Copper deficiency is an independent risk factor for mortality in patients with advanced liver disease.

BACKGROUND AND AIM: Copper is an essential trace metal serving as a cofactor in innate immunity, metabolism, and iron transport. We hypothesize that copper deficiency may influence survival in patients with cirrhosis through these pathways. METHODS: We performed a retrospective cohort study involving 183 consecutive patients with cirrhosis or portal hypertension. Copper from blood and liver tissues was measured using inductively coupled plasma mass spectrometry. Polar metabolites were measured using nuclear magnetic resonance spectroscopy. Copper deficiency was defined by serum or plasma copper below 80 µg/dL for women or 70 µg/dL for men. RESULTS: The prevalence of copper deficiency was 17% (N=31). Copper deficiency was associated with younger age, race, zinc and selenium deficiency, and higher infection rates (42% vs. 20%, p=0.01). Serum copper correlated positively with albumin, ceruloplasmin, hepatic copper, and negatively with IL-1ß. Levels of polar metabolites involved in amino acids catabolism, mitochondrial transport of fatty acids, and gut microbial metabolism differed significantly according to copper deficiency status. During a median follow-up of 396 days, mortality was 22.6% in patients with copper deficiency compared with 10.5% in patients without. Liver transplantation rates were similar (32% vs. 30%). Cause-specific competing risk analysis showed that copper deficiency was associated with a significantly higher risk of death before transplantation after adjusting for age, sex, MELD-Na, and Karnofsky score (HR: 3.40, 95% CI, 1.18-9.82, p=0.023). CONCLUSIONS: In advanced cirrhosis, copper deficiency is relatively common and is associated with an increased infection risk, a distinctive metabolic profile, and an increased risk of death before transplantation.

Ovarian reserve parameters and response to controlled ovarian stimulation in infertile patients.

OBJECTIVE: To determine the ovarian reserve parameters in patients presenting for IVF and intracytoplasmic sperm injection (ICSI) treatment and its association with the number of follicles retrieved and number of oocyte retrieved and fertilized. METHODS: A retrospective cross sectional study was conducted at Australian Concept Infertility Medical Centre from January 2017 to August 2017. Around 120 couples presenting to infertility clinics selected for IVF and ICSI with Females (25-45) had their FSH, AMH and AFC done. After ovulation induction, its response was determined by number of follicles retrieved, quality of oocytes retrieved or fertilized and inseminated. SPSS version 20 was used for the purpose of data analysis. RESULTS: The median age of the patients was 34 (29-38) years. A moderate negative correlation of age and FSH levels was observed with quality of oocytes, Number of oocyte inseminated, number of oocyte fertilized and number of follicle restored. However, a positive correlation of AMH and AFC levels were found with quality of oocytes, Number of oocyte inseminated, number of oocyte fertilized and number of follicle restored. The correlation of AMH levels with number of oocyte inseminated (rho 0.729, p-value <0.001), number of oocyte fertilized (rho 0.721, <0.001) and number of follicle restored (rho 0.723, p-value <0.001) were found strongly correlated. CONCLUSION: Our study concluded that AMH and AFC have a strong correlation with number of follicles restored and number of oocytes retrieved whereas FSH and age has a weak correlation with the number of follicles restored and number of oocytes retrieved.

Influence of Dietary Intake on Sleeping Patterns of Medical Students.

Introduction The aim of the study was to explore the association between the intake of specific food substances and the sleeping patterns of medical students. Methods A cross-sectional study was conducted with 440 medical students, aged 18-24 years, chosen through non-probability consecutive sampling from Karachi, Pakistan. The Pittsburgh sleep quality index (PSQI) was used to measure sleep quality and a self-made questionnaire that categorized foods according to their nutritional constitutions was used to measure the frequency of food consumption. Associations were evaluated using the chi-square test with the level of significance taken as p < 0.05 and strength of significance determined using Cramer's V. logistic regression to predict good sleep quality. Results Significant associations were found with soybeans, whole grains, processed meats, leafy greens, dark chocolate, spices, dairy products, products high in fat and sugar, lima beans, and carbohydrates in relation to sleep quality, with soybeans exhibiting a particularly stronger relationship. The odds of good sleep quality were 2.5 times more likely with soybean intake, 3.26 times more likely with carbohydrates, and 6.57 times more likely with lima beans. Intake of papayas was associated with reduced sleep quality. Conclusion Intake of certain food substances has a significant association with sleep quality. Clinical trials focusing on the nutritional basis of these associations can lead to a new integrated focus on functional foods to combat poor sleep and sleep-related diseases.