Eating Disorders and Disordered Eating Behaviors Among Undergraduate Students in Pakistan as Measured by Eating Disorder Examination Questionnaire (EDE-Q).

Objectives Eating disorders (ED) are an emerging public health issue globally, especially in young adults studying at the undergraduate level. This study aims to assess the frequency of eating disorders, their types, and disordered eating behaviors among such students. Moreover, it aims to identify factors like weight concern, shape concern, eating concern, and restraint, along with assessing the shifting trend of BMI impact on eating disorders using a standardized Eating Disorder Examination Questionnaire (EDE-Q). Methods In this cross-sectional study, 400 undergraduate students (aged 18-25) from four public universities participated from July 2022 to November 2023. Data was collected using the Eating Disorder Examination Questionnaire (EDE-Q). The frequency of eating disorders was computed using SPSS version 27. Results Among the participants, 21.75% (n=84) were identified as having a score surpassing the clinical cut-off. This group comprised 5.5% males (n=22) and 16% females (n=64). The highest prevalence among the four subscales was observed in the Shape Concern subscale (10.5%). Objective binge episodes (19.3%) emerged as the most notable disordered eating attitude. Atypical anorexia nervosa accounted for 13.8% of different eating disorders, while disordered eating was noted in 19.5% (n=78) of individuals. Discussion This study offers critical insights into eating disorders among Pakistan undergraduate students, utilizing the EDE-Q 6.0. Disordered eating behaviors, particularly shape concern and objective binge eating, exhibit significant correlations with these disorders. Weight dissatisfaction emerges as a prominent predictor, suggesting societal influence. The study also reveals a moderate correlation between BMI and eating disorders, challenging conventional assumptions. Furthermore, a changing trend in the prevalence of eating disorders is observed among the male population.

Assessment of musculoskeletal disorders among cricketers playing in domestic clubs of Lahore.

OBJECTIVE: To assess musculoskeletal disorders among male cricketers in an urban centre. METHODS: The cross-sectional study was conducted from October to November 2020 in Lahore, Pakistan, and comprised male cricket players aged 10-25 years playing in four domestic clubs. Data was collected about musculoskeletal disorders experienced during the preceding 12 months using the Extended Nordic Musculoskeletal Questionnaire. Data was analysed using SPSS 22. RESULTS: Of the 89 players with a mean age of 19.24±3.12 years, 35(39.3%) were bowlers, 26(29.2%) were batsmen, 17(19.1%) were all-rounders, and 11(12.4%) were wicketkeepers. The anatomical distribution of disorder was lower-back 68(76.4%), shoulder 40(44.9%), neck 39(43.8%), upper-back 37(41.6%), knees 31(34.8%), ankle/feet 29(32.6%), thighs 27(30.3%), wrist/hands 18(20.2%), and elbows 17(19.1%). There were 22(24.7%) players who had at any time seen a doctor or a physiotherapist, while 24(27%) players had a history of taking sick leave. CONCLUSIONS: The most affected anatomical segments were lower-back, shoulder, knee, ankle and upper-back.

Spectrum of Dyslipidemias in Treatment-Naïve Human Immunodeficiency Virus-Infected Patients Presenting to an HIV Clinic of a Tertiary Care Hospital.

Introduction HIV/AIDS is a major communicable disease worldwide, especially in developing countries where disease prevalence is over 90%. The National AIDS Control Programme of Pakistan reported around 160,000 HIV cases (140,000-190,000) with a 5% prevalence among traditional risks groups. HIV infection is thought to affect lipids metabolism adversely, thus resulting in increased morbidity and mortality. The aim of the study was to find out the frequency and types of dyslipidemia in patients with HIV not taking anti-retroviral therapy, presenting to an HIV clinic at a tertiary care hospital. Methods This cross-sectional study was conducted at the HIV clinic of Jinnah Hospital from January 2020 to July 2020. A total of 280 treatment-naïve patients, fulfilling the inclusion protocol, were included through non-probability consecutive sampling after informed consent. Blood samples of 5 mL were taken using aseptic measures and following standard procedure after ensuring overnight fasting by a nurse and were sent immediately to the pathology laboratory of Allama Iqbal Medical College. The results of the lipid profile were collected the next day and noted in the proforma. Dyslipidemia and type of dyslipidemia were recorded as per operational definition. Data were analyzed by SPSS software, version 27.0 (IBM Corp., Armonk, NY). Cross-tabulation was done to assess the relationship of gender, BMI, and family history on dyslipidemia, and a chi-square test was applied to check statistical significance. Results Among 280 treatment-naïve HIV-infected patients, the majority of patients were females (52%). The mean duration of HIV was 9.31 + 2.13 months. About 55% of patients had a BMI of more than 25 kg m2. A family history of dyslipidemia was found in 62% of the patients. Dyslipidemia was observed in 70% of patients with maximum derangement seen in total cholesterol level (62%). After applying the chi-square test, a significant relation was identified between BMI and family history with dyslipidemia in HIV-infected individuals (p-value = 0.00). Conclusion A considerable proportion of treatment-naïve HIV patients have underlying dyslipidemia with a significant relationship with higher BMI and a family history of dyslipidemia. The findings of this study highlight the importance of early screening for dyslipidemia in HIV patients.

Determining the Association Between Helicobacter pylori Infection and Treatment-Refractory Hypothyroidism.

Introduction Refractory hypothyroidism, despite weight-based thyroxine dosing, is a common endocrinology consultation in outpatients. Chronic Helicobacter (H.) pylori infection has been reported to be responsible for the poor absorption of thyroxine from the small gut leading to suboptimal response with contradictory evidence. This study was carried out to determine the association of chronic Helicobacter pylori infection with refractory hypothyroidism in outpatients presenting to a tertiary care hospital. Methods One hundred thirty patients with the diagnosis of hypothyroidism, visiting Jinnah Allama Iqbal Institute of Diabetes and Endocrinology (JAIDE) Jinnah Hospital Lahore, Pakistan, from January 2020 to February 2021, were included in the study after informed consent following the non-probability consecutive sampling technique. All of these patients were 15-70 years of age, non-pregnant, and receiving thyroxine treatment for at least six weeks. Patients with a history of gastric surgery, malabsorption syndrome, or poor compliance were excluded from the study. Patients' age, sex, and body mass index (BMI) were recorded in a structured proforma. Patients were categorized into two groups, i.e. controls (biochemically euthyroid on thyroxine treatment with TSH < 4.5mU/L) and cases (refractory hypothyroidism despite 1.6 mcg/kg thyroxine treatment with TSH > 4.5 mU/L). The presence of chronic H. pylori infection was checked with serum immunoglobulin G (IgG) testing by enzyme-linked immunoassay (ELISA) from the hospital laboratory and data analysis was done by SPSS version 21.0 (IBM Corp., Armonk, NY). Results One hundred thirty patients were included in this study, with an age range from 15 to 70 years. Of these, 65/130 (50%) were euthyroid on treatment and 65/130 (50%) had treatment-refractory hypothyroidism. The mean age of patients in our study was 45.81 ± 11 years, with 118 (90.8%) female patients. The prevalence of positive H. pylori IgG antibody was 47/130 (36.2%) overall, with 23 patients (35.4%) in the control (euthyroid) group and 24 patients (36.9%) in the cases (refractory hypothyroidism) group. The difference between the two groups was not statistically significant with an odds ratio of 1.069 (CI 0.523 - 2.187) and a p-value of 0.855. Moreover, age, gender, and BMI had no effect on chronic H. pylori association with refractory hypothyroidism. Conclusion This study does not suggest any significant association between chronic H. pylori infection and treatment-refractory hypothyroidism. Other factors like poor compliance, drug-drug interactions, and malabsorption disorders should be preferably sought in case of refractory hypothyroidism.

Diagnostic validation of rapid molecular detection of Mycobacterium tuberculosis in pus samples by GeneXpert.

OBJECTIVE: To evaluate the performance of GeneXpert for detection of mycobacterium tuberculosis in pus samples and compare its results with conventional techniques in terms of validity, rapidity and rifampicin resistance. METHODS: This longitudinal, descriptive study was conducted at Jinnah Hospital, Lahore, Pakistan, from January 2012 to December 2015, and comprised pus samples of people suspected of having extra-pulmonary tuberculosis. Participants were included by using consecutive sampling technique. The pus samples were subjected to Ziehl-Neelsen smear microscopy and Lowenstein-Jensen culture as per World Health Organisation's protocol and GeneXpert as per manufacturer protocol. SPSS 17 was used for data analysis. Validity of GeneXpert and rifampicin resistance were determined and compared with Ziehl-Neelsen staining using Lowenstein-Jensen culture as the gold standard. RESULTS: Of the 212 pus samples, 84(39.6%) were positive on Lowenstein-Jensen culture with mean turnaround time of 20±6 days, 77(36.3%) on GeneXpert and 22(10.4%) on Ziehl-Neelsen smear. The highest detection rate of mycobacterium tuberculosis 62(80.5%) was in lymph node samples by GeneXpert. The sensitivity and specificity of GeneXpert were 91.6% and 100% respectively, while Ziehl-Neelsen smear showed a sensitivity26.2% and specificity of 100%. Rifampicin resistance was detected in 5(6.4%) pus samples by GeneXpert. CONCLUSIONS: GeneXpert had a higher validity compared to Ziehl-Neelsen smear microscopy.

GeneXpert technology. A breakthrough for the diagnosis of tuberculous pericarditis and pleuritis in less than 2 hours.

OBJECTIVES: To evaluate the diagnostic validity of GeneXpert for the detection of Mycobacterium tuberculosis (MTB) in pericardial and pleural effusions samples. METHODS: A cross sectional study was conducted at the Mycobacteriology Laboratory, Allama Iqbal Medical College, Lahore, Pakistan. A total of 286 (158 pleural and 128 pericardial fluids) samples were received from tuberculosis (TB) suspects between January 2014 and August 2016. Every sample was processed for Ziehl-Neelsen (Zn) smear, Lowenstein Jensen (LJ) culture, GeneXpert MTB/RIF assay according to standard protocols. Validity of GeneXpert assay for the detection of MTB was evaluated using LJ culture as gold standard. RESULTS: Out of 286 effusions samples, MTB was isolated by LJ culture in 51 (17.8%) samples followed by GeneXpert in 43 (15%), and acid- fast bacilli (AFB)  was detected by Zn smear microscopy in 11 (3.8%) samples. GeneXpert showed high sensitivity (84.3%), specificity (100%), with positive predictive value (100%), and  negative predictive value (96.7%), while Zn smear showed sensitivity 18.3%, specificity 99.1%, positive predictive value 81.8%, and negative predictive value  85.4%. A strikingly high sensitivity of 72.2% was observed for pericardial fluid by GeneXpert. CONCLUSION: GeneXpert assay is an innovative tool, for prompt detection of MTB and drug resistance. It is definitely an attractive point of care test, with high sensitivity and specificity along with turn around time of 2 hours, which facilitates timely diagnosis and appropriate management of TB pleuritis and pericarditis.

Diabetes mellitus among tuberculosis patients in a tertiary care hospital of Lahore.

BACKGROUND: Diabetes is an important risk factor for Tuberculosis (TB) that might affect disease presentation and treatment response but has hitherto been neglected by the clinicians. There is inadequate data on the prevalence of diabetes mellitus (DM) among TB patients in Pakistan. This study was conducted to determine the frequency of TB patients having DM. METHODS: In this cross-sectional study, 158 TB patients admitted in Gulab Devi hospital were selected by systematic random sampling technique and data were collected using a pretested questionnaire. All patients underwent anthropometric measurements and baseline investigations. Diabetes was confirmed by determining fasting blood sugar level using cut-off value of 126 mg/dl. Data was entered in Epi-Data-6 and analyzed using Epi-Info. RESULTS: Among 158 patients of tuberculosis, 41 (25.9%) were found to be diabetic, out of which 9 (5.69%) were newly diagnosed with diabetes. Moreover 96 (60.8%) patients were 35-55 years of age. Male patients were 97 (61.4%). Most of the patients belonged to the rural area 118 (74.7%) while 115 (72.8%) patients were illiterate and 139 (88%) had monthly income less than 7000 PKR. CONCLUSION: The study concludes that among tuberculosis patients with diabetes mellitus, about 5.69% were newly diagnosed during the course of investigation. This raises the concern that importance is not being given to routine screening of tuberculosis patients for diabetes by the clinicians. Health professionals should be updated about the link between diabetes and TB.