007. A total of 100 known hypertensive patients were administered questionnaire comprising sections on personal information, medical history, tobacco, caffeine, salt consumption, physical activity and sleep pattern. Single blood pressure reading, weight and height were recorded and BMI were calculated. It was observed that hypertensive patients were obese, had reduced physical activity with preference of salt intake. The detection of common habits that might be correlated with hypertension and avoiding them may improve awareness and lead to its prevention