Risk factors for deliberate self-harm in patients presenting to the emergency departments of Karachi

To determine the risk factors for Deliberate Self-Harm [DSH] in patients presenting to the Emergency Departments [EDs] of three tertiary care hospitals of Karachi, Pakistan. Multicentre matched case control study. EDs of the Aga Khan University Hospital, Karachi, Civil Hospital, Karachi and Jinnah Postgraduate Medical Centre, Karachi, from March 2011 to February 2012. A total of 201 cases and 201 matched controls were taken from three hospitals situated in Karachi. All patients of 16 years and above presenting to the EDs of the hospitals with DSH attempt were invited to participate in the study. Controls were ED patients with complaints other than DSH. A control was matched with case for hospital, gender and age. Two questionnaires were used to collect information on the risk factors of DSH. Conditional Logistic Regression [CLR] was used to assess the association of various risk factors with DSH. Risk factors of DSH in Karachi included current history of mental disorder [OR = 4.53, 95% CI = 1.59 - 12.92], not sharing problems with someone [OR = 4.67, 95% CI = 2.4 - 9.0], living in rented houses [OR = 2.58, 95% CI = 1.37 - 4.84], Pathan ethnicity [OR = 5.05, 95% CI = 1.01-25.38] followed by others [OR = 3.88, 95% CI = 0.77 - 19.69] and Urdu speaking [OR = 2.71, 95% CI = 0.59 - 12.45]. Absence of physical illness in the past month had an inverse association with DSH [OR = 0.17, 95% CI = 0.07 - 0.37]. Mental illnesses, low socio-economic status and loneliness were the risk factors of DSH patients presenting to the three EDs of Karachi. Physical illness in the last month was protective against DSH in these patients. Psychiatric evaluation of DSH patients in the ED is important for early diagnosis and management of mental disorders

Major dietary patterns and risk of acute myocardial infarction in young, urban Pakistani population

To investigate the role of dietary intake in the development of premature acute myocardial infarction [AMI] in a hospital-based Pakistani population in Karachi. In a case control study, 203 consecutive patients [146 males and 57 females] with their first AMI and age below 45 years were enrolled with informed consent. Similarly, 205 gender and age matched [within 3 years] healthy adults were also included as controls. Dietary intake of both cases and controls was assessed by using a simple 14-item food frequency questionnaire. Using factor analysis, 3 major dietary patterns- prudent dietary pattern, combination dietary pattern and western dietary pattern were identified. Fasting plasma/serum of both cases and controls were analyzed for homocysteine, folate, vitamin B[12], blood Pb, ferritin, cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides. ANOVAand conditional logistic regression were used to predict the association of dietary patterns with AMI. Consumption of prudent diet, characterized by high consumption of legumes, vegetables, wheat, chicken and fruits, is protective against the risk of premature AMI. Moderate to high consumption of combination diet, characterized by high intake of eggs, fish, fruits, juices and coffee was associated with decreased risk of AMI. No association was observed between western diet, characterized by high intake of meat, fish and tea with milk and risk of AMI. Consumption of a prudent dietary pattern and a combination dietary pattern is protective against the risk of AMI in a Pakistani population

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

To develop and validate a food frequency table [FFQ] for use in urban Pakistani population. A validation study. The Aga Khan University, Karachi, from June to November 2008. 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]. 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. 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.

Illuminating the dark side - vitamin d status in different localities of karachi

This study was conducted to determine the association between place of residence [grouped into neighbourhoods], and 25-hydroxy D [25[OH]D] levels of individuals of Karachi. Addresses of 4788 individuals tested for 25[OH]D at the clinical laboratory of the Aga Khan University [AKU], Karachi, from January 2007 to June 2008 were reviewed. The neighbourhoods were categorized into ten, based on locality attributes. A high overall prevalence [74%] of vitamin D deficiency [VDD] was observed. There was a significant difference [p-value < 0.01] between mean log 25[OH]D levels amongst neighbourhoods grouped according to distinct housing structure attributes and localities. A high frequency of VDD in all the studied localities of an urban city warrant dietary vitamin D supplementation and food fortification