The association between serum adipokines levels with senile osteoporosis: a systematic review and meta-analysis.

Objective: The clinical correlation between adipokines levels in the blood and the incidence of senile osteoporosis (SOP) has not been clearly studied. We conducted this meta-analysis to elucidate the relationship between three common adipokines levels (leptin, adiponectin, and chemerin) and the incidence of SOP. Methods: We searched databases such as CNKI, CBM, VIP, Wanfang, PubMed, Web of Science, Embase, and the Cochrane Library to collect articles published since the establishment of the database until July 30, 2022. Results: In total, 11 studies met the selection criteria. Our meta-analysis showed that serum leptin levels were significantly lower (mean difference [MD], -2.53, 95% CI: -3.96 to -1.10, I2 = 96%), chemerin levels were significantly higher (MD, 30.06, 95% CI: 16.71 to 43.40, I2 = 94%), and adiponectin levels were not significantly different (MD, -0.55, 95% CI: -2.26 to 1.17, P = 0.53, I2 = 98%) in SOP patients compared with healthy older individuals with normal bone mineral density (BMD). In addition, correlation analysis showed that leptin levels were positively correlated with lumbar bone mineral density (LBMD) (r = 0.36) and femoral bone mineral density (FBMD) (r = 0.38), chemerin levels were negatively correlated with LBMD (r = -0.55) and FBMD (r = -0.48), and there were significant positive correlations between leptin and adiponectin levels and body mass index (BMI) (r = 0.91 and 0.97). Conclusions: The likelihood of having SOP was higher in older individuals with low levels of leptin and higher levels of chemerin. In addition, BMI was somewhat lower with low levels of leptin and adiponectin. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42022356469.

Bowman's layer transplantation in advanced keratoconus; 18-months outcomes.

PURPOSE: To assess the outcome of isolated Bowman's layer transplantation (BLT) in advanced keratoconus in the patients not suitable for ultra violet cross-linking and intra stromal corneal ring segments. STUDY DESIGN: Nonrandomized Quasi-Experimental. MATERIALS AND METHODS: Mid corneal stromal dissection followed by implantation of manually isolated bowman layer from a donor into the recipient stromal pocket was performed in the Department of Ophthalmology Khyber Teaching Hospital Peshawar from September 2018 to October 2018 and followed up over 18 months. RESULTS: Eleven eyes of 11 patients, 8 male and 3 female within the age range of 7-28 years with progressive keratoconus went under BLT All keratometry values decreased after surgery. Mean anterior pre-operative SimK changed from 69.05 ± 10.85 D to 61.14 ± 6.23 D at 18 months post-operatively (P = 0.005). Means pre-operative Kmax value decreased from 77.24 ± 7.58 D to 71.07 ± 5.37 D at 18 months post-operatively (p = 0.060). The mean pre-operative posterior keratometry value changed from - 10.03 ± 0.88 to - 8.96 ± 1.06 D at 18 months post-operatively (P = 0.002). Mean pre-operative thinnest corneal thickness increased from 281.64 ± 196.86 um to 355.27 ± 19.17 um at 18th months post-operatively (P = 0.001). Pachymetry p-value pre-operative to 18 months (P = 0.001) was statistically significant. Mean anterior SimK at 6 months post-operatively, 60.55 ± 5.56D changed to 61.14 ± 6.23D at 18 months post-operatively (P = 0.000), Kmax at 6 months postoperative 71.60 ± 5.01 D changed to 71.07 ± 5.37 D at 18 months post-operatively (P = 0.008). Both anterior K values at 6 months and 18 months post-operatively showed less significant change, and the same was true for Kmax data at 6 months and 18 months post-operatively. P-values at 6 months to 18 months post-operatively for cornea back data remained (P = 0.001) unchanged. No complications were observed intra-operatively or post-operatively. CONCLUSION: Bowman layer transplantation is a unique surgical treatment for advanced keratoconus to stabilize progressive ectasia with fewer complications avoiding the need for penetrating or deep anterior lamellar keratoplasty.

Association between interleukin gene polymorphisms and multiple myeloma susceptibility.

The present study performed a retrospective observational study in order to investigate the relationship between the interleukin family gene polymorphisms and risk of multiple myeloma (MM), based on sixteen case-control studies that contained 2,597 patients with MM and 3,851 controls. The results demonstrated that the genotypes IL-6 and IL-1 GG increased the risk of MM by approximately 40.8 and 80.2% compared with the genotypes AA and CC [odds ratio (OR)=1.14, 95% confidence interval (CI), 0.88-1.47, and OR=1.16, 95% CI, 0.61-2.19; respectively]. The results also revealed a significant association between T:C polymorphism of the IL-6 and IL-10 and the risk of MM (TC/CC: OR=1.37, 95% CI, 0.88-2.16 and TT/CC: OR=1.26, 95% CI, 0.77-2.06, respectively). Additionally, no significant association was identified between the C:A polymorphisms of the IL-6 (rs8192284) and IL-10 (rs1800872) receptors and the overall risk of MM (P>0.05). G:C polymorphisms of the IL-1ß1464G>C and IL-6572G>C significantly increased the risk of MM (P<0.05). However, it has been determined that there is a significant association between the C:T polymorphism of the IL-1α-889C>T and IL-1ß-3737C>T and the risk of MM (P<0.001). Subgroup analysis revealed that the detection of G:A polymorphisms in the IL-6 promoter (OR=1.05, 95% CI, 0.78-1.44) is more accurate in MM samples of the Asian population (OR=1.24, 95% CI, 0.92-1.74). In addition, no significant association was identified between the IL gene polymorphisms in MM samples categorized by ethnicity and the IL family type (P=0.27). These single nucleotide polymorphism loci may be the appropriate gene markers for gene screening and a promising therapeutic strategy in the prognostics of patients with MM.

Associations of serum low-density lipoprotein and systolic blood pressure levels with type 2 diabetic patients with and without peripheral neuropathy: systemic review, meta-analysis and meta-regression analysis of observational studies.

BACKGROUND: Compositional abnormalities in lipoproteins and cardiovascular risk factors play an important role in the progression of diabetic peripheral neuropathy (DPN). This systematic review aimed to estimate the predicting value of low-density lipoprotein (LDL) and systolic blood pressure (SBP) level in type-2 diabetes mellitus (T2DM) patients with and without peripheral neuropathy. We also tried to determine whether LDL and SBP are associated with an increased collision risk of DPN. METHODS: A systematic search was conducted for eligible publications which explored the LDL and SBP level in T2DM patients with and without peripheral neuropathy. The quality of the included studies was assessed by the QUADAS-2 tool. The standardized mean difference (SMD) with 95% CI of LDL and SBP level were pooled to assess the correlation between LDL and SBP level with DPN. We performed random effects meta-regression analyses to investigate factors associated with an increased collision risk of DPN. RESULTS: There was a significant association between LDL and SBP with poor prognosis of DPN in those included studies (I2 = 88.1% and I2 = 84.9%, respectively, Both P < 0.001). European T2DM patients have higher serum level of LDL in compare with the European DPN patients (SMD = 0.16, 95% CI: - 0.06 - 0.38; P < 0.001). SBP level was associated with a 2.6-fold decrease in non-DPN patients of T2DM (SMD = - 2.63, 95% CI: - 4.00 - -1.27, P < 0.001). Old age European T2DM patients have significantly high risk for diabetes drivers. Furthermore, the results of the case-control study design model are more precise to show the accuracy of SBP in Asian T2DM patients. CONCLUSION: Our finding supports the LDL and SBP status could be associated with increased risk of peripheral neuropathy in T2DM patients.

Incidence, nature, and temporal trends of adverse events associated with noncardiac procedures among veterans with drug-eluting coronary artery stents.

BACKGROUND: The incidence of adverse events with noncardiac procedures (NCP) after the use of drug eluting stents (DES) is not well studied. We sought to determine the incidence and temporal trends of adverse events in patients undergoing NCP after coronary DES. METHODS: We performed a retrospective review of patients receiving DES during percutaneous coronary intervention (PCI) in the Lexington VAMC between January 1, 2004 and December 31, 2010 to determine the circumstances and the results of their NCP. RESULTS: We identified 1,092 patients who underwent at least one PCI with DES who were followed for at least 3 years. Of those, 452 patients (41%) had a NCP at a median of 534 days after PCI with 1,081 procedures (894 low-, 160 Intermediate-, and 27 high-risk) performed. Clinically relevant NCP-related complications were defined as significant bleeding or stent thrombosis and occurred in 13 individuals (nine perioperative bleeding and four probable/possible stent thrombosis including two mortalities). Five adverse events occurred within the first year at a rate of 0.014 event/patient-year. During the remainder of follow-up (up to 9 years), eight events were documented at a rate of 0.0004 event/patient-years. During the first year of follow-up, there was no significant increase in risk of recurrent myocardial infarction (MI) or target vessel revascularization (TVR) in patients undergoing NCP but higher risk of all-cause mortality in those who did not undergo NCP. However, in patients who underwent NCP, there was a statistically significant increase in myocardial infarction (MI), target vessel revascularization (TVR), and rehospitalization for cardiac reasons compared with those without NCP during long term follow-up (median of 5.6 years). CONCLUSION: NCP after DES requiring management of DAT are relatively common among veterans following PCI using DES. The risk of bleeding and stent thrombosis is concentrated in the first year but remains very low.

General practitioner's knowledge regarding the diagnosis and drug therapy for acute myocardial infarction.

OBJECTIVE: To assess the general practitioners (GP) knowledge regarding the diagnosis and initial drug therapy for acute myocardial infarction (AMI). METHODS: A questionnaire-based survey was conducted in randomly selected GPs of Karachi. Doctors working in community as GPs who were registered medical practitioners having a Bachelor of Medicine & Bachelor of Surgery degree were included in the study. Doctors working at tertiary care facilities or having a post graduate degree or post graduate training in a specialty other than family medicine were excluded from the study. RESULTS: A total of 186 GPs participated in our study. GPs who studied research journals were 2.33 times more likely to investigate serum cardiac troponins levels for the diagnosis of AMI compared to those who did not study research journals (P = 0.02). Twenty six percent of the GPs said that they would refer a patient with suspected AMI without treatment, while 76% said that they would consider some treatment prior to referral. Fifty eight percent of the GPs identified ST segment elevation myocardial infarction (STEMI) of < 12 hours duration as an indication of thrombolysis while 28% identified posterior wall AMI as a thrombolytic indication. CONCLUSION: GPs, although adequately aware of the presenting features of AMI, were lacking in knowledge regarding the means for confirmation of diagnosis, initial drug therapy and were less likely to carry management steps in their practice.

Clinical outcomes of sirolimus with eluting stent implantation in coronary artery disease.

OBJECTIVE: To evaluate the immediate post procedure, thirty-days, and six-months clinical outcomes of sirolimus-eluting stents (SES) implantation in patients with single and multivessel coronary artery disease (CAD). METHODS: A case series of all consecutive patients undergoing percutaneous coronary interventions (PCI) with SES implantation at Shifa International Hospital, Islamabad, were evaluated at early post-procedure, 30-days and six-months clinical follow-up for the incidence of major adverse cardiac event (MACE). This included death, nonfatal myocardial infarction (MI) and repeat revascularization. RESULTS: Out of 206 consecutive patients, 324 had SES implanted. Cumulative MACE rate was 2.93% and 6% at 30-days and six-months follow-ups respectively. Five patients developed ST-segment elevation MI (STEMI). One patient developed non-STEMI. Emergency Coronary Artery Bypass Grafting (CABG) was done in two patients. Repeat (PCI) was carried in three (1.46%) patients for acute in-stent thrombosis. Diabetes Mellitus and multivessel stenting were found to be the independent predictors for acute in-stent thrombosis (P-value < 0.02 and 0.05 respectively). CONCLUSION: SES implantation in coronary artery disease can be safe and effective MACE at one and six months follow-ups.

Tracheomalacia in a patient with unilateral pulmonary and renal agenesis.

We report the case of an eight-month-old boy with tracheomalacia secondary to impingement by the right pulmonary artery, together with congenital agenesis of the left lung and the left kidney. Aortopexy and right pulmonary arterypexy were successful in improving lung function by more than 100%, and the patient remained free of complications in the long term.

Non-clostridial gas gangrene of the neck and mediastinum.

Herein we report a case of gas gangrene of the neck and mediastinum in a poorly managed Type II diabetic with concomitant chronic renal failure and a recent history of mucormycosis. Despite the burden of co-morbidities and the gravity of the illness, the patient was successfully treated and remained free of complications in the long term.

Perceptions of Pakistani medical students about drugs and alcohol: a questionnaire-based survey.

BACKGROUND: Drug abuse is hazardous and known to be prevalent among young adults, warranting efforts to increase awareness about harmful effects and to change attitudes. This study was conducted to assess the perceptions of a group of medical students from Pakistan, a predominantly Muslim country, regarding four drugs namely heroin, charas, benzodiazepines and alcohol. RESULTS: In total, 174 self-reported questionnaires were received (87% response rate). The most commonly cited reasons for why some students take these drugs were peer pressure (96%), academic stress (90%) and curiosity (88%). The most commonly cited justifiable reason was to go to sleep (34%). According to 77%, living in the college male hostel predisposed one to using these drugs. Sixty percent of students said that the drugs did not improve exam performance, while 54% said they alleviated stress. Seventy-eight percent said they did not intend to ever take drugs in the future. Females and day-scholars were more willing to discourage a friend who took drugs. Morality (78%), religion (76%) and harmful effects of drugs (57%) were the most common deterrents against drug intake. Five suggestions to decrease drug abuse included better counseling facilities (78%) and more recreational facilities (60%). CONCLUSION: Efforts need to be made to increase student awareness regarding effects and side effects of drugs. Our findings suggest that educating students about the adverse effects as well as the moral and religious implications of drug abuse is more likely to have a positive impact than increased policing. Proper student-counseling facilities and healthier avenues for recreation are also required.

Intra-cardiac Burkitt's lymphoma mimicking acute pulmonary embolism.

Primary cardiac lymphoma is a rare clinical entity with poor prognosis and delayed diagnosis is often due to variable and non-specific clinical presentation. The case of an elderly male is reported with multiple co-morbidities, who had undergone a spinal laminectomy two weeks prior to presentation, later presented to the emergency room (E.R.) with acute chest pain, dyspnea and hypoxemia. A diagnosis of intracardiac thrombus was made, based on the clinical picture and echocardiography findings but per-operatively, he was found to have an extensive, non-resectable cardiac tumor.

Sleep deprivation and its associated factors among general ward patients at a tertiary care hospital in Pakistan.

OBJECTIVE: To estimate the occurrence rate of sleep deprivation and to identify the environmental, staff-related and patient-related factors associated with SD among general ward patients of a tertiary care hospital in Pakistan. METHODS: In a cross-sectional study, a pre-tested questionnaire was administered to 108 patients admitted into the general medical and general surgical wards of Aga Khan University Hospital, Karachi. RESULTS: In all, 50 (46.3%) respondents felt deprived of adequate sleep in the hospital. Worry about illness disturbed the night-time sleep of 47 (43.5%) patients; most of these had SD (70%) (p < 0.001). Other patients' noise disturbed 31.5% of study subjects and a significant majority (68%) of these had SD (p = 0.003). Over 17% of study subjects reported cell phone's ringing as a disturbing factor; more by those with SD (68%) compared to those with no SD (32%); again the difference was significant (p = 0.003). Physical discomfort and presence of cannula were reported as disturbing factors by 41.7% and 28.7% of the study subjects respectively but these were not significantly associated with SD. CONCLUSION: Our study revealed that sleep deprivation occurs commonly among general ward patients in tertiary care setting. Factors found to be associated with SD were amenable to modification to a greater extent.