Cardiac Arrhythmia Classification Using Advanced Deep Learning Techniques on Digitized ECG Datasets.

ECG classification or heartbeat classification is an extremely valuable tool in cardiology. Deep learning-based techniques for the analysis of ECG signals assist human experts in the timely diagnosis of cardiac diseases and help save precious lives. This research aims at digitizing a dataset of images of ECG records into time series signals and then applying deep learning (DL) techniques on the digitized dataset. State-of-the-art DL techniques are proposed for the classification of the ECG signals into different cardiac classes. Multiple DL models, including a convolutional neural network (CNN), a long short-term memory (LSTM) network, and a self-supervised learning (SSL)-based model using autoencoders are explored and compared in this study. The models are trained on the dataset generated from ECG plots of patients from various healthcare institutes in Pakistan. First, the ECG images are digitized, segmenting the lead II heartbeats, and then the digitized signals are passed to the proposed deep learning models for classification. Among the different DL models used in this study, the proposed CNN model achieves the highest accuracy of ∼92%. The proposed model is highly accurate and provides fast inference for real-time and direct monitoring of ECG signals that are captured from the electrodes (sensors) placed on different parts of the body. Using the digitized form of ECG signals instead of images for the classification of cardiac arrhythmia allows cardiologists to utilize DL models directly on ECG signals from an ECG machine for the real-time and accurate monitoring of ECGs.

Impact of smoking intensities on sleep quality in young Saudi males: a comparative study.

This study aimed to compare various components of sleep quality between cigarette smokers of various intensities and non-smokers in young Saudi males. In total, 73 healthy male participants (31 smokers and 42 non-smokers) aged 17-33 years were recruited over three months (August 2018 to October 2018). All participants completed the Pittsburgh Sleep Quality Index (PSQI) questionnaire. The smokers were then divided into three groups, according to their Smoking Index* (SI) (Cigarettes Per Day (CPD) X Years of Tobacco Use), into mild, moderate, and heavy smokers. The PSQI was significantly higher in heavy smokers than in mild smokers (P=0.022) or non-smokers (p=0.013). A significant positive correlation was observed between the PSQI and the smoking index (p=0.005). Sleep duration was significantly longer in heavy smokers compared to mild (p=0.032) and nonsmokers (p=0.047). Sleep disturbance was significantly higher in moderate than nonsmokers (p=0.035) and moderate than mild smokers (p=0.028). Sleep latency was significantly longer in heavy than nonsmokers (p=0.011). Daytime dysfunction was significantly higher in moderate than mild smokers (p=0.041). Habitual sleep efficiency was significantly greater in moderate than in either mild (p=0.013) or nonsmokers (p=0.021). The use of sleep medication was significantly higher in moderate than nonsmokers (p=0.041). The findings suggest that poorer sleep quality is positively associated with smoking intensity among young Saudi males. Considering the importance of sleep quality for well-being and health, these results suggest exploring how improving sleep quality could inform future smoking cessation interventions.

Evaluating Critical Appraisal Skills by Introducing Journal Clubs to Preclinical Dental Students Using the Assessing Competency in Evidence-Based Medicine (ACE) Tool Through Pre and Post-testing.

Background The ineffective utilization of journal clubs (JCs) for pre-clinical dental students has led to a lack of research into their effectiveness in developing skills such as critical reasoning and evidence-based medicine (EBM) practice. Therefore, we have implemented JCs in first-year undergraduate dental students and measured their effectiveness using the integrated Assessing Competency in Evidence-Based Medicine (ACE) tool. Methodology We conducted a quasi-experimental study where EBM was included in the curriculum for pre-clinical students as a hybrid model with a year-long blended learning approach. The 50-student class was divided into five groups of 10 students, with each group participating in seven JCs related to the physiology curriculum. After conducting critical analysis in self-directed learning sessions, students created interactive PowerPoint presentations followed by discussion. Instructors offered feedback after each session based on 1-2 levels in Kirkpatrick's training evaluation model. Inferential statistics were used for comparative analysis of the ACE tool pre- and post-test using SPSS version 26 (IBM Corp., Armonk, NY, USA). Results A linear trend in median score from 6 in the pre-test to 9 in the post-test was detected using the box and whisker plot. Using paired sample t-test, the mean difference (95% confidence interval) between the pre-test and post-test responses was -3.14 (-2.32 to -3.96) (p < 0.001). In terms of the post-test responses, each item's difficulty index ranged from 0.3 to 0.9. Internal reliability was in the acceptable range of >0.15 (range = 0.5-0.18). The item discriminatory index was in the range of 0.8 to >0.2. Cronbach's alpha was 0.64, which was deemed acceptable. Conclusions Our results show that pre-clinical dentistry students appreciated the use of JCs to improve active learning, critical appraisal, analytical, and decision-making skills. The 15-item ACE measure is a useful and reliable tool for assessing dentistry students' EBM proficiency in Pakistan.

Association of Sleep, Body Weight and Physical Exercise with Plasma BDNF Levels in Healthy Male Saudi Smokers.

Introduction: Brain-derived neurotrophic factor (BDNF) has been shown to impact neural function and development. The BDNF plasma levels may be affected by a smoker's behavior. Thus, the aim of this study was to investigate the association between sleep, body weight and physical exercise with brain-derived neurotrophic factor (BDNF) in healthy male Saudi smokers. Methods: A cross-sectional study, with a convenience sample, was conducted during personal visits to the Anti-Smoking Clinic and Family and Community Medical Center of Imam Abdurrahman Bin Faisal University (IAU) in Dammam at the end of 2018. Blood samples were taken from participants to measure the BDNF plasma levels. Multiple linear regression analysis was used to examine the relationship between plasma BDNF levels and participants' background characteristics, such as smoking index, physical activity, body mass index (BMI) and Pittsburgh sleep quality index (PSQI). Results: A sample of 73 (31 smokers and 42 non-smokers) males took part in the study. The results demonstrated a significant relationship between plasma BDNF levels with physical activity, smoking age, smoking index, PSQI and BMI 25-29.9 (overweight). However, the results showed no significant relationship between plasma BDNF levels and BMI (healthy weight) and obesity. Conclusion: This study shows that physical activity and sleeping quality can provide a positive impact against smoking-associated variation of the BDNF plasma levels, which may affect the health of Saudi males. Further investigation is needed to understand what other potential background characteristics are best predictive or correlated with BDNF plasma levels.

Bacterial prediction using internet of things (IoT) and machine learning.

Water is a basic and primary resource which is required for sustenance of life on the Earth. The importance of water quality is increasing with the ascending water pollution owing to industrialization and depletion of fresh water sources. The countries having low control on reducing water pollution are likely to retain poor public health. Additionally, the methods being used in most developing countries are not effective and are based more on human intervention than on technological and automated solutions. Typically, most of the water samples and related data are monitored and tested in laboratories, which eventually consumes time and effort at the expense of producing fewer reliable results. In view of the above, there is an imperative need to devise a proper and systematic system to regularly monitor and manage the quality of water resources to arrest the related issues. Towards such ends, Internet of Things (IoT) is a great alternative to such traditional approaches which are complex and ineffective and it allows taking remote measurements in real-time with minimal human involvement. The proposed system consists of various water quality measuring nodes encompassing various sensors including dissolved oxygen, turbidity, pH level, water temperature, and total dissolved solids. These sensors nodes deployed at various sites of the study area transmit data to the server for processing and analysis using GSM modules. The data collected over months is used for water quality classification using water quality indices and for bacterial prediction by employing machine learning algorithms. For data visualization, a Web portal is developed which consists of a dashboard of Web services to display the heat maps and other related info-graphics. The real-time water quality data is collected using IoT nodes and the historic data is acquired from the Rawal Lake Filtration Plant. Several machine learning algorithms including neural networks (NN), convolutional neural networks (CNN), ridge regression (RR), support vector machines (SVM), decision tree regression (DTR), Bayesian regression (BR), and an ensemble of all models are trained for fecal coliform bacterial prediction, where SVM and Bayesian regression models have shown the optimal performance with mean squared error (MSE) of 0.35575 and 0.39566 respectively. The proposed system provides an alternative and more convenient solution for bacterial prediction, which otherwise is done manually in labs and is an expensive and time-consuming approach. In addition to this, it offers several other advantages including remote monitoring, ease of scalability, real-time status of water quality, and a portable hardware.

Assessment of Knowledge, Perceptions and Perceived Risk Concerning COVID-19 in Pakistan.

The COVID-19 pandemic is one of unmatched scale and severity. A continued state of crisis has been met with poor public adherence to preventive measures and difficulty implementing public health policy. This study aims to identify and evaluate the factors underlying such a response. Thus, it assesses the knowledge, perceived risk, and trust in the sources of information in relation to the novel coronavirus disease at the outset of the COVID-19 pandemic. An online questionnaire was completed between March 20 and 27, 2020. Knowledge, perceptions, and perceived risk (Likert scale) were assessed for 737 literate participants of a representative sample in an urban setting. We found that respondents' risk perception for novel coronavirus disease was high. The perceived risk score for both cognitive and affective domains was raised at 2.24 ± 1.3 (eight items) and 3.01 ± 1 (seven items) respectively. Misconceptions and gaps in knowledge regarding COVID-19 were noted. Religious leadership was the least trusted (10%) while health authorities were the most trusted (35%) sources of information. Our findings suggest that there was a deficiency in knowledge and high concern about the pandemic, leading to a higher risk perception, especially in the affective domain. Thus, we recommend comprehensive education programs, planned intensive risk communication, and a concerted effort by all stakeholders to mitigate the spread of disease. The first of its kind in the region, this study will be critical to response efforts against current and future outbreaks.

Effects of Turmeric on Cardiovascular Risk Factors, Mental Health, and Serum Homocysteine in Overweight, Obese Females.

CONTEXT: The prevalence of overweight and obesity and associated comorbidities has progressively risen. Curcumin, the active ingredient in turmeric, and turmeric aqueous extract, a concentrated form, have been reported to have beneficial effects in treatment of cardiovascular diseases and their risk factors. However, turmeric has not been studied in its natural form. OBJECTIVE: The present study planned to evaluate the beneficial effects of turmeric in its natural form on obesity-related, cardiovascular-disease risk factors in overweight or obese females. DESIGN: The study used a pre-post, single-arm design. SETTING: The study took place in the Department of Physiology at Imam Abdulrahman Bin Faisal University (Dammam, Saudi Arabia). PARTICIPANTS: The participants were 36 young female students at the university, with a body mass index ≥ 23 kg/m2. INTERVENTION: Participants received a daily dose of 2 g/d of turmeric in capsules for 90 d. OUTCOME MEASURES: Anthropometric measures, blood pressure, serum homocysteine, and mental health status- stress, anxiety, depression scores-were recorded at baseline and postintervention. Dietary intake and physical activity (confounding variables) were also measured. RESULTS: The following anthropometric measures were reduced significantly between baseline and postintervention: (1) body weight-73.47 vs 72.45 kg (P = .04), (2) body mass index-28.75 vs 28.27 kg/m2 (P = .02), (3) waist circumference-81.85 vs 77.96 cm (P = .01), (4) hip circumference-102.72 vs 98.10 cm (P = .001), (5) body fat %-34.34 vs 32.58 (P = .00), (6) systolic blood pressure-119.12 vs 115.92 mm Hg (P = .04), and (7) anxiety scores-7.88 vs 4.73 (P = .03), as compared by paired t test. Homocysteine levels and stress and depression scores showed no significant changes. Dietary intake and physical activity did not vary significantly throughout the study period. CONCLUSION: Turmeric has the ability to reduce weight, decrease body fat percentage, lower systolic blood pressure, and relieve anxiety for young, obese and overweight females, when given at 2 g/d for 90 d.

The effect of smoking on cognition as measured by Cambridge Neuropsychological Test Automated Battery (CATNAB) and brain-derived neurotrophic factor plasma levels.

OBJECTIVES:  To establish an association between cigarette smoking, cognition, and plasma brain-derived neurotrophic factor (BDNF) levels in healthy young adults. METHODS:  This was an ex post facto analytic cross-sectional study conducted between March and November 2018. Participants were 73 healthy males (31 smokers and 42 non-smokers), 17-33 years old. The cognitive function of the participants was assessed through the Cambridge neuropsychological test automated battery (CANTAB). Blood samples were taken to measure the plasma levels of BDNF and the results were compared to identify the association between smoking related variables and cognitive test scores and plasma BDNF levels. A p-value of less than 0.05 was considered statistically significant. RESULTS:  Smokers performed significantly worse than non-smokers in the multitasking test, including reaction time and rapid visual information processing. However, no significant association was observed between smoking related variables and cognitive test scores. The only significant positive correlation was found between plasma BDNF levels and the number of cigarettes smoked per day (r=0.480, p=0.024). No correlation was observed between other smoking related variables and plasma BDNF levels. CONCLUSION:  Plasma BDNF level is positively related to the number of cigarettes smoked per day. Young smokers have significantly impaired sustained attention and less ability to manage conflicting information as compared to age-matched non-smokers.

Comparing the preventive behavior of medical students and physicians in the era of COVID-19: Novel medical problems demand novel curricular interventions.

The global challenge presented by COVID-19 is unparalleled. Shortages in healthcare staff and manpower bring the practical skills of medical students under the spotlight. However, before they can be placed on hospital frontlines, it is crucial to assess their preparedness for patient interaction. This can be achieved by comparing their behavioral dynamics to those of physicians. An online questionnaire was administered between March 20, 2020 and March 27, 2020. The preventive strategies adopted by medical students and physicians at different ages and levels of education were compared by using chi-square test where a p value of <0.05 was considered statistically significant. We report that the demonstration of preventive behaviors increased with educational attainment and age. Older age groups avoided crowded areas, wore more masks, used disinfectants and did not touch their faces as compared to the younger participants (p < 0.001). Similarly, postgraduate doctors used more masks and disinfectants as compared to graduate doctors and medical students (p < 0.001). Based on our results, the lack of preventive behavior shown by medical students has implications for policy makers. We recommend short- and long-term changes to medical programs and admissions policies to equip medical students with the personal and professional skills to better contribute to the healthcare system in the present pandemic and beyond.

Association of RETN C-420G single nucleotide polymorphism with type 2 diabetes mellitus in Pakistani Punjabi Rajput population.

OBJECTIVE: To determine the association of human resistin gene RETN C-420G single nucleotide polymorphism with type 2 diabetes mellitus in a specific ethnic population.. METHODS: The controlled study was conducted from June 2012 to January 2015 at Military Hospital, Rawalpindi, Army Medical College, Rawalpindi, and the Institute of Biomedical and Genetic Engineering, Islamabad, Pakistan. Patients with type 2 diabetes and healthy controls belonging to Pakistani Punjabi Rajput ethnic group were genotyped for human resistin gene RETNC-420G single nucleotide polymorphism. Serum resistin, serum insulin, fasting blood sugar, lipid profile, body mass index and insulin resistance was determined and correlated with genotypes. SPSS 18 was used for data analysis. RESULTS: Of the 789 subjects, 539(68%) were diabetics and 250(32%) were controls. Serum resistin levels were significantly higher in diabetics than controls (p<0.05). The frequency of GG, GC and CC was 15(2.8%), 322(59.75%) and 202(37.5%) in diabtics. This single nucleotide polymorphism was associated with diabetes (p<0.02).Human resistin gene RETN C-420G single nucleotide polymorphism was not associated with serum resistin, insulin, body mass index, insulin resistance and dyslipidaemia in both groups (p<0.05 each). CONCLUSIONS: Human resistin gene RETN C-420G single nucleotide polymorphism was found to be a risk factor for type 2 diabetes in Pakistani Punjabi Rajput population..

A comparison of debate and role play in enhancing critical thinking and communication skills of medical students during problem based learning.

Debate and role play for learning critical thinking and communication skills are being increasingly used in various undergraduate medical schools worldwide. We aim to compare students' views about effectiveness of two teaching strategies; debate and role play to exercise critical thinking and communication skills during problem-based learning (PBL). This is a comparative, cross-sectional, and questionnaire-based study. Our subjects were second year undergraduate female medical students enrolled in Imam Abdulrahman Bin Faisal University (IAU), College of Medicine from September 2014-2016, divided into 10 small PBL groups (10-13 students/group/year). Students rated role play and debate as equally effective in improving communication skills. Debate was rated superior to role play in "opening new avenues of thinking" (p-value is 0.01), whereas in "integration of knowledge of basic medical sciences with clinical skills" and "reflection of real life experience" students rated role play being superior to debate (p-value 0.01 and 0.00, respectively). Both role play and debate are well accepted by the students in PBL curriculum as an effective teaching methodology. Both are perceived equally good in improving students' communication skills. Few aspects of critical thinking are improved more by role plays compared to debate and vice versa. © 2018 by The International Union of Biochemistry and Molecular Biology, 46:336-342, 2018.

Association of ADIPOQ C-11377G (rs266729), TNF-α αG-308A(rs1800629) and TNF-α αG-238A(rs361525) Single Nucleotide Polymorphisms with Type 2 Diabetes Mellitus in Pakistani Population.

OBJECTIVE: To determine the frequencies of adiponectin (ADIPOQ) C-11377G, tumor necrosis factor-alpha (TNF-α) G-308A and TNF-αG-238Asingle nucleotide polymorphisms (SNP) and their association with serum levels in Pakistani T2DM and healthy population. STUDY DESIGN: Case control study. PLACE AND DURATION OF STUDY: Military Hospital, Rawalpindi, Army Medical College and Institute of Biomedical and Genetic Engineering, Islamabad, Pakistan, from June 2012 till 2014. METHODOLOGY: Cases (n=539) and controls (n=250) comprising of T2DM and healthy subjects, respectively, belonging to Pakistani Punjabi Rajput ethnicity were genotyped for SNPs. Serum adiponectin, TNF-α, insulin, blood sugar fasting (BSF), lipid profile, body mass index (BMI), and insulin resistance (IR) was determined and correlated with genotypes. RESULTS: Serum TNF-αwas significantly higher and adiponectin was lower in T2DM than healthy controls (p < 0.003 and 0.0001, respectively, Mann-Whitney U-test). The frequency of ADIPOQ CC, GC and GG was 340 (63.1%), 167 (31%) and 32 (5.9%) in T2DM patients. ADIPOQ -11377 SNPwas not significantly associated with T2DM [OR = 1.116 (95% CI 0.811.53), p = 0.27- Fisher's exact test]. Genotypes deviated from Hardy-Weinberg equilibrium. Minor alleles of TNF-αG-308A and TNF-αG-238Awere not found in either groups. CONCLUSION: Frequency of ADIPOQ -11377 risk allele is low and does not functionally affect the serum adiponectin levels; hence, ADIPOQ C-11377G SNPis not a risk factor for T2DM in Pakistani Punjabi Rajput patients. Moreover, TNF-αG-308A and TNF-αG-238ASNPs are not prevalent in this ethnic group.

Learning through debate during problem-based learning: an active learning strategy.

We explored medical student's views and perceptions of a series of debates conducted during problem-based learning (PBL) practiced as a part of the Spiral curriculum at the Imam Abdulrahman Bin Faisal University, Saudi Arabia. A series of debates were employed during PBL sessions for second-year female medical students, over the period 2014-2016. Each cohort of students was randomly split into 10 small PBL groups and exposed to weekly PBL activity. Within each group, the students were divided into a proposition half and an opposition half. Students were given 1 wk for debate preparation. The students' responses were recorded on a formulated questionnaire. Descriptive statistics were used to analyze quantitative data, and results are presented as percentages. The usefulness of debate in alleviating potential difficulties in communicating with patients was agreed to by 69% (n = 126) of participants. That these sessions evoked critical thinking among students was reported by 78% (n = 142). This series of debates helped 61% (n = 111) of students to learn effectively about controversial issues. Seventy-one percent (n = 130) considered that debate promoted argument generation and interpretation skills. Enhanced ability to analyze and research evidence was reported by 59% (n = 108) of students. One hundred and thirteen students (62%) agreed that debate helped them to improve clinical decision-making, and 75% of students agreed that debates encouraged tolerance toward diverse viewpoints/convincing strategies. The majority of our medical students found debating enhanced analytic decision-making, communication, and critical thinking skills.

Association of IL-6 C-174G (rs 1800795) single nucleotide polymorphism with type 2 diabetes mellitus in Pakistani population.

OBJECTIVE: To determine the association of interleukin-6 C-174G single nucleotide polymorphism with type 2 diabetes mellitus and metabolic parameters. METHODS: This case-control study was conducted from June 2012 to December 2013 at the Military Hospital Rawalpindi, the Centre for Research in Experimental and Applied Medicine, Army Medical College, Rawalpindi, and the Institute of Biomedical and Genetic Engineering, Islamabad, Pakistan. Two cohorts of subjects were genotyped for the single nucleotide polymorphism. One cohort comprised type 2 diabetics and other included healthy subjects. In these groups, serum interleukin-6, serum insulin, blood sugar fasting, lipid profile, body mass index and insulin resistance was determined and correlated with genotypes. RESULTS: Of the 789 participants, 539(68.3%) were in the study group and 250(31.7%) in the control group. Serum interleukin-6 was significantly higher in diabetics than healthy controls (p<0.0001). The frequency of GG, GC and CC was 267(49.5%), 235(43.6%) and 37(6.9%) in diabetic patients and 128(51.2%), 74(29.6%) and 48(19.2%) in healthy controls, respectively. Interleukin-6 C-174G single nucleotide polymorphism was significantly associated with diabetes [odds ratio = 3.22 (95% confidence interval: 2.04-5.1; p<0.0001). Genotypes were within Hardy-Weinberg equilibrium. Interleukin-6 C-174G single nucleotide polymorphism was significantly associated with serum interleukin-6 in the order of GC>GG>CC but was not associated with body mass index, insulin resistance, serum insulin and dyslipidaemia in diabetic patients (p>0.05 each). CONCLUSIONS: Interleukin-6 C-174G single nucleotide polymorphism was a risk factor in type 2 diabetes and contributed to higher serum interleukin-6 levels among the participants.

Role-play as a learning modality in Pakistan.

OBJECTIVES: To assess the effectiveness of role-play practised as a part of an integrated modular curriculum at Shifa College of Medicine, Islamabad. METHODS: Each class of 100 students from the first to the final years of studying for a Bachelor of Medicine, Bachelor of Surgery (MBBS), was split into seven or eight groups. Students divided the roles amongst themselves. Students were given one week's notice to prepare for each session, and had a maximum of 7 minutes for performance and 5 minutes for feedback from faculty members. Faculty staff observed the skills performed and content explored at the level of the students' training. The students' responses were recorded by a formulated questionnaire. Descriptive statistics were used to analyse quantitative data. The results obtained were presented as frequencies and percentages. RESULTS: In this study, 351 (70.2%) of eligible students participated. The advantage of role-play in alleviating potential difficulties in communicating with patients was agreed by 63 per cent (n = 223). Two hundred and forty-two students (69%) considered that role-play promoted teamwork and interpersonnel skills. One hundred and ninety-three students (55%) agreed that role-play helped them to integrate knowledge of basic sciences into clinical skills. That these sessions evoked critical thinking among students was reported by 41 per cent (n = 144). The roles created reflected real life scenarios was agreed by 27 per cent (n = 96) students. Students were given one week's notice to prepare for each session CONCLUSION: Role-play was accepted to enhance communication skills, the promotion of teamwork and the provision of a healthy environment to integrate learning processes among students.

Pattern of dyslipidaemia and impact of increasing age and duration of type 2 diabetes mellitus on dyslipidaemia, insulin levels and insulin resistance.

OBJECTIVE: To study the pattern of dyslipidaemia in Type 2 Diabetes Mellitus patients and to determine the correlation of increasing age and duration of the disease with dyslipidaemia, insulin level and insulin resistance in diabetic patients. METHODS: The cross-sectional case-control study was conducted at Combined Military Hospital, Rawalpindi, and Centre for Research in Experimental and Applied Medicine, Army Medical College, Rawalpindi, Pakistan from June 2011 to June 2012, and comprised patients of type 2 diabetes mellitus and healthy controls. Serum levels of total cholesterol, triglycerides, low density lipoprotein, high-density lipoprotein and insulin in both the cases and the controls. Insulin resistance was calculated by Homeostatic Model of Assessment of insulin resistance. Correlation between increasing age and duration of the disease was determined using biochemical parameters. SPSS 17 was used for statistical analysis. RESULTS: Of the 112 subjects in the study, 72(64%) were patients and 40(36%) were healthy controls. Among the cases, hypertriglyceridaemia was the commonest in 44(61%) followed by low-density-lipoprotein-hypercholesterolaemia 36(50%). Among the controls, 20(50%) subjects had low-density-lipoprotein-hypercholesterolaemia, followed by hypertriglyceridaemia in 17(42.5%). Duration of the disease was not found to be correlated with dyslipidaemia or insulin resistance (p>0.05). There was strong negative correlation of duration of the disease with serum insulin levels (p=0.03). Age showed no significant correlation with dyslipidaemia, serum insulin levels or insulin resistance on regression analysis (p>0.05 each). CONCLUSIONS: In type diabetes mellitus, hypertriglyceridaemia was the commonest dyslipidaemia whereas hypercholesterolaemia was a risk factor in healthy individuals. Besides, the duration of disease was inversely correlated with serum insulin levels and positively correlated with dyslipidaemia.

Gene-gene, gene-environment, gene-nutrient interactions and single nucleotide polymorphisms of inflammatory cytokines.

Inflammation plays a significant role in the etiology of type 2 diabetes mellitus (T2DM). The rise in the pro-inflammatory cytokines is the essential step in glucotoxicity and lipotoxicity induced mitochondrial injury, oxidative stress and beta cell apoptosis in T2DM. Among the recognized markers are interleukin (IL)-6, IL-1, IL-10, IL-18, tissue necrosis factor-alpha (TNF-α), C-reactive protein, resistin, adiponectin, tissue plasminogen activator, fibrinogen and heptoglobins. Diabetes mellitus has firm genetic and very strong environmental influence; exhibiting a polygenic mode of inheritance. Many single nucleotide polymorphisms (SNPs) in various genes including those of pro and anti-inflammatory cytokines have been reported as a risk for T2DM. Not all the SNPs have been confirmed by unifying results in different studies and wide variations have been reported in various ethnic groups. The inter-ethnic variations can be explained by the fact that gene expression may be regulated by gene-gene, gene-environment and gene-nutrient interactions. This review highlights the impact of these interactions on determining the role of single nucleotide polymorphism of IL-6, TNF-α, resistin and adiponectin in pathogenesis of T2DM.

Inhibitory effect of visfatin and leptin on human and rat myometrial contractility.

AIMS: The purpose of this study was to investigate the effect of visfatin on in vitro myometrial contractility in human and rat, and compare it to leptin. MAIN METHODS: Myometrial strips from term pregnant women having a caesarean section or rats were dissected, superfused with physiological saline and the effects of visfatin (500pM-25nM) or leptin (1nM-1µM), on spontaneous and oxytocin-induced contractions were studied. After establishment of regular contractions, tissues were incubated for control and test response at 37°C for 20min, and then contractility was assayed. KEY FINDINGS: In human and rat myometrium, visfatin had similar dose dependent effects on contractility. In the human myometrium, compared with that of controls (100%), 10nM produced a significant (paired t-test) decrease in the 20min integral of spontaneous (64±8%, n=13) and oxytocin-induced contractions (55±9%, n=5), mean±SEM. In rat tissue the decrease was also significant (spontaneous, 76±7%, n=7; oxytocin-induced 68±6%, n=3). Leptin at this concentration (10nM) had no effect in rat or human, and even at a higher concentration (1µM) produced only a small inhibitory effect (~ 80%) on contractions. SIGNIFICANCE: These data are the first to show that visfatin inhibits myometrial contractility and does so more potently than leptin. Our data suggest that increased output of visfatin and leptin in obese pregnant women may impair uterine contractility resulting in an unplanned Caesarean delivery.

A short review of adipokines, smooth muscle and uterine contractility.

Obesity is a major health problem worldwide. The prevalence of obesity is increasing in both developed and developing countries. In the UK, for example, 60% of adults are overweight and 25% are obese. Obesity is associated with many pathological complications including respiratory, cardiovascular and endocrine, but it also affects fertility and is associated with many reproductive complications. This has led us and others to investigate links between women with high BMI, pregnancy outcome and uterine function. These studies in turn have led investigators to ask how obesity can have such an impact on reproduction and, as part of this, to consider the role of the adipokines released from adipose tissues. Our focus in this short review is on adipokines and myometrial activity, and for completeness we overview their effects on other smooth muscles. To date four adipokines (leptin, visfatin, apelin and ghrelin) have been investigated and all affect myometrial contractility, but some more potently than others. We consider the possible mechanisms involved in how adipokines may modify uterine contractility, and discuss the potential impact on labor and delivery.

Morphological analysis of rat ureteric terminal arterioles in situ.

Confocal imaging of Fluo-4, Propidium iodide, and di-8-Anepps loaded ureter were used to study the morphology of terminal arterioles with an inner diameter <50 µm in intact rat ureter. Optical sectioning showed that the muscle coat of the terminal arterioles consisted of a monolayer of highly curved smooth muscle cells which run circumferentially around the endothelium. This technique allowed not only to measure the inner diameter of the terminal arterioles but also to define the orientation and number of revolutions an individual smooth muscle cell made around the endothelium. We measured thickness, width, length, and morphological profile of the myocytes and endothelial cells. Propidium iodide staining showed nuclei of individual cells by continuous imaging at high resolution in serial optical sections. Conventional haematoxylin-eosin, Masson's tri-chrome staining, and transmission electron microscopy were also used in this study to compare the measurements obtained from live confocal imaging with histological standard methods. Parameters obtained from live imaging were significantly different. This technique of live staining allowed measuring the cellular and nuclear dimensions of the terminal arterioles in their natural environment which are important in studying the effects of vascular disease or aging on vascular structure.