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Background: Traditional medical education often lacks contextual experience, hindering students' ability to effectively apply theoretical knowledge in real-world scenarios. The integration of the metaverse into medical education holds great enormous promise for addressing educational disparities, particularly in lower-middle-income countries (LMICs) accompanied by rapid technological advancements. This commentary paper aimed to address the potential of the metaverse in enhancing basic sciences education within the constraints faced by universities in LMICs. We also addressed learning design challenges by proposing fundamental design elements and a suggested conceptual framework for developing metaverse-based teaching methods. The goal is to assist educators and medical practitioners in comprehensivley understanding key factors in immersive teaching and learning. Discussion: By immersing medical students in virtual scenarios mimicking real medical settings and patient interactions, the metaverse enables practice in clinical decision-making, interpersonal skills, and exposure to complex medical situations in a controlled environment. These simulations can be customized to reflect local healthcare challenges, preparing medical students to tackle specific community needs. Various disciplines, including anatomy, physiology, pharmacy, dentistry, and pathology, have begun leveraging the metaverse to offer immersive learning experiences, foster interdisciplinary collaborations, and facilitate authentic assessments. However, financial constraints pose a significant barrier to widespread adoption, particularly in resource-limited settings like LMICs. Addressing these challenges is crucial to realizing the full potential of metaverse technology in medical education. Conclusion: The metaverse offers a promising solution for enhancing medical education by providing immersive, context-rich learning experiences. This paper proposes a conceptual framework and fundamental design elements to aid faculty educators and medical practitioners in effectively incorporating metaverse technology into their teaching methods, thus improving educational outcomes in LMICs. [ABSTRACT FROM AUTHOR]

The World Wide Web and the advancement of computer technology in the 1960s and 1990s respectively set the ground for a substantial and simultaneous change in many facets of our life, including medicine, health care, and medical education. The traditional didactic approach has shifted towards more dynamic and interactive methods, leveraging technologies such as simulation tools, virtual reality, and online platforms. At the forefront is the remarkable evolution that has revolutionized how medical knowledge is accessed, disseminated, and integrated into pedagogical practices. The COVID-19 pandemic also led to rapid and large-scale adoption of e-learning and digital resources in medical education because of widespread lockdowns, social distancing measures, and the closure of medical schools and healthcare training programs. This review paper examines the evolution of medical education from the Flexnerian era to the modern digital age, closely examining the influence of the evolving WWW and its shift from Education 1.0 to Education 4.0. This evolution has been further accentuated by the transition from the static landscapes of Web 2D to the immersive realms of Web 3D, especially considering the growing notion of the metaverse. The application of the metaverse is an interconnected, virtual shared space that includes virtual reality (VR), augmented reality (AR), and mixed reality (MR) to create a fertile ground for simulation-based training, collaborative learning, and experiential skill acquisition for competency development. This review includes the multifaceted applications of the metaverse in medical education, outlining both its benefits and challenges. Through insightful case studies and examples, it highlights the innovative potential of the metaverse as a platform for immersive learning experiences. Moreover, the review addresses the role of emerging technologies in shaping the post-pandemic future of medical education, ultimately culminating in a series of recommendations tailored for medical institutions aiming to successfully capitalize on revolutionary changes. [ABSTRACT FROM AUTHOR]

Background Traditional assessments often lack flexibility, personalized feedback, real-world applicability, and the ability to measure skills beyond rote memorization. These may not adequately accommodate diverse learning styles and preferences, nor do they always foster critical thinking or creativity. The inclusion of Artificial Intelligence (AI), especially Generative Pre-trained Transformers, in medical education marks a significant shift, offering both exciting opportunities and notable challenges for authentic assessment practices. Various fields, including anatomy, physiology, pharmacy, dentistry, and pathology, are anticipated to employ the metaverse for authentic assessments increasingly. This innovative approach will likely enable students to engage in immersive, project-based learning experiences, facilitating interdisciplinary collaboration and providing a platform for real-world application of knowledge and skills. Methods This commentary paper explores how AI, authentic assessment, and Student-as-Partners (SaP) methodologies can work together to reshape assessment practices in medical education. Results The paper provides practical insights into effectively utilizing AI tools to create authentic assessments, offering educators actionable guidance to enhance their teaching practices. It also addresses the challenges and ethical considerations inherent in implementing AI-driven assessments, emphasizing the need for responsible and inclusive practices within medical education. Advocating for a collaborative approach between AI and SaP methodologies, the commentary proposes a robust plan to ensure ethical use while upholding academic integrity. Conclusion Through navigating emerging assessment paradigms and promoting genuine evaluation of medical knowledge and proficiency, this collaborative effort aims to elevate the quality of medical education and better prepare learners for the complexities of clinical practice. [ABSTRACT FROM AUTHOR]

Background: Tirzepatide is a novel dual glucose-dependent insulinotropic peptide (GIP)-glucagon-like peptide 1 (GLP-1) receptor agonist being evaluated for the treatment of various metabolic disorders. We performed a meta-analysis of randomized data on the effects of tirzepatide on serum lipid levels. Methods: We systematically searched the PubMed and ClinicalTrials.gov databases for relevant data from randomized controlled clinical trials. All articles were screened, reviewed, and extracted by at least two independent authors, with conflicts resolved by consensus. Four hundred and thirty-three records were identified in the initial literature search; 18 of them were identified for full-text review, and 14 of those were systematically reviewed and included in the analysis. The meta-analysis was performed using an inverse variance random-effects model. Results: Fourteen articles that reported data from 13 randomized controlled clinical trials were included in the review. Nine trials had a low risk of bias, two had a moderate risk, and two had a high risk of bias. The pooled analysis showed that tirzepatide was efficacious at improving all lipid markers, including cholesterol and triglycerides. Moreover, a clear dose response trend was visible across results from groups taking 5, 10, and 15 mg of tirzepatide. Conclusion: There is growing evidence to support the use of tirzepatide in patients with metabolic diseases such as type 2 diabetes mellitus, metabolic syndrome, and obesity. Our results demonstrate that tirzepatide significantly improves all aspects of patient metabolism and might be superior in this regard to conventional agents such as insulin formulations or traditional GLP-1 agonists. [ABSTRACT FROM AUTHOR]

This study evaluated effect of mental rotation (MR) training on learning outcomes and explored effectiveness of teaching via three-dimensional (3D) software among medical students with diverse spatial intelligence. Data from n = 67 student volunteers were included. A preliminary test was conducted to obtain baseline level of MR competency and was utilized to assign participants to two experimental conditions, i.e., trained group (n = 25) and untrained group (n = 42). Data on the effectiveness of training were collected to measure participants' speed and accuracy in performing various MR activities. Six weeks later, a large class format (LCF) session was conducted for all students using 3D software. The usefulness of technology-assisted learning at the LCF was evaluated via a pre- and post-test. Students' feedback regarding MR training and use of 3D software was acquired through questionnaires. MR scores of the trainees improved from 25.9±4.6 points to 28.1±4.4 (P = 0.011) while time taken to complete the tasks reduced from 20.9±3.9 to 12.2±4.4 minutes. Males scored higher than females in all components (P = 0.016). Further, higher pre- and post-test scores were observed in trained (9.0±1.9 and 12.3±1.6) versus untrained group (7.8±1.8; 10.8±1.8). Although mixed-design analysis of variance suggested significant difference in their test scores (P < 0.001), both groups reported similar trend in improvement by means of 3D software (P = 0.54). Ninety-seven percent of students reported technology-assisted learning as an effective means of instruction and found use of 3D software superior to plastic models. Software based on 3D technologies could be adopted as an effective teaching pedagogy to support learning across students with diverse levels of mental rotation abilities.

Background: More than 75 genetic susceptibility loci have been implicated with hyperglycemia. SNPs in genes linked with satiety, insulin sensitivity, BMR (Adiponectin, FTO, and MC4R), and inflammation and autoimmunity (TNF-a) have been shown to have a relationship with metabolic syndrome. Objectives: To measure the frequency of ADIPOQ, FTO, MCR4, and TNF SNPs in metabolic syndrome patients and controls, and to assess the association of these with hyperglycemia and adiposity status. Methods: A cross-sectional study was conducted. Baseline investigations including lipid profiles, blood glucose levels, and BMI calculation were conducted for n=113 Metabolic Syndrome and n=47 healthy controls. Tetra ARMS PCR and gel electrophoresis were conducted for Adiponectin rs266729, Adiponectin rs1501299, FTO rs9939609, MCR4 rs1297013, and TNF rs1800629. Statistical analysis was performed using SPSS version 26. Results: Difference was observed in lipid profiles (including LDL, triglycerides, and cholesterol but not HDL), body fat percentage (p= 0.034), and both fasting (p=0.000) and random (p=0.000) blood glucose levels among metabolic syndrome patients versus controls. Adiponectin rs1501299, FTO rs9939609, and MCR4 rs1297013 showed genotype frequency differences between groups. Spearman's correlation was applied to test any association of risk allele with study variables and MCR4 rs1297013 showed an independent association with Fasting Blood Glucose Level (r=0.238; p=0.024) irrespective of age, weight, or gender. Conclusion: MCR4 rs1297013 polymorphism is an independent risk factor leading to hyperglycemia in the study population, however, no other SNPs were identified to carry a significant risk. Large-scale genome-wide studies are required to identify the unique set of risk genes for the Pakistani population. [ABSTRACT FROM AUTHOR]

Aims: To determine whether obesity‐associated metabolites are associated with type 2 diabetes (T2DM) risk among South Asians. Materials and Methods: Serum‐based nuclear magnetic resonance imaging metabolomics data were generated from two South Asian population‐based prospective cohorts from Karachi, Pakistan: CARRS1 (N = 4017) and CARRS2 (N = 4802). Participants in both cohorts were followed up for 5 years and incident T2DM was ascertained. A nested case‐control study approach was developed to select participants from CARRS1 (Ncases = 197 and Ncontrols = 195) and CARRS2 (Ncases = 194 and Ncontrols = 200), respectively. First, we investigated the association of 224 metabolites with general obesity based on body mass index and with central obesity based on waist‐hip ratio, and then the top obesity‐associated metabolites were studied in relation to incident T2DM. Results: In a combined sample of the CARRS1 and CARRS2 cohorts, out of 224 metabolites, 12 were associated with general obesity and, of these, one was associated with incident T2DM. Fifteen out of 224 metabolites were associated with central obesity and, of these, 10 were associated with incident T2DM. The higher level of total cholesterol in high‐density lipoprotein (HDL) was associated with reduced T2DM risk (odds ratio [OR] 0.68, 95% confidence interval [CI] 0.53, 0.86; P = 1.2 × 10−3), while higher cholesterol esters in large very‐low‐density lipoprotein (VLDL) particles were associated with increased T2DM risk (OR 1.90, 95% CI 1.40, 2.58; P = 3.5 × 10−5). Conclusion: Total cholesterol in HDL and cholesterol esters in large VLDL particles may be an important biomarker in the identification of early development of obesity‐associated T2DM risk among South Asian adults. [ABSTRACT FROM AUTHOR]

Objectives: Ischemia modified albumin (IMA) may aid in the early detection and management of diabetic retinopathy (DR). In this study, we examined the relationship between IMA and DR, and the effect of intravitreal anti-vascular endothelial growth factor (anti-VEGF) on IMA levels in patients with DR. Methods: This Quasi-experimental study was conducted from March-December 2018 at a Al-Ibrahim Eye Hospital in Karachi, Pakistan. Adult patients (age = 18 year) with Type-2 diabetes mellitus (T2DM) presenting to the Diabetic Clinic were categorized as control (Group-A n=30: DM without DR) or case (Group-B n=59: DM with DR). Patients in Group-B received an intravitreal injection of bevacizumab (anti-VEGF). Visual acuity, retinoscopy and serum IMA were recorded at baseline and at a 30-day follow-up for both groups. Results: A significant drop in IMA levels was seen one month after bevacizumab (IMA baseline: 1590.82±121.22 and follow up: 940.8±91.26; p<0.01) in Group-B subjects. Visual acuity (VA) of patient in Group-B also improved one month after bevacizumab injection in both eyes (p<0.001). Whereas, the IMA levels in Group-A showed an upward rising trend after one month (baseline 448.80±22.4ng/ml and follow up 522.21±33.15 ng/ml; p>0.05) indicating disease progression. Conclusion: Ischemia modified albumin may be used as an effective and novel screening biomarker for assessing oxidative stress associated with DR, and to quantify response to and prognosis after intravitreal bevacizumab injection for DR. [ABSTRACT FROM AUTHOR]

The intrauterine environment and early-life nutrition are regulated by maternal biomarkers in the blood and breast milk. We aimed to explore epigenetic modifications that may contribute to differential chemerin expression in maternal plasma, colostrum, and breast milk and find its association with fetal cord blood and infant weight at 6 weeks postpartum. Thirty-three gestational diabetes mellitus (GDM) mothers and 33 normoglycemic mothers (NGT) were recruited. Two maternal blood samples (28th week of gestation and 6 weeks postpartum), cord blood, colostrum, and mature milk were collected. Methylation-specific polymerase chain reaction and enzyme-linked immunosorbent assay were conducted. The weight of the babies was measured at birth and 6 weeks postpartum. Serum chemerin levels at the 28th gestational week and 6 weeks postpartum were significantly lower for the NGT group as compared to the GDM group; (P < 0.05). Higher colostrum chemerin concentrations were observed in the GDM group and remained elevated in mature milk as compared to NGT (P < 0.05). Colostrum and breast milk chemerin levels showed an independent association with infant weight at 6 weeks postpartum (r = 0.270; P = 0.034) (r = 0.464; P < 0.001). Forty percent GDM mothers expressed unmethylated chemerin reflecting increased chemerin concentration in the maternal blood. This pattern was also observed in newborn cord blood where 52% of samples showed unmethylated chemerin in contrast to none in babies born to normoglycemic mothers. The results of this study highlight the critical importance of altered chemerin regulation in gestational diabetic mothers and its effect during early life period and suggest a possible role in contributing to childhood obesity. [ABSTRACT FROM AUTHOR]

Background: Despite mass vaccination campaigns, the world has seen a steady rise in the number of SARS-CoV-2 cases, with 178,765,626 cases and 3,869,994 COVID-19 related deaths by June 19th, 2021. Therefore, it is important to enforce social distancing to control its spread. With the variation observed in the severity of the pandemic in different countries, it is also imperative to study the social distancing behaviors amongst the population in developed and developing countries. Design and methods: In this cross-sectional study, a total of 394 participants from 14 different countries were surveyed via an online REDCap form. Results: In this study, it was highlighted that despite adequate knowledge, the overall compliance to COVID-19 related preventive measures remains poor, the lowest being in the senior age group (≥ 65 years), and the highest being in adults aged between 25-64 years (p=0.003). Population from the developing countries were more compliant to all preventative measures against COVID-19 spread, except for handwashing, where the difference between the two populations remained insignificant (p=0.038, p<0.001, p=0.016) Socioeconomic status, prior history of COVID-19 infection or presence of comorbidities did not significantly affect compliance rates, however, participants with no prior history of this infection were found to be more compliant to donning a mask in public as compared to those with a positive history (p=0.044). Conclusions: Since compliance remains subpar in both the developing and the developed countries, mass campaigns about COVID-19 related preventive measures remain essential in controlling the disease spread. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to compare demographic profile in Tuberculosis and Non- Tuberculosis individuals. We also aimed to compare divalent metal ions in tuberculosis and Non-Tuberculosis Individuals Methods: This case control study was carried out on 345 subjects. Sample size was calculated through open EPI. Patients were grouped into two categories i.e., Pulmonary Tuberculosis (cases group) with 115 patients and without Pulmonary Tuberculosis (control group) with 230 subjects. Demographic Profile was recorded through already designed proforma. 5 ml sterile gel tube was used to collect blood samples. The samples, which were then centrifuged, and the serum were examined to check the levels of iron and copper. Data was evaluated using SPSS version 25.00. Results: Male patients in productive age groups are more likely to have TB in comparison of female patient. In comparison of patient with normal serum copper, patient with serum copper below normal are less likely for TB and patient with serum copper above normal are more likely to develop TB. Patient with serum iron below normal are also more likely to develop TB in comparison of patients with normal serum iron. Conclusion: Male patients in productive age groups were commonly affected with tuberculosis. In tuberculosis patients, a low serum iron concentrations along with significantly high concentration of serum of copper were found. Subsequently, it may increase the human susceptibility to the infection of mycobacterium tuberculosis. [ABSTRACT FROM AUTHOR]

Background and Objectives: The Covid-19 pandemic has caused large-scale disruption in almost all educational programs across the world. Planning and rapid implementation of assessment through an online format presents the next set of novel challenges that must be addressed by academic administrations across the globe. Methods: This cross-sectional study was conducted between March to August 2020 at the Aga Khan University Medical College. Two hundred medical students of year 1 and 2 participated in the study. We describe the planning, processes, and outcomes of online assessments using video communication platforms conducted at a private university in Pakistan. Standardized protocols were written and piloted, extensive training of student, proctors and staff for preparation and conduct of online assessments were developed. Feedback was recorded after each session and suggestions were incorporated in subsequent high-stakes assessments. Results: A total of three pilot assessments were conducted to identify issues and process refinement. Commercially available lockdown browser and ZOOM were used in the first pilot; 80% of the class was unable to launch lockdown browser and laptops required repeated reload/reboot. For the second pilot assessment, University's VLE page & MS Teams was trailed. Issues with internet connectivity, VLE page slowdown, and suboptimal recording feature in MS Teams were identified. For the final pilot assessment, phased launching of VLE page with single test item per page was implemented with success. The students reported that attempting the online exam on VLE with ZOOM support was user friendly. Ninety percent of the class was supportive of the continuing with the online assessments. Conclusion: In order to device an effective protocol for e-assessments conducting multiple trial runs, and incorporating feedback from all stakeholders is a necessity. [ABSTRACT FROM AUTHOR]

Aim& Objective: Silent information regulator 1 (SIRT1) gene stimulates the expression of antioxidants and repairs damaged cells. It affects the mitochondrial activity within the oocytes to overcome the oxidant stress. We aimed to assess an association of SIRT1 polymorphism (Tag SNPs rs10509291 and rs12778366) with fertility, and assess serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), oestradiol, progesterone, manganese superoxide (MnSOD) and SIRT1.Material and Methods: In this cross-sectional study, 207 fertile and 135 infertile subjects between the ages of 18-45 years were recruited. Polymerase chain reaction (PCR) was performed; products were electrophoresed in a 2% agarose gel. Descriptive analysis of continuous variables was expressed as mean ± standard deviation. Mann-Whitney test was performed for comparison of groups, P value <.001 was considered significant. Single Nucleotide Polymorphism (SNP) data were analysed by applying chi-squared statistics.Results: All subjects were age matched (P = .896). SIRT1 levels were significantly lower in infertile females when compared with fertile subjects (P < .001). AA (rs10509291) and CC (rs12778366) variant frequency was higher in the infertile than fertile subjects (P < .01). Similarly, the frequency of A allele (rs10509291) and C allele (rs12778366) was higher in infertile subjects (P < .001). Infertile females (29%) showed existence of SNP rs10509291 while 49% demonstrated genetic variation of rs12778366. MnSOD and SIRT1 levels were found to be lower in these subjects.Conclusion: The presence of SIRT1 genetic variants (rs10509291 and rs12778366) apparently disturbs the expression of SIRT1 deteriorating mitochondrial antioxidant function within the oocytes, instigating oxidative stress within. Their probable effect on modulating oocyte maturation may be the cause of infertility in females. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of the current study was to compare the serum Apelin level in patients with and without polycystic ovarian syndrome to assess this as a diagnostic marker for PCOS. In a case-control study 60 polycystic ovarian syndrome patients diagnosed according to Rotterdam criteria and 20 healthy controls of reproductive age group were recruited. Study Design: Case Control study. Setting: Jinnah Postgraduate Medical Center in Collaboration with Aga Khan University, Karachi. Period: August 2017 and February 2019. Material & Methods: Blood samples were collected after 12 hours fasting and was used to test serum Apelin, insulin, cortisol and fasting blood glucose levels. Results: Seventy percent PCO subjects had irregular menstrual cycle and 68% suffered from hirsutism; while all PCO subjects had more than 10 antral follicle seen on ultrasound in either one or both ovaries in comparison of 15% controls (p<0.05). Higher Apelin and Testosterone levels in PCO group was reported when compared with controls (p<0.05) across all BMI categories. Apelin showed a positive correlation with number of ovarian cysts (r=0.429; p=0.000); irregular menstrual cyle (r=0.276;p=0.13); blood glucose level (r=0.270; p=0.015) and BMI (r=0.229; p=0.14). Apelin remained independently associated with the risk of PCOS (p=0.020) and elevated testosterone levels (p=0.030). Conclusion: Serum Apelin showed a strong association with irregular menstruation, hirsutism, ovarian cysts, testosterone and deranged blood glucose levels. Therefore, Apelin appears as a potential source for several risk factor in PCOS women of all BMI types. [ABSTRACT FROM AUTHOR]

Objective: To conduct an on line Flipped Class Room (FCR) to facilitate synchronous (in class activity) and asynchronous learning [Virtual Learning Environment (VLE)] and acquire feedback of the learning experience from medical students at Aga Khan University. Methods: This interventional study was conducted with year II students undergoing Endocrine Reproduction Module at the Aga Khan University during April 13 to May 22, 2020. Pre reading material and pretest was shared with the students via Virtual Learning Environment (VLE) one week before the class. Microsoft Teams was used to conduct online session by two facilitators, where student discussion on case studies was encouraged. A WhatsApp group was created with the facilitators to respond to any student queries. The session was recorded and later uploaded on VLE. Posttest and a student satisfaction survey was conducted at the end of the session. Results: The average score for the pretest and posttest was 19.67 ± 1.37 and 24.60 ± 1.34 respectively (p value <0.05). The learner curve showed an increase in the knowledge learned by 4.93 points (p value <0.05). Fifty-five percent students felt that placement of session was appropriate and were satisfied with the instructions and expected outcomes, received constructive feedback for improvement and generated positive attitude towards learning. Conclusions: The innovative model of FCR through facilitation of synchronous and asynchronous learning empowered student's engagement and interactive learning. Students perceived this as a great learning experience which they enjoyed with positive reinforcement from feedback given by the facilitators. They suggested continuation of this model for further learning sessions in other modules of undergraduate medical education at Aga Khan University. [ABSTRACT FROM AUTHOR]

Objectives: To measure Vitamin D levels in diabetic patients with and without kidney disease. Study Design: Prospective Case Control Study. Setting: Diabetic Clinic Ward 6, Nephrology Unit Ward 22 JPMC. Period: 2 year Jan 2016 to Dec 2017. Material & Methods: 102 subjects were enrolled for the study in which their anthropometry was recorded and blood samples were collected for hemoglobin A1C, fasting blood glucose, vitamin D levels, and blood Urea Nitrogen. Results: It is identified from the experiments that vitamin D deficiency links with a prior and an additional hostile inception of diabetes. In this research the levels of Vitamin D was measured in diabetic patients with and without kidney disease and then were correlated with disease severity. Conclusion: It is concluded that vitamin D deficiency in pa tients with CKD is not accepted so far. Whereas Patients with CKD might be connected with better existence rates, when matched to patients who did not consume vitamin D. [ABSTRACT FROM AUTHOR]

Irisin is known as a miracle myo-adipokine that is secreted by skeletal muscle and fat tissue that increases insulin sensitivity. Current literature supports its role as a pathogenic agent in development of gestational diabetes; however, others have reported little or no difference between the two groups. Therefore, this meta-analysis aims to compare Irisin levels in gestational diabetes mellitus (GDM) pregnancies and non-GDM control pregnancies. A detailed literature search was carried via electronic databases, such as Medline, PubMed, and EMBase, for current related papers dating from January 1, 2017 over the last ten years. Only papers published in English were selected. Meta-analysis was preformed according to the Meta-analysis of Observational Studies in Epidemiology guidelines. Effect size and relative weights for each study were estimated and results of individual and combined effect size were plotted in the forest plots. p values <0.05 were regarded to be significant. In most studies, irisin levels in GDM were significantly lower, as compared to the control group. This level favored development of GDM in these subjects. This was confirmed by the forest plot report and contour-enhanced funnel plot of trials compared the GDM and Control group for effect estimates and standard error [I-V pooled SMD -0.482 (95%CI -0.610 to -0.353); Heterogeneity Chi² = 54.53 (d.f. = 7) p = 0.000; I² (variation in SMD attributable to heterogeneity) = 87.2%; Test of SMD = 0: z =7.32 p =0.000]. Lower circulating Irisin can contribute to hyperglycemic disorders such as GDM, through a collective loss of its normal anti-diabetic mechanisms. This revelation paves the way for research into the use of recombinant Irisin as treatment or prevention of GDM, so that the prevalence of GDM and its maternal and fetal consequences may be reduced. [ABSTRACT FROM AUTHOR]

The aim of this case–control study was to assess TIMP2 level in subjects with or without metabolic syndrome (MetS) and to associate levels with non-alcoholic fatty liver changes (NAFLD). Thirty-three MetS subjects and 55 controls were recruited. Anthropometric data, lipid and glucose profile, TIMP2 and liver ultrasound was performed. High TIMP2 was seen in MetS group (145.28 ± 23.11 pg/ml) versus controls (19.06 ± 1.19 pg/ml; p <.001). Serum cholesterol, triglyceride, LDL-c and glucose levels were significantly higher in MetS subjects (p <.05). MetS individuals (72.72%) showed positive fatty liver changes versus 14.5% controls. Elevated TIMP2 positively correlated with waist circumference, body fat, blood glucose and NAFLD. Furthermore, every unit rise in waist circumference and TIMP2 and a unit decrease in HDL were associated with higher odds of developing NAFLD (p <.05). There may be concurrent relationship between TIMP2 and NAFLD in MetS that requires further evaluation to improve risk assessment and early diagnosis of MetS. [ABSTRACT FROM AUTHOR]

Background: We aimed to evaluate irisin and SREBP-1c levels in serum, colostrum and mature breast milk in women with and without gestational diabetes (GDM); and to relate them with maternal glucose, lipid profile and weight status of babies. Methods: GDM positive women (n = 33) and normal glucose tolerant women (NGT) (n = 33) were recruited. Maternal blood samples were collected at 28th week of gestation and later at 6-week post-partum while breast milk samples of the lactating mothers were collected within 72 hours of birth (colostrum) and at 6 weeks post-partum (mature milk). Irisin and SREBP-1c levels were analyzed by commercially available ELISA kits for all maternal samples. Results: Lower levels of irisin were seen in serum, colostrum and mature breast milk of GDM females (p < .01). SREBP-1c profile showed a similar trend of low serum levels in GDM, however, they were undetectable in colostrum and mature breast milk. Weak to moderate correlations of serum irisin with BMI (r = 0.439; p < .001), GTT 0 hours (r = 0.403; p = .01), HbA1c (r = -0.312; p = .011), Fasting blood glucose (r = 0.992; p = .008), and baby weight at birth (r = 0.486; p < .001). Colostrum and mature breast milk irisin showed positive associations with baby weight at 6 weeks (r = 0.325; p = .017; r = 0.296; p = .022, respectively). Serum SREBP-1c at 6 weeks correlated with random blood glucose (r = 0.318; p = .009), and HbA1c (r= -0.292; p = .011). All correlations were lost once we adjusted for maternal BMI. Conclusions: Low irisin and SREBP1-c levels may favor development of GDM in pregnant subjects. Further, low mature breast milk levels may act as a continued stressor from fetal to infant life as long as breast-feeding is continued. Further studies are required to identify the mechanistic relationship between these biomarkers and GDM. [ABSTRACT FROM AUTHOR]

The article provides information on a study which explored Pecha Kucha as an educational modality to rejuvenate learning by promoting understanding of complex concepts in simpler terms, working as a team and managing time effectively. Topics discussed include an overview of Pecha Kucha, the use of Wheel of names to promote an unbiased approach to select presentation groups, and lessons learned from the activity.

Background: Despite the recommendations for postpartum blood glucose monitoring post gestational diabetes mellitus (GDM); scientific evidence reveals that these recommendations may not be fully complied to. This study aimed to follow-up women up to 2 years post-delivery with pregnancies complicated by GDM and healthy controls to assess this fact.Methods: Women with GDM (n = 78) and normal glucose tolerant (n = 89) delivered in 2014 were followed up for 2 years. They were informed and enquired via telephone about their blood glucose screening, physical activity, postpartum complications, and current weight status of mother and baby.Results: Women with previous GDM were older and reported higher body weight 2 years post-delivery. At the 2 year follow-up, n = 11 (14.1%) participants had developed diabetes, all with previous GDM. Both weight at birth (3.8 ± 0.5 kg) and at 2-year (10.7 ± 2.3 kg) for the babies born to GDM mothers was significantly higher than the NGT group babies (2.6 ± 0.63 and 7.1 ± 1.4 kg; p < .05). Only 27 women regularly opted for T2DM screening via monitoring blood glucose or HbA1c levels postpartum. The top reason for failed screening included: believing that GDM would disappear after delivery, and being occupied with the baby.Conclusions: The high incidence of T2DM in women with previous GDM is an alarming finding. Given this trend, systematic follow-up programs are needed to reduce obesity and diabetes risk. [ABSTRACT FROM AUTHOR]

Chronic kidney disease (CKD) patients are at an increased risk of cardiovascular complications and plasma leptin level is elevated in cardio renal syndrome. We wanted to explore leptin levels in patients with different stages of CKD and find its association with risk of cardiovascular disease. This cross-sectional study was conducted in Nephrology Department of Jinnah Post Graduate Medical Centre (JPMC) from January 2014 to September 2014. Group I comprised of controls (GFR=116±8.3, n = 44) acquired from general population, CKD patients were grouped as II, III and IV respectively with GFR; 85.77±9.9 (n = 42), 53.84±9.9 (n=42) and 20.22±8.4 (n = 42).CKD patients with any inflammatory disease, Diabetes Mellitus and on steroid therapy were excluded. Serum leptin, lipid profile and C reactive proteins (CRP) were measured. Leptin and CRP levels increased significantly with progression of CKD. High density lipoproteins (HDL) to low density lipoproteins (LDL) ratio was significantly high in control as compared to CKD groups (p<0.001). A positive correlation of leptin was observed with CRP and HDL/LDL ratio (r= 0.994,p<0.001 and r=-0.403 p<0.001) respectively. Hyperleptinemia observed with progression of CKD contributed to pathogenesis of cardiovascular disease by decreasing HDL/LDL ratio. [ABSTRACT FROM AUTHOR]