Obese subjects with impaired glucose tolerance (IGT) are more susceptible than healthy individuals to oxidative stress and cardiovascular disease. This randomised controlled investigation was designed to test the hypothesis that α-lipoic acid supplementation and exercise training may elicit favourable clinical changes in obese subjects with IGT. All data were collected from 24 obese (BMI ≥ 30 kg/m2) IGT patients. Following participant randomisation into two groups, fasting venous blood samples were obtained at baseline, and before and following intervention. The first group consisted of 12 participants who completed a 12 week control phase followed by 12 weeks of chronic exercise at 65% HRmax for 30 minutes a day, 5 days per week, while ingesting 1 gram per day of α-lipoic acid for 12 weeks. The second group consisted of 12 participants who completed the same 12 week control phase, but this was followed by 12 weeks of 1 gram per day of α-lipoic acid supplementation only (no exercise). The main findings show a comparatively greater rate of low density lipoprotein (LDL) oxidation in the group consisting of α-lipoic acid only (p < 0.05 vs. pre intervention), although total oxidant status was lower post intervention (p < 0.05 vs. baseline) in this group. However, exercise and α-lipoic acid in combination attenuates LDL oxidation. Furthermore, in the α-lipoic acid supplement plus exercise training group, total antioxidant capacity was significantly increased (p < 0.05 vs. baseline and pre intervention). Body fat percentage and waist and hip circumference decreased following exercise training (p < 0.05 vs. post intervention). There were no selective treatment differences for a range of other clinical outcomes including glycaemic regulation (p > 0.05). These findings report that α-lipoic acid ingestion may increase the atherogenicity of LDL when ingested in isolation of exercise, suggesting that in IGT the use of this antioxidant treatment does not ameliorate metabolic disturbances, but instead may detrimentally contribute to the pathogenesis of atherosclerosis and development of CVD. However, when α-lipoic acid is combined with exercise, this atherogenic effect is abolished.

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Aims: Inflammatory cytokines, particularly tumour necrosis factor-α (TNFα), are thought to promote arterial disease through a variety of mechanisms leading to arteriosclerosis and atherosclerosis. We reviewed the existing evidence of the effect of anti-TNFα treatment on arteriosclerosis and atherosclerosis in chronic inflammatory disease. Methods:We performed a systematic review of studies examining effects of monoclonal antibodies against TNFα on subclinical measures of arteriosclerosis (arterial pulse wave velocity) and atherosclerosis (endothelial function measured by flowmediated dilation or forearm blood flow responses to endothelium-dependent agonists, and common carotid intima-media thickness). Results:We identified 60 studies (of 854 potential studies identified using a systematic search) in which effects of anti-TNFα biologics on these measures were assessed in patients receiving anti-TNFα therapy for a clinical indication (usually an inflammatory disease such as an inflammatory arthritis, psoriasis or inflammatory bowel disease). Of these, only 6 were randomised clinical controlled trials. Whilst many observational studies and noncontrolled studies reported positive findings, positive finding were reported in only 1 of 6 randomised clinical controlled trials. Conclusions:There is no strong evidence for an effect of anti-TNFα biologics on the subclinical measures of arteriosclerosis or atherosclerosis examined in this review.This does not exclude a positive effect of TNFα biologics on clinical outcomes through alternate pathways including those induced by remission of the primary inflammatory disease.

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Background: Acute kidney injury (AKI) in pregnant women is commonly seen indeveloping countries. It is associated with significant morbidity, social and personal implications.We conducted a study to assess the prevalence and severity of depression in patients withpregnancy related AKI (PRAKI) in a tertiary care center. Methodology: Patients with PRAKIadmitted from 1-16 to 6-16 under Nephrology service, Jinnah Hospital, Lahore were included inthis cross-sectional study. The Hamilton Rating scale for depression (HAM-D) version translatedand adapted in Urdu, was used to assess the study population. These patients were interviewedwith the HAM-D questionnaire on their first encounter with Nephrology department. Previoushistory of psychiatric illness was excluded. The diagnosis of AKI was based on the classificationof the Acute Kidney Injury Network group. Results: The mean age of the patients was 24±5years. Seventeen (57%) patients were multipara and 13(43%) patients were primigravida. Of the30 patients with AKI, 8 (27%) presented before 28 weeks and 22 (63%) presented after 28 weeksof gestation. The causes of AKI included postpartum hemorrhage in 9 (30%), sepsis in 8 (27%),preeclampsia/eclampsia in 6(20%), shock in 4 (13%) and coagulopathy in 3 (10%) patients.Alive and healthy fetus was found in only 15 (50%) patients. Twenty-one (70%) patients receivedaverage of 5-8 hemodialysis sessions during their hospital stay. Twenty-three (76%) had nodepression (0-7 score), 2 (7%) had mild (8-13 score), 3 (10%) had moderate (14-18 score) and2 (7%) had severe (19-22 score) depression according to HAM-D score. Conclusions: Ourstudy depicted considerable depression of varying degrees in women with PRAKI, increasedawareness and effective monitoring for depression should be integrated into regular maternalcare to decrease morbidity associated with it.

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The present study assessed whether increased fruit and vegetable (F&V) intake reduced the concentrations of the inflammatory marker serum amyloid A (SAA) in serum, HDL 2 and HDL 3 and whether the latter reduction influenced any of the functional properties of these HDL subfractions. The present study utilised samples from two previous studies: (1) the FAVRIT (Fruit and Vegetable Randomised Intervention Trial) study -hypertensive subjects (systolic blood pressure (BP) range 140-190 mmHg; diastolic BP range 90 -110 mmHg) were randomised to receive a 1-, 3-or 6-portion F&V/d intervention for 8 weeks, and (2) the ADIT (Ageing and Dietary Intervention Trial) study -older subjects (65-85 years) were randomised to receive a 2-or 5-portion F&V/d intervention for 16 weeks. HDL 2 and HDL 3 were isolated by rapid ultracentrifugation. Measurements included the following: serum high-sensitive C-reactive protein (hsCRP) by an immunoturbidimetric assay; serum IL-6 and E-selectin and serum-, HDL 2 -and HDL 3 -SAA by ELISA procedures; serum-, HDL 2 -and HDL 3 -cholesterol ester transfer protein (CETP) activity by a fluorometric assay. Although the concentrations of hsCRP, IL-6 and E-selectin were unaffected by increasing F&V intake in both studies (P. 0·05 for all comparisons), those of SAA in HDL 3 decreased in the FAVRIT cohort (P¼ 0·049) and those in HDL 2 and HDL 3 decreased in the ADIT cohort (P¼0·035 and 0·032), which was accompanied by a decrease in the activity of CETP in HDL 3 in the FAVRIT cohort (P¼ 0·010) and in HDL 2 in the ADIT cohort (P¼0·030). These results indicate that SAA responds to increased F&V intake, while other inflammatory markers remain unresponsive, and this leads to changes in HDL 2 and HDL 3 , which may influence their antiatherogenic potential. Overall, the present study provides tangible evidence of the effectiveness of increased F&V intake, which may be of use to health policy makers and the general public.

Problems of the Urinary Tract are one of the most widespread infectious diseases, if left uncontrolled; it could really result in serious complications that can cause acute and chronic urinary tract failure. Objective: To assess the Urinary Tract Problems using Ultrasound Imaging. Methods: It is cross-sectional research conducted at the Radiology Department of District Health Quarter Hospital, Gujranwala, Pakistan from 1, August 2022 to 30, November 2022. Abdominal Ultrasound Techniques was performed in a supine position. A sample size of 102 patients has been calculated via a convenient sampling technique. The patients under the age of 10 years were not included. The data was collected, calculated, and analyzed using SPSS version 26.0. Results: Most of the patients complaining Urinary Tract Problems were between the age of 40 to 80 years 59(57.8%). It was more common in males 54(52.9%). Most of the patients came for Ultrasound had the past history of UTI. Most of the patients came with pain and burning while urination 36(35.3%). The most common cause of Urinary Tract Problems was hydronephrosis 74(72.5%). Conclusion: Urinary Tract Problems were developed in any age group and most common in males. The major cause of Urinary Tract Problem was Hydronephrosis.