Frequency of non-alcoholic fatty liver disease (NAFLD) and its associated risk factors among Type-2 diabetics.

OBJECTIVES: To determine the frequency of Non-Alcoholic Fatty Liver Disease (NAFLD) and its associated risk factors among Type-2 Diabetic patients. METHODS: This cross-sectional study was conducted in Diabetic Clinic of Shaikh Zayed Postgraduate Medical Institute Lahore from September 2019-February 2020. Type-2 diabetics regardless of age were divided into two groups, one with fatty liver disease and the other without this, evaluated by Abdominal Ultrasonography and were further evaluated by measurement of BMI, obesity, HbA1c and lipid profile. Exclusion criteria were patients having history of or currently taking alcohol, chronic Liver Disease of any cause and intake of hepatotoxic drugs. Qualitative measures were compared between groups by using Chi-square test. Binary logistic regression was used to see the association of factors with fatty liver disease. P-value ≤ 0.05 was considered significant. RESULTS: A total of 185 subjects were included in the study with the mean age of 53.0±9.0 years. About 54.6% patients were diagnosed to have fatty liver disease. When compared the cases with and without fatty liver disease, age and HDL cholesterol had no significant difference between groups while other measures like BMI, TGs & cholesterol levels, ALT and AST were significantly higher among cases with NAFLD. BMI >24.5, HbA1c >7.0 and ALT >40.0 can predict NAFLD among Type-2 diabetic patients with 96.8% accuracy. CONCLUSION: There is high prevalence of NAFLD among Type-2 diabetic patients and strong association between Type-2 diabetics with NAFLD and risk factors like; obesity, high HbA1c, hyperlipidemia and high ALT. Therefore, early recognition by ultrasonography in high risk patients and intervention like life style modification, maintenance of healthy weight, obesity prevention, treatment of dyslipidemia and good glycemic control should be achieved in such subjects and can prevent NAFLD.

Novel COVID-19: A Comprehensive Review of Transmission, Manifestation, and Pathogenesis.

A global outbreak highlights the start of a new decade as a new strain of coronaviruses emerges. Coronavirus disease 2019 (COVID-19), also referred to as Wuhan-Hu-1-CoV - amongst many other names - emerged from the West District of Southern China Seafood Wholesale Market in late December 2019. With the emergence of the new decade, the causative agent of COVID-19 was identified: severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). COVID-19 became declared a global pandemic by the World Health Organization (WHO). COVID-19, currently, is affecting 204 countries and territories and two international conveyances. Initial stages of COVID-19 present with symptoms that mimic the common cold and individuals may be asymptomatic carriers and thus, transmitting the virus to others. COVID-19, like other coronaviruses, presents with S glycoproteins on the membrane that plays an integral role in the virus binding with the angiotensin-converting enzyme 2 (ACE2) receptor. The ACE2 receptor is an intramembrane receptor on the type II pneumocytes, where the virus is able to replicate after getting endocytosed within the cytoplasm. As the viral load increases within the alveolar cell, the alveolar epithelial cell will burst, releasing the newly replicated viral RNA. Elderly individuals are at a greater risk of infection due to weakened immune systems and pre-existing medical conditions resulting in a compromised immune response, also increasing the susceptibility of infection. Infected individuals presenting with mild to moderate symptoms are recommended to self-isolate as the majority will recover without any intervention.

Frequency of impaired fasting glucose in first degree relatives of Type-II diabetic patients and its association with Body Mass Index.

OBJECTIVES: To determine the frequency of impaired fasting glucose in first degree relatives of people with Type-II diabetes and its association with BMI. METHODS: This cross-sectional study was conducted in Diabetic clinic of Shaikh Zayed Hospital, Lahore from July to December 2017. Individuals aged ≥35 years, first degree relatives of people with Type-II diabetes, were selected and their fasting blood glucose levels were checked twice a week apart. Study participants were divided into 3 groups. Group-I were those with normal fasting blood glucose (FBS: <100mg/dl), Group-II were those with impaired fasting glucose (100-125mg/dl), considered as high risk and Group-III included those who turned out to be having frank diabetes (FBS: ≥126mg/dl). Exclusion criteria were known diabetes and pregnancy. Proportions of impaired fasting glucose levels versus BMI were compared using Chi-square test. Significance was considered at P <0.001. RESULTS: A total of hundred subjects were included in the study with the mean age of 44.27 years. Sixty percent participants had normal FBS, 31% showed impaired FBS and 09% had frank diabetes (P <0.001). Significant association was found between impaired fasting glucose and BMI, as with increasing BMI the frequency of impaired fasting glucose increases. CONCLUSION: First-degree relatives of people with Type-II diabetes showed higher frequency of impaired fasting glucose and obesity was an important risk factor.

Vitamin C: A Preventative, Therapeutic Agent Against Helicobacter pylori.

The treatment of Helicobacter pylori (H. pylori) induced infections using antibiotic therapies is clinically well accepted; however, using a noninvasive approach with the implementation of therapeutic agents such as vitamin C is not well investigated. Vitamin C has certain characteristics, which allow for it to be considered as a potential treatment option for patients with H. pylori infections. Vitamin C's hostility and mechanism of action towards H. pylori infection in peptic ulcer disease can be classified into two categories: as a preventative agent and alternatively as a therapeutic agent. Preventatively vitamin C acts as a biological antioxidant as well as an immune boosting agent, while therapeutically it acts as an inhibitor of urease, a potential collagen synthesizing agent, and a stimulant in prostaglandin synthesis. As a result, the dosage of vitamin C should be highly regulated. Furthermore, numerous studies have shown that vitamin C supplementation if taken with antibiotics can increase the efficiency of the treatment leading to an increased possibility of eradication of H. pylori in infected individuals. This paper will investigate the recent studies that show different mechanisms through which vitamin C can be used as a preventative or a therapeutic agent for the treatment of H. pylori related infections.

The Mechanisms of Dietary Phytoestrogen as a Potential Treatment and Prevention Agent against Alzheimer's Disease.

Alzheimer's disease (AD) is a major dementia disease worldwide with an increasing incidence rate among the elderly. It is a neurodegenerative disease with symptoms starting slowly and then progressing over time. There has been extensive research on AD prevention and treatment; however, there is no cure as of yet. Several drugs are being researched for the treatment and prevention of AD, with a rising interest in specific dietary compounds as potential interventions with lower side effects. One such dietary compound being tested is phytoestrogen. Phytoestrogens are chemically, structurally, and functionally similar to estrogen, which has numerous functions as a cognition-promoting agent; although, as a supplement it can be damaging. Phytoestrogens have the unique ability to substitute for estrogen in elderly individuals with Alzheimer's disease and depleted estrogen levels. This paper aims to contribute to the collective understanding of phytoestrogen's role in the treatment and prevention of Alzheimer's disease by describing its various mechanisms, including its ability to decrease amyloid beta peptide production, promote calcium outflow and acetylcholine release, and reduce Tau protein phosphorylation. The paper also addresses phytoestrogen's role as an anti-inflammatory and antioxidant agent for the cholinergic neurons associated with Alzheimer's disease.

Medical Students' Perception of the Usage of Lecture Recording Software.

BACKGROUND: Lecture recording software is a useful reference tool that allows students to revisit lectures and understand complicated concepts in higher education. It is also a useful tool for students with learning difficulties, allowing them to reference and learn the material at their own pace. A significant advantage of this tool is the accessibility of course material to the students off campus. This study attempted to learn the students' perception of the purpose, use, and benefit of lecture recording software at a medical school. METHODS: The study was conducted using a structured questionnaire delivered, via an Internet-based survey application in the Fall semester of 2017, to 105 students attending the basic sciences courses. A web link was generated after the 18-point questionnaire was uploaded to an online survey software. The link was communicated electronically to each student along with the date and time of the survey. The survey was anonymous. The results of the survey were summarized using descriptive statistics and graphical methods. Students were asked to submit voluntary, informed consent to participate in the study before attempting to answer the questionnaire. The institutional review board approved the research. RESULTS: The results showed 77% students used this resource to understand points they missed in the class, 75% of them relearned complex ideas/concepts, and 62% of them used it to rewrite class notes. Reportedly, the software was used by students (78%) who missed a class due to an illness or while attending clinical shadowing. Of the students, 87% agreed that the software is helpful because of its off-campus availability while 84% of the students liked the service, as it allowed them to listen to the lectures at their own pace. Many students (65%) felt that the service helped them score better in the exams, whereas 38% did not think the recordings was helpful to get the desired grade and 50% student felt it was time-consuming. CONCLUSION: Despite the time-consuming listening process, students expressed a positive opinion about the usefulness of this software. Recording and archiving class lectures could be a useful academic resource. Students could learn from these archived lectures before the class and engage in the discussion later, enhancing active learning. The result suggests that students should also use other study resources and methods to achieve the desired grades. The induction of this student service into a professional curriculum would enhance the students' satisfaction, effectiveness, and outcomes.

Investigating the Atherogenic Risk of Lipoprotein(a) in Type 2 Diabetic Patients.

Type 2 diabetes mellitus (T2DM) has high morbidity and results in increased risk of mortality mainly due to cardiovascular diseases. Different factors have been found to be responsible for the increased prevalence of coronary artery disease (CAD) in T2DM. One of these factors includes raised serum levels of lipoprotein(a) (Lp(a)). The present study was designed to evaluate the association of Lp(a) levels with T2DM in Libyan patients and find the degree of association between Lp(a), glycemic control, insulin, and lipid profile. The study included 100 T2DM patients, recruited from the Benghazi Center for Diagnosis and Treatment of Diabetes, and 30 apparently healthy age and sex-matched individuals, to serve as controls. All participants completed a questionnaire to obtain clinical information and medical history. Blood samples were collected and analyzed for Lp(a), fasting blood glucose (FBS), HbA1c, insulin, total cholesterol (TC), triglycerides (TAG), low-density lipoprotein c (LDL-c), and high-density lipoprotein c (HDL-c). The results from the comparison between the control and experimental groups showed that Lp(a) was significantly higher in diabetic patients. It showed the positive correlation with TC and LDL-c. On the contrary, it showed no significant correlations with glycemic control parameters nor insulin, TAG, HDL-c, body mass index (BMI), and blood pressor (BP). Cardiovascular disease (CVD) risk in type 2 diabetic patients could be dependent on risk factors other than LDL-c, which may not be an independent risk factor for the development and progression of atherogenesis in T2DM. Lp(a) may be a new metabolic syndrome risk factor, and it may be useful as a cardiovascular risk biomarker in future clinical practice.

Caffeine: A Potential Protective Agent Against Cognitive Decline in Alzheimer's Disease.

Over the past few decades, caffeine has been well recognized as a stimulant whose effects can be detected particularly in the central nervous system. A stimulating effect of caffeine has been found useful in treating patients with many neurological disorders, including Alzheimer's disease (AD). AD is reported to be a rapidly increasing public health problem with lack of a remedial treatment. However, the assumed protective effects of caffeine against AD are of huge interest. This study substantiates caffeine's role as a potential prevention agent against AD through several epidemiological studies. More than 75% of available study reports support the opinion that caffeine has a favorable effect against cognitive decline and AD. Moreover, other studies have discussed the effect of caffeine drinking and concluded several positive effects on cognitive functioning. The present study, however, focuses more on the potential mechanisms by which caffeine diminishes effects as well as delays the onset of AD.

Gastroesophageal Reflux Disease: A Review of Symptomatic Management.

Considered as a chronic illness, gastroesophageal reflux disease (GERD) has manifested itself as a widespread condition throughout the adult population. As a growing epidemic, GERD has reached a staggering prevalence of 10% to 20% in the Western world, by affecting up to 30 million people in the United States alone. Sixty percent of individuals in an adult population will experience symptoms and the impact of GERD over a period of 12 months, whereas a remarkable 20% to 30% of individuals will have weekly symptoms. This rapid increase in the prevalence of the disease requires equally rapid management techniques. Although the disease itself has no cure, management of symptoms and certain pharmacological and surgical advancements have allowed for individuals affected by GERD to receive specific treatment options sufficient for them to live a healthy life. In this paper, such management options will be examined and discussed in reference to their effectiveness in treating the symptoms presented in GERD patients.

Parathyroid Gland Response to Vitamin D Deficiency in Type 2 Diabetes Mellitus: An Observational Study.

Background Studies have linked vitamin D deficiency with the risk of type 2 diabetes mellitus (T2DM) and to the development of chronic complication of diabetes. Vitamin D receptors (VDR) have been found in many tissues in the body including the pancreas, a finding that indicates its role in insulin secretion. In addition, many studies have demonstrated the role of vitamin D and its receptor in insulin sensitivity and signal transduction. Vitamin D deficiency is common throughout the world, but not all vitamin D deficiencies are accompanied by a rise in parathyroid hormone (PTH). The present study was conducted to assess vitamin D deficiency in type 2 diabetic patients in comparison to healthy control and to determine parathyroid gland response to vitamin D deficiency in both groups. Methods This observational study was performed during a period from January to October 2018. The study included 151 type 2 diabetic patients selected from three diabetes clinics and 43 age and sex-matched healthy subjects. Informed consent and clinical information were obtained from all participants before the study. Results of the laboratory analysis for serum 25-hydroxyvitamin D (25-OHD), PTH, calcium, and phosphorous were recorded. The data was analyzed using the statistical package for the social sciences (SPSS) Statistics 17. Results The results showed low vitamin D concentration in both groups; however, there was no significant difference in vitamin D concentration between diabetic patients and the control patients. A high percentage of PTH level was found in severe vitamin D deficient diabetic patients and healthy controls. The higher percentage of diabetic and normal subjects with mild vitamin D deficiency had a normal PTH level. All healthy subjects with vitamin D insufficiency showed normal PTH concentration. About 10% of diabetic patients with severe vitamin D deficiency had a low PTH level. Conclusion The population in our study was generally deficient in 25-OHD irrespective of diabetes mellitus, indicating a greater need for vitamin D supplementation. Not all vitamin D deficient patients have high PTH levels, a finding that supports the emergence of new criteria for vitamin D deficiency, diagnosis and treatment, and highlights the importance of testing PTH in this regard.