Frequency And Factors Associated With Headache Among People Of Various Occupations

Objective: To find out the frequency and factors associated with headache among people of various occupations. Materials andMethods: This cross sectional study with purposive sampling was carried out in four cities, Karachi, Rawalpindi, Rahim Yar Khan andMuzafarabad from June 2011 to September 2011. Data was collected on a specially designed questionnaire with 21 questions both open and closed ended variety. After a written consent 250 individuals working as doctors, engineers, businessmen, bankers, executives, drivers, teachers, armed officers, laborers and household servants aged between 18 and 60 years were enrolled. Individuals suffering from any acute illness like common cold and gastroenteritis etc and chronic debilitating disease like diabetes, cancers were excluded. Results: Two hundred and fifty subjects participated in this study. 82.4 % were males while 17.6% were females. Their age range was 18-60 years Majority of subjects 80.8% were married. Overall frequency of headache was 62.8%. Highest frequency of headache was found in bankers & teachers (80%) and lowest was among doctors (48%).Age, anxiety and work place showed statistically highly significant association with headache. Family history, physical activity, high and low blood pressure and daily working hours were significantly associated with headache. Conclusion: Frequency of headache is found to be high whereas age, family history, physical activity, both high & low blood pressure ,anxiety, daily working hours and work place are found to be associated with headache among people of various profession

Hierarchical Nanostructures of Titanium Dioxide: Synthesis and Applications

This chapter covers different routes of preparation of hierarchical nanostructures (HNS) of titanium dioxide. Keeping the interest in developing modern and sustainable methods of materials chemistry, this chapter focuses on synthesis routes for TiO2 HNSs reported by researchers from all over the world. The chapter includes the details of chemical reactions taking place during the synthesis and the effects of various process parameters like: type of surfactants, organic/inorganic titanium salts, temperature and pressure on products. The obtained TiO2 HNSs from different synthesis routes are subsequently compared in terms of their morphology, crystallite size, surface area, particle size and phase. The merits and demerits of all synthesis techniques are also added for comprehensive information. At the end, various applications of HNSs are discussed and their performance is analyzed with respect to the morphologies obtained from different synthesis techniques

Stanford type B aortic dissection in a middle aged female in civil hospital Karachi, Pakistan

Aortic dissection is a potentially catastrophic illness that presents very rarely usually in sixth or seventh decade. There are two types of dissection; Stanford type A, which is treated surgically while type B is managed pharmacologically. Mortality is high for both types of aortic dissections.  However, when an aortic dissection is detected early and treated promptly, the chance of survival greatly improves.  It usually presents as a sharp tearing pain radiating to interscapular region but can also present atypically hence a high index of clinical suspicion is needed. We register a case a 50 year old female who was a known case of HTN presented with complain of dyspnea. On further investigation she was found to have aortic dissection involving descending aorta. She was managed conservatively but unfortunately died

Myxoid liposarcoma originating in the anterior mediastinum

Myxoidliposarcomas ofthe head and neck aremostly metastaticin nature, with the primarylesion usually in lower extremities or retroperitoneum. Primary mediastinal liposarcomas are even rare Although there have been previous cases reporting their incidence, there is no evidence of any case comprising of both the neck and the mediastinal region yet. We here present a case of a 43 year old male with a primary liposarcoma of the myxoid subtype originating in the anterior mediastinumThis is the first time such a case haspres ented in literature. The patient presented with a right sided neck swelling associated with pain and shortness of breath upon lying down.CT neck revealed an enhancing mass extending from right cervical regionto axilla and enca sing the subclavian artery and involving a portion of the right lung. The patient underwent wide local excision of the mass along with chemo radiotherapy to prevent recurrenc

Zika virus infection: a public health emergency!

Zika virus belongs to the family of Flaviviridae. The Flaviviridae family also includes other human pathogens like West Nile virus (WNV), Yellow fever virus (YFV), mosquito transmitted Dengue virus (DENV), Tick borne encephalitic virus (TBEV) and Japanese encephalitis virus (JEV). Zika virus is a mosquito-borne disease and is transmitted by Aedes aegypti mosquito

Repellent Activity of Certain Plant Extracts (Clove, Coriander, Neem and Mint) Against Red Flour Beetle

Various insect acts as pests for crops and storage grains that cause lot of damage and economic losses. Common control agents are synthetic compounds that are unsafe for humans and environment. Certain parts of plants and herbs are historically used for their repellent activity against insects for grain storage and tree protection. In this context, this study was planned to investigate the repellent activity of extracts of clove, coriander, neem and mint against red flour beetle that cause damage to storage grains and other crops. Insect repellency was tested using multiple concentrations of the extracts. Results of this study demonstrated that these plant extracts proved to have effective repellent activity against the insect. The most effective extract was coriander followed by mint in various concentrations. 1.5 % concentration was found to be most effective. It is concluded from the results that these plants are natural sources of repellent material and hence are a potential source of natural / biological insect repellents

THE BREAST MOUSE: AN OBSERVATIONAL STUDY OF BREAST FIBROADENOMAS IN THE PAKISTANI POPULATION

OBJECTIVE: To assess the characteristics of fibroadenomas and demographics of women presenting with breast masses in order to differentiate such masses from malignant breast masses. METHODS:  This cross-sectional survey was conducted at Khyber Teaching Hospital, Pakistan. Women with breast masses presenting to surgical outpatient department were assessed by taking a thorough history and breast examination, followed by imaging (ultrasound/mammography). Diagnosis was confirmed by fine needle aspiration cytology/Core biopsy. Only diagnosed cases of fibroadenomas were included in this study. RESULTS: Majority (n=93; 70.5%) of fibroadenoma patients were aging from 16-30 years. Seventy (n=70; 53.0%) patients belonged to urban areas. Menstrual cycle was regular in 123 (93.2%) cases. Sixty-four (48.5%) patients were using oral contraceptive pills. Majority (n=79; 59.8%) of patients were nulliparous.  Most (38.6%) women presented with a duration of the lump in 1-6 months. Approximately half (n=51; 53 %) of patient reported no increase in size. Lump was painful in 77 (58.3%) cases and 34 (74.2%) stated that the pain was acyclical. Lumps were mainly located on left side (n=64; 48.5%) and in upper outer quadrants (n=54; 40.9%) of breast. Mean lump size was 4.05 cm. Only 9 (6.8%) patients reported nipple discharge. Almost all of the patients (n=128; 97%) chose to undergo excision of the fibroadenoma. CONCLUSION: Fibroadenomas are a common presentation in women presenting with breast masses in the surgical outpatient department, most frequent in women aging 16-30 years and nulliparous. There is a strong predominance in the left breast in the upper outer quadrant

INHERITED GENETIC SUSCEPTIBILITY TO BREAST CANCER IN PAKISTAN

Breast cancer is a heterogeneous disease. Several genetic, environmental and lifestyle factors are involved in the aetiology of this disease. Genetic risk factors include alterations (mutations) in genes conferring risks to develop breast cancer. Depending on the associated lifetime risks of this malignancy, these genes are categorised into high-, moderate- and low-risk genes. Women carrying mutations in these genes are at an increased risk to develop breast cancer, ovarian cancer and several other malignancies. Breast carcinoma is the most reported malignancy in Pakistani females. Pakistan is a developing country with most of its population living in rural areas; hence, optimal healthcare facilities are inadequate for the early diagnosis and prevention of this disease. Hence, identification of individuals carrying mutations is clinically relevant as different strategies are available for the early detection, risk reduction and better management of this malignancy. This review summarises the findings of the major studies conducted in Pakistan to investigate the contribution of breast cancer predisposing genes. Furthermore, implications of the current studies and future research potentials are discussed.Key words: Breast cancer gene 1/2, breast cancer, checkpoint kinase 2, genetic susceptibility, Pakistan, RAD51C, tumour Protein p53, Vitamin D recepto

BREAST CANCER: EARLY DETECTION INITIATIVE IN PAKISTAN

Female breast cancer is currently the most prevalent cancer worldwide, with estimated global figures of 2.3 million new cases (11.7% of all cancer) in 2020. It is the 5th leading cause of cancer-related mortality worldwide, 685,000 deaths.1,2 Exact cause of the breast cancer is not known however, genetic factors like BRCA 1, 2 & p 53 gene mutations play an important role. Other risk factors include female gender, growing age, high estrogen exposure, obesity, lack of exercise, stress, early menarche and late menopause etc.3 Magnitude of the breast cancer patients in Pakistan is undetermined due to absence of the central registry.4 However, an estimated 90,000 women are diagnosed every year with breast cancer in Pakistan out of which 40,000 die every year.5 It’s said that every 9th woman is at risk of breast cancer in Pakistan, nevertheless, being a woman, every woman is at risk.5,6 Recently activities initiated by the first lady, national & international organizations and civil society to raise the awareness about self-examination and early detection in Pakistan has highlighted the importance of this health problem to the masses. Pakistan Atomic energy commission (PAEC) is the prime stakeholder of the cancer care in Pakistan. PAEC cancer registry report 2018-2019 encompassed the data of cancer patients from all over Pakistan including & Afghan refugees. According to this report, breast cancer was the most common cancer (8,816- 23% and 9,827- 24% cases during 2018 & 2019 respectively) among female of Pakistan. Most common age of reporting of the cancer remained 49 years, compare to 62 years in USA.7 The high-risk group was 40-69 years of age, comprising of about 90% of the breast cancer. According to this data every two out of five females were diagnosed with breast cancer in Pakistan. Highest number of breast cancer patients were seen in Punjab (49% in 2018 & 50% in 2019) and Islamabad (45% in 2018 & 46% in 2019), reasons may include urban life, enhanced awareness and availability of the diagnostic facilities in these areas. Rest of the breast cancer statistics include: Sindh (34.6% in 2018 & 34.0% in 2019), KP (31.1% in 2018 & 34.0% in 2019), Baluchistan (28.8% in 2018 & 30.7% in 2019), Jammu and Kashmir (34.1% in 2018 & 35.0% in 2019), Gilgit Baltistan (25.0% in 2018 & 19.2% in 2019) and Afghanistan (29.2% in 2018 & 34.4% in 2019).  According to the data, since 2015, out of 41,673 total breast cancer patients, 939 (2.2%) males mostly from the Pukhtoon ethnicity suffered. This is in contrast to the world data of less than 1%. Majority of the patients presented with advanced stages of the breast cancer (61% and 63% of total cases were in stage III/ IV during the year 2018 & 2019 respectively).8 Breast cancer is still considered a taboo in the conservative society of Pakistan, where female population stands 109,315,131.9,10 Despite the fact that the World Health Organization Global Breast Cancer Initiative (GBCI) has set the target to reduce 2% breast cancer related deaths per year worldwide, Pakistan lacks breast cancer control program.1,11 There is a lack of infrastructure and service providers in the endeavors of early detection and referral, especially at the primary health care levels.   Breast cancer early detection initiative model in KP Pakistan in the early phase of establishment of the breast cancer Control model, conducted a distinctive situational analysis during 2021, by the breast cancer subcommittee of the Khyber Pakhtunkhwa province (KP) of Pakistan. It was found that there are only eleven mammography machines for 35.5 million population of KP in contrast to seventy Mammogram machines per million population in developed country like USA.12  Chemotherapy services are available in nine facilities, whereas Radio therapy services are available in only seven facilities of KP.13 Provincial Assembly of KP passed a resolution unanimously on 7th July 2020 and a proposal has been approved for the KP ADP budget of 2022-23 as the flagship program of the “Breast cancer early detection initiative” to enhance the capacity of the province for early detection through availability of the specialized ultrasound, Mammograms and biopsy at the seven divisions of KP in addition to project implementation unit at the Provincial capital. Public Health Association KP with the vision to promote Public health and influence health policies, was the prime non-governmental organization, to start the struggle for breast cancer control program in the province, was joined by PAEC and other high profile health professionals. This model should be adopted by the rest of the provinces to reduce deaths among female of Pakistan.  Future preventive strategies should include further strengthening of the early detection initiative. Beside good planning, implementation and referral mechanisms, addition of cancer registry, genetic testing and screening, continuous research, targeted advocacy activities, social mobilization to promote self and clinical examination will help to decrease morbidity and mortality associated with the breast cancer

Non-Adherence to WHO recommendations regarding infant feeding practices results in dilemma of malnourishment: A community-based prospective cohort study conducted in Karachi, Pakistan

Background: The prevalence of chronic malnutrition and its associated morbid outcomes has been a significant cause of health loss globally, affecting millions of children hampering their mental, physical, social, and immune system development. World Health Organization\u27s (WHO) recommendations presenting infant feeding guidelines have largely controlled this burden. However, developing countries including Pakistan have failed to promote these guidelines and still succumb to a huge burden of morbidity and mortality secondary to malnourishment among infants.Methodology: Our study is a prospective cohort including 300 infants without predisposing congenital anomaly, followed from 6 months to 18 months of age. The primary outcome involved was classifying patients as malnourished based on anthropometric measurements, assessing the prevalence of co-morbidities and comparison of results in compliance with WHO guidelines.Results: A total of 276 infants were included and the rest were lost to follow-up. Stratification on socioeconomic status was done; 53% of infants were diagnosed as malnourished, either due to stunted growth, underweight, or both. The odds of development of malnourishment based on non-adherence to WHO guidelines on breastfeeding were 2.87 (p=0.001). The incidence of morbid complications was higher in the malnourished group, including gastrointestinal and respiratory tract infections.Conclusion: The implementation of WHO recommendations on infant feeding techniques can prove to be a pivotal instrument to control the soaring index of morbidities and mortalities associated with malnourishment. A strong focus on parental education and awareness among masses is required for its promulgation and controlling the infant health burden linked to this preventable condition