Effect of Berberine Phytosome on reproductive, dermatologic, and metabolic characteristics in women with polycystic ovary syndrome: a controlled, randomized, multi-centric, open-label clinical trial.

Background: Berberine is a poorly absorbed natural alkaloid widely used as nutraceutical to counteract diarrhoea and to lower cholesterol and hyperglycaemia. It has also been reported to reduce signs and symptoms of polycystic ovary syndrome (PCOS). Objective: To explore, through a multi-centric, randomized, controlled and prospective study, the possible role played by a form berberine that is more easily absorbed (Berberine Phytosome®, BP) in 130 Pakistani women with a diagnosis of PCOS and fertility problems due to menstrual and ovary abnormalities. Results: Ninety days of supplementation with BP, administered at 550 mg x2/die, determined (i) resumption of regular menstruation in about 70% of women (versus 16% in the control group; p < 0.0001), (ii) normalization of the ovaries anatomy in more than 60% of women (versus 13% in the control group; p < 0.0001), (iii) acne improvement in 50% of women (versus 16% in the control group; p = 0.0409) and (iv) hirsutism reduction in 14% of women (versus 0% in the control group; p = 0.0152). The metabolic and the hormonal profiles of the women in the two groups did not significantly differentiate at the end of the study. BP was well-tolerated and no specific side-effects were registered. Respectively after one, two and 8 years of trying, three women supplemented with BP became and are currently pregnant. Conclusion: Our study showed the positive effects of BP supplementation in women with PCOS and confirmed the high safety profile of this nutraceutical. Clinical Trial Registration: https://clinicaltrials.gov/, identifier NCT05480670.

Hepatitis B, C And Hiv Exposure On Nat And Clia Blood Examination Methods At Regional Blood Centre Abbottabad.

BACKGROUND: Blood transfusion is a lifesaving method in clinical emergencies. Despite various preventive measures, the spread of Hepatitis B, C and HIV remains a big issue in Pakistan. This study was done to describe transfusion transmitted diseases using NAT and CLIA techniques, on exposure to these viruses. METHODS: This study was conducted from 1st April to 25th August 2022. A descriptive study was done along with univariate analysis. The data was obtained from the regional blood centre in Abbottabad and it consists of reactive and non-reactive cases of NAT and CLIA in the sample size of 6233 donors. Data was collected from donors, and selected according to predefined criteria. RESULTS: In 6233 samples, 53 were reactive for either Hepatitis B, C or HIV. Forty-seven were reactive with both CLIA and NAT. 6 were reactive with NAT only and 6107 were non-reactive. CONCLUSIONS: NAT yield detected in this study is 0.096%. (1:1039 donations). It implies that NAT should be the preferred method for screening in blood banks.

Comparative Evaluation And Accuracy Of Ict, Clia And Nat For The Detection Of Hepatitis B, C And Hiv In The Blood Donors.

BACKGROUND: A sensitive and specific donor screening strategy is essential for the prevention of transfusion-transmitted infections (TTI). The study was conducted to ascertain the comparative efficacy of ICT, CLIA and NAT methods. METHODS: This cross-sectional analytical study was conducted in Regional Blood Center Abbottabad, Pakistan from 1st April to 25 August 2022. 6233 donors were screened for Hep B, C, and HIV by testing simultaneously with ICT, CLIA and NAT. RESULTS: Active Hep B, C and HIV Infection was present in 0.51%, 0.28% and 0.00048% donors respectively. The sensitivity was found to be higher for HBV and HIV with CLIA as compared to ICT but was equal for HCV with both. whereas specificity was the same with both CLIA and ICT for all three viruses. PPV was higher with ICT for HBV and HCV, but for HIV it was found higher by CLIA. NPV was higher for all three viruses by CLIA as compared to ICT. CONCLUSIONS: In case rapid testing devices are used for the initial screening of blood in countries with limited resources, positive cases must be confirmed by CLIA and if possible, then by NAT because of missing cases in the window period and false positive cases.

Association Of Liver Fatty Acid Binding Protein With Acute Kidney Injury In Paediatric Patients After Cardiac Surgery.

Background: Acute kidney injury (AKI) is a common complication after cardiac surgery. Like Creatinine level, the role of L-FABP in renal injury and its recovery had been shown by studies, so by using/measuring urinary Liver fatty acid-binding protein (uL-FABP) levels it can be a valuable biomarker for monitoring and diagnosis of various renal diseases. The study aimed to determine L-FABP as a biomarker for early diagnosis of AKI acute kidney injury in paediatric patients after cardiac surgery so that early treatment interventions can prevent AKI morbidity. Methods: This descriptive study was conducted in the Pathology laboratory of Sheikh Zayed Hospital, Lahore from 2015 to 2016. Selected through convenience sampling, patients' blood and urine were analysed for desired markers. Results: Out of 88, 10 (11.4%) patients developed AKI after cardiac surgery. In patients with AKI, serum creatinine levels started to rise at 24-48 h after surgery whereas uL-FABP was to be high at 4h. The optimal cut-off value of uLFABP was found 269 ng/l, with this cut-off value sensitivity of marker at four hours to recognize AKI was found to be 80% and specificity was 83.3%, the positive and negative predictive values were 38.1% and 97.0% respectively with an accuracy level 83.0%. Conclusion: It may be concluded from this study that uL-FABP may be considered as an early predictor of the development of AKI in paediatric patients undergoing cardiac surgery.

Association Of Adiponectin With Total Leukocyte Count In Patients Of Coronary Artery Disease.

Background: Hypoadiponectinemia and raised total leukocyte count have been associated with coronary artery disease. The aim of this study was to investigate association of serum adiponectin levels with total leukocyte count in patients of coronary artery disease belonging to Khyber Pakhtunkhwa. Method: This cross-sectional/analytical study consisted of two groups. Group A contained 100 patients of coronary artery disease while group B contained 100 healthy controls. Consent of the study subjects was obtained, their history was recorded and fasting blood samples were analyzed for serum adiponectin level, total leukocyte count (TLC), serum lipid profile which included serum total cholesterol (T-C), triglyceride level (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). Adiponectin level was determined with ELIZA method, TLC was estimated on automated haematology analyzer and lipid profile was determined using enzymatic colorimetric method. SPSS version 21 was used to analyze the data. Results: Subjects with coronary artery disease when compared to healthy subjects showed significantly high level of total leukocyte count (9.26±1.488 vs. 6.37±4.052) and low level of serum adiponectin (4.3±0.80 vs. 9.6±3.69). Moreover, serum lipid profile showed low HDL-C (30.04±9.1 vs. 43.64±7.3) and rose triglyceride (220.1±67.7 vs. 181.86±41.4), total cholesterol (229.3±37.01 vs. 189.4±32.7), and LDL-C (153.78±38.53 vs. 109.16±33.91) levels. Significant negative association of adiponectin with TLC (r -0.826 with p<0.01) was observed in the study subjects. Conclusion: We observed elevated level of total leukocyte count and reduced level of adiponectin in subjects with coronary artery disease. Moreover, hypoadiponectinemia correlated negatively with TLC levels.

Association Of C-Reactive Protein With Hyperlipidemia In Patients With Polycystic Ovarian Syndrome In Khyber Pakhtunkhwa.

BACKGROUND: It has been unknown whether there exist any relations of C-Reactive Protein (CRP) level with hyperlipidaemia in polycystic ovarian syndromes patients. To determine Association of CRP with Hyperlipidaemia in patients with polycystic ovarian syndrome. METHODS: This was a cross sectional descriptive study conducted among 50 each polycystic ovarian syndrome and normal women. After taking a written consent from participants predesigned questionnaire was filled including information regarding demography and medical history. A 3 to 5 ml blood was taken from patients and controls and transferred to laboratory for determination of CRP level and lipid profile. The test results were collected, compiled, entered and analyzed using SPSS Version 20 for determination of any kind of association of CRP with Hyperlipidaemia in patients with polycystic ovarian syndrome. RESULTS: The mean age of study participants was 29.72±4.00 for cases and 29.04±3.99 for control. The cases and control were with the same age range, however there was a significant difference p=0.00 in BMI of the cases and control. There was no significant association observed between CRP and lipid profile parameters among polycystic ovarian syndrome patients. CONCLUSIONS: There exist no association between increasing CRP level and hyperlipidaemia in polycystic ovarian syndrome patients however CRP and lipid profile parameters showed high values among these patients.

Isaric 4c Mortality Score As A Predictor Of In-Hospital Mortality In Covid-19 Patients Admitted In Ayub Teaching Hospital During First Wave Of The Pandemic.

BACKGROUND: Many factors have been identified which can predict severe outcomes and mortality in hospitalized patients of COVID-19. This study was conducted with the objective of finding out the association of various clinical and laboratory parameters as used by International Severe Acute Respiratory and emerging Infections Consortium (ISARIC) World Health Organization (WHO)- ISARIC/WHO 4C Mortality score in predicting high risk patients of COVID-19. Ascertaining the parameters would help in triage of patients of severe disease at the outset, and shall prove beneficial in improving the standard of care. METHODS: This cross-sectional study was carried out in COVID-19 Department of Ayub Teaching Hospital, Abbottabad. All COVID-19 patients admitted from 15th April to 15th July 2020 were included. RESULTS: A total of 347 patients were included in the study. The mean age was 56.46±15.44 years. Male patients were 225 (65%) and female 122 (35%). Diabetes (36%) was the most common co-morbidity, followed by hypertension (30.8%). Two hundred & six (63.8%) patients recovered and 117 (36.2%) patients died. Shortness of breath (80%), fever (79%) and cough (65%) were the most common presenting symptoms. Patients admitted with a 4C Mortality score of 0-3 (Low Risk Category), the patients who recovered were 36 (90%) and those who died were 4 (10.0%). In patients admitted with a 4C Mortality score of more than 14 (Very High-Risk Category), the number of patients who recovered was 1 (20%), and those who died were 4 (80%). The difference in mortality among the categories was statistically significant (p<0.001). Hypertension was a risk factor for death in patients of COVID-19 (Odds ratio=1.24, 95% CI [0.76-2.01]). Lymphopenia was not associated with statistically significant increased risk for mortality. CONCLUSIONS: The ISARIC 4C mortality score can be used for stratifying and predicting mortality in COVID-19 patients on arrival in hospital. We propose that it should be used in every patient of COVID-19 presenting to the hospital. Those falling in Low and Intermediate Risk Category should be managed in ward level. Those falling in High and Very High Category should be admitted in HDU/ICU with aggressive treatment from the start.

Protocols Of Treatment Of Meningitis In Medical Department: Are There Any?

BACKGROUND: Meningitis, whether viral or bacterial is associated with high mortality rate and risk of severe lifelong disability. Early antibiotics administration and favourable outcomes have been demonstrated by previous studies. The purpose of the study was to evaluate whether the patients with suspected meningitis in general medicine department of Ayub Teaching Hospital Abbottabad were being managed according to protocols. METHODS: This cross-sectional study was carried out in the Medical Department of Ayub Teaching Hospital Abbottabad from March 2018-March 2019 in which data was retrospectively collected from the hospital records of all patients with suspected meningitis admitted in Medical Ward. SPSS version 20.0 was used for data analysis. RESULTS: Out of 41 patients in the study 19 (51.74%) were male. Viral encephalitis accounted for 23 (56.1%) tuberculous meningitis for 14 (34.1%), and 4 (9.8%) patients had septic meningitis. Lumbar puncture for CSF examination was performed in 38 (92.7%). Out of 41 patients, 19 (46.3%) received a combination of Ceftriaxone, Acyclovir and Dexamethasone, 16 (39.0%) patients received anti tuberculous treatment (ATT), Dexamethasone and Streptomycin combination, 3 (7.35%) patients were given Ceftriaxone (2g) and Dexamethasone and 1 ( 2.45%) patient was given a combination of Ceftriaxone(2gm) along with Vancomycin (1gm) and Dexamethasone; while 2(4.9%) patients were given a combination of Acycolvir and Dexamethasone. CONCLUSIONS: This study identified practice gaps in the management of patients with suspected meningitis according to guidelines, as lumbar puncture and CSF-RE were not timely done and proper laboratory records were not maintained. Secondly blood culture facilities were not available in the hospital.

Types Of Medico-Legal Cases Reported At The Casualty Department Of Ayub Teaching Hospital Abbottabad.

BACKGROUND: Medicolegal data is very important for administrators, health officials, philanthropists, social workers, law enforcement agencies. Because it is used for planning and implementation of strategies in order to reduce further incidents. This study is conducted with the aim to determine different types of medicolegal cases and patterns of weapons used. METHODS: A total of 246 cases were studied from 1st September 2017 to 31st January 2018. All information was collected on a pro forma. Statistical analysis was done by MS Excel. RESULTS: Out of 246 cases, 219 were male and 27 were female with age ranging from 3 to 72 years. Among total, 162(65.85%) patients were injured due to blunt weapon, 17 (6.91%) cases of firearms, 23 (9.34%) in road traffic accidents, 15 (6.09%) sharp-edged weapons, 7 (2.84%) cases were of sexual violence, 11 (4.47%) were of poisoning. CONCLUSIONS: Injuries of blunt weapons followed by sharp edge and accidental cases occurred more frequently.

Jak 2 Mutation In Recurrent Foetal Loss.

BACKGROUND: The frequency of recurrent fetal loss (RFL) is around 1% of the total pregnancy. Workup is recommended in patients after three consecutive fetal losses. A multitude of chromosomal, environmental, structural immunological and hematological factors can result in RFL. Frequency of pregnancy loss is increased in MPD patients carrying JAK2 V617F mutation. In fact, JAK2 mutation is an independent risk factor for pregnancy complication and fetal loss. This study was conducted to assess the role of the JAK 2 mutation in recurrent pregnancy loss. METHODS: This was a case control study conducted in Armed Forces Institute of Pathology, Rawalpindi. Using un-matched case-control situation a sample size of 216 cases and 216 controls was calculated using the WHO sample size calculator with assumption of 95% confidence interval, 1:1 ratio of cases to control, expected proportion of mutation as 0.10% and 1.06% in control and cases respectively. DNA analyses were performed and results were recorded done by kit method. The data was entered and analyzed using SPSS version 18.0. Odds ratio was calculated to assess the association between JAK2 V617F mutation and recurrent fetal loss. RESULTS: Three out of 216 cases were positive for JAK 2 mutation while one control had positive JAK 2 mutation. The prevalence of JAK2 mutation in cases of RFL was 1.38% (95% C.I 0.58- 2.17%). The odds ratio for JAK 2 mutation in cases and controls was 3.028 (95% C.I of 0.28- 76.13) and a p-value of 0.623. CONCLUSIONS: JAK2 positive females are 3.03 times more at risk of having RFL as compared to JAK2 negative pregnant females. JAK2 mutation testing may be recommended for inclusion in the workup to manage RFL.

Spectrum Of Bacterial Culture And Drug Sensitivity Vs Resistance In Uncomplicated Urinary Tract Infection.

BACKGROUND: The growing antibiotic resistance against uropathogens has made its treatment a challenge for the physicians. This study was conducted to know the spectrum of bacteria responsible for urinary tract infection and their susceptibility and resistance to available antibiotics. METHODS: This hospital based cross-sectional study was carried out from May to October 2017. All patients presenting with urinary tract infection signs and symptoms and were included in the study. A sample of 168 patients of both gender and age were recruited for the study using convenient sampling technique. Antimicrobial isolation and differentiation was determined by using Cystine-lactose Electrolyte Deficient (CLED) Agar. Susceptibility and resistance to 30 available antibiotics were determined. Data was collected on the predesigned proforma. SPSS version 16 was used for data entry and analysis. RESULTS: There were 62 (36.9%) males and 106 (63.1%) females. Mean age of the male patients was 55.34±21.33 years whereas the mean age of the female patients was 45.8±22.07 years and the difference was statistically significant (p=0.007). Gram negative bacteria were isolated from 141 (83.9%) of the cases. Gender wise distribution of Gram negative and positive strains was found statistically significant (p=0.032). E. coli was the commonest bacterium found in 70.8% of cases. It was sensitive to only seven (23%) antibiotics in over 80% of the cases. E. faecalis, K. pneumoniae, P. aeruginosa and S. faecalis were susceptible to 13%, 26.7%, 40% and 23% of antibiotics respectively in over 60% of the cases. 90% of the cultured pathogens were susceptible to Nitrofurantoin in over 80% of the cases. Among cultured pathogens, 70% showed susceptibility to Imipenem, Meropenem, Amikacin, Doxycycline, Fosfomycin and Cefoperazone/Sulbactam in over 60% of the cases. CONCLUSIONS: UTI is more common in women as compared men. E. coli, E. faecalis, K. pneumoniae and P. aeruginosa are the major pathogens responsible for UTI in this part of the country and in over 80% of the cases are still sensitive to Nitrofurantoin.

Nutritional Assessment Focusing On Women And Children In Palas Valley-Kohistan.

BACKGROUND: Proper nutrition and health are fundamental rights and nutrition is a cornerstone that affects and defines the health of all people, rich and poor. The study was done with the objectives to assess the people of Palas valley with regard to their nutritional status and dietary habits to devise ways and means to overcome primary and associated reasons for these problems. METHODS: In this descriptive cross-sectional study residents of Palas valley of district Kohistan were included in the study through multistage cluster sampling method. The Palas valley was divided in to two: Kuz Palas (Lower Palas) and Bar Palas (Upper Palas). Two union council each from Kuz and Bar Palas were randomly selected Among the households, one adult male, one woman of childbearing age, one male child and one female child was selected randomly.. RESULTS: A total of 160 adult and children were interviewed and assessed for the nutritional status. Out of total of 80 children 61 (76.25%) had visible BCG scars. Among children 77.5% were either thinly built or had poor built. Among male adults 95% were of normal built. In adult females, 60% were either of thin built or poor built. Twenty-two percent of male children and 30% of female children were found underweight. Fourteen (35%) males and females have a BMI between 17.1-18.5 while only 6 (15%) of the females have BMI more than 18.5. CONCLUSIONS: Poverty and illiteracy in the absence of effective social and health services is playing havoc with the population of Palas valley. Poor sanitation and poor personal hygiene expose them to infections and parasitic diseases. Poor availability of food, lack of awareness and tough customs and traditions expose lead to malnutrition.

Red Cell Alloimmunization In Multitransfused Thalassaemia Major Patients.

BACKGROUND: Lifelong transfusions are life savers for thalassaemia patients but are associated with many complications. Alloimmunization is a major problem for blood banks. Antigens of foreign red blood cells induce the formation of antibodies in patients suffering from thalassaemia. The purpose of this study was to examine the frequency of red cell alloantibodies and to express the type of these antibodies in thalassaemia patients. METHODS: Patients that have received multiple transfusions were included in this study. Those with the positive Coombs test (DAT) results were excluded from the study and remaining patients were screened for antibodies. A panel of known blood group antigens was used for the patients who had a positive antibody screening test because they had alloantibodies in their serum. First, three cell panel was applied. If the screen was positive then eleven cell panels was used to identify the specific antibody. Both the cell panels were applied at room-temperature, liss (low ionic strength saline) and coombs phase. RESULTS: Three hundred & two patients were selected out of which 65.6% (n=198) were males and 34.4% (n=104) females. Patient's age ranged from 1.5 years to 26 years ±5.40 years. All of the patients were given regular red cell transfusion at 2-4 weeks interval. They were given non leukodepleted transfusions. It is not the practice in any thalassaemia Centre in Pakistan to give phenotypically matched blood for Kell, Kidd, Duffy or any other minor group antigens to patients on regular blood transfusion. Alloimmunization was positive in 12 (4.0%) of the 302 patients studied. Male were 66.67% (n=8) and female were 33.33% (n=4). Samples of these positive patients were further tested to determine specificity of alloantibodies. Anti Cw was most common, detected in 4 out of 12 (1.3%) patients. Anti K, k, S and Lua were detected in 2 out of 12 (0.7%) each. CONCLUSIONS: Thalassemia major patients on regular blood transfusions can develop red cell alloantibodies. Detailed pretransfusion screening would add towards better management of these patients.

Visceral Leishmaniasis In Adults.

Visceral Leishmaniasis (also known as Kala Azar) is a parasitic infection caused by Leishmania Donovani in the East and Leishmania Infantum in the west. It is prevalent in many countries including India, Bangladesh, Nepal, Africa and part of America. The disease follows chronic course and is usually lethal if left untreated. It has also been reported from different parts of Pakistan, including Northern areas, Districts Mansehra & Abbottabad and Hilly areas of Khyber Pukhtoonkhawah. Most the cases have been reported in paediatric population. Except one case, reported previously from Abbottabad. The present two cases were also seen in adults.

Pattern of joints involvement in Kashin-Beck disease: a local osteochondropathy in China.

BACKGROUND: Kashin-Beck Disease (KBD) is an endemic osteochondropathy. The disease starts in childhood and attacks the growth of joint cartilage, the joints become deformed and painful, and the worst forms result in dwarfism. The most fiequent joints involved are the finger, wrist, ankles, knees and elbows. In this study the pattern of joints involved in KBD was studied. METHODS: A total of 368 patients aged above 13 from 6 villages in endemic areas of the Shaanxi province, located in the northwest of China, were selected through multistage stratified sampling. The patients were diagnosed based on the clinical criteria for diagnosis of KBD. The patients were administered with a battery of questionnaires along with clinical examination for joint involvement. RESULTS: The patients presented both as oligoarticular as well as polyarticular pattern. Smaller joints were more frequently involved with a proximal-distal pattern. The number of joints involved increased with the severity of the disease. CONCLUSION: Proximal smaller joints are more frequently involved in the disease. The involvement of bigger joints takes place in later stages of disease, i.e., in the second and third degree. The pattern of joint involvement shows some correlation with Rheumatoid Arthritis which needs further investigation and comparative studies.

Doctors perception about staying in or leaving rural health facilities in District Abbottabad.

BACKGROUND: An imbalance exists between offered medical services and needed health care for the people in rural areas of Pakistan. Many studies have found non-availability, of health care providers as major contributors to the poor health indicators of the rural areas. METHODS AND RESULTS: An endeavor to attend the issue has been made through a cross-sectional survey of the Medical Officers working in the different health facilities of District Abbottabad. The study found that the doctors are neither trained to work in rural setups nor they are given proper facilities and service structure to work there. They perceive to face disadvantages affecting their social, professional and family life, if they join in rural areas. RECOMMENDATIONS: This study recommends strengthening of Community Oriented Medical Education for motivating doctors towards participation in rural health services. Doctors working in rural health facilities might be given financial and professional incentives and a conducive environment to retain them.