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Hypertension (HTN) is a very prevalent health issue around the world. Many factors influence HTN and some of those include diabetes, obesity, gender, age, and diet. Impact of diet on hypertension, is understudied in our region, therefore, this study was set to manifest the effect of diet on HTN prevalence. This cross-sectional study was performed among local Islamabad of population, Pakistan in 3 months from November 2019 to January 2020. 138 people were recruited in study via a developed criterion. Data was collected by self-designed proforma. Data analysis was done by applying IBM SPSS version 25. Descriptive statistics were used for quantitative variables. As data was non-parametric, so we applied non-parametric statistical tests like Mann Whitney test, Kruskal–Wallis test and Spearman correlation analysis were applied to assess, the difference in means of both systolic and diastolic BP between female and male, difference in means of both systolic and diastolic BP among three consumption frequency levels, and association, direction, and strength of between HTN and foods consumption. Present study indicates overall high prevalence of HTN (39.86%) among study population. Means of age, systolic and diastolic BP for study population were 43.42 (with SD of ±8.30) years, 138.01mmHg (with SD of ±19.37), and 89.38mmHg (with SD of ±7.10) respectively. Difference in means of both systolic and diastolic between females and males was not significant (p=0.093 and p=0.078 respectively) although these were higher among males and gender was not associated with HTN significantly (p=0.069). Strength and direction for association between fast food and HTN was strong and positive, for association between snack food and HTN was strong and positive while for association between fresh fruits and raw vegetables was strong and negative with correlation coefficients (+0.690 for diastolic, +0.710 for systolic), (+0.651 for diastolic, +0.661 for systolic), (-0.712 for diastolic, -0.712 for systolic) respectively. In short, present study concludes that HTN was more prevalent among males, fast food, snack foods eaters and fresh fruits and raw vegetables non-eater in contrast to females, fresh fruits and raw vegetables eaters and non-eaters of fast foods and snack foods. Higher consumption of fast foods and snack lead to higher prevalence of HTN and vice versa whereas higher consumption of fresh fruits and raw vegetables bring decline in the incidence of HTN incidence and vice versa. So, we are dependent on awareness among people about the influence of food on HTN and gender specific measures for each gender to reduce HTN incidence.

Purpose The rs641738 C>T in membrane-bound O-acyltransferase domain-containing protein 7 (MBOAT7) is implicated, along with the rs738409 C>G polymorphism in patatin-like phospholipase domain-containing protein 3 (PNPLA3), in nonalcoholic fatty liver disease (NAFLD). The association of these polymorphisms and NAFLD are investigated in Hispanic children with obesity. Methods Obese children with and without NAFLD were enrolled at a pediatric tertiary care health system and genotyped for MBOAT7 rs641738 C>T and PNPLA3 rs738409 C>G. NAFLD was characterized by the ultrasonographic presence of hepatic steatosis along with persistently elevated liver enzymes. Genetic variants and demographic and biochemical data were analyzed for the effects on NAFLD. Results Among 126 enrolled subjects, 84 in the case group had NAFLD and 42 in the control group did not. The two groups had similar demographic distribution. NAFLD was associated with abnormal liver enzymes and elevated triglycerides and cholesterol (pG had an additive effect in NAFLD; however, MBOAT7 rs641738 C>T had no effects alone or synergistically with PNPLA3 polymorphism. NAFLD risk increased 3.7-fold in subjects carrying PNPLA3 GG genotype and decreased in MBOAT7 TT genotype. Conclusion In Hispanic children with obesity, PNPLA3 rs738409 C>G polymorphism increased the risk for NAFLD. The role of MBOAT7 rs641738 variant in NAFLD is less evident.

Obstructive sleep apnea (OSA) is a common sleep related disorder, and it is affected by number of factors including age, gender, obesity, educational status and menopause. However, in the presence of conflicting findings regarding impact of menopause on OSA, our study was aimed to check the prevalence of OSA in women and impact on it of menopause. This descriptive cross-sectional study was conducted in around 3months from August 2020 to October 2020 in a rural area of Punjab, Pakistan. 205 participants were recruited according to set criteria of our study. Women with age from above 30 years to 60 years, who had regular menstrual cycles or had cessation of menses since at least one last year were enrolled in the study whereas women who had irregular menstrual cycles and were not willing to participate were excluded from the study. Data was collected by two questionnaires including self-structured proforma and STOP Questionnaire. Data analysis was done with the help of SPSS version 25. Different tests including Chi-square test and Independent Sample t-test were applied to evaluate the study variables. In general, current study indicates high prevalence (28.3%) of high risk of OSA among women, however, STOP score was higher among postmenopausal women (1.641 with SD±0.908) as compared to premenopausal women (1.073 SD±0.693)) which means that postmenopausal women had higher risk of development of OSA in comparison with premenopausal women. The association between OSA risk and menopause was statistically significant (p=0.001). The difference of score between premenopausal women and postmenopausal women was significant statistically (p=0.0001). In short, prevalence of OSA high risk is higher among postmenopausal women in comparison with premenopausal women and menopause affects OSA but the mechanism is still not clear.

Happiness is a collection of various kinds of emotions including positive and negative because of satisfaction in life. Happiness affects almost every aspect of life, however, among students, its most important impact is on their academic performance. Academic performance is positively affected by happiness and subsequently their performance as a physician. Therefore, our current study is set to assess the impact of happiness on academic performance among final-year medical students of Rawalpindi Medical University Pakistan. This may provide us a new way to bring improvement in academic performance of medical students. This descriptive cross-sectional study was carried out among final-year medical students of Rawalpindi Medical University in January 2020. Collection of data was accomplished with the help of two questionnaires including Oxford Happiness Questionnaire for happiness assessment and self-structured questionnaire which was developed to obtain required data about demographic details and marks in last professional examination. Students who had diagnosed any physical and mental illness were excluded. From total of 223 students who were enrolled at the beginning of study, only 186 returned correctly filled questionnaires so final sample size became 186. Data analysis was completed through SPSS v.25.0. Different statistical tests including Independent sample t-test, Chi-square test, Pearson’s correlation, and linear regression were used to assess the study variables. Statistically significant and strong positive association was noted between happiness and academic performance of students (p = 0.000). To evaluate the direction and strength of association between happiness and academic performance, Pearson’s correlation coefficient was calculated, and it was 0.809 with p-value 0.000). Difference in happiness score between male students and female students (p=0.015) and between boarder students and non-boarder students (p=0.000) was statistically significant. Likewise, the difference in academic performance that was assessed through marks in last professional examination was also statistically significant between male student and female students (p=0.001) and between boarder students and non-boarder students (p=0.000) was also statistically significant. With p-value of 0.000 for F test, simple linear regression model was valid. Value of unstandardized regression Coefficient (B) was 61.40. R² was 0.655 (65.5%). Our study overall shows higher happiness score and better academic performance among female and non-boarder students relative to male and boarder students. This current study also indicates statistically significant and strong positive association between happiness and academic performance, which means that increase in happiness increases the academic performance of students and vice versa. So, with the implementation of appropriate measures for the increase in happiness we can bring enhancement in academic performance of medical students.

Nonalcoholic fatty liver disease (NAFLD) is the hepatic manifestation of the obesity epidemic and affects approximately 10% of children in the US. The presence of hepatic fibrosis may be the most important factor in determining the prognosis of NAFLD. Noninvasive methods to identify the presence of fibrosis in children with NAFLD are greatly needed. Hepatocyte apoptosis activates hepatic stellate cells and plays a central role in fibrosis progression in NAFLD. The aim of the present study was to evaluate the use of plasma cytokeratin-18 (CK18) fragment levels, a marker of hepatocyte apoptosis, as a noninvasive biomarker in detecting liver fibrosis in pediatric NAFLD.Consecutive children with biopsy-proven NAFLD were included and blood samples and anthropometric measurements were collected at the time of the biopsy. NAFLD activity score was calculated (0-8) and fibrosis stage was scored (0-4). We measured plasma CK18 levels using the M30-Apoptosense enzyme-linked immunosorbent assay kit.A total of 201 subjects were enrolled in the study. The mean age was 10.7 ± 2.5 years, and 37 % were boys. Sixty-eight percent of the patients had any fibrosis, with 56% having F1, 6% having F2, and 6 % having F3. CK18 levels were found to be significantly higher in subjects with any fibrosis compared with those without fibrosis (304.6 ± 124.8 vs 210.4 ± 70.9, P 0.001). CK18 level revealed good accuracy for prediction of any fibrosis (F1-F3) with AUROC of 0.75. Multivariate logistic regression was performed to assess whether CK18 in combination with another clinical factor could improve accuracy of prediction of fibrosis. Together, CK18 with waist circumference percentile generated an area under the receiver operating characteristics curve of 0.842 for prediction of any fibrosis.CK18 is a promising noninvasive biomarker for fibrosis in NAFLD in children. A fibrosis prediction model that includes CK18 and waist circumference percentile should be validated in other populations.

Background: Body weight homeostasis and the progression of obesity to comorbidities such as nonalcoholic steatohepatitis (NASH), type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD) involve the gut-brain axis, a complex and highly coordinated system of peripheral appetite hormones and centrally mediated neuronal regulation. Data on the role of a gut-adipose axis in children with obesity-related comorbidities are sparse. We determined novel signals in the gut-adipose axis such as pro-uroguanylin (PUG) produced in the gut and spexin, predominantly produced in white adipose tissue along with traditional appetite/satiety hormones in insulin-resistant children with (NASH) and simple obesity. Method: A total of 29 children (age: 8-17 years) in three groups, normal weight (NW; n=11; BMI95th%) and biopsy-proven NASH (n=9; NAS-score>2) were studied. Spexin, PUG, leptin, total (T)- and high molecular weight (HMW)-adiponectin and insulin were measured. Results: Spexin, PUG and both T and HMW adiponectins were lower in children with NASH compared to both children with simple obesity and their NW counterparts, while leptin and insulin were higher (p Conclusions: Lower concentrations of novel signals such as PUG and spexin in the current study suggest that perturbations in the gut-brain axis occur at an early age in the clinical course of obesity and NASH. The potential role of these novel gut-adipose axis signals, by themselves or in unison with other factors, in diagnosing and/or monitoring the development and/or progression of obesity-related comorbidities such as NASH, T2DM and CVD as well as the potential development of more directed therapies appears to be promising and warrants further studies. Disclosure M.D. Di Guglielmo: None. S. Mansoor: None. V. Uppal: None. K.N. Furuya: None. S. Kumar: None. P. Balagopal: None.

Background Nonalcoholic fatty liver disease (NAFLD) is the most common form of chronic liver disease in children and can progress to liver cirrhosis during childhood. Patients with more advanced fibrosis on biopsy tend to have more liver complications. Noninvasive hepatic fibrosis scores have been developed for adult patients with NAFLD; however, these scores have not been validated in children. The aim of our study was to evaluate some of these scores in assessing the presence of fibrosis in children with biopsy-proven NAFLD. Methods Our study consisted of 92 biopsy-proven NAFLD children from five major US centers. Fibrosis was determined by an experienced pathologist (F0‐4). Clinically significant fibrosis was defined as fibrosis stage C2, and advanced fibrosis was defined as F3‐4. The following fibrosis scores were calculated for each child: AST/ALT ratio, AST/platelet ratio index (APRI), NAFLD fibrosis score (NFS), and FIB-4 index. ROC was performed to assess the performance of different scores for prediction of presence of any, significant, or advanced fibrosis. A p value \0.05 was considered statistically significant. Results Mean age was 13.3 ± 3 years, and 33 % were females. Eleven (12 %) subjects had no fibrosis, 35 (38 %) had fibrosis score of 1, 26 (28 %) had fibrosis score of 2, and 20 (22 %) had a score of 3. APRI had a fair diagnostic accuracy for the presence of any fibrosis (AUC of 0.80) and poor diagnostic accuracy for significant or advanced fibrosis. AST/ALT, NFS, and FIB-4 index all either had poor diagnostic accuracy or failed to diagnose the presence of any, significant, or advanced fibrosis. Conclusion Noninvasive hepatic fibrosis scores developed in adults had poor performance in diagnosing significant fibrosis in children with NAFLD. Our results highlight the urgent need to develop a reliable pediatric fibrosis score.

Childhood obesity has reached epidemic proportions, and by 2012, more than one third of American children were overweight or obese. As a result, increasingly, children are developing complications of obesity including liver disease. In fact, non-alcoholic fatty liver disease is the most common form of chronic liver disease seen in children today. Recently, there has been a burgeoning literature examining the pathogenesis, genetic markers, and role of the microbiome in this disease. On the clinical front, new modalities of diagnosing hepatic steatosis and hepatic fibrosis are being developed to provide non-invasive methods of surveillance in children. Lastly, the mainstay of treatment of pediatric non-alcoholic fatty liver disease (NAFLD) has been largely through lifestyle interventions, namely, dieting and exercise. Currently, there are a number of clinical trials examining novel lifestyle and drug therapies for NAFLD that are registered with the US National Institutes of Health ClinicalTrials.gov website.

Nonalcoholic fatty liver disease (NAFLD) and its spectrum ranging from simple steatosis to nonalcoholic steatohepatitis (NASH) and fibrosis have been increasing in the pediatric population. The presence and severity of fibrosis in patients with NAFLD are important prognostic factors for the risk of disease progression to cirrhosis. The gold standard for staging liver fibrosis is a liver biopsy. However, given the risks of this procedure, especially in the pediatric population, the development of noninvasive markers to diagnose and monitor progression of NAFLD is desirable. This paper will review recently developed noninvasive methods for diagnosing liver fibrosis in children with NAFLD. These include simple fibrosis scores, advanced biochemical markers, and radiologic imaging studies. Simple fibrosis scores use readily available laboratory tests; available one include AST/ALT ratio, AST to platelet ratio index (APRI), fibrosis (FIB)-4 index, NAFLD fibrosis score (NFS), pediatric NAFLD fibrosis index (PNFI), and pediatric NALFD fibrosis score (PNFS). Advanced biochemical markers include biomarkers of hepatocyte cell death such as cytokeratin 18 fragment levels, and markers of extracellular matrix turnover such as the Enhanced Liver Fibrosis (ELF) test and hyaluronic acid. Radiologic imaging studies estimate liver stiffness as a surrogate for liver fibrosis; these include transient elastography (TE), magnetic resonance elastography (MRE), and acoustic radiation force impulse imaging (ARFI).

Background Noninvasive hepatic fibrosis scores that predict the presence of advanced fibrosis have been developed and validated in adult patients with NAFLD. The aims of our study were to assess the utility of commonly used adult fibrosis scores in pediatric NAFLD and to develop a pediatric specific fibrosis score that can predict advanced fibrosis. Methods Consecutive children with biopsy-proven NAFLD were included. Fibrosis was determined by an experienced pathologist (F0-4). Advanced fibrosis was defined as fibrosis stage ≥ 3. The following adult fibrosis scores were calculated for each child: AST/ALT ratio, AST/platelet ratio index (APRI), NAFLD fibrosis score (NFS), and FIB-4 Index. Multivariable logistic regression analysis was performed to build a new pediatric model for predicting advanced fibrosis. Results Our cohort consisted of 242 children with a mean age of 12.4 ± 3.1 years and 63% were female. 36 (15%) subjects had advanced fibrosis. APRI and FIB-4 were higher in patients with advanced fibrosis compared to those with fibrosis stage 0-2; however, AST/ALT ratio and NFS were not different between the two groups. We used our data to develop a new model to predict advanced fibrosis which included: ALT, alkaline phosphatase, platelet counts and GGT. The multivariable logistic regression model (z) was defined as follows: z = 1.1+(0.34*sqrt(ALT))+(0.002*alkaline phosphatase) - (1.1*log(platelets) - (0.02*GGT). This value was then converted into a probability distribution (p) with a value between 0 to 100 by the following formula: p = 100 × exp(z)/[1+exp(z)]. The AUCROC for this model was 0.74 (95% CI: 0.66, 0.82). This was found to be significantly better than APRI, NAFLD Fibrosis Score and FIB-4 Index. Conclusion Noninvasive hepatic fibrosis scores developed in adults had poor performance in diagnosing advanced fibrosis in children with NAFLD. We developed a new pediatric NAFLD fibrosis score with improved performance characteristics.

Background: Noninvasive hepatic fibrosis scores that predict the presence of advanced fibrosis have been developed and validated in adult patients with NAFLD. The aims of our study were to assess the utility of commonly used adult fibrosis scores in pediatric NAFLD and to develop a pediatric specific fibrosis score that can predict advanced fibrosis. Methods: Consecutive children with biopsy-proven NAFLD were included. Fibrosis was determined by an experienced pathologist (F0–4). Advanced fibrosis was defined as fibrosis stage $3. The following adult fibrosis scores were calculated for each child: AST/ALT ratio, AST/platelet ratio index (APRI), NAFLD fibrosis score (NFS), and FIB-4 Index. Multivariable logistic regression analysis was performed to build a new pediatric model for predicting advanced fibrosis. Results: Our cohort consisted of 242 children with a mean age of 12.463.1 years and 63% were female. 36 (15%) subjects had advanced fibrosis. APRI and FIB-4 were higher in patients with advanced fibrosis compared to those with fibrosis stage 0–2; however, AST/ALT ratio and NFS were not different between the two groups. We used our data to develop a new model to predict advanced fibrosis which included: ALT, alkaline phosphatase, platelet counts and GGT. The multivariable logistic regression model (z) was defined as follows: z=1.1+(0.34*sqrt(ALT))+(0.002*alkaline phosphatase) – (1.1*log(platelets) – (0.02*GGT). This value was then converted into a probability distribution (p) with a value between 0 to 100 by the following formula: p=1006exp(z)/[1+exp(z)]. The AUCROC for this model was 0.74 (95% CI: 0.66, 0.82). This was found to be significantly better than APRI, NAFLD Fibrosis Score and FIB-4 Index. Conclusion: Noninvasive hepatic fibrosis scores developed in adults had poor performance in diagnosing advanced fibrosis in children with NAFLD. We developed a new pediatric NAFLD fibrosis score with improved performance characteristics.