Frequency and determinants of vitamin D deficiency among premenopausal and postmenopausal women in Karachi Pakistan

Background: Vitamin D deficiency is becoming a serious public health problem, even in sun-drenched cities like Karachi, Pakistan. We investigated the prevalence of vitamin D deficiency and its association with sociodemographic characteristics, anthropometric measures, and lifestyle factors among premenopausal and postmenopausal women (n = 784).Methods: Face-to-face interviews were conducted to collect information and serum concentrations of 25-hydroxyvitamin D were measured after the interviews.Results: A total of 57% of women were vitamin D deficient with higher vitamin D deficiency found among premenopausal women (64.7%) compared to postmenopausal women (49%). The median serum concentrations of 25-hydroxyvitamin D (IQR) were 16.7 ng/ml (IQR 9.8-30.0). Factors associated with vitamin D deficiency were lower socioeconomic status (OR 2.00; 95% CI 1.15-3.48), younger age with highest vitamin D deficiency found in \u3c 35 years of age group (OR 3.11; 95% CI 1.76-5.51), and winter season (OR 1.51, 95% CI 1.07-2.15) after adjusting for multiple confounders. The use of vitamin D supplement (OR 0.59, 95% CI 0.38-0.92) and vigorous exercise (OR 0.20, 95% CI 0.05-0.80) were protective against vitamin D deficiency.Conclusions: The study shows a high prevalence of vitamin D deficiency, with detrimental health effects, among younger women belonging to lower socioeconomic status and during the winter season. The use of vitamin D supplements and vigorous exercise were protective measures. Public health campaigns are needed for education and awareness about vitamin D deficiency to improve vitamin D status for younger women living in poor environments

A Multicentre Case Control Study of Vitamin D and Breast Cancer Risk among Pakistani Women

The prevalence of Vitamin D inadequacy is high worldwide but particularly elevated among women living in Karachi, Pakistan, even though the city is located at a high latitude with year-round adequate concentrations of UVB radiation. Sun exposure is the major source of Vitamin D, but due to multiple factors in the predominately Muslim population and modern lifestyle behaviors, Vitamin D deficiency is becoming a major public health problem. There are new data emerging that highlight the potential protective effect of Vitamin D for breast cancer, but evidence varies between different studies. Therefore, we undertook this study with the overall aim to evaluate the role of Vitamin D in breast cancer among Pakistani women. To meet these objectives, this case control study was conducted in two hospitals of Karachi, Pakistan: Aga Khan University Hospital (AKUH) and Karachi Institute of Radiation and Nuclear Medicine Hospital (KIRAN) during 2015-2017. Breast cancer cases had newly diagnosed histologically confirmed primary breast cancer. Controls were women free of breast or any other cancer were matched by age (year of birth + 5 years), residence in the same geographic area and study site from surgery, family medicine and oncology clinics of AKUH & KIRAN. An interviewer-administered detailed questionnaire was used, and venous blood was collected to measure serum Vitamin D level at the end of interview. The detailed questionnaire provided the opportunity to explore several factors related to breast cancer in this cohort. The objectives of the present study were: 1) To determine the association of Vitamin D (serum Vitamin D (25-hydroxyVitamin D) level, Vitamin D supplementation and sun exposure with breast cancer among Pakistani women, 2) To identify other risk factors associated with breast cancer among Pakistani women, 3) To evaluate the risk factors associated with triple negative breast cancer TNBC and non TNBC subtypes (including hormone receptor status and stage of diagnosis), 4) To evaluate the association of diet with BC among Pakistani women using the modified AHEI 2010 and its component scores 5) to assess patient delay in breast cancer diagnosis, its associated factors and stage of diagnosis among breast cancer patients in Karachi, Pakistan. Main study findings were that Vitamin D deficiency was significantly associated with increased risk of breast cancer, and intake of Vitamin D supplements was associated with decreased risk of breast cancer, supporting the hypothesis that Vitamin D may play a protective role against breast cancer. Other factors associated with increased breast cancer risk were poor socioeconomic status, poor education and lack of employment status. There was no association of any of the reproductive factors or familial risk factors with breast cancer and it is likely that environmental and lifestyle factors related to poor socioeconomic status had a major role in breast cancer etiology. There was an association of an even higher risk of the triple negative breast cancer subtype than non-triple negative breast cancer subtype, among women with both Vitamin D deficiency and poor socioeconomic status. Based on these findings’ correction of Vitamin D deficiency in women is a reasonable and cost effective strategy to reduce the incidence of all subtypes of breast cancer and triple negative breast cancer like aggressive breast cancer in particular. Such an approach should be carefully interpreted and further confirmed by large prospective studies or clinical trials. In another sub study, high intake of grains, both whole and refined, was also significantly associated with a higher risk of breast cancer in Pakistani women. Limiting refined carbohydrate intake might be a beneficial public health message as it may represent a potentially modifiable risk factor for breast cancer in our population but requires additional in-depth study. Breast cancer diagnosis delay study reported that despite noticing a breast lump, 64.9% of women diagnosed with breast cancer delayed medical consultation by a median of 7 months. The recommendation from this study is to provide better education to women about breast cancer awareness, and methods of self-examination and what are the most likely signs of breast cancer. In conclusion, Pakistan is a low-income group country with fifty percent of women below the poverty line. Breast cancer rates and mortality are particularly high among poor women. This study identifies several inexpensive strategies and approaches that if implemented may help reduce the incidence, delay in breast cancer diagnosis and morbidity of breast cancer in Pakistani women.Thesis (Ph.D.) -- University of Adelaide, Adelaide Medical School, 201

Cancer Prevention and Control in Pakistan: Review of Cancer Epidemiology and Challenges

With current situation of increasing burden of cancer in Pakistan, this report reviews studies related to cancer burden and cancer prevention and control in Pakistan. Electronic databases used were PubMed, Medline, EMBASE, the University of Adelaide library & AKU library database, to search for relevant articles on the topic of cancer prevalence in Pakistan published in English. We conducted a literature search of published epidemiological and clinical studies relating to this topic up to March 1st, 2020. There is a dearth of epidemiological studies in cancer risk factors, prevention and control. Most studies are hospital based with small sample sizes and underpowered. Epidemiological integrated transdisciplinary research in collaboration with hospitals is needed to find the actual burden, etiology and feasible prevention strategies of cancer unique to our population with focus on low cost screening methods for early detection of cancers and premalignant lesions in our population. There is an urgent need for a centralized national cancer registry to have combined results of cancer registry from Pakistan Atomic Energy Commission, Karachi Caner Registry, Punjab Cancer Registry and cancer registries from the rest of Pakistan. There is a need to make cancer incidence as notifiable disease mandatory to have the data of cancer incidence in Pakistan. Collaboration is also needed to work with diverse groups like the National Cancer Society of Pakistan (NCSP), National Cancer Control Plan, and Society of Medical Oncology Pakistan to draft and implement plans and strategies for national cancer control programs. It will help mobilize Ministry of Health and policy makers to address the alarming high incidence of different types of cancers in Pakistan

Factors associated with mammographic breast density among women in Karachi Pakistan

Background: There are no studies done to evaluate the distribution of mammographic breast density and factors associated with it among Pakistani women.Methods: Participants included 477 women, who had received either diagnostic or screening mammography at two hospitals in Karachi Pakistan. Mammographic breast density was assessed using the Breast Imaging Reporting and Data System. In person interviews were conducted using a detailed questionnaire, to assess risk factors of interest, and venous blood was collected to measure serum vitamin D level at the end of the interview. To determine the association of potential factors with mammographic breast density, multivariable polytomous logistic regression was used.Results: High-density mammographic breast density (heterogeneously and dense categories) was high and found in 62.4% of women. There was a significant association of both heterogeneously dense and dense breasts with women of a younger age group \u3c 45 years (OR 2.68, 95% CI 1.60-4.49) and (OR 4.83, 95% CI 2.54-9.16) respectively. Women with heterogeneously dense and dense breasts versus fatty and fibroglandular breasts had a higher history of benign breast disease (OR 1.90, 95% CI 1.14-3.17) and (OR 3.61, 95% CI 1.90-6.86) respectively. There was an inverse relationship between breast density and body mass index. Women with dense breasts and heterogeneously dense breasts had lower body mass index (OR 0.94 95% CI 0.90-0.99) and (OR 0.81, 95% CI 0.76-0.87) respectively. There was no association of mammographic breast density with serum vitamin D levels, diet, and breast cancer.Conclusions: The findings of a positive association of higher mammographic density with younger age and benign breast disease and a negative association between body mass index and breast density are important findings that need to be considered in developing screening guidelines for the Pakistani population

Patient delay in breast cancer diagnosis in two hospitals in Karachi, Pakistan: Preventive and life-saving measures needed

Purpose: Patients with breast cancer in Pakistan commonly present with advanced disease. The objectives of this study were to evaluate the frequency and length of delays in seeking medical consultation and to assess the factors associated with them.Methods: Four hundred ninety-nine patients with newly diagnosed breast cancer were enrolled and interviewed over the period from February 2015 to August 2017. Information on sociodemographic factors, delay to medical consultation, stage of breast cancer at presentation, and tumor characteristics of the breast cancer were collected through face-to-face interviews and medical file review.Results: The mean (standard deviation) age of patients with breast cancer was 48.0 (12.3) years. The mean (standard deviation) patient delay was 15.7 (25.9) months, with 55.2% of women detecting a breast lump but not seeking a medical consultation because of a lack of awareness about the significance of the lump. A total of 9.4% of the women decided to seek treatment initially using complementary and alternative medicine and traditional treatment; 9.4% of the women presented to a health care provider with a breast lump but no action was taken, and they were wrongly reassured about the lump without mammography or biopsy. For 26% of the women, the delay in presentation was caused by anxiety, fears and misconceptions regarding diagnosis and treatment, and other social factors including possible adverse effects on their relationship with their husband. Multivariable analysis showed a strong association of lower socioeconomic status (odds ratio [OR], 8.11 [95% CI, 2.46 to 26.69]) and late stage of breast cancer (OR, 4.83 [95% CI, 1.74 to 13.39]) with a patient delay of ≥ 3 months.Conclusion: Patient delay is a serious problem in Pakistan. There is an urgent need for intensive and comprehensive breast cancer education that addresses the myths and misconceptions related to breast cancer

A multicenter case control study of association of vitamin D with breast cancer among women in Karachi, Pakistan

Background: The prevalence of vitamin D inadequacy and breast cancer are both high among women living in Karachi, Pakistan. Methods: A matched case control study was conducted in two hospitals of Karachi, Pakistan to evaluate the association of vitamin D (serum 25-hydroxyvitamin D) concentrations, vitamin D supplementation and sun exposure with breast cancer among Pakistani women. A total of 411 newly diagnosed histologically confirmed primary breast cancer cases were enrolled and 784 controls, free of breast and any other cancers, were matched by age (year of birth ± 5 years), residence in the same geographic area and study site. Information was collected on sociodemographic history, history of vitamin D supplementation, past medical and obstetrical history, family history of breast cancer, sun exposure history, histopathology reports and anthropometric measurement and venous blood was collected to measure serum 25-hydroxyvitamin D (25(OH)D) concentration. Results: Compared to patients with sufficient serum vitamin D (\u3e30 ng/ml), women with serum vitamin D deficiency (\u3c20ng/ml), had a higher risk of breast cancer (OR = 1.65, 95%CI: 1.10, 2.50). Women with history of vitamin D supplementation one year prior to enrollment, had significant protective effect against breast cancer (OR = 0.32, 95% CI: 0.24, 0.43). Conclusions and Recommendation: Serum vitamin D deficiency was associated with increased risk of breast cancer, while vitamin D supplementation was associated with decreased risk of breast cancer. In Pakistani women, where vitamin D deficiency is common, raising and maintaining serum vitamin D at population level is a safe and affordable strategy. It may play a role in reducing the incidence of both vitamin D deficiency and breast cancer, particularly among poor women where the breast cancer mortality is highest due to limited resources for early detection, diagnosis, and treatment. The effects of vitamin D with regard to breast cancer risk in Karachi Pakistan should be further evaluated

A multicentre matched case control study of risk factors for Preeclampsia in healthy women in Pakistan

<p>Abstract</p> <p>Background</p> <p>Preeclampsia is one of the leading causes of maternal and perinatal morbidity and mortality world-wide. The risk for developing preeclampsia varies depending on the underlying mechanism. Because the disorder is heterogeneous, the pathogenesis can differ in women with various risk factors. Understanding these mechanisms of disease responsible for preeclampsia as well as risk assessment is still a major challenge. The aim of this study was to determine the risk factors associated with preeclampsia, in healthy women in maternity hospitals of Karachi and Rawalpindi.</p> <p>Methods</p> <p>We conducted a hospital based matched case-control study to assess the factors associated with preeclampsia in Karachi and Rawalpindi, from January 2006 to December 2007. 131 hospital-reported cases of PE and 262 controls without history of preeclampsia were enrolled within 3 days of delivery. Cases and controls were matched on the hospital, day of delivery and parity. Potential risk factors for preeclampsia were ascertained during in-person postpartum interviews using a structured questionnaire and by medical record abstraction. Conditional logistic regression was used to estimate matched odds ratios (ORs) and 95% confidence intervals (95% CIs).</p> <p>Results</p> <p>In multivariate analysis, women having a family history of hypertension (adjusted OR 2.06, 95% CI; 1.27-3.35), gestational diabetes (adjusted OR 6.57, 95% CI; 1.94 -22.25), pre-gestational diabetes (adjusted OR 7.36, 95% CI; 1.37-33.66) and mental stress during pregnancy (adjusted OR 1.32; 95% CI; 1.19-1.46, for each 5 unit increase in Perceived stress scale score) were at increased risk of preeclampsia. However, high body mass index, maternal age, urinary tract infection, use of condoms prior to index pregnancy and sociodemographic factors were not associated with higher risk of having preeclampsia.</p> <p>Conclusions</p> <p>Development of preeclampsia was associated with gestational diabetes, pregestational diabetes, family history of hypertension and mental stress during pregnancy. These factors can be used as a screening tool for preeclampsia prediction. Identification of the above mentioned predictors would enhance the ability to diagnose and monitor women likely to develop preeclampsia before the onset of disease for timely interventions and better maternal and fetal outcomes.</p

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed