Introducing the 'Benign Eyelid Lesion Pathway': 1 year experience of synchronous tele-oculoplastics in a tertiary hospital.

BACKGROUND: Patients with benign eyelid lesions make up a large proportion of referrals to the oculoplastic service and lend themselves well to telemedicine with assessments heavily reliant on history, observation-based examination and photographs to enable management decision-making. Our tertiary unit set up tele-oculoplastics clinics for all new patients referred for benign eyelid lesions comprising tele-consultation with antecedent patient photograph: Benign Eyelid Lesion Pathway (BELP). One year on, we describe a retrospective analysis of 974 patients looking at distinct parameters of effectiveness. METHODS: We retrospectively collected data from electronic patient records (EPR) for BELP patients from July 2020 to August 2021 (n = 974). We analysed time efficiency (referral time to treatment plan, consultation duration in minutes, average waiting times, number of patients seen per clinician and DNA rate), accessibility, safety (via video surveillance clinic) and theatre utilisation. RESULTS: 57.3% (n = 558) were listed for a surgical procedure direct from tele-consultation with 94.9% (n = 513) of these proceeding to surgery; 22.8% (n = 222) were discharged, 10.7% (n = 104) had further video follow-up and 6.7% (n = 65) required face-to-face follow-up. Our results showed efficient referral-to-treatment times, waiting times, consultation times and non-attendance rate. There was only a 2.57% non-attendance rate. There was no missed diagnosis of a malignancy of a presumed benign lesion. CONCLUSION: Tele-oculoplastics provides a streamlined, safe, effective, and logistically convenient way to review benign eyelid lesions. With the increased waiting times for referral to biopsy of eyelid lesions, this clinic shows it is imperative to provide digital accessibility for patient assessment and booking to operating theatre.

Effects of varying levels of gonadotropins and estrogen in adolescent females having type 1 diabetes with their impact on health-related quality of life in Karachi Pakistan.

The purpose of this study is to evaluate quality of life, the gonadotropins and estrogen levels in type 1 diabetic adolescent females. This cross-sectional study was conducted at Baqai Institute of Diabetology and Endocrinology (BIDE). The Diabetes quality of life for youth questionnaire (DQOLY) was used to evaluate quality of life. FSH was found to be significantly lower in Type 1 Diabetes. HbA1c had a significant inverse moderate correlation with FSH(-0.300*).In Type 1 Diabetes, FSH had a positive moderate correlation with LH(0.415*), (P-value<0.05). LH and estradiol levels were almost similar in both groups. Overall mean percentage score of DQOLY questionnaire for Type 1 Diabetes was 26.94±1.36. Low QOL score was observed on the basis of impact on activities. Adolescent females with Type 1 Diabetes were found to be shorter and underweight than non-diabetic adolescent females. Lower height and weight of the diabetes as compared to controls cannot be attributed to only metabolic control, suggesting other mechanisms for short stature. Control on metabolism has always been the target for diabetes treatment for ensuring the improved prognosis of disease but also for the quality of life in Type 1 diabetes.

An analysis of the Kozak consensus in retinal genes and its relevance to gene therapy.

Purpose: The classic Kozak consensus is a critical genetic element included in gene therapy transgenes to encourage the translation of the therapeutic coding sequence. Despite optimizations of other transgene elements, the Kozak consensus has not yet been considered for potential tissue-specific sequence refinement. We screened the -9 to -1 region relative to the AUG start codon of retina-specific genes to identify whether a Kozak consensus that is different from the classic sequence may be more appropriate for inclusion in gene therapy transgenes that treat inherited retinal disease. Methods: Sequences for 135 genes known to cause nonsyndromic inherited retinal disease were extracted from the NCBI database, and the -9 to -1 nucleotides were compared. This panel was then refined to 75 genes with specific retinal functions, for which the -9 to -1 nucleotides were placed in front of a GFP transcript sequence and RNAfold predictions performed. These were compared with a GFP sequence with the classic Kozak consensus (GCCGCCACC), and sequences from retinal genes with minimum free energy (MFE) predictions greater than the reference sequence were selected to generate an optimized Kozak consensus sequence. The original Kozak consensus and the refined retina Kozak consensus were placed upstream of the Renilla luciferase coding sequence, which were used to transfect retinoblastoma cell lines Y-79 and WERI-RB-1 and HEK 293T/17 cells. Results: The nucleotide frequencies of the original panel of genes were determined to be comparable to the classic Kozak consensus. RNAfold analysis of a GFP transcript with the classic Kozak sequence in the 5' untranslated region (UTR) generated an MFE prediction of -503.3 kcal/mol. RNAfold analysis was then performed with a GFP transcript containing each -9 to -1 Kozak sequence of 75 retinal genes. Thirty-eight of the 75 genes provided a greater MFE value than -503.3 kcal/mol and exhibited an absence of stable secondary structures before the AUG codon. The -9 to -1 nucleotide frequencies of these genes identified a Kozak consensus of ACCGAGACC, differing from the classic Kozak consensus at positions -9, -5, and -4. Applying this sequence to the GFP transcript increased the MFE prediction to -500.1 kcal/mol. The newly identified retina Kozak sequence was also applied to Renilla luciferase plus the REP1 and RPGR transcripts used in current clinical trials. In all examples, the predicted transcript MFE score increased when compared with the current transcript sequences containing classic Kozak consensus sequences. In vitro transfections identified a 7%-9% increase in Renilla activity when incorporating the optimized Kozak sequence. Conclusions: The Kozak consensus is a critical element of eukaryotic genes; therefore, it is a required feature of gene therapy transgenes. To date, the classic sequence of GCCRCC (-6 to -1) has typically been incorporated in gene therapy transgenes, but the analysis described here suggests that, for vectors targeting the retina, using a Kozak consensus derived from retinal genes can provide increased expression of the target product.

Fasting Glucagon Level in Type 2 Diabetes and Impaired Glucose Tolerance and Its Association With Diabetes-Associated Clinical Parameters: A Study From Karachi, Pakistan.

Aim and objective The study aims to analyze fasting glucagon in patients with type 2 diabetes and impaired glucose tolerance and correlate it with anthropometric and biochemical parameters in a large proportion of Pakistani people with diabetes.  Methodology The participants of the study were categorized into three groups based on oral glucose tolerance test, as per American Diabetes Association guidelines. Group A consisted of normal glucose tolerance subjects (n=30), Group B consisted of subjects with impaired glucose tolerance (n=30), and Group C had full-blown subjects with type 2 diabetes (n=30). Biochemical parameters, such as fasting glucagon, fasting plasma and 2-hour glucose, glycated hemoglobin, and lipid profile, and anthropometric parameters, such as body mass index (BMI), waist and hip circumference, waist-to-hip ratio, and systolic and diastolic blood pressure, were measured. Results The mean values of fasting glucagon level in Group A, Group B, and Group C were 39.24±4.5, 44.5±8.25, and 49.02±9.15 pg/ml, respectively. Statistically significant difference was not found in fasting glucagon level among these groups (p-value 0.614). Fasting glucagon was positively and independently correlated with 2-hour plasma glucose, systolic blood pressure, diastolic blood pressure, BMI, hip and waist circumference, and hip-to-waist ratio in Group C. In Group B, fasting glucagon was positively correlated with 2-hour plasma glucose, BMI, and hip circumference, while it was not correlated with fasting plasma glucose in both groups. In Group A, fasting glucagon found positively correlated with systolic blood pressure and hip circumference. Conclusion Our observation suggests that fasting plasma glucose is not concomitant with glucagon levels; however, glucagon suppression, after glucose intake, was dysregulated in type 2 diabetes and impaired glucose tolerance. Moreover, glucagon is associated with central obesity in type 2 diabetic patients. .

Relationship between diabetic retinopathy and diabetic nephropathy; A longitudinal follow-up study from a tertiary care unit of Karachi, Pakistan.

OBJECTIVE: To determine the development and progression of diabetic retinopathy in subjects with diabetic nephropathy. METHODOLOGY: This retrospective longitudinal follow up study was conducted in outpatient department of Baqai Institute of Diabetology and Endocrinology (BIDE), a tertiary care diabetes unit of Karachi Pakistan, from January 2005 to December 2016. Type 2 diabetic subjects with newly diagnosed diabetic nephropathy (DN) and sex-age matched controls were identified from the electronic database of the institute, Health Management System (HMS). Subjects with type 1 diabetes, gestational diabetes and subjects with diabetic retinopathy (DR) at the baseline of both DN and non-DN group were excluded from the study. Statistical analyses were conducted by using SPSS version 20. RESULT: Out of 3056 type 2 diabetic subjects, 2389 were with DN and 667 were without DN. The incidence of retinopathy was found to be 21.7 per 1000 person years. The incidence rate ratio (IRR) of 2.57 (1.92-3.43) showed that retinopathy was significantly higher in subjects with DN as compared to subjects without DN. Kaplan-Meier survival plot confirmed that subjects with DN had a worse diabetic retinopathy-free survival than subjects without DN. CONCLUSION: Diabetic nephropathy is an independent risk factor for the development and progression of diabetic retinopathy.

Frequency of urinary tract infection and antibiotic sensitivity of uropathogens in patients with diabetes.

OBJECTIVE: To determine the frequency of urinary tract infections and antibiotic sensitivity among patients with diabetes. METHODS: This observational study was carried out in Microbiology Department of Baqai Institute of Diabetology and Endocrinology (BIDE), Baqai Medical University from April 2015 to June 2016. All patients with diabetes having symptoms of UTI attending out patients department of BIDE were analyzed. All samples received in the laboratory were processed according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Antimicrobial susceptibility pattern was determined by disc diffusion method. RESULTS: A total number of 199 urine specimens, frequency of UTI were 24 (12.06%) in male and 175 (87.94%) in female. UTIs were highly found in (age group 51-60) 70 (35.18%). Escherichia coli was the most frequent pathogen (71%), followed by Klebsiellapneumoniae (7.48%), Proteus mirabilis (1.87%), Staphylococcus aureus (9.35%), Candida (5.61%) and Candidaalbicans were (2.80%). Majority of gram negative uropathogens were shown high sensitivity towards Imipenem and Piperacillin / Tazobactam followed by Nitrofurantion, Ceftriaxone, Levofloxacin, Ofloxacine, Ciprofloxacin, Norfloxacin, Cefixime, Nalidixic acid and Cephradine. Gram positive was most sensitive to Nitrofurantionand Vancomycin followed by Piperacillin / Tazobactam, Imipenem, Cephradine, Ceftriaxone, Norfloxacin and Cefixime. CONCLUSION: We observed the higher frequency of UTIs in female as compared to male participants due to poor hygiene. E.coli was the most frequent pathogen responsible for UTI in patients with diabetes, followed by Staphylococcus aureus.

Comparative effect of Beta blocker-Atenolol and Murraya koenigii (L.) spreng (Curry leaves) on cardiac enzyme (CK-MB) level in male albino rats.

Murraya koenigii (L.) spreng (curry leaves) have traditionally been used for its various medicinal properties. The current study was conducted to assess the comparative effect of Murraya koenigii (L.) spreng (curry leaves) and market available beta blocker drug Atenolol on cardiac enzyme (CK-MB) level in male albino rats. Out of total 26 locally bred male Albino Wistar rats (180 to 200gm weight) two rats were treated with only voltral for dose adjustment. Remaining 24 rats were randomly categorized into following 1 control (C) group and 3 experimental groups Model (M), Test 1 (T1) and Test 2 (T2) containing 6 rats in each group. Rats in C group were orally fed by 0.9% saline solution while rats of M and both test groups T1 and T2 were orally treated with voltral tablet (30mg /kg body weight) for three weeks to increase the level of CK-MB heart enzyme. After voltral treatment rats in test group T1 were treated orally with Atenolol (30 mg/kg body weight) and T2 with Murraya koenigii (L.) spreng (curry leaves) extract (180 mg/kg body weight) for last three weeks. Results show that rats treated with Atenolol showed a decrease in level of heart enzyme as compare to M group, while Murraya koenigii (L.) spreng treated rats group T2 showed more significant decrease of heart enzyme (CK-MB) level as compared to M and T1 groups with significantly improved behavioral activity including increased locomotor activity, short-term memory and reduction in depression. These results demonstrate that natural herbal treatment by curry leaves extract play an effective role in lowering the cardiac enzyme (CK-MB) level to its normal range which helps reducing the risk of CVD and CHD.

Comparative liver function assessment of natural and available drug (Ferrous sulfate) for iron-deficiency anemia in rat model.

To assess the comparative effect of anti-anaemic drug (ferrous sulfate) with naturally occurring anti-anaemic compound (Illicium verum commonly called star anise) on liver in rat model. Model and both test groups were made anaemic. Ferrous sulfate was given to T1 group of rats as 30mg/kg body weight (b.w) and Illicium verum to T2 group of rats with dose of 80mg/kg b.w for six weeks. Illicium verum treated group (T2 rats) produced depression, decreased anxiety and enhanced short-term memory, whereas ferrous sulfate treated group (T1 rats) enhanced long term memory. The liver function test of T2 rats showed that the total bilirubin was in normal range, but direct bilirubin, SGPT, ALP and GGT were significantly decreased in T2 rats in comparison with T1 and also from model group of rats. It was concluded in this study that by comparing the effect of ferrous sulfate with naturally occurring Illicium verum on iron-defficiency anaemia, illicium verum produces same effects and can be used to treat iron-defficiency anaemia without affecting liver function.

Association of serum liver enzyme Alanine Aminotransferase (ALT) in patients with type 2 diabetes.

OBJECTIVES: To assess the association of raised serum liver enzyme (ALT) with type 2 diabetic subjects. METHODS: This retrospective data was accessed at Baqai Institute of Diabetology and Endocrinology (BIDE) from January 2005 to May 2016. A total of 1966 subjects with type 2 diabetes were included in the study. Subjects were divided into two groups; in group A 1284 subjects had ALT within the normal range (ALT≤35iu/l) and in Group-B 682 subjects had elevated ALT (ALT>35iu/l). Details of demographics, anthropometric measurements and biochemical results at baseline were extracted from the health management system of BIDE. Data analysis was conducted on Statistical Package for Social Sciences (SPSS) version 20. RESULTS: Out of 1966 type 2 diabetic subjects 1284(65.4%) were observed with normal value of ALT (≤35) and 682(34.6%) with elevated ALT (>35). Overall mean age of subjects was 54.66±10.98 years and mean BMI was 27.34±5.99 kg/m2. Significant difference was observed between the groups in age (if ALT>35), gender (more likely to be male) and triglyceride (higher if ALT>35).Whereas no significant difference was found between the groups in HbA1c, cholesterol, HDL and LDL. CONCLUSION: High frequency of elevated ALT suggests the association of liver disease with type 2 diabetes. The type 2 diabetic subjects need to be routinely screened and further studies to assess the possible associations with NAFLD and insulin resistance are required to further clarify the disease process.

Neutrophil-to-lymphocyte ratio and microvascular complications in subjects with type 2 diabetes: Pakistan's perspective

Background/aim: The aim of this study is to find the association between diabetic microvascular complications and the neutrophil-to-lymphocyte ratio (NLR) in subjects with type 2 diabetes. Materials and methods: This was a retrospective study based on hospital data records from January 2005 to May 2016 at the Baqai Institute of Diabetology and Endocrinology. The eligibility criteria included subjects with type 2 diabetes with their latest complete blood count while subjects with conditions such as chronic inflammation, cancer, heart failure, and end-stage renal disease were not eligible for inclusion. Subjects were divided into two groups: one with any microvascular complications and the other with no microvascular complications. Body mass index, anthropometric measurements, and blood pressure were measured. Results: Out of 5620 type 2 diabetic subjects, 3202 (57%) were male and (2418) 43% were female. Among these, 3374 diabetic subjects had one or more microvascular complications and 2246 had no microvascular complications. The NLR was found to be 1.14 times higher in diabetic subjects with at least one microvascular complication as compared to diabetic subjects without any complications (4.34 ± 3.32 vs. 3.36 ± 2.67; P < 0.0001). Factors likely associated with microvascular complications were high levels of NLR, HbA1c, serum creatinine, and systolic blood pressure and longer duration of diabetes. Conclusion: According to the results, the NLR is an efficient, cheaper, and readily available marker of inflammation and it is known as an important predictor for the existence of microvascular complications in subjects with type 2 diabetes.

Characteristics and variations of in vivo Schlemm's canal and collector channel microstructures in enhanced-depth imaging optical coherence tomography.

BACKGROUND/AIMS: To characterise in vivo Schlemm's canal (SC) and collector channels (CC) microstructures using enhanced-depth imaging (EDI) optical coherence tomography (OCT). METHODS: Serial horizontal EDI OCT B-scans (81 scans, 15×5° rectangle) were prospectively obtained in the nasal and temporal limbus. SC cross-sectional area (CSA) was measured by delineating its lumen in each B-scan. CCs connected to SC were counted. SC CSA and the number of CCs were compared between the nasal and temporal areas. RESULTS: Eleven eyes (11 normal subjects) were included (mean age, 28±5 years). SC and CCs were clearly demarcated in EDI OCT B-scans with excellent repeatability and reproducibility (intraclass correlation coefficients, 0.830-0.886 and 0.793, respectively; all p<0.001). SC CSA varied considerably among subjects, ranging from 1664 to 6007 µm2 (average, 3514±1235 µm2), and among different regions of the same eye with coefficient of variation in each eye ranging from 23% to 46% (average, 32±7%). The number of CCs in the analysed area also varied considerably among subjects, ranging from 5 to 11 (average, 8.73±1.85). The mean SC CSA (3839±1402 µm2 vs 3189±1209 µm2; p=0.033) and number of CCs (5.5±1.4 vs 3.3±1.1; p=0.001) were significantly greater nasally than temporally. The mean SC CSA was significantly correlated with the number of CCs (r=0.635, p=0.036). CONCLUSIONS: High-quality images of the aqueous outflow pathway can be obtained with a clinical device, avoiding postacquisition processing. In vivo SC and CC microstructures vary considerably among individuals and regions. SC tends to be larger in regions with more CCs.