Culture-bound addictions among low income workers of Karachi, Pakistan

Background: The self-efficacy of individuals is influenced by experiences in the community, in the workplace, and in broader civil society, all of which exert a collective influence on attitudes and behaviors. The low-income population is more likely to engage in the use of culture bound addictive substances which include tobacco, gutkha, betel nut/areca nut, alcohol and caffeine. The objective of the study was to identify the type of culture-bound substances used by low-income workers and also to determine the prevalence of substance use among low-income workers, in Karachi, Pakistan.Methods: A cross sectional study was carried out in Karachi, Pakistan. Trained interviewers used a semi-structured questionnaire to interview 707 workers to collect information on socio-demographic characteristics, and addiction history. The data were analyzed using SPSS version 18.Results: Majority (26.4%) of the participants were aged between 26 and 30 years. More than one-third (35.1%) were educated up to secondary level only. Half of the sample (50.8) had 6 to 10 house hold members whereas only one member was employed among 34.8% of the respondents. 39.5% participants reported a household income between Rs11000 and Rs 20000 per month. Half of the sample (50.4%) reported some sort of substance use in their daily routine. A significant number (39.5%) of workers were found to be addicted to tobacco, gutkha or betel nut alone, while another 10.5% were using these substances in combination.Conclusions: Addiction to culture bound substances is prevalent among 50% of the low income workers of Karachi, Pakistan. The common culture bound addiction substances the workers were found to be using were tobacco, ghutka and betel nut. The findings of the present study can­not be generalized due to the limited sample. Still, the study provides evidence of this unhealthy behavior among workers that not only affects their productivity but plays a vicious role in poverty and poor health cycle. Future research should direct attention toward workers' health and working conditions to formulate effective public health interventions to reduce the risky behavior among low income workers. Moreover, there is a need to develop health education programs to create awareness and empowerment among low-income workers to prevent substance use.

Nature and extent of perceived stigma among epileptics in Pakistan

Background: Epilepsy is one of the oldest disorders known to mankind. Often the social stigma (whether a “felt” stigma or an “enacted” stigma) attached to epilepsy is a greater handicap to the person with epilepsy compared to the disability associated with seizures or the side-effects from medications. The aim of this study was to explore the perceived sigma and discrimination among epileptics of Karachi, Pakistan.Methods: A descriptive cross sectional study was conducted in Karachi, Pakistan in the year 2016. A standardized pretested semi-structured questionnaire was completed by 120 epilepsy patients selected through purposive sampling from Department of Neurology, Jinnah Postgraduate Medical Centre. Informed verbal consent was obtained prior to the interview. The data were analysed using IBM SPSS Statistics version 22 and Microsoft excel.Results: The average age of the sample participants was 18-50 years. Almost two third (68%) of the respondents were male. More than half (55%) of the sample was educated up to matriculation. Among them 28.5% were married. Three fifth (60%) of participants were unemployed.  More than half (60%) of the respondents reported discrimination in educational opportunities and three fourth (78.5%) in job opportunities. Results indicated that (75%) participants encountered social problem like being discriminated (30%), or segregated (11%) in performance of daily tasks and were avoided (58.8%) to get marry more often with the belief that people with epilepsy are infectious.Conclusions: The study concludes that there is significant perceived stigma among epileptics living in a big metropolitan city of a developing country. The nature of stigma includes discrimination in education, marriage and job opportunities. There is a need for public awareness programmes to address this ignored facet of epilepsy, since it has both medical as well as social implications

Exploring nutritional status, physical activity and body mass index of Pakistani teens

Background: Obesity is becoming an increasingly prevalent problem in Pakistan, as it has in other developing countries. Childhood obesity poses high cost to the well-being and negatively affects children’s health, causes chronic disease as children grow older. The aim of this study was to explore nutritional status, physical activity and body mass index (BMI) of school and college going students of mid and late adolescence age (14 to 19 years) studying in multi-ethnic city of Karachi, Pakistan.Methods: A descriptive cross-sectional study was carried out among school and college going students of public and private educational institutes of Karachi, Pakistan. The study sample of 171 students was conveniently selected from these institutes.  The data was collected through a semi-structured questionnaire. In order to calculate BMI, the height and weight of each student were measured after completion of the questionnaire. The data were entered and analysed using IBM SPSS version for Windows 20.0 software.Results: The average age of the respondents was 16.2 years with 68% students belonged to school and 32% to College, and 57.3% were males and 42.7% were females. More than half sample (59.6%) participants belonged to privileged and 40.4% to underprivileged class. The sample was eating a wide variety of junk food in daily routine including chips, packed fruit juices, packed flavoured milk, ice creams/ frozen yogurts both at home and at school/college. The physical activity of the school students was found to be better than the college students. No participant had regular activity or strenuous physical games for more than one hour per day. Around one third (38%) respondents used to watch TV or play computer games for more than two hours a day. Almost half of the students’ BMI was within the normal ranges, but remaining half of the sample was either overweight or underweight.Conclusions: This study indicates that a large proportion of school and college students had physical inactivity, unhealthy dietary habits and they were overweight. All these interrelated factors were independent of their household socioeconomic condition and ethnicity. There is a need to educate and create awareness about healthy lifestyle among the adolescents and the community at large.

Intracytoplasmic sperm injection and advanced maternal age: Success or treatment failure

Infertility rate documented in Pakistan is 21.9% with only 25% success rate even after procedures like intracytoplasmic sperm injection (ICSI). This rate is further on the decline with enhancement of female age. We aimed to observe the effect of female age on oocyte parameters and reproductive outcome after ICSI. It was done by retrospective analysis of a quasi- experimental design carried out after approval from Ethical review board of Islamabad clinic serving infertile couples from July 2010 to August 2011. The response to ovarian stimulation in (282) females was assessed on the basis of groups, A, B, C and D with age ranges up to 25years; 25.1 to 30years; 30.1 to 35years and \u3e35years, respectively. The outcome was assessed as non-pregnant, preclinical abortion and clinical pregnancy groups on the basis of beta hCG and cardiac activity by trans-vaginal scan. We observed that maximum number of pregnancies 32 (38%) occurred in C group, and least 10 (10%) in group A. There was a statistical reduction in the number of mature and fertilized oocytes as the age advanced from group C to D (p\u3c0.05).This shows that reduction in maturity and fertilization of oocytes with advancement of age recommends early referral of couples to assisted reproductive clinics

Importance of estimation of follicular output rate (FORT) in females assisted by intracytoplasmic sperm injection

Background: We aimed to estimate pregnancy outcome after ICSI in terms of oocyte parameters, embryo quality, endometrial thickness, hormone and cytokine levels in women stratified on the basis of follicular output rate (FORT).Methods: Quasi experimental design was carried out after approval from “Ethical review board of Islamabad clinic serving infertile couples” from July 2010 to August 2013. One thousand and fifty females were selected with the criteria of age between 21-40 years, infertility of more than 2 years, body mass index of 18-35 kg/m2, menstrual cycle of 25 ± 7 days, both ovaries present with normal uterine cavity, serum FSH levels less than 8 IU/ml and normal thyroid-stimulating hormone levels. Females on short agonist or antagonist protocol with diagnosis of polycystic ovarian syndrome, fibroids or in their male partner sperms retrieved by testicular biopsy were excluded from the study. Down regulation of ovaries was followed by controlled ovarian stimulation, Ovulation Induction (OI), oocyte pick up, in vitro fertilization, Embryo Transfer (ET) and confirmation of pregnancy was done by serum beta hCG of more than 25 mIU/ml and  cardiac activity on trans vaginal scan. Enzyme linked immuno sorbent assay was used for peak and mid luteal estradiol (E2), progesterone (P) and interleukin I-β estimation on OI and ET days respectively. FORT (ratio of preovulatory follicle count to antral follicle count × 100 on OI day) stratified females into low under the 33rd percentile, medium between the 33rd and the 67th percentile and high above the 67th percentile. Characteristics   of groups were compared by one way analysis of variance.  Results: Females 276 (33%), 288 (34%) and 282 (33%) comprised of low, medium and high FORT groups respectively. The number of retrieved, mature and fertilized oocytes, cleaved embryos, endometrial thickness and number of gestational sacs in the high FORT group was significantly high (P <0.001). High peak and midluteal E2 (P = 0.0025, 0.0001), low P (P = 0.0001) and high peak interleukin-1β (P = 0.0001) was observed in high FORT in comparison with medium FORT with resultant greater number of clinical pregnancies 183 (65%).  Conclusions: The FORT in non PCOS patients may reflect good reproductive outcome after ICSI with maximum clinical pregnancies in high FORT group.

Induction of Labour at Term: Comparison of Prostaglandin E2 with Foley Catheter

Background: Induction of labour (IOL) or cervical ripening of an unfavourable cervix can be achieved by both pharmacological and surgical methods. When the cervix is unripe, Foley catheters and prostaglandins method of IOL is used. In this study, we aimed to compare the success rate and cost-effectiveness of vaginal prostaglandin E2 pessary with Foley catheter. Methods: This quasi-experimental study was conducted at the Gynaecological department of Ziauddin hospital from June-December 2019. A total of n=256 women at term were selected according to inclusion criteria. Group 1 was induced with Foley catheter and group 2 with Prostaglandins E2 vaginal pessary. The success rate to achieve delivery, the time interval between induction, delivery and the cost were recorded and compared between the two methods. Student’s t-test (continuous variables) and Chi-square (categories) were used for statistical analysis and p-value < 0.05 was considered statistically significant. Results: The mean age of the females was 27.15 ± 5.5 years. The mean induction to the delivery time interval for PGE2 (group 2) was 15.77 ± 7.37 hours and Foley catheter (group 1) 17.31 ± 7.19 hours (p=0.02). The study did not find any statistically significant difference between the two methods of labour induction(p>0.05). It was found that overall, 198 (77.3%) women delivered by spontaneous vaginal deliveries and 58 (22.7%) by lower Caesarean section (p=0.02, 0.04). However, the total cost of prostaglandins (Rs.1500/-) was higher than the cost of Foley catheter (Rs. 256/-) (p=0.00). Conclusion: Foley catheter to induce labour in an unfavourable cervix is an effective, safe, and inexpensive method of labour induction. Keywords: Foley Catheter; Prostaglandin E2; Induction of Labour; Cost

Low-dose azathioprine and allopurinol versus azathioprine monotherapy in patients with ulcerative colitis (AAUC)::An investigator-initiated, open, multicenter, parallel-arm, randomised controlled trial

BACKGROUND: Retrospective studies suggest that for patients with ulcerative colitis (UC) combination therapy with low-dose azathioprine and allopurinol (L-AZA/ALLO) may result in higher remission rates than monotherapy with azathioprine (AZA). We prospectively investigated the effects of these drugs for remission in patients with moderate-to-severe UC. METHODS: Open-label, unblinded, randomised, controlled, investigator-initiated, multicentre study conducted at eight hospital sites in Denmark. Adult patients with established UC, who were steroid dependent/refractory, thiopurine naïve, had a normal thiopurine methyltransferase, and achieved remission with steroids or infliximab were eligible for inclusion. Patients were randomly assigned by the investigators (1:1) to 52 weeks of treatment with once daily oral AZA (median dose 50 mg) combined with ALLO 100 mg versus AZA monotherapy (median dose 200 mg), using a computer-generated randomisation list with blocks of six. The trial was open without masking. All randomised patients who received at least one dose of study drug were included in primary and safety analyses (intention to treat population). The primary outcome was steroid and infliximab free remission after 52 weeks, defined as a Mayo Score of ≤1 and no rectal bleeding. The trial is completed and is registered in ClinicalTrials.gov (ClinicalTrials.gov NCT03101800). FINDINGS: Between January 9, 2017 and February 10, 2021, 47 patients were randomised to l-AZA/ALLO and 42 to AZA and received at least one dose of the study drug. After 52 weeks, 20 of 47 (43%) patients in the l-AZA/ALLO group and nine of 42 (21%) patients in the AZA group achieved remission (odds ratio 2·54 [95% CI 1·00 to 6.78, p < 0·048]). Fourteen patients (30%) in the l-AZA/ALLO group and 16 (38%) in the AZA group were withdrawn from the study due to adverse events. INTERPRETATION: This study suggests that after one year l-AZA/ALLO therapy may be associated with a beneficial effect on steroid- and infliximab-free clinical remission in patients with moderate-to-severe UC and should be considered as first line therapy. FUNDING: Funding for AAUC was provided by The Capital Region of Denmark (Regionernes Medicinpulje (6062/16))

Nature and extent of perceived stigma among epileptics in Pakistan

Background: Epilepsy is one of the oldest disorders known to mankind. Often the social stigma (whether a “felt” stigma or an “enacted” stigma) attached to epilepsy is a greater handicap to the person with epilepsy compared to the disability associated with seizures or the side-effects from medications. The aim of this study was to explore the perceived sigma and discrimination among epileptics of Karachi, Pakistan.Methods: A descriptive cross sectional study was conducted in Karachi, Pakistan in the year 2016. A standardized pretested semi-structured questionnaire was completed by 120 epilepsy patients selected through purposive sampling from Department of Neurology, Jinnah Postgraduate Medical Centre. Informed verbal consent was obtained prior to the interview. The data were analysed using IBM SPSS Statistics version 22 and Microsoft excel.Results: The average age of the sample participants was 18-50 years. Almost two third (68%) of the respondents were male. More than half (55%) of the sample was educated up to matriculation. Among them 28.5% were married. Three fifth (60%) of participants were unemployed.  More than half (60%) of the respondents reported discrimination in educational opportunities and three fourth (78.5%) in job opportunities. Results indicated that (75%) participants encountered social problem like being discriminated (30%), or segregated (11%) in performance of daily tasks and were avoided (58.8%) to get marry more often with the belief that people with epilepsy are infectious.Conclusions: The study concludes that there is significant perceived stigma among epileptics living in a big metropolitan city of a developing country. The nature of stigma includes discrimination in education, marriage and job opportunities. There is a need for public awareness programmes to address this ignored facet of epilepsy, since it has both medical as well as social implications

Impact of peak estradiol levels on reproductive outcome of intracytoplasmic sperm injection

Objective: To observe effect of peak estradiol (E2) levels on outcome after intra cytoplasmic sperm injection (ICSI).Methods: Quasi experimental design conducted in Islamabad Clinic Serving Infertile Couples from June 2010 till August 2011. Down regulation with mid luteal suppression of 564 females aged 18-41 years was done with gonadotrophin releasing hormone agonist followed by controlled ovarian stimulation, ovulation induction (OI), oocytes pickup and embryo transfer. Samples for peak serum E2 at the time of OI was estimated by Enzyme Linked Immuno Sorbent Assay. The association of peak E2 with outcome groups of Intracytoplasmic sperm injection (ICSI) (Group I) beta hCG \u3c5 m IU/ml, (Group II) with beta hCG\u3e5 mI U/ml and no cardiac activity and (Group III) with beta hCG\u3e5mIU/ml and cardiac activity on trans vaginal scan was identified. Statistical comparison by one way analysis of variance (ANOVA) via SPSS version 15 was done.Results: A clinical pregnancy rate of 36% was achieved, pregnant females(Group III) had higher peak E2 2269 ± 80.97 as compared to 1419 ± 37.07 and 1807±90.28 pg/ml (mean ± SD) in Groups I and II respectively (p\u3c0.0001) Elevated serum E2 was significantly associated with better oocyte recovery, fertilization, cleavage and implantation rates (p\u3c0.0001) .CONCLUSION: A high serum E2 measured on OI day can predict success of treatment after ICSI. Females who had high peak E2 had greater number of retrieved, mature and fertilized oocytes with thick endometrial lining that helped in implantation and clinical pregnancy

Exploring nutritional status, physical activity and body mass index of Pakistani teens

Background: Obesity is becoming an increasingly prevalent problem in Pakistan, as it has in other developing countries. Childhood obesity poses high cost to the well-being and negatively affects children's health, causes chronic disease as children grow older. The aim of this study was to explore nutritional status, physical activity and body mass index (BMI) of school and college going students of mid and late adolescence age (14 to 19 years) studying in multi-ethnic city of Karachi, Pakistan. Methods: A descriptive cross-sectional study was carried out among school and college going students of public and private educational institutes of Karachi, Pakistan. The study sample of 171 students was conveniently selected from these institutes. The data was collected through a semi-structured questionnaire. In order to calculate BMI, the height and weight of each student were measured after completion of the questionnaire. The data were entered and analysed using IBM SPSS version for Windows 20.0 software. Results: The average age of the respondents was 16.2 years with 68% students belonged to school and 32% to College, and 57.3% were males and 42.7% were females. More than half sample (59.6%) participants belonged to privileged and 40.4% to underprivileged class. The sample was eating a wide variety of junk food in daily routine including chips, packed fruit juices, packed flavoured milk, ice creams/ frozen yogurts both at home and at school/college. The physical activity of the school students was found to be better than the college students. No participant had regular activity or strenuous physical games for more than one hour per day. Around one third (38%) respondents used to watch TV or play computer games for more than two hours a day. Almost half of the students' BMI was within the normal ranges, but remaining half of the sample was either overweight or underweight. Conclusions: This study indicates that a large proportion of school and college students had physical inactivity, unhealthy dietary habits and they were overweight. All these interrelated factors were independent of their household socioeconomic condition and ethnicity. There is a need to educate and create awareness about healthy lifestyle among the adolescents and the community at large. [Int J Res Med Sci 2016; 4(8.000): 3563-3569