Adult Pakistani Population Research Articles

Transepithelial corneal crosslinking in treatment of progressive keratoconus: 12 months' clinical results.

Objective:The purpose of this study was to evaluate the safety and efficacy of transepithelial corneal collagen cross linking (TE-CXL) with modified riboflavin and accelerated UVA irradiance in thin corneas with pachymetry less than 400 microns at thinnest point, untreatable by epithelium off corneal collagen cross linking (CXL) in adult Pakistani population with progressive keratoconus.Methods:This quasi experimental study included twenty six eyes of 26 patients with progressive keratoconus who underwent accelerated transepithelial CXL in Armed forced institute of ophthalmology with 12 months follow up. Modified riboflavin, ParaCel ((riboflavin 0.25%, Benzalkonium chloride, EDTA, Trometamol, hydroxypropyl methylcellulose) and vibeX Xtra (riboflavin 0.25%) (Avedro, USA)) were applied to cornea in two stages. Uncorrected and Corrected Distant Visual Acuities (UDVA, CDVA), spherical equivalent (SE), astigmatism, pachymetry at thinnest point (Pachy thin), apex keratometry (Kmax), simulated and steep keratometry (Sim K, steep K) were measured at baseline and at 3, 6 and 12 months post operatively. The cornea was then exposed to accelerated UVA irradiance of 9mW/cm2 for 10 min (total dose 30 mW/cm2).Results:The mean age of the patient was 24.54±5.16 years. UDVA, CDVA, SE, astigmatism significantly improved at all postoperative test points (p=0.000, 0.004, 0.000, 0.004 respectively). Kmax and pachy thin were significantly reduced over baseline at 1 year (p=0.000, 0.004 respectively). Topographic indices Sim K and steep K did not show significant changes. No intra or post-operative complications were reported.Conclusion:Transepithelial accelerated CXL with modified riboflavin is a safe and effective procedure which halt disease progression in thin corneas with progressive keratoconus.

Validation of a food frequency questionnaire for assessing macronutrient and calcium intake in adult Pakistani population.

To develop and validate a food frequency table (FFQ) for use in urban Pakistani population. A validation study. The Aga Khan University, Karachi, from June to November 2008. Healthy adult females, aged ³ 18 years who consented to be included in the study were inducted, while males, unhealthy females, aged below 18 years or who did not consent were excluded. The FFQ was administered once while 4, 24 hours recalls spread over a period of one year were administered as the reference method. Daily intakes for energy, protein, fat, and calcium intake were estimated for both the tools. Crude and energy adjusted correlations for nutrient intakes were computed for the FFQ and mean of 4, 24 hours recalls and serum N-telopeptide of type-I collagen (NTx). The correlation coefficients for the FFQ with mean of 4, 24 hours recall ranged from 0.21 for protein to 0.36 for calcium, while the correlation for nutrient estimates from the FFQ with NTx ranged from -0.07 for calcium to 0.01 for energy. Highly significant correlations were found for nutrient intakes estimated from the FFQ vs. those estimated from the mean of 4, 24 hours recalls but no correlations was found between nutrient estimates from the FFQ and serum NTx levels. FFQ was concluded to be a valid tool for assessing dietary intake of adult females in Pakistan.

Hepatitis C virus prevalence and genotype distribution in Pakistan: Comprehensive review of recent data.

Hepatitis C virus (HCV) is endemic in Pakistan and its burden is expected to increase in coming decades owing mainly to widespread use of unsafe medical procedures. The prevalence of HCV in Pakistan has previously been reviewed. However, the literature search conducted here revealed that at least 86 relevant studies have been produced since the publication of these systematic reviews. A revised updated analysis was therefore needed in order to integrate the fresh data. A systematic review of data published between 2010 and 2015 showed that HCV seroprevalence among the general adult Pakistani population is 6.8%, while active HCV infection was found in approximately 6% of the population. Studies included in this review have also shown extremely high HCV prevalence in rural and underdeveloped peri-urban areas (up to 25%), highlighting the need for an increased focus on this previously neglected socioeconomic stratum of the population. While a 2.45% seroprevalence among blood donors demands immediate measures to curtail the risk of transfusion transmitted HCV, a very high prevalence in patients attending hospitals with various non-liver disease related complaints (up to 30%) suggests a rise in the incidence of nosocomial HCV spread. HCV genotype 3a continues to be the most prevalent subtype infecting people in Pakistan (61.3%). However, recent years have witnessed an increase in the frequency of subtype 2a in certain geographical sub-regions within Pakistan. In Khyber Pakhtunkhwa and Sindh provinces, 2a was the second most prevalent genotype (17.3% and 11.3% respectively). While the changing frequency distribution of various genotypes demands an increased emphasis on research for novel therapeutic regimens, evidence of high nosocomial transmission calls for immediate measures aimed at ensuring safe medical practices.

To Determine the Risk Factors and Prevalence of Osteoporosis among Adult Pakistani Population Residing in Karachi Using Quantitative Ultrasound Technique

our country too. The purpose of our study was to determine the prevalence of osteoporosis, and also to establish the risk factors associated with it in Pakistan. Method: It was a cross sectional study that was conducted in the primary care setting in different areas of Karachi. Bone mineral density assessment was done by the speed of sound using the quantitative ultrasound technique at the right Calcaneus. A structured questionnaire was prepared, to evaluate the risk factors associated with osteoporosis Results: Out of 500 participants 21.6% were male and 78.4% were female. The overall prevalence of osteoporosis was 30.7% (24% male and 32.6% females). The prevalence of osteopenia was 44.5% (51% being male and 42.6% being female). Factors that were statistically (p value <0.05) associated with low bone mineral density were increasing age, female gender for osteoporosis, normal to heavy weight, office work in both male and female, inadequate physical activity, inadequate sun exposure, inadequate intake of calcium, smoking in males and smokeless tobacco in both male and female, intake of steroids. Past history of fracture among the participants and the history of fracture in the parents, diabetes and depression also showed positive association, balanced diet and educational status and hypertension could not provide any significant statistical association with low bone mineral density. Conclusion: The prevalence of osteoporosis is high among the adult population of Karachi and it is associated with modifiable risk factors. Non-communicable diseases like, diabetes and depression, also gave a positive association, which needs further prospective studies to confirm this association.

Estimated Percentage of Typhoid Fever in Adult Pakistani Population (TAP) Study

Abstract Typhoid fever is a serious infection with high morbi-dity and mortality in untreated cases. It is one of the very common infections in developing countries due to various factors involving hygiene and sanitation. Objective: To determine the estimated percentage of typhoid fever in Pakistani population and to find the commonly prescribed antibiotics for the disease. Material and Methods: This cross sectional study was conducted on 1036 patients, selected from forty five general practitioner clinics, between June to Octo-ber 2010. Patients of > 18 years of age with > 3 days history of fever (> 100oF) and high index of suspicion for typhoid fever were tested for typhoid fever using Typhidot kits and positive cases were recruited for monitoring response to treatment. The febrile patients with clear cut history of urinary or respiratory infect-ion, hypovolemic shock or hepatobiliary disease were excluded and not tested by typhidot kit. The antibiotics prescribed to study population by various general prac-titioners were noted. Data was analysed on SPSS. Res-ults were expressed in percentages and proportions. Results: Total 1036 patients were recruited. Typhoi-dot test was negative in 63.9% and positive in 36.1% patients with highest percentages of positive cases in Karachi, Rawalpindi and Hyderabad. The maximum number of cases were reported in summer season espe-cially from June to August. Most of the patients were between ages of 19 - 39 years. The commonest anti-biotics prescribed were Ofloxacin, Ciprofloxacin and Levofloxacin. Conclusion: Typhoid fever is very common infection in Pakistan caused by Salmonella typhi which is trans-mitted among humans through faeco-oral route. Dise-ase can be controlled not only by antibiotics like fluo-roquinolones but by patient education, improvement in hygiene and sanitation, safe supply of clean drinking water and prophylactic vaccination as well. However, timely diagnosis and appropriate management with proper antibiotics is the key to avoid the acute compli-cations and chronicity of the disease. Key Words: Typhoid fever, Ofloxacin, Ciprofloxacin, Levofloxacin Typhidot test.

No change in calcium absorption in adult Pakistani population before and after vitamin D administration using strontium as surrogate

Vitamin D, parathyroid hormone levels and calcium absorption was assessed before and after cholecalciferol using Strontium as a surrogate. Increase in 25OHD, lowering of iPTH with no effect on Sr absorption was seen, suggesting the possibility that maximal Ca absorption had already been achieved in these volunteers. This paper discusses the determination of calcium (Ca) absorption, using strontium (Sr) as a surrogate, before and after a single IM injection of vitamin D(3) (600,000 IU). Baseline serum 25-hydroxyvitamin D (25OHD), Sr, Ca, P, and intact parathyroid hormone (iPTH) were determined in 53 fasting volunteers, followed by administrating (PO) 0.03 mM (4.8 mg/kg) SrCl(2) and collecting blood at 0.5, 1 and 4 h to determine the absorption (AUC(0 → t )) of Sr. Following the initial absorption test, volunteers received a single IM injection of 600,000 IU vitamin D(3). Two months later, the fasting serum and the Sr absorption test were repeated, as described above. The IM injection of vitamin D(3) caused a significant increase in fasting 25OHD (from 43.5 ± 19 to 66.1 ± 19.1 nmol/L (p < 0.001)) and a trend toward lower serum iPTH (from 59.8 ± 27.8 to 53 ± 31 ng/L). Fasting serum Ca and P remained unchanged. A higher 25OHD level failed (p = 0.32) to translate into a higher rate of Sr absorption. AUC(0 → 4 h) were almost identical before and after the IM injection of vitamin D(3). A single vitamin D(3) injection of 600,000 IU significantly increase mean 25OHD concentration and tended to lower iPTH concentrations in volunteers with initially low 25OHD status, suggesting to utilize this simple form of treatment to improve vitamin D status and to have a possible biological effect on Ca homeostasis. However, we found no obvious effect on Sr absorption, suggesting the possibility that maximal vitamin D-dependent Ca absorption had already been achieved in these volunteers at a lower vitamin D status.

Refractive Errors in the Adult Pakistani Population: The National Blindness and Visual Impairment Survey

Purpose: To determine the prevalence of refractive error (RE) and spectacle wear and to explore the need for spectacle correction in adults (30 years or older) in Pakistan. Methods: Multi-stage, cluster random sampling national survey. Each subject had their medical history taken, visual acuity measured, and underwent autorefraction, biometry and fundus examination. Those that presented with visual acuity of less than 6/12 in either eye underwent more detailed examination, including corrected distance visual acuity measurement (autorefraction results placed in a trial lens frame). Myopia was defined as a spherical equivalent of worse than –0.5D, hypermetropia as greater than +0.5D, and astigmatism as greater than 0.75D. Spectacle need (i.e., those that improved from unaided VA with spectacle correction) was determined along with the spectacle coverage, defined as the proportion of need that was met (by the participant's own spectacles). Results: The crude prevalence of myopia, hypermetropia and astigmatism was 36.5%, 27.1%, and 37%, respectively. The prevalence of spectacle wear in phakic participants was 4.0%, significantly lower than for those who were pseudo/aphakic (41.7%). Just over a quarter (25.8%) of spectacle wearers presenting with visual impairment (< 6/12) were able to improve their vision when retested with their autorefraction prescription. The overall spectacle coverage (6/12 cutoff) was 15.1%. Conclusions: This survey provides the first reliable national estimates. RE services are not covering the majority of the population in need and the provision of spectacle correction, as a highly cost effective treatment for visual impairment, needs addressing within the country's national eye care program.

HEALTH STATUS OF THE PAKISTANI POPULATION

It was encouraging to see the report by Pappas et al. on the health status of the Pakistani population.1 However, the results presented in Tables 1 and 2 of their article may underestimate the potential burden of noncommunicable diseases in Pakistan, in particular that of overweight and obesity. The authors use body mass index (BMI) values of ≥25 and ≥30 to define overweight and obesity, respectively. Current recommendations for the Asia-Pacific region2 define adult overweight at BMI ≥23 and obesity at BMI ≥25. There is growing support for the use of lower BMI cutoffs for Asians, especially given their propensity to abdominal obesity.3, 4 If BMI ≥25 is used to define obesity, a different picture emerges from the National Health Survey of Pakistan. Table 1 would indicate obesity prevalence rates as follows for adults aged 25 to 64 years, moving from low to middle to high socioeconomic status (and rounding to the nearest whole number): for rural areas, 9%, 15%, and 27%; for urban areas, 21%, 27%, and 42%. These figures are alarmingly high for rural and urban areas but especially for urban areas. In Table 2, the authors compare the prevalence of overweight for adults aged 25 to 64 years in the United States and Pakistan. While BMI ≥25 may be a good indicator of overweight in the US context, BMI ≥23 may be a better indicator for Pakistanis. If so, Table 2 would indicate a prevalence of obesity in Pakistan for the age group 25 to 64 at 13% for males and 23% for females. These figures are closer to obesity prevalence rates for US adults 20 years and older, especially for females (20% for males, 22% for females).5 Also, use of BMI ≥23 for overweight would reclassify a proportion of the adult Pakistani population as overweight that was previously considered normal weight. This implies that the health burden from overweight and obesity in Pakistan is currently underestimated. Nonetheless, the authors have demonstrated, and the revised analysis given above emphasizes, that Pakistan is a country in transition, facing a double burden of disease. As Akhter and Pappas rightly point out in their editorial, the forces of globalization influence health.6 How well countries like Pakistan adjust to changes brought on by increasing industrialization and urbanization will depend to some extent on the level of support it receives from local and international bodies, but also on an internal examination of its priorities.

Chewing sticks and the oral hygiene habits of the adult Pakistani population

This paper discusses the oral hygiene habits of the adult Pakistani population with special reference to chewing sticks. Information collected during the National Health Survey of Pakistan (1990-1994) showed that in the rural areas more than 50 per cent of the population used chewing sticks or miswak as a tool for oral hygiene. Conversely, in the urban population the majority use a toothbrush. About 36 per cent of the Pakistani population clean their teeth daily, irrespective of the method employed. Eight per cent of the 120 million population never clean their teeth, while 54 per cent clean their teeth either on alternate days, weekly or monthly.