Is Hyperleptinemia a risk factor for hypertension?

Background: Major risk factors of hypertension [HTN] including obesity, insulin resistance, renal pathology, increased sympathetic nerve activity [SNA] and vascular inflammation are associated with hyperleptinemia. Therefore hyperleptinemia may act as a mediator of blood pressure, linking body fat mass with changes in insulin action, sympathetic neuronal outflow and renal pathology

Objective: The objective of our study was to explore the relationship between hyperleptinemia and HTN in Pakistani population

Materials and Methods: It was a case control study of 6 months duration, carried out at Shifa College of Medicine and Shifa International Hospital, Islamabad. One hundred and four male subjects, 52 with HTN and 52 without HTN were included in this study. Leptin levels were measured by enzyme-linked immunosorbent assay [ELISA] technique. The relationship of leptin [LEP], body mass index [BMI], fasting blood sugar [FBS] and cholesterol levels with blood pressure were assessed

Results: Patients with HTN versus patients without HTN had a higher body mass index [28.0 +/- 0.12 to 24.11 +/- 0.27 kg/m[2]], FBS [169.20 +/- 7.34 to 127.50 +/- 2.30 mg/dl], total cholesterol [160 +/- 3.72 to 158 +/- 2.71 mg/dl] and LEP [53.40 +/- 5.32 to 21.65 +/- 3.50 ng/ml] levels. In univariate analysis, obesity, hyperglycemia and hyperleptinemia [with P values of 0.000, 0.001, 0.000, respectively], whereas in multivariate analysis, hyperglycemia and hyperleptinemia [with P values of 0.006 and 0.001, respectively] were risk factors for HTN. Our study also showed that hyperleptinemia is an independent risk factor for HTN

Conclusions: We observed a strong positive relationship between hyperleptinemia and hypertension, thereby indicating that increased leptin levels could be considered as a risk factor for HTN and cardiovascular disease. Further studies are needed to probe the underlying pathophysiological mechanisms responsible for hyperleptinemia in HTN

Comparison of methanolic extract of acacia modesta leaves and glibenclamide on hyperlipidemia in alloxan induced diabetic rats

AIMS AND OBJECTIVES: To evaluate the hypolipidemic effect of Acacia modesta [AM] leaves extract in comparison with glibenclamide in alloxan induced diabetic rats

STUDY DESIGN: An Experimental study

PLACE AND DURATION: This study was carried out at the Shifa College of Medicine and National Institute of Health, Islamabad from October 2010 to October 2011

MATERIALS AND METHODS: One hundred and twenty healthy male albino rats were equally divided into four groups [n=30], groups A [normal control], B [diabetic control], C [diabetic rats treated with glibenclamide] and group D [diabetics rats treated with AM leaves extract]. Diabetes was induced in overnight fasting [14-16 hrs] rats of groups B, C and D by single intraperitoneal injection of alloxan [110 mg/kg b.w] and was confirmed by measuring fasting blood glucose level >200 mg/dl on 4th post-induction day. Rats of group C and D were treated with glibenclamide [900 µg/kg b.w] and Acacia modesta leaves extract [400 mg/kg b.w] respectively for 3 weeks. Serum triglycerides, cholesterol, LDL and serum HDL levels were measured by homogenous enzymatic colorimetric method

RESULTS: A significant decrease [p<0.05] in the levels of serum triglyceride, cholesterol and LDL levels, and an increase in HDL levels were noticed in rats treated with glibenclamide [group C] and AM leaves extract [group D] than the diabetic control rats [group B]. Group C showed a significant decrease in the levels of cholesterol, triglycerides and LDL with a significant increase in levels of HDL as compared to group D

CONCLUSION: Administration of AM leaves extract results in hypolipidaemic activity in diabetic rats as that of glibenclamide

C-reactive protein in patients with acute coronary syndrome: association with coronary markers, lipid profile and markers of coagulation

To determine levels of C-reactive protein [CRP] and its association with coronary markers, lipid profile and markers of coagulation in patients of acute coronary syndrome [ACS]. Case control study. The study was conducted at Shifa college of Medicine and Shifa international hospital for a period of one year [November 2005-December 2006]. Sixty nine age matched controls and 133 consecutive patients of ACS were included in the study. CRP were measured by immunoturbidometric method, MB fraction of creatine kinase [CK-MB] and Troponin-I by micro-particle enzyme immunoassay, lipid levels by Colorimetric Enzymatic methods, platelets by celldyn and coagulation markers were measured by CA-50 Sysmax. At admission mean CRP levels, cardiac biomarkers, lipid profile and coagulation markers were significantly increased in patients of ACS versus controls. Within the patients of ACS the mean levels of CRP, CK-MB, Trop I, prothrombin time [PT] and activated partial thromboplastin time [APTT] were significantly raised in patients with ST-elevation myocardial infarction [STEMI] and non STEMI [NSTEMI] versus patients of unstable angina [UA]. Association between CRP levels and coronary markers, coagulation markers and lipid profile was found to be non significant. The CRP levels were increased in patients with ACS as compared to controls. The CRP levels were insignificantly correlated with coronary markers [CK-MB, Trop I], coagulation markers [platelet count, PT, APTT], and lipid profile [cholesterol, triglyceride, HDL and LDL cholesterol] in patients with ACS

Attitude of Pakistani doctors towards euthanasia and assisted suicide

To determine the attitude of junior and senior Pakistani physicians towards euthanasia and assisted suicide. A descriptive study. The study was carried out at Shifa International Hospital Islamabad in 2006 [January to November]. Shifa International Hospital Islamabad is a 500 bed tertiary care hospital with 400 resident staff and 140 specialists. An anonymous enclosed questionnaire on the respondent's opinion of euthanasia / assisted suicide was distributed to the doctors who were requested to rate according to degree of agreement, willingness to participate in these practices, and safeguard or restrictions needed if the practices were legalized. The total response rate was 66% and male to female ratio was 7:1. Most of the respondents were Muslims and had familiarity with the subject. Seventy seven percent believe that the practice of euthanasia and assisted suicide was not ethically justified, while 9% were in its favor. Pakistani doctors oppose euthanasia and assisted suicide

Deregulation of serum leptin levels in acute coronary syndrome

To test whether leptin is a risk factor for acute myocardial infraction. A case control study. The study was carried out at Shifa International Hospital Islamabad for one year. Serum leptin levels of 86 patients of acute coronary syndrome [ACS] were compared with 86 age and sex matched controls. Leptin levels were measured by enzyme linked immunosorbent assay [ELISA] technique. Our study indicated that patients of ACS have higher body mass index [BMI], systolic and diastolic blood pressure and blood sugar levels as compared to the controls [normal subjects free of any cardiac disease]. Moreover serum leptin levels were also significantly higher in the patients of ACS [47.87 +/- 6.16 ng/ml] as compared to the control group [14.97+ 1.90ng/ml]. Smoking, higher systolic and diastolic blood pressure, blood sugar and leptin levels were significant risk factors for ACS in univariate analysis. Whereas smoking, higher systolic blood pressure, blood sugar and leptin levels also remained significant risk factors for ACS in the multivariate model. Multivariate analysis indicated that increased leptin levels lead to 7.9% increase in the odds ratio of ACS. The current study has indicated that patients of ACS have significantly higher leptin levels as compared to controls, and this leads to 7% increase in the odds ratio of ACS. This study showed that in addition to the traditional risk factors like diabetes mellitus, smoking and hypertension, increased leptin levels is also an important link in the development of cardiovascular disease. Therefore development of therapeutic agents primarily directed against increased leptin levels could contribute in reducing the mortality and morbidity associated with CAD

Complementary and alternative medicine: Attitude of medical community in Pakistan

To determine the awareness and use of Complementary and Alternative Medicine [CAM] among General Practitioners [GP's] and Medical students in Islamabad/ Rawalpindi area. In this descriptive study, a self-administered proforma with eight questions was distributed to randomly selected GP's in Islamabad and Rawalpindi area and final year medical students of Shifa college of medicine, Islamabad in 2005-2006. Responses of the participants were analyzed by computer software SPSS version 10. Up to 71% GP's and medical students claim to have self knowledge about CAM. Less than 31% had any formal education [workshop or seminar] about CAM. Less than 45% claim to have used it personally or refer patients for CAM therapy. More than 80% take history from patients about CAM use and about 50% had noted significant side effects of CAM. More than 50% GP's and students think that homeopathy, herbal medicine and acupuncture are effective way of treatment and recommend strongly to include those at National level. Knowledge of GP's and final year medical students about CAM is predominantly based on self-learning without any formal education on this subject. Practice of CAM is quite similar in terms of personal use, patient referral, patient history taking and witnessing of side effects in both groups

C-reactive protein and acute coronary syndrome: Comparison of conservative and interventional management

Inflammation plays a key rote in the initiation and progression of atherosclerosis, the most common cause of acute coronary syndrome. C-reactive protein [CRP] that enhances plaque inflammation is synthesized six hours after myocardial infarction. High sensitivity C-reactive protein was measured by Immunoturbiditory method in 50 healthy controls and 100 patients of acute coronary syndrome on conservative or interventional management. Serum C-reactive protein levels [mg/L +/- SEM] at the time of admission were significantly raised in patients of acute coronary syndrome [11.90 +/- 2.30] as compared to controls [2.30 +/- 0.18] and further increased progressively during 24 hours of follow up period. C-reactive protein levels also increased significantly in patients who underwent interventional management [115.90 +/- 7.73] as compared to those who were on conservative management [22.28 +/- 5.54]. Serum C-reactive protein levels were found to be significantly raised in patients with acute coronary syndrome as compared to controls. In addition, patients undergoing interventional management had higher C-reactive protein levels, post intervention, as compared to those on conservative management

Synergistic interaction of adenosine diphosphate-epinephrine and epinephrine - collagen in aggregation of human platelets

Efficient hemostasis in human body depends on a complicated series of events which actively involve blood platelets. Platelets exhibit diverse responses in a variety of agonists. In vivo, most of the agonists act in synergism, causing aggregation of platelets. In this study, the synergism between ADP ' Epinephrine and Epinephrine ' Collagen has been determined by means of turbidometric method, which measures changes in optical density of platelet suspension. The study was carried out at the department of Hematology, Armed Forces Institute of Pathology, Rawalpindi. The subthreshold concentrations of each of the agonists were established with the help of dose response curve. By adding these agonists in subthreshold concentrations, the synergism between ADP ' Epinephrine and Epinephrine ' Collagen was determined. The combinations of these agonists in subthreshold levels showed the synergistic responses in causing platelet aggregation. These findings indicate that the optimal platelet aggregation does occur between the above mentioned pairs of agonists even when each of the agonist is added to the other in subthreshold doses

Chidhood obesity and Pakistan

Obesity and overweight have become a problem of public health magnitude associated with substantial economic burden not only in the developed countries but also in the developing countries. The number of overweight children and adolescents has doubled in the last two decades in the United States and worldwide, including developing countries. No study on childhood obesity and overweight is available in Pakistan. Obesity in children impacts on their health in both short and long-term and obesity and its preventive strategies are poorly understood. Increasing number of these children and adolescents all over the world demand not only a substantial political will but also an investment for primary and secondary preventive measures and novel approaches in the treatment modalities