Does lipocalin-2 affect metabolic syndrome in hepatic infections?

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\u3c0.001). LCN-2 correlated moderately with alanine aminotransferase (ALT) (r=0.369), alkaline phosphatase ALP (r=0.419), and HbA1c (r=0.341) (p\u3c0.01). All correlations were lost when adjusted for the presence of hepatitis, indicating that liver infection exacerbates insulin resistance.Conclusion: Based on our findings, circulating LCN-2 is elevated in T2DM subjects with hepatitis B co-infection and may contribute towards deranged inflammatory response

Awareness to Handle Research and Healthcare Waste (RHCW) in teaching and research institutes; a comprehensive review

Environmental pollution has become the major challenge not only for developing countries but also for developed ones Worldwide. The major goal of this comprehensive review is to compile the reference data regarding the different types of waste generated in teaching, research, and healthcare institutes and specific strategy to manage such wastes. In addition to the pharmaceutical, leather, chemicals, food, and paper industries, teaching, research, and healthcare institutions are also significant sources of different types of Non-hazardous as well as hazardous wastes. Therefore, a simple and implementable guideline for cleaning and waste disposal services in such institutions requires strict adherence to applicable policies and procedures. Research and healthcare waste (RHCW) management is a joint effort among Research Laboratory Personnel, Healthcare facilitators, Building Services Personnel, and Local Environmental Health and Safety Personnel. As Pakistan is among the developing countries situated in South Asia, most of the institutes, including teaching, research, and healthcare, try to follow the WHO guidance or manage hazardous and non-hazardous wastes with self-planned strategies. Although most of the local Governing bodies and Institutional bodies are trying to handle the wastes at their levels by following different protocols, introducing a protocol at the National level is the need of the current era to fight against environmental pollutants.

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND: Disorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021. METHODS: We estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined. FINDINGS: Globally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer. INTERPRETATION: As the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Analysis of Maternal Morbidity and Mortality Referred to Tertiary Care Hospitals of Pakistan

Background and Aim: Maternal morbidity is a major health problem affecting approximately millions of women annually and had a substantial influence on fetal and infant health that might lead to maternal mortality. Maternal mortality is an indicator of the quality of obstetric care in a community directly reflecting the utilization of health care services available. The present study was conducted in order to analyze the maternal morbidity and mortality cases referred to a tertiary care hospital. Methodology: This cross-sectional study was conducted on 89 maternal deaths out of 9874 obstetrical admissions or births referred to department of Gynae/Obs of tertiary care hospitals i.e Makran Medical College, Turbat/ Teaching Hospital, Kech and Dow University of Health Sciences, Karachi over a period of five years from 2017 to 2021. All the pregnant women with gestation age &gt;24 weeks admitted for any obstetrical emergencies were enrolled in this study. Patient’s demographic characteristics, clinical features during admission, and maternal relevant information were collected on pre-designed proforma. SPSS version 21 was used for data analysis. Results: Out of total 9874 births, maternal deaths were 89; the mortality incidence with prevalence was hemorrhage 7 (7.9%), hypertensive disorders 34 (38.2%), anesthetic issue 2 (2.2%), sepsis 14 (15.7%), and medical complications 31 (34.8%). The occurrence of direct and indirect maternal death was 55 (61.8%) and 34 (38.2%) respectively. The incidence of the mortality rate was 22.9%. Of the total 387 morbidity cases, hypertensive disorders were the prevalent cause with 295 (76.2%) cases followed by obstetric hemorrhage 55 (14.2%), medical complications 25 (6.5%), sepsis 11 (2.8%), and anesthetic complications 1 (0.3%). The incidence of morbidity was 77.4 per year. Conclusion: Medical complications, sepsis, and hemorrhage are the leading causes of maternal mortality, followed by hypertensive disorders. Mortality and morbidity rates were 22.9% and 3.9% respectively. All of these causes can be avoided with proper antenatal care facilitation. Keywords: Hemorrhage, Maternal mortality, Sepsis</jats:p

Association of BDNF Gene (rs6265/G196A) Polymorphism with Depression

Depression affects an individual’s feelings, thoughts, and behavior. It is known as the most common mental illness worldwide with complex origin. The risk factors for depression include both genetic as well as environmental factors. Depression is affecting more than 300 million individuals globally and is categorized as a major cause of the global burden of disease. Several studies demonstrate the involvement of the brain-derived neurotrophic factor (BDNF) gene in the etiology of depressive disorder. This study was designed to assess the association of (rs6265/G196A) polymorphism of the BDNF gene in the pathogenesis of depression. The cross-sectional study was conducted consisting of 357 samples from Rawalpindi, Pakistan. Depression was determined through questionnaire, using DSM-Ⅳ (Diagnostic and Statistical Manual for Mental Disorders-Version Ⅳ). DNA was extracted from the blood samples of study participants. The conventional polymerase chain reaction was performed to amplify the BDNF gene and to detect the frequency of rs6265/ G196A SNP in the samples of subjects under study. Statistical analysis was done using Pearson’s Chi-Squared test. It was observed that the homozygous GG genotype is more prevalent in study subjects than the homozygous AA or heterozygous AG genotypes. However, depression is likely to be more prevalent in AA genotype i.e., 37.8%, less prevalent in AG genotype i.e., 34.0%, and least prevalent in GG genotype i.e., 28.2%. This data shows the A allele of the BDNF gene to be more associated with depression than the G allele, suggesting this polymorphism to be a somewhat potential target for anti-depressants.</jats:p

Comparison of light microscopy and digital microscopy for learning oral pathology practicals among second year dental students

Background/purpose: Previous studies have shown that digital microscopy is an indispensable tool for teaching oral pathology laboratory course. Despite this, our institute relies solely on recommended/reference book images for oral pathology practicals, neglecting both light and digital microscopy methods. Gathering students' feedback on these methods is essential before considering digital microscopy as part of the oral pathology curriculum. Therefore, this study aimed to compare the usefulness of light and digital microscopy among second-year dental students. Materials and methods: The study was conducted from December 6 to December 7, 2023, in the Department of Oral Pathology, Dr. Ishrat-ul-Ibad Khan Institute of Oral Health Sciences, Dow University of Health Sciences. The study involved the selection of five cases from the oral pathology course, followed by feedback on students' diagnostic skills, learning impact and acceptance rate of light and digital microscopy using an online questionnaire. Mann–Whitney U test was used to compare students' responses and P-value < 0.05 was set as statistically significant. Results: There was a statistically significant difference in diagnostic scores between light microscopy and digital microscopy (P < 0.05). Statistically significant differences favoring digital microscopy were observed in various aspects, including interpreting variations, diagnosis, time efficiency, and image clarity. Conclusion: Although diagnostic scores were lower, digital microscopy was perceived as a useful method for enhancing diagnostic skills among dental students. Both light microscopy and digital microscopy are viable options for oral pathology practicals, however, digital microscopy was preferred by students due to its time efficiency and clear image quality