Comparative and Predictive Significance of Serum Leptin Levels in Non-alcoholic Fatty Liver Disease.

Background Non-alcoholic fatty liver disease (NAFLD) has emerged as the single most common chronic non-viral liver disease. The burden of the disease on healthcare-providing services has increased tremendously. Although a liver biopsy is the most authentic laboratory investigation for scoring the disease progression, it is an invasive technique. Researchers are vigorously working to find alternate markers for the scoring purpose. Despite the importance and association of leptin with metabolic syndrome and its related disorders, there have been relatively fewer studies on serum leptin and its association with NAFLD. Objective This study aimed to investigate variations in serum leptin levels between subjects with and without fibrosis in NAFLD and to assess the predictive value of serum leptin levels in NAFLD subjects. Materials and methods The study comprised 130 NAFLD subjects from two tertiary care hospitals in Lahore along with 86 healthy controls that were age, gender, and BMI matched with the subjects. Based on the NAFLD fibrosis score (NFS), the subjects were divided into two sub-groups, subjects with simple steatosis and those with fibrosis. Fasting serum leptin, glucose, and insulin levels were measured using enzyme-linked immunosorbent assay (ELISA). The Kruskal-Wallis test was applied to find differences between the three groups and Fisher's exact test for categorical comparison. To assess the predictive value of serum leptin for steatosis and fibrosis in NAFLD subjects, receiver operation characteristic (ROC) curve analysis was implemented. Results The difference in serum leptin level was statistically highly significant (p-value <0.001), with leptin levels of 10 (17.1) ng/mL among controls, 20.5 (21) ng/mL in simple steatosis, and 21 (28.6) ng/mL in fibrosis. The area under the ROC curve was 0.67 and 0.52 for steatosis and fibrosis, respectively. The cut-off value of 12.2 ng/mL showed 70% sensitivity and 50% specificity for steatosis, while at a threshold of 18 ng/mL, leptin demonstrated 40% sensitivity and specificity for fibrosis. Conclusion In conclusion, this study found that serum leptin levels are higher in NAFLD subjects compared to healthy controls, and it is a good independent predictor for the detection of liver steatosis.

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.

Salivary aquaporin-3 as a screening biomarker for xerostomia in patients with periodontal disease and the effects of xerostomia on oral health-related quality of life.

Xerostomia is a subjective condition of dryness of the oral cavity that may lead to several oral problems deteriorating oral health-related quality of life. This study aimed to (1) determine the prevalence of xerostomia, (2) compare the general health status, unstimulated salivary flow rate, and oral health-related quality of life in xerostomics and non-xerostomics, and (3) investigate the potential of salivary aquaporin-3 (AQP-3) as a screening biomarker for xerostomia in patients with periodontal disease. Demographics and systemic health data were collected from 109 healthy participants, 20 to 55 years old, with Community Periodontal Index (CPI) score ≥ 3. For subjective assessment of xerostomia, Shortened Xerostomia Inventory (SXI) was used. For objective assessment of xerostomia, unstimulated salivary flow rate was measured. Shortened Oral Health Impact Profile (S-OHIP) was utilized for oral health-related quality of life assessment. The collected saliva samples were processed and stored at -80°C. Quantification of salivary AQP-3 protein was done with enzyme-linked immunosorbent assay. Xerostomia was reported in 78% of the subjects based on SXI score. Median concentration of AQP-3 was significantly higher in xerostomics compared to non-xerostomics, p = 0.001. Moreover, oral health-related quality of life was significantly poor in xerostomics compared to non-xerostomics, p = 0.002. Furthermore, there were significant correlations between AQP-3 and SXI (r = 0.21, p = 0.025), AQP-3 and S-OHIP (r = 0.2, p = 0.042), S-OHIP and SXI (r = 0.37, p < 0.001), unstimulated salivary flow rate and random blood glucose level (r = 0.32, p = 0.001), and body mass index and mean arterial pressure (r = 0.44, p < 0.001). Regression analysis showed that body mass index, CPI score 3, and salivary AQP-3 were suitable predictors for presence of xerostomia. AQP-3 could be a potential screening biomarker for xerostomia in patients with periodontal disease for its early identification may help improve oral health-related quality of life of the individuals.

Determination of COVID-19 Vaccine Hesitancy Among University Students.

Introduction With the sudden outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), vaccines appear to be the most efficient measure in combating spread. However, vaccines are only effective if a community collectively uptakes vaccination. This approach is growing increasingly difficult with the emergence of 'Vaccine Hesitancy.' This paper aims to determine the association between university curricula and the degree of hesitancy for the COVID-19 vaccine. Methods The online questionnaire assessed demographic data, prior knowledge of vaccines, attitude towards COVID-19 vaccines using an adapted version of the WHO Strategic Advisory Group of Experts (SAGE) Working Group's Vaccine Hesitancy Survey (VHS) and factors likely to motivate vaccine uptake. By using binary scoring, the degree of hesitancy among students was determined. Exploratory Factor Analysis (EFA) on VHS revealed underlying causes of hesitancy. To analyze the dependence between hesitancy and curriculum, a chi-squared test was conducted. Results Medical students scored higher for prior knowledge of vaccines (M = 3.54) as opposed to non-medical students (M = 3.49). Medical students responded favorably to COVID-19 vaccines with only 1.37% showing hesitancy for all nine items of VHS, compared to 2.55% of non-medical students. EFA produced three subscales within the VHS: lack of confidence, risk factor concern, and misinformation. The lack of confidence factor accounted for 65% of the data obtained. The chi-square test solidified that vaccine hesitancy is dependent on curriculum. Conclusion The majority of non-medical students showed hesitancy towards obtaining COVID-19 vaccines compared to medical students who were more willing, largely owing to their knowledge and understanding of vaccines.

Association of Working Environment and Anxiety Levels in Clinical Professionals During the COVID-19 Pandemic.

Introduction Coronavirus disease 2019 (COVID-19) is a global pandemic and has become a major life-threatening challenge. The sudden and fast spread of the COVID-19 pandemic worldwide caused a sudden increase in the workload of health care workers in parallel with the possible increase in mortality rates and the spread of this disease to a large number of people. Clinicians, who are our frontline warriors, are not only at high risk of catching COVID-19, but their mental health is also at stake. The objective of this study was to determine the prevalence of anxiety and its association with the working environment in clinical professionals during the COVID-19 pandemic. Methods This cross-sectional study collected data from 400 medical doctors through an online survey, carried out for six months. The anxiety of participants was assessed by using the Zung Self Rating anxiety scale (SAS). An anxiety index of greater than or equal to 50 was marked as anxious. Descriptive chi-square analysis and correlation analysis were used. Results This study found that out of a total, 20.1% of the participants suffered from anxiety. Anxiety was found to be positively associated with sociodemographic factors like the age of the doctor (p=0.001), their gender (p=0.000), their working environment (p=0.005), working in basic healthcare units (p=0.015), patient load per week (p=0.005), personal protective equipment (PPE) availability to doctor according to WHO guidelines (p=0.007), and patient compliance with doctors' orders (p=0.009). Conclusion We conclude that professional healthcare workers suffered from anxiety due to working conditions in the COVID-19 pandemic. Specific interventions and steps such as improving staffing and resources, policies to ensure fair distribution of working hours and rest breaks, workplace protections, work-family balance, health professional's emotional stability, and long-term benefits should be taken so as to minimize the lasting effects of these factors.

Etiological Profile and Antimicrobial Patterns in Blood Culture Specimens in a Tertiary Care Setting.

Introduction Universally, blood stream infections are linked with increasing morbidity and mortality. Timely diagnosis for identification of bacterial etiology, their susceptibility pattern and choice of empiric treatment plays a vital role in management. Objective To reveal the etiological profile and antibiotic sensitivity in blood culture specimens in a tertiary care setting. Methods This descriptive study was carried out in pathology laboratory of a tertiary care hospital from August 2016 to July 2019. All the 750 blood culture bottles were processed and isolates were recognized by morphological appearance on recommended media, gram stain, and different biochemical tests using Analytic Profile Index. Antibiotic sensitivity was implemented by modified disc diffusion method as per Clinical and Laboratory Standards Institute (CLSI) principles (2019). Results Out of 750 blood samples, 212 (28.26%) were culture positive. The percentage of gram-negative bacilli (n = 105) and gram-positive cocci (n = 104) was almost same (49.52%), while candida spp. was recovered from three (1.41%) isolates. The identified gram-negative bacteria were E. coli and Acinetobacter baumannii each (19.04%), Klebsiella pneumoniae and Pseudomonas aeruginosa each (16.19%), Enterobacter cloaca (11.42%), Salmonella typhi (8.57%), Burkholderia cepacia (1.90%), and Raoultella terrigena (7.61%). Among gram-positive isolates, coagulase-negative staphylococci (79.80%), Staphylococcus aureus (6.73%), Enterococcus spp. (11.53%) and Streptococcus spp. (1.92%) were recovered. Colistin, imipenem, meropenem, and amikacin were most successful against gram-negative rods. The sensitivity to vancomycin, teicoplanin and linezolid was 100%, for gram positive organisms. Methicillin resistance was present in 84.4% Staphylococcal isolates. Conclusion Local data showing changing etiological pattern and antibiogram of isolated pathogens, along with adequate infection prevention and control measures can be useful to improve patient care, in terms of hospital stay, duration of medication and treatment cost.

Correlation of Serum Anti-Mullerian Hormone with Ovarian Follicle Output Rate in Infertile Females: A Clomiphene Citrate Challenge Test.

Background Failure to achieve a successful pregnancy after 12 months of unprotected intercourse is a pathology of the reproductive system known as infertility. Anti-Mullerian hormone (AMH) not only reflects the ovarian reserve but also is known to be a predictor of several assisted reproductive techniques, e.g., in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), and clomiphene citrate challenge test. In this study, AMH levels are correlated with the follicular output rate after the clomiphene citrate challenge test. Objective The objective of this study is to correlate AMH with the follicular output rate (FORT) after the clomiphene citrate challenge test. Materials and methods This study included a total of 80 primary and secondary infertile females, divided into early (18-30) and late (31-45) reproductive age groups either currently under clomiphene citrate treatment or advised to start clomiphene treatment, culled from out-patient department and centers of assisted reproductive techniques. On the third day of the menstrual cycle, blood samples were taken to determine serum AMH levels by ELISA. Then on the fifth day of the menstrual cycle, antral follicular counts were calculated through transvaginal ultrasound and oral tablet clomiphene citrate was started, and on day 12 and then on day 5, transvaginal ultrasound was repeated to record the number and diameter of dominant follicles. Results The pre-ovulatory (mature) follicle count was divided by the antral follicle count ×100 for calculating the FORT, which showed a negative Spearman Rho correlation (p = 0.048) with AMH. P-value ≤ 0.05 was considered significant.   Conclusion It is concluded that the most commonly administered drug, clomiphene citrate, may not be the treatment of choice for patients with high levels of AMH and may, in fact, interfere with the chances of achieving pregnancy. This study can provide guidelines to clinicians for patient counseling, given the results of the clomiphene citrate challenge test on the basis of AMH levels.

Association of Oxidative Stress and Production of Inflammatory Mediators Matrix Metalloproteinase-9 and Interleukin 6: Systemic Events in Radicular Cysts.

Background Matrix metalloproteinase-9 (MMP-9) and antioxidants are associated with the pathogenesis of cysts and may initiate and sustain the formation of new capillaries. Objective The objective of this study was to determine the association of oxidative stress and the production of inflammatory mediators MMP-9 and interleukin 6 (IL-6) in systemic events in radicular cyst growth. Materials and methods Fifty patients (34 men, 16 women) with periapical granulomas and radicular cysts were included in this cross-sectional study. Twenty subjects (12 men, eight women) with no signs of periodontal diseases were recruited as controls. Blood serum levels of MMP-9, IL-6, superoxide dismutase (SOD), malondialdehyde (MDA), and glutathione peroxidase (GPx) were recorded. We also recorded body mass index (BMI) and tumor necrosis factor-alpha (TNF-alpha) levels. Results The mean age of the test group patients and control patients was 45.9 and 48.8 years, respectively. The BMI of test group patients (23.77± 3.88 kg/m2) was higher than that of the controls (27.98 ± 3.88 kg/m2; p ≤ 0.000). Levels of serum MDA (p ≤ 0.033), IL-6 (p ≤ 0.041), TNF-alpha (p ≤ 0.004), and MMP-9 (p ≤ 0.033) were significantly increased in patients as compared with control values. SOD (p ≤ 0.003) and GPx (p ≤ 0.033) levels were significantly reduced in patients as compared with controls. Conclusion Oxidative imbalance and the increased production of inflammatory mediators may be associated with systemic events in radicular cysts. Bone-resorbing mediators and proinflammatory cytokines that were evaluated in the study (MMP-9, IL-6, C-reactive protein, TNF-alpha) were also elevated in the serum of the ailing group, thus documenting a well-established role for these circulating biochemical variables in the course of the progression and pathogenesis of radicular cyst development.

Role of Interleukin-10 and Abdominopelvic Ultrasound as a Potential Predictor of Disease Severity in Dengue Hemorrhagic Fever.

Introduction Dengue viral infections are a major cause of morbidity and mortality in tropical/subtropical countries. Early and prompt detection of dengue hemorrhagic fever (DHF), though challenging, is helpful to identify an individual that would benefit from intensive therapy. Objective The goal of this study was to determine the plasma interleukin-10 (IL-10) levels in DHF patients at four to seven days of disease onset and 24 hours after the first sample. We also aimed to determine the association of plasma IL-10 levels and abdominopelvic ultrasound findings. Methods A total of 50 registered DHF patients aged 15 to 50 years were recruited. Plasma IL-10 concentration measurements and abdominopelvic ultrasounds were performed. Patients were also categorized based on ultrasound grading I to IV (based on severity). Outcomes were described as recovery and shock. Platelet count and hematocrit percentages were also recorded. Results Plasma IL-10 levels were elevated in DHF patients and associated with fatal outcomes (p = 0.00). Binary regression-coefficient showed the direct effect of high levels of plasma IL-10 on the fatal outcome of patients 24 hours after the first sample (p = 0.04). Disease severity was predicted by a positive correlation between ultrasound grades and outcomes (p = 0.00). Spearman's correlation coefficient found a highly significant inverse relationship between plasma IL-10 levels and platelet count after 24 hours (p = 0.01). However, a significant positive relationship was observed between elevated plasma IL-10 levels and hematocrit percentage after 24 hours (p = 0.01). Conclusion Elevated plasma IL-10 levels and abdominopelvic ultrasonography are promising potential predictors of disease progression and fatal outcome in DHF patients.

Interleukin-10 as a Marker of Disease Progression in Dengue Hemorrhagic Fever.

OBJECTIVE: To evaluate the plasma interleukin-10 (IL-10) levels in patients suffering from dengue hemorrhagic fever between 4 to 7 days of onset of disease and 24 hours after the first sample, to find out the association of plasma IL-10 levels with the outcome. STUDY DESIGN: Analytical study. PLACE AND DURATION OF STUDY: All major hospitals of Lahore, Pakistan, from August to November 2012. METHODOLOGY: Participants included 50 registered patients of dengue hemorrhagic fever (DHF) aged between 15 - 50 years. Plasma IL-10 concentrations were measured on above stated day. Outcome was described as recovery and shock. Platelet count and hematocrit percentages were also recorded. Statistical analyses were done using SPSS version 19. Ap-value ≤0.05 was considered significant. RESULTS: Plasma IL-10 levels were found to be raised in DHF patients and were associated with fatal outcome (p=0.004). In recovered DHF patients, plasma IL-10 levels decreased after 24 hours (mean 26.54 ± 16.03 pg/ml) as compared to admission time (mean 74.39 ± 61.69 pg/ml) but in case of DHF patients suffering from shock, plasma IL-10 was found to be higher after 24 hours (mean 87.69 ± 7.77 pg/ml) as compared to levels at admission time (mean 42.56 ± 28.09 pg/ml). ROC curve analysis revealed a change (30 units pg/ml) of plasma IL-10 concentration, within 24 hours of admission, raised from the base line to be 105 times more critical for shock in DHF patients (100% sensitivity and 71.4% specificity, p < 0.001). CONCLUSION: Elevated plasma IL-10 is a potential predictor of disease severity and fatal outcome in DHF patients.

Serum 25-Hydroxy Vitamin D Level in Preeclamptic and Normotensive Pregnancies.

OBJECTIVE: To compare serum 25-hydroxy vitamin D level between preeclamptic and normotensive pregnancies. STUDY DESIGN: Cross-sectional analytical study. PLACE AND DURATION OF STUDY: Department of Physiology, Federal Postgraduate Medical Institute, Shaikh Zayed Hospital, Lahore, in collaboration with Sir Ganga Ram Hospital and Lady Willingdon Hospital, Lahore, from March 2012 to April 2012. METHODOLOGY: Thirty registered preeclamptic patients with systolic and diastolic blood pressure > 140/90 mm Hg on more than two occasions, 6 hours apart, and proteinuria at least 300 mg in 24-hour urine collection; and 30 normotensive uncomplicated pregnant women matched for age, gestational age, parity and BMI were included by convenient sampling technique. Vitamin D levels of less than 50 n mol/l (< 20 ng/ml) was the cutoff point. Spearman's rank correlation of vitamin D with systolic blood pressure and arterial pressure in both preeclamptic and normotensive pregnant women was presented in a tabulated form. RESULTS: Vitamin D deficiency was found in 95% of preeclamptic and normotensive pregnant women. The difference of vitamin D level between the two groups was not found significant. Although there was an inverse correlation between serum vitamin D and systolic blood pressure and arterial pressure in preeclamptic group, but this was not statistically significant. CONCLUSION: Vitamin D deficiency does not seem to be affected by the state of preeclamptic and normotensive pregnancy. The correlation of systolic blood pressure and arterial pressure and vitamin D needs to be explored further by increasing the sample size.

Correlation of CRP levels in third trimester with fetal birth weight in preeclamptic and normotensive pregnant women.

OBJECTIVE: To evaluate the levels of C-reactive protein, an inflammatory marker in preeclamptic and normotensive pregnant women and to determine its correlation with fetal birth weight. STUDY DESIGN: Cross-sectional analytical study. PLACE AND DURATION OF STUDY: Unit of Obstetrics and Gynaecology, Shaikh Zayed Hospital and Gynaecological Unit II of Jinnah Hospital, Lahore, from December 2011 to May 2012. METHODOLOGY: The participants included 60 cases with preeclampsia and 60 normotensive pregnant women, all in their third trimester. All the participants were in the age group of 20 - 40 years and had a BMI range of 18 - 25. High sensitive C-reactive protein (hsCRP) levels were measured by Enzyme Link Immunosorbent Assay. Statistical analysis was done using SPSS (version 15). The values were considered significant at 0.05 level of significance. RESULTS: C-reactive protein levels were significantly high (p < 0.001) in the preeclamptic group with a median value of 8.8 (0.3 - 25.5) as compared to 5.4 (0.24 - 9.8) mg/l in the normotensive women. The birth weight of babies was also significantly low in the preeclamptic group. The high CRP levels were negatively correlated with fetal birth weight in preeclamptic group. CONCLUSION: Elevated C-reactive protein levels in the preeclamptic pregnant women is a part of an exaggerated maternal systemic inflammatory response, and correlates with low fetal birth weight.