HIGH SALT INTAKE IMPLICATIONS AS RISK FACTOR FOR HYPERTENSION AND COMPARISON OF THREE SALT ESTIMATION METHODS- FINDINGS FROM ISLAMABAD, PAKISTAN

Objectives: The study was designed to estimate daily salt intake, its discretionary use in healthy individuals and to validate three common methods for salt estimation in Pakistani population. Methodology: Information on demography and discretionary salt use was collected from healthy adults (>18 years) along with a blood sample, spot and 24 hour urine samples. Sodium, chloride, potassium levels and serum creatinine were measured using standard methods. For daily salt estimation, three common methods i.e. INTERSALT, Tanaka and Kawasaki were validated for their applicability in local settings. Results: Overall 24 h sodium excretion was 158 mmol/l indicating intake of 8.64 (±4.43) grams salt per day which was significantly associated with male gender (p. <0.004) and adding salt during cooking (p. <0.0001). Most (73%) of the participants know about hazardous effects of high salt intake, however, only 25% consider important to lower salt intake. None of three methods i.e. INTERSALT (bias: -19.64; CCC -0.79), Tanaka (bias: 167.35; CCC -0.37) and Kawasaki (bias: -42.49, CCC -0.79) showed any agreement between measured and estimated 24 hour sodium. Conclusion: Daily intake of salt was high which increases the risk for hypertension. Comparison of methods for estimation revealed that none of the three methods could be used for estimating daily intake of salt in local settings of Pakistan.

Awareness and Attitudes of the Pakistani Population With Regard to Physician–Pharmaceutical Company Interaction: A Cross-Sectional Study

Objective: To determine the awareness and attitudes of the Pakistani population regarding physician–pharmaceutical company interactions.Methods: The data were collected from primary health care clinics and pharmacy outlets located within cities of six randomly selected districts of the Punjab Province. Those individuals (age ≥18 years) who have just completed their visit to the physician and well understand Urdu language were approached. Descriptive analysis was performed for all variables by using SPSS (IBM version 26).Results: A total of 3,852 participants fully completed the study out of 4,301 (response rate 89.5%). Of those, 30.9% were female; two-thirds (66.7%) were aware of drug representatives’ visits to clinics. The majority were aware of pharmaceutical company material presence (or absence) in the physicians’ rooms (56.6%), company items with logos (66.8%), patient education materials (73.4%), and 60.8% thought that receiving gifts from companies was “wrong/unethical” practice for physicians, which was lower in comparison to other professions such as judges to accept gifts from lawyers (65.6%) and professional sports umpires to acknowledge gifts (64.3%). A minority said that they have lower trust on physicians for using drug company notepads or pens (16.7%), going on trips sponsored by the company (16.7%), accepting gifts &lt;15,000 PKR (90.3 US$) (26.7%), and accepting gifts &gt;15,000 PKR (90.3 US$) (40.0%).Conclusion: Survey participants were well aware of physician–pharmaceutical company interactions. Participants were more knowledgeable regarding the pharmaceutical company presence (or absence) in physicians’ offices than about gift-related practices of physicians. Trust on the physician was not affected by small gifts but by the large gifts.

A Cephalometric Evaluation of Soft Tissue Following Maxillary Incisors Retraction

Background: Class 2 Division 1 is the most prevalent type of malocclusion affecting about 32% of Pakistani population. With upper maxillary premolar extraction is one of most frequent treatment choice. Aim: To evaluate the effects of these extractions on soft tissue show variable results depending upon the sex, ethnicity, maxillary arch crowding and pretreatment structure of lips. Methods: In this study pretreatment cephalograms of 106 Class 2 div 1 patients were taken whose treatment plan include extraction of maxillary 1st premolar. Then the second and final cephalograms were taken when retraction of incisors was completed. Mean changes in the position of upper and lower lip were measured with respect to Ricketts E-line before and after completion of retraction of maxillary incisors. Results: After the extraction of premolars there is a significant (P value=0.000) reduction in the lip protrusion of -2.033mm±1.148mm and -1.695mm±1.628mm in both upper and lower lip respectively. Conclusion: Extraction of maxillary premolars cause significant reduction of lip prominence and achieve facial esthetic balance. Keywords: Class 2 div 1, lip position, Premolar Extraction

Absence of Glutathione S-Transferase Theta 1 Gene Is Significantly Associated With Breast Cancer Susceptibility in Pakistani Population and Poor Overall Survival in Breast Cancer Patients: A Case-Control and Case Series Analysis

PurposeDeletion of Glutathione S-Transferase Theta 1 (GSTT1) encoding gene is implicated in breast cancer susceptibility, clinical outcomes, and survival. Contradictory results have been reported in different studies. The present investigation based on a representative Pakistani population evaluated the GSTT1-absent genotype in breast cancer risk and prognosis.MethodsA prospective study comprising case-control analysis and case series analysis components was designed. Peripheral blood samples were collected from enrolled participants. After DNA extraction, GSTT1 genotyping was carried out by a multiplex PCR with β-globin as an amplification control. Association evaluation of GSTT1 genotypes with breast cancer risk, specific tumor characteristics, and survival were the primary endpoints.ResultsA total of 264 participants were enrolled in the molecular investigation (3 institutions). The study included 121 primary breast cancer patients as cases and 143 age-matched female subjects, with no history of any cancer, as controls. A significant genetic association between GSTT1-absent genotype and breast cancer susceptibility (p-value: 0.03; OR: 2.13; 95% CI: 1.08-4.29) was reported. The case-series analysis showed lack of association of GSTT1 genotypes with menopause (p-value: 0.86), tumor stage (p-value: 0.12), grade (p-value: 0.32), and size (p-value: 0.07). The survival analysis revealed that GSTT1-absent genotype cases had a statistically significant shorter overall survival (OS) than those with the GSTT1-present genotype cases (mean OS: 23 months vs 33 months). The HR (95% CI) for OS in patients carrying GSTT1-absent genotype was 8.13 (2.91-22.96) when compared with the GSTT1-present genotype.ConclusionsThe present study is the first report of an independent significant genetic association between GSTT1-absent genotype and breast cancer susceptibility in a Pakistani population. It is also the foremost report of the association of this genotype with OS in breast cancer cases. Upon further validation, GSTT1 variation may serve as a marker for devising better population-specific strategies. The information may have translational implications in the screening and treatment of breast cancers.

Genetic Association of FTO rs9939609 Polymorphism with Hypertension in Pakistani Population

Background: Hypertension is a medical condition that often occurs parallel to diabetes and obesity. Previously, the role of fat mass and obesity associated (FTO) gene rs9939609 polymorphism (c.46-23525T>A) with obesity has been reported while prevalence and etiological differences exist among different regions and ethnic groups. Aim: To investigate the association of FTO rs9939609 SNP with hypertension in Pakistani population. Study design: Cross-sectional study. Place and duration of study: Institute of Biomedical and Genetic Engineering (IBGE), Islamabad, Pakistan from 1st January 2019 to 31st December 2020. Methodology: One hundred and ten diagnosed hypertension patients along with 128 healthy volunteers were selected randomly. The single nucleotide polymorphism was analyzed using Amplified Refractory Mutation System-Polymerase Chain Reaction. Results: In hypertension patients, females were found to be relatively more affected and average blood pressure lies in stage 1. However, we found no significant difference in genotypic frequencies of FTO rs9939609; TT (22.6%), AA (39.6%) and AT (37.8%) and TT (17.18%), AA (39.06%), and AT (43.75%) among HT and controls, respectively. The p and OR values for risk type genotype (AA) are 0.4697 and 0.7700 (95% CI=0.3788-1.565), respectively. Subsequently, the high percentage (60.0 %) of risk genotype (AA) was found in obese-body mass index in hypertension patients. Conclusion: FTO rs9939609 single nucleotide polymorphism may not be a genetic risk factor associated with onset of hypertension directly and is linked with obesity in Pakistani patients. Keywords: FTO, Hypertension, Obesity, Pakistani patients, rs9939609

Correlation of lip profile preferences in Pakistani population; and its comparison with orthodontic norms

Objective: To determine the most desired lip profile and compare the subjective sense of aesthetics among orthodontists, general dentists and the general population. Method: The cross-sectional study was conducted at the Orthodontic Department of the Armed Forces Institute of Dentistry, Rawalpindi, Pakistan, from January 1 to February 25, 2020, and comprised different silhouettes for each gender with increasing lip procumbence from -6mm to +6mm with respect to Rickett’s E-line which were created using Photoshop CS 8.0 after cephalometric analysis of 20 cephalograms. The sample comprised an equal number of orthodontists in group A, general dentists in group B and orthodontic treatment-seekers in group C with equal representation of the two genders. Data was analysed using SPSS 24. Results: Of the 180 subjects, there were 60(33.3%) in each of the three groups, with 30(50%) males and as many females in all the groups. All the three groups preferred the average lip profile for males (p=0.018) and 2mm procumbent lips for females (p=0.008). There was significant difference of opinion between groups A and C (p=0.034) and between groups B and C (p=0.022). Conclusion: There was found to be a marked difference of opinion among the orthodontists, the general dentists and the orthodontic treatment-seekers regarding the desired lip profile. Key Words: Aesthetics, Pakistani population, Cephalometrics, Lip profile. Continuous...

Effect of Internet Addiction on Depression among Pakistani Population amidst the COVID 19

Background: Internet addiction has proved to have detrimental effects on the mental health wellbeing of people. During COVID19, these effects are amplified significantly; therefore, this study aims to assess the effect of internet addiction (IA) on the presence of depression among the Pakistani population amidst COVID 19. MethodsA cross-sectional design was employed using an anonymous web-based survey link. This link was disseminated via different social media platforms. The "Young's Internet Addiction Test" (IAT) and "Depression, Anxiety, and Stress Scale-21" (DASS-21) screening tools were used to measure Internet addiction (IA) and level of depression respectively. Adjusted odds ratios along with 95% confidence interval were reported using multinomial logistic regression for the association of IA and other predictors associated with depression. Results A total of 1145 individuals has completed this survey. Overall, the prevalence of severe and extremely severe depression was found to be 9.7% and 16.4% amidst the Pakistani population during the Covid-19 outbreak. The odds of extreme depression were 15 times more among (AIU) addicted internet users (95% CI: 8.26-28.8) and 7 times more among (PIU) problematic internet users (95% CI: 4.57-12.05) as compared to (NIU) normal internet users. ConclusionIn the aftermath of COVID 19, depression was found to be significantly related to internet addiction. This study determined that addicted and problematic internet users are more prone to suffer from depression.