Digital Commons Network^™

Developing Local Guidelines For Management Of Sepsis In Adults: Sepsis Guidelines For Pakistan (Sgp), Madiha Hashmi, Fazal Hameed Khan, Sarwar Zubairi, S. Tipu Sultan, Saeeda Haider, Sadqa Aftab, Javed Husain, Anwar Ul Haq, Zahid Akhtar Rao, Amin Khuwaja, Syed Farjad Sultan, Zunairah Rais, Roohina Baloch, Naseem Salahuddin, Aslam Khan, Faisal Sultan, Kamran Chima, Amjad Ali, Gohar Ali

Department of Anaesthesia

Background: The purpose of developing ‘Sepsis Guidelines for Pakistan’ (SGP) is to provide clinicians practicing in local hospitals with a framework to aid timely recognition and management of adult patients in sepsis by adopting evidence-based recommendations of Surviving Sepsis Campaign (SSC) tailored to available resources. These recommendations are not meant to replace the SSC Guidelines.
Methodology: SGP is an initiative of Pakistan Society of Critical Care Medicine (PSCCM). Four key decision points to be addressed in the guidelines were identified by a thirteen member multidisciplinary committee i.e., grading the hospitals in the country, recognition of sepsis and associated organ dysfunction, …

Bridging Evidence, Policy, And Practice To Strengthen Health Systems For Improved Maternal And Newborn Health In Pakistan, Atsumi Hirose, Sarah Hall, Zahid Memon, Julia Hussein

Centre of Excellence in Women and Child Health

Policy and decision making should be based on evidence, but translating evidence into policy and practice is often sporadic and slow. It is recognised that the relationship between research and policy uptake is complex and that dissemination of research findings is necessary, but insufficient, for policy uptake. Political, social, and economic context, use of (credible) data and dialogues between and across networks of researchers and policymakers play important roles in evidence uptake. Advocacy is the process of mobilising political and public opinions to achieve specific aims and its role is crucial in mobilising key actors to push for policy uptake. …

Knowledge And Attitudes Of Select Ugandan Nurses Towards Documentation Of Patient Care, Grace Nakate, Diane Dahl, Karen B. Drake, Pammla Petrucka

School of Nursing & Midwifery, East Africa

Ideally through documentation, nurses track changes in a patient’s condition, make decisions about needs, and ensure continuity of care. However, nursing documentation has often not met these objectives. In Uganda, the systematic nursing specific approach is not reflected in documentation of nursing care. A mixed methods intervention study was conducted to determine knowledge and attitudes of nurses towards documentation, including an evaluation of nurses’ response to a designed nursing documentation form. Forty participants were selected through convenience sampling from six wards of a Ugandan health institution. The study intervention involved teaching nurses the importance of documentation and using of the …

Psychobiobehavioral Model For Preterm Birth In Pregnant Women In Low- And Middle-Income Countries, Shahirose S. Premji, Ilona S. Yim, Aliyah Dosani (Mawji), Zeenatkhanu Kanji, Salima Sulaiman, Wangira Musana, Pauline Samia, Kiran Shaikh, Nicole Letourneau

School of Nursing & Midwifery, East Africa

Preterm birth (PTB) is a final common outcome resulting from many interrelated etiological pathways; of particular interest is antenatal psychosocial distress (i.e., stress, anxiety, and depression). In LMI countries, both exposure to severe life stressors and rate of PTB are on average greater when compared with high-income countries. In LMI countries women are exposed to some of the most extreme psychosocial stress worldwide (e.g., absolute poverty, limited social resources). High prevalence of antenatal stress and depression have been observed in some studies from LMI countries. We propose a psychosocial, biological, and behavioral model for investigating the complex multisystem interactions in …

Gender Differences In Clinical Characteristics And Outcome Of Acute Heart Failure In Sub-Saharan Africa: Results Of The Thesus-Hf Study, Okechukwu S. Ogah, Beth A. Davison, Karen Sliwa, Bongani M. Mayosi, Albertino Damasceno, Mahmoud U. Sani, Charles Mondo, Anastase Dzudie, Dike B. Ojji, Charles Kouam, Ahmed Suliman, Neshaad Schrueder, Gerald Yonga, Sergine Abdou Ba, Fikru Maru, Bekele Alemayehu, Christopher Edwards, Gad Cotter

Internal Medicine, East Africa

Background: The impact of gender on the clinical characteristics, risk factors, co-morbidities, etiology, treatment and outcome of acute heart failure in sub-Saharan Africa has not been described before. The aim of this study was to evaluate the sex diffe rences in acute heart failure in sub-Saharan Africa using the data from The sub-Saharan Africa Survey of Heart Failure (THESUS-HF).

Methods and results: 1,006 subjects were recruited into this prospective multicenter, international observational heart failure survey. The mean age of total population was 52.4 years (54.0 years for men and 50.7 years for women). The men were significantly older (p …

Impact Of A Community-Based Perinatal And Newborn Preventive Care Package On Perinatal And Neonatal Mortality In A Remote Mountainous District In Northern Pakistan, Zahid Memon, Gul N Khan, Sajid Bashir Soofi, Imam Y Baig, Zulfiqar Ahmed Bhutta

Centre of Excellence in Women and Child Health

Background: There is limited evidence from community-based interventions to guide the development of effective maternal, perinatal and newborn care practices and services in developing countries. We evaluated the impact of a low-cost package of community-based interventions implemented through government sector lady health workers (LHWs) and community health workers (CHWs) of a NGO namely Aga Khan Health Services on perinatal and neonatal outcomes in a sub-population of the remote mountainous district of Gilgit, Northern Pakistan.
Methods: The package was evaluated using quasi experimental design included promotion of antenatal care, adequate nutrition, skilled delivery and healthy newborn care practices. Control areas …

Human Rights In The New Global Strategy., Jyoti Sanghera, Lynn Gentile, Imma Guerras-Delgado, Lucinda O’Hanlon, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

The Global Strategy for Women’s and Children’s Health (2010), with its emphasis on participatory decision making processes, non-discrimination, and accountability, affirmed the importance of human rights. Despite important gains following its launch women, children, and adolescents continue to experience serious violations of their health and health related human rights, including discrimination in access to quality healthcare. A human rights based approach must thus be fully integrated throughout the Global Strategy.

The right to health is recognised by several legal tools and treaties relating to human rights, including the International Covenant on Economic, Social and Cultural Rights; the Convention on the …

Women’S Health Priorities And Interventions, Marleen Temmerman, Rajat Khosla, Laura Laski, Zoe Mathews, Lale Say

Obstetrics and Gynaecology, East Africa

Over the past decades, governments have taken steps towards improving women’s health in line with commitments made in key international summits. Progress has been made in reducing maternal mortality,1 which accelerated with the launch of the United Nations secretary general’s Global Strategy for Women’s and Children’s Health in 2010. Use of maternal healthcare and family planning has increased in some countries.2 Progress has also been seen on two determinants of women’s health—school enrolment rates for girls and political participation of women—but not for others such as gender based violence.3

However, societies are still failing women in relation to health, especially …

Implementation Of Point-Of-Care Diagnostics Leads To Variable Uptake Of Syphilis, Anemia And Cd4+ T-Cell Count Testing In Rural Maternal And Child Health Clinics, Caroline De Schacht, Carlota Lucas, Nádia Sitoe, Rhoderick Machekano, Patrina Chongo, Marleen Temmerman, Ocean Tobaiwa, Laura Guay, Seble Kassaye, Ilesh V. Jani

Obstetrics and Gynaecology, East Africa

Introduction: Anemia, syphilis and HIV are high burden diseases among pregnant women in sub-Saharan Africa. A quasi-experimental study was conducted in four health facilities in Southern Mozambique to evaluate the effect of point-of-care technologies for hemoglobin quantification, syphilis testing and CD4+ T-cell enumeration performed within maternal and child health services on testing and treatment coverage, and assessing acceptability by health workers.

Methods: Demographic and testing data on women attending first antenatal care services were extracted from existing records, before (2011; n = 865) and after (2012; n = 808) introduction of point-of-care testing. Study outcomes per health facility were compared …

The Role Of Neighborhood Environment In Promoting Risk Factors Of Cardiovascular Disease Among Young Adults: Data From Middle To High Income Population In An Asian Megacity, Mohammad Ahraz Hussain, Sandal Noorani, Amna Khan, Hafsa Asad, Anam Rehan, Aamir Kazi, Mirza Zain Baig, Arish Noor, Amash Aqil, Nida Shahab Bham

Community Health Sciences

Background: Modifiable risk factors of cardiovascular diseases (CVD) have their triggers in the neighborhood environments of communities. Studying the environmental triggers for CVD risk factors is important to understand the situation in a broader perspective. Young adults are influenced the most by the environment profile around them hence it is important to study this subset of the population.Methods: This was a descriptive study conducted using the EPOCH research tool designed by the authors of the PURE study. The study population consisted of young adults aged 18-25 in two areas of Karachi. The study setting was busy shopping malls frequented by …

Major Dietary Patterns And Risk Of Acute Myocardial Infarction In Young, Urban Pakistani Population, Romaina Iqbal, Saleem Perwaiz Iqbal, Mohsin Yakub, Asal Khan Tareen, Mohammad Perwaiz Iqbal

Community Health Sciences

Objective: To investigate the role of dietary intake in the development of premature acute myocardial infarction (AMI) in a hospital-based Pakistani population in Karachi.
Methods: In a case control study, 203 consecutive patients (146 males and 57 females) with their first AMI and age below 45 years were enrolled with informed consent. Similarly, 205 gender and age matched (within 3 years) healthy adults were also included as controls. Dietary intake of both cases and controls was assessed by using a simple 14-item food frequency questionnaire. Using factor analysis, 3 major dietary patterns- prudent dietary pattern, combination dietary pattern and western …

R990g Polymorphism Of Calcium Sensing Receptor Gene Is Associated With High Parathyroid Hormone Levels In Subjects With Vitamin D Deficiency: A Cross-Sectional Study, Hafsa Majid, Aysha Habib Khan, Tariq Moatter

Department of Pathology and Laboratory Medicine

Single nucleotide polymorphisms (SNPs), R990G and A986S of the calcium sensing receptor (CaSR) gene, are shown to influence response of parathyroid hormone (PTH) in subjects with optimal vitamin D levels. This cross-sectional study was conducted in subjects with vitaminDdeficiency (VDD) to observe association’s betweenCaSR polymorphisms, plasma iPTH, and serumcalcium levels. Adult females (𝑛 = 140) with known VDD, intact parathyroid hormone (iPTH), and calcium levels were recruited for genotype analysis.The frequencies of the 986 alleles GG, GT, and TT were 68%, 25%, and 7%, respectively, whereas the frequencies of the 990 alleles AA, AG, and GG were 80%, 8.9%, and …

Diagnosis And Management Of Preeclampsia In Community Settings In Low And Middle-Income Countries, Rehana A. Salam, Jai K. Das, Anum Ali, Soumyadeep Bhaumik, Zohra S. Lassi

Department of Paediatrics and Child Health

Hypertensive disorders of pregnancy contribute significantly to maternal mortality and morbidity. Preeclampsia belongs to the spectrum of hypertensive disorders of pregnancy and if undiagnosed and/or untreated leads to fatal consequences for both the mother and the baby. Early detection and prevention of preeclampsia is limited by uncertainty in the knowledge about its etiopathogenesis. While much work has been done in establishing clinical guidelines for management of preeclampsia in the hospital or tertiary care settings, there is considerable lack of work in the domain of evidence-based guidelines for screening, identification and management of preeclampsia at the community-level. The article reviews these …

Food Choices And Practices During Pregnancy Of Immigrant Women With High-Risk Pregnancies In Canada: A Pilot Study, Gina M A. Higginbottom, Helen Vallianatos, Joan Forgeron, Donna Gibbons, Fabiana Mamede, Rubina Barolia

School of Nursing & Midwifery

Background: Immigrant women may be regarded as a vulnerable population with respect to access and navigation of maternity care services. They may encounter difficulties when accessing culturally safe and appropriate maternity care, which may be further exacerbated by language difficulties and discriminatory practices or attitudes. The project aimed to understand ethnocultural food and health practices and how these intersect in a particular social context of cultural adaptation and adjustment in order to improve the care-giving capacities of health practitioners working in multicultural perinatal clinics.
Methods: This four-phase study employed a case study design allowing for multiple means of data collection …

Factors That Affect Attachment Between The Employed Mother And The Child, Infancy To Two Years, Naureen Kassamali, Salma Amin Rattani

School of Nursing & Midwifery

To explore a mother's feeling of attachment and the affects her working status on the attachment relationship with her child, upon ethical clearance from the institutional ethics committee, in-depth interviews of nine participants were conducted. Mothers enrolled were those who resumed the employment within the first year of post-delivery and were having a child up to two years of age. Results revealed that maternal employment itself does not enhance or deteriorate attachment with the child. It is combinations of factors that revolve around it impact on their bond. Overall, maternal integration or the balance of the dual roles of employment …

The Role Of School Leadership In Retention Of Girls In School: A Case Study Of One Public Primary School In Morogoro Region Tanzania, Jackline John

Master of Education

The increased enrolment of girls in primary schools has been a tremendous step in improving girls’ access to education in Tanzania. However, the rate at which girls leave primary school before completion seems to be very high. This study explored the role of school leadership in retention of girls in one public primary school in Morogoro region in Tanzania. A case study design and purposive sampling technique was used in this study. Semi structured interviews, focus group discussions and document analysis were used to collect qualitative data for this study. A head teacher, two class teachers of grade five and …

How Can Inquiry-Based Teaching Approach Be Used By Physics Teachers In A Rural Secondary School To Improve Students’ Participation In Learning Physics? A Case Study Of A Rural Public Secondary School In Kanungu District In Uganda., Mugimba Kenneth Oryateisa

Master of Education

Several researchers have published that there is a decline in the number of students interested in studying science today. They attribute this to the poor methods of teaching used by science teachers in schools today. They assert that there is no correlation between what is taught in science lessons and its relevance in real world. For that reason students fail to know the implications of studying science and its use in everyday life. One prospective way of improving students’ interest and motivation to learn science will be the teaching of science lessons using inquiry activities that will improve students’ participation …

The Burden Of Dysphagia And Chest Infection In Acute Ischemic Stroke In A Tertiary Care Hospital Of Islamabad Capital Territory, Rao Suhail, Shahzad Ahmed, Sumaira Nabi, Mansoor Iqbal

Pakistan Journal of Neurological Sciences (PJNS)

Stroke is the foremost cause of severe neurologic disability in adults and is associated with a variety of complications. Dysphagia complicates acute ischemic strokes (AIS) in 42% cases and is more evident during the first week after ischemic stroke. Chest infection complicates AIS in 32% of the cases and 89% of these cases are due to dysphagia. Videofluoroscopy is the gold standard for swallowing assessment but due to non availability, bedside swallowing assessment is a more handytool. Methods: From August 2013 to February 2014151 patients were enrolled according to the set criteria.Each patient was assessed for dysphagia according to the …

Diagnostic Issues And Clinical Spectrum Of Childhood Degenerative Brain Diseases, Tipu Sultan, Ashfa Ameer Khan, Muhammad Arshad Khawaja, Zia Ur Rahman, Ahsan Waheed Rathore

Pakistan Journal of Neurological Sciences (PJNS)

To find out the spectrum of clinical presentation and typesof neurodegenerative disorders of childhoodin tertiary care child neurology centre of Pakistan. To find out the role of brain imaging in the diagnosis of degenerative brain disorders in children. Methods: It will bea retrospective, descriptive study conducted at department of paediatric neurology,The Children’s Hospital, Institute of child health, Lahore, Pakistanfrom January 1st,2004 to December 31,2013 (10 years). A total of 22,737 patients were admitted in the Paediatric Neurology department in the above said period. Out of them 366 children fulfilled the inclusion criteria. History, clinical examination and relevant investigations were evaluated …

Gender Based Differences In Diabetic Peripheral Neuropathy, Athar Javed, Ahmad Furqan, Mohsin Zaheer, Naeem Kasuri

Pakistan Journal of Neurological Sciences (PJNS)

Diabetic peripheral neuropathy (DPN) is one of the common complications of diabetes mellitus. Aim: To find out gender based differences in frequency of DM, age at diagnosis of DM and subsequent onset of DPN, duration of DM and DPN and electrophysiological patterns. Methodology: On the basis of non-probability purposive sampling, a cross sectional study was conducted at Neurology department, Mayo Hospital, Lahore. Patients fulfilling the ADA criteria for DM, and DPN were included in the study. Data was analyzed using SPSS 16 version. Results: A total of 125 patients were included in the study with 57/125 (45.6%) males and 68/125 …

Interventions To Promote Adherence To Antiretroviral Therapy In Africa: A Network Meta-Analysis, Edward J. Mills, Richard Lester, Kristian Thorlund, Maria Lorenzi, Katherine Muldoon, Steve Kanters, Sebastian Linnemayr, Robert Gross, Yvette Calderon, K Rivet Amico, Harsha Thirumurthy, Cynthia Pearson, Robert H. Remien, Lawrence Mbuagbaw, Lehana Thabane, Michael Chung, Ira B. Wilson, Albert Liu, Olalekan A. Uthman, Jane Simoni, David Bangsberg, Sanni Yaya, Till Bärnighausen, Nathan Ford, Jean B. Nachega

Internal Medicine, East Africa

Background: Adherence to antiretroviral therapy (ART) is necessary for the improvement of the health of patients and for public health. We sought to determine the comparative effectiveness of different interventions for improving ART adherence in HIV-infected people living in Africa.

Methods: We searched for randomised trials of interventions to promote antiretroviral adherence within adults in Africa. We searched AMED, CINAHL, Embase, Medline (via PubMed), and ClinicalTrials.gov from inception to Oct 31, 2014, with the terms “HIV”, “ART”, “adherence”, and “Africa”. We created a network of the interventions by pooling the published and individual patients' data for comparable treatments and comparing …

Frequency Of Peripheral Neuropathy In Newly Diagnosed Patients Of Diabetes Mellitus Iion Clinical And Electrophysiological Basis, Muslim Ali Lakhiar, Naila Naeem Shahbaz, Abdul Hafeez Bughio, Jai Prakash

Pakistan Journal of Neurological Sciences (PJNS)

To determine the frequency of peripheral neuropathy in newly diagnosed patients of Diabetes Mellitus type II on clinical and electrophysiological basis. Methods: This is Hospital based descriptive cross sectional study conducted at department of Neurology Civil Hospital Karachi/ Dow University of Health Sciences from 20th December 2011 to 20th June 2012. Data was collected from Neurology OPD, Medicine OPD and Diabetic Clinic Civil Hospital Karachi. Results: Total no of patients were 107 who were already diagnosed as type 2 Diabetes Mellitus. Out of these, there were 57 (53.3%) male patients and 50 (46.7%) female patients, with ratio of males to …

Maternal And Perinatal Health Research Priorities Beyond 2015: An International Survey And Prioritization Exercise, Joao Paulo Souza, Mariana Widmer, Ahmet Metin Gülmezoglu, Theresa Anne Lawrie, Ebunoluwa Aderonke Adejuyigbe, Guillermo Carroli, Caroline Crowther, Sheena M. Currie, Therese Dowswell, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Maternal mortality has declined by nearly half since 1990, but over a quarter million women still die every year of causes related to pregnancy and childbirth. Maternal-health related targets are falling short of the2015 Millennium Development Goals and a post-2015 Development Agenda is emerging. In connection with this, setting global research priorities for the next decade is now required.

Methods: We adapted the methods of the Child Health and Nutrition Research Initiative (CHNRI) to identify and set global research priorities for maternal and perinatal health for the period 2015 to 2025. Priority research questions were received from various international …

Newborn Care In Indonesia, Lao People’S Democratic Republic And The Philippines: A Comprehensive Needs Assessment, Els Duysburgh, Birgit Kerstens, Melissa Diaz, Vini Fardhdiani, Katherine Ann Reyes, Khamphong Phommachanh, Marleen Temmerman, Basil Rodriques, Nabila Zaka

Obstetrics and Gynaecology, East Africa

Background: Between 1990 and 2011, global neonatal mortality decline was slower than that of under-five mortality. As a result, the proportion of under-five deaths due to neonatal mortality increased. This increase is primarily a consequence of decreasing post-neonatal and child under-five mortality as a result of the typical focus of child survival programmes of the past two decades on diseases affecting children over four weeks of age. Newborns are lagging behind in improved child health outcomes. The aim of this study was to conduct a comprehensive, equity-focussed newborn care assessment and to explore options to improve newborn survival in Indonesia, …

Competing Interests Of Undergraduate Medical Education And Industry: Integration Into Longitudinal Curricular Themes., Shahryar Noordin, Sheilla Pinjani

Department of Surgery Docs

Abstract

Recent changes in curricula around the globe with emphasis on teaching/learning and assessing professionalism in medical schools has been the priority. With the changing public expectations and professional demands, it has become imperative to develop clear guidelines and policies for students and faculty to better understand and meet the expectations of them as part of professionalism. In order to analyse this problem and highlight potential solutions, a literature search was conducted using Eric, Medline, Google Scholar and CINAHL Plus databases from 1985 to February 2013. We reviewed publications regarding the relationship between the pharmaceutical and device industry and medical …

Pharmacy Newsletter : December 2014, Pharmacy Department

Department of Pharmacy Archives

Content:

• New WHO Guide to Prevent and Control Cervical Cancer
• Analgesic use in Adult Patients with Advanced Chronic Liver Disease or Cirrhosis
• The Novel Treatment of Clostridium Diffi cile Associated Diarrhea (CDAD)
• 25th September, World Pharmacist Day-Celebration

Vaccine Effectiveness And Risk Factors Associated With Measles Among Children Presenting To The Hospitals Of Karachi, Pakistan., Aysha Zahidie, Saba Wasim, Zafar Fatmi

Community Health Sciences

OBJECTIVE:

To determine the risk factors regarding guardian's practices associated with development of Measles and also find out effectiveness of Measles vaccine among children less than 12 years of age presenting to the hospitals of Karachi.

STUDY DESIGN:

Matched case control study.

PLACE AND DURATION OF STUDY:

Multicenter surveillance was conducted in 11 public and private sector hospitals of Karachi from January 2011 to September 2012 in consultation with World Health Organization Measles Surveillance Cell.

METHODOLOGY:

Cases were children aged less than 12 years with Measles presenting to the hospitals. Controls for cases were enrolled from the same hospitals without …

Risk Factors Associated With Birth Asphyxia In Rural District Matiari, Pakistan: A Case Control Study, Farhana Tabassum, Arjumand Rizvi, Shabina Ariff, Sajid Bashir Soofi, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: During the past two decades there has been a sustained decline in child mortality; however, neonatal mortality has remained stagnant. Each year approximately 4 million babies are born asphyxiated resulting in 2 million neonatal deaths and intrapartum stillbirths. Almost all neonatal deaths occur in developing countries, where the majority is delivered at homes with negligible antenatal care and poor perinatal services.
Objectives: To identify socio-demographic and clinical risk factors associated with birth asphyxia in Matiari District of Sindh Province, Pakistan.
Method: A matched case control study was conducted in Matiari District with 246 cases and 492 controls. Newborn deaths …

The Impact Of Polio Eradication On Routine Immunization And Primary Health Care: A Mixed-Methods Study, Svea Closser, Kelly Cox, Thomas M. Parris, R Matthew Landis, Judith Justice, Ranjani Gopinath, Kenneth Maes, Hailom Banteyerga Amaha, Ismaila Zango Mohammed, Rashid Jooma

Section of Neurosurgery

Background: After 2 decades of focused efforts to eradicate polio, the impact of eradication activities on health systems continues to be controversial. This study evaluated the impact of polio eradication activities on routine immunization (RI) and primary healthcare (PHC).
Methods: Quantitative analysis assessed the effects of polio eradication campaigns on RI and maternal healthcare coverage. A systematic qualitative analysis in 7 countries in South Asia and sub-Saharan Africa assessed impacts of polio eradication activities on key health system functions, using data from interviews, participant observation, and document review.
Results: Our quantitative analysis did not find compelling evidence of widespread and …

Body Mass Index Or Body Fat! Which Is A Better Obesity Scale For Pakistani Population?, Syeda Sadia Fatima, Rehana Rehman, Bushra Chaudhry

Department of Biological & Biomedical Sciences

Ojective: To compare two methods of classifying obesity based on body mass index and body fat percentage.
Methods: The cross-sectional study was conducted from November 2012 to August 2013 at Jinnah Postgraduate Medical Centre, Karachi. Male and female volunteers between the ages 15-65 years were selected using simple random sampling. They were classified into different groups for body mass index and body fat percentage measured through bioelectrical impedance scale. The subjects were sub-grouped into underweight, normal weight, overweight and obese. SPSS 11 was used for statistical analysis.
Results: The mean age of the 828 healthy volunteers was 25.67±10.10 years. A …