Correlation of serum YKL-40 with anthropometric measurements and spirometric indices between healthy individuals and asthamatics in a tertiary care hospital

Objective: To correlate serum levels of YKL-40 with anthropometric measurements and spirometric indices between normal individuals and asthmatics

Methodology: The case control study was conducted in Department of Chest Medicine, JPMC, Karachi from the month of August 2015 till March 2016. The study recruited sixty participants after satisfying the inclusion and exclusion criteria; among those 30 were normal healthy individuals [PEF > 80% and pulse rate of 60 – 80 beats per minutes]; while equal were cases of mild to moderate asthma [PEF more than 50% and pulse rate of 100 – 120 beats per minutes] matched for age and gender. Vitallograph compacta and peak flow meter was used for spirometric indices. Moreover, anthropometric measurements were age, gender, weight [kg], height [m] and body mass index [kg/m2]. Ykl-40 Elisa kit was used for serum YKL 40 levels. The data was entered and analysed using SPSS version 21 [IBM, Chicago, IL]

Result: In comparison of Spirometric Evaluation [FEV1, FVC, FEV1/FVC% and PEFR] between control and patients with mild to moderate asthma. significant difference was found in the mean values of FEV1, FVC, FEV1/FVC and PEFR between cases and controls. Significant inverse correlation was found between YKL-40 with FEV1, FVC, FEVI/FVC% and PEFR among Controls. YKL-40 was found to be significantly correlated with only FEV1/ FVC [%] among cases with correlation co-efficient as – 0.510 [p-value < 0.004]

Conclusion: There is an inverse correlation between serum YKL-40 levels and spirometric evaluation thus as the inflammation in asthma increases, YKL-40 level upsurges and causes decrease in lung function tests

Analgesic and anti-inflammatory activities of fixed oil of Macrotyloma uniflorum [Lam.) Verdc. in mice and rats

Macrotyloma uniflorum commonly known as horse gram or kulthi bean is grown as a pulse for livestock and human consumption. The beans contain about 1.3% fat, 18% protein, 15% carbohydrate along with vitamins and minerals. In traditional medicine it is used as antihyperglycemic, antioxidant, antihypertensive and diuretic. Other important medicinal uses include treatment of renal stones, obesity, piles, oedema and fever. The present study evaluated analgesic [by acetic acid induced writhing, hot plate and tail flick tests in mice] and anti-inflammatory [carrageenan induced paw edema in rats] activities of Macrotyloma uniflorum fixed oil [MUFO]. Four groups were included in study: Group-I: Normal Saline Control [2ml/kg], Group-II: MUFO [2ml/kg], Group-III: MUFO [4ml/kg], and Group-IV: Standard Acetyl salicylic acid [ASA 300mg/kg]. All results were significant however delayed onset of action was observed in tail flick and paw edema tests. Acute oral toxicity of the oil was also checked in mice and was found safe up to 4ml/kg dose, as no signs of toxicity and mortality were observed. It is concluded that Macrotyloma uniflorum fixed oil may possess analgesic and anti-inflammatory activity which can be related with a peripheral mechanism of action

Stress, anxiety and depression in students of a private medical school in Karachi, Pakistan

Objective: To determine frequency of stress, anxiety and depression and their coping mechanisms in undergraduate students of a private sector university

Methods: A cross sectional study was conducted at Aga Khan University recruiting students from Medical School, School of Nursing and Midwifery, and Dental Hygiene program who had attended at least six months on campus from October 2016 until August 2017. The "Aga Khan University Anxiety and Depression Scale" and "Student-Life Stress Inventory" scales were used to assess depression and anxiety, and stressors

Results: A total of 283 students participated in this study and all of them scored higher than the cutoff on both scales labeling them as highly stressed. Students from dental hygiene program reported more stressors as compared to MBBS [p<0.001] and SONAM [p=0.002]. Factors identified as stressors included pressure to pass exam, meeting family's expectations of good academic performance, and missing home

Conclusion: Stress, anxiety and depression are found to be highly prevalent among undergraduate students in medical setting in Karachi. Awareness, recognition, and timely management may reduce stress among the students and improve their performance and quality of life

Cross talk between serum kisspeptin-leptin during assisted reproduction techniques

Background and objective: Leptin facilitates onset of puberty by impact on hypothalamic Kisspeptin, gonadotropin releasing hormone, follicle stimulating and luteinizing hormone. The link of peripheral Leptin-Kisspeptin in regulating the ovarian and endometrial tissue in relation to adiposity is unknown. Therefore, we wanted to identify Kisspeptin-Leptin association with body mass index [BMI] and success of assisted reproductive treatments [ART] in infertile females

Methods: A cross sectional study was carried from August 2015 till May 2017 after receiving ethical approval at Australian Concept Infertility Medical Centre, and Aga Khan University. The study group comprised of females with an age range of 25-37 year who had duration of unexplained infertility for more than two years. They were grouped as; underweight [<18 kg/m2], normal weight [18-22.9 kg/m2], overweight 23-24.99 kg/m2 and obese [>25 kg/m2]. Kisspeptin and Leptin levels were measured by enzyme linked immune sorbent assay before down regulation of ovaries and initiation of treatment protocol of ART.Failure of procedure was detected by beta human chorionic gonadotropin <25mIU/ml [non-pregnant] whereas females with levels >25mIU/ml and cardiac activity on trans-vaginal scan were declared pregnant

Results: Highest Kisspeptin and Leptin levels were seen in normal weight group [374.80 +/- 185.08ng/L; 12.78 +/- 6.8 pg/ml] respectively, yet the highest number of clinical pregnancy was observed in overweight group [42%].A strong correlation of Kisspeptin with Leptin [r=0.794, p=0.001] was observed in the overweight females

Conclusion: Leptin-Kisspeptin-fertility link is expressed by maximum number of clinical pregnancies in the female group that showed strongest relationship between serum Leptin and Kisspeptin levels, irrespective of their BMI

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

Flipped classroom instructional approach in undergraduate medical education

Objective: In this study we implemented the "flipped classroom" model to enhance active learning in medical students taking neurosciences module at Aga Khan University, Karachi

Methods: Ninety eight undergraduate medical students participated in this study. The study was conducted from January till March 2017. Study material was provided to students in form of video lecture and reading material for the non-face to face sitting, while face to face time was spent on activities such as case solving, group discussions, and quizzes to consolidate learning under the supervision of faculty. To ensure deeper learning, we used pre- and post-class quizzes, work sheets and blog posts for each session. Student feedback was recorded via a likert scale survey

Results: Eighty four percent students gave positive responses towards utility of flipped classroom in terms of being highly interactive, thought provoking and activity lead learning. Seventy five percent of the class completed the pre-session preparation. Students reported that their queries and misconceptions were cleared in a much better way in the face-to-face session as compared to the traditional setting [4.09 +/-1.04]

Conclusion: Flipped classroom[FCR] teaching and learning pedagogy is an effective way of enhancing student engagement and active learning. Thus, this pedagogy can be used as an effective tool in medical schools

Is hyperglycemia a risk factor for neonatal morbidity and mortality?

Objective: To determine the extent of morbidity and mortality in newborns with neonatal hyperglycemia where published data are limited

Study Design: Observational case control study

Place and Duration of Study: Department of Neonatology, the Children's Hospital and the Institute of Child Health Lahore, from 1[st] May to 31[st] Oct 2015

Material and Methods: A prospective, observational case control study was conducted in the Department of Neonatology, the Children's Hospital and the Institute of Child Health, Lahore, from 1st May till 31st October 2015. The sample size was 192, with 96 babies each in 'study' and 'control' groups. All neonates fulfilling the inclusion criteria were enrolled in the 'study group' while 'control group' consisted of euglycemic babies matched for age, weight, gestational age and clinical status. All babies were monitored for morbidity intraventricular hemorrhage [IVH], necrotizing enterocolitis [NEC], infections and outcome [duration of hospital stay, discharged or expired]

Results: The data analysis showed that 74% neonates, of study group, had hyperglycemia during first week of their lives. Moreover, 84.4% babies were less than 2.5kg. Significant high number of babies in the study group developed complications [p<0.001]. These complications included IVH [p<0.001], NEC [p=0.024] and infections [p=0.019]. As regards outcome, the neonates in the study group had significantly prolonged hospital stay [p=0.028], lower discharge rate [p=0.040] and higher mortality [p=0.040]

Conclusion: Hyperglycemia not only significantly increases risk of IVH, NEC and infections, but also prolongs hospital stay and contributes to mortality among newborns

Hand sanitation practices within clinical settings: its knowledge and practice among students of Peshawar Medical College [PMC]

Introduction: Healthcare-associated infection is a major cause of morbidity and mortality. Hand hygiene is regarded as the most effective method of prevention but is poorly performed by health workers. Maintaining adequate hand hygiene remains amongst the three requisites of good health. This study was conducted to assess the knowledge regarding different hand sanitation techniques and various factors responsible for non-compliance among students of Peshawar Medical College

Material and Methods: It was a cross-sectional survey based on self-administered questionnaire carried out at Peshawar Medical College. Self-designed questionnaire was distributed and responses obtained from students after their informed consents. SPSS 15 was used for analyzing data

Results: Response rate of the students was 51.6%. In total 87[56.1%] students were male and 68[43.9%] were female. Prevention in transmission of resistant microbes among patients in clinical settings was reported negative by the students [65.8%], the seven standardized steps were known by 42.6% of the students whereas 39.6% students applied it in clinical settings

Conclusion: Awareness about standardized steps of hand sanitation was not adequate among these medical students in the clinical settings; using soap and water for hand sanitation was found to be an effective tool for reducing surface tension between dirt and skin. Non-availability of hand sanitizers and careless attitude to medical students was considered as one of poor compliances. Findings may be considered important in controlling various factors responsible for poor adherence to different hand hygiene practices among medical students in clinical settings

Early miscarriges related to rubella infections in woman of reproductive age group

Rubella is a highly contagious viral disease, spread through contact with discharges from the nose and throat of an infected person. For women who are not immune, rubella infection during pregnancy poses a high risk of congenital birth defects and miscarriages or stillbirths. Researches show that infection during the first trimester carries an 85% risk of birth defects. We present a case report of a woman who suffered from rubella during her first trimester of pregnancy with a history of repeated miscarriages

Status of hospital infection control measures at seven major tertiary care hospitals of northern Punjab

To determine the availability and implementation of various hospital infection control measures at tertiary care hospitals. Survery. National Institute of Science and Technology, Islamabad, from June through August 2008. Seven tertiary care very busy hospitals were selected; one from Islamabad, 5 from Rawalpindi, and one from Lahore. A detailed proforma was designed addressing all the issues pertaining to hospital infection control measures. Air sampling was done and growth yielded was identified by standard methods. Analyses revealed that all of the hospitals had an Infection Control Committee. Microbiological diagnostic facilities were adequate at all the hospitals and overall microorganism yield was very high. Antibiotic policy was claimed by most, not available on ground. Majority of the operation theatres were without proper air flow system and autoclaves were not being regularly monitored. There was no proper disposal for sharps and needles. Incineration was not the usual mode for infectious waste. The results of the present study imply availability of proper hospital infection control policies with need of strict implementation of such measures