Comparative hepatoprotective effect of Nigella sativa pre- and post-treatment to rabbits

Synthetic drugs are associated with adverse side-effects and rapid increase in resistance to most of them inspires to evaluate plants for their therapeutic values. We have been aimed to suggest the medicinal use of Nigella sativa seed aqueous extract to minimize the severity of liver damage via its antioxidant properties and its role in maintenance of cell ion-homeostasis. Annoyances in serum levels of some antioxidants and trace metals in human hepatitis C infected patients were compared with that from acetaminophen-induced hepatotoxic rabbits. Serum analysis of human patients and that of hepatotoxic rabbits have exhibited the same trend of incidence of liver marker enzymes, antioxidant levels, and trace metal concentrations, except for the serum levels of cobalt. Significance of pre-/ or posttreatment of Nigella sativa to acetaminophen induced-hepatotoxic rabbit has also evaluated. NS post-treatment to rabbits has been found effective in normalizing the levels [P<0.001] of serum liver markers; especially the ALP levels, and the antioxidants; with significant effect on the serum catalase levels. However, NS pre-treatment has shown its role [P<0.001] in maintaining the serum nickel and cobalt concentrations. Therefore, we suggest the use of Nigella sativa seeds as pre-/ or post-treatment therapy, and also as supplement to the normal medications of liver infection to normalize the status of cell antioxidants and trace metal concentrations

prospective clinical and electrophysiological survey of acute flaccid paralysis in pediatric patients

Objective: Recognition of common causes of acute flaccid paralysis in children

Study Design: Descriptive study

Place and Duration of Study: Combined Military Hospital Peshawar, from Aug 2009 to Jun 2012

Material and Methods: The demographic data including age, gender and clinical data including history of injection, stool results, and final diagnosis [polio, non-polio enterovirus, traumatic injection neuritis, GBS and an unknown group] were expressed in terms of frequencies and percentages. Chi-square test was applied for the association of age-groups with various causes of AFP. A p-value of less than 0.05 was taken as statistically significant. SPSS version 20 was used for statistical analyses

Results: Injection neuritis and post-viral paralysis [polio, non-polio enterovirus] were the common causes of AFP

Conclusion: As the study identified common causes of AFP which are essentially preventable, it highlighted certain issues during the process. First is the lack of nursing staff training or iatrogenic disability due to quackery, which requires urgent intervention to prevent it. Second is a deficiency in the WHO management protocol for AFP. NCS EMG proved to be a vital diagnostic tool for AFP, which is not included in the WHO AFP protocol at present.It is suggested that this diagnostic modality should be included in the AFP diagnostic protocol for better diagnostic yield

Outcome of stapled haemorrhoidectomy versus open milligan morgan haemorrhoidectomy at allied hospital

Objective: to compare the postoperative outcome of stapled haemorrhoidectomy and conventional Milligan Morgan's haemorrhoidectomy at Allied Hospital

Study Design: simple comparative study

Place of Study: Surgical Unit 1, Allied Hospital Faisalabad

Duration of Study: January 2011 to September 2012

Sample size: 50 patients

Material and Methods: fifty patients of 3rd and 4th degree hemorrhoids were selected for admission from the outpatient department. Patients with additional anal disease [e.g. fissure, abscess, fistula, ano-rectal cancer etc.] were excluded. Two groups of twenty five each were made. Group A for stapled haemorrhoidectomy and Group B for Milligan- Morgan haemorrhoidectomy [MMH]. The operative time was measured in minutes. Postoperative pain was assessed through visual analogue scale [VAS]. Bleeding was measured as mild, moderate and profuse. Other postoperative complications during hospital stay like urinary retention, anal stenosis etc. were noted. T-test, chi-square test and repeated measured analysis of variance were applied to compare the variables

Results: a majority of patients[combined in both groups] had third degree haemorrhoids. The mean length of operative time was found statistically insignificant between stapled and open groups [34 vs 36 minutes]. In Group A 23 [92%] patients were discharged in 24 hrs while 2 [8%] patients were discharged after 24 hrs. In Group B 9 [36%] patients were discharged in 24 hrs and 16 [64%] patients were discharged after 24 hrs. In group A 19 [76%] patients were having mild bleeding, 5 [20%] moderate bleeding and 1 [4%] profuse bleeding. In Group B 7 [28%] patients were having mild, 16 [64%] moderate and 2 [8%] profuse bleeding. In Group A 15 [60%] patients were having mild pain, 7 [28%] moderate and 3 [12%] severe pain on visual analogue scale. In Group B 4 [16%] patients were having mild pain, 15 [60%] moderate and 6 [24%] severe pain. The proportion of postoperative anal stenosis, prolapsed recurrence, persistent pain, recurrent bleeding and urinary retention was higher in MMH than stapled haemorrhoidectomy group

Conclusion: there was a significant difference between stapled haemorrhoidectomy and Milligan Morgan's for bleeding, pain and hospital stay. However the mean length of operative time was insignificantly different

Clinical audit on treatment of mucosal and multiple cutaneous leishmaniasis lesions with pentavalent systemic antimony

Cutaneous leishmaniasis is a parasitic disease spread by the female sandfly occurring throughout the Americas from Texas to Argentina, and in the Old World, particularly the Middle East and North Africa. The condition is diagnosed every year in travelers, immigrants, and military personnel. The treatment mainstay is pentavalent antimony [e.g., sodium stibogluconate]. Not all patients require treatment; many lesions heal spontaneously. The treatment is usually indicated in mucosal, mucocutaneous and multiple active cutaneous lesions. 30 patients of cutaneous leishmaniasis were included from the dermatology ward. The method of data collection was retrospective. The basis of proposal was local guidelines. The audit type was process. The standard set was "100% patients with mucosal and multiple cutaneous leishmaniasis lesions should be treated with pentavalent systemic antimonials"

GBS and AFP [acute flaccid paralysis] system in AJK

Main objective of the study is to highlight the major cause of AFP and% of GBS represents the AFP during the study period. Retrospective analytical study. This study was conducted in AJK, for the duration of three years from January 2011 to December 2013. Retrospective analysis of AFP cases reported during 2011-2013. Primarily the AFP cases investigated through history and clinical examination. Principal cause of AFP [Acute flaccid Paralysis] cases were investigated through specific tests like serum electrolytes, CSF [cerebrospinal fluid], electromyogram and viral culture from stool sample to exclude poliovirus. All the cases reported from AJK and taken on the line list labeling as GBS were included in the study during 2011-2013. Three years data analysis shows more than 50% GBS cases presenting AFP and the numbers are increasing every year. Most of the GBS and even AFP belong to 6-59 months age group. More than 55% GBS cases recover completely and this proportion increased from 2011-2013. Data analysis revealed GBS is a major cause of AFP in AJK and needs not to be overlooked to keep poliovirus transmission ceased here. AFP surveillance system is huge resource and this is a high time to study all the causes responsible for acute flaccid paralysis to strengthen polio eradication efforts and to develop understanding for prevention and control, to avoid acute flaccid paralysis related morbidity and mortality amongst children in Pakistan

Evaluation of AFP surveillance sensitivity in AJK

Main objective of the study is to analyse sensitivity of the surveillance system, required to keep poliovirus circulation ceased in AJK. Retrospective analysis of AFP cases reported during the study period. This study included all the AFP cases reported during the study period in AJK from Jan. 2011 to Dec. 2013. Historical data is used to analyse AFP surveillance for detecting poliovirus infection in children age <15 years in the study area based on few assumptions that all the results are negative and adequate information were available to make ultimate diagnosis of each AFP case reported in the area during study period. Surveillance sensitivity analysed using AFP surveillance criteria recommended by WHO and variable used in AFP surveillance system. Surveillance sensitivity is analysed based on two indicators "non polio AFP rate" and stool adequacy. Sensitivity level analysed in AFP cases aged 6-59 months for >/= 7 OPV doses including routine and SIAs revealed 6/10 districts have high sensitivity. Long absence of Polio virus in the area, creeping up of boredom among health human resource, Clinician's failure to notify all AFP cases resulting in down going Surveillance sensitivity

Diabetics and their diseases, what do they know? Assessing knowledge level among diabetic patients

Limb loss is one of the most devastating complications of Diabetes mellitus. Prevention is possible only with a well educated patient. We set out to assess patient education by physicians and foot care awareness in patients attending our DHQ Hospital. Descriptive study. This study was carried out at the DHQ Hospital, Mirpur, Azad Kashmir from 01.12.2012 to 30.03.2013. This was a descriptive study involving 311 patients attending DHQ Hospital, Mirpur, Azad Kashmir. The patients were chosen by convenience sampling. The patients could be either type 1 or type 2 diabetics. A total of 18 multiple-choice questions were used. Patients less than 40 years were excluded from the study. 314 patients were enrolled in the study. 37.62% of patients were aged 40 to 50 years. Females comprised 52.41% of the patients. 49.52% of patients were illiterate. About a third of patients [31.51%] visited their doctor weekly or fortnightly. A size-able number of patients [39.55%] had never or rarely been guided about life style changes by their doctors. 68.17% of patients had never or rarely been guided about diabetic complications. Only 23.15% patients were aware about foot care. Pearson Chi-Square values were highly significant P<0.0001 for education and foot care awareness. Patient education by physicians is almost non-existent in Pakistan and needs to be improved. Improving literacy will improve patient foot care awareness

Comparative studies of salivary and blood sialic acid, lipid peroxidation and antioxidative status in oral squamous cell carcinoma [OSCC]

Oral squamous cell carcinoma [OSCC] is considered to be a serious life threatening issue for almost two decades. The objective of this study was to evaluate the over production of lipid peroxidation [LPO] byproducts and disturbances in antioxidant defense system in the pathogenesis of oral cancer. Lipid peroxidation and antioxidant status in OSCC patients were estimated and compared the sensitivity and specificity of circulating biomarkers [MDA, Sialic acid, Catalase, SOD, GSH and Neuraminidase] with B-2 microglobulin [B-2MG] at different thresholds in blood and saliva using receiver operating characteristics [ROC] curve design. Our results showed that the levels of MDA and Sialic acid were significantly increased in plasma of OSCC patients as compared to healthy subjects whereas antioxidant level was significantly decreased. ROC analysis indicated that MDA in saliva is a better diagnostic tool as compared to MDA in blood and B-2MG in blood is better diagnostic marker as compared to B-2MG level in saliva

Endoscopic third venfri'cufosfomy for obstructive hydrocephalus

To determine the success rate of endoscopic third ventriculostomy [ETV] for treating obstructive hydrocephalus. Cross-sectional observational study. The Neurosurgery Department of PGMI, Lady Reading Hospital, Peshawar, from May 2010 to November 2011. Patients with Obstructive hydrocephalus due to aqueductal stenosis, tectal and non-tectal tumour and already shunted patients for obstructive hydrocephalus presented with blocked shunt were included in the study. Patients with congenital hydrocephalus and secondary to meningitis were excluded. Endoscopic third ventriculostomy was performed. Success, complications and mortality was noted. Data was analyzed by descriptive statistics using SPSS software version 17. There were 155 patients including 72 males and 83 females with ratio of 1: 1.33. Success rate was 71%. Indication of surgery was obstructive hydrocephalus due to aqueductal stenosis, posterior fossa tumour, brain stem and CP angle tumour. Complications were seen in 18 patients including mortality in 3 patients. ETV is effective, safe and successful procedure in patients with obstructive hydrocephalus. It may be used as replacement procedure of ventriculo-peritoneal shunt as initial line of management in selected patients

Gastro-oesophagectomy with two field lymphadenectomy- an optimal treatment for resectible carcinoma of the oesophagus and gastric cardia

Background: The aim of the study was to examine the outcome of surgical treatment for carcinoma of the oesophagus and gastric cardia with two-field lymph node dissection at a high volume centre by a single surgeon over 7 years period

Methods: From January 1992 to March 1999, 316 patients underwent oesophagectomy with two field lymph node clearance for cancer of the oesophagus at our unit by a single consultant surgeon. Once the data collection at the base hospital was complete, it was sent to The Cancer Intelligence Unit Information Centre at Bristol for verification of data. The data analysis was then undertaken using SPSSv9. The main technique utilized was the Kaplan-Meier survival estimate. Kaplan-Meier survival functions were produced and compared, using the log rank test, for a number of pre-specified variables and their associated levels. Multivariate analysis was performed using Cox's proportional hazards modeling

Results: The average age at the time of surgery was 63.5 years, with a male to female ratio of 2:1. 86% of patients had dysphagia at the time of presentation. 88%[277] Patients had Ivor Lewis oesophagectomy, while 6%[20] had McKeown`s and 1%[4] had left thoracolaparotomy. 5% [14] of the patients underwent total laryngo-pharyngo-oesophagectomy. In total 62% [197] of patients had adenocarcinoma and 31% [99] had squamous cell carcinoma. 68% [215] of patients had lymph node metastasis while 32% [101] had no lymphatic involvement at resection. 80% had pyloroplasty or pyloromyotomy. 8% had anastomotic leak. 30-day mortality was 7%. Overall 5-year survival was 33%, with a very significant survival difference between lymph node negative and positive patients [25%vs 49%; p<0.01]. There was no statistically significant difference in survival on the basis of gender [p=0.47], histology [p=0.48] or age [p=0.299]. In total 72 patients received adjuvant treatment and had significant survival benefit [p=0.002] but because of selection bias the results are of doubtful significance

Conclusion: It is concluded that for tumours of lower 1/2 of oesophagus Ivor Lewis oesophagectomy with two-field lymphadenectomy is safe and effective procedure. It can be performed with low morbidity and mortality and good long-term survival. Oesophageal cancer still remains a disease of old age and that on the basis of age alone no one should be denied the opportunity of surgical resection. Gastric outlet drainage had a strong influence on the incidence of postoperative leak

Posterior spinal fixation with pedicle screws and rods system in thoracolumbar spinal fractures

To determine the effectiveness of posterior spinal fixation in maintaining the stability of spine and to determine mortality in 6 months after posterior spinal fixation. Quasi experimental study. Department of Orthopaedics, Jinnah Postgraduate Medical Centre, Karachi and Department of Orthopaedics, Postgraduate Medical Institute, Hayatabad Medical Complex, Peshawar, from April 2006 to April 2009. Fifty patients with unstable thoracolumbar spinal fractures from T7 - L4 were included. All the patients were operated by posterior approach using pedicle screws and rods. Effectiveness of the fixation was measured at 6 months postoperatively in terms of relief of pain and improvement in mobility using Oswestry disability index, range of motion of spine using Schobar Test/sign, reduction in deformity by measuring Cobb angle, local kyphosis angle [LKA], thoracolumbar angle, anterior and posterior vertebral heights [AVH and PVH respectively], evidence of union was made using plain radiographs and by computer assisted measurement using " OSIRIS " software. The data was then analyzed using SPSS software version 13 and presented in the form of tables and charts. Twenty-eight patients were operated within first week. In 38 patients, 4 screws were used and in 12 patients, 8 screws were used with 2 rods. Pain and disability showed improvement, with mean 71.98% score pre-operatively to 44.96% mean at last visit [p = 0.001]. Mean range of motion increased 0.5 - 2 cms postoperatively in all directions [p = 0.001]. Mean kyphosis angle, Cobb angle and thoracolumbar angle improved postoperatively. Anterior and posterior vertebral body heights increased postoperatively with resultant decrease in anterior vertebral body compression. Ninety six percent patients showed signs of postoperative union on last visit and only 3 people died of unrelated causes till last visit. Posterior spinal fixation with pedicle screws and rods is an effective surgical technique in maintaining stability of spine by improvement in pain and mobility, range of motion of spine, correction of deformity and bone union

Total hip arthroplasty for childhood fused hip

The conversion of a painless fused hip of a long standing duration to a mobile hip is usually not demanded due to a number of per-operative problems, iatrogenic complications and a high demanding procedure. The conversion is, however, required when a patient develops chronic back pain or a painful pseudoarthrosis of the hip. Conversion due to pseudoarthrosis in a recent fracture through femoral neck of previously fused painless hip has never been reported. We are reporting this unique indication for conversion

audit of the mortality due to severe head injuries in a neuro-surgical intensive care unit

To analyze the data of patients died in neurosurgical intensive care unit due to severe head injuries. This retrospective study was conducted in neurosurgical intensive care unit in Lady Reading Hospital, Peshawar from January to December 2007. The Clinical record of all the patients presenting with severe head injuries, who then expired in neurosurgical intensive care unit was collected. The record was analyzed accordingly for discussion and recommendations. Out of 112 patients, majority were young adults [n=64, 57.14%] followed by children [n=34, 30.35%] and elderly [n=10, 8.92%]. Road traffic accidents were the major cause of presentation [n=75, 66.96%] followed by history of fall [n=23, 20.53%] and fire arm injuries [n=13, 11.60%]. The correctable surgical causes were present only in 18 patients [16.07%] and the majority 94 [83.92%] were given conservative management. Among the non-surgical cases, both ventilatory therapy in 7 [6.25%] and tracheostomy in 39 [34.82%] patients failed to change the outcome. Road traffic accident was the major contributor in the mortality in patients presenting to neurosurgical intensive care unit. Most involved were young adults

Frequency of causes of ventriculo-peritoneal shunt failure in hydrocephalus patients

To analyze ventriculo-peritoneal shunt [VP shunt] failure cases in hydrocephalic patients, in a tertiary care hospital. This descriptive study was carried out in the Department of Neurosurgery Lady Reading Hospital Peshawar, from June 2009 to May 2010 [one year].The medical record of all cases operated in last one year was checked from record room. Documentation was done according to proforma designed indicating age, sex, clinical features, investigations with findings on X-rays, CT and MRI and per operative findings. Complications related to upper end, lower end and shunt track were noted. Data was analyzed to assess the causes for shunt failure in hydrocephalus patients. A total of 56 patients were included in this study. There were 43 children and 13 adults. Among children, 26 were males and 17 were females while in adults, 5 were males and 8 were females. Out of these, 28 patients were having blocked shunt, 20 cases with infected shunt, 6 patients had eroded and 2 patients displaced shunt. Although shunt surgery is a common procedure performed for hydrocephalus, different complications were associated in our study where shunt failure was mainly due to shunt dysfunction, infection or breakage of shunt system. Complications were more with upper end. Infection was common in pediatric age group

Experience with 349 cases of intradural spinal tumors at Lady Reading Hospital Peshawar

To analyze the variables of patients operated for intradural spinal tumors at Lady Reading Hospital Peshawar. An analytical descriptive study Place and duration of study: Department of Neurosurgery Lady Reading Hospital Peshawar, from April 2003 to March 2010 [7 years]. Medical record of patients with spinal tumors were revised and patients suffering from intradural spinal tumors were searched. There were total 572 cases of spinal tumors, of which 349 had different intradural lesions. Their clinical features, radiological reports, peroperative findings and histological reports were analyzed in different aspects. Of the total 349 patients with intradural spinal tumors 201 were males and 148 female, with male to female ratio of almost 1.4:1. Age of the patients ranged between 2 years to 77 years, with median of 39.2 years. The common clinical features were backache, leg weakness, parasthesia and poor sphincters. Magnetic Resonance Imaging of the spine was the main [309 cases] diagnostic tool along with plain x-ray and myelography in limited cases [35 cases]. CT myelogram was done only in 5 cases. Dorsal spine was involved in 62.5% cases, lumber and cervical spine in 25.5% and 12% patients respectively. Neurofibroma was the commonest [51%] intradural spinal tumor, we also had meningioma in 30.66%. Other intraspinal lesions were dermoid, lipoma, ependymoma, astrocytoma, tuberculoma, arachnoid and hydatid cysts. Of all the spinal tumors intradural are more common [61%] than extradural. Neurofibroma and meningioma constituted majority of cases belonging to extramedullary intradural group, while ependymoma and dermoid were common intramedullary tumor. 3rd and 5th decade of life were the common age group for both intramedulary and extramedullary tumors. Intramedullary tumors were common in 3rd decade of life

Role of nerve conduction study and electromyography in adult traumatic brachial plexopathy

Traumatic brachial plexopathy mostly affects young adults and has a very high rate of morbidity. The aim of this clinical survey was to highlight this problem and the diagnostic and prognostic value of electrodiagnostic procedures. Fifty adult patients with the clinically brachial plexus injury who were referred to Armed Forces Institute of Rehabilitation Medicine [AFIRM] Rawalpindi for nerve conduction study [NCS] and electromyography [EMG] were included in this survey. They were followed up for two years. The recovery was assessed as per Medical Research Council [MRC] scale and electrophysiologically. Traumatic plexopathy mainly affects young adult males with mean age of 24+7.26 years. The recovery was better with C5 and 6 lesions and those having neurapraxia and it was worse with avulsion injury. Nerve conduction studies and electromyography proved to be the key investigation in assessing brachial plexus injury, in regard to their localization, severity and extent. The best investigation for assessment of brachial plexus injury is Electrodiagnostic procedures

Significance of trigger point in trigeminal neuralgia

To know the significance of trigger point as an indicator of aberrant vascular loop in patients with trigeminal neuralgia. Material and This study was performed in the department of neurosurgery Postgraduate Medical Institute, Lady Reading Hospital, Peshawar from May 2003 to April 2006. Patients with clinical history of trigeminal neuralgia were admitted for micro vascular decompression. Detailed clinical history, along with clinical findings particularly side and site of trigger point of trigeminal pain were documented. Imaging studies like CT, MRI were done in these cases and per-operative findings were documented after surgical procedure. Forty-three patients with trigeminal neuralgia were operated for micro vascular decompression during the study period. There were 24 [55.8%] males and 19 [44.2%] females with ratio of 1.2: 1, and a mean age of 53 years. Duration of symptoms was from 3 to 7 years. A total of 43 cases of trigeminal neuralgia were recorded. Right side was involved in 19 and left side in 24 cases. Peri-oral and peri-nasal trigger point was observed in 39 [90.7%] cases during examination while offending arterial loop was seen in 35 [81.4%] cases per-operatively, thick arachnoid adhesion in 4 [9.3%] cases and veins in 4 [9.3%] cases. Trigger point during clinical examination indicated the presence of offending arterial loops in patients with trigeminal neuralgia

Efficacy of fine needle aspiration cytology in the diagnosis of breast lumps

To determine the sensitivity and specificity of fine needle aspiration cytology [FNAC], by comparing the results with excision biopsy. This observational and comparative study was conducted in Surgical B Ward of Khyber teaching hospital Peshawar, Pakistan from August 2002 to May 2003. A total of 50 women, who had a clinically palpable breast lump were subjected to concurrent FNAC and excision biopsy. Out of 12 malignant lesions on excision biopsy, FNAC correctly diagnosed 9, and 2 were diagnosed suspicious, and the remaining one was misdiagnosed as non malignant. So false negative being 1/12 [8.3%]. Of 38 benign cases on excision biopsy, FNAC diagnosed correctly duct ectasia 3, tuberculosis 2, and galactocele 1, while out of 22 fibroadenoma, FNAC diagnosed 20, and 2 were diagnosed as unsatisfactory. Ten cases diagnosed as fibrocystic disease on excision biopsy, FNAC picked only 6 cases correctly. The one case diagnosed on FNAC as fibrocystic disease, turned out to be malignant on histology. The remaining 4 cases of fibrocystic disease diagnosed on histopathology were either reported as unsatisfactory [3 cases] or suspicious [1 case] on FNAC. The sensitivity and specificity of FNAC was 91.66% and 96.96% respectively. Breast cytology was an effective and rapid method of diagnosis of breast diseases. It helps in deciding which patient needs early open biopsy. A negative cytology does not exclude the possibility of malignancy, as there was a false negative rate of 8.3%

Surgical audit of unit ii, department of surgery abbasi Shaheed Hospital, Karachi

To report the experience of one year audit of general surgical procedures and comparison of results with other audit data. This study was carried out from January 2005 to December 2005 in the Department of Surgery, unit II, of Abbasi Shaheed Hospital, Karachi. Total numbers of patients were 881, majority of them were between 16 to 50 years of age group [73.4%]. Elective surgeries were performed in 449 [50.9%] cases whereas 315 [35.7%] cases underwent emergency surgical procedures. Rest of the patients were managed conservatively i.e. 117 [13.2%] cases. The most frequent region was gastrointestinal tract [36.1%], in which appendiceal pathologies were commonly encountered. Average duration of stay was 12 days. There was an overall mortality of 1.2% and a complication rate 5.9%. We conclude that audit is essential for better health practice and should be perform yearly. Moreover, there should be proper audit program and committse for this purpose

Deficiency of vitamin C in south Asia

Vitamin C [L-ascorbic acid] is a water soluble vitamin which is an antioxidant and has a wide variety of biological functions for growth and development of the human body. It is essential for maintaining good health. The objective of this review is to share with the scientific community, the status of vitamin C in the South Asian populations compared to other populations in the world. The focus in this review is on populations from Pakistan, India, Thailand, Malaysia, Nepal and Singapore. Mean plasma levels of vitamin C of Indians/South Asians living abroad did not vary much compared to other ethnic groups, however, there was a significant decrease in these levels among those living in Pakistan and India. In general, males, smokers, persons using drugs of abuse, individuals infected with H. pylori or parasitic infections and those with low-HDL cholesterol have lower plasma levels of vitamin C when compared to females, non-smokers and normal healthy subjects free from drugs of abuse and infections [parasitic as well as H. pylori] and having normal levels of HDL cholesterol. In winter, plasma levels of vitamin C are, generally, higher compared to summer. Availability of non-sweet fruits, namely oranges, grape fruit, guava, lime and strawberries in winter could be the reason for that. There is a positive relationship between serum haptoglobin [Hp] levels and serum vitamin C concentrations. Individuals carrying a Hp2-2 phenotype [less stable Hp] have lower levels of vitamin C. The prevalence of vitamin C deficiency [plasma levels < 2 mg/ml] is highest among Indians and people of South Asian origin compared to other races except the Mexican population. Lower intake of fresh fruits and vegetables and over-cooking of food by South Asians might contribute to the high prevalence of vitamin C deficiency in these populations. The high proportion of individuals with low levels of vitamin C in Pakistani, Indian, Malay and Chinese populations compared to most Western populations might explain higher rates of cardiovascular disease and cancer among South Asians