Common pediatric surgical conditions and associated health-seeking behaviors in Pakistan: An urban and rural comparative assessment.

Approximately five billion people do not have access to necessary surgical treatment globally and up to 85% of children in LMICs are affected with conditions requiring surgical care by the age of 15 years. It is crucial to identify common surgical conditions in children in Pakistan to inform healthcare professionals and policymakers for effective resource allocation. This representative cross-sectional household survey conducted on children aged 5-10 years assessed existing surgical diseases and healthcare-seeking behaviors in the two largest provinces (Sindh and Punjab) of Pakistan. The data was collected through a validated cross-sectional survey tool [Surgeons OverSeas Assessment of Surgical Need (SOSAS)]. Caregivers were asked about their child's recent and past surgical conditions in six distinct anatomical regions and pictures were taken of identified conditions after appropriate consent for further diagnosis. Health-seeking behaviors including the kind of treatment sought, the nature of care received, and the reasons for not receiving care were noted. 13.5% of children surveyed reported a surgical condition, with a similar distribution across urban (13.2%) and rural (13.7) areas and the most common cause was trauma. The greatest number of surgical conditions were found to be on the head and neck region (57.7%), while the back accounted for the least number of conditions (1.7%). Our results outline a need for organizing all entities (governmental, non-governmental, and private) involved in child health to ensure efficient resource allocation to cater to existing surgical problems.

Assessment of pediatric surgical needs, health-seeking behaviors, and health systems in a rural district of Pakistan.

Surgical conditions are responsible for up to 15% of total Disability-Adjusted Life Years (DALY) lost globally. Approximately 4.8 billion people have no access to surgical care and this studies aim is to assess the surgical disease burden in children under the age of five years. We used Surgeons OverSeas Assessment of Surgical Need (SOSAS) and Pediatric Personnel, Infrastructure, Procedures, Equipment, and Supplies (PediPIPES) survey tools in Tando Mohammad Khan (TMK). A set of photographs of lesions were also taken for review by experts. All the data was recorded electronically via an android application. The current surgical need was defined as the caregiver's reported surgical problems in their children and the unmet surgical need was defined as a surgical problem for which the respondent did not access care. Descriptive analysis was performed. Information of 6,371 children was collected. The study identified 1,794 children with 3,072 surgical lesions. Categorization of the lesions by the six body regions suggested that head and neck accounted for the greatest number of lesions (55.2%) and the most significant unmet surgical need (16.6%). The chest region had the least unmet surgical need of 5.9%. A large percentage of the lesions were managed at a health care facility, but the treatment essentially consisted of mainly medical management (87%), and surgical treatment was provided for only 11% of lesions. The health facility assessment suggested that trained personnel including surgeons, anesthetic, or trained nurses were only available at one hospital. Basic procedures such as suturing and wound debridement were only performed frequently. This study suggests a high rate of unmet surgical need and a paucity of trained health staff and resources in this rural setting of Pakistan. The government needs to make policies and ensure funding so that proper trained staff and supplies can be ensured at district level.

The correlation of arsenic levels in drinking water with the biological samples of skin disorders.

Arsenic (As) poisoning has become a worldwide public health concern. The skin is quite sensitive to As and skin lesions are the most common and earliest nonmalignant effects associated to chronic As exposure. In 2005-2007, a survey was carried out on surface and groundwater arsenic contamination and relationships between As exposure via the drinking water and related adverse health effects (melanosis and keratosis) on villagers resides on the banks of Manchar lake, southern part of Sindh, Pakistan. We screened the population from arsenic-affected villages, 61 to 73% population were identified patients suffering from chronic arsenic toxicity. The effects of As toxicity via drinking water were estimated by biological samples (scalp hair and blood) of adults (males and females), have or have not skin problem (n=187). The referent samples of both genders were also collected from the areas having low level of As (<10 microg/L) in drinking water (n=121). Arsenic concentration in drinking water and biological samples were analyzed using electrothermal atomic absorption spectrometry. The range of arsenic concentrations in lake surface water was 35.2-158 microg/L, which is 3-15 folds higher than World Health Organization [WHO, 2004. Guidelines for drinking-water quality third ed., WHO Geneva Switzerland.]. It was observed that As concentration in the scalp hair and blood samples were above the range of permissible values 0.034-0.319 microg As/g for hair and <0.5-4.2 microg/L for blood. The linear regressions showed good correlations between arsenic concentrations in water versus hair and blood samples of exposed skin diseased subjects (R2=0.852 and 0.718) as compared to non-diseased subjects (R2=0.573 and 0.351), respectively.

Determination of toxic elements in different brands of cigarette by atomic absorption spectrometry using ultrasonic assisted acid digestion.

In this paper, a sample preparation method based on ultrasonic assisted acid extraction (UAE) of Al, As, Cd, Ni and Pb from filler tobacco (FT) of different local branded (LBCs) and imported branded cigarettes (IBCs) consumed in Pakistan. Acid extracts obtained upon sonication were determined by atomic absorption spectrometry. Parameters influencing extraction such as pre-sonication time 10-15 min, sonication time 2-10 min, mass of sample 0.1-0.5 g, particle size <35-125 microm and, extractant (nitric acid) concentrations (2-10%) were fully optimized to get quantitative recovery of toxic elements (TEs). The proposed method was validated with a certified reference material (CRM) Virginia tobacco leaves (ICHTJ-cta-VTL-2), and also applied a conventional acid digestion method (CDM) on same CRM, for comparative purpose. The average relative standard deviation of UAE method of CRM, ranged as 1.64-8.42% for N = 6, depending on the analytes. Extraction efficiencies for CRM were close to 97.1, 97.5, 98.5, 97.8 and 96.7 for Al, As, Cd, Ni and Pb, respectively. The concentrations of Al, As, Cd, Ni and Pb in cigarettes were present in all branded cigarettes, there is no any significance difference among LBCs and IBCs, except in few cases of LBCs, have high level of Cd and Al. Our results were compared with other worldwide studies.

Evaluation of toxic metals in blood and urine samples of chronic renal failure patients, before and after dialysis.

The determination of toxic elements in the biological samples of human beings is an important clinical screening procedure. The aim of this work was to determine total content of toxic elements-aluminum (Al), cadmium (Cd), and lead (Pb)-in whole blood and urine samples of male chronic renal failure patients (CRFPs) on maintenance hemodialysis from 2006 to 2007. The study included 100 CRFPs, plus 150 healthy volunteers in the control group. The concentration of toxic elements (TEs) were determined in blood sample before and after hemodialysis, while urine sample was determined once, before dialysis. Toxic elements were analyzed by electrothermal atomic absorption spectrometer, prior to microwave-induced acid digestion. The accuracy of the total Al, Cd, and Pb measurements was tested by simultaneously analyzing certified reference materials. No significant differences were established between the analytical results and the certified values (paired t-test at p > 0.05). The levels of TEs in blood samples of patients before dialysis were found to be higher than blood samples after dialysis session. In the control group, the blood levels of Al, Cd, and Pb were significantly lower than the chronic renal failure patients. Moreover, the study shows that analyzing levels of Al, Cd, and Pb may be useful in hemodialysis patients in evaluating TEs status.

Application of fractional factorial design and Doehlert matrix in the optimization of experimental variables associated with the ultrasonic-assisted acid digestion of chocolate samples for aluminum determination by atomic absorption spectrometry.

A simple and rapid method based on ultrasound energy is described for the determination of aluminum (AI) in complex matrixes of chocolate and candy samples by electrothermal atomic absorption spectrometry. The optimization strategy was carried out using multivariate methodologies. Five variables (temperature of the ultrasonic bath; exposure time to ultrasound energy; volumes of 2 acid mixtures, HNO3-H2SO4-H2O2 (1 + 1 + 1) and HNO3-H2O2 (1 + 1); and sample mass) were considered as factors in the optimization process. Interactions between analytical factors and their optimal levels were investigated using fractional factorial and Doehlert matrix designs. Validation of the ultrasonic-assisted acid digestion procedure was performed against standard reference materials, milk powder (SRM 8435) and wheat flour (SRM 1567a). The proposed procedure allowed Al determination with a detection limit of 2.3 microg/L (signal-to-noise = 3) and a precision, calculated as relative standard deviation, of 2.2% for a set of 10 measurements of certified samples. The recovery of Al by the proposed procedure was close to 100%, and no significant difference at the 95% confidence level was found between determined and certified values of Al. The proposed procedure was applied to the determination of Al in chocolate and candy samples. The results indicated that cocoa-based chocolates have higher contents of Al than milk- and sugar-based chocolates and candies.

Evaluation of arsenic levels in grain crops samples, irrigated by tube well and canal water.

The aim of this study was to evaluate the uptake of arsenic (As) by grain crops (wheat, maize and sorghum) grown on agricultural soil irrigated with tube well water (SIT) as test samples and for comparative purposes, same grain crop samples grown on agricultural soil irrigated with fresh canal water (SIC) were marked as control samples, collected simultaneously from three sub-districts of Khairpur, Pakistan. Moreover, this paper demonstrated the total and EDTA (0.05 M) extractable As in both understudied soils that correlate with the respective total As in the edible parts of the studied grain crops. A significantly high accumulation of As was found in grains grown on SIT as compared to those grown on SIC. This study highlights the increased danger of growing food crops in the agricultural land continuously irrigated by As contaminated ground water.

Determination of arsenic in scalp hair of children and its correlation with drinking water in exposed areas of Sindh Pakistan.

This study was focused on the analysis of arsenic (As) levels in scalp hair of children (age, <10 years) collected from two towns of Khairpur, Pakistan, to evaluate the effects of As-contaminated groundwater. For comparative purposes, scalp hair samples of children were also collected from that area having low levels of As (<10 µg/L) in drinking water. Groundwater and scalp hair samples of children were collected and analyzed by electrothermal atomic absorption spectrometry prior to microwave-assisted acid digestion. The average As concentrations in groundwater samples of two towns, Thari Mirwah and Gambat, were found to be 28.5 and 98.3 µg/L, respectively. The range of As concentrations in scalp hair samples of children who belong to Thari Mirwah and Gambat was 1.25-1.61 µg/g and 1.73-3.63 µg/g, respectively. Twenty percent of the total children who belong to Gambat have skin lesions on their hands and feet. A positive correlation coefficient (R = 0.91-0.99) was obtained between As contents in drinking water and scalp hairs of children of both towns.

Respiratory effects in people exposed to arsenic via the drinking water and tobacco smoking in southern part of Pakistan.

In this study, a survey has been conducted during 2005-2007 on surface and groundwater arsenic (As) contamination and its impact on the health of local population, of villages located on the banks of Manchar lake, southern part of Sindh, Pakistan. We have also assessed the relationship between arsenic exposure through respiratory disorders in male subjects with drinking water and smoking cigarettes made from tobacco grown in agricultural land irrigated with As contaminated lake water. The biological samples (blood and scalp hair) were collected from As exposed subjects (100% smokers) and age matched healthy male subjects (40.2% smoker and 59.8% non smokers) belong to unexposed areas for comparison purposes. The As concentration in drinking water (surface and underground water), agricultural soil, cigarette tobacco and biological samples were determined by electrothermal atomic absorption spectrometry. The range of As concentrations in lake water was 35.2-158 microg/L (average 97.5 microg/L), which is 3-15 folds higher than permissible limit of World Health Organization (WHO, 2004). While the As level in local cigarette tobacco was found to be 3-6 folds higher than branded cigarettes (0.37-0.79 microg/g). Arsenic exposed subjects (with and without RD) had significantly elevated levels of As in their biological samples as compared to referent male subject of unexposed area. These respiratory effects were more pronounced in individuals who had also As induced skin lesions. The linear regressions showed good correlations between As concentrations in water versus hair and blood samples of exposed subjects with and without respiratory problems.

Arsenic fractionation in sediments of different origins using BCR sequential and single extraction methods.

The arsenic (As) contaminated sediment serves as a long-term source of arsenic because its mobility and transport in the environment are strongly influenced to associated solid phase. A single extraction method based on the reagents employed in the BCR three steps sequential extraction scheme (BCR-SES) for partitioning of arsenic (As) in sediment samples has been developed. The single-step extraction enabled a reduction of extraction times, yielding extractable contents in accordance with those obtained by application of the BCR-SES, which can be regarded as a standard method and validated by using certified reference material BCR 701. The extractable As content associated with different phases in sediment samples were analysed by electrothermal atomic absorption spectrophotometer. The extraction efficiency of As by single-step extraction was slightly higher than BCR-SES, ranged (100-104%), while difference was not significant at 95% confidence limit with <10% precision. The sediment samples from different origins varied in their physico-chemical properties and total As content. The relative mobility of As obtained from different origins was found in increasing order as: acid soluble fraction