Centralized healthcare database for ensuring better healthcare: Are we lagging behind?

doi: https://doi.org/10.12669/pjms.40.3.9084 How to cite this: Tariq S, Tariq S, Shoukat AA. Centralized healthcare database for ensuring better healthcare: Are we lagging behind? Pak J Med Sci. 2024;40(3):---------. doi: https://doi.org/10.12669/pjms.40.3.9084 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Osteoprotegerin genetic polymorphisms and their influence on therapeutic response to ibandronate in postmenopausal osteoporotic females

OBJECTIVES

The present study investigated osteoprotegerin (OPG) genetic polymorphisms and their influence on the therapeutic response to ibandronate in postmenopausal osteoporotic females.

METHODS

This case-control study included 135 postmenopausal females (89 osteoporotic females and 46 non-osteoporotic females). Each osteoporotic patient received a monthly 150 mg ibandronate tablet for six months, and blood samples were taken before and after treatment. Bone mineral density (BMD) was measured using DEXA Scan. Three SNPs (A163G, T245G, and G1181C) of the OPG gene were selected for analysis.

RESULTS

Serum OPG levels were significantly lower in osteoporotic subjects than in the control group. The percentage changes in OPG levels in the osteoporotic group before and after treatment with ibandronate were significant (p < .001). After six months of therapy with ibandronate, the percentage changes in OPG levels with AA, TT, TC, GC, and GG genotypes were significant. Following six months of ibandronate treatment, the AA genotype of rs3134069, TT, TC genotypes of rs3102735, GG, and GC genotypes of rs2073618 SNP showed a significant increase in OPG levels. Age, BMI, and GC polymorphism (rs2073618 (G/C) G1181C) were inversely associated with low BMD. Adjusted odds ratios (OR) showed that BMI, GC, GG polymorphism (rs2073618 (G/C) G1181C) and TC polymorphism (rs3102735 (T/C) A163G) were inversely associated with low BMD.

CONCLUSION

The inverse association of rs2073618 and rs3102735 with low BMD indicates the protective role of these SNPs in our population. More research is needed to replicate these results in another cohort and to determine the molecular processes by which such SNPs may influence BMD.

Role of meteorological parameters with the spread of Covid-19 in Pakistan: application of autoregressive distributed lag approach

This research focuses on the impacts of different meteorological parameters (temperature, humidity, rainfall, and evapotranspiration) on the transmission of Covid-19 in the administrative regions and provinces of Pakistan, i.e., Azad Jammu and Kashmir, Gilgit Baltistan, Khyber Pakhtunkhwa, Islamabad, Punjab, Sindh, and Balochistan from June 10, 2020, to August 31, 2021. This study analyzes the relation between Covid-19-confirmed cases and the meteorological parameters with the help of the autoregressive distributed lag model. In this research, additional tools (t-statistics, f-statistics, and time series analysis) are used for the motive of examining the linear relationship, the productivity of the model, and for the significant association between dependent and independent variables, lnccc and lnevp, lnhum, lnrain, lntemp, respectively. Values of t-statistics and f-statistics reveal that variables have a connection and individual significance for the model exist. Time series display that the Covid-19 spread increased from June 10, 2020, to August 31, 2021, in Pakistan. Temperature positively influenced the Covid-19-confirmed cases in all provinces of Pakistan in the long run. Evapotranspiration and rainfall influenced positively, while specific humidity influenced negatively on the confirmed Covid-19 cases in Azad Jammu Kashmir, Khyber Pakhtunkhwa, and Punjab. Specific humidity had a positive impact, while evapotranspiration and rainfall had the negative impact on the Covid-19-confirmed cases in Sindh and Balochistan. Evapotranspiration and specific humidity influenced positively, while rainfall influenced the Covid-19-confirmed cases negatively in Gilgit Baltistan. Evapotranspiration influenced positively, while specific humidity and rainfall influenced negatively on the Covid-19-confirmed cases in Islamabad.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13762-023-04997-4.

Factors leading to delayed and challenging presentation of benign breast lumps in young females

Background and Objective

A delayed presentation of benign breast diseases may lead to a therapeutic challenge when they enlarge enormously or become multiple. Aim of this study was to evaluate the factors leading to delayed presentation of benign breast lumps.

Methods

This cross-sectional study was conducted at Madinah Teaching Hospital and Allied Hospital, Faisalabad from January 2019 to October 2021. One hundred and forty five female patients were selected by non-probability purposive sampling. Patients with large size (>5cm) or multiple benign breast lumps were included. An interview was conducted using structured questionnaire translated in Urdu. Factors leading to delayed presentation and social impact scale for stigma were evaluated.

Results

Patients had a mean age of 26.52 ± 6.90 years. The average delay of seeking medical care was 8.48 ± 8.41 months. Factors leading to delayed presentation were; lack of knowledge n=112 (77.2%) and parda (religious issues) n=112 (77.2%), followed by poverty n=109 (75.2%), and fear of cancer n=90 (62.1%). All the sub-scales of stigma, i.e., social rejection, financial insecurity, internalized shame and social isolation were high in late presenters, though, only financial insecurity was significantly high in late presenters (p=0.03).

Conclusion

Lack of awareness, socioeconomic factors and disease related stigma were the main factors related to delayed presentation in young females with benign breast diseases. Addressing these factors may improve timely diagnosis and management of delayed and challenging cases.

Stress and depression among students: Are we doing enough?

doi: https://doi.org/10.12669/pjms.38.8.7076 How to cite this:Tariq S, Tariq S, Mubarak N. Stress and depression among students: Are we doing enough? Pak J Med Sci. 2022;38(8):2056-2057.  doi: https://doi.org/10.12669/pjms.38.8.7076 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Scintillation light detection in the 6-m drift-length ProtoDUNE Dual Phase liquid argon TPC

DUNE is a dual-site experiment for long-baseline neutrino oscillation studies, neutrino astrophysics and nucleon decay searches. ProtoDUNE Dual Phase (DP) is a 6  ×  6  ×  6 m 3 liquid argon time-projection-chamber (LArTPC) that recorded cosmic-muon data at the CERN Neutrino Platform in 2019-2020 as a prototype of the DUNE Far Detector. Charged particles propagating through the LArTPC produce ionization and scintillation light. The scintillation light signal in these detectors can provide the trigger for non-beam events. In addition, it adds precise timing capabilities and improves the calorimetry measurements. In ProtoDUNE-DP, scintillation and electroluminescence light produced by cosmic muons in the LArTPC is collected by photomultiplier tubes placed up to 7 m away from the ionizing track. In this paper, the ProtoDUNE-DP photon detection system performance is evaluated with a particular focus on the different wavelength shifters, such as PEN and TPB, and the use of Xe-doped LAr, considering its future use in giant LArTPCs. The scintillation light production and propagation processes are analyzed and a comparison of simulation to data is performed, improving understanding of the liquid argon properties.

POS0661 MAJOR COST SAVINGS ASSOCIATED WITH BIOLOGIC DOSE REDUCTION IN PATIENTS WITH INFLAMMATORY ARTHRITIS

Background

Anti-TNF drugs have dramatically improved the management of inflammatory arthritis (IA).

Although the introduction of biosimilars have reduced the cost, chronic use of biologic agents

has a high impact on healthcare expenditure. This study evaluated the cost effectiveness of a

dose reduction strategy for the most commonly used anti- TNF drugs over a period of 10 years

in patients with IA in remission.

Objectives

The purpose of this study was to explore whether patients with Inflammatory Arthritis (IA) (Rheumatoid Arthritis (RA), Psoriatic Arthritis (PsA) or Ankylosing Spondylitis (AS) would remain in remission after 10 year period, following a reduction in biologic dosing frequency and to calculate the cost savings associated with dose reduction.

Methods

This prospective, non-blinded, non-randomised study was commenced in 2010. Patients

with IA, Rheumatoid arthritis (RA),ankylosing spondylitis (AS) and Psoriatic arthritis (PsA)

who were in remission as defined by disease activity indices (DAS28<2.6, BASDAI<4), and

were offered Anti TNF dose reduction. Patients on etanercept were reduced from 50mg

weekly to fortnightly, adalimumab 40mg once monthly instead of fortnightly. Patients were

assessed for disease activity at 1, 4 and 10 years following reduction in dosing

frequency.Cost saving was calculated by deducting the total annual cost of the biologic

agent used over 10 years compared with the cost if the dosing interval had not changed.

Results

Seventy nine patients with inflammatory arthritis in remission were recruited. 57% had rheumatoid arthritis (n=45), 13% psoriatic arthritis (n=10) and 30% ankylosing spondylitis (n=24). 57% (n=45) were taking etanercept and 43% (n=34) adalimumab. The percentage of patients who maintained dose reduction at 10 years was 9% (n=7). Of the total 48 patients who were successfully dose reduced at year 1 (n=42), (69%, n=29) were able to maintain the dose reduction up to 4 years and 9% (n=7) maintained this dose reduction up to year 10. The estimated cost saving was €4,928 per patient per year. Estimated cost savings for 7 patients on reduced dose was €344,952.88 over 10 years.

Conclusion

Anti TNF dose reduction strategy in patients with IA results in substantial cost savings. Implementation of a dose reduction strategy while monitoring of disease activity reduces the financial impact of the use of biologic therapies. Further studies should be done to identify which patients are more likely to remain in remission while on dose reduction.

References

[1]Bonafede MM, Gandra SR, Watson C, Princic N, Fox KM. Cost per treated patient for etanercept, adalimumab, and infliximab across adult indications: a claims analysis. Adv Ther. 2012 Mar;29(3):234-48. doi: 10.1007/s12325-012-0007-y. Epub 2012 Mar 9. PMID: 22411424.

[2]Joaquín Borrás-Blasco, Antonio Gracia-Pérez, J Dolores Rosique-Robles, MD Elvira Casterá & F Javier Abad (2014) Clinical and economic impact of the use of etanercept 25 mg once weekly in rheumatoid arthritis, psoriatic arthropathy and ankylosing spondylitis patients, Expert Opinion on Biological Therapy, 14:2, 145-150, DOI: 10.1517/14712598.2014.868433

[3]Carter CT, Changolkar AK, Scott McKenzie R. Adalimumab, etanercept, and infliximab utilization patterns and drug costs among rheumatoid arthritis patients. J Med Econ. 2012;15(2):332-9. doi: 10.3111/13696998.2011.649325. Epub 2012 Jan 6. PMID: 22168788.

Disclosure of Interests

None declared

Knowledge, Awareness, and Practices Regarding the Novel Coronavirus Among a Sample of a Pakistani Population: A Cross-Sectional Study

OBJECTIVES

We aimed to investigate knowledge, attitudes, and practices regarding the new coronavirus in a sample of the general Pakistani population.

METHODS

This survey was carried out through The University of Faisalabad (TUF), Pakistan, between February 2020 and April 2020. The questionnaire was circulated on various online platforms to gather information. The data were analyzed on SPSS-22.

RESULTS

Out of 2121 respondents (13.7% were male, and 86.3% were females), 7.4% were married, 4.5% had a high income, and 5.8% had fewer family members. Coronavirus disease (COVID-19) knowledge scores were significantly low in the < 21 years age group as compared to the 21 to 25 years age group (P < 0.001) and > 25 years age group (P < 0.001). The males, married community, high income people, and few family members groups had significantly higher coronavirus knowledge than their respective groups (P = 0.033; P = 0.001; P < 0.001; P = 0.042, respectively).

CONCLUSION

Our findings suggest that the knowledge score among our study population was not up to the mark. However, a positive correlation between the correct knowledge and appropriate attitude and practice was found among study participants. Older age groups and the high income group were associated with adequate knowledge scores.

The Prevalence and Patterns of Menopausal Symptoms in Women Living with HIV

Increasing numbers of women with HIV are experiencing menopause. We use data from a large, representative sample of women with HIV to describe the prevalence and clustering of menopausal symptoms amongst pre-, peri- and post-menopausal women using hierarchical agglomerative cluster analysis. Of the 709 women included, 21.6%, 44.9% and 33.6% were pre-, peri- and post-menopausal, respectively. Joint pain (66.4%) was the most commonly reported symptom, followed by hot flashes (63.0%), exhaustion (61.6%) and sleep problems (61.4%). All symptoms were reported more commonly by peri- and post-menopausal women compared to pre-menopausal women. Psychological symptoms and sleep problems clustered together at all menopausal stages. Somatic and urogenital symptom clusters emerged more distinctly at peri- and post-menopause. We recommend regular and proactive assessment of menopausal symptoms in midlife women with HIV, with an awareness of how particular patterns of symptoms may evolve over the menopausal transition.

Effect of Ibandronate Therapy on Serum Chemerin, Vaspin, Omentin-1 and Osteoprotegerin (OPG) in Postmenopausal Osteoporotic Females

Osteoporosis is a condition in which bone mineral density is reduced due to altered bone microstructure, which results in increased skeletal fragility and incidence of various types of fractures. Adipokines such as chemerin, vaspin, omentin-1 and osteoprotegerin are involved in bone remodeling. The current study was designed to determine the changes in circulating chemerin, vaspin, omentin-1, and osteoprotegerin levels after treatment with oral ibandronate 150 mg in postmenopausal osteoporotic females. The present study enrolled 107 postmenopausal osteoporotic females from a tertiary care hospital in Faisalabad, Pakistan, based on stringent inclusion and exclusion criteria. Sixty-six healthy postmenopausal, non-osteoporotic females with no systemic illness were chosen from the general population. The assessment of bone mineral density (BMD) was done using a DEXA scan. Serum levels of chemerin, vaspin, omentin-1 and osteoprotegerin were estimated using commercially available enzyme-linked immunosorbent assay kits. The collected data were analyzed with the Statistical Package for Social Sciences (SPSS) version 24. Following 6 months of ibandronate treatment, there was a significant decrease of 24.24% (p < .033) in serum chemerin levels, as well as a significant increase in serum vaspin levels 343.32% (p < .001) and osteoprotegerin levels 19.57% (p < .001), with no significant change in omentin-1 levels. Thus, an increase in serum chemerin levels and a decrease in serum vaspin and osteoprotegerin levels could be implicated in osteoporosis.

Emotional Intelligence and Academic Performance of Students

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”.

Serum Resistin Levels and Related Genetic Variants Are Associated With Bone Mineral Density in Postmenopausal Women

BACKGROUND

Osteoporosis is a multifactorial disorder and a number of genetic variants or loci responsible for bone mineral density (BMD) have been identified. Resistin, a novel adipokine has diverse role in human body including its function in bone remodeling. The objective of this study was to see the association of serum resistin levels and related genetic variants (rs3931020, rs13144478) with BMD in postmenopausal females.

METHODS

This comparative analytical study was conducted on postmenopausal osteoporotic (n=101), osteopenic (n=77) and non-osteoporotic (n=74) females. For comparison and correlational analysis, Kruskal-Wallis test and Spearman's rho correlation were used respectively. Hardy-Weinberg equilibrium (HWE) was calculated by using Chi-square test (χ²).

RESULTS

There was significant difference in the serum levels of resistin (p <0.001), among the three groups. Significant negative correlation of resistin was observed with BMD at various sites. Serum resistin levels were significantly low in the rs3931020 AA homozygous genotype (p = 0.010), and significantly high in the rs13144478 AT heterozygous genotype (p = 0.020), BMD at all sites except left femoral neck was significantly high in rs3931020 AA genotype, while BMD at lumbar spine, left hip and total BMD were significantly low in the rs13144478 TT homozygotes.

CONCLUSION

High serum resistin levels are associated with low BMD and single nucleotide variation in rs3931020 and rs13144478 may lead to high serum resistin levels and low bone mineral density. Resistin can serve as a new genetic marker, potential therapeutic target and predictor of osteoporosis.

Association of serum levels of Visfatin, Intelectin-1, RARRES2 and their genetic variants with bone mineral density in postmenopausal females

BACKGROUND

Adipokines are engaged in bone physiology and regulate bone mineral density (BMD) by playing protective or cynical role in bone metabolism. The study is designed to measure and compare BMD, adipokines (retinoic acid receptor responder protein-2 RARRES2, visfatin and Intelectin-1) and their genetic variants in postmenopausal osteoporotic, osteopenic and non-osteoporotic females.

METHODS

This comparative study included postmenopausal non-osteoporotic (n=72), osteopenic (n=72) and osteoporotic (n=100) females with two years of amenorrhea and age between 50 to 70 years. Gold standard DXA was used to measure BMD. Hardy-Weinberg equilibrium was established. Kruskal-Wallis test for comparisons, logistic and multivariate regression analysis were used to rule out the predictors of BMD.

RESULTS

On comparing the three groups, significant differences were observed in serum RARRES2 (p <0.001) and serum visfatin (p=0.050). The significant positive predictor of BMD at lumbar spine and total hip was serum visfatin. BMD at right and left femoral neck was predicted negatively by serum chemerin while BMD at left femoral neck was also predicted positively by serum calcium levels. There was significant difference in BMD at right femoral neck (p = 0.033) between rs7806429 genotypes. The odds of having low BMD increases with increasing serum levels of chemerin and decreasing serum levels of visfatin and calcium.

CONCLUSION

The adipokines RARRES2 and visfatin are associated with BMD. RARRES2 is an independent negative and visfatin is positive predictor of BMD in postmenopausal females. BMD at right femoral neck was significantly low in RARRES2 rs7806429 TC heterozygotes.

Protection of bone mineral density in heart failure patients:audit on current clinical practice in a busy tertiary care hospital cardiology department in Ireland

Background

The strong association between heart failure (HF) and osteoporosis is well recognised. Heart failure, due to its multiple risk factors and common pathogenesis with osteoporosis can lead to low bone mineral density (BMD) and increase the risk of fragility fractures. The mortality of HF patients following these fractures is high. Current National Osteoporosis Foundation Guidelines recommend that pharmacological therapy should be reserved for postmenopausal women and men aged 50 years or older who present with a hip or vertebral fracture, where the vertebral fractures may be clinical or identified on a radiograph alone.

Methods

Most HF patients have frequent chest radiographs over their course years. We aimed to audit the prevalence of osteoporosis and current practice of prescribing BMD-protection in patients attending the HF clinic in a busy tertiary care hospital in Ireland. 100 patients attending the clinic in the last one year were randomly selected and clinical, medication and chest radiograph information on this cohort was collected via the hospital electronic information system. All those patients with Radiologist confirmed vertebral compression fractures (VCF) on their plain chest radiographs were audited regarding osteoporosis screening and bone protection prescription.

Results

Due to limited penetration,18 out of 100 chest radiographs were inconclusive,reducing the sample size to 82. 9 out of the remaining 82 patients had radiologist confirmed VCF on their plain chest radiographs whereas 2 patients had VCF incidentally picked up on their lumbar spine x-rays. All patients were aged more than 50. 4 were female and 7 male. Median ejection fraction calculated was 35%. 3 out of 11 were smokers,8 had atrial fibrillation and were on anticoagulation,4 had DM-II and 2 had CKD. 10 were on loop diuretics. Of note,4 patients were on calcium and vitamin D supplements but only 1 patient was on antiresorptive therapy for osteoporosis.

Conclusion

Despite its strong association with heart failure,Osteoporosis remains undertreated in this patient cohort.Due to the significant mortality and morbidity associated with major osteoporotic fractures, doctors should carefully assess and screen heart failure patients for osteoporosis and initiate specific therapy where indicated.

Funding Acknowledgement

Type of funding sources: None.

Prospects for beyond the Standard Model physics searches at the Deep Underground Neutrino Experiment: DUNE Collaboration

The Deep Underground Neutrino Experiment (DUNE) will be a powerful tool for a variety of physics topics. The high-intensity proton beams provide a large neutrino flux, sampled by a near detector system consisting of a combination of capable precision detectors, and by the massive far detector system located deep underground. This configuration sets up DUNE as a machine for discovery, as it enables opportunities not only to perform precision neutrino measurements that may uncover deviations from the present three-flavor mixing paradigm, but also to discover new particles and unveil new interactions and symmetries beyond those predicted in the Standard Model (SM). Of the many potential beyond the Standard Model (BSM) topics DUNE will probe, this paper presents a selection of studies quantifying DUNE's sensitivities to sterile neutrino mixing, heavy neutral leptons, non-standard interactions, CPT symmetry violation, Lorentz invariance violation, neutrino trident production, dark matter from both beam induced and cosmogenic sources, baryon number violation, and other new physics topics that complement those at high-energy colliders and significantly extend the present reach.

Relationship of BMI with Junk Food, sleep pattern, exam performance and awareness about its ill health effects in healthy teenagers

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.

Association of serum chemerin with calcium, alkaline phosphatase and bone mineral density in postmenopausal females

Objectives:

To investigate the association of serum chemerin with calcium, alkaline phosphatase and bone mineral density in postmenopausal non-osteoporotic and osteoporotic females.

Methods:

This cross-section analysis was carried out at the orthopedic department of Madina Teaching Hospital, Faisalabad, Pakistan, in the year 2017-2019. Postmenopausal females were divided into two groups according to their bone mineral density (BMD). All osteoporotic females had a T-score of -2.5 or less. Data were analyzed on SPSS-24.

Results:

A total of 140 women were included in our study (80 osteoporotic and 60 non-osteoporotic). Non significant difference in age and BMI was observed between osteoporotic and non-osteoporotic subjects (p=0.152) and (p=0.291) respectively. There was a significant difference found in total BMD, serum chemerin levels between osteoporotic and non-osteoporotic subjects p<0.001 in both parameters. No significant correlation of serum chemerin was found with serum calcium, serum alkaline phosphatase and BMD in postmenopausal osteoporotic females (p=0.907), (p=0.318) (p=0.664) respectively. A significant negative correlation was found between serum alkaline phosphatase levels and total BMD in postmenopausal osteoporotic females (p=- 0.039). Linear regression analysis of serum alkaline phosphatase levels with total BMD showed no association between BMD and serum alkaline phosphatase levels (p=0.869).

Conclusion:

There is no association of serum chemerin with calcium, ALP and bone mineral density in non-osteoporotic and osteoporotic postmenopausal females.

Perceived stress, severity and sources of stress among female medical students in a private medical college in Pakistan

OBJECTIVE

To investigate apparent stress, severity and sources of stress among female medical undergraduate students.

METHODS

The cross-sectional, questionnaire-based study was conducted at the University Medical and Dental College, Faisalabad, Pakistan, from August to December, 2016, and comprised female medical students from first year to final year. The students were divided into pre-clinical, para-clinical and clinical groups. Data was analysed using SPSS 20.

RESULTS

Of the 514 students, 271(52.7%) were in the pre-clinical group with a mean age of 19±1 years, 111(21.6%) were in the para-clinical group with mean age 20.59±0.77 years, and 132(25.7%) were in the clinical group with mean age 21.83±1.03 years. The marks of the students were negatively related with stress scores in all groups, but they were highly significant in pre-clinical year only (p0.001). Severe stressors stated by respondents were, 'raised parental expectations', 'frequent examinations', 'sleeping difficulties', 'anxiety about the future', 'quality of food in the mess', and 'accommodation away from home'.

CONCLUSIONS

The subjects showed high levels of stress. Major stressors were academic and psychosocial.

Emotional Intelligence, A predictor of undergraduate student’s academic achievement in altered living conditions

Abstract Objective: To compare the impact of trait emotional intelligence between students of different faculties and associated factors. Methods: the cross-sectional analytical study was conducted from August 2016 to March 2017 at the University of Faisalabad, Faisalabad, Pakistan, and comprised trait undergraduate students, both boarders and day scholars, from seven different faculties. Data was collected using the trait emotional intelligence questionnaire–short form. Student’s yearly test scores were obtained as a measure of academic achievement. Data was analysed using SPSS 20. Results: Of the 498 students, 109(21.9%) were studying medicine, 56(11.2%) dental sciences, 76(15.2%) optometry, 83(16.6%) nutrition and dietetics, 109(21.9%) physiotherapy, 35(7%) pharmacy, and 30(6%) social sciences. The overall mean age was 19.84±1.30 years. There were 210(42.2%) boarders compared to 288(57.8%) day scholars. There was significant difference in emotional intelligence based on student’s faculty (p<0.0001). Significant impact was seen on test scores of faculty residing status (p<0.05). Significant relation of emotional quotient and residing status with student’s test scores (p<0.05). Conclusion: Emotional intelligence was found to be an important factor in academic achievement and important variable in different faculties and different living conditions. Key Words: Achievement, Emotional intelligence, Faculty, Medical students, Social conditions. Continuous...

Association of serum osteoprotegerin with severity of chronic liver disease in female patients: A potential biomarker

Objective

To determine the association of serum osteoprotegerin (OPG) with the severity of chronic liver disease in female patients.

Methods

This case-control study was conducted in Madina Teaching Hospital from 2019-2020.An institutional review board of University Medical and Dental College, The University of Faisalabad gave the approval to conduct the study. Only female patients of age group 40 to 60 years having CLD were included in this study. Total 80 participants were enrolled after fulfilling the inclusion and exclusion criteria. Serum OPG levels were measured by enzyme linked immunosorbant assay (ELISA) supplied by ELAB Sciences, USA. The severity of disease was assessed by Child-Pugh classification.

Results

OPG levels were significantly different between the three Child-Pugh classes. OPG levels were significantly high in class C indicating increased level of this cytokine in CLD as compared to class A (p = <0.05). There was a positive association of OPG with splenomegaly (OR = 2.10, p = <0.001), hepatomegaly (OR = 4.41, (p = <0.05), skin pigmentation (OR = 2.06, p = <0.05), malena (OR = 1.87, p = <0.05) and prolonged bleeding (OR = 1.86, p = <0.05).

Conclusion

The levels of serum Osteoprotegerin is increased in severe form of chronic liver disease (Class C) of Child-Pughs classification as compared to mild (Class A) and moderate (Class B) forms of Child-Pughs classification.

Serum resistin levels as predictor of low bone mineral density in postmenopausal women

Resistin, a novel adipokine may play an important role in bone metabolism. The study is designed to discover the association of bone mineral density (BMD) with serum resistin levels, anthropometric measures and to elucidate serum resistin as a predictor of BMD in postmenopausal women. Postmenopausal women (n = 160) were recruited and divided into two groups, non-osteoporotic (n = 70) and osteoporotic (n = 90). BMD was evaluated by DXA scan. High serum resistin levels and low weight are independent contributors to low BMD and can influence BMD at lumbar spine, right femoral neck, right hip, left femoral neck, and left hip in postmenopausal women.

Venetoclax in the Treatment of Chronic Lymphocytic Leukemia: Evidence, Expectations, and Future Prospects

Chronic lymphocytic leukemia (CLL) is the most common form of leukemia in the western adult population; it is also prevalent worldwide. The B cell lymphoma-2 (BCL-2) family proteins play a key role in regulating intrinsic apoptosis and, in many cancers, are the main culprits behind tumor survival and therapy resistance. Hence, the role of BCL-2 inhibitors is very beneficial in the treatment of CLL. Venetoclax is the first selective, orally bioavailable BCL-2 inhibitor. This review article discusses factors such as the pharmacokinetics, pharmacodynamics, acquired resistance to venetoclax, responders vs. non-responders in venetoclax monotherapy, and the synergistic role of venetoclax with other drugs in detail. Venetoclax is the first BH3 mimetic drug and selective BCL-2 inhibitor that has received FDA approval. This drug has proved to provide good therapeutic responses in CLL patients irrespective of the presence of adverse clinical or genetic features, including in patients with relapsed or refractory forms of CLL. We anticipate that novel combination therapies, including venetoclax and immunotherapy, will further alter the treatment landscape for patients with relapsed CLL, particularly for those with deletion 17p (del 17p) CLL, which carries a very poor prognosis.

Association of perceived stress with healthy and unhealthy food consumption among teenagers

OBJECTIVE

To evaluate unhealthy and healthy food consumption and their association with perceived stress in teenagers.

Methods

The cross-sectional study was conducted from February to April 2017 at five educational institutions in Faisalabad, Pakistan, and comprised individuals of either gender aged 13-19 years. Dietary habits were recorded on a proforma and perceived stress scores were calculated using Cohen's perceived stress scale. Multiple regression analysis was used to predict perceived stress scores.

RESULTS

Of the226 subjects, 96(42.5%) were males and 130(57.5%) were females. The frequency of consumption per week of sweet snacks, fried foods, soft drinks, sports drinks, energy drinks and vegetables was significantly more in males compared to the females (p<0.05 each). The consumption of such unhealthy food had significant positive relationship with perceived stress scores, while consumption of healthy food, like fresh fruits and vegetables, had a significant negative relationship with it in males only (p<0.05 each). Perceived stress score was primarily predicted by higher consumption of sports drinks (p<0.05) and lower consumption of fresh fruits (p<0.05).

CONCLUSIONS

Increased consumption of unhealthy food items and low intake of healthy food could lead to stress in young individuals, especially in males.

The association between severe menopausal symptoms and engagement with HIV care and treatment in women living with HIV

Using data from the PRIME Study, an observational study of the menopause in women living with HIV in England, we explored the association between menopausal symptoms and: (i) antiretroviral therapy (ART) adherence and (ii) HIV clinic attendance. We measured menopausal symptom severity with the Menopause Rating Scale (MRS, score ≥17 indicating severe symptoms), adherence with the CPCRA Antiretroviral Medication Adherence Self-Report Form, and ascertained HIV clinic attendance via self-report. Odds ratios were obtained using logistic regression. Women who reported severe menopausal symptoms had greater odds of suboptimal ART adherence (adjusted odds ratio (AOR) 2.22; 95% CI 1.13, 4.35) and suboptimal clinic attendance (AOR 1.52; 95% CI 1.01, 2.29). When psychological, somatic and urogenital domains of the MRS were analysed individually there was no association between adherence and severe symptoms (all p > 0.1), however there was an association between suboptimal HIV clinic attendance and severe somatic (AOR 1.98; 95% CI 1.24, 3.16) and psychological (AOR 1.76; 95% CI 1.17, 2.65) symptoms. Severe menopausal symptoms were significantly associated with sub-optimal ART adherence and HIV clinic attendance, however we cannot infer causality, highlighting the need for longitudinal data.

"Support for the supporters": a qualitative study of the use of WhatsApp by and for mentor mothers with HIV in the UK

Third-sector organizations, an important support for people living with HIV, increasingly use digital technology to improve service efficiency and reach. However, there is limited empirical evidence on this use by women living with HIV. The 4M Network (4MNet) is a peer-run UK-wide network of trained Mentor Mothers (MMs) living with HIV; it uses the WhatsApp platform as its primary digital communication tool. We report on a qualitative study about 4MNet MMs' experiences of using WhatsApp, to inform the design of future digital support services. Seven telephone interviews were conducted with five MMs and two project management team (PMT) members in February 2019. Interviews were analyzed using Interpretive Phenomenological Analysis (IPA). WhatsApp was found to have several key features that provided both positive and negative use considerations. WhatsApp eased communication among MMs and supported participation in group activities despite differing schedules and geographic locations. Challenges encountered with WhatsApp included: financial restrictions to data storage and continual access; self-confidence using technology; and security and privacy concerns. Peer-led digital communication is found to be acceptable and effective for women living with HIV. Understanding barriers and valued features of existing digital platforms increasingly used among potentially marginalized groups is vital for informing inclusive innovation.

Association Between Vitamin D and Resistin in Postmenopausal Females With Altered Bone Health

BACKGROUND

Resistin is a relatively novel adipokine that has a role in bone remodeling and may regulate bone mineral density (BMD). Vitamin D and adipokines have a dynamic role in the body's various metabolic processes, including bone metabolism, and may alter bone metabolism in relation to each other. This study aimed to investigate the association between vitamin D and serum resistin levels in postmenopausal non-osteoporotic and osteoporotic females.

METHODS

This correlational analytical study was conducted on 161 postmenopausal females, divided into two groups, non-osteoporotic and osteoporotic, between 50-70 years. Bone mineral density (BMD) was assessed by dual-energy X-ray absorptiometry (DXA) scan. Serum resistin and vitamin D levels were analyzed by enzyme-linked immunosorbent assay (ELISA) method. Serum calcium, phosphate, and alkaline phosphatase with spectrophotometry. A correlation was checked using spearman's rho correlation coefficient, and multivariate stepwise regression analysis was used to predict serum resistin levels.

RESULTS

Postmenopausal females (n=161) having sufficient, insufficient and deficient levels of vitamin D were 87 (54.0%), 64 (39.8%), and 10 (6.2%), respectively. Lumbar spine BMD (p < 0.001), total hip BMD (p < 0.001), and serum resistin levels (p < 0.001) were significantly different between the two groups. There was a significant negative correlation between serum resistin and vitamin D in postmenopausal females (rho = -0.182, p = 0.021) and osteoporotic group (rho = -0.253, p = 0.019) but non-significant in non-osteoporotic group (rho = -0.077, p = 0.509). Serum vitamin D was found to be independent predictor of serum resistin levels, accounting for only 3% variance.

CONCLUSION

Serum vitamin D levels were low while serum resistin levels were high in postmenopausal osteoporotic females and vitamin D is a negative predictor of serum resistin levels.

Thermal, electro-magnetic and thermoelectric investigation of CoNb1-x Ti x Sn (x = 0, 0.75, 0.5, 1) half-Heusler alloy

In this work, structural, thermal, electro-magnetic and thermoelectric attributes of CoNb_1-x Ti _x Sn (x  =  0, 0.75, 0.5, 0.25, 0) alloys have been investigated using density functional theory (DFT). The structural reforms, brought to CoNbSn, portray the increase in its rigidity when increasing the Ti content substituted at the Nb site. They also remodel the character of the alloy from semiconducting paramagnetic to half-metallic ferromagnetic nature. By investigating elastic properties that are interlinked with structural optimizations and enthalpy of formation, studied alloys displayed stable structure. Thermoelectric properties such as Seebeck coefficient (S), electrical conductivity (σ/τ) and power factor (S ² σ/τ), are calculated based on the Boltzmann transport theory. Results revealed that for x  =  0.75 in CoNb_1-x Ti _x Sn, a temperature dependent switch from n-type to p-type is observed. According to the results obtained, CoNb_1-x Ti _x Sn alloys could have potential thermoelectric applications.

Alkaline phosphatase is a predictor of Bone Mineral Density in postmenopausal females

Objectives:

The study was planned to determine whether serum calcium, phosphate and alkaline phosphatase (ALP) are predictors of bone mineral density (BMD) in postmenopausal non-osteoporotic, osteopenic, and osteoporotic females.

Methods:

In this cross sectional study, conducted at Shaikh Zayed Hospital, Lahore in the year 2014-2015, postmenopausal females between 50-70 years of age were taken and divided into three groups non-osteoporotic (n=52), osteopenic (n=69) and osteoporotic (n=47). Serum ALP, phosphate and calcium were used in a stepwise multiple regression analysis to predict T-score in these groups.

Results:

In normal postmenopausal females, the prediction model was statistically significant, F(2, 41) = 6.041, p < 0.05 and showed a T-score variance of 22%. T-score was primarily predicted by higher levels of phosphate and calcium. In postmenopausal osteopenic females, T-score was only predicted by lower levels of ALP. The model was statistically significant, F(1, 59) = 4.995, p < 0.05, and accounted for approximately 7% of the variance of T-score. In postmenopausal osteoporotic females, the prediction model contained no predictors.

Conclusion:

Our study suggested that calcium and phosphate are the strongest predictors of T-score in postmenopausal normal females, while in postmenopausal osteopenic females ALP was the strongest predictor of T-score. Elevated serum ALP levels may help in determining loss of BMD in postmenopausal females.

Status of bone health and association of socio-demographic characteristics with Bone Mineral Density in Pakistani Females

Background & Objective:

The “silent thief” of bone osteoporosis is associated with various modifiable factors, identifying these factors is important in decreasing the prevalence of this highly prevalent disease. Therefore, this study was planned to identify these risk factors for osteoporosis in premenopausal and postmenopausal Pakistani women.

Methods:

A total of 1205 pre and postmenopausal females between the ages of 20 to 80 years were selected. Detailed history about the socio-demographic characteristics including age, education, profession, marital and resident status was recorded. Medical and gynecological history was also taken after informed consent Bone health of females was assessed using calcaneal ultrasound bone densitometer. SPSS 22.0 was used to analyze data.

Results:

Univariate analysis showed that age (30-39 yrs, and 60-69 yrs), occupation (housewives) and education (secondary and primary education, illiterate) were significantly associated with low bone mass density (LBMD). Multivariate analysis showed that age 30-39 years (OR=0.25 95%CI 0.13 – 0.49), age 40-49 years (OR=0.30 95%CI 0.15 – 0.59), age 50-59 years (OR=0.42 95%CI 0.22 – 0.79), primary education (OR=3.83, 95%CI 2.30 - 6.38) and illiteracy (OR=3.83 95%CI 2.52 – 5.82), were significantly associated with LBMD. The prevalence of osteopenia and osteoporosis was 29.8%, 27.2%, respectively, while 43% subjects had normal BMD.

Conclusion:

It is concluded that, within Pakistani population, the prevalence of osteopenia is high even at an early age group and the odds of having LBMD are more in less educated or illiterate women.

Association between leptin, obesity, hormonal interplay and male infertility

Male infertility is a major health problem worldwide. We investigated a possible association between leptin, obesity, hormonal interplay and male infertility. This cross-sectional study of 313 males (178 infertile and 135 fertile) was carried out in 2017. The subjects were categorised by body mass index (BMI) and body fat percentage (BF%) into normal weight, overweight and obese. Significantly higher levels of BMI and BF% (p-value < 0.001) and lower levels of FSH, LH, testosterone, and SHBG (p-value < 0.001) were found in infertile males. However, no significant difference was observed in leptin levels (p-value = 0.35). Leptin levels were significantly higher, and all the sex hormones were significantly lower (p-value < 0.001) in obese subjects, whereas according to BF% only leptin, FSH and SHBG were significantly different. Leptin showed a significant positive correlation with BMI and BF% (p < 0.001). A strong positive link to serum testosterone was found with age, FSH, and LH (p < 0.001) and a negative one with BMI and BF% (p < 0.001). In mutivariable anlaysis, after adjusting for the other covariates, a significant association between FSH and testosterone (p-value <0.001) was found. Serum leptin levels did not differ significantly in fertile and infertile groups, and no association was found with infertility. Furthermore, male obesity was found to be associated with infertility with the decrease in levels of sex hormones.

Interplay of vitamin D, vitamin B12, homocysteine and bone mineral density in postmenopausal females

Osteoporosis is most common age related, multifactorial disease. The aim of the researchers were to discover the association between serum homocysteine, vitamin D, vitamin B₁₂ and bone mineral density in postmenopausal non-osteoporotic and osteoporotic females. In this cross- sectional study, 156 postmenopausal females between 50-70 years of age were recruited and divided into two groups, non-osteoporotic (n = 52) and osteoporotic (n = 104). There was significant negative correlation of homocysteine with vitamin D and B₁₂ in postmenopausal non-osteoporotic and homocysteine with vitamin B₁₂ in postmenopausal osteoporotic females. Serum homocysteine levels were predicted by vitamin D in postmenopausal non-osteoporotic and vitamin B₁₂ in postmenopausal osteoporotic females.

Role of water chemistry and stabilizers on the Vero-cells-based infectivity of Newcastle disease virus live vaccine

Newcastle disease virus (NDV) live vaccines are supplied in lyophilized form and usually administered through conventional routes (drinking water, spray, or eye drop) following reconstitution in a diluent. Virus inactivation due to physico-chemical properties of the diluent at the time of administration may lead to vaccine failure. The present study aimed to evaluate the survival of NDV live vaccine strain immersed in 5 pH-amended water samples (pH 5.00, pH 6.00, pH 7.00, pH 8.00, and pH 9.00) by sequential determination of virus infectivity on Vero cells for 3 hours. Minimum reduction in virus infectivity was recorded in the water with neutral or slightly alkaline pH, while the virus was relatively less stable at extreme pH conditions. Maximum reduction of infectivity was observed in the water with pH 9.00 in which the virus was completely inactivated within 3 hours. Addition of stabilizers (Cevamune^® or skimmed milk) slightly altered the pH and total dissolved solids (TDS) values of the virus-charged water samples. In the stabilizer-added water samples, minimum reduction in infectivity was observed in the water with neutral pH, followed by the ones with a pH of 8.00, 6.00, 5.00, and 9.00. In all types of water samples, T-90 values (time required for 90% reduction in virus infectivity) were highest (485 minutes) at neutral pH (pH 7.00) and lowest (102 to 134 min) at an extreme alkaline condition (pH 9.00). Results of the present study indicate that water with a pH range of 7.00 to 8.00 is suitable for administration of NDV live vaccines. However, the addition of Cevamune^® or skimmed milk may have beneficial effects on preserving the infectivity of the virus, even at extreme pH conditions.

TENNIS ELBOW

Introduction: Lateral epicondylitis, also called as Tennis Elbow is the primarycause of musculo-skeletal ache including extensor origin of forearm. Repetitive movements areconsidered to be the root cause of this disorder. This disorder involves overexertion of fingers andwrist extensors that causes significant disability ultimately affecting the quality of life. The basisfor diagnosing lateral epicondylitis is very clear clinically. The strategy of injecting steroid locallyhas proven to dispense predictable and consistent transient relief of pain. Recent treatmentinvolve Platelet Rich Plasma (PRP) administration locally. Study Design: Prospective study.Period: 01-07-2014 to 30-06-2016. Setting: Department of Orthopedic Surgery Allied /DHQHospital Faisalabad. Subject and Methods: Total of 38 patients aging 25-60 years belongingto either gender with Lateral Epicondylitis who met inclusion criteria were enrolled in this studyand divided in two (2) groups A and B. The group which was treated with steroid injection waslabeled as A and group B comprised of patients which were treated with prepared PRP injection.Outcome was analyzed on the basis of Visual Analogue Scale of pain and functional outcomeusing qDash scores at baseline, 6 weeks and 12 weeks. Results: In Group A, baseline VASwas 7.3 + 2.1 and q DASH was 83+1.2. At 6 weeks and 12 weeks VAS was 5.3+ 3.1 and 6.1+1.2 respectively. qDash scores were 78 + 4.2 and 63 + 1.6 at 6 and 12 weeks respectively.In Group B VAS was 7.2+ 2.2, 5.3 +1.3, 3.2+ 1.2 at baseline, 6 weeks and 12 weeks. WhileqDash Scores were 81+3.2, 74+3.7, 58+1.2 at baseline, 6 weeks and 12 weeks respectively.Conclusion: Steroid and PRP are effective equally for treating lateral epicondylitis. Accordingto this study, PRP is ranked superior to steroid for its long term effectiveness in controlling painand improve functional outcome.

Evolution of pH buffers and water homeostasis in eukaryotes: homology between humans and Acanthamoeba proteins

Aim: This study intended to trace the evolution of acid–base buffers and water homeostasis in eukaryotes. Acanthamoeba castellanii  was selected as a model unicellular eukaryote for this purpose. Homologies of proteins involved in pH and water regulatory mechanisms at cellular levels were compared between humans and A. castellanii. Materials & methods: Amino acid sequence homology, structural homology, 3D modeling and docking prediction were done to show the extent of similarities between carbonic anhydrase 1 (CA1), aquaporin (AQP), band-3 protein and H+ pump. Experimental assays were done with acetazolamide (AZM), brinzolamide and mannitol to observe their effects on the trophozoites of  A. castellanii. Results: The human CA1, AQP, band-3 protein and H+-transport proteins revealed similar proteins in Acanthamoeba. Docking showed the binding of AZM on amoebal AQP-like proteins.  Acanthamoeba showed transient shape changes and encystation at differential doses of brinzolamide, mannitol and AZM.  Conclusion: Water and pH regulating adapter proteins in Acanthamoeba and humans show significant homology, these mechanisms evolved early in the primitive unicellular eukaryotes and have remained conserved in multicellular eukaryotes.

Knowledge and attitude of blood donation among female medical students in Faisalabad

OBJECTIVE

To assess the knowledge, practices and attitude of medical students towards blood donation.

METHODS

This cross-sectional study was conducted at the University of Faisalabad, Faisalabad, Pakistan, from April to August 2016, and comprised female medical students. Multi-stage sampling technique was employed. A structured questionnaire was included as data-collection tool. Statistical analysis was done using SPSS 20.

RESULTS

Of the 500 students, 469(93.8%) responded to the questionnaire. Of them, 419(89.3%) females had never donated blood and only 2(0.4%) were regular voluntary donors. The best source from which the participants heard about blood donation was friends 259(55.2%). When coming to reasons for not donating blood, there was significant association of many factors like fear (p <0.001), the collection facility being far from the place (p <0.001), not having enough time to donate (p <0.001). Of the 50(10.7%) respondents who had ever donated blood, 48(96%) said the main motivator was saving lives of the people.

CONCLUSIONS

Female medical students were aware of the basic knowledge about blood donation.

Evaluation of Cognitive levels and Item writing flaws in Medical Pharmacology Internal Assessment Examinations

OBJECTIVES

This study aimed to evaluate the cognitive levels of Multiple Choice Questions (MCQs) & Short Answer Questions (SAQs) and types of Item Writing Flaws (IWFs) in MCQs in Medical Pharmacology internal assessment exams.

METHODS

This descriptive, study was conducted over a period of six months, from December 2015 to May 2016 and evaluated six internal assessment examinations comprising SAQs and MCQs. A total of 150 MCQs and 43 SAQs were analyzed. These questions were administered to third-year medical students in the year of 2015. All SAQs were reviewed for their cognitive levels and MCQs were reviewed for cognitive levels as well as for IWFs. Items were classified as flawed if they contained one or more than one flaw. The cognitive level of the questions was determined by the modified Bloom's taxonomy.

RESULTS

The proportion of flawed items out of 150 items in six exams ranged from 16% to 52%. While the percentage of total flawed items was 28%. Most common types of flaws were implausible distractors 19.69% (26), extra detail in correct option 18.18% (24), vague terms 9.85% (13), unfocused stem 9.09% (12) and absolute terms 9.09% (12). The two-third of MCQs 97(64.67%) were assessing the recall of information, while 29 (19.33%) and 24 (16%) were assessing the interpretation of data and problem-solving skills respectively. The majority of the SAQs (90.7%) were assessing recall of the information and only 9.3% were assessing interpretation of data while none of the questions was assessing the problem-solving skills.

CONCLUSIONS

The cognitive level of assessment tools (SAQs & MCQs) is low, and IWFS are common in the MCQs. Therefore, faculty should be urged and groomed to design problem-solving questions which are devoid of any flaws.

Frequency of different blood groups and its association with BMI and blood pressure among the female medical students of Faisalabad

OBJECTIVE

To determine the frequency of different blood groups among female medical students and to find the association of blood groups and body mass index with blood pressure.

METHODS

This cross-sectional study was performed at the University Medical and Dental College, Faisalabad, Pakistan, from March to April 2016, and comprised female medical students. Participants were divided into groups on the basis of their ABO blood groups and on body mass index criteria. Blood groups were determined by simple conventional slide method. Blood pressure was estimated by manual auscultatory technique with a mercury sphygmomanometer. Data was analysed usingSPSS20.

RESULTS

There were 145 students with an overall mean age of18.4±0.75 years (range: 17-23 years). Blood group B was the predominant group 65(44.8%). Besides, 130(89.6%) subjects were rhesus positive and 23(53%) subjects of blood group O were pre-hypertensive. Multiple regression analysis indicated significant positive association of blood group O with both systolic and diastolic blood pressure (p=0.002, 0.001). However, subsequent logistic regression showed significant association only with diastolic blood pressure (p=0.001). Relative risk of pre-hypertension for obese (p=0.001) was greater than non-obese subjects. Body mass index was significantly associated with both systolic and diastolic blood pressure (p=0.004, 0.042).

CONCLUSIONS

Blood group B was the most common blood group. Blood group O was associated with diastolic pre-hypertension, while body mass index was associated with both systolic and diastolic pre-hypertension.

Frequency of nutritional anemia among female medical students of Faisalabad

BACKGROUND AND OBJECTIVE

Anemia is a common health problem worldwide. This problem is most commonly faced by 18 to 25 years of females. Medical students especially female hostelites poses high risk of anemia because of their poor eating habits, breakfast skipping, long schedule in college, burden of medical studies, clinical postings, and extra-curricular activities. Therefore the current study was designed to determine the hemoglobin status in young female medical students. We also elucidate its association with BMI.

METHODS

A cross sectional study was conducted at The University of Faisalabad during December 2015 to February 2016. A total of 221 female students were recruited by convenient sampling technique. All relevant information about participants was taking by administering structured questionnaire. Participants were categorized as hostelities and day scholars for comparison. Study subjects were also sub grouped on the bases of their BMI. Hemoglobin, MCV, MCH and MCHC were estimated at Madina Teaching Hospital Faisalabad. Statistical analysis was performed on SPSS 20.

RESULTS

Mean age of the study subjects was 19.92 ±0.93. 33.4% of the students were found to be anemic. Significantly high number of hostelites (39.2%) were anemic as compared to day scholars (23.1%) (P value= 0.015*). On analyzing by BMI categories, greater number of underweight subjects was found to be anemic as compared to normal and overweight subjects.

CONCLUSION

Anemia is more prevalent in hostelites as compared to day scholar female medical students which might also affect the efficiency of these students.

Association of serum leptin with bone mineral density in postmenopausal osteoporotic females

OBJECTIVE

Present study was designed to find out whether leptin is a predictor of bone mass density (BMD) in premenopausal women (PMW) and postmenopausal osteoporotic women (PMOPW) or it has no association with BMD.

METHODS

One hundred and ninety two women (98 PMOPW and 94 PMW) were recruited for this study. The control group was BMI matched with osteoporotic subjects. BMD assessment was done on calcaneus by peripheral ultrasound bone densitometry and T scores were determined. Serum leptin levels were measured by enzyme-linked immunosorbent assay (ELISA).

RESULTS

Serum leptin and BMD values were significantly different in both groups (leptin, 18.56 ± 8.65 ng/ml versus 21.64 ± 9.80 ng/ml, p = 0.02) and (BMD, -0.70 ± 0.19 versus -3.17 ± 0.59, p = 0.000), respectively. In PMOPW serum leptin and BMD were considerably correlated with weight (lep, r = 0.53, p = <0.001; BMD, r = -0.21, p = 0.02), BMI (lep, r = 0.52, p = <0.001; BMD, r = -0.27, p = 0.005), waist circumference (lep, r = 0.61, p = <0.001; BMD, r = 0.18, p = 0.04), hip circumference (lep, r = 0.58, p = <0.001). Multivariate linear stepwise regression analysis showed that weight and BMI in PMW and PMOPW were independent predictors of BMD. Serum leptin level was not found to be the predictor of BMD in both groups.

CONCLUSION

The present results indicate that body weight and BMI have an impact on BMD while serum leptin is not associated with BMD in PMW and PMOPW.

Relationship of anthropometric measures with bone mineral density in postmenopausal non-osteoporotic, osteopenic and osteoporotic women

BACKGROUND AND OBJECTIVES

Body mass index (BMI) has been shown to be a more important predictor of bone mineral density (BMD). The objective of this study was to investigate the relationship of anthropometric measures including body mass index with bone mineral density in postmenopausal non-osteoporotic, osteopenic and osteoporotic women.

METHODS

In this cross sectional study postmenopausal females between 50-70 years of age were recruited and divided into three groups: non-osteoporotic (n=52), osteopenic (n=69) and osteoporotic females (n=47). Anthropometric measures and bone mineral density were assessed. ANOVA was applied to compare groups while Post hoc Tuckey's test was used for multiple comparisons between the groups. Spearman's rho correlation was used to establish correlations.

RESULTS

Body mass index (p = 0.034) and hip circumference (p = 0.013) were significantly higher in osteopenic as compared to osteoporotic females and waist to hip ratio was significantly higher (p = 0.005) in osteoporotic as compared to non-osteoporotic females. Significant positive correlation of body mass index was found with T-score (p = 0.022) and ultrasound bone profile index (p< 0.001) in postmenopausal females.

CONCLUSIONS

High body mass index is associated with high bone mineral density and reduced fracture risk in postmenopausal females. Increasing age and high waist to hip ratio can also lead to reduced bone mineral density in postmenopausal females.

Mid-luteal estradiol levels of poor/good responders and intracytoplasmic sperm injection

Objective:

To assess mid-luteal estradiol (E2) levels in poor and good responders and determine its effect on the outcome after intracytoplasmic sperm injection (ICSI).

Methods:

The current study was carried out in females who underwent ICSI from June 2011 to September 2013 in “Islamabad Clinic Serving Infertile Couples”. They were categorized into good and poor responders on the basis of female age ≤40 years, basal follicle stimulating hormone ≤12 mIU/ml, and antral follicle count >5, respectively. Their mid-luteal E2 measured on the day of embryo transfer was stratified into groups (A-E) on the basis of 20th, 40th, 60th and 80th percentile values. The outcome was categorized into non-pregnant with beta human chorionic Gonadotrophin (hCG) 5-25 m IU/ml, and clinical pregnancy with beta hCG>25 m IU/ml.

Results:

The conception rate was 12% (63/513) in poor responders and 72% (237/329) in good responders respectively. The mid-luteal E2 levels were higher in conception as compared to non-conception cycles (p<0.001) in good and poor responders.

Conclusion:

Maximum pregnancies in poor and good responders (53% and 98% respectively) with mid-luteal E2 levels above 80^th percentiles confirm the role of the increase in mid-luteal E2 for augmentation in conception rate of females after ICSI.

Comparison of parameters of bone profile and homocysteine in physically active and non-active postmenopausal females

BACKGROUND AND OBJECTIVES

Optimal physical activity is important in attaining a peak bone mass. Physically active women have better bone mineral density and reduce fracture risk as compared to females living a sedentary life. The objective of this study was to compare parameters of bone profile and serum homocysteine levels in physically active and non-active postmenopausal females.

METHODS

In this cross sectional study postmenopausal females between 50-70 years of age were recruited and divided into two groups: Physically inactive (n=133) performing light physical activity and Physically active (n=34) performing moderate physical activity. Physical activity (in metabolic equivalents), bone mineral density and serum homocysteine levels were assessed. Spearman's rho correlation was applied to observe correlations. Two independent sample t test and Mann Whitney U test were applied to compare groups. P-value ≤ 0.05 was taken statistically significant.

RESULTS

Parameters of bone profile were significantly higher and serum homocysteine levels were significantly lower in postmenopausal females performing moderate physical activity as compared to females performing light physical activity. Homocysteine was not significantly related to T-score and Z-score in both groups.

CONCLUSION

Improving physical activity could be beneficial for improving the quality of bone, decreasing fracture risk and decreasing serum homocysteine levels.

First Measurement of Electron Neutrino Appearance in NOvA

We report results from the first search for ν_{μ}→ν_{e} transitions by the NOvA experiment. In an exposure equivalent to 2.74×10^{20} protons on target in the upgraded NuMI beam at Fermilab, we observe 6 events in the Far Detector, compared to a background expectation of 0.99±0.11(syst) events based on the Near Detector measurement. A secondary analysis observes 11 events with a background of 1.07±0.14(syst). The 3.3σ excess of events observed in the primary analysis disfavors 0.1π<δ_{CP}<0.5π in the inverted mass hierarchy at the 90% C.L.

Successful fertility treatment with gonadotrophin therapy for male hypogonadotrophic hypogonadism

Gonadotrophin therapy with human chorionic gonadotrophin and recombinant FSH is indicated for use in men with reduced spermatogenesis due to hypogonadotrophic hypogonadism (HH). Patients require regular monitoring for side effects and desired response to treatment. We present a man with HH, azoospermia and a history of previous anabolic steroid usage who had undergone gonadotrophin therapy, had subsequently achieved conception and has now fathered a child.