101 American Scientific Research Journal for Engineering, Technology, and Sciences (ASRJETS) ISSN (Print) 2313-4410, ISSN (Online) 2313-4402 http://asrjetsjournal.org/ Survey of Hypocalcaemia Frequency in District Lahore, Pakistan Anam Javed *a , Hafiz Imran Hashmi b , Aiman Shahid c , Sidra Mehmood d , Saba Khurshid e a Assistant Professor of Zoology, School of Zoology, Minhaj University, Lahore, Pakistan b,c,d BS Researcher, School of Zoology, Minhaj University, Lahore, Pakistan a Email: dranam.zoology@mul.edu.pk b Email: hashmihafizimran@gmail.com c Email: aimanshahidfts@gmail.com d Email: sidramehmood80@gmail.com e Email: sabakhurshid80@gmail.com Abstract Calcium is important for regulation of various physiological functions like bones, teeth, different types of muscular movements, blood pressure, body growth and maintenance. But continuous calcium deficiency may cause hypocalcaemia in which major cause is insufficient intake of calcium along with other pathological states, financial constraints and lack of general public awareness about the significance and physiological role of calcium. Statistical analysis on the basis of current survey indicates that females remain malnourished and suffer from hypocalcaemia more than males. That’s why; there is urgent need of organized efforts for general public awareness from government and private platforms. Moreover, future researchers should introduce better diagnosis techniques and economical dietary sources and treatments to reduce frequency of hypocalcaemia. Keywords: Calcium; hypocalcaemia; public awareness; malnourished; economical dietary sources. 1. Introduction Calcium is integral mineral for proper functioning of not only of bones, teeth, muscular movements, blood pressure regulation but also for normal cardiac, nervous and endocrine activities along with vitamin D [1]. That’s why; for growth and maintenance, regular intake of calcium having diet is essential for infants to older ones [2,3]. ------------------------------------------------------------------------ * Corresponding author. http://asrjetsjournal.org/ American Scientific Research Journal for Engineering, Technology, and Sciences (ASRJETS) (2021) Volume 80, No 1, pp 101-106 102 Moreover, dietary deficiencies may lead to depletion of stored calcium in the bones, which often results in osteoporosis [5]. Another cause of hypocalcaemia is in take of medications, such as diuretics, medical treatments e.g., renal failure and hypo-parathyroidism [2]. It is also common observation that due to aging, people of age 30 and above, gradually lose bone density due to hypocalcaemia which can be initially characterized by tetany, muscle cramps, numbness and tingling in the limbs. Whereas later signs of calcium deficiency can be seen as skin dryness, fragile nails and tooth decay, moreover, in females prominent signs of hypocalcaemia include disturbances in menstrual cycle like more cramping and a change in menstrual flow. In case of severe calcium deficiency, osteomalacia, rickets, minor and even sometimes major fractures occur [4-6]. Thus calcium deficiency is a worldwide problem and recent research more precisely highlights that initial stage of this deficiency may lead to metabolic alterations and potential pathological changes but accurate diagnosis of hypocalcaemia is difficult so far [7]. That’s why; this survey was conducted to investigate the frequency of hypocalcaemia and level of general public awareness in Lahore. 2. Methodology Table 1: Survey Performa for estimation of hypocalcaemia frequency in Lahore, Pakistan Name Age 15-25 yrs 26-35 yrs >50 yrs <50 yrs Gender Female Male Monthly Income 15000- 25000 26000- 40000 41000- 60000 60000- above Already on medication for other health issues Yes No Symptoms Yes No Minor fracture of bones Muscles cramps Weak and brittle nails Shrinking of hands Dental problems Weak tooth roots Dry skin Extreme Fatigue Spots on skin White spot on nails Spots on teeth Pain in limbs due to movement Alopecia This study was a cross-sectional descriptive survey of 85 persons who were residents of various areas American Scientific Research Journal for Engineering, Technology, and Sciences (ASRJETS) (2021) Volume 80, No 1, pp 101-106 103 (Township, Johar Town, Model Town, Mughal Pura, Ghazi Road, Thukar, Shahdra, Bhatta Chowk, Service Hospital, Chungi Amar Sidhu and Kotlakhpat) of Lahore, Pakistan. In sample of this design, patients of hypocalcaemia were observed and they were divided in of four age groups: group 1 (15-25yrs), group 2 (26- 35yrs), group 3 (36-50) and group 4 (more than 50yrs). A questionnaire was designed to assess the knowledge, attitude, and practices of hypocalcaemia patients along with corresponding demographic variables (Table 1). ANOVA test was used for statistical analysis [15]. The study was approved by the ethical committee of Minhaj University Lahore. Informed verbal consent was taken from each eligible participant before administration of the questionnaire. Willing participants were informed in detail by the investigators about the research project and its consequences. The investigators asked the questions verbally in Urdu and filled out the form. Privacy of the patients was ensured during filling of questionnaires [8]. 3. Results & Discussion Though Lahore is one of the most populated cities of Pakistan but broad spectrum variations in living standers also exist. These variations also affect the health of people either directly or indirectly. That’s why; this survey was conducted to highlight etiology of an important general public health issue of calcium deficiency and to point out the need of general public awareness and introduction of low cost alternatives for poor people to avoid hypocalcaemic state which usually remains untreated due to financial crisis and lack of awareness. The obtained results showed that during walk and movement pain in arms and legs (55.29%) is the most frequently symptom of calcium deficiency in people. Similarly, the occurrence ratio of muscle cramps (47.05%), fatigue (47.05%) and skin dryness (42.35%) is also found much higher (Table 2). Table 2: Frequency of hypocalcaemia symptoms in Lahore, Pakistan Symptoms No. of affected persons Percentage (%) Minor fracture of bones 14 16.47 Muscles cramps 40 47.05 Weak and brittle nails 23 27.05 Shrinking of hands. 23 27.05 Dental problems 31 36.47 Weak tooth roots 32 37.64 Dry skin 36 42.35 Extreme Fatigue 40 47.05 Spots on skin 26 30.58 White spot on nails 24 28.23 Spots on teeth 22 25.88 Pain in limbs 47 55.29 Alopecia 17 20.00 Whereas statistical analysis of gender based data presents much higher ration of calcium deficiency in females than males (Table 3) and reported data shows that females usually remain malnourished than males due to social American Scientific Research Journal for Engineering, Technology, and Sciences (ASRJETS) (2021) Volume 80, No 1, pp 101-106 104 gender differences and norms though sunlight exposure is sufficient in Pakistan which is also a good source of vitamin D but still considerable percentage of people is suffering from calcium deficiency [9]. Table 3: Frequency of Hypocalcaemia according to gender Males Females 2.9091 ± 0.547 *4.8182 ± 0.6441 *Values of means ± S.E.M. Data of respective columns were compared by employing ANOVA and significant difference was found at 0.05% probability level. According to age comparison, it was noticeable that out of 85 patients, 40 patients were falling in age group 1whereas 31 patients in group 2, 06 patients in group 3 and 08 patients in group 4 (Figure 1). So it cannot be ignored that hypocalcaemia is more frequently reported among youngsters than older ones. It is again mainly due to intake of calcium deficient diet and lack of awareness [10]. In this regard, economic status was also potent cause of this disorder, hypocalcaemic patients were of monthly earning up to 25,000 pkr (43.53%), up to 40,000 pkr (34.12%), up to 60,000 pkr (15.3%) and more than 60,000 pkr (7.06%). It is clear that people with financial crisis are more prone to calcium deficiency based complications [11]. Figure 1: Graphical comparison of hypocalcaemia patients according to age During etiological survey of calcium deficiency, another cause was noticed that patients who are already undergoing some other medical treatments may also face hypocalcaemia [12] and current survey showed such cases up to 46.7%. Furthermore, when public awareness level and trend of hypocalcaemia recovering medication intake was observed then only 26.5% patients told that they take proper medicine to recover calcium deficiency whereas rest of 73.5% were found still unaware that why this disorder should be resolved soon and what are the possible long lasting effects, if it is left untreated [13]. 4. Conclusion This etiological survey of hypocalcaemia indicated major two contributory factors: general public unawareness [14] and financial constraints, that’s why; people maximum ignore this serious health issue. But awareness campaigns from government and various NGOs are urgently required to control the frequency of hypocalcaemia. Similarly, organized efforts regarding provision of economical dietary sources to masses are American Scientific Research Journal for Engineering, Technology, and Sciences (ASRJETS) (2021) Volume 80, No 1, pp 101-106 105 also required. 5. Future perspective Further steps should be taken by the government/non-government organizations for personal health care public awareness by not ignoring the initial symptoms of hypocalcaemia and researchers [14] should introduce appropriate diagnosis tools and quick cures to control this disorder. Acknowledgements This collaborative scientific effort was solely performed by Dr. Anam Javed, Hafiz Imran Hashmi, Aiman Shahid , Sidra Mehmood and Saba Khurshid without funding support by any authority or organization. References [1]. P. Yao, D. Bennett, M. Mafham, X. Lin, Z. Chen, J. Armitage and R. 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