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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
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Background: Kisspeptin [KP] is a neuropeptide that causes the release of the gonadotropin releasing hormone, which controls hypothalamo pituitary ovarian axis and exerts a number of peripheral effects on reproductive organs. The primary objective of this study was to compare baseline KP levels in females with different types of infertility and identify possible correlations with risk of failure to conceive, preclinical abortion and pregnancy after intracytoplasmic sperm injection [ICSI]
Materials and Methods: A longitudinal cohort study was carried out from August 2014 until May 2015 by recruiting 124 female patients undergoing ICSI, after obtaining ethical approval from the Australian Concept Infertility Medical Center. Cause of infertility due to male, female and unexplained factors was at a frequency of 32 [24%], 33 [31%] and 59 [45%] among the individuals respectively. KP levels were measured by ELISA assay before the initiation of the ICSI treatment protocol. Outcome of ICSI was categorized into three groups of non-pregnant with beta-human chorionic gonadotropin [beta-hCG]<5-25 mIU/ml, preclinical abortion with beta-hCG>25 mIU/ml and no cardiac activity, and clinical pregnancy declared upon confirmation of cardiac activity. Results based on cause of infertility and outcome groups were analyzed by one-way ANOVA
Results: Females with unexplained infertility had significantly lower levels of KP when compared with those with male factor infertility [176.69 +/- 5.03 vs. 397.6 +/- 58.2, P=0.001]. Clinical pregnancy was observed in 28 [23%] females of which 17 [71%] had a female cause of infertility. In the non-pregnant group of 66 [53%] females, common cause of infertility was unexplained 56[85%]. A weak positive correlation of KP levels with fertilized oocytes and endometrial thickness was observed [P=0.04 and 0.01 respectively]
Conclusion: Deficiency of KP in females with unexplained infertility was associated with reduced chances of implantation after ICSI
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Background and Objective: Genetic studies on gestational diabetes [GDM] are relatively scarce; moreover, limited data is available for KCNQ1 polymorphism in Pakistani pregnant women. We aimed to determine the frequency of KCNQ1 rs2237895 in GDM and normal pregnant controls and its association with GDMrelated phenotypes
Methods: A total of 637 pregnant females [429 controls and 208 cases] in their second trimester were classified according to the International Association of the Diabetes and Pregnancy Study criteria in this study. Their blood samples were genotyped for KCNQ1 SNP rs2237895 using PCR-RFLP method and sequencing. Fasting and two hour-post glucose load blood levels, serum HbA1c, insulin, and anthropometric assessment was performed. Pearson's Chi Square test, Mann- Whitney U test, and regression analyses were performed. A p-value of <0.05 was considered significant
Results: The variant genotyped was in Hardy-Weinberg equilibrium [p>0.05]. The rs2237895 showed an association with GDM [OR 2.281; 1.388-3.746: p <0.001] and remained significant after multiple adjustments for age and body mass index [OR 2.068; 1.430-2.997: p=0.005]. The C allele showed positive association with insulin level, and HOMA-IR in study subjects
Conclusions: This study identifies that KCNQ1 rs2237895 polymorphisms might be associated with risk of GDM in Pakistani population and that it is related to higher glucose levels and insulin resistance. Further large scale studies are required to consolidate on the functional aspect of this polymorphism
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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
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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
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Background: Successful ICSI depends on ovarian response to stimulation and maturation of oocytes retrieved
Objective: To identify predictors of number of retrieved oocytes during intra cytoplasmic sperm injection [ICSI]
Methods: A cross sectional study carried out at Islamabad Clinic Serving Infertile Couples @ Saudi Pak Tower from January 2011 till December 2012. Female subjects [n= 282] aged 20 -40 years had base line estimation of follicle stimulating hormone, estradiol, antral follicle count and ovarian volume on the second day of cycle. Down regulation of ovaries was followed by controlled ovarian stimulation for 12 +/- 2days. On the day of ovulation induction by intramuscular injection of human chorionic gonadotropin, pre-ovulatory follicle count [PFC] was measured by trans vaginal scan and serum estradiol, progesterone and interleukin I- beta were estimated. Data was expressed as mean +/- standard deviation and median with interquartile range. Correlation coefficient was measured to study degree of association of demographic and clinical factors with NRO. Univariate regression of NRO as dependent variable with predictors was confirmed by multivariate regression
Results: Retrieved oocytes had strongest correlation with PFC [r = 0.98]. Multivariable analysis stipulated that in the presence of other variables PFC had similar strongest effect on oocytes. AFC showed significant but negative effect on NRO by multiple regressions. Progesterone, E2, IL-I beta, FSH and injections used for stimulation had insignificant effect in the presence of other variables
Results: PFC measured at the time of ovulation induction is strongest predictor of oocytes which are obtained during oocyte pick up procedure of ICSI
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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
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Índice de Massa Corporal , Ferritinas/sangue , Proteína C-Reativa , Fragmentos de Peptídeos , Estudos Transversais , Ferro/sangue , InflamaçãoRESUMO
Intracytoplasmic sperm injection [ICSI] is an advanced technique employed in assisted reproductive clinics for treatment of infertile couples. The reproductive endocrinologists try their level best to identify factors that enhance success rate after ICSI. To compare estradiol progesterone ratio on ovulation induction day amongst pregnancy outcome groups following ICSI. A cross sectional study was conducted on 323 couples of Assisted Reproductive Clinic in Islamabad from June 2010 till August 2011. Down regulation of females aged 18-40 years with gonadotrophin releasing hormone agonist was followed by calculated stimulation with gonadotrophin injections [COS]. Oocytes pickup was done 36 hours after ovulation induction by 16G adapter and double lumen oocyte aspiration needle under general anesthesia. Oocytes were fertilized in vitro, graded and only blastocysts were transferred seven days after ovulation induction. Serum estradiol and progesterone were measured by enzyme linked immuno sorbent assay on ovulation induction day, ratio was compared in three groups of females; no conception with betahCG 5-25 mIU/ml, preclinical abortion with betahCG >25 mIU/ml and no cardiac activity on transvaginal scan and clinical pregnancy with betahCG >25mIU/ml and cardiac activity on transvaginal scan. Females having high estradiol/ progesterone ratio were able to achieve clinical pregnancy shown by a positive betahCG and cardiac activity on transvaginal scan. These females also had significantly high number of oocytes, endometrial thickness and implantation rate. A high estradiol/progesterone ratio on the day of ovulation induction predicts the success of intra cytoplasmic sperm injection
Assuntos
Humanos , Feminino , Estradiol , Progesterona , Resultado da Gravidez , Injeções de Esperma Intracitoplásmicas , Estudos TransversaisRESUMO
There has been an increase in number of obese infertile females booked for advanced infertility treatment procedures like in vitro fertilization [IVF] and intra cytoplasmic sperm injection [ICSI]. The knowledge of impact of body mass index [BMI] on reproductive outcome can help to counsel these patients. To compare reproductive outcome in females of different BMI after ICSI. Cross-sectional study of 323 females was conducted from June 2010 till August 2011. Females were grouped on the basis of BMI; underweight, [BMI <18 kg/m[2]], normal weight, [BMI 18-22.9 kg/m[2]] overweight [BMI 23-25.9 kg/m[2]] and obese [BMI >/= 26 kg/m[2]]. The procedure involved down regulation of ovaries, controlled ovarian stimulation, ovulation induction by hCG, oocyte pickup, in vitro fertilization and embryo transfer of blastocysts. The oocyte yield and embryological data of all BMI groups was compared by ANOVA [analysis of variance]. Pregnancy outcome of these was categorized as; no conception betahCG <5 m IU/ml, preclinical abortion with betahCG >5 m IU/ml, no cardiac activity on trans vaginal scan [TVS] and clinical pregnancy with betahCG >5mIU/ml and cardiac activity on trans vaginal scan. Females with BMI 23-25.99 kg/m[2] had maximum oocyte retrieval, fertilization, implantation and clinical pregnancy rates in comparison to obese females with BMI >/= 26 kg/m[2]. A BMI cut off value of above 26 kg/m[2] in our study population is associated with a negative impact on pregnancy outcome
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Humanos , Feminino , Resultado da Gravidez , Peso Corporal , Índice de Massa Corporal , Estudos Transversais , Transferência Embrionária , Indução da OvulaçãoRESUMO
Osteoporosis is a progressive systemic disease of the bone causing significant reduction in bone mineral density and microarchitecture of bone tissue .All women experience slow bone loss with age . In Pakistan accelerated bone loss at menopause in women is about 75.3% increasing upto 97%with age thus making osteoporosis a major health problem.At the time of menopause, serum automated beta-Crosslaps increases by 86% a pattern consistent with accelerated bone loss within the first few years following menopause .we therefore hypothesized that estimation and comparsion beta-Crosslaps levels in Premenopausal and Postmenopausal women may be use as a diagnostic and screening marker for prevention of postmenopausal osteoporosis. A cross sectional comparative study. This study was conducted in department of Physiology, BMSI in collaboration with Karachi gymkhana through a medical campaign in September 2011. A total of 94 subjects [premenopausal and postmenopausal] were included in this study that was performed in the urban area of Karachi city in 2011. Data was collected from all subjects through a questionnaire including questions regarding their age, menstrual history, menopausal and medical history. Blood samples from all these subjects were collected for the determination of bone turnover marker beta crosslaps. Bone mineral density [BMD] of the heel bone was done by single x-ray absorptiometry. The results of our study showed that the levels of serum beta-Crosslaps in postmenopausal women were significantly higher as compared to premenopausal women p<0.01.There was a significant rise in the beta-Crosslaps levels with the increasing age among the postmenopausal women p<0.01.BMD [bone mineral density] value have negative correlation the beta-crosslaps levels p<0.01 i.e with the increasing age there was decrease in BMD value and increase in beta-crosslaps values. Serum beta-crosslaps levels in postmenopausal women can provide valuable information regarding the decreasing bone density and hence may be considered a cost effective diagnostic as well as screening marker for the prevention of postmenopausal osteoporosis
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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