review on requirements for vitamin D fortification in Pakistan

Despite the fact that Pakistan is a country situated near equator and has plenty of sunshine, it still has major population deficient in vitamin D3. The majority of food opted by general public is not sufficient source of vitamin D. For the reason vitamin D fortification is a compulsory requirement for healthy living. Developed countries like United Kingdom and Canada have overall improved their population vitamin D status by fortifying foods with vitamin D. For applying a well maintained vitamin D food fortification strategy in Pakistan , it is necessary to review various methods , type of food and their fortification results implemented all over the world. This review investigates all such prospective approaches which could be used for the fortification of foods in Pakistan. Looking at the socio economic status the majority of Pakistani residents, vitamin D fortification of staple foods such as whole grains, flour and rice by spray methods might serve as viable approaches in targeting majority of Pakistani population to ingest and improve their vitamin D status

review of vitamin D in Pakistani population

Vitamin D is a secosteroid which has an important function in bone metabolism and immunomodulation. Decreased levels of vitamin D are associated with many critical diseases like cardiovascular, cancer, diabetes, tuberculosis and osteoporosis. Low vitamin D can cause obesity and restrict bone growth and bone health in children and adults. Despite being near to equator, Pakistani citizens suffer from low vitamin D levels making them prone to many diseases and there is no guidelines for the treatment of vitamin D deficiency in general and diseased population of Pakistan. This review highlights the prevalence of vitamin D in different disease as well as healthy groups of Pakistani citizens through literature search. Further it also reviewed the literature available on knowledge of clinicians about vitamin D deficiency and its affects

Prevalence of shisha smoking in college, university and madarsa students aged 20-25 years in Pakistan

To estimate the prevalence of shisha smoking, its trends and associated factors in college, university and madarsa students aged 20-25 years in Pakistan. This survey was done on 7582 subjects belonging to 71 institutions from five cities and Federal Capital Islamabad, using a population based sample. Data was collected using cluster sampling from public/private colleges, universities and madarsas. After taking informed consent, about 10% students from each speciality including both genders were collected using a structured self administered questionnaire designed in Urdu and English. Variables included age, gender, socio-economic status, habits, trends, knowledge and perceptions about shisha smoking. The study was approved by Institutional Review Board. Data was analyzed on SPSS version 15 and chi square was used for statistical significance. Out of 71 educational institutions, 43 were public and 28 private including 8 madarsas. There were 2971 students from professional and 4174 from non-professional institutions. Overall prevalence of shisha smoking was 19.7% [n=1410] being more common in males [29.8%] than females [10.4%] Students started smoking shisha at 17-18 years age [57.2%] and almost 75% started this habit in year 2009-2010. The highest prevalence of shisha smoking was seen in Federal Capital Islamabad [28.1%], and lowest in Peshawar [11.2%]. The shisha smoking was more in professional and private educational institutions [p<0.000] with almost 29% students using it in engineering colleges and none using it in madarsas [alma/alia courses]. The trend was highest in students belonging to high socio-economic status [30.7%] and those already smoking cigarettes [74.1%] Pleasure seeking was the commonest reason for smoking shisha [7.1%] and almost 11% students were influenced by their friends. Shisha cafe's were site used by most smokers and majority preferred double apple or mint flavor. Almost a quarter [23.8%] students smoked shisha just for enjoyment and 12.1% thought that it is less harmful than cigarette smoking. Almost 20% students in colleges and universities are smoking shisha. Majority thinking shisha to be harmless or less harmful than cigarette smoking indicating that knowledge about adverse effects of shisha smoking is tremendously low in this educated youth of our country. Shisha should be subjected to the same regulation as cigarettes and other tobacco products and public should be educated about its harmful effects

Dermatological manifestations of dengue fever

Each year dengue related infections are rising in tropical countries. There is not enough data available on dermatological manifestations of dengue fever. This study was conducted to investigate prevalence and type of dermatological manifestations of dengue fever [DF], Dngue Haemorrhagic Fever [DHF], and Dengue Shock Syndrome [DSS]. A Prospective study was contacted in Department of Medicine, Shaikh Zayed Hospital, Lahore, from 3[rd] Oct to 20[th] Nov 2010. Specific serological tests for DF were done in all 60 patients admitted with suspected diagnosis of DF, DHF or DSS. Forty-eight confirmed cases were evaluated for age, gender, mucocutaneous features and outcome of the disease. Forty-eight out of 60 patients had positive serology for dengue fever. Male to female ratio was 1.09:1. Their ages ranged 5-68 years with a mean of 31.5 +/- 15.2. DF, DHF and DSS were found in 71%, 19% and 10% respectively. Common dermatological presentations were oral mucous membrane congestion [66.67%], generalised morbiliform rash [64.58%] and eye congestion [64.58%]. Purpuric spots along with mucous membrane congestion, generalised morbiliform rash and eyes congestion was observed in 20.83%, 12.5% and 6.25% patients respectively. All except one patient improved clinically. One patient died of respiratory distress and haemorrhage on second day of admission. Dermatological features are significantly noticeable in dengue fever patients. These may help us in early diagnosis and better management of patients.

Levels of 25-OH vitamin D in healthy asymptomatic adults: pilot study

The deficiency of Vitamin-D has been reported in all age groups in developing countries; in spite of adequate sun light required for the production of 25-hydroxyvitamin D. To determine the levels of vitamin D among healthy asymptomatic adults. Hospital based analytical study, conducted at Sheikh Zayed Medical Complex, Lahore. Healthy subjects between 40-60 years, who were either the staff of the hospital or attendants of the patients were included. Those who were taking vitamin supplement, using sun screen and lactating mothers were excluded. A proforma including the demographic information, exposure to sun, diet intake and BMI was recorded for all subjects. 5cc of blood was taken from all, serum separated, stored at -20[degree sign]C. 25-hydroxyvitamin D levels were done within 48 hours using ELISA method. A value between 75-250 nmol/L was taken as normal using international standards. Eighty healthy adults were enrolled whose mean age was 47.2 +/- 6.3 years. The levels of vitamin D ranged between 13.1- 77.5 nmol/L. Levels were deficient in 25% subjects and insufficient in 73.7% giving an overall low level in 98.7% of the respondents. Only 1.3% had sufficient 25-hydroxyvitamin D levels. The levels did not show any significant difference between genders, skin pigment or dietary intake. The levels for the 56-60 yrs age group were significantly higher when compared with those in the age groups of 40-45 yrs and 46-50 yrs [p<0.041 and 0.038 respectively]. The association of 25-hydroxyvitamin D with exposure to sunlight was significant [p<0.001]. Respondents with BMI >30 had significantly lower 25-hydroxyvitamin D levels than those who had BMI between 18-25 [p<0.036]. Low levels of vitamin D were found in 98% of the apparently healthy population

Association of diet with hirsutism in females of reproductive age

Causes of hirsutism range from minor illnesses like fever, nausea, headache to severe conditions like adrenal hyperplasia and polycystic ovarian syndrome while, in some cases the cause remains obscure and dietary factors are placed under this heading. To study the role of dietary factors in causing hirsutism. Department of Dermatology, NHRC, Sheikh Zayed Medical Complex, Lahore from Dec 2008- Dec 2009. Fifty clinically confirmed cases of hirsutism and 50 healthy females aged between 12-20 years were studied. A modified Ferriman-Gallwey [FG] score was used to determine the severity of hirsutism which were graded into 4 grades. Cases with virilism, post menopausal, menopause cushing's syndrome were excluded. Informed consent was obtained from all participants and their demographic data, height and weight and dietary pattern was recorded on specially designed performa. All 50 healthy controls had grade 1 or no hirsutism, while among hirsute females, 10[20%] had grade 2, 28[56%] grade 3 and 12[24%] grade 4 hirsutism. Consumption of red meat and broiler chicken was more in hirsute females whereas, intake of milk and vegetables was more in healthy controls. Dietary habits also appear to play some role in hirsutism in females

Significance of total and free thyroid hormones in relation to serum proteins in chronic hepatitis B patients and normal controls

Hepatitis B destroys the liver cells. Proteins [albumin, pre albumin and thyroid binding globulin] produced by liver cells play an important role in metabolism and transport of thyroid hormones, therefore liver dysfunction is likely to disturb the transport of thyroid hormones resulting in disease. To determine the significance of thyroid hormones in relation to serum proteins in Chronic Hepatitis B patients. It was a cross sectional study conducted at National Health Research Complex [NHRC] and department of Gastroenterology Sheikh Zayed Medical Complex Lahore. One hundered Chronic Hepatitis B patients diagnosed by Polymerase Chain Reaction were matched with 100 healthy persons, served as control, were selected for total and free thyroid hormones using ELISA, while serum proteins were estimated spectrophotometrically. Serum total protein levels were within the normal range in both Chronic Hepatitis B patients and controls with mean value of 6.55g/dl and 7.2g/dl respectively, however serum albumin levels were lower in Chronic Hepatitis B patients [mean 2.69g/dl] as compared to controls [mean 4.1g/dl]. Serum globulin was increased [4.09g/dl] in patients as compared to controls [mean 3.1g/dl].Albumin globulin ratio was <1[mean 0.73] in Chronic Hepatitis B patients while in controls it was >1[mean13.5]. Consequently, increased globulin resulted in more binding of T4 [mean 194nmol/L] in Chronic Hepatitis B patients as compared to controls [mean 123nmol/L]. Conversion of T4 to T3 in Chronic Hepatitis B cases was also disturbed resulting in slight decrease of total T3 [mean 1.77nmol/L] as compared to controls [mean 2.3nmol/L].Free T3 [mean 3.56pmol/L] and Thyroid Stimulating Hormone [mean 0.68mIU/ml] also showed slight decrease when compared with controls [mean 4.5pmol/L, mean 1.52mIU/ml].FT4 remained within normal range in both the groups. In Chronic Hepatitis B related liver disease and cirrhosis, serum albumin levels go down while globulins go up and these changes alter the binding of thyroid hormones and Thyroid Stimulating Hormone resulting in disturbance in thyroid hormone levels

Familial primary hyperparathyroidism

A case of primary hyperparathyroidism in a 17 years old female is described. Patient presented with severe abdominal and pelvic pains associate with discomfort. Diagnostic testing revealed multiple upper and lower limb fractures and renal stones. Case was self limiting. Patient's condition resolved on parathyroidectomy for adenoma and partial thyroidectomy. Follow-up showed familial links