Pattern of drugs of abuse identified in chemical samples

OBJECTIVE: To determine the pattern of drugs of abuse in urine and blood samples processed at referral laboratory in Pakistan so that information on the type of drugs used can be identified and used for ready reference for future strategy. Study Design: Observational study. PLACE AND DURATION OF STUDY: Clinical Laboratory of The Aga Khan University Hospital, Karachi, from July 2006 to March 2008. Methodology: Retrospective review of records were done for the common drugs that are used for screening at the Clinical Laboratory include alcohol, amphetamine, barbiturates, benzodiazepines, cannabinoids, cocaine and opiates. Alcohol was tested in blood and others were identified using urine. Percentages of tests screened positive and negative for individual drugs were computed by using SPSS 16.0. The ratio between male and female users was also established. RESULTS: A total of 17,714 tests were performed for drugs. The mean age of the patients whose samples were processed was 30+/-14.84 years. Majority used benzodiazepines 520/1317 (39.5%) among the samples tested for drug of abuse, followed by cannabinoids 423/5450 (7.8%), alcohol 75/1302 (5.8%), barbiturates 32/1148 (2.8%), opiates 137/5640 (2.4%), cocaine 5/1655 (0.3%) and amphetamine 3/1202 (0.2%). In all, males 15411 (87%) were tested more frequently as compared to females 2303 (13%). CONCLUSION: Males were more frequently tested for drug abuse; however, drug abuse is increasingly seen among females. Benzodiazepines are the most frequently used. The same pattern of drugs abuse existed in different gender and age group. There is a need to explore the pattern and type of drug abuse on national scale

Validation of a food frequency questionnaire for assessing Macronutrient and calcium intake in adult Pakistani population

Objective: To develop and validate a food frequency table (FFQ) for use in urban Pakistani population. Study Design: A validation study. Place and Duration of Study: The Aga Khan University, Karachi, from June to November 2008. Methodology: Healthy adult females, aged ≥ 18 years who consented to be included in the study were inducted, while males, unhealthy females, aged below 18 years or who did not consent were excluded. The FFQ was administered once while 4, 24 hours recalls spread over a period of one year were administered as the reference method. Daily intakes for energy, protein, fat, and calcium intake were estimated for both the tools. Crude and energy adjusted correlations for nutrient intakes were computed for the FFQ and mean of 4, 24 hours recalls and serum N-telopeptide of type-I collagen (NTx). Results: The correlation coefficients for the FFQ with mean of 4, 24 hours recall ranged from 0.21 for protein to 0.36 for calcium, while the correlation for nutrient estimates from the FFQ with NTx ranged from -0.07 for calcium to 0.01 for energy. Conclusion: Highly significant correlations were found for nutrient intakes estimated from the FFQ vs. those estimated from the mean of 4, 24 hours recalls but no correlations was found between nutrient estimates from the FFQ and serum NTx levels. FFQ was concluded to be a valid tool for assessing dietary intake of adult females in Pakistan

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Assessing the effect of dietary calcium intake and 25 OHD status on bone turnover in women in Pakistan

Summary: Bone health assessed in three towns of Karachi, Pakistan in females showed poor calcium intake, vitamin D deficiency, secondary hyperparathyroidism, and high bone turnover. Correlates of high bone turnover included females residing in Saddar Town, underweight females less than 30 years of age from low socio-economic status, and secondary hyperparathyroidism. Aims: To assess bone health and association of dietary calcium and 25 hydroxy vitamin D with bone turnover in the community-dwelling females of Karachi. Methods: Bone health was assessed in three randomly selected towns of Karachi, Pakistan. One premenopausal female fulfilling the inclusion criteria from each household was included in the study. Dietary calcium was assessed through a food frequency questionnaire and biochemical markers including calcium, phosphates, albumin, magnesium, creatinine, and SGPT, intact parathyroid hormone, 25 hydroxy vitamin D, and N-telopeptide of type I collagen were measured to assess the bone health. Results: Three hundred and five females were included from three towns. Overall, 90.5% of females had vitamin D deficiency with 42.6 and 23.3% having secondary hyperparathyroidism and high bone turn over respectively. Prevalence of vitamin D deficiency, secondary hyperparathyroidism, and high bone turnover was significantly different among towns. Mean vitamin D levels were significantly low and iPTH levels significantly high in females with high bone turnover. Calcium intake was not significantly different among females with normal, high, and low bone turnover. Correlates ofhigh bone turnover included females residing in Saddar Town, underweight females less than 30 years of age belonging to low socio-economic status, and secondary hyperparathyroidism. Conclusion: Compromised bone health is seen in community-dwelling females of Karachi. There is a need to perform large-scale community-based studies in all age groups to understand the interplay of markers in our population to understand the impact of these variables translating into the risk of osteoporosis

Role of therapeutic plasma exchange in the treatment of severe hypertriglyceridemia: an experience

Hypertriglyceridemia of obesity, the metabolic syndrome, and type II diabetes mellitus are highly prevalent in Saudi Arabia. Severe hypertriglyceridemia is a rare but well known cause of acute pancreatitis. In treatment pancreatic rest, lifestyle changes, and lipid-lowering medications are essential, but the response is slow. Recently the role of therapeutic plasma exchange (TPE) has been stressed for fast and effective management in addition to insulin and heparin infusion. TPE for hypertriglyceridemic pancreatitis resulted in drastic improvements in clinical and laboratory findings and patient outcomes as suggested in our cases. However, this procedure is limited due to its high cost and availability only in specialized hospitals

Prevalence of vitamin D deficiency and its correlates: results of a community-based study conducted in Karachi, Pakistan

UNLABELLED: Of the 305 premenopausal females in a cross-sectional study in randomly selected communities of Karachi, Pakistan, 90.1 % showed to be vitamin D deficient. Age, town of residence, and housing structure were significant predictors of vitamin D levels. Measures to address D deficiency and its associated long latency effects are urgently needed.AIMS: This study aims to find out the prevalence and risk factors of vitamin D deficiency in community-dwelling premenopausal females in Karachi.Methods: A cross-sectional study was conducted in randomly selected communities downtown (Saddar) and suburbs (Gulshan and Malir Town) in Karachi, Pakistan. Information related to sociodemographics (age, education, employment, and household income), housing structure, sunlight exposure, and skin pigmentation as well as dietary intake (using a food frequency questionnaire) was collected. Serum vitamins D(3) levels were also measured. Mean and SD was computed for continuous variables and frequency and proportions were computed for categorical variables. Data were further analyzed by Chi-square test and ANOVA. Multiple linear regression analysis was done to find out determinants of vitamin D (VD) levels.Results: Total of 305 premenopausal females were recruited. Mean age, BMI, and waist circumference of the study participants was 31.97±8 years, 25.06±5.6 kg/m(2), and 88.42±13.3 cm, respectively. Majority of the females were vitamin D deficient (91.50 %) with mean vitamin D levels of 21.77±21.66 nm/L. Mean vitamin D levels were significantly different among females residing in downtown and suburbs. High frequency of vitamin D deficiency was observed in females dwelling in downtown (Saddar). According to the results of multiple linear regression analysis, determinants of VD levels were age, town of residence, and housing structure.CONCLUSION: High prevalence of vitamin D deficiency is seen in females in the community of Karachi, Pakistan. Age, town of residence, and housing structure were the significant predictors of vitamin D levels. Measures to combat the issue of D deficiency and its associated long latency effects are urgently needed

Bone health status of Premenopausal healthy adult females in Pakistani females

Bone health status in healthy premenopausal females was assessed. We found high bone turnover in 36.8 % and vitamin D deficiency and insufficiency in 82.8 and 16.1 %, respectively, and secondary hyperparathyroidism in 25.9 % of the subjects. This is alarming as there is inability to achieve peak bone mass and predisposes to osteoporosis risk. Purpose: This study aimed to assess bone health status in healthy females by using biochemical markers of bone metabolism in blood [N-telopeptide of type I collagen (NTx), 25-hydroxyvitamin D (25OHD), and plasma intact parathyroid hormone (iPTH)]. Material and methods: One hundred and seventy-four healthy premenopausal female volunteers were recruited from an urban residential area in Karachi. Demographic details were collected on a preformed questionnaire. Blood samples for the estimation of serum NTx, 25OHD, and plasma iPTH were taken in a fasting state. Data were analyzed using Statistical Package for Social Sciences 16.0. A p value of \u3c0.05 was considered as significant. Results: High bone turnover, as depicted by NTx, was seen in 36.8 % cases. Vitamin D deficiency, insufficiency, and sufficiency were seen in 82.8, 16.1, and 1.1 % respectively. Secondary hyperparathyroidism was present in 25.9 % of the subjects, while others had blunted PTH response. Significant correlates of bone health were serum 25OHD levels, duration of sun exposure, and the practice of wearing veil (p value \u3c 0.001). Conclusion: 56++56+Bone turnover is high with high prevalence of vitamin D deficiency in apparently healthy premenopausal females predisposing them to higher risk for development of osteoporosis