Orexin and male reproduction

Orexins (or hypocretins) are hypothalamic neuropeptides with a multitude of physiological functions. They occur in two known forms, namely, orexin A and orexin B with a common precursor, preproorexin. The orexin receptors (orexin 1R and orexin 2R) belong to the Family of G-protein coupled receptors. The primary function of the orexin system, i.e. the orexins, their receptors and associated neuronal circuitries, perhaps is to increase spontaneous physical activity and food intake, thereby promoting an increase in energy expenditure. Reports suggest that orexins may be the key brain components to mediate the mechanism of obesity resistance. Recent research also has thrown lights upon a significant role of orexins, especially orexin A, in regulation of male reproductive functions owing to their receptor expressions in vital testicular cells, such as Leydig cells, Sertoli cells as well as spermatozoa at different developmental stages, even in the epididymis and penis. Moreover, orexins have been reported to greatly influence gonadotropin-releasing hormone neurons and their secretions to regulate reproductive functions via modulation of the hypothalamic-pituitary-gonadal axis. Evidence thus implicates participation of orexins in steroidogenesis, spermatogenesis, transportation and maturation of sperm as well as in the control of penile function. However, further research is required in this direction to elucidate the mechanisms by which orexins play a role in different testicular functions and effect of orexins on semen quality

Prevalence and correlates of anger among undergraduate students in Malaysia

Anger is a vital emotion for human survival. Mild level of anger that occurs briefly can be beneficial, but it may cause harm if it occurs continuously with poor control. Specifically, among medical doctors, controlling emotion is important to keep check of their professional conduct. In Malaysia, there is a growing number of reports on the misconduct and aggressive behaviours of health care workers, including housemen and medical doctors, proving a need to explore the issue among current medical trainees. Hence, this study aims to investigate the association between socio-demographic characteristics with anger among medical students in the Universiti Putra Malaysia. Cross-sectional study with stratified random sampling method was conducted. Novaco Anger Inventory and the State and Trait Anger Expression Inventory-2, was used in current study. The results showed a significant association between gender (p= 0.015) and intensity of anger. Besides, results also showed a significant association between gender and trait anger levels (p=0.003). For anger expression and control, the results showed a significant associations between year of study (p= 0.028) and gender (p=0.015), with anger expression and control. There was a relationship between year of study and anger expression, as well as gender and intensity of anger, trait anger levels, and anger expression

Association of maternal and cord plasma total, free and bioavailable 25-hyrodroxyvitamin D with neonatal anthropometric measurements at birth: a preliminary study in a private hospital

Introduction: 25-hydroxyvitamin D (25OHD) is the principal biomarker of vitamin D status. In circulation, 25OHD is primarily bound to vitamin D binding protein (VDBP), leaving a small proportion bound to albumin and as free form. Previous studies have suggested that free 25OHD is better correlated with health outcomes. However, in pregnancy where VDBP level is extremely elevated, the correlations between free 25OHD with health outcomes are far from conclusive. Here we show the associations of maternal and cord total, free and bioavailable 25OHD con-currently with neonatal anthropometric measurements in healthy pregnant mothers-neonates pairs. Method: Total 25OHD level was measured by using chemiluminescent immunoassay. Free and bioavailable 25OHD were calculated using published mathematical models. Results: The results showed that birth weight and head circumference were negatively associated with maternal total 25OHD but not significantly associated with free and bioavailable 25OHD. There were no significant associations between cord total, free and bioavailable 25OHD with any of the neonatal anthropometric measurements. Conclusion: The outcomes of this study should encourage further research in a larger sample size. Notably, future research could lead to the establishment of causative relationships and plausible mechanisms between maternal and cord 25OHD with neonatal anthropometric measurements

Prevalence and correlates of polycystic ovarian syndrome among women attending infertility clinic

Polycystic ovarian syndrome (PCOS) is a complex endocrine disorder which affects 5% to10% of women worldwide. The disease is caused by insulin resistant that results in hyperinsulinaemia, and further stimulates the excessive production of androgen and luteinizing hormone. Hyperandrogenism which is referred to the excessive production of androgen leads to the clinical conditions like acne, obesity, alopecia and irregular menstruation. Previous studies have shown the risk factors of PCOS include age, ethnicity, obesity, smoking, alcohol consumption and menstrual problem. A cross sectional study was conducted at infertility clinic in Hospital Serdang. Simple random sampling was adopted to recruit 138 women who attended the infertile clinic. Data including sociodemographic data, lifestyle factors, medical disorders, gynaecology disorders, family medical history, menstrual problem, diagnostic criteria of PCOS, metabolic parameters, and causes of infertility, were retrieved from medical record. Chi square test and SPSS version 21 was used for data analysis. Among 138 participants, 37.7% are diagnosed with PCOS and 62.3% are not diagnosed with PCOS. Among PCOS patients, 92.3% are found to age less than 35 years old, 90.4% Malay, 75% with menstrual problem and 80.8% obese. Age, menstrual problem, and obesity were significantly associated with PCOS diagnosis. Measures like medical education and healthy lifestyle should be implemented to prevent the complications of PCOS

The impact of severity of antenatal anaemia on maternal and perinatal outcome in Hospital Serdang, Central Malaysia

Introduction: Anaemia in pregnancy is one of the most common public health issues in developing countries, affecting approximately 60% of pregnant woman worldwide. Severity of antenatal anaemia had been robustly linked with complications in maternal and perinatal outcome. Objective: This study aimed to analyze the relationship of antenatal anaemia with maternal and perinatal outcome among parturient delivering in Hospital Serdang. Materials and method: This retrospective cross-sectional study was conducted in a tertiary public hospital in Serdang, Selangor. 473 anaemic mothers were recruited from the electronic medical database by clinical notes and cross-referencing to the datasets of relevant test. All subjects received antenatal oral iron supplementation. Results: Multiparous mother contributed to majority of the anemia cases in pregnancy (60.5%). Out of 473anaemic mother suffering from Iron Deficiency Anemia (IDA), 61.3% (n=290) mothers had mild anaemia, 38.5%(n=182), and 0.2% (n=1) mothers had moderate and severe anaemia respectively. A significant association was demonstrated between severity of anaemia with post-partum haemorrhage and small for gestational age. On contrary, severity of maternal anaemia was non-significantly associated with placenta abnormalities, pre-eclampsia and sepsis. Conclusion: Anaemia amongst pregnant women especially multipara imposed a spectrum of health problems to both, mother and child. Prevention is not insurmountable; hence active intervention by all level of health care provider is imperative in order to decrease poor maternal and perinatal outcome

Influence of vitamin D binding protein polymorphism, demographics and lifestyle factors on vitamin D status of healthy Malaysian pregnant women

Background: Vitamin D deficiency (VDD) has been related to vitamin D binding protein (GC) gene polymorphism, demographics and lifestyle factors in different populations. However, previous studies only focused on demographic and lifestyle factors or genetic factors alone. Therefore, this cross-sectional study aimed to assess the association between GC gene polymorphism, demographics and lifestyle factors with VDD among Malaysian pregnant women. Method: Information on demographic characteristics, dietary vitamin D intake from supplement and food, time spent outdoors, skin type and clothing were collected using a questionnaire. Plasma total 25-hydroxyvitamin D (25OHD) levels were measured using an Ultra-High-Performance Liquid Chromatography (UHPLC). Maternal GC single nucleotide polymorphisms (SNPs) (rs4588 and rs7041) were determined using restriction fragment length polymorphism (RFLP) technique. Results: Results showed that 50.2% of pregnant women were vitamin D deficient (25OHD < 30 nmol/L). VDD (25OHD < 30 nmol/L) was significantly associated with age, veiled clothing, maternal vitamin D intakes from both food and supplements, and GC rs7041(and GC diplotypes). In contrast to previous studies that reported for non-pregnant population, a significant positive association was found between CC genotype for SNP GC rs7041, GC 1s-1s and GC If-2 with risk of VDD (25OHD < 30 nmol/L). Conclusions: The high prevalence of maternal VDD found in this study suggests the need for urgent development and implementation of vitamin D supplementation or fortification strategies to reduce VDD among pregnant women. The discrepancy in the association between GC rs7041 gene polymorphism and VDD reflects the variation in the factors associated with VDD in pregnancy compared to non-pregnant state

Sociodemographic determinants of knowledge and attitude in the primary prevention of cervical cancer among University Tunku Abdul Rahman (UTAR) students in Malaysia: preliminary study of HPV vaccination

Background: Cervical cancer is the third most common cancer affecting women around the world in which the Human Papillomavirus (HPV) is the one of the recognized causative agent affecting women health. In response to this health issue, the Malaysian government had officially implemented the HPV immunisation programme for secondary schoolchildren in 2010 at the age of 13 years old and above. The purpose of this study is to investigate the sociodemographic determinants of knowledge and attitude among students of Universiti Tunku Abdul Rahman (UTAR) towards the HPV vaccination programme. Methods: A cross-sectional study was conducted using self-administered questionnaires, recruiting 374 UTAR's students as the respondents by using convenience sampling method. Respondents were categorized as having good/poor level of knowledge and positive/negative attitude towards HPV vaccination. Results: Over half of the respondents were females (64.5%) and the majority were aged 20 years old and below (55.8%). Generally, 54.7% of the total respondents had a high level of knowledge towards HPV vaccine while 57.5% of the total respondents showed a negative attitude towards HPV vaccine. Female respondents aged 20 years old and below showed good knowledge (56.4%) and a more positive attitude (55.8%) towards HPV vaccine. Students from the Faculty of Medicine and Health Sciences (FMHS) exhibited higher knowledge (67.3%) and positive attitude (62.4%) as compared to the Faculty of Accountancy and Management (FAM) which showed only 32.7% of knowledge and 37.6% of positive attitude towards the HPV vaccination. Conclusion: The majority of UTAR students possess good knowledge regarding HPV vaccination. Nonetheless, they demonstrated a negative attitude towards HPV vaccination, depicting the necessity to impart and further intensify the sense of health awareness among all students, especially among male students. The judicious use of social media apart from the conventional mass media should be an advantage as to enhance the practice of HPV vaccination among them and thereafter minimize the health and economic burdens of cervical cancer

Effects of gestational diabetes mellitus on the quality and quantity of blood hematopoietic stem cells: a case-control study

Aim: To evaluate the effects of gestational diabetes mellitus (GDM) on the quantity and quality of hematopoietic stem cells (HSC). Methods: In this case-control study, HSC were isolated from umbilical cord blood (UCB) procured at delivery from 63 mothers with GDM and 67 healthy mothers. Total nucleated cells (TNC) and CD34+ cells were quantified using BD FACSCalibur flow cytometer. The quantity and quality of stem cells were determined. Results: The GDM group had lower total cord blood volume and lower number of nucleated HSC compared with healthy mothers. Regarding stem cell quantity parameters, they had significantly lower UCB volume (P=0.041), TNC count (P=0.022), total viable NC count (P=0.014), and CD34+ percentage (P=0.014). Regarding the quality of stem cells, they had significantly lower viable TNC percentage (P=0.015). The predictors for total TNC count were longer labor duration (adjusted B coefficient [p]: 0.031 [0.046]), greater estimated blood loss (0.089 [0.005]), female neonates (12.322 [0.049]), and higher placenta weight (0.080 [0.033]). The predictors of total viable NC count were greater estimated blood loss (0.092 [0.003]), female neonates (13.16 [0.035]), and greater placenta weight (0.083 [0.026]). Conclusion: The GDM group had much lower quantity and quality of UCB stem cells. Our results should be taken into consideration when drawing cord blood for unrelated stem cell banking in an obstetric unit to ensure the obtaining of optimal cord blood samples and to avoid unnecessary expenses

Prevalence of anxiety among gestational diabetes mellitus patients: a systematic review and meta-analysis

Background: A diagnosis of gestational diabetes mellitus (GDM) negatively influences maternal mental health. There is a lack of systematic review and meta-analysis on prevalence of anxiety among GDM women. AIM To pool data from existing literature to determine the pooled estimates for the prevalence of anxiety among women diagnosed with GDM. Methods: We searched multiple databases including MEDLINE, Cinahl, PubMed and Scopus to identify studies published up to 31 October 2019 with data on the prevalence of anxiety among women diagnosed with GDM. Data were extracted from published reports. Estimates were pooled using random-effects meta-analyses. Results: We reviewed 19 abstracts, retrieved 10 articles and included three studies incorporating 12744 GDM women from three countries. The pooled prevalence of anxiety was 29.5% (95%CI: 6.9, 52.0) among GDM women. Conclusion: Prevalence of anxiety among GDM women was high. We suggest that epidemiological studies on anxiety should be conducted urgently as it merits clinical attention. In addition, it is important to identify factors associated with anxiety among women diagnosed with GDM

Core clinical cases in obstetrics: management & commentaries

Obstetrics has evolved from an apprentice system to a more structured course format. Advances have been constructed with the use of simulated cases, problem-based learning and e-learning resources; however, this has led to a separation of the learning environment from the clinical art of real medicine. Pregnancy is an instinctive process, yet each pregnancy for each individual is unique and complex. I have written this book with both clinicians, medical and post-grad students in mind, with cases varying in complexity, to reinforce common or vital subject areas. This book therefore differs from those of clinical medicine and surgery in that the cases selected are core obstetrics cases, a real case scenario for which management were based on clinical grounds and evidence-based medicine. In view of the possibility of progress and advances in medical sciences, readers are encouraged to complement the information contained here with other reliable sources. I hope this book will stimulate and challenge as well as build confidence for those working or learning in obstetrics