The physician factor and anatomical site in 8846 consecutive mediastinal lymph node aspirations in a cross-sectional study.

Mediastinal lymph node fine needle aspiration (MLN-FNA) is a common procedure; however, the physician factor in pathological category, and anatomical site are not routinely assessed. Cytology reports for endobronchial ultrasound (EBUS)/endoscopic ultrasound (EUS) MLN-FNA specimens (8846) were retrieved for July 2012-Dec 2019, classified by hierarchical free text string match algorithm into 51 diagnostic categories, four mutually exclusive diagnostic groups (benign |suspicious |malignant |insufficient), and 24 anatomical sites. Pathologist and submitting physician/surgeon bias were assessed using logistic regression and funnel plots|control charts centered on the group median (diagnostic/capture) rate. Eleven pathologists and seven submitting physician/surgeon were involved in more than 250 specimens each. Overall, the MLN-FNAs were benign|suspicious|malignant|insufficient in 46%|4%|25%|24% of specimens. Percent malignant (number of samples) varied by station; 7| 4R| 4L| 2R| 10R| 11R| 11L were respectively 21%(3,101), 27%(2,453), 19%(1,289), 41%(435), 27%(497), 24%(357), 26%(229). The number of outlier (P < 0.05/P < 0.001) pathologists of 11 from the group median rate for benign|suspicious|malignant|insufficient was 0/0| 3/1| 0/0| 3/0 respectively. The outlier (P < 0.05/P < 0.001) submitting physicians/surgeons of 7 for benign|suspicious|malignant|insufficient was 3/2| 2/2| 3/2| 3/2 respectively. The physician and anatomical site are significant predictors of MLN-FNA pathology.

Micro Rna 182-3-P, 519-D-5p, 378-3p As Non-Invasive Predictors Of Preeclampsia.

BACKGROUND: MicroRNAs (miRNAs) are an emerging field of interest in many diseases. Some of the miRNAs have been reported to be expressed differentially in diseased states of pregnancy. The current study was designed to measure and compare the levels of microRNA 182-3-p, 519-d-5p, and 378-3p and it was hypothesized that the microRNA 182-3-p, 519-d-5p, and 378-3p can be used as a non-invasive predictor of preeclampsia. METHODS: Expression level of the miRNAs 182-3-p, 519-d-5p, and 378-3p was measured in the serum of preeclamptic and normal pregnancies by real-time PCR. Data was entered and analysed by Statistical Package for the Social Sciences 22 (SPSS). RESULTS: Significantly high expression levels of MiRNA 182-3p, 519-d-5p and low levels of miR-378-3p were associated with preeclampsia (PE). CONCLUSIONS: The results revealed that miR-182-3p is a powerful predictor of PE with an Odds Ratio of 5.9 and can be used as a noninvasive, reliable predictor of PE to screen these patients at an early stage. Screening at early gestation with follow-up studies can emphasize the results.

Physician and Surgeon Communication Assessed via the Pathology Requisition in a Regional Laboratory Over Ten Years.

Background Ineffective communication between healthcare providers is a known risk factor for adverse events. Objective The aim of this study was to retrospectively assess the communication with pathology via an analysis of the information provided on the pathology requisitions over ten years. Methods All in-house surgical specimens and all non-gynecologic cytopathology specimens accessioned from 2011 to 2020 were retrieved at a regional laboratory. Cases with any clinical information were deemed to have a clinical history present (CHP). CHP was tabulated by submitting physicians/surgeons (SPS), hospital site, year, and tissue group. Results The study period contained 554,817 relevant pathology reports, of which 553,966 could be extracted. The overall CHP rate was 74% and varied from 76% to 67% over the study period. SPSes submitting ≥200 cases (n=314) had a mean/median/standard deviation/max/min CHP rate of 81%/92%/23%/100%/5%. The CHP varied between four hospital sites, from 53% to 97%. CHP varied from 61% to 99% by tissue group. Conclusions CHP is associated with several factors and appears to depend on the hospital culture, specialty, and individual physician/surgeon. The pathology requisition is a way to measure and track the communication that is clinically relevant. Improving communication with pathologists/the pathology department will likely require process changes and mandates. Hospital and laboratory accreditation bodies should consider effective communication with pathology a marker of quality and an accreditation issue.

Safety and Pharmaceutical Evaluation of a Novel Natural Polymer, Ocicum, as Solubility and Dissolution Enhancer in Solid Dispersion.

Plant mucilages are commonly employed as excipients in pharmaceutical manufacturing. Ocimum basilicum (Lamiaceae family), a source of hydrophilic mucilage referred herein as Ocicum, was evaluated for the solubility enhancer of a model drug, aceclofenac, in solid dispersions prepared using different methods. Polymer was extracted from O. basilicum and solid dispersions of aceclofenac were fabricated with Ocicum or Poloxamer 407 using polymer-to-drug ratios of 1:1, 1:2 and 1:3 utilizing solvent evaporation, lyophilization and melt methods. Ocicum was evaluated for its safety via acute toxicity study including different biochemical and hematological parameters including liver and kidney profiles. Moreover, different characterization studies including melting-point, Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), scanning electron microscopy (SEM), differential scanning calorimetry (DSC) and differential thermal analysis (TGA) were used for evaluation of polymer and solid dispersions. Furthermore, solubility and dissolution studies were performed to confirm solubility enhancement. Ocicum was found to be safer, and different characterization studies confirmed the purity of the compounds. In addition, Ocicum exhibited up to 6.27-fold enhanced solubility as compared to pure aceclofenac; similarly, 4.51-fold increased solubility by the synthetic polymer in their respective solid dispersions was shown. Furthermore, Ocicum-based solid dispersions showed substantial improvement in dissolution of aceclofenac. Therefore, it can be concluded from the above-mentioned results that Ocicum might be used as an economical natural oral delivery carrier alternative to the synthetic polymers.

Correlation of insulin resistance with neutrophil to lymphocyte ratio and serum ferritin in male patients of metabolic syndrome.

OBJECTIVE: To determine the correlation of insulin resistance with neutrophil-to-lymphocyte ratio and serum ferritin, and to evaluate whether NLR and serum ferritin can predict insulin resistance in metabolic syndrome. METHODS: The cross-sectional analytical study was conducted at the University of Health Sciences, Lahore, Pakistan, from July 2016 to 2019, and comprised male patients of metabolic syndrome and healthy controls. The correlation involving insulin resistance, serum ferritin and neutrophil-to-lymphocyte ratio was determined. Data was analysed using SPSS 22. RESULTS: Of the 210 subjects, 160(76.2%) were cases with a median age of 45 years (interquartile range: 39-50 years), and 50(23.8%) were controls with a median age of 41 years (interquartile range: 35-50 years). Serum ferritin, alanine aminotransferase, total neutrophil count, lymphocyte count and neutrophil-to-lymphocyte ratio were significantly higher among the cases than the controls (p<0.05). Significant positive correlation of insulin resistance was observed with serum ferritin and neutrophil-to-lymphocyte ratio (p<0.05)) among the cases. Neutrophil-to-lymphocyte ratio significantly predicted insulin resistance among the cases (p<0.05). Conclusion: Neutrophil-to-lymphocyte ratio was fund to be a significant predictor of insulin resistance in metabolic syndrome.

Pathologist workload, work distribution and significant absences or departures at a regional hospital laboratory.

OBJECTIVE: Assess the work environment of salaried pathologists via (1) the national workload system (L4E), (2) work distribution among/in three hospital groups, and (3) the frequency of significant absences or departures (SADs). METHODS: Automated analysis of pathology reports from a regional laboratory (accessioned 2011-2019) using validated computer code. RESULTS: The study set contained 574,099 pathology reports, reported by 63 pathologists. The average yearly L4E workload units/full-time equivalent for three hospital groups were 8,101.6, 6,906.5 and 4,215.8. The average Gini coefficient for full-time pathologists in the three hospital groups were respectively 0.05, 0.16 and 0.23. The average yearly SADs rates were respectively 13%, 16% and 9%. The group with the highest SADs rate had the intermediate Gini coefficient and intermediate workload. CONCLUSIONS: High individual workload and work maldistribution appear to be associated with SADs. Individual workload maximums and greater transparency may be essential for limiting staff turnover, maintaining high morale, and efficient laboratory function with a high quality of care.

Expression levels of MiRNA-16, SURVIVIN and TP53 in Preeclamptic and Normotensive women.

OBJECTIVE: To measure and compare micro ribonucleic acid-16, survivin and tumour protein p53-regulated apoptosis-inducing protein 1 expression levels in preeclamptic and normotensive pregnancies, and to check the correlation of micro ribonucleic acid-16 with messenger ribonucleic acid expression of survivin and tumour protein p53. METHODS: The observational cross-sectional comparative study was conducted at the Department of Physiology and Cell Biology, University of Health Sciences, Lahore, Pakistan, from 2016 to 2018, and comprised preeclamptic women in group A and normotensive women in group B. The preeclamptic patients were further categorised into early-onset preeclampsia subgroup A1and late-onset preeclampsia group A2. Expression of micro ribonucleic acid-16, messenger ribonucleic acid expression of survivin and tumour protein p53 in preeclamptic and normotensive pregnancies were analysed using real time polymerase chain reaction. Data was analysed using SPSS 22. RESULTS: Of the 54 patients, 27(50%) were in each of the two groups. Within group A, 14(52%) patients were in group A1 and 13(48%) in group A2. The expression of micro ribonucleic acid 16 showed significant increase in group A compared to group B (p<0.05). The difference was not significant between the subgroups A1 and A2. The levels of messenger ribonucleic acid expression of survivin and tumour protein p53 were deregulated in group A, with a decrease in survivin and an increase in tumour protein p53. The messenger ribonucleic acid expression of survivin and tumour protein p53 showed statistically significant differences across subgroups A1 and A2 (p<0.05). The micro ribonucleic acid-16 expression correlated negatively with messenger ribonucleic acid expression of survivin, but exhibited a positive correlation with tumour protein p53. CONCLUSIONS: Deregulated micro ribonucleic acid-16 along with differentially expressed apoptotic genes, survivin and tumour protein p53 might result in altered apoptosis implicated in the pathogenesis of preeclampsia.

Association between hypoxia-inducible factor-1 alpha rs11549465 (1772 C>T) polymorphism and metabolic syndrome.

OBJECTIVE: To find the association of single nucleotide polymorphism of hypoxia-inducible factor-1 alpha, rs11549465 (1772 Cytosine > Thymine) with metabolic syndrome, and to compare the anthropometric and biochemical variables in different genotypes of hypoxia-inducible factor-1 alpha. METHODS: The cross-sectional comparative study was conducted at the University of Health Sciences, Lahore, Pakistan, from July 2016 to April 2019, and comprised patients of metabolic syndrome selected from the Sheikh Zayed Hospital, Lahore. Healthy controls were also enrolled. Fasting venous sample was taken for the determination of study parameters. The genetic variant of hypoxia-inducible factor-1 alpha was analysed by restriction fragment length polymorphism polymerase chain reaction. Data was analysed using SPSS 22. RESULTS: Out of 400 subjects, 200(50%) each were patients and controls. The frequency of CC genotype of hypoxia-inducible factor-1 alpha Cytosine > Thymine in patients was 166(83%) and in controls 147(73.5%); CT genotype was 34(17%) and 53(26.5%) respectively, while TT genotype was not observed. There was a significant association of the C allele and CC genotype (p=0.03) with the increased risk of metabolic syndrome (p=0.02). On comparison of study variables in the two genotypes, systolic blood pressure, anthropometric and lipid parameters were significantly higher in the wild CC genotype compared to CT in the control group (p<0.05), but there was no significant difference in the patients (p>0.05). CONCLUSIONS: Major allele C of hypoxia-inducible factor-1 alpha 1772 Cytosine > Thymine was found to be associated with increased risk of metabolic syndrome.

Evolution of anatomic pathology workload from 2011 to 2019 assessed in a regional hospital laboratory via 574,093 pathology reports.

OBJECTIVE: Quantify changes in workload in relation to the anatomic pathologist workforce. METHODS: In house pathology reports for cytology and surgical specimens from a regional hospital laboratory over a nine- year period (2011-2019) were analyzed, using custom computer code. Report length for the diagnosis+microscopic+synoptic report, number of blocks, billing classification (L86x codes), billings, national workload model (L4E 2018), regional workload model (W2Q), case count, and pathologist workforce in full-time equivalents (FTEs) were quantified. Randomly selected cases (n = 1,100) were audited to assess accuracy. RESULTS: The study period had 574,093 pathology reports that could be analyzed. The coding accuracy was estimated at 95%. From 2011 to 2019: cases/year decreased 6% (66,056 to 61,962), blocks/year increased 20% (236,197 to 283,751), L4E workload units increased 23% (165,276 to 203,894), W2Q workload units increased 21% (149,841 to 181,321), report lines increased 19% (606,862 to 723,175), workforce increased 1% (30.42 to 30.77 FTEs), billings increased 13% ($6,766,927 to $7,677,109). W2Q in relation to L4E underweights work in practices with large specimens by up to a factor of 2x. CONCLUSIONS: Work by L4E for large specimens is underrated by W2Q. Reporting requirements and pathology work-up have increased workload per pathology case. Work overall has increased significantly without a commensurate workforce increase. The significant practice changes in the pathology work environment should prompt local investment in the anatomic pathology workforce.

TCF7-L2 rs7903146 polymorphism in metabolic syndrome with and without acute coronary syndrome.

OBJECTIVE: To determine the frequency and association of single nucleotide polymorphism of transcription cell factor7-like2 rs7903146 (C>T) in metabolic syndrome patients with and without acute coronary syndrome. METHODS: The cross-sectional comparative study was conducted at the University of Health Sciences, Lahore, Pakistan, from July to December 2017. Patients of metabolic syndrome with and without acute coronary syndrome were selected from Sheikh Zayed Hospital, Lahore, and the Punjab Institute of Cardiology, Lahore. Healthy subjects were enrolled to act as controls. A fasting blood sample of 8ml was taken for deoxyribonucleic acid extraction and estimation of biochemical parameters. Single nucleotide polymorphism of transcription cell factor7-like2 rs7903146 C>T was determined using restriction fragment length polymorphism. SPSS 22 was used for data analysis. RESULTS: Of the 500 subjects, 200(40%) were group A patients without acute coronary syndrome, 100(20%) were in group B with acute coronary syndrome and 200(40%) were group C controls. Overall, 385(77%) were males and 115(23%) were females. The frequency of CC variant in group A was 35(17.5%) and in group C 22(11%), while CT was 32(16%) and 65(32.5%), and TT was 133(66.5%) and 113(56.5%), respectively. There was significant association of TT genotype with increased risk of metabolic syndrome (p=0.031), and CC genotype had no association (p=0.121). There was no significant difference of genotype frequency between groups A and B (p=0.246), but TT variant was significantly higher in group A compared to group B (p=0.009). CONCLUSIONS: TT genotype of transcription cell factor7-like2 rs7903146 C>T was found to be associated with increased risk of metabolic syndrome in patients without acute coronary syndrome compared to those with acute coronary syndrome and healthy controls.

Determinants of depression among undergraduate medical students of a private medical college in Lahore.

OBJECTIVE: To assess the prevalence and determinants of depression in undergraduate medical students within their learning environment. METHODS: The descriptive cross-sectional study was conducted at the Lahore Medical and Dental College, Lahore, Pakistan, from May to June 2015, and comprised medical students of all the five professional years. A structured questionnaire was used to collect data. Section one of the questionnaire related to demographic information, section two comprised Patient health questionnaire-9 for screening depression, and section three was the Dundee ready education environment measure inventory to gather students' perceptions of their learning environment. Data was analysed using SPSS 22. RESULTS: Of the 533 students, 206(39%) were males, 327(61%) were females, 213(40%) were of preclinical years and 320(60%) were of clinical academic years. Overall, 399(75%) students were found to be depressed. Of them, 255(64%) were females and 144(36%) were males. Among the students, 96(18%) had negative perception of their learning environment, and out of these, 91(95%) were found to be depressed. There was significant association of depression with female gender (p=0.037) and negative perception of the students of their learning climate (p<0.001). CONCLUSIONS: The prevalence of depression was found to be high among the medical students and it was associated with female gender and negative perception of the learning environment.

Elevated Tumor Necrosis Factor (TNF)-α mRNA Expression Correlates with Nuclear Factor Kappa B Expression in Peripheral Blood Mononuclear Cells in Preeclampsia.

OBJECTIVE: To evaluate, compare and correlate the mRNA expression of nuclear factor kappa B (NF-kB) and tumor necrosis factor alpha (TNF-α) in peripheral blood mononuclear cells in preeclampsia and normotensive group. STUDY DESIGN: Cross-sectional comparative study. PLACE AND DURATION OF STUDY: The study was done in the Department of Physiology and Cell Biology, University of Health Sciences, Lahore, from November 2016 to November 2018. METHODOLOGY: Blood samples were collected and mRNA expression of NF-kB and TNF-α was measured quantitatively by real-time polymerase chain reaction in peripheral blood mononuclear cells in 27 preeclamptic and 27 normal pregnancies. The preeclamptic group was further divided into early and late onset preeclampsia. Statistical analysis was done using SPSS (version 22). RESULTS: The peripheral blood mononuclear cells mRNA expression of NF-kB and TNF-α differed within the two groups with an increase in expression in the diseased group (p <0.001). There was an increase of 2.79 fold in mRNA expression of TNF-α while the result for NF-αB was 2.28 fold. The difference in the expression of both NF-kB and TNF-α was significant within the two subgroups of preeclampsia (p <0.001). TNF-α was found to be strongly correlated with NF-kB (p <0.01).

Adrenergic receptor beta-3 rs4994 (T>C) and liver X receptor alpha rs12221497 (G>A) polymorphism in Pakistanis with metabolic syndrome.

The present study aimed to determine the association of adrenergic receptor beta-3 (ADRB3) rs4994 T>C and liver X receptor alpha (LXR-α) rs12221497 G>A polymorphism with metabolic syndrome (Met S) and the related traits in Pakistanis. Patients of Met S were recruited from the Endocrinology and Diabetic Clinic of Sheikh Zayed Hospital Lahore, over the time span of 6 months from July to December 2016. Single-nucleotide polymorphism (SNP) of ADRB3 was determined by restriction fragment length polymorphism and of LXR-α by amplification refractory mutation system polymerase chain reaction. The frequency of TT variant of ADRB3 T>C in Met S was 69 (34.5%) and in controls 89 (44.5%), frequency of TC 103 (51.5%) and 96 (48%), and of CC 28 (14%) and 15 (7.5%), respectively. In the recessive model (CC: TT + TC), CC genotype was found to be associated with the increased risk of Met S (P = 0.027; odds ratio [OR] = 2.09; confidence interval [CI] =1.08-4.03) and the association remained significant after controlling for the confounders such as age and sex. The frequency of GG variant of LXR-α G>A in Met S was 35 (17.5%) and in controls 15 (7.5%), GA 129 (64.5%) and 137 (68.5%), and AA 36 (18%) and 48 (24%), respectively. In the recessive model (GG: GA + AA), GG genotype was found to be associated with the increased risk of Met S (P = 0.004; OR = 2.52; CI = 1.33-4.80) and the association remained significant after controlling for the confounders such as age and sex. It was concluded that SNP of ADRB3 (190 T>C) and LXR-α (-115 G>A) were associated with the risk of Met S and might increase the susceptibility to the obesity-related traits.

Peroxisome proliferator activated receptor gamma 34C>G variant and anthropometric parameters in metabolic syndrome.

OBJECTIVE: To determine the frequency of 34 Cytosine >Guanine (proline 12 alanine) variant of peroxisome proliferator activated receptor gamma, and to associate it with metabolic syndrome, insulin resistance and anthropometric obesity parameters. METHODS: The cross-sectional comparative study was conducted at the University of Health Sciences, Lahore, Pakistan, from September 2016 to 2017, and comprised patients of metabolic syndrome and healthy controls. Blood pressure and anthropometric measurements of all the subjects were recorded. Fasting blood sample of 4ml was taken for biochemical parameter and deoxyribonucleic acid extraction. The frequency of genetic variant was determined by amplification refractory mutation system polymerase chain reaction. Data was analysed using SPSS 22. RESULTS: Out of 400 subjects, 200 (50%) each were patients and controls. Overall, there were 308 (77%) males and 92 (23%) females. Patients had significantly higher blood pressure, body mass index, waist circumference, waist-to-hip ratio, mid-arm circumference and triceps skinfold thickness compared to the controls (p<0.0001). Insulin resistance was also significantly higher in the patients (p<0.0001) and showed significant correlation with body mass index, waist circumference, waist-to-hip ratio, mid-arm circumference and triceps skinfold thickness (p<0.05).Waist circumference and triceps skinfold thickness were significant predictors of homeostatic model assessment for insulin resistance. Overall, the frequency of homozygous dominant genotype CC of PPAR2 34C>G was 291 (72.75%), heterozygous CG was 93 (23.25%) and homozygous recessive GG was 16 (4%).There was no significant difference in frequency of genotypes between the groups (p=0.216). However, waist circumference and body mass index were significantly lower in GG genotype compared to the CC (p=0.006 versus p=0.02). CONCLUSIONS: Waist circumference and triceps skinfold thickness were found to be the significant predictors of homeostatic model assessment for insulin resistance, while no association was found between 34 C>G variant of peroxisome proliferator activated receptor gamma and metabolic syndrome.

Genetic Association of Apolipoprotein A5-1131T>C Polymorphism with Traits of Metabolic Syndrome.

OBJECTIVE: To investigate the association of -1131T>C polymorphism of apolipoprotein A5 (APOA5) with metabolic syndrome and associated traits. STUDY DESIGN: A cross-sectional comparative study. PLACE AND DURATION OF STUDY: Department of Physiology, University of Health Sciences Lahore, from July 2016 to December 2017. METHODOLOGY: Study population included 200 cases of metabolic syndrome and 200 controls. Cases were selected from Sheikh Zayed Hospital, Lahore according to the International Diabetes Federation guidelines. Fasting blood sample of 8 ml was taken for biochemical and genetic analysis, as per objective. Demographics, waist circumferance and blood pressure (BP) were also recorded. RESULTS: Subjects with metabolic syndrome had significantly higher waist circumference, BP, serum lipid and glycemic parameters as compared to the controls (p<0.001). The observed frequency of APOA5-1131T>C genotype TT was 180 (45%), 202 (50.5%) for TC and 18 (4.5%) for CC. Minor C allele frequency of APOA5-1131T>C variant was significantly higher in metabolic syndrome as compared to the controls (0.33 vs. 0.26: p = 0.031*). In the Dominant genotype model (TC+CC vs. TT), 'TC+CC' genotype was significantly associated with the increased risk of metabolic syndrome (OR: 1.50, CI: 1.01-2.23, p = 0.044*). Waist circumference and fasting triglyceride levels were significantly higher in 'TC +CC' genotype as compared to the 'TT' in metabolic syndrome and controls (p = <0.001 and 0.043; p = 0.022 and 0.006). CONCLUSION: There was significant association of the 'TC+CC' genotype of APOA5 -1131T>C with the increased risk of Met S and the association remained significant after controlling for age and gender.

Serum profile of cytokines and their genetic variants in metabolic syndrome and healthy subjects: a comparative study.

AIM: To identify genetic variants in promoter areas of IL-6 -174 G>C and TNF-α -308 G>A in metabolic syndrome (Met S) and controls and associate them with Met S and serum cytokine levels.It was a cross-sectional study, including 224 cases of Met S and 200 controls. A fasting blood sample was taken and biochemical parameters including serum glucose, insulin, lipid profile, interleukin-6 (IL-6) and tumor necrosis factor α (TNF-α) were measured. Restriction fragment length polymorphism was used to identify the genetic variants of IL-6 and TNF-α. Serum levels of IL-6 and TNF-α and insulin resistance were significantly higher in cases than the controls. IL-6 showed significant positive correlation with HOMA-IR and TNF-α. CC genotype of IL-6 was associated with the increased risk of Met S (P=0.016, OR for CC vs GC+GG = 2.33, CI: 1.15-4.71). There was no significant difference of TNF-α genotypes between the cases and the controls. Serum TNF-α and IL-6 levels were significantly higher in AA and CC genotypes of TNF-α (-308 G>A) and IL-6 (-174 G>C) as compared with the GG (P=0.00 and P=0.001). Significant correlation of IL-6 with TNF-α and insulin resistance was observed that may provide us a therapeutic target for preventing metabolic derangements from insulin resistance.

Metabolic syndrome: an update on diagnostic criteria, pathogenesis, and genetic links.

Metabolic syndrome (MetS), today a major global public health problem, is a cluster of clinical, metabolic, and biochemical abnormalities, such as central adiposity, hypertension, insulin resistance, and dyslipidemias. These MetS-related traits significantly increase the risk of type 2 diabetes mellitus, adverse cardiac events, stroke, and hepatic steatosis. The pathogenesis of MetS is multifactorial, with the interplay of environmental, nutritional, and genetic factors. Chronic low-grade inflammation together with visceral adipose tissue, adipocyte dysfunction, and insulin resistance plays a major role in the progression of the syndrome by impairing lipid and glucose homeostasis in insulin-sensitive tissues, such as the liver, muscle, and adipocytes. Adipose-derived inflammatory cytokines and non-esterified fatty acids establish the link between central obesity IR, inflammation, and atherogenesis. Various studies have reported an association between MetS and related traits with single-nucleotide polymorphisms of different susceptibility genes. Modulation of cytokine levels, pro-oxidants, and disturbed energy homeostasis, in relation to the genetic variations, is described in this review of the recent literature, which also provides updated data regarding the epidemiology, diagnostic criteria, and pathogenesis of MetS.

Functional role of human interleukin-32 and nuclear transcription factor-kB in patients with psoriasis and psoriatic arthritis.

OBJECTIVE: Inflammation and its associated cell signaling events have been well documented in psoriasis and psoriatic arthritis. However, the potential for interleukin (IL)-32 and its associated signaling to provoke an inflammatory response or to contribute in the pathogenesis of psoriasis or psoriatic arthritis are still in early phase. This study determined the role of IL-32 and nuclear transcription factor (NF)-κB in patients with plaque psoriasis and psoriatic arthritis. METHODS: Levels of IL-32 were determined in the plasma samples of patients with plaque psoriasis, psoriatic arthritis, and normal healthy subjects by human IL-32-specific Sandwich enzyme-linked immunosorbent assays. To investigate the role of a transcription factor in these patients, activated NF-κBp65 levels were determined in the peripheral blood mononuclear cells (PBMCs) by highly sensitive NF-κB transcription factor kit. RESULTS: The levels of IL-32 in the plasma samples of plaque psoriasis or psoriatic arthritis patients were found to be significantly higher as compared with the levels of IL-32 present in the normal human plasma samples (P < 0.01). Levels of activated NF-κB were also found higher in plaque psoriasis or psoriatic arthritic patients as compared with the PBMCs of healthy humans (P < 0.05). CONCLUSIONS: This study shows the role of IL-32 and NF-κB in plaque psoriasis and psoriatic arthritic patients. Results indicate that IL-32 and NF-κB promote inflammation in patients with psoriasis and psoriatic arthritis. Disruption of IL-32 or NF-κB signaling event might provide a novel target for the management of plaque psoriasis and psoriatic arthritis.

Serum Levels of Visfatin and Interleukin-6 in Non-Obese Versus Obese Men with Coronary Artery Disease.

OBJECTIVE: To evaluate and compare the serum levels of visfatin, interleukin-6 and lipid profile in non-obese and obese male patients with coronary artery disease. STUDY DESIGN: Observational, comparative study. PLACE AND DURATION OF STUDY: Punjab Institute of Cardiology and Lahore General Hospital, Lahore, from July to December 2013. METHODOLOGY: The participants included 20 non-obese group I with coronary artery disease (CAD) and 20 obese males group II with coronary artery disease (angiographically confirmed). All the participants were in the age group of 35 - 55 years being non-smokers and non-diabetic. Serum visfatin and interleukin-6 levels were analysed by Enzyme Linked Immunosorbent Assay (ELISA). Lipid profile was also evaluated. Results were compared with T-test and Mann Whitney U test. The values were considered significant at 0.05 level of significance. RESULTS: Serum visfatin 9.05 versus 3.9 ng/ml and interleukin-6 12.80 versus 0.60 pg/ml levels were significantly (p-value < 0.001 of both) raised in the obese CAD group as compared to non-obese with CAD. Lipid profile also showed raised levels of total serum cholesterol, low density lipoproteins, triglycerides, very low density lipoproteins and low levels of high density lipoproteins in obese group. CONCLUSION: Significantly raised levels of serum visfatin and interleukin-6 indicate adipose tissue as an imperative source of these adipocytokines involved in inflammation in CAD. Altered lipid profile also seen in obese patients with CAD.

Medical Students' Perceptions Of Their Learning Environment At Lahore Medical And Dental College Lahore.

BACKGROUND: The present study was designed to assess medical students' perceptions of their learning environment at Lahore Medical and Dental College, Lahore. METHODS: It was a crosssectional descriptive study conducted at Lahore Medical and Dental College, Lahore. Five hundred and thirty-three students participated in this study. A questionnaire was used as a study tool, comprising of demographic information and the 'Dundee Ready Education Environment Measure' (DREEM) inventory. Data was entered and analyzed using SPSS 21 package. A comparison of scores between different MBBS classes was done by using ANOVA. Comparison of scores between gender and high school education was done by using Mann-Whitney U tests. RESULTS: Study population included 62% females and 32% males. About 58% of the participants were between 18-21 years and 42% were between 22-25 years of age. The mean total DREEM score was 120.27/200. The mean score of the domains: 'Students' perceptions of learning' was 28.31/48, 'Students' perceptions of teaching' was 26.92/44, 'Students' academic self- perceptions' was 21.37/32, 'Students' perceptions of atmosphere' was 27.72/48, and 'Students' social selfperceptions' was 16.40/28. Total DREEM and its subclasses score was significantly higher in F. Sc. students than the students with A level/American board (p-value <0.001). When DREEM scores were analyzed according to gender, perceptions of both male and female were positive. Age had no significant bearing on the total DREEM scores or scores in its subclasses. CONCLUSIONS: Overall perceptions or experiences of the MBBS students of their learning environment at Lahore medical and Dental College, Lahore were more positive.