Increased body mass index may lead to hyperferritinemia irrespective of body iron stores

Objective: Obesity causes subclinical inflammation which results in the secretion of various bioactive peptides that are key players in metabolic regulation of iron homeostasis. We sought to establish correlation of one such peptide (ferritin) with marker of subclinical inflammation (CRP) in various BMI.Methods: Total 150 subjects between the ages of 20-60 years were included in the cross-sectional study conducted at Basic Medical Sciences Institute, Jinnah Post Graduate Medical Centre, Karachi, Pakistan. Body Mass Index (BMI) was calculated by weight (kg) /height (m(2)). The given values were used as reference for Group A: normal weight (18.0-22.9 kg/m2), Group B: overweight (23.0-24.9 kg/m2), Group C: obese ( \u3e 25.0 kg/m2) according to South Asian criteria. Serum Iron, Total Iron Binding Capacity, serum Transferrin Saturation, serum Ferritin and C-reactive protein were measured by commercially available kits. ANNOVA with Tukey\u27s minimum significant difference and Spearman Rho correlation were used considering p \u3c 0.05 significant.Results: The results identified an increased serum Ferritin and CRP in obese versus lean subjects (p \u3c 0.001). BMI showed significantly positive correlation with serum CRP (r = 0.815; p-value \u3c 0.01) and Ferritin (r = 0.584; p-value \u3c 0.01). However, serum Iron levels and Transferrin saturation decreased in obese versus normal weight individuals (p \u3c 0.001).Conclusion: This integrated new data reveals that individuals with high BMI had high levels of Serum Ferritin despite low levels of iron with high levels of C- reactive protein. This might be caused due to inflammatory conditions prevailing in the presence of increased adipose tissue

AHSG rs4918 Polymorphism poses a weak predisposition to insulin resistance during pregnancy

Objective: To identify the association between Fetuin-A levels and genetic polymorphism with gestational diabetes mellitus among pregnant women visiting a tertiary care centre. Methods: This cross-sectional case-control study was conducted at Aga Khan University Hospital, Karachi, from December 2015 to September 2016, and comprised pregnant women in their second trimester. Those with gestational diabetes mellitus were considered the cases while the rest acted as controls. The enzyme-linked immunosorbent assay was used to quantify Fetuin-A levels while genotyping for alpha-2-Heremans-Schmidglycoprotein rs4918 was performed using restriction fragment length polymorphism technique. Blood samples were collected and serum and deoxyribonucleic acid were extracted and stored at -80°C. SPSS 21 was used to analyse the findings. Results: Of the 88 subjects, there were 44(50%) in each group. Serum Fetuin-A concentration was higher in cases compared to the controls (p\u3c0.01). The genotype data for the cases was 0.668 and for the controls 0.840 (p\u3e0.05). However, the G allele showed a weak risk or predisposition towards gestational diabetes mellitus (p=0.038). Conclusion: Increased Fetuin-A levels were found to be related to the occurrence of gestational diabetes mellitus, indicating that Fetuin-A possibly contributes towards insulin resistance

Stages of chronic kidney disease and soluble Transferrin Receptor (sTfR), Ferritin, ratio

Objective: To assess the ratio of soluble transferrin receptor to ferritin in different stages of chronic kidney disease.Methods: This case-control study was conducted at the Aga Khan University Hospital and the Jinnah Postgraduate Medical Centre, Karachi, from January to September 2014, and comprised chronic kidney disease patients and healthy controls. Group 1 comprised controls, whereas groups 2, 3 and 4 had patients based on their mean glomerular filtration rate. SPSS 19 was used for data analysis.Results: Of the 170 participants, 126(74.1%) were cases and 44(25.9%) were controls. The overall mean age was 55.87±3.48 years and the mean body mass index was 24.25±2.9 kg/m2. Decreased levels of iron and haemoglobin were observed in cases compared to controls (p\u3c0.001), while high serum ferritin was seen in cases compared to the controls (p\u3c0.001). Correspondingly, the soluble transferrin receptor-to-ferritin ratio was significantly decreased in groups 2, 3 and 4 (p\u3c0.001).Conclusions: The ratio of soluble transferrin receptor to ferritin was lower in higher stages of chronic kidney disease

Anti mullerian hormone: Ovarian response indicator in young patients receiving long GnRH agonist protocol for ovarian stimulation

Objective: Anti Mullerian hormone (AMH) is gaining place as ovarian marker, chiefly in infertility assistance. We explored its correlation with oocytes retrieval after long GnRH agonist protocol for stimulation, in younger and older infertile population.Methods: This retrospective analysis compiled data of 166 females, receiving ICSI treatment from June 2014 to March 2015. Serum FSH, LH, Estadiol, AMH and antral follicle count were assessed. Outcomes were measured as good (5 to 19 oocytes) and bad responders.Results: Higher discriminatory power of AMH (AUROC; 0.771; p \u3c 0.05) was seen in comparison to FSH (0.692; p \u3c 0.05) and AFC (0.690; p \u3c 0.01). AMH reported strongest association with oocyte retrieved (odds ratio of 15.06). Subgroup analysis reported 68.6 % risk of bad response with AMH levels of less than 1.37ng/ml. This association was observed more significant in young infertile patients \u3c35 year of age (r=0.245; p=0.012) versus older population \u3e35 year (r=0.169; p\u3e0.05).Conclusion: Our study reaffirms that serum AMH correlates well with oocytes retrieved, particularly in females younger than 35 years. We suggest incorporation of AMH in baseline assessment of infertile females, who are falsely advised to postpone interventions based on their age and normal FSH levels

Students\u27 perception of educational environment at Aga Khan University Medical College, Karachi, Pakistan

Objective: To assess educational environment in Aga Khan University Medical College (AKUMC) by Dundee Ready Educational Environmental Measure (DREEM) scale.Methods: A cross-sectional survey of students at the AKUMC with simple random sampling was carried out from June 2014 till March 2015. Responses in five subscales were used to calculate DREEM scores.Results: The average DREEM score was 125.77±16.8 with a reliability of 91.3%. With regards to subscales, on the 12-item students\u27 perceptions of learning (PoL) subscale, the maximum score was 48; 11 items of students\u27 perceptions of teachers (PoT) had a maximum score of 44; students\u27 academic self-perceptions (ASP) identified by 8 items showed maximum score of 32; students\u27 perceptions of atmosphere (PoA) with 12 items obtained maximum score 48 and students\u27 social self-perceptions (SSP) subscale of 7 items had a maximum score of 28.Conclusion: Students perceived a positive learning environment at AKUMC Karachi

Dream of a conducive learning environment: One DREEM for all medical students!

Objective: To compare students\u27 response assessed by Dundee Ready Educational Environment Measure on the basis of the year of study, gender and pre-medical educational background.Methods: This cross-sectional study was carried out at the Aga Khan University Medical College, Karachi, Pakistan, from June 2014 to March 2015, and comprised medical students. The average scores of Dundee Ready Educational Environment Measure scales and subscales were compared between gender and educational background. Responses were also compared on the basis of year of study.Results: Of the 416 participants, 184 (44%) were males and 232 (56%) were females. There were 100 (24%) students in the first year, 90 (21.6%) in second, 92 (22.1%) in third, 91 (21.9%) in fourth and 43 (10.3%) in the fifth year. The mean Dundee Ready Educational Environment Measure score was 125.7±16.8. The mean score of females and students with higher secondary school background was significantly better as compared to males and students in British General Certificate of Education background, respectively (p \u3c 0.0001, p=0.017). Female medical students were satisfied with the atmosphere of teaching and learning (p \u3c 0.0001; p=0.011). Year-wise comparison showed significantly better Dundee Ready Educational Environment Measure score responses by fourth-year students (p \u3c 0.0001).CONCLUSIONS: Assessment by Dundee Ready Educational Environment Measure endorsed approval of conducive learning environment with reference to atmosphere, teaching, learning, sense of well-being, academic self-perception and achievement by all medical students

Association of circulatory kisspeptin levels and hormonal interplay with male infertility: A cross-sectional study in Karachi, Pakistan

Objectives: To determine the impact of Kisspeptin on male reproductive axis in a selected urban population.Methods: The cross-sectional study was conducted at the Sindh Institute of Reproductive Medicine in collaboration with Aga Khan University, Karachi, from July, 2017, to February, 2018, and comprised infertile males with abnormal sperm parameters who were placed in Group A and fertile males with normal sperm parameters placed in Group B. Serum samples were estimated for Kisspeptin, follicle stimulating hormone, luteinizing hormone, testosterone and sex hormone-binding globulin using enzyme-linked immunosorbent assay. Data was analysed using SPSS 22.Results: Of the 313 male subjects, 178(57%) were in Group A and 135(43%) in Group B. Median Kisspeptin levels were higher among fertile males compared to infertile males (p\u3c0.001). Mean follicle stimulating hormone, luteinizing hormone and testosterone values were higher among the fertile males (p\u3c0.001). There was significant interaction between follicle stimulating hormone and testosterone (p\u3c0.1).Conclusions: Fertility in males depended on optimal secretion of Kisspeptin which exert edits effect on hypothalamic pituitary gonadal axis to increase male reproductive hormone production

Kisspeptin and attributes of infertile males and females: A cross-sectional study in a subset of Pakistani population

Kisspeptin, a peptide hormone, plays a pivotal role in fertility and neuroendocrine regulation of hypothalamo-pituitary-gonadal axis. Increased kisspeptin and reproductive hormones are responsible for fertility in male and females. This study aimed to explore the role of kisspeptin on hypothalamo-pituitary-gonadal axis by comparing the levels of kisspeptin in fertile and infertile subjects and identifying single nucleotide polymorphisms (SNPs) of KISS1 gene in exon 2 and exon 3 of infertile male and female cohorts. A cross-sectional study was carried out on 80 males (44 infertile and 36 fertile) and 88 females (44 in each group). Significantly high levels of kisspeptin (KP), follicle-stimulating hormone (FSH), luteinizing hormone and testosterone were observed in fertile male and female subjects except low FSH levels in comparison with infertile female subjects. One polymorphism in exon 2 (E1225K [G/A 3673]) and three in exon 3 (P1945A [C/G 5833]; Insertion of T at 6075; G2026G [C/G 6078]) in infertile group were detected, with low KP and hormonal levels. Male subjects had abnormal sperm parameters and unsuccessful attempt of intracytoplasmic sperm injection in females. Expression of SNP in exon 2 and exon 3 of KISS1 could be responsible for alteration in release of reproductive hormones and gonadal functions, hence causing infertility

Soluble transferrin receptor, Ferritin index in Pakistani population

Inflammation affects the reliability of ferritin. The serum level of transferrin receptor protein (sTfR) represents true demand of iron in the body. This study attempts to identify levels of sTfR and correlate the trends of sTfR/ferritin index with BMI in the population of Karachi. 132 gender matched volunteers between the ages of 20-60 years were recruited for this cross-sectional study. BMI was calculated using the formula: (weight in kg / height in m2). Following groups were made according to South Asian criteria of BMI; Group A: normal weight (18.0-22.9 kg/m2), Group B: overweight (23.0-24.9 kg/m2), Group C: obese ( \u3e 25.0 kg/m2). Serum ferritin, sTfR and CRP levels were determined using ELISA kits. Statistical comparisons were performed using Mann Whitney U and Spearman\u27s rank correlation, where p \u3c 0.05 was considered significant. The results identified increased in TIBC, sTfR, ferritin and CRP in obese as compared to normal weight individuals (p \u3c 0.001). sTfR/ferritin ratio was 0.822 which signifies increased risk of acute myocardial infarction in group C. Serum iron (r=-0.359,p=0.004) showed negative correlation with BMI while serum ferritin (r=0.237,p \u3c 0.001) and sTfR (r=0.263,p= 0.036) levels were positively associated to BMI. This study highlights a novel finding that sTfR is most likely a better clinical measure of iron status in inflammatory conditions as its expression is effected by erythropoiesis and not by inflammation. Risk of Acute myocardial infarction can also be predicted by increased sTfR/ferritin ratio

Role of Leptin and dyslipidemia in chronic kidney disease

Chronic kidney disease (CKD) patients are at an increased risk of cardiovascular complications and plasma leptin level is elevated in cardio renal syndrome. We wanted to explore leptin levels in patients with different stages of CKD and find its association with risk of cardiovascular disease. This cross-sectional study was conducted in Nephrology Department of Jinnah Post Graduate Medical Centre (JPMC) from January 2014 to September 2014. Group I comprised of controls (GFR=116±8.3, n = 44) acquired from general population, CKD patients were grouped as II, III and IV respectively with GFR; 85.77±9.9 (n = 42), 53.84±9.9 (n=42) and 20.22±8.4 (n = 42).CKD patients with any inflammatory disease, Diabetes Mellitus and on steroid therapy were excluded. Serum leptin, lipid profile and C reactive proteins (CRP) were measured. Leptin and CRP levels increased significantly with progression of CKD. High density lipoproteins (HDL) to low density lipoproteins (LDL) ratio was significantly high in control as compared to CKD groups (