Post Stratification Research Articles

Quasi Experimental Study to Ascertain Link of PPI to Bone Profile in Healthy Individuals

Proton pump inhibitor (PPI) is only acid blocking agent used for treating the disease known as gastroesophageal reflux (non-erosive), erosive esophagitis disease, dyspepsia disease and the peptic ulcer disease because of its efficacy and potency. However, overuse of it is examined an immediate result of absence of determination of need for steady treatment in many outdoor subjects Objective: To evaluate impact of proton pump inhibitor (PPI) on bone biochemistry in young individuals of Hyderabad. Methods: The study contained 227 young individuals of age 20-45 years, it was conducted in Liaquat University Hospital, Hyderabad City and Medicine OPD’s of Jamshoro. The research study is undertaken using Quasi experimental study. The study duration is 6 months starting from 15th March 2020 to 15th September 2020 and sampling technique is non – probability convenience. SPSS 21 software is used to analyze the data. The post stratification chi – square test is performed at the interval of 95% confidence, besides it the P-value is observed ≤ 0.05. Results: There is no effect on serum calcium and vitamin D levels with use of proton pump inhibitor PPI. P-value was observed 0.7 for the serum calcium and the p- value for Serum Vitamin D was 0.1. Conclusions: Hence, the study showed that proton pump inhibitor PPI use for less than 6 months have no effect on bone biochemistry.

Symptomatic septal nasal deviation and its association with sinusitis: A clinical study.

Objective: To determine the frequency of symptomatic nasal septal deviation in patients with sinusitis. Study Design: Cross-Sectional Study. Setting: Department of Otolaryngology and Plastic Surgery, Jinnah Hospital & Burn Center Lahore. Period: 1st January, 2019 to 31st December, 2019. Material & Methods: A total of 165 cases who fulfill the inclusion criteria were enrolled from ENT & Plastic Surgery OPD of Jinnah Hospital & Burn Center, Lahore. After the informed consent, clinical and CT scan examination was done with 16-slice MDCT scanner in all the cases. The images were retrieved in external hard drives. The nasal septum was evaluated for presence of deviated nasal septum. Data was entered and analyzed using SPSS v23.0 and was stratified for age and gender. Chi-square test was applied for post stratification. A p-value ≤0.05 was considered as significant. Results: Among 165 patients there were 109(66.1 percent) males and 56 (33.9%) females. The average mean age was 37.3± 12.3 years.121 (73.3%) patients out of 165 had deviated nasal septum (DNS) associated with sinusitis. Conclusion: Nasal septal deviation is a very common condition in our country and is significantly associated with sinusitis. This study highlights the prevalence of deviated nasal septum and its accompanying symptoms that need to be considered during the clinical and radiological evaluation of patient.

Stand validation of lidar forest inventory modeling for a managed southern pine forest

We evaluated area-based approaches (ABAs) to light detection and ranging (lidar) predictions of plot- and stand-level forest attributes (tree count, height, basal area, volume, aboveground biomass, broadleaf/conifer, and diameter at breast height — “diameter”). ABA methods included post-stratification (PS), ordinary least squares (OLSs) regression, k nearest neighbors ( kNN), and random forest (RF). This study was conducted on the Savannah River Site in South Carolina, USA. Plot- and stand-level predictions were validated against fixed-radius 0.04 ha (0.1 acre) plots in 49 ≈2.0 ha (5 acre) stands. Our findings demonstrate that lidar can be incorporated operationally into forest inventory systems to provide stand-level inferences for a wide range of forest attributes. Volume predictions for specific diameter classes, however, often fared poorly (root mean squared error (RMSE) > 100%) for the methods we explored, especially for larger (less common) diameter trees. Stand-level results were consistently better than pixel-level results (10–200+ percentage points). kNN and RF performed similarly and better than OLS and PS, but RF was the most robust to model configurations, while kNN has practical advantages such as simultaneous predictions of many attributes.

Association of Polycystic Ovarian Syndrome with Metabolic Disorders

Objective: To determine the association of Metabolic Disorders in women of reproductive age with polycystic ovarian syndrome (PCOS) Study Design and setting: Cross Sectional Study conducted in the Department of Gynecology and Obstetrics, Ward 9, Jinnah Postgraduate Medical Center, Karachi. Methodology: The study was conducted from November 2021 to February 2022. A total of 227 diagnosed patients of PCOS were included in this study. Five components of Metabolic syndrome were assessed: Body Mass Index (BMI), blood pressure, central obesity, fasting blood sugar and lipid profile. Informed consent was obtained from all participants. Patients’ history, physical examination and laboratory investigations in terms of symptoms and findings relating to MS were recorded and assessed using SPSS version 21. Descriptive statistics were calculated and stratification was done. Chi-square test used post stratification and p-value =0.05 were considered significant. Results: Mean age was 27.05±4.51 years. Mean symptom duration was 11.26±3.02 months. Central obesity, hypertension, hypertriglyceridemia, HDL-cholesterol <50 mg/dl and fasting glucose >100 mg/dl were found in 44.9%, 31.7%, 38.3%, 27.3%, and 38.8% patients, respectively. A total of 47 (20.7%) study subjects were identified with two or more above components of MS. Significant association of MS with age (>27 years; p<0.000) and duration of disease (>12 months; p<0.000) was observed. Conclusion: A higher prevalence of MS was observed when participants aged more than 27 years and had symptoms for more than a year. Higher BMI was also found nearing statistical significance

Comparison of Llevel of improvement in serum albumin after protein supplementation verses standard treatment in patients on maintenance hemodialysis.

Background: Hemodialysis has been shown to increase protein catabolism and led to significant loss of proteins during hemodialysis. Hypoalbuminemia has been associated with adverse outcomes. Therefore, the main aim of this study is to determine the effect of intradialytic protein supplementation on serum albumin in hemodialysis patients.
 Methods: 116 hypoalbuminemic patients, as defined by the operational definition, on twice per week hemodialysis, from 15.09.15 to 15.03.16, were enrolled after obtaining informed consent. A non-randomized control trial was conducted after dividing the study population was divided into 2 groups; the study group which received 20g oral protein supplementation and the control group which have not received any supplementation. Outcome in terms of improvement in serum albumin was recorded on a predesigned proforma. SPSS version 17 was used for analysis. Effect modifiers were controlled by stratification. Chi square test was used to compare improvement in serum albumin between two groups and also after post stratification.
 Results: There were total 49 male and 67 female patients. Mean age of total patients was 57.25 years. 94.1% of the patients showed improvement in serum albumin in the intervention group and 56.9% in the control group. Patients of both genders between 46 to 75years, and those dialyzed for a shorter duration showed significant improvement in serum albumin levels.
 Conclusion: As intradialytic oral protein supplementation significantly improved serum albumin levels, specifically in elderly patients, it is therefore recommended to routinely administer nutritional supplements in hypoalbuminemic hemodialysis patients in order to reduce the overall mortality associated with hypoalbuminemia.

1215-P: Evaluating Alternate Bias Correction Methods in Estimating Diabetes Prevalence with Electronic Health Records

Background: The Assessing the Burden of Diabetes by Type in Children, Adolescents and Young Adults (DiCAYA) Network aims to provide timely estimates of diabetes prevalence and incidence using large scale electronic health record (EHR) data. However, patients who self-select into health systems are likely to differ demographically and by health status than the overall source population of interest, which could limit the generalizability of surveillance estimates. Methods: Using simulations, we evaluated the potential of established bias correction methods (inverse probability weighting, post stratification, raking and multilevel regression with post stratification (MRP)) to mitigate selection biases within EHR data. The EHR sample was assumed to have overrepresentation of younger, higher socioeconomic status (SES) and white individuals than the source. Simulations varied the selection processes (e.g. dependent on diabetes status) and misspecification in the adjustment methods. The performance of each method was assessed as the absolute difference between the estimated prevalence in the sample and true prevalence in the simulated source. Results: When selection was dependent on demographics alone, the mean bias in the crude prevalence estimate was -0.7 percentage points (pp) . Each method performed well in removing this bias when demographics that affected selection were adequately accounted for. Biases remained when SES was misclassified in the adjustment process, with best performance seen for MRP (-0.5 pp) . When selection was dependent on diabetes status, the mean bias in the crude prevalence estimate was 1.3 pp and each method similarly worsened this bias (2.3 pp) . Conclusions: These methods are easy to implement and can provide reliable surveillance estimates if factors that are associated with selection into the EHR can be accounted for. However, novel methods may be needed when selection is dependent on diabetes status or other unmeasured factors. Disclosure S.Conderino: None. M.Rosenman: None. V.W.Zhong: None. K.Reynolds: Research Support; Amgen Inc., Merck & Co., Inc., Novartis Pharmaceuticals Corporation. S.Park: None. L.H.Utidjian: None. J.Divers: None. R.Anthopolos: None. L.Thorpe: None. B.Cai: None. H.Shao: Board Member; BRAVO4HEALTH, LLC. T.C.Ong: None. T.L.Crume: None. B.S.Schwartz: None. H.Kirchner: None. Funding Centers for Disease Control and Prevention (1 U18DP006633-01-00)

Frequency of Pregnancy Induced Hypertension in Teenage Pregnancy, Presenting in a Tertiary Care Hospital

Objective: To determine the frequency of pregnancy induced hypertension in teenage pregnancy, presenting in a tertiary care hospital. Design of the Study: It’s a descriptive case series Study Settings: This study was done at Department of Gynaecology & Obstetrics, Ziauddin Hospital, Karachi from January 2021 to June 2021. Material and Methods: Total 163 women with gestational age 20 and more weeks, age 10 to 19 years, singleton pregnancy, and with any parity were included in the study. On the basis of clinical examination, pregnancy comprised hypertension was diagnosed. If any patient had BP equal or more than 140/90 on more than two separate occasions, then it was considered as hypertensive. Patients were followed at 24, 28, 34, 36, and 38 weeks till delivery to look for development of Pregnancy induced hypertension. If patient developed any complications, was admitted and managed accordingly. By using computer program SPSS-17, data was entered and analyzed. For post stratification Chi-square test was applied and p-value ≤0.05 was considered as significant. Results of the Study: The average maternal age was 16.53±1.94 years. The mean parity was 3.03±1.44 and mean gravidity was 2.80±1.44. The mean gestational age was 31.17±3.52 weeks, with range 16(21–37) weeks. Age of 49 women was ≤15 years and age of rest of the 114 women patients was >15 years. The parity of gravidity of 113 women was ≤3 and it was >3 in 50 women. The parity of 131 women was ≤3 and in the 32 women it was >3. The gestational age of 73 women was ≤30 weeks and gestational age of 90 women was >30 weeks. The pregnancy induced hypertension was found in 24(14.7%) females who are expecting involved in the research. Among women with PIH the mean age was 16.46±2.14 years and mean gestational age was 30.83±3.26 weeks. The results showed no statistically significant association of maternal age, gravidity, parity, and gestational age with pregnancy induced hypertension. Conclusion: For higher incidence of pregnancy induced hypertension, the younger maternal age is a significant risk factor. Keywords: Pregnancy Induced Hypertension, Teenage Pregnancy, Frequency

Predicting IoT failures with Bayesian workflow

IoT networks are so voluminous that they cannot be treated as individual devices, but as populations. Main aim of the paper is to create a comprehensive method for predicting failures taking device variance into consideration. We propose using data fusion of happenstance observations (resets and failures) to better estimate device parameters. We propose using methods of population analysis in Bayesian statistics to estimate failure times investigating only a part of the population. For this purpose, we use multilevel hierarchical Bayesian model and provide it with post stratification. We propose model assumptions, construct the model and evaluate it, and perform computations using Hamiltonian Monte Carlo. This method is known as the Bayesian workflow. We have analyzed three different models showing that, in case of small device variance, it can be ignored, or at least compensated, while significant differences require hierarchical modeling. We also show that hierarchical model shows significant robustness to a small amount of data. We have shown attractiveness of Bayesian approach to modeling failures of IoT devices. Ability to diagnose and tune models, and assure their computational fidelity is a great advantage of Bayesian workflow.

A Two Parameter Ratio-Product-Ratio Estimator in Post Stratification

In this paper we consider a two parameter ratio-product-ratio estimator for estimating population mean in case of post stratification following the estimator due to Chami et al (2012). The bias and mean squared error of proposed estimator are obtained to the first degree of approximation. We derive conditions under which the proposed estimator has smaller mean squared error than the sample mean , ratio estimator and product estimators . Empirical studies gives insight on the magnitude of the efficiency of the estimator developed.

Frequency of Subclinical Hypothyroidism among Patients of Polycysitic Ovarian Syndrome (PCOS)

Introduction: Polycystic ovarian syndrome (PCOS) is the most common form of chronic anovulation associated with androgen excess; perhaps occurring in 5-10% of reproductive women. PCOS is viewed as a heterogeneous disorder of multifactorial etiology. It is also associated with increased metabolic and cardiovascular risk factors. Subclinical hypothyroidism is “mild” thyroid failure in which thyroid stimulating hormone (TSH) is elevated and free thyroxine (fT4) is normal. Objective: To determine the frequency of subclinical hypothyroidism among patients of polycystic ovarian disease presenting in the outpatient department of tertiary care hospital. Study Setting: The Study was conducted in Mayo Hospital, Lahore. Duration of Study: June 5, 2019 to January 3, 2020 Study Design: Cross-Sectional Study Methods: All polycystic ovarian disease patients were enrolled. Blood samples of the patients were taken by using aseptic techniques and sent to pathology laboratory for measurement of serum TSH level. The frequency of subclinical hypothyroidism among patients of polycystic ovarian disease was identified. Data were entered and analyzed using SPSS v25.0. Data were stratified for age and BMI to deal with effect modifiers. For post stratification, Chi-square test was applied to see the significance. A p-value≤0.05 was considered significant. Results: Total 136 patients with polycystic ovarian disease were selected for this study. Mean age was 28.4±7.9 years. Among 136 patients, 26(19.1%) had subclinical hypothyroidism. By stratification of subclinical hypothyroidism, it was found that age >30 years and obese had significant effect having subclinical hypothyroidism (p=0.00001, p=0.001). Conclusion: Subclinical hypothyroidism may be a modifiable risk factor, associated with polycystic ovarian disease. Steps should be taken to minimize more this risk factor by screening and early intervention. Key Words: Subclinical Hypothyroidism, Polycystic Ovarian Disease.

Efficacy of Intralesional Vitamin D3 Injection in Cutaneous Warts

Background: Cutaneous warts are common dermatological viral infection caused condition which causes cosmetic problems besides it primary morbidity like pain and discomfort. Intralesional vitamin D3 derivatives therapy is recent and effective modality for treatment of cutaneous warts. Objective: To determine the efficacy of intralesional vitamin D3 injection in cutaneous warts in local patients. Methods and patients: A descriptive case series study conducted from June to December 24, 2019 at Dermatology OPD, SMBBMU- Larkana.A sample of 65 patients with cutaneous warts, either gender, age 20-50 years, 3 months to 6 months history were included after taking a valid informed/ written consent. Pregnant and lactating women, patients on immunosuppersive therapy, signs of any systemic or local inflammation or infection, history of pasthma allergic skin disorders meningitis or convulsions, history of hypersensitivity to Vitamin D3 were excluded. The injections of vitamin D3 (vials containing 6,00,000 IU of cholecalciferol in 1 ml = 15 mg)were given at 2 weekly intervals for a maximum of four injections.A standard questionnaire was used to collect demographic and study related data. Data analysis was performed through SPSS Version-21. Descriptive and inferential statistics were calculated. Stratification was done and post stratification chi square test was applied. P-value ≤0.05 was considered as significant. Results: The mean age of patients was 27.9±5.1 with C.I (26.63-29.16) years. The Mean ± SD of duration was 4.4±1.9 with C.I (3.92-4.87) months. The Mean ± SD of number of warts was 14.3±4.2 with C.I (13.25-15.34). Out of 65 patients, 35 (53.8%) were malewhile 25 (38.5%) patients were belong to urban areas. Primary outcome of this study i-e; the efficacy was n=54 (83.1%). Stratified analysis revealed that younger age (20 – 30 years), male gender, urban residence, 3-5 mm size, 2-3 months duration (p value = 0.009) were associated with more efficacy of intralesional vitamin D3 injection in cutaneous warts. Conclusion:This study clearly demonstrates that recalcitrant plantar warts can be treated successfully with intralesional vitamin D3 injection. The immunotherapy of injection vitamin D3 has better patient compliance, good therapeutic response without cosmetic disfigurement and capable of preventing recurrences. Keywords: Efficacy, Intralesional Vitamin D3, Cutaneous Warts, Treatment,Immunotherapy

Comparison between effectiveness of dentine desensitizer and one bottle self-etch adhesive on dentine hypersensitivity.

Dentine hypersensitivity is one of the most common chief complaints of patients observed by dentists in their practice. However, there is a lack of universal consensus over the selection of reliable treatment modality. To compare the effectiveness between dentine desensitizer and self-etch adhesive in patients complaining of moderate to severe dentine hypersensitivity pain. A total of 254 patients with moderate to severe dentine hypersensitivity were randomly divided into Group A (Single Bond Universal Agent) and Group B (Seal & Protect Agent) according to the treatment provided. Sensitivity was assessed by means of mechanical (probing) and evaporative (air blast) stimuli. Discomfort Internal Scale (DIS) was explained to patients. DIS scores were recorded after one minute and one month following the application of both agents. Descriptive statistics were calculated. Stratification was done to control confounder and post stratification chi-square test was also applied. The statistically significant difference (p= 0.000) in effectiveness between the two groups was observed. The mean discomfort internal scale score at baseline, after 1minute and after 1month in Group A was 3.65 ± 0.60, 2.33 ± 0.64 and 0.41 ± 0.71 respectively, while in Group B, it was 3.55 ± 0.58, 2.40 ± 0.62 and 0.72 ± 0.92 respectively. Overall, 86.6% patients observed improvement in dentinal sensitivity in Group A while in Group B only 67.7% patients reported reduction in sensitivity. Self-etch adhesive significantly reduces dentin hypersensitivity, immediately after one minute of its application and is effective for a period of one month compared to desensitizing agent.

Comparison of intralesional corticosteroid injection with and without thumb Spica cast for de-Quervain tenosynovitis.

Objective: To compare efficacy of methyl prednisolone acetate injection with and without thumb spica cast for the treatment of de-Quervain tenosynovitis. Study Design: Randomized Controlled Trial. Setting: Orthopedic Unit, Allied Hospital, Faisalabad. Period: April 2016 to September 2016. Material & Methods: In each group 41 patients were included with non-probability consecutive sampling. Results: Eighty two patients were enrolled in the study. Out of 82 patients in the study, 3 (3.7%) were males and 79 (96.3%) were females. There were 10 (12.20%) pateints with age >40 years, and 36 (43.90%) patient in each of age group 21-30 and 31-40 years. The proportions of cured persons between two groups i.e., treated with corticosteroid injection and those treated with combination of injection and thumb Spica splint were found same with p-value 0.19 for Z=1.31. The efficacy was independent of treatment methods with χ2=1.10 (p-value = 0.30). The same independence pattern was also observed in different age groups. Age range was between 18 and 70 years. Statistical analysis was performed using chi-square test. Six weeks following treatment, 29 (35.37%) patients from group A and 34 (41.46%) patients from group B showed relief of pain, swelling and tenderness and a negative Finkelstein test (p-value 0.295). post stratification of gender showed no significant association (p-value 0.388 and 0.328 in groups A and B respectively). Conclusion: It has been concluded that use of corticosteroid injection alone is sufficient to treat de-Quervain syndrome as compared to the use of thumb Spica splint with corticosteroid injection. It is therefore recommended that in patients suffering from de-Quervain syndrome, corticosteroid injection may be the choice of treatment.

Reasons for not seeking early dental care in patients presenting in the exodontia department at a Tertiary Care Hospital in Lahore, Pakistan.

Objective: The aim was to gain insight on patient factors and administrative shortcomings in the dental health department that prevent patients from seeking timely dental care. Study Design: Cross Sectional Survey. Setting: Punjab Dental Hospital, Lahore, Pakistan. Period: 7 January 2020 to 28 February 2020. Material & Methods: A structured close ended questionnaire was filled by information obtained from 400 patients that presented in the Exodontia OPD requiring extractions due to irreversible tooth damage. The data was collected from 244 (61%) females and 156 (39%) males. It was analyzed using SPSS version 20.0 and post stratification chi-square test was applied to see the significance of all comparative statistics. P value of <0.05 was taken as significant. Results: Out of 400 patients, 350 had not visited a dentist when the symptoms first appeared. Of these n=213 (60.86%) were females and n=137 (39.14%) were males. Majority of the patients were in the age range of 40-65 years and belonged to the low socioeconomic class n=213 (60.9%). The main causes of patients presenting now were pain and swelling. The major reasons reported for delayed visit were: “Self-medication” n=113 (24.57%),” Symptoms will resolve on their own” n=79 (17.17%),” No awareness” n=64 (13.91%),” Non serious and lazy attitude” n=39 (8.48%) and “Busy schedule” n=36 (7.83%). Conclusion: Our findings suggested that only a small proportion of people visited the dentist when the symptoms first appeared. Most of the patients ignored their symptoms to such an extent that the only possible treatment that could be offered was extraction of the concerned tooth. There was a general misconception that dental diseases are not very serious and can be resolved by over the counter medications. Thus, more dental awareness programs should be incorporated in the government health policy to increase focus on oral health.

Comparison of Variance Estimators for Systematic Environmental Sample Surveys: Considerations for Post-Stratified Estimation

The estimation of the sampling variance of point estimators under two-dimensional systematic sampling designs remains a challenge, and several alternative variance estimators have been proposed in the past few decades. In this work, we compared six alternative variance estimators under Horvitz-Thompson (HT) and post-stratification (PS) point estimation regimes. We subsampled a multitude of species-specific forest attributes from a large, spatially balanced national forest inventory to compare the variance estimators. A variance estimator that assumes a simple random sampling design exhibited positive relative bias under both HT and PS point estimation regimes ranging between 1.23 to 1.88 and 1.11 to 1.78 for HT and PS, respectively. Alternative estimators reduced this positive bias with relative biases ranging between 1.01 to 1.66 and 0.90 to 1.64 for HT and PS, respectively. The alternative estimators generally obtained improved efficiencies under both HT and PS, with relative efficiency values ranging between 0.68 to 1.28 and 0.68 to 1.39, respectively. We identified two estimators as promising alternatives that provide clear improvements over the simple random sampling estimator for a wide variety of attributes and under HT and PS estimation regimes.

Outcomes of Newly Diagnosed Patients of Peripartum Cardiomyopathy at Liaquat University Hospital, Hyderabad, Sindh, Pakistan

Objective: To determine the outcomes of newly diagnosed patients of peripartum cardiomyopathy at Liaquat University Hospital, Hyderabad.
 Methodology: Total 91 patients of peripartum cardiomyopathy were included. A detailed medical history and base line equitable investigations were done. Patients were kept under observation for 7 days during their hospital stay and study outcomes were recorded. Descriptive statistics were calculated. Stratification was done and post stratification chi square test or fisher exact test was applied. Two sided P-value ≤0.05 was considered as significant.
 Results: The overall mean age was 29.06±4.71 years. Total 73.6% patients were belonged to urban and 26.4% belonged to rural areas. 52.7% patients had normal delivery while 40% had C-section and 6.6% had instrumental assisted deliveries. As far as outcomes are concerned, 65.9% patients had congestive heart failure, 12.1% patients had arrhythmias, 35.2% patients admitted in ICU, 64.8% patients admitted in recovery and 7.7% patients were died.
 Conclusion: In a prospective cohort with PPCM, most women recovered; however, rates of CHF were observed significantly in patients with diabetes mellitus and hypertension. In-hospital mortality was comparatively less frequent but it was significantly associated in women having age less than 30 years.

Efficient estimation of the odds using judgment post stratification

This work deals with problem of estimating the odds using judgment post stratification (JPS) sampling design. Several estimators of the odds are described and the asymptotic normality of each of them is established. Monte Carlo simulation study is then used to compare different estimators of the odds in the JPS with the standard estimator in simple random sampling (SRS) with replacement for both perfect/imperfect ranking and for both JPS data with/without empty strata. The comparison results indicate that the estimators developed here can be highly more efficient than their SRS counterpart in some certain circumstances. Finally, a real dataset from the third National Health and Nutrition Examination Survey (NHANES III) is employed for illustration purposes.

Status of undernutrition of left-behind children under 6 years old in rural China in 2013

To analyze and describe the status and characteristics of undernutrition among left-behind children under 6 years old in rural China in 2013. Data was from the China Nutrition and Health Surveillance among 0-5 Years Old Children and Lactating Women in 2013. Stratified multistage cluster sampling method was used, and 4576 participants under 6 years old from 55 sites of 30 provinces, autonomous region and municipalities were involved. Definition of undernutrition were according to the WHO 2006 growth standard in children less than 5 years old and the WHO 2007 growth reference in children of 5 years old. Results were computed by post stratification weight based on national census from the National Bureau of Statistics in 2010. The prevalence of stunting was 10. 6% among left-behind children under 6 years old in rural China in 2013. It was 11. 6% in boys and 9. 4% in girls. The rate of general rural area and poor rural area were 7. 1% and 16. 6%. The prevalence of stunting showed a significant difference in sex(P=0. 022), general rural and poor rural(P=0. 006), three regions(P=0. 003), parental type of outing(P=0. 005), mother's education(P<0. 001), annual per capita household income(P<0. 001). The prevalence of underweight was 3. 2% among left-behind children under 6 years old in rural China in 2013. It was 3. 4% in boys and 2. 9% in girls. The rate of general rural area and poor rural area were 1. 6% and 2. 0%. The prevalence of stunting showed a significant difference in general rural and poor rural(P<0. 001), three regions(P<0. 001), annual per capita household income(P=0. 0144), mother's education(P<0. 001). The prevalence of wasting was 2. 3% among left-behind children under 6 years old in rural China in 2013. It was 2. 3% in boys and 2. 2% in girls. The rate of general rural area and poor rural area were 1. 5%, 3. 5%. The prevalence of stunting of general rural showed a significant difference in parental type of outing(P=0. 033), the prevalence of stunting of poor rural showed a significant difference in mother's education(P<0. 001), annual per capita household income(P=0. 020). The undernutrition rate among left-behind children under the age of 6 in rural China should be paid attention, especially in the higher subgroups of poor rural areas, western regions, low-income families, mothers away from home and mothers with less than junior middle school education.

Prevalence of vitamin D deficiency in type 2 diabetics and its association with glycemic control

Background: Optimal glycaemic control in type 2 diabetics is of utmost importance in preventing the complications of diabetes which lead to increased morbidity and mortality related to the disease. Some studies have shown that vitamin D deficiency was prevalent in type 2 diabetic patients and was associated with poor glycaemic control. This study aimed to determine the vitamin D3 levels in type 2 diabetic patients and its association with glycaemic control.
 Patients and methods: This cross sectional study was carried out in the outdoor department of Medical Unit II of Sir Ganga Ram Hospital/Fatima Jinnah Medical University Lahore from Feb 10, 2019 to May 9, 2019. A total of 45 cases of type 2 diabetes mellitus were enrolled in this study after taking informed consent from them. Demographic details (name, age, gender, including duration of diabetes) were obtained and blood sample were taken for HbA1c and 25-OH vitamin D3 levels. Vitamin D deficiency was diagnosed by taking serum level <20 ng/mL as cut off. The data analysis was carried out in SPSS version 20. Quantitative variables like age and duration of diabetics were taken as mean and standard deviation. Qualitative variables, gender and vitamin D3 levels and HbA1c levels were taken as percentage. Post stratification chi-square test was applied taking p-value <0.05 as significant.
 Results: Out of 45 patients, 17 (37.78%) were male and 28 (62.2%) were female. Mean age was 49.56 ± 10.77 years. Mean duration of diabetes was 5.91 ± 3.74 years. Mean vitamin D levels were 36.36±17.9 ng/ml. Out of 45 patients, 7 (15.6%) were found deficient, 10 (22.2%) insufficient, 27 (60%) sufficient and 1 (2.2%) had vitamin D toxicity. Among the patients with sufficient vitamin D levels, 12 (44.4%) were male and 15 (55.5%) were female. Two (16.6%) male patients with sufficient vitamin D levels had good glycemic control as compared to none of the female patients. Two (16.6%) male and 2 (13.3%) female patients with sufficient vitamin D had fair HbA1c. Most of the patients had poor control of HbA1c despite sufficient vitamin D levels including 8 (66.6%) males and 13 (86.6%) females. Mean HbA1c concentration was 9.3±1.66%. Out of 45 patients, 2 (4.4%) had good glycaemic control, 5 (11.11%) had fair and 38 (84.4%) had poor control. It was seen that out of 7 vitamin D deficient, 6 (85.7%) had poor glycemic control, 1 (14.3%) had fair and none had good glycaemic control. The post stratification chi-square test was applied to determine the significant association between vitamin D levels and HbA1c and showed a p-value of 0.196 which is statistically insignificant. The Pearson correlation revealed a value of -0.012 which shows a negative correlation between vitamin D and HbA1c levels.
 Conclusions: No statistical significance could be established between vitamin D deficiency and poor glycemic control. There is a weak negative correlation between vitamin D and HbA1c levels showing that low Vitamin D levels are associated with higher HbA1c concentration.

COMPARISON OF MANIFESTATIONS OF GIARDIA AND ASCARIS INFESTATIONS BETWEEN BOTH GENDERS PRESENTING WITH DIARRHEA

Objective: To assess the occurrence and intensity of Giardia and Ascaris infestations in children of both genders reporting with diarrhea.
 Study Design: Comparative cross sectional study.
 Place and Duration of Study: Paediatrics department, Combined Military Hospital, Gilgit, from Jul 2016 to Jul2018.
 Methodology: Patients of either gender with worm infestation were included in the study. Patients more than13 years old were excluded. The sampling technique used was non probability consecutive sampling. The stoolexamination (R/E) for the diagnosis of worm infestation was done. Stratification was done with regards to age,mother education, gender, type of water used and post stratification chi square test was applied. p-value was0.613 when calculated for the manifestation between both genders. p-value ≤0.05 was considered significant.
 Results: Total number of patients in our study was 100. Among them, males were 65 (65%) and females were 35(35%). Mean age of patients in our study was 4.20 ± 2.61 years (Mean ± SD). Abdominal pain being most common symptom in 43 (43%) of patients. Majority of the patients were from 2 to 10 years of age, 79 (79%). Helminthic infestation was the most common observed in 52 (52%) whereas Protozoal infestation was observed in 48 (48%) patients. The most common parasite isolated was Giardia 41 (41%) followed by Ascaris 36 (36%). p-value of 0.613 was found between both gender.
 Conclusion: In our study Helminthic infestation was more common. The most common parasite isolated wasGiardia followed by Ascaris.