Association of tobacco use and other determinants with pregnancy outcomes: a multicentre hospital-based case-control study in Karachi, Pakistan.

OBJECTIVES: The study aimed to identify the effects of maternal tobacco consumption during pregnancy and other factors on birth outcomes and obstetric complications in Karachi, Pakistan. DESIGN: A multicentre hospital-based case-control study. SETTING: Four leading maternity hospitals of Karachi. PARTICIPANTS: A random sample of 1275 women coming to the gynaecology and obstetric department of selected hospitals for delivery was interviewed within 48 hours of delivery from wards. Cases were women with adverse birth outcomes and obstetric complications, while controls were women who had normal uncomplicated delivery. PRIMARY AND SECONDARY OUTCOME MEASURES: Adverse birth outcomes (preterm delivery, low birth weight, stillbirth, low Apgar score) and obstetric complications (antepartum haemorrhage, caesarean section, etc). RESULTS: Final multiple logistic regression analysis revealed that with every 1 year increase in age the odds of being a case was 1.03 times as compared with being a control. Tobacco use (adjusted OR (aOR): 2.24; 95% CI 1.56 to 3.23), having no slits in the kitchen (proxy indicator for indoor air pollution) (aOR=1.90; 95% CI 1.05 to 3.43), gravidity (aOR=0.83; 95% CI 0.73 to 0.93), non-booked hospital cases (aOR=1.87; 95% CI 1.38 to 2.74), history of stillbirth (aOR=4.06; 95% CI 2.36 to 6.97), miscarriages (aOR=1.91; 95% CI 1.27 to 2.85) and preterm delivery (aOR=6.04; 95% CI 2.52 to 14.48) were significantly associated with being a case as compared with control. CONCLUSIONS: This study suggests that women who had adverse pregnancy outcomes were more likely to have exposure to tobacco, previous history of adverse birth outcomes and were non-booked cases. Engagement of stakeholders in tobacco control for providing health education, incorporating tobacco use in women in the tobacco control policy and designing interventions for tobacco use cessation is warranted. Prenatal care and health education might help in preventing such adverse events

Dynamics of Wheat Market Integration in Northern Punjab, Pakistan

The economy of Pakistan is largely dependent on the agriculture sector which contributes about 21 percent to the GDP and employs about 43.4 percent of the labour force. Agriculture and agro-based industrial products contribute about three fourth of the total foreign exchange earnings from export [Pakistan (2007)]. About 66 percent of the population lives in rural areas of Pakistan and directly or indirectly depends on agriculture for its livelihood. The welfare and participation of the rural population in the economy is therefore, central to the country’s progress. Despite the importance of agricultural sector in the national economy, there is a wide gap between food supply and demand due to low performance of agriculture [FAO (2000)]. The country is not producing enough commodities like wheat, rice and edible oil etc. to meet even the basic food needs of the population and as a consequence poverty is on the rise, particularly in the rural areas. In order to reduce poverty, agriculture has to grow faster and at a sustainable basis

Diversity of Mosquitoes Collected from the Southern Areas of Khyber Pakhtunkhwa Pakistan

OBJECTIVES: The objective of the study was to assess the diversity of mosquitoes in various towns of the southern belt of KPK. METHODOLOGY: This was a descriptive study that was conducted in numerous towns of Western belt of Khyber Pakhtunkhwa. The study areas were Darra Adam Khel, District Kohat, District Karak, District Banu, District D.I. Khan and newly merged districts Mir Ali and Miranshah. From each study site, the samples were collected randomly. The sample collection was done through survey and area visits whereas; the identification process was done in a parasitology laboratory of Hayatabad-Peshawar. Sampling was done from June 2016 to May 2017. RESULTS: A total of 2150 adult mosquitoes were gathered and collected from 42 different locations of the southern belt of KPK and were identified. Based on their identification, 5 genera of the mosquitoes were recognized which were Culex, Anopheles, Psorophora, Aedes and Uranotenia. Culex was found to be most dominant in all the visited areas with a percentage of 12.65 in Miranshah followed by 11.81 in Mirali, 7.16 in Karak, 6.88 in Darra Adam Khel, 6.69 in D.I.Khan, 6.41 in Kohat and 5.11 in Bannu respectively. The results of our findings also revealed the presence of Culex genera in all the habitats and remained the dominant genera among the others followed by Anopheles and Psorophora. Aedes was found in the habitat of plants and grasses etc. whereas Uranotenia was found in marsh/swampy areas as well as in plants/grasses habitat only. CONCLUSION: The outcomes reveal that a climate shifting and extensive urbanization process is enforcing the diversity of mosquitos’ fauna in the southern belt of KPK

Consumption Behavior and Household Economies of Scale An Analysis of Variations across Rural-Urban Regions of Pakistan

The study attempts to explore the expenditure elasticities of various food items across the provinces of Pakistan while taking in to account the rural and urban regions separately. Household Integrated Income and Consumption Survey (hereafter HIICS) data for the year 2015-2016 is utilized. In addition, the household economies of scale towards the consumption are also being focused on the same lines. The study has made use of double log specification of Engel curve. The included 20 food items are appeared as normal commodities having expenditure elasticity less than one. All the expenditure elasticities have positive signs and are less than one which shows that all the food commodities are necessities and normal goods i.e. as income increases their expenditure will increase at a decreasing rate. The negative sign of the household size depicts that there is a negative relationship with consumption i.e. supports the notion that households with higher family size enjoy the economies of scale towards the consumption of food

Short course adjuvant terlipressin in acute variceal bleeding: A randomized double blind dummy controlled trial

Background & Aims: Terlipressin is recommended for 3-5 days as adjuvant to endoscopic variceal band ligation (EVBL) in esophageal variceal bleeding (EVB). We assessed whether terlipressin can be administered for a shorter period of time to Patients with EVB. Methods: All eligible EVB Patients received 24 h of open label terlipressin at presentation. After successful EVBL, Patients were randomized to receive active or dummy terlipressin for the next 48 h. We excluded Patients with failure to achieve initial hemostasis, bleeding gastric varices, known hepatoma, and/or portal vein thrombosis, advanced cirrhosis (Child-Pugh score \u3e= 12), and Patients on a ventilator. The primary outcome was failure to control EVB. The secondary outcomes were 30-day mortality, re-bleeding and composite outcome of failure to control EVB. Results: A total of 130 eligible Patients were randomized to receive terlipressin for a total of 24 (short course or SC) or 72 h (usual course or UC). Baseline Patient characteristics were comparable, the majority of Patients were HCV-infected and male. There was one failure to control EVB (1.5%) in UC and none in SC terlipressin (p = 0.50). The 30-day re-bleeding rate was 1.5% and 3.1% in UC, and SC terlipressin, respectively (p = 0.50). The 30-day mortality was 12, 6 (9.2%) Patients in each group (p = 0.50). The 30-day failure to control bleeding was observed in 14 Patients, seven in each group (p = 0.494). Conclusions: In Patients with esophageal variceal bleeding, a 24-h course of terlipressin is as effective as a 72-h course when used as an adjunctive therapy to successful EVBL

Furazolidone, Co-amoxiclav, Colloidal Bismuth Subcitrate, and Esomeprazole for patients who failed to eradicate Helicobacter pylori with triple therapy

There is increasing evidence of Helicobacter pylori (H. pylori) resistance to the classical triple therapy consisting of a proton-pump inhibitor and clarithromycin with either amoxicillin or metronidazole. This study is aimed at establishing the efficacy and safety of a 14-day regimen to eradicate H. pylori in patients who have failed with the classical triple therapy given for 14 days. One hundred seventy-six patients diagnosed to have H. pylori infection were given triple therapy for 14 days. Fifty-two patients who failed to respond as evident from positive 14C-urea breath test (UBT) done 4–6 weeks after the completion of triple therapy were offered a combination regimen comprised of furazolidone 200 mg b.i.d, co-amoxiclav 1 g b.i.d., colloidal bismuth subcitrate 240 mg b.i.d., and esomeprazole 40 mg b.i.d. for 14 days. The mean age of these patients was 41 ± 13 years (range 20–67). Thirty-four were males. To document eradication of H. pylori, UBT was repeated 4 weeks after the completion of treatment. On an intention-to-treat analysis, the eradication rate was 81% (42 out of 52) whereas on per-protocol basis, the eradication rate was 82.4% (42 out of 51). In conclusion, this new regimen represents a suitable second-line therapy

Role of N-acetylcysteine in adults with non-acetaminophen-induced acute liver failure in a center without the facility of liver transplantation.

PURPOSE: We aimed to study the role of N-acetylcysteine (NAC) in non-acetaminophen-induced acute liver failure (NAI-ALF). METHODS: A total of 47 adult patients were prospectively enrolled with NAI-ALF (group 1 or NAC group) and oral NAC was given. The primary outcome was reduction in mortality with the use of NAC in NAI-ALF. The secondary outcomes were to evaluate safety of NAC and to assess factors predicting mortality. We compared these results with records of NAI-ALF patients admitted in our hospital from 2000 to 2003 (n = 44) who were not given NAC (group 2 or historical controls). RESULTS: The two groups were comparable for the etiology of ALF, prothrombin time (PT), alanine aminotransferase, creatinine, albumin, etc. The mean age in group 1 was 27.7 ± 11.8 years and in group 2 37.5 ± 18.8 years (P = 0.004). Bilirubin was 20.63 ± 11.03 and 14.36 ± 8.90 mg/dl in groups 1 and 2, respectively (P = 0.004). There were 8 (17%) and 1 (2.3%) pregnant ALF women with acute hepatitis E virus (HEV) infection in groups 1 and 2, respectively (P = 0.031). All patients were given supportive care, including mechanical ventilation. A total of 34 (37.36%) patients survived; 22 (47%) in group 1 (NAC group) and 12 (27%) in group 2 (controls) (P = 0.05). On multivariable regression analysis, patients not given NAC (odds ratio [OR] = 10.3, 95% confidence interval [CI] = 1.6-65.7), along with age older than 40 years (OR = 10.3, 95% CI = 2.0-52.5), PT more than 50 s (OR = 15.4, 95% CI = 3.8-62.2), patients requiring mechanical ventilation (OR = 20.1, 95% CI = 3.1-130.2), and interval between jaundice and hepatic encephalopathy (OR = 5.0, 95% CI = 1.3-19.1) were independent predictors of mortality