Role of δ-tocotrienol and resveratrol supplementation in the regulation of micro RNAs in patients with metabolic syndrome: A randomized controlled trial.

OBJECTIVE: To determine the effect of δ-tocotrienol and resveratrol mixture (TRM) supplementation in comparison to placebo for 24 weeks, on the relative expression of miRNAs (miRNA-130b-5p, miRNA-221-5p, miR-15b-5p, miRNA-122-5p, and miRNA-376b-5p) in patients with Metabolic syndrome (MetS). DESIGN: This randomized placebo-controlled trial was conducted at the tertiary care institute of the NUMS, Rawalpindi, Pakistan. A total of 82 adult MetS patients were enrolled and randomly grouped into the TRM group (n = 41) and the Placebo group (n = 41). Patients in the TRM group were given 400 mg capsules (δ-tocotrienol 250 mg; Resveratrol 150 mg) and placebo received (cellulose 400 mg capsule) twice daily for 24 weeks. RESULTS: The TRM supplementation revealed a significant (p < 0.001) upregulation of 3.05-fold in miRNA-130b-5p and 2.45-fold in miRNA-221-5p while miRNA-122-5p was downregulated by 2.22-fold as compared to placebo. No significant difference was observed in miRNA-15b-5p and miRNA-376b-5p. Moreover, TRM group participants with reverted MetS had significantly (p < 0.05) upregulated miRNA-130b-5p, miRNA-221-5p, and downregulated miRNA-122-5p relative to non-reverted patients with MetS. CONCLUSION: Daily TRM supplementation may improve metabolic syndrome by upregulated miR-130b-5p, which is involved in central obesity and inflammation, as well as miR-221-5p, which is involved in insulin resistance. Additionally, TRM downregulate of miRNA 122, which improved dyslipidemia.

Development and validation of a questionnaire about hidden curriculum in medical institutes: A pilot study.

The goal of the current study was to develop and validate a questionnaire that would reveal characteristics of medical hidden curricula. It is an extension of the qualitative research that was done by researchers on hidden curriculum, and a second part of the qualitative was the creation of a questionnaire by a panel of experts. Using both exploratory factor analysis (EFA) and the quantitative portion, the questionnaire was verified. The sample size was 301, and the participants, who were from medical institutes, were both genders and between the ages of 18 and 25. First, a thematic analysis of the qualitative portion was used to create a 90-item questionnaire. The validity of the questionnaire's content was certified by the expert panel. A 39-item questionnaire was subsequently created after the items that overlapped and the items that did not represent the particular theme were eliminated. After that, we validated the survey. A total of 39 high-loading components made up the six variables of EFA, which explained 62% of the variance. The 33-item questionnaire, from which six items were deleted, was found to have satisfactory psychometric qualities. As a result, the accountability of faculty and students in curricula and extracurricular activities combined with equal opportunity is one factor, communication and relationships with stakeholders combined with evidence-based reforms and implementations are the second factors, and student-centeredness and empowerment as the third main factor of the hidden curriculum are all considered to be important factors. All these three main constructs were collectively used to measure hidden curricula in medical institutes.

δ-Tocotrienol in Combination with Resveratrol Improves the Cardiometabolic Risk Factors and Biomarkers in Patients with Metabolic Syndrome: A Randomized Controlled Trial.

Background: Metabolic syndrome (MetS) is a cluster of central obesity, hypertension, hyperglycemia, and dyslipidemia. It is a global health issue with an increased risk of cardiovascular disease. Recently, a few natural products have been reported with promising anti-inflammatory and antioxidative effects. We aimed to evaluate the impact of δ-tocotrienol and resveratrol mixture (TRM) supplementation on cardiometabolic risk factors and biomarkers in patients with MetS. Methods: A randomized controlled trial was conducted at the hospitals of National University of Medical Sciences Rawalpindi, Pakistan. A total of 82 patients with MetS aged 18-60 years were enrolled based on International Diabetes Federation-2005 diagnostic criteria and randomly grouped into TRM (n = 41) and placebo (n = 41). Patients in the TRM group were given a 400 mg capsule (δ-tocotrienol 250 mg; resveratrol 150 mg), and a placebo (cellulose 400 mg) twice daily for 24 weeks. The biochemical tests were analyzed on ADVIA 1800 Chemistry® analyzer and inflammatory biomarkers by ELISA methods. Results: In the TRM group, a significant reduction in waist circumference, blood pressure, mean (95% confidence interval) of fasting plasma glucose -0.15 mmol/L (-0.22 to -0.08), serum triglyceride -0.32 mmol/L (-0.47 to -0.17), and increment in high-density lipoprotein cholesterol were observed as compared with placebo. TRM supplementation also improved biomarkers: high-sensitive C-reactive protein -0.61 mg/L (-0.89 to -0.33), interleukin-6-1.99 pg/mL (-2.50 to -1.48), tumor necrosis factor-α -2.19 pg/mL (-2.55 to -1.83), malondialdehyde -0.48 µmol/L (-0.65 to -0.30), and total antioxidant capacity 1.71 U/mL (1.29 to 2.13). Conclusion: TRM supplementations improved cardiometabolic risk factors and biomarkers of inflammation and oxidative stress without any significant side effects in the patients with MetS. Clinical Trials Registry: The clinical trial was registered in Sri Lanka Clinical Trials Registry (https://slctr.lk/trials/slctr-2019-021).

Comparison Of Cvd Risk Assessment Via Qrisk®2 Vs Reynolds Risk Score In Inflammatory Joint Diseases.

BACKGROUND: The risk of cardiovascular disease in patients with inflammatory joint diseases is very high and rheumatologists need to screen their patients for this risk. A number of screening tools have been used in this patient population. Objective was to compare the cardiovascular risk assessment in patients with inflammatory joint diseases using QRISK®2 and Reynolds Risk Score. METHODS: Four hundred and one patients with inflammatory joint diseases were enrolled via consecutive non probability sampling. Their future cardiovascular disease risk was calculated via the QRISK®2 and Reynolds Risk Scores. The resulting scores were analyzed for any correlation. RESULTS: There was no significant correlation between the scores obtain via both risk assessment tools (p>0.05).

Cost-effectiveness of Screening and Confirmatory Tests for Multiple Myeloma in Pakistani Population: An Audit Report.

OBJECTIVE: To find out the use of screening and confirmatory tests for diagnosis of multiple myeloma as ordered by clinicians. STUDY DESIGN: An Audit. PLACE AND DURATION OF STUDY: Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi, from January 2012 to January 2017. METHODOLOGY: Data retrieved from Laboratory Information Management system (LIMs) by selecting serum protein electrophoresis (SPE) as screening test and immunoelectophoresis (IE) and immunofixation (IF) as confirmatory tests. RESULTS: There were 3,108 tests of serum protein electrophoesis and 1,329 tests of immunoelectophoresis had been performed in last five year. Cost-effective clinical audit of SPE tests showed that only 17.1% tests of SPE were either used for proper diagnosis of multiple myeloma (totally justified tests 13%) or useful for diagnosis of other important diseases whose early diagnosis were helpful for patients management (partially justified tests 4.1%). The cost related to these tests were justified while 82.8% tests of SPE were either normal (total unjustified tests 24.4%), or diagnosed irrevalent and nonspecific diseases (partially unjustified 58.4%). IE and IF audit revealed that only 26.6% tests were properly utilised for diagnosis and differentiation of multiple myeloma and its subtypes and cost attributable to these tests were justified while 73.4% of these confirmatory tests were normal and cost related to them was not justified. CONCLUSION: Overutilisation of laboratory tests for diagnosis of multiple myeloma can be minimised by proper clinical scrutiny of request forms.

Appetite Regulation In Relation To Energy Provision.

BACKGROUND: Appetite control is a very complex process which influences the short term feeding behaviour and a long term adaptive process that responds to the energy input. Appetite control and food intake is influenced by a combination of behavioural, psychological and neuro-endocrine influences. METHODS: For identification of articles search engines of the databases EMBASE, OVID, Pub med and MEDLINE were used for papers published from 2002 to 2015 in English language. RESULTS: The higher endogenous peptide YY (PYY) and cholecystokinin (CCK) and lower ghrelin levels are not always associated with subjective feelings of fullness or hunger and a decreased energy intake which highlights the fact that appetite control and food intake is a very intricate process. CONCLUSIONS: When food is ingested, numerous physiological, hormonal, social and psychological processes are triggered in an intricate manner. Therefore, it can be said that ghrelin, PYY and CCK are just few pieces, which contributes to the process of appetite control and energy intake.

COMPARISON OF PEAK EXPIRATORY FLOW RATE AND LIPID PROFILE IN ASYMPTOMATIC SMOKERS AND NON-SMOKERS.

BACKGROUND: Tobacco is the major risk factor for chronic obstructive airway disease (COAD), other pulmonary diseases, cancer, cardiovascular and cerebrovascular diseases. The objective of study was to determine the mean Peak Expiratory Flow Rate (PEFR) and serum lipid profile. in apparently healthy male smokers and non-smokers. METHODS: This cross-sectional study was conducted in Ayub Teaching Hospital, Abbottabad from 15th December, 2009 to 15th June, 2010. Apparently healthy smokers and non-smokers from population coming to Hospital as attendants of the patients or as employees of the hospital were inducted in the study. PEFR and lipid profile of all the subjects was accessed. RESULTS: There were total of 300 male subjects, 150 smokers and 150 non-smokers. The mean age of study subjects was 26.6 +/- 5.5 years. The mean PEFR of smokers was 450.621/min and that of non-smokers was 494.81 L/min, the difference being statistically significant (p-value <0.05).The mean total cholesterol of smokers is 5.30 +/- 0.86 mmol/l and it was 3.84 +/- 0.54 mmol/l in non-smokers. Mean serum Triacyl Glycerols (TAGs) and Low Density Lipoproteins (LDL) cholesterol of smokers was 2.04 +/- 0.38 and 3.5 +/- 0.83 mmol/l whereas it was 1.44 +/- 0.52 and 2.02 +/- 0.66 mmol/l in non-smokers. Mean High Density Lipo-protein (HDL) of smokers was 0.86 +/- 0.30 mmol/l and of non-smoke is 1.20 +/- 0.41 mmo/l. There was statistically significant difference between serum lipid profile of smokers and non-smokers (p<0.05). the mean serum Total Cholesterol (TC), TAGs and LDL were significantly higher in smokers as compared to non-smokers. However HDL was significantly lower in smokers in comparison to non-smokers. CONCLUSION: There was statistically significant difference between PEFR of smokers and non-smokers.

NUTRITIONAL SUPPLEMENTS AND THEIR USE IN THE TREATMENT OF MALNUTRITION IN DEVELOPING COUNTRIES.

BACKGROUND: Despite the high global prevalence of malnutrition, it remains under-treated, or undetected. The high energy nutritional supplements are usually prescribed to promote rapid weight gain. However, there is no consensus on the most effective way to treat mild to moderate malnutrition. METHODS: For identification of articles search engines of the databases OVID, MEDLINE, EMBASE and Pub med were used for papers published from 2003 to 2014 in English language. RESULTS: The total energy intake including the supplements is significantly improved. However, the rate of weight gain by the high energy nutritional supplements in moderately malnourished children is less than the expected weight gain. CONCLUSION: While assessing the impact of the supplementation on child nutritional status, other factors should also be taken into account, including appetite suppression, replacement of habitual food intake and compliance to the intervention.

Frequency of albuminuria in diabetic patients presenting with macrovascular complications.

BACKGROUND: Diabetes mellitus is major cause of morbidity and premature mortality from its long-term complications such as cardiovascular disease, blindness, renal failure, amputation and stroke. The study was conducted to determine the frequency of albuminuria in diabetic patients presenting with macro-vascular complications like myocardial infarction (MI) and stroke. METHODS: This descriptive study was conducted at Ayub Medical College, Abbottabad from December 2010 to May 2011. Total 88 diabetic patients admitted with macro-vascular disease were included in this study. The patients were subjected to two urine specimen's examination, one for routine examination for infection and dipstick analysis for albuminuria. Second was tested for albumin was tested in the urine. RESULTS: Out of 88 patients with a mean 47.12 ± 7.58 years, 39 (44.32%) were female while 49 (55.68%) were male. Overall albuminuria was detected in the urine of 81 out of total 88 patients (92%) when tested by heating method whereas it was detected in 41 (46.6%) cases by the dipstick method. CONCLUSION: Frequency of albuminuria is much.higher in diabetic population with macro-vascular complications; hence albumin in the urine of diabetic patient can be regarded as an indicator for impending macro-vascular complications of diabetes.

Spectrum of trigeminal neuralgia.

BACKGROUND: Trigeminal neuralgia (TN) is a very painful condition characterized by paroxysmal shock like pain in the distribution of one or more branches of trigeminal nerve caused by neurovascular conflict at the root entry zone of trigeminal nerve. This study was conducted to analyse the demography and pattern of TN in our setup. METHODS: This descriptive study was conducted in the Oral Surgery unit, Department of Dentistry, Ayub Medical College. Abbottabad, from April 2009 to October 2011. A total of 117 patients were included in study by convenience (non probability) sampling technique. All the patients presenting with the clinical features of TN were included in study. RESULTS: Out of 117 cases, 49 (41.9%) were males and remaining 68 (58.1%) were females. Age of the patients ranged from 32-72 (53.90 +/- 10.21) years. Right side was involved in 63 patients (53.8%), while the left side was involved in 51 patients (43.60). In only three cases (2%) there was bilateral involvement. The maxillary division was involved in 68 cases (58.1%) and mandibular division was involved in 37 cases (31.6%). The most common site of involvement was infra-orbital, which was involved in 68 cases (58.11%). The next common site was the mental nerve which showed involvement in 35 cases (29.9%) followed by inferior alveolar nerve which was affected in 14 cases (12%). Thirty three (28.2%) patients were having mild pain. 54 (46.2%) patients having moderate, 21 (18%) patients with severe and 9 (7.7%) patients were having very severe pain. No patient in our study had a family history of TN. Among our patients 103 (88%) patients underwent dental extraction for the same pain. CONCLUSION: The incidence of TN is more in old age especially in females. TN is frequently misdiagnosed in with tooth ache, so there is need to educate the medical practitioners and masses in order to avoid un-necessary tooth extractions.

Serum homocysteine as a risk factor for coronary heart disease.

BACKGROUND: Homocysteine (Hcy) is an intermediate formed during the catabolism of sulphur containing essential amino acid, methionine and Less than one percent of tHcy is found as the free form. Development of atherosclerotic changes and thrombo-embolism are common features in patients with homocysteinuria. This study was conducted to assess the relationship of Hcy and coronary heart disease (CHD) in our population. METHODS: The cross-sectional analytical study was carried out at the Department of Biochemistry, Hazara University Mansehra and Ayub Medical College, Abbottabad. A total of 80 subjects were included in this study and were divided into 2 groups. Cases Group consisted of 40 patients who had confirmed Myocardial Infarction (MI) coming for routine follow-up (first re-visit) after the acute attack. Control Group consisted of 40 matching healthy individuals. Demographic data including age, gender, dietary habits, height and weight as documented in preformed proforma. Blood pressure was taken in sitting posture. Serum total Hcy were measured. Data was entered into computer using SPSS 16.0 for analysis. RESULTS: The mean age of the cases was 59.68 +/- 8.06 (30-70) years and that of the controls was 58.93 +/- 6.93 (48-76) years. The average BMI of cases was 27.70 +/- 3.61 Kg/m2 and of the controls was 25.66 +/- 2.98 Kg/m2. This increase of BMI from controls to cases was statistically significant (p < 0.050). The mean systolic BP of the cases was 153.88 +/- 11.90 mmHg in comparison with 142.62 +/- 11.65 mmHg for the controls. This difference was statistically significant (p < 0.001). Mean tHcy level of the cases was 17.15 +/- 4.45 micromol/l while that of controls was 12.20 +/- 2.53 micromol/l. There is a statistically significant difference between cases and controls with respect to Hcy levels (p < 0.001). CONCLUSION: Plasma tHcy level has a powerful predictor value of CHD and routine screening for elevated Hcy concentrations is advisable especially for individuals who manifest atherothrombotic disease without their traditional risk factors.

Liver function tests in preeclampsia.

BACKGROUND: Preeclampsia is a multisystem disorder that can induce damage to cardiovascular system, kidneys, brain and liver. Pregnancy-induced hypertension (PIH) is responsible for significant maternal and perinatal morbidity. This study was conducted to compare the liver function tests in preeclampsia with normal pregnancy. METHODS: This study was carried out on 100 pregnant women after 20 weeks of gestation admitted in Obs/Gyn units of Ayub Teaching Hospital, Abbottabad. The subjects were divided into two groups. Group A consisted of 50 cases of preeclampsia having blood pressure > or = 140/90 mmHg, proteinuria in 24 hours > or = 300 mg and oedema; Group B had 50 normal pregnant women after 20 weeks of gestation. The data including BMI, parity, period of gestation, blood pressure and presenting complaints of all subjects were recorded. Serum bilirubin and plasma levels of liver enzymes ALT, AST and ALK were measured. RESULTS: The mean BMI of the cases was 29.04 +/- 3.97 and that of controls was 26.54 +/- 3.11. The mean value of serum bilirubin in cases was 10.78 +/- 3.74 micromol/L and in controls it was 7.92 +/- 2.42 micromol/L (p < 0.001). The mean values of enzyme ALT in cases was 55.81 +/- 31.93 U/L while in the controls it was 15.22 +/- 3.30 U/L (p < 0.001). Mean serum AST in the cases was 41.34 +/- 10.76 U/L and in the controls it was 24 +/- 2.54 U/L (p < 0.001). Mean ALK level of cases before delivery was 454.16 +/- 243.69 U/L, and in controls it was 181.34 +/- 66.76 U/L (p < 0.001). CONCLUSION: Raised levels of serum bilirubin and liver enzymes ALT, AST and ALK were found in preeclampsia cases.

Pre-hospital management of spinal injuries in a natural disaster.

BACKGROUND: Spinal injuries are one of the most devastating and crippling conditions known to mankind. Natural calamities follow no rules, and all have the potential of devastating medical and public health resources, earthquakes being the deadliest. The incidence of spinal injuries increases by leaps and bounds in such calamities. Improper pre-hospital management and inadvertent manipulation of the spine during rescue and transfer can aggravate the damage. This study was conducted in order to access the level of pre-hospital care that had been provided to the patients with spinal injuries reaching Ayub Teaching Hospital, Abbottabad after the October 2005 earthquake. METHODS: This study was conducted in the department of Neurosurgery, Ayub Medical College after the earthquake of October 2005. All patients sustaining spinal injuries were included in the study. Demographic data like age, gender and time of arrival at hospital were recorded. The important aspects of pre-hospital care like spinal immobilisation, intravenous access, fluid resuscitation, catheterisation, pain killers and intravenous steroids administration were also recorded. RESULTS: Out of the 83 patients with spinal injuries, 55 (66.26%) were females and 28 (33.7%) were males. Age ranged from 12-68 years (mean 26.6 +/- 13.2 years). At the time of presentation 70 (84.3%) patients had complete spinal injury whereas 13 (15.6%) had incomplete spinal injury. Sixty-one (73.5%) patients were paraplegic and 22 (26.5%) cases were quadriplegic. Only 8 (9.6%) patients were brought to the hospital after proper spinal immobilisation on the spinal boards. Intravenous line was maintained in 24 (28.9%) patients and only 18 (21.7%) received some sort of fluid resuscitation. Thirty-eight (45.7%) were catheterised. 18 (21.6%) received some sort of parenteral analgesics and 4 (4.8%) received steroids at the time of patients. Only 10(12%) were brought in properly equipped ambulances. CONCLUSION: Poor pre-hospital management of spinal injured patients depicts the lack of emergency preparedness as well as the lack of basic knowledge rescue teams and health care providers about the common trauma management measures. There is a dire need of educating rescue workers and volunteers about spinal injury in order to save lives minimise the secondary damage to already affected spine.

TB dots strategy in District Rawalpindi: results and lessons.

BACKGROUND: Tuberculosis (TB) is one of the most ancient diseases of mankind. Despite newer modalities for diagnosis and treatment, unfortunately, people are still suffering, and TB is among the top 10 killer infectious diseases in the world. TB is a devastating disease due to its rapid transmission and high rate of mortality causing around 1.8 million deaths annually. This study was conducted to evaluate the effectiveness of the Directly Observed Therapy Short-course (DOTS) in the target population. METHODS: Two Tehsils of District Rawalpindi were selected for the study. All patients under TB treatment attending Basic Health Units (BHUs) and Rural Health Centres (RHCs) were included in the study. The patients with extra pulmonary TB and children under five years of age were excluded from the study. All patients were contacted individually and asked about the DOTS program activity using a preformed questionnaire that mainly contained questions regarding knowledge of the patients about their disease and the role of health facility in treating and following the disease. RESULTS: Out of the 224 patients who were included in the study, 87 (38.8%) were male, and 137 (61.2%) were female. Majority (48.8%) of the patients was in age group of 21-40 years and 62.5% patients had positive family history of TB. Among the patients, 51.8% were illiterate, 31.7% had studied till primary level, and only 16.5% had the educational qualification of Matric or above. In our study 69.2% of patients themselves or through their relatives reported to the health facilities to get treatment, while the rest were picked by community health workers, 62.9% were diagnosed by the public hospitals, 23.2% were diagnosed by general practitioners and 12.9% by the federal public hospitals. In our study 69.6% of the patients were not observed at all or were observed by the family members. CONCLUSION: TB is mainly a disease of the poor and illiterate people. Despite many achievements a bulk of patients are not picked by the community health providers nor are they properly observed. We need to improve the current working of the DOTS personnel. General practitioners are playing a big role in diagnosing the disease, so they need to be integrated in the DOTS to effectively diagnose and control TB.

Comparative therapeutic response to pegylated interferon plus ribavirin versus interferon alpha-2b in chronic hepatitis C patients.

BACKGROUND: Hepatitis C is an epidemic worldwide since discovery in 1989. Conventional interferon alpha-2b plus Ribavirin therapy was started in 1998 but over all sustained viral response (SVR) rates are much below the desired rates to eradicate the diseases and stopping its epidemic. This study was conducted to access the therapeutic and cost-effectiveness of long acting pegylated interferon alpha-2b plus Ribavirin therapy verses conventional interferon alpha-2b plus Ribavirin. METHODS: This comparative study was done at PAF Hospital Shorkot Cantt from July 2005 to July 2008. One hundred anti-HCV positive patients were selected randomly for the study according to willingness due to cost affordability of the patients for conventional interferon. Group-A was labelled as pegylated interferon alpha-2b plus Ribavirin group, and Group-B interferon alpha-2b plus Ribavirin group. Both groups were given treatment for 24 weeks. Early virological response (EVR) was accessed at 12 weeks of treatment. Sustained virological response (SVR) in both the groups was done at 24th week during the treatment and 6 monthly after treatment for 2 years. Initially non-responders and relapsed patients within 2 years of treatment were re-treated for 24 weeks with the same treatment. In both groups nonresponders and relapsed patients were labelled as resistant patients. Both groups were followed with same protocol for 2 years. RESULTS: Out of 100 patients included in the study, 34% were females and 66% were males. Group-A patients over all showed 94% SVR as compare to 80% in Group-B in 2 year follow-up. Group-A showed 6% resistant patients as compare to Group-B (20%). Conventional interferons were better tolerated. Higher incidence of side-effects was seen in Group-A. CONCLUSION: Pegylated interferon plus Ribavirin showed 94% SVR in 2 years. Pegylated interferon plus Ribavirin is the treatment of choice.