Objective: To investigate the association of gold standard liver biomarkers with serum cytokeratin 18 (CK18), serum Alanine aminotransferase (ALT) and serum aspartate (AST). Methods: This was cross sectional study. It was conducted at Mayo Hospital from January 2016 to December 2017. It comprised of 148 non-alcoholic fatty liver disease subjects of age 40-60 years. After written informed consent, study anthropometric measurements (age, height, waist circumference and hip circumference) were taken and serum AST, ALT and CK-18 were estimated by sandwiched ELISA technique. Data was analyzed using SPSS 21.0. Descriptive were presented as mean and standard deviation. Association between CK18, serum AST and ALT were analyzed by regression analysis and are presented as beta coefficient. P-value ≤ 0.05 was taken as significant. Results: Study comprised of 148 subjects with mean age 44.81±6.2. Of total population 29.1% were male and 70.9% were female. Significant positive association of CK18 was found with serum ALT (P-value 0.005*). However, no association was found between AST and serum CK18. (P-value 0.29). Conclusion: Significant positive association was found between Serum CK18 and serum ALT. doi: https://doi.org/10.12669/pjms.36.3.1674 How to cite this:Altaf B, Rehman A, Jawed S, Raouf A. Association of liver biomarkers and cytokeratin-18 in Nonalcoholic fatty liver disease patients. Pak J Med Sci. 2020;36(3):---------. doi: https://doi.org/10.12669/pjms.36.3.1674 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background: Chronic obstructive lung disease (COPD) is a highly preventable disease with smoking as most recognizable risk factor globally. COPD remains undiagnosed worldwide due to unavailability of gold standard spirometry. Technical difficulties in this procedure, faced by patient result in over and under diagnosis of this prevalent disease. Objective of this study was to screen the undiagnosed air way obstruction which reflects the COPD among the smokers and nonsmokers. PEFR was used for assessment, as it is simple, reliable and easily available way at most of the health care centers. Methodology: A cross sectional study was conducted from May 2018 to Dec 2018 at private medical institute and private hospital in Faisalabad. It comprised of 200 males (smokers and nonsmokers) who had no previous history of diagnosis of COPD. Relevant information related to smoking including pack years and medical history specially related to COPD was inquired on structured questionnaire. Air way obstruction was assessed by PEFR using vitalograph compact. Data was analyzed by SPSS 21 version. Continuous variables are presented as mean and standard deviation (SD) and compared by Independent t-test among study groups. Categorical variables are expressed as proportions and compared by X2 test. P value ? 0.05 was considered significant. Results: Results are showing that 91.56% of the studied smokers have air way obstruction based on yellow and red zones of PEFR. Out of total COPD smokers 62.7% were in yellow zone and 28.9% were in red zone. Only 29.1% of nonsmokers have PEFR values within yellow. None of nonsmoker was in red zone (P value 0.001*). PEFR was significantly lower in smokers in comparison to nonsmokers (P value 0.003*). 95.5% of Subjects in red zone were symptomatic, while only 51.2% of subjects in yellow zone were symptomatic considering mild to severe air flow obstruction. Conclusion: Smokers and nonsmokers have undiagnosed airway obstruction with symptoms reflecting COPD but greater proportion of smoker were involved. PEFR was lower in smokers as compared to nonsmokers.

Objectives: To explore the association between the body mass index (BMI) and inter arm difference (IAD) blood pressure and to understand how these factors influence blood pressure. Study Design: Cross-sectional study. Place and Duration of Study: Aziz Fatimah Medical and Dental College Faisalabad Pakistan, from Nov to Dec 2020. Methodology: Total 100 healthy medical students aged 19-21 years were included in the study. Height in meters and weight in kilograms were documented by stadiometer (ZT-100). BMI was assessed by Quetelet's index (BMI=weight in Kg/height in m2). Blood pressure was recorded simultaneously in both arms by the auscultatory method. Inter arm difference in blood pressure was estimated by calculating differences in diastolic and systolic pressures between the right and left arm. Results: Mean age of the participants was 19.83 ± 1.23 years. Significant difference was noted in systolic and diastolic interarm blood pressure among obese and non-obese groups (p-values <0.001). BMI was positively associated with diastolic and systolic inter-arm blood pressure (p-values <0.001). Conclusion: Body mass index is positively associated with inter arm difference in blood pressure, and both positively impact the blood pressure.

The fast-food industry is one of the booming industries in Pakistan with rapidly developing human resources. However, quick growth has become impeded by numerous human resource management challenges. The purpose of this study is to investigate factors/variables that cause stress among employees in the workplace which consequently affect their performance. Pakistan’s fast-food sector has been taken into account and a comprehensive study has been carried out to find out which variables result in employee stress and affect their overall job performance. Primary data was collected through three hundred and fifty questionnaires disseminated throughout various areas of Lahore, Karachi and Islamabad including Emporium Mall, Packages Mall and Dolmen Mall, Lucky One Mall, Centaurus, and key areas popular for fast-food in those cities. Several statistical tools including; Reliability and Validity Analysis, Factor Analysis, Regression analysis, KMO, Cronbach Alpha and the Bartlett Test, are used for data analysis on SPSS and Smart PLS. Results of the analysis show that Work Overload, Job Insecurity (independent variable) and Employee Stress (mediating variable) have a significant impact on Employee Performance (dependent variable). The relationship of Job Security and Work Overload with Employee Stress is positive. Similarly, the relationship between Employee Stress and Employee Performance is also positive and significant. The study described in this paper thoroughly focuses on all the major causes of employee’s stress and its impact on employee performance, it also suggests how Fast-food sector of Pakistan should consider these factors in order to address these issues and provide favorable workplace environment.

Objective: To determine the impact, obesity and age on the lung functions determined by PEFR of healthy workers of chemical industries. Methodology:  This was a cross sectional study performed at private medical college of Faisalabad. Three days medical camp was arranged during 2nd to 4th  September 2020 after taking approval from institutional ethical committee. All relevant information including age, residence and history about chemical exposure were recorded in a structured proforma. Obesity was determined on basis of BMI grading. BMI was calculated from estimated Height and weight   PEFR of each participant was determined using Wright’s Peak flow meter.  Data was analyzed by SPSS21. Results: Mean± SD age, height and weight of the studied population was 38.85 ± 12.1, 170.07  ±12.0   and 78.12 ±12.7. lowest PEFR value was found in subjects with age range 61 to 70 years as compred to youger subjects . The mean PEFR value were significantly different  with respect to various age catagoeies with  p value= 0.000 Highest mean PEFR values were found in  taller subjects having height ≥ 180 cm and lowest values were found in subjects with height 150-159 cm,  the difference in means was statisticaly significant with p value= 0.05. Morbid  obese subjects showing comparatively  lower PEFR values in morbid obese  with significant p value =0.002. . PEFR was found to be negatively associated with age ( p- value= 0.000*)  and BMI( p value =0.001*). Our results also showed weak positive association of PEFR with height, however this relation was not found to be statistically significant (p value= 0.081). Conclusion: Peak expiratory flow rate is negatively associated with increasing BMI and age, reflecting that elderly and obese subjects are more prone to have affected lung function due to exposure to chemicals

Objectives: To find an association between circulating oestradiol and thyroid autoimmunity in females with polycystic ovarian syndrome (PCOS) and its impact on their health. Materials and Methods: This study was conducted at Aziz Fatimah Medical and Dental College, after obtaining ethical approval from Institutional Ethical Committee (letter No. DME/568-19) from April to September 2017. Hundred PCOS females enrolled in the age range 17-35 years were taken who fulfilled inclusion and exclusion criteria. Blood samples were drawn and stored at Aziz Fatima Hospital, Faisalabad. All blood samples were analyzed for the levels of Oestradiol, thyroid stimulating hormone (TSH), free triiodothyronine (FT3), free tetra-iodothyronine (FT4), and thyroid peroxidase antibody (TPO-Ab). The data was analyzed using SPSS 23. Results: Of the total population, TPO-Ab was positive in 26% of study participants. It was observed that 64% and 40% of TPO-Ab positive subjects were in the oestradiol quartiles E3 and E4 respectively and none of them were found to be in E1 and E2 quartiles. We have found a significant association of the E2 with TSH, FT4, and TPO-Ab, however, no significant correlation was found between TSH and TPO-Ab. Beta coefficient (?) of 1.006 shows that higher E2 was significantly related to higher TPO-Ab titer with p-value = 0.002. Similarly, a significant but weak positive association was found between E2 and TSH. E2 was significantly negatively associated with FT4. Conclusion: Oestradiol is positively associated with TPO antibodies and TSH and negatively associated with FT4 in PCOS patients. Our findings suggest that thyroid autoimmunity is commonly found in PCOS females.   Keywords: Oestradiol, Polycystic ovarian syndrome, Thyroid peroxidase antibody

Aim: Different training tests are used to measure and train an individual for improvement in stationary and dynamic postural stability. Y-balance test has been utilized to test the dynamic postural stability among healthy individuals and athletes. Patients suffering from diabetes mellitus due to muscular weakness are prone to have altered dynamic postural stability. The primary objective of this study is to test the dynamic postural stability status of patients with Type-II diabetes mellitus through the Y-balance test. Methods: This cross-sectional observational investigation was conducted from June 2022 to November 2022 at Shalamar Hospital, Pakistan on 33 participants of both genders between the age group of 45-60 years. of both genders amid the age group of 45-60 years from the Diabetic Institute of Pakistan. A measuring tape was used to measure Y-balance test readings. SPSS software version 22 was used to analyze the results. Mean and standard deviation was calculated and independent and paired t-test were used to compare results. Results: Out of 33 study participants, 48.5% were male, and 51.5% were female. The findings of this study show that interlimb leg length differences were not noteworthy but both limbs had substantial results in the anterior direction (P ≤ 0.06). Furthermore, both males and females showed no interlimb differences in leg length in the posteromedial direction, however; females showed greater interlimb differences in the anterior and posterolateral direction (P ≤ 0.05). Practical Implication: Reference standards are indispensable for the accurate interpretation of the inspection results. Clinicians would use these normative numbers to institute a patient’s performance level. Since YBT enactment differs in diverse cultures, precise YBT reference standards must be recognized. Conclusions: Dynamic postural stability status of patients with Type-II diabetes mellitus through the Y-balance test showed significant differences appearing in the anterior reach distance than posterolateral and posteromedial reach distances, especially in females. Keywords: Diabetes Mellitus, Dynamic Postural Stability, Physiotherapy, Physical Therapy, Type II Diabetes Mellitus, Y-Balance Test.

Objectives: Polycystic ovary syndrome (PCOS) is a rampant endocrine disorder distressing women of child bearing age worldwide. Many current researches have detected the presence of some organ specific and non-specific autoantibodies in females with PCOS. Study Design: Cross Sectional study. Setting:  Aziz Fatimah Hospital, Faisalabad, Pakistan. Period: April to September 2017. Material & Methods: This study comprised of 88 female subjects of 17-35 years old. Participants were divided into four group’s i.e PCOS obese females, PCOS non-obese, obese females without PCOS and age matched controls. Thyroid function was evaluated by the measurement of serum TSH, FT3 and FT4 levels. Thyroid peroxidase antibody was detected as an indicator of thyroid autoimmunity. All parameters were measured by chemiluminescence immunoassay technique (CLIA). SPSS version 22 was used for the statistical analysis of the data. Results: Out of total 88 female participants, 38.6% were hypothyroid and 61.4% were euthyroid females. While on comparing the percentages of hypothyroidism among the study groups PCOS, non-PCOS patients and obese we found higher percentages of hypothyroidism among non-obese PCOS. Thyroid peroxidase antibody levels were higher in PCOS obese subjects. PCOS patients have 15 times more risk for hypothyroidism as compared to non-PCOS patients. Conclusion: Hypothyroidism was commonly found in PCOS patients with high levels of TPO-Antibody indicating that PCOS is an independent risk factor for hypothyroidism which suggests that evaluation of thyroid function and autoimmunity must be deliberated in PCOS patients.