The trabecular pattern of the femoral neck (Singh index) has been used as a measure of osteopenia and fracture risk but the value of this method is controversial. This study assessed the usefulness of the Singh index (SI) by using dual energy X-ray absorptiometry (DXA) as the "gold standard". 659 Caucasian women (45-70 years) from an age-sex register of a general practice had their femoral neck and lumbar spine bone densities measured by DXA and had antero-posterior hip X-rays performed which were then categorized into six osteopenia grades using the SI method. The intraobserver and interobserver reproducibility of this method was good (kappa = 0.64 and 0.61, respectively). The SI grades correlated significantly with body mass index (r = 0.35) and age (r = 0.17) (p < 0.001). The mean femoral neck and lumbar spine bone densities were significantly higher with increasing SI grade even after adjustment for age and body mass index (p < 0.001). The proportion of subjects below the fracture threshold (2 SD below mean peak bone mass) decreased with increasing SI grade, ranging from 100% in SI grade 2 to 16.8% in SI grade 6. There was, however, wide overlap of bone densities between the grades. Using the criteria "osteoporosis < or = SI grade 4", the sensitivity and specificity of the SI method diagnosing low bone mass was 35.1% and 90.0%, respectively. These data suggest that the SI is a reproducible tool which may detect differences in bone mass between populations or subgroups within populations, although caution should be used in classifying individual patients because of the wide variation in bone density. The method has a low sensitivity but a relatively high specificity in diagnosing low bone mass.

Type 2 diabetes mellitus (T2DM) and insulin resistance (IR) are linked to each other. Obesity and T2DM are states of low-grade chronic inflammation, which result in increased levels of inflammatory markers such as C-reactive protein (CRP), interleukins 6 (1L-6) and tumor necrosis factor alpha (TNF-α). Relation of TNF-α with obesity induced IR and T2DM is unclear as results obtained from different studies are very controversial. Objective: This study was designed to compare TNF-α levels and insulin resistance in obese and non-obese type 2 diabetics. Methodology: A cross sectional comparative study was conducted in diabetic clinic of Mayo Hospital, Lahore. We determined and compared TNF-α levels and insulin resistance in 90 subjects where there were 50 obese patients with T2DM and 40 were non-obese Type 2 diabetic patients. TNF-α and serum insulin levels were determined using ELISA. Insulin resistance was calculated using HOMA-IR. Comparison between groups was performed using independent sample t-test. The P value ≤ 0.05 was considered statistically significant. Results: Mean HOMA-IR and TNF-α values were significantly (p-value <0.01) higher in obese diabetics (17.13+8.77) and (10.96+4.69), respectively when compared to non-obese Type 2 diabetic patients (3.40+5.05) and (3.49+2.36) respectively. Mean HOMA-IR in males was 6.52+7.03 and in females was 12.85+10.54 (p-value 0.006). Conclusion: Increased inflammation in obese diabetics explains the role of tumor necrosis factor alpha in insulin resistance induced by obesity. Weight reduction in obese individuals will help in reducing TNF-α levels and to improve insulin sensitivity in T2DM.

Body mass index is the fat content of body whereas hyperuricemia is the condition when serum uric acid level crosses the optimum normal level. Increase in BMI may influence serum uric acid. Objective: To find out the relationship of BMI with serum uric acid level in local population. Study Design: Cross sectional study. Setting: Lady Aitchison hospital Lahore. Period: March 2017- August 2017. Material and Methods: Written informed consent was taken prior to data collection. Detailed history was asked and weight in kilograms and height in meters was noted. Body mass index was calculated. Uric acid was measured by uricase method after taking 1 ml venous blood under aseptic measures. Results: Body mass index and serum uric acid of the subjects were compared with the standard values that were 24.99kg/m2 and 5.7mg/dl and statistical analysis showed a significant difference (p-0.023 and p-0.000) respectively. Simple linear regression revealed 0.391 units change in serum uric acid level with one unit change in BMI. Conclusion: Serum uric acid increased with increase in BMI.

ABSTRACT… Background: Hyperuricemia develops when serum uric acid level exceeds the normal value. Estrogen may influence the level of serum uric acid. Postmenopausal females have a remarkable reduction in its level, so serum estradiol is studied in relation to serum uric acid levels in pre and post-menopausal women. Objective: To find out the relationship of serum Estradiol with serum uric acid level in premenopausal and postmenopausal women in local population. Study Design: Case control study. Setting: This study was conducted in Lady Aitchison Hospital Lahore. Period: March 2017-August 2017. Material and Methods: 134 females were enrolled in total and were grouped in to two. Group A comprised of premenopausal and Group B included postmenopausal females. After complete history and general physical examination, 5 ml venous blood sample under aseptic measures was taken. Serum uric acid was measured by enzymatic and serum estradiol by Enzyme-linked immunosorbent assay method. Results: The mean age of pre and postmenopausal women was 32 and 57 ± 7 years, with significantly lower in premenopause. The mean serum E2 was 91.86 ± 26.71 mg/dL in premenopause and 22.04 ± 9.28 mg/dL in postmenopause, with significantly lower mean in postmenopause. Mean serum uric acid was statistically higher in postmenopause that was 6.04 ± 0.58 mg/dL, when compared to premenopause that was 4.22 ± 0.90 mg/dL. Conclusion: Serum uric acid levels increased due to decreased serum estradiol in postmenopausal women as compared to premenopausal women. Article Citation: Naseem R, Al-Fareed Zafar SM, Jawed S, Mukhtar S, Ijaz F, Aftab RK. Influence of serum estradiol on serum uric acid level in pre and postmenopausal women. Professional Med J 2019; 26(9):1587-1591.

The relationship between obesity and hypertension has long been recognized. Overweight and obesity are disorders of balance of energy affecting people of various ethnic groups, age and socio–economic statuses. It has been found that obesity is closely associated and correlated with hypertension. Preventive strategies for obesity may offer a cost-effective approach towards lowering blood pressure. Objectives: To determine the frequency of obesity according to body mass index and waist hip ratio and its relationship with hypertension among medical students. Methodology: It was a descriptive cross sectional study where a total of 213 students of 1st year MBBS and BDS were involved. Their waist circumference, hip circumference, height and weight were recorded. Moreover, on these subjects bosy mass index (BMI), waist circumference (WC), waist hip ratio (WHR) were calculated and blood pressure was recorded. Results: Amongst 213 students, a total of 97(45.5%) were male and 116 (54.5%) were females. Among studied subjects, 2 (2.1%) males and 8 (6.9%) females were underweight, whereas 55(56.7%) male and52(44.8%) were of normal weight. The prevalence of overweight in male and females was 17(17.5%) and 22(19.0%), prevalence in obese I in male and female was 20(20.6%) and 23(19.8%), and obese II was 3(3.1%) and 11(9.5%) respectively. Frequency of obesity was found to be more in females than in males according to BMI and WHR. Hypertension was present in 12(30.8%) normal weight students, 6(15.4%) overweight, 14(35.9%) obese I and 7(17.9%) obese II subjects. Correlation between BMI, WC, and WHR was positively significant with SBP and DBP. Conclusion: High prevalence of overweight and obesity was observed in students. Strong positive correlation of BMI, WC and WHR with systolic and diastolic blood pressures was shown in our study. Results of this study indicate that increase in BMI leads to increase in hypertension.