Areca Nut Chewing and the Risk of Re-hospitalization and Mortality Among Patients With Acute Coronary Syndrome in Pakistan / 예방의학회지

OBJECTIVES: Areca nut is widely consumed in many parts of the world, especially in South and Southeast Asia, where cardiovascular disease (CVD) is also a huge burden. Among the forms of CVD, acute coronary syndrome (ACS) is a major cause of mortality and morbidity. Research has shown areca nut chewing to be associated with diabetes, hypertension, oropharyngeal and esophageal cancers, and CVD, but little is known about mortality and re-hospitalization secondary to ACS among areca nut users and non-users. METHODS: A prospective cohort was studied to quantify the effect of areca nut chewing on patients with newly diagnosed ACS by categorizing the study population into exposed and non-exposed groups according to baseline chewing status. Cox proportional hazards models were used to examine the associations of areca nut chewing with the risk of re-hospitalization and 30-day mortality secondary to ACS. RESULTS: Of the 384 ACS patients, 49.5% (n=190) were areca users. During 1-month of follow-up, 20.3% (n=78) deaths and 25.1% (n=96) re-hospitalizations occurred. A higher risk of re-hospitalization was found (adjusted hazard ratio [aHR], 2.05; 95% confidence interval [CI], 1.29 to 3.27; p=0.002) in areca users than in non-users. Moreover, patients with severe disease were at a significantly higher risk of 30-day mortality (aHR, 2.77; 95% CI, 1.67 to 4.59; p < 0.001) and re-hospitalization (aHR, 2.72; 95% CI, 1.73 to 4.26; p < 0.001). CONCLUSIONS: The 30-day re-hospitalization rate among ACS patients was found to be significantly higher in areca users and individuals with severe disease. These findings suggest that screening for a history of areca nut chewing may help to identify patients at a high risk for re-hospitalization due to secondary events.

Lead poisoning due to herbal remedies for infertility: a case report

Lead poisoning remains a major public health problem due to lack of awareness of its ill effects among the clinical community. The non-availability of information on lead levels at primary health centers results in many lead poisoning cases being treated symptomatically, without the diagnosis being sought. We report a case that presented with abdominal pain and vomiting which eventually turned out to be due to lead poisoning secondary to herbal medicine taken as treatment for infertility

Public health problems in low and high socio economic areas of Karachi, Pakistan

Despite many media campaigns by government and private sectors highlighting, water and sanitation treatment plans and policies, the public health problems are still common in different socioeconomic areas. The objective of our study was to explore the major public health problems prevailing in two different socioeconomic areas. The objective of our study was to explore the major public health problems prevailing in two different socio economic areas in Karachi, Pakistan. A cross sectional survey was conducted from January 1, 2008, to June 15, 2008. Convenience sampling was used to select the EVACUE housing situated and model village. From each house selected, interviews were conducted based on one participant per house. The main outcome variables were measure of different qualities of drinking water safety, taste, etc. Problems of waste and sanitation included disposal of solid waste and leakage of drainage system in the area. The results found water quality to be good with safe drinking water and less residents complained in EVACUEE as compared to Model. Health problems of drinking water and sanitation were more prevalent in low socio economic areas as compared to higher socio economic area