Department of Physiology

“TO EVALUATE THE ASSOCIATION BETWEEN NAFLD/NASH IN PREDIABETES AND TYPE 2 DIABETES MELLITUS WITH NON-INVASIVE BIOMARKERS.”

2026-02-24T05:13:53Z

“TO EVALUATE THE ASSOCIATION BETWEEN NAFLD/NASH IN PREDIABETES AND TYPE 2 DIABETES MELLITUS WITH NON-INVASIVE BIOMARKERS.” DR.ZAKIA NASEEM 06-117232-001 Hepatic steatosis, or the buildup of extra fat in the liver, is a hallmark of nonalcoholic fatty liver disease (NAFLD), a group of liver disorders that affect people who drink little or no alcohol. Metabolic risk factors like obesity, insulin resistance, type 2 diabetes, and dyslipidemia are frequently linked to it. NAFLD is usually diagnosed when fat accumulation is <5% in hepatocytes. In addition to fat accumulation, NASH, the more serious kind of NAFLD, additionally comprises injury to hepatocytes and liver inflammation, with or without fibrosis. Hepatocellular carcinoma, cirrhosis, and severe fibrosis can develop from NASH. The World Health Organization (WHO) estimates that 642 million adults worldwide will have diabetes mellitus (DM) by 2040, rising from the 422 million adults who had it in 2014.T2DM is a substantial contributor to morbidity and mortality and places a heavy financial strain on the healthcare systems of the world . It is characterized by a combination of inherited and environmental factors that results in relative insulin insufficiency and insulin resistance. NAFLD AND T2DM both are highly prevalent disease worldwide. According to research both have a strong relation .there are many studies that proven the relation between them globally, nonetheless, there are still discrepancies in research and clinical awareness, particularly in low- and middle-income countries, like Pakistan. We aim to detect the prevalence of NAFLD or NASH in T2DM and pre-diabetic patients. The study was conducted in NMC hospital located in Karachi, Pakistan. The patients were enrolled from the diabetic clinic, after consent was taken , questionnaire was filled with vitals and anthropometric measurement was taken ,the patient then send for blood sampling followed by ultrasound abdomen. According to our study we found that Prevalence of non-alcoholic fatty liver disease was 17.9% and 82.1% among pre-diabetes and diabetes patients respectively whereas prevalence of Non alcoholic steatohepatitis was 0% and 100% among pre-diabetes and diabetes patients respectively. We found significant association of non-alcoholic steatohepatitis with age group. Additionally, We found significant difference for age (p<0.001), LDL (p=0.006), ALT (p<0.001), AST (p<0.001) and ALT/AST ratio (p<0.001) according to non alcoholic fatty liver disease. Supervised by Prof,Dr.Shazia Shakoor

COMPARATIVE ANALYSIS OF C-REACTIVE PROTEIN /ALBUMIN RATIO AND RANSON CRITERIA FOR EVALUATING THE SEVERITY OF ACUTE PANCREATITIS.

2024-12-24T05:35:28Z

COMPARATIVE ANALYSIS OF C-REACTIVE PROTEIN /ALBUMIN RATIO AND RANSON CRITERIA FOR EVALUATING THE SEVERITY OF ACUTE PANCREATITIS. SIDRA ANEES (06-117222-002) Acute pancreatitis is a sudden inflammation of the pancreas, which is characterized by the activation of pancreatic enzymes and auto digestion of the gland itself. It is becoming a prevalent disease in western as well as Asian population including Pakistan. High rates of gallstones and alcohol consumption are the contributing factors to this prevalence The exact prevalence of acute pancreatitis in Pakistan is not well-documented, but estimates indicate that the incidence ranges from 5 to 80 cases per 100,000 people annually, depending on the region and population studied. Acute pancreatitis can clinically be manifested as severe abdominal pain, nausea, vomiting and fever. A few of its common etiologies include gallstones, alcohol, certain medications, and metabolic disorders. It has a wide range in severity from mild, self-limiting episodes to severe, life-threatening complications. The diagnosis of acute pancreatitis is typically confirmed through clinical evaluation, laboratory tests, and imaging studies. Various scoring systems are used to analyze it severity such as Ranson’s criteria, BISAP and APACHE score. In this study a new parameter CRP/Albumin ratio is assessed in comparison of the traditional Ranson’s criteria. After FRC and IRB approval, 105 patients were included age group 18-60 years with a diagnosis of acute pancreatitis. Patients with co-morbidities such as Chronic Liver Disease, Chronic Kidney Disease, or chronic inflammatory were excluded from the study. Age, Gender, Ranson criteria. CRP/Albumin ratio were the parameters of the study. ELISA test was performed for this study. Data was analyzed using SPSS version 25. Quantitative variables such as age, WBC, LDH, AST, serum amylase, serum lipase, CRP, serum albumin, creatinine, serum bilirubin, urea, hematocrit, duration of symptoms, SBP, DBP, heart rate, respiratory rate, SpO2, CRP / Albumin ratio and Ranson score was reported as mean and SD or median (IQR). While qualitative variables such as gender, residence, diabetes, hypertension, smoking and severity of acute pancreatitis was reported as frequency and percentage. Chi- square test and Fisher test were also applied. P value was less than 0.05 and it’s statistically significant. In our study male were greater in number IX than female. More people were from rural areas than urban areas. Most of the patients were smokers, they had diabetes, hypertension and multi organ failure. Our study specified that the CRP/albumin ratio (CAR) has significant advantages over the old Ranson criteria for assessing acute pancreatitis. Unlike the Ranson criteria, which require numerous parameters and a 48-hour assessment time, the CRP/Albumin ratio is a simple, easily accessible blood test that can be evaluated at admission, offering rapid insight into the patient's inflammatory and nutritional status. This enables quicker risk categorization and decision-making. Furthermore, the CAR integrates the dynamic markers of CRP and albumin, indicating both acute inflammation and general health state, whereas the Ranson criteria require a more complex and time-consuming combination of clinical and laboratory measurements. The CRP/Albumin's simplicity and immediacy make it a more practical and potentially more effective tool for early AP control Supervised by Prof,Dr.Shazia Shakoor

ASSOCIATION OF PIVKA II WITH HEPATOCELLULAR CARCINOMA

2024-12-24T05:22:42Z

ASSOCIATION OF PIVKA II WITH HEPATOCELLULAR CARCINOMA DR MUHAMMAD SAEED 06-117222-001 Primary liver tumours are significantly influenced by hepatocellular carcinoma, a diverse liver disease. Clinically, this carcinoma presents with obstructive jaundice, pyogenic liver abscess, and hepatic encephalopathy in addition to variceal or intraperitoneal hemorrhage. In hepatocellular cancer, metastasis outside liver frequently in the lung, abdominal lymph nodes, bone, and adrenal glands. The prevalence of HCC in Pakistan is estimated to be between 3.7% and 16.7%. Exposure to aflatoxin B, hepatitis B or C viruses’ infections (HBV or HCV), and alcoholic cirrhosis are the major factors in the HCC development. In Pakistan the causes of HCC such as hepatitis B and hepatitis C virus are common therefore it is a potential burden. Alpha fetoprotein is used as biomarker for detection of HCC, but its specificity and sensitivity are less and also its level is increased in other liver disease. Current diagnostic tools for HCC suffer from a lack of practical and acceptable biomarkers with high specificity and sensitivity. Therefore, it is critical to investigate potential new biomarkers for HCC that can improve the precision of early diagnosis and improve the chances of successful outcomes. Through a comparative cross sectional study conducted over the course of six months, 55 subjects were included in the study who were diagnosed with hepatocellular carcinoma. Subjects ranged in age from 18 to 65 years old and male or female has been included in the study. Blood samples of the patients were taken and then stored in the laboratory. AFP and PIVKA II levels in the serum were then analyzed by enzyme-linked immunoassay (ELISA). PIVKA II sensitivity and specificity with the alpha fetoprotein has been compared through ROC curve. The sensitivity of PIVKA II was 79.4% and specificity was 72.9% at the level of >40m AU/ml. the sensitivity of AFP was 75.7% and specificity was 71.5% at the level of 10ng/ml. a combination of PIVKA II and AFP give the sensitivity of 80.3% and specificity of 75.2. % sensitivity and specificity of PIVKA II was more in HCC cases as compared to alpha viii fetoprotein. Hence it was concluded that the sensitivity and specificity of protein induced vitamin K since II (PIVKA II) is higher than the Alpha Fetoprotein (AFP). Supervised by Prof. Dr Shazia Shakoor

ASSOCIATION OF ANTI-MULLERIAN HORMONE (AMH) WITH POLYCYSTIC OVARIAN SYNDROME (PCOS) IN PATIENTS WITH, AND WITHOUT HYPOTHYROIDISM

2024-12-24T05:46:41Z

ASSOCIATION OF ANTI-MULLERIAN HORMONE (AMH) WITH POLYCYSTIC OVARIAN SYNDROME (PCOS) IN PATIENTS WITH, AND WITHOUT HYPOTHYROIDISM DR. ZAHRA TAPAL (06-117212-005) Polycystic ovarian syndrome (PCOS) is the leading cause of female infertility due to anovulation. Another condition that has a significant impact on ovarian health is hypothyroidism. Both these conditions are widely prevalent. Hypothyroidism, as well as PCOS bring about a similar effect on the ovary in terms of polycystic appearance, which is why it is important to rule out hypothyroidism while planning workup of PCOS. The anti Mullerian hormone (AMH), also known as Mullerian-inhibiting hormone (MIH) is produced by granulosa cells of the pre-antral and small antral follicles in women until menopause. Production of AMH regulates folliculogenesis by inhibiting recruitment of follicles from the resting pool, thus promoting growth of a single dominant follicle. AMH can help predict the functional ovarian reserve since it is a product of the granulosa cells, which envelop each egg and provide them energy. An AMH level of >3.8ng/mL is being considered to help in the diagnosis of PCOS. However, hypothyroidism can alter the levels of AMH, and so it is important to ascertain whether serum AMH levels are reliable in PCOS patients with hypothyroidism. The objective of this study was to measure and compare the levels of AMH in women of reproductive age that have been diagnosed with PCOS (by Rotterdam Criteria, 2003) alone, and those that have been diagnosed with PCOS as well as hypothyroidism (TSH>4.2 mIU/L). In this case-control study, carried out at the National Medical Centre (NMC) hospital in Karachi, subjects were divided into two groups. Cases, consisting of 42 subjects; these were subjects diagnosed with both conditions, PCOS as well as hypothyroidism. Controls; 42 subjects diagnosed with PCOS alone. Serum TSH, Fasting Insulin, AMH, and BMI were measured in both groups. Age, and duration of infertility was recorded in both groups. Statistical analysis was done using SPSS software version 26. The results showed a statistically insignificant difference between AMH levels (4.39 ± 2.05 in cases vs. 4.19 ± 1.86 in controls) in both groups. Fasting insulin (16.17 ± 8.91 in case vs. 14.26 ± 6 controls) , BMI (28.14 ± 5.12 in cases vs. 29.39 ± 6.09 in controls), and duration of infertility (4.62 ± 3.87 in cases vs. 3.86 ± 3.04 in controls) was similar in both groups. The results of this study support use of AMH as a diagnostic marker in PCOS, even in patients suffering from hypothyroidism. Supervised by Shazia Shakoor