BackgroundPreeclampsia is one of the leading causes of maternal and perinatal morbidity and mortality world-wide. The risk for developing preeclampsia varies depending on the underlying mechanism. Because the disorder is heterogeneous, the pathogenesis can differ in women with various risk factors. Understanding these mechanisms of disease responsible for preeclampsia as well as risk assessment is still a major challenge. The aim of this study was to determine the risk factors associated with preeclampsia, in healthy women in maternity hospitals of Karachi and Rawalpindi.MethodsWe conducted a hospital based matched case-control study to assess the factors associated with preeclampsia in Karachi and Rawalpindi, from January 2006 to December 2007. 131 hospital-reported cases of PE and 262 controls without history of preeclampsia were enrolled within 3 days of delivery. Cases and controls were matched on the hospital, day of delivery and parity. Potential risk factors for preeclampsia were ascertained during in-person postpartum interviews using a structured questionnaire and by medical record abstraction. Conditional logistic regression was used to estimate matched odds ratios (ORs) and 95% confidence intervals (95% CIs).ResultsIn multivariate analysis, women having a family history of hypertension (adjusted OR 2.06, 95% CI; 1.27-3.35), gestational diabetes (adjusted OR 6.57, 95% CI; 1.94 -22.25), pre-gestational diabetes (adjusted OR 7.36, 95% CI; 1.37-33.66) and mental stress during pregnancy (adjusted OR 1.32; 95% CI; 1.19-1.46, for each 5 unit increase in Perceived stress scale score) were at increased risk of preeclampsia. However, high body mass index, maternal age, urinary tract infection, use of condoms prior to index pregnancy and sociodemographic factors were not associated with higher risk of having preeclampsia.ConclusionsDevelopment of preeclampsia was associated with gestational diabetes, pregestational diabetes, family history of hypertension and mental stress during pregnancy. These factors can be used as a screening tool for preeclampsia prediction. Identification of the above mentioned predictors would enhance the ability to diagnose and monitor women likely to develop preeclampsia before the onset of disease for timely interventions and better maternal and fetal outcomes.

PURPOSE Patients with breast cancer in Pakistan commonly present with advanced disease. The objectives of this study were to evaluate the frequency and length of delays in seeking medical consultation and to assess the factors associated with them. METHODS Four hundred ninety-nine patients with newly diagnosed breast cancer were enrolled and interviewed over the period from February 2015 to August 2017. Information on sociodemographic factors, delay to medical consultation, stage of breast cancer at presentation, and tumor characteristics of the breast cancer were collected through face-to-face interviews and medical file review. RESULTS The mean (standard deviation) age of patients with breast cancer was 48.0 (12.3) years. The mean (standard deviation) patient delay was 15.7 (25.9) months, with 55.2% of women detecting a breast lump but not seeking a medical consultation because of a lack of awareness about the significance of the lump. A total of 9.4% of the women decided to seek treatment initially using complementary and alternative medicine and traditional treatment; 9.4% of the women presented to a health care provider with a breast lump but no action was taken, and they were wrongly reassured about the lump without mammography or biopsy. For 26% of the women, the delay in presentation was caused by anxiety, fears and misconceptions regarding diagnosis and treatment, and other social factors including possible adverse effects on their relationship with their husband. Multivariable analysis showed a strong association of lower socioeconomic status (odds ratio [OR], 8.11 [95% CI, 2.46 to 26.69]) and late stage of breast cancer (OR, 4.83 [95% CI, 1.74 to 13.39]) with a patient delay of ≥ 3 months. CONCLUSION Patient delay is a serious problem in Pakistan. There is an urgent need for intensive and comprehensive breast cancer education that addresses the myths and misconceptions related to breast cancer.

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Background The prevalence of vitamin D inadequacy and breast cancer are both high among women living in Karachi, Pakistan. Methods A matched case control study was conducted in two hospitals of Karachi, Pakistan to evaluate the association of vitamin D (serum 25-hydroxyvitamin D) concentrations, vitamin D supplementation and sun exposure with breast cancer among Pakistani women. A total of 411 newly diagnosed histologically confirmed primary breast cancer cases were enrolled and 784 controls, free of breast and any other cancers, were matched by age (year of birth ± 5 years), residence in the same geographic area and study site. Information was collected on sociodemographic history, history of vitamin D supplementation, past medical and obstetrical history, family history of breast cancer, sun exposure history, histopathology reports and anthropometric measurement and venous blood was collected to measure serum 25-hydroxyvitamin D (25(OH)D) concentration. Results Compared to patients with sufficient serum vitamin D (>30 ng/ml), women with serum vitamin D deficiency (<20ng/ml), had a higher risk of breast cancer (OR = 1.65, 95%CI: 1.10, 2.50). Women with history of vitamin D supplementation one year prior to enrollment, had significant protective effect against breast cancer (OR = 0.32, 95% CI: 0.24, 0.43). Conclusions and recommendation Serum vitamin D deficiency was associated with increased risk of breast cancer, while vitamin D supplementation was associated with decreased risk of breast cancer.

Background Vitamin D deficiency is becoming a serious public health problem, even in sun-drenched cities like Karachi, Pakistan. We investigated the prevalence of vitamin D deficiency and its association with sociodemographic characteristics, anthropometric measures, and lifestyle factors among premenopausal and postmenopausal women (n = 784). Methods Face-to-face interviews were conducted to collect information and serum concentrations of 25-hydroxyvitamin D were measured after the interviews. Results A total of 57% of women were vitamin D deficient with higher vitamin D deficiency found among premenopausal women (64.7%) compared to postmenopausal women (49%). The median serum concentrations of 25-hydroxyvitamin D (IQR) were 16.7 ng/ml (IQR 9.8–30.0). Factors associated with vitamin D deficiency were lower socioeconomic status (OR 2.00; 95% CI 1.15–3.48), younger age with highest vitamin D deficiency found in < 35 years of age group (OR 3.11; 95% CI 1.76–5.51), and winter season (OR 1.51, 95% CI 1.07–2.15) after adjusting for multiple confounders. The use of vitamin D supplement (OR 0.59, 95% CI 0.38–0.92) and vigorous exercise (OR 0.20, 95% CI 0.05–0.80) were protective against vitamin D deficiency. Conclusions The study shows a high prevalence of vitamin D deficiency, with detrimental health effects, among younger women belonging to lower socioeconomic status and during the winter season. The use of vitamin D supplements and vigorous exercise were protective measures. Public health campaigns are needed for education and awareness about vitamin D deficiency to improve vitamin D status for younger women living in poor environments.

Background: A year after the COVID-19 pandemic vaccination rollout, vaccine elicited immunity is waning and newer variants e.g. The Delta Variants and Omicron have necessitated the administration of booster doses because of the rise in breakthrough infection rate. The objectives of our study are to determine the prevalence of acceptance status of Covid-19 booster dose in the adult population of Pakistan and its association with knowledge and perceived benefits. Methodology: A cross-sectional study was conducted by online self-administered questionnaire shared to the general population of Pakistan. The form was distributed to 100,000 people out of which 461 responded. The questionnaire was based on the Health Belief Model. Frequencies and proportions for categorical variables, and the Chi-squared test was used to examine differences between COVID-19 booster acceptance and perceived barriers in getting a booster dose and between booster acceptance and knowledge on health benefits of a booster dose. Results: 89.4% reported acceptance of the COVID 19 booster dose . The youngest age group of 18-30 years had acceptance prevalence of this group was 85.4% . Participants with respiratory disease (2.6%) had an acceptance prevalence of 12%, along with participants who identified “other” comorbidities (2.4%) that had a 10% acceptance prevalence. Of all subjects who participated 97% (n=447) had been vaccinated and 32.1% (n=148) had received the booster dose. Knowledge was significant at a p-value <0.01 for acceptance of a booster dose. One of the significant perceived barriers and concerns regarding the Covid-19 booster dose according to chi square test results, was being too busy to get the booster dose. Conclusion: Our research has findings which indicate a relatively large percentage of respondents accepting COVID-19 booster vaccination. More efforts are needed to help people register and educate people about the long-term risks.

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With current situation of increasing burden of cancer in Pakistan, this report reviews studies related to cancer burden and cancer prevention and control in Pakistan. Electronic databases used were PubMed, Medline, EMBASE, the University of Adelaide library & AKU library database, to search for relevant articles on the topic of cancer prevalence in Pakistan published in English. We conducted a literature search of published epidemiological and clinical studies relating to this topic up to March 1st, 2020. There is a dearth of epidemiological studies in cancer risk factors, prevention and control. Most studies are hospital based with small sample sizes and underpowered. Epidemiological integrated transdisciplinary research in collaboration with hospitals is needed to find the actual burden, etiology and feasible prevention strategies of cancer unique to our population with focus on low cost screening methods for early detection of cancers and premalignant lesions in our population. There is an urgent need for a centralized national cancer registry to have combined results of cancer registry from Pakistan Atomic Energy Commission, Karachi Caner Registry, Punjab Cancer Registry and cancer registries from the rest of Pakistan. There is a need to make cancer incidence as notifiable disease mandatory to have the data of cancer incidence in Pakistan. Collaboration is also needed to work with diverse groups like the National Cancer Society of Pakistan (NCSP), National Cancer Control Plan, and Society of Medical Oncology Pakistan to draft and implement plans and strategies for national cancer control programs. It will help mobilize Ministry of Health and policy makers to address the alarming high incidence of different types of cancers in Pakistan.