Bridging the Gap: A narrative review of osteoporosis disability, adipokines, and the role of AI in postmenopausal women.

Osteoporosis is a global health concern characterized by reduced bone density and compromised bone quality, resulting in an increased risk of fractures, particularly in postmenopausal women. The assessment of bone mineral density (BMD) plays a pivotal role in diagnosing osteoporosis, as it accounts for approximately 70% of overall bone strength. The World Health Organization (WHO) has endorsed BMD measurement as a reliable method for diagnosing this condition. In Pakistan, the incidence of bone fractures is on the rise, largely attributable to an aging population and a range of contributing factors. Understanding the global and local prevalence of osteoporosis, its impact on morbidity and mortality, and the contributing factors is vital for developing effective preventive and therapeutic strategies. The role of adipokines, including chemerin, vaspin, and omentin-1, in bone metabolism is an emerging area of investigation. These adipokines play diverse roles in physiology, ranging from inflammation and metabolic regulation to cardiovascular health. Understanding their potential impact on bone health is a topic of ongoing research. The intricate relationship between bone density, bone quality, and overall bone strength is central to understanding the diagnosis and management of osteoporosis. Current innovation in machine learning and predictive model can bring revolution in the field of bone health and osteoporosis. Early identification of people with osteoporosis or risk of fracture through machine learning can prevent disability and improve the quality of life.

Factors leading to delayed and challenging presentation of benign breast lumps in young females.

Background and Objective: A delayed presentation of benign breast diseases may lead to a therapeutic challenge when they enlarge enormously or become multiple. Aim of this study was to evaluate the factors leading to delayed presentation of benign breast lumps. Methods: This cross-sectional study was conducted at Madinah Teaching Hospital and Allied Hospital, Faisalabad from January 2019 to October 2021. One hundred and forty five female patients were selected by non-probability purposive sampling. Patients with large size (>5cm) or multiple benign breast lumps were included. An interview was conducted using structured questionnaire translated in Urdu. Factors leading to delayed presentation and social impact scale for stigma were evaluated. Results: Patients had a mean age of 26.52 ± 6.90 years. The average delay of seeking medical care was 8.48 ± 8.41 months. Factors leading to delayed presentation were; lack of knowledge n=112 (77.2%) and parda (religious issues) n=112 (77.2%), followed by poverty n=109 (75.2%), and fear of cancer n=90 (62.1%). All the sub-scales of stigma, i.e., social rejection, financial insecurity, internalized shame and social isolation were high in late presenters, though, only financial insecurity was significantly high in late presenters (p=0.03). Conclusion: Lack of awareness, socioeconomic factors and disease related stigma were the main factors related to delayed presentation in young females with benign breast diseases. Addressing these factors may improve timely diagnosis and management of delayed and challenging cases.

Serum resistin levels as predictor of low bone mineral density in postmenopausal women.

Resistin, a novel adipokine may play an important role in bone metabolism. The study is designed to discover the association of bone mineral density (BMD) with serum resistin levels, anthropometric measures and to elucidate serum resistin as a predictor of BMD in postmenopausal women. Postmenopausal women (n = 160) were recruited and divided into two groups, non-osteoporotic (n = 70) and osteoporotic (n = 90). BMD was evaluated by DXA scan. High serum resistin levels and low weight are independent contributors to low BMD and can influence BMD at lumbar spine, right femoral neck, right hip, left femoral neck, and left hip in postmenopausal women.

Emotional intelligence and academic performance of students.

The medical profession deals with 'humanism' which involves interactions with people, the ability to think about them, care for them, and to provide positive reinforcement in clinical follow-ups. Emotional intelligence integrates the significant features of personal relationships to promote self-management skills, like adaptability, control of temperaments and reduction of tension, which can improve performance of individuals. This has led to increasing interest in the importance of emotional intelligence for effective academic growth, professional experiences and clinical practice. There are many studies examining the correlation between emotional intelligence and academic achievement at different education levels, signifying its importance to predict students who need guided intervention. With proven relationship between emotional intelligence and academic success, the assessment of emotional intelligence can be introduced in entrance exams of medical schools to recognise students who might need directed intermediation. With the agreement of all stakeholders, emotional intelligence training workshops and awareness sessions can be introduced for educators and students.

Relationship of BMI with Junk Food, sleep pattern, exam performance and awareness about its ill health effects in healthy teenagers.

OBJECTIVE: To evaluate the relationship of body mass index of healthy teenagers with junk food, sleep pattern, exam performance and awareness about its ill effects. METHODS: The cross-sectional study was conducted from March to June 2017 at University Medical and Dental College, University of Faisalabad, Faisalabad, Pakistan, and comprised subjects aged 13-19. Data was collected using face-to-face interviews, getting the examnation results from respective educational insititutions and calculating the body mass index, Data was analysed using SPSS 22. RESULTS: Of the 226 subjects, 96(42.5%) were boys with a mean age of 15.68 ±1.83 years, and 130(57.5%) were girls with a mean age of 17.00±1.74 years. Based on body mass index, 35(15.5%) subjects were underweight, 88(39%) were normal, 28(12.4%) overweight, 56(24.7%) pre-obese and 19(8.4%) were obese. The independent predictors of body mass index were higher consumption of soft drinks in males and higher consumption of soft drinks and salt in females (p<0.05). CONCLUSION: Teenagers were found to be well aware of the ill effects of junk food, but they were found to be happy with their dietary habits and unwilling to change it.

Association of serum chemerin with calcium, alkaline phosphatase and bone mineral density in postmenopausal females.

OBJECTIVES: To investigate the association of serum chemerin with calcium, alkaline phosphatase and bone mineral density in postmenopausal non-osteoporotic and osteoporotic females. METHODS: This cross-section analysis was carried out at the orthopedic department of Madina Teaching Hospital, Faisalabad, Pakistan, in the year 2017-2019. Postmenopausal females were divided into two groups according to their bone mineral density (BMD). All osteoporotic females had a T-score of -2.5 or less. Data were analyzed on SPSS-24. RESULTS: A total of 140 women were included in our study (80 osteoporotic and 60 non-osteoporotic). Non significant difference in age and BMI was observed between osteoporotic and non-osteoporotic subjects (p=0.152) and (p=0.291) respectively. There was a significant difference found in total BMD, serum chemerin levels between osteoporotic and non-osteoporotic subjects p<0.001 in both parameters. No significant correlation of serum chemerin was found with serum calcium, serum alkaline phosphatase and BMD in postmenopausal osteoporotic females (p=0.907), (p=0.318) (p=0.664) respectively. A significant negative correlation was found between serum alkaline phosphatase levels and total BMD in postmenopausal osteoporotic females (p=- 0.039). Linear regression analysis of serum alkaline phosphatase levels with total BMD showed no association between BMD and serum alkaline phosphatase levels (p=0.869). CONCLUSION: There is no association of serum chemerin with calcium, ALP and bone mineral density in non-osteoporotic and osteoporotic postmenopausal females.

Emotional Intelligence: A predictor of undergraduate student's academic achievement in altered living conditions.

OBJECTIVE: To compare the impact of trait emotional intelligence between students of different faculties and associated factors. METHODS: The cross-sectional analytical study was conducted from August 2016 to March 2017 at the University of Faisalabad, Faisalabad, Pakistan, and comprised undergraduate students, both boarders and day scholars, from seven different faculties. Data was collected using the trait emotional intelligence questionnaire-short form. Student's yearly test scores were obtained as a measure of academic achievement. Data was analysed using SPSS 20. RESULTS: Of the 498 students, 109(21.9%) were studying medicine, 56(11.2%) dental sciences, 76(15.2%) optometry, 83(16.6%) nutrition and dietetics, 109(21.9%) physiotherapy, 35(7%) pharmacy, and 30(6%) social sciences. The overall mean age was 19.84±1.30 years. There were 210(42.2%) boarders compared to 288(57.8%) day scholars. There was significant difference in emotional intelligence based on student's faculty (p<0.0001). Significant impact was seen on test scores of faculty residing status (p<0.05). Significant relation of emotional quotient and residing status with student's test scores (p<0.05). CONCLUSIONS: Emotional intelligence was found to be an important factor in academic achievement and important variable in different faculties and different living conditions.

Perceived stress, severity and sources of stress among female medical students in a private medical college in Pakistan.

OBJECTIVE: To investigate apparent stress, severity and sources of stress among female medical undergraduate students. METHODS: The cross-sectional, questionnaire-based study was conducted at the University Medical and Dental College, Faisalabad, Pakistan, from August to December, 2016, and comprised female medical students from first year to final year. The students were divided into pre-clinical, para-clinical and clinical groups. Data was analysed using SPSS 20. RESULTS: Of the 514 students, 271(52.7%) were in the pre-clinical group with a mean age of 19±1 years, 111(21.6%) were in the para-clinical group with mean age 20.59±0.77 years, and 132(25.7%) were in the clinical group with mean age 21.83±1.03 years. The marks of the students were negatively related with stress scores in all groups, but they were highly significant in pre-clinical year only (p0.001). Severe stressors stated by respondents were, 'raised parental expectations', 'frequent examinations', 'sleeping difficulties', 'anxiety about the future', 'quality of food in the mess', and 'accommodation away from home'. CONCLUSIONS: The subjects showed high levels of stress. Major stressors were academic and psychosocial.

Association of serum osteoprotegerin with severity of chronic liver disease in female patients: A potential biomarker.

OBJECTIVE: To determine the association of serum osteoprotegerin (OPG) with the severity of chronic liver disease in female patients. METHODS: This case-control study was conducted in Madina Teaching Hospital from 2019-2020.An institutional review board of University Medical and Dental College, The University of Faisalabad gave the approval to conduct the study. Only female patients of age group 40 to 60 years having CLD were included in this study. Total 80 participants were enrolled after fulfilling the inclusion and exclusion criteria. Serum OPG levels were measured by enzyme linked immunosorbant assay (ELISA) supplied by ELAB Sciences, USA. The severity of disease was assessed by Child-Pugh classification. RESULTS: OPG levels were significantly different between the three Child-Pugh classes. OPG levels were significantly high in class C indicating increased level of this cytokine in CLD as compared to class A (p = <0.05). There was a positive association of OPG with splenomegaly (OR = 2.10, p = <0.001), hepatomegaly (OR = 4.41, (p = <0.05), skin pigmentation (OR = 2.06, p = <0.05), malena (OR = 1.87, p = <0.05) and prolonged bleeding (OR = 1.86, p = <0.05). CONCLUSION: The levels of serum Osteoprotegerin is increased in severe form of chronic liver disease (Class C) of Child-Pughs classification as compared to mild (Class A) and moderate (Class B) forms of Child-Pughs classification.

Association between leptin, obesity, hormonal interplay and male infertility.

Male infertility is a major health problem worldwide. We investigated a possible association between leptin, obesity, hormonal interplay and male infertility. This cross-sectional study of 313 males (178 infertile and 135 fertile) was carried out in 2017. The subjects were categorised by body mass index (BMI) and body fat percentage (BF%) into normal weight, overweight and obese. Significantly higher levels of BMI and BF% (p-value < 0.001) and lower levels of FSH, LH, testosterone, and SHBG (p-value < 0.001) were found in infertile males. However, no significant difference was observed in leptin levels (p-value = 0.35). Leptin levels were significantly higher, and all the sex hormones were significantly lower (p-value < 0.001) in obese subjects, whereas according to BF% only leptin, FSH and SHBG were significantly different. Leptin showed a significant positive correlation with BMI and BF% (p < 0.001). A strong positive link to serum testosterone was found with age, FSH, and LH (p < 0.001) and a negative one with BMI and BF% (p < 0.001). In mutivariable anlaysis, after adjusting for the other covariates, a significant association between FSH and testosterone (p-value <0.001) was found. Serum leptin levels did not differ significantly in fertile and infertile groups, and no association was found with infertility. Furthermore, male obesity was found to be associated with infertility with the decrease in levels of sex hormones.

Association of perceived stress with healthy and unhealthy food consumption among teenagers.

OBJECTIVE: To evaluate unhealthy and healthy food consumption and their association with perceived stress in teenagers. METHODS: The cross-sectional study was conducted from February to April 2017 at five educational institutions in Faisalabad, Pakistan, and comprised individuals of either gender aged 13-19 years. Dietary habits were recorded on a proforma and perceived stress scores were calculated using Cohen's perceived stress scale. Multiple regression analysis was used to predict perceived stress scores. RESULTS: Of the226 subjects, 96(42.5%) were males and 130(57.5%) were females. The frequency of consumption per week of sweet snacks, fried foods, soft drinks, sports drinks, energy drinks and vegetables was significantly more in males compared to the females (p<0.05 each). The consumption of such unhealthy food had significant positive relationship with perceived stress scores, while consumption of healthy food, like fresh fruits and vegetables, had a significant negative relationship with it in males only (p<0.05 each). Perceived stress score was primarily predicted by higher consumption of sports drinks (p<0.05) and lower consumption of fresh fruits (p<0.05). CONCLUSIONS: Increased consumption of unhealthy food items and low intake of healthy food could lead to stress in young individuals, especially in males.

Alkaline phosphatase is a predictor of Bone Mineral Density in postmenopausal females.

OBJECTIVES: The study was planned to determine whether serum calcium, phosphate and alkaline phosphatase (ALP) are predictors of bone mineral density (BMD) in postmenopausal non-osteoporotic, osteopenic, and osteoporotic females. METHODS: In this cross sectional study, conducted at Shaikh Zayed Hospital, Lahore in the year 2014-2015, postmenopausal females between 50-70 years of age were taken and divided into three groups non-osteoporotic (n=52), osteopenic (n=69) and osteoporotic (n=47). Serum ALP, phosphate and calcium were used in a stepwise multiple regression analysis to predict T-score in these groups. RESULTS: In normal postmenopausal females, the prediction model was statistically significant, F(2, 41) = 6.041, p < 0.05 and showed a T-score variance of 22%. T-score was primarily predicted by higher levels of phosphate and calcium. In postmenopausal osteopenic females, T-score was only predicted by lower levels of ALP. The model was statistically significant, F(1, 59) = 4.995, p < 0.05, and accounted for approximately 7% of the variance of T-score. In postmenopausal osteoporotic females, the prediction model contained no predictors. CONCLUSION: Our study suggested that calcium and phosphate are the strongest predictors of T-score in postmenopausal normal females, while in postmenopausal osteopenic females ALP was the strongest predictor of T-score. Elevated serum ALP levels may help in determining loss of BMD in postmenopausal females.

Status of bone health and association of socio-demographic characteristics with Bone Mineral Density in Pakistani Females.

BACKGROUND & OBJECTIVE: The "silent thief" of bone osteoporosis is associated with various modifiable factors, identifying these factors is important in decreasing the prevalence of this highly prevalent disease. Therefore, this study was planned to identify these risk factors for osteoporosis in premenopausal and postmenopausal Pakistani women. METHODS: A total of 1205 pre and postmenopausal females between the ages of 20 to 80 years were selected. Detailed history about the socio-demographic characteristics including age, education, profession, marital and resident status was recorded. Medical and gynecological history was also taken after informed consent Bone health of females was assessed using calcaneal ultrasound bone densitometer. SPSS 22.0 was used to analyze data. RESULTS: Univariate analysis showed that age (30-39 yrs, and 60-69 yrs), occupation (housewives) and education (secondary and primary education, illiterate) were significantly associated with low bone mass density (LBMD). Multivariate analysis showed that age 30-39 years (OR=0.25 95%CI 0.13 - 0.49), age 40-49 years (OR=0.30 95%CI 0.15 - 0.59), age 50-59 years (OR=0.42 95%CI 0.22 - 0.79), primary education (OR=3.83, 95%CI 2.30 - 6.38) and illiteracy (OR=3.83 95%CI 2.52 - 5.82), were significantly associated with LBMD. The prevalence of osteopenia and osteoporosis was 29.8%, 27.2%, respectively, while 43% subjects had normal BMD. CONCLUSION: It is concluded that, within Pakistani population, the prevalence of osteopenia is high even at an early age group and the odds of having LBMD are more in less educated or illiterate women.

Interplay of vitamin D, vitamin B12, homocysteine and bone mineral density in postmenopausal females.

Osteoporosis is most common age related, multifactorial disease. The aim of the researchers were to discover the association between serum homocysteine, vitamin D, vitamin B12 and bone mineral density in postmenopausal non-osteoporotic and osteoporotic females. In this cross- sectional study, 156 postmenopausal females between 50-70 years of age were recruited and divided into two groups, non-osteoporotic (n = 52) and osteoporotic (n = 104). There was significant negative correlation of homocysteine with vitamin D and B12 in postmenopausal non-osteoporotic and homocysteine with vitamin B12 in postmenopausal osteoporotic females. Serum homocysteine levels were predicted by vitamin D in postmenopausal non-osteoporotic and vitamin B12 in postmenopausal osteoporotic females.

Knowledge and attitude of blood donation among female medical students in Faisalabad.

OBJECTIVE: To assess the knowledge, practices and attitude of medical students towards blood donation. METHODS: This cross-sectional study was conducted at the University of Faisalabad, Faisalabad, Pakistan, from April to August 2016, and comprised female medical students. Multi-stage sampling technique was employed. A structured questionnaire was included as data-collection tool. Statistical analysis was done using SPSS 20. RESULTS: Of the 500 students, 469(93.8%) responded to the questionnaire. Of them, 419(89.3%) females had never donated blood and only 2(0.4%) were regular voluntary donors. The best source from which the participants heard about blood donation was friends 259(55.2%). When coming to reasons for not donating blood, there was significant association of many factors like fear (p <0.001), the collection facility being far from the place (p <0.001), not having enough time to donate (p <0.001). Of the 50(10.7%) respondents who had ever donated blood, 48(96%) said the main motivator was saving lives of the people. CONCLUSIONS: Female medical students were aware of the basic knowledge about blood donation.

Association of serum leptin with bone mineral density in postmenopausal osteoporotic females.

OBJECTIVE: Present study was designed to find out whether leptin is a predictor of bone mass density (BMD) in premenopausal women (PMW) and postmenopausal osteoporotic women (PMOPW) or it has no association with BMD. METHODS: One hundred and ninety two women (98 PMOPW and 94 PMW) were recruited for this study. The control group was BMI matched with osteoporotic subjects. BMD assessment was done on calcaneus by peripheral ultrasound bone densitometry and T scores were determined. Serum leptin levels were measured by enzyme-linked immunosorbent assay (ELISA). RESULTS: Serum leptin and BMD values were significantly different in both groups (leptin, 18.56 ± 8.65 ng/ml versus 21.64 ± 9.80 ng/ml, p = 0.02) and (BMD, -0.70 ± 0.19 versus -3.17 ± 0.59, p = 0.000), respectively. In PMOPW serum leptin and BMD were considerably correlated with weight (lep, r = 0.53, p = <0.001; BMD, r = -0.21, p = 0.02), BMI (lep, r = 0.52, p = <0.001; BMD, r = -0.27, p = 0.005), waist circumference (lep, r = 0.61, p = <0.001; BMD, r = 0.18, p = 0.04), hip circumference (lep, r = 0.58, p = <0.001). Multivariate linear stepwise regression analysis showed that weight and BMI in PMW and PMOPW were independent predictors of BMD. Serum leptin level was not found to be the predictor of BMD in both groups. CONCLUSION: The present results indicate that body weight and BMI have an impact on BMD while serum leptin is not associated with BMD in PMW and PMOPW.

Frequency of different blood groups and its association with BMI and blood pressure among the female medical students of Faisalabad.

OBJECTIVE: To determine the frequency of different blood groups among female medical students and to find the association of blood groups and body mass index with blood pressure. METHODS: This cross-sectional study was performed at the University Medical and Dental College, Faisalabad, Pakistan, from March to April 2016, and comprised female medical students. Participants were divided into groups on the basis of their ABO blood groups and on body mass index criteria. Blood groups were determined by simple conventional slide method. Blood pressure was estimated by manual auscultatory technique with a mercury sphygmomanometer. Data was analysed usingSPSS20. RESULTS: There were 145 students with an overall mean age of18.4±0.75 years (range: 17-23 years). Blood group B was the predominant group 65(44.8%). Besides, 130(89.6%) subjects were rhesus positive and 23(53%) subjects of blood group O were pre-hypertensive. Multiple regression analysis indicated significant positive association of blood group O with both systolic and diastolic blood pressure (p=0.002, 0.001). However, subsequent logistic regression showed significant association only with diastolic blood pressure (p=0.001). Relative risk of pre-hypertension for obese (p=0.001) was greater than non-obese subjects. Body mass index was significantly associated with both systolic and diastolic blood pressure (p=0.004, 0.042). CONCLUSIONS: Blood group B was the most common blood group. Blood group O was associated with diastolic pre-hypertension, while body mass index was associated with both systolic and diastolic pre-hypertension.

Relationship of anthropometric measures with bone mineral density in postmenopausal non-osteoporotic, osteopenic and osteoporotic women.

BACKGROUND AND OBJECTIVES: Body mass index (BMI) has been shown to be a more important predictor of bone mineral density (BMD). The objective of this study was to investigate the relationship of anthropometric measures including body mass index with bone mineral density in postmenopausal non-osteoporotic, osteopenic and osteoporotic women. METHODS: In this cross sectional study postmenopausal females between 50-70 years of age were recruited and divided into three groups: non-osteoporotic (n=52), osteopenic (n=69) and osteoporotic females (n=47). Anthropometric measures and bone mineral density were assessed. ANOVA was applied to compare groups while Post hoc Tuckey's test was used for multiple comparisons between the groups. Spearman's rho correlation was used to establish correlations. RESULTS: Body mass index (p = 0.034) and hip circumference (p = 0.013) were significantly higher in osteopenic as compared to osteoporotic females and waist to hip ratio was significantly higher (p = 0.005) in osteoporotic as compared to non-osteoporotic females. Significant positive correlation of body mass index was found with T-score (p = 0.022) and ultrasound bone profile index (p< 0.001) in postmenopausal females. CONCLUSIONS: High body mass index is associated with high bone mineral density and reduced fracture risk in postmenopausal females. Increasing age and high waist to hip ratio can also lead to reduced bone mineral density in postmenopausal females.