Homeostasis model assessment of insulin resistance in non-diabetic heart failure patients: a case-control investigation at tertiary care Hospitals of Karachi

Heart failure is a progressive, chronic disorder. Insulin resistance [IR] has been more and more involved as a preliminary metabolic perturbance predisposing to hyperglycemia, hyperlipidemia and atherosclerosis with others heart diseases. To investigate the relation of insulin resistance [IR] in non-diabetic heart failure patients this case-control study was carried out to ascertain the presence of IR with the aid of Homeostasis Model Assessment of Insulin Resistance [HOMA-IR] in non-diabetic heart failure patients [NDHF patients] compared with healthy controls. The sample size was calculated for both, cases [NDHF patients] and control [healthy subjects], which was initially consisted of 113 respondents each. The study consisted of two phase duration. In Phase I, NDHF patients were approached initially; only 80 patients with NDHF completed the study procedure. In Phase II, 80 healthy subjects were targeted and matched. Fasting blood glucose level [FBGL] and serum insulin was estimated. Mathematical model to quantify beta-cell function and insulin resistance was also computed through Homeostasis Model Assessment of Insulin Resistance [HOMA-IR] in both groups. Data was analyzed on SPSS version 16. Mean values with +/- standard deviation [SD] of insulin [10.2+/-4.36] and HOMA-IR [2.52+/-1.15] were significantly [p <0.05] higher in NDHF patients as compared to control subject [6.4+/-3.39, 1.45+/-0.80]. Average insulin to glucose ratio was 0.10+/-0.044 in NDHF patients which was significantly [p <0.0001] lowered in controls i.e., 0.073+/-0.039. Marginal and matrix plot analysis revealed that a higher patients count have had the HOMA-IR values <1.5 units while opposite scenario was observed in control group. Regression analyses of HOMA-IR with FBGL [as independent indicator] also authenticate the similar pattern. The present study concludes that insulin resistance [decreased insulin sensitivity] is a characteristic finding in Pakistani population of heart failure as compared to matched healthy controls

Comparison of Ki-67/MIB-1 labelling index and histopathological grading of astrocytoma

Background: Astrocytomas are common malignant brain tumours. Ki-67/MIB-1 index serves as an important supplementary tool in the diagnosis and prognosis of human astrocytoma

Methods: Forty [40] cases of various histopathological [WHO] grades of astrocytoma [Pilocytic, diffuse, Anaplastic and Glioblastoma multiforme] were included in this study. Ki-67/MIB-1 labelling index of these tumours was estimated by immunohistochemistry, performed on paraffin sections. Histopathological grading and Ki-67/MIB-1 labelling index were compared. The results were analyzed by one way ANOVA

Results: Out of 40 cases two were diagnosed as pilocytic astrocytoma [WHO grade-1] with a mean Ki-67/MIB-1 labelling index of 0.7+/-1.4 [range 0.6-0.8%]. Thirteen cases were of diffuse astrocytoma [WHO grade II], with a mean Ki-67/MIB-1 labelling index of 3.07+/-3.7 [range 1-15%]. Nine cases were diagnosed as Anaplastic astrocytoma [WHO grade III] with a mean Ki67/MIB-1 labelling Index of 11.55+/-7.8 [range 2-35%]. Sixteen cases were diagnosed as Glioblastoma multiforme with a mean Ki-67/MIB-1 labelling Index of 14.1+/-8.9 [range [5-36%]. ANOVA showed a significant differences between four compared groups [p=0.003]

Conclusion: Immunohistochemical analysis of Ki-67/MIB-1 labelling index increases significantly with increasing grade of malignancy. The Ki-67/MIB-1 labelling index can be used as an adjuvant to histopathological grading for proper diagnosis and grading of astrocytoma especially in borderline cases and in small biopsies

Effect of breastfeeding on anthropometric parameters in postnatal growth of pre-pubertal male children

Background: Breastfed and bottle-fed children's growth is not on the same pattern. This study was conducted to find out the effect of breast and bottle feeding on pre-pubertal children

Methods: This comparative study was conducted in the Department of Physiology, University of Health Sciences, Lahore. The study was conducted during the period from Oct 2013 to Apr 2015. A total number of 90 male pre-pubertal children were included in this study. Only male children were included to avoid bias of sex. Participants were selected from the school children of the locality around the University of Health Sciences [UHS] Lahore. They belonged to middle socioeconomic group. Their age range was 8-10 years, on the basis of history taken from parents of children. Participants were divided into two groups. Group-I, It included 45 male children having exclusive breastfeeding during the first year after birth. Group-II, It included 45 male children having exclusive bottle feeding during the first year after birth

Results: The median [Q1-Q3] weights were 27 Kg [25-29] and 25 Kg [22-29] in breastfed and bottle-fed groups respectively. The difference was considered significant with p=0.017. The median [Q1-Q3] heights were 133 Cm [130-137] and 130 Cm [122-136] in breastfed group and bottle-fed group respectively. The breastfed group children had significantly greater height [p=0.030] as compared with the bottle-fed group children

Conclusion: Breastfeeding has a positive effect on Height and weight of pre-pubertal children

Serum prolactin: a diagnostic marker in fertile female suffering from rheumatoid arthritis

RA is more common in females due to sex hormones such as estrogen and prolactin which modulate the immune response. Prolactin is similar to growth hormone and placentary lactogen and is secreted by pituitary lactotrophs having an immune stimulatory effect promoting autoimmunity. Elevated level of prolactin in RA run parallels with fluctuation of disease activity. Prolactin is required for interleukin-2 dependent proliferation of lymphoid cell. Level of estradiol increases with disease severity. Its levels are higher in inflammatory knee exudates of patient with RA. Experimental study. The study was carried out in the Department of Biochemistry, BMSI, in collaboration of Medical Ward 6, JPMC Karachi [October 2009 to March 2010]. 35 diagnosed cases of RA were selected with their consent. From general population, thirty five normal healthy subjects were selected for comparison. In the present study the serum levels of prolactin, estrogen, ESR, and RA factor were determined. The results of our study showed that in patients suffering from RA showed highly significant results [p<0.00l] of prolactin, estrogen, ESR and RA factor. Increased serum status of prolactin and estrogen in patients with rheumatoid arthritis [RA], may serve as marker for diagnosis, and prognosis

Status of HbA1c; Iron deficient diabetic and non diabetic patients

Glycated hemoglobin [HbA1c] is a marker to identify the average plasma glucose level over past three months but it is also influenced by the iron deficiency status of an individual. Research is designed to assess the relationship between HbA1c concentration and iron status among diabetic and non diabetic subjects. Cross sectional comparative study. Tertiary Care Unit of Karachi, Pakistan. Period: Dec 2010 till June 2011. A total of 75 subjects of both sexes were taken and divided into three groups. Fasting and random glucose levels, serum iron and TIBC were performed by enzymatic method while HbA1c was estimated by fast iron resin separation method and Complete blood count [CBC] was done by Coulter. The data feeding and analysis was on computer package SPSS [Statistical Packages of Social Sciences] version 16.0. the results were given in the mean and Standard Deviation [SD] and correlation [r] for quantitative data i.e. age, FBS, RBS, HbA1c, Serum Iron, Hb HCT, and TIBC. Using Analysis of Variance [ANOVA] with tukey test for comparison [Controls, Iron deficiency anemia with and without diabetes mellitus]. In all statistical analysis only p < 0.01 will be considered significant. HbA1c is a non-specific marker of Diabetes mellitus in iron deficieny anemia patients. Thus it is reccomended that iron status of diabetic patients must be considered while interpreting results. This study showed significantly raised levels of Fasting blood glucose [FBS], random blood glucose [RBS] and HbA1c in diabetic anemic patients when compared to control and nondiabetic anemic subjects [p < 0.01] while total iron binding capacity [TIBC] and HbA1 c in nondiabetic anemic subjects were also significantly raised when compared to control [p < 0.01]. Hemoglobin [Hb], Hematocrit [HCT] and Serum Iron levels were significantly decreased in diabetic and nondiabetic anemic subjects when compared to control [p < 0.01]. Our study depicted that while diagnosing Diabetes meliitus in iron deficient patients one should be carefull as HbA1c is not a very reliable parameter to assess glycemic control in iron deficiency anemia patients

Frequency of depression among students at Quaid-e-Azam medical college Bahawalpur

Background: Depression and anxiety badly affects the performance of an individual, especially medical students are exposed to many stresses during their education

Objectives: This study was conducted to assess the prevalence of depression among medical students at different levels of their MBBS course

Subjects and Methods: It was a cross-sectional, descriptive study, conducted at Quaid-e-Azam Medical College, Bahawalpur. A sample of two hundred [200] medical students [100 males and 100 females] was chosen by stratified systematic random sampling technique. Their age range was 18 to 24 years. Agha Khan University Anxiety and Depression Scale was used to assess the depression among students, with students having score 2': 20 labelled as having depression. Data was collected on a specially designed questionnaire and entered into SPSS version 16.0 and was analyzed on the same software

Results: Out of total 200 participants 53[26.50%] fulfilled the depression criteria while 147[73.50%] scored below 20. Among students, frequency of depression gradually decreases from 1" year MBBS class [29.27 %] through 2"d year [25.64 %] to 3d' year [15.15%]. After 3d' year MBBS, frequency of depression among students increased through 4th year [25.53 %] to final year MBBS [35%]

Conclusion: There is high prevalence of depression among medical students. The rise in depression scores may be due to emotional distress initially on entering the course that decreased with time up to third year. It increased afterwards which may be due to burden of clinical work and ward duties. Academic burden during final year, feelings of having their target a few steps away and anticipation of future responsibilities may be the most stressful during the MBBS course

Phenylthiocarbamide [PTC] taste sensitivity and blood groups in students at Bahawalpur

Background: Phenylthiocarbamide [PTC] taste sensitivity is a genetically controlled trait. ABO and Rh blood groups are also inherited traits

Objectives: We conducted this study to find out any epistatic relationship between the expression of the PTC-gene and the blood groups genes

Patients and Methods: Among the 739 students, who had given informed consent, 286 were males and 453 were females. Each participant underwent a simple taste test in which a drop of freshly prepared, 0.5% solution of PTC was placed on the dorsum of tongue and participant was asked to mention the taste perceived. After this he/she was asked to spit out the chemical and to rinse the mouth with water. To find out blood groups, we mixed a drop of blood with antisera i-e anti A, anti B and anti D on a glass slide. By examining for agglutination of RBC's, we determined the ABO and Rh blood type of the participants

Results: The percentage of blood group 'A' among the non-tasters is 22.16%. Blood group 'B' is 37.11% 'AB' 9.79%; Blood group 'O' 30.92%, Rh positive blood group 87.11% and Rh-negative blood group 12.89% among the non-tasters. There is no significant [p>0.05] difference between percentages of non-taster males [27.27%] and non-taster females [25.66%]

Conclusion: There is no epistatic relationship between PTC gene and blood group genes in our population

Effect of changed sleep pattern on academic performance of Medical Students at Quaid-e-Azam Medical college, Bahawalpur

Background: Sleep circadian rhythm is influenced by physiological control and any change in this cycle effects individual cognitive functions

Objectives: To study sleep-wake pattern and academic performance of medical students at Quaid-e-Azam Medical College, Bahawalpur

Participants and Method: This retrospective study was carried out on 258 students, selected by convenient sampling technique, of which 108 were males and 150 were females. They were asked to fill a specially designed questionnaire regarding their sleep pattern after admission in the medical college and academic performance in the medical college. This was compared with their pre-medical performance

Results: Majority [52.3%] of participants reported a decreased sleep duration in the medical college and they scored 60-70% marks in their last professional examination. About one-fourth [24%] of students reported an increased sleep duration after admission into medical college and they scored less than 60% marks in their last professional examination. Another one-fourth [23.7 %] claimed that they had no change in their sleep duration after admission into medical college, and they scored more than 70 % marks in their last professional examination. All the participants scored more than 85% in their pre-medical examination

Conclusion: Any change in sleep duration, increase or decrease affects the students' performance adversely. Increased sleep duration in the medical college seems more harmful than decreased sleep duration

Frequency of major risk factors for coronary heart disease in patients of southern Punjab

Background: Coronary Heart Disease [CHD] in most common form of heart diseases and premature deaths

Objective: To determine the risk factors of coronary heart disease [CHD] in patients from Southern Punjab

Subjects and Methods: This retrospective study was carried out in the Community Medicine Department, Nishtar Medical College, Multan in collaboration with the CPE Institute of Cardiology, Multan and Cardiology Ward, Nishtar Hospital, Multan. All patients presenting with acute coronary heart disease, from September to November, 2009, were included in this study. The diagnosis was made by a Cardiologist. Patients were interviewed for the presence or absence of Conventional Risk Factors for CHD. The risk factors studied were gender, smoking, hypertension, positive family history, diabetes mellitus, obesity, dyslipidemia, anxiety and depression. All information was entered into a pre designed proforma. Data was analyzed in SPSS version 10

Results: Among patients of CHD, 70% were males and 30% were females. Smoking habit was seen in about half of the patients [49.50%]. Hypertension was present in 45%, positive family history in 32%, diabetes mellitus in 29.50% of patients 26% were obese, 23% have dyslipidemia while 15% reported to have anxiety and depression

Conclusion: We conclude that after male gender, smoking habit was the most prevalent risk factor seen in our study population. Other risk factors found, in the descending order, were hypertension, positive family history, diabetes mellitus, obesity, dyslipidemia, and anxiety and depression. Our study demonstrates the importance of modifiable risk factors which may be targetted in designing the preventive strategies for CHD

Systemic lupus erythematosus, female of fertile age changes in reproductive hormones estrogen and prolactin levels

Systemic lupus erythematosus [SLE] is an important autoimmune disease and occurs when the body is mistakenly attacked by its own immune system. Prolactin acts as a cytokine and plays an important role in human immune response including autoimmune diseases. SLE is an immune complex mediated disease and is more common during pregnancy. Research is designed to analyze the level of serum prolactin in the pathogenesis of systemic lupus erythematosus and compared with estrogen in female of fertile age. Observational Study was carried out in the Department of Biochemistry, BMSI, in collaboration of ward-6 JPMC Karachi. Thirty five diagnosed cases of SLE and in addition 35 normal healthy controls from general population were included in the study. Serum levels of prolactin, estrogen, RA factor and ESR were estimated and correlated. The data was analyzed by using SPSS version 17. The student t-test and chi-square test was used the p-value <0.05 consider significant. The results showed that patients suffering from SLE have highly significant [p<0.001] serum level of reproductive hormones prolactin and estrogen, in addition, significant changes in ESR indicate the infection when compared with control. Further, prolactin was negatively correlated with estrogen as well as with menarche while BMI have positively correlation with estrogen regardless of prolactin and menarche. Enhanced serum prolactin and estrogen changes in patients with systemic lupus erythematosus [SLE], may be used as a prognostic tool for autoimmune diseases

Snake-bite problem, ophitoxaemia and folk treatment seen in patients admitted to nishtar hospital, multan

Background: Snake bite is largely an unrecognized public health problem. No snake bite data is available from any reliable source for Pakistan. This study was carried out to document the epidemiological, clinical and outcome data and the folk treatments in this area

Patients and Methods: A total number of 53 patients complaining of snake bite, admitted to Nishtar Hospital Multan during June-October, 2007 were included in this study. After taking a proper consent, history and physical examination were recorded on admission. Patients were followed up till discharge and physical features, laboratory findings, treatment and outcome were recorded on a proforma. Patients were grouped on the basis of their physical findings, and anti snake venom [ASV] used

Results: More males [62%] of working age group [age > 18 years] were bitten mostly on the lower limbs [64.15%] mostly during August-September [85.80%]. None of the patients could recognize the offending snake. Thirty seven percent of patients developed features of intoxication [ophitoxaemia], 23% of patients bitten by the venomous snakes were of 'dry bite1 type and 40% were possibly bitten by non-venomous snakes or those were bat bite, rat bite or thorn prick injuries. Patients who developed ophitoxaemia were treated by injecting anti snake venom [ASV] and other therapeutic measures were taken. Sixty percent of them showed haemotoxic symptoms, 50% of the patients showed neurotoxic symptoms and 20% of them needed ventilatory support in ICU. Most of them [85%] cured completely, some of them [15%] left against medical advice but were in better condition. No death took place in the hospital

Conclusion: Most patients complaining of snake bite did not develop features of ophitoxaemia. Twenty three percent of snake bites were 'dry bites'. Most folk treatments were not beneficial. Local application of Azadirachta Indica [Neem] has some scientific basis

Gender differences among suspected pulmonary tuberculosis patients undergoing sputum smear microscopy attending the department of chest medicine and tuberculosis, Nishtar hospital, Multan

To assess the gender differences among pulmonary tuberculosis suspects undergoing diagnostic sputum smear microscopy. This retrospective study was carried out in the Department of Physiology Nishtar Hospital Multan in collaboration with Department of Chest Medicine and Tuberculosis. Data from January 2005 and October 2007 were analyzed. The hospital records of newly diagnosed patients of pulmonary tuberculosis were selected. The patients were classified into various groups according to gender and age. Female/Male ratio of more than one [1.05/1] was found among pulmonary tuberculosis aspects undergoing sputum examination attending the Out Patient Department of Chest Medicine, however, AFB sputum smear positive cases were less among female patients, and female/male ratio was less than one [0.84/1.0]. The overall AFB sputum smear positive cases were significantly higher in male patients. Gender and age are both traditionally known variables in terms of incidence and prevalence of pulmonary tuberculosis. The existing gender disparity and pattern of gender specific treatment seeking is one of such indicators, which call for more attention to both males and females, especially productive age group

Color vision deficiency in medical students of Karachi

This study was designed to find out the prevalence of color blindness in the medical students of Karachi. Total of 550 medical and dental students was tested for color blindness. Ishihara pseudo-isochromatic color plates were used to find out any colour vision defect in the participants. Among them 365 were females and 185 were males. Out of 550 students 11[2%] were found to have color blindness, out of which 10 [5.4%] were males and 01[0.27%] were females. The prevocational screening for color vision is highly recommended; early in educational life because for some potential medical students, the handicap is so severe that a change in their proposed course of study is often advisable

Phenyithiocarbamide taste sensitivity in a student population in Karachi

[PTC] among young adult population at Karachi. Student population of Karachi Medical and Dental College [KMDC], Karachi was included in this study. Total students consented to participate in the study were 258; 95 were males and 163 were females. They were asked to taste a drop of 0.5% solution of PTC, which was then spit out and mouth was rinsed with water. Out of 258 students, 41[15.89%] were found to be non-taster to PTC. Among 95 males, 19 [20%] were non-tasters and among 163 females, 22 [13.5%] were found non-taster to FTC. In young adult population of Karachi, 15.89% are non-taster to PTC. Males have 20% non-tasters and females have 13.5% non-tasters among them. Males have more non-tasters among them as compared with the females

Incidence of AFB sputum smears positive patients of pulmonary tuberculosis attending out patient department of chest medicine, Nishtar hospital, Multan

To find out the incidence of AFB smear positive patients of pulmonary tuberculosis who presented to out - patient department of chest medicine from January 2005 to October 2007. This retrospective study was carried out in the Department of Physiology in collaboration with Department of Chest Medicine and Tuberculosis Nishtar Hospital Multan. In this study, the hospital records of newly diagnosed patients of pulmonary tuberculosis were analyezd. The patients were classified into, various groups according to age and gender. The incidence of AFB smear positive patients and frequency of the presentation was calculated. The overall percentage of AFB smear positive cases between January 2005 and October 2007 in region of Multan was 22.16%, but it has dropped gradually from 2005 to 2007 both in male and female patients. A higher incidence was seen in population ranging in age between 10-30 years. Sputum smear examination for AFB is simple and cost-effective method to provide a fairly realistic estimate of the incidence or prevalence of tuberculosis. Although there was a decreasing trend in the incidence of AFB smear positive cases from 2005 to 2007, the high burden of tuberculosis among Pakistani population still warrants renewed and enhanced efforts to control TB. The higher prevalence of persistent cough and AFB-positive sputum smears need further exploration

Glycemic control and the role of exercise in obese type-2 diabetics

To assess the role of exercise on serum levels of glucose, insulin and triglycerides in type-2 diabetics and to assess the therapeutic value of exercise in the management of type-2 diabetes mellitus in obese subjects. A total number of thirty sedentary subjects were included in this study. Half of them were obese, normal, healthy subjects [Group-I] half [15] were obese, type-2 diabetics [Group-II]. Both the groups were having non-significant differences regarding age, sex and Body mass index, although both groups have a BMI of more than 30. Before the start of the exercise period fasting blood samples were collected to establish the baseline parameters in each case. The subjects underwent a session of 30 minutes of moderate intensity exercise daily for ten days. Another fasting blood sample was drawn from each subject after 10 days. Parameters in pre and post exercise period were compared. Serum glucose levels decrease significantly [p<0.05] in both the obese control group as well as the obese diabetic group but the decrease was more marked in obese diabetic group. Serum insulin levels were non-significantly [p>0.05] decreased in both groups. Serum triglycerides were also decreased significantly [p<0.05] in both the groups. Exercise has beneficial effects to decrease the serum levels of glucose and triglycerides. So, the exercise has a very important role in the management of type-2 diabetes mellitus in obese patients

study on knowledge of diseases causation among adults of an urban slum of Multan

A cross-sectional study with descriptive and analytical components was carried out at Basti Oddan, an urban slum of Multan city. The concept of disease causation regarding tuberculosis, hepatitis B and malaria among 320 adults was assessed utilising a pre-tested questionnaire. Data was entered and analysed using SPSS software, 11[th] version. Running and tabulation of all the variable frequencies were done as part of data management. Tables were used to present the data. Chi -square test was used as the test of significance. Level of significance was set at 0.05. The overall knowledge of disease, causation was poor i.e. less than 50%. Respondents with better educational status had better concept of causation regarding three common communicable diseases. The association between economic status and concept of disease causation was variable i.e. no significant association between economic status and awareness of tuberculosis causation. However a positive association between economic status and awareness regarding hepatitis B and malaria was noted. It is concluded that there is great need to improve the educational status of the people otherwise any health improvement program is unlikely to succeed

Possible relation between phenylthiocarbamide taste sensitivity and goitre

The ability or inability to taste the bitterness of phenylthiocarbamide [PTC] is a classic inherited trait that has been studied in relation to various diseases. This study was carried out to find out any possible association between PTC-taste sensitivity and goitre. A total number of 471 subjects were studied. Among them 224 subjects were normal, healthy adults, taken as control and 247 were patients of goitre coming to Nishtar Hospital Multan for treatment. A 0.5% solution of PTC was freshly prepared. A drop of PTC Wution was placed on the dorsum of the tongue and the person was asked to state the taste perceived. Person was asked to spit out the chemical and rinse the mouth with water afterwards. Patients of goitre were clinically diagnosed by inspection and palpation method out of 224 normal healthy adults, 18.3% were non-tasters to PTC. Among 247 patients of goitre 36.84% were non-tasters to PTC. Number of non-tasters was highly significantly [P0 < 001] increased in the goitre patients as compared with the normal subjects. Percentage of non-tasters was non-significantly increased among male patients of goitre as compared with the normal subjects. Among female population, 10.88% of normal healthy females were non-taster to PTC and 37.37% of females having goitres were found to be non-tasters to PTC. Difference was highly significant [P0 < .001]. Female non-tasters to PTC are more prone to develop goitre as compared with the normal healthy females. PTC non-taster status is a vulnerability marker for females