Metabolic syndrome and obesity among marginalised school-going adolescents in Karachi, Pakistan: a cross-sectional study.

Background: Metabolic syndrome (MetS) is a cluster of cardiometabolic risk factors which increase the likelihood of developing type 2 diabetes and cardiovascular disease. This study aimed to determine the prevalence of MetS among adolescents living in slums aged 11-18 years in Karachi, Pakistan. Methods: Data were collected from 689 adolescents attending five schools in two slum areas of Karachi, Korangi and Baldia, from February 2023 to March 2023. Measurements of weight, height, waist circumference, and blood pressure were obtained from the study participants. Blood samples were collected to assess fasting plasma glucose, High density lipoprotein HDL-cholesterol, and triglyceride levels as per National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III). The prevalence of MetS was estimated using five diagnostic criteria, i.e., International Diabetes Federation (IDF-2007), World Health Organization, NCEP-ATP III, de Ferranti et al., and Cruz and Goran. Findings: The study revealed an overall prevalence of MetS among the adolescents in the two slum areas as 16.7%. A higher prevalence of MetS was observed among females (9.1%) and those with lower body mass index BMI (13.6%). The diagnostic criteria proposed by Cruz and Goran were found to be the most sensitive, with a MetS diagnosis rate of 22.93%. The study also identified several significant risk factors associated with MetS, including sedentary lifestyle (7.7%), lack of physical activity (7.5%), increased screen time (1.5%), lower fruit consumption (6.1%), and underweight (7.7%). Among slum-dwelling adolescents, low levels of HDL-cholesterol (33.96 ± 5.21), high triglyceride levels (161.45 ± 63.09), and elevated fasting plasma glucose levels (112.59 ± 28.92) were prevalent components of MetS. Interpretation: This study provides compelling evidence of a high prevalence of MetS among marginalised school-going adolescents in Karachi, Pakistan. The findings underscore the importance of early identification of adolescents at risk of developing MetS (especially those living in slum areas) and the implementation of effective preventive strategies to mitigate the risk of type 2 diabetes and cardiovascular disease in later life. Funding: None.

Anxiety levels among school-going adolescents in peri-urban areas of Karachi, Pakistan.

INTRODUCTION: Mental health problems are pervasive nowadays. Adolescents are often expected to balance academic performance with familial obligations and work to support the family financially if they belong to low-socio-economic areas. These pressures can lead to Anxiety, stress, and even depression. OBJECTIVE: The study's main objective is to assess the association of gender, parenting style, eating habit, and screen timing with the level of Anxiety among school-going adolescents in three peri-urban areas of Karachi, Pakistan. METHODOLOGY: A school-based cross-sectional study was conducted among adolescents of age group 10-19 years using the Generalized Anxiety Disorder-7 (GAD-7) scale in two months in, three populated peri-urban areas of Karachi, Pakistan. Collected Data was analyzed by statistical software SPSS version with 80% response rate. FINDING: In our collected data, 544 students participated; 313 (57%) were female, and 231(42%) were male. Among them 173(33%) participants showed moderate to severe level of anxiety out of which 140(26%) were female and 33(7%) were male. As per our study, strict Parenting style plays a significant role in developing moderate to severe 108(20%) levels of Anxiety, shown among adolescents in the studied population. In addition to this, those who do not take tuition 115 (21%), do not use transport to school 91(16%), spend significant time in games on mobile and computer 101 (18%), and have no involvement in physical activities 172 (31%) show more moderate to severe level anxiety than others factors. A significant multivariate association between level of anxiety with gender, school commute, type of lunch Intake, smoker family member at home, physical activity, video game, tuition and strict parent. CONCLUSION: This study concluded that there are various factors which have great association with anxiety and can affect adolescents' mental health badly. The factors were parental strictness, video game playing, a sedentary lifestyle, and the smoking habits of family members. Children and adolescents must be evaluated as soon as possible while they are still young to prevent mental health issues.

Depression and suicidal ideation among individuals with type-2 diabetes mellitus, a cross-sectional study from an urban slum area of Karachi, Pakistan.

Background: Suicidal thoughts and depression are associated with patients with diabetes, especially patients with low socioeconomic backgrounds and prolonged illness. Objective: We aimed to estimate suicidal thoughts and depression among patients with type 2 diabetes (T2D) in the slums of Karachi. Methods: This cross-sectional study was conducted across 38 locations in the slums of Karachi to understand depression, suicidal thoughts, and other supporting factors of depression associated with T2D. The three-item Oslo Social Support Scale, the Patient Health Questionnaire-9 (PHQ-9) scale, and the Ask Suicide Screening Questions were used to screen the patients. Results: A total of 504 study participants were interviewed, with a response rate of 98%. The prevalence of depression among patients with diabetes was 30.83%, and suicidal ideation was 20.39%. In the final multivariate analysis, being socioeconomically poor, physically disabled, and having poor social support were independent predictors of depression. Conclusion: Diabetes, low socioeconomic level, a lack of social support, and physical disability were all linked to depression. Therefore, trained health providers should conduct an early depression-focused routine screening for patients with diabetes.

Respiratory Diseases' Burden in children and adolescents of marginalized population: A retrospective study in slum area of Karachi, Pakistan.

Background: Worldwide, the burden of respiratory disease has dramatically increased, endangering public health. To our knowledge, there have been no reported cases of respiratory illness among children and adolescents living in the slums of Karachi, Pakistan. This study aimed to assess the burden of respiratory disease in marginalized slum populations and the factors causing such an increase in disease burden. Methods: This study was conducted in 35 slums of Karachi, Pakistan, to determine the prevalence of respiratory disease in children and adolescents. Data on pneumonia, bronchitis, bronchiolitis, tuberculosis, and asthma from August 2019 to July 2022 were analyzed and inferences were drawn. Results: Among the studied diseases, pneumonia was more prevalent among females (39,864, 44.9%), followed by males (19,006, 21.4%). Most of the children (59,988, 67.6%) were aged 1-5 years. In addition, of those diagnosed with pneumonia, 50,348 (56.8%) were from the same age group. Furthermore, bronchiolitis was found among 10,830 (12.2%) children aged 5-9 years. The majority (46,906, 52.9%) of the studied population belonged to the Pathan ethnicity, followed by Sindhi (21,522, 24.2%), and most of them (84,330, 95.1%) were of a lower socioeconomic status. Conclusions: This study found that pneumonia is the most common respiratory disease followed by bronchiolitis in children and adolescents in a marginalized slum population of Karachi, Pakistan. Both pneumonia and bronchiolitis have seasonal variations in their occurrence.

Efficiency of proteolytic enzymes in treating lumbar spine osteoarthritis (low back pain) patients and its effects on liver and kidney enzymes.

Lumbar spine osteoarthritis with 40-85% prevalence, degeneration of spine with remarkable narrowing of disc space and osteophytes formation trigger pain in lower back. Pain in lower portion of back is now considered to be the second most commonly treated health issue in primary health care setups. This pain causes disability, functional loss and job absentees. Commonly pain is managed pharmacologically by NSAIDS but resulted in severe gastric side effects. The purpose of this trial was to appraise the properties of bromelain and papain, the vegetal proteolytic enzymes, in comparison with standard drug on LBP patients. Forty men and women with lumbar spine osteoarthritis were recruited and divided into group 1, received aceclofenac 100mg tablet b.i.d as standard treatment, group 2, patients treated with aceclofenac 100 mg tablet b.i.d and enzyme supplements 250 mg b.i.d for 6 weeks. All the participants were evaluated for their body mass index, vital signs and liver/kidney enzymes before and after treatment. Moreover intensity of pain were also measured through visual analogue scale (VAS) and oswestry low back pain questionnaire (ODI) before treatment (0 week), 3rd week and 6th week of treatment. The enzyme group patients showed significantly diminished pain scores VAS from 7.10±1.29 to 5.85±1.531*** (P=0.001), ODI score from 56.2±8.70 to 51.6±8.125*** (P=0.000), significantly diminished enzymes; ALP from 210.00±55.24 to 196.90±51.02 (P=0.054*) and serum creatinine from 0.97±0.153 to 0.87±0.139 (P=0.035*) and improved quality of life. Hence, this study suggested that the enzyme supplements for 6 weeks have prolonged beneficial carry-over effects in comparison to standard treatment without producing any change in BMI (P>0.05) and vital signs (P> 0.05).

Histopathological effects on stomach, liver and kidney associated with Cedrus deodara root oil in ulcer induced rats (Wistar strain).

Cedrus deodara have been used traditionally in ayurvedic system against peptic ulcer. Present work is concerned with the determination of histopathological effects in ethanol induced ulcer on rats (Wistar Strain) treated with Cedrus deodara root oil at a dose of 200mg/kg and comparison of its antiulcer activity against control, positive control and standard anti-ulcer drug (Omeprazole). The aim was to find out the antiulcer effect of Cedrus deodara root oil and to observe histopathology of liver, kidney as well. 120 Albino rats were taken and divided into four groups i.e. A, B, C and D designated as control, positive control, standard and treated groups respectively. Normal and intact general architecture of mucosa and submucosa layers of stomach observed. No significant changes observed in thickness of epithelium, no inflammatory cells were present on the mucosa and submucosal layer and gastric glands were normal. Liver of albino rats, showed no dilation and congestion in central as well as portal vein. Kidney of albino rats exhibited no shrinkage in glomeruli, no congested and dilated renal corpuscles, neither hemolysis nor congested and dilated renal tubules were seen. It is concluded that C. deodara root oil has anti-ulcer properties without effecting kidney and liver tissues.

The novel effect of propranolol in glibenclamide induced hepatotoxicity.

Glibenclamide (GBC) has been associated with hepatotoxicity in humans. This study conducted on rabbits to evaluate the hepatotoxicity of GBC alone and in combination therapy with propranolol (PPL). Liver enzymes like alanine transaminase (ALT), alkaline phosphatase (ALP) and gamma-glutamyltransferase (γ-GT) and bilirubin (BRB) are used to evaluate hepatotoxicity associated with GBC. Histological findings, micrometry and scanning electron microscopy (SEM) used to find hepatotoxicity by GBC and with PPL. GBC caused significant elevation of liver functions as compared to control (p<0.005). PPL reduced the level of serum ALT, ALP, γGT and BRB when administered with GBC (p<0.005). The results prevailed that there is a significant change in hepatic cells structure and significant change in its diameter of nucleus (p<0.05). The necrosis and granuloma with decreased in number of hepatic cells were observed in GBC treated rabbits. However, the combination of GBC with PPL has shown healthy and nearly similar structure as that of controlled group and confirmed by SEM microscopy. PPL reduced the blood flow to hepatic portal system and thus, avoid the noxious substances to liver. It is affirmed that the use of PPL offered beneficial effect on hepatotoxic drugs.

Bioconversion potential of Trichoderma viride HN1 cellulase for a lignocellulosic biomass Saccharum spontaneum.

The industrialisation of lignocellulose conversion is impeded by expensive cellulase enzymes required for saccharification in bioethanol production. Current research undertakes cellulase production from pretreated Saccharum spontaneum through Trichoderma viride HN1 under submerged fermentation conditions. Pretreatment of substrate with 2% NaOH resulted in 88% delignification. Maximum cellulase production (2603 ± 16.39 U/mL/min carboxymethyl cellulase and 1393 ± 25.55 U/mL/min FPase) was achieved at 6% substrate at pH 5.0, with 5% inoculum, incubated at 35°C for 120 h of fermentation period. Addition of surfactant, Tween 80 and metal ion Mn(+2), significantly enhanced cellulase yield. This study accounts proficient cellulase yield through process optimisation by exploiting cheaper substrate to escalate their commercial endeavour.

Prevalence of hypertension in healthy school children in Pakistan and its relationship with body mass index, proteinuria and hematuria.

To determine the prevalence of high blood pressure (BP) in healthy school Pakistani children and its association with high body mass index (BMI), asymptomatic hematuria and proteinuria, we studied 661 public school children and measured their body weight, height and BP and urine dipstick for hematuria performed on a single occasion. Hypertension (BP >95 th centile) and pre-hypertension (BP >90 th centile) were defined based on the US normative BP tables. Over-weight and obesity were defined according to the World Health Organization (WHO) classification of BMI. The mean age of the children was 14 ± 1.3 years. The mean BMI was 18.5 ± 4.3 kg/m 2 . The majority (81.8%) of the children were found to be normotensive (BP <90 th centile). Pre-hypertension was observed in 15% and hypertension in 3% of the children. Overweight was observed in 7.7% and obesity in 1% of the children. The independent risk factors for hypertension and pre-hypertension were age of the child (RR 1.2 95% CI 1-1.4), gender (RR 2.0 for being female 95% CI 1-4.4), BMI >25 (RR for BMI b/w 25-30 = 2.6, RR for BMI >30 = 4.3), positive urine dipstick for proteinuria (RR = 2.3 95% CI 0.7-7.7) and positive urine dipstick for hematuria (RR 1.0 95% CI 0.2-8.3). Hypertension in children is strongly correlated with obesity, asymptomatic proteinuria and hematuria. Community based screening programs for children should include BP recording, BMI assessment and urine dipsticks analysis and approach high-risk groups for early detection and lifestyle modifications.