PDF Archive

Easily share your PDF documents with your contacts, on the Web and Social Networks.

Share a file Manage my documents Convert Recover PDF Search Help Contact



IJSR NOVEMBER 2017 PRINT FILE 11 ONLINE .pdf


Original filename: IJSR NOVEMBER 2017 PRINT FILE 11 ONLINE.pdf
Title: IJSR Index Nov 2017.cdr
Author: Office01

This PDF 1.6 document has been generated by CorelDRAW X8 / Corel PDF Engine Version 18.1.0.661, and has been sent on pdf-archive.com on 18/02/2018 at 17:36, from IP address 73.221.x.x. The current document download page has been viewed 313 times.
File size: 9.9 MB (60 pages).
Privacy: public file




Download original PDF file









Document preview


A Medico Journal

11

ISSN No. 2277 – 8179

INTERNATIONAL JOURNAL OF
SCIENTIFIC RESEARCH
Editor In-Chief
Dr. Khansa Memon
SARA Publishing Academy

Editorial Advisory Board
Sushrut Arora
Dr.Takuma Hayashi
Postdoctoral Associate, Baylor College of Dept. of Immunology and Infectious Disease,
Medicine, Pediatric - Newborn Section of
Shinshu University Graduate School of
Neonatology, Texas Children\'s Hospital, 1102 Medicine, 3-1-1, Asahi, Matsumoto, Nagano
Bates St., TXFC-590.02, Houston, TX 7703
390-8621, JAPAN
DR.R K Chittoria
Additional Professor & Head, Dept of Plastic
Surgery, Jipmer, Pondicherry-605006 &
Incharge Telehealth/telemedicine
Programme Jipmer

Dr.Reena Gupta
Assistant Professor in Institute of
Pharmaceutical
Research, GLA University,
Mathura, U.P., India

Prof Dr PJ Hisalkar
Department of Biochemistry,
People's College of Medical Sciences &
Research Centre, Karond Bypass Road,
Bhanpur, Bhopal-462037 (MP)
Dr.Sanjay D.Deshmukh
Professor, Pathology, Smt. Kashibai.
Navale Medical College, PuneBangalore Westerly Bypass,
NARHE, PUNE 411041, India.

Faris Q.B. Alenzi
Dr. Sumit Sethi
Department of Medical Laboratories, College
Department of Psychiatry, Universidade
of Applied Medical Sciences, Salman bin
Federal de Sao Paulo – UNIFESP, Sao Paulo,
Abdulaziz University (Al-Kharj)
BRAZIL

Dr.Emre Yalcinkaya
Aksaz Military Hospital,
Department of Cardiology, 48750,
Marmaris, Mugla, Turkey

Prof.Dr.Amer A. Taqa

Dr.Temur Z. Kalanov

Dr. N. S. Neki

Department of Dental Basic Science,
College of Dentistry, Mosul University, Iraq

Home of Physical Problems, Pisatelskaya 6a,
100200 Tashkent, Uzbekistan

PROFESSOR Medicine, GOVT. MEDICAL
COLLEGE, AMRITSAR, PUNJAB

ADVERTISEMENT DETAILS
Position

B/w (single Color)

Fore Color

Full Inside Cover

` 6000/-

` 12500/-

Full Page (inside)

` 5000/-

-

SUBSCRIPTION DETAILS
Period
One Year (12 issues)
Two Years (24 issues)
Three Years (36 issues)
Five Years (60 issues)

Rate

Discount

` 3000/` 6000/` 9000/` 15000/-

Nil
` 200/` 300/` 600/-

Amount
Payable
` 3000/` 5800/` 8700/` 14400/-

You can download the Advertisement / Subscription form from website www.worldwidejournals.com. You will require to print the form.
Please fill the form completely and send it to the Editor, International Journal of Scienti c Research along with the payment in the form of
Demand Draft/Cheque at Par drawn in favour of International Journal of Scienti c Research payable at Ahmedabad.
1.
2.
3.
4.
5.
6.
7.

Thoughts, language, vision and examples in published research paper are entirely of author of research paper. It is not necessary that
both the editor, and editorial board agrees with the author. The responsibility of the matter of research paper/article is entirely of author.
Editing of the International Journal of Scienti c Research is processed without any remittance. The selection and publication is done
after recommendations of at least two subject expert referees.
In any condition if any National/International University denies accepting the research paper published in IJSR, then it is not the
responsibility of Editor, Publisher and Management
Only the rst author is entitle to receive the copies of all co-authors
Before re-use of published paper in any manner, it is compulsory to take written permission from the Editor-IJSR unless it will be assumed
as disobedience of copyright rules
All the legal undertaking related to International Journal of Scienti c Research is subject to Ahmedabad Jurisdiction.
The research journal will be send by normal post. If the journal is not received by the author of research paper then it will not be the
responsibility of the Editor and publisher. The amount for registered post should be borne by author of the research paper in case of
second copy of the journal.

Editor,
INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH
303, Maharana Pratap Complex, Opp. Kapadia Guest House, B/H V.S.Hospital, Paldi, Ahmedabad-380006
Gujarat, (India) | Cell: +91 8866 00 3636, +91 9904 00 0288
Website : www.worldwidejournals.com | Email : ijsr@worldwidejournals.com

Our Other Journals...

Indian Journal of Applied Research
ISSN - 2249-555X | IF : 4.894 | IC Value : 79.96
Journal DOI : 10.15373/2249555X
Email: editor@ijar.in Website: www.ijar.in
IJAR - Indian Journal of Applied Research is a double reviewed monthly print journal that accepts research works from scholars,
academicians, professors, doctorates, lecturers, and corporate in their respective expertise of studies. Work after publication will be
retrievable on the website bifurcated based on issues of the month and its publication date. Moreover, the journal serves the research world
since October, 2011
The journal is wide and available for diverse intellectual and educational pursuit from all corners of the society to enrich the learning
experience of the group readers.
The periphery of the subject areas includes:
Accountings, Finance, Management Accounting, Business, Commerce, Corporate Governance, Financial Accounting, Arts, Fine Arts,
Designing, Medical, Bio-medical, clinical research, home science, Medical science, Psychology, Human ideology, Sociology, Economics,
Education, Engineering, Electronics, Electrical, Information technology, Computer Science, Management, Organization behaviour,
Organization psychology, Marketing manage.

PARIPEX Indian Journal of Research
ISSN - 2250-1991 | IF : 5.761 | IC Value : 79.96
Journal DOI : 10.15373/22501991
Email: editor@paripex.in Website: www.paripex.in
PARIPEX - INDIAN JOURNAL OF RESEARCH (PIJR) is a double-reviewed monthly print-in published journal since January 2012. The aim of
the journal to become a serious vehicle for inspiring and disseminating research papers, articles, case studies, review articles etc in all subject
areas by the academicians, research scholars, corporate and practitioners with substantial experience and expertise in their respective elds.
This journal is kept wide to provide platform for diversity of intellectual pursuit from all corners of the society for enrichment and
enhancement of the group readers. The Journal is been published on every 15th of the month.
Accountings, Arts, Bio-medical, Biology, Business, Commerce, Corporate Governance, Clinical Research, Designing, Economics, Education,
Engineering, Finance, Financial Accounting, Fine Art, Geography, History, Home Science, Human Resource, Intellectual Property Rights,
Industrial Laws, Information Technology, Journalism, Literature, Management, Marketing, Management Accounting, Medical Science,
Organization Behavior, Organizational Psychology, Philosophy, Pharmaceutical Science, Political Science, Rural India, Statistics, Science, Social
Sciences, etc.

Global Journal for Research Analysis
ISSN No 2277 - 8160 | IF : 4.547 | IC Value 80.26
Journal DOI : 10.15373/22778160
Email: gjra@worldwidejournals.com Website: www.worldwidejournals.com
Global Journal For Research Analysis (GJRA) is a double reviewed monthly print journal that accepts research works from scholars,
academicians, professors, doctorates, lecturers, and corporate in their respective expertise of studies. Work after publication will be
retrievable on the website bifurcated based on issues of the month and its publication date. The journal is published on every 15th of the
Month.
The journal is wide and available for diverse intellectual and educational pursuit from all corners of the society to enrich the learning
experience of the group readers.
The periphery of the subject areas includes:
Accountings, Finance, Management Accounting, Business, Commerce, Corporate Governance, Financial Accounting, Arts, Fine Arts,
Designing, Medical, Bio-medical, clinical research, home science, Medical science, Psychology, Human ideology, Sociology, Economics,
Education, Engineering, Electronics, Electrical, Information technology, Computer Science, Management, Organization behaviour,
Organization psychology, Marketing management, Law, Corporate, Human Resources, Geography, History, Intellectual Property Rights,
Industrial Laws, Journalism, Literature, Philosophy, Pharmaceutical Science, Political Science, Rural India, Statistics, Social Sciences, etc

INDEX
Sr.
No.
1

2

3

4
5

6

7
8
9
10
11
12

13
14
15

Title
LEVEL OF THE SERUM ADIPONECTIN AS A BIOCHEMICAL MARKER OF LIVER
FIBROSIS IN HEPATITIS C PATIENTS.
Mahmoud Saad Berengy, Abd El- Monem Gaballah, Abd El- Mohsen Shaheen, Khaled El-Mola, Hany
awadallah, Mohamed heiza, Mohamed Ali Awad Gad
The Preferred Learning Styles of Saudi Family Medicine Residents
Dr. Norah Hanthal Al-Marri, Dr. Rawan Mohammad Aseeri, Dr.Moataza Mahmoud Abdel Wahab, Dr.
Bader Abdulmohsen Al-Mutairi
Use of milk progesterone assays for determining reproductive performance in camel under farming
system
Elagba Mohamed, Ayman Mustafa
IN VITRO AND IN VIVO EFFECTS OF ALPHA STONE, A POLYHERBAL FORMULA ON
MITOCHONDRIAL PERMEABILITY TRANSITION PORE IN RAT LIVER
Olanlokun John Oludele, Adejo Deborah, Olorunsogo Olufunso Olabode
Fluoride in East Nile drinking water sources Khartoum State, Sudan
Khatir M. K. Ahmed, Mona A. Haroun, H.M. Al-Solami
RELATION BETWEEN CAPTURE OF SCOMBEROMORUS SIERRA
(PERCOIDEI:SCOMBRIDAE) WITH SEA SURFACE TEMPERATURE AND CHLOROPHYLL
A OFF THE COAST OF THE CENTRAL MEXICAN PACIFIC (2003-2013)
Castro-Garibay H., Gallardo-Cabello M., Espino-Barr, E., Salmerón García O., Aguirre-Gómez R.
UTILIZATION OF PET WASTES AND THE SIDE PRODUCTS OF BIODIESEL PRODUCTION
N. Todorov, Donka Todorova
Curcumin as a Potential Therapeutic Drug for Neurodegenerative Complaints
Fashun Yan
Assessment of Referrals by Family Physicians at King Abdul-Aziz Hospital–Al Ahsa
Dr. Mounther Mohammed Al Naim, Dr. Abdulrahman Khalid Al Naim, Dr. Mohammed Al Jamaan
A PROTOCOL FOR PREVENTIVE DENTAL CARE BEFORE RECEIVING HEAD AND NECK
RADIOTHERAPY
Blanca Estela Estrada Esquivel, Wendy Melisa Bolanos Oviedo
Factors Affecting Sand Harvesting In Machakos County, Kenya
Mr. Erastus Kibiru Gitonga, Dr. Jones Agwata, Dr. Peter Baaro Gathura
Perceived Stress and Coping strategies in Undergraduate Medical Students
Hassan Sami, Ibrahim Adil Hassan, Sajjad Hussain, Koomail Saeeda, Hussain Ali, Mohammad Ayoob,
Abdul Sattar Khan
EFFECT OF MILTEFOSINE ON THE NUMBER OF LEISHMANIA DONOVANI
AMASTIGOTE IN VL INFECTED MACROPHAGE IN VITRO
GHUSOON A. ABD-AL- HUSSIEN, KHAWLA H. ZGHAIR
Sauna Bathing and the Cardiovascular System
Thomas F Heston
DEWANDARU (Eugenia uniflora L) FRUIT EXTRACT’S HEPATOPROTECTIVE EFFECT TO
THE CC14 INDUCED MICE
Puguh Santoso, Bagus Komang Satriyasa

Page
No.
1-4

5-8

9-11

12-16
17-21

22-30

31-32
33-33
34-37
38-39
40-43
44-47

48-52
53-54
55-56

ORIGINAL RESEARCH PAPER

Volume-6 | Issue-11 | November-2017 | ISSN No 2277 - 8179 | IF : 4.176 | IC Value : 78.46

INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH
LEVEL OF THE SERUM ADIPONECTIN AS A BIOCHEMICAL MARKER OF LIVER
FIBROSIS IN HEPATITIS C PATIENTS.

Medical Science

Mahmoud Saad
Berengy
Abd El- Monem
Gaballah
Abd El- Mohsen
Shaheen
Khaled El-Mola
Hany awadallah
Mohamed heiza
Mohamed Ali
Awad Gad

Internal Medicine Department ; Damietta Faculty of Medicine,Al-Azhar University ,
Medical Biochemistry Department, Faculty of Medicine, Cairo, Al-Azhar University,
Medical Biochemistry Department, Faculty of Medicine, Cairo, Al-Azhar University,
Tropical medicine Department, Faculty of Medicine, Damietta, Al-Azhar University,
Tropical medicine Department, Faculty of Medicine, Damietta, Al-Azhar University,
Tropical medicine Department, Faculty of Medicine, Damietta, Al-Azhar University,
Medical Biochemistry Department, Faculty of Medicine, Damietta, Al-Azhar University

ABSTRACT
Background: Adiponectin is a protein hormone secreted by adipose tissue. There is no data about the secretion of adiponectin during hepatitis C
infection; some studies revealed that hyperadiponectinemia found with chronic HCV infection is signicantly associated with the development of
liver brosis. Nonetheless, the action of adiponectin in chronic HCV infection is still controversial.
Objective: measurement of the serum adiponectin as a biochemical marker of liver brosis in hepatitis C patients.
Subjects and Methods: The present study was conducted on sixty patients suffering from chronic hepatitis C and twenty eight healthy volunteers
served as controls.
Results: The signicant nding of this study is that chronic HCV patients have increased circulating adiponectin levels than healthy controls (9.16
± 6.72 for HCV vs. 4.12 ± 1.78 for control, p <0.05) and it can be used as a biochemical marker for grade 4 brosis in metavir score which indicate
cirrhosis while no signicant difference between non cirrhotic grades and control group, also, adiponectin correlates positively with grade of
brosis.
Conclusion: This study demonstrated that hyperadiponectinaemia in HCV-infected patients correlate with hepatic brosis and it can be used as a
biochemical marker for grade 4 brosis in metavir score which indicates cirrhosis.

KEYWORDS
AdiponectI in – HCV – brosis
Introduction
Hepatitis C virus (HCV) infection is a major global health issue.
Estimates indicate that three to four million persons are newly infected
each year, 170 million people are chronically infected and death rate is
about 20-25% of cirrhotic cases (Ghazal et al., 2015).
Egypt has the highest prevalence of HCV in the world, estimated
nationally about 14.7% (Mohamoud et al., 2o13).
Left untreated, chronic HCV infection can cause liver brosis ending
in cirrhosis and hepatocellular carcinoma. Of those with chronic HCV
infection, the risk of cirrhosis of the liver is 15–30% within 20 years.
The risk of HCC in persons with cirrhosis is approximately 2–4% per
year (WHO, 2014).
The classical view of adipose tissue as just a passive reservoir for
energy storage has radically changed (Fisman et al., 2014).
Besides its function as an energy reservoir, white adipose tissue plays a
key role as an organ secreting numerous bioactive molecules
collectively called adipokines or adipocytokines (Robinson et al.,
2011).
adiponectin is a protein product of 244 amino acids consisting of four
domains, an amino-terminal signal sequence, a variable region, a
collagenous domain (cAd) and a carboxyterminal globular domain
(gAd). Adiponectin automatically self-associates into larger
structures. Initially, three adiponectin molecules bind together to form
a homotrimer. The trimers continue to self-associate and form a
hexamer or dodecamer (Ghoshal & Bhattacharyya, 2015).
Adiponectin has two isoforms in the circulation: full length

adiponectin (fAd); and a globular fragment (a proteolytically cleaved
fragment consisting of gAd) (Silva et al., 2014).
The globular fragment is present in small amounts in plasma and
increases free fatty acid oxidation in muscle tissue, an important
mechanism for the control of energy homoeostasis, while full length
adiponectin has the capacity to group globular domains into three
isoforms: trimeric (low molecular weight); hexameric (middle
molecular weight); and multimeric (high-molecular-weight). Each
oligomeric form has distinct biological properties and activates
different cellular signaling pathways in several tissues (Neumeier et
al., 2006).
Both globular and full length adiponectin exert their effects via
transmembrane G-protein coupled receptors, adiponectin receptor-1
(Adipo-R1), and adiponectin receptor-2 (Adipo-R2) and has the
following functions; insulin sensitizing, hepatoprotective and anti
atherosclerotic actions (Adya et al., 2015).
Our aim in this study was to measure the serum adiponectin as a
biochemical marker of liver brosis in hepatitis C patients.
Subjects and Methods
Sixty patients suffering from chronic hepatitis C and twenty eight
healthy volunteers served as controls were enrolled in the study.
The following criteria were excluded from this study:
Ÿ

Ÿ

Subjects suffering from any systemic diseases like diabetes
mellitus, hypertension, cardiovascular system diseases, and renal
dysfunction.
Smokers, alcoholics and drug addicts.

International Journal of Scientific Research

1

Volume-6 | Issue-11 | November-2017
Ÿ
Ÿ
Ÿ

Subjects with positive HBV.
Subjects who are known to have any auto-immune disease or those
taking any medication that affect the immune system.
Subjects who are known to have hormonal treatment.

Only patients with HCV hepatitis were included in this study.
The subjects selected from out patients clinic of Damietta Tropical
Hospital and New Damietta hospital Al-Azhar University. All patients
have presented to the hospital by positive HCV antibody and they are
coming to be assessed as potential candidate for anti viral therapy. An
informed consent was obtained from the patients prior to their
enrollment in this study. This study protocol was approved by the
hospital's ethical committee.
Laboratory investigations including liver function tests, hepatitis C
virus (HCV) antibody, HCV RNA viral load (PCR), serum creatinine,
fasting blood glucose lipid prole and adiponectin were done.

ISSN No 2277 - 8179 | IF : 4.176 | IC Value : 78.46

T.Cholest.
(mg/dL)
LDL (mg/dL)
HDL (mg/dL)
AST
(IU /L )
ALT
(IU /L )
T. Bil. (mg/dL)
Albumin (g/dL)

NS (0.8)

114.35±30.74 126.23±73.61
NS (0.2)
46.75±9.51
42.48±9.04
S (0.04)
26.17±7.69 42.40±20.40 HS (< 0.001)
21.92±7.13

40.91±21.01

HS (< 0.001)

0.68±0.16
3.69±0.39

0.937±0.234
3.67±0.523

HS (< 0.001)
NS (0.8)

S: Signicant.
HS: Highly signicant.
NS: Non signicant.
Table (2): Mean serum adiponectin levels of the studied groups.
Controls (n=28)
Mean±SD

BMI was calculated as body weight in kilograms divided by the square
of height in meters (kg/m2).
Abdominal ultrasonography: It aimed at establishing the diagnosis
by imaging the liver; spleen; portal, splenic and hepatic veins;
detection of ascites; and hepatic focal lesion.

183.28±32.92 185.91±74.08

Adiponectin
(μg / mL )

4.12±1.78

HCV
(n=60)
Mean ±SD
9.16±6.72

Significance &
p value
HS (< 0.001)

HS: Highly signicant

Liver biopsy: The biopsy was done for histopathological examin
ation. The biopsies were examined by Metavir score.
Statistical analysis: Patient's data were tabulated and analyzed using
SPSS 23.0 for Windows 8 Quantitative data were expressed by mean
and standard deviation (SD) and analyzed using t-student, Pearson or
Spearman correlation whenever appropriate. Qualitative data were
expressed by number and percent. p value was considered signicant
in when less than 0.05.
Results
The main clinical and laboratory data are summarized in Table (1):
As shown in Table (2), the mean adiponectin levels is 9.16±6.72 μg /
mL in the chronic HCV group and 4.12±1.78 μg / mL in the control
group and this difference is highly signicant ( p < 0.001) (gure 1).
Table 3 show the correlation between adiponectin and the various
parameters performed in the study among HCV group.
There is no signicant correlation found between adiponectin and
ALT, AST, total bilirubin or viral load.
On the contrary, there is highly signicant and negative correlation
between adiponectin and BMI (r = -0.479, p <0.001), albumin (r = 0.714, p <0.001), total cholesterol (r = -0.609, p <0.001) and LDL (r = 0.635, p <0.001).
Also, no signicant correlation found between adiponectin and TG or
HDL.
In the present study we categorized HCV group into cirrhotic group
represented by F4 in metavir score which examine liver biopsy and non
cirrhotic group represented by F1, F2 and F3.
Table 4 shows the comparison between adiponectin levels in control,
non cirrhotic group (F1, F2 and F3) and cirrhotic group (F4).
There is no signicant difference between control and non cirrhotic
groups as regard adiponectin but, there is highly signicant difference
between cirrhotic and non cirrhotic or control groups. So we make
receiver operating characteristic (ROC) curve analysis which
conducted to identify the optimal adiponectin levels for potential
prediction of development of cirrhosis within CHC patients (gure 2).
Table (1): Main clinical and laboratory data of the studied groups.
CONTROL
HCV
Significance &
(n=28)
(n =60)
p value
Mean ± SD Mean ± SD
Age (years)
46.71±5.93
51.06±7.07
S (0.006)
BMI(weight/height2) 27.14±4.35
27.97±3.81
NS (0.3)
TG (mg/dl)
108.57±56.21 84.73±41.30
NS (0.02)

2

International Journal of Scientific Research

Fig. 2: Mean adiponectin levels among the studied groups.
Table (3): Correlation between serum adiponectin
and various parameters among the HCV group.
Adiponectin & other
parameters
BMI
ALT
AST
T. Bilirubin
Viral load
Albumin
T. Cholesterol
LDL
TG
HDL
HS: Highly signicant.
NS: Non signicant

Pearson's
correlation
coefficient "r"
-0.479
0.066
0.162
-0.062
0.252
-0.714
-0.609
-0.635
-0.006
0.174

Significance
&
p value
HS (<0.001)
NS (0.615)
NS (0.217)
NS (0.638)
NS (0.052)
HS (<0.001)
HS (<0.001)
HS (<0.001)
NS (0.963)
NS (0.183)

Table (4): comparison between mean adiponectin levels in control,
non cirrhotic group and cirrhotic groups.
Control Non cirrhotic Cirrhotic Significance
(n=28)
(F1,F2,F3)
(F4)
&
Mean ± SD
(n=40)
(n=20)
p value
Mean ± SD Mean ± SD
Adiponectin 4.12±1.7
5.09±2.1
17.31±5.1 HS (< 0.001)
(μg / mL)
HS: Highly signicant

Volume-6 | Issue-11 | November-2017

Fig. 2: A receiver operating curve (ROC) analysis of Adiponectin
levels for the prediction of development of cirrhosis in CHC patients.
Adiponectin cut off 11.21 sensitivity = 100% , specicity = 90%, PPV
= 95.2, NPV = 100, Accuracy = 99% and area under the curve (AUC) is
0.989
Discussion
Hepatitis C virus (HCV) infection is a common liver disease with an
estimated 3% of the world’s population chronically infected with this
viral pathogen. The majority of the infected individuals (60-80%)
develop chronic hepatitis C (CHC), which is associated with
progressive liver brosis and a risk of cirrhosis after 20 years (Torti et
al., 2012).
Egypt has the highest prevalence of HCV worldwide (15%) and the
highest prevalence of HCV-4, which is responsible for almost 90 % of
infections and is considered a major cause of chronic hepatitis, liver
cirrhosis, hepatocellular carcinoma, and liver transplantation in the
country (Hamdy et al., 2015).
The liver is the major organ responsible for mediating the whole body
metabolic effects generated by adiponectin through the activation of
specic receptors (Nawrocki et al., 2006).
In the hepatocytes, adiponectin regulates two metabolic pathways, anti
inammatory peroxisome proliferator-activated receptor alpha and
fatty acid oxidation, which have been shown to be reduced in chronic
HCV-infected liver (Sheikh et al., 2008).
Circulating adiponectin levels have been reported to be elevated in
CHC independently of age, body mass, diabetes, and severity of liver
brosis (Canavesi et al., 2015).
In addition, hypoadiponectinemia has been reported to enhance
hepatic steatosis, inammation, brosis, and hepatocarcinogenesis in
animal models of liver diseases (Asano et al., 2009).
Indeed, reduced adiponectin levels were found in patients with
nonalcoholic steatohepatitis (NASH) and were associated with
increased steatosis and necroinammation in the liver. However, the
role of adiponectin in hepatitis C virus (HCV)-induced chronic
hepatitis is still not understood and the relationship between
adiponectin level and disease severity remains controversial (Arano et
al., 2013).
The aim of this study was to dene the potential role of adipocyte
derived adiponectin as a marker for liver brosis in patients with
chronic hepatitis C infection in Egypt. Hypothesized that dysreg
ulation of adiponectin and adiponectin receptor system could
contribute to the development of brosis in chronic hepatitis C virus
patients. This hypothesis is supported by results of several recent
studies. Corbetta et al., 2011 said that in patients with chronic HCV
hepatitis, brosis was associated with hyperadiponectinemia,
suggesting a state of adiponectin resistance and Canavesi et al., 2015
stated that CHC is associated with increased serum adiponectin
independently of age, body mass, diabetes, and of severe liver brosis,
particularly in men.
The signicant nding of this study is that chronic HCV patients have
increased circulating adiponectin levels than healthy controls (9.16 ±
6.72 for HCV vs. 4.12 ± 1.78 for control, p <0.05) and it can be used as
a biochemical marker for grade 4 brosis in metavir score which
indicate cirrhosis while no signicant difference between non cirrhotic
grades and control group, also, adiponectin correlate positively with
grade of brosis.
On comparing the mean adiponectin levels in both groups under study
as regard the gender, it was found that, mean adiponectin level is
increased in the females than males in the control group without
statistical signicant difference (4.3± 1.9 for females & 3.8± 1.6 for
males, p = 0.394). The same result in HCV group (9.6±7.8 for females,
and 8.8 ±6.1for males, p = 0.665).
This disagrees with Corbetta et al., 2011 who revealed that there is
signicant difference between male and females as regard serum
adiponectin in chronic HCV patients and controls.

ISSN No 2277 - 8179 | IF : 4.176 | IC Value : 78.46

The present study revealed that there is signicant correlation between
adiponectin and BMI in both cases and controls ®= -,497 , p< 0.001for
cases & r=-,557 , p< 0.01 for controls).
This agrees with other study which revealed that there is signicant
negative correlation between serum adiponectin and BMI in both cases
and controls (Jonsson et al., 2005).
On the contrary, Liu et al., 2005 reported that serum adiponectin did
not correlate with BMI.
The present study revealed that ALT, AST and total bilirubin are highly
signicantly higher in HCV group than controls, and there is no
signicant correlation found between adiponectin and liver enzymes
or total bilirubin in the HCV studied group (p = 0.615, 0.217, 0.638
respectively ).
These results coincide with that of the studies done by others who
reported that no signicant correlation between serum adiponectin and
ALT levels could be found in chronic HCV-infected patients
(Corbetta et al., 2011).
Yokoyama et al., 2004 demonstrated that the serum adiponectin level
was inversely correlated with the levels of serum AST and ALT in a
study done to assess the relation between adiponectin and non
alcoholic fatty liver disease concluding that hypoadiponectinaemia
may worsen liver disease associated with metabolic disease.
Also, the same result was reported by Derbala et al., 2009 who said
that there is a signicant negative correlation between serum
adiponectin and ALT, which implies that hypoadiponectinaemia
contributes to an increase in transaminase activity and attributed that to
possible triglyceride accumulation but, hypoadiponectinaemia causes
liver injury independently from hyperlipidaemia, insulin resistance
and obesity.
In the present study, there was signicant and negative correlation seen
between serum adiponectin levels and albumin which represent
synthetic liver function in HCV group (r = -0.714, p <0.001).
These results coincide with that of the study which reported that there
is signicant correlation between serum adiponectin and albumin
(Salman et al., 2010).
In the present study there was no signicant correlation seen between
serum adiponectin levels and viral load (p =0.052).
This agrees with study by Khattab et al., 2012 who reported that
neither serum adipocytokines nor homeostasis model assessment
estimated insulin resistance (HOMA-IR) was correlated with viral
load.
Also, Derbala et al., 2009 concluded that adiponectin changes are not
related to viral load, insulin resistance or other demographic data,
suggesting that this change is histologically related.
On the other hand, a study by Liu et al., 2005 reported that high HCV
load was signicantly associated with lower serum adiponectin levels,
but serum adiponectin levels did not correlate with other clinical
parameters. This may be attributed to HCV genotype-specic
differences in hepatic mRNA expression of adiponectin receptors.
Furthermore, in HCV group we found a highly signicant negative
correlation between adiponectin and both total cholesterol and LDL (r
= -0.609, p <0.001 & r = -0.635, p <0.001) respectively, also, there is an
inverse correlation seen with TG and positive correlation with HDL
but, without important signicance.
On the contrary, in control group there is no signicant negative
correlation between adiponectin and both total cholesterol and LDL (r
= -.361, p >0.01 & r = -.374, p >0.01) respectively, whereas a highly
signicant correlation between adiponectin and both TG and HDL (r =
-.584, p= 0.001 & r = .650, p <0.001) respectively.
These results coincide with that of the study done by Komatsu et al.,
2007 on apparently healthy subjects, it was reported that serum
adiponectin was positively correlated with HDL and inversely
correlates with triglycerides.

International Journal of Scientific Research

3

Volume-6 | Issue-11 | November-2017

This disagrees with study by Corbetta et al., 2011 who revealed that
Serum HDL cholesterol and triglycerides levels were signicantly
correlated with serum adiponectin levels in both cases and controls.

ISSN No 2277 - 8179 | IF : 4.176 | IC Value : 78.46

9.
10.

The main nding of this study was that there is no signicant difference
between control and non cirrhotic groups as regard adiponectin but,
there is highly signicant difference between cirrhotic and non
cirrhotic or control groups (p <0.001). So we make receiver operating
characteristic (ROC) curve analysis which conducted to identify the
optimal adiponectin level for potential prediction of development of
cirrhosis within CHC patients. Adiponectin best cut-off value was
11.21μg/mL, with a sensitivity of 100% and a specicity of 90%. The
area under the curve was 0.98. The PPV was 95.2% and the NPV was
100% with an accuracy of 99%.
This agrees with study by Corbetta et al., 2011 reported that severe
stages of brosis were characterized by serum adiponectin levels
signicantly higher than those in healthy controls and mild to moderate
brosis.
Also, Salman et al., 2010 stated that Adiponectin is elevated in
cirrhosis and shows correlation with degree of hepatocellular injury
and do not correlate with parameters of body composition or
metabolism but exclusively with reduced liver function.
The signicant increase of the serum adiponectin levels may be
explained by the impaired biliary secretion in the cirrhotic liver as
biliary excretion has previously been shown to be involved in the
clearance of adiponectin (Derbala et al., 2009).
Since CHC is associated with insulin resistance, it would be expected
to be also linked to decreased circulating adiponectin. Increased
adiponectin levels in the presence of insulin resistance have thus led
Corbetta et al., 2011 to hypothesize a state of adiponectin resistance
that would account for the association of high adiponectin levels with
the risk of hepatocellular carcinoma and overall mortality in CHC
(Canavesi et al., 2015).
Other Various mechanisms have been proposed to explain the raised
levels of adiponectin with brosis progression, such as an imbalance
between the production of adiponectin by adipocytes and its excretion
by the liver, an increase in adiponectin production by hepatic stellate
cells (HSC) (Silva et al., 2007).
Masaki et al., 2004 proposed that the signicant increase of the serum
adiponectin levels might reect one of the body anti-inammatory
mechanisms in chronic liver disease.
Canavesi et al., 2015 said that the signicant increase of the serum
adiponectin levels may be explained by a feedback mechanism to
counteract insulin resistance, which would be consistent with the
negative correlation between adiponectin and insulin levels in CHC
patients.
Conclusion: This study demonstrated that hyperadiponectinaemia in
HCV-infected patients correlate with hepatic brosis and it can be used
as a biochemical marker for grade 4 brosis in metavir score which
indicates cirrhosis.
REFERENCES
1.
2.
3.
4.

5.

6.

7.
8.

Adya R, Tan BK, & Randeva HS. (2015). Differential effects of leptin and adiponectin in
endothelial angiogenesis. Journal of diabetes research, 648239. http:// doi.org/
10.1155/2015/648239
Arano T, Nakagawa H, Ikeda H, & Koike K. (2013). Adiponectin in chronic hepatitis C.
Clinical journal of gastroenterology, 6(4), 259-263.
Asano T, Watanabe K, Kubota N, Gunji T, Omata M, Kadowaki T, & Ohnishi S. (2009).
Adiponectin knockout mice on high fat diet develop brosing steatohepatitis. Journal of
gastroenterology and hepatology, 24(10), 1669-1676.
Canavesi E, Porzio M, Ruscica M, Rametta R, Macchi C, Pelusi S, Fracanzani AL,
Dongiovanni P, Fargion S, & Magni P. (2015). Increased circulating adiponectin in
males with chronic HCV hepatitis. European journal of internal medicine, 26(8), 635639.
Corbetta S, Redaelli A, Pozzi M, Bovo G, Ratti L, Redaelli E, Pellegrini C, Beck-Peccoz
P, & Spada A. (2011). Fibrosis is associated with adiponectin resistance in chronic
hepatitis C virus infection. European journal of clinical investigation, 41(8), 898-905.
Derbala M, Rizk N, Al-Kaabi S, Amer A, Shebl F, Al Marri A, Aigha I, Alyaesi D,
Mohamed H, & Aman H. (2009). Adiponectin changes in HCV-Genotype 4: relation to
liver histology and response to treatment. Journal of viral hepatitis, 16(10), 689-696.
Fisman EZ, & Tenenbaum A. (2014). Adiponectin: a manifold therapeutic target for
metabolic syndrome, diabetes, and coronary disease? Cardiovascular Diabetology, 13,
103. http://doi.org/10.1186/1475-2840-13-103.
Ghazal AA, Shawky SM, Maharem DA, El Deeb MK, El Ghlied LA, & Mouftah SF.
(2015). Assessment of host metabolic factors: Adiponectin, TNF-and Insulin resistance

4

International Journal of Scientific Research

11.
12.
13.
14.
15.

16.
17.

18.

19.
20.
21.
22.
23.
24.

25.
26.

inuence on the degree of hepatic steatosis in patients infected with Hepatitis C virus.
Int. J. Curr. Microbiol. App. Sci, 4(2), 770-784.
Ghoshal K, & Bhattacharyya M. (2015). Adiponectin: Probe of the molecular paradigm
associating diabetes and obesity. World journal of diabetes, 6(1), 151.
Hamdy K, Al Swaff R, Hussein HA, & Gamal M. (2015). Assessment of serum
adiponectin in Egyptian patients with HCV-related cirrhosis and hepatocellular
carcinoma. Journal of Endocrinological Investigation, 38(11), 1225-1231.
Jonsson JR, Moschen AR, &Hickman J. (2005). Adiponectin and its
receptors with
chronic hepatitis c. Journal of Hepatology, 43 (6), 929-936.
Khattab MA, Eslam M, Mousa YI, Ela-adawy N, Fathy S, Shatat M, Abd-Aalhalim H,
Kamal A, & Sharawe MA. (2012). Association between metabolic abnormalities and
hepatitis C-related hepatocellular carcinoma. Ann Hepatol, 11(4), 487-494.
Komatsu M, Ohfusa H, Aizawa T, & Hashizume K. (2007). Adiponectin inversely
correlates with high sensitive C-reactive protein and triglycerides, but not with insulin
sensitivity, in apparently healthy Japanese men. Endocrine journal, 54(4), 553-558.
Liu C-J, Chen P-J, Jeng Y-M, Huang W-L, Yang W-S, Lai M-Y, Kao J-H, & Chen D-S.
(2005). Serum adiponectin correlates with viral characteristics but not histologic
features in patients with chronic hepatitis C. Journal of hepatology, 43(2), 235-242.
Masaki T, Chiba S, Tatsukawa H, Yasuda T, Noguchi H, Seike M, & Yoshimatsu H.
(2004). Adiponectin protects LPS-induced liver injury through modulation of TNF-α in
KK-Ay obese mice. Hepatology, 40(1), 177-184.
Mohamoud YA, Mumtaz GR, Riome S, Miller DW, & Abu-Raddad LJ. (2013). The
epidemiology of hepatitis C virus in Egypt: a systematic review and data synthesis.
BMC infectious diseases, 13(1), 1.
Nakagawa H, Fujiwara N, Tateishi R, Arano T, Nakagomi R, Kondo M, Minami T, Sato
M, Uchino K, & Enooku K. (2015). Impact of serum levels of interleukin-6 and
adiponectin on all-cause, liver-related, and liver-unrelated mortality in chronic hepatitis
C patients. Journal of gastroenterology and hepatology, 30(2), 379-388.
Nawrocki AR, Rajala MW, Tomas E, Pajvani UB, Saha AK, Trumbauer ME, Pang Z,
Chen AS, Ruderman NB, & Chen H. (2006). Mice lacking adiponectin show decreased
hepatic insulin sensitivity and reduced responsiveness to peroxisome proliferatoractivated receptor γ agonists. Journal of Biological Chemistry, 281(5), 2654-2660.
Neumeier M, Weigert J, Schäfer A, Wehrwein G, Müller-Ladner U, Schölmerich J,
Wrede C, & Buechler C. (2006). Different effects of adiponectin isoforms in human
monocytic cells. Journal of leukocyte biology, 79(4), 803-808.
Robinson K, Prins J, & Venkatesh B. (2011). Clinical review: adiponectin biology and
its role in inammation and critical illness. Crit Care, 15(2), 221.
Salman TA, Allam N, Azab GI, Shaarawy AA, Hassouna MM, & El-haddad OM. (2010).
Study of adiponectin in chronic liver disease and cholestasis. Hepatology international,
4(4), 767-774.
Sheikh MY, Choi J, Qadri I, Friedman JE, & Sanyal AJ. (2008). Hepatitis C virus
infection: molecular pathways to metabolic syndrome. Hepatology, 47(6), 2127-2133.
Silva TE, Colombo G, & Schiavon LL. (2014). Adiponectin: A multitasking player in the
eld of liver diseases. Diabetes & metabolism, 40(2), 95-107.
Torti C, Zazzi M, Abenavoli L, Trapasso F, Cesario F, Corigliano D, Cosco L, Costa C,
Curia RL, & De Rosa M. (2012). Future research and collaboration: the “SINERGIE”
project on HCV (South Italian Network for Rational Guidelines and International
Epidemiology). BMC infectious diseases, 12(Suppl 2), S9.
World Health Organization. (2014). Guidelines for the screening, care and treatment of
persons with hepatitis C infection: World Health Organization.
Yokoyama Hirokazu, Hirose Hiroshi, Ohgo Hideki, & Saito Ikuo. (2004). Inverse
association between serum adiponectin level and transaminase activities in Japanese
male workers. Journal of hepatology, 41(1), 19-24.

ORIGINAL RESEARCH PAPER

Volume-6 | Issue-11 | November-2017 | ISSN No 2277 - 8179 | IF : 4.176 | IC Value : 78.46

INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH
THE PREFERRED LEARNING STYLES OF SAUDI FAMILY MEDICINE RESIDENTS

Medicine

Dr. Norah Hanthal
Al-Marri
Dr. Rawan
Mohammad Aseeri
Dr.Moataza
Mahmoud Abdel
Wahab
Dr. Bader
Abdulmohsen AlMutairi

Family Medicine Post-Graduate Program, National Guard Health affairs, Eastern
Province, Saudi Arabia
Family Medicine post-Graduate Program, King Fahd Military Medical Complex , Eastern
Province, Saudi Arabia
PhD, MBChB, Associate professor, Imam Abdulrahman bin Faisal University-IAU
Family & Community Medicine
Consultant Family Medicine and Geriatric Medicine, Director of Family, Community and
Emergency Medicine Administration, King Fahd Military Medical Complex - Dhahran

ABSTRACT
Trainers in the family medicine program must have knowledge of the preferred method of education of residents to develop appropriate teaching
methods. LS is dened as an individual's unique approach to learning. This study's intent was to determine the preferred learning styles of family
medicine residents in the Kingdom of Saudi Arabia, and to compare those styles with sociodemographic personal characteristics. A descriptive
cross-sectional study using the VARK questionnaire was conducted among family medicine residents from all training centers in various Saudi
Arabian provinces. Results revealed that the unimodal aural LS was the most preferred while the multimodal LS was the least preferred. A
signicant relation was found between visual LS and residency level (p= 0.045). However, there was no relation between a preferred LS and either
sociodemographic characteristics or GPA. These ndings can help training programs improve the quality of the teaching process to better t
preferred learning styles.

KEYWORDS
Introduction and Literature Review:
There is a tremendous demand for family physicians in the Kingdom of
Saudi Arabia. The Ministry of Health has dealt with this issue by
requesting a 14-month training program that included various major
and subspecialty rotations (Al-Khaldi et al. 2014). There are more than
2,000 primary healthcare centers in the Kingdom of Saudi Arabia. That
number is expected to increase, which will create a continual demand
for qualied Family Physicians. The growing number of primary care
centers is an issue that prompted authorities (including those in the
Saudi Commission for Health Specialties) to meet the subsequent
demand for personnel by increasing the number of training centers.
To develop an efcient health care system, family physicians should be
professionally trained. The Kingdom of Saudi Arabia opened the
family medicine residency training program in 1996. It has been 32
years since the Saudi Board of Family Medicine was established. At the
time of this study, the family medicine training program in Saudi
Arabia was a four-year program. To improve educational methods
during the residency program, trainers should be familiar with the
learning style of their residents (scfhs.org.sa 2017).
There are some learning–related concepts that have been the focus of
attention when attempting to identify the factors affecting learning
performance. One of those factors, learning style (LS), has been the
focus of this study. LS refers to the concept that people learn
information in a variety of ways (Al-Khaldi et al. 2014).
LS is a theory that positively afrms that learners have distinct
preferences for how they process and understand information. A
structural LS tends to be stable over time. However, the style may
change between experiences or processes. Keefe (1979) dened LS as
“the composite of cognitive, affective and physiological
characteristics that serve as relatively stable indicators of how a learner
perceives, interacts and responds to a learning environment”.
Many tools have been developed to understand how a person learns.
These include Vermunt's Inventory of Learning Styles, Kolb's learning

styles, the Myers-Briggs Type Indicator, and Fleming's VARK
Questionnaire.
Fleming established the VARK mode in 1987. It is based on a
categorization of learners by their preferred sensory modalities, i.e.,
visual (V), aural (A), read/write (R), and kinesthetic (K). Some
examples of the VARK learning style preferences (LSPs) are the
examination or creation of pictures and animations (visual),
discussions and question-answer sessions (aural), taking notes or
creating laboratory reports (read/write), and engaging in physical
experiences or manipulating objects (kinesthetic). A single learner can
have a dominant modality preference for learning (unimodal), or have
a preference for a combination of two or more sensory modalities
(multimodal) (Almigbal 2015).
The relationship between LS and academic performance has been
studied by many academic researchers. Some impressive results were
found by the Roger H. Kim study. Kim's study revealed that general
surgery residents showed a strong overall preference for a multimodal
LS (Kim et al. 2015). In another study, more than two-thirds of medical
students preferred a dominant unimodal LS, while the remainder
preferred a multimodal LS (Liew et al. 2015). At the International
Medical University (IMN) in Kuala Lumper, students who selected a
unimodal LS strongly preferred the kinesthetic type (Liew et al. 2015).
Another study revealed that one-third of pre-clinical medical students
in Oman equally preferred different unimodal LSs, and that the
remainder preferred either bimodal or multimodal LSs (Panambur et
al. 2014).
Alkhasawneh et al. discovered that a multimodal LS (mostly the
kinesthetic type paired with a visual or read/write preference) was
dominant for more than half of all nursing students (Al-Khasawneh
2013).
In Saudi Arabia, little is known about the relationship between learning
style preference and academic achievement. However, a multimodal
LS was discovered to be the most commonly preferred LS among 4thand-5th-year medical students at the King Saud bin AbdulAziz

International Journal of Scientific Research

5


Related documents


ijsr november 2017 print file 11 online
nihms544840
liver international 29 7 1051 1055
jdit 2015 0428 016
10 1038 ejcn 2014 289
premium chinese tonic herbs1352


Related keywords