Establishment of health related physical fitness evaluation system for school adolescents aged 12-16 in Pakistan: a cross-sectional study.

Background: The decline in adolescent physical fitness is a significant global public health concern, and Pakistan is no exception. The country's absence of a health-related physical fitness (HRPF) evaluation system has compounded this issue. To bridge this gap, this study aims to develop a scientifically-based HRPF evaluation system for the adolescent population that meets international standards. The evaluation system identifies at-risk children and improves adolescent health outcomes, including obesity, cardiovascular and musculoskeletal disorders, chronic diseases, and psychological illnesses, through crucial physical fitness evaluation. This study specifically aims to establish an HRPF evaluation system for school adolescents aged 12-16 in Pakistan. Methods: A cross-sectional study was conducted among 2,970 school adolescents aged 12-16 years in the South Punjab, Pakistan. The study used a stratified sampling technique to select participants. The HRPF evaluation system included four components: cardiorespiratory endurance, core muscular endurance, muscular strength, and body composition. Data were collected through standardized tests and anthropometric measurements. Results: The study's results indicated that the HRPF evaluation scoring system was feasible and valid for evaluating the HRPF of school adolescents in the South Punjab region of Pakistan. The results of the evaluation system categorized participants into five groups based on their performance: excellent (6.2%), good (24.9%), medium (50.7%), poor (17%), and very poor (1.2%). Conclusion: The study establishes an HRPF evaluation system for Pakistani school adolescents. This system lays the foundation for implementing effective strategies to improve their physical health. The findings offer valuable insights to policymakers, health professionals, and educators, enabling them to promote fitness and devise impactful interventions for enhancing HRPF in this population.

Assessment of health-related quality of life among patients with obesity, hypertension and type 2 diabetes mellitus and its relationship with multimorbidity.

Obesity, hypertension (HTN) and type 2 diabetes (T2D) are among the multifactorial disorders that occur at higher prevalence in a population. This study aims to assess the health-related quality of life (HRQoL) of patients with obesity, HTN and T2D individually and in the form of multimorbidity. A questionnaire-based cross-sectional study was conducted among the patients in 15 private clinics of Punjab, Pakistan. A stratified random sampling technique was used to collect the data from patients with obesity, HTN and T2D or their comorbidity. A total of 1350 patients responded by completing the questionnaire. The HRQoL of these patients was assessed using the EQ-5D-5L questionnaire (a standardized instrument for measuring generic health status). Statistical analysis was performed using chi-square test, Mann-Whitney U test, and Kruskal-Wallis test. Multivariate linear regression model was used to model the visual analogue scale (VAS) score. In total, 15% of patients had combined obesity, HTN and T2D; 16.5% had HTN and T2D; 13.5% had obesity and HTN and 12.8% had obesity and T2D. Only 15.8% of patients had obesity, 14.3% had HTN, and 12% had T2D. Mann Whitney-U test gave the statistically significant (p = <0.001) HRQoL VAS score55.1 (±23.2) of patients with the obesity. HRQoL VAS scores of patients with obesity were found to be higher when compared to patients with both T2D 49.8 (±15.4) and HTN 48.2 (±21). Diagnosis of one, two and three diseases showed significant results in VAS with all variables including gender (p = 0.004), educational level (p = <0.001), marital status (p<0.001), residence (p = <0.001), financial situation (p = <0.001) and monthly income (p = <0.001). The most frequently observed extremely problematic dimension was anxiety/ depression (47%) and the self-care (10%) was the least affected. Patient HRQoL is decreased by T2D, HTN, and obesity. The impact of these diseases coexisting is more detrimental to HRQoL.

Potential of GJA8 gene variants in predicting age-related cataract: A comparison of supervised machine learning methods.

Cataracts are the problems associated with the crystallins proteins of the eye lens. Any perturbation in the conformity of these proteins results in a cataract. Age-related cataract is the most common type among all cataracts as it accounts for almost 80% of cases of senile blindness worldwide. This research study was performed to predict the role of single nucleotide polymorphisms (SNPs) of the GJA8 gene with age-related cataracts in 718 subjects (400 age-related cataract patients and 318 healthy individuals). A comparison of supervised machine learning classification algorithm including logistic regression (LR), random forest (RF) and Artificial Neural Network (ANN) were presented to predict the age-related cataracts. The results indicated that LR is the best for predicting age-related cataracts. This successfully developed model after accounting different genetic and demographic factors to predict cataracts will help in effective disease management and decision-making medical practitioner and experts.

Assessing Patient Satisfaction with Community Pharmacy Services: A Large Regional Study at Punjab, Pakistan.

Purpose: Patient satisfaction can be used to assess the quality of services provided at pharmacies. Our aim was to determine the level of patient satisfaction with pharmacy services and related factors at community pharmacies located in Punjab, Pakistan. Methods: A questionnaire-based cross-sectional study was conducted from May 2021 to July 2021 by administering the questionnaire to the patients using stratified random sampling method. Survey instrument comprised 4 sections including demographics, satisfaction towards provision of facilities, the provision of information, their accessibility to patients, the relationship between pharmacists and patients and the continuity of care provided. Categorical data were represented by percentages. Descriptive statistics were calculated for satisfaction scores. Simple and multiple logistic regression models were used to find the odds ratios. A p-value of less than 0.05 was considered statistically significant. Results: Response rate of the survey was 92%. Only 30% of patients agreed that the pharmacist was available for counseling on their visit. About 52% agreed that the counseling time provided by pharmacist was enough. Most of the pharmacy patients (61%) trusted the pharmacist regarding any query about medicine and were satisfied with the way the pharmacist resolved issues. Mean satisfaction score of the pharmacy patients was 45.75 with a range of 25 (highly satisfied) to 66 (highly dissatisfied). Conclusion: The provision of community pharmacy services to patients was not satisfactory. Furthermore, the absence of pharmacist in the pharmacy and the lack of provision for counseling time raised concerns.

Disposal Practices of Expired and Unused Medications Among Households in Punjab, Pakistan.

BACKGROUND: The practice of disposing expired or unused medications by different households is generally not considered and is largely neglected. OBJECTIVE: The study was carried out to determine the disposal practices regarding expired and unused medications in rural areas of Punjab, Pakistan. METHODS: The study was conducted by interviewing different households and students (rural areas) from different universities in Punjab, Pakistan. The sample size was 676 and the questionnaire was used for data collection. RESULTS: Out of 676 members, 552 (81.6%) had medications at the time of the visit. Only 14.5% (n= 80) were taking medication. Only 14.5% (n = 80) kept medication because the treatment was still in progress with the patients while 85.5% (n= 472) had medications that should be discarded. The main reasons for keeping the unused medications at home were completed treatment 34.7% (n= 164) after recovering from ailment. About 60.57% of female disposed the drugs in domestic trash while majority of male participants (48.72%) buried the drugs in the ground. Over 80% of respondents (n = 542) were unaware of the disposal methods. Almost half of the participants (n= 322) had no information about the impact of improper disposal. Statistically significant variations (p<0.001) were observed in the disposal practices depending on gender, age, education and occupation. CONCLUSION: Improper disposal of medication is a common practice in rural areas of Punjab, Pakistan. The launch of public education programs and the development of drug disposal facilities are very necessary to protect the environment and community health.

Machine learning methods for predicting major types of rheumatic heart diseases in children of Southern Punjab, Pakistan.

Objective: Rheumatic heart disease (RHD) is a major health problem in the world, particularly in developing countries. This study aimed to predict mitral regurgitation (MR) and mitral stenosis (MS) RHD among children with RHD. Methodology: Data was collected from the Pediatric Cardiology Department at Chaudhry Pervaiz Elahi Institute of Cardiology Multan, Pakistan from March to October 2019. A sample of 561 children aged 4-14 years, who were diagnosed with RHD of either MR or MS, were recruited from the hospital's outpatient department. The presence of multivariate outliers was detected, and different machine learning methods, including subset logistic regression, subset logistic regression after deletion, stepwise winsorized logistic regression, robust logistic regression, subset deep neural network, and random forest models were compared using the area under receiver operating characteristics (ROC) curve, sensitivity, and specificity. Parsimony was also considered in model selection. Results: Out of 561 patients in this study, 75.94% had RHD MR and 24.06% had RHD MS. The average age of study participants was 9.19 ± 2.45 years and of them 55.43% were male. Among the male participants, 58.6 and 45.2% had MR and MS, respectively; and among female participants, those were 70.4 and 29.6%, respectively. Subset logistic regression after deletion appeared as competitive with a discrimination power of 90.1% [95% CI 0.818-0.983]. The sensitivity and specificity of this model were 85.1 and 70.6%. Conclusion: The best predictive model was subset logistic regression after deletion. The predicted method will be used in the decision-making process, which helps early diagnosis of the disease and leads to prevention. The study findings provide the proper guideline for earlier diagnosis of the RHD MR and MS cases among children with RHD in Pakistan.

Assessment of health-related quality of life in hypertensive hemodialysis patients.

BACKGROUND AND OBJECTIVES: Globally, the prevalence of hypertension (HTN) with the coexistence of chronic kidney disease (CKD) is increasing, resulting in poor quality of life. The main objective of the study was to measure the health-related quality of life (HRQoL) of hypertensive hemodialysis patients. METHODS: A multicenter follow-up study was carried out in six public and two private dialysis centers in Pakistan. A total of 517 hypertensive hemodialysis patients responded by completing the questionnaire at baseline and two subsequent phases. The quality of life of these patients was assessed using the EQ-5D-5L questionnaire (a standardized instrument for measuring generic health status). Statistical analysis was done using a multivariate linear regression model, Friedman test and Kruskal Wallis test. RESULTS: The majority of patients (58.2%) had normal body mass index and about 60.5% of the patients were taking less salt due to HTN. Friedman test gave the statistically significant results (p ≤ 0.001) in systolic blood pressure (BP), diastolic BP and EQ-5D visual analogue scale (VAS) score between three phases (initial visit, first follow-up and second follow-up). A significant improvement was observed in self-care and usual activities from initial visit to first follow-up (p < 0.05). The most problematic dimension among the hypertensive patients with CKD was pain/discomfort (86.5%). CONCLUSIONS: HTN with coexisting CKD in hemodialysis patients severely affected HRQoL. Pain/discomfort was the most problematic dimension among the participants.

Antibiotic use: A cross-sectional survey assessing the knowledge, attitudes, and practices amongst students of Punjab, Pakistan.

Objective: The aim of the study was to assess the knowledge, attitudes and practices of students regarding the use of antibiotics in Punjab, Pakistan. Participants: 525 medical and non-medical students from Punjab in Pakistan. Methods: The t-test and ANOVA were used to compare the average response of respondents. Chi-square test was used to measure the association of different elements. Results: The mean age was 20.78 ± 2.10%. About 14% of the students agreed about the appropriateness of antibiotics for viral infections, and 15% of students said they stopped taking the drugs when symptoms subsided. 65.7% of students took antibiotics only when prescribed by a doctor and 54% bought antibiotics without prescription. Statistically significant results were found among the students who had heard about the antibiotic resistance (p < 0.05). Conclusion: This study will help assess the adequacy of current educational campaigns, maximize rationalization of antibiotic use, and minimize gaps in knowledge and attitudes.

Nutritional status and growth centiles using anthropometric measures of school-aged children and adolescents from Multan district.

BACKGROUND: Nutritional status among children and adolescents is assessed using growth rates. The aim of this study was to assess age- and gender-specific height, weight, and body mass index (BMI) centiles among children and adolescents relative to World Health Organization (WHO) references. METHODS: A sample of 1040 school-aged children and adolescents aged 3-18 years from Multan District in Pakistan were selected for the study between January and March 2020. Multistage stratified random sampling was used for sample selection. Centile curves of height, weight, and BMI for age and gender were obtained using the lambda-mu-sigma (LMS) method, and results were compared with WHO 2007 references. RESULTS: For boys and girls, the average height was 137.37 ± 8.24 and 135.62 ± 9.64 cm, average weight was 36.32 ± 6.84 and 35.21 ± 7.27 kg, and average BMI was 18.44 ± 2.67 and 18.36 ± 2.91, respectively. The height centiles of boys were higher than the WHO reference, and during the prepubertal period (age 8 years or older) the centiles were lower than the WHO reference. The height centiles of girls were higher than the WHO reference, and during the pubertal period (age 10 years or older) the centiles were lower than the WHO reference. The gender-wise BMI centiles were higher compared to the WHO reference. CONCLUSION: The prevalence of thinness, overweight, and obesity in boys and girls was significantly higher than the WHO reference. The results of this study on centiles are up-to-date and will be used as a standard for comparison.

Predatory functional response and fitness parameters of Orius strigicollis Poppius when fed Bemisia tabaci and Trialeurodes vaporariorum as determined by age-stage, two-sex life table.

BACKGROUND: The polyphagous predatory bug O. strigicollis is an active predator used to control thrips and aphids. The whitefly species Bemisia tabaci and Trialeurodes vaporariorum are voracious pests of different economic agricultural crops and vegetables. METHOD: In this study, the Holling disc equation and the age-stage, two-sex life table technique were used to investigate the functional response and biological traits of third instar nymphs and adult female O. strigicollis when presented third instar nymphs of both whitefly species as prey. RESULTS: The results showed a type II functional response for each life stage of O. strigicollis when fed each whitefly species. The calculated prey handling time for different O. strigicollis life stages were shorter when fed T. vaporariorum than when fed B. tabaci nymphs. In contrast, the nymphal development of O. strigicollis was significantly shorter when fed B. tabaci than T. vaporariorum nymphs. Additionally, the total pre-oviposition period of adult females was statistically shorter when fed B. tabaci nymphs than T. vaporariorum nymphs. Furthermore, the survival rates and total fecundity of O. strigicollis were higher when fed B. tabaci than T. vaporariorum. There were no significant differences in any population parameters of O. strigicollis when fed either whitefly species. These results show that O. strigicollis could survive and maintain its populations on both species of whitefly and could therefore serve as a biological control agent in integrated pest management (IPM).

An alternative approach to treat obesity with leptogenic polyherbal formulation obesecure: A randomized clinical trial study.

Obesity is a common disease of developing countries, including Pakistan. Obesity is a risk factor for many diseases which can be life threatening or making the person unable to perform daily routine work. In the current study, clinical trials were designed to evaluate the effects of medical intervention by comparing the effects of placebo control drug "Plasicure" with the herbal medicinal formulation "Obesecure". The test drug formulation was designed on the basis of the screening study for Leptogenic drugs. To evaluate the safety of the test drug, the toxicity index and the safety profile of test formulation was assessed on animal models. The drug was found safe for further clinical study. Randomized Controlled Clinical Trials were conducted. The statistical analysis was carried out by the application of Two-Way Repeated Analysis of Variance test. The clinical findings of randomized controlled trial revealed that the test drug was Leptogenic and effective in weight reduction as compared to control drug Plasicure therapy as the p-value deduced was 0.001 in leptin level and 0.000 in case of BMI after the conduction of Two-Way Repeated Analysis of Variance test. Hence it is concluded that obscure therapy is more significant than control drug Plasicure therapy in the management and treatment of obesity.