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Anticoagulants are the first-line treatment option for patients with Budd-Chiari syndrome (BCS); however, intervention is required when this fails. Although, the ultimate treatment is liver transplant, other radiological procedures are for the management of the disease and bridge to definitive therapy. TIPS (trans jugular intrahepatic portosystemic shunt) is a method used by interventional radiologists to create a shunt between portal vein and hepatic vein. At times it is technically not possible, in such cases, direct intrahepatic portosystemic shunt (DIPS) is performed. This patient underwent a successful DIPS procedure for BCS along with balloon dilatation (venoplasty) for inferior vena cava (IVC) stenosis. Keywords: Budd-Chiari syndrome (BCS), Trans jugular intrahepatic portosystemic shunt (TIPS), direct intrahepatic portosystemic shunt (DIPS), inferior vena cava (IVC).

Background. Diabetic kidney disease (DKD), one of the complications of diabetes in patients, leads to progressive loss of kidney function. Timely intervention is known to improve outcomes. Therefore, screening patients to identify high-risk populations is important. Machine learning classification techniques can be applied to patient datasets to identify high-risk patients by building a predictive model. Objective. This study aims to identify a suitable classification technique for predicting DKD by applying different classification techniques to a DKD dataset and comparing their performance using WEKA machine learning software. Methods. The performance of nine different classification techniques was analyzed on a DKD dataset with 410 instances and 18 attributes. Data preprocessing was carried out using the PartitionMembershipFilter. A 10-fold cross validation was performed on the dataset. The performance was assessed on the basis of the execution time, accuracy, correctly and incorrectly classified instances, kappa statistics (K), mean absolute error, root mean squared error, and true values of the confusion matrix. Results. With an accuracy of 93.6585% and a higher K value (0.8731), IBK and random tree classification techniques were found to be the best performing techniques. Moreover, they also exhibited the lowest root mean squared error rate (0.2496). There were 15 false-positive instances and 11 false-negative instances with these prediction models. Conclusions. This study identified IBK and random tree classification techniques as the best performing classifiers and accurate prediction methods for DKD.

Background: Hyperglycemic condition and compromised immune system may contribute to the progression of COVID-19 infection and increase the disease severity, relatively requiring a longer recovery period among diabetic patients. Objective: A systematic review was conducted to examine cytokine levels, the prevalence of risk factors, and other comorbidities in COVID-19 patients with and without diabetes mellitus during the early COVID-19 outbreak. Methods: A systematic literature search was conducted in PubMed central, PMC Europe databases, and Web of Science, evaluating the articles published between Dec 1st, 2019, and June 15th, 2020. This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: The systematic search generated 14,960 articles and ended up with 9 articles, of which 8 articles involved data on the comparison of cytokines in diabetic and non-diabetic subjects with COVID-19, while 4 of them involved data on cytokines in the diabetes patients compared either by the severity of diseases or the rate of survival. Among the studied cytokines, interleukin-6, interleukin- 8, and tumor necrosis factor-α may cause the worst prognosis or fatality among diabetic patients. Increased cytokine levels indicate higher mortality and are linked to risk factors and comorbidities, such as hypertension and cardiovascular disease. Management of diabetes by insulin treatment may reduce the rate of mortality among diabetic patients but may be contraindicated in diabetic patients with COVID-19 who had at least one previous comorbidity, especially hypertension and CVD. Conclusion: The pathophysiological mechanisms linked to cytokine storm in diabetic patients may lead to the design of treatment strategies in the future, thus improving early diagnosis of the disease and mitigating cytokine storm-associated morbidity and mortality.

The current study was conducted for the examination of the effect of the teachers’ behavior on students’ academic achievement while opting for the Positivist paradigm. It was quantitative research. A total of 600 students(50 percent including males and females) were selected using Cluster sampling out of 1200 students. “Teachers’ Behavior Assessment Scale” adopted from (Hadie,Hassan, Bahri, And Yusoff, 2018) has been used for the measurement of teachers’ behavior. It comprised of the five-point Likert’s rating scale which ranges from “Almost Never” to “Almost Always” comprising 60 items. These 60 items have been categorized under eight categories/ indicators. On the other hand,the students’ GPA has been taken and used for measuring their academic achievement. The data underwent the Mean, SD, Pearson’s r and Linear regression outcome which showed that the students’ achievement has been positively and moderate affected by the teachers’ achievement.

Purpose: Every person in this world has the right to be educated and by every person means every single person, yes, the persons of special needs as well. About 15 percent of the world’s population has suffered various forms of disabilities such as visual and hearing impairment, physically handicapped, or mental retardation. The 1st purpose of this research was to find out the problems that a teacher faced while teaching a special learner at a higher education level. 2nd to find out the student’s perspective of studying in an inclusive setting at the university level. Design/Methodology/Approach: A phenomenological design was used and both teachers and their students took interviews. Qualitative theme analysis method was used in this study to analyze the teachers and students’ perceptions. Findings: The study’s findings provide an understanding of the experiences of teachers as well as perspectives regarding disabilities of learners in the regular classroom. They both recognized four zones that obstruct their capability to efficiently teach in a mixed ability classroom and the regular classroom. (a) Insufficient knowledge of teachers and lack of awareness about inclusion in the classroom. (b) Lack of training employed in inclusive or regular classrooms with differently-abled students; (c) Lack of examination to choose the most suitable aids which helpful for the teaching in the inclusive regular classroom. (d). Learning difficulty and psychological issues in the classroom. Implications/Originality/Value: From This research everyone will be benefited: students, as per their learning will be improved by it; educators as it will improve their teaching and efficiency in the classroom and parents, as their children will more likely to have a positive environment in the university. It will provide them an opportunity to learn from each other at the university level.

This study was conducted while using the Quasi-Experimental design to examine the effect of Cooperative learning on prospective teachers' Meta cognitive skills. The sample for this study included two sections/ groups, each comprising 40 students (40 males 40 females=80) enrolled in the fifth Semester of the B.Ed Honors program in a public university. One of the sections was declared as the Experimental, whereas the other as the Controlled group. The understudy sections were pre-tested, and then the experimental group was exposed to the intervention (cooperative learning strategy), which lasted for one Semester. Both sections were post-tested after the completion of the intervention. Meta cognitive Skills Assessment Tool (MSAT) was used for pre and post-test. Based on the results, it is concluded that Cooperative Learning helps develop Meta cognitive skills in prospective teachers. Therefore, it is recommended that the teachers should teach while using the Cooperative learning approach.

With the onset of the novel coronavirus disease pandemic (COVID-19) that emerged from Wuhan in China, the need of the hour can be summarized into two groups. The first one is a potent vaccine as a prophylactic measure to prevent the virus from infecting people, and the second is a rapid diagnosis of the disease to help healthcare professionals and government authorities to plan and control the spread and provide effective care and treatment. This review delves into the latter, describing the COVID-19 and its treatment, including the race for an effective vaccine, and highlighting the role of serological testing in managing the pandemic since a well-designed study to understand mechanisms and serological correlations of protective immunity is crucial for rational clinical and public health policies. In conclusion, swift vaccination and response tactics, such as social distancing, hand hygiene, wearing of masks, and, if required, lockdown practices continue to be important in managing the pandemic while carefully monitoring any possible outbreak due to the variants.

This study investigates the influence of spent coffee (SC), and potassium hydroxide (KOH) modified spent coffee (ACT-SC) as fillers on the mechanical and thermal properties of epoxidized natural rubber (ENR) biocomposites. The results show the tensile strength, 100% modulus, elongation at break of the ACT-SC rubber biocomposites were enhanced, which was further confirmed by changes in the diffraction pattern for filler filled composite. The SEM micrograph indicates the biocomposite was substantially more homogenous with modified spent coffee. However, FTIR analysis revealed no significant differences between the modified and unmodified samples. In addition, the thermal analysis results show the thermal stability of ENR-ACT-SC is higher than that of ENR-SC but lower than that of ENR.

Metabolomics is rapidly evolving omics technology in personalized medicine, it offers a new avenue for identification of multiple novel metabolic mediators of impaired glucose tolerance and dysglycemia. Liquid chromatography–mass spectrometry, gas chromatography–mass spectrometry and nuclear magnetic resonance spectroscopy are most commonly used analytical methods in the field of metabolomics. Recent evidences showed that metabolomic profiles are link to the incidence of diabetes. In this review, an overview of metabolomics studies in diabetes revealed several diabetes-associated metabolites including 1,5-anhydroglycitol, branch chain amino acids, glucose, α-hydroxybutyric acid, 3-hydroundecanoyl-carnitine and phosphatidylcholine that could be potential biomarkers associated with diabetes. These identified metabolites can be used to develop personalized prognostics and diagnostic, and help in diabetes management.

Khalid Siddiqui,1 Shaik Sarfaraz Nawaz,1 Assim A Alfadda,1– 3 Muhammad Mujammami1,2,4 1Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 2Department of Medicine, College of Medicine, and King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia; 3Obesity Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 4University Diabetes Center, King Saud University Medical City, King Saud University, Riyadh, Saudi ArabiaCorrespondence: Khalid Siddiqui, Strategic Center for Diabetes Research, College of Medicine, King Saud University, P.O. Box 245, Riyadh, 11411, Saudi Arabia, Tel +966 114724179 Ext.3106, Fax +966 114725682, Email ksiddiqui@ksu.edu.saBackground: Diabetic Nephropathy (DN) is one of the most typical causes of end-stage renal disease and thyroid hormone exerts effects on the kidney. There are few reports on the role of thyroid hormone in the progression of DN. We aimed to assess the relationship between thyroid hormone and DN.Methods: In this cross-sectional study, 400 patients with type 2 diabetes (T2D) (aged between 35 and 70 years) were divided into two groups T2D control and DN group according to albumin creatinine ratio (ACR). Clinical biochemistry parameters were measured using the Rx Daytona chemistry analyzer and thyroid hormone levels (TT4, TT3, TSH, FT4, and FT3) using the Evidence Biochip analyzer. To assess the relationship between thyroid hormone and DN, multiple logistic regression models were developed.Results: Serum FT4 and FT3 levels were significantly lower in DN compared to T2D controls (p< 0.05). Thyroid hormone levels tend to decrease with the progression of DN. In unadjusted and adjusted logistic regression models, FT3 levels were negatively associated with odds of having DN (OR=0.28, CI=0.128– 0.616, p=0.002).Conclusion: The free triiodothyronine level was negatively associated with the progression of DN. Further longitudinal studies are required to assess the cause of thyroid hormone differences.Keywords: diabetic nephropathy, type 2 diabetes, thyroid hormone

Purpose: The disparity between students' perceptions and expectations is measured in this study to determine the perceived service quality (SQ) of sample university’s academic library units. Design/Methodology/Approach: Under the typology of quantitative approach survey method was used. The SERVQUAL instrument consisting of 22 items was adopted for assessing student's expectations and perceptions. The students enrolled in regular programmes of the academic year 2013-2014 were taken as population. Using stratified random sampling through proportional allocation, a sample of 372 respondents was designed. Data were analyzed quantitatively using descriptive statistics and qualitatively using NVIVO software for content of open-ended questions. Findings: The results revealed that student's expectations were higher than their perception. Implications/Originality/Value: Based on the findings, it was concluded that the concerned authorities may take initiatives to improve the library services provided by the library staff. In this way the students’ expectations can be met.

Summary: The authors present a low-cost simulation technique to discuss the airway management, the surgical technique, the problems to be faced by the anesthesia and the operating teams, and how to proceed with the operative surgery to separate the conjoined twins. Key words: Conjoined twins; Simulation Citation: Shamim F, Syed R, Siddiqui K, Khan FA. Low-cost simulation technique in planning and preparing perioperative team for conjoined twins separation surgery. Anaesth. pain intensive care 2022;26(2):833−834. DOI: 10.35975/apic.v26i6.2059

Teaching beliefs are the essence of teacher’s academic activity. They contain a set of assumptions or suggestions about the teaching profession, teachers, students, and more the process of teaching and learning. They influence their planning, decision making, work ethic, student relationships, evaluation method, material and material selection and among other things, classroom practices. This investigation is aimed to analyze pedagogical beliefs and its relationship to actual classroom practices of teachers at college level. As this study also reveals the differences among pedagogical beliefs and classroom practices based on teachers’ gender and most importantly explores relationship among them at college level. The investigator adopted quantitative approach and conducted a survey study. Participants were randomly selected teachers and students from government degree colleges of Lahore who provided their responses about pedagogical beliefs and classroom practices through self-developed questionnaires. The outcomes shown that educators’ pedagogical beliefs as well as classroom acts at college level are not significantly correlated to each other.

The teachers are trained with the aim to provide the necessary knowledge and skills that could help them in dealing with difficulties that they face during teaching, from the planning of a lesson to its implementation. All those skills could be developed among prospective teachers during the phase of their learning. The current study was supposeded to assess the implementation of such skills in classrooms and then measure its effect on the students’ performance. For this purpose, a quasi-experiment was carried out. Consequently, two intact groups enrolled in the third semester of B.Ed. honors at a public university were considered as a sample of the study. Metacognitive Awareness Inventory (MAI) by Schraw and Dennison (1994) was adapted to test Metacognition. Parallel to this, the researcher developed rubrics and observation sheets to assess students’ performance of tasks. Results of the current research reflected that metacognition development has a significant effect on the task performance of students who received the intervention. In light of these results, it is suggested that teacher training institutes should consider the development of Metacognition among their students. Teachers should incorporate different techniques that help them in inculcate metacognition development among their students.

Perspicuous organization and persuasion are required in academic writing for creating unity, making claims, sequencing, and eloquence. Hedging is a distinctive aspect of academic writing. Hedging can be employed as a communicative strategy to decrease or enhance the strength of claims (Hyland, 1998). This research study explores the frequencies and grammatical categories of hedges in the research dissertations written by Pakistani authors. The corpus of the study contains 150 research dissertations of sciences and social sciences. The frequencies and forms of hedges are examined by utilizing Varttala’s (1999) classification of Hedges. Lists of hedges have been developed to identify the different categories of hedges. Instances of hedges have been extracted from the corpora with the help of AntConc 3.5.8 (2019) software. The results reveal that the authors from the field of social sciences are more careful and cautious in making their claims as compared to the sciences.

Metacognitive awareness is awareness about perception which further involves declaration, procedure as well as condition aspects, whereas, procrastination involves the action of delaying or postponing something. Both metacognition and procrastination are interrelated and can affect academic performance. Academic performance is an indicator of students' learning at any educational level but several factors can have an impact on it. This investigation was mainly conducted to determine the impact of metacognitive awareness and procrastination on the academic performance of learners in universities. The nature of this study was quantitative and a survey approach was adopted for this study. The sample of the study was comprised of twelve hundred graduates and postgraduates from universities by utilizing cluster sampled methods. To find the awareness of students’ metacognition the MAI (Schraw & Denison, 1994) was applied because of its appropriateness as well as for finding the procrastination behavior of students the Aitken Procrastination Inventory (Aitken, 1982) was applied in this investigation. Academic performance was determined through students’ previous GPA (grade point average). The findings of this investigation revealed that metacognition and procrastination significantly affect the academic performance of university students.

Nawaf A Alshammari,1,2,&ast; Abdulaziz A Alodhayani,3,&ast; Salini S Joy,4 Arthur Isnani,5 Muhammad Mujammami,1,4,6 Assim A Alfadda,4– 6 Khalid Siddiqui4 1University Diabetes Center, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia; 2King Salman Specialist Hospital, Diabetes and Endocrine Center, Hail Health Cluster, Hail, Hail Region, Saudi Arabia; 3Department of Family and Community Medicine College of Medicine, King Saud University, Riyadh, Saudi Arabia; 4Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 5Obesity Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 6Department of Medicine, College of Medicine, and King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia&ast;These authors contributed equally to this workCorrespondence: Khalid Siddiqui, Strategic Center for Diabetes Research, College of Medicine, King Saud University, P.O. Box 245, Riyadh, 11411, Saudi Arabia, Email ksiddiqui@ksu.edu.saBackground: Neuropathy is the most common microvascular complications among diabetic patients. Diabetic peripheral neuropathy (DPN) is the predominant variety which may associate with increased in mortality and morbidity among type 2 diabetes mellitus (T2DM).Objective: To assess the prevalence of diabetic peripheral neuropathy and its correlation with risk factors among T2DM.Methods: This was a cross-sectional retrospective study, data was collected from a previous cohort study conducted at the University Diabetes Center, King Saud University Medical City (KSUMC), King Saud University, Riyadh, Saudi Arabia. The data of T2DM patients were collected from case report form, included demographic data, history of chronic diabetes neuropathy, and laboratory reports. Statistical analysis includes Student`s t test, chi square test, and Pearson correlation and logistic regression were performed.Results: A total of 430 patients with T2DM data was collected and analyzed, and of them 54% were females, with the mean age of 55.88 years. The prevalence of diabetic neuropathy among study participants were 40.2%, and 73.3% of them having the subtype polyneuropathy. The mean BMI; p = 0.006, FBS; p < 0.001, HbA1c; p < 0.001, cholesterol p = 0.001, LDL; p < 0.001, and triglyceride; p < 0.001 levels were a significantly higher among participants with diabetic neuropathy than without neuropathy. The male gender (Risk Ratio: 1.294, 95% CI:1.090, 1.536) p = 0.003, fasting blood glucose (Risk Ratio: 1.157, 95% CI:1.051, 1.273) p = 0.003 Cholesterol (Risk Ratio: 1.588, 95% CI:1.174, 2.147) p = 0.003, triglyceride (Risk Ratio: 1.290, 95% CI:1.086, 1.538), p = 0.004, and LDL (Risk Ratio: 1.299, 95% CI:1.073, 1.574), p = 0.007) were found to be significant risk factors for DPN.Conclusion: DPN is highly prevalent among T2DM patients in Saudi Arabia. Poor glycemic control and hyperlipidemia were associated with significantly higher risk for DPN patients among T2DM.Keywords: diabetic peripheral neuropathy, hyperlipidemia, glycemic control, type 2 diabetes

Highlights • Both Adiponectin and PAI-1 levels are associated with the Metabolic abnormalities. • This study demonstrates that subjects with MetS have low adiponectin and higher PAI-1 levels compare to non-MetS. • Higher PAI-1 levels are associated with higher odds of risk and prevalence of MetS. • Pharmacological targeting of PAI-1 is necessary for MetS management., Introduction Metabolic syndrome (MetS) is a multifactorial disease characterized by metabolic abnormalities. Plasminogen activator inhibitor-1(PAI-1) is a key factor of the fibrinolysis its expression is elevated in insulin resistance, obesity, and MetS. In addition, an adiponectin produced by adipocytes is also key factor in MetS. This study aimed to investigate the relationship between PAI-1, adiponectin levels in MetS. Patients and Methods A total of 379 subjects were analyse in this cross-sectional study. MetS was defined by NCEP ATP-III criteria. Anthropometric, fasting blood glucose, HbA1c, total cholesterol, high-density lipoprotein, low-density lipoprotein, triglycerides, PAI-1, and adiponectin were measured. Results PAI-1 levels were higher in MetS compared with non-MetS. In addition, adiponectin levels were significantly lower in MetS compared to non-MetS. Furthermore, increased level of PAI-1 corresponds with increase in prevalence of MetS. PAI-1 levels were significantly associated with MetS (OR = 2.51, CI = 1.23 – 5.14; p = 0.039). Conclusion PAI-1 increases the risk of MetS. PAI-1 and adiponectin regulation is useful in assesing the presence and severity of MetS. Further pharmacological targeting of PAI-1 studies are necessary for MetS management.

BACKGROUND: To evaluate tunnel dialysis catheter (TDC) patency and its outcome among patients receiving TDC in a tertiary care hospital.METHODS: Retrospectively patients’ records were reviewed who underwent TDC placement during February 2016 to November 2020 at Department of Interventional Radiology, Liaquat National Hospital, Karachi, Pakistan. Patients’ age, gender, residence, comorbidity, catheter placement site, use of antibiotics before catheter insertion, reasons for catheter removal and total catheter days were retrieved from patients’ medical record file.RESULTS: 130 patients received TDC with a median follow-up of 148 (inter-quartile range: 60.8 – 274.3) days. 94(72.3%) catheters were electively removed whereas 18(13.8%), 16(12.3%) and 2(1.5%) catheters were removed due to infections, blockage and physical damage respectively. None of the mortality was observed due to catheter related complication. The incidence of overall infection, bacteremia and other infections during one year was 7.3, 5.01 and 3.19 per 10,000 patient-days respectively. Infection free survival rate was 68% with mean time to infection was 676.63 (95% CI: 593.87 – 759.39) days. During the study, total catheter patency was 53.2%. None of the patients’ characteristics was associated with catheter related infections and catheter patency.CONCLUSION: TDCs are the best available alternative for short to intermediate term use for hemodialysis when all preventive measures are taken to avoid catheter related complications either infectious or non-infectious until permanent dialysis access is achieved or renal transplant is done. It may also serve as long term hemodialysis mode in patients in whom permanent access or transplant is not preferred.

During the current pandemic Covid-19, the universities had to start their online classes instead of traditional on-campus classes. The students are a pivotal point as well as a significant stakeholder of education, so they must be given the opportunity for expressing their perspectives in this regard. So, this study aimed to investigate university students' perceptions regarding online and on-campus classes. The students’ perspectives were further compared regarding the abovementioned to get insight into what they prefer to be taught with. The survey was conducted for this study. The sample consisted of 440 university students enrolled in the BS Program at three public whereas three private universities at Lahore. The sample includes students of both genders (male=221, female=219). The instrument for data collection was developed by the researcher which was consisted of five point Likert’s rating scale with 40 items. Based on findings, it is concluded that overall university students prefer to learn through on-campus classes as compared to online classes. Moreover, males students are more inclined towards learning through online classes, whereas female students were in favor of on-campus classes.

The thesis work has been the integral part of the MPhil in Education program. However, it has been observed that students are in a great fix regarding the completion of their thesis work. So, the purpose was to investigate the difficulties encountered by the students during research at MPhil level. Their experiences were further examined on the basis of their gender and university type. The data was collected by the survey. The conveniently selected sample consisted of 300 MPhil students including male and female, studying in public as well as in private universities. The data was collected through a questionnaire which was a 4-point Rating Scale comprising 25 items. It has 3 factors: i) supervisor’ selection, ii) supervisors’ support, iii) institutional support. The descriptive statistics for calculating the percentage of students’ perspectives as well as Inferential Statistics (Mann-Whitney U tests) was used to find out the difference on the basis of students’ gender and university type. The results revealed that majority of students selected their supervisors themselves willingly, but few of them forced to select their supervisor on their teachers’ referrals, research topics were allotted to students by supervisors themselves. Their supervisors were not easily approachable as they were unable to give students the due time because of their academic and administrative burdensome responsibilities, even neither the concerned HOD/ director is available at ease for students nor they are provided the access to paid e-libraries. By keeping in mind, the importance of thesis in accomplishment of degrees of MPhil students, there is need to conduct further studies to explore supervisors’ point of view as some of the problems are concerned with the supervisors’ support too, that will help to minimize the students’ problems.

Background: Cervical cancer affects women in the time that they are critical to economic and social stability. Objective: The aim of this narrative review to assess the socio-economic consequences of cervical cancer. Methods: In this review, Pubmed, Scopus, ISI web of science, Conferences databases and Iranian databases were searched. In order to search related articles, researchers used the following terms: “Uterine cervical neoplasms” OR ‘cervical cancer”; Costs and cost analysis; costs of illness, burden, socioeconomic. After the primary search, some records were obtained from 1960 to 2018. After studying titles, abstracts, and in some cases the full texts, 48 relevant articles were included in this research. Results: Hospitalization costs were the highest direct costs. However, total social costs are higher than health and medical costs. There is a dramatic increase in direct costs with the increase in age and stage of the disease. The costs are less for people aged 75 and up and for stage 4 because of less invasive treatment received by older women and the limited choice of treatment in advanced stages. The costs for persons who were screened 6 months to 5 years before diagnosis were lower. Conclusion: The burden of the disease is high. Early detection of cancer can save lives and reduce health care costs. Studies evaluating the costs associated with cervical cancer as well as virusrelated diseases in developing countries, calculating indirect costs and the impact of the disease on family members, relatives, and especially the spouse of the affected women are recommended.

Background: A possible relationship between thyroid hormones and glucose metabolism in diabetes has already been established. Objectives: We aimed to evaluate the thyroid function markers and their relationship with inflammation, which is considered as a pathogenic condition of diabetes. Methods: This cross-sectional study included 276 patients with type 2 diabetes. Serum levels of thyroid (TSH, FT4, and FT3) and inflammatory markers (CRP, IL-6, and TNF-α) were measured. Results: The mean age of the subjects was 55.2 years and mean diabetes duration of 16.8 years. The inflammatory markers showed significant differences with the tertiles of TSH and thyroid hormones. TSH was significantly correlated with inflammatory markers, IL-6 (r = 0.13, P = 0.020) and TNF-α (r = 0.17, P = 0.003), while FT4 had a correlation only with TNF-α (r = 0.25, P = Conclusion: Abnormalities in the thyroid hormone metabolism are related to the increased inflammatory activity as well as insulin resistance, and are associated with the disorders of glucose metabolism.

Background/aim In recent years, the diagnostic utility of urinary protein levels has been demonstrated for the early detection and progression of kidney disease. This study aimed to evaluate the associations of the non-albumin protein (NAP) with different urinary marker for tubular and glomerular damage in patients with type 2 diabetes (T2D). Methods In this observational cross-sectional study, 424 patients with T2D duration > 10 years were classified into two groups according to estimated glomerular filtration rate (eGFR). The ratios of different urinary markers (albumin, NAP, total protein, transferrin, retinol-binding protein (RBP), and neutrophil gelatinase-associated lipocalin (NGAL) to creatinine were analyzed. Results The levels of urinary biomarkers increased significantly with decrease in eGFR levels. In the group with moderately decreased eGFR, the albumin to-creatinine ratio (ACR), non-albumin protein-to-creatinine ratio (NAPCR), and total protein-to-creatinine ratio (PCR) were independently associated with all urinary markers after being adjusted for risk factors. The area under the receiver operating characteristics (ROC) curve for ACR and PCR had a better diagnostic value than other urinary biomarkers. Comparing ROC curve of NAPCR with other urinary biomarkers, it was significantly better than NGAL/Cr (p = 0.033). Conclusions The findings of the present study confirm that ACR and PCR are diagnostic biomarkers in T2D patients with decreased eGFR. NAPCR in these patients diagnostically only outperformed NGAL/Cr.

Metacognition and reflective teaching are concepts that complement each other if we refer to a reflective teacher. This study investigates whether metacognitive awareness of prospective teachers can be improved through reflective journals. In present study reflective journals are comprised of practice sheets through which the prospective teachers can practice their metacognitive thoughts consciously. The methodology followed is experimental research by using qusai-experimental design into two phases. Both, control and experimental groups were taught through a combination of teaching strategies that we normally use in our classes such as lecture, discussion, or through inquiry, etc., in phase 1. In phase 2, reflective journals, along with other strategies that were used in the 1st phase, were introduced. The results of data analysis revealed a significant enhancement of prospective teachers metacognitive awareness and its constituent factors e.g., metacognitive knowledge and metacognitive regulation.

The present study aimed to develop and validate an instrument by employing quantitative measures for the assessment of prospective teachers professional Dispositions of Instructional Planning and Strategies (DIPS) in line with National Professional Standard for Teachers in Pakistan (NPST) developed by Ministry of Education (MoE) as policy guideline in the context of Pakistan. The instrument was employed to 424 prospective teachers in the Institute of Education and Research University of Punjab using stratified sampling with the representation of prospective teachers form all programs, semesters, and gender. Five dimensions of DIPS Scale namely, Critical Thinking and Multiple-ways of Problem Solving, Team Work and Cooperative Learning, Collaboration and Cooperation, Enabling Students for Independent Learning, Attainment of Curriculum Goals were identified. The Cronbach Alpha reliability of the instrument was found 0.8. The finding provides preliminary evidence of a valid and reliable tool for the pre-service teachers in Pakistan.

The increasing number of female adult learners required a need for a deeper and more additional background related consideration on the effects contributing toward educational achievement for the learners who return to study. The aim of this study is to define the role of Transformative Interventions in developing Conducive Learning Environment for female adult learners in higher education with the consideration on hindrances faced, as they re-engage and continuing their post-compulsory educational passage. Qualitative approach with explanatory case study design has been employed to conduct this study. Semi-structured open-ended interviews conducted for 16 purposefully selected female participants. Two private and two public universities were selected from which adult working students and experienced of having transformative learning interventions during their course. Moreover, the experiences and responses highlighted the needs, hindrances and expectations of the adult students in higher education. They identified reflective activities including article review and reflective writing, faculty support, seminars, educational conferences, presentations, projects on real life issues, discussion and introducing demanding courses are the important transformative learning interventions for developing Conducive environment for adults. The major factor responsible for developing Conducive environment was experiences and exposure by the adult learner and providing opportunities through the Andragogy and expertise. Notes on interviews and reflection journals were utilized to triangulate data to support these methods. Data analysis and results of the study indicated that participants experienced transformative learning interventions through both educational and non-educational related activities held in university by Higher Education.

We are presenting a unique case, based on peri-operative management of a patient who was brought to the operating room for video-assisted thoracoscopy (VATS) for lung abscess decortication end up with right upper lobe of lung resection via thoracotomy in an emergency.

Zobeida Eljaaly,1,2,&ast; Muhammad Mujammami,1– 3,&ast; Shaik Sarfaraz Nawaz,3 Mohamed Rafiullah,3 Khalid Siddiqui3 1University Diabetes Center, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia; 2Division of Endocrinology, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 3Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia&ast;These authors contributed equally to this workCorrespondence: Khalid SiddiquiStrategic Center for Diabetes Research, College of Medicine, King Saud University, P.O. Box 245, Riyadh, 11411, Saudi ArabiaEmail ksiddiqui@ksu.edu.saObjective: Patients with diabetes are at higher risk of the negative consequences of hyperuricemia. The objective of this study was to investigate gender and age-specific differences in the uric acid levels and to evaluate the associated risk factors among patients with diabetes.Methods: A retrospective cross-sectional study was conducted at Strategic Center for Diabetes Research from September 2019 to January 2020, among adult type-2 diabetic patients. Serum uric acid (SUA) and several other metabolic and clinical parameters were examined. Multiple regression analysis was done to identify risk factors independently associated with hyperuricemia.Results: A total of 433 patients were included in the analysis. SUA level was higher in males than females (5.82± 1.65 mg/dL versus 5.29± 1.54 mg/dL, p < 0.001). The prevalence of hyperuricemia was higher in females than males (28.8% versus 20.5%, p = 0.049). There was no significant difference in uric acid levels or the prevalence of hyperuricemia by age groups in the total sample or gender-stratified samples. In multivariate analysis, hyperuricemia was associated with bigger hip circumference (odds ratios [OR] were 1.03, 95% CI = 1.01– 1.05), higher triglycerides (OR = 1.005, 95% CI = 1.002– 1.008), and higher serum creatinine (OR = 1.34, 95% CI = 1.21– 1.49). Hip circumference, total cholesterol, high-density lipoprotein, and serum creatinine were independent risk factors in males, while triglycerides and higher serum creatinine were independent risk factors among females.Conclusion: The present study demonstrates gender-specific differences in the uric acid levels and hyperuricemia prevalence. In males and females, hyperuricemia was associated with hip circumference, total cholesterol, high-density lipoprotein, triglycerides, and serum creatinine. Future large studies are needed to confirm our findings, especially in elderly females.Keywords: uric acid, hyperuricemia, gender, diabetes, risk factors, Saudi Arabia

Shaik Sarfaraz Nawaz,1,&ast; Khalid Siddiqui,1,&ast; Muhammad Mujammami,1– 3 Obeed Alotaibi,2 Saud Sulaiman Alanazi,1 Mohamed Rafiullah1 1Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 2University Diabetes Center, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia; 3Division of Endocrinology, Department of Medicine, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia&ast;These authors contributed equally to this workCorrespondence: Khalid Siddiqui, Strategic Center for Diabetes Research, College of Medicine, King Saud University, P.o Box: 245, Riyadh, 11411, Saudi Arabia, Tel +966 114724179 Ext.3106, Fax +966 114725682, Email ksiddiqui@ksu.edu.saBackground: Osteopontin (OPN) is a 44-kDa multifunctional protein and has a diverse role in biomineralization, tissue remodeling, and chronic inflammation. However, its role in type 2 diabetes (T2D) patients with microvascular complications is not clear. Therefore, the present study aimed to investigate the role of OPN in T2D patients with microvascular complications.Methods: A total of 324 type 2 diabetes patients in the age group of 38– 66 years were included in this study; 249 T2D patients were diagnosed with microvascular complications. OPN was measured using an enzyme-linked immunosorbent assay kit. Clinical data, such as age, gender, diabetes duration, systolic blood pressure, diastolic blood pressure, were measured. Correlation between OPN levels with different clinical parameters was evaluated.Results: In patients with microvascular complications, OPN levels were significantly higher than those without microvascular complications (p < 0.05). Moreover, OPN levels were positively associated with systolic blood pressure (SBP), C-reactive protein, and albumin creatinine ratio (ACR). Multiple linear regression analysis showed that OPN levels were independently associated with C-reactive protein (p < 0.045).Conclusion: The findings in the present study showed that OPN level was more positively associated with C-reactive protein than that with glucose metabolism in patients with microvascular complications. Thus, OPN might serve as a marker in predicting vascular disease.Keywords: osteopontin, diabetes, microvascular complication, inflammation, C-reactive protein

Background COVID-19 is diagnosed using RT-PCR assays of samples from nasal and oropharyngeal swabs. People with negative RT-PCR often presented with clinical manifestations of COVID-19. The data on such patients are lacking. The present study aims to characterize the patients who were suspected COVID-19 cases and tested negative in RT-PCR compared to patients who had been tested RT-PCR positive. Methods This is a retrospective, observational study of adult suspected and confirmed patients of COVID-19 admitted to King Saud University Medical City, Riyadh, Saudi Arabia, from 1st March 2020 until 30th November 2020. Laboratory confirmation is done through nasal/pharyngeal swab specimens, tested positive in RT-PCR assay. Patients with initial negative RT-PCR test results were assessed again within 48−72 h to avoid false-negative results. Patient data were extracted from the electronic medical files of each included patient using a predesigned case report form. Results The study included 488 (80.93%) patients with RT-PCR swab results positive, and 115 (19.07%) patients who were negative. Respiratory rate and diastolic blood pressure were higher among the swab-positive cases. More number of swab-negative patients had comorbidities such as coronary heart disease, chronic kidney disease, and carcinoma. Fever, cough, and shortness of breath were reported higher among the swab-positive cases. ALT and AST, and LDH levels were found higher among RT-PCR-positive patients. Serum creatinine, blood urea nitrogen and troponin were more elevated in RT-PCR-negative patients. Antibiotics, anticoagulants, and corticosteroids were used more by swab-positive patients. Significantly higher number of RT-PCR-positive patients required proning, high-flow nasal cannula, non-invasive mechanical ventilation, and invasive mechanical ventilation. Acute cardiac ischemia and death were found to be similar among the patients. However, deaths occurred significantly earlier among the swab-positive cases when compared to the swab-negative group. Conclusion Distinctive symptoms and markers of COVID-19 are more frequent among patients who had RT-PCR-positive results.

Hyperglycemic condition and compromised immune system may thrive Coronavirus disease-2019 (COVID-19) infection and increase disease severity, requiring a relatively longer recovery period among diabetic patients.A systematic review was conducted to look into cytokine levels, prevalence of risk factors, and other comorbidities in COVID-19 patients with and without diabetes mellitus during the early COVID-19 outbreak.A systematic literature search was conducted in PubMed central, PMC Europe databases, and Web of Science including the articles published between 1 Dec 2019 and 15 June 2020. This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).The systematic search generated 14,960 articles and ended up with 9 articles, of which 8 articles had data on the comparison of cytokines in diabetic and non-diabetic subjects with COVID-19, 4 of them had data on cytokines compared in the diabetes patients only either by the severity of diseases or on the rate of survival. Among studied cytokines, interleukin-6, interleukin-8, and tumor necrosis factor-α may cause the worst prognosis or fatality among diabetic patients. Increased cytokine indicates higher mortality and links with risk factors and comorbidities such as hypertension and cardiovascular disease. Management of diabetes by insulin treatment may reduce the rate of mortality among diabetic patients but may be contraindicated in diabetic patients with COVID-19 who had at least one previous comorbidity, especially hypertension and CVD.The pathophysiological mechanisms linked to cytokine storms in diabetic patients may lead to design the treatment strategies in the future to improve early diagnosis or therapeutic strategies and mitigate cytokine storm-associated morbidity and mortality.