Detection of interleukins-6 and 8 in saliva as potential biomarkers of oral pre-malignant lesion and oral carcinoma: A breakthrough in salivary diagnostics in Pakistan.

Oral cancer is at rise in our population due to increasing use of areca nut (Betel nut) with or without tobacco. It is the second frequent malignant tumour for both the gender in Pakistan. This non-interventional case control study was carried out with the aim to explore saliva as diagnostic medium for detecting interleukins (IL) 6 and 8 as biomarkers of pre-malignant lesions (PML) and oral carcinoma. Total 105 subjects were recruited and were divided into three groups "A", "B" and "C" each comprising of 35 subjects. Group "A" comprised of cases with strong clinical evidence of oral PML. Group "B" constitute clinical and histologically proven OSCC and group "C" include disease free subjects as controls. Saliva from all the recruited subjects was procured by drooling method and stored at-200C before further process. All the collected samples were centrifuged at 4500 rpm for 15 minutes at 4oC. Supernatant fluid was used in ELISA for detection and quantification of IL-6 & IL-8. Data was analysed by using Chi-square test and multivariate analysis was done by non-parametric test. P-value of 0.05 was taken as standard reference. Significant co-relation was found for qualitative salivary detection of IL-6 and IL-8 among the groups (P<0.001 and <0.0001 respectively). Regarding quantitative salivary concentration of leukotrienes, no significant co-relation was found in levels of IL-6 among the groups while there was significant association of IL-8 levels between the groups (P<0.0001).On post Hoc multiple comparison, significant co-relation was found among oral PML group and controls (P=0.001) and OSCC group and control (P=<0.0001). In conclusion salivary detection of IL-6 & IL-8 could be used as probable biomarker for early detection of oral PML & OSCC in etiologically distinct population of Pakistan.

Salivary detection of human Papilloma virus 16 & 18 in pre-malignant and malignant lesions of oral cavity: Is it feasible in Pakistani context of Socio-Cultural Taboos?

OBJECTIVE: To evaluate salivary detection of HPV-16 & 18 would be feasible and informative biomarker for oral pre-malignant and malignant lesion in our population. METHODS: This non-interventional, case control study was carried out at department of E.N.T, Head and Neck Surgery, Dow University of Health Sciences, Dow Medical College and Civil Hospital Karachi, Pakistan between July 2011 to December 2012. Total of 105 cases were recruited. These were divided in three groups 'A', 'B' & 'C' having 35 subjects each. Group'A' constitutes patients having strong clinical evidence of oral pre-malignant lesions (PML). Group 'B' includes histologically proven oral squamous cell carcinoma (OSCC) and Group 'C' comprised disease free subjects as controls. After taking informed consent, relevant clinical history was recorded on institutional approved performa. Saliva from all subjects was procured by standard 'drooling method'. Samples were stored at +4°C and later transferred to Laboratory to store at-20°C before further process. Samples were centrifuged at 4500 rpm for 15 minutes at 4°C. Cell pellets sediments were used for identification of HPV-16 & 18 by real-time PCR method. Data was entered and analysed using SPSS version 16. P-value of 0.05 was taken as standard. RESULTS: In group 'A', HPV-16 was detected in 3 (8.6%) cases while HPV-18 was not detected in any of the subject. In group 'B', HPV-16 was detected in 07 (20%) while HPV-18 was found in 06 (17.1%) cases. Mixed HPV-16 and HPV-18 were found in 02 (5.7%) cases. In group 'C', HPV-16 was detected in 03(8.6%) while HPV-18 was not detected in any of the subjects. Significant relationship was observed between the groups for HPV-18 detection (P= 0.002) while for HPV-16, no significant association was found (P= 0.245). CONCLUSION: HPV infection for the causation of oral cancer cannot be fully established possibly due to small sample size. More over differences in genetic makeup, environment, indulgence in peculiar risk factor habits, sexual practices and difficult evaluation of the acquisition of viral load due to socio-cultural and religious restrictions could be the reason.

Influence of anthropometric measurements on abnormal gonadotropin secretion in women with polycystic ovary syndrome.

OBJECTIVE: To evaluate the influence of anthropometric measurements on abnormal gonadotropin secretion in patients with polycystic ovary syndrome (PCOS). STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: The Institute of Basic Medical Sciences (IBMS), DUHS in collaboration with Gynae/infertility clinics of the Civil Hospital and Lady Dufferin Hospital, Karachi, from October 2010 to February 2011. METHODOLOGY: One hundred and sixty three oligomenorrhic PCOS women of reproductive age (18 - 40 years) fulfilling the revised Rotterdam 2003 criteria were studied. The data recorded on a prescribed proforma included current age, age at menarche, menstrual irregularities, presence of hirsuitism, acne, infertility, familial nature, blood pressure, BMI and waist-hip ratio. Blood samples for gonadotropin assay were taken randomly on day 6th to 30th of menstrual cycle, in a gel tube. Hormonal assay was performed using chemiluminescent immunoassay. Kruskul Wallis test was used to assess the influence of BMI levels on LH:FSH values. RESULTS: The mean weight was 66.14 ± 11.02 kg and mean BMI was 27.03 ± 4.42 kg/m2. There was no significant difference in mean LH/FSH ratio (p=.575) among BMI groups. However, there was a positive correlation between BMI and LH:FSH ratio (p=0.04, r=0.155). CONCLUSION: There was high frequency of obesity (69%) in women with PCOS. Although no significant difference was found between mean LH:FSH ratio among different BMI groups levels but significant correlation between BMI levels and LH: FSH suggested that there was positive relation between BMI and LH: FSH.

Effect of exercise training program in post-CRET post-CABG patients with normal and subnormal ejection fraction (EF > 50% or < 50%) after coronary artery bypass grafting surgery.

The aim of the present study is to compare the effect of exercise training program in post-Cardiac Rehabilitation Exercise Training (CRET), post-CABG patients with normal & subnormal ejection fraction (EF >50% or <50%) who have undergoing coronary artery bypass grafting (CABG) surgery. The study was conducted on 100 cardiac patients of both sexes (age: 57-65 years) who after CABG surgery, were referred to the department of Physiotherapy and Rehabilitation between 2008 and 2010 at Liaquat National Hospital & Medical College, Karachi. The patients undertook exercise training program (using treadmill, Recumbent Bike), keeping in view the Borg's scale of perceived exertion, for 6 weeks. Heart Rate (HR) and Blood Pressure (BP) were measured & compared in post CABG Patients with EF (>50% or <50%) at the start and end of the exercise training program. Statistical formulae were applied to analyze the improvement in cardiac functional indicators. Exercise significantly restores the values of HR and BP (systolic) in post CABGT Patients with EF (>50% or <50%) from the baseline to the last session of the training program. There appeared significant improvement in cardiac function four to six weeks of treadmill exercise training program. After CABG all patients showed similar improvement in cardiac function with exercise training program. The exercise training program is beneficial for improving exercise capacity linked with recovery cardiac function in Pakistani CABG patients.

The relationship between sleep and cognitive functioning in adult people.

The purpose of the current study is to find out if subjective sleep complaints will have less cognitive functioning in older people (50 years and above). Sleep was assessed with the subscale Sleep Problems of the Symptoms Checklist-90 (Arrendell & Ettema 1986). Cognitive performance was measured with the Mini Mental Status Examination (Folstein, et al 1975) which is used as a dependent variable. Subjective complaints would be negatively associated with cognitive performance, since in elder people biological sleep is likely to be related with cognitive changes. A group of 12 people were given the task of collecting data through purposeful sampling techniques. Sample size of 120 participants was assessed. Each member of the group collected data from 10 subjects. Pearson Correlation Moment was applied for data analysis. In older persons the coefficient of falling asleep difficulty was -0.05 (p=0.33) and for waking up too early the coefficient was -0.13 (p=0.012) while for restless sleep coefficient was calculated as -0.09 (p=0.094). The assumption was verified that sleep problems negatively associated with cognitive functioning.

Anthropometric and metabolic indicators in hypertensive patients.

OBJECTIVE: To determine the relationship between anthropometric variables with blood glucose and lipid concentrations in different stages of hypertension and evaluate the risk factors involved in progression of pre-hypertension stage in to clinical hypertension stage-1. STUDY DESIGN: Case-control study. PLACE AND DURATION OF STUDY: National Institute of Cardiovascular Disease and General Practitioner's Clinics, Karachi, from 2005 to 2007. METHODOLOGY: The study was conducted on 276 participants aged 25-65 years and classified into four categories of control, prehypertension (pre-HTN), hypertension (HTN) stage I and II, according to 7th JNC report. Anthropometric measurements and blood chemistry were obtained. The relationship between obesity indices (Body Mass Index [BMI], Waist Circumference [WC], Waist Hip Ratio [WHpR], Waist Height Ratio [WHtR], Basal Metabolic Rate [BMR] and Cardiovascular Disease [CVD] risk factors [blood pressure, serum lipids and glucose levels]) were investigated. The analysis of variance and test of Pearson's coefficient correlation were applied to assess relationship of all the variables. RESULTS: The mean WHR had significant correlation with both systolic and diastolic BP in all groups of HTN, as well as with blood glucose level in control and pre-HTN groups. BMI was positively correlated with cholesterol (r=0.29) and triglyceride (r=0.25) in HTN stage-1. Impaired and high blood glucose levels were found in pre-HTN group; all lipid parameters except triglycerides were higher in HTN stage I. CONCLUSION: WHR was positively and independently related to occurrence of arterial hypertension. Elevated levels of WHR, BMI, fasting blood glucose, total cholesterol and triglycerides were responsible for progression of pre-HTN stage in to HTN stage-1.

Changes in blood pressure, BMI and ECG Patterns in women using low-dose contraceptives.

OBJECTIVE: To determine the cardiovascular risk factors in users of second generation contraceptives by recording changes in body mass index, blood pressure and electrocardiogram. DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: The National Institute of Fertility Research Centers at Jinnah Postgraduate Medical Center and PIB Maternity Home Karachi, from July 1997 to 1999. MATERIALS AND METHODS: Sixty four women volunteered for this study (age range 20-35 years), belonging to low-income group with similar socio-cultural background. The Body Mass Index (BMI) was calculated by measuring height and weight of the subjects; systolic and diastolic blood pressure and ECG recording by standard method. The group means, standard deviations and coefficient correlation for interrelationship among variables in respective groups of subjects were calculated using relevant statistical method and software program. RESULTS: There was no significant difference between BMI of two types of contraceptive users as compared to non users; but BMI was significantly correlated with both systolic and diastolic blood pressures in injectable users as compared to controls. ECG alterations frequently observed in contraceptive users (40%) as compared to controls were normal findings. CONCLUSION: It was observed that women aged < 30 years and using contraceptives for more than three years had a tendency to gain weight and developed a mild increase in systolic and diastolic blood pressures.

Role of exercise in osteoporosis prevention--current concepts.

Osteoporosis is a metabolic disorder of the bones due to loss of both bone mineral and bone matrix in equal proportions resulting in a bone that is weak and unable to support the body. This becomes a problem in the elderly who are then at risk of frequent fractures increasing the morbidity and mortality. Measures taken early in life in the form of calcium and exercise go far in preventing the development of this disorder. The primary purpose of this narrative review is to evaluate the current literature and to provide insight into the role of exercise relating to osteoporosis. Emphasis is given to the importance of the specific types of exercises needed to increase bone strength and muscle power, keeping in view the age and general physical condition of the person.

Clinical and neurological study of women with precatamenial epilepsy.

OBJECTIVE: To describe clinical features and seizure dispersion in precatamenial/pericatamenial epilepsy patients. DESIGN: Case series. PLACE AND DURATION OF STUDY: Department of Neurology (formerly Neuropsychiatry), Jinnah Postgraduate Medical Centre (JPMC), Karachi, from July 1991 to November 2001. PATIENTS AND METHODS: Present study included 33 untreated pericatamenial (n: 23, age: 12-40 years, menstrual cycles: 147) and precatamenial (n: 10, age: 13-32 years, menstrual cycles: 70) epileptics with tonic-clonic seizures. Clinical features and seizure dispersion were evaluated during premenstruation, menstruation, and postmenstruation phases. RESULTS: Women with precatamenial epilepsy had highly significant mean phase day seizures during premenstruation versus other phases, whereas women with pericatamenial epilepsy did not show any significant variations. Premenstrual seizures were found significantly more and others as significantly less in % number in precatamenials compared to those in pericatamenials. Furthermore, precatamenial epileptics with primary generalized seizures were significantly higher in % number and secondary generalized seizures as significantly lower against those in pericatamenial epileptics. All precatamenial epileptics under study had incontinence compared to 65% pericatamenial epileptics that had incontinence. Majority of the patients in both groups showed post-ictal headache. CONCLUSION: The present report describes the extent of exacerbation of premenstrual tonic-clonic seizures with clinical features. These investigations may help in understanding partly the complexity of catamenial/precatamenial/ pericatamenial/noncatamenial seizures, and similarities and dissimilarities between pericatamenial and precise precatamenial seizures.

Current trends in type 1 diabetes mellitus--stem cells and beyond.

Search for a cure for type-1 diabetes mellitus has lead to many avenues of research, all having the same objective: to replace the lost beta cells and prevent their further destruction by the immune system. Transplantation of islets of Langerhans seems closer to achieving this goal with the recent introduction of new improved immunosuppressive protocols including monoclonal antibodies against the T-lymphocytes. But the need for acquiring beta cells in large numbers rather limits this approach. With the recent advancement in stem cell technology, it may be possible to gather enough stem cells for transplantation purposes. In this regard, embryonic stem cells have shown the greatest promise due to their capacity for unlimited proliferation and differentiation into any cell type. This review discusses the current direction of research regarding diabetes mellitus type-1, while explaining the progress being made in stem cell usage in finding a cure for the disease.

Influence of steroid hormones in women with mild catamenial epilepsy.

BACKGROUND: In view of considerable differences of opinion regarding the reproductive steroid hormonal pathogenesis in catamenial epilepsy, hormonal analysis of estrogen and progesterone in catamenial epileptics for a precise correlation is of significant importance. METHODS: Clinical, neurological and physiological assessments, and radioimmunoassay of plasma estradiol-17beta and progesterone a day prior to the onset of menstruation were carried out in noncatamenial and mild catamenial epileptics having multiple frequency tonic-clonic (primary and secondary generalized) seizures. RESULTS: Highly significant rise (p > 0.0001) of estradiol-17beta was obtained for catamenial epileptics compared to normal subjects as well as noncatamenial epileptics (p > 0.02). However, nonsignificant fluctuations of progesterone were found for both catamenial and noncatamenial epileptics against normal subjects as well as catamenial versus noncatamenial epileptics. CONCLUSIONS: The present report suggests that estradiol have a precise role in the mild premenstrual exacerbation of seizures. However, no significant change in progesterone levels might have been due to mild exacerbation of seizures in these patients. Furthermore, we suggest the importance of how we collect and categorize the data and which pathophysiologic process/ clinicobiological mechanism is involved in patients with catamenial epilepsy. Contradictory results in literature may be related to differential levels of excitation/inhibition equilibrium during various cycle phases. More precise studies including the determination of the blood levels of antiepileptic drugs, however, are required.