Embryo cell allocation patterns are not altered by biopsy but can be linked with further development

It has been suggested that first embryo cleavage can be related with the embryonic-abembryonic axis at blastocyst stage in mice. Thus, cells of the 2-cell embryo might be already biased to form the inner cell mass or trophectoderm. This study was conducted to observe the possible effects of embryo biopsy on cell allocation patterns during embryo preimplantation in two different mouse strains and the effects of these patterns on further development. First, one blastomere of the 2-cell embryo was injected with a lipophilic tracer and cell allocation patterns were observed at blastocyst stage. Blastocysts were classified into orthogonal, deviant or random pattern. For the first experiment, embryos were biopsied at 8-cell stage and total cell counts (TCC) were annotated. Furthermore, non-biopsied blastocysts were transferred into foster mothers. Then, pups and their organs were weighed two weeks after birth. Random pattern was significantly recurrent (≈60%), against orthogonal (<22%) and deviant (<22%) patterns among groups. These patterns were not affected by biopsy procedure. However, TCC on deviant embryos were reduced after biopsy. Moreover, no differences were found between patterns for implantation rates, litter size, live offspring and organ weights (lungs, liver, pancreas and spleen). However, deviant pups presented heavier hearts and orthogonal pups presented lighter kidneys among the group. In conclusion, these results suggest that single blastomere removal does not disturb cell allocation patterns during pre-implantation. Nonetheless, the results suggest that embryos following different cell allocation patterns present different coping mechanisms against in vitro manipulations and further development might be altered.

Association of Vitamin D binding protein polymorphism with risk of type 2 diabetes mellitus in a Pakistani urban population: A case control study

OBJECTIVE

To assess if genotypes/diplotypes of vitamin D binding protein have any association with type 2 diabetes mellitus.

METHODS

This case-control study was conducted from January 2013 to July 2015 at the endocrinology clinics of the Aga Khan University Hospital, Karachi, and comprised adult patients with type 2 diabetes and their age- and gender-matched healthy controls. Venous blood was obtained and assessed for serum/plasma 25 hydroxyvitamin D, parathyroid hormone, calcium, alkaline phosphatase and creatinine. Deoxyribonucleic acid was isolated and genotyping was done by polymerase chain reaction-restriction fragment length polymorphism procedures.

RESULTS

Of the 330 participants, there were 165(50%) cases and as many controls. There were 116(70.3%) males and 49(29.7%) females in each group. The mean age of the patients was 48.82±9.23 years and that of the controls was 46.27±8.77 years (range: 22-70 years) (p=0.010) Mean serum concentration of 25 hydroxy vitamin D was significantly higher among the patients compared to the controls (p<0.001), but not significantly different by genotypes or diplotypes (p>0.05). Multiple conditional logistic regression revealed an association of group-specific 1-2 genotype with patients when adjusted for age, body mass index, and serum levels of 25 hydroxy vitamin D with matched adjusted odds ratio (95% confidence interval) being 3.1(1.22-7.88).

CONCLUSIONS

Group-specific 1-2 genotype of vitamin D binding protein gene was associated with the risk of type 2 diabetes.

Shift in disparities in hepatitis C treatment from interferon to DAA era: A population-based cohort study

We evaluated the shift in the characteristics of people who received interferon-based hepatitis C virus (HCV) treatments and those who received recently introduced direct-acting antivirals (DAAs) in British Columbia (BC), Canada. The BC Hepatitis Testers Cohort includes 1.5 million individuals tested for HCV or HIV, or reported cases of hepatitis B and active tuberculosis in BC from 1990 to 2013 linked to medical visits, hospitalization, cancer, prescription drugs and mortality data. This analysis included all patients who filled at least one prescription for HCV treatment until 31 July 2015. HCV treatments were classified as older interferon-based treatments including pegylated interferon/ribavirin (PegIFN/RBV) with/without boceprevir or telaprevir, DAAs with RBV or PegIFN/RBV, and newer interferon-free DAAs. Of 11 886 people treated for HCV between 2000 and 2015, 1164 (9.8%) received interferon-free DAAs (ledipasvir/sofosbuvir: n=1075; 92.4%), while 452 (3.8%) received a combination of DAAs and RBV or PegIFN/RBV. Compared to those receiving interferon-based treatment, people with HIV co-infection (adjusted odds ratio [aOR]: 2.96, 95% CI: 2.31-3.81), cirrhosis (aOR: 1.77, 95% CI: 1.45-2.15), decompensated cirrhosis (aOR: 1.72, 95% CI: 1.31-2.28), diabetes (aOR: 1.30, 95% CI: 1.10-1.54), a history of injection drug use (aOR: 1.34, 95% CI: 1.09-1.65) and opioid substitution therapy (aOR: 1.30, 95% CI: 1.01-1.67) were more likely to receive interferon-free DAAs. Socio-economically marginalized individuals were significantly less likely (most deprived vs most privileged: aOR: 0.71, 95% CI: 0.58-0.87) to receive DAAs. In conclusion, there is a shift in prescription of new HCV treatments to previously excluded groups (eg HIV-co-infected), although gaps remain for the socio-economically marginalized populations.

Diabetic ketoacidosis characteristics and differences In type 1 versus type 2 diabetes patients

BACKGROUND

Diabetes is undoubtedly one of the most challenging health problems of the 21st century. It is well known that diabetes once develop can lead to several complications. Diabetic ketoacidosis (DKA) is one of the life-threatening complications of diabetes. This study was designed to determine the frequency of DKA in diabetes patients and find out the clinical and biochemical determinants of DKA.

METHODS

This descriptive study was conducted at Aga Khan University Hospital (AKUH) Karachi, Pakistan from January 2010 to February 2016. All known or newly diagnosed diabetic patients of >16 years of age irrespective of gender and type of diabetes were included. Information regarding patient's demographics, presenting symptoms, precipitating causes of DKA, biochemical profiles and outcome at the time of discharge was collected.

RESULTS

Majority (54.7%) had moderate and 12.4% had severe DKA at presentation. Previous history of DKA was found higher in type 1 diabetes patients (T1DM) (14%) as compare to (4%) type 2 diabetes patients (T2DM) (p<0.05). DKA severity was observed more (12%) in newly diagnosed (T1DM) (p<0.05). Comorbidities were found more (81%) in (T2DM) (p<0.05) Mortality was also observed higher in Type 2 diabetes patients (p<0.05).

CONCLUSIONS

Majority of the diabetics had moderate to severe DKA at presentation. Mortality and morbidity related with DKA was found considerably higher among patients with T2DM while infection, myocardial infarction and stroke found as triggering factors in these patients.

Vitamin-D Toxicity And Other Non-Malignant Causes Of Hypercalcemia: A Retrospective Study At A Tertiary Care Hospital In Pakistan

BACKGROUND

Hypercalcemia is a common clinical problem; primary hyperparathyroidism and malignancy is commonest causes of hypercalcemia. Aetiology of hypercalcemia are changing, causes that were diseases of the past like Vitamin-D toxicity and milk alkali syndrome are observed more often. Vitamin-D deficiency is an important problem and overzealous replacement of Vitamin-D has been observed, suspected to cause toxicity.

METHODS

This was a retrospective review of patients admitted at the Aga Khan University Hospital from January 2008 to December 2013 with hypercalcemia. We reviewed the electronic health records for laboratory and radiological studies, and discharge summaries to establish the cause of hypercalcemia. Patients with solid tumour malignancy were excluded from the analysis. The treatment records and hospital course of patients diagnosed with Vitamin-D toxicity were also reviewed.

RESULTS

Primary hyperparathyroidism was the most common cause of hypercalcemia comprising 41 (28.2 %) patients. Vitamin-D toxicity was present in 25 (17.3%) and probable Vitamin-D toxicity 11 (7.6 %) inpatients. Vitamin-D toxicity and probable Vitamin-D toxicity together comprised 36 (24.8%) cases. Other causes of hypercalcemia included multiple myeloma 18 (12.4%) patients, tuberculosis 6 (4.1%) patients, chronic kidney disease6 (4.1%) cases, sarcoidosis 4 (2.7%) and lymphoma 3 (2.0%) patients. In 29(20%) patients a cause of hypercalcemia could not be determined and were labelled as undiagnosed cases.

CONCLUSIONS

Vitamin-D toxicity was the second commonest cause of hypercalcemia after primary hyperparathyroidism. Knowledge of the prevalent and emerging causes of hypercalcemia is important for prompt diagnosis and treatment..

Typical graves' ophthalmopathy in primary hypothyroidism

Graves ophthalmopathy (GO) usually occurs in a close temporal relationship with hyperthyroidism. It is rare in patients with normal thyroid function (euthyroid GO) and in patients with hypothyroid forms of thyroid autoimmune diseases (hypothyroid GO). We report a 52-years old man presenting in our endocrine clinic with diagnosed primary hypothyroidism 3 months back during evaluation for glaucoma. He was later referred by an ophthalmologist to exclude Grave's eye disease, where he had presented with chief complaints of bilateral prominent eyes. On examination there was only bilateral exophthalmos with marked chemosis. Magnetic resonance imaging (MRI) of the orbits showed typical findings of GO. Grave's ophthalmopathy is a rare condition to come across in patients with primary hypothyroidism, and is being first time reported from Pakistan. Patients with hypothyroidism and Graves ophthalmopathy can be successfully treated with steroids in a similar manner as in patients with GO associated with hyperthyroidism.

A Prospective Study of Altered Inflammatory Response and Its Clinical Outcome following Laparoscopic and Open Cholecystectomy

BACKGROUND

Inflammatory response following surgical trauma has long been a matter of study. Results, however, have been varied. We sought to assess changes in the levels of proinflammatory and anti-inflammatory cytokines in patients undergoing laparoscopic and open cholecystectomy and their impact on the clinical outcome of patients concerning the postoperative pain score.

METHODS

The study involved 90 cholecystectomies (55 laparoscopic and 35 open) for chronic cholecystitis. Blood samples were collected 2 hours preoperatively and at 4 and 24 hours post surgery. Sera were evaluated for the levels of interleukin-1β, interleukin-10, and tumor necrosis factor-alpha. The independent sample t-test was used to compare the means of a variable between the 2 groups. Statistical analysis was done using SPSS, version 17.

RESULTS

The rise in the levels of interleukin-1β, interleukin-10, and tumor necrosis factor-alpha was significantly more in the open cholecystectomy group at 4 hours (P<0.00). At the 24^th postoperative hour, the levels of all 3 cytokines were also higher in the open cholecystectomy group (P<0.001 for interleukin-1β, P=0.185 for interleukin-10, and P<0.001 for tumor necrosis factor-alpha). At the 4^th postoperative hour, the patients in the laparoscopic cholecystectomy group had a significantly lower pain score (P<0.001) than the open group.

CONCLUSION

Both laparoscopic and open cholecystectomy procedures altered the inflammatory milieu of our patients in the postoperative period. Inflammation caused by the laparoscopic procedure was significantly less. More research is needed to target specific inflammatory and anti-inflammatory cytokines to reduce surgical stress and improve patient outcomes.

Patterns, control and complications of diabetes from a hospital based registry established in a low income country

BACKGROUND

Diabetes registry enables practitioners to measure the characteristics and patterns of diabetes across their patient population. They also provide insight into practice patterns which can be very effective in improving care and preventing complications. The aim of this study was to assess the patterns, control levels and complications at the baseline of the patients attending clinic at the large tertiary care hospital in Karachi, Pakistan with the help of the registry. This can be used as a reference to monitor the control and also for a comparison between peer groups.

METHODS

This was a cross sectional study with the data obtained from diabetes registry collected with the help of pre-designed questionnaire. HbA1c was used as a central diabetes measure and other related factors and complications were assessed with it.

RESULTS

Only 16.6% of the participants had optimal HbA1c ≤ 7.0%. 52.9% of the patients were classified as having poor control defined by HbA1c of >8%. Three fourth of the study population were obese according to Asian specific BMI cutoffs and majority had type 2 diabetes with duration of diabetes ranging from less than one to about 35 years, mean(SD) duration being 7.6 years (7.1). Overall only 4% of the patients were on combine target of HbA1c, LDL and BP. Results of multivariable logistic regression showed that the odds of having optimal glycemic control increased by 3% with every one year increase in age. In addition, having longer duration of diabetes was associated with 56% lower odds of having good glycemic control. Moreover, having higher triglyceride levels was associated with 1% lower odds of having good glycemic control.

CONCLUSION

This highlights the large burden of sub optimally controlled people with diabetes in Pakistani population, a low income country with huge diabetes prevalence and ineffective primary health care system creating enormous health and economic burden.

Microalbuminuria in Type-2 Diabetes Mellitus; the tip of iceberg of diabetic complications

OBJECTIVE

To determine the prevalence of microalbuminuria and its association with hypertension and other diabetic complications among Type-2 diabetic patients attending at Aga Khan University Hospital Karachi.

METHODS

1280 Type-2 diabetes patients who visited the outpatient department of Aga Khan University Hospital from September 2014 to August 2016 were included in the study. Microalbuminuria was diagnosed if spot urinary microalbumin excretion was confirmed to be more than 20mg/l. Hypertension was diagnosed if BP >140/90 or already on antihypertensive medications. Other demographic, clinical and laboratory data were also recorded.

RESULTS

Microalbuminuria was diagnosed in 404(31.56%) patients and among these albuminuric patients 335(82.9%) had hypertension. They were also dyslipidemic, having raised triglyceride levels, lower HDL levels, with more prevalence of background diabetic retinopathy and peripheral neuropathy. They also showed higher HbA1C levels and longer duration of diabetes.

CONCLUSION

The prevalence of the microalbuminuria in our patients with Type-2 diabetes is 31.56% and is not only an early sign of diabetic nephropathy but also a host of other diabetic complications and should be dealt early with strict control of their hyperglycemia and hypertension to help prevent the future complications.

Role of primary T-cell immunodeficiency and hepatitis B coinfection on spontaneous clearance of hepatitis C: The BC Hepatitis Testers Cohort

T-cell host immune response against hepatitis C virus (HCV) has been suggested to play an important role in determining HCV infection outcome. However, data from human studies are not available. This study examined the effect of primary T-cell deficiency along with other factors on the spontaneous clearance of HCV in a large population-based cohort in British Columbia, Canada. The BC Hepatitis Testers Cohort includes all individuals tested for HCV in BC in 1990-2013 linked with data on their medical visits, hospitalizations and prescription drugs. HCV-positive individuals with at least one valid HCV PCR test on/after HCV diagnosis (n=46 783) were included in this study. To examine factors associated with the spontaneous clearance of HCV, multivariable logistic regression was fitted on the full sample, and Cox proportional hazards model on the HCV seroconverters. Spontaneous clearance was observed in 25.1% (n=11 737) of those tested for HCV. After adjusting for potential confounders, the odds of spontaneous clearance of HCV was lower in people with primary T-cell immunodeficiency (adjusted odds ratio [aOR]: 0.55, 95% CI: 0.32-0.94), and higher in females (aOR: 1.61, 95% CI: 1.54-1.68) and in those coinfected with HBV (aOR: 2.31, 95% CI: 1.93-2.77). Similar results were observed in HCV seroconverters except HBV coinfection was not significant. In conclusion, primary T-cell immunodeficiency is associated with a lower spontaneous clearance of HCV while female sex and coinfection with HBV are associated with a higher spontaneous clearance.

SODIUM AND WATER IMBALANCE AFTER SELLAR, SUPRASELLAR, AND PARASELLAR SURGERY

OBJECTIVE

To report the frequency of sodium and water disturbances (SWDs) in patients undergoing sellar, suprasellar, and parasellar surgery (SSPS).

METHODS

We conducted a cross-sectional, retrospective study on 115 patients in the Aga Khan University Hospital after ethical approval. Patients were 16 years old or older undergoing pituitary or sellar surgeries. We collected data on basic sociodemographic characteristics and clinical indication for surgery. We noted laboratory values for serum electrolytes, plasma and urine osmolality, urine sodium, and 24-hour fluid balance from the immediate postoperative day until discharge and follow-up. We recorded medical management plans. We also recorded diabetes insipidus (DI), syndrome of inappropriate antidiuretic hormone (SIADH), cerebral salt wasting (CSW), triphasic response, and hyponatremia, according to the diagnostic definitions. Finally, we performed data analysis using Statistical Package for the Social Sciences, version 19.0.

RESULTS

Of 115 patients, there were 61.7% males, mean age 42.3 ± 13.86 years, 91.3% had pituitary adenoma (73.0% nonfunctioning), and 86.1% underwent transsphenoidal surgical approach. Transient DI occurred from days 1 to 6, peaking with 57.4% on day 2. Permanent DI and SIADH were rare. We did not note typical triphasic response or CSW in any of the patients. However, isolated hyponatremia occurred in 11%, and 20.9% had DI with hyponatremia.

CONCLUSION

Transient DI is the most common postoperative SWD after SSPS. Hyponatremia occurred alone and following DI. This is the first study describing postoperative SWDs after different sellar surgeries in Pakistan.

ABBREVIATIONS

ADH = antidiuretic hormone CSW = cerebral salt wasting DI = diabetes insipidus SIADH = syndrome of inappropriate antidiuretic hormone SSPS = sellar, suprasellar, and parasellar surgery SWD = sodium and water disturbance.

Association of vitamin D deficiency with poor glycaemic control in diabetic patients

OBJECTIVE

An association between serum levels of vitamin D and glycaemic control in type-2 diabetes mellitus (DM) patients has been reported in some of the studies carried out in the West. However, there are no reports on this relationship in Pakistani diabetic patients. The aim of this study was to ascertain whether vitamin D levels have any influence on glycaemic control in Pakistani patients with type-2 DM.

METHODS

In a cross-sectional survey, relationship between serum levels of 25-hydroxy vitamin D (25(OH)D) and glycated haemoglobin (HbA1C) was examined in 141 type-2 diabetic patients including 102 males and 39 females; age range 22 to 70 years, visiting the Aga Khan University Hospital during July 2013-April 2014. Venous blood was collected and analyzed for serum/plasma levels of 25(OH)D and related biomarkers using kit methods. HbA1C levels <7.0% and >7.0% were taken as indicators of good and poor glycaemic control, respectively. An association between 25(OH)D and HbA1C was investigated using regression analysis.

RESULTS

Percent vitamin D deficiency (serum level of 25(OH)D < 20 ng/ml) was significantly higher in patients with poor glycaemic control compared to patients with good glycaemic control (58.7% vs. 30.6%; p-value=0.006). Binary logistic regression analysis revealed positive association between vitamin D deficiency and poor glycaemic control while adjusting for BMI, serum levels of albumin, alanine aminotransferase and alkaline phosphatase (OR, 4.86 (95% CI, 1.9-11.9; p-value<0.001).

CONCLUSIONS

The association between vitamin D deficiency and abnormal HbA1C in Pakistani diabetic patients is suggestive that patients with hypovitaminosis D could benefit from vitamin D supplementation.

Effect of Oral Iron on Markers of Oxidative Stress and Antioxidant Status in Children with Iron Deficiency Anaemia

INTRODUCTION

Conflicting reports are available on the relationship of Iron Deficiency Anaemia (IDA) and iron therapy with oxidative stress.

AIM

To study the levels of markers of oxidative stress and anti-oxidant status in children with IDA and to assess the effect of iron therapy on the same.

MATERIALS AND METHODS

This prospective, single centre, hospital based study was a sub-study of a randomized controlled trial conducted in the Department of Paediatrics, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh in collaboration with the Department of Biochemistry (of the same institution) between October 2009 to February 2011. The sub-study was conducted in two parts: in the first part, levels of a biomarker of oxidative stress {Malondialdehyde (MDA)} and anti-oxidant enzymes {Superoxide Dismutase (SOD), Catalase (CAT), Glutathione Peroxidase (GPx)} were assessed and compared between 67 children with IDA and 31 non-anaemic controls; in the second part, the effect of oral iron (6mg/kg/day) for eight weeks on these markers was studied in a subset of 35 children with IDA. The Bivariate correlations procedure was used to compute pair wise associations for a set of variables. T-tests (Independent samples t-test/Paired sample t-test) and Non-parametric tests (Mann-Whitney test/Wilcoxon signed-rank test) were applied as applicable for normally and non-normally distributed data, respectively.

RESULTS

Levels of anti-oxidant enzymes were significantly lower (p<0.001) in children with IDA as compared to controls, viz., SOD {median, 8.63 (IQR, 8.60-8.66) vs. 9.46 (IQR, 9.14-9.62) units/mg protein}, CAT {median, 8.49 (IQR, 8.46-8.50) vs. 9.10 (IQR, 9.04-9.14) μmol H₂O₂/min/mg protein} and GPx {median, 49.19 (IQR, 48.99-49.60) vs. 56.94(IQR, 56.80-57.14) mol NADPH oxidized /min/ mg protein}. Whereas, levels of MDA were significantly higher (p<0.001) in IDA group {median, 1.50 (IQR, 1.48-1.52) vs. 1.24 (IQR, 1.20-1.27) moles/ml of serum}. Levels of Haemoglobin (Hb) and markers of iron status (serum iron, transferrin saturation and ferritin) had a very strong, highly significant positive correlation (p<0.001) with levels of anti-oxidant enzymes (SOD, CAT, and GPx) but a very strong, highly significant negative correlation (p<0.001) with MDA. Total Iron Binding Capacity (TIBC) on the other hand, had a strong, highly significant (p<0.001) negative correlation with SOD, CAT, and GPx but a strong, highly significant positive correlation (p<0.001) with MDA. After eight weeks of daily iron therapy, a highly significant rise (p<0.001) from baseline was observed in levels of SOD, CAT, and GPx in subjects with IDA. On the other hand, MDA levels declined significantly (p<0.001).

CONCLUSION

Lipid peroxidation is increased and anti-oxidant defenses lowered in IDA. These changes, however, may be mitigated effectively with oral iron therapy.

Effect of different staking methods and stem pruning on yield and quality of summer tomato

The study was carried out during summer of 2012 with BARI hybrid tomato 4, planted in the Olericulture farm of Bangladesh Agriculture Research Institute, Joydebpur, Gazipur, Bangladesh to find out the response of plants to some staking and pruning treatments on yield, fruit quality and cost of production. A two factor experiment consisting of three staking methods and four level of pruning, laid out in complete block design with three repetitions. Plants were staked on inverted „V? shaped staking, high platform and string. The plants were pruned to two stem, three stem, four stem and no pruning as control. Results showed that significantly the highest total number of fruits per plant (37.1), marketable fruits per plant (33.7), yield per plant (1.68 kg) and total yield (44.6 t/ha) were produced by the plants having the treatment string staking with four stem. The highest fruit set (43.50%) was found in the plants staking with string having three stems. Plants grown on string staking allowing two stem gave the maximum length (4.71 cm), diameter (4.83 cm) and weight (53.4g) of single fruit as well as maximum fruit firmness (3.43 kg-f cm-2). From the economic point of view, it was apparent that summer tomato produced by string staking with four stem pruning exhibited better performance compared to other treatment combinations in relation to net return and BCR (2.10).Bangladesh J. Agril. Res. 41(3): 419-432, September 2016

Preconception optimization of glycaemic control in diabetes

The prevalence of Diabetes Mellitus is increasing worldwide. In developing countries 25% of adult females with diabetes are in the reproductive age. Thus in developing countries increased number of pregnancies are complicated by diabetes. Uncontrolled diabetes in pregnancy is associated with increased risk for both mother and foetus. These risks can be minimized by good control of diabetes before and during pregnancy. Management in the preconception period is discussed in this review article. Detailed management involves general advice of lifestyle modification followed by specific details of screening for complications of diabetes. Changes in the drugs for both glycaemic control and other co-morbid conditions are discussed. The recommended insulin regimen in the preconception period and monitoring of glycaemic control by self-monitoring of blood glucose (SMBG) and HbA1C has also been highlighted.

Developing and Conducting a Dissertation Study through the Community-Based Participatory Research Approach

The community-based participatory research (CBPR) approach has been shown to be innovative and effective in conducting research with communities experiencing health disparities. Doctoral nursing students, and other doctoral students in the health sciences, who are interested in this approach can benefit through structured CBPR training experiences in learning how to engage with communities, build community capacity, share resources, implement CBPR study plans, and disseminate results of CBPR-focused studies. The objectives of this case-study are to demonstrate ways in which one doctoral student aligned with academic mentors and a funded CBPR project to build a relationship with the Sikh Asian Indian (AI) community of New York City to develop and implement a CBPR-focused doctoral dissertation study. The purpose of the research was to examine the relationship between the experience of perceived discrimination and health outcomes in this community. CBPR methods utilized in developing the study entailed the author partaking in formal and informal CBPR learning experiences, building relationships with community and academic partners early on through volunteering, developing a research plan in collaboration with members of the community and academic partners, identifying an appropriate setting and methods for recruitment and data collection, increasing capacity and resources for all partners (the author, community, and academic), and presenting dissertation study findings to the community. In conclusion, CBPR-focused doctoral experiences are novel pedagogical and professional approaches for nursing and health science students which can lead to mutual benefits for all involved, and ultimately successful and effective community-based health research.

Three siblings with familial non-medullary thyroid carcinoma: a case series

Background

In 2015, thyroid carcinoma affected approximately 63,000 people in the USA, yet it remains one of the most treatable cancers. It is mainly classified into medullary and non-medullary types. Conventionally, medullary carcinoma was associated with heritability but increasing reports have now begun to associate non-medullary thyroid carcinoma with a genetic predisposition as well. It is important to identify a possible familial association in patients diagnosed with non-medullary thyroid carcinoma because these cancers behave more destructively than would otherwise be expected. Therefore, it is important to aggressively manage such patients and screening of close relatives might be justified. Our case series presents a diagnosis of familial, non-syndromic, non-medullary carcinoma of the thyroid gland in three brothers diagnosed over a span of 6 years.

Case presentations

We report the history, signs and symptoms, laboratory results, imaging, and histopathology of the thyroid gland of three Pakistani brothers of 58 years, 55 years, and 52 years from Sindh with non-medullary thyroid carcinoma. Only Patients 1 and 3 had active complaints of swelling and pruritus, respectively, whereas Patient 2 was asymptomatic. Patients 2 and 3 had advanced disease at presentation with lymph node metastasis. All patients underwent a total thyroidectomy with Patients 2 and 3 requiring a neck dissection as well. No previous exposure to radiation was present in any of the patients. Their mother had died from adrenal carcinoma but also had a swelling in the front of her neck which was never investigated. All patients remained stable at follow-up.

Conclusions

Non-medullary thyroid carcinoma is classically considered a sporadic condition. Our case report emphasizes a high index of suspicion, a detailed family history, and screening of first degree relatives when evaluating patients with non-medullary thyroid carcinoma to rule out familial cases which might behave more aggressively.

Euglycaemic diabetic ketoacidosis in a patient with type 2 diabetes started on empagliflozin

Diabetes ketoacidosis (DKA) is largely associated with type 1 diabetes and has hyperglycaemia as a cardinal feature. We discuss the case of a 42-year-old man, a patient with type 2 diabetes, who presented to the emergency room, with nausea, vomiting and abdominal pain. He had recently changed his diabetes medications and started on an SGLT2 inhibitor (empagliflozin) along with metformin, pioglitazone, liraglutide and self-adjusted exogenous insulin. DKA was suspected in the wake of clinical examination and lab findings but glucose levels were below the cut-off for DKA; therefore, he was diagnosed with euglycaemic DKA. He was successfully managed with intravenous hydration and insulin infusion. We discuss the link of SGLT2 inhibitors with DKA and the pathophysiology behind euglycaemic DKA.

Growth, Yield and Profitability of Cabbage (Brassica oleracea L.) as Influenced by Applied Nitrogen and Plant Spacing

An experiment was conducted with cabbage during October 2012 to February 2013 at the Horticulture Farm of Sher-e-Bangla Agricultural University, Dhaka, Bangladesh. Four levels of nitrogen: viz. 0, 150, 250 and 350 kg ha-1 and three plant spacings: 50 x 30, 50 x 40 and 50 x 50 cm were applied in a Randomized Complete Block Design with three replications. Nitrogen @ 250 kg ha-1 with the spacing of 50 x 50 cm was more effective and produced the highest fresh weight of head(2.17 kg), marketable head yield (86.93 t ha-1). This treatment was also more profitable than the rest of the treatments, while the lowest profit was in N0S1.The Agriculturists 2015; 13(1) 35-45

Diagnostic validity of ultrasonography in thyroid nodules

OBJECTIVE

To determine the diagnostic validity of thyroid ultrasound in differentiating between benign and malignant thyroid nodules.

METHODS

The cross-sectional study was conducted at Aga Khan University Hospital, Karachi, from August 2011 to January 2013, and comprised all patients of either gender with thyroid nodules referred for ultrasound thyroid and fine needle aspiration cytology. Ultrasonography was performed by radiologists and ultrasound parameters were assessed and compared with cytology results in all nodules. Diagnostic validity of each ultrasound feature was calculated.

RESULTS

Of the 101 patients, 81(80%) were female. The overall mean age was 43±13 years (range: 15-73 years). On histocytopathology, 96(95%) nodules were benign and 5(4.9%) were malignant. The sensitivity and specificity of ultrasound features in predicting malignancy were calcification 80% and 68%; hypoechogenecity 80% and 52%; ill-defined lobulated margin 40% and 96%; solid 80% and 40%; taller than wider 50% and 63%. Each ultrasound feature had negative predictive value ranging from 95% to 98% in malignant nodules.

CONCLUSIONS

Identification of calcification, hypoechogenecity and solid with ill-defined margins in a thyroid nodule on ultrasound was helpful in suspecting thyroid malignancy and warranted urgent diagnostic fine needle aspiration cytology.