Allelic Diversity of the Hemochromatosis Gene (HFE) in Malays, Chinese and Indians

@#Introduction: Hereditary hemochromatosis (HH) is an autosomal recessive disorder that causes accumulation of iron in circulating blood and organs. The disease is associated with H63D, S65C and C282Y variants of the haemochromatosis (HFE) gene and, if not treated can cause organ damage and may prove fatal. The main objectives of the present survey were to screen these genetic variants and establish risk profiles for developing HH in Malays, Chinese and Indians. Methods: A total of two hundred and twenty-two unrelated and healthy individuals together representing Malay, Chinese and Indian ethnicities in Malaysia were scored for the H63D, S65C and C282Y variants using a polymerase chain reaction-restriction fragment length polymorphism technique. Results: There are clear differences in H63D, S65C and C282Y allele and genotype frequency distributions between Malays, Chinese and Indians. In particular, H63D is more common in Chinese (5.19%) and Indians (7.29%), while S65C is more common in Malays (1.03%) and Chinese (1.04%). In addition, a susceptibility genotype for HH (the compound heterozygote for C282Y and H63D) was only detected in Indians (0.02%). Conclusion: Overall, our study is the first to provide data on the prevalence of H63D, S65C, and C282Y genetic variants and HH risk profiles for Malays, Chinese and Indians.

Therapeutic effects of anthocyanin-rich Hibiscus sabdariffa L. extract on body mass index, lipid profile and fatty liver in obese-hypercholesterolaemic rat model

Background: Hibiscus sabdariffa L. or Roselle, is one of the most common flower plants cultivated worldwide. Traditionally, it is claimed to reduce weight and cholesterol level. The aim of this study was to evaluate the effects of anthocyanin-rich Roselle aqueous extract on the physical, biochemical and histological changes in obese-hypercholesterolaemic rat model.Methods: Thirty Sprague-Dawley male rats were divided into five groups (n=6 per group). Group 1 is normal control (NC) rat that was fed with normal diet. The remaining rats (Group 2-5) were fed with commercial high-fat diet (HFD) for 6 weeks to induce obese-hypercholesterolaemic (OH) rat. After induction, the OH rats were divided into 4 groups: OH-Untreated group, OH-ARTE; OH treated with 300 mg/kg Roselle aqueous (anthocyanin-rich) and 1% trifluoroacetic acid extract (ARTE), OH-Orlistat; OH treated with 37 mg/kg orlistat and OH-Atorvastatin; OH treated with 10 mg/kg atorvastatin. After the 3 weeks intervention period, all rats were sacrificed. Body mass index, lipid profile and liver enzymes were evaluated. The liver section was subjected to hematoxylin and eosin staining for histopathological evaluation.Results: This study showed that 3 weeks administration of ARTE significantly reduced BMI, improved levels of lipid profile and liver enzymes, and histopathological changes of liver when compared to OH-untreated rats. The results were also comparable to the standard drugs.Conclusions: This study suggested that Roselle extract constitutes an effective and safe alternate treatment for obesity and hyperlipidaemia.

A Review on Chronic Pain in Rheumatoid Arthritis: A Focus on Activation of NR2B Subunit of N-Methyl-D-Aspartate Receptors

@#Chronic pain is a debilitating condition that occurs after tissue damage, which substantially affects the patient’s emotional state and physical activity. The chronic pain in rheumatoid arthritis (RA) is the result of various autoimmune-induced inflammatory reactions in the joints. Both types of peripheral and central pain processing can lead to sensitisation. Non-steroidal anti-inflammatory drugs (NSAIDs) and disease-modifying anti-rheumatic drugs (DMARDs) can result in potent anti-inflammatory effect. However, these drugs are not able to suppress the pain from RA for a prolonged period. For years, researchers have examined the role of the N-methyl-D-aspartic acid receptor 2B (NR2B) subunit of N-methyl-D-aspartate receptors (NMDAR) in chronic and neuropathic pain models. This NMDAR subtype can be found in at the peripheral and central nervous system and it represents an effective therapy for RA pain management. This review focuses on the NR2B subunit of NMDAR and the different pathways leading to its activation. Furthermore, specific attention is given to the possible involvement of NR2B subunit in the peripheral and central pathogenesis of RA.

Incidence of vaginal erosion with different synthetic materials for suburethral sling in the treatment of Stress Urinary Incontinence: A systematic review

The aim of this systematic review is to compare the vaginalerosion rates in different synthetic materials used insuburethral slings in Tension Free Vaginal Tape (TVT-O/TOT) procedures in management of female stress urinaryincontinence.Methods: PRISMA 2009 framework was adopted for studydesign. Scholarly literature search was done usingMEDLINE, EMBASE, the Cochrane Library and ClinicalTrials.gov using selected keywords. Five articles fulfilled theinclusion and exclusion criteria. Our main outcome ofinterest is to review the ideal properties of the suburethralsling, procedure of insertion and post-surgical complicationfollowing the sling insertion primarily vaginal erosion.Results were compared using one way-ANOVA test andindependent T- test.Results: Total of 1725 subjects were available for analysisin the five studies. Monofilament polypropylene constituted92.5% of the total sample size from one study alone.Polyester (n= 16/51) causes higher incidence rate of vaginalerosion compared to monofilament polypropylene (31.4 vs.,4.7; p = 0.01). There was no difference in the vaginal erosionrate between monofilament polypropylene and multifilamentpolypropylene (4.7 vs, 14.1; p=0.055) as well as betweenmultifilament polypropylene and polyester (14.1 vs, 31.4;p=0.068). Although there was a marginally lower rate ofvaginal erosion in TVT-O over TVT, the difference was notsignificant. (5.6 vs., 6.4, p=0.468). Common presentations ofvaginal erosion were vaginal discharge, perineal pain anddyspareunia. Conclusion: Given the limited sample size, polyester slingmaterial appears to cause higher rates of vaginal erosion.No difference in erosion rate was seen between TVT andTVT-O.

Adverse outcome of a teenage pregnancy

Introduction: Pregnancy at very young age is a high risk pregnancy. It can lead to the vicious cycle of medical, physical and social problems from which a pregnant girl and her fetus can hardly escape. Approximately 90% of the teenage births occur in developing countries. In teenage pregnancy both mother and her child are at high risk of disease and death. Early pregnancy in teenage is considered as an independent risk factor for adverse pregnancy outcome

Objective: To determine the adverse fetomaternal outcome in teenage pregnancies

Methodology: This retrospective study was conducted in department of obstetrics and Gynecology unit-II , Liaquat University Hospital Hyderabad from 1[st] January 2015 to 31[st] December 2015. Data was collected from hospital records of all nulliparous women aged between13-19 years with a singleton birth of 28 weeks or above. Multigravida women, with multiple pregnancies, alcoholics, smokers, having any medical disorder and those with strong family history of hypertension were excluded from the study. Maternal and Perinatal outcome measures recorded were anemia, pregnancy induced hypertension, pre-eclampsia, preterm labour, operative delivery, stillbirth and low birth weight

Results: The mean age of subjects included in this study was 17.35 years +/- SD1.06 years. Average gestational age at delivery was 36.86 +/-SD 2.15 weeks. Common complications seen in adolescent mothers were Anemia [34.2%], Pregnancy induced hypertension [33.3%] and preterm delivery [23.9%]. Most of the deliveries carried out vaginally however caesarean section was done in 33.33% cases. Regarding fetal outcome, 12.82% deliveries ended in stillbirth and out of live newborns, 21.57% were low birth weight

Conclusion: Teenage Pregnancy are associated with increased risk of unfavorable obstetric outcome, so every effort should be taken to provide optimal care and support to these young mothers

First trimester termination of pregnancy -role of sublingual misoprostol

The objective of this study was to evaluate the efficacy acceptability and dose of misoprostol sublingually in the management first trimester pregnancy failure. Observational Study. This study was conducted in the Department of Obstetrics and Gynaecology at Peoples Medical College Hospital Nawabshah from 01.01.2010 to 31.12.2010. A total 150 patients with the diagnosis of missed and incomplete miscarriage upto 13 weeks gestation. All eligible women who consented were counseled and given detail information protocol. A total of 150 patients with missed miscarriage 119 [79.33%] and incomplete miscarriage 31 [20.66%].The mean age group 28.34 years ,mean parity 4.79 and mean gestational age 8.61 weeks. Efficacy was 92%, 127 [84.66%] had complete miscarriage by the end of 7 days with 2 doses of misoprostol 600ug sublingually 3 hours apart. 23 [15.33%] require 3rd dose of misoprostol and 11 [7.33%] underwent surgical evacuation. Patients satisfaction was 94% [141 patients]. Misoprostol prove with benefit of efficacy, safety and acceptability in first trimester pregnancy failure. In low resources countries achieve infection haemorrhage and uterine damage can for two commonly reported on consequences of post surgical care. Misoprostol treatment can prove to be a rewarding step towards reducing morbidity and mortality

Maternal factors associated with low birth weight babies

To determine the maternal factors associated with low birth weight babies in women age of 15-35 years. Case control study. This study was carried out in the department of gynecology and obstetrics, Isra University Hospital [IUH] Hyderabad, Sindh from 02-05-2009 to 02-11-2009. Total 200 women were included in the study.100 as cases and 100 as control. Mothers aged 15-35 years, who deliver live or dead singleton baby through vaginal delivery or cesarean section after 37 week of gestation were included in the study while others who have delivered newborn with congenital abnormalities, had multiple pregnancy or known chronic illness [hypertension, tuberculosis, diabetes mellitus] were excluded from the study. The mean +/- SD of maternal age [years] in cases was26.40 +/- 4.77 and controls was 26.23 +/- 4.36 with P-value 0.739. The mean +/- SD of maternal weight [Kg] in cases was 53.13 +/- 8.93 and in controls was 64.97 +/- 13.72 with P-value < 0.001. Maternal history of smoking and anemia had significant association with low birth weight with P-Value of 0.005 and <0.001 respectively. It was concluded from our study that malnutrition, anemia, short stature like under weight and height are important risk factors for low birth weight

Laparoscopic evaluation of female infertility

Sub-fertility is inability to ensure child bearing when it is wanted. Prevalence of sub-fertility in industrialised countries has been quoted as 20%, and seems to be on the rise. Traditional way to assess the uterine cavity, tubal structure and tubal patency was hysterosalpingography but it has now been largely superseded by laparoscopy and hysteroscopy. The objective of this study was to highlight the role of laparoscopy in establishing diagnosis of female infertility. This descriptive study was conducted in Gynaecology Unit of Liaquat University of Medical Health Sciences, Hyderabad, Pakistan from 28[th] August 2000 to 1[st] July 2001. Total 200 sub-fertile patients attended the gynaecology OPD. Out of these 30 patients were selected for laparoscopy and dye test who were suspected cases of endometriosis, abnormal HSG and unexplained infertility. Those patients who had medical disorders and contraindication for laparoscopy were excluded from study. Detailed history of every patient was recorded on a proforma and physical examination was performed. Laparoscopy was scheduled in proliferative phase of menstrual cycle. Data were analysed using SPSS 11. Frequency and percentages were calculated to describe the results. Out of 200 sub-fertile patients total 30 patients were selected for laparoscopy. Twenty [66%] patients were in primary infertility group while 10 [33%] patients were in secondary infertility group. Eleven [55%] patients of primary infertility belong to age group of 18-25 years while 6[60%] patients of secondary infertility belong to age group of 26-33 years [TABLE 1]. Mean duration of sub fertility at time of presentation in primary infertility group was 1.95 years while in secondary infertility was 2.70 years [Table 2]. In primary infertility group main associated symptoms were dysmenorrhoeal in 8 [40%], irregular cycles 5 [25%], and dyspareunia in 4 [20%]. In secondary infertility group 3 [30%] patients had dysmenorrhoeal and dyspareunia while 2 [20%] had irregular cycles. The commonest cause observed in patients with primary infertility was endometriosis spots which accounted for 11 [55%]. In secondary infertility tubal occlusion was more common which accounted for 3 [30%]. Laparoscopic procedures are less invasive, more convenient and more precise for diagnosis of sub-fertility in women