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Objective: To explore knowledge, attitudes and practices of laypersons and health professionals towards foetal programming, and factors affecting it. Method: The mixed methods study was conducted at the Aga Khan University, Karachi, from January 20 2021 to May 13, 2022, and comprised adults of either gender with access to social media platforms. Data was collected using an online survey questionnaire in English and Urdu developed to capture responses from a diverse pool of participants. The survey tool was circulated through WhatsApp, Facebook and Instagram. Two focus group discussions were conducted; one with laypersons in group A and the other with health and allied professionals in group B. Data was analysed using SPSS 21, while data related to focus group discussions was subjected to thematic analysis. Results: Of the 358 participants, 173(48.3%) were in group A and 185(51.7%) were in group B. There were 34(18.4) subjects in group A and 27(15.6) in group B who had knowledge of foetal programming (p>0.05). Only factors related to father’s health and dietary elements on the foetus were significantly different between the groups (p

Introduction: Undergraduate medical students have consistently been shown to have high prevalence of mental health disorders in comparison to their peers from non-medical backgrounds and sleep quality is a critical aspect for maintaining mental wellbeing. The aim of this study is to compile prevalence on poor sleep quality and analyze its potential risk factors. Methodology: A cross sectional study was conducted at the Aga Khan University. Undergraduate medical students asked to fill out a self-reported questionnaire that was sent via email which included the 14-point Perceived Stress Scale (PSS), Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). 302 students responded and the data was analyzed using chi square and logistic regression to determine their association with Sex, BMI, Year of Study and Academic Score. Results: The mean age of study participants was 21.58 + 1.41 years and majority were males (58%). The mean PSQI, ESS and PSS scores were 6.35 + 3.28, 7.72 + 4.58 and 28.38 + 7.81 respectively. 11.3% of participants reported poor sleep quality, which was significantly associated with female sex and academic performance. 28.5% of students had excessive daytime sleepiness, which was significantly associated with female sex and academic year (first year). “Stress” and “Overthinking/Anxiety” were the two most common self-reported reasons for Poor Sleep Quality. 85.4% of students were stressed with an average PSS score of 28.38 + 7.81. Conclusion: This study therefore shows a high prevalence of stress with moderate sleep disturbance prevalence, which was associated with female sex and academic performance.

Background: Subclinical hypothyroidism (SCH) is characterized by high thyroid stimulating hormone (TSH) levels (4.5 to 10 IU/L) and normal T3 and T4 hormones. It may occur with or without mild symptoms of hypothyroidism and autoimmunity. In pregnancy one of the common complications is SCH. Multiple adverse maternal and neonatal outcomes such as cognitive and neuropsychiatric effects are associated with SCH. Globally, 3-15% of the general population is affected by SCH. In Pakistan, the prevalence of SCH is ~ 8.1% in women during gestation. This study was conducted to see the effects of maternal SCH during pregnancy on young rats in terms of behavioural and gross brain structure changes and their reversibility after treatment with levothyroxine. Method: 14 Female Sprague Dawley rats (200–300g) were acclimatized and allowed to get impregnated. They were divided into 3 groups. 1. Treated (n=4): was induced with SCH by propylthiouracil (PTU) 5µg/kg/day at PD6 and treated with levothyroxine from gestational day 16 to postnatal day 40. 2. Untreated (n=5): was induced with SCH and left untreated. 3. Control (n=5) was administered with equal volumes of saline. Body weight of pups was recorded regularly. Histological procedures were performed at postnatal day 7, 14 and 21 to identify any neonatal neurological problems. Behavioural tests such as elevated plus maze, forced swim and tail suspension tests were performed to test anxiety and depression. Result: On postnatal day 7, pups from the untreated mothers showed a substantial decline in body weight compared to treated and control groups. These differences were more profound with age at P14 and P21. No major changes were seen in the gross brain structure of untreated rats as compared to treated rats. The most depressed behaviour was found in pups from untreated dams evident from significantly increased immobility time in FST and TST as compared to healthy ones. Conclusion: Despite the absence of any gross changes in the brain structure, minor but significant behavioural difference, indicative of depression, was observed in the pups of untreated rats.

Objectives: The purpose of the current study was to compare the serum Apelin level in patients with and without polycystic ovarian syndrome to assess this as a diagnostic marker for PCOS. In a case-control study 60 polycystic ovarian syndrome patients diagnosed according to Rotterdam criteria and 20 healthy controls of reproductive age group were recruited. Study Design: Case Control study. Setting: Jinnah Postgraduate Medical Center in Collaboration with Aga Khan University, Karachi. Period: August 2017 and February 2019. Material & Methods: Blood samples were collected after 12 hours fasting and was used to test serum Apelin, insulin, cortisol and fasting blood glucose levels. Results: Seventy percent PCO subjects had irregular menstrual cycle and 68% suffered from hirsutism; while all PCO subjects had more than 10 antral follicle seen on ultrasound in either one or both ovaries in comparison of 15% controls (p

Background Human Kidney Injury Molecule-1, also known as HAVCR-1 (Hepatitis A virus cellular receptor 1), belongs to the cell-surface protein of immunoglobulin superfamily involved in the phagocytosis by acting as scavenger receptor epithelial cells. The study focused on pinpointing the mechanisms and genes that interact with KIM-1. Methods This in-silico study was done from March 2019 to December 2019. The Enrichment and protein-protein interaction (PPI) network carefully choose proteins. In addition, the diagramed gene data sets were accomplished using FunRich version 3.1.3. It was done to unveil the proteins that may affect the regulation of HAVCR1 or may be regulated by this protein. These genes were then further considered in pathway analysis to discover the dysregulated pathways in diabetic nephropathy. The long list of differentially expressed genes is meaningless without pathway analysis. Results Critical pathways that are dysregulated in diabetic nephropathy patients have been identified. These include Immune System (Total = 237, P Conclusion The top 5 genes that are interacting directly with HIVCR1 include CASP3, CCL2, SPP1, B2M, and TIMP1 with degrees 161, 144, 108, 107, and 105 respectively for Immune system pathways (Innate Immune System, Cytokine Signaling Immune system, Adaptive Immune System and Neutrophil degranulation).

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

Metabolic syndrome (MetS) and non-alcoholic fatty liver disease (NAFLD) are emerging threats in Pakistan. The prevalence of MetS is reported to be 18–46% in general population. Adipokines and their genetic polymorphisms are now considered as risk factors for these conditions. Chemerin modulates glucose and lipid homeostasis, nesfatin-1 acts as an anorexigenic peptide, desnutrin regulates adipose tissue fatty acid oxidation, adipocyte fat content, and size. Therefore, this study was designed to identify the molecular and genetic differences in the above-mentioned biomarkers in metabolic syndrome positive and negative individuals. This cross-sectional study was carried out at the Aga Khan University during October 2018 till August 2019. MetS positive (n = 92) versus negative (n = 208) adults aged between 18 and 50 years of age were recruited. MetS was diagnosed on the basis of National Cholesterol Education Program Adult Control Panel III criteria. Serum adipokine levels, lipid profile, blood glucose, and insulin were measured. Fatty liver was detected by ultra-sonographic scans. Chemerin rs17173608 polymorphism was determined by tetra-arm polymerase chain reaction. Higher chemerin (37.87 ± 13.60 vs. 24.03 ± 12.32 pg/ml), low desnutrin (103.08 ± 5.84;270.19 ± 25.67 pg/ml), and nesfatin levels (276.49 ± 31.09; 754.34 ± 57.77 pg/ml) were seen in Mets/NAFLD positive versus negative individuals, respectively. Serum chemerin showed a moderate positive correlation with MetS and fatty liver while desnutrin showed weak correlation with MetS, whereas nesfatin showed a moderate correlation with MetS and fatty liver (p < 0.05). Each unit increases in chemerin, and decrease in desnutrin was associated with higher odds of developing NAFLD (p < 0.05). The variant rs17173608 showed association with MetS phenotype (1.841 (1.101–3.078); p = 0.020). Presence of the minor “G” allele was seen to increase the risk of developing MetS by 1.567 (p < 0.012). High chemerin and low desnutrin are linked to fatty liver changes and MetS in a subset of local population. The presence of chemerin “G” allele increases the risk of developing MetS even further in the same individuals. Further studies are required for an in-depth analysis of the mechanism through which these biomarkers cause the effect.

Objective: To conduct an on line Flipped Class Room (FCR) to facilitate synchronous (in class activity) and asynchronous learning [Virtual Learning Environment (VLE)] and acquire feedback of the learning experience from medical students at Aga Khan University. Methods: This interventional study was conducted with year II students undergoing Endocrine Reproduction Module at the Aga Khan University during April 13 to May 22, 2020. Pre reading material and pretest was shared with the students via Virtual Learning Environment (VLE) one week before the class. Microsoft Teams was used to conduct online session by two facilitators, where student discussion on case studies was encouraged. A WhatsApp group was created with the facilitators to respond to any student queries. The session was recorded and later uploaded on VLE. Posttest and a student satisfaction survey was conducted at the end of the session. Results: The average score for the pretest and posttest was 19.67 ± 1.37 and 24.60 ± 1.34 respectively (p value

To determine whether obesity-associated metabolites are associated with type 2 diabetes (T2DM) risk among South Asians.Serum-based nuclear magnetic resonance imaging metabolomics data were generated from two South Asian population-based prospective cohorts from Karachi, Pakistan: CARRS1 (N = 4017) and CARRS2 (N = 4802). Participants in both cohorts were followed up for 5 years and incident T2DM was ascertained. A nested case-control study approach was developed to select participants from CARRS1 (NIn a combined sample of the CARRS1 and CARRS2 cohorts, out of 224 metabolites, 12 were associated with general obesity and, of these, one was associated with incident T2DM. Fifteen out of 224 metabolites were associated with central obesity and, of these, 10 were associated with incident T2DM. The higher level of total cholesterol in high-density lipoprotein (HDL) was associated with reduced T2DM risk (odds ratio [OR] 0.68, 95% confidence interval [CI] 0.53, 0.86; P = 1.2 × 10Total cholesterol in HDL and cholesterol esters in large VLDL particles may be an important biomarker in the identification of early development of obesity-associated T2DM risk among South Asian adults.

Objectives: Ischemia modified albumin (IMA) may aid in the early detection and management of diabetic retinopathy (DR). In this study, we examined the relationship between IMA and DR, and the effect of intravitreal anti-vascular endothelial growth factor (anti-VEGF) on IMA levels in patients with DR. Methods: This Quasi-experimental study was conducted from March-December 2018 at a Al-Ibrahim Eye Hospital in Karachi, Pakistan. Adult patients (age ≥ 18 year) with Type-2 diabetes mellitus (T2DM) presenting to the Diabetic Clinic were categorized as control (Group-A n=30: DM without DR) or case (Group-B n=59: DM with DR). Patients in Group-B received an intravitreal injection of bevacizumab (anti-VEGF). Visual acuity, retinoscopy and serum IMA were recorded at baseline and at a 30-day follow-up for both groups. Results: A significant drop in IMA levels was seen one month after bevacizumab (IMA baseline: 1590.82±121.22 and follow up: 940.8±91.26; p0.05) indicating disease progression. Conclusion: Ischemia modified albumin may be used as an effective and novel screening biomarker for assessing oxidative stress associated with DR, and to quantify response to and prognosis after intravitreal bevacizumab injection for DR. doi: https://doi.org/10.12669/pjms.38.4.4813 How to cite this:Kumar W, Martins RS, Anjum N, Fatima SS. Ischemia modified albumin as a useful marker for diagnoses and management of diabetic retinopathy. Pak J Med Sci. 2022;38(4):---------. doi: https://doi.org/10.12669/pjms.38.4.4813 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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

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Objectives: The aim of the current study was to appraise the relationship between women’s body image perception and depression in case and controls. Methods: In this case-control study 60 polycystic ovarian syndrome patients established agreeing to the Rotterdam criteria and 60 healthy controls of reproductive age group were enrolled. The PCOS patients and healthy controls were evaluated on questionnaire for physical appearance and depression. Body image perception was accessed using the validated Body Esteem Scale. The symptoms of Depression were evaluated with the Quick Inventory of Depressive Symptomatology-Self Report. Results: 55% of PCOS patients had depression while 36.7% were found with depression in the control group. In the PCOS group 65% of patients were found with positive body image while 98.3% of patients were found with positive body image. Significant association of study cases group was found with BMI group (p=0.049), diet habit (p=0.013), depression (p=0.044) and body image (p=0.000). Patients with depression are also more likely to have PCOS in comparison with those who haven’t (OR=2.111). Conclusion: There was a significant association of study group with body image perception and depression. Therefore, health of the patients with this set of symptoms is essential to be acknowledged more fully, predominantly in relation to the despair and poor body image. The outcomes of this study foster implications for clinical practice and propose that a multidisciplinary team should be involved in treatment of PCOS. Key words: Polycystic Ovary Syndrome (PCOS), Quick Inventory of Depressive Symptomatology (QIDS), Depression.

BackgroundPakistan has not been a major contributor to medical research, mainly because of the lack of learning opportunities to medical students. With the increase in online learning systems during COVID-19, research related skills can be taught to medical students via low-cost peer taught virtual research workshops.Aim of the StudyTo assess the effectiveness of a comprehensive low-cost peer-taught virtual research workshops amongst medical students in Pakistan.MethodsThis quasi-experimental study assessed the effectiveness of five virtual research workshops (RWs) in improving core research skills. RWs for medical students from across Pakistan were conducted over Zoom by medical students (peer-teachers) at the Aga Khan University, Pakistan, with minimal associated costs. The content of the workshops included types of research, ethical approval and research protocols, data collection and analysis, manuscript writing, and improving networking skills for research. Improvement was assessed via pre-and post-quizzes for each RW, self-efficacy scores across 16 domains, and feedback forms. Minimum criteria for completion of the RW series was attending at least 4/5 RWs and filling the post-RW series feedback form. A 6-month post-RW series follow-up survey was also emailed to the participants.ResultsFour hundred medical students from 36 (/117; 30.8%) different medical colleges in Pakistan were enrolled in the RWs. However, only 307/400 (76.75%) medical students met the minimum requirement for completion of the RW series. 56.4% of the participants belonged to the pre-clinical years while the rest were currently to clinical years. The cohort demonstrated significant improvement in pre-and post-quiz scores for all 5 RWs (p p p p = 0.043).ConclusionVirtual RWs allow for a wide outreach while effectively improving research-related knowledge and skills, with minimal associated costs. In lower-middle-income countries, virtual RWs are a creative and cost-effective use of web-based technologies to facilitate medical students to contribute to the local and global healthcare research community.

BACKGROUND Women with gestational diabetes mellitus have an increased risk of developing gestational hypertension, which can increase fetal and neonatal morbidity and mortality. In the past decade, single nucleotide polymorphisms in several genes have been identified as risk factors for development of gestational hypertension. The epidermal growth factor receptor activates tyrosine kinase mediated blood vessels contractility; and inflammatory cascades. Abnormalities in these mechanism are known to contribute towards hypertension. It is thus plausible that polymorphisms in the epidermal growth factor receptor gene would be associated with the development of hypertension in women with gestational diabetes. AIM To determine whether the epidermal growth factor receptor rs17337023 SNP is associated with the occurrence of hypertension in gestational diabetic women. METHODS This pilot case-control study was conducted at two tertiary care hospitals in Karachi, from January 2017-August 2018. Two hundred and two women at 28 week of gestation with gestational diabetes were recruited and classified into normotensive (n = 80) and hypertensive (n = 122) groups. Their blood samples were genotyped for epidermal growth factor receptor polymorphism rs17337023 using tetra-ARMS polymerase chain reaction. Descriptive analysis was applied on baseline data. Polymorphism data was analyzed for genotype and allele frequency determination using chi-squared statistics. In all cases, a P value of < 0.05 was considered significant. RESULTS Subjects were age-matched and thus no difference was observed in relation to age of the study subjects (P >0.05). Body fat percentage was significantly higher in hypertensive females as compared to normotensive subjects (35.138 ± 4.29 Case vs 25.01 ± 8.28 Control; P < 0.05). Similarly, systolic and diastolic blood pressures among groups were significantly higher in hypertensive group than the normotensive group (P < 0.05). Overall epidermal growth factor receptor rs17337023 polymorphism genotype frequency was similar in both groups, with the heterozygous AT genotype (56 in Case vs 48 in Control; P = 0. 079) showing predominance in both groups. Furthermore, the odds ratio for A allele was 1.282 (P = 0.219) and for T allele was 0.780 (P = 0.221) in this study. CONCLUSION This pilot study indicates that polymorphisms in rs17337023 may not be involved in the pathophysiology of gestational hypertension in gestational diabetes via inflammatory cascade mechanism. Further large-scale studies should explore polymorphism in epidermal growth factor receptor and other genes in this regard.

BACKGROUND Both obesity and vitamin D deficiency are important health issues in Pakistan. The connection between body composition, Vitamin D and leptin in young adults is important to be studied as body composition may affect bone health and therefore the possibility of osteoporosis in later life. Few studies have attempted to investigate the effect of body composition and leptin with vitamin D in adolescence. AIM To investigate the association of serum leptin with body composition, lipids and 25-hydroxyvitamin D (25OHD) in adults. METHODS This cross-sectional study was conducted on 167 apparently healthy adults. Demographics were recorded, bioelectrical impedance analysis was performed and clinical history noted. Serum leptin was measured using DIA source kit on ELISA and total 25OHD was measured on ADVIA-Centaur; Siemens. Total cholesterol and high density lipoprotein cholesterol were quantified using Enzymatic Endpoint Method and Cholesterol Oxidase-Phenol Aminophenazone method respectively. Biochemical analysis was done in the Departments of Pathology and Laboratory Medicine and Biological and Biomedical Sciences, Aga Khan University Hospital Karachi Pakistan. RESULTS Median age of the group (n = 167) was 20 years (IQR 27-20); 55.7% were females. Majority (89.2%, n = 149) of the study group was 25OHD deficient, 6% (n = 10) had insufficient serum 25OHD levels and 4.8% (n = 8) had sufficient D levels. Females, had higher median leptin levels [2.71 (IQR 4.76-1.66 ng/mL)] compared to their counterparts [1.3 (3.60-0.54 ng/mL), P < 0.01]. Multiple regression analysis suggested that basal metabolic rate, muscle mass, body fat percent, bone mass and serum 25OHD were the most contributing factors to serum leptin levels. Bone mass and serum 25OHD in fact bore a negative correlation with leptin. CONCLUSION The results indicate that basal metabolic rate, muscle mass, body fat percent, bone mass and serum 25OHD have an impact on serum leptin. Being a cross sectional study causal relationship between leptin and other variables could not be determined.

Soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) is linked to endothelial dysfunction; a key factor in pre-eclamptic pathogenesis. This study aimed to compare sTWEAK levels during pregnancy to assess for its prognostic ability.Sixty three high risk pregnant women were followed up from 12 weeks of gestation till term. Serum levels of sTWEAK and platelet derived growth factor (PlGF), blood pressure, serum glucose, uric acid, urea/creatinine and liver function tests were measured. Subjects were stratified according to the ACOG criteria as women who developed PE, or PIH or remained normotensive at term. A negative control group of normotensive healthy pregnant women (n = 17) was also recruited for comparison.Baseline sTWEAK levels were lower (4.03 ± 0.37 ng/dl) in HR cohort that developed PE and further reduced at term (1.93 ± 0.23 ng/dl) as compared to HR subjects who remained normotensive and negative control group (30.53 ± 0.79 ng/dl; p 0.01). Likewise PlGF levels were significantly lower (74.22 ± 10.11 pg/ml) in HR cohort that developed PE (p = 0.013). At term 39.68% (n = 22) HR subjects with low sTWEAK developed PIH and 34.92% (n = 24) developed PE. In terms of high risk characteristics observed in the HR group; 73% of the subjects were multiparous, whereas 26.98% reported to have developed PE in previous pregnancies.sTWEAK levels at early pregnancy weeks were found to be low in high risk females who developed PE at follow up versus normotensive pregnant women. Baseline TWEAK might serve as an independent variable for prediction of pre-eclampsia; however longitudinal studies with larger sample size are required to ascertain the causal relation.

Background and Objectives: The Covid-19 pandemic has caused large-scale disruption in almost all educational programs across the world. Planning and rapid implementation of assessment through an online format presents the next set of novel challenges that must be addressed by academic administrations across the globe. Methods: This cross-sectional study was conducted between March to August 2020 at the Aga Khan University Medical College. Two hundred medical students of year 1 and 2 participated in the study. We describe the planning, processes, and outcomes of online assessments using video communication platforms conducted at a private university in Pakistan. Standardized protocols were written and piloted, extensive training of student, proctors and staff for preparation and conduct of online assessments were developed. Feedback was recorded after each session and suggestions were incorporated in subsequent high-stakes assessments. Results: A total of three pilot assessments were conducted to identify issues and process refinement. Commercially available lockdown browser and ZOOM were used in the first pilot; 80% of the class was unable to launch lockdown browser and laptops required repeated reload/reboot. For the second pilot assessment, University’s VLE page & MS Teams was trailed. Issues with internet connectivity, VLE page slowdown, and suboptimal recording feature in MS Teams were identified. For the final pilot assessment, phased launching of VLE page with single test item per page was implemented with success. The students reported that attempting the online exam on VLE with ZOOM support was user friendly. Ninety percent of the class was supportive of the continuing with the online assessments. Conclusion: In order to device an effective protocol for e-assessments conducting multiple trial runs, and incorporating feedback from all stakeholders is a necessity. doi: https://doi.org/10.12669/pjms.37.4.3948 How to cite this:Fatima SS, Idrees R, Jabeen K, Sabzwari S, Khan S. Online assessment in undergraduate medical education: Challenges and solutions from a LMIC university. Pak J Med Sci. 2021;37(4):945-951. doi: https://doi.org/10.12669/pjms.37.4.3948 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

AIM & OBJECTIVE Silent information regulator 1 (SIRT1) gene stimulates the expression of antioxidants and repairs damaged cells. It affects the mitochondrial activity within the oocytes to overcome the oxidant stress. We aimed to assess an association of SIRT1 polymorphism (Tag SNPs rs10509291 and rs12778366) with fertility, and assess serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), oestradiol, progesterone, manganese superoxide (MnSOD) and SIRT1. MATERIAL AND METHODS In this cross-sectional study, 207 fertile and 135 infertile subjects between the ages of 18-45 years were recruited. Polymerase chain reaction (PCR) was performed; products were electrophoresed in a 2% agarose gel. Descriptive analysis of continuous variables was expressed as mean ± standard deviation. Mann-Whitney test was performed for comparison of groups, P value

To generate a protocol describing the methodology for a study assessing the effectiveness of a comprehensive series of peer-taught online research workshops for surgical residents across Pakistan in terms of improving research-related knowledge and skills, and long-term research involvement and output.The quasi-experimental study will consist of a series of six online research workshops conducted over Zoom for surgical residents across Pakistan. An online sign-up form will be circulated on social media to current surgical residents throughout Pakistan. Curricular content covered in the workshops will be developed in collaboration with experienced research faculty at the Departments of Surgery and Community Health Sciences at the Aga Khan University Hospital, Karachi. Facilitators of the workshops will be current surgical residents with a solid track record of research involvement at the hospital. Improvement in research-related knowledge and skills will be assessed through pre- and post-tests for each workshop. A post-series feedback form will assess satisfaction with the organisation, content relevance, peer-teaching and online delivery of the workshops. Long-term research involvement and output will be assessed by follow-up surveys at 6 months and 1 year post-workshop. All data-collection will be done via Google Forms. For ethical purposes, informed consent will be taken from participants prior to enrolment; data will be collected using a unique identifier number to maintain anonymity; and the only incentive provided to participants will be a Certificate of Completion for the research workshop series.We expect that surgical trainees participating in the series of six research workshops will demonstrate a highly significant percentage improvement (p0.001) in the pre- and post-tests for each of the six core research competencies taught. On post-series feedback, we expect the majority of participants (80%) to rate the overall organisation, effectiveness of online mode of instruction, and relevance to surgical training of the workshops as excellent/good. We also expect that most participants (80%) would strongly agree/agree that peer-education is an effective model of teaching in research workshops. Finally, we expect statistically significant improvement (p0.05) in research involvement and output in terms of publications as assessed in the 6 months and 1year post-workshop follow-up surveys.In light of the ever-growing need for academic surgeons in Pakistan, this research protocol details a comprehensive strategy for research capacity-building among surgical trainees across the country. By equipping trainees with the knowledge and skills to conduct high-quality research, virtual research workshops provide a novel, grassroots-level and sustainable solution for addressing the surgical research crisis in Pakistan.

Objectives: This study was aimed to assess maternal vitamin D status during pregnancy and determine the association between maternal 25(OH) D levels with risk of preeclampsia (PE). Methods: A cross-sectional study was conducted with 172 pregnant women recruited from JPMC between January and December 2017 who were divided as normotensive (n=80) and pre-eclamptic (n=92) groups. Blood pressure was recorded at 20 and 32 weeks of gestation. Five ml of blood sample was collected at 20 weeks of gestation to assess the vitamin D levels by commercially available ELISA assay. Results: PE group had a significantly higher systolic (p

Background and objective Lipocalin-2 (LCN-2) is an adipokine that plays a protective role in various inflammatory disorders and regulates innate immune response to acute and chronic infections. However, scant information is available regarding the relationship between serum LCN-2 levels and type 2 diabetes mellitus (T2DM) occurring concurrently with chronic hepatic infections. The present study sought to investigate the association of LCN-2 with T2DM patients with hepatic infections. Methods The association of LCN-2 with T2DM, hepatic steatosis, and inflammation was tested in 37 non-T2DM noninfectious individuals (group A, control group) and 55 age-matched patients with T2DM and chronic infection (group B). Anthropometric data were measured and the body-fat percentage was calculated using bioelectrical impedance analysis (BIA). Hemoglobin (Hb), fasting plasma glucose (FPG), hemoglobin A1c (HbA1c), liver function enzymes (LFEs), lipid profile, and total leukocyte count (TLC) were measured. Serum LCN-2 levels were measured using a commercially available sandwich enzyme-linked immunosorbent assay method. Results Levels of LCN-2 were significantly elevated in group B (1896.90 ± 73.13 ng/ml) versus control group A (263.58 ± 15.66 ng/mL; p

OBJECTIVE The purpose of this study is to compare the thyroid hormone (TH) profile in male infertile subjects with normal and altered sperm parameters and assess its relationship with spermogram and reproductive hormones. DESIGN This cross-sectional study was conducted in Karachi from August 2017 till September 2018 on 376 male subjects between 25 and 55 years of age. The reference values for the "Normal Sperm Parameters" group was; sperm count (TC) >39 million per ejaculate, total sperm motility (Progressive and Non-progressive) >40% and normal morphology of ≥4%. Male subjects, having any one of the sperm parameters below the reference values comprised the group of "Altered Sperm Parameters". The thyroid profile; Thyroxine (T4), triiodothyronine (T3), thyroid stimulating hormone, Thyroid Peroxidase antibodies (Anti-TPO) was estimated in addition to reproductive hormones Testosterone and Sex hormone binding globulin (SHBG). Independent sample T test and Analysis of Variance was applied for comparison of groups. Linear regression was performed and unadjusted and adjusted beta coefficient with 95% CI was reported. A P-value of