DOES VITAMIN D DEFICIENCY CONTRIBUTE TO THE SEVERITY OF ASTHMA IN CHILDREN AND ADULTS?

Role of vitamin D in the health of bones has been well established for over decades; It was known that its deficiency caused rickets in children and osteomalacia in adults. Later it was discovered that these can be corrected by giving vitamin D. Researchers discovered that vitamin D can be synthesized by exposure to sun. Hence it was also named "the sunshine vitamin". As time passed it was observed that low levels of vitamin D were associated with multiple diseases. This sparked the interest of the scientific community to further the research on vitamin D which led to the studies that started associating vitamin D with various diseases like cancers (prostate, colon and breast), autoimmune diseases (rheumatoid arthritis), infectious diseases (tuberculosis, hepatitis B, hepatitis C, HIV), cardiovascular diseases, mental illnesses (schizophrenia), diabetes mellitus (type 1, type 2 and gestational) and allergic conditions like asthma. With time, more studies were carried out relating levels of vitamin D to development of asthma, asthma exacerbations and risk factors leading to development of asthma like respiratory tract infections with positive associations. A number of studies were carried out which tried to explain the possible molecular mechanisms relating deficiency of vitamin D in pathogenesis of asthma. This review summarizes the role of vitamin D in development of asthma and probable mechanisms relating vitamin D to the pathogenesis of asthma.

A Systematic Review on the Mental Health Status of Patients Infected With Monkeypox Virus.

Objectives: This study aims to extract and summarize the literature on the mental health status of patients with monkeypox. Methods: This review was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using different databases and publishers such as Scopus, Sage, ScienceDirect, PubMed, BMJ, Wiley Online Library, Wolters Kluwer OVID-SP, and Google Scholar. The literature review was based on monkeypox and mental health. The year of publication was 2021-2023, during the monkeypox disease period. Data were extracted from opinions, editorials, empirical studies, and surveys. Results: Based on the literature related to the mental status of patients with monkeypox, the following themes and subthemes were identified: anxiety and depression, self-harm and suicidal tendencies, neuropsychiatric symptoms, mental health, social stigma, sex workers, vaccination, and stress-related diseases. Conclusion: A review of monkeypox virus infection studies reveals that 25%-50% of patients experience anxiety and depression due to isolation, boredom, and loneliness. Factors such as infected people, a lack of competence among healthcare professionals, and shame over physical symptoms exacerbate mental insults. The implications of society include increased self-harm, suicide, low productivity, fear of stigmatization, and transmission of infection.

Iron status parameters in preeclamptic women.

BACKGROUND: Evidence of increased oxidative stress due to endothelial dysfunction in preeclampsia has been well established. Increase in the oxidative stress is catalyzed in the presence of free transitional metals. Therefore, the relationship of iron status with preeclampsia was under investigation. OBJECTIVE: The objective of the study was to compare red blood cell (RBC) count, hemoglobin (Hb) concentration, hematocrit (Hct), RBC indices, and iron status parameters in preeclamptic and healthy pregnant women. METHOD: Blood samples were collected from 40 pregnant females diagnosed as preeclampsia and 80 normal pregnant females at the Department of Obstetrics and Gynecology at King Abdulaziz Medical City, Riyadh, Saudi Arabia between February 2009 and January 2010. We recorded RBC count, Hb concentration, Hct, RBC indices, serum iron and ferritin levels in both the groups. RESULT: Mean serum iron in preeclampsia group was 23.48 ± 9.05, while 12.2 ± 5.21 in normal group (p <0.05). Similarly, mean serum ferritin concentration in preeclamptic and normal pregnant women were 32.56 ± 11.72 and 19.89 ± 8.86, respectively (p < 0.05). No significant differences were found among RBC count, Hb concentration, Hct, and RBC indices in both the groups. CONCLUSION: We recommend that any pregnant female with higher serum iron and ferritin concentrations should be further investigated for preeclampsia.

Adipocytokines in subjects with and without ischemic cerebrovascular disease.

OBJECTIVE OF THE STUDY: To investigate adipocytokines in patients with ischemic cerebrovascular disease and to develop an association between them. METHODS: In this study plasma adiponectin, leptin and Interleukin 6 (IL 6) concentration were measured by ELISA. Blood glucose and lipid profile was done by standard kit methods. RESULTS: A total of 80 subjects with and without CVD were studied. The mean plasma level of IL6 of the forty patients with ischemic CVD was significantly higher than that of the forty subjects without CVD (41.64 + 2.50 versus 22.76 + 0.76 pg/mL; P < 0.001). The mean plasma level of adiponectin was significantly lower in patients with ischemic CVD than that of subjects without CVD (4.36 +/- 0.21 microg/mL versus 6.9 +/-0.241microg/mL; P < 0.001). Serum leptin concentrations were significantly higher (p < 0.001) in stroke patients (51.61 + 1.39) as compared with controls (37.76 + 1.207). Leptin levels were significantly negatively correlated with adiponectin (P < 0.01) and significantly positively correlated (P < 0.01) with interleukin 6 in stroke patients. CONCLUSION: Present report provides additional support to the evidence of involvement of cytokines in inflammatory immune response of patients with cerebrovascular disease.

Role of oxidative stress in the pathogenesis of preeclampsia.

Hypertensive disorders of pregnancy are associated with an increased risk of maternal and fetal morbidity and mortality. The cause and the pathogenesis of the pregnancy-induced syndrome, preeclampsia, is still poorly understood. Published evidence of altered biomarkers for the endothelial dysfunction suggests that the initiating event in preeclampsia is the reduced placental perfusion, which leads to widespread dysfunction of the maternal vascular endothelium. This review focuses on the role of free radicals in generating the oxidative stress taking antioxidants into consideration which tend to overcome it as well as the role of placenta in preeclamptic pregnancy.

Adiponectin and infarction size in subjects with and without cerebrovascular disease.

OBJECTIVE: To investigate whether hypo-adiponectinemia is present in ischemic stroke patients. METHODS: This comparative study was carried out in the Biochemistry Department, Ziauddin University, Karachi, Pakistan in 2008. In this study, plasma adiponectin concentration was measured by an enzyme-linked immunosorbent assay in subjects with and without ischemic cerebrovascular disease (CVD). RESULTS: A total of 80 subjects were studied (40 patients with CVD, and 40 without CVD as controls). The mean plasma level of adiponectin of the 40 patients with ischemic CVD was significantly lower than that of the 40 subjects without CVD (4.36+/-0.21 ug/mL versus 6.97+/-0.241 ug/mL; p=0.000). Decreasing concentrations of adiponectin were negatively correlated with infarction size in ischemic CVD patients. CONCLUSION: These data show that there are significantly lower levels of plasma adiponectin in patients with ischemic CVD. Moreover, adiponectin is negatively correlated with infarction size in these patients suggesting the possible role of adiponectin in cerebrovascular disease.

Relationship between adiponectin, glycemic control and blood lipids in diabetic type 2 postmenopausal women with and without complication of ischemic heart disease.

BACKGROUND: Recently major adipocytokine, adiponectin, are thought to play important roles in the regulation of cardiovascular and metabolic homeostasis. We compared serum adiponectin concentrations and lipid profile in diabetic patients with and without complication of cardiovascular disease in postmenopausal women. METHODS: We included 120 female subjects between the age of 45 and 60 years. The subjects were divided into 3 groups and each group comprised of 40 subjects. First group comprised of normal healthy controls, second group diabetic type 2 patients with no history of ischemic heart disease (IHD) and the third group diabetic patients with IHD. Serum adiponectin concentrations, serum triglycerides, cholesterol, LDL cholesterol and HDL cholesterol concentrations were determined. RESULTS: Values of fasting and random blood glucose, serum triglycerides, cholesterol, LDL cholesterol were significantly increased (P<0.001) in diabetic patients with IHD as compared with normal control subjects except for serum adiponectin and HDL cholesterol concentrations, which were significantly decreased (P<0.001) in diabetic patients and diabetic patients with IHD group. When values of cholesterol, triglycerides, LDL cholesterol, HDL cholesterol, fasting and random blood glucose and adiponectin were compared among diabetic and diabetic patients with IHD, it was observed that they were significantly increased (P<0.001) except for adiponectin, which was decreased significantly (P<0.001) and random blood glucose, LDL and HDL cholesterol in which no change was observed between the 2 groups. CONCLUSIONS: Serum adiponectin concentrations may be a predictor for development of cardiovascular disease in postmenopausal diabetic patients.

Comparison of adiponectin, leptin and blood lipid levels in normal and obese postmenopausal women.

OBJECTIVE: To determine adiponectin, leptin and blood lipid levels in normal and obese postmenopausal women and to compare them. METHODS: Eighty postmenopausal women were selected which included 40 normal controls and 40 obese women matched for age and height. Adiponectin and leptin levels were determined by ELISA. Triglycerides, cholesterol, LDL cholesterol and HDL cholesterol were determined by standard kit methods using Clinicon 4010. RESULTS: Serum adiponectin level decreased and leptin level increased significantly (P < 0.001) in obese women compared to controls. Similarly triglycerides, cholesterol and LDL cholesterol were increased significantly (P < 0.001) in obese subjects compared with controls. No significant change in HDL cholesterol was observed in both groups. Significant correlation of leptin with lipid profile was observed when both groups were combined. CONCLUSION: Serum adiponectin level decreased and leptin level increased significantly in obese women compared to controls. Significant correlation exists between leptin and lipid profile in combined group.

Has the inclusion of a longitudinally integrated communication skills program improved consultation skills in medical students? A pilot study.

BACKGROUND: Evidence highlights a lack of communication skills in doctors leading to dysfunctional consultations. To address this deficit, a private medical college instituted curricular reforms with inclusion of a longitudinal communication skills program. A pilot study was undertaken to evaluate the effectiveness of this program by comparing the consultation skills of medical students of this college with a medical college without a communication skills program. METHODS: A 4-station Objective Structured Clinical Examination (OSCE) was conducted in the third and final year. Mann-Whitney U-test was used to compare the difference in the distribution between OSCE stations total and construct scores. RESULTS: At the end of the third year, 21 (31.34%), students of the study site (medical college 1 [college with integrated longitudinal communication skills program]) and 31 (46.26%) students from the comparison site (medical college 2 [comparable college without communication skills program]) consented. Medical college 1 achieved a significantly higher overall mean total station score of 68.0% (standard deviation [SD] =13.5) versus 57.2% (SD = 15.4) (P < 0.001). Significantly higher mean scores were achieved on three stations. At the end of the final year, 19 students (29.3%) from medical college 1 and 22 (34%) students from medical college 2 consented. The difference in overall mean total station score reduced from 9.2% to 7.1% (70.2) (SD = 13.7) versus 63.1 (SD = 15.2) (P = 0.004). The mean scores of both colleges decreased in "Patient presenting with Hepatitis C Report" station (P values 0.004 and 0.775) and in "Patient Request for Faith Healing Therapy in Diabetes Mellitus" station (P values 0.0046 and 0.036), respectively. CONCLUSION: Longitudinal communication skills in an undergraduate curriculum positively impacted consultation skills. Community-based training and faculty development are required to develop effective patient-centered consultation skills.

Changes in glycosylated proteins in type-2 diabetic patients with and without complications.

BACKGROUND: Diabetes mellitus constitutes one of the most important problems in developing and developed countries. Increased glycosylation of various proteins in diabetic patients has been reported by many authors. The present study describes the changes in protein glycosylation in diabetic patients with and without diabetic complication. METHODS: The study included one hundred and three subjects. Among them 21 were type 2 diabetic patients without any clinical evidence of chronic diabetic complications, 21 were type 2 diabetic patients with cardiovascular complications, 20 were type 2 diabetic patients with cataract, 20 were type 2 diabetic patients with retinopathy and 21 apparently normal, age, sex and weight matched controls. The patients were selected from Ziauddin Medical University Hospital, Karachi and Jinnah Postgraduate Medical Centre, Karachi. RESULTS: Fasting plasma glucose was increased in all diabetic patients and correlated significantly with glycosylated hemoglobin, glycosylated plasma proteins and serum fructosamine concentrations. There was no significant difference in the levels of fasting plasma glucose, glycosylated plasma proteins, glycosylated hemoglobin, serum fructosamine, hexosamine or sialic acid between diabetic patients with or without chronic complications. Alpha-1 and alpha-2 globulin fraction were significantly increased in diabetic patients without complications, diabetic patients with cardiovascular complications and diabetic patients with cataract. Albumin was found to be decreased in diabetic patients with cataract while gamma globulin was increased in diabetic patients with cardiovascular complications and diabetic patients with cataract. CONCLUSIONS: In uncomplicated diabetic patients alpha-1 and alpha-2 glycoproteins were increased. In diabetic patients with cardiovascular complications alpha-1, alpha-2 and gamma globulin were increased while in diabetic patients with cataract alpha-1, alpha-2 and gamma globulin were increased but serum albumin was significantly decreased.

Pattern of perfusion defects seen in ischemic heart disease patients on technetium (Tc99m) tetrofosmin scanning.

BACKGROUND: Cardiovascular disease is common cause of death in developed as well as developing countries. The most common cause of Ischemic Heart disease is narrowing of coronary arteries, a process called as atherosclerosis. The objective of the present study is to determine the pattern of ischemic changes detected by technetium tetrofosmin (Tc99m). METHODS: Sixty five patients presenting as known or suspected ischemic heart disease over a period of two years (December 1995 to December 1998) at Ziauddin Hospital were included in the study. Each patient underwent Tc99m tetrofosmin stress and rest studies. Tetrofosmin study was performed according to one day protocol. RESULTS: By segmental analysis (five segment per patient), 35 patients had perfusion defects by SPECT Tc99m tetrofosmin imaging. Out of 95 perfusion defects, reversible ischemia and mixed defects were more common in inferior wall and fixed defect in left ventricular apex. CONCLUSION: Reversible ischemia and mixed defects were more common in inferior wall and fixed defect in left ventricular apex.

Comparison of troponin T and enzyme levels in acute myocardial infarction and skeletal muscle injury.

BACKGROUND: The objective of this study was to compare the levels of troponin T and enzymes levels in myocardial infarction and skeletal muscle injury. METHODS: This study was carried out at Basic Medical Sciences Institute, JPMC Karachi, Pakistan. Ninety subjects were selected. Thirty controls, thirty patients suffering from myocardial infarction and thirty suffering from skeletal muscle injury were selected from National Institute of Cardiovascular Diseases. Creatine kinase, aspartate amino-transferase, lactate dehydrogenase and Troponin T were determined by kit methods. RESULTS: Troponin T level rises significantly (p < 0.01) in patients suffering from myocardial infarction. Creatine kinase (CK), CKMB, aspartate aminotransferase and lactate dehydrogenase levels rises significantly (p < 0.01) in both groups compared with controls. CONCLUSION: Troponin T is an early indicator of myocardial infarction and is superior to CKMB in diagnosis of myocardial injury. There is no increase in troponin T levels in skeletal muscle injury.

Biomarkers of oxidative stress in women with pre-eclampsia.

AIM: The potential role of oxidative stress in the pathophysiology of pre-eclampsia has been reported in the literature. There are only a few studies that have investigated changes in malondialdehyde (MDA), vitamin E and total blood glutathione together in pre-eclampsia. Therefore, the aim of this study was to measure the levels of MDA, vitamin E and total glutathione as putative circulatory markers of oxidative stress for the early detection of pre-eclampsia. PATIENTS & METHODS: In this case-control study, blood samples were collected from 40 pre-eclamptic and 80 normal pregnant females at the department of obstetrics and gynecology at King Abdulaziz Medical City (Riyadh, Saudi Arabia) between February 2009 and January 2010. Circulating markers of oxidative stress were evaluated, including MDA, total glutathione and vitamin E, by high-performance liquid chromatography. RESULTS: Markers of oxidative stress including serum MDA, total glutathione and vitamin E were found to be significantly different in both groups. CONCLUSION: MDA, vitamin E and blood total glutathione are possible candidate markers to predict pre-eclampsia.

Association of adipokines with obesity in children and adolescents.

BACKGROUND: Childhood obesity is a global epidemic and is associated with a higher risk of chronic diseases such as hypertension, diabetes mellitus and other metabolic disorders. Several adipokines including resistin, visfatin, leptin and adiponectin are synthesized and secreted by adipocytes, which play an important role in obesity. PATIENTS & METHODS: A total of 90 subjects (60 controls and 30 obese) between the ages of 5 and 18 years were selected. Serum visfatin, TNF-α, resistin, insulin and adiponectin were measured using ELISA and insulin resistance was calculated by the Homeostasis Model of Assessment-Insulin Resistance. RESULTS: Mean ± standard deviation Homeostasis Model of Assessment-Insulin Resistance, serum TNF-α and visfatin levels were significantly higher in obese subjects (3.99 ± 0.94, 12.99 ± 3.42, 10.89 ± 2.72, respectively) compared with the control group (1.60 ± 0.34, 7.22 ± 2.22 and 4.97 ± 1.57, respectively). Mean ± standard deviation serum adiponectin levels were significantly lower in obese children (5.95 ± 1.02) compared with controls (9.07 ± 1.25). Binary logistic regression shows that adiponectin and visfatin are associated with obesity. CONCLUSION: Circulating levels of adipokines vary in obesity and adiponectin and visfatin are associated with obesity.

Circulating levels of resistin, IL-6 and lipid profile in elderly patients with ischemic heart disease with and without diabetes.

BACKGROUND: The cytokines that act as inflammatory hormones show a role in coronary atherosclerotic disease. AIMS: This study aimed to measure serum resistin, IL-6 levels and lipid profile in nondiabetic controls, diabetics, and ischemic heart disease subjects with and without diabetes. Association between resistin and IL-6 was also determined. MATERIALS & METHODS: In this comparative cross-sectional study, 147 subjects were selected, aged between 40 and 70 years. Subjects were divided into four groups as mentioned above. Plasma glucose was measured using the gluco-oxidase method. Lipid profile levels were measured using standard enzymatic methods. Levels of resistin and IL-6 were determined by ELISA. RESULTS: Out of 147 patients, 36 were controls and 111 were cases. Serum resistin and IL-6 levels increased significantly in diabetics (23.4 ± 0.74 ng/ml and 73.1 ± 2.57 ng/ml, respectively) and nondiabetics with ischemic heart disease (14.1 ± 0.51 ng/ml and 66.2 ± 2.08 ng/ml, respectively) compared with diabetics and nondiabetic controls. Positive correlations were found between IL-6 and resistin, and a significant positive correlation was shown in ischemic heart disease groups (r = 0.659; p = 0.001). CONCLUSION: This study shows that the plasma resistin and IL-6 concentrations increased significantly in patients with ischemic heart disease with and without diabetes. This shows that there is a possible role of resistin and IL-6 in inflammatory processes, especially in atherosclerosis.

Leptin and blood lipid levels in postmenopausal diabetic women with and without complication of ischemic heart disease.

BACKGROUND: Recent studies have provided evidence that leptin has significant effects on vascular development and repair. The aim was to determine the levels of leptin and lipid profile in diabetic postmenopausal women with and without the complication of ischemic heart disease and to develop correlation between them. Moreover, the relationship between leptin levels and extent of ischemic changes were determined. MATERIAL/METHODS: One hundred twenty postmenopausal subjects between the ages of 45 and 60 years were included in the study. They were divided into three groups of forty subjects each. The first group comprised normal healthy controls, the second diabetic type 2 patients with no history of ischemic heart disease (I1ID), and the third diabetic patients with IHD. Serum leptin levels were determined by a Kit obtained from DRG and samples were analyzed on ELISA. Fasting and random blood glucose was determined by the glucose oxidase method, cholesterol, triglycerides, LDL cholesterol, and HDL cholesterol were also determined by kits obtained from Merck. RESULTS: The results show that leptin and serum lipid levels increased significantly in diabetic patients with IHD compared with diabetic patients without IHD as well as normal subjects. Moreover; the sertum leptin level increased significantly in the diabetic patients with IHD who had positive findings in myocardial perfusion scan compared with those having negative findings. CONCLUSIONS: Hyperleptinemia in diabetic patients shows that leptin contributes to the development of cardiovascular disease in diabetic patients.