Association between residential green spaces and pregnancy outcomes: a systematic review and meta-analysis.

Residential exposure to greenness has shown positive influences on pregnancy outcomes like birth weight, preterm births, and small to gestational age (SGA) deliveries. We aimed to comprehensively review and investigate these associations by conducting a systematic review with meta-analysis. Relevant studies were retrieved from PubMed, EMBASE, ScienceDirect, and Google Scholar databases before June 2023. Summary effect estimates included birth weight, low birth weight (LBW), preterm births, and SGA which were calculated for 0.1 unit increase in residential greenness exposure. Overall quality of the evidence was examined through Joanna Briggs Institute (JBI) critical appraisal tool. The review included 31 articles and found a statistically significant increase in birth weight measured at 250 m buffer distance (ß = 8.95, 95% CI = 1.63-16.27). Green spaces were also associated with lower odds of LBW (OR = 0.97, 95% CI = 0.96-0.98). Residential greenness had positive impacts on pregnancy outcomes that calls for emphasis on urban planning, especially in developing countries.

Oxidative stress in polycystic ovary syndrome: a case-control study.

OBJECTIVE: To compare the serum levels of biochemical and oxidative stress markers i.e., malondialdehyde (MDA) and paraoxonase-1(PON1) in polycystic ovary syndrome (PCOS) patients and healthy female individuals of reproductive age group (18-40 years). METHODS: This case-control study was conducted in Dow University of Health Sciences (DUHS), Karachi from June 2019 to October 2020. Seventy Subjects including 35 PCOS patients that have primary subfertility problem (cases) and 35 healthy and fertile females (controls) were recruited. Serum samples were collected for analysis of insulin, sex hormone-binding globulin, testosterone, fasting blood glucose and lipid profile. PON 1 and MDA levels were estimated by ELISA. Comparison between the two groups was done using independent t-test. RESULTS: The patients had significantly increased mean body mass index (28.5+4.6 kg/m2 vs 25.7+4.5 kg/m2, p=0.014), systolic (129.6±13.9 mm of Hg vs 113±7.7 mm of Hg, p<0.001) and diastolic (78.7±8.8 mm of Hg vs 74.6±6.7 mm of Hg, p=0.032) blood pressures compared to controls. The high-density lipoprotein cholesterol levels were significantly lower in PCOS (42.2±8.6mg/dl) than controls (48.8±11.8mg/dl, p=0.009, p=0.009). Serum insulin (14.3±5.8 uIU/mL) vs (10.0±5.2 uIU/mL), p=0.002 and testosterone levels (1.3±0.9 nmol/L) vs (0.82±0.3 nmol/L), p<0.001 were significantly higher whereas sex hormone binding globulin (SHBG) levels (35.2±19.7nmol/L vs 58.8±31.0 nmol/L) were significantly lower in patients than healthy controls (p<0.001). Both oxidative stress markers, paraoxonase 1 (7.7±2.4 vs 6.4±2.6 µg/mL, p=0.04) and malondialdehyde (2.5±1.0 vs 1.9+0.51µg/mL, p=0.034) levels were significantly elevated in PCOS patients than controls. No significant correlation was found between dietary habits and life style between cases and controls. CONCLUSIONS: The study reported significantly elevated levels of oxidative stress markers in PCOS patients.

Serum Leptin levels in newly diagnosed Epileptic Patients.

Objectives: To compare leptin levels in newly-diagnosed treatment-naive epileptic patients and healthy controls. METHODS: This case-control study was conducted from January 10 to September 15, 2022, at the Dow University of Health Sciences, Karachi, and comprised newly-diagnosed epileptic patients age 12-35years who had no comorbidity. The subjects were enrolled from the Neurology out-patient department of Civil Hospital, Karachi. Healthy individuals matched for age, gender and body mass index were also enrolled as controls. Blood samples were collected between 8am and 10am for the evaluation of serum leptin levels using enzyme-linked immunosorbent assay. Data was analysed using SPSS 26. RESULTS: Of the 100 subjects, 64(64%) were males and 36(36%) were females. There were 50(50%) cases with mean age 19.34±5.65 years, and 50(50%) controls with mean age 19.76±5.67 (p=0.614). 100% of 50 individuals in control group did not have any family history of epilepsy,while 18% of cases (9) reported a positive family history. Mean leptin level in cases was 31.03±19.37 compared to 5.25±4.03 in the controls (p<0.05). CONCLUSIONS: Serum leptin levels were elevated in newly-diagnosed epileptic patients compared to healthy controls.

Historical trends in breast cancer presentation among women in Pakistan from join-point regression analysis.

Objective: Breast cancer prevalence in Pakistan is among the highest in Asian countries. Recent changes in the temporal trends of breast cancer are largely unknown and examination of these trends can provide a direction in national planning for future health programs. The aim of this study was to examine recent changes in breast cancer incidence in Pakistan. Methods: A total of 9,771 diagnosed breast cancer women were registered from 2004 to 2015 in three hospitals of Karachi. Join-point regression analysis was applied to assessing the age-standardized breast cancer presentation trends for each five-year age group. Age-specific average annual percentage changes were also calculated to assess the proportion of women with increased or decreased incidence of breast cancer. Results: Age-standardized rates of breast cancer steadily increased from 24.7 per 100,000 in 2004, to 45.4 per 100,000 in 2015. The analytical trend based on the join-point model showed an average percentage increase breast cancer prevalence of 5.4 (95% CI = 3.1, 7.8). Significantly higher prevalence rates were identified among women aged 40-44 years and 65-69 years with an average percentage change of 18.5 (95% CI = 2.3, 37.2) and 14.3 (95% CI = 2.2, 27.9) respectively in the four years from 2011 to 2015. Conclusion: The findings indicate the trend in age-standardized prevalence increased significantly in all age groups with noticeably larger increases observed among older and post-menopausal women from 2011 to 2015. The results warrant the need for more targeted interventions to high-risk groups and a sound foundation for cancer control program planning and policy development in Pakistan to reduce the increasing incidence of breast cancer.

Esophageal cancer patient survival: A retrospective study from a tertiary care hospital in Pakistan.

Objective: To determine the pattern, tumor characteristics of esophageal cancer (EC) and survival of esophageal carcinoma patients presenting to upper GI Unit at Dr. Ruth K.M. Pfau Civil Hospital Karachi. Methods: We conducted a retrospective analysis of histologically confirmed EC patients from 2016 to 2021 at Upper GI Unit - Dr. Ruth K.M. Pfau Civil Hospital, Karachi. Data were collected using a filled Proforma, medical records, pathology reports and surgical notes, and patients or their family members were contacted for informed consent. Statistical analyses were performed using STATA version 16.0. Time to event was measured from the date of diagnosis to the date of the last follow-up or recorded death. Descriptive statistics and survival analyses, including Kaplan-Meier method and log-rank test, were employed. Univariate and multivariate Cox regression analyses were conducted to assess independent predictors of survival. Results: Total 152 patients with a median age of 45 (range 80-15) years were enrolled in this study. Clinical stages-III, IV-A and IV-B were identified in 35.5% (n = 54), 23.7% (n = 36) and 34.2% (n = 52), respectively. Total of 62% (n=94) had died at median follow up of 9.56 months and three years overall survival rate was 10.0%. Univariate survival analysis revealed that patients with clinical stage-II (p-value 0.002) and patients treated with combined surgery plus chemo-radiotherapy (p-value 0.040) was significantly associated with lower risk of mortality among other stages and treatment modality groups. Conversely, patients having metastasis (p value <0.001) and those with vascular involvement >90 degrees (p value <0.001) showed worse survival outcomes. Conclusion: Our study reveals a three years survival rate of 10.0%, emphasizing the formidable challenge of advanced-stage malignancies. Clinical stage, vascular involvement, and metastasis emerged as significant predictors of mortality. Moreover, integrating surgery with chemo-radiotherapy significantly improved three years survival (36.8% vs. 14.2%). Despite single-center limitations, our findings provide crucial regional insights into esophageal carcinoma outcomes.

Clinical efficacy of scaling and root planing with and without metronidazole on glycemic control: three-arm randomized controlled trial.

BACKGROUND: Treating periodontitis through non-surgical periodontal therapy (NSPT) may improve glycemic control in type-2 Diabetes Mellitus (T2DM) patients. However, the evidence to maintain this improvement beyond four months is insufficient. Hence, this trial was conducted to assess clinical efficacy of NSPT on glycemic control in T2DM patients. METHODS: This three-arm randomized controlled trial recruited 150 known T2DM participants (35-65 years), suffering from moderate to severe periodontitis, having HbA1c level ≥ 6.5% at baseline. Participants were followed up at 3 and 6 months. Intervention for test group-1 included scaling and root planing (SRP) with metronidazole (MET) and oral hygiene instructions (OHI). Test group-2 was intervened with SRP + OHI and control group with OHI only. Stata v. 14 was used to observe inter and intragroup mean changes in glycemic [glycated hemoglobin (HbA1c), fasting blood glucose (FBG)] and periodontal variables [bleeding on probing (BOP), periodontal pocket depth (PPD), clinical attachment loss (CAL)] using ANOVA and RMANOVA. Proportion of change in outcome variable (HbA1c) was assessed between treatment groups using chi-square test. Change was considered significant at p-value ≤ 0.05. RESULTS: A significant reduction was observed in BOP, PPD, CAL, HbA1c and FBG over time [p < 0.05]. Significant reductions were observed in same variables in both test groups in comparison to control arm [p < 0.05]. No change between the two test groups was observed [p > 0.05]. CONCLUSION: Scaling and root planing improves glycemic control of T2DM patients independently of the use of MET. Therefore, SRP after every 6 months may be suggested and included as a part of overall diabetes management for patients suffering from T2DM. Clinical trial registration NCT 03,343,366 [Date of Registration: 17/11/2017].

Determinants of stunting, underweight and wasting among children < 5 years of age: evidence from 2012-2013 Pakistan demographic and health survey.

BACKGROUND: Childhood malnutrition is a critical public health concern in Pakistan. We aimed to explore factors associated with malnutrition in Pakistani children (< 5 years of age) using the Pakistan Demographic and Health Survey (PDHS) 2012-2013. METHODS: Sample of 3071 Pakistani children aged 0-59 months from the PDHS 2012-2013, with complete anthropometric measurements were included in the study. Nutritional status was evaluated using anthropometric indices; height-for-age, weight-for-height and weight-for-age, as proxy measures of three forms of under-five malnutrition including stunting, wasting and underweight respectively. Uni- and multivariate binary logistic regressions were used to examine the association between selected maternal-socio-demographic and child level variables (such as child sex, age, size at birth, antenatal clinic visits, recent diarrheal incidence and breastfeeding status) and three proxy measures of child nutritional status. RESULTS: About 44.4% of under-five children were stunted, 29.4% were underweight and 10.7% were wasted. Children whose mothers lived in rural areas (aOR = 0.67, 95%CI 0.48-0.92), were aged ≥18 years at marriage (aOR = 0.76, 95%CI 0.59-0.99) and had visited antenatal clinic more than 3 times during pregnancy (aOR = 0.61, 95%CI 0.38-0.98) were less likely to be stunted. Mother's low educational level (aOR = 2.55, 95%CI 1.26-5.17), short stature (aOR = 2.31, 95%CI 1.34-3.98), child's small size at birth (aOR = 1.67, 95%CI 1.14-2.45) and mother's BMI were significantly associated with child's underweight status. Children whose mothers had no education were more likely to be wasted (aOR = 3.61, 95%CI 1.33-9.82). CONCLUSION: The study suggests that most of the analysed factors that accounted for malnutrition in Pakistani children (such as mother's age at marriage, educational level and mothers' nutritional status) are preventable. Therefore, to reduce the burden of malnutrition interventions that can address these factors are required such as community based education and targeted nutritional interventions.

Estimates of past and future time trends in age-specific breast cancer incidence among women in Karachi, Pakistan: 2004-2025.

BACKGROUND: The current demographic trends indicate that breast cancer will pose an even greater public health concern in future for Pakistan. Details on the incidence, disease severity and mortality in respect of breast cancer are limited and without such data, therefore, future health policies or systems in respect of this disease cannot be strategically planned or implemented. The aim of this study was to examine past trends of age-specific breast cancer incidence rates (2004-2015), and to estimate the future volume of breast cancer cases in Karachi through the year 2025. METHODS: Two statistical methods, namely the functional time series models and the log-linear regression model were used; additionally, their real forecasting efficacy in epidemic time series was also evaluated. RESULTS: In the past, women aged 60-64 years had the highest overall breast cancer incidence rates, while from 2016 to 2025, large increases in breast cancer rates among women aged 50 to 64 years are expected. The total projected breast cancer incidence will increase by approximately 23.1% in 2020 to 60.7% in 2025. Cases of breast cancer diagnosed in younger women, aged 30-34 years, will increase from 70.7 to 130.6% in 2020 and 2025 relative to 2015. CONCLUSIONS: The breast cancer incidence appeared to have been rising more rapidly among post-menopausal women (aged 55 to 59), while a stable increase in incidence in the youngest age group (15-29 years) of women is expected. The results also infer an expected increase in incidence cases of breast cancer among middle aged women in Karachi, Pakistan. An increase in the number of incident cases of cancer has implications for understanding the health-care needs of growing population and the subsequent demands on health-care system.

Betel Quid Dependency and Associated Intrapersonal, Interpersonal, and Environmental Factors among Adolescents: A School-Based Cross-Sectional Survey.

BACKGROUND: Betel quid (BQ) is one of the fourth most commonly used substance globally. Though BQ is a psycho-active substance, yet little has been explored regarding dependency on it particularly among adolescents. OBJECTIVES: Therefore, in this study, we aimed to determine adolescents' dependency on BQ, along with their intrapersonal, interpersonal and environmental determinants of dependency. METHODS: This cross-sectional study focused on 2200 school-going adolescents of Karachi, Pakistan in 2016. Primary outcome was dependency on BQ among adolescents. Both univariate and multivariate regressions were used to estimate crude and adjusted odds ratios (after adjustments for all intrapersonal, interpersonal, and environmental factors) with 95% confidence level. RESULTS: Out of 2200 students, 874 (39.7%) were found to be BQ users amongst whom 69 (7.9%) were dependent on BQ. Comparing the groups with only areca nut users as reference category, betel quid with tobacco additives chewers were considerably dependent (OR = 14.08, 95% CI 3.64-54.16). The individuals who chewed >5 chews per day (OR = 1.87, 95% CI 1.08-3.29) and chronic users (>1year) (OR = 2.02, 95% CI 1.09-3.74) were more likely to be dependent. Older students (>12 years) (OR = 2.12, 95% CI 1.06-4.23), and who studied in government schools were significantly dependent (OR = 3.32, 95% CI 1.80-6.10) than those who studied in private schools. CONCLUSIONS: In conclusion, intrapersonal characteristics like more than 5 chews per day, chronic chewers of more than a year, BQ with tobacco chewers, older adolescents and children studying in government schools were significantly associated with BQ dependency.

Individual, social and environmental determinants of smokeless tobacco and betel quid use amongst adolescents of Karachi: a school-based cross-sectional survey.

BACKGROUND: With 600 million people using betel quid (BQ) globally, and smokeless tobacco (SLT) use being more wide-spread; the duo is an uphill public health concern in South Asian countries. SLT and/or BQ use increases the risk for morbidity and mortality from oral cancer. Because SLT and/or BQ use is initiated during adolescence, it renders this group more vulnerable; and particular attention is needed to curb SLT and/or BQ use to reduce related disease burden. We aimed to observe the differential individual, social and environmental features amongst SLT and/or BQ users to determine the key influencers of its use in adolescents. METHODS: This study was a cross-sectional survey of 2140 adolescents from secondary schools of Karachi, Pakistan. The main outcome measure was SLT and/or BQ use based on their consumption in the past 30 days. Univariate and multivariate regression binary logistic analyses were employed while reporting results in both crude form and adjusted odds ratio (after adjusting for all remaining individual, social and environmental level variables) with 95% confidence level. A p-value of < .05 was considered significant for all analyses. RESULTS: The overall prevalence of SLT and/or BQ use was 42.6% (n = 912) of the total sample. The SLT and/or BQ consumer group had more males than females. A significant proportion of user (n = 558, 61.2%) was found in co-education schools. Students whose peers (OR = 6.79, 95% CI 4.67-9.87, p-value <0.001) and/or either of the parents (OR = 2.16, 95% CI 1.73-2.65, p-value <0.001) used SLT and/or BQ, alongside, adolescents who had not attended knowledge based sessions in schools regarding harmful effects of SLT and/or BQ were more likely to consume it. It's availability with outside school hawkers increased the odds of its use by 6 times, as indicated by both univariate and multivariate models after adjusting for the remaining variables. CONCLUSION: In conclusion, students studying in co-education, parents and peers use, lack of knowledge based sessions on harmful health effects of SLT and/or BQ, and easy availability of the product from hawkers outside school all contribute towards enhanced risk of SLT and/or BQ use in adolescents.

Socio-economic, environmental and demographic determinants of rise in obesity among Pakistani women: A Systematic Review.

Nutrition transition is a shift in eating and disease patterns towards diet-nutrition-related non-communicable diseases (NR-NCDs). This shift in many developing countries has been accompanied with changes in behaviours, lifestyles, diets, physical inactivity, smoking and alcohol consumption. In addition to the burden of under-nutrition, nutrition transition has caused a sudden rise in overweight/obesity-related chronic diseases in developing countries. Little research has been done in Pakistan to explore nutrition transition, and its associated nutrition challenges. The current study attempted to investigate the socio-economic, environmental and demographic determinants of rise in obesity among women of reproductive years (15-49 years) in Pakistan. A review of related published literature for a period of 10 years (2005-2015) was carried out. Also, data from National Nutrition Survey (NNS-2011) and Pakistan Demographic and Health Survey (PDHS 2012-13) was reviewed and used to supplement the published researches from Pakistan. For this purpose, a computer-based search was performed on PubMed and PubGet to retrieve relevant articles. The major socio-economic and environmental risk factors contributing to the risk of obesity among Pakistani women were sedentary lifestyle, lack of awareness, higher rates of urbanisation along with shift in dietary pattern from high-fibre diet to low-fibre, and high-calorie diet. The results of this review highlight the need for designing and implementing of national nutrition policy focussed on improving the awareness of determinants and consequences of nutrition-related illness in Pakistan.

Burden of waterpipe smoking and chewing tobacco use among women of reproductive age group using data from the 2012-13 Pakistan Demographic and Health Survey.

BACKGROUND: Despite the general decline in cigarette smoking, use of alternative forms of tobacco has increased particularly in developing countries. Waterpipe (WP) and Chewing Tobacco (CT) are two such alternative forms, finding their way into many populations. However, the burden of these alternative forms of tobacco and their socio demographic determinants are still unclear. We assessed the prevalence of WP and CT use among women of reproductive age group in Pakistan. METHODS: Data from the most recent Pakistan Demographic and Health Survey 2012-13 (n = 13,558) was used for this analysis. Information obtained from ever married women, aged between 15 and 49 years were analyzed using two separate data subgroups; exclusive WP smokers (total n = 12,995) and exclusive CT users (total n = 12,771). Univariate and Multivariate logistic regression analyses were conducted and results were reported as crude and adjusted Odds Ratio with 95% confidence intervals. RESULTS: Prevalence of WP smoking and CT were 4% and 2%, respectively. After multivariate adjustments, ever married women who were: older than 35 years (OR; 4.68 95% CI, 2.62-8.37), were poorest (OR = 4.03, 95% CI 2.08-7.81), and had no education (OR = 9.19, 95% CI 5.10-16.54), were more likely to be WP smokers. Similarly, ever married women who were: older than 35 years (OR = 3.19, 95% CI 1.69-6.00), had no education (OR = 4.94, 95% CI 2.62-9.33), were poor (OR = 1.64, 95% CI 1.07-2.48) and had visited health facility in last 12 months (OR = 1.81, 95% CI 1.22-2.70) were more likely to be CT users as well. CONCLUSION: Older women with lower socio-economic profile were more likely to use WP and CT. Focused policies aiming towards reducing the burden of alternate forms of tobacco use among women is urgently needed to control the tobacco epidemic in the country.

Anti-smoking initiatives and current smoking among 19,643 adolescents in South Asia: findings from the Global Youth Tobacco Survey.

BACKGROUND: Cigarette smoking habit usually begins in adolescence. The developing countries in South Asia like Pakistan, India, Bangladesh, and Nepal, where the largest segment of the population is comprised of adolescents, are more susceptible to smoking epidemic and its consequences. Therefore, it is important to identify the association between anti-smoking initiatives and current smoking status in order to design effective interventions to curtail the smoking epidemic in this region. METHODS: This is a secondary analysis of national data from the Global Youth Tobacco Survey (GYTS) conducted in Pakistan (year 2003), India (year 2006), Bangladesh (year 2007), and Nepal (year 2007). GYTS is a school-based survey of students targeting adolescents of age 13-15 years. We examined the association of different ways of delivering anti-smoking messages with students' current smoking status. RESULTS: A total of 19,643 schoolchildren were included in this study. The prevalence of current smoking was 5.4% with male predominance. No exposure to school teachings, family discussions regarding smoking hazards, and anti-smoking media messages was significantly associated with current smoking among male students. Participants who were deprived of family discussion regarding smoking hazards (girls: odds ratio (OR) 1.56, 95% confidence interval (CI) 0.84-2.89, p value 0.152; boys: OR 1.37, 95% CI 1.04-1.80, p value 0.025), those who had not seen media messages (girls: OR 2.89, 95% CI 1.58-5.28, p value <0.001; boys: OR 1.32, 95% CI 0.91-1.88, p value 0.134), and those who were not taught the harmful effects of smoking at school (girls: OR 2.00, 95% CI 0.95-4.21, p value 0.066; boys: OR 1.89, 95% CI 1.44-2.48, p value <0.001) had higher odds of being current smokers after multivariate adjustment. CONCLUSION: School-going adolescents in South Asia (Pakistan, India, Nepal, and Bangladesh) who were not exposed to anti-tobacco media messages or were not taught about the harmful effects in school or at home had higher odds of being current smokers than their counterparts.

Effect of smoking cessation interventions on abstinence and tuberculosis treatment outcomes among newly diagnosed patients: a randomized controlled trial.

The study evaluates the effectiveness of smoking cessation interventions [Behavioral Change Communication (BCC) and Behavioral Change Communication plus bupropion (BCC+)] compared to conventional Directly Observed Therapy Short Course (DOT) treatment in improving pulmonary tuberculosis treatment outcomes and abstinence among newly diagnosed pulmonary tuberculosis (PTB) patients, highlighting the scarcity of robust experimental studies. The current randomized controlled trial, conducted at Ojha Institute of Chest Diseases between October 2017 and June 2019, randomized 292 patients who were current smokers with newly diagnosed pulmonary tuberculosis into three arms: control (n = 97), BCC (n = 97), and BCC+ (n = 98) arms. The outcomes of the interventions were compared in terms of favorable treatment outcomes and abstinence achieved at the end of 6 months. Baseline characteristics were compared between groups. Cox regression quantified the effect size of interventions for both outcome variables and reported as (crude and adjusted) hazard ratios with 95% confidence intervals (CI). No statistically significant difference was observed in baseline characteristics in each arm. Both BCC+ and BCC showed a statistically significant effect in achieving favorable PTB outcomes at 6 months (aHR 2.37, 95% CI 1.52-3.70 and aHR 2.34, 95% CI 1.51-3.60), as well as for abstinence from smoking at 6 months (BCC+: aHR 4.03, 95% CI 2.18-7.44 and BCC: aHR 3.87, 95% CI 2.12-7.05) compared to the control arm. Both BCC and BCC+ aided by pharmacologic agents such as bupropion when incorporated with conventional DOTs were found to be significantly effective in attaining favorable tuberculosis treatment outcomes as well as in attaining smoking abstinence at the end of the 6-month treatment.This study shows that adding smoking cessation programs (with or without extra drugs like bupropion) to standard Directly Observed Treatment Short Course (DOTs) treatment for people who have recently been diagnosed with pulmonary tuberculosis has a great positive impact on how well the overall antituberculosis treatment works. Our trial shows very promising results for such a combined therapy (DOTs and smoking cessation) in a country where the burden of both tuberculosis and smoking is very high.

Metabolic puzzle: Exploring liver fibrosis differences in Asian metabolic-associated fatty liver disease subtypes.

BACKGROUND: Metabolic-associated fatty liver disease (MAFLD) is a liver condition marked by excessive fat buildup in the absence of heavy alcohol use. It is primarily linked with metabolic issues like insulin resistance, obesity, and abnormal lipid levels, and is often observed with other conditions such as type 2 diabetes and cardiovascular disease. However, whether the subtypes of MAFLD based on the metabolic disorder differentially impact liver fibrosis is not well explicated, especially in the Asian population. AIM: To compare the severity of liver fibrosis among different MAFLD subtypes. METHODS: A total of 322 adult patients of either gender with fatty liver on ultrasound were enrolled between January to December 2021. MAFLD was defined as per the Asian Pacific Association for the Study of the Liver guidelines. Fibrosis-4 index (Fib-4) and nonalcoholic fatty liver disease fibrosis score (NFS) were employed to evaluate liver fibrosis. RESULTS: The mean age was 44.84 ± 11 years. Seventy-two percent of the patients were female. Two hundred and seventy-three patients were classified as having MAFLD, of which 110 (40.3%) carried a single, 129 (47.3%) had two, and 34 (12.5%) had all three metabolic conditions. The cumulative number of metabolic conditions was related to elevated body mass index, triglyceride (TG) levels, and glycated hemoglobin, lower high-density lipoprotein (HDL) levels, higher liver inflammation (by aspartate aminotransferase and γ-glutamyl transferase), and higher likelihood of fibrosis (by NFS and Fib-4 scores) (P < 0.05 for all). The proportion of advanced fibrosis also increased with an increase in the number of metabolic conditions (4.1%, 25.5%, 35.6%, and 44.1% by NFS and 6.1%, 10.9%, 17%, and 26.5% by Fib-4 for no MAFLD and MAFLD with 1, 2, and 3 conditions, respectively). Among MAFLD patients, those with diabetes alone were the eldest and had the highest mean value of NFS score and Fib-4 score (P < 0.05), while MAFLD patients diagnosed with lean metabolic dysfunction exhibited the highest levels of TG and alanine aminotransferase but the lowest HDL levels (P < 0.05). CONCLUSION: The study suggests that the severity of liver fibrosis in MAFLD patients is influenced by the number and type of metabolic conditions present. Early identification and management of MAFLD, particularly in patients with multiple metabolic conditions, are crucial to prevent liver-related complications.

Women's awareness, knowledge, attitudes, and behaviours towards nutrition and health in Pakistan: Evaluation of kitchen gardens nutrition program.

INTRODUCTION: Vulnerability to malnutrition is very high with low-income women and their children in rural Balochistan with contributing factors including lack of awareness about proper nutrition, low literacy, scarcity of vegetables and fruit, and low purchasing power of households. The Food and Agriculture Organization's kitchen garden program provides resources to improve nutrition and health knowledge and promote healthy eating practices. The objective of this study was to assess nutrition and health awareness, knowledge, attitudes, behavioural intentions/behaviours (AKAB) of women who attended the kitchen garden program and trainings. MATERIALS AND METHODS: A community based cross-sectional survey (N = 209) using a two-stage cluster sampling method was used to select households with survey participants being mothers with children under five years of age. A pretested questionnaire was administered via face-to-face surveys by trained enumerators in two districts of Balochistan province of Pakistan. Nutrition and health AKAB were constructed indices. Chi-square tests compared statistical differences in AKAB by women attending against a control group who did not-attend kitchen garden interventions. Binary logistic regression analyses were performed to assess kitchen garden program outcomes against key AKAB indicators, while adjusting for covariates. RESULTS: Significant differences (p<0.001) were identified between intervention and control groups with women attending kitchen garden being more aware of the components of kitchen garden (65.8% vs 36.8%), and more knowledgeable about causes of illnesses caused by poor nutrition including, iron deficiency anemia, pregnancy, and unborn child health complications, compared to women not attending kitchen gardens program. Logistic regression analysis identified women attending kitchen gardens also had higher odds of being more knowledgeable (OR = 1.59, 95%CI 1.27-1.99, p<0.001), having improved attitudes (OR = 4.86, 95%CI 2.77-8.53, p <0.001), and behavioural intentions/behaviours (OR = 1.98, 95%CI 1.26-3.12, p = 0.003) towards improved nutrition and health. CONCLUSIONS: Substantial opportunities exist for achieving improved nutrition and health outcomes with vulnerable groups in Balochistan, through greater participation in kitchen gardens behavioural change programs and interventions. As part of scaling-up efforts, academically rigorous project evaluations should be institutionalized for continuous improvement of nutrition programs to address micronutrient deficiencies in rural communities.

Patterns of musculoskeletal disorders in health care providers and their association with ergonomic risks.

Objectives. Musculoskeletal disorders (MSDs) have a high prevalence among allied health care providers because of the demanding nature of their work and lack of practicing proper ergonomics. The aim of this study focused on patterns of work-related musculoskeletal disorders (WMSDs) affecting different health care providers working in a different unit of a tertiary care hospital. Methods. This cross-sectional study collected data from 2000 allied health care providers working at various departments of Civil Hospital and Dow University Hospital of Karachi (DUHS), via self-administered questionnaire, based on Occupational Safety and Health Administration (OSHA) guidelines. Results. Our findings revealed that 92.9% of individuals had MSDs as a result of poor ergonomics, with 93% reporting that the disease interferes with their normal job routine. Conclusions. Medical technologists are the most affected group among allied health care workers. Lack of knowledge and improper ergonomic culture results in such a high prevalence rate in allied health care workers in Pakistan.

Utility of the serial portable chest x-ray for the diagnosis and quantification of COVID-19 patients.

Objective: To determine the role of the serial portable chest X-ray in the diagnosis and quantification of patients with confirmed COVID-19 admitted to a tertiary care hospital. Methods: A retrospective study was conducted at Dow Institute of Radiology, Dow University of Health Sciences. Confirmed positive cases of COVID-19 from November 2020 to January 2021 were retrospectively studied. Patients' demographics and clinical characteristics, chest X-ray findings, and outcomes were retrieved through electronic medical records. Baseline and final follow-up chest X-rays findings were compared by using chest X-ray severity score. Multivariable logistic regression was used to evaluate the relationship between patients' characteristics and patient outcomes. Results: The study included 329 patients with a mean age of 56.43 ± 13.10 years (range 16-85 years). Peripheral consolidation and ground glass opacities (89.4%) were the most common X-ray findings followed by bilateral lung involvement (79.0%) and perihilar consolidation/ground glass opacities (69.9%). Among the patients who were admitted, 61.4% were discharged, 49.5% had prolonged length of stay ≥10 days, and 37.7% died. After adjustment of all patients' characteristics, the multivariate model showed no significant difference in chest X-ray severity score in relation to the patient's outcome. Patients who were admitted to the intensive care unit, and received oxygen support, bilevel positive airway pressure, and a ventilator were significantly associated with the outcome of being discharged, prolonged hospital stay, and death. Conclusion: Peripheral consolidation and ground glass opacities were the most common chest X-ray findings in admitted COVID-19 patients. No significant difference in chest X-ray severity score was noted in the primary outcome of being discharged, prolonged hospital stay, and death. There is no requirement for daily chest X-rays in hospitalized patients until required in the condition of worsening symptoms or significant intervention such as endotracheal intubation.

Clinical and Biochemical Characteristics of COVID-19 Patients During the Delta-Omicron Wave with Risk Assessment of Adverse Outcomes.

OBJECTIVE: To compare clinical and biochemical characteristics of hospitalised COVID-19 patients and risk assessment of disease outcomes Study Design: Descriptive study. Place and Duration of the Study: Department of Pathology, Dow International Medical College and Sindh Infectious Diseases Hospital and Research Centre, from January to March 2022 Methodology: SARS CoV-2 PCR-positive hospitalised patients were enrolled. Delta or omicron variants infected patients were followed till the last recorded event of hospitalisation. After a detailed history, clinical and biochemical profiles were recorded during the hospitalisation. Length of hospitalisation, ICU admission and in-hospital mortality were taken as outcomes and odd ratios were calculated. RESULTS: During the study period, omicron was the predominant SARS CoV-2 variant. Omicron-infected patient were older (67 vs. 62 years) and had a significantly shorter duration between appearance of symptoms and hospitalisation (5 vs. 8 days), when compared with the delta patients. Median values of LDH, ferritin and TLC were significantly higher in delta patients (p<0.05). Delta infected patients have a 3.9 times more risk of prolonged hospital stay. In patients with increased TLC, the risk of prolonged hospitalisation and ICU admission was found 16% and 23%, respectively. However, the aOR for ICU admission and in- Hospital mortality were not found significant for the delta and omicron-infected patients. CONCLUSION: The clinical course and biochemical profiles are diverse in delta and omicron patients. Hospitalised patients with omicron infection exhibit shorter stays. High values of TLC are found associated with an increased risk of longer hospital stay and ICU admissions. KEY WORDS: COVID-19, Delta variant, Omicron variant, Hospitalised patients, Outcomes, In-hospital mortality, Biochemical markers, Clinical severity.