Muhammad Jaffar Khan

Role of Gut Microbiota in the Aetiology of Obesity: Proposed Mechanisms and Review of the Literature

The aetiology of obesity has been attributed to several factors (environmental, dietary, lifestyle, host, and genetic factors); however none of these fully explain the increase in the prevalence of obesity worldwide. Gut microbiota located at the interface of host and environment in the gut are a new area of research being explored to explain the excess accumulation of energy in obese individuals and may be a potential target for therapeutic manipulation to reduce host energy storage. Several mechanisms have been suggested to explain the role of gut microbiota in the aetiology of obesity such as short chain fatty acid production, stimulation of hormones, chronic low-grade inflammation, lipoprotein and bile acid metabolism, and increased endocannabinoid receptor system tone. However, evidence from animal and human studies clearly indicates controversies in determining the cause or effect relationship between the gut microbiota and obesity. Metagenomics based studies indicate that functionality rather than the composition of gut microbiota may be important. Further mechanistic studies controlling for environmental and epigenetic factors are therefore required to help unravel obesity pathogenesis.

Longitudinal Changes in Body Mass Index in Children with Craniopharyngioma

Objective: We investigated the relationship of body mass index at presentation and pituitary status with long-term changes in BMI over a period of 5 years. Study Design: Craniopharyngioma patients (n = 25) attending a tertiary pediatric endocrine center were divided into three groups based on their BMI at presentation [BMI ≥2 standard deviation scores (SDS), 0-1.99 SDS, and <0 SDS) and then analyzed for trends of BMI over a period of up to 5 years. Results: Median (interquartile range) BMI SDS and hypopituitarism at presentation versus at the 5-year follow-up were as follows: BMI SDS ≥2 group (n = 10): 3.55 (0.68), 6/10 versus 3.76 (1.13), 8/10; BMI SDS 0-1.99 group (n = 11): 1.68 (1.05), 3/11 versus 1.64 (2.04), 7/11, and BMI SDS <0 group (n = 4): -0.23 (0.93), 2/4 versus 0.61, 4/4. At the 5-year follow-up, 10/10, 7/11, and 1/4 subjects when divided in groups according to BMI at presentation were obese. Conclusions: Our data indicate that obesity at presentation, rather than panhypopituitarism either at or after presentation, predicts obesity 5 years after diagnosis. However, obesity at presentation is not always associated with the subsequent development of panhypopituitarism. Pediatric craniopharyngioma subjects who have BMI SDS ≥2 at presentation require early and aggressive intervention to help prevent the complications of obesity.

Association of clinical characteristics of patients presenting with influenza like illness or severe acute respiratory illness with development of acute respiratory distress syndrome

Clinical judgement and suspicion of influenza based on signs and symptoms of influenza-like illness and severe acute respiratory illness are critical for better patient outcome. Whether clinical characteristics of patients are associated with the development of acute respiratory distress syndrome and PCR positivity of samples was the aim of this study. We included all patients (n=37) presenting with influenza like illness (ILI) or severe acute respiratory illness (SARI) to a tertiary care hospital in northwest Pakistan during December 2015 until the end of January 2016. Each patient was assessed for signs and symptoms, clinical features, treatment, complications and outcome of ILI and SARI. Throat or nasopharyngeal swabs were obtained from 36 patient and analyzed for the presence of Influenza virus by quantitative PCR. Patients presenting with ILI or SARI were febrile (p<0.001, one sample t-test), significantly tachypneic (p<0.001) and had critically lower oxygen saturation (p<0.001). Nasal congestion at presentation (p=0.006, chi-square test for association) and infiltrates on chest radiographs (p=0.025) were significantly associated with acute respiratory distress syndrome. Likelihood of the occurrence of ARDS was significantly increased with decrease in oxygen saturation (Odds ratio; 0.75, 95% CI; 0.46, 1.21, p=0.048) and marginally significantly increased in lower age (Odds ratio; 0.82, 95% CI; 0.58, 1.15, p=0.055) and higher white cell count (Odds ratio; 1.001, 95% CI; 0.99, 1.002, p=0.054). The presence of Influenza type A/H1N1pdm09 strains was confirmed in 7/11 patients. However no significant difference was observed in the clinical features and complications of PCR positive and negative patients. Clinical signs and symptoms of influenza-like illness or severe acute respiratory illness significantly predict the development of complications irrespective of the positivity or negativity of laboratory qPCR reports.

Revisiting thoracic surface anatomy in an adult population: A computed tomography evaluation of vertebral level

To compare key thoracic anatomical surface landmarks between healthy and patient adult populations using Computed Tomography (CT). Sixteen slice CT images of 250 age and gender matched healthy individuals and 99 patients with lung parenchymal disease were analyzed to determine the relationship of 17 thoracic structures and their vertebral levels using a 32‐bit Radiant DICOM viewer. The structures studied were: aortic hiatus, azygos vein, brachiocephalic artery, gastroesophageal junction (GEJ), left and right common carotid arteries, left and right subclavian arteries, pulmonary trunk bifurcation, superior vena cava junction with the right atrium, carina, cardiac apex, manubriosternal junction, xiphisternal joint, inferior vena cava (IVC) crossing the diaphragm, aortic arch and junction of brachiocephalic veins. The surface anatomy of all structures varied among individuals with no significant effect of age. Binary logistic regression analysis showed a significant association between individual health status and vertebral level for brachiocephalic artery (P = 0.049), GEJ (P = 0.020), right common carotid (P = 0.009) and subclavian arteries (P = 0.009), pulmonary trunk bifurcation (P = 0.049), carina (P = 0.004), and IVC crossing the diaphragm (P = 0.025). These observations differ from those reported in a healthy white Caucasian population and from the vertebral levels of the IVC, esophagus, and aorta crossing the diaphragm in an Iranian population. The differences observed in this study provide insight into the effect of lung pathology on specific thoracic structures and their vertebral levels. Further studies are needed to determine whether these are general changes or pathology‐specific. Clin. Anat. 30:227–236, 2017.

The Routine Use of Fecal Calprotectin in Clinical Pediatric Practice: Almost there or Still Issues to Address?

The Routine Use of Fecal Calprotectin in Clinical Pediatric Practice: Almost there or Still Issues to Address?

Role of Zinc in Shaping the Gut Microbiome; Proposed Mechanisms and Evidence from the Literature

Zinc is an important constituent of diet that regulates gut epithelial wall and modify gut microbiome in humans as well as animals. Zinc deficiency may affect 39% children in Pakistan, according to the recent National Nutritional Survey 2011. Although zinc has been used in the prevention and treatment of diarrhea, the relationship of plasma zinc status with potentially pathogenic bacteria has not been studied. In this review, we have discussed evidence suggesting the impact of zinc on gut microbiota and its interaction with gut epithelium. Furthermore, animal and human studies suggesting the role of zinc in modifying gut microbiota have been presented.

Morphology of the human hard palate: a study on dry skulls

To determine morphological variations of the hard palate in dry human skulls, 85 skulls of unknown age and sex from nine medical schools in Khyber Pakhtunkhwa, Pakistan were examined. The transverse diameter, number, shape and position of the greater (GPF) and lesser (LPF) palatine foramina; canine to canine inter-socket distance; distance between greater palatine foramen medial margins; on each side, the distances between greater palatine foramen and base of the pterygoid hamulus, median maxillary suture and posterior border of the hard palate; palatal length, breadth and height; maximum width and height of the incisive foramen; and the angle between the median maxillary suture and a line between the orale and greater palatine foramen were determined. Palatine index and palatal height index were also calculated. An oval greater palatine foramen was present in all skulls, while a mainly oval lesser palatine foramen was present in 95.8% on the right and 97.2% on the left. Single and multiple lesser palatine foramina were observed on the right/left sides: single 44.1%/50.7%; double 41.2%/34.8%; triple 10.2%/11.6%. The greater palatine foramen was located above the third molar in 74.7% (right)/87.8% (left), between the second and third molars in 25.3%/9.5%, and above the second molar in 2.7% (left). A single oval-shaped incisive foramen was observed in 87.1%. The median maxillary suture angle was 13.74±1.58° on the right and 13.14±1.68° on the left. In conclusion, no significant differences were observed in any distances on the right and left side related to greater palatine foramen; however a significant difference (p <0.05) was observed between the right and left sides for median maxillary suture angle.

Examining the effectiveness of consuming flour made from agronomically biofortified wheat (Zincol-2016/NR-421) for improving Zn status in women in a low-resource setting in Pakistan: study protocol for a randomised, double-blind, controlled cross-over trial (BiZiFED)

Introduction Dietary zinc (Zn) deficiency is a global problem, particularly in low-income and middle-income countries where access to rich, animal-source foods of Zn is limited due to poverty. In Pakistan, Zn deficiency affects over 40% of the adult female population, resulting in suboptimal immune status and increased likelihood of complications during pregnancy. Methods and analysis We are conducting a double-blind, randomised controlled feeding study with cross-over design in a low-resource setting in Pakistan. Households were provided with flour milled from genetically and agronomically biofortified grain (Zincol-2016/NR-421) or control grain (Galaxy-2013). Fifty households were recruited. Each household included a woman aged 16–49 years who is neither pregnant nor breastfeeding, and not currently consuming nutritional supplements. These women were the primary study participants. All households were provided with control flour for an initial 2-week baseline period, followed by an 8-week intervention period where 25 households receive biofortified flour (group A) and 25 households receive control flour (group B). After this 8-week period, groups A and B crossed over, receiving control and biofortified flour respectively for 8 weeks. Tissue (blood, hair and nails) have been collected from the women at five time points: baseline, middle and end of period 1, and middle and end of period 2. Ethics and dissemination Ethical approval was granted from the lead university (reference no. STEMH 697 FR) and the collaborating institution in Pakistan. The final study methods (including any modifications) will be published in peer-reviewed journals, alongside the study outcomes on completion of the data analysis. In addition, findings will be disseminated to the scientific community via conference presentations and abstracts and communicated to the study participants through the village elders at an appropriate community forum. Registration details The trial has been registered with the ISRCTN registry, study ID ISRCTN83678069.

Morfometría del Foramen Mental en una Población de Khyber Pakhtunkhwa (KP) Pakistán

Knowledge of variations in MF location, size and shape is important when anesthetizing nerves of the mandibular region in dental procedures. The location, shape and position of the MF were determined in 119 human mandibles of unknown age a nd sex from different KP medical institutions. Parameters determined were: MF length and width; accessory mental foramen (AMF) wid th; MF and AMF to midline (MF-ML) (AMF-ML), upper (MF-UM) (AMF-UM) and lower mandibular margins (MF-LM) (AMF-LM) and posterior border of the mandibular ramus (MF-PRM) (AMF-PRM). AMF position in relation to the MF was also noted. MF were mainly oval and situated below the second premolar. MF mean length and width were: 2.4 ± 0.89 (right) and 2.4 ± 0.727 mm (left), and 3.0 ± 0.80 (right) and 2.9 ± 0.94 mm (left) respectively. MF-ML, MF-UM, MF-LM and MF-PRM distances on the right and left sides were: 29.1 ± 2.19 mm and 28.1 ± 2.12 mm; 11.0 ± 3.99 mm and 11.2 ± 3.98 mm; 13.1 ± 1.83 mm and 12.8 ± 1.74 mm; and 69.3 ± 5.52 mm and 68.7 ± 5.02 mm, respectively. Double mental foramen (DMF) were observed on both sides (10.9 % right, 12.6 % left) with length and width 0.7 ± 0.42 mm and 0.9 ± 0.34 mm (right) and 0.8 ± 0.32 mm and 1.0 ± 0.47 mm (left): they were mainly oval (5.8 % right, 7.56 % left). DMF-MF distance was 8.9 ± 4.58 mm on the right and 6.6 ± 4.11 mm on the left. An oval accessory mental foramen was observed in one mandible. There was no difference between right and left MF; however differences in the parameters measured were observe d in relation to other populations indicating the need to be aware of such differences when undertaking surgical procedures around t h MF.

Revisiting Thoracic Surface Anatomy in an Adult Population: A Ct Evaluation of Vertebral Level.

To compare key thoracic anatomical surface landmarks between healthy and patient adult populations using Computed Tomography (CT). Sixteen slice CT images of 250 age and gender matched healthy individuals and 99 patients with lung parenchymal disease were analyzed to determine the relationship of 17 thoracic structures and their vertebral levels using a 32‐bit Radiant DICOM viewer. The structures studied were: aortic hiatus, azygos vein, brachiocephalic artery, gastroesophageal junction (GEJ), left and right common carotid arteries, left and right subclavian arteries, pulmonary trunk bifurcation, superior vena cava junction with the right atrium, carina, cardiac apex, manubriosternal junction, xiphisternal joint, inferior vena cava (IVC) crossing the diaphragm, aortic arch and junction of brachiocephalic veins. The surface anatomy of all structures varied among individuals with no significant effect of age. Binary logistic regression analysis showed a significant association between individual health status and vertebral level for brachiocephalic artery (P = 0.049), GEJ (P = 0.020), right common carotid (P = 0.009) and subclavian arteries (P = 0.009), pulmonary trunk bifurcation (P = 0.049), carina (P = 0.004), and IVC crossing the diaphragm (P = 0.025). These observations differ from those reported in a healthy white Caucasian population and from the vertebral levels of the IVC, esophagus, and aorta crossing the diaphragm in an Iranian population. The differences observed in this study provide insight into the effect of lung pathology on specific thoracic structures and their vertebral levels. Further studies are needed to determine whether these are general changes or pathology‐specific. Clin. Anat. 30:227–236, 2017.