Quasi experimental analysis to evaluate the effects of educational sessions in improvement of Knowledge Practice regarding Food hygiene among women in rural community.

Care Introduction: Food is a vital need for a human being it's a source of energy that provides important ingredients for body growth. According to the European Food Safety Authority food composition affecting 69553 individuals, with the domestic kitchen as a second-most typically reported setting for food contamination. Food handlers (women) play an important role in the incidences of food spoilage. By health education knowledge of food, hygiene can be improved. Methods: Quasi-experimental study design was used in this study by using pre and post-test phase, conducted among women in rural community Ali Raza Abad Lahore, to determine the effectiveness of health education on knowledge and practice of food hygiene in women. The sample size was 60 that calculated by using convenient sampling technique in which those participants selected who were conveniently available to participate in the study. SPSS version 21 statistical software was used for data analysis at 95% of confidence interval and P-value was 0.05 Results: Results showed that the total mean of knowledge before intervention was 15.75 but after intervention, the total mean of knowledge was 27.93 similarly the total mean of practice before the intervention was 16.23 but after interventions mean of practice was 34.95 that showed the significant increase in knowledge and practice of women regarding food hygiene. Conclusions: This study described the effectiveness of health education for knowledge and practice of food hygiene among women in the rural community. The mean knowledge and practice score on food hygiene increased significantly after health education. Keywords- Effectiveness. Health education. Food hygiene. Knowledge. Practice.

Um estudo da relação causal de autonomia no trabalho, apoio social e intenção de rotatividade

Boredom at workplace is a negative well-being displayed by both blue and white collar employees who had lost their passion and value towards jobs under non stimulating working environment. Yet, there are limited studies in this area. Scholars had constantly associated boredom with negative working performance such as job dissatisfaction, high absenteeism, poor health condition and low organizational commitment. However, the association with turnover intention remains debatable. In Pakistan, the turnover intention among academicians of universities are in critical stage ever since year 2015. Although the Higher Education Commission Pakistan recognize the potential of private universities in supporting Pakistan to improve education in the countries, this issue remains unsolved which may jeopardize the success. Therefore, this study put forward the antecedents and consequence of boredom at workplace under a single model which includes the investigation of job autonomy, social support, and turnover intention among academicians. A quantitative study was conducted by obtaining data from 279 academicians working for 25 private universities in Lahore an Islamabad. The results showed that job autonomy was not significantly associated with turnover intention because job autonomy has no association with boredom at the first place. In contrast, social support was negatively associated with boredom which led to positive association with turnover intention. Moreover, the result confirmed the presence of boredom as mediator upon bootstrapping. It is suggested that private universities shall motivate academicians to actively participate in trainings, conferences, and seminars as the opportune time can be used to build good rapport among them.El aburrimiento en el lugar de trabajo es un bienestar negativo que muestran tanto los empleados de cuello azul como los de clase blanca que han perdido su pasión y valor hacia los empleos en un entorno laboral no estimulante. Sin embargo, hay estudios limitados en esta área. Los académicos han asociado constantemente el aburrimiento con el desempeño laboral negativo, como la insatisfacción laboral, el alto ausentismo, la mala condición de salud y el bajo compromiso organizacional. Sin embargo, la asociación con la intención de rotación sigue siendo discutible. En Pakistán, la intención de rotación entre los académicos de las universidades se encuentra en una etapa crítica desde el año 2015. Aunque la Comisión de Educación Superior de Pakistán reconoce el potencial de las universidades privadas para ayudar a Pakistán a mejorar la educación en los países, este problema sigue sin resolverse, lo que puede poner en peligro el éxito.. Por lo tanto, este estudio expuso los antecedentes y las consecuencias del aburrimiento en el lugar de trabajo bajo un modelo único que incluye la investigación de la autonomía laboral, el apoyo social y la intención de cambio entre los académicos. Se realizó un estudio cuantitativo mediante la obtención de datos de 279 académicos que trabajan en 25 universidades privadas en Lahore y Islamabad. Los resultados mostraron que la autonomía laboral no se asoció significativamente con la intención de la rotación, ya que la autonomía laboral no tiene ninguna asociación con el aburrimiento en primer lugar. En contraste, el apoyo social se asoció negativamente con el aburrimiento, lo que llevó a una asociación positiva con la intención de la rotación. Además, el resultado confirmó la presencia de aburrimiento como mediador en el arranque. Se sugiere que las universidades privadas motiven a los académicos a participar activamente en capacitaciones, conferencias y seminarios, ya que el momento oportuno se puede utilizar para establecer una buena relación entre ellos.O tédio no local de trabalho é um bem-estar negativo exibido por funcionários de colarinho azul e branco que perderam a paixão e o valor para empregos em ambiente de trabalho não estimulante. No entanto, existem estudos limitados nesta área. Os acadêmicos associaram constantemente o tédio ao desempenho negativo do trabalho, como insatisfação no trabalho, alto absenteísmo, condições de saúde precárias e baixo comprometimento organizacional. No entanto, a associação com a intenção de rotatividade continua a ser discutível. No Paquistão, a intenção de rotatividade entre acadêmicos de universidades está em fase crítica desde 2015. Embora a Comissão de Educação Superior do Paquistão reconheça o potencial das universidades privadas em apoiar o Paquistão para melhorar a educação nos países, esta questão permanece sem solução, o que pode comprometer o sucesso. Portanto, este estudo apresenta os antecedentes e conseqüências do tédio no local de trabalho sob um único modelo que inclui a investigação da autonomia do trabalho, apoio social e intenção de rotatividade entre os acadêmicos. Um estudo quantitativo foi realizado através da obtenção de dados de 279 acadêmicos que trabalham para 25 universidades privadas em Lahore e Islamabad. Os resultados mostraram que a autonomia do trabalho não estava significativamente associada à intenção de rotatividade, porque a autonomia do trabalho não tem nenhuma associação com o tédio em primeiro lugar. Em contraste, o apoio social foi negativamente associado ao tédio, o que levou a uma associação positiva com a intenção de rotatividade. Além disso, o resultado confirmou a presença do tédio como mediador no bootstrapping. Sugere-se que as universidades privadas motivem os acadêmicos a participar ativamente de treinamentos, conferências e seminários, já que o momento oportuno pode ser usado para construir um bom relacionamento entre eles

Effect of replacement therapy on clinical symptoms in patients with vitamin D deficiency

Background: 25(OH) D is an important component for human health. Vitamin D deficiency is a worldwide problem. Previous epidemiological studies have shown the association of this deficiency with development of other chronic disease that also increase the morbidity. So early detection of deficiency helps to plan intervention and treatment to avoid morbidity. Objective: To evaluate the association of vitamin D deficiency in individuals suffering with chronic diseases and the effect of replacement therapy on the clinical symptoms of vitamin D deficiency. Method: This study analyzed a total of 115 patients visiting the Diabetes and Endocrine Research Centre. Factors such as age, gender, duration of sun exposure and body parts exposed to sunshine were studied. The data was recorded on a questionnaire performa. Patients with 25(OH) D levels below 30ng/ml were considered to have insufficient levels. 48 patients who agreed for treatment were given standard loading and maintenance dose of vitamin D. 31 Patients reported back after 3 months of maintenance dose treatment. Results: The mean age of patients was 47.82±13.86 years. Duration of sunshine exposure was significantly low with p-value of 0.005. In our study, 112/115(97.3%) patients were found to have 25(OH) D level below 30ng/ml and 41/115 (21.5%) were severely deficient. 48(41%) patients agreed for replacement therapy. However, only 31 reported back with vitamin D level. In comparison to pretreatment records, there was significant improvement in vitamin D levels after 3 months of treatment. There was improvement with symptoms such as lethargy which improved in 11/17, whereas depression and body aches improved in 12/19 and 16/26 patients respectively. Conclusion: It is important to recognize the deficiency of vitamin D level in patient suffering from chronic diseases in order to avoid other co morbidities. So, this study can help to make policy in future about which population needs to be screened and what preventive precautions can be taken

Case Report Transorbital Stab Injury with Retained Knife: A Narrow Escape

Transorbital penetrating injuries are unusual but may cause severe brain damage if cranium is entered. These kinds of injuries are dangerous as the walls of orbit are very thin, hence easily broken by the otherwise innocent objects. Because of the very critical anatomical area involved, these injuries pose a serious challenge to the physicians who first receive them as well as the treating team. These may present as trivial trauma or may be occult and are often associated with serious complications and delayed sequel. Prompt evaluation by utilizing best diagnostic modality available and timely interference to remove them are the key aspects to avoid damage to vital organs surrounding the injury and to minimize the late complications. We report a case of transorbital assault with a 13 centimeter long knife which got broken from the handle and the blade was retained. The interesting aspect is that there was no neurological deficit on presentation or after removal

The potential of plasma-derived hard carbon for sodium-ion batteries

Sodium-ion batteries (SIB) are receiving wider attention due to sodium abundance and lower cost. The application of hard carbon to SIB electrodes has shown their significant potential to increase rates, capacities, stability, and overall performance. This article describes the significance of hard carbon, its structural models, and mechanisms for SIB applications. Further, this work unveils the potential of plasma methods as a scalable and sustainable manufacturing source of hard carbon to meet its increasing industrial demands for energy storage applications. The working mechanisms of major plasma technologies, the influence of their parameters on carbon structure, and their suitability for SIB applications are described. This work summarises the performance of emerging plasma-driven hard carbon solutions for SIB, including extreme environments, and revolves around the flexibilities offered by plasma methods in a wider spectrum such as multi-materials doping, in-situ multilayer fabrication, and a broad range of formulations and environments to deposit hard carbon-based electrodes for superior SIB performance. It is conceived the challenges around the stable interface, capacity fading, and uplifting SIB capacities and rates at higher voltage are currently being researched, Whereas, the development of real-time monitoring and robust diagnostic tools for SIB are new horizons. This work proposes a data-driven framework for plasma-driven hard carbon to make high-performance energy storage batteries

Neurokinin 1 receptor antagonist along with dexamethasone reduces the inflammation in COVID-19 patients: a novel therapeutic approach

Background: Corona virus infection is a respiratory infection, compromising the normal breathing in critical patients by damaging the lungs. The aim of this study was to evaluate the clinical outcomes of Substance P receptor Neurokinin 1 antagonist in COVID-19 patients against the usual treatments as controls.Methods: It is a two-arm, open-label, randomized clinical trial that was carried out at Bahria International Hospital in Lahore, Pakistan. PCR-positive, hospitalized patients older than 18 years old, all sexes, and in the critical to life-threatening stage were included. 52 patients were placed in control group A and 67 patients were placed in intervention group B out of a total 119 patients who were randomly assigned to both arms. Before and after the intervention, lab tests were conducted in both groups. Aprepitant, a neurokinin-1 receptor antagonist, was additionally administered to the other arm while the other arm got standard therapy and care. Additionally, both groups received oral administration of the corticosteroid dexamethasone.Results: Patients in group A were on average 56.05 years old, compared to 58.1 years old in group B. There were 24 women in group A and 28 in group B, while there were 28 men and 39 women in group A. Group A had three critical cases, but group B had six. The reduction in C-reactive protein in the intervention group, improvement in platelet count in group B, and normalization of ferritin and LDH levels in group B all indicated decreased inflammation in the biochemical and haematological parameters in both groups. However, because of the reduced sample size, it wasn't very significant.Conclusion: The results of this recent trial provide a solid indication of Aprepitant's medicinal potential. Patients who got a combined therapy of dexamethasone and aprepitant had better clinical results, more favourable lab results, and lower levels of C-reactive protein, an inflammatory marker

Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions

Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021

Background: Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050. Methods: Using forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: In the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]). Interpretation: Globally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions

Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

Background: Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods: For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings: Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation: Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life

Role of Vitamin D in Preventing Relapse and maintaining Remission in Patients with Ulcerative Colitis - A Case Control Study

Background & Objectives: Ulcerative colitis (UC) affects the mucosa of the rectum and the colon, and is characterized by flares and remission. It is observed that defect of proliferation of T-lymphocytes is the causative factor of ulcerative colitis. Vitamin D appears to play an important role in decreasing the incidence of active UC. The study was undertaken to determine the effect of Vit.D in patients with ulcerative colitis (UC). Place & Duration of Study: This study was conducted from January 2014 to January 2016 in Mayo Hospital, Lahore, Pakistan. Methodology: Data was collected from patients suffering from UC who visited the surgical out-patient department and/or were admitted to the surgical floor. A total of 84 patients within the age range of 18-70 years and divided into two equal groups of 42 were included in the study. The control group was given standardized treatment of ulcerative colitis according to severity of disease as measured by Truelove and Witt's criteria. The intervention group was given an additional dose of Vitamin D along with primary disease treatment. Results: It was seen that patients in the intervention group showed significant remission and a decrease in the frequency of relapses. Conclusion: Our study supports the hypothesis that vitamin D supplementation helps to achieve significant remission and reduce relapse in patients suffering with active ulcerative colitis