Triglyceride-glucose index: A surrogate marker of homeostasis model assessment of insulin resistance to predict diabetic nephropathy.

Objectives: To determine the association of triglyceride-glucose index with homeostasis model assessment of insulin resistance in type 2 diabetes mellitus patients, and to determine the association of triglyceride-glucose index with urinary albumin-to-creatinine ratio for predicting diabetic nephropathy. METHODS: The observational, cross-sectional study was conducted from September 2021 to September 2022 at the Department of Chemical Pathology, Pakistan Railway Hospital, Rawalpindi, Pakistan and comprised recently-diagnosed type 2 diabetes mellitus patients. Recorded data included age, gender, vitals, diabetes duration, body mass index and other pertinent demographic and clinical information. Measurements included spot urine albumin-to-creatinine ratio, triglycerideglucose index, homeostasis model assesment of insulin resistance as well as fasting serum insulin, fasting plasma glucose, glycosylated haemoglobin, triglycerides, total cholesterol and serum creatinine. On the basis of triglyceride-glucose index scores, the participants were divided into 4 quartiles; Q1=4.5-5, Q2=5.1-5.5, Q3=5.6-6, and Q4=>6. Data was analysed using SPSS 26. RESULTS: Of the 218 patients, 141(64.7%) were females and 77(35.3%) were males. The overall mean age was 49.22±11.46 years. There were 102(46.8%) overweight patients, 33(15.1%) obese and 82(37.2%) had normal weight. There were 58(26.6%) patients in Q1, 86(39.4%) in Q2, 46(21.1%) in Q3 and 28(12.8%) in Q4. Those in Q4 showed elevated fasting plasma glucose, glycated haemoglobin, triglycerides, total cholesterol, low-density lipoprotein cholesterol, homeostasis model assessment of insulin resistance and urine albumin-to-creatinine ratio (p<0.05), as well as low values for high-density lipoprotein cholesterol and estimated glomerular filtration rate(p<0.05). Fasting serum insulin was negatively linked to glycated haemoglobin (r=-0.12, p=0.07). Triglyceride-glucose index (r=0.76, p<0.001), homeostasis model assessment of insulin resistance (r=0.48, p<0.001), and urine albumin-to-creatinine ratio (r=0.10,p=0.05) positively correlated with glycated haemoglobin. Fasting serum insulin (r=-0.13, p=0.05), negatively correlated with triglyceride-glucose index, while homeostasis model assessment of insulin resistance (r= 0.32, p<0.001) and urine albumin-to-creatinine ratio (r=0.28, p=0.05) had a positive correlation. The estimated glomerular filtration rate was significantly positively linked with fasting serum insulin (r=0.05, p=0.05), and correlated significantly negatively with triglyceride-glucose index (r=-0.35, p=0.01), homeostasis model assessment of insulin resistance (r=-0.01, p=0.86) and urine albumin-to-creatinine ratio (r=-0.02, p=0.8). CONCLUSIONS: The triglyceride-glucose index showed a strong association with homeostasis model assessment of insulin resistance, and surpassed it in terms of predicting diabetic nephropathy in type 2 diabetes mellitus patients.

Association of sleep patterns and water intake with cognitive functions in adults in an urban environment.

Objectives: To explore the behavior patterns of students and working adults regarding the duration and quality of sleep and water intake in an urban environment and to identify the relationship between nighttime sleep extent and water intake with mood and cognitive performance. Methods: This was a descriptive correlational study conducted at Islamic International Medical College, Riphah University at the Pathology department from March to June 2022. A total of 160 participants with age range of 20 to 50 years completed a self-report questionnaire regarding sleep patterns, water intake, and perceptions of mood, concentration, and memory. Analyzed the relationship between sleep duration, water intake, mood, mindfulness/concentration, and memory using Kendall's Tau-b correlation coefficient in SPSS 22. Results: A significant number (28.7%) of participants had a sleep duration of ≤ 6 hours, with 41.3% sleeping after midnight. 82.5% of the participants switch off-screen just before sleeping. 63.7% have a routine water intake of less than 2 L/day. An aberrant statistically significant negative correlation between total sleeping hours and mood (τb = -.313, p = 0.004) was identified, showing a negative effect on mood with a sleeping time of ≥ 9 hours when compared with the other two groups (6-9 hours, τb = - .689, p = 0.001, ≤ 6hours, τb = - .697, p = 0.001). A significant correlation between daily water intake and concentration was found, wherein a decrease in daily water intake showed a negative effect on concentration (τb = .289, p = 0.008). Conclusions: Sleep duration and water intake patterns may affect mood and cognitive performance. Regular sufficient nighttime sleep and adequate hydration may help improve cognitive functioning and mood.

Association of vascular endothelial growth factor a gene (VEGFA) polymorphisms, rs699947 and rs1570360, with diabetic retinopathy and altered VEGF secretion in the Pakistani patients with type 2 diabetes mellitus: a casecontrol study.

OBJECTIVE: To investigate the association of vascular endothelial growth factor A gene polymorphisms 2578C/A (rs699947) and 1154G/A (rs1570360) with type 2 diabetes mellitus, diabetic retinopathy and serum vascular endothelial growth factor levels in Pakistani patients. METHODS: The case-control study was conducted from Jan 2017 to Dec 2018 after approval from the ethics review board of Riphah International University, Islamabad, Pakistan, and comprised type 2 diabetes mellitus patients of either gender with diabetic retinopathy in group A, and without diabetic retinopathy in group B. Non-diabetic healthy individuals were enrolled in control group C. Genotyping was done by amplification refractory mutation system-polymerase chain reaction and serum vascular endothelial growth factor levels were measured using enzyme-linked immunosorbent assay. Data was analysed using SPSS 22. RESULTS: Of the 450 subjects, 150(33.3%) were in each of the 3 groups. The mean age in group A was 58.16±9.42, in group B 56.25±8.5 years and in group C it was 55.90±10.90. The proportion of Punjabi ethnicity was significantly high in group B compared to other groups (p<0.05). There was no significant association of rs699947 and rs1570360 genotypic and allelic frequencies in group B compared to group A. Further, rs699947 AA genotype was significantly associated with proliferative diabetic retinopathy compared to group A (p<0.05). Minor allele A showed significant association in groups A and B compared to group C (p<0.05). Significantly raised serum vascular endothelial growth factor levels were found in group B compared to group A (p<0.05), and were associated with rs699947 and rs1570360 heterozygosity in group A (p<0.05). Also, rs699947 genotype showed significant association with groups A and B in Punjabi and Pathan ethnicities (p<0.05) and with Kashmiri ethnicity in group B (p<0.05). CONCLUSIONS: There was a strong association of vascular endothelial growth factor 2578C/A (rs699947) gene polymorphism with proliferative diabetic retinopathy in type 2 diabetic Pakistani patients, suggesting its role in the pathogenesis of this condition.

Secondary traumatic stress and death anxiety in healthcare professionals: Moderating role of social support.

Background & Objective: It's hard to deny the buffering impact of social support as it provides much-needed assistance to counter untoward circumstances that individuals face in their daily life. By focusing on the moderating role of social support, the present investigation studied the relationship between secondary traumatic stress and death anxiety that healthcare professionals encounter in their regular work life. Method: Through a cross-sectional correlational design, 200 participants were included from various hospitals in Lahore (from June-August, 2022) by employing a non-probability purposive sampling technique. They provided basic sociodemographic information along with their responses on self-reported questionnaires for the current investigation. Results: Results were analyzed through SPSS 21 which indicated that secondary traumatic stress had a positive association with death anxiety, unlike social support which had a negative relationship with death anxiety. Findings also revealed social support as a significant moderator for secondary traumatic stress and death anxiety. Conclusions: It can be concluded that increased social support could benefit healthcare professionals as it weakened the association between secondary traumatic stress and death anxiety. Other than academia and research, these findings have implications across a variety of professional settings including physical and mental healthcare professionals who can benefit from these indigenous findings.

Efficacy and pitfalls of digital technologies in healthcare services: A systematic review of two decades.

The use of technology in the healthcare sector and its medical practices, from patient record maintenance to diagnostics, has significantly improved the health care emergency management system. At that backdrop, it is crucial to explore the role and challenges of these technologies in the healthcare sector. Therefore, this study provides a systematic review of the literature on technological developments in the healthcare sector and deduces its pros and cons. We curate the published studies from the Web of Science and Scopus databases by using PRISMA 2015 guidelines. After mining the data, we selected only 55 studies for the systematic literature review and bibliometric analysis. The study explores four significant classifications of technological development in healthcare: (a) digital technologies, (b) artificial intelligence, (c) blockchain, and (d) the Internet of Things. The novel contribution of current study indicate that digital technologies have significantly influenced the healthcare services such as the beginning of electronic health record, a new era of digital healthcare, while robotic surgeries and machine learning algorithms may replace practitioners as future technologies. However, a considerable number of studies have criticized these technologies in the health sector based on trust, security, privacy, and accuracy. The study suggests that future studies, on technological development in healthcare services, may take into account these issues for sustainable development of the healthcare sector.

'The best interest of patients, not self-interest': how clinicians understand altruism.

BACKGROUND: Altruism refers to acting in 'the best interest of patients, not self-interest'. With an observed discordance between the concept and practice of altruism, and increasing attention to 'pathologic altruism', the role of altruism is blurred in present day medical care. In this background, the required balance of altruistic attitude which needs to be fostered in medical students needs clarity. This problem may be best addressed by the practicing clinicians. The objectives of this study were to explore clinicians' understanding of altruism in the clinical context and to identify the key concepts of altruism which they felt, must be included in clinical practice. METHODS: It was an exploratory qualitative study to identify clinicians' understanding of altruism and the key practice points for altruism. Online semi-structured interviews were conducted from 18 clinicians through Zoom and transcribed using Otter. Open coding of interview transcripts was done using Atlas ti 8 and grouped by commonalities under sub themes and themes. RESULTS: The main concepts regarding the clinicians' understanding of altruism were prioritizing patients' interest above oneself, favouring patients beyond routine duty and organized team work for practicing altruism. The essential practice areas identified for altruism were finding a balance between altruistic tendency and self/family life, identifying one's individual capacity for altruism, establishing teamwork for developing a workplace altruistic attitude, and facilitating patients beyond routine duty. CONCLUSIONS: Altruism is an important professionalism attribute for clinicians, however prioritizing patients interest requires a balanced approach so that it is effective and sustainable. Workplace altruistic cultures may be better promoted through organized team-based approach rather than individual efforts.

Association analysis of -429T/C receptor for advanced glycation end products (RAGE) gene polymorphism with type 2 diabetic retinopathy and serum soluble RAGE levels in Pakistani patients.

OBJECTIVE: To investigate the association of receptor for advanced glycation end products gene polymorphism 429T/C (rs1800625) with diabetic retinopathy and serum soluble receptor for advanced glycation end products levels in patients with type 2 diabetes. METHODS: The case-control study was conducted from January 2017 to December 2018 at Pakistan Railway Hospital, Rawalpindi, and the Multidisciplinary Laboratories of Islamic International Medical College, Riphah International University (RIU), Islamabad, Pakistan. Those included were healthy controls in group A, diabetics without retinopathy in group B and patients having diabetic retinopathy in group C. Genotyping for 429T/C was done by tetra-primer amplification refractory mutation system-polymerase chain reaction. Serum soluble receptor for advanced glycation end products levels were measured using enzyme-linked immunosorbent assay. Data was analysed using SPSS 22. RESULTS: Of the 450 subjects, 150(33.3%) were in each of the three groups. The frequency of TT, TC and CC genotypes of 429T/C polymorphism were 137(91.3%), 10(6.7%) and 3(2%) in group A; 133(88.6%), 13(8.7%) and 4(2.7%) in group B; and 127(84.7%), 18(12%) and 5(3.3%) in group C. No significant association of 429T/C genotypic and allelic frequencies were found with groups B and C (p>0.05). Serum soluble receptor for advanced glycation end products levels were significantly high in patients with proliferative diabetic retinopathy and were positively correlated with fasting plasma glucose in group C (p<0.05). TC and CC genotypes were significantly associated with raised serum soluble receptor for advanced glycation end products, and TC with raised fasting plasma glucose in group C. CONCLUSIONS: The 429T/C receptor for advanced glycation end products gene polymorphism was found to be associated with severe non-proliferative diabetic retinopathy, and serum soluble receptor for advanced glycation end products levels had a positive correlation with severity of diabetic retinopathy.

Association analysis of 374T/A (rs1800624) receptor for advanced glycation end-products (RAGE) gene polymorphism with diabetic retinopathy in Pakistani patients.

OBJECTIVES: to determine the relationship of 374T/A (rs1800624) polymorphism in the gene encoding RAGE with Type-2 diabetes mellitus (T2DM), diabetic retinopathy (DR) and serum soluble RAGE (sRAGE) level in Pakistani patients. METHODS: A case-control study, conducted from January 2017 to December 2018, involving 150 healthy controls (HC), 150 T2DM patients with no retinopathy (DNR) and 150 DR patients diagnosed by coloured fundus photography. Tetra-primer amplification refractory mutation system - polymerase chain reaction (T-ARMS-PCR) was used for genotyping. Serum sRAGE levels were measured by enzyme-linked immunosorbent assays (ELIZA). RESULTS: The frequency of TT, TA and AA genotypes of rs1800624 polymorphism were: 92.7%, 6%, 1.3% in HC, 80%, 17.3%, 2.7% in DNR and 76.7%, 19.3%, 4.3% in DR groups. Heterozygous TA genotype and mutant A allele showed significant association with diabetes and DR vs HC. In dominant model, mutant allele showed significant association with DNR and DR vs HC. No significant association of rs1800624 was detected with DR and its sub-groups, non-proliferative DR (NPDR) and proliferative DR (PDR) vs DNR. Dividing NPDR into mild, moderate and severe, heterozygous TA genotype showed significant association with moderate and severe NPDR vs DNR. In DNR and DR groups, TA genotype was significantly associated with raised sRAGE. CONCLUSION: rs1800624 RAGE gene polymorphism might be a risk factor for T2DM and NPDR in Pakistani patients. Raised sRAGE levels have a positive correlation with PDR and are associated with heterozygosity of rs1800624 polymorphism in DNR and DR groups.

Impact of Multifaceted Workplace Bullying on the Relationships between Technology Usage, Organisational Climate and Employee Physical and Emotional Health.

This research article investigates the effect of organisational climate and technology usage on employees' physiological and emotional health damage resulting from face-to-face bullying and cyberbullying at the workplace. Furthermore, we investigated emotional intelligence as a coping strategy to moderate employee physiological and emotional health damage. The research used a quantitative research design. A five-point Likert-scale questionnaire was used to collect data from a multistage sample of 500 officials from Pakistan's four service sectors. Results revealed that organisational climate and technology usage are negatively related to face-to-face bullying and cyberbullying at the workplace. At the same time, workplace bullying adversely affects an employee's emotional and physiological health. However, emotional intelligence can reduce an employee's emotional health damage due to workplace bullying. Thus, we suggest incorporating emotional intelligence training at the workplace to minimise the devastating effects of face-to-face bullying and cyberbullying on employees' physical and emotional health.

Lead exposure and its adverse health effects among occupational worker's children.

Lead exposure is an important environmental health problem particularly affecting the children of occupational workers living in the lead-contaminated environment. The objectives of the study were to find out the frequency, potential sources and adverse health effects of elevated blood lead level (BLL) in the children of lead-related occupational workers. It was a comparative cross-sectional study. A total of two hundred forty six children aged 1-6 years, comprising an equal number (n = 123) from lead smelters/battery recycle plant workers living close to the industries at Wah/Gujranwala, Pakistan (lead-exposed group) and those living 30 km away from the industrial area (controls) were included. Demographic and clinical data of each subject was collected. Blood lead analysis was carried out by using kits on the lead analyzer (3010 B ESA, USA). Biochemical tests of renal and hepatic profile were analyzed on Selectra E auto analyzer. The median age of children was 4 years; comprising of 69 boys and 54 girls. The lead-exposed children had significantly high BLLs median (range) 8.1 (1-20.9) microg/dL as compared to controls 6.7 (1-13.3) microg/dL (p 10 microg/dL) in 38 (31%) as compared with 14 (11%) in controls. Hematopoietic, renal, and hepatic functions were significantly impaired in the lead-exposed children. In conclusion, the children of lead-related occupational workers have significantly increased frequency (31%) of lead poisoning. The potential source of lead overexposure in these children may be indirect through father's clothes and contaminated environment at home. Increased lead accumulation adversely affects health of these children.

Evaluation of lead body burden in occupational workers by lead mobilization test.

OBJECTIVE: To determine total lead body burden by the Lead mobilization test (LMT) by measuring 4 hours urinary lead excretion in the lead exposed as compared to unexposed industrial workers after administration of 10 mg/Kg of dimercaptosuccinic acid and correlate it with blood lead levels, at Wah district Rawalpindi. METHODS: Total 149 males consisting of 87 lead exposed workers and 62 controls were included. Dimercaptosuccinic acid (DMSA), 10mg/kg body weight, was administered orally. Four hours urine specimens before and after DMSA administration were collected. Blood lead levels (BLL) were determined on 3010B ESA lead analyzer and urinary lead was measured on atomic absorption analyst 800 (Perkin Elmer). RESULTS: The lead exposed workers had high BLL median (range) 291 (90-611) ug/L as compared to controls 108 (10-310) ug/L (p=0.01). The occupational workers also revealed high DMSA-chelated urinary lead excretion (DMSA Pb-U) median (range) 28 (1.7-268) ug/4h as compared to controls 6 (1-27) ug/4h (p<0.01). Four hours DMSA Pb-U was significantly correlated with BLL (r=0.67), baseline Pb-U (r=0.54) and DMSA Pb-U/creatinine ratio (r=.81) in the lead exposed group (p<0.001). Increased lead exposure was detected in 43% of the subjects by using the WHO criteria for BLL while 54% were identified with LMT. Thirteen (15%) lead exposed workers had BLL more than OSHA permissible limits. CONCLUSION: Lead mobilization test is a more reliable diagnostic test than BLL for assessment of toxicologically active fraction of total lead body burden and imminent health risks in occupational workers.