Mean BMI Levels Research Articles

A Case Control Study of vNOTES versus Conventional Laparoscopic Salpingectomy for Ectopic Pregnancy

While the laparoscopic approach is the surgical treatment of choice for ectopic pregnancy, vNOTES is emerging as an alternative route with its good optical visibility and avoidance of abdominal incisions. The authors compare demographics and outcome data of vNOTES vs conventional laparoscopic salpingectomy for the surgical management of ectopic pregnancy. Case control study SETTING: A London University hospital PATIENTS: Women with ectopic pregnancy unsuitable for medical management who underwent surgical management INTERVENTION: 25 cases of vNOTES vs 25 conventional laparoscopic salpingectomy MEASUREMENTS AND MAIN RESULTS: The mean patient age (29.7±53 vs 31.4±6.7 days), parity (1.2±1.1 vs 1.6±2.1), BMI (26.7±5.3 vs 27.2±5.4 kg/m3), gestation age (8.44±2.1 vs 7.3±1.7 weeks) and βhCG levels (3725.4±3674.8 vs 4376.5±6493.4 IU/litre) were comparable (p>0.05, t test) between patients having vNOTES vs conventional laparoscopic salpingectomy. While estimated blood loss was similar (218.2±491.7 vs 173.5±138.7 mls)(p>0.001), vNOTES patients had statistically shorter duration of surgery (35.8±14.4 vs 75.8±19.7 mins)(p<0.001, t test) and length of stay (median: 11.5 vs 19.7 hours)(U=72, p<0.05, Mann-Whitney U test). Less patients in the vNOTES group required postoperative opioids (9% vs 25%) and median Visual Analogue Score (/10) for pain at 24 hours was significantly lower (2.0 vs 4.0)(U=75, p<0.05, Mann-Whitney U test). Patients from the vNOTES group were able to return to normal daily activity 11.3 days quicker (5.8±4.3 vs 17.1±8.2 days)(p<0.05, t test). vNOTES cases cost approximately USD150 more due to the price of the commercial kits but this is offset by reduced intraoperative time, length of stay and need for postprocedure analgesia. Patients undergoing vNOTES have shorter intraoperative times and length of stays, less postoperative pain and more rapid recovery, which help mitigate higher cost incurred by commercial kits. While the vNOTES approach for ectopic pregnancy appears safe and efficacious, more robust data from larger randomised studies are needed.

Alterations in nonesterified free fatty acid trafficking rather than hyperandrogenism contribute to metabolic health in obese women with polycystic ovary syndrome

To determine whether alterations in nonesterified fatty acid (NEFA) dynamics or degree of hyperandrogenism (HA) contribute to the difference in insulin sensitivity between women with metabolically healthy obese polycystic ovary syndrome (PCOS) (MHO-PCOS) and women with metabolically unhealthy obese PCOS (MUO-PCOS). Prospective cross-sectional study. Tertiary-care academic center. One hundred twenty-five obese women with PCOS. Consecutive obese (body mass index [BMI] ≥ 30 kg/m2) oligo-ovulatory women (n = 125) with PCOS underwent an oral glucose tolerance test and a subgroup of 16 participants underwent a modified frequently sampled intravenous glucose tolerance test to determine insulin-glucose and -NEFA dynamics. Degree of insulin resistance (IR) in adipose tissue (AT) basally (Adipo-IR) and dynamically (the nadir in NEFA levels observed [NEFAnadir], the time it took for NEFA levels to reach nadir [TIMEnadir], and the percent suppression in plasma NEFA levels from baseline to nadir [%NEFAsupp]); peak lipolysis rate (SNEFA) and peak rate of NEFA disposal from plasma pool (KNEFA); whole-body insulin-glucose interaction (acute response of insulin to glucose [AIRg], insulin sensitivity index [Si], glucose effectiveness [Sg], and disposition index [Di]); and HA (hirsutism score, total and free testosterone levels, and dehydroepiandrosterone sulfate levels). A total of 85 (68%) women were MUO-PCOS and 40 (32%) were MHO-PCOS using the homeostasis model of assessment of IR. Subjects with MUO-PCOS and MHO-PCOS did not differ in mean age, BMI, waist-to-hip ratio, HA, and lipoprotein levels. By a modified frequently sampled intravenous glucose tolerance test, eight women with MUO-PCOS had lesser Si, KNEFA, and the percent suppression in plasma NEFA levels from baseline to nadir (%NEFAsupp) and greater TIMEnadir, NEFAnadir, and baseline adipose tissue IR index (Adipo-IR) than eight subjects with MHO-PCOS, but similar fasting NEFA levels and SNEFA. Women with MUO-PCOS had a higher homeostasis model of assessment-β% and fasting insulin levels than women with MHO-PCOS. In bivalent analysis, Si correlated strongly and negatively with Adipo-IR and NEFAnadir, weakly and negatively with TIMEnadir, and positively with KNEFA and %NEFAsupp, in women with MUO-PCOS only. Independent of age and BMI, women with MUO-PCOS have reduced NEFA uptake and altered insulin-mediated NEFA suppression, but no difference in HA, compared with women with MHO-PCOS. Altered insulin-mediated NEFA suppression, rather than HA or lipolysis rate, contributes to variations in insulin sensitivity among obese women with PCOS.

Prevalence of Depression among Patients with Type-1 and Type-2 Diabetes Mellitus

The diabetic patients are more likely to experience depression. The study's objective was to determine the depression prevalence in newly diagnosed patients with type-I (T1DM) and type-II (T2DM) diabetes, as well as the relationship between these symptoms and several independent clinical and sociodemographic variables. Place and Duration: Study took place in the Department of Endocrinology and metabolism in Services Hospital Lahore, Pakistan for six months of duration from January 2017 to June 2017. Methods: A total of 320 patients included in the study, including two control groups of 180 people without diabetes and 75 patients in each group with T1DM and T2DM. The clinical, biochemical and sociodemographic characteristics of the patients were assessed and Beck Depression Inventory (BDI) was used to assess the symptoms of depression among patients. The association between the scores of BDI and independent factors such age, sex, mean arterial pressure, diabetes duration, BMI, diabetic complications and HbA1c level were assessed in the logistic regression analysis. Results: Compared to controls, females and males with T1DM and T2DM had significantly higher mean BDI scores. Females had depression symptoms more frequently than males diagnosed with diabetes mellitus. Patients with T1DM reported depressive symptoms among 20% of females and 5.7% of males, whereas those with T2DM have depression among 40.6% of women and 23.2% of men. The depression increased with age in patients with T1DM and T2DM, their HbA1c level rises, and they experience more complications. Women with T2DM also have a three-fold high risk of developing depressive symptoms than males. Conclusion: In conclusion, diabetic patients are more likely to experience depression in comparison to non-diabetics. 13.3% of T1DM patients and 30.7% of the T2DM patients having depressive symptoms. HbA1c level, age and the occurrence of comorbidities all raise the risk of depression in both T1DM and T2DM, and in T2DM depression is gender -specific. Keywords: Depressive symptoms, Beck Depression Inventory, type I and type II diabetes mellitus.

Prevalence and Determinants of Selected Cardiovascular Disease Risk Factors: A cross-sectional study among Adults in Sabaragamuwa Province, Sri Lanka

Introduction: Cardiovascular Disease (CVD) is the leading cause of death and disability worldwide. The objective of this study was to assess the prevalence of selected risk factors of CVDs and their associations with socio-demographics and anthropometrics factors among adults in the Sabaragamuwa Province of Sri Lanka. Methods: A descriptive cross-sectional study was conducted among adults aged between 30-60 years. Participants were selected using a three staged random sampling method. The WHO STEPS wise approach was used to collect data. Results: There were 366 participants with a male to female ratio of 1:2.1. The mean age was 45.2 years (SD=8.8). Approximately two-thirds (63.4%) of the participants were physically inactive. Prevalence of high blood pressure, high blood glucose level, high total cholesterol level, high low-density lipoprotein (LDL) cholesterol level, low high-density lipoprotein (HDL) cholesterol level and high triglycerides were 27.0%, 22.1%, 39.9%, 37.7%, 29.0%, and 37.7% respectively. The mean values of systolic blood pressure (SBP), diastolic blood pressure (DBP) and triglyceride level were significantly higher among men, whereas mean values of HDL, LDL, waist circumference and BMI were higher in women. Mean SBP, DBP and prevalence of blood pressure increased with age. Mean waist circumference, BMI, total cholesterol, and triglyceride level increased with the years of education. Conclusion: The prevalence of CVD risk factors was considerably high in this population. Therefore, it is essential to plan public health interventions considering the population characteristics associated with CVD risk factors.&#x0D; &#x0D; Keywords: Adults, Cardiovascular disease, Risk factors, Sri Lanka, WHO STEP wise approach

Association of Serum Anti-Mullerian Hormone Level with Age in Subfertile Patients

Introduction: Infertility affects approximately 10%-15% of reproductive-aged couples. Ovarian reserve describes the number of good-quality oocytes remaining within the ovaries. As a women ages, her ovarian reserve declines, principally due to apoptotic loss of primordial follicles. Serum AMH level is being considered a possible testing method for determining ovarian reserve. The aim of the study was to observe any association between serum Anti- Mullerian Hormone (AMH) level with patient age among subfertile patients. Methods: This cross-sectional observational study was conducted at the Department of Obstetrics and Gynaecology, Infertility Unit, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. The study duration was 14 months, from October 2011 to December 2012. The present study was conducted with 86 women of the reproductive age group with subfertility. Result: There was a gradual linear decline of AMH observed with an increment of age. The mean value of FSH and LH gradually increased in the higher age groups of 40-45 years than in the lower age group of 21-30 years. The mean BMI levels were almost similar in all age groups, and no remarkable difference could be discerned. The difference in AMH levels among the different age groups was statistically significant. a statistically significant negative correlation between age and serum AMH was observed, while a significant positive correlation was observed between FSH and age. Conclusion: As the age of a women advances, the AMH level decreases. The serum AMH is negatively correlated with age and serum FSH is positively correlated with age.

RF18 | PSAT162 Male Runners Have Impaired Tibial Cortical Bone Integrity and Strength Compared to Non-athletes

Abstract Female athletes with low energy availability are at risk for impaired bone microarchitecture and strength associated with hypogonadism. Data are lacking for bone outcomes in male athletes. We studied 31 men 16-30 years (n=15 runners with mean (±SD) mileage 43±4 miles/week, n=16 non-athlete controls). We assessed distal tibia and radius volumetric BMD (vBMD) and microarchitecture by high resolution peripheral quantitative CT (HRpQCT), estimated bone strength by microfinite element analysis and body composition by DXA. Testosterone, estradiol (by LC-MS) and leptin (by electrochemiluminescence) were measured. Groups did not differ for mean age (24.5±3.6y), BMI (22.2±2.6 kg/m2), lean mass, or testosterone or estradiol levels. Mean tibial cortical vBMD was lower and porosity higher in athletes than controls (p&amp;lt;0.01). In contrast, mean tibial trabecular vBMD and number were higher, and separation lower, in athletes (p&amp;lt;0.02). Athletes with BMI ≤ 21 kg/m2 had lower tibial failure load (bone strength estimate) than those with BMI &amp;gt;21 kg/m2 (p=0.007). Lean mass (R=0.85, p&amp;lt;0.0001), serum leptin (R=0.59, p=0.046) and estradiol (R=0.66, p=0.007), but not testosterone, were associated with tibial failure load in athletes. Athlete and control groups did not differ for HRpQCT variables at the radius. Despite weight-bearing activity, male runners have impaired tibial cortical BMD and microarchitecture, which may increase their risk for bone stress injuries. Lower leptin (reflecting lower fat mass) and estradiol (converted from testosterone in adipose tissue), as well as lean mass, are determinants of lower tibial strength in these athletes, suggesting that low energy availability is a risk factor for impaired bone strength in male runners. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m., Sunday, June 12, 2022 12:36 p.m. - 12:41 p.m.

Hypogonadism in Benign Prostate Hyperplasia: A Cross Sectional Study

Benign prostatic hyperplasia is a common health problem affecting men older than 50 years. It is estimated that 30 million men have benign prostatic hyperplasia related clinical features Objective: The objective of this study was to find out the relationship between hypogonadism in patients presenting with benign prostate hyperplasia at tertiary care center. Methods: A descriptive cross-sectional study conducted at Urology Department Lady Reading Hospital Peshawar for a period of one year from June 2019 to May 2020. A total of 361 patients with benign prostate hyperplasia were studied. The sampling technique was consecutive non probability sampling and WHO sample size calculator was used for sample size determination. Serum testosterone level was done all patients as per inclusion criteria. All the data was analyzed in SPSS version 20.0. Results: The mean age, height weight, BMI and testosterone level of qualitative variables were 56.42±10.05, 167.54±9.97, 64.96±12.92, 23.07±4.96 and 15.36±6.36 respectively. The testosterone level decreased with ageing in different age groups. 29.6% patients of our study were 50-59 years old. The hypertensive and diabetic patients with BPH were 31.3% and 22.4% respectively. Out of 361 patients 67 were hypo gonadal men making 18.6%. The hypogonadism had statistically significant mean values of serum testosterone level (p&lt;0.001). Conclusions: This study concluded on the analytical findings that hypogonadism is significantly associated with benign prostate hyperplasia. The testosterone levels decrease with the increase of age and thus patients with low testosterones are more prone to develop benign prostate hyperplasia.

The Relation Between Cortisol and Anthropometric Measurements Throughout Lifespan: A Systematic Review and Meta-Analysis

Introduction: Recently, cross-sectional studies report associations between long-term glucocorticoid levels in scalp hair (HairGC) and obesity. However, there is a wide variation in studied outcomes and associations, possibly caused by differences in population characteristics, e.g. age, sex, dispersion of adiposity, and used laboratory methods. The aim of this systematic review and meta-analysis was to investigate the relation between HairGC and anthropometrics and to explore possible moderators of this association. Methods: We searched the Medline, Embase, Cochrane, Web of Science, Scopus, Cinahl, PsycInfo, and Google Scholar databases for articles that relate HairGC to measures of adiposity (date 11-16-2020). Primary outcomes were correlations between hair cortisol (HairF) and cortisone (HairE), and anthropometrics: BMI, waist circumference (WC) and waist-hip-ratio (WHR). Authors were contacted to provide missing outcome information. Pooled correlation coefficients were calculated using random effects models. Assessment of heterogeneity was performed using the I2 statistic. Exploratory moderator analyses were performed with subgroup analyses and meta-regression. This systematic review was performed in accordance to the PRISMA guidelines. Results: Our systematic search identified 150 cohorts, comprising a total of 37,107 unique individuals, of which 15,033 sampled from population-based cohorts. For BMI, the pooled correlation for HairF was 0.121 (95% CI 0.083–0.158, n=26,941; I2 94.2%, p<0.001) and for HairE 0.108 (95% CI 0.047–0.167, n=7,250; I2 52%, p<0.01). For WC, the pooled correlation for HairF was 0.111 (95% CI 0.058–0.164, n=10,290; I2 63%, p<0.01) and for HairE 0.200 (95% CI 0.137–0.264, n=2,198; I2 0%, p=0.42). For WHR, the pooled correlation for HairF was 0.102 (95% CI 0.040–0.163, n=6,865; I2 27%, p=0.14) and for HairE 0.261 (95% CI 0.195–0.330, n=1,314; I2 0%, p=0.40). A higher percentage of male participants was related to stronger correlations with WC (p<0.001), but not with BMI and WHR. Mean age, mean BMI, and mean HairGC levels of the cohorts did not significantly moderate the pooled correlations, neither did the used laboratory techniques (immunoassays vs mass spectrometry-based assays). Conclusion: This unique, large meta-analysis demonstrates that long-term endogenous glucocorticoids as assessed by HairGC show small but consistent correlations to measures of obesity, despite a large heterogeneity between the included cohorts. The strongest associations were found between HairE and WC and between HairE and WHR. This suggests that glucocorticoid levels in the high-normal range, especially cortisone, may contribute to or reflect the state of specifically central adiposity, even within the general population.

Obesity and Pancreatic Cancer: A Matched-Pair Survival Analysis.

Background: Morbid obesity is a risk factor for pancreatic ductal adenocarcinoma (PDAC). However, the impact of obesity on postoperative outcomes and overall survival in patients with PDAC remains a controversial topic. Methods: Patients who underwent pancreatic surgery for PDAC between 1997 and 2018 were included in this study. Matched pairs (1:1) were generated according to age, gender and American Society of Anesthesiologists status. Obesity was defined according to the WHO definition as BMI ≥ 30 kg/m2. The primary endpoint was the difference in overall survival between patients with and without obesity. Results: Out of 553 patients, a total of 76 fully matched pairs were generated. Obese patients had a mean BMI-level of 33 compared to 25 kg/m2 in patients without obesity (p = 0.001). The frequency of arterial hypertension (p = 0.002), intraoperative blood loss (p = 0.039), and perineural invasion (p = 0.033) were also higher in obese patients. Clinically relevant postoperative complications (p = 0.163) and overall survival rates (p = 0.885) were comparable in both study groups. Grade II and III obesity resulted in an impaired overall survival, although this was not statistically significant. Subgroup survival analyses revealed no significant differences for completion of adjuvant chemotherapy and curative-intent surgery. Conclusions: Obesity did not affect overall survival and postoperative complications in these patients with PDAC. Therefore, pancreatic surgery should not be withheld from obese patients.

The joint association of diabetes distress and depressive symptoms with all-cause mortality in Japanese individuals with type 2 diabetes: a prospective cohort study (Diabetes Distress and Care Registry in Tenri [DDCRT 20]).

The independent association of depressive symptoms and diabetes distress with mortality risk in individuals with diabetes has not been evaluated. We examined the temporal joint association of diabetes distress and depressive symptoms at baseline and the subsequent risk of all-cause mortality. The longitudinal data of 3118 individuals with type 2 diabetes were obtained from a large Japanese diabetes registry. To assess the joint association of diabetes distress and depressive symptoms at baseline with the subsequent risk of all-cause mortality, the Cox proportional hazards model was used with adjustment for potential confounders. The mean age, BMI and HbA1c levels were 64.7years, 24.6kg/m2 and 58.6mmol/mol (7.5%), respectively, and 38.1% of the participants were women. In the multivariable-adjusted models evaluating the diabetes distress and depressive symptoms separately, the HRs for all-cause mortality were 1.67 (95% CI 1.14, 2.43; p = 0.008) and 1.40 (95% CI 1.05, 1.85; p = 0.020), respectively. In such models evaluating the joint association of diabetes distress and depressive symptoms, compared with individuals without diabetes distress or depressive symptoms (DD-/DS-), the HRs for all-cause mortality for the group without diabetes distress but with depressive symptoms (DD-/DS+), with diabetes distress but without depressive symptoms (DD+/DS-), and with diabetes distress and depressive symptoms (DD+/DS+) were 1.34 (95% CI 0.99, 1.86; p = 0.056), 1.96 (95% CI 1.10, 3.50; p = 0.023) and 1.71 (95% CI 1.06, 2.77; p = 0.029), respectively. We did not observe a significant interaction between diabetes distress and depressive symptoms with all-cause mortality risk (p = 0.2636). In the stratified analysis by sex, a significant joint association of diabetes distress and depressive symptoms with the risk of all-cause mortality was observed only in men. Diabetes distress and depressive symptoms were independently associated with all-cause mortality risk in male participants with type 2 diabetes, but we did not observe a significant interaction between diabetes distress and depressive symptoms in relation to all-cause mortality. Graphical abstract.

EMBRYOLOGIC OUTCOMES IN INTRACYTOPLASMIC SPERM INJECTION (ICSI) CYCLES UTILIZING SPERM SELECTED VIA A MICROFLUIDICS DEVICE COMPARED TO STANDARD SELECTION

Microfluidics sperm sorting allows for improved selection of normal sperm compared with conventional sperm preparation, but blastulation rate after its use has not been studied. We aim to compare the high-quality blastulation rate in cycles in which sperm was chosen via a microfluidics device versus standard sperm selection. Single academic IVF center retrospective cohort study. The IVF/ICSI cycles of 45 patients aged 18-46 years between 2014-20 utilizing a microfluidics chamber (ZyMotTM) with ICSI for sperm selection were compared to the same patients’ previous ICSI cycles in which standard sperm selection was used. Use of microfluidics was based on physician discretion and/or the IVF lab recommendation based on previous low fertilization rate or blastulation rate. For standard selection, after centrifugation and washing by swim-up method sperm was chosen manually based on motility and morphology. In study cycles, motile sperm were manually selected after traversing through a microfluidics chamber. Primary outcome was high-quality blastulation rate (≥3BB by Gardner scoring). Secondary outcomes included fertilization rate, number of high-quality blastocysts frozen, and euploidy rate among IVF cycles using preimplantation genetic testing for aneuploidy (PGT-A). For paired data, McNemar’s test was used for categorical and paired T-test for continuous data. A two-sided p-value of <0.05 was considered statistically significant. Mean patient age, partner age, BMI, and AMH level at the time of standard selection cycle were 37.3 years, 37.7 years, 25.5 kg/m2, and 2.5 ng/mL, respectively. The majority of patients’ primary infertility diagnosis was male factor (42.2%), followed by unexplained (22.2%). 35.6% of patients used the same stimulation protocol for both cycles. The use of PGT-A, mean numbers of oocytes retrieved, and pre- and post-processing sperm parameters were similar. Although the high quality blastulation rate was higher in microfluidics cycles, the difference was not significant. The fertilization rate, euploidy rate and mean number of embryos frozen did not differ significantly (Table 1).Table 1Embryologic OutcomesStandard Selection CyclesMicrofluidics Cyclesp-valueNo. of oocytes retrieved (n ± SEM)10.1 ± 8.811.7 ± 8.60.08Fertilization rate (% ± SEM)54.1 ± 4.657.8 ± 3.50.49High-quality blastulation rate (% ± SEM)25.2 ± 7.338.1 ± 4.70.15Number of high-quality blastocysts frozen (n ± SEM)1.9 ± 0.32.8 ± 0.60.11Euploidy rate (% ± SEM)16.7 ± 8.920.1 ± 6.40.78 Open table in a new tab Microfluidics sperm selection did appear to improve blastulation rate although this was not statistically significant due to the sample size. Further large prospective randomized studies are needed.

COMPARISON OF POST OPERATIVE PAIN WITH EFFICACY OF INTRAVENOUS ACETAMINOPHEN VERSUS KETAMINE AMONG PATIENTS UNDERGOING ABDOMINAL HYSTERECTOMY

Objective; To determine the effectiveness in terms of postoperative pain with intravenous acetaminophen versus ketamine among women undergoing abdominal hysterectomy. Material and Methods; A total of 114 women undergoing abdominal hysterectomy were taken in this study. The study was conducted at Akhtar Saeed Trust Hospital, Lahore and Nishtar Hospital Multan. Data was analyzed with statistical analysis program (SPSS version 21). Analysis was done to compare proportion of acetaminophen group and ketamine group. Chi-square test was applied to compare both groups in terms of efficacy taken p ≤0.05 as significant. Results; Our study comprised of 114 ladies undergoing abdominal hysterectomy, mean age of the study cases was 54.13 ± 6.89 years (with minimum age of the patients was 39 years while maximum age was 68 years). Majority of our study cases i.e. 92 (80.7 %) had parity more than 3 and American Society of Anesthesiology (ASA) score level 1 in 93 (81.6%). Sixty one (53.1%) belonged to rural areas, while mean duration of surgery was 72.80 ± 11.32 minutes. Mean BMI level in our study cases was noted to be 23.98 ±4.17 Kg/m 2 and obesity was present in 34 (29.8%) of our study cases. Efficacy was noted in 60 (52.6 %) of our study cases. Efficacy was 73.7% study cases in group A while 18 (31.6%) in group B (p=0.000). Conclusion; Our study results support the use of intravenous acetaminophen (IVA) for pain management in patients undergoing abdominal hysterectomy compared with ketamine. Intravenous acetaminophen is safe, reliable and effective for the pain management in postoperative abdominal hysterectomy patients which was associated with shorter hospital stay and cost effective for the suffering families. No adverse reactions were noted in this study with the use of intravenous acetaminophen. Keywords; Intravenous acetaminophen, Ketamine, Abdominal Hysterectomy. DOI: 10.7176/JMPB/67-04 Publication date: August 31 st 2020

Outcome of non-invasive ventilation (NIV) among patients with type II respiratory failure due to acute exacerbation of chronic obstructive pulmonary disease (COPD).

Objectives: To determine the “frequency of ‘success’ of non-invasive ventilation (NIV) among patients with type II respiratory failure due to acute exacerbation of chronic obstructive pulmonary disease (COPD)”. Study Design: Cross sectional Study. Setting: Department of Pulmonology Nishtar Hospital Multan. Period: March 2016 August 2016. Material &amp; Methods: A total of 101 study cases meeting inclusion and exclusion criteria of this study were registered using non probability consecutive sampling technique. Arterial samples for arterial blood gases (ABG) were sent. Base line pH and pcO2 were measured. All the patients were offered with NIV for 12 hours. After 12 hours, ABG was again measured to see any improvement in pH and pCO2. Success as labeled as ‘yes’ if pH &gt; 7.35 and pCO2 is &lt; 60 mm of Hg. The patients were discharged and follow up time was adjusted. Results: Out of these 101 study cases, 53 (52.5 %) were male and 48 (47.5 %) were female patients having mean age 61.50 ± 10.77 years. Mean duration of disease was 8.54 ± 5.26 years. Mean BMI levels of our study cases was 23.31 ± 2.18 Kg/m2. Mean baseline pH value was 7.32 ± 0.016. Mean baseline pCO2 value was calculated to be 67.56 ± 6.05 mmHg. Mean pH value at 12 hours after NIV was 7.37 ± 0.02. Mean pCO2 value at 12 hours after NIV was calculated to be 51.32 ± 6.30 mm Hg. Success was achieved in 98 (97%) of our study cases. Success was stratified with regards to gender, age, BMI and duration of disease and p values calculated were found to be p=1.00, p= 0.591, p=0.026 and p=0.606 respectively. Conclusion: Our study results indicate that Non-invasive ventilation (NIV) is effective, reliable, safe and very cost effective method among the patients with respiratory failure due to acute exacerbation of COPD.

OUTCOME OF INTRAVENOUS ACETAMINOPHEN IN PAIN RELIEF AMONG UNDERGOING ABDOMINAL HYSTERECTOMY

Objective; To determine the efficacy of intravenous acetaminophen for postoperative pain after abdominal hysterectomy. Material and Methods; A total of 114 women undergoing abdominal hysterectomy were taken in this study. The study was conducted from June 2018 to May 2019 at department of Anesthesiology, Nishtar Hospital, Multan. Results; Our study comprised of 114 ladies undergoing abdominal hysterectomy, mean age of the study cases was 54.13 ± 6.89 years (with minimum age of the patients was 39 years while maximum age was 68 years). Majority of our study cases i.e. 92 (80.7 %) had parity more than 3 and American Society of Anesthesiology (ASA) score level 1 in 93 (81.6%). Sixty one (53.1%) belonged to rural areas, while mean duration of surgery was 72.80 ± 11.32 minutes. Mean BMI level in our study cases was noted to be 23.98 ±4.17 Kg/m 2 and obesity was present in 34 (29.8%) of our study cases and Efficacy in terms of pain reduction was 73.7%. Conclusion; Our study results support the use of intravenous acetaminophen (IVA) for pain management in patients undergoing abdominal hysterectomy. Intravenous acetaminophen is safe, reliable and effective for the pain management in postoperative abdominal hysterectomy patients which was associated with shorter hospital stay and cost effective for the suffering families. No adverse reactions were noted in this study with the use of intravenous acetaminophen. Keywords; Intravenous acetaminophen, pain relief, Abdominal Hysterectomy. DOI : 10.7176/JMPB/62-10 Publication date: December 31 st 2019

PREVALENCE OF NAFLD AND IT’S ASSOCIATION WITH INSULIN RESISTANCE IN PATIENTS WITH DIABETES

Objectives: Non Alcoholic Fatty Liver Disease (NAFLD) is characterized by fatty infiltration of the liver, mostly in the form of triglycerides (TG), which exceeds 5% of the liver weight.NAFLD is strongly associated with Insulin Resistance(IR).Patients with NAFLD also having type 2 diabetes carry added risk of progressive forms of the disease particularly cirrhosis. They also have poor glycemic control owing to IR. So it is logical to identifying the patients with diabetes having NAFLD could estimates the future risk and help in prevention of chronic liver disease and delaying the progression to NASH and cirrhosis and various complications of Diabetes.&#x0D; Methods: This was a cross sectional observational study conducted in department of medicine, N.S.C.B., MCH, Jabalpur in which 100 cases of diabetes were taken who satisfied inclusion and exclusion criteria. Abdominal USG was used for evidence of fatty liver and it’s grading and fasting serum levels of insulin (FIL) and fasting blood sugar(FBS) were used to calculate HOMA IR value to find presence of IR.&#x0D; Results: Our study showed prevalence of NAFLD was 56%(n-56),Among these,in 58.92%(n-33) cases NAFLD is associated with IR(chi square value-4.1,p value-0.041).Prevalence of NAFLD was slightly more in females-56.6%(n-30) as compare to males-55.32%(n-26).Strong association of NAFLD with IR is found among females as compare to males (p-0.022 and p-0.79 respectively). Waist circumference, Mean BMI, FBS, Triglycerides, FIL and HOMA IR levels in cases with NAFLD (95.11±12.46, 24.83±2.42, 176.13±66.79, 180.07±51.35, 13.59±15.42, 5.33±5.21)were higher as compare to non NAFLD (85.84±9.86, 22.41±2.16, , 134.8±34.41,139.09±39.27, 6.79±4.49, 2.37±1.94)respectively. The mean AST and ALT levels were higher in NAFLD group than Non NAFLD group (t= 2.23,2.19) respectively with p value &lt;0.05.Prevalence of NAFLD was 88.23%(n-15)in obese population.&#x0D; Conclusion: Given the high prevalence of NAFLD in patients with diabetes, the possibility of NAFLD should be suspected in all of them. These patients with NAFLD have high propensity of IR than Non NAFLD patients, so are at higher risk of developing complications of diabetes, NASH and cirrhosis. Also obese diabetic patients have higher incidence of NAFLD and IR as compared to non-obese patients. It seems reasonable to expect that early diagnosis of NAFLD and early intervention with strict glycemic control and weight loss would prevent complications.

Low Cruciferous Vegetable Intake is Associated with Elevated Inflammation in Preadolescent Girls

Subclinical chronic inflammation, measured by C-reactive protein (CRP), is strongly linked to cardiovascular disease (CVD) in adults. CRP has been shown to be elevated in some children and is considered a potential risk factor for early onset CVD. Strategies to reduce chronic inflammation among children is paramount. In adults, higher cruciferous vegetable intake has been associated with lower inflammation. PURPOSE: To examine the relation between cruciferous vegetable intake and CRP among preadolescent girls. METHODS: Among girls aged 9-12 yrs (N=296), cruciferous vegetable intake was measured by the Youth/Adolescent Questionnaire and categorized as >0-0.25, 0.26-0.50, >0.50 servings per day. Fasting serum CRP (mg/L) was measured by the Beckman Coulter AU5812 Clinical Chemistry Analyzer. Girls with CRP values >10mg/L were excluded. CRP levels were categorized by normal, moderately increased risk, and high risk for CVD according adult cut-offs (CRP <1, ≥1-3, >3 mg/L). Multinomial logistic regression with covariates of BMI percentile, maturation, and physical activity was used to evaluate CRP category relation with cruciferous vegetable intake. RESULTS: Mean age, BMI, and CRP levels were 10.8±1.1 yrs, 20.7±5.1 kg/m2, and 1.3±1.8 mg/dl, respectively. The proportion of girls in the normal, moderate, and high risk CRP categories were (N/%): 218 (69.2%), 50 (15.9%), 47 (14.9%). Average cruciferous vegetable intake was 0.27±0.3 servings/day. Low cruciferous vegetable intake (>0-0.25 servings/day) was significantly associated with a CRP level of 1-3mg/L (RRR=3.5, 95% CI 1.1-11.3; P=0.04). CONCLUSIONS: Cruciferous vegetable intake among girls aged 9-12 years was low overall. The lowest intake was associated with the CRP risk category considered to confer a moderately elevated risk of CVD among adults. Enrichment of the diet with cruciferous vegetables is an intervention strategy that should be tested in girls to reduce inflammation and CVD risk early, regardless of BMI status. Supported by National Institute of Child Health and Human Development (HD074565) and the National Cancer Institute (P30CA023074)

To Evaluate the Association between Serum Leptin and Insulin/Insulin Resistance in Polycystic Ovarian Syndrome in a Tertiary Care Centre in North India

Background: Polycystic ovarian syndrome (PCOS) a common endocrinological disorder among women in the reproductive age group, is associated with hyperinsulinemia/Insulin resistance, obesity, menstrual irregularities and anovulation.&#x0D; Aim and Objectives: The present study was conducted to evaluate the association between insulin/insulin resistance and leptin among women with PCOS in a sample population of a tertiary care centre in North India.&#x0D; Materials: Ninety newly diagnosed cases of PCOS as per Rotterdam criteria were enrolled in the study, along with ninety normal women of similar age and BMI. Serum insulin, fasting glucose and serum leptin were estimated, Insulin resistance was calculated using (HOMA-IR) the homeostatic model for assessment-insulin resistance.&#x0D; Results: In our study leptin levels were raised in both cases and in controls. Leptin levels correlated positively with BMI among the cases (r=0.21) and also among the controls (r=0.003). In our study PCOS women had higher mean BMI and leptin levels when compared to controls. Insulin levels correlated positively with BMI among the cases (r=0.21) and was statistically significant (P=.004). Insulin levels were higher in women with BMI in the overweight and obese category. Although most of our cases were of lean weight and BMI in the normal range, high insulin and IR was detected in them showing impaired glucose metabolism. Leptin levels were higher in cases group who also had high IR when compared to healthy controls in our study. Leptin levels correlated positively with IR among cases (r=0.25) and this was statistically significant (P=.013).&#x0D; Conclusion: Our study showed higher serum Leptin, insulin and IR among PCOS cases when compared to the control group.

Metabolic antioxidant status in obese individuals

To assess the level of metabolic antioxidant-uric acid in obese individuals. ​Obesity is the major health problem worldwide. This condition leads to the development of or causative factors for the many other disease conditions like cardiovascular disease, chronic renal failure, diabetes mellitus and so on. Many metabolic products are synthesized in this condition may prevent or proceed with the disease condition. So, the current study aimed to assess the one of the metabolic product- uric acid level in obese individuals. 20 age and sex-matched healthy individuals with BMI (19.9-24.9), 20obese individuals were selected from those attending the outpatient department of Saveetha Dental College, and hospitals. Informed consent was obtained from the patients before sample collection. 5 ml of venous blood was collected in plain collection tubes and centrifuged in3000rpm. Then serum was separated and analyzed to estimate the Serum Uric acid by Uricase method using ERBA CHEM 5 plus analyzer. Mean BMI and Uric acid level of the control group were 21.89±1.87 and 3.57±0.9respectively. Mean BMI and Uric acid level of the study group were 37.13±5.13 and 6.0±1.28. There is a significant difference between these two groups with the p-value of 0.0001. The data of the present study suggested uric acid level was increased in obese individuals.

Diabetes Distress and All-Cause Mortality in Patients with Type 2 Diabetes—A Prospective Cohort Study

We studied a cohort of 3,3Japanese patients with type 2 diabetes to determine the prospective association between diabetes distress measured by problem areas in diabetes (PAID) survey at baseline and subsequent risk of all-cause mortality. Longitudinal data were obtained from this cohort who completed the PAID survey at baseline. We excluded patients with a past history of any cancer. We categorized PAID total score into quintiles and assessed the independent correlation with all-cause mortality using the Cox proportional hazards model adjusted for potential confounders [age, gender, BMI, HbA1c, diabetes therapy, urine albumin/creatinine ratio, retinopathy, diabetic neuropathy, and past medical history]. Mean patient age, BMI, and HbA1c level were 64.9 years, 24.6 kg/m2, and 7.5% (57.6 mmol/mol), respectively. Median total PAID score was 29 overall, and 21, 25, 30, 39, and 55 for the1st to 5th quintiles, respectively. We observed 251 of any death cases during median follow-up of 6.1 years. Compared with the 1st quintile of PAID score, the multi-variable adjusted hazard ratios of all-cause mortality were 1.11 (95% CI, 0.78-1.60; p = 0.56), 0.87 (95% CI, 0.56-1.35; p = 0.524), 0.95 (95% CI, 0.62-1.44; p = 0.802), and 1.60 (95% CI, 1.09-2.35; p = 0.016). In conclusion, diabetes distress measured by the PAID survey was associated with a subsequent risk of all-cause mortality in patients with type 2 diabetes. Disclosure Y. Hayashino: None. S. Okamura: None. S. Tsujii: None. H. Ishii: None.

Association of diabetes therapy-related quality of life and physical activity levels in patients with type 2 diabetes receiving medication therapy: the Diabetes Distress and Care Registry at Tenri (DDCRT 17).

To examine the association between diabetes therapy-related quality of life (DTR-QOL) and physical activity levels, and identify factors associated with high diabetes therapy-related quality of life. Cross-sectional data from 2970 patients with type 2 diabetes in a Japanese diabetes registry were assessed for independent correlations between DTR-QOL (domains 1-4) and high physical activity levels. Data collected by the International Physical Activity Questionnaire were analyzed by logistic regression and adjusted for potential confounders. The mean patient age, BMI and HbA1c level were 65.8years, 24.7kg/m2 and 7.6% (58.7mmol/mol), respectively. Univariate analysis showed that DTR-QOL domain 1, 2 and 4 scores were significantly associated with physical activity levels (p=0.0046, p=0.0004 and p<0.001, respectively, but domain 3 score was not (p=0.5073). In a multivariable-adjusted logistic regression model, odds ratios (ORs) of DTR-QOL domains 1, 3 and 4 were independently associated with high physical activity (ORs for 2nd to 4th quartile and p for trend; [domain 1] 1.16, 1.56, 1.22, p=0.032; [domain 3] 1.45, 1.55, 1.38, p=0.049; [domain 4] 1.09, 1.30, 1.51, p=0.001, respectively), but domain 2 was not (ORs for 2nd to 4th quartile and p for trend; 1.19, 1.26, 1.23, p=0.096). High diabetes therapy-related QOL scores were associated with high levels of physical activity in patients with type 2 diabetes. Because this is a cross-sectional study, further study is needed to evaluate the causal association between therapy-related QOL and physical activity.