Search

Calcium and Vitamin D deficiency is highly prevalent in Pakistan. Both micronutrients have a significant role in human growth and development. Supplementation becomes essential when the available natural sources like food and sunlight, cannot replenish the deficiencies. Nevertheless, it is critical that while prescribing Calcium or Vitamin D supplements, physicians should know the composition and specific application of each supplement. This review explores the different types of Calcium and Vitamin D pharmaceutical supplements available in the market their composition, indication and contraindications. Data of Calcium and Vitamin D supplements has been colected by Pakistani drug sites databases, including 'Drug Infosys (www.druginfosys.com)', 'Dawaee.pk', 'Sehat.com.pk' and 'Medicine Net' by pharmacists and orthopaedists. The commonly prescribed supplements are Cholecalciferol (Vitamin D) and Calcium Carbonate (Calcium). Over time, an increase in market share of Vitamin D and Calcium supplementations is due to their over-the-counter availability, increased physicians' prescriptions, and self-prescribed use by the population. There is a need to develop national guidelines and policies to safeguard the population's health at large. [ABSTRACT FROM AUTHOR]

Objective: to determine of vitamin D administration in preventing recurring benign paroxysmal positional vertigo events. Study Design: Quasi experimental study. Place and Duration of Study: Department of ENT, Combined Military Hospital, Rawalpindi Pakistan, from Jul 2021 to Jan 2022. Methodology: Study was conducted on 80 patients who were diagnosed with recurrent benign paroxysmal vertigo. Patients were enroled in two groups (Group A and B) by lotery method. Vitamin D supplements and canal repositioning manoeuvre were administered to patients in Group A, while just canal repositioning procedure was given to patients in Group B. Patients were told to folow up over six months. Vitamin D supplement consumption and BPPV atacks were tracked over 6-month folow up period. Results: In folow-up period, most patients in Group A 24(60.0%) had no episodes of vertigo, whereas 10(25.0%) had single episode of vertigo. Furthermore, none of the patients experienced three episodes. Many patients in Group B 19(47.5%) developed one or more episodes. The difference between both groups was statisticaly significant (p<0.05). Conclusion: Low vitamin D levels are found in most individuals with benign paroxysmal positional vertigo events. Vitamin D supplementation significantly decreased the frequency and recurrence of benign paroxysmal positional vertigo events, according to the findings. [ABSTRACT FROM AUTHOR]

Objective: To investigate the viability of utilizing preoperative serum vitamin D levels as a predictor of postoperative transient hypocalcemia in patients who were undergoing total thyroidectomy in our population. Study Design: Prospective Observational study. Setting: Shifa International Hospital Islamabad, Pakistan. Period: 1st July 2020 to 30th June 2022. Material & Methods: All the data was collected prospectively. Patients are divided into two groups depending on the pre- operative vitamin D levels. The preoperative vitamin D levels are checked on the day of admission before the surgery. After the surgery, their post-operative serum calcium levels are checked at 6 hours, 24 hours and 48 hours. Intact PTH levels are also checked after the surgery and correlation of transient hypocalcemia with intact PTH levels is also checked. Results: Our results strongly predict that serum Vitamin D levels and intact parathyroid hormone (PTH) levels are diagnostic indicators of transient hypocalcemia in post thyroidectomy patients. Conclusion: Our study shows: Pre-operative vitamin D is an early indicator of hypocalcemia in post-thyroidectomy patients. Serum intact parathyroid hormone levels is an early indicator of hypocalcemia in post-thyroidectomy patients. [ABSTRACT FROM AUTHOR]

Objective: Serum vitamin D (25-hydroxyvitamin-D; 25(OH) D) is associated with glucose metabolism in obese subjects. However, results are conflicting as other related metabolites like a parathyroid hormone (PTH) were not accounted for. We examined the joint association of 25(OH) D and PTH with the prevalence of insulin resistance (IR) in non-diabetic obese women. Method: This study included 220 obese women (mean BMI 33.7 ± 5.8) of the age range 20–50 years. Blood sample in fasting was analyzed for glucose, insulin, 25(OH) D, PTH, and calcium levels. Vitamin D levels less than 12 ng/ml and more than 30 ng/ml were considered deficiency and sufficiency, respectively. Results: Most women (96.8%) were either vitamin D deficient or insufficient. Fasting glucose was positively and insulin and HOMA-IR index were negatively correlated (r = 0.047, –0.032, –0.024, respectively) with vitamin D. All these correlations were positive with PTH levels (r = 0.193, 0.108, and 0.136, respectively). IR was detected in 96 (43.6%) women. Vitamin D and calcium were comparable, but PTH was significantly (p < 0.05) higher in IR than in non-IR obese women. The obese women with a PTH level more than median value (17.0 pg/ml; n = 111) had a significantly higher percentage of women with IR than those below (n = 109) this threshold (57.4% versus 30.4%; p = 0.0003). The highest prevalence of IR (64.1%) was detected in vitamin D-deficient women having more than median PTH levels. Conclusion: The prevalence of insulin resistance in obese women could be better explained by serum vitamin D and PTH levels jointly rather than vitamin D levels alone. [ABSTRACT FROM AUTHOR]

Objective: To assess the effect of a single-dose, oral vitamin D supplementation (soft gel capsule of 200,000 IU) in subjects with painful diabetic neuropathy (PDN) in Pakistan. Design: Randomized control trial. Materials and Methods: This randomized control trial was conducted at the Baqai Institute of Diabetology and Endocrinology (BIDE), Pakistan from November 2021 to August 2022. Subjects with diabetes without any signs of vitamin D deficiency were included. Baseline details were obtained by a predesigned questionnaire. Douleur neuropathy 4 (DN4) score was used for diagnosing PDN. Biochemical tests include serum 25-hydroxyvitamin D (OH)D and HbA1c for screening at baseline and at 3 months follow-up were analyzed. Subjects were categorized into two: a control group and an intervention group. The intervention group was given a single soft gel vitamin D capsule (200,000 IU) after screening by expert paramedical staff. Based on baseline serum vitamin D levels, the intervention group was further categorized into insufficient vs. deficient groups, and the control group was categorized into insufficient vs. sufficient. Results: Of 159 participants, 19.5% vs. 44.7% subjects were with insufficient vs. deficient vitamin D levels in the intervention group, and 10.7% vs. 25.1% were with insufficient vs. sufficient vitamin D levels in the control group, respectively. Though the findings are insignificant, DN4 score at follow-up in intervention groups and control groups was reduced compared to the baseline DN4 score. Furthermore, we observed a reduction in post-HbA1c levels in both the intervention groups (insufficient vs. deficient) and the control-sufficient group. Conclusion: Treatment with vitamin D supplementation in people with PDN helps to improve vitamin D levels, DN4 score, and HbA1c levels, though doseresponse is yet to be compared. [ABSTRACT FROM AUTHOR]

Hypovitaminosis D (Vitamin D deficiency and insufficiency) is a major public health problem globally. A high prevalence of vitamin D deficiency (VDD) and vitamin D insufficiency (VDI) has been noted in South Asian (SA) women of childbearing age despite the abundant sunshine. Therefore, this study aimed to systematically review the existing data from population-based studies in this region to summate the magnitude of the problem. Articles published and reported prevalence of VDD/VDI in eight South Asian countries during period of 2010- 2020 were searched and screened from PUBMED and Google Scholar using PRISMA guidelines. The study population was healthy women of childbearing age (18-45 years) and included pregnant and non-pregnant women. Fourteen population-based studies were found from SA countries India, Sri Lanka, Pakistan, Bangladesh and Nepal. No studies were available from Afghanistan, Bhutan, and Maldives pertaining to the searched period. Participant groups were from diverse socioeconomic and cultural backgrounds. The prevalence ranged from 61.5% from Pakistan to 100% from Bangladesh. This systematic review reported a significantly higher prevalence of hypovitaminosis D among SA women of childbearing age. Inadequate sun exposure, lack of consumption of good vitamin D food sources due to either illiteracy or economic constrains has been regarded as potential determinants of hypovitaminosis D among participants. The findings of this study would help pertinent stake holders to prepare suitable national level programs to enhance the Vitamin D status of women of childbearing age. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is most common in Pakistani women at young age compared to West where it is most common after 60 years of age. Variations in genes controlling vitamin D activity would play a role in determining the risk of breast cancer in women at early age. Purpose: To determine the association of vitamin D receptors (VDR) gene polymorphisms (FokI) with breast cancer risk in Pakistani women. Methods: FokI polymorphisms were studied through the polymerase chain reaction-restriction fragment length polymorphism technique on blood samples of 300 breast cancer and 300 healthy women. Results: This study found that circulating level of 25(OH)D3 was significantly lower among breast cancer patients as well as healthy subjects. Patients with large tumor size had significantly lower vitamin D levels. VDR FokI genotypes were significantly distributed (P = 0.00001) in Pakistani women with newly diagnosed breast cancer. A significant association between different FokI genotypes and circulating levels of 25(OH)D3 was found. Patients with FF genotype was significantly (P < 0.0001) associated with higher risk of breast cancer (OR 8.9, 95% CI 0.17-0.45) compared to Ff and ff genotype. Conclusion: VDR gene FokI polymorphism was associated with plasma vitamin D level and significant differences found in mean serum vitamin D levels between genotype groups of FokI. The study concluded that FokI might be one of the contributors to increase relative risk of breast cancer in Pakistani women. [ABSTRACT FROM AUTHOR]

Objective: To study the association of sociodemographic factors and Vitamin D levels with the severity of depressive symptoms in patients with depression. Study Design: Cross-sectional study. Place and Duration of Study: Psychiatry Department, Fauji Foundation Hospital, Rawalpindi Pakistan, from May to Nov 2021. Methodology: This study included all the patients diagnosed with depression per ICD 10 criteria by the consultant psychiatrist. Depression was further categorized in severity using Beck's Depression Inventory. Vitamin D levels were sent to all the patients diagnosed with depression in the laboratory of our hospital. The cut-off score of less than 50nmol/l was taken as low vitamin levels. Results: Out of 103 patients studied, 23(22.3%) had mild, 49(47.6%) had moderate, and 31(30.1%) had severe depression. In severely depressed patients, 19(61.3%) were above 50 years of age, 12(38.7%) had no formal education, and 21(67.7%) had low vitamin D levels. Among mildly depressed patients, 5(21.7%) were above 50 years of age, 2(8.7%) had no formal education, and 17(73.9) had low vitamin D levels. We found that vitamin D levels, age of the patient, and level of education had a statistically significant relationship with the severity of depression, (p-valve less than 0.05). Conclusions: The level of vitamin D, age, and the level of education had a significant association in the target population with the severity of depressive symptoms. [ABSTRACT FROM AUTHOR]

Objective: To evaluate serum vitamin-D levels in patients with Alopecia areata compared to healthy controls. Study Design: Comparative cross-sectional study. Place and Duration of Study: Dermatology Outpatient Department, Fauji Foundation Hospital, Rawalpindi Pakistan, from Nov 2019 to Apr 2020. Methodology: The study included 70 patients with Alopecia areata (Group-1) and 70 healthy controls (Group-2). Complete blood count, TSH, urea and creatinine, fasting plasma glucose, liver function tests, serum Calcium and vitamin-D levels were performed. Results: The mean vitamin-D levels of Group-1 were 38.28±22.07ng/mL, and the mean vitamin-D levels of Group-2 were 39.61±18.36ng/mL. In Group-1, deficient vitamin-D levels were seen in 14(20.0%) of Group-1, and insufficient in 19(27.1%) and 37(52.9%) had normal levels. In Group-2, 10(14.3%) had deficient levels, 16(25.0%) had insufficient levels and 44(62.9%) had normal levels. No statistically significant difference seen between Group-1 and Group-2. Conclusion: There is no association between vitamin D level and Alopecia Areata. [ABSTRACT FROM AUTHOR]

Objective: To evaluate serum vitamin D levels in patients with vitiligo and compare them to the healthy controls. Study Design: Comparative cross-sectional study. Place and Duration of Study: Dermatology Outpatient Department, Fauji Foundation Hospital, Rawalpindi Pakistan, from Nov 2019 to Apr 2020. Methodology: The study included 75 patients with vitiligo (Group-1) and 75 healthy controls (Group-2). Complete blood count, urea and creatinine, liver function tests, TSH, fasting plasma glucose, vitamin B12 levels, serum calcium and vitamin D levels were performed. In addition, vitamin D levels were compared in both groups. Results: The mean age of Group-1 was 32.81±20.59 years, and Group-2 was 40.13±16.09 years. In Group-1, deficient vitamin D levels were seen in 17(22.7%) of cases, insufficient in 25(33.3%) and 33(44.0%) had normal levels. In Group-2, 10(13.3%) had deficient levels, 10(13.3%) had insufficient levels and 55(77.3%) had normal levels. Patients with vitiligo had low serum 25(OH)D levels compared to controls, and this difference was statistically significant (p=0.001). Conclusion: Low serum vitamin D levels are seen in patients with vitiligo compared to controls. [ABSTRACT FROM AUTHOR]

Background: Vitamin D can influence more than 200 genes in various tissues showing its credibility among the fat-soluble vitamins. Vitamin D deficiency is directly proportional to major clinical conditions such as cardiovascular diseases, diabetes, malignancy, and multiple sclerosis. This study was conducted to determine the vitamin D level of individuals and its association with depression. Methods: Vitamin D levels of 100 healthy and 100 depressed subjects were determined. The isolated subjects were screened on the Beck Depression Inventory (BDI) scale and divided into three groups according to their age. Group-I comprised subjects of age 20 years and below, Group-II included subjects of age 21 to 60, and Group-III comprised subjects of ≥ 61 years of age. A sufficient level of vitamin D in normal subjects was noted, while mild deficiency of vitamin D status was observed in depressed subjects. Results: Our study has reported a higher percentage of vitamin D deficiency in the Peshawar region. The results of our study indicated that depression was common in individuals having vitamin D deficiency. Conclusions: The study showed a very high frequency of vitamin D deficiency in subjects with depression in Peshawar, Pakistan. The deficiency of vitamin D was observed more in females as compared to males. Further studies should explicate whether the highly widespread vitamin D deficiency could be cost-effectively treated as part of preventive or treatment interventions for depression. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of vitamin D deficiency in chronic liver disease patients. Study Design: Cross-sectional study. Place and Duration of Study: Gastroenterology Department, Liaquat National Hospital and Medical College, Karachi Pakistan, from Jan to Dec 2020. Methodology: Patients between the age of 18 to 50 years, of either gender, already diagnosed case of chronic liver diseases for 6 months and had sun exposure of at least 15 minutes twice weekly were included in this study. History was taken after taking informed written consent, the clinical assessment was done, and blood samples were sent for serum vitamin D levels to determine the results. Results: The study included 177 patients with chronic liver disease. One hundred eleven patients (62.7%) were males and 66 patients (37.3%) were females, with the mean age of 45.0 ± 6.306 years. Vitamin D deficiency was observed in 100 patients (56.5%). Conclusion: The frequency of vitamin D deficiency was quite high. It increases with age and body mass index and is predominant in the male gender, while no association was noted with sun exposure time. [ABSTRACT FROM AUTHOR]

Objective: To determine the association between serum vitamin D levels and febrile seizures in the paediatric patients. Study Design: Case-Control Study. Place and Duration of Study: Abbasi Shaheed Hospital, Karachi Pakistan, from Mar 2020 to Mar 2021. Methodology: The study included all pyrexia paediatric patients, both with and without febrile seizures, as cases and controls. Children aged below six months or older than 60 months, with a previous history of afebrile seizures, diagnosed with central nervous system infection, dehydration, or electrolyte disturbance, were excluded from the study. Serum vitamin D levels and other demographic data were documented. Results: The study included 86 cases and controls. The mean age of cases was 28.07±16.47, and the controls were 26.38±15.72 months. The rate of vitamin D insufficiency was three times more likely in cases compared to controls, i.e. [OR, 95% CI: 3.95 (2.084-7.489)] with p=0.0001. Conclusion: Vitamin D deficiency is substantially more likely in the case than in the control group. As a result, children with febrile seizures should have their serum vitamin D levels tested. [ABSTRACT FROM AUTHOR]

Objective: To determine the association of single nucleotide polymorphism of vitamin D receptor gene Fok 1 (rs10735810) with dental caries in Pakistani adolescents. Study Design: Case-control study. Place and Duration of Study: Biochemistry Department, Islamic International Medical College, Rawalpindi in cooperation with Pathology Department, Railway General Hospital, Rawalpindi Pakistan, from Sep 2019 to Aug 2020. Methodology: A total of 304 participants were included in the study. There were 152 dental caries cases and 152 normal agematched controls. After taking written informed consent, blood samples were collected from each participant. DNA extraction was done by Chelex Method. PCR was carried out to determine the respective allelic frequencies of Fok 1 (rs10735810) genotype using specific primers. Results: Out of 304 study participants, there were 26 males (17.1%) and 126 females (82.9%) in case-group; and 37 males (24.3%) and 115 females (75.7%) in control-group. No significant association of Fok 1 (rs10735810) genotype with DMFT score was found in dental caries case-group. Regarding genotypic and allelic frequencies, there was no significant association of Fok 1 (rs10735810) genotype with dental caries case-group. Conclusion: Single nucleotide polymorphism of vitamin D receptor gene Fok 1 (rs10735810) is not associated with dental caries in Pakistani adolescents. [ABSTRACT FROM AUTHOR]

Objective: To assess the vitamin D levels among patients presenting with acute ischemic stroke and relationship of these levels with short-term outcome and the severity of stroke. Study Design: Cross-sectional study. Place and Duration of Study: Department of Medicine, Pak Emirates Military Hospital Rawalpindi Pakistan, from Dec 2019 to Feb 2021. Methodology: A total of 300 patients with ischemic stroke diagnosed by the consultant medical specialist or neurologist on the basis of clinical and neuro-radiological findings were included in this study. Serum Vitamin D levels were assessed along with other baseline investigations among the study participants. Severity of stroke was assessed via National Institutes of Health Stroke scale and short-term outcome was assessed by modified Rankin scale. Results: Out of 300 patients of acute ischemic stroke, 183 (62.3%) were males while 117 (37.3%) were females. 151 (50.3%) of the patients had Vitamin D levels within range while 149 (49.7%) had deficient vitamin levels. On National Institutes of Health Stroke scale, 163 (54.3%) had mild, 87 (29%) had mild to moderately severe, 33 (11%) had severe and 17 (5.7%) had very severe symptoms. Statistical analysis revealed that short-term outcome and stroke severity had a statistically significant relationship (p-value <0.05) with Vitamin D deficiency among patients suffering from acute ischemic stroke. Conclusion: Almost half of the patients presenting with acute ischemic stroke had vitamin D deficiency in our study. Those having vitamin D deficiency had more chances of having severe form of ischemic stroke and poor short-term outcome. [ABSTRACT FROM AUTHOR]

Background: There are no studies done to evaluate the distribution of mammographic breast density and factors associated with it among Pakistani women.Methods: Participants included 477 women, who had received either diagnostic or screening mammography at two hospitals in Karachi Pakistan. Mammographic breast density was assessed using the Breast Imaging Reporting and Data System. In person interviews were conducted using a detailed questionnaire, to assess risk factors of interest, and venous blood was collected to measure serum vitamin D level at the end of the interview. To determine the association of potential factors with mammographic breast density, multivariable polytomous logistic regression was used.Results: High-density mammographic breast density (heterogeneously and dense categories) was high and found in 62.4% of women. There was a significant association of both heterogeneously dense and dense breasts with women of a younger age group < 45 years (OR 2.68, 95% CI 1.60-4.49) and (OR 4.83, 95% CI 2.54-9.16) respectively. Women with heterogeneously dense and dense breasts versus fatty and fibroglandular breasts had a higher history of benign breast disease (OR 1.90, 95% CI 1.14-3.17) and (OR 3.61, 95% CI 1.90-6.86) respectively. There was an inverse relationship between breast density and body mass index. Women with dense breasts and heterogeneously dense breasts had lower body mass index (OR 0.94 95% CI 0.90-0.99) and (OR 0.81, 95% CI 0.76-0.87) respectively. There was no association of mammographic breast density with serum vitamin D levels, diet, and breast cancer.Conclusions: The findings of a positive association of higher mammographic density with younger age and benign breast disease and a negative association between body mass index and breast density are important findings that need to be considered in developing screening guidelines for the Pakistani population. [ABSTRACT FROM AUTHOR]

Background and Objectives: To compare the differences in musculoskeletal health with vitamin D alone in comparison with vitamin D with physical activity (PA) among chronic kidney disease (CKD) patients.Methods and Study Design: An open labeled, randomized, controlled trial was conducted at two tertiary care centers in Pakistan. Patients with CKD stage 2-4 and vitamin D deficiency (<20 ng/mL) were recruited in the trial. Both the arms were given oral vitamin D (cholecalciferol) drops (4000 IU) once daily for three months. One arm received only vitamin D (VD arm), while the second arm received vitamin D along with PA (VDPA arm).Results: Of the 1,235 CKD stage 2-4 subjects contacted, forty-six subjects were enrolled. Eighteen were assigned to VD arm and twenty-eight were assigned to VDPA arm. Between groups comparison shows that bicep strength increases from 15 to 17 kg. Likewise, back flexibility and aerobic fitness also increased among those who receive vitamin D and physical activity, however these differences were not statistically significant (p>0.05). Sensitivity analysis within group comparison shows rise of bicep strength from 13.8 kg to 15.2 kg in the VD alone arm (p=0.05); however, in the VDPA arm, there is a greater difference of 14.3 kg to 17.2 kg (p<0.001).Conclusions: Targeted PA among CKD patients has potential to improve bicep strength and back flexibility. However, as the sample size was small, further studies would be required to suggest whether a PA should be included as part of the treatment regimen. [ABSTRACT FROM AUTHOR]

Objective: To determine frequency of vitamin D deficiency in patients presenting with fibromyalgia and its association with various factors. Study Design: Cross sectional study. Place and Duration of Study: Medicine department, Pak Emirates Military Hospital Rawalpindi, from Sep 2018 to Feb 2019. Methodology: Ninety patients of fibromyalgia were included in the study. Diagnosis of fibromyalgia was made by the consultant rheumatologist on the basis of American College of Rheumatology Criteria needed for fibromyalgia diagnosis and classification. Vitamin D levels <20ng/ml were considered as deficient. Age, education, marital status, menstrual abnormallities and body mass index were correlated with the presence of vitamin D deficiency among the patients suffering from fibromyalgia. Results: Out of 90 patients of fibromyalgia, 57 (63.3%) showed the presence of vitamin D deficiency while 33 (36.7%) had no deficiency of vitamin D. Among the study participants 88 (97.8%) patients were females and only 2 (2.2%) patients were males. Mean age of the patients was 39.4 ± 3.365 years. After applying the binary logistic regression, we found that presence of menstrual abnormalities and high body mass index had significant association with the presence of vitamin D deficiency among the patients of fibromyalgia (p-value<0.05). Conclusion: Vitamin D deficiency emerged as a common finding among the patients of fibromyalgia in a teaching hospital of Pakistan. Vitamin D deficiency should be screened at the rheumatology clinics and special attention should be paid to the patients who are overweight or obese and female patients with the menstrual abnormalities. [ABSTRACT FROM AUTHOR]

The COVID‐19 pandemic has introduced a new battle in human history for a safe and fearless life. Therefore, this cross‐sectional survey was conducted (Punjab, Pakistan) on healthy recovered, home quarantined COVID‐19 patients to draw conclusive health support guidelines in the fight against this pandemic. COVID‐19 recovered patients (n = 80) of age ≥14 years were randomly selected during the period November 2020 to February 2021. A nutrition and lifestyle changes questionnaire, containing ten sections and seventy questions, was completed through the telephone/WhatsApp. Data were transferred into an Excel spreadsheet and statistically analyzed by applying chi‐square, correlation, and a t test of independent values using SPSS‐16 software. The patients had an age range of 14 to 80 years, of which 52 (65%) were male and 28 (35%) were female, and 32 (40%) had a normal BMI. The patients had a peak COVID‐19 recovery period of 2 weeks, and a mean recovery period of 2.8 ± 1.4 weeks. Certain variables, including gender (males), age (>40 years), sleep (≤5 hr), less/no physical activity, obesity, diabetes mellitus, and autoimmune diseases, were significantly associated with delayed recovery. Poor nutritional outcomes, including lower intakes of water, legumes, nuts, meat, and milk/yogurt; and higher consumption of fast/fried/junk/spicy foods and cold water/drinks, were also significantly associated with a longer recovery period. The results were similar for not taking daily doses of multivitamins, and vitamins C, D, E, and zinc. This study identified that staying physically active, maintaining sensible body weight, having a sleep of 7 hr, consuming more foods of plant origin especially plant‐based proteins from nuts and legumes, taking supplemental doses of multivitamins, vitamin D, E, and zinc, along with drinking ≥2 L of water daily can provide a significant role in early and safe recovery from COVID‐19. [ABSTRACT FROM AUTHOR]

Objective: To compare analytical method for 25 hydroxy vitamin D2 and D3 on LC/MS-MS and with routine vitamin D Immunoassay method. Study Design: Cross Sectional study. Setting: Department of Chemical Pathology and Endocrinology AFIP, Pakistan. Period: March 2019 to March 2020. Material & Methods: Samples were extracted and a mass spectrometer coupled to high performance liquid chromatography was adopted for quantitation of 25-hydroxyvitamin D2 and D3 in human samples (serum). After validation it was then applied to 120 serum samples from healthy individuals for method comparison. Results: The method was validated in terms of accuracy, precision, linearity on calibration curve, Limit of Detection and Limit of Quantitation. Our study showed a statistically insignificant difference in results among both the methods (p=0.715). Limit of detection (LOD) was 2.49 ng/ml and limit of quantitation (LOQ) was 3.9 ng/ml for both the metabolites. Percentage RSD was 0.8% and 1.3% for D2 and D3 respectively. This method has an advantage of minimal cross-reactivity with 24,25 hydroxy vit D and 25,26 di- hydroxy vit D metabolite than the routinely used assays. Conclusion: This methodology will be helpful in guiding patient management and assess possibility of malabsorption syndrome in patients on D2 therapy. It can give highly cost effective reliable results of Vitamin D at a tertiary care setting which has an already installed LCMS/MS with huge workload, as compared to costly Immunoassay method. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to determine the prevalence of vitamin D deficiency in Pakistani systemic lupus erythematosus (SLE) patients and the effect of vitamin D deficiency on the severity and outcomes of SLE. Patients and methods: This retrospective study evaluated SLE patients presenting to our hospital between January 2009 and December 2018. A total of 98 patients (13 males, 85 females; mean age 39.8±14.9 years; range, 16 to 73 years) with vitamin D levels available at the time of diagnosis were included in the study. Disease activity was measured using SLE disease activity score at the time of diagnosis and at the two-year mark. Results: Sixty-five patients were deficient in Vitamin D and out of those 46 were severely deficient. The severe disease group had more patients with vitamin D deficiency at both visits (43/78 and 33/46) while patients in remission all had normal vitamin D (12/12 and 14/14) (p=0.001). Conclusion: Vitamin D deficiency is common in SLE patients and also significantly associated with increased disease activity at the time of diagnosis and at the two-year mark. We hope this study becomes a platform for the global medical community to come together and implement early screening and monitoring of vitamin D levels and to determine the optimal level of supplementation for prevention of poor outcomes in SLE. [ABSTRACT FROM AUTHOR]

In Pakistan, there is limited evidence for the levels and relationship of 25 (OH) Vitamin D (25(OH)D) status in pregnant women and their newborns, while the association between maternal 25(OH)D and newborn anthropometric measurements remains unexplored. Sociodemographic data were collected from 213 pregnant mothers during their visit to a tertiary care hospital at the time of childbirth. Anthropometric measurements were performed on all mothers and their newborns and blood samples collected from both for 25(OH)D levels. Participants were classified into two groups according to their 25(OH)D status: sufficient (25(OH)D ≥50 nmol L−1) and deficient (25(OH)D <50 nmol L−1). Simple and multiple regression models were used for analysis. Among 213 pregnant women, prevalence of 25(OH)D deficiency was 61.5%, and their newborn was 99.5% (mean 25(OH)D levels: 46.3 [11.3] and 24.9 [5.4] nmol L−1, respectively). Maternal sociodemographic characteristics were similar between 25(OH)D deficient and sufficient mothers, whereas newborn 25(OH)D levels were significantly lower in the former (22.60 [4.53] vs. 27.67 [3.82] nmol L−1, respectively, P < 0.001). There was a strong positive association between maternal and newborn 25(OH)D levels (r, 0.66; r2, 43%, B [SE], 0.3 [0.02]; P < 0.001). Association of maternal 25(OH)D levels with newborn weight, length and head circumference was not significant (all P > 0.05). Our study shows a high prevalence of 25(OH)D deficiency in pregnant women and their newborns and a strong positive association between maternal and newborn 25(OH)D levels. Findings of this study indicate the importance of maintaining sufficient 25(OH)D levels during pregnancy. [ABSTRACT FROM AUTHOR]

Objective: To identify the risk factors for the development of stress fractures in this sub population in our country. Study Design: Comparative cross sectional study. Place and Duration of Study: Combined Military Hospital Abbottabad Pakistan, from Jan 2015 to Aug 2017. Methodology: This study was conducted to identify different variables as risk factors for stress fractures in training cadets. We analyzed age, gender, running and sports prior to joining training, duration of marching, daily milk and carbonated drinks consumption, cigarette smoking, serum albumin, calcium and vitamin D levels, calf muscle diameter, leg length discrepancy and tibiofemoral angles. Results: A total of 275 participant included in this study, 140 cases, 51% and 135 controls, 49%. Mean age was 20 years. Two hundred and sixty eight (97%) were males and 7 (3%) were females. Grade-2 stress fracture was the commonest with 63 (45%) cases. Regular daily running prior to joining training p<0.006, regular milk intake p<0.005 were found to have a protective effect while subnormal serum calcium level p<0.001, serum vitamin D insufficiency p<0.009, thinner calf diameter p<0.001, heavy daily march p<0.039, leg length discrepancy p<0.025 were significant risk factors. Fourteen percent needed operative treatment. Conclusion: Regular daily running prior to joining training, regular milk intake, thicker calf diameter has a protective effect, while subnormal serum calcium and serum vitamin D levels, daily heavy march, leg length discrepancy are significant risk factors. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy of Alfacalcidol (I.V) and Paricalcitol (I.V) for the treatment of secondary hyperparathyroidism (SHPT) in hemodialysis patients. Material and Methods: An open-label randomized clinical trial was carried out to compare the efficacy of intravenous paricalcitol and alfacalcidol. We recruited 80 patients with end-stage renal disease receiving maintenance hemodialysis in a tertiary care hospital dialysis unit. The participants were randomly divided into two groups. A wash-out period of one week was decided for each patient in whom he/she did not receive any medication for the treatment of hypocalcemia, hyperphosphatemia, or secondary hyperparathyroidism. Afterward, patients received an expanding dosage of alfacalcidol or paricalcitol for a time of about four months, and then after a further washout period of one week, each group received opposite treatment (paricalcitol or alfacalcidol) for a further four months (16 weeks). Results: The analyzed data for the same end-points revealed no difference between the two groups. No significant statistical difference in terms of calcium levels in both groups was noted. The study also found no big difference in the ability of both drugs to treat secondary hyperparathyroidism, while keeping serum phosphate and calcium levels inside the desired range. The study also found no distinction in the frequency of hypercalcemia and hyperphosphatemia as a side effect of Vitamin D analogue's treatment. Conclusion: The study concludes that alfacalcidol and paricalcitol are equally effective in the treatment of secondary hyperparathyroidism in the dialysis population. Since Paricalcitol is expensive as compared to alfacalcidol, in an economically challenged country like Pakistan, Alfacalcidol can be a better choice when treating SHPT as we did not find any gross difference in the ability of two drugs to restrict SHPT. [ABSTRACT FROM AUTHOR]

Objective: To study the clinical, biochemical and radiological features and management outcomes of patients with primary hyperparathyroidism. Methods: This retrospective study was conducted at the Aga Khan University Hospital, Karachi, Pakistan and comprised data of patients with primary hyperparathyroidism from 2008 to 2017. Results: Out of 103 patients, 83(80.6%) were female. Overall mean age was 59.3±16.2 years. Musculoskeletal manifestations were seen in 60(58.3%) patients and renal manifestations in 28(27.2%). Ostieits fibrosa cystica was found in 04(3.88%) patients. Overall, Ultrasound neck and sestamibi scan localized the lesion in 66 (64.1%) and 77 (76.2%) patients respectively. Among 79 patients who underwent surgery, 67 (84.8%) patients had an adenoma, 05 (6.3%) had hyperplasia and 02(2.53%) patients had parathyroid carcinoma whereas histopathology was inconclusive in 5 (6.32%) out of the 79 surgically treated patients. Disease recurrence was seen in 13 out of 79(16.45%) patients who underwent surgery. Conclusion: Primary hyperparathyroidism is associated with significant morbidity in our population. Targeted measures like improving patient awareness, routine calcium screening, vitamin D supplementation and a high index of suspicion by the clinician may help in early diagnosis of the condition and thus reduce morbidity. [ABSTRACT FROM AUTHOR]

Background and Objective: Parathormone (PTH) and serum Vitamin D3 (VD3) share a complex interplay where increased VD3 leads to a negative response on parathormone level. Our objective was to determine the correlation of parathormone (PTH) and Vitamin D3 (VD3) levels in nursing mothers and infants 1-6 months' age from South Punjab, Pakistan. Methods: This study is a secondary data analysis of previously conducted cross sectional study which was conducted at the Department of Pediatric Medicine, Nishtar Medical University, Multan, during August 2010 to June 2011. Study included 67 infants 1-6 months of age and 60 nursing mothers. A venous blood sample was drawn for estimation of VD3, calcium, phosphate, alkaline phosphatase, parathormone and albumin. Spearman correlation coefficient was calculated to determine the inverse correlation between PTH and VD3 levels. Results: Mean age (in days) of the infants was 83±53.7 days whereas maternal mean age was 25.53 ± 4.12 years. Median VD3 level in infants was 20.90 ng/ml (IQR - 49.5). Median serum PTH levels were 20.90 pg/ml (IQR - 26.17). Median VD3 level in nursing mothers was 21.0 ng/ml (IQR 7.2-43.8). Median maternal serum PTH levels were 20.89 pg/ml (IQR 2.9 - 232.4). Substantial negative relation between VD3 and parathormone in infants and mothers was not evident (r = - 0.027, p-value 0.83) and (r = 0.156, p-value 0.23) respectively. A significant positive association between infant and maternal VD3 was observed (rs -0.55, p-value < 0.001). Conclusion: Our study affirms that the customary negative correlation between VD3 and parathormone levels does not exist. [ABSTRACT FROM AUTHOR]

Background: Despite favorable climatic conditions, vitamin D deficiency (VDD) is widespread in Pakistan. Current study was aimed to evaluate the prevalence of VDD in Pakistani pregnant women and effectiveness of various regimen of Vitamin D supplementation. Methodology: This hospital-based prospective cohort study included pregnant women at 12th to 24th weeks of gestation attending Gynae clinic from October 2018 to April 2019. Patients were classified into control and treatment groups (Groups: G1, G2 and G3) according to the dose of vitamin D supplementation. Patients received various regimens of vitamin D including 2000 IU/day (G1), 5000 IU/day (G2) and stat 200000 IU (G3). The levels of vitamin D were measured before and after supplementation. The effectiveness of dosages were compared between and within the groups. Moreover, factors associated with vitamin D sufficiency and insufficiency were ascertained using appropriate statistical methods. Results: Among 281 pregnant women (mean age: 28.22 ± 4.61 years), VDD was prevalent in 47.3% cases. Vitamin D supplementation caused significant rise in the levels 25(OH)D in treatment groups, while there was no significant difference in control group. The highest mean increment in vitamin D (23.14 ± 11.18 ng/ml) was observed with dose 5000 IU/day followed by doses 200000 IU stat (21.06 ± 13.73 ng/ml) and 2000 IU/day (10.24 ± 5.65 ng/ml). Vitamin D toxicity was observed in one patient who received 200000 IU stat of vitamin D. The frequency of VDD following the supplementation was 5.7%. Education status, duration of sun exposure and use of sunblock was substantially associated with vitamin D sufficiency in the current study. Conclusion: Our findings underscore the high proportion of VDD among pregnant women in Pakistan. Maternal vitamin D supplementation substantially improved the levels of 25(OH)D. Of three used regimens, the dose of 5000 IU/day is considered safe and equally effective as of 200000 IU stat. Since pregnancy is a time of tremendous growth and physiological changes for mother and her developing fetus with lifelong implications for the child, gestational vitamin D supplementation should be considered to ensure the optimal vitamin D accrual in pregnant women. This study generates the hypothesis that vitamin D supplementation at a dose of 5000 IU/day during pregnancy is superior to the other regimens. However, well-controlled randomized trials are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Objectives: To correlate vitamin D levels with severity of hypertension. Material and Methods: This study was conducted from September 2016 to December 2016 which comprised seventy-five male subjects from outdoor department of Lahore General Hospital, Lahore Pakistan, and divided into stage I and stage II hypertension groups and healthy attendants were taken as controls. Newly diagnosed hypertensive male patients were included and patients having secondary hypertension, low vitamin D, known kidney, liver, thyroid, parathyroid or cardiac disease were excluded. Blood pressure of subjects was measured using a mercury sphygmomanometer and blood samples for analysis of vitamin D levels were taken. Results: Subjects included had a mean age of 39.97 ± 8.24 years. Mean vitamin D levels (ng/mL) were 35.99 ± 8.08, 28.71 ± 10.85 and 28.12 ± 9.94 in controls, stage I hypertension and stage II hypertension groups respectively. Mean systolic blood pressure (SBP) and mean diastolic blood pressure (DBP) was 110.72 ± 5.59 mm Hg 73.24 and ± 3.35mm Hg in controls, 131.20 ± 8.83 mm Hg and 91.80 ± 5.86 mm Hg in stage I HTN and 144.28 ± 19.28 mm Hg and 103.40 ± 12.05 mm Hg in stage II HTN group, respectively. Both SBP and DBP were inversely related to low 25 (OH) D levels (r=-0.289 & -0.315) respectively. Conclusion: There is an association suggestive of increased SBP, DBP and mean arterial pressure with lower levels of Vitamin D. [ABSTRACT FROM AUTHOR]

Background: Pakistan has one of the highest reported incidence of vitamin D deficiency in studies conducted worldwide. However, there has been very limited exploration of vitamin D related knowledge, attitudes and practices among healthy youth in Pakistan.Methods: A cross-sectional survey was conducted among youth (aged > 16 years) from two engineering universities in Pakistan. Participants were asked questions on their concern about vitamin D levels, testing, and supplementation practices. Knowledge was examined using questions about food sources, health benefits and factors affecting vitamin D production within the human body. Of the 900 eligible students invited to participate, 505 (56%) completed the questionnaire and were included in the analysis.Results: Only 9% participants were able to identify the correct food sources of vitamin D, 33% were aware of the bone health benefits (bone health and calcium absorption) of vitamin D and 36% identified sunlight exposure as a factor influencing vitamin D production. Knowledge about food sources and health benefits of vitamin D was not associated with gender and individuals concern about their levels. Those tested and taking supplements were more likely to identify bone related health benefits and factors affecting vitamin D production. Forty percent male and 52% female students expressed concern that their vitamin D levels were too low. However, 72% participants reported that they had never been tested for vitamin D levels. Use of supplements was significantly higher among female students (F = 52% vs M = 37%; P = 0.003). Those who had been tested for vitamin D deficiency were more likely to take supplements.Conclusion: Despite being identified as a high-risk population, knowledge about vitamin D was limited among university students. Interventions are needed to increase awareness about the importance of vitamin D for health, including the need for exposure to sunlight and adequate dietary intake of vitamin D. Our study provides much needed baseline evidence for making health-policy recommendations for this vulnerable population group. [ABSTRACT FROM AUTHOR]

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. In Pakistani women, where vitamin D deficiency is common, raising and maintaining serum vitamin D at population level is a safe and affordable strategy. It may play a role in reducing the incidence of both vitamin D deficiency and breast cancer, particularly among poor women where the breast cancer mortality is highest due to limited resources for early detection, diagnosis, and treatment. The effects of vitamin D with regard to breast cancer risk in Karachi Pakistan should be further evaluated. [ABSTRACT FROM AUTHOR]

Objective: To determine the pattern of Vitamin D status in patients presenting with complaints of non-specific bone pains and to correlate the association of sunlight exposure with Vitamin D deficiency/insufficiency Study Design: Cross-sectional study. Place and Duration of Study: Department of Chemical Pathology, CMH, Abbottabad Pakistan, from Aug 2020 to Jul 2021. Methodology: All patients with non-specific bone pain were asked about demographic, clinical and sunlight exposure. Vitamin D assays were performed after history taking. Result: A total of 247 patients were tested for vitamin D levels. 103(41.7%) were male and 144(58.3%) were females. 56(22.7%) had >60 minutes of daily sunlight exposure, 67(27.1%) had 30 to 60 minutes, and 124(50.2%) had less than 30 minutes of daily sunlight exposure. Vitamin D deficiency was found in 132(53.4%) patients, insufficiency was seen in 74(30.0%) patients and 41(16.6%) patients had normal vitamin D levels. Vitamin D deficiency correlated significantly with low sunlight exposure time. Conclusion: Vitamin D deficiency was seen in 53.4% of patients with non-specific bone pains, while insufficiency was seen in 30.0% of patients. Moreover, our study showed association of Vitamin D deficiency with a decreased duration of sunlight exposure. [ABSTRACT FROM AUTHOR]

Background & Objective: Vitamin D deficiency (VDD) prevalence is very high in pediatric population in developing countries including Pakistan. VDD contribute significantly to morbidity and mortality among children under five years. Therefore, it is vital to study vitamin D levels in population for future interventions and disease control. Our objective was to determine 25(OH)D levels in children of one to 59 months of age in socio-economically diverse communities of Karachi, Pakistan. Methods: The cross- sectional analytical survey was carried out over 6 months from January -June 2017. Following proportionate sampling technique four clusters were randomly selected from Korangi, Saddar, Sindhi para and Manzoor colony, Karachi. Blood samples for 25(OH)D and zinc levels were carried out using ELISA and colorimetry. VD level <20 ng/ml was defined as VDD and serum zinc <65ug/dl as low zinc levels. Data including area of residency, gender, ethnicity, parent's education, family income, house status, duration of sun exposure and history of VD and zinc intake in last 3 months was collected from parents / care seekers on pretested and pre-coded semi-structured questionnaire. Data was analyzed using SPSS version-20. Frequencies and percentages were computed for categorical variables like gender, type of malnutrition whereas mean with standard deviation was used for VD and zinc levels and vitamin D status was compared in three different residential categories according to nutritional status. Results: Out of 120 children, 67 (56%) were boys and 53 (44%) girls. Mean VD level was 22.8±14.8 ng/ ml. Around 60% (70) children were VD deficient, whereas 15 % (18) had insufficient 25(OH)D levels. VDD was more prevalent among low socio-economic group with no obvious difference in age category. Mean zinc level was 123.8±47.45 ug/dl and it was either normal or high (42%) rather than low. Malnutrition was observed in 65% children and majority (82%) of them were undernourished. Optimal sun exposure was reported in 24% children only. Conclusion: Vitamin D deficiency was highly prevalent in our study population. Children of low socioeconomic strata and with sub-optimal sun light exposure are at high risk of vitamin D deficiency. Unexpectedly, high zinc levels in majority of our children with low VD status needs further evidence to substantiate this inverse relation. [ABSTRACT FROM AUTHOR]

Background Vitiligo is a common, acquired, often heritable, multifactorial pigmentary disorder with a complex pathogenesis. Vitamin D is a fat soluble essential hormone synthesized in the skin on exposure to ultraviolet B present in the sunlight. It plays its role in calcium homeostasis as well as in immunoregulation. Low levels of vitamin D have been observed in vitiligo patients, who seem to improve with NBUVB treatment. Objective To determine the mean change in serum vitamin D levels in patients of vitiligo after narrow band ultraviolet B therapy. Study design Quasi experimental. Settings Dermatology Department, Pakistan Air Force Hospital, E9, Islamabad. Duration of study Study was carried out over a period of six months from 10-05-2017 to 09-11-2017. Subjects and Methods A total of 30 patients were included in this study. Serum vitamin D level was analyzed at baseline in all the patients who planned to undergo Narrow Band Ultraviolet B phototherapy for vitiligo. The phototherapy was given for 8 weeks and vitamin D levels were measured again. Results Mean age of the patients was 32.77±10.68 years. There were 18 males (60%) and 12 females (40%). Pre-treatment serum vitamin D levels were 25.97±16.10 nmol/l while posttreatment serum vitamin D levels were 39.07±15.67 nmol/l (p<0.001). Conclusion In conclusion, low vitamin D levels in vitiligo patients were improved after narrow band ultraviolet B phototherapy, which may contribute to its therapeutic efficacy. [ABSTRACT FROM AUTHOR]

Objective: To examine vitamin D status and its association with cortical/sub-cortical cognitive functioning in patients with Parkinson's Disease Dementia. Study Design: Cross sectional study. Place and Duration of Study: Bahawal Victoria Hospital, Civil Hospital and Nishter Hospital Pakistan during May 2016 to June 2017. Material and Methods: Fifty patients diagnosed with PDD at Bahawal Victoria Hospital, Civil Hospital and Nishter Hospital Pakistan during May 2016 until June 2017 and fifty healthy individuals participated in the study. Blood samples were examined for serum 25 hydroxy vitamin D. Following, Parkinson's disease cognitive rating scale was administered to assess cortical and sub-cortical cognitive functioning. Results: Results showed that patients with PDD were deficient in serum 25 hydroxy vitamin D and cortical/subcortical cognitive functioning in contrast with healthy individuals. Serum 25 hydroxy Vitamin D and education level of patients with PDD were significant predictors of cortical and subcortical cognitive impairment. Conclusion: Hypovitaminosis D is a biomarker of cortical and subcortical cognitive deficits in patients with PDD. [ABSTRACT FROM AUTHOR]

Background: Spine tuberculosis is common in Pakistan and this needs expert treatment to decrease morbidity. The objective of this study was to compare Modified Kalafong (MKF) and Modified Hong Kong (MHK) operations for spinal TB patients regarding neurological recovery and deformity correction. Material and Methods: This cross sectional study was conducted at Combined Military Hospital (CMH), Rawalpindi, Pakistan, on data from February 2012 to November 2020. According to the selection criteria and availability of data, 70 patients out of 90 consecutive patients handled surgically by MKF or MHK Operations were chosen for this research. Frankel grade system, Cobb’s technique and Bridwell’s criteria were used for assessment of results. Results: There were thirty-one cases of MHK and thirty-nine cases of MKF patients. Age, Neurological recovery, and Numbers of Vertebrae involved with TB were comparable across the two groups. In the MHK, the mean operating time was 6.12 hours, whereas in the MKF, it was 5.37 hours. When compared to the MKF, where the mean blood loss was 0.921 L, the MHK had a greater mean blood loss of 1.139 L. Deformity correction with MHK was 79.467 % against 58.40% via MKF, which was statistically significant (P 0.001). The MHK group had a much shorter mean time to fusion (4.56 months) than the MKF group (6.74 months), which is significant (P 0.05) statistically. Conclusion: Our study revealed significant differences between MHK and MKF spinal tuberculosis surgeries in terms of fusion time, blood loss and deformity correction. [ABSTRACT FROM AUTHOR]

Background: Vitamin D deficiency is common in children with severe acute malnutrition, in whom it is associated with severe wasting. Ready-to-use therapeutic food (the standard treatment) contains modest amounts of vitamin D that do not reliably correct deficiency. Objective: The aim of this study was to determine whether high-dose oral vitamin D3 enhances weight gain and development in children with uncomplicated severe acute malnutrition. Design: We conducted a randomized placebo-controlled trial of high-dose vitamin D3 supplementation in children aged 6-58 mo with uncomplicated severe acute malnutrition in Pakistan. Participants were randomly assigned to receive 2 oral doses of 200,000 IU vitamin D3 or placebo at 2 and 4 wk after starting ready-to-use therapeutic food. The primary outcome was the proportion of participants gaining >15% of baseline weight at 8 wk after starting ready-to-use therapeutic food (the end of the study). Secondary outcomes were mean weight-for-height or -length z score and the proportion of participants with delayed development at the end of the study (assessed with the Denver Development Screening Tool II), adjusted for baseline values. Results: Of the 194 randomly assigned children who started the study, 185 completed the follow-up and were included in the analysis (93 assigned to intervention, 92 to control). High-dose vitamin D3 did not influence the proportion of children gaining >15% of baseline weight at the end of the study (RR: 1.04; 95% CI: 0.94,1.15, P = 0.47), but it did increase the weight-for-height or -length z score (adjusted mean difference: 1.07; 95% CI: 0.49,1.65, P < 0.001) and reduce the proportion of participants with delayed global development [adjusted RR (aRR): 0.49; 95% CI: 0.31, 0.77, P = 0.002], delayed gross motor development (aRR: 0.29; 95% CI: 0.13, 0.64, P = 0.002), delayed fine motor development (aRR: 0.59; 95% CI: 0.38, 0.91, P = 0.018), and delayed language development (aRR: 0.57; 95% CI: 0.34, 0.96, P = 0.036). Conclusions: High-dose vitamin D3 improved the mean weight-for-height or -length z score and developmental indexes in children receiving standard therapy for uncomplicated severe acute malnutrition in Pakistan. [ABSTRACT FROM AUTHOR]

Objective: To evaluate serum levels of 25-hydroxyvitamin D (25-OHD) in patients with viral warts. Study Design: Comparative cross-sectional study. Place and Duration of Study: Dermatology Department, Fauji Foundation Hospital, Rawalpindi Pakistan, from Jul to Dec 2020. Methodology: One hundred patients were included in the study, 50 with viral warts (Group-1) and 50 without warts (Group-2). Our study included both male and female patients of 10 to 60 years of age. Three categories were made according to their serum vitamin D levels. First, all participants were tested for serum vitamin D levels using ELISA. Results: In Group-1, 20(40%) had insufficient, and 25(50%) had deficient vitamin D levels. A statistically significant decrease in serum 25-OHD levels (p = 0.004) was found in patients with viral warts. In Group-2, 9(18%) had insufficient, and 2(4%) had deficient vitamin D levels. The mean serum vitamin D level was 22.61±10.11 in Group-1 and 45.12±24.60 in Group-2, resulting in a significant difference between patients with viral warts and those without viral warts regarding serum vitamin D levels (p=0.004). Conclusion: Patients with viral warts have deficient vitamin D levels. [ABSTRACT FROM AUTHOR]

Background Pregnancy is a time of optimal motivation for many women to make positive behavioural changes. We aim to describe pregnant women with similar patterns of self-reported health behaviours and examine associations with birth outcomes. Methods We examined the clustering of multiple health behaviours during pregnancy in the Born in Bradford cohort, including smoking physical inactivity, vitamin d supplementation and exposure to second-hand smoke. Latent class analysis was used to identify groups of individuals with similar patterns of health behaviours separately for White British (WB) and Pakistani mothers. Multinomial regression was then used to examine the association between group membership and birth outcomes, which included preterm birth and mean birthweight. Results For WB mothers, offspring of those in the 'Unhealthiest' group had lower mean birthweight than those in the 'Mostly healthy but inactive' class, although no association was observed for preterm birth. For Pakistani mothers, group membership was not associated with birthweight differences, although the odds of preterm birth was higher in 'Inactive smokers' compared to the 'Mostly healthy but inactive' group. Conclusions The use of latent class methods provides important information about the clustering of health behaviours which can be used to target population segments requiring behaviour change interventions considering multiple risk factors. Given the dominant negative association of smoking with the birth outcomes investigated, latent class groupings of other health behaviours may not confer additional risk information for these outcomes. [ABSTRACT FROM AUTHOR]

Background and Objective: The contagious and invasive nature has made coronavirus disease-19 (COVID-19) a critical health issue for the community. The lower respiratory tract is the major site of inflammation seen in COVID-19-positive individuals. Vitamin D (Vit D) has been proposed to have a positive role in immunomodulation, hence, this study aimed to determine the association between Vit D levels and the severity of COVID-19 in infected pediatric patients presenting at a secondary healthcare hospital in Pakistan. Methods: This cross-sectional analytical study was conducted on 100 pediatric patients of the age range 1-18 years from March to December 2021. These patients were hospitalized and diagnosed with coronavirus disease with confirmed results on a real-time reverse transcription-polymerase chain reaction. Blood samples of the patients were taken to monitor the baseline levels of markers of acute infection and Vit D levels. Patients with serum Vit D levels ≤ 20ng/ml were labeled with deficiency, those with levels 21-29ng/ml were presumed to have Vit D insufficiency whereas levels ≥30 ng/ml were considered normal. Results: There were 57 (57%) males and 43 (43%) female pediatric patients. The mean age of the patients was 10.46 ± 4.25 years (1-18 years). The deficient Vit D level group had a greater frequency of pyrexia, weakness, cough, anosmia, headache, myalgia, and diarrhea. The levels of Vit D and severity of the disease were significantly associated (p-value = 0.027). Conclusion: Pediatric patients with COVID-19 having optimum levels of Vit D were less likely to develop complications associated with the severity of the disease. [ABSTRACT FROM AUTHOR]

Objective: To study the association of sociodemographic factors and Vitamin D levels with the severity of depressive symptoms in patients with depression. Study Design: Cross-sectional study. Place and Duration of Study: Psychiatry Department, Fauji Foundation Hospital, Rawalpindi Pakistan, from May to Nov 2021. Methodology: This study included all the patients diagnosed with depression per ICD 10 criteria by the consultant psychiatrist. Depression was further categorized in severity using Beck's Depression Inventory. Vitamin D levels were sent to all the patients diagnosed with depression in the laboratory of our hospital. The cut-off score of less than 50nmol/l was taken as low vitamin levels. Results: Out of 103 patients studied, 23(22.3%) had mild, 49(47.6%) had moderate, and 31(30.1%) had severe depression. In severely depressed patients, 19(61.3%) were above 50 years of age, 12(38.7%) had no formal education, and 21(67.7%) had low vitamin D levels. Among mildly depressed patients, 5(21.7%) were above 50 years of age, 2(8.7%) had no formal education, and 17(73.9) had low vitamin D levels. We found that vitamin D levels, age of the patient, and level of education had a statistically significant relationship with the severity of depression, (p-valve less than 0.05). Conclusions: The level of vitamin D, age, and the level of education had a significant association in the target population with the severity of depressive symptoms. [ABSTRACT FROM AUTHOR]

Cost-effective interventions are needed to address undernutrition, particularly micronutrient deficiencies, which are common in children under the age of five in low- and middle-income countries. A community-based, non-randomized clinical trial was undertaken in the Kurram district of Khyber Pakhtunkhwa from January 2018 to June 2019, to evaluate the effect of locally produced micronutrient powder (local name: Vita-Mixe) on plasma micronutrient status, hemoglobin level, and anthropometric outcomes. Children aged 24-48 months old were recruited and allocated to the intervention and control arm of the study. The enrolled children in the intervention arm received one micronutrient powder (MNP) sachet for consumption on alternate days for 12 months. To assess the impact of the intervention on plasma levels of zinc, vitamin D, vitamin A, and hemoglobin level, blood samples were taken at baseline and after one year following the intervention. The analysis was conducted using Enzyme-Linked Immunosorbent Assay (ELISA), atomic absorption spectrometry, and an automated hematology analyzer. For the impact on growth parameters, the anthropometric assessment was performed using WHO standard guidelines. A 24 h dietary recall interview was used to assess the nutrient intake adequacy. Results showed that in the intervention arm, children had on average a 7.52 ng/mL (95% CI 5.11-9.92, p -value < 0.001) increase in the plasma level of vitamin A, 4.80 ng/mL (95% CI 1.63-7.95, p -value < 0.002) increase in vitamin D levels and 33.85 µg/dL (95% CI 24.40-43.30, p -value < 0.001) increase in the plasma zinc level, as well as a 2.0g/dL (95% CI 1.64-2.40, p -value < 0.001) increase in hemoglobin level. Statistically significant improvement was observed in the weight-for-height z-score (WHZ) (from -1.0 ± 0.88 to -0.40 ± 1.01, p < 0.001) and weight-for-age z-score (WAZ) (from -1.40 ± 0.50 to -1.05 ± 0.49, p < 0.001) in the intervention group compared to the control group. No statistically significant change was observed in the height-for-age z-score (HAZ) in the intervention group ( p = 0.93). In conclusion, micronutrient powder supplementation is a cost-effective intervention to improve the micronutrient status, hemoglobin level, and growth parameters in under-five children, which can be scaled up in the existing health system to address the alarming rates of undernutrition in Pakistan and other developing countries.

Objective: To assess the knowledge and attitude towards sun exposure related practices among university students of twin cities. Study Design: Quantitative analytical cross-sectional study. Place and Duration of Study: A Quantitative analytical cross-sectional study was carried out in the university students of Rawalpindi and Islamabad Pakistan, from Jan till Apr 2022. Methodology: Total participants were 317. Participants were university students, who were studying during 2021-2022 under registered universities within the twin cities. The data was gathered through online Google Forms. IBM SPSS version 25 was used for analysis. Results: 42.5% participants exposed themselves to the sun doing outdoor activities for over 90 days a year, while 49.3% did so for 1-2 hours a day. 29% of the people got painful burns at least once or twice this year. Only 20% participants took shelter in shade or used umbrellas, 14.5% used hats. 20.4% never used sunscreen, while 22.6% did, and among them, 44.3% were unaware of the SPF they used. 48% do not like using sunscreen. 65.4% believed sun protection creams were the best way to protect themselves. 81.1% think at least 30 minutes of sun a day are advisable for adequate Vitamin D levels. (p<0.05) Conclusion: It was found that people does have knowledge about the importance of shade and clothing material, such as hats, to avoid the harmful effects of sun exposure but they do not practice it. When it comes to sunscreen, most do not use it and those who do, do not possess significant knowledge about its SPF. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: To evaluate the histomorphological effects of Vitamin D on Norethisteroneinduced hepatosteatosis in female rats. Study Design: Laboratorybased experimental study. Place and Duration of Study: Department of Anatomy, Army Medical College/National University of Medical Sciences Rawalpindi in collaboration with the National Institute of Health (NIH), Pathology Laboratory Pak Emirates Military hospital, and Armed Forces Institute of Pathology, (AFIP) Rawalpindi Pakistan, from Aug to Nov 2021. Methodology: Thirty female Sprague Dawley rats weighing 250-300 gm were randomly divided into three groups (10 for each group). Group-A served as control. For eight weeks, Group-B was given Norethisterone 4.55 mg/kg/day by oral gavage. Group-C was given 1000 IU/kg/day of Vitamin D by intraperitoneal injection for five consecutive days/week, along with Norethisterone for eight weeks. All the animals were sacrificed at the end of the experiment. The colour and consistency of the liver specimen were noted. Liver specimens were processed and staining was done with H and E stains. Histologically steatosis in the specimen was assessed. Results: The results were compared among the groups. Experimental Group-B, when compared with Control Group-A, showed a significant change in the colour (p-value 0.033) and consistency of the liver (p-value 0.033) along with marked steatosis (p-value 0.001). There was a significant improvement in hepatosteatosis (p-value 0.001), which led to improved colour (p-value 0.029) and consistency of the liver (p-value 0.029) in Experimental Group-C when compared with Experimental Group- B. Conclusion: Vitamin D ameliorates hepatosteatosis induced by Norethisterone in the female rat. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: To determine the association between low Vitamin-D status and risk of pre-eclampsia and preterm birth in women using low-dose Aspirin in the tertiary care setting. Study Design: Prospective comparative study. Place and Duration of Study: Gynecology and Obstetrics Department, Pak Emirates Military Hospital, Rawalpindi Pakistan from Sep 2018 to Sep 2019. Methodology: A total of 383 pregnant women were divided into three Groups. Pregnant women were included based on the criteria; if one of the five high-risk factors or more than one moderate risk factors were met. High-risk factors were; 1) Type-1 or 2 diabetes mellitus, 2) chronic hypertension, 3) hypertensive disease in previous pregnancy, 4) autoimmune disease such as systemic lupus erythematous or antiphospholipid syndrome, 5) chronic kidney disease. Results: There were 127 pregnant women in Group-1 with Vitamin-D deficiency. In Group-2, there were pregnant women with Vitamin-D insufficiency; in Group-3, there were 18 pregnant women with Vitamin-D sufficiency. The mean Vitamin-D level in Group-1 was 22.40±1.50 nmol/L, the mean Vitamin-D level in Group-2 was 32.82±9.80nmol/L and in Group-3 mean Vitamin-D level was 76.63±8.00 nmol/L. Early onset pre-eclampsia, chronic hypertension with superimposed pre-eclampsia, gestational diabetes, spontaneousvaginal delivery and delivery at term were found to statistically significant among the Groups (p<0.05). Conclusion: We aimed to determine whether vitamin D status was linked with high-risk pregnancies, which could overshadow the impact of vitamin D under existing conditions. Our findings help relate the status and pre-eclampsia of maternal vitamin D to preterm birth. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: To determine the association between vitamin D status and rsecurrent wheezing. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Paediatrics, Pak Emirates Military Hospital (PEMH), Rawalpindi Pakistan, from Aug 2019 to Aug 2020. Methodology: Sixty infants with recurrent wheezing and 60 healthy age-matched infants without acute or chronic illness were inducted into the study. 25 (OH) Vitamin D, immunoglobulin E (IgE) levels and eosinophil counts were measured. In addition, data were analyzed to find the association of vitamin D levels with recurrent wheezing. Results: In the Control-Group, the mean 25 (OH) vitamin D levels were 25.90±7.57 ng/ml and in the Recurrent Attack- Group was 13.90±4.63 ng/ml (p= 0.02). The mean IgE levels of the Control-Group were 22.80±2.67 IU/ml, and the Recurrent Attack-Group was 149.20±30.60 IU/ml (p=0.001). Eosinophil count in Recurrent Attack-Group was 150.40±23.11 cells/uL and 338.95±33.50 cells/uL in Control-Group respectively (p= 0.08) Conclusion: There is a strong association between low vitamin D levels and recurrent wheezing. [ABSTRACT FROM AUTHOR]

Background: Vitamin D status is a key determinant of maternal and neonatal health. Deficiency has been reported to be common in Pakistani women, but information regarding environmental and genetic determinants of vitamin D status is lacking in this population.Methods: We conducted a cross-sectional study among three groups of healthy women living in Lahore, Pakistan: university students, students or employees of Medrasas or Islamic Institutes, and employees working in office, hospital or domestic settings. Multivariate analysis was performed to identify environmental and genetic determinants of vitamin D status: polymorphisms in genes encoding the vitamin D receptor, vitamin D 25-hydroxylase enzyme CYP2R1 and vitamin D binding protein [DBP] were investigated. We also conducted analyses to identify determinants of body ache and bone pain in this population, and to determine the sensitivity and specificity of testing for hypocalcaemia and raised serum alkaline phosphatase to screen for vitamin D deficiency.Results: Of 215 participants, 156 (73 %) were vitamin D deficient (serum 25[OH]D <50 nmol/L). Risk of vitamin D deficiency was independently associated with illiteracy (adjusted OR 4.0, 95 % CI 1.03-15.52, P = 0.04), <30 min sun exposure per day (adjusted OR 2.13, 95 % CI 1.08-4.19, P = 0.02), sampling in January to March (adjusted OR 2.38, 95 % CI 1.20-4.70), P = 0.01) and lack of regular intake of multivitamins (adjusted OR 2.61, 95 % CI 1.32-5.16, p = 0.005). Participants with the GG genotype of the rs4588 polymorphism in the gene encoding vitamin D binding protein tended to have lower 25(OH)D concentrations than those with GT/TT genotypes (95 % CI for difference 22.7 to -0.13 nmol/L, P = 0.053). Vitamin D deficiency was independently associated with increased risk of body ache or bone pain (adjusted OR 4.43, 95 % CI 2.07 to 9.49, P = 0.001). Hypocalcaemia (serum calcium concentration ≤9.5 mg/dL) and raised alkaline phosphatase concentration (≥280 IU/L) had low sensitivity and very low specificity for identification of vitamin D deficiency.Conclusion: Vitamin D deficiency is common among healthy women of child-bearing age in Lahore, Pakistan: illiteracy, decreased sun exposure and lack of multivitamin intake are risk factors. [ABSTRACT FROM AUTHOR]