Salivary Cortisol Levels in Severely Depressed Patients and Healthy Individuals

Introduction: This study compared the levels of salivary cortisol in patients suffering from severe depression and in healthy individuals. Methods: Sample size included 30 diagnosed cases of major depression based on outdoor clinical assessment (from April 2015 to December 2105) and was established by ICD-10 and DSM-IV criteria and 30 physically and mentally healthy subjects. In this study diagnosed cases of hyperaldosteronism, Cushing’s syndrome/ disease were omitted. A predesigned proforma was created on the basis of Becks Inventory. Saliva samples were collected and processed, and the measurement of cortisol levels was done by ELISA. Results: In a normal subject, the mean cortisol level was 1.46 ± 0.9 μg/dl (Mean ± SD) whereas in depressive patients it was raised (2.2 ± 1.6 μg/dl, p=0.031). Results also showed that high level of cortisol in saliva was found in individuals with a positive family history of depression (2.3 ± 1.8 μg/dl) as compared to healthy subjects (1.5 ± 1.0 μg/dl). Mean BMI was also found to be different between the 2 groups (p=0.012). Conclusion: We concluded that salivary cortisol may act as an early diagnostic tool and non-invasive biomarker for prompt diagnosis of potential cases of depression for effective management. Hence, early initiation of treatment can be helpful in improving the late clinical consequences in severely depressed patients and decreasing the morbidity.

Comparison of excision and primary closure [primary closure] versus modified Limberg flap [modified limberg flap] repair in the treatment of sacrococcygeal pilonidal sinus disease [sacrococcygeal pilonidal sinus disease]

Objective: To compare excision with primary closure and excision with modified limberg flap repair in the treatment of sacrococcygeal pilonidal sinus disease

Design: Quasi experimental study. Setting and duration of study: Surgical Unit-I at Allied Hospital, PMC, Faisalabad, from April 2011 to July 2012

Methods: A total of 60 patients with sacrococcygeal pilonidal sinus disease, 30 underwent Excision with primary closure, and 30 had Excision of sinus with modified limberg flap repair

Results: Though modified limberg flap group was associated with comparatively longer operative time [48.57 vs 32.57 minutes] and longer hospital stay [5.90 vs 4.17 days]. However, post op analgesic requirement in either groups was comparable [33.3% vs 40%]. There was a significant difference in recurrence rate in both groups [20% vs 3.3%]

Conclusion: For the surgical treatment of sacrococcygeal pilonidal sinus disease, modified limberg flap repair is a better technique due to less chances of recurrences, in maiaging sacrococcygeal pilonidal sinus disease

Free medical camps in rural areas of Azad Jammu and Kashmir

To describe the demographics, diagnoses and treatment offered to the people attending five free medical camps in various rural areas of Azad Jammu and Kashmir [AJK] during 2012. Cross sectional descriptive study. Bhimber district of AJK from January 2012 to December 2012. Five free medical camps each of two days duration were established during this period in Nihala, Gola, Poona, Nalee and Barroh which are located in the Bhimber district. Camps were staffed by Army doctors and nursing assistants. The particulars of the attending patients were recorded at the reception and diagnoses along with the medicines dispensed noted at the dispensary. A total of 7320 patients attended the five medical camps. The age of the patients ranged from 05 days to 101 years, mean age being 35 years. Females constituted 59% [4319] of the patients. Majority of the patients were agricultural workers. The most frequent complamts were gastrointestinal [30.4%] musculoskeletel [25.5%] and visual acuity problems [15.1%]. Other common complaints were related with dermatology, ear, nose and throaf [ENT] and gynecology. A total of 5010 prescriptions were recorded and the commonest medicines prescribed were multivitamins [30.5%], analgesics [28.3%], antibiotics [22.3%] and antihelminthics [21.7%].Gastrointestinal and musculoskeletal ailments dominate in the rural population of AJK. Recruiting a pediatrician, gynecologist and ophthalmologist in rural medical camps would greatly improve the efficiency of such camps and increase patient satisfaction. Such camps are recommended until the indigenous healthcare system is developed enough

Association of raised intraocular pressure and its correlation to the energy used with raised versus normal intraocular pressure following Nd: YAG laser posterior capsulotomy in pseudophakes

To determine the frequency of raised intraocular pressure [IOP] after Nd: YAG laser posterior capsulotomy and its association with the energy used with raised versus normal intraocular pressure in pseudophakes. Comparative, cross-sectional study. Ophthalmology Department, PNS Shifa Hospital, Karachi, from August 2008 to February 2009. Pseudophakes having poor vision due to posterior capsular opacification [PCO] in an otherwise normal looking eye and intraocular pressure between 10-20 mmHg were included in the study. Patients with diabetic retinopathy, corneal diseases, inflammatory eye diseases, posterior segment surgery, glucoma, trabeculectomy, maculopathy and any systemic disease were excluded from the study. Particulars of the eligible patients and pre-laser intraocular pressure were entered in specially designed proforma. Nd: YAG laser posterior capsulotomy was done. Laser energy used was noted and then their post-laser intraocular pressure was checked after 4 hours. Unpaired t-test was used for comparison of means of IOP and energy levels. Chi-square test was applied to compare the proportions of patients with raised and the normal IOP with YAG laser energy used during posterior capsulotomy. Raised intraocular pressure IOP >/= 5 mmHg from the baseline] after Nd: YAG laser posterior capsulotomy was noted in both the low energy and the 'high energy' groups but it was more common in the high energy group [p < 0.001, r=0.512]. Higher YAG laser energy has significantly higher chances of raising IOP. Hence, it was recommended that each patient undergoing Nd: YAG laser capsulotomy should receive minimum possible laser energy and must be followed up for raised intraocular pressure

Refractory keratitis in hot climate

This article presents patients with unilateral painful red eye refractory to recommended standard treatment regimes in which staining, culture and sensitivity reports were inconclusive. On ocular examination hazy cornea with central corneal abscess was common in all cases. Corneal biopsy was reserved for cases with inconclusive laboratory reports as well as poor response to standard treatment regime. The former revealed fungal hyphae in all cases. Patients mentioned had general predisposition e.g. diabetes mellitus, hot climate [Multan] as well as predisposing factors such as contact lenses, dry eye syndrome, poor ocular hygiene, agricultural background were more prone to fungal keratitis, hence better diagnosed and confirmed early by contemplating corneal biopsy