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Background: Infertility, which affects 8%–12% of couples worldwide and 21.9% of couples in Pakistan in particular, is a major reproductive health issue. In vitro fertilization (IVF) has emerged as a prevalent therapeutic intervention. Recent studies have identified insulin-like growth factor-I (IGF-I) as a promising biomarker for assessing embryo viability and predicting implantation outcomes in IVF procedures. Objective: To evaluate the relationship between IGF-I levels and IVF outcomes in women with primary and secondary infertility. Materials and methods: This prospective cohort study included 133 infertile women (99 with primary infertility and 34 with secondary infertility) aged 20-45 years. IGF-I levels were measured using an ELISA kit. Participants were grouped based on infertility type and cause of infertility. Statistical analyses included the Mann-Whitney U test, Pearson chi-square test, Kruskal-Wallis test, and Pearson correlation coefficient. Results: Women with secondary infertility had significantly higher IGF-I levels compared to those with primary infertility (279.40±85.89 ng/ml vs. 239.11±74.55 ng/ml, p=0.02). Male factors were the predominant cause of infertility in both groups. Patients with male-factor infertility had the highest IGF-I levels (267.1±77.6 ng/ml). Significant positive correlations were found between IGF-I levels and the number of oocytes fertilized (r=0.398, p

Abstract Objective The objective of the study was to explore the extent to which faculty members in undergraduate medical education apply cognitive psychology principles in their teaching practices, and to evaluate the perceived effectiveness of these principles in enhancing student learning. Methods This mixed method study was conducted on faculty members of public and private sector universities. Focused group discussions were conducted, and the responses of the participants were measured on a 5-point- Likert Scale. The instrument was tested for validity and reliability by measuring Cronbach’s alpha and performing exploratory factor analysis. Mann–Whitney U test was applied on the attributes scores to compare 13 attributes by institutions, designations and domains. Results One theme, 7 sub-themes and 19 categories were identified from the focused group discussion. as Kaiser- Meyer-Olkin index was 0.88 and Bartlett’s test of sphericity was significant. Reliability was established at 0.95. The faculty self-perceived practicing psychology principles mostly scored in the middle level, where they think they apply less strategies. While highly significant results were noted for using Meyer’s multimedia principles. Conclusion Faculty members followed the principles of cognitive psychology to some extent. However, they all felt that using these principles can transform the teaching and learning of medical education.

Abstract Background Mentorship training programs demand a paradigm shift from theory-driven to hands-on practical approach with prioritization of preparation of mentors and mentees for their roles through self-awareness and targeted professional development planning. There is a lack of evidence generated from the health professions education institutions of global south regarding effectiveness of workshops in fostering mentorship culture. Methods This mixed method study with convergent parallel design was conducted through a collaborative mentoring workshop; “Faculty Mentoring-Building stronger by digging deeper” by Aga khan University Medical College, Karachi and University of Lahore, Punjab, Pakistan. Objective of the research was to emphasize the importance of faculty mentoring program, roles and responsibilities of mentors and mentees and perception of the participants regarding the associated role of institutions. It aimed to educate faculty members to develop personal development plans for becoming effective mentors and mentees. The demographic data was collected before the workshop, during the workshop data was collected from SWOT analysis, followed by goal settings and the action plans made by participants at the end. Post workshop online feedback was acquired by a questionnaire to comprehend participants’ educational attainment. Association between quantitative findings was done through ANOVA, while the qualitative data was subjected to thematic analysis. Results Total of 37 faculty members participated in the hands-on workshop. All faculty equally perceived the workshop as satisfactory and reported that hands-on practice led to positive experience of setting clear goals and action plans in developing oneself both as mentor and mentee. Themes identified were; Faculty Mentorship Program, Personal development Plan of Mentors and Mentees and Building Positive Mentor-Mentee Relationships. Voluntary structured program, choice of more than one faculty mentor and portfolio development based on personal SWOT was recommended by participants for the success of formal mentoring programs. Conclusion Medical Faculty of Pakistani Universities at all career levels is interested in development of formal mentoring programs in their universities. Formal training for the same is also recommended by the participants. Institutions should cultivate a culture of mentorship that supports the professional growth and success of academics for cultivating the minds that are in turn shaping our future generations.

Objectives: This study aims to evaluate the factors influencing the success of Intrauterine insemination (IUI) in infertile patients due to male causes in Brunei Darussalam. Methodology: Pre-diagnosed male infertility patients of all ages were included in this retrospective cohort analysis from the “Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital's” Brunei Darussalam between January 2015 and December 2020. South Asian criteria were used for BMI categorization. Statistical evaluation of the data was conducted utilizing R-studio. Results: Out of 240 research participants, 92.1% were Malay. IUI resulted as a successful pregnancy for 18 males (7.5%), while 222 subjects (92.5%) had unsuccessful conception. The semen parameters were correlated with age and BMI. Although the difference was statistically insignificant, the male subjects with successful outcomes after IUI were young, BMI was less, and the semen quality variables were better than the male subjects who had unsuccessful outcomes. Conclusion: The male study subjects with the outcome of successful IUI resulting in pregnancy were younger, and had lower BMI and better semen parameters than the group in which IUI failed to result in pregnancy.

Background: Oxidative stress, an imbalance of pro-oxidants and antioxidants, is reported to be associated with female infertility. This study was aimed to compare cortisol (oxidative stress marker) and vitamin E (antioxidant) levels in the fertile and infertile female population of Karachi, Pakistan. Materials and Methods: A total of 88 females, recruited from Australian Concept Infertility Medical Centre, were divided equally into infertile cases and fertile controls. Serum cortisol and vitamin E (VE) levels were measured using commercially available enzyme-linked immunosorbent assay (ELISA) kits. Statistical comparison was done by Chi-square and Mann-Whitney U-test. Correlation between two continuous variables was determined by Spearman’s Correlation. The P value < 0.05 was considered significant in all cases. Results: The median age for the fertile group was 31.0 (IQR= 27.0-37.0) and for the infertile group, 32.0 (IQR= 28.0-38.0). Of the infertile females, 70.5% (n= 31) had primary infertility while 29.5% (n= 13) had secondary infertility. A significant difference in the cortisol levels was seen between the fertile and the infertile groups. (p value= 0.001). VE levels were significantly decreased in the infertile females (p value= 0.026). The levels of cortisol and VE were found to be in a weak negative correlation in the infertile women (-0.163). Conclusion: A balance between oxidants and antioxidants is required to maintain the reproductive potential in females. Decrease in the antioxidant vitamin E, and an increase in pro-oxidant cortisol, may be associated with a risk of infertility in females.

ABSTRACT Background: Problem based learning (PBL) introduced by Howard Barrows at McMaster University in 1969 is generaliy regarded as an effective learning strategy with an active process of personal cognitive construction. Many medical colleges have adapted this methodology as partial or complete part of their curriculum. This strategy not only caters to the knowledge domain but also polishes attitude and soft skills in an individual. Objectives: To evaluate efficacy of PBL development program carried out at Bahria IJniversity Medical & Dental College (BUMDC) Methods: It was a cross sectional study conducted after completion of PBL development program at BUMDC from November 2008 till Dec 2011. Perception of faculty members about the program was acquired by purposeful sampling technique through a self reported questionnaire. All faculty members involved in PBL program were included. Their response was assessed on a 5-point Likert scale with a score of I—strongly disagree (SDA), 2-disagree (DA), 3=neutral (N), 4= agree (A), 5=strongly agree (SA).The data was analyzed by SPSS version 15 Results: Faculty was exposed to 5 training workshops after which a total of 12, 27, 29 and 28 PBLs in 2008, 2009, 201 0 and 2011 respectively were prepared and presented in structured meetings. The participants who responded (96%) were 34 lecturers, 10 Assistant Professors, 2 Associate Professors and 3 Professors. It was found that 37% of respondents who did not have prior experience of constructing PBL learnt to apply this learning strategy. They also became aware of its existence, importance, significance, relevance and corrected their deficiencies (73%). Conclusion: The PBL development program organized through workshops helped faculty members at BIJMDC to accept this teaching strategy with it true philosophy, involvement and professional commitment. KEY WORDS: Problem Based Learning, Facilitator's Perceptions, Structured Meetings.

Objective: To assess usefulness of student’s seminars in teaching of physiology. Methods: A cross sectional study conducted from January 2010 to December 2011. The students seminars were scheduled once in two months for a duration of 2 hours with at least three presentations. Presentation of 30 minutes carried by a group of four students was, followed by question and answer session. The response of students on usefulness of seminars was acquired through a questionnaire with three components; I) usefulness of seminars in understanding of Physiology acquired on 5 point Likert Scale strongly disagree (0) to strongly agree (5); II) useful for leaning capabilities on three point scale, not at all, to some extent and to a great extent, and III) comprised the free comment section. Frequency of responses was analyzed by SPSS version 11. Results: A total of 13 seminars were conducted by Department of Physiology. Response showed that 62 (71%) and 71(82%) were not able to understand content and difficult concepts of Physiology. Only 2(2%) rated its usefulness to understand pathological aspects, it did not help altogether in theory examination and only 5 (6%) rated its efficacy for practical examination. Working in group enabled them 42(48%) to interact with each other. Seminars helped in self directed learning with development of presentation and communication skills in 21(24%), 28 (32 %) and 32(37%) respectively. The students recommended this to be conducted in small groups. Conclusion: Students were not satisfied with the utility of seminars in teaching of Physiology and improvement in their learning capabilities. Key Words: Seminars, Teaching Methodologies, Learning Capabilities

Background: The presence of around 12 or more follicles in one or both ovaries with diameter ranging from 2-9mm is known as polycystic ovaries (PCO). This condition is associated with hyperandrogenemia and is one of the most common causes of infertility. Due to increase in use of ultrasonography as a diagnostic tool, more cases of PCOs are being timely reported. This has also lead to diagnosis of PCO in younger age group. Objective: To measure the effect of age on ovarian and uterine morphology in infertile women with polycystic ovaries (PCO). Methods: The cross sectional study was conducted in Karsaz Hospital, Karachi from January 2010 to March 2011. One hundred infertile women with PCOs were subdivided into age groups (years) 20-30 (group I) and 31- 40 (group II). The ovarian volume (OV), follicles count (FC) and size (FS), uterine area (UA) and endometrial thickness (Endo) were determined by ultrasonography. Unpaired t-test was applied to analyze the result. Results: The ovarian morphology showed a significant decrease in group II; the OV transabdominally was 14.26± 2.42 vs 10.56±1.0 (0.00) and transvaginally 14.93±2.55 vs 11.75±1.06 (0.00). The FC was 14.00±1.60 vs 12.3±0.78 (0.023) and FS was 8.23±8.9vs 3.29±6.9 (0.00). The uterine morphology however showed a significant increase in group II. The UA was 87.79±5.83 vs 118.71±22.83 (0.00) and endo was 0.46±0.10 vs 0.57±0.12 (0.00). Conclusion: Ovarian morphology variables include OV, FC and FS decrease in the older infertile group of women with PCOs but the uterine morphology variables showed an increase in area with thickening of endometrium in the older group. The association of endometrium and PCOs has not been reported in this part of the world and the study is an attempt to fill this gap and prevent misdiagnosis of endometrial cancer. Key Words: Polycystic Ovaries, Infertile, Ovarian Volume, Follicle Count, Follicle Size, Uterine Area, Endometrial Thickness.

Background: Successful ICSI depends on ovarian response to stimulation and maturation of oocytes retrieved. Objective: To identify predictors of number of retrieved oocytes during intra cytoplasmic sperm injection(ICSI). Methods: A cross sectional study carried out at Islamabad Clinic Serving Infertile Couples @ Saudi Pak Tower from January 2011 till December 2012. Female subjects (n= 282) aged 20 -40 years had base line estimation of follicle stimulating hormone, estradiol, antral follicle count and ovarian volume on the second day of cycle. Down regulation of ovaries was followed by controlled ovarian stimulation for 12 ± 2days. On the day of ovulation induction by intramuscular injection of human chorionic gonadotropin, preovulatory follicle count (PFC) was measured by trans vaginal scan and serum estradiol, progesterone and interleukin I-β were estimated. Data was expressed as mean ± standard deviation and median with interquartile range. Correlation coefficient was measured to study degree of association of demographic and clinical factors with NRO. Univariate regression of NRO as dependent variable with predictors was confirmed by multivariate regression. Results: Retrieved oocytes had strongest correlation with PFC (r = 0.98). Multivariable analysis stipulated that in the presence of other variables PFC had similar strongest effect on oocytes. AFC showed significant but negative effect on NRO by multiple regressions. Progesterone, E2, IL-I β, FSH and injections used for stimulation had insignificant effect in the presence of other variables. Conclusion: PFC measured at the time of ovulation induction is strongest predictor of oocytes which are obtained during oocyte pick up procedure of ICSI. Key Words: Intracytoplasmic Sperm Injection, Pre-ovulatory Follicle Count, Ovarian Reserve, Antral Follicle Count, Controlled Ovarian Stimulation.

Structured morning meetings (SMM) were introduced in department of Physiology at Bahria University Medical & Dental College from May 2009. The responses from faculty members who attended the SMM for a period of one year affirmed this to be a healthy activity. It helped 9 (90%) and 7(70%) faculty members in preparation and improvement of multiple choice questions and objective structured practical examination for the examination. The presentation skills of 7(70%) presenters were improved by this exercise. The respondents recommended its continuation in future. Key Words: Structured morning meetings. Medical education, Faculty, Capacity building

Faculty mentoring is relatively new in health sciences literature. Faculty mentors are considered to have multiple roles including being a supervisor, teacher, or a coach. Little or no attention to formal mentoring of faculty allows faculty to seek informal mentoring, creating a risk of unexpected outcome. There is dearth of literature with respect to formal mentoring programs from the subcontinent. Although, informal faculty mentoring has been in place but there is no standard faculty mentorship model to be followed at Aga Khan University Medical College (AKU-MC). An observational study was conducted in September 2021 at AKU MC with convenient sampling to share the perceptions of the AKU-MC faculty mentors in a faculty mentorship workshop so that further advanced level faculty development workshops could be planned in this area. Twenty-two faculty mentors participated to share their perspectives on the responsibilities of faculty mentor, faculty mentee and the institution to see faculty grow and to have a sustainable mentorship programme. Challenges faced by the faculty mentors during the process of mentorship were also discussed. Majority of the participants emphasized on the role of the faculty mentor to be supportive, guiding, reflective and formative (respond to the emotional needs, encourage, effective communication, know own limitations, observe, provide feedback). Faculty mentor role modeling, ability to maintain confidentiality, creating and maintaining mentor-mentee relationship, availability of framework of formal mentoring in an academic institution and opportunities within the academic setting to learn mentorship were the main challenges of being a faculty mentor. The process provided valuable training and education to the faculty for the development and strengthening of formal mentoring program. Faculty recommended that institutions should provide the opportunity for development of junior faculty mentors by organizing capacity building activities.

Silent information Regulators (SIRT1) gene stimulates antioxidants’ expression, repairs cells damaged by oxidative stress (OS), and prevents the cells’ dysfunction. In particular, the role of different Sirtuins, particularly SIRT1 in reproduction, has been widely studied over the past decade. Decreased SIRT 1 causes mitochondrial dysfunction by increasing Reactive Oxygen Species (ROS), lipid peroxidation, and DNA damage in both male and female gametes (Sperms and Oocytes), leading to infertility. In the female reproductive system, SIRT1 regulates proliferation and apoptosis in granulosa cells (GCs), and its down-regulation is associated with a reduced ovarian reserve. SIRT1 also modulates the stress response to OS in GCs by targeting a transcription factor vital for ovarian functions and maintenance.ROS-mediated damage to spermatozoa’s motility and morphology is responsible for 30–80% of men’s infertility cases. High levels of ROS can cause damage to deoxyribo nucleic acid (DNA) in the nucleus and mitochondria, lipid peroxidation, apoptosis, inactivation of enzymes, and oxidation of proteins in spermatozoa. SIRT 1 is a cardioprotective molecule that prevents atherosclerosis by modulating various mechanisms such as endothelial injury due to impaired nitric oxide (NO) production, inflammation, OS, and regulation of autophagy. SIRT 1 is abundantly expressed in tubular cells and podocytes. It is also found to be highly expressed in aquaporin 2 positive cells in the distal nephron suggesting its involvement in sodium and water handling. SIRT1 improves insulin resistance by reducing OS and regulating mitochondrial biogenesis and function. It also decreases adiposity and lipogenesis and increases fatty acid oxidation. So, its involvement in the multiple pathways ensures its unique role in reproductive and metabolic derangement mechanisms.

Objective: To assess the perceptions of postgraduate medical education residents regarding educational environment at a medical institution in Afghanistan. Methods: The descriptive cross-sectional study was conducted from 2017 to 2018 at the French Medical Institute for Mothers and Children, Kabul, Afghanistan, FMIC, and comprised postgraduate medical residents. Dundee Ready Educational Environment Measure was administered to determine the perception of learning environment by the residents’ perceptions related to learning, teachers, academic self-perception, atmosphere and social self-perceptions sub scales. Data was analysed using SPSS 22. Results: Of the 63 subjects, 55(87.30%) were males and 42(66.66%) were married. The overall mean age was 30±4.38 years. There was no significant difference in mean subscales scores and overall scores in relation to participants’ age, gender, type of specialty, province and year of training (p>0.05). There was a significant difference in students’ perception of teachers in relation with the type of specialty (p

Objective: To explore a disparity in anti-oxidants (SIRT1) and pro-oxidants (cortisol) levels as a plausible cause of unexplained infertility in females. Methodology: It was a cross sectional study in which 342 females with unexplained infertility were recruited from ACIMC outpatient clinic: 135 infertile cases and 207 fertile controls. Biochemical estimation of serum cortisol and SIRT1 was performed using Enzyme Linked Immuno Sorbent Assay. Statistical comparisons were performed using Student-t test and Mann-Whitney U test. Associations between circulating hormone levels and infertility were determined using Spearman's rank correlation. Associations were considered significant where value of p was less than 0.05. Results: The stress hormones profile of case and control demonstrated that the antioxidant SIRT1 was significantly lower in infertile females when compared with the fertile (p =

Medical profession deals with human interactions and ability to empathize improves clinical interactions as well as brings out good clinical outcomes. This has led to increasing interest in the importance of Emotional Intelligence (EI) for effective clinical practice. EI integrates the important aspects of interpersonal and intrapersonal relationships to promote self-management skills like adaptability, control of temperaments and tension free states, which have a profound effect on the academic performance of students. There has been substantial evidence proving that being emotionally intelligent can help individuals excel through life transitions starting from school to college, and later into to the working world. There are many studies in the literature that examine the correlation between EI and academic achievement in different education levels which signify importance of EI levels to predict “students who are in need of guided intervention”.

In our society, people’s health behaviors are considered a dilemma that can intensify the probability of developing a disease in the future. This study aimed to investigate the association between health risk behaviors and depression among a sample of university students, Karachi, Pakistan. A self-reported health behavior questionnaire was distributed to 813 consented students. The Center for Epidemiological Studies-Depression (CES-D-10) questionnaire was used, a short, self-report scale that measures the recent level of depressive symptomatology, primarily focusing on depressed mood. Their results were further compared with some important health behaviors and social activities. At the univariate stage, the chi-square test was executed to compare the characteristics of categorical variables with depression status. The effect size was measured in terms of the odds ratio (OR) using logistic regression models. According to the adopted classification of CES-D, one out of eight students were found to be depressed. Among students’, females were found to be 70% more depressed than males (OR: 1.7, 95% CI: 0.9–3.0). Depression was higher among students who were not satisfied with their lives, were socially isolated, had trouble sleeping, little control over things, and the future depends on others. The chances of depression were 90% higher among students who did not share private concerns with others (P = 0.01). Overall, depression prevalence was 12.5%, and it was associated with dissatisfaction with life, social isolation, insomnia, and others. Female students were found to be more depressed compared to males.

OBJECTIVE: To observe the effect of metformin on oxidative stress (OS) levels and SIRT1 expression in primary human granulosa cell cultures from infertile females. METHODS: This cross-sectional study was conducted from August 2017–July 2019 on ten infertile patients after approval from Ethical Review Committee. After written informed consent, follicular fluid of subjects was collected for establishing primary human granulosa cell cultures (HGCs), which were used for testing capacity of metformin to reduce OS in H2O2 induced HGCs. Cultured HGCs were divided into three groups: a) Control=HGCs without any treatment, b) Test-1=HGCs induced with H2O2 (metformin absent), and c) Test-2=HGCs treated with metformin after H2O2 induction. Baseline-OS (control-group) was estimated, it was induced and measured by an increase in optical density (OD) (Test 1&2). Finally, Test-2 was incubated with metformin (1ml of 100mmol/l concentration) and effect of metformin on oxidative stress levels were determined by Mishra oxidative stress assay. Furthermore, effect of metformin to modulate SIRT1 expression in OS-induced cells was analyzed using quantitative-PCR. RESULTS: Mean age and BMI of subjects was 32.04±2.29 years and 27.61±2.15 kg/m2 respectively. Test (OS-induced) samples gave an OD of 0.28 (0.16-0.40) while control HGC samples gave an OD of 0.153 (0.09-0.23). Significant reduction was noted in ODs of metformin treated test cells. Relative expression of SIRT1 in metformin untreated and treated cells was 61.5% and 80%, respectively. CONCLUSION: Metformin was found to suppress oxidative stress in human granulosa cells and increases the expression of SIRT1 in OS induced environment of primary cell cultures.

Objective: To determine perception of medical students about learning from integrated simulated clinical skills sessions in Respiration and Circulation module of Year 1 undergraduate medical curriculum at Aga Khan University. Subjects & Methods: This cross-sectional study was conducted at the Centre for Innovation in Medical Education, Aga Khan University (AKU) from July 2018 to February 2019. Integrated clinical skills session involves use of a combination of live simulated patient and mechanical simulator to teach clinical skills. These sessions were conducted in Respiration and Circulation Module of MBBS Year I curriculum after which quantitative data was collected by a questionnaire that assessed usefulness of integrated clinical skills teaching method and confidence gained by students. The responses acquired were assessed on a Likert scale ranging from 1-5, (strongly agree -strongly disagree). Descriptive analysis was performed. A focused group discussion (FGD) with students and an in-depth interview with a facilitator conducting the clinical skills sessions was arranged. Simple verbatim transcription of FGD recordings and thematic analyses was executed. Results: Quantitative analysis showed that more than 90% of the students believed integrated sessions were effective in acquiring the learning objectives and found them enjoyable and motivating. 80% expressed confidence that they had accomplished learning objectives and felt they have learned practical clinical skills. Qualitative analysis revealed that these sessions enhanced understanding of subject matter and student engagement during sessions. Conclusion: Integrated clinical skills sessions improved student interest, engagement and promoted student confidence. It should be implemented in undergraduate medical teaching curriculum. Continuous...

BACKGROUND & OBJECTIVE: Kisspeptin (KP) and spexin (SPX) are neuropeptides that play a substantial role in metabolism and sexual function. Our objective is to explore the association of spexin and kisspeptin with sperm parameters and lipid profile in the infertile male population. METHODOLOGY: The cross-sectional study was conducted from March 2017 till July 2018 in Aga Khan University Hospital, Karachi, Pakistan, after acquiring ethical approval (4813-BBS-ERC-17). Convenient sampling was applied to recruit 44 normozoospermic subjects as controls and 44 patients with abnormal sperm parameters”. Serum levels of kisspeptin and spexin were measured by enzyme linked immunosorbent assay and Cobas c111 analyzer was used for estimation of high and low density-lipoprotein, triglyceride and serum cholesterol levels. Mann-Whitney U tests and spearman’s rank correlation test were used to analyze quantitative variables, and data was presented by means, standard error (SE) and correlations coefficient, with a statistical significance set at p≤0.05. RESULTS: The mean kisspeptin values of ‘altered sperm parameters’ males 13.23 ± 3.34 were lower than normal sperm parameters 31.89 ± 3.25 (p

Objective: Biliary tract cancers are among the most fatal subtypes of gastrointestinal cancer. The pathogenesis of these tumors involves several molecular alterations in the genes. This review article focuses mainly on the role of K-Ras (a proto-oncogene) and p53 (a tumor-suppressor gene) which are among the most commonly mutated genes, with K-Ras activation being detected in 50% to 75% and P53 inactivation in 30% to 40% of biliary tract carcinomas. Methods: PubMed and Google Scholar were searched using the terms TP53, KRAS, mutation, biliary tract carcinoma, cholangiocarcinoma, murine model. In total, 72 articles were reviewed of which 26 articles from the 21st Century were included in this review. The articles excluded were mere repetitions, duplicates or were irrelevant. No data was retrieved from posters, presentations, cell lines and symposiums. Moreover, experiments involving bile aspirations were not included in this review article. Results: Three studies conducted in China, Japan and Taiwan reported a positive correlation between K-Ras mutation and biliary tract carcinoma. Only one study conducted in China showed the sole correlation between p53 inactivation and biliary tract carcinoma. Among the studies conducted in China, Japan and Europe, only four showed a positive association between both K-Ras mutation and p53 inactivation and biliary tract carcinoma. Conclusion: K-Ras and p53 mutation both contribute to biliary tract carcinoma. K-Ras mutation, however, has a much higher frequency as compared to p53 inactivation in these cancers. Keywords: p53, K-Ras, mutation, biliary tract carcinoma, cholangiocarcinoma, murine models. Continuous..

Background: Outbreak of COVID-19, in many countries, has imposed a lockdown on their residents. The usefulness of extenuative actions is extremely reliant on society's knowledge, attitudes, and practices (KAP) toward pandemic control.Objective: This study aimed to explore the awareness, attitudes, and practices of the general Pakistani population to COVID-19.Methods: From June 13, 2020, until June 30, 2020, a cross-sectional online KAP survey was conducted among the Pakistani public. For data collection, a validated self-administered questionnaire was used. The survey instrument consisted of six demographic characteristics, 14 items on knowledge, four on attitudes, and six items on practices, modified from a previously published questionnaire on COVID-19.Results: The present study included 2,307 participants, 58.3% males and 41.7% of females. The majority (86.7%) sought information from social media (SM) and television, 95% had good practices, 89.9% had positive attitudes, and two-thirds (67.4%) of the respondents had adequate knowledge. The students and people from younger age groups had more positive attitudes compared with others. Highly educated w with other groups (p < 0.001). In logistic regression analysis, the odds ratio indicated that the private job was negatively associated, and high monthly income was positively associated with adequate knowledge (OR = 0.595). Old age was the predictor of negative attitude, and high school degrees and master's degrees were associated with good practice scores.Conclusion: The Pakistani general population has an overall positive attitude and proactive practices against COVID-19, but their knowledge is inadequate. The most important source of information was SM, followed by television. These are playing a crucial role in educating the Pakistani public.

Madam, There is an increased prevalence of infertility in male population. With reference to a variety of mechanisms, oxidative stress (OS) is responsible for alteration in structural and functional integrity of sperm leading to altered sperm parameters, hence leading to infertility (1). Metformin though proved to be a first-line hypoglycemic agent has demonstrated antioxidant properties in numerous tissues. It inhibits the mitochondrial respiratory chain in the liver, which leads to stimulation of AMP-activated protein kinase (AMPK)-dependent as well as AMPK-independent mechanisms (2). Metformin triggers alanine production within the Sertoli cells (SCs,) balances the NADH/NAD+ equilibrium and provides antioxidant environment. This drug is a treatment of choice in treating females with Polycystic Ovaries (PCOS) on the basis of its capability to reduce insulin sensitivity as well as angiogenesis through the nuclear factor ?B (NF-?B) pathway which renders it to reduce oxidant species, thus improving the reproductive environment (3). Continuous....

Dear Madam, Infertility is a known source of distress among couples worldwide. This agony significantly stems from the concern of not having an identifiable cause leading to infertility. With male factors accounting for 20-30% of the total causes of infertility (1), a thorough evaluation of both the partners is done. Upon evaluation, Vitamin D deficiency was noticed significantly in males coming to infertility centres. However, its functions and how it impacted reproduction was not known until the research led to the discovery of Vitamin D Receptor (VDR) in many organs of the male reproductive tract. It is now known that vitamin D deficiency decreases male fertility by contributing to oxidative stress and gonadal insufficiency, disrupting spermatogenesis, affecting sperm morphology and normal calcium haemostasis. (2) Oxidative stress, caused by an imbalance between oxidative and antioxidative mechanisms, is believed to be a well-known mechanism underlying idiopathic male infertility. Reproductive health professionals and researchers fittingly started searching for antioxidants to combat this imbalance. A study concluded that adding vitamin D to a cryopreserved semen sample reduced oxidative stress and resulted in better fertility outcomes (3). Animal trials have shown that Vitamin D supplementation reduced oxidative stress and improved semen DNA integrity (4). As Vitamin D exerts its effects by binding to Vitamin D receptors, it was noted that vitamin D receptor null mutant mice had a significant reduction in successful reproductive outcomes due to gonadal insufficiencies. Reduced levels of oestrogen and testosterone were seen along with low sperm count, reduced motility, abnormal spermatogenesis and histological abnormalities in testes of mutant mice. These insufficiencies were attributed to a decreased CYP2R1, CYP27B1 and CYP24A1 expression, lower aromatase activity, secondary to suppression of CYP19 gene and calcium supplementation improved fertility in such cases. (5) There is limited human data available on how Vitamin D deficiency causes gonadal insufficiency, which is important to maintain normal reproductive physiology. More studied are needed to clarify the role of vitamin D in gonadal physiology. Considering the importance of Vitamin D on reproductive functions, its role in causing Oxidative stress and gonadal dysfunction, we suggest randomized control trials in pre-pubertal phase. Continuous....

Abstract Objective: To evaluate the relationship of body mass index of healthy teenafers with junk food, sleep pattern, exam performance and awareness about its ill effects. Methods: The cross-sectional study was conducted from March to June 2017 at University Medical and Dental College, University of Faisalabad, Faisalabad, Pakistan, and comprised subjects aged 13-19. Data was collected using face-to-face interviews, getting the examnation results from respective educational insititutions and calculating the body mass index, Data was abalysed using SPSS 22. Results: Of the 226 subjects, 96(42.5%) were boys with a mean age of 15.68 ± 1.83 years, and 130(57.5%) were girls with a mean age of 17.00±1.74 years. Based on body mass index, 35(15.5%) subjects were underweight, 88(39%) were normal, 28(12.4%) overweight, 56(24.7%) pre-obese and 19(8.4%) were obese. The independent predictors of body mass index were higher consumption of soft drinks in males and higher consumption of soft drinks and salt in females (p

Abstract Objective: To compare the impact of trait emotional intelligence between students of different faculties and associated factors. Methods: the cross-sectional analytical study was conducted from August 2016 to March 2017 at the University of Faisalabad, Faisalabad, Pakistan, and comprised trait undergraduate students, both boarders and day scholars, from seven different faculties. Data was collected using the trait emotional intelligence questionnaire–short form. Student’s yearly test scores were obtained as a measure of academic achievement. Data was analysed using SPSS 20. Results: Of the 498 students, 109(21.9%) were studying medicine, 56(11.2%) dental sciences, 76(15.2%) optometry, 83(16.6%) nutrition and dietetics, 109(21.9%) physiotherapy, 35(7%) pharmacy, and 30(6%) social sciences. The overall mean age was 19.84±1.30 years. There were 210(42.2%) boarders compared to 288(57.8%) day scholars. There was significant difference in emotional intelligence based on student’s faculty (p

Objective: To assess the role of Insulin growth factor-I (IGF-I) in females selected for assisted reproductive technique (ART). Methods: In this cross-sectional study 133 infertile females were recruited for Intracytoplasmic sperm injection (ICSI). The antral follicle count (AFC), pre-ovulatory follicle count (PFC), total doses of follicle stimulating hormone (FSH) were estimated. IGF was measured. Successful pregnancy conception after ICSI was confirmed by an intrauterine gestational sac with cardiac activity after embryo transfer. Receiver Operating Curve (ROC) analysis was also done to find out the area under the curve for clinically pregnant samples using IGF-I. Binary logistic regression analysis was done to estimate the odds ratio with 95% confidence interval for clinical pregnancy using IGF-I; all p-values less than 0.05 were considered significant. Results: Study results revealed that IGF-I gave positive association with clinical pregnancy outcome, and is a more reliable predictor of clinical pregnancy. IGF-I gives 39.8% positive correlation with number of oocytes fertilized. These correlations were statistically significant with p-values less than 0.05. Area under the curve for clinical pregnancy using IGF-I, was 72.4% which reveals the importance of IGF-1 in predicting the outcome of ART. Conclusion: Based on the results of the present study we came to the conclusion that IGF-I is a better and cheaper option and an important tool in the field of infertility.

Flipped classroom (FCR) is an active learning pedagogical method in which the students prepare prior to class using different modalities, for example, reading materials and videos, and afterward spend the time in class discussing the content and reinforcing the concepts. We chose to replace one problem-based case on “Shock” with flipped-style teaching in the respiration circulation module of a private medical university. Our objective was to use the clinical presentation of “Shock” to open a window to interrelate basic science concepts of cardiovascular physiology and pathology. It aimed to merge the case-based discussion with small-group discussions in the form of FCR activity. The qualitative study gives an overview of comments of facilitators, observers, and leadership of the Department and University obtained during focus group discussions and in-depth interviews. Thematic analysis of responses emphasized the importance of FCR as an effective teaching learning modality, which can be made more effective by careful selection of topic and provision of facilities to support technology-enhanced learning. The discussions with facilitators, observers, and leadership revealed its usefulness through student’s engagement and increased participation to build learning of the key concepts. Student satisfaction in these activities can be enhanced by construction of knowledge acquired in non–face-to-face component with substantial pre-reading materials, videos, peer discussions, quizzes, and prompt feedback.

Background: Gestational diabetes mellitus (GDM), one of the most common metabolic disorders of pregnancy, is estimated to raise 16-27% worldwide every 10 years. Researchers, using Homeostasis model assessment test (HOMA IR), a tool for assessing insulin resistance, have found a number of causes. This study was designed to investigate the correlation between insulin resistance and GDM in the second trimester. Methods: This study recruited 84 pregnant women (24 to 28 weeks of gestation) from OPD of Gynaecology/Obstetrics and Family Medicine Department, Dr. Ziauddin Hospital Karachi Pakistan from May 2018 to January 2019. A thorough anthropometric measurements and antenatal history was recorded through structured questionnaire after informed consent. After 10 hours fast, venous blood (5ml) was drawn for fasting blood glucose (FBS), insulin levels and Glucose challenge test (GCT) for screening gestational diabetes. Results: Out of 84 subjects, 37 had higher GCT values while 47 had normal level. FBS was found significantly associated (p < 0.05). With GCT among GDM subjects 16(19%) had normal Body Mass Index (BMI) and 18(21.4%) had normal body fat percentage however, 2(2.4%) had high insulin levels and 13(15.5%) high FBS levels. The value HOMA IR, ≤1.29 was found in 38(45.2) healthy mothers and 25(29.8) GDM. Patients’ GCT had positive association with parity, FBS, insulin, HOMA IR and BMI. Conclusion: Linear strong positive correlation was found between insulin resistance and GCT in the second trimester. Patients with significantly higher GCT values and index value of HOMA IR greater than >1.29 are at risk for developing GDM.

ObjectiveTo relate serum and follicular fluid (FF) kisspeptin and estradiol levels in different stages of stimulation during Intracytoplasmic Sperm Injection (ICSI) with oocyte maturity and endometrial thickness among unexplained infertile females.MethodsThis cross-sectional study was carried out at the Australian Concept Infertility Medical Centre from March 2017 till March 2018. Fifty unexplained infertile females, booked for ICSI, were included in the study. Serum kisspeptin and estradiol were estimated by Enzyme-Linked Immunosorbent Assay in all four stages; 1: follicular stimulation, 2: ovulation induction, 3: oocyte pickup, and 4: embryo transfer. FF was aspirated during oocyte retrieval (stage 3) for the analysis of KP and estradiol. Pregnancy outcomes were categorized as non-pregnant, preclinical abortion, and clinical pregnancy.ResultsThe age of the study subjects was 32.04 ± 2.29 (Mean±SD) years, with mean BMI of 28.51 ± 4.15 (Mean±SD) kg/m2. Mean serum kisspeptin and estradiol levels increased in all subjects as the stimulation proceeded stages 1-3; however, the mean dropped after retrieval of the oocytes (stage 4). Out of 27 female subjects who completed the cycle, 17 remained non-pregnant, 4 had preclinical abortion, and 6 acquired clinical pregnancy. The FF kisspeptin concentration was significantly higher than serum concentrations and positively correlated with serum and FF estradiol concentrations. FF-kisspeptin correlated with serum kisspeptin in Stage 3 (r = 0.930, pConclusionIncrease in serum and FF-kisspeptin and estradiol levels from stages 1 to 3, resulted in an optimum endometrial thickness, probability of fertilization of oocytes and chances of clinical pregnancy in Assisted Reproductive Techniques /ICSI cycles of unexplained infertile females.

BackgroundOn account of the COVID-19 pandemic, many changes have been implicated in university medical students. We are cognizant that pandemic can be controlled with dedicated contributions from all involved in the healthcare profession. Therefore, it is important to know the pandemic and application of knowledge by the medical students to formulate a further line of management in Pakistan.ObjectiveWe aimed toinvestigate the knowledge, attitudes, and practices (KAP) regarding COVID-19 and its impact on medical students of Pakistan.MethodsA cross-sectional survey was conducted in June 2020 by a validated self-administered questionnaire. The survey instrument was tailored from a published questionnaire comprised of questions on demographics (6), knowledge (14), attitudes (4), and practices (6).ResultsOf the 1474 medical students in the study, 576(39.1%) were males, and 898(60.1%) were females. Two-thirds of the participants 1057(71.7%) had adequate knowledge, and almost all the students had positive attitudes (1363(92.5%), and good practices 1406(95.4%) to COVID-19. Two-thirds of the medical students 1023(69%) believed that the COVID-19 outbreak had affected their social, mental, and psychological well-being. One-quarter of the medical students 391(26%) become more religious, 597(40%) realized the importance of life, and 1140(77%) became careless because of the pandemic. The female medical students were 2.545 times (p < .001) and 4.414 times (p < .001) more likely to have positive attitudes and good practices toward COVID-19 as compared to males.ConclusionMedical students, especially females and senior year scholars, were well-versed with desired levels of knowledge, attitudes, and preventive measures toward COVID-19. Most of them recognized COVID 19, is shaping their social, mental, and psychological well-being and encroaching on the healthcare system and economy. The information acquired by the KAP study may help to devise effective preventive strategies for future events.

Background: Obesity may establish a crucial barrier for effective fertility treatment in polycystic ovary syndrome (PCOS) females. Objective: To compare results of intra-cytoplasmic sperm injection (ICSI) in females with and without polycystic ovarian syndrome and further appraise the effect of obesity in PCOS females. Materials and Methods: A cross-sectional study from June 2015 to July 2016 included non-PCOS and PCOS (recognized by Rotterdam criteria) females who underwent ICSI. The PCOS were further stratified into non-obese and Obese according to the South Asian criteria for body mass index. Results were categorized on the basis of beta-human chorionic gonadotropin (β-hCG) and transvaginal scan into non-pregnant (β-hCG 25 mIU/ml with no fetal cardiac activity) and clinical pregnancy (β-hCG >25 mIU/ml with fetal cardiac activity on transvaginal scan). In addition, reproductive outcomes; implantation rate, clinical pregnancy rate and miscarriage rate among obese and non-obese PCOS and non-PCOS patients were compared. Results: Our results revealed 38.5% clinical pregnancy rate in non-PCOs females, 23.8% in non-obese PCOS females whereas 26.4% in obese PCOS. Preclinical abortions were found to be highest (31.5%) in non-obese PCOS females and were the lowest (26.2%) in non-PCOS females. In non-PCOS group and non-obese PCOS females 35.4% and 44.6%, respectively, failed to become pregnant. Conclusion: The success after ICSI in terms of number of clinical pregnancies was more in non-PCOS patients as compared to PCOS. Increase in body mass index reflected a negative impact on the reproductive outcome in PCOS patients.

Background Kisspeptin (KP) is a neuropeptide that causes the release of the gonadotropin releasing hormone, which controls hypothalamo pituitary ovarian axis and exerts a number of peripheral effects on reproductive organs. The primary objective of this study was to compare baseline KP levels in females with different types of infertility and identify possible correlations with risk of failure to conceive, preclinical abortion and pregnancy after intracytoplasmic sperm injection (ICSI). Materials and Methods A longitudinal cohort study was carried out from August 2014 until May 2015 by recruiting 124 female patients undergoing ICSI, after obtaining ethical approval from the Australian Concept Infertility Medical Center. Cause of infertility due to male, female and unexplained factors was at a frequency of 32 (24%), 33 (31%) and 59 (45%) among the individuals respectively. KP levels were measured by ELISA assay before the initiation of the ICSI treatment protocol. Outcome of ICSI was categorized into three groups of non-pregnant with beta-human chorionic gonadotropin (β-hCG)25 mIU/ml and no cardiac activity, and clinical pregnancy declared upon confirmation of cardiac activity. Results based on cause of infertility and outcome groups were analyzed by one-way ANOVA. Results Females with unexplained infertility had significantly lower levels of KP when compared with those with male factor infertility (176.69 ± 5.03 vs. 397.6 ± 58.2, P=0.001). Clinical pregnancy was observed in 28 (23%) females of which 17 (71%) had a female cause of infertility. In the non-pregnant group of 66 (53%) females, common cause of infertility was unexplained 56(85%). A weak positive correlation of KP levels with fertilized oocytes and endometrial thickness was observed (P=0.04 and 0.01 respectively). Conclusion Deficiency of KP in females with unexplained infertility was associated with reduced chances of implantation after ICSI.

BackgroundThis study aimed to estimate stress markers, oxidative stress (OS), reproductive hormones and sperm parameters in male smokers and non-smokers and observe the impact of oxidative stress markers and smoking on sperm count, motility and morphology in a selected population of Karachi, Pakistan.MethodsThis cross-sectional study was conducted from July 2017 to July 2018 at Aga Khan University (AKU), in Karachi, Pakistan. The subjects were recruited from the Sindh Institute of Reproductive Medicine (SIRM), Karachi based on defined inclusion criteria. The subjects were categorized into fertile and infertile based on cut off values of sperm parameters as recommended by the WHO i.e., sperm count/ejaculate of 39 × 106/ml, sperm motility 40% and normal morphology 4%. Two hundred eleven fertile and 165 infertile male subjects were included in the study. Serum cortisol, adrenaline, superoxide dismutase (SOD), and glutathione peroxidase (GPX) were analyzed by ELISA kits. Data was analyzed on SPSS-22. A p-value of

Objective: FTY720, an immunomodulator derived from sphingosine-1-phosphate, has recently demonstrated its immunomodulatory, anti-inflammatory, anti-oxidant, anti-apoptotic and anti-inflammatory properties. Furthermore, FTY720 might be a key pharmacological target for preconditioning. In this preclinical model, we have investigated the effects of FTY720 on myocardium during reperfusion in an experimental model of cardioplegic arrest (CPA) and cardiopulmonary bypass.Methods: 30 Sprague–Dawley rats (300–350 g) were randomized into two groups: Group-A, treated with FTY720 1 mg/kg via intravenous cannulation, and Group-B, as control. After 15 min of treatment, rats underwent CPA for 30 min followed by initiation of extracorporeal life support for 2 h. Support weaning was done, and blood and myocardial tissues were collected for analysis. Hemodynamic parameters, inflammatory mediators, nitro-oxidative stress, neutrophil infiltration, immunoblotting analysis, and immunohistochemical staining were analyzed and compared between groups.Results: FTY720 treatment activated the Akt/Erk1/2 signaling pathways, reduced the level of inflammatory mediators, activated antiapoptotic proteins, and inhibited proapoptotic proteins, leading to reduced nitro-oxidative stress and cardiomyocyte apoptosis. Moreover, significant preservation of high-energy phosphates were observed in the FTY720-treated group. This resulted in improved recovery of left ventricular systolic and diastolic functions.Conclusion: The cardioprotective mechanism in CPA is associated with activation of prosurvival cell signaling pathways that prevents myocardial damage. FTY720 preserves high-energy phosphates attenuates myocardial inflammation and oxidative stress, and improves cardiac function.

Background The measurement of follicular output rate (FORT) has been proposed as a good indicator for evaluating follicular response to the exogenous recombinant follicle- stimulating hormone (rFSH). This places FORT as a promising qualitative marker for ovarian function. The objective of the study was to determine FORT as a predictor of oocyte competence, embryo quality and clinical pregnancy after intracytoplasmic sperm injection (ICSI). Materials and Methods This prospective study was carried out on a group of infer- tile females (n=282) at Islamabad Clinic Serving Infertile Couples, Islamabad, Paki- stan, from June 2010 till August 2013. Downregulated females were stimulated in injection gonadotropins and on ovulation induction day, pre-ovulatory follicle count (PFC) was determined using transvaginal ultrasound scan (TVUS), and FORT was determined as a ratio of PFC to antral follicle count (AFC)×100. Group I consisted of females with a negative pregnancy test, while group II had a positive pregnancy test that was confirmed with the appearance of fetal cardiac activity. Linear regression analyses of categorical variables of clinical pregnancy along with other independent variables, including FORT, were performed using SPSS version 15.0. Results Pregnancy occurred in 101/282 women who were tested, recording a clinical pregnancy rate of about 35.8%. FORT values were higher in group II as compared to group I females (P=0.0001). In multiple regression analysis, 97.7, 87.1, 78.2, and 83.4% variations were explained based on the number of retrieved oocytes per patients, number of metaphase II oocytes retrieved, number of fertilized oocytes, and number of cleaved embryos, respectively, indicating FORT as an independent predictor. Conclusion FORT is a predictor of oocyte competence in terms of a number of retrieved, mature and fertilized oocytes. It also gives information about the number of cleaved em- bryos and clinical pregnancy rate.

Background: The prevalence of infertility and vitamin D deficiency is common in Pakistan. Therefore, our study aims were to assess and compare Vitamin D; 25-hydroxyvitamin (25OHD) and reproductive hormone levels in male fertile and infertile subjects with normal and abnormal sperm parameters. Furthermore, the study is aimed to explore the association of 25OHD levels with these sperm parameters in a selected population of Karachi, Pakistan.Methods: The cross-sectional study was carried out from August 2016 till December 2017, 313 study subjects were recruited from an Infertile Clinic from Islamabad, Pakistan, and the general population. First, we took the couples' history of parenting and then carried out a semen analysis and infertile and fertile male subjects were then subgrouped into “normal” and “altered sperm parameter/s.” Forward linear regression was done for selection of 25OHD as a significant predictor of sperm parameters.Results: The median values of the total count, motility, morphology as well as serum 25OHD were significantly higher in the group with “normal” (186) as compared to subjects (127) in “abnormal sperm parameters” group. The 25OHD levels were significantly high in males with “normal sperm parameters”; 80.90 ± 23.33 nmol/L vs. “altered sperm parameter/s,” 64.68 ± 24.21 nmol/L (mean ± SD) with p < 0.001. Serum testosterone level had a significant positive correlation with 25OHD while LH had a significant negative correlation with 25OHD (p < 0.001), and FSH level had a non-significant negative correlation with 25OHD. Results of regression model showed one unit increase of motility would give 0.15-unit positive significant impact on 25OHD; 20% variation in 25OHD was explained by the total count, motility, and morphology, while the model was adjusted for BMI.Conclusion: The impact of 25OHD levels on sperm parameters can be emphasized on the basis of detection of its high serum levels in “normal” subjects in both fertile as well as infertile males in comparison to subjects that had altered sperm parameters; total sperm count, motility, and normal morphology. The considerably positive association between 25OHD, testosterone, total count, motility, and morphology further accentuates its impact on normal spermatogenesis and the male reproductive functions required for acquiring fertility.

The study aimed to investigate the levels of serum leptin in PCOS females and to correlate it with metabolic and hormonal parameters. Sixty-two PCOS and ninety normal cycling (NC) females with matched age and body mass index (BMI) were recruited for this cross-sectional study. Serum leptin, FSH, LH, E2, free testosterone, progesterone, thyroid profile, and FBG levels were measured. The mean leptin levels in PCOS and NC were not significantly different (45.56 ng/mL ± 1.49 vs 41.78 ± 1.31 ng/mL, P>0.05); however, leptin levels showed a strong correlation with BMI in PCOS and NC group (r=0.77, P

OBJECTIVE: The objective of the study was to identify the occurrence and outcome of low back ache amongst computer users and their relation to age, gender, occupation and duration of computer use. MATERIALS AND METHODS: A self reported questionnaire tailored from Occupational Health and Safety Act of the Ministry of Labor, Ontario, Canada was used. RESULTS: 416 participants 55.5% males and 45% females using computers for a minimum of five years with age range 22 to 59 years belonged to different occupational groups. Consecutive hours of computer work was found to be associated with work related backache or discomfort in 27.4% (n = 114) participants (16.1% male, 11.3% female). Frequent short breaks improved backache (p value

Chemerin is a novel protein linked to adipocyte differentiation and the development of metabolic imbalances. We sought to examine the relationship of chemerin with metabolic syndrome disturbances including body fat percentage, serum lipid, glucose, insulin levels and body fat percentage in lean and obese volunteers. A cross-sectional study of 90 randomly selected healthy males from Pakistan were divided into three groups as per Body Mass Index (BMI) criteria for South Asian Population. Anthropometric measurements were taken for BMI, waist circumference, hip circumference and body fat percentage, while serum analyses were performed for fasting blood glucose, fasting insulin, fasting lipid profile and serum chemerin. Associations between serum chemerin levels and body fat and other metabolic syndrome parameters were performed using ANOVA and multiple regression analyses. Data was presented as Mean±SD. In all statistical analyses p-values