Neuregulin 4 (NRG4) - the hormone with clinical significance in gestational diabetes mellitus.

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.

Serum Tumor Necrosis Factor-Alpha as a Competent Biomarker for Evaluation of Disease Activity in Early Rheumatoid Arthritis.

Aim The cytokines particularly tumor necrosis factor-alpha (TNF-α) have a substantial role in the pathophysiology of rheumatoid arthritis (RA). The goal of this study was to evaluate the role of serum TNF-α as a competent biomarker of disease activity in RA and to assess the correlation of serum TNF-α with DAS28-ESR (disease activity score-erythrocyte sedimentation rate in 28 joints) and other markers expressed in serum of RA patients. Methodology The study was conducted from May 2020 to October 2020 after approval from the Ethical Review Committee of Ziauddin University. This cross-sectional study included 90 diagnosed cases of RA from 30 to 65 years with the complaint of arthralgia. Patients from the rheumatology clinic were enrolled in the study by a non-probability consecutive sampling technique. Informed consent was taken from each patient and they were assessed through a set of questions based upon disability in the performance of daily activities due to RA. Evaluation of serum levels of anti-cyclic citrullinated peptide (ACCP), rheumatoid factor (RF), erythrocyte sedimentation rate, and TNF-α were done by enzyme-linked immunosorbent assay (ELISA). Patients were segregated into groups based upon DAS28-ESR with erythrocyte sedimentation rate as an inflammatory marker. The Kruskal Wallis test was applied for the comparison of different variables in these groups. Spearman correlation was applied for the association between different variables. Multiple variable analysis was performed to assess the predictability of disease activity by serum markers included in the study. Results The results of our study disclosed a significant difference in ACCP, TNF-α, tender joint count of 28 joints (TJ-28), swollen joint count of 28 joints (SJ-28), and health assessment questionnaire-disability index (HAQ-DI) in disease activity groups. A significant correlation of serum TNF-α with DAS28-ESR in RA patients was observed. Conclusion This study illustrated a significant correlation of serum TNF-α with DAS28-ESR in RA patients. We found that expression of serum TNF-α may intensify the inflammatory activity in early RA, therefore, RA patients must be screened for this cytokine to monitor that disease activity could be useful for patients undergoing anti-TNF therapy.

Establishing age specific spirometry reference ranges for children/adolescents of Karachi, Pakistan: Randomized trials.

OBJECTIVE: To establish age-specific normative spirometry reference range along with regression equation for children and adolescents. METHODS: The cross-sectional study was conducted from April to October 2017, and comprised children and adolescents aged 7-18 years at 8 educational institutions representing various socio-economic strata of Karachi. A modified version of the International Study of Asthma and Allergies in Childhood Questionnaire was used. Spirometry variables including forced vital capacity, forced expiratory volume in 1 second, ratio between the two, peak expiratory flow rate, forced expiratory flow between 25% and 75% expired volume were recorded and interpreted. By normal distribution curve the reference values were established, and mean}2 standard deviation values were taken as significant. Pearson's correlation coefficient and linear regression models were calculated for all pulmonary variables with age. RESULTS: Of the 751 subjects, 484(64.4%) were boys and 267(35.5%) were girls. The overall mean age was 12.96}2.8 years. The mean lung volume for forced vital capacity was 2.21}0.75, forced expiratory volume in 1 second 2.08}0.73, ratio between the two 92.9}4.7, peak expiratory flow 231.3 } 70.5 and forced expiratory flow between 25% and 75% expired volume was , , , 2.68}1.2. These lung volumes directly increased with age from children to adolescents (p<0.05). All variables showed a significant difference between boys and girls (p<0.05). CONCLUSIONS: There was a linear positive correlation of age with lung function variables, while the boys presented higher values than the girls.

Collating Spirometry reference values in Asian children and Adolescents; puzzle out the reasons for variations.

Lung function tests are essential for the diagnosis and management of different respiratory tract diseases; among them the spirometry is the gold standard technique. The accurate diagnosis, management and monitoring require proper interpretation of the results which depends upon the availability of spirometry reference data for that particular region to differentiate the diseased condition from the normal ones. Multiple studies had been done to find out their own area specific reference ranges but it is still lacking. This need was fulfilled by the Global Lung Function Initiative (GLI) in 2012, which reported the first global spirometry equation for all of the age groups. But some of the studies reported difference among GLI reference range and the measured range for that particular region. So here is the review of the reference ranges among 35,603 Asian children and adolescents from the 32 studies done specifically in Asia. The aim was to compare them with the study done by GLI team, along with these, tried to rule out the causal factor that are responsible for the variations in the reference ranges among the children and adolescents of different population. The literature was searched by using Google scholar and PubMed during the month of March up to July 2017. The review of all the articles published in Asia, specifically accounting for normal reference ranges in children and adolescent exhibit a wide variation among the reference ranges. This also suggest involvement of multiple modifiable and non-modifiable risk factors. So it's necessary to update the reference ranges for spirometry and its prediction equation as well.

Evaluation of QT parameters in patients of thalassaemia major with iron overload.

OBJECTIVE: To study QT parameters in Thalassaemia Major patients and their association with serum ferritin levels. METHODS: This cross-sectional study was conducted at Ziauddin University, Karachi, from February 2013 to September 2014, and comprised patients of Thalassaemia Major. Participants' serum ferritin levels were determined and electrocardiography was performed. Data was analysed using SPSS 20. RESULTS: Of the 135 participants, 68(50.4%) were in the 7-14 years age group and 69(51%) were males. Significant prolongation of QT, corrected QT interval and increased QT dispersion was observed in patients with serum ferritin levels more than 2,500 nanogram/millilitre (p<0.001 each). These measurements of corrected QT and QT dispersion had a positive linear correlation with serum ferritin levels (r=0.760 and 0.786). CONCLUSIONS: Electrocardiography could be a useful means for the pre-clinical detection of cardiac involvement due to iron overload in Thalassaemia Major patients.

Haematological reference values for full-term, healthy, newborns of Karachi, Pakistan.

OBJECTIVE: To establish reference haematological values (complete blood count) in healthy full-term newborns of Karachi. METHODS: This is a cross sectional study design based on cord blood sample of 404 newborns and their mothers recruited from Sindh Government Qatar Hospital, Ziauddin University Hospital gole market campus, Sindh Government hospital, Liaquatabad and Chinniot maternity and child hospital. Karachi from July 2006 to April 2008. Both mother's and the new born baby's blood was collected in EDTA containing tubes and analyzed for different haematological parameters. The data entry and analysis was done on computer package SPSS (Statistical Packages of Social Sciences) version 12.0. The results were given in the text as mean, standard deviation and 95% confidence intervals of haematological values (complete blood count). RESULTS: The mean haemoglobin was found to be (14.99 +/- 1.47 gm), which is lower than the standard value described in literature. However the total WBCs count and platelet count were found to be (13.61 +/- 4.23) and (256. 25 +/- 76.54) respectively, which were similar to the other studies. CONCLUSION: Our values provide reference range for haematological values in healthy newborns of Karachi, for clinical use by our physicians.

Exercise-induced bronchospasm in male athletes at Karachi.

BACKGROUND: Exercise is one of the most common precipitant of acute asthma encountered in clinical practice. To determine frequency of Exercise-induced Bronchospasm (EIB) in male athletes, who had represented or were aspiring to represent at national and/or international level. Athletes of different departments and institutes, district, provincial and national squad who were residing, practicing and attending training camps at Karachi during November 2000 to January 2002 were included. METHODS: It's an observational study on the frequency of EIB in athletes. A 21-item structured and pre-tested questionnaire was given for personal, biological and environmental information and an acquaintance session was conducted with each athlete to explain the procedure. Six minutes of competitive field free running Peak expiratory flow (PEF) rate, pulse rate and oxygen saturation were measured at 5-min, 15-min and 30-min. A player was considered EIB positive based on a post exercise decrement in PEF rate > or = 15% at any defined point of time. RESULTS: The mean age of participating athletes was 27 +/- 6 years. Out of the one hundred and seventy-nine (n = 179) athletes who participated in the study, 13 (7%) were found to be EIB positive. CONCLUSION: Our findings indicate that a significant number of our athletes suffer from EIB. It is suggested that either the department or national sports body should take the responsibility of screening for EIB making it a part of their training sessions.