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Objective: To investigate the correlation of Adenine-1012-Guanine (rs4516035) promoter region polymorphism of vitamin-D receptor gene with serum levels of omentin-1, vitamin-D and vitamin-D receptor protein in patients with coronary artery disease., Methods: The case-control study was conducted from January to June 2020 at the cardiac unit of Civil hospital Karachi (CHK), and comprised coronary artery disease patients and controls. The tetra-primer amplification refractory mutation system polymerase chain reaction method was used to genotype Adenine-1210Guanine polymorphism in the vitamin D receptor gene. Serum levels of omentin-1, vitamin-D, and vitamin-D receptor protein were measured in both the groups using an enzyme-linked immunosorbent assay. Data was analysed using SPSS 17., Results: Of the 1,000 subjects, there were 500(50%) cases; males 306(61.2%) and 194(38.8%) females with overall mean age of 51.08±9.55 years. The remaining 500(50%) were controls; 290(58%) males and 210(42%) females with overall mean age of 50.9±10.78 years. The mutant Guanine allele was more prevalent in controls 261(52.2%), and had a non-significant correlation with coronary artery disease (p=0.45). Among the cases, the wild Adenine-Adenine genotype had a higher prevalence 402(80.4%) and had a significant correlation with coronary artery disease (p<0.001). The heterozygous genotype Adenine-Guanine was significantly more predominant among the controls 346(69.2%) compared to the cases 66(13.2) (p=0.002)., Conclusions: Adenine-1012-Guanine polymorphism in the vitamin-D receptor gene was found to be a protective polymorphism for coronary artery disease in the recessive model.

Objective: To explore the burden of drug-resistant tuberculosis in Khyber Pakhtunkhwa, Pakistan., Methods: The cross-sectional study was conducted from March 1, 2016, to February 28, 2017, at the Khyber Pakhtunkhwa Tuberculosis Reference Laboratory, Hayatabad Medical Complex, Peshawar, Pakistan, and comprised referred suspected tuberculosis patient samples. Drug Susceptibility testing on all Mycobacterium tuberculosis complex strains was performed and data was subjected to statistical analysis., Results: Of the 8220 samples, 4230 (51.5%) were related to females and 3990 (48.5%) to males. Also, 1978 (24%) were related to patients aged 15-24 years. Of the total, 1351 (16.5%) samples were positive on culture. Drug susceptibility testing showed 525 (39%) samples to be resistant to at least one of the first- and second-line drugs. Among the culture-positive cases, 5 (0.4%) were extensively drug-resistant, 62 (4.6%) multi-drug resistant, 243 (18%) polyresistant, 215 (16%) monoresistant and 826 (61%) were pan-sensitive., Conclusions: Drug-resistant tuberculosis in newly-diagnosed tuberculosis patients was alarmingly high in Khyber Pakhtunkhwa region.

Objective: To compare stress markers and reproductive hormones in fertile and infertile females, and to relate the markers with age, duration and cause of infertility, and body mass index.., Methods: The case-control study was conducted at Aga Khan University Hospital, Karachi, from March 2017 to February 2018. Females aged 16-50 years regardless of ethnic background were recruited from the Australian Concept Infertility Medical Centre, Karachi, and were equally divided into infertile cases group A, and fertile controls group B. Serum follicular stimulating hormone, luteinizing hormone, estradiol, glutathione reductase and cortisol were measured using enzyme-linked innmunosorbent assay. SPSS 19 was used for statistical analysis.., Results: There were 328 female subjects divided into two equal groups of 164(50%). Serum luteinizing hormone and cortisol was higher in the group A than in group B (p<0.001). Serum glutathione reductase was low in group A compared to group B (p<0.001). Duration of infertility, serum levels of glutathione reductase and cortisol were also significantly different among infertile females when distributed on the basis of cause of infertility (p<0.05). Serum cortisol had negative correlation with glutathione reductase (p<0.001). Age and body mass index had a positive correlation with serum cortisol (p=0.035; p=0.63), while there was a negative correlation with glutathione reductase (p = -0.732).., Conclusions: Prolonged duration of infertility, age of females and body mass index enhanced the production of stress hormones and decreased antioxidant activity which augmented the risk of infertility.

Objective: To evaluate the occurrence of gestational diabetes mellitus and its association with demographic and anthropometric variables in pregnant women., Methods: This cross-sectional study was conducted at the Aga Khan University Hospital, Abbasi Shaheed Hospital and Memon Hospital in Karachi, from February 2014 to December 2015, and comprised pregnant women who were screened by 75-g 2-hour oral glucose tolerance test, (24-28 weeks of gestation) and classified as per the criteria of the International Association of Diabetes and Pregnancy Study Group. Weight, body mass index and serum glycated haemoglobin levels were measured. Women with pre-gestational diabetes were excluded. SPSS 21 was used for data analysis., Results: Of the 1,210 participants, 208(17.2%) had gestational diabetes, while 1,002(82.8%) did not have the condition. Gestational diabetes was associated with advancing age, deranged glycated haemoglobin, elevated body mass index at booking (p<0.001) and history of first-degree type 2 diabetic relatives (p=0.05). When stratified according to ethnicities, no difference was observed in terms of gestational diabetes predilection among those who had the condition (p>0.05)., Conclusions: Pre-existing adiposity and presence of strong family history rendered a considerable number of pregnant women to suffer from gestational diabetes.

Objective: To identify cut-off value of endometrial thickness required for implantation of embryo after intracytoplasmic sperm injection., Methods: The auasi-experimental study was conducted from July 2011 to June 2012 at an assisted reproductive clinic in Islamabad. Down-regulation of ovaries, controlled ovarian stimulation, oocyte pick-up, in vitro fertilisation, blastocyst transfer and confirmation of pregnancy with beta human chorionic gonadotropin more than 5mIU/ml. Patients were categorised into two groups on the basis of endometrial thickness < 8mm and >8mm.On ovulation induction, before human chorionic gonadotropin injection, endometrial thickness was measured by trans-vaginal scan. Receiver operating curve was used to define groups on the basis of endometrial thickness cut-off value for pregnancy. The groups were compared in terms of the number of retrieved, mature and fertilised oocytes along with oocyte maturity, fertilisation and implantation rates by chi square test., Results: There were 282 females; 116(41%) in Group A with endometrial thickness < 8mm, and 166(59%) in Group B with endometrial thickness >8mm. In group A, 6(5%) and in Group B, 95(57.2%) patients had a positive pregnancy test. The number of mature, fertilised oocytes and cleaved embryos was significantly high in Group B (p=0.01; p=0.001; p=0.001respectively). Increase in endometrial thickness enhanced chances of oocyte maturity, fertilisation, cleavage and implantation (p< 0.0001 each)., Conclusions: Endometrial thickness of 8mm was associated with a positive pregnancy outcome after intracytoplasmic sperm injection. Implantation of embryo was facilitated by better oocyte parameters, oocyte maturity, fertilisation and its cleavage in females who exhibited endometrial thickness above the cut-off value.

Objectives: To evaluate the bathing and cleaning practice, based on Sphere Standards and Indicators, of internally displaced people in the camp of Jalozai, Pakistan., Methods: This descriptive cross sectional survey was done in displaced population of Jalozai camp Nowshera from February to September 2010. Systematic Random Sampling was done (10% of Phase II Population). Study unit was a single family residing in the camp. A customized structured questionnaire was administered to households and information as recorded by the researchers. Informed consent and confidentiality was maintained while interviewing the household., Results: Although 97% (n=111) families were using soap for bathing but surprisingly none of them were on required Sphere Standards. Similarly 93% (n=107) were using laundry soaps and 49% (n=56) were using washing powder but again were not fulfilling the standards. It was discovered based on our survey that 64% (n=71) displaced people were not using anything for cleaning their children and none were using washable nappies. It was also observed that 99% (n=114) were using toothpastes and other local means for dental hygiene. Less than 10 toothpastes/year were provided to 79% families while 21% (n=24) were not provided at all., Conclusion: Our survey population was not on required SPHERE standards for sufficient bathing and laundry soap and they had no access to sufficient amount of toothbrush and toothpaste. Children were not provided with washable nappies or diapers.

Objective: To identify the risk factors involved in development of infection in individuals colonized with Methicillin-resistant Staphylococcus aureus (MRSA) among intensive care unit (ICU) patients., Methods: A total of 1431 patients were admitted in ICU of which 63 grew MRSA during January 1998 to December 1999. Patients who developed infection with MRSA in less than 48 hours of their admission to ICU were excluded. Medical records of all patients who grew MRSA were reviewed and 57 patients were identified for inclusion in the study. Thirty-seven of these had features of infection with MRSA and were selected as cases and 20 were identified as asymptomatic colonizers and labeled as controls. Risk factors like age of the patient, duration of ICU stay, gender, co-morbidity, presence and duration of central lines, number of arterial-punctures and number and duration of intubations were compared between cases and controls., Results: Cases were found to be significantly older (52.8 +/- 15.1) than controls (34.9 +/- 21.2). Other identified risk factors were diabetes mellitus (p = 0.001) and the first 15 days of central line placement (p = 0.025). Although chronic liver disease and hypertension could not be identified as significant risk factors, they clearly showed association. Other risk factors were not significantly different from controls., Conclusion: It is suggested that greater care is required for the elderly, diabetic patients with a central venous line in place especially during the first fifteen days of its introduction.