Red Blood Cell Distribution Width as a Surrogate Marker of Disease Activity in Patients with Rheumatoid Arthritis

Objective: To determine the association between red blood distribution width and disease activity in patients with rheumatoid arthritis and to compare the red blood distribution width in patients of rheumatoid arthritis with that in healthy subjects. Methodology: This comparative case-control observational study was conducted at Pakistan Institute of Medical Sciences, on rheumatoid arthritis patients visiting the (Out Patient Departments) OPDs between September, 2020 and March, 2021. Study subjects were selected by non-probability convenient sampling and a control group comprising of healthy subjects was similarly selected from general medical OPDs. Complete blood picture and erythrocyte sedimentation rate were obtained for each patient and disease activity score was calculated for rheumatoid arthritis patients. Statistical Package for Social Sciences (SPSS) version 26 was used for data analysis. Data was checked for normality by using the Kolmogorov Smirnov test. An independent samples t-test was used for comparing means and Pearson’s correlation coefficient for establishing an association between variables. P value less than 0.05 was considered significant. Results: Of the total 140 patients, 60 (85.7%) in each group were female and 10 (14.3%) were male. The mean age was 39.23 years and 36.87 years in the case and control groups respectively. The mean disease duration of rheumatoid arthritis was 6.63 years. RDW was significantly elevated in patients with rheumatoid arthritis (16.82%) as compared to the control group (14.47%) and strong positively correlated  with disease activity score (p 0.00038). Conclusion: Red blood cell distribution width is strongly related to disease activity in patients of rheumatoid arthritis and may help in monitoring disease activity in rheumatoid arthritis patients

Correlation of Body Mass index with Disease Activity in Rheumatoid Arthritis

Objective:  To evaluate correlation between body mass index and disease activity in rheumatoid arthritis patients. Methodology: This comparative case-control observational study was conducted at Pakistan Institute of Medical Sciences, on rheumatoid arthritis patients visiting the (Out Patient Departments) OPDs between July, 2021 and December, 2021.The study subjects were selected by non-probability convenient sampling from outpatient department. Body mass index and disease activity score were calculated for rheumatoid arthritis patients in OPD. Statistical Package for Social Sciences (SPSS) version 26 was used for data analysis. Mean ± S.D was calculated for age, body mass index and disease activity.  Pearson’s correlation coefficient was used for establishing an association between variables. P value less than 0.05 was considered significant. Simple scatter with fit line was plotted to show graphical association between body mass index and disease activity.  Results: A total 60 patients with 35 (58.3%) female and 25(41.7%) were male. The mean age was 47.21 years. The mean DAS-28 for normal weight group was 2.74 and for overweight group was 4.17. There was positive correlation between body mass index and DAS-28 with r was 0.584 (p<0.05). When correlation on gender basis was calculated, for female patients r was 0.653 and for males 0.529, respectively.  Conclusion: In Rheumatoid Arthritis patients, body mass index is positively correlated with disease activity. Evaluation of this requires trial on large scale, thus, helping in tailoring new management plan, including, weight reduction rather than escalating drug treatment for disease control and improving quality of life in rheumatoid arthritis patients

Association of Clinicopathological features of Cholecystitis with Helicobacter Pylori Infection in Gall bladders

Background: Helicobacter pylori (H. pylori) have been associated with gastritis, but its presence in other parts of the gastrointestinal system has not been studied much. Few previous studies have identified “H. pylori” in gallbladder and found its association in causing cholecystitis and gallstones, but there is limited data showing a significant association in Pakistan. This study was designed to identify H. pylori microorganism in cholecystitis patients and find its association with the morphological changes seen in the affected gall bladders. Material and Methods: All patients with acute and chronic cholecystitis admitted in Akbar Niazi Teaching Hospital (ANTH) between the ages of 18 and 80 years from January 2017 till March 2019, who underwent cholecystectomy, were included in the study. Gall bladder specimens were sent to Pathology department, ANTH after surgery and were analyzed for the presence of H pylori bacteria using Hematoxylin and Eosin and Giemsa staining. Signs of inflammation, hyperplasia, metaplasia, mucosal atrophy or erosion, lymphoid infiltration, fibrosis, cholesterolosis or any other morphological changes were also noted. Association of H. pylori with cholecystitis and other morphological changes were assessed by Chi Square analysis. P value less than 0.05 was considered statistically significant.Results: Chronic cholecystitis was present in 91% cases and acute cholecystitis in 9%. Other histological findings were Hyperplasia (10%), Metaplasia (15%), Fibrosis (79%), Cholesterolosis (19%) and ulcerations (36%). H pylori was found in 17% of gall bladders and all the cases were of chronic cholecystitis, with 11.7% males and 88% females. Gallstones were present in 76.4% cases and were more common in 41-60 years’ age group (64.7%). Other histological findings seen in H. pylori positive cases were; Hyperplasia in 11.7% cases, Metaplasia in 17.6%, Fibrosis in 94.1%, cholesterolosis in 23.5% and ulcerations in 17.6% cases. Association of H. pylori with gender, cholecystitis, gall stones, histological features and age distribution was non-significant.Conclusion: Although H. pylori infection has been found in cases of chronic cholecystitis and gall stone formation, its association with cholecystitis and other morphological changes could not be proved. Hence, it is uncertain whether H. pylori eradication in patients with gastritis can prevent cholecystitis or gall stones formation

A novel HPTLC method for quantitative estimation of biomarkers in polyherbal formulation

AbstractObjectiveTo explore the quantitative estimation of biomarkers gallic acid and berberine in polyherbal formulation Entoban syrup.MethodsHigh performance thin layer chromatography was performed to evaluate the presence of gallic acid and berberine employing toluene: ethyl acetate: formic acid: methanol 12:9:4:0.5 (v/v/v/v) and ethanol: water: formic acid 90:9:1 (v/v/v), as a mobile phase respectively.ResultsThe Rf values (0.58) for gallic acid and (0.76) for berberine in both sample and reference standard were found comparable under UV light at 273 nm and 366 nm respectively. The high performance thin layer chromatography method developed for quantization was simple, accurate and specific.ConclusionsThe present standardization provides specific and accurate tool to develop qualifications for identity, transparency and reproducibility of biomarkers in Entoban syrup

Prevalence and Association of Diabetic Retinopathy with Diabetic Foot Ulcer: A Cross-Sectional Observational Study

We aimed to elucidate prevalence and association of diabetic retinopathy (DR) in patients with diabetic foot ulcer (DFU) from Pakistan. In this cross-sectional study, about 225 DFU patients who underwent ophthalmic examinations within 6 months of diagnosis of foot ulceration were included. The medical records of 305 diabetic patients without DFU were included as controls. The association of DR with DFU was assessed by comparing DFU patients with proliferative DR (PDR) and DFU patients without PDR. Out of 225 DFU patients, 215 patients (95.6%) had DR and 169 patients (75.1%) had PDR. The prevalence of DFU was significantly greater (P = 0.0527) among the male diabetic patients, whereas advanced age of these patients (≥41 years) had a significant effect (P = 0.0286) on development and progression of PDR. A longer duration of diabetes (≥10 years) was identified as a significant contributing factor for the development of both DFU (P = 0.0029) and PDR (P = 0.0299). Moreover, the risk of PDR increased in diabetic patients with higher DFU grades (grade 3 and grade 4). In conclusion, retinopathy was prevalent in DFU patients. Therefore, DFU patients with advancing age and longer duration of diabetes should undergo retinal examinations for timely diagnosis and management of DR

Association of hypertension and dyslipidaemia with increasing obesity in patients with Type 2 Diabetes Mellitus

The study was performed to estimate the association of hypertension and dyslipidaemia with increasing body weight and obesity in Type II diabetics of Lahore, Pakistan. An observational study was conducted by enrolling 2708 obese diabetics from four diabetes care centres of Lahore, Pakistan. Data was collected for a period of 7 months. Associations were estimated using chi-square, binary and multinomial logistic regression. Data suggested that blood pressure, systolic and diastolic, exhibited continual increase with increasing body weight and obesity class in diabetes patients with 41.8% increase in the prevalence of hypertension in obesity class III subjects (OR; 1.91, p=0.02). Likewise, triglycerides and total cholesterol exhibited continual increase in their mean values with increasing obesity, i-e., an overall increase in the prevalence of dyslipidaemia of 27.2% in obesity class 3 subjects (OR; 1.94, p=0.29). Taken together, this data suggested that hypertension is potentially associated with increasing obesity in diabetics, while dyslipidaemia demonstrated plausible association only with obesity class 3

Pattern of Thrombocytopenia In Pregnancy At Teaching Hospital Of Rahim Yar Khan, Pakistan

Background:  Platelet count less than 150 × 109 / L is referred to as thrombocytopenia, which is the second common blood disorder in pregnancy after anemia. Although pregnancy is related with physiological variations in platelet count, however, several pathological conditions also cause thrombocytopenia showing significant impact on health of mother and her baby. The prevalence of thrombocytopenia during pregnancy is 7 to 11%. The physiological thrombocytopenia is multifactorial, related to hemodilution, increased platelet consumption and increased platelet aggregation. Objective: To determine the pattern of thrombocytopenia during third trimester of pregnancy in Rahim Yar Khan. Methodology: This cross-sectional study was carried out at Teaching Hospital of Rahim Yar Khan with effect from May 16, 2022 to September 30, 2022. Five hundred (500) pregnant females in their third trimester were the part of this study. All the study subjects were selected from the department of gynecology and obstetrics at Sheikh Zayed Hospital, Rahim Yar Khan which is a renowned teaching hospital of the region attached with Sheikh Zayed Medical College. Data collection was done on a pre-designed questionnaire. Sample of blood was taken in EDTA and Gel containing vacutainers by convenient sampling technique. Results: The frequency of thrombocytopenia during pregnancy was found 10.4%. Gestational thrombocytopenia was the most common type among thrombocytopenic pregnancies with frequency of 63.46% in comparison to pre-eclampsia 30.76%, HELLP Syndrome 3.80% and immune thrombocytopenic purpura 1.90%. The mean age of pregnant women was observed 27.53±5 years. There is no significant difference in number of thrombocytopenic patients from rural and urban areas (p=0.2). Conclusion: The frequency of thrombocytopenia during the third trimester of pregnancy is observed high, so the regular screening is necessary to avoid any adverse outcome. Specially the patients with Pre-eclampsia and HELLP syndrome should be monitored critically.   Key words: Platelet Count, Thrombocytopenia in Pregnancy, Types of Thrombocytopenia, Pre-Eclampsi

Resistance of polio to its eradication in Pakistan

<p>Abstract</p> <p>Background</p> <p>This study is based on EPI (Expanded Program on Immunization) immunization surveys and surveillance of polio, its challenges in immunization and the way forward to overcome these challenges.</p> <p>Methods</p> <p>Several Government documents, survey reports and unpublished program documents were studied and online search was made to find information on EPI Pakistan. SPSS 16 and Microsoft Excel 2007 were used for the statistical analysis.</p> <p>Results</p> <p>Immunization against polio is higher in urban areas as compared to rural areas. Marked variation in vaccination has been observed in different provinces of Pakistan in the last decade. Secondly 10-20% of the children who have received their first dose of trivalent polio vaccine were deprived of their 2^ndand 3^rddose because of poor performance of EPI and Lack of information about immunization.</p> <p>Conclusion</p> <p>In spite of numerous successes, such as the addition of new vaccines and raising immunization to over 100% in some areas, EPI is still struggling to reach its polio eradication goals. Inadequate service delivery, lack of information about immunization and limited number of vaccinators were found to be the key reason for poor performance of immunization and for large number of cases reported each year due to the deficiency of second and third booster dose.</p

MAP/Microtubule Affinity Regulating Kinase 4 Inhibitory Potential of Irisin: A New Therapeutic Strategy to Combat Cancer and Alzheimer’s Disease

Irisin is a clinically significant protein playing a valuable role in regulating various diseases. Irisin attenuates synaptic and memory dysfunction, highlighting its importance in Alzheimer’s disease. On the other hand, Microtubule Affinity Regulating Kinase 4 (MARK4) is associated with various cancer types, uncontrolled neuronal migrations, and disrupted microtubule dynamics. In addition, MARK4 has been explored as a potential drug target for cancer and Alzheimer’s disease therapy. Here, we studied the binding and subsequent inhibition of MARK4 by irisin. Irisin binds to MARK4 with an admirable affinity (K = 0.8 × 107 M−1), subsequently inhibiting its activity (IC50 = 2.71 µm). In vitro studies were further validated by docking and simulations. Molecular docking revealed several hydrogen bonds between irisin and MARK4, including critical residues, Lys38, Val40, and Ser134. Furthermore, the molecular dynamic simulation showed that the binding of irisin resulted in enhanced stability of MARK4. This study provides a rationale to use irisin as a therapeutic agent to treat MARK4-associated diseases