The kaleidoscope of the glass ceiling: experiences of Pakistani female doctors - a qualitative narrative inquiry.

OBJECTIVE: To explore the extent and factors leading to the glass ceiling for Pakistani female doctors in leadership positions. Method: The qualitative narrative study was conducted the Department of Medical Education, Riphah International University, Islamabad, Pakistan from March to July 2021, and comprised female doctors with 10-15 years of professional experience who were either currently at top leadership position or had retired from such a position in public and private medical clinical setups and medical colleges. Data was collected using in-depth interviews conducted through Zoom due to the coronavirus disease-2019 pandemic. The transcribed data was processed using ATLAS.ti.9 software for thematic analysis with an inductive approach. RESULTS: Of the 9 subjects aged 47-72 years having professional experience of 11-39 years, 4(44.4%) were clinicians, 3(33.3%) had basic medical science background and 2(22.2%) were health profession educationists. In terms of qualifications, 4(44.4%) were PhDs, 4(44.4%) were Fellows of the College of Physicians and Surgeons, Pakistan, and 1(11.1%) had an M. Phil. Besides, 4(44.4%) subjects were from the public sector, and 5(55.5%) from the private sector, 1(11.1%) had retired from service. The extent of experiencing the glass ceiling was common to all but 1(11.1%) participant. Factors identified included 'institutional challenges', 'family support issues', 'personal challenges' and 'societal unacceptance'. Detailed analysis revealed that women in leadership positions faced 'malintent of seniors', 'discrimination', 'stereotyping', 'lack of mentors' and 'ethnic background conditioning' at the institutional level. On the personal front, they faced 'lack of support of in-laws', 'insecurity of husbands', 'need of personal attributes' and 'beauty as a barrier'. CONCLUSIONS: The glass ceiling was found to be a challenge faced by Pakistani female doctors in leadership positions in both clinical settings and academia.

Association of lipoprotein(a) with lipid profile and response to statin treatment in hyperlipidaemic patients.

Objectives: To determine serum levels of lipoprotein(a) in the local population, its relationship with other parameters of lipid profile and statins' response to lipoprotein(a). METHODS: The cross-sectional analytical study was conducted at the Pak-Emirates Military Hospital and Army Medical College, Rawalpindi, Pakistan, from March 2018 to March 2019, and comprised of healthy controls in group I, persons with hyperlipidaemia without medications in group II, and diagnosed cases of hyperlipidaemic on statin therapy in group III. The samples were studied using enzyme-linked immunosorbent assasy for lipoprotein(a) estimation, and an automated chemistry analyser for lipid profile estimation. Data was analysed using SPSS 21. RESULTS: Of the 90 subjects with a mean age of 43±5 years, 30(33.3%) were in each of the three groups. Mean body mass index, total cholesterol, triglycerides and low-density lipoprotein were significantly different among the groups. Lipoprotein(a) level was not correlated with statins (p>0.05), but had a positive correlation with low-density lipoprotein. CONCLUSIONS: Lipoprotein(a) was found to be raised even in the absence of dyslipidaemia, and it was controversially raised with statin therapy. Lipoprotein(a) can very well be regarded as an independent risk factor for all the known complications of hyperlipidaemia.

Frequency of behavioural tendencies resembling attention-deficit hyperactivity disorders in undergraduate medical students: a cross sectional study.

OBJECTIVE: To determine the frequency of behavioural tendencies resembling attention deficit hyperactivity disorders in undergraduate medical students. METHODS: The descriptive cross-sectional study was conducted from January 2017 to November 2018 at the Army Medical College, Rawalpindi, Pakistan, and comprised medical students from four medical institutions in the twin cities of Rawalpindi-Islamabad. Data was collected using the Adult attention deficit hyperactivity disorder Self-report scale V1.1 screener. Behavioural patterns were assessed on the basis of the the symptoms checklist of the scale. Data was analysed using SPSS 25. RESULTS: Of the 409 subjects, 191(45.7%) were males and 218(53.3%) were females. Overall, 4 or more symptoms were found in 121(29.6%). Of these, 59(30.9%) were males and 62(28.4%) were females. Those who scored high showed higher levels of inattention and hyperactivity (p<0.005). CONCLUSIONS: A significant number of medical students showed behavioural tendencies that resembled attention deficit hyperactivity disorders.

Comparison of serum levels of Cystatin-C and traditional renal biomarkers for the early detection of pre-hypertensive nephropathy.

OBJECTIVE: To compare serum Cystatin-C and serum creatinine levels along with estimated glomerular filtration rate of apparently healthy people of South Asian descent with pre-hypertension to determine which is better in detecting reversible renal dysfunction. METHODS: :The comparative cross-sectional study was conducted at the Army Medical College, Rawalpindi, Pakistan, in 2013-14, and comprised apparently normal healthy male and female volunteers. The subjects were divided into normotensive group 1 and pre-hypertensive group 2. Serum Cystatin-C levels were measured by sandwhich enzyme-linked immunosorbent assay technique whereas serum creatinine levels were measured by Jaffe's procedure. Glomerular filtration rate estimation was done by using standard equations. SPSS 20 was used for data analysis. RESULTS: Of the 78 subjects, 39(50%) were in normotensive group 1 and 39(50%) in the pre-hypertensive group 2. The mean age was 38.74 } 5.71 years in group 1 and 38.07 } 3.84 years in group 2. Serum Cystatin-C levels were higher in group 2 than in group 1(p= 0.0001), whereas serum creatinine levels manifested no statistical difference between the groups (p=0.106). Estimated glomerular filtration rate based on Cystatin-C significantly decreased in group 2 than in group 1 (p=0.0001). Serum Cystatin-C displayed a significant positive correlation and estimated glomerular filtration rate based on Cystatin-C negative correlation with the rising blood pressure values (p=0.0001).Serum Cystatin-C reflected a very high sensitivity and specificity at a cutoff value of 0.77 mg/l compared to serum creatinine. CONCLUSIONS: Serum Cystatin-C and Estimated glomerular filtration based on rate Cystatin-C appeared to be better renal biomarkers in the detection of pre-hypertensive nephropathy.

Evaluation of histo-pathogical patterns of ovarian masses in relation to age in Rawalpindi-Islamabad region - Lab Research.

OBJECTIVE: To evaluate the histopathological patterns of ovarian tumours in relation to age in Rawalpindi-Islamabad region of Pakistan. METHODS: The retrospective study was conducted at the Army Medical College, Rawalpindi, Pakistan, and comprised data related to ovarian tumour cases from 2013 to 2017). Tumour type, tumour subtype, tumour size, cancer staging and age of patients were noted from the medical records. Ovarian tumours were broadly classified in accordance with the World Health Organisation system for ovarian neoplasms. RESULTS: Out of 420 ovarian tumour cases, 250 (59.5%) were benign, 24 (5.7%) were borderline, and 146 (34.8%) were malignant. In terms of classification, 268 (63.8%) were surface epithelial tumours, 100 (23.8%) germ cell tumours, 29 (6.9%) sex cord stromal tumours, 12 (2.9%) metastatic tumours, n= and 11(1.2%) were miscellaneous.. Of the malignant tumours, 146(61.6%) were found in patients aged over 40 years. Serous cystadenoma was the most common 82(32.8%) benign tumour, while serous cyst-adenocarcinoma constituted the main bulk 48(32.9%) of malignant tumours.. CONCLUSIONS: The frequency of ovarian tumours was found to be quite high among women of Rawalpindi-Islamabad region..

Motivation, Cognitive and Resource Management Skills: Association of Self-Regulated Learning Domains with Gender, Clinical Transition and Academic Performance of Undergraduate Medical Students.

BACKGROUND: Studies have associated self-regulated learning with better medical academic performance. However, limited data depicts inter-gender variabilities and differences between pre-clinical students and those undergoing clinical transition. Our study aims to bridge this gap. METHODS: In this comparative cross-sectional study, Motivated Strategies for Learning Questionnaire was administered to 550 undergraduate students of Army Medical College. RESULTS: Three hundred thirty-nine of 550 students responded. Reliability analysis was performed (Cronbach's α = 0.936). Extrinsic motivation was higher than intrinsic. Use of cognitive, metacognitive, and resource management skills was modest. Academic performance was weakly but significantly correlated with intrinsic goal orientation (p = 0.031), extrinsic goal orientation (p = 0.003), elaboration (p = 0.001), time/study environment (p = 0.009), and effort regulation (p = 0.009). Extrinsic goal orientation mean score was significantly lower (p < 0.001) for third year students when compared with that of pre-clinical students. Females had higher task-value scores (p = 0.009) while males had higher self-efficacy (p = 0.002) and critical thinking (p = 0.012) scores. CONCLUSION: Study concludes that academic performance and self-regulated learning domains are weakly but significantly correlated. Students undergoing clinical transition have lower extrinsic motivation. Inter-gender variabilities exist in task-value, critical thinking, and self-efficacy domains. This study opens up new vistas for educationists who should revise curricula, academic reward systems, and pedagogy forms. Interventional studies should be designed to bring improvements in self-regulated learning domains.

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..

Comparison of quality of sleep between medical and non-medical undergraduate Pakistani students.

OBJECTIVE: To compare the quality of sleep between medical and non-medical undergraduate students. METHODS: The comparative cross-sectional study was conducted from March to May 2017 at different universities and colleges of Rawalpindi/Islamabad cities in Pakistan. Pittsburgh sleep quality index questionnaire was distributed among undergraduate students. Comparison was made between the global and component scores of medical and non-medical students. Excel 2013 was used for data analysis. RESULTS: Of the 606 students approached, 520(85.8%) responded. Among them, 266(51.1%) were medical students and 254(48.9%) were non-medical. Also, 327(62.9%) were females and 193(37.1%) males. Overall mean age of the subjects was 20.25±1.54 years. Among the medical students, 179(67.3%) and among the non-medical 128(50.4%) subjects were classified as poor sleepers with mean score of 6.386 ± 2.923. The scores were significantly higher among medical students, indicating poorer sleep quality and were higher still among female medical students (p<0.05). However, no gender difference was found among non-medical students. CONCLUSIONS: A considerable proportion of Pakistani undergraduate students have disturbed sleep patterns that tend to deteriorate further among medical students.

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.

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.

Non-steroidal anti-inflammatory drugs vs. Paracetamol: drug availability, patients' preference and knowledge of toxicity.

BACKGROUND: Self-medication is a common practice which is influenced by level of education, society factors and health care facilities availability. In our region, Pakistan, it is very common and awareness regarding prescription implementation needs to be ensured. Hence the current study highlights the preference, availability and knowledge of toxicity of non-steroidal antiinflammatory medications and paracetamol in Pakistan. METHODS: It was a Descriptive, cross sectional, conducted in Rawalpindi and Islamabad, Pakistan from May to august 2012. A total of 1000 questionnaires comprising of 21 questions were distributed to the persons with age groups from 18 years to 40 years. Non-probability convenience sampling technique was used for results deduction. Data was analysed using descriptive statistics. RESULTS: The most commonly used medicine was Mefenamic acid (n=191, 40.8%). Paracetamol was second on the priority list (n=146, 31.3%). About 178 out of 467(38.1%) used these medications for headache. Very few responders knew about the toxic doses of the medicines they used. Only 52 (11%) were aware of the raised bleeding tendency being the most common side effect of acetylsalicylic acid and 129 (28%) were aware of liver damage by paracetamol toxicity. CONCLUSIONS: In Pakistan, common people take NSAIDs and Paracetamol without prescription and majority of them are unaware of the side effects of these medicines. This is the reason it is important to make the general public aware of the problems they may face if they misuse or over use the drugs without the prescription.

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.

Cut-off values of anthropometric indices to determine insulin resistance in Pakistani adults.

OBJECTIVE: To determine the cut-off values of anthropometric indices to indicate insulin resistance and correlation of these indices with insulin resistance in Pakistani adults. METHODS: The cross-sectional study was conducted at the Military Hospital and Army Medical College, Rawalpindi, Pakistan, from June 2010 to November 2011. The study measured 209 adults for body mass index, waist circumference, waist-to-hip ratio, waist-to-height ratio and conicity index. Receiver operating characteristics curve analyses were done to determine the predictive values of these anthropometric measures and their cut-off values for insulin resistance by triglyceride/high density lipoprotein ratio. RESULTS: Overall mean age was 51.5 +/- 1.16 years (range: 28-73) and there were 136 (65%) males and 73 (35%) females. Body mass index had the maximum predictive value for insulin resistance followed by waist circumference and waist-to-height ratio in males (p < 0.0001), sensitivity and specificity being 68% and 62% respectively with cut-off value of 25.04 kg/m2. ROC curve analyses showed the maximum predictive value of conicity index for insulin resistance followed by waist circumference and waist-to-height ratio in females (p < 0.08), sensitivity and specificity being 65% and 50% respectively with cut-off value of 1.39. CONCLUSION: In Pakistani male adults, BMI is the best indicator of insulin resistance, while in female adults, conicity index is the best indicator.This is the first study in Pakistan reporting predictive values of anthropometric indices as a non-invasive method in determining insulin resistance.

Association of interferon-alpha and ribavirin-induced thyroid dysfunction with severity of disease and response to treatment in pakistani asian patients of chronic hepatitis C.

Objective. To determine the association of thyroid dysfunction with the severity of the disease and response to treatment in patients of chronic hepatitis C. Design. Cohort study. Patients. One hundred and sixty seven noncirrhotic chronic hepatitis C patients were grouped into treatment group (n = 107) and control group (n = 60). Measurements. Baseline S. ALT and S. AST by IFCC and S. TSH, S. free T4, and S.T3 level were measured by chemiluminescence method. The severity of the disease was measured by Knodell histopathological index (HPI) on liver biopsy. Study group patients underwent 24-weeks IFN and ribavirin therapy and thyroid functions were determined at weeks 0, 12, and 24. Response to therapy was determined by PCR-HCV test. Results. 20 treated patients (18.69%) developed thyroid dysfunction with relative risk (RR) of 11.25 and attributable risk (AR) of 91%. Females were at higher risk. Hypothyroidism was common than hyperthyroidism. There was no significant association between thyroid dysfunction and severity of the disease (P = 0.81) and response to therapy (P = 0.79). Conclusion. Interferon-alpha and ribavirin therapy induces thyroid dysfunction in chronic hepatitis C patients. There is no association between severity of disease and response to therapy with interferon-induced thyroid dysfunction.

Awareness of cardiopulmonary resuscitation in medical-students and doctors in Rawalpindi-Islamabad, Pakistan.

OBJECTIVE: To assess the level of awareness regarding basic and practical knowledge of cardiopulmonary resuscitation and its importance in the eyes of medical/dental students and doctors. METHODS: The cross-sectional study was conducted in medical and dental colleges as well as hospitals of Rawalpindi and Islamabad, Pakistan, from June to September 2011. Non-probability convenience sampling was used and structured questionnaires on basic and practical knowledge of the procedure were distributed. The questionnaire had 26 items related to basic and advanced knowledge of the required skills. Doctors were divided into two groups based on their years of service and practice. Those with less than 5 years' experience were grouped as junior doctors, while rest as senior doctors. Descriptive statistics were employed to analyse the data using SPPS version 17 and Microsoft Excel. Percentages were worked out and the results were interpreted. RESULT: Of the 1000 questionnaires distributed, 646 (64.6%) were received duly filled and represented the study sample. Of the 646 participants, 34 (5.26%) were dentists, 424 (65.63%) were medical students, 92 (14.24%) were doctors and 96 (14.86%) were dental students. Basic knowledge of doctors was found to be better than that of dentists (n = 96; 50% vs. n = 8; 23%). Similarly, the advance knowledge of doctors was better than the dentists (n = 53; 58% vs. n = 11; 31%). The basic knowledge of junior doctors was found to be almost equal to the senior doctors (n = 26; 44.75% vs. n = 15; 45.5%). The advance knowledge of junior doctors was found to be better than the senior doctors (n = 27; 45.37% vs. n = 10; 29.48%). Among the students, 157 (37%) of the medical students had basic knowledge of CPR, while 36 (38%) dental students had basic knowledge of the topic. Medical students had more advanced knowledge (n = 157; 37%) than dental students (n = 34; 35%). CONCLUSION: The awareness of basic and advance knowledge of cardiopulmonary resuscitation skills in medical/dental students and doctors in Rawalpindi and Islamabad was inadequate.

Effect of Acacia nilotica leaves extract on hyperglycaemia, lipid profile and platelet aggregation in streptozotocin induced diabetic rats.

BACKGROUND: To consider new hypoglycaemic, anti-hyperlipidaemic and anti-platelet aggregation sources, aqueous methanol extract of Acacia Nilotica (AN) leaves was investigated in streptozotocin induced diabetic rats. METHODS: Diabetes mellitus was induced in 90 out of 120 male albino rats by administering 50 mg/Kg bodyweight (bw) streptozotocin intraperitonealy, and was confirmed by measuring fasting blood glucose level > 200 mg/dL on 4th post-induction day. The rats were equally divided into 4 groups, A (normal control), B (diabetic control), C (diabetics rats treated with plant extract) and group D (diabetics rats treated with glyburide). The rats of group C and D were given single dose of 300 mg/Kg bw, AN extract, and 900 microg/Kg bw glyburide respectively for 3 weeks. Blood glucose levels were measured by glucometer, platelet aggregation by DiaMed method, beta-thromboglobulin and insulin by ELISA technique, and lipid components were measured by enzymatic calorimetric method. RESULTS: Significant differences (p < 0.05) were noticed in blood glucose, serum insulin, platelet aggregation and triglyceride levels in diabetic rats treated with AN extract and glyburide as compared to diabetic controlled rats. A significant difference (p < 0.05) in beta-thromboglobulin and LDL levels was also noticed in rats treated with glyburide than the diabetic controlled rats. The levels of fasting blood glucose, beta-thromboglobulin and platelet aggregation were significantly reduced (p < 0.05) in diabetic rats treated with glyburide than AN extract treated rats. CONCLUSIONS: Administration of AN leaves extract showed hypoglycaemic and anti-platelet aggregation activity in diabetic rats as that of glyburide.

Correlation of serum alanine aminotransferase and aspartate aminotransferase levels to liver histology in chronic hepatitis C.

OBJECTIVE: To assess the correlation of serum alanine aminotransferase and aspartate aminotransferase levels to severity of disease on liver biopsy in patients of chronic hepatitis C. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of Gastroenterology at Military Hospital, Rawalpindi, from January 2006 to February 2007. METHODOLOGY: One hundred and seven diagnosed non-cirrhotic chronic hepatitis C adult patients were included. Serum alanine aminotransferase and aspartate aminotransferase levels were determined. Knodell histopathological Index was determined on liver biopsy. The correlation and regression value between serum alanine aminotransferase levels and liver histology and serum aspartate aminotransferase and liver histology in chronic hepatitis C patients was determined using Pearson correlation analysis. RESULTS: Patients of chronic hepatitis C had raised serum alanine aminotransferase and levels with the mean baseline level of 93 International units per litre (IU/L) with a range of 13-383 IU/L. Serum aspartate aminotransferase levels were also elevated with mean baseline level of 59.65 IU/L ranging from 18-370 IU/L. On liver biopsy based on Knodell histopathological Index, 47.7% of patients had mild, 39.9% had moderate and 13.1% had severe disease. There was significant association between serum alanine aminotransferase levels severity of the disease on liver biopsy (p < 0.03) with weak positive correlation between the two (r = 0.217). There was also significant association between serum aspartate aminotransferase levels and severity of the disease on liver biopsy (p < 0.001) with weak positive correlation between the two (r = 0.32). CONCLUSION: The serum alanine aminotransferase and serum aspartate aminotransferase levels do not indicate the severity of the disease on liver biopsy in chronic hepatitis C patients.

Interferon-alpha induced and ribavirin induced thyroid dysfunction in patients with chronic hepatitis C.

Chronic hepatitis C (CHC) is one of the commonest infectious diseases of the liver and may lead to cirrhosis or hepatocellular carcinoma. Combination therapy with pegylated interferon (PEG-IFN) and Ribavirin is the treatment of choice for CHC. Combination therapy is thought to act by means of antiviral mechanisms and immunomodulation. Thyroid dysfunction is the most common autoimmune adverse effect associated with combination therapy; hypothyroidism is more common than hyperthyroidism. Antithyroid antibodies and female sex have a predictive value in the development of interferon induced thyroid disease (IITD). Patients with CHC should be informed of the possibility of side effects on the thyroid gland. Screening for antithyroid antibodies and thyroid function tests should be performed in patients with CHC before the commencement of antiviral treatment, and during and after it. This article reviews different aspects of IITD, including its pathogenesis, clinical manifestations, association with treatment regimens and treatment response and the outcome of thyroid dysfunction.

Comparison of nerve conduction studies with diabetic neuropathy symptom score and diabetic neuropathy examination score in type-2 diabetics for detection of sensorimotor polyneuropathy.

OBJECTIVE: To compare the nerve conduction studies in clinically undetectable and detectable sensorimotor polyneuropathy in type 2 diabetics. METHODS: Diagnosed diabetics (n = 60) were divided in two groups. Group 1 (n1 = 30) with clinically undetectable and group 2 (n2 = 30) with clinically detectable Diabetic Polyneuropathy. Detection of the sensorimotor neuropathy was done according to Diabetic Neuropathy Symptom Score and Diabetic Neuropathy Examination scores. The simplified nerve conduction studies protocol was followed in recording amplitudes, velocities and latencies of minimum two (Sural, Peroneal) and maximum six i.e. three sensory (Sural, Ulnar, Median) and three motor (Peroneal, Ulnar, Tibial) nerves. RESULTS: The comparisons were done between different parameters of nerve conduction studies with the neurological scores in undetectable and detectable groups using Pearson's chi square test. The amplitudes, velocities, latencies, outcome and grading of neuropathy in nerve conduction studies when compared with neurological detection scores showed a significant relation in each group regarding evaluation (p = 0.005, p = 0.004, p = 0.05, p = 0.00001, p = 0.003 respectively). CONCLUSIONS: Diabetic Neuropathy Symptom Score and Diabetic Neuropathy Examination Score together can help in prompt evaluation of the diabetic sensorimotor polyneuropathy though nerve conduction study is more powerful test and can help in diagnosing subclinical cases.