Aliskerin: a direct renin inhibitor improves pancreatic functional b cell mass in type 2 diabetic mice

Objective: To evaluate the effects of Aliskerin on functional pancreatic beta cell mass in type 2 diabetic mice. Study Design: Analytical experimental study. Place and Duration of Study: The study was conducted at the animal house of National Institute of Health, Islamabad. Duration of the study was of twelve weeks after initial acclimatization of one week

Material and Methods: Twenty four BALB/c mice, both male and female, of 35 to 40 grams were used for this study. Animals were randomly divided into four groups. Two served as control, one was normal and the other was diabetic control. The remaining two were used as interventional groups and received either pioglitazone or aliskerin for four weeks after induction of diabetes. Fasting blood glucose levels with fasting insulin levels were estimated. Insulin resistance was determined by calculating homa IR and pancreatic morphology was assessed by evaluating pancreatic beta cell mass

Results: After treatment, pioglitazone reduced all the biochemical parameters significantly when compared with diabetic control and negative correlation between glucose and insulin was changed into positive correlation [r value, 0.92] with significant p-value [0.015], while aliskerin caused a significant rise [p-value 0.009] in functional pancreatic beta cell mass

Conclusion: Aliskerin has a significant anti-diabetic role as far as pancreatic morphology is concerned

Comparative study of telmisartan with pioglitazone on insulin resistance in type 2 diabetic mice

Objective: To evaluate and compare the effects of telmisartan and pioglitazone on peripheral insulin resistance in diabetic mice

Study Design: Randomized control trail

Place and Duration of Study: National Institute of Health, Islamabad and pharmacology dept, Army Medical College, from 17th March to 17th June 2014

Material and Methods: Twenty four BALB/c mice, both male and female, of 35 to 40 grams were used for this study. Animals were randomly divided into four groups. Two were taken as control groups, one was normal control and the other was diabetic control. Two were taken as interventional groups and received either pioglitazone or telmisartanfor four weeks after induction of diabetes

Results: After treatment, pioglitazone reduced all the biochemical parameters significantly when compared with diabetic control. Negative correlation between glucose and insulin was changed into positive correlation [r-value, 0.92] with significant p-value [0.015] in pioglitazone treated group, while telmisartan only managed to convert a negative correlation between insulin and glucose into statistically non-significant positive

Conclusion: Telmisartan although reduces glucose levels and improves beta cell mass but the effect is statistically non-significant as compared to pioglitazone. In hypertensive type 2 diabetics a combination of these two drugs may help in reducing the dose of pioglitazone and consequently the cardiovascular adverse effects of pioglitazone

Maternal morbidity and mortality in Pakistan - an overview of major contributors

Objective: To assess the trend of the proportion of maternal mortality ratio [MMR] due to common direct causes that are the major contributors in Pakistan

Study Design: Descriptive method study

Place and Duration of Study: The study was conducted in Jun 2014

Material and Methods: Descriptive method study was conducted in June 2014. Data collected in different time periods from articles published between 01 Jan 2005 to 31 Dec 2012 in medical journals, proceedings of workshops/conferences as well as from newsletters of the National Committee of Maternal Health [NCMH] along with global borden of disease [GBD] 2013 to estimate MMR. Data were later tabulated accordingly in June 2014

Results: In the hospitals over 80% of the deaths are due to direct causes. Direct causes account for 78.1% of deaths, hemorrhage being the most common followed by sepsis, eclampsia, rupture of the uterus, and abortions. The contributors were greater in booked multi-gravid as of 20 to 40 years, para 3 to 5, under matric education and with less than Rs. 10,000 monthly income

Conclusion: Massive hemorrhage and uncontrolled hypertension are major contributors of maternal morbidity in Pakistan

Sexual health among young sexually active females with vaginal candidiasis

Background: sexual health among females in a low middle income country like Pakistan substantially affects quality of life. Vaginal Candidiasis is a common infection found among the females leading to discomfort and pain during the sexual intercourse

Objective: to determine the sexual health, among young sexually active females with vaginal candidiasis

Methodology: it was a cross sectional study conducted in Nawaz Sharif Social Security Teaching Hospital, Lahore from 1[st] January to 31[st] December 2015. Two hundred sexually active married females between 16 - 22 years of age were selected by non- probability convenience sampling after obtaining their informed verbal consent. Three groups of study subjects were selected, Group A, Candida Positive, Group B, Candida negative and Group C with Vaginitis due to other cause. Complaints which were recorded and analyzed were dyspareunia, itching, vaginal discharge and vulvar soreness. Data through a pretested questionnaire was collected, entered in and analyzed by Statistical Package for Social sciences [SPSS] version 16

Results: in group A, 54% have dyspareunia, in group B, 17% were having dyspareunia and in Group C, 29% have dyspareunia. Growth of candida and oral contraceptive use was significantly associated with dyspareunia. [p<0.05]

Conclusion: this study showed that candida infection affects sexual health and is the major factor that hinders sexual intercourse due to dyspareunia. Use of oral contraceptives is an associated contributing factor in dyspareunia due to recurrent candidiasis

Frequency of healthy overweight adult females in a cluster

Objective: To find out the frequency of healthy overweight / obese females as determined by body mass index in a cluster

Study Design: Descriptive / cross sectional study

Place and Duration of Study: This study was conducted at the Out-Patient Department of CMH Landi Kotal hospital from 1[st] Jan 2016 to 30[th] June 2016

Materials and Methods: non-probability convenience sampling between 18-24 years of age was taken. They were subject to anthropometric and body mass index measurements. Blood pressure and resting heart rate were taken. Further data was collected by a questionnaire, based on socio-demography, physical activity, self- perception of body weight and health status. Informed consent was taken prior conducting the study

Results: Among 500 females, mean age was 19 +/- 1 year, and age range was 18 to 24 years. 436 cases belonged to rural areas and 64 cases belonged to urban areas. 104 individuals [20.8%], belonged to group 1; 320 [64%] individuals belonged to group 2; 60 [12%] individuals belonged to group 3; 16 [3.2%] individuals belonged to group 4. Blood pressure and pulse rate were recorded under standard conditions in all groups [Table 1]. None of the individuals had irregular pulse. All females responded to the pre-tested questionnaire. According to the collected data, 89% knew that overweight was related to diseases. About losing weight; 18% individuals replied as dieting, 22% individuals replied as exercise, 54% individuals replied both dieting and exercise and 6% individuals did not know the way to lose weight

Conclusion: Frequency of overweight / obesity was 15% among healthy adult females. Health awareness campaigns to deliver the message for healthy eating habits, regular exercise and maintaining ideal weight will be extremely helpful in controlling the obesity in the community

Incidentally diagnosed lobular carcinoma-in-situ in a case of multiple fibroadenomas

A case of lobular carcinoma in situ [LCIS] arising within a fibroadenoma. Diagnosis of LCIS was made based on histopathological examination of the excised lumps. The case report highlights the role of histopathology in the diagnosis of this entity coexisting in a fibroadenoma, as ultrasound missed the presence of pre-malignant cells. Fibroadenomas have genetic correlation, as was defined in our case. This case stresses the need for histological evaluation of all breast masses in women

Status of postgraduate training and continuing medical education of family physicians in Pakistan

The study aimed to find out the status of postgraduate training and continuing medical education [CME] of family physicians of Pakistan. It was a 10 months postal survey between November 2009 and September 2010. Postal questionnaires were sent to randomly selected 1200 family physicians. The data was analyzed using SPSS v-17. The response rate of survey was 24%. The number of family physicians receiving any kind of post graduate training was 104 [36%] while 184 [64%] had no postgraduate training at all. Medicine was the most common subject in postgraduate training [N=19, 18% of 104]. The number of family physicians holding any degree was 87 [30%]. Mean weekly time spent on self education was 6.5 hours with a range of 1 to 10 hours. Most of family physicians are practicing without training and mostly update their knowledge from books and use of online CME is low

Continuing medical education as a tool for postgraduate qualification for family physicians

To find the effectiveness of Continuing Medical Education [CME] program as a tool for professional development by comparing the passing rates of those doctors who participated in CME course with those who did not take the CME program. Doctors who appeared in Membership of Royal College of General Practitioners [MRCGP] exam in 2007 and 2008 from Lahore Examination Center were included in the study. Their data was compiled from copies of their registration forms and results announced by Royal College of General Practitioners, UK. A total of 145 Family Physicians appeared in MRCGP Exam in 2007 and 2008. One hundred fourteen [78%] were members of CME and 31 [22%] were not. Twenty eight were successful in final part 2 of MRCGP Exam, out of which 27 [96% of 28] were CME members and one [6%] were non members. Continuing Medical Education programs can also be used to prepare practicing Family Physicians for postgraduate exam

Increase in serotonin-1A receptor responsiveness following haloperidol, withrawal

In view of a role of 5-hydroxtryptamine [serotonin; 5-HT]-1A receptors in the elicitation of extrapyramidal symptoms [EPS], The present study was designed to monitor pre- and postsynaptic responses to a selective 5 HT-1A ligand, 8-hydroxy-2- [di-n-propylamino] tetralin [8-OH-DPAT] following single and repeated [two times a day for 9 days] administration of haloperidol [5 mg/kg] in rats. The intensity of 5 H-T syndrome elicited by 8-OH-DPAT [0.5 mg/kg] was taken as measure of postsynaptic response. 8-OH-DPAT induced decreases of 5-HT metabolism in the striatum and brain were taken as a measure of postsynaptic response. 8-OH-DPAT induced forepaw treading and hyperlocomotion were smaller in haloperidol than saline injected rats. The decreases were not observed following withdrawal from repeated administration of haloperidol. Flat body posture not altered by single injection of haloperidol was enhanced following withdrawal from repeated administration of haloperidol. Haloperidol plus 8OH-DPAT injected animals exhibited comparable levels of 5-HT metabolism in the striatum as well as in the brain. Administration of 8-OH-DPAT significantly decreased 5-HT metabolism in brain but not in striatum of repeated saline injected animals. Conversely, same dose of 8-OH-DPAT injected to haloperidol-injected animals did not decrease 5-HT metabolism in the brain but decreased it in the striatum. The results show an increase in the responsiveness of pre-and postsynaptic 5-HT-responsiveness of post and presynaptic 5-HT-1A receptors may be involved in the greater incidence of EPS in patients treated with neuroleptics such as haloperidol

5-HT-1A receptor responsiveness following subchronic administration of buspirone

Anxiety and its disorders have long been known to be familial. Anxiety levels are associated with low social connectedness and high environmental threats. Studies provide evidence that anxiety disorders may be link to malfunctioning of serotonin neurotransmission. The present study is designed to monitor serotonin-1A [5-HT-1A] receptor responsiveness following subchronic administration of a serotonergic anxiolytic buspirone. Administration of 8-hydroxy-2-[di-n-propylamino]-tetralin [8-OH-DPAT] at a dose of 0.25 mg/kg produced comparable syndrome in repeated saline and repeated buspirone injected rats. Cage crossings were significantly lower in repeatedly buspirone injected rats. Decreases in 5-hydroxytryptamine [5-HT] and 5- hydroxyindoleacetic acid [5-HIAA] levels were higher in saline than buspirone injected rats. Result suggests that following long term administration of buspirone somatodendritic and postsynaptic 5-HT-1A receptors are desensitized. Role of serotonin 1 A receptors in the treatment of anxiety is discussed

Dopamine and serotonin neurotransmission in the reinforcing effects of alchol and apomorphine

To determine the role of dopamine and 5-hydroxytryptamine [5-HT; serotonin] in the reinforcing effects of alcohol and apomorphine. Experimental study. Department of Biochemistry, University of Karachi from September to November 2004. The study was conducted on 24 male albino Wistar rats. Reinforcing effects were monitored in a conditioned place preference [CPP] paradigm using a light-dark activity box. Slicing and punching method was used to collect dorsal and ventral striatum. Neurochemical estimations were done by HPLC-EC. Withdrawal from repeated administration of ethanol [1g/kg/day] as well as apomorphine [1 mg/kg/day] elicited reinforcement that could be monitored in a CPP paradigm. CNS depressant effects of ethanol were not altered on repeated administration but CNS stimulatory effects of apomorphine increased. Reinforcing effects of ethanol but not apomorphine were associated with a decrease in dopamine metabolism in the ventral striatum. A decrease in the activity of dopaminergic neurons following withdrawal from repeated administration is involved in the compulsive use of abused drugs

Can cannabis abuse lead to anxiety and depression?

To determine the association of cannabis abuse with depression, anxiety and mixed anxiety depression as well as to establish the psychometric properties of the scale used in the study i.e. Hospital anxiety and depression [HAD] scale. Retrospective study.Different localities of Rawalpindi and Islamabad.40 cannabis patients suffering from cannabis dependence and 40 normal persons were selected from different localities of Rawalpindi and Islamabad. The Urdu modified version of Hospital anxiety and depression scale [HADS] was used to assess the severity of anxiety and depression in both groups. The mean age of cannabis dependent patients was 29.60 and that of non-addicts 29.33. It shows more depression in cannabis abusers as compared to non cannabis addicts. Addicts have more anxiety as compared to non-addicts. Cannabis addicts have more mixed anxiety depression as compared to non-addicts. The other objective of the study was to establish the Alpha reliability coefficient and item-total correlation of the scale, the findings of which suggest that all the items of the scale are highly consistent. The findings of the study suggest that the cannabis abusers have more depression, anxiety and mixed anxiety depression as compared to non- addicts. Anxiety, depression and mixed anxiety depression in addicts can be due to biological, psychosocial, genetic and neurochemical factors which need to be investigated in future studies