Serum tumour necrosis factor alpha in osteopenic and osteoporotic postmenopausal females: A cross-sectional study in Pakistan.

OBJECTIVE: To compare biochemical parameters serum tumour necrosis factor alpha, calcium, magnesium, bone-specific alkaline phosphatase and vitamin D in postmenopausal women. METHODS: This cross-sectional study was carried out from June 2015 to July 2016 at Jinnah Medical and Dental College, Karachi, and comprised postmenopausal women. Bone mineral density done by dual energy X-ray absorptiometryscan categorised subjects by World Health Organisation classification into normal (T score > -1) osteopenic (T score between -1 and -2.5) and osteoporotic (T score < -2.5). Biochemical parameters like tumour necrosis alpha, calcium, magnesium, bone-specific alkaline phosphatase and vitamin D were measured by solid phase enzyme amplified sensitivity immunoassay method. SPSS 16 was used to analyse the data. RESULTS: Of the 146 women, 34(23%) were normal, 93(67%) were osteopenic and 19(13%) were osteoporotic. There was significant difference in mean body mass index, serum tumour necrosis factor alpha and calcium in all the three groups (p<0.01). Significant mean difference was observed in serum calcium levels between normal and osteopenic, and between normal and osteoporotic group (p<0.05 each) without any significant mean difference between osteopenic and osteoporotic groups (p>0.05). A significant difference was observed for mean tumour necrosis factor alpha values between normal and osteoporotic groups (p<0.05). Tumour necrosis factor alpha showed negative correlation with bone mineral density in osteopenic and osteoporotic groups (p>0.05). CONCLUSIONS: Increased bone turnover in postmenopausal osteopenic women can be predicted by increased serum cytokine.

Vitamin A Supplementation for Prevention and Treatment of Malaria during Pregnancy and Childhood: A Systematic Review and Meta-analysis.

Animal studies have shown that vitamin A plays a role in immunity and protection against infectious diseases. Its role reducing incidence of diarrhea and measles, and childhood mortality is known, but its role in relation to malaria is unclear. Thus, a comprehensive, systematic literature search was conducted on PubMed and Cochrane Library to identify randomized controlled trials (RCTs) on the role of vitamin A during pregnancy and childhood for prevention and treatment of malaria. A total of 107 titles/abstracts were identified, of which 15 articles (11 studies) were selected for final inclusion. Based on the meta-analysis, vitamin A supplementation during pregnancy had no benefit for placental infection (relative risk = 1.09; 95% confidence interval (CI), 0.95-1.25; fixed effects, I2 = 0; 2 RCTs). Similarly, there was no effect on peripheral parasitemia or episodes of new clinical malaria. Preventive vitamin A supplementation in children younger than 5 years did not reduce the incidence of peripheral parasitemia or malaria mortality (latter rate ratio = 0.49; 95% CI, 0.07-3.26; random effects, I2 = 72%, 2 RCTs). Vitamin A as an adjunct treatment for cerebral or severe malaria in children did not have benefit on survival, fever resolution time, parasite clearance time, or incidence of neurological or other complications. Vitamin A has no benefit for malarial infection either as prevention or treatment in pregnancy or childhood based on RCT evidence.

Real-life effectiveness, safety, and tolerability of amlodipine/valsartan or amlodipine/valsartan/hydrochlorothiazide single-pill combination in patients with hypertension from Pakistan.

OBJECTIVE: EXCITE (clinical EXperienCe of amlodIpine and valsarTan in hypErtension) evaluated the real-life effectiveness, safety, and tolerability of single-pill combinations (SPCs) of amlodipine/valsartan (Aml/Val) and amlodipine/valsartan/hydrochlorothiazide (Aml/Val/HCTZ) in patients with hypertension from 13 countries in the Middle East and Asia. Here, we present data from Pakistan. METHODS: This was a 26-week observational, multicenter, prospective, open-label study. At week 26, change from baseline in mean sitting systolic (msSBP) and diastolic blood pressure (msDBP) and the proportion of patients achieving BP goal (SBP/DBP <140/90 mmHg; <130/80 mmHg in patients with diabetes) and response rates (SBP <140 mmHg [130 mmHg for patients with diabetes] or reduction of ≥20 mmHg; DBP <90 mmHg [80 mmHg for patients with diabetes] or reduction of ≥10 mmHg), were evaluated. Incidence of adverse events (AEs) and serious AEs (SAEs) was recorded as safety variables. Subjective assessment of effectiveness, compliance and tolerability was done by the physician. RESULTS: A total of 500 patients with hypertension (mean age of 48 years) were prescribed Aml/Val (n = 471, 94%) or Aml/Val/HCTZ (n = 29, 6%); 439 (87.8%) patients completed the study. At week 26, the mean BP decreased from 153.4/91.1 mmHg at baseline to 128.9/78.4 mmHg in the Aml/Val cohort (-24.5/-12.7 mmHg; p < 0.0001) and from 171.6/99.3 mmHg at baseline to 127.7/77.4 mmHg (-43.9/-21.9 mmHg; p < 0.0001) in the Aml/Val/HCTZ cohort. BP goals were achieved by 57% and 55.2% of patients in the Aml/Val and Aml/Val/HCTZ cohorts, respectively. A total of 40 (8%) patients reported at least one AE during the study period. Most common AEs included nausea (1.6%), headache (1.2%), vomiting (1.2%), and edema (1.2%). Most patients in Aml/Val cohort and all patients in Aml/Val/HCTZ cohort rated the effectiveness, compliance and tolerability as 'good' or 'very good'. CONCLUSIONS: Aml/Val with or without HCTZ in a SPC was effective and well-tolerated for BP reduction in this cohort of patients with hypertension from Pakistan.

Frequency of tetanus toxoid immunization among college/university female students of Karachi.

BACKGROUND: Tetanus is a deadly infectious disease for which immunisation is available in EPI at both infant level and for females of reproductive age. More than 95% of patients who develop tetanus have not been previously immunised. Objectives of the study were to determine the frequency of tetanus vaccination and to access the awareness of immunisation among females studying in 11 girls' colleges of Karachi and University of Karachi. METHOD: A cross sectional study was conducted among 1,407 females studying in colleges and University of Karachi from April to August 2007 using a prescribed questionnaire. RESULT: Among 1,407 female students who were interviewed for the study, 232 (16.48%) were not aware about tetanus immunisation program for females of reproductive age. Only 560 students (39.80%) received at least 1 of 5 recommended doses. Only 41 female students (2.91%) received complete course of 5 doses. CONCLUSION: Coverage of tetanus immunisation among literate females in most populous city of the country is far behind satisfactory. There is need for awareness and crash programs of tetanus immunisation.