ISSUES OF WOMEN HEALTH IN NON-MUSLIM COMMUNITY OF KARACHI, PAKISTAN: A QUALITATIVE SURVEY

Background: The women from non-Muslim community of Karachi have to face several issues regarding their health. The objective of this study was to find out the issues regarding the women health in non-Muslim community of Karachi and to provide suggestions in this context.Materials Methods: This qualitative survey was conducted at Pakistan Study Center, University of Karachi, Pakistan from July 2011 to December 2011. Eleven Non-Muslim populated areas of Karachi were selected. The primary data was collected through structured interview schedule, including 15 open ended questions. One doctor from each cluster of the eleven minority populations was interviewed. The responses were noted on a notebook. The theme was to understand the health issues faced by women around fourteen concepts; provision of food to boys and girls, health of girls before marriage, health of girls after marriage, side effects of early age marriages, women’s health during pregnancy, role of midwife, presence of non-qualified practitioners, problems during maternity, concept of family planning, health facility during emergency, weight of children at the time of birth, mother feed for the children, role of dirty and polluted atmosphere, and diseases due to reserved professions. Results: There was a lack of awareness in the non-Muslim families of Karachi regarding provision of equal food to their children on the basis of sex. The physical health of girls before marriage was not good in these families. After marriage they are also at risk of mental illness due to poverty, illiteracy, uncomfortable residential units and having limited access to the lady doctors. The overcrowded houses and polluted atmosphere also affects badly their physical health.Conclusion: The non-Muslim women are deprived from health facilities due to socio-economic problems. It is the dire need to provide health education to the non-Muslim women in their settlements. Moreover, Health care facilities may be provided by establishing Basic Health Units, Rural Health Centers, Maternal Child Health centers in these areas as per population density.

PERCEPTION OF HOARDING BEHAVIOR AMONG GENERAL POPULATION OF RAWALPINDI AND ISLAMABAD CITIES OF PAKISTAN: AN EXPLORATORY QUALITATIVE INQUIRY

Background: Hoarding is a complex phenomenon that has received extensive attention in recent years. Most studies have been conducted in Western culture with few from other regions of world, which advocates need to explore the phenomenon in different cultural contexts. Objective of this study was to ascertain the perception of hoarding behavior among general population of Rawalpindi and Islamabad cities of Pakistan.Materials Methods: This exploratory qualitative study with grounded theory design was conducted in National Institute of Psychology, Quaid-i-Azam University, Islamabad, Pakistan from September 2015-May 2016. Sample of 46 subjects from different socio-cultural backgrounds was selected from otherwise healthy adult (20-60 years) population of Rawalpindi Islamabad cities of Pakistan by purposive sampling. A qualitative research methodology was employed to develop theoretical understanding of phenomenon. Focus group discussions with six groups were conducted to assess existence and phenomenology of hoarding behavior in present cultural framework. Data was analyzed using grounded theory method.Results: Findings of this study support current literature concerning the role of emotional attachments, associated positive and negative affect, certain personality characteristics and early experiences in development and maintenance of hoarding behavior. This study also confirms that material possessions are source of security by providing sense of identity to owner, and are considered symbols of status in society. Finally, it involves the account of socio-cultural aspects like status transformation, with resulting sense of competition, gender role, impact of material deprivation, and religious construction of phenomenon that emerged as more of culture specific elements in indigenous settings of Pakistan.Conclusion: This study addresses factors that underpin major themes in relation to form and prevalence of hoarding behavior in cultural context of Pakistan and discusses the findings in reference to the similarities and differences with extant literature.

IMMUNOMODULATORY ROLE OF VITAMIN D: CLINICAL IMPLICATIONS IN INFECTIONS AND AUTOIMMUNE DISORDERS

Vitamin D exerts its well-known effects on bone health and calcium-phosphate homeostasis primarily through the vitamin D receptor signaling pathway. Vitamin D also has several extra-skeletal actions and its deficiency is not only implicated in musculoskeletal disorders, but also cardiovascular disorders, diabetes, neurodegenerative conditions and cancers. There is a growing body of research highlighting the link of vitamin D deficiency and alterations in vitamin D signaling with certain infections and autoimmune disorders although the evidence is inconsistent and inconclusive. Vitamin D has been suggested to play a fundamental role in curbing infections and mitigating autoimmune disease processes. The present review was undertaken to explore the promise of vitamin D as a protective agent and a clinically useful therapeutic adjunct against infections and autoimmune diseases and identify knowledge gaps and limitations of the available data for informing future work. An exhaustive search was conducted in established databases including Google Scholar, PubMed, Science Direct and Springer for articles published on vitamin D, immunity, infection and autoimmune disorders. All relevant articles published in the English language between the year 200 and 2020 were retrieved for writing the review. Although a considerable body of evidence highlighting the potential clinical benefits of vitamin D against the development of various autoimmune conditions and for the prevention of infections has emerged over the last decade, the findings are limited by the lack of appropriately designed randomized controlled trials which are needed to formulate precise clinical recommendations.

SYNTHESIS, CHARACTERIZATION AND IN VIVO EVALUATION OF PH SENSITIVE HYDROXYPROPYL METHYL CELLULOSE-GRAFT-ACRYLIC ACID HYDROGELS FOR SUSTAINED DRUG RELEASE OF MODEL DRUG NICORANDIL

Background: Anti hypertensive drugs like “Nicorandil” require frequent dosing due to their shorter half-life. Such drugs are also pH sensitive, due to which greater portions of these drugs are degraded in acidic pH of stomach resulting in lesser bioavailability. The objective of this study was to formulate graft polymeric carrier system for sustained delivery of nicorandil to minimize dosing frequency and enhance patient compliance. Materials Methods: This animal model study was conducted in Department of Pharmacy, Islamia University of Bahawalpur, Pakistan. Hydroxypropyl methyl cellulose-graft-acrylic acid hydrogels were synthesized by free radical solution polymerization with diverse weight ratios of polymer, monomer and cross linker. Total duration of study was 1.5 years from March 2013 to August 2015. The N, N-methylene bis acrylamide and potassium persulfate were used as crosslinker and initiator respectively. Hydrogels were characterized for swelling ratio, equilibrium swelling, gel content, porosity and in vitro drug release. The surface morphology of synthesized hydrogels was evaluated by using Scanning Electron Microscopy. Thermal properties of hydrogels were evaluated by Thermogravimetric Analysis and Differential Scanning Calorimetry whereas FTIR was done to examine chemical compatibility. Finally, in vivo evaluation of prepared hydrogels was carried out in rabbits using simple parallel study design to estimate various pharmacokinetic parameters.Results: HPMC-co-AA hydrogels had good pH sensitivity whereas; they demonstrated maximum and minimum swelling at pH 7.4 and 1.2 respectively. Swelling ratio, gel fraction and cumulative percent drug release were decreased with increasing crosslinker concentration while these parameters were increased with increasing AA and HPMC concentrations. A porous network was observed in the SEM images. All formulation ingredients of prepared hydrogels showed good compatibility as determined by FTIR. Results of in vivo study proved the pH sensitivity and sustained drug release of prepared hydrogels.Conclusion: The HPMC-graft-AA hydrogels showed good pH-sensitivity and sustained-release profile for model drug nicorandil.

IMPORTANCE OF SOCIAL FACTORS IN HEALTH: CAUSES OF THE CAUSES

The industrial revolution in 1830 led to the urbanization resulting in creation of urban slums. More complex health problems ultimately steered the concept of public health. The social revolution during the Second World War emphasized that health could only be achieved through socioeconomic improvement. Progress in the field of social sciences rediscovered that man is a social being, not only a biological animal. Social services for the improvement of life conditions have been the major factors in reducing mortality, morbidity and improving the standard of life of an individual, family and society.

DISTRIBUTION OF DR-TB BY SEX, AGE GROUPS, OCCUPATION, PROVINCE, DIVISION, DISTRICT, TYPE OF DISEASE, TYPE OF DRUG RESISTANCE, TREATMENT REGIMEN AND OUTCOME OF TREATMENT IN DR-TB POPULATION IN D.I.KHAN DIVISION, PAKISTAN

Background: Drug-resistant tuberculosis (DR-TB) is the major cause of mortality worldwide. Our objectives were to determine the distribution of DR-TB by sex, age groups, occupation, province, division, district, type of disease, type of drug resistance, treatment regimen and outcome of treatment in DR-TB population in D.I.Khan Division, Pakistan.Materials Methods: This cross-sectional study was conducted in Department of Community Medicine, Gomal Medical College, D.I.Khan, Pakistan. A sample of 286 DR-TB patients was selected consecutively from population at risk. Sex, age groups, occupation, province, division and district were demographic while type of disease, type of drug resistance, treatment regimen and outcome of treatment were research variables. All variables being nominal were described by count, percentage cumulative percentage with 95% confidence interval for proportion. Distribution of DR-TB patients by all the ten variables were substantiated by chi-square goodness-of-fit test.Results: Out of 286 DR-TB patients, 123 (43%) were men and 163 (57%) women. DR-TB cases were most prevalent in age group 15-44 years 172 (60.14%), housewife 140 (48.95%), Khyber Pakhtunkhwa 175 (61.19%), D.I.Khan Division 178 (62.24%) and district 121 (42.31%). Most common type of disease, drug resistance and treatment regimen was pulmonary TB 282 (98.60%), MDR 273 (95.45%) and longer treatment (n=273 MDR-TB) 246 (90.11%) respectively. Treatment success rate was 161 (56.29%). The observed prevalence by occupation, province, division, district and type of disease in our sample was similar to expected prevalence in population (p.05 for all), while it was different from population by sex, age groups, type of drug resistance, regimen and treatment outcome (p.05 for all).Conclusion: The prevalence of DR-TB was higher in women, age group 15-44 years, housewife, Khyber Pakhtunkhwa and D.I.Khan Division and District. Most common type of disease, drug resistance and treatment regimen was pulmonary TB, MDR and longer treatment respectively. Treatment success rate was 56.29%. The observed prevalence by occupation, province, division, district and type of disease in sample was similar to population, while it was different by sex, age groups, type of drug resistance, regimen and treatment outcome.

PREVALENCE, DISTRIBUTION AND DETERMINANTS OF INTESTINAL TUBERCULOSIS IN ADULT INDOOR PATIENTS WITH ACUTE SMALL INTESTINAL OBSTRUCTION IN POPULATION OF PESHAWAR DIVISION, PAKISTAN

Background: Acute small intestinal obstruction (ASIO) is one of the commonest causes of emergency hospital admissions, morbidity and mortality. Intestinal tuberculosis (ITB) is common cause of ASIO in developing countries leading to significant morbidity and mortality. Our objectives were to determine prevalence, distribution and determinants of ITB in adult indoor patients with ASIO in population of Peshawar Division, Pakistan.Materials Methods: This cross-sectional study was conducted at Department of Surgery Peshawar Medical College, Peshawar, Pakistan from January 2019 to June 2020. The data was collected from its three affiliated hospitals; Mercy Teaching Hospital, Kuwait Teaching Hospital Prime Teaching Hospital, Peshawar. 207 ASIO subjects were selected from population at risk consecutively. Sex, age groups and presence of ITB were variables. Prevalence and distribution were described by count, percentage and confidence intervals for proportion for population. Hypotheses for distribution were tested by chi-square goodness of fit and of association by chi-square test of association.Results: Out of 207 patients with ASIO, 128 (61.84%) were men and 79 (38.16%) women, 87 (42.03%) were in age group 18-40 and 120 (57.97%) in 41-60 years. Out of 207 patients with ASIO, 41 (19.81%) had ITB, while 166 (80.19%) had no ITB. Out of 41 ITB patients, 25 (12.08%) were men and 16 (7.73%) women, 17 (8.21%) in age group 18-40 and 24 (11.60%) in 41-60 years. The prevalence of ITB was similar to expected (p=.5695). The distribution across sex (p=.00001) was different and across age groups (p=.12501) was similar to expected. Presence of ITB was not associated to sex (p=.8992) and age groups (p=.9347).Conclusion: Prevalence of intestinal TB in adult indoor acute small intestinal obstruction (ASIO) population of Peshawar Division, Pakistan was 19.81%. Prevalence was higher in men than women and higher in 41-60 years than 18-40 years age group population. Overall prevalence of intestinal TB was similar to expected. Observed distribution across sex was different and across age groups was similar to expected. Presence of intestinal TB was not associated to sex and age groups respectively.

FREQUENCY, DISTRIBUTION AND DETERMINANTS OF HYPERTENSION IN ADULT STROKE POPULATION OF D.I.KHAN DIVISION, PAKISTAN

Background: Global Health Estimates 2015 has shown the stroke as second leading global cause of death and 3rd leading global cause for DALYs for year 2015. The objectives of this study were to determine the frequency, distribution and determinants of hypertension in adult stroke population of D.I.Khan Division, Pakistan. Materials & Methods: This cross-sectional study was conducted in Department of Community Medicine, Gomal Medical College, D.I.Khan, Pakistan from February 1, 2017 to April 30, 2017. A sample 217 was selected with margin of error 5.59%, 90%CL and 50% prevalence of hypertension in 200,000 adults at risk of stroke population through consecutive sampling. All indoor adult patients of stroke were eligible. Sex, age groups, and residence and presence of hypertension were variables. Frequency and distribution of hypertension were analyzed by count and percentage. Hypotheses for distribution were substantiated by chi-square goodness-of-fit and of association by chi-square test of association. Results: Out of 217 patients with stroke, 123 (56.7%) were men and 94 (43.3%) were women, 86 (39.6%) were≤60 years and 131 (60.4%) were>60 years, and 105 (48.4%) were urban and 112 (51.6%) were rural. Frequency of hypertension was 132/217 (60.83%). Out of 132 patients with hypertension, men were 74 (34.10%), women 58 (26.73%), age group≤60 years 46 (21.20%), >60 years 86 (39.63%), urban 72 (33.18%) and rural 60 (27.65%). Presence of hypertension was associated to residence (p=.023) but not to sex (p=.817) and age groups (p=.072). Conclusion: Frequency of hypertension in adult stroke population of D.I.Khan Division, Pakistan was found to be similar as expected. Frequency was more in men, in older age group (of>60years) and in urban population. The presence of hypertension in adult stroke population of D.I.Khan Division was associated to residence but not to sex and age groups.

REFRACTORY ANEMIA AND PANCYTOPENIA AS PRESENTATIONS OF FALCIPARUM MALARIA IN POPULATION OF KHYBER PAKHTUNKHWA, PAKISTAN

Background: Falciparum malaria is a common disease in our area. Apart from its classical presentation, at times it may present with refractory anemia or pancytopenia. The aim of this study was to determine the refractory anemia and pancytopenia as complications of falciparum malaria and apart from peripheral blood smears the significance of rapid antigen tests and bone marrow examination in the diagnosis of falciparum malaria. Material & Methods: The descriptive study included 200 consecutive cases of fever and refractory anemia or pancytopenia from 2011 to 2014. Stratification of patients according to the clinical scenario included Group-A having fever with refractory anemia and Group-B with fever and pancytopenia. A detailed history, thorough clinical examination, and pertinent laboratory tests were performed. All patients were treated with antimalarial drugs and followed-up for eight weeks. The pre and post treatment hematologic parameters were compared. Results: Among the 200 patients, 85 were males and 115 females. The age ranged from 15 to 55 years. Stratification of patients on clinical scenario revealed 175(87.5%) patients with fever and refractory anemia (Group-A). Among these, 125(62.5%) patients were reported smear positive for P. falciparum. In the remaining 50 smear negative patients rapid antigen tests were performed and all were reported positive. In 25 patients of Group B with fever and pancytopenia, the peripheral smear for malaria was positive only in 5 patients. In the remaining 20 cases both the peripheral blood smears and rapid antigen tests were reported negative. Bone marrow examination was planned to confirm the bone marrow suppression as the cause of peripheral pancytopenia, to exclude leukemia and to identify P. falciparum. The bone marrow examination revealed P. falciparum in all these cases. All the patients had a dramatic response to treatment with antimalarials in terms of disappearance of fever and correction of anemia and bone marrow rescue with reversal of pancytopenia to normal counts. Conclusion: Plasmodium falciparum should be considered in all cases of prolonged fever with refractory anemia or pancytopenia in malaria endemic areas, even with negative smear and rapid antigen tests. Bone examination is mandatory for the diagnosis in such cases. There is dramatic response of such patients to treatment with antimalarial drugs and hematinics.