ABSTRACT
Objectives: To determine if we are missing clinical depression in patients with Rheumatoid Arthritis and its relationship with functional disability and level of formal education in such patients
Methods: The data for this cross-sectional, analytical study was gathered from May 2015 till December 2015 and comprised of 128 with Rheumatoid arthritis diagnosed according to ACR/EULAR 2010 criteria. The study was conducted at Fauji Foundation Hospital Rawalpindi. Functional status was assessed with Modified Health Assessment Questionnaire [mHAQ] and Beck's Depression Inventory [BDI] was used for evaluation of symptoms of depression. The relation between depression, functional disability and educational status was established using Pearson correlation coefficient
Results: The study included 128 patients with no previous diagnosis of depression. 122 [95.3%] were females and 6 [4.7%] were males. The mean age was 51.75 +/- 9.25 years. Mean duration of disease was 8.95 +/- 7.1 years. According to this study, the diagnosis of clinical depression was missed in 47.7% of patients with Rheumatoid Arthritis who had been under regular follow up at a tertiary care facility. About 18% were keen to seek professional help for depressive symptoms while 62.6% had functional disability [mild - severe]. There is a positive correlation with BDI [Pearson's correlation +1] and functional disability. No correlation could be established between level of education and depression as out of 79 [61.7%] patients with no basic education, 45.5% had depression. In remaining 49 [38.2%] patients, with some formal education, 51.3% had clinical depression
Conclusion: Almost half of the patients with Rheumatoid Arthritis coming to a tertiary care set up had clinical depression but were never diagnosed or referred to a Psychiatrist. There is a positive correlation between depression and functional disability; however no statistically significant correlation could be established with the level of formal education. The study further emphasizes the importance of early recognition and swift referral of such patients to a psychiatrist since it is known to improve both treatment outcomes and functional status
ABSTRACT
The objective of this study was to compare the efficacy of 10, 15, and 20mg bolus doses of prophylactic IV ephedrine for prevention of maternal hypotension associated with spinal anesthesia for cesarean section. A prospective, quasi experimental study. The study was conducted at Department of Anesthesiology and Intensive Care, Shalamar Hospital Lahore [Pakistan], and was completed in six months period from January to June 2008. Ninety parturients of ASA grade I and II, receiving spinal anesthesia for elective C-section were included in this study. They were randomly divided into three groups. Group-I received lOmg, Group-II 15mg, and Group-Ill 20mg prophylactic IV ephedrine immediately after administration of spinal anesthesia. Intra operative hemodynamic changes were recorded and the data were analyzed. Incidence of hypotension was significantly higher in Group-I parturients receiving a lOmg prophylactic dose of ephedrine than in Group-II and Group-Ill parturients receiving 15mg or 20mg of ephedrine respectively [53.3% versus 13.3% and 3.3% respectively]. There was however, a significantly higher incidence of reactive hypertension in Group-II parturients [46.7%]. 15mg bolus dose of prophylactic IV ephedrine can effectively prevent spinal induced maternal hypotension during cesarean section without adverse effects like reactive hypertension