Search

Residential exposure to greenness has shown positive influences on pregnancy outcomes like birth weight, preterm births, and small to gestational age (SGA) deliveries. We aimed to comprehensively review and investigate these associations by conducting a systematic review with meta-analysis. Relevant studies were retrieved from PubMed, EMBASE, ScienceDirect, and Google Scholar databases before June 2023. Summary effect estimates included birth weight, low birth weight (LBW), preterm births, and SGA which were calculated for 0.1 unit increase in residential greenness exposure. Overall quality of the evidence was examined through Joanna Briggs Institute (JBI) critical appraisal tool. The review included 31 articles and found a statistically significant increase in birth weight measured at 250 m buffer distance (β = 8.95, 95% CI = 1.63–16.27). Green spaces were also associated with lower odds of LBW (OR = 0.97, 95% CI = 0.96–0.98). Residential greenness had positive impacts on pregnancy outcomes that calls for emphasis on urban planning, especially in developing countries. [ABSTRACT FROM AUTHOR]

Objective: To determine the pattern, tumor characteristics of esophageal cancer (EC) and survival of esophageal carcinoma patients presenting to upper GI Unit at Dr. Ruth K.M. Pfau Civil Hospital Karachi. Methods: We conducted a retrospective analysis of histologically confirmed EC patients from 2016 to 2021 at Upper GI Unit - Dr. Ruth K.M. Pfau Civil Hospital, Karachi. Data were collected using a filled Proforma, medical records, pathology reports and surgical notes, and patients or their family members were contacted for informed consent. Statistical analyses were performed using STATA version 16.0. Time to event was measured from the date of diagnosis to the date of the last follow-up or recorded death. Descriptive statistics and survival analyses, including Kaplan-Meier method and log-rank test, were employed. Univariate and multivariate Cox regression analyses were conducted to assess independent predictors of survival. Results: Total 152 patients with a median age of 45 (range 80-15) years were enrolled in this study. Clinical stages-III, IV-A and IV-B were identified in 35.5% (n = 54), 23.7% (n = 36) and 34.2% (n = 52), respectively. Total of 62% (n=94) had died at median follow up of 9.56 months and three years overall survival rate was 10.0%. Univariate survival analysis revealed that patients with clinical stage-II (p-value 0.002) and patients treated with combined surgery plus chemo-radiotherapy (p-value 0.040) was significantly associated with lower risk of mortality among other stages and treatment modality groups. Conversely, patients having metastasis (p value <0.001) and those with vascular involvement >90 degrees (p value <0.001) showed worse survival outcomes. Conclusion: Our study reveals a three years survival rate of 10.0%, emphasizing the formidable challenge of advanced-stage malignancies. Clinical stage, vascular involvement, and metastasis emerged as significant predictors of mortality. Moreover, integrating surgery with chemo-radiotherapy significantly improved three years survival (36.8% vs. 14.2%). Despite single-center limitations, our findings provide crucial regional insights into esophageal carcinoma outcomes. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of different causes of Lower GI bleeding on colonoscopy in younger aged patients. Study type, settings & duration: This prospective, cross-sectional study was conducted at Endoscopy Unit, National Institute of Liver and Gastrointestinal Diseases, Dow University of Health Sciences, Karachi from September 2020 to September 2021. Methodology: In this study, patients presenting with lower GI bleed who underwent colonoscopy at inpatient, outpatient department and referral cases were asked to participate after obtained informed consent from them. The sampling technique used was consecutive sampling. Results: This study included 197 patients, 106 (53.8%) of whom had hemorrhoids alone, 59 (29.9%) had simultaneous diagnosis of hemorrhoids with other etiology, and 32 (16.2%) had aetiologies besides hemorrhoids. Hemorrhoids caused the most lower gastrointestinal bleeding (53.8%), followed by nonspecific ilietis/colitis (17.8%) and polyps (9.1%). Hemorrhoids affected older people and males more. Hemorrhoids were also more common among married and addict patients as compared to unmarried and non-addicted patients. Haemorrhoids was associated with increased weight loss (39.4% vs. 21.2%, p-value = 0.010) as well as antibiotic usage (35.1% vs. 32.4%, p-value = 0.006). Conclusion: The study reveals a significant association between age, gender, marital status, addiction history, weight loss, and antibiotic usage in the diagnosis and treatment of lower gastrointestinal bleeding. [ABSTRACT FROM AUTHOR]

Objective: Breast cancer prevalence in Pakistan is among the highest in Asian countries. Recent changes in the temporal trends of breast cancer are largely unknown and examination of these trends can provide a direction in national planning for future health programs. The aim of this study was to examine recent changes in breast cancer incidence in Pakistan. Methods: A total of 9,771 diagnosed breast cancer women were registered from 2004 to 2015 in three hospitals of Karachi. Join-point regression analysis was applied to assessing the age-standardized breast cancer presentation trends for each five-year age group. Age-specific average annual percentage changes were also calculated to assess the proportion of women with increased or decreased incidence of breast cancer. Results: Age-standardized rates of breast cancer steadily increased from 24.7 per 100,000 in 2004, to 45.4 per 100,000 in 2015. The analytical trend based on the join-point model showed an average percentage increase breast cancer prevalence of 5.4 (95% CI = 3.1, 7.8). Significantly higher prevalence rates were identified among women aged 40-44 years and 65-69 years with an average percentage change of 18.5 (95% CI = 2.3, 37.2) and 14.3 (95% CI = 2.2, 27.9) respectively in the four years from 2011 to 2015. Conclusion: The findings indicate the trend in age-standardized prevalence increased significantly in all age groups with noticeably larger increases observed among older and post-menopausal women from 2011 to 2015. The results warrant the need for more targeted interventions to high-risk groups and a sound foundation for cancer control program planning and policy development in Pakistan to reduce the increasing incidence of breast cancer. [ABSTRACT FROM AUTHOR]

Background: The evaluation of degree of liver fibrosis is an important prognostic factor in the management of NAFLD patients. Noninvasive risk stratification is needed to triage individuals with advanced fibrosis for optimal treatment and surveillance. Objective: To find the frequency of fibrosis in NAFLD patients using multiple non-invasive tests and to match the performance of noninvasive tests in diagnosing liver fibrosis. Methods: An observational study done in Out-patient Clinics of National Institute of Liver and GI diseases (NILGID), Dow University Hospital from January 2021 to January 2022. All consecutive NAFLD patients during the study period were enrolled. Liver fibrosis was assessed in each patient with non invasive scoring including APRI score (AST to platelet ratio index), AST/ALT ratio, NFS (NAFLD fibrosis scores) and FIB-4. Results: 322 patients (mean age 44.84 ±10.94 years) were included. The mean values for ALT and AST levels were 40.67 ± 31.69IU/L and 31.85 ± 22.60 respectively. The best diagnostic accuracy was observed with FIB4 score having AUROC of 0.904. A robust correlation was observed between APRI index and FIB-4 score (r = 0.734, p-value < 0.01), and between FIB-4 score and NFS score (r = 0.700, p-value <0.01). Whereas correlation of APRI index with NFS score was moderate (r=0.394), and with AST/ALT ratio was weak (r = 0.201). Conclusion: Noninvasive markers, FIB4 and NFS score demonstrate a dependable ability to diagnose and rule out liver fibrosis, which proves to be an economical approach in management of patients with NAFLD. [ABSTRACT FROM AUTHOR]

Objectives. Musculoskeletal disorders (MSDs) have a high prevalence among allied health care providers because of the demanding nature of their work and lack of practicing proper ergonomics. The aim of this study focused on patterns of work-related musculoskeletal disorders (WMSDs) affecting different health care providers working in a different unit of a tertiary care hospital. Methods. This cross-sectional study collected data from 2000 allied health care providers working at various departments of Civil Hospital and Dow University Hospital of Karachi (DUHS), via self-administered questionnaire, based on Occupational Safety and Health Administration (OSHA) guidelines. Results. Our findings revealed that 92.9% of individuals had MSDs as a result of poor ergonomics, with 93% reporting that the disease interferes with their normal job routine. Conclusions. Medical technologists are the most affected group among allied health care workers. Lack of knowledge and improper ergonomic culture results in such a high prevalence rate in allied health care workers in Pakistan. [ABSTRACT FROM AUTHOR]

Aims: To assess the seasonal variations in hematological disorders among patients diagnosed on the basis of bone marrow biopsy, who attended National Institute of Blood Diseases (NIBD) clinics during 2006 to 2015. Methods: We retrospectively reviewed the 10‐year records of hematological disorders among patients' NIBD clinics from year 2006 to 2015. All cases of aplastic anemia (AA), acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), immune thrombocytopenic purpura (ITP), and acute promyelocytic leukemia (APML) were categorized on the basis of the seasons in which they were diagnosed such as winter (December‐February), spring (March‐May), southwest monsoon periods (June‐September), and retreating monsoon period (October and November). Statistical analysis was performed by using SPSS and STATA. Inferential statistics were explored using the chi‐square test for heterogeneity to evaluate seasonal variations. P‐value <0.05 was taken as significant. Results: A total of 1982 cases were reviewed. Men were predominantly higher (n = 1190, 60%) as compared to women (n = 792, 40%). Frequency of ALL was found to be higher (513, 25.9%), followed by ITP (504, 25.4%), AML (490, 24.7%), AA (396, 20%), while APML was observed in only 79 (4%) patients. Seasonal variations in the diagnosis of hematological disorders were observed (P‐value <.001), except in APML diagnosis (P‐value =.445). Significant seasonal variations were also detected in both genders in stratified analysis. Conclusion: The finding of this study has reported an increase in the hematological disorder during 2006 to 2015. Particularly, majority of the cases were reported in southwest monsoon period, whereas least cases were reported in retreating period. Significant seasonal and yearly variations were detected in all diagnosis except the APML. [ABSTRACT FROM AUTHOR]