Source: Hawn & Jung 2003, Kemp 2004, In-depth, 2006, WHO 2009
![[photo] display of items used in a paan chewing session](https://i0.wp.com/geriatrics.stanford.edu/wp-content/uploads/2014/03/paan.jpg?resize=250%2C221&ssl=1)
Submucosal Fibrosis can be caused by chewing paan. Above we see a display of the items used in a paan chewing session, often the cause of sub mucosal fibrosis. The betel leaves are toward the bottom center and folded. The upper left shows slices of the dry areca nut, while the upper right displays slices of the tender areca nut. A pouch of tobacco is shown on the far right; tobacco is a recent introduction to the chewing of paan.
Source: https://en.wikipedia.org/wiki/Paan.
Public Domain.
Amebiasis
Mainly seen in immigrants from small towns and rural areas due to unhealthy hygienic and poor sanitary conditions.
Dengue Virus
There is an increase in the number of dengue virus cases in Pakistani immigrants in the last decade. Most cases are seen in immigrants from rural areas.
Hepatitis B
Hepatitis A and E occur, and hepatitis B is endemic. It is more aggressive due to co-infection and super-infection with delta virus. Intra-familial spread of hepatitis B is quite high. Pakistan has a high carrier rate of hepatitis B: between 10 to 14 percent according to ELISA and RIA analyses respectively.
Hookworm
Hookworms are among the most widespread of human parasites and occur all over the tropics and subtropics. They are bloodsucking roundworms that inhabit the duodenum and jejunum. Usually the infection is mild (hookworm carrier state), but sometimes the infection is heavy and results in anemia and/or hypoproteinemia (hookworm disease). Hookworms are occasionally imported to the United States by immigrants.
Submucosal Fibrosis
This condition is related to chewing paan, a quid of betel leaf, areca nut and tobacco. Submucosal fibrosis results in an increased prevelance of oral cavity cancer.
Thalassemia
Thalassemia is one of the most common inherited hemoglobin disorders in Pakistan. The carrier frequency is estimated to be 5.4%.In Pakistan, 5 out of 100 people are thalassemia patients and around 8 million people are thalassemia carriers. Thalassemia reduces the amount of hemoglobin in the human body leading to anemia.
Malaria
According to the United Nations World Health Organization (WHO), Pakistan has been classified as a country with moderate malaria prevalence and relatively well-established control programs. Despite this, the disease is estimated to cause at least 50,000 deaths out of an estimated 500,000 reported malaria cases every year.
Tuberculosis
Pakistan ranks eighth on the list of 22 high-burden tuberculosis (TB) countries in the world, according to the World Health Organization’s (WHO’s) Global Tuberculosis Control 2009. In 2007, an estimated 297,108 people in Pakistan (primarily adults in their productive years) developed TB. The emergence of multidrug-resistant (MDR) TB and TB-HIV co-infection is a growing concern in the country.
