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Rubab ZE, Naz S, Ashraf M, Shahid S, Rehman R. Identification of a Single Nucleotide Polymorphism of Vitamin D Receptor (VDR) and Vitamin D Binding Protein (VDBP) Gene and Its Dysregulated Pathway Through VDR-VDBP Interaction Network Analysis in Vitamin D-Deficient Infertile Females. Cureus 2024; 16:e55602. [PMID: 38586664 PMCID: PMC10995750 DOI: 10.7759/cureus.55602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2024] [Indexed: 04/09/2024] Open
Abstract
INTRODUCTION The prevalence of female infertility in Pakistan is currently estimated at 22%, and emerging research suggests that vitamin D (VD) deficiency (VDD) may play a significant role in influencing female fertility. The focus of this study was to investigate the single nucleotide polymorphism (SNP) patterns within the VD binding protein (VDBP). The study aimed to explore dysregulated pathways and gene enrichment through an interaction network analysis, specifically focusing on the interplay between the VD receptor (VDR) and VDBP in females experiencing unexplained infertility (UI) coupled with VDD. METHODS A cross-sectional study was conducted on VD-deficient, fertile, and UI female subjects. VDBP and VDR were assessed by enzyme-linked immunoassay and genotyping performed. FunRich (version 3.1.3; http://funrich.org/index.html) was employed for analysis of the identified proteins: VDR and VDBP and with their mapped gene datasets, gene enrichment, and protein-protein interaction (PPI) network. RESULTS The mean VD and VDR values of infertile females were significantly lower than those of fertile females. VDBP in infertile females (median (IQR)): 296.05 (232.58-420.23)) was lower than that of fertile females (469.9 (269.57-875.55), (p=0.01)). On sequence analysis, a mutation rs 4588 SNP (Thr 436 Lys) was found in exon 11 of the VDBP gene of UI females, but no mutation in exons 8 and 9 of the VDR gene, with some insignificant intronic variants, was observed. The proteins such as plasma membrane estrogen receptor signaling pathway (p < 0.001), VDR, SMAD3, NCOR1, CREBBP, NCOA1, STAT1, GRB2, PPP2CA, TP53, and NCOA2 were enriched after biological pathway grouping when VDR was made the focused gene and directly interacting with VDBP. CONCLUSION The females with UI exhibited significantly low VD, VDBP, and VDR. The plasma membrane estrogen receptor signaling pathway was enriched in VDD infertile females.
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Affiliation(s)
- Zil E Rubab
- Department of Biochemistry, Ziauddin University, Karachi, PAK
| | - Sumaira Naz
- Department of Obstetrics and Gynaecology, The Aga Khan University, Karachi, PAK
| | - Mussarat Ashraf
- Department of Biological and Biomedical Sciences, The Aga Khan University, Karachi, PAK
| | - Saba Shahid
- Department of Biological and Biomedical Sciences, The Aga Khan University, Karachi, PAK
| | - Rehana Rehman
- Department of Biological and Biomedical Sciences, The Aga Khan University, Karachi, PAK
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Amjad S, Munir A, Mushtaq S, Rehman R. Correlation of serum kisspeptin and leptin with non-obstructive azoospermia: A cross-sectional study in a subset of Karachi population. Pak J Med Sci 2024; 40:410-414. [PMID: 38356829 PMCID: PMC10862447 DOI: 10.12669/pjms.40.3.8125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 10/19/2023] [Accepted: 11/18/2023] [Indexed: 02/16/2024] Open
Abstract
Objective To determine the association of serum kisspeptin, leptin, and other hormonal profile with non-obstructive azoospermia (NOA) in infertile male subjects. Methods This cross-sectional study was conducted at Australian Concept Infertility Medical Center, and Ziauddin University, Karachi from March 2018 to March 2020. The duration of the study was two years. Serum samples of 106 azoospermic participants were taken. Division of the subjects was done on a histological basis into obstructive azoospermia (OA) n=36, NOA n=70 which were further divided into spermatid maturation arrest (SMA), n=41, and sertoli cell-only syndrome (SCOS) n=29. Serum kisspeptin and leptin were measured by ELISA (Cloud-Clone Corp). Results The follicle-stimulating hormone (FSH) (p<0.01), luteinizing hormone (LH) (p<0.01), thyroid-stimulating hormone (TSH) (p<0.01), and estradiol (p<0.01) was significantly high in the NOA group. However, kisspeptin was significantly decreased (p<0.01) in the NOA group. In the multivariate analysis after adjusting for other variables, the results showed that with the decrease in kisspeptin, the chances of being NOA were increased. Moreover, with the increase in Leptin, FSH, LH, and TSH the chances of being NOA were significantly enhanced. Conclusion Serum kisspeptin, leptin, FSH, LH, TSH, and estradiol can be a potential marker for NOA in terms of better diagnosis, targeted therapeutic management, and the decision to proceed with surgical intervention.
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Affiliation(s)
- Sofia Amjad
- Sofia Amjad, Ph.D. Department of Physiology, Azra Naheed Medical College, Superior University, Lahore, Pakistan
| | - Adnan Munir
- Adnan Munir, FCPS. Department of Andrology. Australian Concept Infertility, Medical Center Karachi, Karachi, Pakistan
| | - Shamim Mushtaq
- Shamim Mushtaq, Ph.D. Department of Biochemistry, Ziauddin University, Karachi, Pakistan
| | - Rehana Rehman
- Rehana Rehman, Ph.D. Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
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Rehman R, Ali TS, Khalid S, Ali R. The ongoing evolution of mentorship: Advancing the formal mentorship program at AKU-SONAM. Pak J Med Sci 2024; 40:514-519. [PMID: 38356814 PMCID: PMC10862465 DOI: 10.12669/pjms.40.3.8212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 10/30/2023] [Accepted: 11/28/2023] [Indexed: 02/16/2024] Open
Abstract
Objective To investigate the perceptions of mentors, mentees, administrators (including chairs, co-chairs, and coordinators of the mentoring program), and leadership regarding the Faculty Mentorship Program at AKU School of Nursing and Midwifery (AKU-SONAM). Additionally, the study aimed to explore the strengths and challenges faced by the program. Methods A qualitative exploratory study on mentorship was carried out in AKU-SONAM from February till December 2021. In this study we conducted purposive criterion sampling. The study participants included mentors, mentees, administrators, and the dean of AKU-SONAM. An interview guide was developed, validated, and reviewed by experts. After piloting, two focused group discussions and three in-depth interviews were conducted. Results Thematic analysis of the data revealed the following themes: "Nurturing growth and development in mentoring relationships," "Establishing a strong foundation for effective mentoring," and "Opportunities for growth and development through overcoming challenges." Conclusion The participants expressed confidence in the existing support system, leadership, and mentorship program at the institution. They highlighted the significance of regular monitoring to recognize areas of improvement uphold high standards and ensure excellence.
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Affiliation(s)
- Rehana Rehman
- Rehana Rehman Professor, Department of Biological & Biomedical sciences, Aga Khan University, Karachi. Pakistan
| | - Tazeen Saeed Ali
- Tazeen Saeed Ali Interim Dean, School of nursing and Midwifery Aga Khan University, Karachi. Pakistan
| | - Saira Khalid
- Saira Khalid Nursing Instructor, College of Nursing Armed Forces Postgraduate, Medical Institute (AFPGMI), Rawalpindi. Pakistan
| | - Rahila Ali
- Rahila Ali Senior Instructor, Department for Educational Development, Aga Khan University, Karachi. Pakistan
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Samma ZH, Khan HN, Riffat S, Ashraf M, Rehman R. Unraveling the Genetic Associations of DENND1A (rs9696009) and ERBB4 (rs2178575) with Infertile Polycystic Ovary Syndrome Females in Pakistan. Biochem Genet 2023:10.1007/s10528-023-10537-z. [PMID: 37870708 DOI: 10.1007/s10528-023-10537-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/26/2023] [Indexed: 10/24/2023]
Abstract
Polycystic Ovary Syndrome (PCOS) is a complex genetic disorder in reproductive-aged women which is associated with comorbidities of reproductive, metabolic, cardiovascular, endocrine, and psychological nature. PCOS is the most common cause of anovulatory infertility. Pathogenesis of PCOS involves strong interaction between environmental and genetic factors. Many Single-Nucleotide Polymorphisms (SNPs) have been associated with PCOS in different populations. Currently, very limited association studies of PCOS and infertility have been done on Pakistani population. The variants DENND1A rs9696009 and ERBB4 rs2178575 are significantly associated with PCOS in Chinese and European populations. These candidate genes regulate the production of androgen hormone, Anti-Mullerian Hormone (AMH), and luteinizing hormone. All these hormones are involved pathogenesis of PCOS and infertility. The aim of the study is to find an association of DENND1A rs9696009 and ERBB4 rs2178575 variants with PCOS in infertile Pakistani females. In this case-control study, 300 infertile females were recruited. The cases (n = 160) were infertile female diagnosed with PCOS (Rotterdam Criteria), and controls (n = 140) were infertile women with no evidence of PCOS. The genomic DNA was isolated, and genotyping was done by PCR-Restriction fragment length polymorphism and further validated by DNA Sanger Sequencing. The Chi-Square analysis showed rs2178575 (ERBB4) was significantly associated with infertility (χ2 = 10.282, p = 0.005852) while rs9696009 (DENND1A) did not show any significant association (χ2 = 3.10, p = 0.212036). Furthermore, multinomial logistic regression analysis was performed and revealed that rs2178575 (ERBB4) heterozygous genotypes (GA) and mutant genotypes (AA) decrease the risk of infertility by 0.541 times (OR = 0.541, 95% CI = 0.314-0.930, p = 0.026) and 0.416 times (OR = 0.416, 95% CI = 0.228-0.757, p = 0.004), respectively, compared to wild-type genotype (GG). The ERBB4 variant is significantly associated with PCOS infertile women and genetically indicated that ERBB4 (rs2178575) decreases the risk of infertility in females having PCOS.
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Affiliation(s)
- Zainab Hanif Samma
- Department of Biological and Biomedical Sciences, The Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Haq Nawaz Khan
- Department of Biological and Biomedical Sciences, The Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Sumaira Riffat
- Department of Physiology, Sindh Medical College, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Mussarat Ashraf
- Department of Biological and Biomedical Sciences, The Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Rehana Rehman
- Department of Biological and Biomedical Sciences, The Aga Khan University, Stadium Road, Karachi, 74800, Pakistan.
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Ali R, Ahmed Khan T, Gul H, Rehman R. An interplay of Progesterone, Leukemia Inhibitor Factor and Interleukin-6 in the window of implantation; Impact on fertility. Cytokine 2023; 170:156332. [PMID: 37586287 DOI: 10.1016/j.cyto.2023.156332] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/29/2023] [Accepted: 08/07/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND The process of implantation is crucial for the initiation of conception and hence fertility. In addition to a number of factors, it is regulated by a cross talk of gonadotrophins [Luteinizing Hormone (LH), Follicle Stimulatory Hormone (FSH)], ovarian steroids [Estrogen (Et), Progesterone (Pt)] and cytokines [Leukemia inhibitory factor (LIF) and Interleukin 6 (IL6)]. These biomarkers are chief players of implantation. OBJECTIVE We aimed to explore the role of gonadotrophins (LH, FSH, LH/FSH ratio), ovarian steroids (Et, Pt) and cytokines (LIF, IL6) in the implantation process. This aim was achieved by comparing these hormones and cytokines in the fertile and infertile groups [Polycystic ovaries (PCOs), endometriosis, unexplained infertility (Uex-IF)] and finding their association in all study groups. METHODS A case control study conducted from October 2020-March 2023. A total of 135 infertile women (with PCOs, Uex-IF, and endometriosis) and 177 fertile women (matched for age and BMI) were selected. Levels of 'Et', 'Pt', 'LIF' and, 'IL6' were estimated using Enzyme Linked Immunosorbent Assay (ELISA). LH and FSH values were obtained from hospital desk records. The Independent Student'st-test was used to compare fertile and infertile groups. One-way ANOVA test was used to compare more than two groups, and Pearson's chi-square (χ2) test was employed to compare percentages of variables. Pearson correlation analysis was performed to assess the associations and correlations. A p value < 0.05 was considered statistically significant. RESULTS Significantly higher levels of LIF and IL6 were observed in fertile women compared to infertile women. Pt levels were significantly greater in the fertile group than in the infertile group. The FSH/LH ratio was significantly higher in the fertile group. Among infertile women, PCOs (71%) and Uex-IF (91%) exhibited lower Pt levels than the fertile controls (p < 0.01), but these levels remained within the reference range (RR). Among the fertile group (81%), levels of LIF within the RR were significantly higher compared to those with Uex-IF (49%) and females with endometriosis (37%). Moreover, the highest number of participants (57%) with Uex-IF exhibited IL6 levels significantly below the RR in comparison to the fertile group and infertile groups (PCOS and endometriosis). However, lower levels of IL6 were observed in women with Uex-IF. In the control group, LIF exhibited a significant positive correlation with IL6 (r = 0.370), Pt (r = 0.496), Et (r = 0.403), and LH (r = 0.428). Among women with PCOs, LIF showed a significant positive correlation with IL6 (r = 0.443), Pt (r = 0.607), and LH (r = 0.472). In cases of Uex-IF, LIF demonstrated a significant positive correlation with IL6 (r = 0.727). Females with endometriosis displayed a significant positive correlation between LIF and IL6 (r = 0.535) as well as Pt (r = 0.605). In fertile women, a positive correlation was observed between LH and IL6 (r = 0.197, p = 0.009), LIF (r = 0.428, p = 0.000), Pt (r = 0.238, p = 0.001), and Et (r = 0.356, p = 0.000). Furthermore, a positive correlation was found between LH and LIF (r = 0.472, p = 0.000) in women with PCOs. CONCLUSION Elevated levels of Pt were found to increase the production of LIF in fertile females. However, infertile females with PCOs and Uex-IF exhibited deficient levels of Pt, supporting its role as a biomarker for successful implantation in infertile women. These females showed decreased levels of gonadotropins as well as reduced LH/FSH ratio and diminished secretion of receptivity marker LIF, in addition to reduced Pt secretion. This suggests that reduced gonadotropin levels contribute to a lower LH/FSH ratio, resulting in decreased Pt secretion and ultimately leading to low levels of LIF, thereby causing impaired implantation in women with PCOs and Uex-IF. The exploration of low levels of LIF in patients with endometriosis requires further investigation. The significantly low levels of IL6 in the Uex-IF group elucidate the role of this cytokine in association with decreased Pt and LIF synthesis within this group.
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Affiliation(s)
- Rabiya Ali
- Department of Physiology, Karachi Institute of Medical Sciences (KIMS), CMH, Malir Cantt, Karachi, Pakistan; Department of Physiology, University of Karachi, Karachi, Pakistan.
| | | | - Hina Gul
- Department of Community Health Sciences, United Medical and Dental College, Karachi, Pakistan.
| | - Rehana Rehman
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan.
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Rehman R, Ali R, Khalid S, Ali TS. Seeds of trust ripe as luscious fruits: Faculty mentorship forum at Aga Khan University Medical College. Pak J Med Sci 2023; 39:1268-1274. [PMID: 37680801 PMCID: PMC10480750 DOI: 10.12669/pjms.39.5.7175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 01/24/2023] [Accepted: 05/08/2023] [Indexed: 09/09/2023] Open
Abstract
Background & Objective Faculty members require mentoring in all stages of their professional development. Aga Khan University (AKU) has initiated mentorship programs for students and faculty at AKU Medical College (AKU- MC) and AKU School of Nursing and Midwifery (AKU-SONAM). This study aimed to explore perceptions of mentors, mentees, administrators (chairs, co-chairs, founder members and coordinators of the mentoring program) and leadership and further investigate the strengths and challenges faced by 'Faculty Mentorship Program' at AKU- MC. Methods We conducted a qualitative exploratory study from February till December 2021 after approval from AKU using purposive criterion sampling. Mentors, mentees, administrators and dean of AKU- MC were included in the study. The interview guide was developed, validated and reviewed by experts. After piloting, four focused group discussions and 8 in-depth interviews were conducted in AKU- MC. Results The findings described the transition from informal to formal mentorship, identified challenges faced by mentors and mentees and suggested the role of leadership / administrators. The themes identified were "Continuous improvement of mentoring practices", "Building strong foundations for mentoring relationships", and "Growth and development through challenging experiences". Conclusion The faculty mentorship program at AKU-MC was in line with the goals and vision of the institution. All participants identified the need of additional resources, administrative support, rewards, incentives and recognition of mentors for sustainability of the program.
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Affiliation(s)
- Rehana Rehman
- Rehana Rehman, Professor, Department of Biological & Biomedical Sciences, Aga Khan University, Karachi. Pakistan
| | - Rahila Ali
- Rahila Ali, Senior Instructor, Department for Educational Development, Aga Khan University, Karachi. Pakistan
| | - Saira Khalid
- Saira Khalid, Nursing Instructor, College of Nursing Armed Forces Postgraduate, Medical Institute (AFPGMI), Rawalpindi. Pakistan
| | - Tazeen Saeed Ali
- Tazeen Saeed Ali Interim Dean, School of nursing and Midwifery, Aga Khan University, Karachi. Pakistan
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Rehman R, Baig M, Alam F. Editorial: Oxidative Stress, metabolic dysfunction and subfertility. Front Physiol 2023; 14:1247585. [PMID: 37711465 PMCID: PMC10497859 DOI: 10.3389/fphys.2023.1247585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/22/2023] [Indexed: 09/16/2023] Open
Affiliation(s)
- Rehana Rehman
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Mukhtiar Baig
- Faculty of Medicine Rabigh, King Abdulaziz University, Rabigh, Jeddah, Saudi Arabia
| | - Faiza Alam
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei
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Alam F, Khan AH, Baig M, Rehman R. Editorial: Recent advances in vitamin D supplementation for improved reproductive endocrine and metabolic parameters. Front Endocrinol (Lausanne) 2023; 14:1251388. [PMID: 37664848 PMCID: PMC10471959 DOI: 10.3389/fendo.2023.1251388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 08/09/2023] [Indexed: 09/05/2023] Open
Affiliation(s)
- Faiza Alam
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Bagawan, Brunei
| | - Aysha Habib Khan
- Pathology & Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Mukhtiar Baig
- Faculty of Medicine, Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rehana Rehman
- Department of Biological & Biomedical Sciences, Aga Khan University, Karachi, Pakistan
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Ashraf M, Khan HN, Ibrahim R, Shahid M, Khan S, Fatima A, Ullah S, Rehman R. Genetic association of vitamin D receptor gene with female infertility. Nucleosides Nucleotides Nucleic Acids 2023; 43:116-133. [PMID: 37496429 DOI: 10.1080/15257770.2023.2236167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 05/17/2023] [Accepted: 07/09/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Infertility is defined as failure to achieve a clinical pregnancy after 12 months of unprotected intercourse. It affects 15% of couples globally and 22% of couples within Pakistan. Female infertility can be caused by numerous genetic or environmental factors including hormone imbalances and exposure to chemicals or radiation. The prevalence of vitamin D deficiency among the adult population was reported to be 14-59% with a higher prevalence in Asian countries. Furthermore, the expression of Vitamin D receptor (VDR) can play a vital role in the reproductive organs of females. Hence, the aim of our present study was to check the association of VDR polymorphisms with infertile females. For this purpose, blood samples were collected for genotyping of four known VDR mutations [FokI (rs2228570), TaqI (rs731236), ApaI (rs7975232), and BsmI (rs1544410)] via PCR-based RFLP assay. RESULTS Genotyping indicated that FokI, TaqI, and ApaI are associated with infertility (p = 0.004*, p = 0.013*, and p = 0.033*, respectively). However, BsmI did not show any significance. Multinomial regression analysis indicated that FokI heterozygous genotypes increase the risk of infertility by 2.5 times (hetero: OR = 2.5, 95%, p = 0.001*) as compared to wild type. Heterozygous genotypes of TaqI and ApaI were found to play a protective role and reduce the risk of infertility by 58 and 52%, respectively [TaqI: OR = 0.42, 95%, p = 0.004*, ApaI: OR = 0.48, 95%, p = 0.01*, respectively] as compared to wild type. Multinomial logistic regression analysis was also performed for allelic data as well. CONCLUSION Thus, it could be summarized that among the studied polymorphisms of VDR, FokI SNP greatly increased the risk of infertility, while TaqI and ApaI genotypes protect from infertility. However, BsmI does not influence the risk of infertility in Pakistani females.
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Affiliation(s)
- Mussarat Ashraf
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Haq Nawaz Khan
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Rabab Ibrahim
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Maheen Shahid
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Sher Khan
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Ambrin Fatima
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Saif Ullah
- University of Karachi, Karachi, Pakistan
| | - Rehana Rehman
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
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Alam F, Shahid M, Riffat S, Zulkipli IN, Syed F, Ashraf M, Rehman R. SIRT1 and antioxidants in infertile females: Exploration of the role of vitamin D. PLoS One 2023; 18:e0287727. [PMID: 37428803 DOI: 10.1371/journal.pone.0287727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/09/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Deficiency of silent information regulator 1 (SIRT1) can trigger inflammation, mitochondrial malfunctioning, and apoptosis through the hypothalamic-pituitary-ovarian axis, producing poor quality oocytes, leading to infertility. Normal vitamin D (VD) levels promote SIRT1 activity required for optimal fertility, and low levels of either may result in fertility problems owing to cell-membrane de-stabilization, increased autophagy, DNA damage leading to increased reactive oxygen species and mitochondrial dysfunction. Therefore, in this study, we want to estimate the levels of VD, SIRT1 and antioxidants (MnSOD; manganese superoxide dismutase, GR; glutathione reductase, visfatin) and oxidants (adrenaline & cortisol) in individuals living with infertility and explore the association of VD with SIRT1 expression (levels), antioxidants, and oxidants contributing to infertility in women. The significance of this study is that it highlights the importance of maintaining optimal levels of VD for reproductive health in females. METHODS This cross-sectional study included 342 (135 infertile and 207 fertile) female subjects. Serum levels of MnSOD, SIRT1, visfatin, GR, VD, adrenaline, and cortisol were analyzed by ELISA and were compared in fertile and infertile samples using the Mann Whitney U test. RESULTS There were significantly high levels of VD, SIRT1, GR, MnSOD and visfatin in fertile female participants. However, mean adrenaline and cortisol levels were higher in infertile samples with a significant negative correlation with VD. A significant negative correlation of VD with MnSOD, SIRT1, visfatin and GR was observed (p <0.01). In VD subset groups, MnSOD levels were significantly high in VD sufficient groups however, adrenaline and cortisol levels were significantly high in groups suffering from VD deficiency. CONCLUSIONS Deficiency of VD is associated with a decrease in SIRT1 and other antioxidants, which may deter natural reproductive functions leading to infertility. Further studies are required to determine the cause-effect relationship of VD deficiency on conception and interpretation of the involved mechanism.
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Affiliation(s)
- Faiza Alam
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei Darussalam
| | - Maheen Shahid
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | | | - Ihsan Nazurah Zulkipli
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei Darussalam
| | - Fatima Syed
- Fatima Syed, Fazaia Ruth Pfau Medical College-FRPMC, Karachi, Pakistan
| | - Mussarat Ashraf
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Rehana Rehman
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
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Zehra T, Tariq M, Rehman R, Zuberi RW. Basics of faculty-to-faculty mentoring: A process to identify support and challenges. PLoS One 2023; 18:e0287127. [PMID: 37310981 DOI: 10.1371/journal.pone.0287127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 05/30/2023] [Indexed: 06/15/2023] Open
Abstract
Faculty mentoring is relatively new in health sciences literature. Faculty mentors are considered to have multiple roles including being a supervisor, teacher, or a coach. Little or no attention to formal mentoring of faculty allows faculty to seek informal mentoring, creating a risk of unexpected outcome. There is dearth of literature with respect to formal mentoring programs from the subcontinent. Although, informal faculty mentoring has been in place but there is no standard faculty mentorship model to be followed at Aga Khan University Medical College (AKU-MC). An observational study was conducted in September 2021 at AKU MC with convenient sampling to share the perceptions of the AKU-MC faculty mentors in a faculty mentorship workshop so that further advanced level faculty development workshops could be planned in this area. Twenty-two faculty mentors participated to share their perspectives on the responsibilities of faculty mentor, faculty mentee and the institution to see faculty grow and to have a sustainable mentorship programme. Challenges faced by the faculty mentors during the process of mentorship were also discussed. Majority of the participants emphasized on the role of the faculty mentor to be supportive, guiding, reflective and formative (respond to the emotional needs, encourage, effective communication, know own limitations, observe, provide feedback). Faculty mentor role modeling, ability to maintain confidentiality, creating and maintaining mentor-mentee relationship, availability of framework of formal mentoring in an academic institution and opportunities within the academic setting to learn mentorship were the main challenges of being a faculty mentor. The process provided valuable training and education to the faculty for the development and strengthening of formal mentoring program. Faculty recommended that institutions should provide the opportunity for development of junior faculty mentors by organizing capacity building activities.
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Affiliation(s)
- Tabassum Zehra
- Department for Educational Development, Aga Khan University, Karachi, Pakistan
| | - Muhammed Tariq
- Department for Educational Development, Aga Khan University, Karachi, Pakistan
| | - Rehana Rehman
- Department for Basics & Biological Sciences, Aga Khan University, Karachi, Pakistan
| | - Rukhsana W Zuberi
- Department for Educational Development, Aga Khan University, Karachi, Pakistan
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Ali R, Iqbal MUN, Rehman R, Khan TA. Interplay of "leukemia inhibitory factor receptor gene" (rs3099124) polymorphism, leukemia inhibitory factor and ovarian steroids with unexplained infertility. Nucleosides Nucleotides Nucleic Acids 2023:1-13. [PMID: 36924393 DOI: 10.1080/15257770.2023.2188911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE OF THE STUDY To explore the association of leukemia inhibitory factor receptor (LIFR) gene variant rs3099124, ovarian steroids, and leukemia inhibitory factor with unexplained infertility in Pakistani females. METHODOLOGY A case-control investigation in which eighty-one (81) females with unexplained infertility and one hundred and sixty-two (162) fertile counterparts (age and body mass index compared) were recruited between October 2016 and 2018. Ten milliliters of venous blood was collected from all participants. "Genomic DNA" was taken out from lymphocytes in peripheral blood samples. "Tetra Amplification Refractory Mutation System Polymerase Chain Reaction (T-ARMS-PCR)" was constructed through software "Primer-I". Amplification was carried out by "T-ARMS-PCR" followed by subsequent sequencing for confirmation and extensive consonance. Estradiol, Progesterone and Leukemia Inhibitory Factor (LIF) were measured in serum by ELISA. RESULTS Statistically significant difference was noticed in genotype frequency in "LIFR-gene variant; rs3099124" (χ2 = 28.222, P value < 0.01) between research participants. Although, rs "3099124" "AA" (OR = 0.000; 95%CI = 0-0) and "GA" genotypes (OR = 0.525; 95%CI = 0.226-1.22) showed non-significant safety/protection against unexplained infertility yet minor/risk allele "A" frequency was greater in women with unexplained infertility suggesting a possible explanation of implantation failure. LIF concentration varied between fertile and infertile groups (χ2 = 9.857, P < 0.05) revealing significant threat of unexplained infertility in women with decreased LIF concentration (OR = 2.316, 95%CI = 1.214-4.416). Progesterone was significantly related to unexplained infertility in both study groups (χ2 = 20.347, P < 0.05). High progesterone reduced the possibility of unexplained infertility (OR = 0.306; 95% CI = 0.166-0.567). CONCLUSION LIFR gene variation (rs3099124) and reduced LIF secretion may cause implantation failure in women with unexplained infertility.
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Affiliation(s)
- Rabiya Ali
- Department of Physiology, Karachi Institute of Medical Sciences (KIMS), CMH, Malir Cantt., Karachi, Pakistan
| | | | - Rehana Rehman
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
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Ashraf M, Kazmi SU, Tariq H, Munır A, Rehman R. Association of trinucleotide repeat polymorphisms CAG and GGC in exon 1 of the androgen receptor gene with male infertility: a cross-sectional study. Turk J Med Sci 2022; 52:1793-1801. [PMID: 36945970 PMCID: PMC10390128 DOI: 10.55730/1300-0144.5525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/10/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND : Infertility is a global problem that brings about serious sexual and social consequences that strain the health sector and society. The expansion of CAG and GGC repeats in androgen receptor (AR) gene (Ensembl number ENSG00000169083) may lead to reduced fertility. Our objective was to determine the association of CAG and GGC repeats with altered sperm parameters in male infertile subjects. METHODS This was a cross-sectional study conducted at Aga Khan University, Karachi, Pakistan. A total of 376 males were recruited, out of which group A (N = 208) and group B (N = 168) were comprised of subjects with normal and altered sperm parameters, respectively, from 18 to 60 years. The numbers of CAG and GGC repeats were determined by using PCR amplification and sequence analysis using the Molecular Evolutionary Genetic Analysis (MEGA) software version 6.0. Statistical analysis was performed using the SPSS version 20 and the P-value of <0.05 was considered significant. RESULTS The mean androgen receptor gene CAG repeats were significantly longer in males with altered sperm parameters as compared to male subjects with normal sperm parameters (P < 0.001). There was no significant difference found for GGC repeats for subjects with altered sperm parameters. DISCUSSION Longer CAG length corresponded to greater severity of spermatogenic defect and may lead to subfertility recommendations.
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Affiliation(s)
- Mussarat Ashraf
- Department of Biological and Biomedical Sciences, Medical College, Aga Khan University, Karachi, Pakistan
| | - Shahana Urooj Kazmi
- Department of Clinical Microbiology and Immunology, Faculty of Science, Dadabhoy Institute of Higher Education, Karachi, Pakistan
| | - Hemaila Tariq
- Department of Biological and Biomedical Sciences, Medical College, Aga Khan University, Karachi, Pakistan
| | - Adnan Munır
- Department of Urology, Medical College, Liaquat National Hospital, Karachi, Pakistan
| | - Rehana Rehman
- Department of Biological and Biomedical Sciences, Medical College, Aga Khan University, Karachi, Pakistan
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Rehman R, Salahuddin H, Zafar A, Rehman S, Anjum N, Sami Z. Follicular sensitivity index and insulin growth factor-1: Predictor of success after intracytoplasmic sperm injection. Pak J Pharm Sci 2022; 35:1761-1765. [PMID: 36861240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
To compare follicular sensitivity index (FSI) and Insulin Growth Factor (IGF) -1 for prediction of oocyte yield, embryo quality and the pregnancy consequence in infertile females booked for Intracytoplasmic Sperm Injection (ICSI). Study design was cross sectional where in 133 infertile females enrolled for ICSI were included. Antral follicle count (AFC), Pre-ovulatory follicle count (PFC), FSI, total dosages of follicle stimulating hormone (FSH); designed as pre-ovulatory follicle count × 100,000/ (antral follicle count × total administered stimulation doses) were estimated. IGF was measured by Enzyme Linked Immuno Sorbent Assay. Efficacious pregnancy conception after Intracytoplasmic Sperm Injection (ICSI) was established by means of intrauterine gestational sac with cardiac activity after transfer of embryo. Odds ratio was determined for clinical pregnancy by means of FSI and IGF-I, p-values <0.05 were considered significant. FSI was found to be a stronger predictor of pregnancy than IGF-I. Both IGF-I and FSI contributed positive association with clinical pregnancy consequences but FSI was found to be a more reliable predictor of clinical pregnancy. The advantage of using FSI over IGF-I is that FSI is a noninvasive test while IGF-I needs blood sampling. We recommend calculation of FSI for prediction of pregnancy outcomes.
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Affiliation(s)
- Rehana Rehman
- Department of Biochemistry, Bahria University of Health Science, Pakistan
| | - Huma Salahuddin
- Department of Biochemistry, Bahria University of Health Science, Pakistan
| | - Amara Zafar
- Department of Biochemistry, Bahria University of Health Science, Pakistan
| | - Sadia Rehman
- Department of Biochemistry, Bahria University of Health Science, Pakistan
| | - Nargis Anjum
- Department of Biochemistry, Bahria University of Health Science, Pakistan
| | - Zara Sami
- Department of Biochemistry, Bahria University of Health Science, Pakistan
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Fatima T, Afzal U, Shaharyar S, Khan S, Ashraf M, Rafaqat W, Kayani MR, Rehman R. MTHFR-c 677C>T polymorphism and male infertility: An analysis in a cohort of Pakistani men. Rev Int Androl 2022; 20:274-280. [DOI: 10.1016/j.androl.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 07/27/2020] [Accepted: 05/24/2021] [Indexed: 11/30/2022]
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Shareef S, Rehman R, Haque M, Silverberg J. LB895 Readability, Understandability, and Actionability of Online Patient Education Materials for Sunscreen. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Rehman R, Azhar A, Naseem Z, Haider G, Farooqui N, Farhat S. PCOS model: Apoptotic changes and role of vitamin D. ELECTRON J GEN MED 2022. [DOI: 10.29333/ejgm/12275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Alam F, Rehman R. P-714 Visfatin and Silent Information Regulator 1 (SIRT1) in Pakistani infertile females. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
What is the relationship of SIRT1 and oxidative stress markers with obesity among infertile Pakistani females?
Summary answer
Progressive decline in antioxidants with the increase in BMI suggests that obesity causes oxidative stress that consequently leads to infertility in females.
What is known already
Deficiency of Silent Information Regulator 1 (SIRT1) can trigger inflammation, mitochondrial malfunctioning and apoptosis through the hypothalamic-pituitary-ovarian axis, producing poor quality oocytes, triggering obesity and associated metabolic disorders. SIRT1 expression levels are higher in endocrine system dysfunctions. Obesity has a potential risk for subfertility, infertility, deteriorated embryo quality, decreased endometrial receptivity, implantation failure and increased miscarriage rates. Visfatin increases in response to low levels antioxidants in obese, and its expression is negatively associated with the antioxidants produced. It disturbs glucose metabolism and promotes obesity, rendering it a powerful candidate as an OS marker.
Study design, size, duration
This cross-sectional study was conducted from August 2017 – July 2019, at Aga Khan Hospital in collaboration with Australian Concept Infertility Medical Centre (ACIMC) on 207 fertile and 135 infertile female subjects were recruited after ethical approval from of Aga Khan Hospital (AKU-ERC-2018-0557-601).
Participants/materials, setting, methods
kg)/height in meters (m2). Females were categorized by South-Asian criteria of BMI (normal-weight=18.0-22.9; overweight = 23-24.9; obese >25.0 kg/m2). Commercially available ELISA kits were used for estimation of serum Manganese Superoxide Dismutase (MnSOD), Glutathione Reductase (GR), visfatin and SIRT1. Pearson Chi-Square test and ANOVA were applied to compare the means within BMI groups. Association of variables was observed by Spearman correlation with significance at p < 0.05.
Main results and the role of chance
The mean BMI was 25.94 ± 5.1 kg/m2; 27.5% of females were normal-weight, 22.8% overweight, while 40.9% were obese. BMI was significantly high in infertile subjects (p < 0.001). MnSOD, visfatin and GR were lower in infertile females, decreasing from normal-weight to obese (p < 0.001). Increase in BMI was associated with a decrease in SIRT1 and antioxidants levels in both fertile and infertile females.
Limitations, reasons for caution
The small sample size was a limitation of the current study due to financial constraints, on the basis of which measurement of other non-enzymatic antioxidants such as malondialdehyde (MDA), glutathione, total antioxidant capacity (TAC), nitric oxide (NO) and reactive oxygen species could not be made possible.
Wider implications of the findings
SIRT1 is a fascinating target in various disease situations due to the promise of pharmacological and/or natural modulators of SIRT1 activity within the framework of endocrine and immune-related disease models.
Trial registration number
non applicable
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Affiliation(s)
- F Alam
- Universiti Brunei Darussalam, PAPRSB Institute of Health Sciences , Bandar Seri Begawan, Brunei
| | - R Rehman
- Aga Khan University, Biological & Biomedical Sciences , Karachi, Pakistan
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Rehman R, Khan F, Kayani N, Ali TS. Reflection of mentors and mentees at initiation of Faculty Mentorship Program at Aga Khan University: A perspective. Pak J Med Sci 2022; 38:1691-1695. [PMID: 35991259 PMCID: PMC9378395 DOI: 10.12669/pjms.38.6.5454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 04/09/2022] [Accepted: 04/25/2022] [Indexed: 11/27/2022] Open
Abstract
Objectives: To explore perception of mentors and mentees about ‘Mentorship Program at Aga Khan University Medical College (AKU-MC) from a structured feedback form Methods: A retrospective study was conducted for evaluation of mentorship program at AKU-MC during the period from Jan 2019 to March, 2021. Responses on validated “Pre-intervention Probe Forms”, from forty-seven mentors and fourteen mentees inducted in the program were reviewed. Confidentiality and anonymity of data were deliberated. All replies to each question were entered in a separate worksheet to determine the frequency and percentage of answers. Responses conveying same message, but worded differently were then grouped. Results: All the mentees (n=14) responded positively to the question on the “understanding of the mentoring program. The mentees (n=12, 86%) recognized the potential of the program to transfer knowledge and skills, (n=11, 79%) supported its role for achievement of goals, (n=7, 50%), acknowledged its role in faculty relationships. The mentors expressed their enthusiasm to help the mentee’s in their professional development. They (n=20, 43%) offered support to set career goals, (n=29, 62%) proposed transfer of knowledge, skills, and experiences to achieve goals, (n=15, 32%) decided to be “role models”. Some (n=10, 21%) forecasted improved communication skills, (n=14, 30%) boosted leadership capabilities, (n=13, 28%) expected improved work performance, (n=15, 32%) opinioned that networking and leadership qualities will impact the growth of the mentee to meet the university’s expectations. Conclusion: Both mentors and mentees recognized the importance of the faculty mentorship program at AKU-MC for professional guidance, development and improvement in work performance.
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Affiliation(s)
- Rehana Rehman
- Dr. Rehana Rehman, MBBS, M. Phil, Ph.D., FHEA (UK) Associate Professor, Department of Biological & Biomedical Sciences Aga Khan University, Karachi, Pakistan
| | - Fauzia Khan
- Dr. Naila Kayani, Prfessor of Pathology & Medicine Aga Khan University, Karachi, Pakistan
- Correspondence: Dr. Fauzia Khan, Department of Anesthesiology, Faculty of Health Sciences, Medical College, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan.
| | - Naila Kayani
- Dr. Fauzia Khan, MBBS, FRCA Professor, Department of Anesthesiology Aga Khan University, Karachi, Pakistan
| | - Tazeen Saeed Ali
- Dr. Tazeen Saeed Ali, Professor & Assistant Dean School of Nursing & Midwifery Aga Khan University, Karachi, Pakistan
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Attique H, Baig S, Ishtiaque S, Rehman R, Ahmed ST, Ali Shahid M. Neuregulin 4 (NRG4) - the hormone with clinical significance in gestational diabetes mellitus. J OBSTET GYNAECOL 2022; 42:1931-1936. [PMID: 35603674 DOI: 10.1080/01443615.2022.2054683] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study aimed at determining the association between serum neuregulin 4 (NRG4) and insulin in gestational diabetes mellitus (GDM) and their correlation with other metabolic parameters. A cross-sectional study was conducted from June 2018 to February 2019 at Ziauddin University, Karachi. Pregnant women (n = 80), at 24-28 weeks of gestation, were recruited. Demographic data, anthropometric measurements and antenatal history were recorded. The fasting blood was drawn for testing fasting blood sugar (FBS), NRG4, insulin and lipid profile. The subjects were evaluated for glucose challenge test after 50 g glucose ingestion. NRG4 levels (1.00 ± 0.15) were found significantly high (p < .04) in healthy group compared to GDM (0.95 ± 0.11). In GDM females, high levels for FBS (p < .02) and cholesterol (p < .03) were observed. Homeostatic model assessment of insulin resistance (HOMA-IR) had direct weak association with NRG4, inverse relationship with cholesterol and LDL but significant association (p < .05) with insulin. Significantly high NRG4 in healthy females suggests its potential role in regulating insulin sensitivity. Impact StatementWhat is already known on this subject? Neuregulin 4 (NGR4) is a batokine which plays a potential role in regulating insulin sensitivity, maintaining energy and metabolic homeostasis. Due to its role in lipid and glucose homeostasis, some studies report its role in gestational diabetes mellitus (GDM) but the results were controversial.What do the results of this study add? The study showed that NGR4 levels were significantly low in GDM subjects. Other metabolic factors especially insulin and homeostatic model assessment of insulin resistance (HOMA-IR) were found associated significantly (p < .05) with NGR4.What are the implications of these findings for clinical practice and/or further research? NGR4 can be a potential biomarker for gestational diabetes. Nevertheless, in order to confirm these findings, further studies, with bigger sample size are required to further ascertain the prospects of NRG4 as a potential biomarker for gestational diabetes.
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Affiliation(s)
- Hira Attique
- Department of Physiology, Ziauddin University, Karachi, Pakistan
| | - Saeeda Baig
- Department of Biochemistry, Ziauddin University, Karachi, Pakistan
| | - Shahina Ishtiaque
- Department of Gynaecology and Obstetrics, Dr. Ziauddin Hospital, Karachi, Pakistan
| | - Rehana Rehman
- Department of Biological and Biomedical Sciences, Agha Khan University, Karachi, Pakistan
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Rehman R, Alam F, Abidi SH, Farooqi N, Jehan F. Oxidative stress and metformin: An in-vitro study on serum and primary human granulosa cell cultures. ELECTRON J GEN MED 2022. [DOI: 10.29333/ejgm/12037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Nadeem Parpio Y, Farooq S, Zahid N, Abdul-Ghafar J, Rehman R. Perception of postgraduate medical residents regarding educational environment at French Medical Institute for Mothers and children, Kabul Afghanistan. J PAK MED ASSOC 2022; 72:669-673. [DOI: 10.47391/jpma.2138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Objective: To assess the perceptions of postgraduate medical education residents regarding educational environment at a medical institution in Afghanistan.
Methods: The descriptive cross-sectional study was conducted from 2017 to 2018 at the French Medical Institute for Mothers and Children, Kabul, Afghanistan, FMIC, and comprised postgraduate medical residents. Dundee Ready Educational Environment Measure was administered to determine the perception of learning environment by the residents’ perceptions related to learning, teachers, academic self-perception, atmosphere and social self-perceptions sub scales. Data was analysed using SPSS 22.
Results: Of the 63 subjects, 55(87.30%) were males and 42(66.66%) were married. The overall mean age was 30±4.38 years. There was no significant difference in mean subscales scores and overall scores in relation to participants’ age, gender, type of specialty, province and year of training (p>0.05). There was a significant difference in students’ perception of teachers in relation with the type of specialty (p<0.05).
Conclusions: The educational environment at the medical institution in Afghanistan was perceived by the students of residency programme as conducive.
Key Words: Dundee ready educational environmental measure, DREEM, Educational environment, Residency programme, Afghanistan.
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Rehman R, Tariq S, Tariq S. Emotional Intelligence and Academic Performance of Students. J PAK MED ASSOC 2022; 71:2777-2781. [DOI: 10.47391/jpma.1779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Medical profession deals with human interactions and ability to empathize improves clinical interactions as well as brings out good clinical outcomes. This has led to increasing interest in the importance of Emotional Intelligence (EI) for effective clinical practice. EI integrates the important aspects of interpersonal and intrapersonal relationships to promote self-management skills like adaptability, control of temperaments and tension free states, which have a profound effect on the academic performance of students. There has been substantial evidence proving that being emotionally intelligent can help individuals excel through life transitions starting from school to college, and later into to the working world. There are many studies in the literature that examine the correlation between EI and academic achievement in different education levels which signify importance of EI levels to predict “students who are in need of guided intervention”.
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Alam F, Syed H, Amjad S, Baig M, Khan TA, Rehman R. Interplay between oxidative stress, SIRT1, reproductive and metabolic functions. Curr Res Physiol 2021; 4:119-124. [PMID: 34746831 PMCID: PMC8562188 DOI: 10.1016/j.crphys.2021.03.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 03/08/2021] [Accepted: 03/17/2021] [Indexed: 01/05/2023] Open
Abstract
Silent information Regulators (SIRT1) gene stimulates antioxidants' expression, repairs cells damaged by oxidative stress (OS), and prevents the cells' dysfunction. In particular, the role of different Sirtuins, particularly SIRT1 in reproduction, has been widely studied over the past decade. Decreased SIRT 1 causes mitochondrial dysfunction by increasing Reactive Oxygen Species (ROS), lipid peroxidation, and DNA damage in both male and female gametes (Sperms and Oocytes), leading to infertility. In the female reproductive system, SIRT1 regulates proliferation and apoptosis in granulosa cells (GCs), and its down-regulation is associated with a reduced ovarian reserve. SIRT1 also modulates the stress response to OS in GCs by targeting a transcription factor vital for ovarian functions and maintenance. ROS-mediated damage to spermatozoa's motility and morphology is responsible for 30-80% of men's infertility cases. High levels of ROS can cause damage to deoxyribo nucleic acid (DNA) in the nucleus and mitochondria, lipid peroxidation, apoptosis, inactivation of enzymes, and oxidation of proteins in spermatozoa. SIRT 1 is a cardioprotective molecule that prevents atherosclerosis by modulating various mechanisms such as endothelial injury due to impaired nitric oxide (NO) production, inflammation, OS, and regulation of autophagy. SIRT 1 is abundantly expressed in tubular cells and podocytes. It is also found to be highly expressed in aquaporin 2 positive cells in the distal nephron suggesting its involvement in sodium and water handling. SIRT1 improves insulin resistance by reducing OS and regulating mitochondrial biogenesis and function. It also decreases adiposity and lipogenesis and increases fatty acid oxidation. So, its involvement in the multiple pathways ensures its unique role in reproductive and metabolic derangement mechanisms.
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Affiliation(s)
- Faiza Alam
- Department of Physiology, University of Karachi, Karachi, Pakistan.,PAPRSB Institute of Health Scienecs, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Hareem Syed
- Department of Cardiology, Tabba Heart Institute, Karachi, Pakistan
| | - Sofia Amjad
- Department of Physiology, Ziauddin University, Karachi, Pakistan
| | - Mukhtiar Baig
- Department of Clinical Biochemistry, Faculty of Medicine, Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Rehana Rehman
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
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Farhat S, Rehman R, Fatima SS. Flipped Laboratory Sessions using Video Vignette and Active Learning: A Hybrid Approach for Online Teaching. J Coll Physicians Surg Pak 2021; 31:1139-1140. [PMID: 34500544 DOI: 10.29271/jcpsp.2021.09.1139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/25/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Sabah Farhat
- Department of Biological and Biomedical Sciences, The Aga Khan University Hospital, Karachi, Pakistan
| | - Rehana Rehman
- Department of Biological and Biomedical Sciences, The Aga Khan University Hospital, Karachi, Pakistan
| | - Syeda Sadia Fatima
- Department of Biological and Biomedical Sciences, The Aga Khan University Hospital, Karachi, Pakistan
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Alam F, Rehman R, Farooqui N, Jehan F, Abidi SH. P–229 Oxidative stress and Metformin; an in-vitro study on serum and primary human granulosa cell cultures. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
What is the effect of administration of Metformin on the oxidative stress (OS) levels in serum and primary human granulosa cell cultures of infertile females?
Summary answer
Metformin suppresses oxidative stress in serum and human granulosa cells and increases the expression of SIRT1 in OS induced environment.
What is known already
Oxidative stress (OS) is a resultant of mitochondrial dysfunction when it either fails to fight against the oxidants or the expression of the antioxidants is not sufficient. Cellular damage including DNA damage is a common resultant of oxidative stress. OS effects the oocyte maturation and moreover, the cleavage phase in the early embryonic stage. The raised levels of OS makers are hypothesized to compromise the nuclear maturation and the mitotic spindles of the maturing oocytes. Metformin seemed to decrease oxidative stress and improve insulin resistance, dyslipidaemia and endothelial dysfunction in PCOS patients
Study design, size, duration
This cross-sectional study was conducted from August 2017 – July 2019, at Aga Khan Hospital in collaboration with Australian Concept Infertility Medical Centre (ACIMC) on ten infertile patients undergoing egg retrieval after ethical approval from of Aga Khan Hospital (AKU-ERC–2018–0557–601).
Participants/materials, setting, methods
Serum samples were obtained and analysed. Follicular fluid of these subjects was collected for establishment of primary cell culture model of normal human granulosa cells (hGCs). Serum and hGC cultures were grouped as; a) control: treatment, b) Test1: H2O2 induced OS, and c) Test2: H2O2 induced OS treated with metformin. OS was estimated in all groups by Mishra method. The two Test groups were assessed for SIRT1 levels using quantitative PCR employing SIRT1 specific primers
Main results and the role of chance
With mean age of 32.04 ± 2.29 years the mean BMI was 27.61 ± 2.15 kg/m2. OS was induced and measured by an increase in optical density (OD) in hGC Test samples which showed 0.28 (0.16–0.40) OD when compared with control hGC samples 0.153 (0.09–0.23). There was a significant reduction in ODs after metformin treatment in the stress induced cells 0.182 (0.05–0.30). A similar pattern was observed in the serum samples in ODs; control: 0.105 (0.09–0.15), stress induced samples: 0.199 (0.19–0.20). and stress induced serum sample with metformin treatment: 0.1415 (0.06–0.18).
The Ct values obtained to express the effect of metformin on SIRT1 levels, for OS induced (Test1) and OS induced metformin treated (Test2) cells were found to be 29.12 and 26.42, respectively. We also observed a significant (85%) difference in the fold change of SIRT1 expression between metformin treated and untreated cells.
Limitations, reasons for caution
Small sample size is the limitation of this study. The impact of metformin on cell cultures due to different causes of infertility could not be ascertained
Wider implications of the findings: Metformin suppresses oxidative stress in serum and human granulosa cells and increases the expression of SIRT1 in OS induced environment, therefore, metformin may be considered as a treatment of oxidative stress in infertile patients. Randomized control trial with large sample size is recommended to confirm the cause and effect relationship.
Trial registration number
Not applicable
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Affiliation(s)
- F Alam
- PAPRSB Institute of Health Sciences- Universiti Brunei Darussalam- Brunei, Phsiology, Darussalam, Brunei
| | - R Rehman
- Aga Khan University, Biological & Biomedical Sciences, Karachi, Pakistan
| | - N Farooqui
- Aga Khan University, Biological & Biomedical Sciences, Karachi, Pakistan
| | - F Jehan
- Australian Concept Infertility Medical Centre, Embryology, Karachi, Pakistan
| | - S H Abidi
- Aga Khan University, Biological & Biomedical Sciences, Karachi, Pakistan
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Amjad S, Mushtaq S, Rehman R, Zahid N, Munir A, Siddiqui PQR. P–076 Probability of sperm retrieval in azoospermic patients and mRNA expression profile of JMJD1A, TNP2 and PRM2 : in a subset of karachi population. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
To access successfulness of sperm retrieval by evaluating the mRNA expression profile of JMJD1A, TNP1, TNP2, PRM1 and PRM2 in patients undergoing surgical sperm retrieval procedure.
Summary answer
Probability of sperm retrieval in azoospermia is decreased when mRNA expression profile of JMJD1A TNP2 and PRM2 in testicular tissue is decreased.
What is known already
Studies have been done on expression of JMJD1A in non-obstructive azoospermic patients in other part of the world with smaller sample size but this is the first study in Pakistan with larger number of patients. Study design, size, duration: Crossectional study, 100 azoospermic patients coming for purpose of sperm retrieval by TESE or micro-TESE in Australian Concept Infertility Medical Center, Karachi,from March, 2018 to December, 2019
Participants/materials, setting, methods
All recruited azoospermic patients were evaluated by history, physical examination, and hormonal assessment. RNA was extracted by pureLink RNA Micro kit and mRNA expression of the JMJD1A, TNP1, TNP2, PRM1 and PRM2 genes was determined using innu-SCRIPT One Step RT_qPCR SyGreen kit. For quantitative variables independent t test and for categorical variables chi-square/ Fisher Exact test was used. Unadjusted and adjusted prevalence ratio were reported by using cox regression algorithm. Main results and the role of chance: The patients were categorized into (i) Group-I: Patients with successful sperm retrieval n = 42, (ii) Group-II: Patients with unsuccessful sperm retrieval n = 58. The patients were categorized into (i) Group-I: Patients with successful sperm retrieval n = 42, (ii) Group-II: Patients with unsuccessful sperm retrieval n = 58. Azoospermic men in the successful sperm retrieval group had significantly decreased expression of JMJD1A (P < 0.001), TNP2(P < 0.001), and PRM2 (P 0.008). In addition to this regarding hormonal parameters: FSH (P 0.004), LH(P < 0.001), TSH(P<.011) were significantly different in azoospermic men with successful and unsuccessful sperm retrieval. In multivariate analysis, after adjusting for the other covariates, a significant association was found between JMJD1A, TNP2, PRM2 and successful sperm retrieval (p-value <0.05).
Limitations, reasons for caution
It is unicentric and outcomes for fertilization were not assessed. Azoospermic patients from multi-centeres were difficult because of lack of facility of sperm retrieval procedures at these centers and it was difficult to follow the fertrilization outcome.
Wider implications of the findings: This will be useful for making the decision in azoospermic men to proceed for ICSI or not. In addition to this, the repetition of unnecessary surgical procedures can be avoided, as the azoospermic men often undergo number of rounds of ICSI, with the hope of becoming biological father.
Trial registration number
non-clinical trials
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Affiliation(s)
- S Amjad
- Ziauddin University, Physiology, Karachi, Pakistan
| | - S Mushtaq
- Ziauddin University, Biochemistry, Karachi, Pakistan
| | - R Rehman
- Aga Khan University, Department of Biological & Biomedical Sciences-, Karachi-, Pakistan
| | - N Zahid
- Aga Khan University, Surgery, Karachi, Pakistan
| | - A Munir
- Australian Concept Infertility Medical Center, Andrology-, Karachi, Pakistan
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Rehman R, Chabaan A, Hamzavi I, Fahs F, Mohammad TF. The Etiquettes of Hijab: Recommendations to Improve Care in Dermatology Clinics. Br J Dermatol 2021; 186:176-177. [PMID: 34350980 DOI: 10.1111/bjd.20665] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/28/2021] [Accepted: 07/31/2021] [Indexed: 10/20/2022]
Abstract
A strong physician-patient relationship is the foundation of providing excellent patient care, as it improves providers' job satisfaction and patients' confidence, which influences their health outcomes.1,2 Strong relationships also prompt more accurate identification of patients' needs and perceptions, which may be used as an indicator of physician competence.3 Given the diverse racial, cultural, and religious backgrounds of patients, it is imperative for physicians to have a fundamental understanding of different cultures in order to provide the best care for patients.
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Affiliation(s)
- R Rehman
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - A Chabaan
- University of Michigan-Dearborn, Dearborn, MI, USA
| | - I Hamzavi
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| | - F Fahs
- Department of Dermatology, Wayne State University, Detroit, MI, USA
| | - T F Mohammad
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
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Shahid M, Khan S, Ashraf M, Akram Mudassir H, Rehman R. Male infertility: Role of vitamin D and oxidative stress markers. Andrologia 2021; 53:e14147. [PMID: 34247390 DOI: 10.1111/and.14147] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/10/2021] [Accepted: 05/25/2021] [Indexed: 01/06/2023] Open
Abstract
Spermatozoa are vulnerable to oxidative stress because of their inherent reduced antioxidant defence and DNA repair mechanisms. Polyunsaturated fatty acids in sperm plasma membrane break down to cytotoxic lipid aldehyde, 4-Hydroxynonenal, whereas 3-Nitrotyrosine is generated by peroxynitrite induced tyrosine nitration. Both oxidative stress markers contribute to altered sperm function and infertility. Vitamin D, a membrane antioxidant, has a potential scavenger capacity. We compared oxidative stress markers and vitamin D in male subjects with normal and altered sperm parameters and explored association of these markers: 4-Hydroxynonenal and 3-Nitrotyrosine with Vitamin D. Higher 4-Hydroxynonenal levels in altered sperm parameter group and a negative correlation with sperm count, motility and morphology (p < 0.001) was observed. Vitamin D serum concentration in altered sperm parameters was less (p = 0.016) showing a significant positive correlation with sperm count and morphology. 4-Hydroxynonenal was significantly higher in altered sperm parameters showing negative correlation with vitamin D. Highest serum concentrations of 4-Hydroxynonenal were observed in vitamin D-deficient subjects. Significantly higher concentration of 4-Hydroxynonenal was estimated in altered sperm parameters of vitamin D sufficient group (p < 0.001). This suggests 4-Hydroxynonenal as an oxidative stress marker leading to altered sperm function and infertility with some association with vitamin D; needs to be explored.
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Affiliation(s)
| | - Sher Khan
- Department of Biological and Biomedical Sciences, The Aga Khan University, Karachi, Pakistan
| | - Mussarat Ashraf
- Department of Biological and Biomedical Sciences, The Aga Khan University, Karachi, Pakistan
| | - Hina Akram Mudassir
- Department of Biochemistry, Federal Urdu University of Arts, Science & Technology, Karachi, Pakistan
| | - Rehana Rehman
- Department of Biological and Biomedical Sciences, The Aga Khan University, Karachi, Pakistan
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Amjad S, Mushtaq S, Rehman R, Zahid N, Munir A, Siddiqui PQR. Spermatozoa retrieval in azoospermia and expression profile of JMJD1A, TNP2, and PRM2 in a subset of the Karachi population. Andrology 2021; 9:1934-1942. [PMID: 34235877 DOI: 10.1111/andr.13076] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 07/04/2021] [Accepted: 07/05/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND The difficulties encountered in surgical spermatozoa retrieval for intracytoplasmic sperm injection procedure in azoospermic men have stressed the dire need for a robust biomarker for the prediction of spermatozoa retrieval. Data have highlighted the role of JMJD1A (Jumonji domain-containing 1A), a histone H3K9 demethylase, and other nuclear proteins, protamines (PRM) and transition nuclear proteins (TNP), as biomarkers in male infertility. OBJECTIVE To access successful spermatozoa retrieval at the time of intracytoplasmic sperm injection by evaluating the mRNA expression profile of JMJD1A, TNP, and PRM in testicular tissue. MATERIALS/METHODS About 100 azoospermic patients, who visited the Australian Concept Infertility Medical Center, Karachi for spermatozoa retrieval by testicular sperm extraction or microsurgical testicular sperm extraction participated in the study. mRNA expression of the JMJD1A, TNP1, TNP2, PRM1, and PRM2 genes was determined. Patients were categorized into successful spermatozoa retrieval (n = 42) group and unsuccessful spermatozoa retrieval (n = 58) group. RESULTS Azoospermic men in successful spermatozoa retrieval had significantly increased expression of JMJD1A, TNP2, and PRM2. The hormonal parameters - follicle-stimulating hormone, luteinizing hormone, and thyroid-stimulating hormone were significantly higher in unsuccessful spermatozoa retrieval. Multivariate analysis showed a significant association between JMJD1A, TNP2, PRM2, and successful spermatozoa retrieval. The area under the receiver operating characteristics curve showed a significant discriminatory ability to predict the spermatozoa retrieval outcome in azoospermic patients for mRNA expression of JMJD1A, TNP2, and PRM2 was 71, 72, and 73%, respectively. The area under the curve for follicle-stimulating hormone, luteinizing hormone, and thyroid-stimulating hormone was 0.67, 0.81, and 0.65, respectively. DISCUSSION Our study demonstrates that the mRNA expression profile of JMJD1A, TNP2, and PRM2 along with hormonal parameters, is a useful marker to assess the probability of spermatozoa retrieval before intracytoplasmic sperm injection intervention. CONCLUSION The probability of spermatozoa retrieval in azoospermic patients is increased when the mRNA expression profile of JMJD1A, TNP2, and PRM2 in testicular tissue is increased.
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Affiliation(s)
- Sofia Amjad
- Department of Physiology, Ziauddin University, Karachi, Pakistan
| | - Shamim Mushtaq
- Department of Biochemistry, Ziauddin University, Karachi, Pakistan
| | - Rehana Rehman
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Nida Zahid
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Adnan Munir
- Department of Andrology, Australian Concept Infertility Medical Center, Karachi, Pakistan
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Ali R, Iqbal MUN, Rehman R, Khan TA. Association of novel stop-gained leukaemia inhibitory factor receptor gene (rs121912501) variant, leukaemia inhibitory factor and ovarian steroids with unexplained infertility among Pakistani women. Int J Clin Pract 2021; 75:e14245. [PMID: 33914392 DOI: 10.1111/ijcp.14245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 04/13/2021] [Accepted: 04/16/2021] [Indexed: 11/30/2022] Open
Abstract
AIMS AND OBJECTIVES Embryo implantation is a complex process that requires sequential steps at the interface of embryo interaction with decidual endometrium. Many women after experiencing multiple attempts of assisted reproductive techniques fail to get implantation because of instability of leukaemia inhibitory factor and leukaemia inhibitory factor receptor-signal transducer and activator of transcription factor 3 (LIF-LIFR STAT3) signalling cascade. Therefore, this study explores the association of ovarian steroids, LIF and LIFR stop-gained variant using the tetra primer amplification refractory mutation system-polymerase chain reaction (TARMS-PCR) with unexplained infertility (UEX-IF) among Pakistani women. MATERIALS AND METHODS This is a case-control study, a total of 81 unexplained infertile women and 162 fertile controls (with age and BMI matched) were inducted. Serum estradiol, progesterone and LIF were determined using enzyme-linked immunosorbent assay (ELISA). T-ARMS-PCR was designed using Primer 1 software. Genomic DNA was extracted from peripheral blood and amplified using T-ARMS-PCR followed by sequencing for validation and comprehensive concordance. RESULTS This study established differences in LIF levels (χ2 = 9.857, P < .05) between patients and controls as well as explored the decreased LIF significantly raised the risk of UEX-IF (OR = 2.316; 95% CI = 1.214, 4.416). Progesterone (P) was significantly associated with UEX-IF between fertile and infertile counterparts (χ2 = 20.347, P < .05). It was also observed that increased Progesterone reduced the risk of UEX-IF (OR = 0.306; 95% CI = 0.166, 0.567). A rapid and inexpensive method for genotyping novel LIFR gene polymorphism through T- ARMS-PCR was successfully developed. LIFR gene SNP (rs121912501) had significant association (χ2 = 200.681, P < .05) with UEX-IF. LIFR rs121912501 "TT" genotype (OR = 5.417; 95% CI = 1.868, 15.709) and "CT" genotype (OR = 3.104, 95% CI = 1.586,6.076) were at increased risk of infertility. CONCLUSION UEX-IF can be caused by LIFR gene variation irrespective of increased P. It may open the doors for the discovery of new management plans for infertile women.
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Affiliation(s)
- Rabiya Ali
- Department of Physiology, Karachi Institute of Medical Sciences (KIMS), CMH, Malir Cantt, Karachi, Pakistan
| | | | - Rehana Rehman
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Taseer A Khan
- Department of Physiology, University of Karachi, Karachi, Pakistan
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Azhar A, Abid F, Rehman R. Polycystic Ovary Syndrome, Subfertility and Vitamin D Deficiency. J Coll Physicians Surg Pak 2021; 30:545-546. [PMID: 32580859 DOI: 10.29271/jcpsp.2020.05.545] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/28/2020] [Indexed: 11/11/2022]
Abstract
Polycystic ovarian syndrome (PCOS) is the most common endocrine female disorder, affecting 4-18% women of reproductive age. The prevalence of PCOS in South Asian women, especially in Pakistani women, is much higher (52%) as compared to white population (20 - 25% in UK). In Pakistan, vitamin D status displays 31.2% vitamin D insufficiency, 53.5% vitamin D deficiency, and 15.3% normal vitamin D values. Vitamin D deficiency, though very common in the general population, is even more prevalent in PCOS patients, seen in approximately 67-85%, which further correlates to their related comorbidities. A lot of researches have to be directed to examine the association among the PCOS and vitamin D, which may display monitoring role in several symptoms related to PCOS, such as ovulatory dysfunction, endocrine disruption, and insulin resistance. Vitamin D supplementation can, therefore, be employed to improve the metabolic and endocrine disorders; especially improving hormonal profile, oxidative stress, and ovulation outcome in PCOS patients. Key Words: Vitamin D, Infertility, Ovulatory Dysfunction, Insulin Resistance.
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Affiliation(s)
- Arfa Azhar
- Department of Biological and Biomedical Sciences, The Aga khan university, Karachi, Pakistan
| | - Fatima Abid
- Department of Physiology, Jinnah Sindh Medical Institute, Karachi, Pakistan
| | - Rehana Rehman
- Department of Biological and Biomedical Sciences, The Aga khan university, Karachi, Pakistan
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Rehman R, Zafar A, Zahid N, Mohammed N. Follicular Sensitivity Index: A Tool To Predict Successful Conception After Intra-cytoplasmic Sperm Injection. J Coll Physicians Surg Pak 2021; 30:443-445. [PMID: 32513372 DOI: 10.29271/jcpsp.2020.04.443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 10/06/2019] [Indexed: 11/11/2022]
Abstract
Follicular sensitivity index (FSI) is used for estimation of follicular responsiveness to controlled ovarian hyperstimulation (COH) during intra-cytoplasmic sperm injection (ICSI). In a retrospective study, FSI of 1,385 females was calculated as [pre-ovulatory follicle count (PFC) × 100,000]/ [antral follicle count (AFC) × total received stimulation doses]. Females were then categorised into low, middle and high FSI groups according to FSI tertile values. FSI was 8.65 ±2.82 in non-pregnant as compared to 12.02 ±2.04 (p <0.01) in pregnant cohort. FSI turned out to be a strong predictor of successful conception on the receiver operating curve with cutoff value 10.36 at 76% specificity, sensitivity of 86% and area under the curve (AUC; 0.83). Calculation of FSI can thus predict the chances of successful conception in females with different causes of infertility. Key Words: Follicular sensitivity index, Infertility, Intra-cytoplasmic sperm injection, Ovarian response, Follicular output rate.
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Affiliation(s)
- Rehana Rehman
- Department of Biological and Biomedical sciences, The Aga Khan University, Karachi, Pakistan
| | - Amara Zafar
- Dow Medical College (DMC), Dow University of Health Sciences, Karachi, Pakistan
| | - Nida Zahid
- Department of Surgery, The Aga Khan University, Karachi, Pakistan
| | - Nuruddin Mohammed
- Department of Obstetrics and Gynaecology, The Aga Khan University, Karachi, Pakistan
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Mirza MB, Sulaiman A, Hashmi S, Zaki S, Rehman R, Akbar R. Use of simulation based technology in pre-clinical years improves confidence and satisfaction among medical students. J PAK MED ASSOC 2021; 71:1296-1302. [PMID: 34125799 DOI: 10.47391/jpma.1152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine perception of medical students about learning from integrated simulated clinical skill sessions as part of the undergraduate curriculum. METHODS The cross-sectional study was conducted at the Centre for Innovation in Medical Education, Aga Khan University (AKU), Karachi, from July 2018 to February 2019, and comprised first year medical students undertaking the Respiration and Circulation module of the curriculum. Quantitative data was collected using a questionnaire and the responses were assessed on a five-point Likert scale. Data was analysed using SPSS 21. Qualitative data was gathered through focused group discussion with students and an in-depth interview with the facilitator conducting the sessions. The data was subjected to thematic analyses. RESULTS Of the 161 subjects, 71(44%) participated in the session I and 90(56%) in the session II. Altogether 68(96%) students in session I and 81(90%) in session II believed integrated sessions to be effective in achieving learning objectives, and 65(92%) in session I and 79(88 %) in session II found them motivating, while 61(86%) in session I and 76(84%) in session II expressed the confidence that they had accomplished learning objectives and felt they had learned practical clinical skills; session I, 59(84%), session II, 73(81%). Qualitative analysis revealed that these sessions enhanced understanding of the subject matter and student engagement. CONCLUSIONS Integrated clinical skills sessions improved students' interest, engagement and confidence. It should be implemented in undergraduate medical teaching curriculum.
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Affiliation(s)
| | - Anjiya Sulaiman
- 5th Year Medical Student, Aga Khan University, Karachi, Pakistan
| | - Satwat Hashmi
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Samar Zaki
- Department of Family Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Rehana Rehman
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Rozmeen Akbar
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
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Rehman R, Jawed S, Ali R, Noreen K, Baig M, Baig J. COVID-19 Pandemic Awareness, Attitudes, and Practices Among the Pakistani General Public. Front Public Health 2021; 9:588537. [PMID: 34178907 PMCID: PMC8219954 DOI: 10.3389/fpubh.2021.588537] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 04/26/2021] [Indexed: 12/23/2022] Open
Abstract
Background: Outbreak of COVID-19, in many countries, has imposed a lockdown on their residents. The usefulness of extenuative actions is extremely reliant on society's knowledge, attitudes, and practices (KAP) toward pandemic control. Objective: This study aimed to explore the awareness, attitudes, and practices of the general Pakistani population to COVID-19. Methods: From June 13, 2020, until June 30, 2020, a cross-sectional online KAP survey was conducted among the Pakistani public. For data collection, a validated self-administered questionnaire was used. The survey instrument consisted of six demographic characteristics, 14 items on knowledge, four on attitudes, and six items on practices, modified from a previously published questionnaire on COVID-19. Results: The present study included 2,307 participants, 58.3% males and 41.7% of females. The majority (86.7%) sought information from social media (SM) and television, 95% had good practices, 89.9% had positive attitudes, and two-thirds (67.4%) of the respondents had adequate knowledge. The students and people from younger age groups had more positive attitudes compared with others. Highly educated w with other groups (p < 0.001). In logistic regression analysis, the odds ratio indicated that the private job was negatively associated, and high monthly income was positively associated with adequate knowledge (OR = 0.595). Old age was the predictor of negative attitude, and high school degrees and master's degrees were associated with good practice scores. Conclusion: The Pakistani general population has an overall positive attitude and proactive practices against COVID-19, but their knowledge is inadequate. The most important source of information was SM, followed by television. These are playing a crucial role in educating the Pakistani public.
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Affiliation(s)
- Rehana Rehman
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Shireen Jawed
- Department of Physiology, Aziz Fatima Medical and Dental College, Faisalabad, Pakistan
| | - Rabiya Ali
- Department of Physiology, Karachi Institute of Medical Sciences, Karachi, Pakistan
| | - Khola Noreen
- Department of Community Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Mukhtiar Baig
- Department of Biochemistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Javaria Baig
- Liaquat College of Medicine and Dentistry, Karachi, Pakistan
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Abstract
The COVID-19 pandemic requires a rapid understanding of the pathogenesis of the spectrum of the disease and factors associated with varied clinical presentations. Immune dysregulation with a cytokine storm (CS) progressing to ARDS with resemblance to sHLH is suggested as a main cause of tissue injury. Low levels of vitamin D were observed in COVID-19 cases with higher incidence of mortality in 20 European countries, increased risk of severity in COVID-19 contributing to ARDS or fulminant myocarditis and micro vascular thrombosis is proposed. Vitamin D may be protective against acute respiratory tract infections, as it regulates the inflammatory cytokine response of respiratory epithelial cells and macrophages, suppress CS and other manifestations seen in SARS-Cov-2. Hence, it is suggested as one of the therapies in SARS-CoV-2 infection. Major research gaps are identified globally in clinical management and this relationship. There is an imperative requisite to understand the interplay of markers in SARS-CoV-2, its risk factors and potential role of vitamin D to improve clinical outcome by pandemic of COVID-19. We therefore perform this review for understanding the pathophysiology of SARS-CoV-2 infections and the role of vitamin D in combating it.
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Affiliation(s)
- Aysha Habib Khan
- Department of Pathology & Laboratory Medicine & Medicine, Aga Khan University, Karachi, Pakistan
| | - Noreen Nasir
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Nosheen Nasir
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | | | - Rehana Rehman
- Department of Biological & Biomedical Sciences, Aga Khan University, Stadium Road, Karachi, Pakistan
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Alam F, Rehman R, Fatima SS, Ashraf M, Khan TA. Suggested role of silent information regulator 1 (SIRT1) gene in female infertility: A cross-sectional study in Pakistan. Int J Clin Pract 2021; 75:e14132. [PMID: 33735475 DOI: 10.1111/ijcp.14132] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 03/02/2021] [Indexed: 01/09/2023] Open
Abstract
AIM & OBJECTIVE Silent information regulator 1 (SIRT1) gene stimulates the expression of antioxidants and repairs damaged cells. It affects the mitochondrial activity within the oocytes to overcome the oxidant stress. We aimed to assess an association of SIRT1 polymorphism (Tag SNPs rs10509291 and rs12778366) with fertility, and assess serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), oestradiol, progesterone, manganese superoxide (MnSOD) and SIRT1. MATERIAL AND METHODS In this cross-sectional study, 207 fertile and 135 infertile subjects between the ages of 18-45 years were recruited. Polymerase chain reaction (PCR) was performed; products were electrophoresed in a 2% agarose gel. Descriptive analysis of continuous variables was expressed as mean ± standard deviation. Mann-Whitney test was performed for comparison of groups, P value <.001 was considered significant. Single Nucleotide Polymorphism (SNP) data were analysed by applying chi-squared statistics. RESULTS All subjects were age matched (P = .896). SIRT1 levels were significantly lower in infertile females when compared with fertile subjects (P < .001). AA (rs10509291) and CC (rs12778366) variant frequency was higher in the infertile than fertile subjects (P < .01). Similarly, the frequency of A allele (rs10509291) and C allele (rs12778366) was higher in infertile subjects (P < .001). Infertile females (29%) showed existence of SNP rs10509291 while 49% demonstrated genetic variation of rs12778366. MnSOD and SIRT1 levels were found to be lower in these subjects. CONCLUSION The presence of SIRT1 genetic variants (rs10509291 and rs12778366) apparently disturbs the expression of SIRT1 deteriorating mitochondrial antioxidant function within the oocytes, instigating oxidative stress within. Their probable effect on modulating oocyte maturation may be the cause of infertility in females.
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Affiliation(s)
- Faiza Alam
- Department of Physiology, University of Karachi, University Road, Karachi, Pakistan
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Badar Seri Begawan, Brunei Darussalam
| | - Rehana Rehman
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Syeda Sadia Fatima
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Mussarat Ashraf
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Taseer Ahmed Khan
- Department of Physiology, University of Karachi, University Road, Karachi, Pakistan
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Abstract
OBJECTIVE To study the impact of Vitamin E (VE) levels of follicular fluid (FF) on oocyte competence, embryo development and pregnancy outcome in patients after intra cytoplasmic sperm injection (ICSI). METHODS It was a cross-sectional study conducted in Islamabad Clinic Serving Infertile Couples in which follicular fluid of 137 females booked for ICSI, was obtained during oocyte retrieval, centrifuged and stored for analysis. VE levels in FF were analyzed by enzyme linked immune sorbent assay. Receiver Operating Curve (ROC)was used to demarcate VE levels required for acquiring pregnancy. Generalized linear model using log binomial regression was applied to see the effect of VE on pregnancy, the effect of VE on oocyte and embryo parameters was assessed by linear regression; all p-values less than 0.05 were considered statistically significant. RESULTS ROC suggested 5.49 (unit) as the cutoff value of VE in the pregnancy group, with 72.9% area under the curve. Ninety-one females comprised Group I with VE > 5.49, whereas forty six females formed Group II with VE < 5.49. Follicular fluid VE levels were significantly high in 39 (28.5%) females who compromised pregnancy group. Chances of pregnancy increased to 4% with an increase in VE levels (p-value 0.01). VE gave significant positive relationship with all oocyte (retrieved, mature and fertilized) parameters, cleavage of embryo till its differentiation to blastocysts (p<0.01). CONCLUSIONS Adequate amount of VE in follicular fluid enhances the possibility of maturation of oocytes which resulted in better reproductive outcome after ICSI.
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Affiliation(s)
- Mussarat Ashraf
- Department of Biological and Biomedical Sciences, University of Karachi, Karachi, Pakistan
| | | | | | - Faiza Alam
- Dartment of Pediatric Children Hospital, Rabwah, Pakistan
| | - Rehana Rehman
- Department of Biological and Biomedical Sciences, University of Karachi, Karachi, Pakistan
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Alam F, Farooqui N, Rehman R. Metformin, Oxidative Stress and Male Infertility: Way Forward. J PAK MED ASSOC 2021; 71:781-782. [PMID: 33941985 DOI: 10.47391/jpma.11-1318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Madam,
There is an increased prevalence of infertility in male population. With reference to a variety of mechanisms, oxidative stress (OS) is responsible for alteration in structural and functional integrity of sperm leading to altered sperm parameters, hence leading to infertility (1).
Metformin though proved to be a first-line hypoglycemic agent has demonstrated antioxidant properties in numerous tissues. It inhibits the mitochondrial respiratory chain in the liver, which leads to stimulation of AMP-activated protein kinase (AMPK)-dependent as well as AMPK-independent mechanisms (2). Metformin triggers alanine production within the Sertoli cells (SCs,) balances the NADH/NAD+ equilibrium and provides antioxidant environment. This drug is a treatment of choice in treating females with Polycystic Ovaries (PCOS) on the basis of its capability to reduce insulin sensitivity as well as angiogenesis through the nuclear factor ?B (NF-?B) pathway which renders it to reduce oxidant species, thus improving the reproductive environment (3). Continuous....
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Affiliation(s)
- Faiza Alam
- Department of Physiology, University of Karachi, Pakistan
| | - Nida Farooqui
- Department of Biological Biomedical Sciences Aga Khan University, Karachi
| | - Rehana Rehman
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
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40
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Abstract
Dear Madam,
Infertility is a known source of distress among couples worldwide. This agony significantly stems from the concern of not having an identifiable cause leading to infertility. With male factors accounting for 20-30% of the total causes of infertility (1), a thorough evaluation of both the partners is done.
Upon evaluation, Vitamin D deficiency was noticed significantly in males coming to infertility centres. However, its functions and how it impacted reproduction was not known until the research led to the discovery of Vitamin D Receptor (VDR) in many organs of the male reproductive tract. It is now known that vitamin D deficiency decreases male fertility by contributing to oxidative stress and gonadal insufficiency, disrupting spermatogenesis, affecting sperm morphology and normal calcium haemostasis. (2)
Oxidative stress, caused by an imbalance between oxidative and antioxidative mechanisms, is believed to be a well-known mechanism underlying idiopathic male infertility. Reproductive health professionals and researchers fittingly started searching for antioxidants to combat this imbalance. A study concluded that adding vitamin D to a cryopreserved semen sample reduced oxidative stress and resulted in better fertility outcomes (3). Animal trials have shown that Vitamin D supplementation reduced oxidative stress and improved semen DNA integrity (4).
As Vitamin D exerts its effects by binding to Vitamin D receptors, it was noted that vitamin D receptor null mutant mice had a significant reduction in successful reproductive outcomes due to gonadal insufficiencies. Reduced levels of oestrogen and testosterone were seen along with low sperm count, reduced motility, abnormal spermatogenesis and histological abnormalities in testes of mutant mice. These insufficiencies were attributed to a decreased CYP2R1, CYP27B1 and CYP24A1 expression, lower aromatase activity, secondary to suppression of CYP19 gene and calcium supplementation improved fertility in such cases. (5)
There is limited human data available on how Vitamin D deficiency causes gonadal insufficiency, which is important to maintain normal reproductive physiology. More studied are needed to clarify the role of vitamin D in gonadal physiology. Considering the importance of Vitamin D on reproductive functions, its role in causing Oxidative stress and gonadal dysfunction, we suggest randomized control trials in pre-pubertal phase. Continuous....
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Affiliation(s)
| | | | - Rehana Rehman
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
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41
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Raja MHR, Farooqui N, Zuberi N, Ashraf M, Azhar A, Baig R, Badar B, Rehman R. Endometriosis, infertility and MicroRNA's: A review. J Gynecol Obstet Hum Reprod 2021; 50:102157. [PMID: 33957270 DOI: 10.1016/j.jogoh.2021.102157] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 04/27/2021] [Indexed: 12/15/2022]
Abstract
The review aims to explore circulating small non- coding regulatory Ribonucleic Acids (miRNA) as biomarkers of endometriosis; a reproductive age group disorder. miRNA are linked with genetic, epigenetic and angiogenic factors, hormones, cytokines, chemokines, oxidative stress (OS) markers, mediators of inflammation, hypoxia, angiogenesis and altered immune system contributing to the pathogenesis of endometriosis. Hormonal imbalance occurs by decreased levels of miRNAs -23a and miRNAs -23b and increase in miRNAs -:135a, 135b, 29c and 194-3p. Angiogenesis by vascular endothelial growth factor is attributed to increased miRNAs -126, miRNAs -210, miRNAs -21, miRNAs -199a-5p and miRNAs 20A. OS upregulates miRNAs -302a by increased levels of Tumor Necrosis factor (TNF)-α, TNF- β and Interleukin -1β. Upregulation of miRNAs -199a and miRNAs -16 promotes inflammation and cell proliferation in the endometriotic lesions. The gold standard to diagnose endometriosis is laparoscopy, yet miRNA can be validated as diagnostic tool for detection, progression and prevention of endometriosis in large, independent cohorts of women, with and without endometriosis.
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Affiliation(s)
| | - Nida Farooqui
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan.
| | - Nadeem Zuberi
- Obstetrics and Gynecology, Aga Khan University, Karachi, Pakistan.
| | - Mussarat Ashraf
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan.
| | - Arfa Azhar
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan.
| | - Rozeena Baig
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan.
| | - Bisma Badar
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan.
| | - Rehana Rehman
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan.
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Tariq H, Zahid N, Amir D, Ashraf M, Aftab MA, Yousaf S, Rehman R. Estimation of folic acid/micro nutrients levels; Does it reflect sperm parameters. Int J Clin Pract 2021; 75:e13790. [PMID: 33128252 DOI: 10.1111/ijcp.13790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 10/21/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To study the impact of vitamin B12, folic acid (FA) and methylmalonic acid (MMA) on sperm parameters; count, motility and morphology leading to male fertility. METHODS The cross-sectional study comprised of one hundred and eighty-six subjects with normal sperm parameters (fertile) and 88 subjects with abnormal sperm parameters labelled as "infertile" from a sample population of Karachi, Pakistan. Vitamin B12, FA and MMA levels in serum were analysed by enzyme linked immune sorbent assay. Unadjusted and adjusted prevalence ratio with their 95% CI were reported by using cox regression algorithm to assess the association of Vitamin B12, FA and MMA and other factors with male Infertility. Unadjusted and adjusted beta coefficients with 95% CI were reported by using linear regression analysis for assessing relationship of Vitamin B12, FA and MMA and other factors with semen parameters (count, motility and morphology); P value of <.05 was considered significant. RESULTS It was declared that with every 1 unit increase in vitamin B12, FA and MMA the prevalence of infertility was decreased by 1%, 17% and 74%, respectively. Multivariate analysis revealed that vitamin B12, FA and MMA had a significant association with total sperm count, motility and morphology. The sperm parameters were also affected by increase in; LH, BMI and body fat %. There was a significant positive correlation of; LH with Vitamin B12 and FA (0.423 < 0.001, 0.338 < 0.001) and testosterone with vitamin B12 and FA (0.326 < 0.001, 0.291 < 0.001), respectively. CONCLUSION All the studied micronutrients; Vitamin B12, FA and MMA had a positive effect on sperm parameters; count, motility and morphology and the associated reproductive hormones which explains their role on reproductive functions required to acquire fertility.
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Affiliation(s)
- Hemaila Tariq
- Medical College, Aga Khan University, Karachi, Pakistan
| | - Nida Zahid
- Epidemiology and Biostatistics, Senior Instructor Research, Aga Khan University, Karachi, Pakistan
| | - Daniyal Amir
- Medical College, Aga Khan University, Karachi, Pakistan
| | - Mussarat Ashraf
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | | | | | - Rehana Rehman
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
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Rehman R, Fatima K, Hussain M, Sarim M, Gazzaz ZJ, Baig M. Association between depression and health risk behaviors among university students, Karachi, Pakistan. Cogent Psychology 2021. [DOI: 10.1080/23311908.2021.1886626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Rehana Rehman
- Department of Biological & Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Kiran Fatima
- Department of Physiology, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Mehwish Hussain
- Department of Public Health, College of Public Health, Imam Abdurrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Mohammad Sarim
- Department of Emergency Medicine, Shifa International Hospital, Islamabad, Pakistan
| | - Zohair Jamil Gazzaz
- Department of Medicine, Faculty of Medicine, Rabigh, King Abdul Aziz University, Jeddah, Saudi Arabia
| | - Mukhtiar Baig
- Department of Clinical Biochemistry/Medical Education, Faculty of Medicine, Rabigh, King Abdul Aziz University, Jeddah, Saudi Arabia
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Azhar A, Haider G, Naseem Z, Farooqui N, Farooqui MU, Rehman R. Morphological changes in the experimental model of polycystic ovary syndrome and effects of vitamin D treatment. J Obstet Gynaecol Res 2021; 47:1164-1171. [PMID: 33496002 DOI: 10.1111/jog.14671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/19/2020] [Accepted: 12/25/2020] [Indexed: 12/18/2022]
Abstract
AIM This research was designed to develop an animal model by inducing polycystic ovary syndrome (PCOS) with dehydroepiandrosterone (DHEA) and observe reproductive and morphological changes after treatment with vitamin D. MATERIALS AND METHODS Thirty pre-pubertal female Sprague-Dawley (SD) dams were recruited. The animals were distributed 10 each in control, PCOS and vitamin D-treated groups. In control group 0.2 ml of sesame oil was given. PCOS group was administered DHEA by the daily dose of 6 mg/kg for 30 days. In vitamin D-treated group, animals were injected 6 mg/kg/day DHEA daily and 120 ng 1, 25(OH) 2D3/100 g subcutaneously once a week. The occurrence of reproductive phenotypic PCOS was evaluated by estrous cycle, morphology and histological changes of ovary, uterus on light microscope. RESULTS The results of this study showed significant weight gain, obesity, and estrous irregularity in PCOs group as compared to control and vitamin D-treated group. CONCLUSION Administration of vitamin D (120 ng 1, 25(OH) 2D3/100) improved the cycle characteristics, reduced body weight and morphological features in PCOS induced animals. The results support the effect of vitamin D treatment for metabolic and reproductive characteristic features in PCOS females.
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Affiliation(s)
- Arfa Azhar
- Department of Biological and Biomedical Sciences, The Aga Khan University, Karachi, Pakistan
| | - Ghulam Haider
- Department of Biological and Biomedical Sciences, The Aga Khan University, Karachi, Pakistan
| | - Zehra Naseem
- Department of Biological and Biomedical Sciences, The Aga Khan University, Karachi, Pakistan
| | - Nida Farooqui
- Department of Biological and Biomedical Sciences, The Aga Khan University, Karachi, Pakistan
| | - Mohammad U Farooqui
- Department of Pharmacy, Shaeed Muhtarma Benazir Bhutto Medical University, Larkana, Pakistan
| | - Rehana Rehman
- Department of Biological and Biomedical Sciences, The Aga Khan University, Karachi, Pakistan
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45
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Tariq S, Tariq S, Tariq S, Rehman R. Relationship of BMI with Junk Food, sleep pattern, exam performance and awareness about its ill health effects in healthy teenagers. J PAK MED ASSOC 2021; 71:59-63. [PMID: 33484520 DOI: 10.47391/jpma.507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Objective To evaluate the relationship of body mass index of healthy teenagers with junk food, sleep pattern, exam performance and awareness about its ill effects. METHODS The cross-sectional study was conducted from March to June 2017 at University Medical and Dental College, University of Faisalabad, Faisalabad, Pakistan, and comprised subjects aged 13-19. Data was collected using face-to-face interviews, getting the examnation results from respective educational insititutions and calculating the body mass index, Data was analysed using SPSS 22. RESULTS Of the 226 subjects, 96(42.5%) were boys with a mean age of 15.68 ±1.83 years, and 130(57.5%) were girls with a mean age of 17.00±1.74 years. Based on body mass index, 35(15.5%) subjects were underweight, 88(39%) were normal, 28(12.4%) overweight, 56(24.7%) pre-obese and 19(8.4%) were obese. The independent predictors of body mass index were higher consumption of soft drinks in males and higher consumption of soft drinks and salt in females (p<0.05). Conclusion Teenagers were found to be well aware of the ill effects of junk food, but they were found to be happy with their dietary habits and unwilling to change it.
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Affiliation(s)
- Saba Tariq
- Department of Pharmacology, University Medical and Dental College, Faisalabad
| | - Sundus Tariq
- Department of Physiology, University Medical & Dental College, Faisalabad, Pakistan
| | - Saffee Tariq
- Rawalpindi Medical University, Rawalpindi, Pakistan
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46
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Abstract
OBJECTIVE To compare stress markers and antioxidants in fertile and infertile males, and to explore their effects on reproductive hormones and fertility. METHODS The cross-sectional case-control study was conducted from July 2017 to July 2018 at the Islamabad Clinic Serving Infertile Couples, Islamabad, Pakistan, and comprised male subjects aged 25-55 years. Infertile subjects were the cases, while healthy fertile males acted as the controls. Stress hormones cortisol and adrenaline and antioxidants glutathione peroxidase and superoxide dismutase were measured using enzyme-linked immunosorbent assay. Data was analysed using SPSS 22. RESULTS Of the 376 subjects, 241(64%) were cases and 135(36%) were controls. Median cortisol, adrenaline, superoxide dismutase and glutathione levels were significantly higher among the cases compared to te controls (p<0.05). Follicle stimulating hormone and luteinizing hormone levels were higher in cases compared to the controls (p=0.05). Mean testosterone level was higher among the controls than the cases (p<0.001). After adjusting for other covariates, every increase of 7 units in cortisol increased the prevalence of infertility by 3% (p=0.001). There was significant interaction between luteinizing hormone and testosterone in the final model (p<0.05). CONCLUSIONS Stress together with decrease in antioxidants was found to play a significant role in reducing the fertilising potential of male infertile subjects.
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Affiliation(s)
- Rehana Rehman
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Sofia Amjad
- Department of Physiology, Ziauudin University, Karachi, Pakistan
| | | | - Nida Zahid
- The Aga Khan University Hospital, Karachi
| | - Masnoon Akhter
- Department of Biological and Biomedical sciences, Aga Khan University Hospital, Karachi, Pakistan
| | - Mussarat Ashraf
- Department of Biological & Biomedical Sciences, Aga Khan University, Karachi
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Amjad S, Mushtaq S, Rehman R, Munir A, Zahid N, Siddique PQR. Protamine 1/Protamine 2 mRNA ratio in nonobstructive azoospermic patients. Andrologia 2021; 53:e13936. [PMID: 33427330 DOI: 10.1111/and.13936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 10/28/2020] [Accepted: 11/19/2020] [Indexed: 11/26/2022] Open
Abstract
Altered protamine 1 (PRM1)/ protamine 2 (PRM2) mRNA ratio in testicular biopsy samples correlates with sperm quality and its fertilising ability. This study is planned to assess PRM1/ PRM2 mRNA ratio in subgroups of azoospermia to suggest a more reliable and accurate marker for assessing sperm quality in nonobstructive azoospermia (NOA). A cross-sectional study was done on testicular biopsy samples, taken from 106 azoospermic patients. Samples were histologically classified into subgroups: 36 obstructive azoospermia (OA), and two groups of NOA: 41 round spermatid maturation arrest (SMA) and 29 Sertoli cell-only syndrome (SCOS). OA samples showed histologically normal spermatogenesis and serve as a positive control. mRNA expression of jumonji domain-containing 1A (JMJD1A), PRM1, PRM2 and transition nuclear proteins (TNP1, TNP2) genes was determined, by RT-qPCR. Significantly lower expression of JMJD1A (p < .001), PRM1 (p = .0265) and PRM2 (p = .0032) has been seen in the SCOS group of NOA. We found significant (p < .001) increase in PRM1/PRM2 mRNA ratio in testicular biopsy samples of SCOS group of NOA patients and significant negative correlation of PRM1/PRM2 mRNA ratio with JMJD1A. Hence, PRM1/PRM2 mRNA ratio may represent a more reliable and accurate marker to assess sperm quality in NOA in addition to standard semen parameters.
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Affiliation(s)
- Sofia Amjad
- Department of Physiology, Ziauddin University, Karachi, Pakistan
| | - Shamim Mushtaq
- Department of Biochemistry, Ziauddin University, Karachi, Pakistan
| | - Rehana Rehman
- Department of Biological & Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Adnan Munir
- Department of Andrology, Australian Concept Infertility Medical Center, Karachi, Pakistan
| | - Nida Zahid
- Department of Surgery, Aga Khan University, Karachi, Pakistan
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Rehman R, Fatima SS. An innovation in Flipped Class Room: A teaching model to facilitate synchronous and asynchronous learning during a pandemic. Pak J Med Sci 2021; 37:131-136. [PMID: 33437264 PMCID: PMC7794122 DOI: 10.12669/pjms.37.1.3096] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/18/2020] [Accepted: 10/08/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To conduct an on line Flipped Class Room (FCR) to facilitate synchronous (in class activity) and asynchronous learning [Virtual Learning Environment (VLE)] and acquire feedback of the learning experience from medical students at Aga Khan University. METHODS This interventional study was conducted with year II students undergoing Endocrine Reproduction Module at the Aga Khan University during April 13 to May 22, 2020. Pre reading material and pretest was shared with the students via Virtual Learning Environment (VLE) one week before the class. Microsoft Teams was used to conduct online session by two facilitators, where student discussion on case studies was encouraged. A WhatsApp group was created with the facilitators to respond to any student queries. The session was recorded and later uploaded on VLE. Posttest and a student satisfaction survey was conducted at the end of the session. RESULTS The average score for the pretest and posttest was 19.67 ± 1.37 and 24.60 ± 1.34 respectively (p value <0.05). The learner curve showed an increase in the knowledge learned by 4.93 points (p value <0.05). Fifty-five percent students felt that placement of session was appropriate and were satisfied with the instructions and expected outcomes, received constructive feedback for improvement and generated positive attitude towards learning. CONCLUSIONS The innovative model of FCR through facilitation of synchronous and asynchronous learning empowered student's engagement and interactive learning. Students perceived this as a great learning experience which they enjoyed with positive reinforcement from feedback given by the facilitators. They suggested continuation of this model for further learning sessions in other modules of undergraduate medical education at Aga Khan University.
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Affiliation(s)
- Rehana Rehman
- Rehana Rehman, PhD. Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Syeda Sadia Fatima
- Syeda Sadia Fatima, PhD. Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
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Rehman R, Alam F, Baig M, Khan AH, Ahmed N. Editorial: Vitamin D Deficiency and Sufficiency in Reproduction and Bone Metabolism. Front Endocrinol (Lausanne) 2021; 12:740021. [PMID: 34552565 PMCID: PMC8451175 DOI: 10.3389/fendo.2021.740021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 07/29/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rehana Rehman
- Department of Biological & Biomedical Sciences, Aga Khan University, Karachi, Pakistan
- *Correspondence: Rehana Rehman,
| | - Faiza Alam
- PAPRSB Institute of Health Sciences, University of Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Mukhtiar Baig
- Department of Clinical Biochemistry, Faculty of Medicine, Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Aysha Habib Khan
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Naseer Ahmed
- Department of Medicine, Rehman Medical Institute, Peshawar, Pakistan
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Siddiqi HS, Rehman R, Syed FF, Martins RS, Ibrahim MT, Alam F. Peer-Assisted Learning (PAL): An innovation aimed at engaged learning for undergraduate medical students. J PAK MED ASSOC 2020; 70:1996-2000. [PMID: 33341847 DOI: 10.5455/jpma.29714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of Peer Assisted Learning in teaching at undergraduate level and to assess its effects on Peer Leaders and Peer Learners. METHODS The cross-sectional study was conducted at the Aga Khan University, Karachi, from May to October 2017, and comprised Peer Learners who were trained by faculty members in workshops and pre-run of experiments. Students were divided into two groups; Group A had Peer Learners taught by Peer Leaders, and Group B had those taught by trained lab technologists. Knowledge of the groups was assessed by a quiz using Kahoot. Post-session feedback questionnaires were also filled by the participants. Data was analysed using SPSS 23. RESULTS There were 10 Peer Leaders with a mean age of 19.5±0.85 years, and 62 Peer Learners with a mean age of 19.08±0.81 years. Among the learners, there were 35(56.5%) males and 27(43.5%) females. Post-session assessment showed a significant difference in the test performance by the two groups (p<0.05). Feedback indicated that the learners found Peer Leaders more accessible than lab staff, leading to enhanced understanding of the subject. CONCLUSIONS Peer-Assisted Learning was found to promote learning by creating an informal student-friendly learning environment.
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Affiliation(s)
- Hasan Salman Siddiqi
- Department of Biological & Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Rehana Rehman
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Farzeen Fatma Syed
- Royal Liverpool and Broadgreen University Hospital NHS Trust, University Of Liverpool, UK
| | | | | | - Faiza Alam
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
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