Major factors responsible for child malnutrition: A review.

Pakistan is one of the countries in which children suffer from malnutrition, and problems of stunting, wasting and under-weight are common among children. The narrative review was planned to examine published research on child malnutrition, factors associated with malnutrition, gender discrimination regarding nutrition and their related outcomes. Studies included were those based on data related to child malnutrition in Pakistan. Total 12 articles from the preceding five years were reviewed to assess the nutritional status prevailing in Pakistan. Most of the studies used the World Health Organisation z-scores for the assessment of stunting and wasting. Majority of the studies had a cross-sectional design. Other studies conducted in South Asian countries were also used to make a comparison and to see if the prevalence of child malnutrition and the factors associated with malnutrition were the same as in Pakistan or not. It was concluded that maternal health and maternal education were the most important factors for enhancing the probability of child malnutrition. No gender difference existed in terms of child malnutrition. Economic conditions and financial status of the family played an important role in child malnutrition.

Contemporary Views of the Extraction, Health Benefits, and Industrial Integration of Rice Bran Oil: A Prominent Ingredient for Holistic Human Health.

Globally, 50% of people consume rice (Oryza sativa), which is among the most abundant and extensively ingested cereal grains. Rice bran is a by-product of the cereal industry and is also considered a beneficial waste product of the rice processing industry. Rice bran oil (RBO) is created from rice bran (20-25 wt% in rice bran), which is the outermost layer of the rice kernel; has a lipid content of up to 25%; and is a considerable source of a plethora of bioactive components. The main components of RBO include high levels of fiber and phytochemicals, including vitamins, oryzanols, fatty acids, and phenolic compounds, which are beneficial to human health and well-being. This article summarizes the stabilization and extraction processes of rice bran oil from rice bran using different techniques (including solvent extraction, microwaving, ohmic heating, supercritical fluid extraction, and ultrasonication). Some studies have elaborated the various biological activities linked with RBO, such as antioxidant, anti-platelet, analgesic, anti-inflammatory, anti-thrombotic, anti-mutagenic, aphrodisiac, anti-depressant, anti-emetic, fibrinolytic, and cytotoxic activities. Due to the broad spectrum of biological activities and economic benefits of RBO, the current review article focuses on the extraction process of RBO, its bioactive components, and the potential health benefits of RBO. Furthermore, the limitations of existing studies are highlighted, and suggestions are provided for future applications of RBO as a functional food ingredient.

"Expectations and Perceptions of Medical Students From a 4-Week Research Module: A Longitudinal Cohort Survey".

OBJECTIVES: Clinical decision-making revolves around evidence-based medicine. Evidence-based medicine entails research problems, their evaluation against available scientific literature and implementing the results into practice. Medical undergraduates lack experience in the research process. This study aimed to analyze the difference between the precourse expectations and postcourse perception of students after an interventive, mandatory research module. METHODS: This longitudinal cohort survey was conducted at Azad Jammu Kashmir Medical College, Muzaffarabad. Fourth-year medical students were included in this study. After ethical review board approval, online survey questionnaires were circulated at 2 data points: before starting the research module and after it ended. Data were analyzed and nonparametric Mann-Whitney U test and Wilcoxon tests were applied to compare the difference in responses, regarding expectation and perception of the research module. RESULTS: Total participants were 104; the response rate was 100% for the expectation questionnaire, whereas it dropped to 77% for the perception questionnaire. Female students had a higher response rate. In comparison of the 2 questionnaires, a statistically significant difference was observed in the student's ability to conduct literature search and critical literature appraisal (P = .000 and .00, respectively). There was also a perceived improvement in scientific writing, problem-solving abilities, and communication skills. Overall, a significant difference was found between the expectation and perception of students. CONCLUSION: Students had high expectations from the research module. After the course, their perception of their own communication skills, research abilities, scientific writing, and research aptitude has significantly improved.

Relationship Between Physical Inactivity and Obesity in the Urban Slums of Lahore.

Introduction There are several factors such as physical inactivity, sedentary lifestyle, and diet that can be responsible for weight gain or obesity. Regular physical activity is important for better physical and emotional well-being. The objective of the study is to observe the prevalence of obesity or over-weight and how lack of physical activity contributes to weight gain and other health issues. Methods This cross-sectional study was conducted in Shalamar Town, Lahore on 646 participants. Data was collected using the WHO STEPS instrument. The inclusion criteria were a minimum age of 30 years and residents of Shalimar Town, Lahore for more than five years. The exclusion criteria were participants with comorbid conditions like HIV, TB, and terminal stage of cancer. Test of association and binary logistic regression analysis was performed to observe a significant association between demographic variables and non-communicable diseases among the participants involved in performing physical exercise. Results About 22.1% of the participants had normal BMI, 5.3% were underweight whereas 34.2% of the participants were overweight and 32.4% obese. Male participants were found to be more physically active compared to females. Hypertension and diabetes were statistically significantly associated with physical activity. BMI and waist-hip ratio were found to be associated with moderate physical exercise. Conclusion Most of the participants were not involved in moderate physical activity. Overall, an alarming 66.6% of the participants were either overweight or obese. In general, males were found to participate more in intense physical activity.

Burden of noncommunicable diseases in Pakistan.

Background: Cases of noncommunicable (NCD) diseases are increasing in Pakistan. They are responsible for 58% of all deaths and information on the risk factors is lacking. Aims: To determine the prevalence of diabetes, hypertension and abnormal heart rate and their risk factors in a multiethnic, low-income area of Lahore. Methods: This was a cross-sectional study conducted in an urban settlement of Lahore in 2018-2019. Eligible participants were aged ≥ 30 years and resident in selected settlements. We used a modified World Health Organization stepwise approach to NCD risk factor surveillance (STEPS) questionnaire to collect data from a random sample of 906 residents. The modified questionnaire had a Cronbach alpha of 80.0%. Participants were interviewed in their homes and their height, weight, heart rate, and hip circumference were measured. Results: Most of the respondents were women (64.5%). The greatest proportion of the participants were aged 30-39 years (42.4%). Of all the respondents, 40.1% had hypertension, 15.8% had diabetes and 17.0% had ischaemic heart disease. Of the risk factors examined, 68.8% of the respondents were overweight or obese, 37.0% had pre-hypertension, 13.6% used tobacco, and 1.8% used alcohol. Age was the most significant risk factor for noncommunicable diseases. Body mass index was significantly associated with diabetes in women, while family history of diabetes was significantly associated with diabetes in men. Conclusion: The prevalence of hypertension and diabetes was higher among our study participants in Lahore than reported in the national statistics. Significant proportions of the respondents had pre-hypertension and pre-diabetes, making them vulnerable to serious complications of hypertension and diabetes.

Use of Isoniazid Monotherapy in Comparison to Rifamycin-Based Regimen for the Treatment of Patients With Latent Tuberculosis: A Systematic Review.

Tuberculosis (TB) is a common infectious disease that is present all around the world. This insidious disease needs drastic measures for its eradication. One of the actions contributing to it is the timely diagnosis and offering suitable treatment options for latent tuberculosis patients. In this review, we will discuss and compare the variety of options available for this purpose. We searched PubMed/Medline, Cochrane library, Google Scholar, and Science Direct to find articles regarding the effectiveness, safety, and completion of any of the five regimens available for latent tuberculosis infection. These options are the most classic and standard nine months of isoniazid given daily, which is now more commonly given as six months course, three months of daily isoniazid and rifampin, three months of weekly isoniazid and rifapentine, and four months of daily rifampin. We looked into free full-text studies published from 2011 to 2021 available in English language and human studies. After applying inclusion/exclusion criteria and removing duplicates and screening, 34 articles were shortlisted for quality assessment check, after which we finalized nine studies. Cochrane risk-of-bias assessment tool was used for quality check of randomized control trials, New-Castle Ottawa tool for observational studies, and assessment of multiple systematic reviews (AMSTAR) tool for systematic reviews. Efficacy was checked by tracking down the new cases of TB in the sample population that took the treatment for latent tuberculosis infection. New rifamycin-based regimens were almost equal in effectiveness to isoniazid regimens. The side effect profile is different for both regimens, but short-duration courses tend to have a higher chance of completion.

Is Acupuncture Safe and Effective Treatment for Migraine? A Systematic Review of Randomized Controlled Trials.

Migraine is a debilitating condition that places a substantial economic burden on society and seriously affects patients' quality of life. Currently, there is no known "cure" for migraines, and pharmacologic treatments or prophylaxis carry many unwanted effects. Acupuncture has been accepted as an alternative treatment. However, its effectiveness is still debated. This is a systematic review of randomized controlled trials (RCT) that investigate acupuncture safety and efficacy in migraine versus various control groups. We searched PubMed, Google Scholar, Science Direct, and Cochrane library using keywords: migraines, migraine with aura, migraine without aura, headache, acupuncture, and needling therapy. Two independent reviewers participated in data extraction and assessment. Fifteen randomized controlled trials involving 2,056 participants that met the inclusion criteria were obtained and analyzed. Based on the findings, seven out of 10 trials that compared acupuncture with sham acupuncture showed a more significant reduction in the frequency of migraine attacks and headache intensity. Four studies revealed acupuncture is just as effective and has fewer side effects than any western medicine. Acupuncture can be recommended as an alternative or adjunct to drug treatment for patients suffering migraines. However, further clinical trials that utilized the Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA) recommendation are still needed to strongly present an evidence-based strategy.

Efficacy of Behavioural Intervention, Antipsychotics, and Alpha Agonists in the Treatment of Tics Disorder in Tourette's Syndrome.

Tourette's Syndrome (TS), in which patients have sudden, repeated, involuntary twitches and movements, called tics, is a condition of the nervous system. They can be motor, vocal, simple, or complex tics. It can be physically, emotionally, mentally, and socially distressing and challenging for those suffering from it. Usually, it is accompanied by various comorbidities like attention-deficit hyperactivity disorder, obsessive-compulsive disorder, and sleep disorders. A variety of environmental and genetic factors are also associated with tics in TS like the first-degree relatives are more at risk of developing TS.TS is heterogeneous with complicated patterns of inheritance and phenotypic manifestations. There is a strong association between common single nucleotide polymorphisms (SNP, s) in the SLITRK1 gene and TS. Environmental factors like prenatal, postnatal, and perinatal factors directly influence tics in TS. These factors are low birth weight, intrauterine growth retardation (IGR), and various infections. The treatment of TS can be broadly classified into non-pharmacological and pharmacological treatment. Non-pharmacological therapy includes various behavioural interventions that can be helpful in situations when patients are tolerant of medical treatments. Psychoeducation and counselling play an essential role in the treatment of TS. It is vital to give a proper understanding to the patient and their family about the disease. Cognitive-behavioral intervention for tics, cognitive-behavioral therapy, exposure and response prevention, relaxation techniques, deep brain stimulation, and habit reversal training are the commonly used therapies for tics. These therapies have shown good efficacy because it improves the Yale Global Tic Severity Scale score (YGTSS) significantly. And they show effectiveness in patients who are irresponsive to medical treatment. The main lines of medical treatment are antipsychotics and alpha agonists. Typical (haloperidol, pimozide) or atypical (aripiprazole, risperidone, olanzapine) Antipsychotics differ in their side effects, efficacy, and tolerance in different age groups of children. Haloperidol was the first drug approved by the Food and Drug Administration for tics, but later on, new developments and improvements were made as far as drug therapy is concerned. The alpha-agonist most commonly used is clonidine which is also available in the form of adhesive patches. Another alpha agonist which is also widely used is guanfacine. Botulinum toxin and baclofen have also shown efficacy in dealing with tics in TS with other comorbidities. We will review in this article all the main lines of treatment and their effectiveness in TS.

Patterns of Dyslipidemia Among Acute Coronary Syndrome (ACS) Patients at a Tertiary Care Hospital in Lahore, Pakistan.

INTRODUCTION: Dyslipidemia refers to the presence of abnormalities in lipid parameters. It has become a global issue with a high risk of cardiovascular diseases (CVDs). The aim of the investigation was to find out the pattern and prevalence of dyslipidemia among patients with the acute coronary syndrome (ACS). METHODOLOGY: A cross-sectional study design was used. Data were collected using convenient sampling from 101 patients presenting with ACS, admitted at the critical care unit (CCU) / Rasheeda Begum Cardiac Centre (RBCC) of Shalamar Hospital, during a 12-month period from January 2020 to December 2021. Dyslipidemia is diagnosed by testing the lipid profile when there are one or more abnormal readings of the lipid profile. RESULTS: Nearly 43 (42.6%) had ST-segment elevation myocardial infarction (STEMI), 27 (26.7%) had non-ST segment elevation myocardial infarction (NSTEMI), and 31 (30.7%) were categorized as unstable angina (USA). Overall dyslipidemia was present in 84 (83.2%) patients. The prevalence of dyslipidemia was 55 (65%) in male patients and 29 (34.5%) in female patients. Dyslipidemia was present in 39 (90.7%) patients with STEMI, 25 (80.6%) in the USA, and 20 (74.1%) with NSTEMI. CONCLUSION: The prevalence of dyslipidemia was quite high among ACS patients. The proportion of obese patients was also high in our study. However, dyslipidemia was more frequent in overweight patients.

Perception of Parents of Thalassemic Child to Thalassemia in Pakistan.

Background Thalassemia is an inherited blood disorder characterized by reduced hemoglobin synthesis. Aim of our study is to assess the parental knowledge of thalassemia patients and their awareness regarding treatment and preventive measures against thalassemia. Methods It is an observational study done at Ali Zaib Foundation Thalassemia Center in Sahiwal, Pakistan, in May 2019. One hundred parents were enrolled in this study and a subjective questionnaire was used to collect data through direct structured survey method over a period of 30 days. Results There were parents of 62 (62%) male patients and 38 (38%) female patients, with a median age of 8.5 ± 6.2 years. Forty-three (43%) parents were illiterate while eight (8%) parents were highly educated. Sixty-six (66%) patients were born to parents with consanguineous marriages. Eighty-two (82%) parents were aware of thalassemia, 72 (72%) were aware of the risk of thalassemia due to cousin marriages, 76 (76%) parents were aware of the importance of prenatal diagnosis (PND), while 88 (88%) believed that a PND was beneficial. Fifty-two (52%) parents knew about thalassemia treatment, 80 (80%) were aware of the importance of blood screening, and 14 (14%) patients were receiving iron chelation therapy. Seventy-eight (78%) parents were aware of thalassemia prevention. All parents believed that the public requires awareness of the importance of premarital screening and PND. Conclusion Parental awareness regarding ß-thalassemia, its treatment and prevention is fair but far from ideal. Premarital screening, provision of accurate information to the public by professionals, and adequate screening and PND of at-risk families can significantly reduce the rates of thalassemias.

Some Twist of Molecular Circuitry Fast Forwards Overnight Sleep Hours: A Systematic Review of Natural Short Sleepers' Genes.

This systematic review focuses on different genetic mutations identified in studies on natural short sleepers, who would not be ill-defined as one type of sleep-related disorder. The reviewed literature is from databases such as PubMed, PMC, Scopus, and ResearchGate. Due to the rare prevalence, the number of studies conducted on natural short sleepers is limited. Hence, searching the search of databases was done without any date restriction and included animal studies, since mouse and fly models share similarities with human sleep behaviors. Of the 12 articles analyzed, four conducted two types of studies, animal and human (cross-sectional or randomized-controlled studies), to testify the effects of human mutant genes in familial natural short sleepers via transgenic mouse or fly models. The remaining eight articles mainly focused on one type of study each: animal study (four articles), cross-sectional study (two articles), review (one article), and case report (one article). Hence, those articles brought different perspectives on the natural short sleep phenomenon by identifying intrinsic factors like DEC2, NPSR1, mGluR1, and ß1-AR mutant genes. Natural short sleep traits in either point-mutations or single null mutations in those genes have been examined and confirmed its intrinsic nature in affected individuals without any related health concerns. Finally, this review added a potential limitation in these studies, mainly highlighting intrinsic causes since one case study reported an extrinsically triggered short sleep behavior in an older man without any family history. The overall result of the review study suggests that the molecular mechanisms tuned by identified sleep genes can give some potential points of therapeutic intervention in future studies.