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Abstract Life cycle assessment was carried out for a conventional wooden furniture set produced in Mardan division of the Khyber Pakhtunkhwa province of Pakistan during 2018-19. Primary data regarding inputs and outputs were collected through questionnaire surveys from 100 conventional wooden furniture set manufacturers, 50 in district Mardan and 50 in district Swabi. In the present study, cradle-to-gate life cycle assessment approach was applied for a functional unit of one conventional wooden furniture set. Production weighted average data were modelled in the environmental impacts modelling software i.e., SimaPro v.8.5. The results showed that textile used in sofa set, wood preservative for polishing and preventing insects attack and petrol used in generator had the highest contribution to all the environmental impact categories evaluated. Total cumulative energy demand for wooden furniture set manufactured was 30,005 MJ with most of the energy acquired from non-renewable fossil fuel resources.
Resumo A abordagem de avaliação do ciclo de vida foi realizada para um conjunto de móveis de madeira convencional produzido na divisão Mardan da província de Khyber Pakhtunkhwa do Paquistão durante 2018-19. Os dados primários sobre entradas e saídas foram coletados por meio de pesquisas por questionário de 100 fabricantes de conjuntos de móveis de madeira convencionais, 50 no distrito de Mardan e 50 no distrito de Swabi. No presente estudo, a abordagem de avaliação do ciclo de vida do berço ao portão foi aplicada para uma unidade funcional de um conjunto de móveis de madeira convencional. Os dados da média ponderada da produção foram modelados no software de modelagem de impactos ambientais, isto é, SimaPro v.8.5. Os resultados mostraram que os têxteis usados no conjunto de sofás, o preservativo de madeira para polir e prevenir o ataque de insetos e a gasolina usada no gerador tiveram a maior contribuição em todas as categorias de impacto ambiental avaliadas. A demanda total acumulada de energia para o conjunto de móveis de madeira fabricado foi de 30.005 MJ, com a maior parte da energia adquirida de recursos de combustíveis fósseis não renováveis.
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Meio Ambiente , Decoração de Interiores e Mobiliário , PaquistãoRESUMO
Abstract Ferns are often used by indigenous people in Khyber Pakhtunkhwa, Pakistan. This study was designed to collect the ethnomedicinal and traditional knowledge of these locals about this group of vascular plants. Forty taxa belong to nineteen genera and ten families are used in the treatment of different diseases. The Pteridaceae was the most representative family with twelve taxa (30%), followed by Athyriaceae and Dryopteridaceae with six taxa each (30%), and Thelypteridaceae with five taxa (12.5%). Regarding the genera, Adiantum, Asplenium and Dryopteris ranked first with four taxa each (30%), followed by Aleuritopteris, Diplazium, Pteris and Equisetum with three taxa each (30%), followed by Athyrium, Oeosporangium, Polystichum and Pseudophegopteris with two taxa each (20%). These taxa were commonly used in the treatment of respiratory disorders i.e. asthma, bronchitis, emphysema, pneumonia; intestinal ulcer, stomach, urinary ailments and skin disorders by the methods of decoction and infusion. Traditional knowledge about ethnomedicinal plants is a valuable and essential source for the discovery of allopathic, herbal and homeopathic medicines.
Resumo As samambaias são frequentemente usadas pelos indígenas em Khyber Pakhtunkhwa, Paquistão. Este estudo foi desenhado para coletar o conhecimento etnomedicinal e tradicional desses moradores sobre este grupo de plantas vasculares. Quarenta táxons pertencem a dezenove gêneros, e dez famílias são utilizadas no tratamento de diferentes doenças. Pteridaceae foi a família mais representativa com doze táxons (30%), seguida por Athyriaceae e Dryopteridaceae com seis táxons cada (30%), e Thelypteridaceae com cinco táxons (12,5%). Em relação aos gêneros, Adiantum, Asplenium e Dryopteris ficaram em primeiro lugar com quatro táxons cada (30%), seguidos por Aleuritopteris, Diplazium, Pteris e Equisetum com três táxons cada (30%), e Athyrium, Oeosporangium, Polystichum e Pseudophegopteris com dois táxons cada (20%). Estes táxons foram comumente usados no tratamento de distúrbios respiratórios, isto é, asma, bronquite, enfisema, pneumonia; úlcera intestinal, estômago, doenças urinárias e doenças da pele pelos métodos de decocção e infusão. O conhecimento tradicional sobre plantas etnomedicinais é uma fonte valiosa e essencial para a descoberta de medicamentos alopáticos, fitoterápicos e homeopáticos.
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Humanos , Plantas Medicinais , Gleiquênias , Traqueófitas , Paquistão , Fitoterapia , Medicina TradicionalRESUMO
Domestic donkey plays a key role as a draft animal in rural economy of Pakistan where its population is increasing every year. The complete mtDNA control region of forty randomly sampled donkeys was PCR- amplified and sequenced bi-directionally using specific primers. Distinct mtDNA haplotypes obtained in the current study (KY446001−KY446011) were subjected to haplotype (h) and nucleotide diversity (π) measures using DnaS as well as to phylogenetic, Network, and AMOVA analyses. There were a total 27 polymorphic sites present within 11 unique mtDNA haplotypes from the studied 40 animals from different regions. Neighbor-joining network and median-joining network both illustrated the splitting of all these haplotypes into two well-defined Nubian and Somali lineages, confirming African maternal origin of Pakistani domestic donkey. Diversity parameters h (0.967± 0.037) and π (0.02917± 0.00307) were found to reveal high levels of genetic diversity in Pakistani donkeys. AMOVA demonstrated only 1% of genetic differences between two mtDNA maternal lineages, pointing to lack of population substructure in Pakistani donkeys as is the case with worldwide domestic donkey population. Pakistani donkeys have African maternal origin and high levels of mtDNA diversity. High genetic diversity may be due to non-selective breeding and heteroplasmy. We herein provide the first report on mtDNA diversity of control region in Pakistani domestic donkey.
O burro doméstico possui um papel fundamental como animal de tração na economia rural do Paquistão, onde a população desse animal está aumentando a cada ano. A região de controle de mtDNA completa de 40 burros amostrados aleatoriamente foi ampliada por PCR e sequenciada bidirecionalmente por intermédio de primers específicos. Haplótipos distintos de mtDNA obtidos no estudo atual (KY446001 − KY446011) foram submetidos a medidas de haplótipo (h) e diversidade de nucleotídeos (π) por meio de DnaS, bem como análises filogenéticas, de rede e AMOVA. Havia um total de 27 sítios polimórficos presentes em 11 haplótipos de mtDNA exclusivos dos 40 animais estudados de diferentes regiões. A rede de união de vizinhos e a rede de união mediana ilustram a divisão de todos esses haplótipos em duas linhagens núbias e somalis bem definidas, confirmando a origem materna africana do burro doméstico do Paquistão. Os parâmetros de diversidade h (0,967 ± 0,037) e π (0,02917 ± 0,00307) revelaram altos níveis de diversidade genética em burros paquistaneses. AMOVA demonstrou apenas 1% de diferenças genéticas entre as duas linhagens maternas de mtDNA, apontando a falta de subestrutura populacional em burros paquistaneses, como é o caso da população mundial de burros domésticos. Os burros paquistaneses têm origem materna africana e altos níveis de diversidade de mtDNA. A alta diversidade genética pode ser por causa da reprodução não seletiva e de heteroplasmia. Aqui, fornecemos o primeiro relatório sobre a diversidade do mtDNA da região de controle em burros domésticos do Paquistão
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Animais , Paquistão , Variação Genética , DNA Mitocondrial , EquidaeRESUMO
Malaria is one of the major public health issues globally. Malaria infection spreads through mosquito bites from infected female Anopheles mosquitoes. This study aims to conduct a systematic review and meta-analysis on malaria prevalence in Pakistan from 2006 to 2021. We searched PubMed, Science Direct, EMBASE, EMCare, and Google Scholar to acquire data on the prevalence of malaria infections. We performed a meta-analysis with a random-effects model to obtain the pooled prevalence of malaria, Plasmodium vivax, and Plasmodium falciparum. Meta-analysis was computed using R 4.1.2 Version statistical software. I2 and time series analysis were performed to identify a possible source of heterogeneity across studies. A funnel plot and the Freeman-Tukey Double Arcsine Transformed Proportion were used to evaluate the presence of publication bias. Out of the 315 studies collected, only 45 full-text articles were screened and included in the final measurable meta-analysis. Pooled malaria prevalence in Pakistan was 23.3%, with Plasmodium vivax, Plasmodium falciparum, and mixed infection rates of 79.13%, 16.29%, and 3.98%, respectively. Similarly, the analysis revealed that the maximum malaria prevalence was 99.79% in Karachi and the minimum was 1.68% in the Larkana district. Amazingly, this systematic review and meta-analysis detected a wide variation in malaria prevalence in Pakistan. Pakistan's public health department and other competent authorities should pay close attention to the large decrease in mosquito populations to curb the infection rate.
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This study aimed to assess the coverage of essential postnatal maternal care services among women residing in the slums of Islamabad. A community-based, cross-sectional study was conducted to assess the coverage of essential postnatal care (PNC) services. Using random sampling, 416 women living in the squatter settlements of Islamabad Capital Territory were selected as study participants. Data was analyzed by using SPSS version 22. Descriptive statistics were employed to display frequencies for categorical variables, whereas mean, median, and standard deviation were calculated for continuous variables. The analysis of data showed that 93.5 percent of the women utilized postnatal services at least once after delivery. Approximately 9 percent and 4 percent of women received all eight recommended services within 24 h of birth and beyond 24 h of birth, respectively. Effective PNC services were received by only 1 percent of the women. The study revealed that the utilization of effective PNC was very low. The majority of the women delivered in health institutions and received their first PNC checkups, but follow-up for the recommended checkups was very low. These results can help health professionals and policymakers in designing programs and developing efficient strategies that would improve PNC service utilization in Pakistan.
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Background: Breast cancer is most common in Pakistani women at young age compared to West where it is most common after 60 years of age. Variations in genes controlling vitamin D activity would play a role in determining the risk of breast cancer in women at early age. Purpose: To determine the association of vitamin D receptors (VDR) gene polymorphisms (FokI) with breast cancer risk in Pakistani women. Methods: FokI polymorphisms were studied through the polymerase chain reaction-restriction fragment length polymorphism technique on blood samples of 300 breast cancer and 300 healthy women. Results: This study found that circulating level of 25(OH)D3 was significantly lower among breast cancer patients as well as healthy subjects. Patients with large tumor size had significantly lower vitamin D levels. VDR FokI genotypes were significantly distributed (P ≤ 0.00001) in Pakistani women with newly diagnosed breast cancer. A significant association between different FokI genotypes and circulating levels of 25(OH)D3 was found. Patients with FF genotype was significantly (P < 0.0001) associated with higher risk of breast cancer (OR 8.9, 95% CI 0.17-0.45) compared to Ff and ff genotype. Conclusion: VDR gene FokI polymorphism was associated with plasma vitamin D level and significant differences found in mean serum vitamin D levels between genotype groups of FokI. The study concluded that FokI might be one of the contributors to increase relative risk of breast cancer in Pakistani women.
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Neoplasias da Mama , Vitamina D , Humanos , Feminino , Pessoa de Meia-Idade , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/genética , Paquistão/epidemiologia , Receptores de Calcitriol/genética , Polimorfismo Genético , Genótipo , Estudos de Casos e ControlesRESUMO
There is widespread agreement that improved health should be regarded as a means and an end in the context of the development process. The health of the populace and the equitable provision of healthcare are two indicators of a society's level of development. A variety of factors influences child mortality. This study investigated the causes of child death and the interaction effect of birth spacing (B.S.) and maternal health care services (MHCS) on child mortality. Using SPSS version 20, we used the Pakistan Demographic and Health Survey (PDHS) 2017-2018 data set to investigate the associated factors of child mortality and the moderating influence of birth spacing using binary logistic regression. The outcome variable is categorical with two categories. The findings indicated that the risk of infant death decreased with adequate B.S. between two pregnancies and access to maternal health care services. Birth spacing was found to moderate the link between access to maternal health care services (MHCS) and child mortality. Our research leads us to conclude that the amount of time between children's births significantly reduces infant mortality. When the birth spacing is at least 33 months, the relationship between maternal health care services and child mortality becomes more evident and negative.
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Purpose: To understand pregnant women's experience with midwifery-led antenatal care services using the Respectful Maternity Care charter in primary health centers in Karachi, Pakistan. Methods: This cross-sectional study was at Rehri Goth and Ibrahim Hyderi, two peri-urban communities in Karachi, Pakistan, where women receive antenatal care services. All pregnant women in their third trimester who consented during the study period were included. The participants were asked about access to care, antenatal care experience, person-centered approach, and general satisfaction with the facility using a pre-designed questionnaire. These themes were mapped onto the universal Respectful Maternity Care charter. Descriptive statistics were used to summarize the findings in each of these themes. Multivariable logistic regression techniques to determine the relationship between the dependent and independent variables. Results: There were 904 women who agreed to participate in this study during January to December 2021. Majority of the women (94%, n=854) were satisfied with the operating hours and cleanliness. More than 90% of the women reported positive experiences regarding privacy, respectful treatment by midwives, and non-discriminatory care. However, 40% (n=362) of the women reported not receiving adequate information and informed consent before a medical procedure, while 65% (n=587) reported poor counseling for birth preparedness. Maternal age, women's occupation, women's education, and parity were found to be significantly associated with respect provided, satisfaction with counseling and the consent process. Conclusion: This study reported satisfaction of pregnant women with the facility's ambiance, respect, and care; however, poor communication skills regarding consent and antenatal counseling were reported. The findings suggest the need for more efficient strategies, such as regular respectful maternity care and technical training to strengthen midwife-patient interactions and enhance overall satisfaction, thus improving maternal and newborn outcomes.
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Introduction: The primary objective of this study was to evaluate the baseline characteristics of Lynch syndrome (LS). Furthermore, the study aimed to evaluate overall survival (OS) among patients with LS. Materials and Methods: This was a retrospective study of colorectal cancer patients registered from January 2010 to August 2020 with an immunohistochemical diagnosis of LS. Results: A total of 42 patients were assessed. The mean age at presentation was 44 years, with male predominance (78%). Demographic preponderance was from the North of Pakistan (52.4%). The family history was positive in 32 (76.2%) patients. The colonic cancer distribution was 32 (76.2%) on the right side. Most of the patients presented with Stage II disease (52.4%), and the common mutations were MLH1 + PMS2 16 (38.1%) followed by MSH2 + MSH6 9 (21.4%). The 10-year OS was found to be 88.1%. However, the OS was 100% post pancolectomy. Conclusion: LS is prevalent in the Pakistan population, especially in the North of Pakistan. Clinical presentation and survivals are similar to the Western population.
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Introduction: Data on the utilisation of epidermal growth factor receptor (EGFR) tyrosine-kinase inhibitors (TKIs) and their clinical outcomes in a heterogeneous Pakistani-Asian population have not been previously reported. This manuscript presents the first account of the clinical outcomes of EFGR-TKIs in EGFR-mutant lung adenocarcinoma among Pakistani-Asians. Materials and methods: A real-world data study was conducted on all advanced lung cancer patients harbouring EGFR-mutations from the cancer registry of Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan. We identified three different patterns of the use of EGFR-TKIs (Groups 1, 2 and 3) that reflect the ground realities of cancer care and delivery in Pakistan. We also noted a significant proportion of patients (Group 4) without access to EGFR TKIs. We compared the objective response rates (ORR), progression-free survival (PFS) and overall survival (OS) of each of the four groups and reported their toxicity profile. Results: Within the limitations of a retrospective analysis, we saw differences in the frequency of EGFR mutations in this population. However, response rates and long-term outcomes of EGFR TKI therapy were comparable with the existing data. The overall use of EGFR TKIs led to a superior outcome in ORR, PFS and OS compared to chemotherapy alone; (77.8% vs. 50.0%, 16.3 vs. 10.7 months; P = 0.099; 85.6 vs. 25.9 months, respectively; P = 0.13). Conclusion: Except for modest differences, EGFR-mutant advanced lung adenocarcinoma outcomes among Pakistani-Asians are comparable to those of other populations.
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Globally, the hazardous substance in children's goods is of great concern. Toxic chemicals are potentially harmful to the health and growth of infants and children. Lead (Pb) and cadmium (Cd)-contaminated children's jewelry is widely encountered in many countries. This study aims to determine the concentration of metal toxicants (Pb, Cd, Ni, Cu, Zn, Co, and Fe) in event-based (Independence Day festival) children's jewelry, considering time-limited and fast production products that may compromise the quality and safety parameters during manufacturing. The determinations are for the time-constraint industrial production of children's jewelry in the context of the toxic substances in a variety of base materials used. This is the first time event-based children's jewelry has been monitored and critically assessed for metal contamination. Forty-two samples, including metallic, wooden, textile, rubber, plastic, and paint-coated plastic children's jewelry, were tested. Seventy-four percent of samples detected Pb and Cd in quantifiable amounts. Ni in 71%, Cu in 67%, Co in 43%, and Zn and Fe were detected in 100% samples with quantifiable amounts. Twenty-two ID-CJ samples exceeded the US regulatory limit for Pb and four samples for Cd. However, twenty-nine samples for Pb, eleven for Cd, five for Co, and one for Cu exceeded the EU regulatory limit. The highest concentration of Pb was found in paint-coated plastic jewelry, and the highest Cd was found in metallic jewelry. These results suggest that the potential hazards of event-based children's jewelry deserve the attention of government agencies seeking to limit children's exposure to toxic chemicals. Intergovernmental organizations and individual countries regulate chemicals in consumer products, but a coordinated international approach is lacking. Some continents and countries still lack in regulations for children's products, especially jewelry, and toys.
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Background: During the last decades, migratory behavior has had a key role in population growth and redistribution in Pakistan. Migration has far-reaching socioeconomic implications for individuals and society at large that could influence the health integrity of Pakistani women. This study aimed to describe the migration patterns and drivers as well as their association with adequate access to reproductive and maternal care among married Pakistani women aged 15-49. Methods: The data from the 2017-18 Pakistan Demographic Health Survey (PDHS) was used to extract the information on the explanatory (sociodemographic and migration backgrounds) and outcome variables (unmet needs for family planning, adequate antenatal care, and delivery at health facilities). Bivariate and multivariate logistic regression analyses were employed to examine the relationship between these explanatory and outcome variables before and after adjustment for sociodemographic inequalities. Results: In unadjusted models, the odds of having adequate ANC and delivery at health facilities were approximately 2 to 4 times higher in those living (urban non-migrant), moving to (urban to urban, rural to urban), or leaving the urban areas (rural to urban) as compared to rural non-migrants; likewise, the odds of the unmet needs for family planning was about 20-50% lower in the same migration streams compared to rural non-migrant. However, after adjustment for sociodemographic inequalities, most of these associations attenuated and only the association of urban to urban migration with unmet needs for family planning and the association of urban non-migrant with delivery at health facilities remained significant. Conclusion: Although the findings suggest that Internal migration flows, particularly those to urban areas (urban to urban and rural to urban), could be associated with better access to reproductive and maternity care among married Pakistani women aged 15-49 years; adjustment for sociodemographic inequalities, particularly education and wealth, nullified this association to a great extent. This has important implications for current policies and interventions in Pakistan and calls for policy reform and women's rights advocacy to enhance the literacy level of young Pakistani girls through well-tailored interventions, maintaining them at school.
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Serviços de Saúde Materna , Feminino , Humanos , Gravidez , Paquistão/epidemiologia , Cuidado Pré-Natal , Escolaridade , Inquéritos EpidemiológicosRESUMO
Over the past few decades, the development of transport infrastructure has attracted huge local and foreign direct investments to raise the overall industrial output in Pakistan. Meanwhile, the transport sector has emerged as one of the most emissions-intensive industrial sectors. Thus, this study is the first to investigate how Pakistan's transport infrastructure across four modes-roads, trains, ports, and airways-affects industrial value addition and carbon footprints in the country. By making use of the theoretical and empirical literature, the study builds carbon emission and economic output models to determine the economic and environmental sustainability of transport infrastructure development in the country. The empirical findings conclude long-term environmental sustainability issues in transportation infrastructure development. All means of transport infrastructure development have a significant positive impact on carbon dioxide emissions in the country. Only ports and highways, however, provide a positive contribution to industrial output. Additionally, population growth, capital, labor, and urbanization are positively linked with the industrial output and carbon dioxide emission in the country, whereas trade openness helps to offset the emission intensity to some extent. Given this evidence, we provide detailed policy implications by highlighting the significance of greener technologies under new transport-related infrastructure investment that addresses SDG-9.
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Objective: To assess upper-to-lower body segment ratio and arm span to height difference in children. METHODS: The descriptive, cross-sectional study was conducted in schools of the Raiwind area near Lahore, Pakistan, from November 2021 to May 2022, after approval from the ethics review committee of the Sharif Medical and Dental College, Lahore. The sample comprised children aged 3-14 years whose height fell between the 3rd and 97th centiles on the Centers for Disease Control and Prevention height-for-age chart. Data was analysed using SPSS 23. RESULTS: Of the 1,836 children, 906(49.3%) were boys with mean age 8.45±3.02 years, mean height 132.54±17.78cm and mean weight 32.0±13.72kg. Besides, there were 930(50.7%) girls with mean age 8.26±3.21 years, mean height 130.41±18.03cm and mean weight 31.09±13.88kg. The mean upper-to-lower body segment ratio in boys was 1.06±0.15 at age 3 years, 0.96±0.08 at age 7 and 0.94±0.08 at age 10. The mean upper-to-lower body segment ratio in girls was 1.08±0.08 at age 3 years, 0.98±0.07 at age 7, and 0.92±0.10 at age 10. The mean arm span to height difference in boys was -1.81±5.83 and in girls -4.09±5.77. Conclusion: Upper-to-lower body segment ratio and arm span to height difference may help paediatricians in the evaluation of disproportionate short stature.
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Braço , Estatura , Masculino , Feminino , Humanos , Criança , Pré-Escolar , Estudos Transversais , Paquistão , Peso CorporalRESUMO
OBJECTIVE: To evaluate individual and community-level factors influencing neonatal mortality in Pakistan. METHODS: The retrospective, secondary-data, quantitative study was done from July 2021 to January 2022 after approval from the ethics review committee of the International Islamic University, Islamabad, Pakistan, and comprised data of live births from November 22, 2017, to April 30, 2018, which was the period covered by the Pakistan Demographic and Health Survey 2017-18. Significant community-level, maternal and proximate determinants of neonatal mortality were identified. Data was analysed using STATA 13. RESULTS: Among the 12,708 live births covered, the neonatal mortality rate within the first month of birth was 5337(42%), and 3939(31%) neonatal deaths occurred in the first week of life, while 3431(27%) deaths occurred on the first day. Distance to health facility (adjusted hazard ratio: 1.1; 95% confidence interval: 0.8-1.6), unimproved toilet facility (adjusted hazard ratio: 2.0; 95% confidence interval: 0.7-2.1), caesarean section deliveries (adjusted hazard ratio: 1.6; 95% confidence interval: 0.6-1.9) and child's birth size smaller than average (adjusted hazard ratio: 1.7; 95% confidence interval: 1.1-2.7) carried significantly higher risk of neonatal deaths. Compared to women aged 15-19 years, older women's child (adjusted hazard ratio: 0.6; 95% confidence interval: 0.2-1.6) and neonates having birth order 3 compared to birth order 1 (adjusted hazard ratio: 0.5; 95% confidence interval: 0.2-0.9) and female gender of child (adjusted hazard ratio: 0.3; 95% confidence interval: 0.2-0.9) were less likely to die. CONCLUSIONS: There was a markedly high prevalence of neonatal mortality rate in Pakistan. Unimproved toilet facility, distance to health facility, caesarean mode of delivery and small size of the child at birth were found linked with increased risk of neonatal mortality.
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Cesárea , Morte Perinatal , Recém-Nascido , Criança , Humanos , Feminino , Gravidez , Idoso , Paquistão/epidemiologia , Estudos Retrospectivos , Mortalidade Infantil , Ordem de NascimentoRESUMO
BRCA1 variants are extensively associated with increased risk of breast cancer. Early detection and screening of variants is still rare in developing countries. Here, we investigated six BRCA1 variants in 300 subjects from Pakistani population using tetra amplification-refractory mutation system (T-ARMS) PCR. Our results indicate significant association of BRCA1 variants rs8176237 (AA; OR 8.2, 95% CI 3.02-22.64, p < 0.0001), rs1060915 (CC; OR 4.29, 95% CI 1.94-9.48, p = 0.0003), and rs799912 (TT; OR 3.16, 95% CI 1.44-6.94, p = 0.004) with up to 8-fold increased odds of breast cancer under recessive model. Furthermore, BRCA1 haplotypes AGCACG and AGCCCT were associated with up to 18% breast cancer cases (p < 0.05). Additionally, we found association of these variants with up to 11-fold increased odds of benign breast tumors. Linkage disequilibrium (LD) block-wise analysis revealed haplotypes GCAC and ATAC were associated with significantly increased risk. To our knowledge, this is the first study that identifies the association of these BRCA1 variants with breast tumors in Pakistani population. In conclusion, BRCA1 variants investigated in the present study are associated with high odds of benign- and malignant breast tumors. Studies with bigger sample size may help early detection and screening to reduce the odds of breast cancer.
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Due to its high prevalence, we aimed to create postmenopausal osteoporosis clinical practice guideline via GRADE-ADOLOPMENT for Pakistan. We recommend a higher dose (2000-4000 IU) of vitamin D for osteoporotic patients who are old, have malabsorption, or are obese. The guideline will help standardize care provision and improve health care outcomes for osteoporosis. PURPOSE: Postmenopausal osteoporosis affects one in every five postmenopausal women in Pakistan. An evidence-based clinical practice guideline (CPG) is needed to standardize care provision to optimize health outcomes. Hence, we aimed to develop CPG for the management of postmenopausal osteoporosis in Pakistan. METHODS: The GRADE-ADOLOPMENT process was used to adopt (as is or with minor changes), exclude (omit), or adapt (modify based on local context) recommendations to the source guideline (SG)-clinical practice guidelines for the diagnosis and treatment of postmenopausal osteoporosis-2020 update from American Association of Clinical Endocrinology (AACE). RESULTS: The SG was "adoloped" to cater to the local context. The SG consisted of 51 recommendations. Forty-five recommendations were adopted as is. Due to unavailability of drugs, 4 recommendations were adopted with minor changes, and one was excluded, while one recommendation was adopted with the inclusion of use of a surrogate FRAX tool specific for Pakistan. One recommendation regarding vitamin D dosage was adapted to recommend a dose of 2000-4000 IU of vitamin D in patients with obesity, malabsorption, and old age. CONCLUSION: The developed Pakistani postmenopausal osteoporosis guideline consists of 50 recommendations. The guideline created recommends a higher dose (2000-4000 IU) of vitamin D for patients who are old, have malabsorption, or are obese, which is an adaptation from the SG by the AACE. This higher dose is justified as lower doses prove to be suboptimal in these groups and should be complemented with baseline vitamin D and calcium levels.
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Osteoporose Pós-Menopausa , Osteoporose , Humanos , Feminino , Osteoporose Pós-Menopausa/tratamento farmacológico , Osteoporose Pós-Menopausa/diagnóstico , Paquistão/epidemiologia , Osteoporose/tratamento farmacológico , Vitamina D/uso terapêutico , Obesidade , Vitaminas/uso terapêuticoRESUMO
As a vector of wide range of pathogenic agents, ticks pose health threats to wild and domestic animals, and humans. Information is unavailable about the prevalence and spatial survey of Hyalomma kumari ticks and associated Rickettsia spp. in Pakistan. Concerning this knowledge gap, the present study aimed to molecularly detect Rickettsia species associated with H. kumari infesting small ruminants in Khyber Pakhtunkhwa (KP), Pakistan. A total of 409 H. kumari ticks were collected from 163/295 infested hosts with an infestation rate of 55.25%. A total of 204 females, 158 males, and 47 nymphs were collected. Goats were heavily infested by 224 ticks having an infestation rate of 58.33% (98/168), whereas sheep were infested by 185 ticks having a lesser infestation rate of 51.18% (65/127). Genomic DNA extracted from ticks was used for the amplification of tick (cox I, 16S rRNA, ITS-2) species and Rickettsia (gltA, ompA, and ompB) partial genes. Eighty-three ticks were subjected to PCR, and 8/83 (9.6%) were found positive for rickettsial agents. The cox I and 16S rRNA sequences of H. kumari showed 98.90-99.74% identity with H. kumari sequences reported from Pakistan, and phylogenetically clustered to the corresponding species reported from Pakistan and India. The obtained rickettsial gltA, ompA, and ompB sequences showed 100% identity with Rickettsia sp. of the Rickettsia conorii reported from Pakistan. In the phylogenetic trees, rickettsial sequences clustered with uncharacterized Rickettsia sp. from Pakistan and R. conorii from Israel, Russia, South Africa, and India. The present molecular based detection of H. kumari-associated R. conorii will facilitate effective surveillance in the region.
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Bartonella can infect a variety of mammals including humans and has been detected in the Americas, Europe, Africa, and Asia. Roughly two-thirds of identified Bartonella species are found and maintained in rodent reservoirs, with some of these species linked to human infections. Rodents (N=236) were caught from the Sahiwal division of Punjab, Pakistan and tested for Bartonella using PCR targeting gltA and rpoB genes, followed by sequencing of rpoB-positive samples. Genetic relatedness to other published Bartonella spp. rpoB gene sequences were examined using BLAST and phylogenetic analysis. Overall, 7.62% (18/236) of rodents were positive for both gltA and rpoB fragments. Rattus rattus and R. norvegicus had 7.94% (12/151) and 7.05% (6/85) positivity rates for Bartonella DNA, respectively. Phylogenetic analysis revealed a close relatedness between Bartonella spp. from Pakistan to Bartonella spp. from China, Nepal, and Malaysia. This study is the first reported detection of Bartonella spp. in R. rattus and R. norvegicus from the Sahiwal area of Punjab, Pakistan.
Assuntos
Infecções por Bartonella , Bartonella , Ratos , Animais , Humanos , Bartonella/genética , Infecções por Bartonella/epidemiologia , Infecções por Bartonella/veterinária , Paquistão/epidemiologia , Filogenia , Epidemiologia Molecular , Mamíferos , RoedoresRESUMO
Recurrent aphthous stomatitis (RAS) is a benign ulcerative condition, defined by the recurrent formation of non-contagious mucosal ulcers. Surfactant protein D (SP-D) is secreted frequently at surfaces exposed directly to body fluids. This study aims to investigate the association of SP-D single nucleotide polymorphisms (SNPs) with the onset of RAS. Blood samples from 212 subjects (106 cases/controls each) were collected during 2019 and genotyped for SP-D SNPs (rs721917, rs2243639, rs3088308) by polymerase chain reaction and restriction fragment length polymorphism followed by 12% polyacrylamide gel electrophoresis. Minor aphthous (75.5%) was the commonly observed ulcer type as compared to herpetiform (21.7%) and major aphthous ulcers (2.8%). A family history of RAS was reported in 70% of cases. RAS was found significantly associated with rs3088308 genotypes T/A (95% (Cl): 1.57-5.03, p = 0.0005), A/A (95% (Cl): 1.8-6.7, p = 0.0002), T-allele (95% (Cl): 1.09-2.36, p = 0.01), A-allele (95% (Cl): 1.42-3.91, p = 0.01), rs721917 genotype T/T (95% (Cl): 1.15-25.35, p = 0.03), and T-allele (95% (Cl): 1.28-3.10, p = 0.002). Female gender and obese body mass index (BMI) were significantly associated with rs3088308 genotypes T/A (95% (CI): 1.89-15.7, p = 0.001), T/T (95% (Cl): 1.52-11.9, p = 0.005), A-allele (95% (Cl): 1.65-7.58, p < 0.001), and T-allele (95% (Cl): 1.4-10.1, p <0.001) and rs721917 genotype T/T (95% (CI) = 1.3-33, p = 0.02), respectively. This study describes the association of SP-D SNPs (rs721917, rs3088308) with RAS in the Pakistani population.
