Assessment Of Services / Facilities Available At Primary Health Centres Of District Budgam, Kashmir: A Cross Sectional Study

The importance of Primary Health Care was internationally known after Alma Ata Conference in 1978. Primary health care in India is delivered by Sub center and Primary Health Center. Primary Health Center is the first contact with a health care professional of a community. National Rural Health Mission laid standards known as Indian Public Health Standards. This study was done in order to assess the quality of services and to identify any gaps in the health care delivery by Primary Health Centers(PHCs) in the District Budgam.This was a cross–sectional study done in four Primary Health Centers of the district and information regarding the availability of services at Primary Health Center’s was obtained using a pre–structured, pre–tested checklist which was prepared from Indian Public Health Standards. It was found that OPD services were provided by all while only one PHC provided emergency 24*7 services.50% of the Primary Health Centers had laboratory services for routine blood/urine/stool tests and only 25% had facilities for electrography,X–ray, and USG. However, 100% of the PHCs provided rapid tests for pregnancy .Although all Primary Health Centers provided ANC, family planning services but only 25% provided 24 hour delivery facility.New–born care was available at 75% PHCs while MTP services were available at only 25% of the PHCs The services at Primary Health Centers are not up to mark there is deficiencies in the basic services. Indian Public Health Standards should be taken seriously and evaluation should be done as per these standards at regular intervals so that we can improve the service delivery right from Primary health care level.

Does playing video games effect cognitive abilities in pakistani children?

Objective: To find out the effect of playing video games on cognitive abilities among teenagers

Methods: A comparative cross sectional study was conducted at two schools in Rawalpindi from August 2014 till February 2015. A sample size of 171 was calculated by using WHO sample size calculator using non-probability convenient sampling technique. A mixed questionnaire was used as a data collection tool and two groups were defined as video gamers and non-video gamers. Video gamers were those students who were using video games for two hours or more. Cognitive ability of the students were assess by standardized questionnaire named Wonderlic Cognitive Ability Test Questionnaire. Data were entered and analyzed in SPSS version 20

Results: There were 93 [54.4%] gamers whereas 78[45.4%] were non-gamers. Mean age of the participants was 18.86 +/- 1.46 years. Gamers with correct answers to knowledge, analogy, processing speed, deductive reasoning, mathematical intelligence were 57[61.3%], 67[72%], 68 [73%], 58 [62.4%] and 73[78.5%] respectively. Significant association was found between gamer status and gender [p=0.023], analogy [p=0.049], processing speed [p<0.001], deductive reasoning [p=0.003] and mathematical intelligence [p<0.001]. There was no significant association of gamer status with knowledge [p=0.188]

Conclusion: Gamers exhibit better range of cognitive abilities specifically involving analogy, processing speed, deductive reasoning and mathematical intelligence. In this study, those who play video games on long term basis, showed improvement in cognitive abilities, in comparison to those who do not indulge in gaming activities

Quantitative assessment of the variations in thyroid dimensions in relation to increase in serum TSH in euthyroids

Background: Volumetric evaluation of thyroid gland volume [TGV] is one of the criteria determining the iodine status of a population. TGV is the product of 3 dimension of each lobe: Anterio-posterior [AP] x medio-lateral [ML] x and craniocaudal [CC] x correction factor

Objectives: To determine the effect of serum TSH on thyroid dimensions of each lobe and to measure the amount of effect of per unit increase in serum TSH on thyroid dimensions of each lobe in euthyroids

Study Design: It was a cross-sectional study

Setting: The study was conducted at Ziauddin University Hospital, Clifton, Karachi. Methodology: Healthy participants aged 21 years and above were included through convenient sampling. Serum Thyroid stimulating hormone was evaluated and ultrasound of thyroid gland TG of 192 euthyroid participants was performed. Spearman correlation and regression analysis was applied to evaluate the relationship between TSH and TG dimensions

Results: Relationship of increase in serum TSH with decrease in light lobe AP dimension was most significant. [r= -0.142 P-Value=0.001] and CC dimension least significant [r= -0.0098 P-Value=0.001]. Where as in the left lobe AP dimension decreases significantly with increase serum TSH [r= -0.147 P-value=0.001]. 11.7% of total variation in AP dimension, 3.5% of total variation in ML dimension and 6.5% of total variation in CC dimension in right lobe thyroid are because of serum TSH. While 9.5% of the total variation in AP dimension in left lobe is also due to serum TSH

Conclusion: Negative and significant correlation between serum TSH and thyroid dimensions was observed. Serum TSH inversely and significantly affects all the dimensions of the right lobe and only one dimension in the left lobe

Prevalence of xerostomia in healthy individuals

Objective:To determine the prevalence of Xerostomia in apparently healthy individuals

Methodology:This prospective cross sectional study was conducted on persons accompanying the patients at Medical and Dental OPD of Muhammad Medical College, Mirpurkhas in collaboration with Liaquat University of Health Sciences [LUMHS] Jamshoro from January 2016 to July 2016. 156 patients visited and the accompanying persons were 3015. Only adults were included and 915 patients consented to participate. Standardized questionnaire regarding demographic details, systemic diseases, use of drugs, and cigarette smoking was filled. Fox questionnaire was used to confirm Xerostomia. The data collected was analyzed by SPSS version 22. Qualitative variables were expressed as number and in percentage

Results: Among nine hundred and fifteen participants, age range was 21-65 years. The mean age was 47+/-7.6years,

those above 30 years were 813 [88.9%], whereas under 30years were 102 [11.1%]. Xerostomia was more common in persons above 30 years and difference between two age groups was statistically significant. In our study, 317

[34.6%] gave history of tobacco consumption as cigarettes or gutka or pan. Out of 915 patients, 508 [55.5%] had systemic diseases. Out of these 508 only 387 [76.1%] were taking medications. A significant association of Xerostomia

with drug intake was seen

Conclusion: The frequency of Xerostomia in apparently healthy subjects was high and alarming. Predisposing factors were age, female gender, systemic disease, use of drug and tobacco consumption.

Frequency and pattern of cytogenetic alterations in primary amenorrhea cases of Kashmir, North India

Background: Primary amenorrhea [PA] is proposed to have multiple etiological factors that include genetic factors, intrauterine malformations, endocrine dysfunction and environmental factors, as revealed by previous studies pertaining to amenorrhea. However, among the various proposed etiologies, genetic factors appear to be highly associated with PA as approximately 40% of PA cases have been found to have genetic causes

Aim of the study: The present study was proposed to establish the frequency and pattern of chromosomal abnormalities in PA cases of Kashmir

Subjects and methods: A total of 108 females within the age group of 14-33 years and having a history of amenorrhea were included in the study. Peripheral blood lymphocyte cultures were set for each subject according to standard protocol and chromosomal analysis was carried out on well spread metaphases by the help of Cytovision software Version 3.9

Results: The results of the present study reveal that the incidence of chromosomal abnormalities in PA cases of this region is almost similar with those of many reports around the world. However, we report two unique chromosomal alterations viz., 46, XX, dup2q[13] and 46,XX, t[2,5][p11.2;q34] that have not been found elsewhere in the literature

Conclusion: The results of the present study indicate that chromosomal analysis of females with PA, after the exclusion of nongenetic causes, should be essentially considered for the precise diagnosis and the development of more successful treatment. The study being the first of its kind in this part of the world forms the basis for further studies of the PA cases of this region. The precise molecular characterization of the unique breakpoint regions reported in our study can possibly help in the identification of new genes involved in primary amenorrhea

Cytogenetic diagnosis of Roberts SC phocomelia syndrome: first report from Kashmir

There are several syndromes in which specific mitotic chromosomal abnormalities can be seen, like premature centromere separation, premature [sister] chromatid separation, and somatic aneuploidies. Identifications of such specific cytogenetic findings can be the key factor that leads towards the diagnosis of syndromes like Roberts SC phocomelia. The case presented here as Roberts SC phocomelia syndrome was identified as a child with multiple congenital anomalies and dysmorphic features. Conventional cytogenetic analysis of the case revealed premature sister chromatid separation. The premature centromeric separation was also confirmed by C banding analysis of the child. It is the first and the only case of Roberts SC phocomelia diagnosed from this part of the world. The present case report emphasizes the importance of conventional cytogenetics in the diagnosis of such syndromes

In vitro interaction of antimicrobial agents in combination with plant extract against multidrug-resistant bacterial strains

Aims: To evaluate the possible in vitro interaction between methanolic extract of root of Adiantumcapillus-veneris and certain known antimicrobial drugs i.e. Oxacillin, Ceftazimide, Cefriaxone, Ofloxacin, Meropenem, Erythromycin, Cefuroxime, Cefoxitin, Cefotaxime and Ampicillin. Methodology and results: The study was carried out against ten bacterial strains (Staphylococcus aureus, S. epidermidis, Salmonella typhi, Klebsiella pneumoniea, Shigella dysentriea, Proteus vulgaris, Pseudomonas aeruginosa, Providencia species, Citrobacter freundii and Escherichia coli isolated from urine, pus and blood samples. Both disc diffusion and well diffusion methods were used to determine antimicrobial activity of plant extract in combination with antibiotics. Antimicrobial sensitivity showed that Meropenem was the most effective antibiotic with zone of inhibition (ZI) of 25-33 mm among all tested antibiotics followed by Ofloxacin (10-26.5 mm), Ceftriaxone (8-20 mm), while Oxacillin showed no activity against almost all bacterial strains. The study showed that most bacterial strains were resistant to most of the antibiotics used, ranging from 20-60%. The methanolic extract (mEXT) of A. capillus-veneris used alone was active against most of the bacterial isolates with maximum activity against E. coli with 16 mm ZI. The study also indicated that there was an increased activity in case of combination of mEXT with antibiotics. The combined effects of plant extract with antibiotics were synergistic against most of the bacterial strains. The mEXT showed maximum synergistic effect with Ceftazimide with ZI of 42 mm followed by Meropenem (40 mm) and Ceftriaxone (28 mm) against multidrug-resistant (MDR) bacterial strains. Conclusion, significance and impact of study: The data suggests that plant extract could be used as alternative to antibiotics. These results give scientific backing that combination between plant extract and antibiotics would be useful in fighting the emerging drug-resistant bacterial pathogens.

Awareness about anticancer fruits: a questionnaire based study

Cancers have been the leading cause of death worldwide and poor diet and physical inactivity are major risk factors in cancer-related deaths. Cancer caused over 8 million deaths worldwide in 2013 and has moved from the third leading cause of death in 1990 to the second leading cause behind cardiovascular disease in 2013. Aim of this study was to assess the base line knowledge of Dental Graduates about the anti-cancer dietary components with the aim that their knowledge will have an impact on the awareness of the community. The study was conducted through a 18 instrument questionnaire on a sample consisted of sixty four dental graduates [24 males and 40 females] from University College of Dentistry, The University of Lahore. Awareness regarding different fruits that can have anticancer effect was assessed through the questionnaire. Dental graduates were aware of the fact that different fruits have an anticancer effect thus should be included in the diet however, it was important to note that only 61.33% dental graduates were aware of the fact that citrus fruits exhibit anti carcinogenic activity. Moreover in this study 40%, 55.67% and 50.33% dental graduates considered straw berries, rasp berries and blue berries respectively exhibiting anti-carcinogenic effect. Awareness level of dental graduates regarding role of berry fruit as anti-carcinogen was limited. This study concludes that though base line knowledge about anti-cancer diet was there but further anticancer diet awareness surveys and programs are needed. This may help in changing the dietary habits and thus may help in reducing the increasing incidence of cancers

Age of menarche in relation to socioeconomic status, BMI, physical activity and stress among high school girls

Over the past 50 years, the average age of onset of menarche has significantly declined and found to be a risk factor for breast cancer

Objectives: The research objective is to assess the effect of socioeconomic status, BMI, physical activity and stress on the age of menarche of school girls of urban and peri-urban communities in Lahore

Methods: This cross-sectional study estimated the age at menarche and investigated its relationship with socioeconomic status, BMI, physical activity and stress. It was carried out in 2 schools of peri-urban and urban communities of Lahore, selected through convenience sampling. The data was collected from adolescent girls [aged 13-17 years] from grades 9 and 10 through self-constructed questionnaire. All 199 adolescent girls experiencing menstruation were enrolled in the study

Results: The estimated average age at menarche was 12.66 +/- 1.12 years collectively and 12.92il.21 and 12.37 +/- 1.59 in girls of peri-urban and urban schools respectively. Mean age of menarche was not significantly different in categories of BMI, levels of physical activity and stress but showed statistically significant difference in categories of socio-economic status

Conclusion: It was concluded that mean age of menarche is influenced by socio-economic status

Effectiveness of sterilization and disinfection of extracted human teeth for institutional use: a case control study conducted at a tertiary care hospital

Objectives: To determine the most effective method of sterilization and disinfection of extracted human teeth foruse in dentalcolleges

Study Design: Case Control study

Place and Duration of Study: This study was conducted at OMFS and Microbiology Department, KMDC, Karachi from June 2013 to December 2013

Materials and Methods: Freshly extracted human teeth [n=50] were obtained and sent for bacteriological processing. Teeth were dividing into 5 groups; samples were taken pre and post treatment. A platinum wire loop was flamed in red heat and cooled; sample was inoculatedinC for 48 hours. Colony count was noted to observe the quantity of microorganism, which determines the efficacy of the sterilizing method

Results: The results of the study revealed that the autoclave, hot air oven had shown no growth.While5% sodium hypochlorite, hydrogen peroxide and normal saline had shown positive growth of microorganisms

Conclusion: Autoclave and Hot air oven are effective methods of sterilization of extracted human being teeth for use in dental college in preclinical settings

Correlation of thyroid gland volume with age and gender in a subset of Karachi population

Background: Thyroid gland volume [TGV] is highly variable as it is greatly influenced by age, gender, anthropometric measurements and geographical location. It has become essential for every population to determine reference range of their normal thyroid gland volume [TGV] in healthy individuals. This in turn will help the population in grading of goiter and will guide in large scale iodine monitoring programs

Objective: To determine TGV in a subset of Karachi population and to determine its association with age and gender

Methods: A cross-sectional study employing 421 volunteers aged 21 years and above went through the ultrasound [US] examination of their thyroid gland [TG] after being confirmed euthyroid by their serum thyroid stimulating hormones [TSH] evaluation

Results: TGV in the study was found to be 6.26 +/- 2.89 ml. Males had significantly higher TGV 6.78 +/- 2.88 ml as compared to females 5.7 +/- 2.79 ml [P=0.00]. Volume of right lobe was significantly greater than that of left lobe [P=0.00] in both the genders. TGV increased significantly with age till 60 years [P<0.05] and after the age of 60 years it decreased [P=0.035]

Conclusion: Mean volume of thyroid gland in this studied population is not only smaller than that of the Western countries but is also much smaller than the neighboring country Iran. The study has also proved that there was a significant decrease in mean thyroid gland volume after the age of 60 years. Prolonged and severe iodine deficient status of Pakistan till recent past could be an answer for small thyroid gland volume in the studied population. Similar studies in future will give more accurate facts and figures regarding mean thyroid gland volume in this population if Pakistan retains itself as an iodine sufficient State

Frequency of thyroid incidentalomas in Karachi population

The aim of this study was to determine frequency of thyroid incidentalomas [TI] through ultrasound [US] and its association with age, gender and ethnicities. It was a cross-sectional study. Total 269 adults who were asymptomatic for thyroid disease aged 21 years and above underwent ultrasound examination of their thyroid. Frequency of TI found was 21%. TI was detected in 25% of females and 16% males [P= 0.078]. 61% had thyroid nodules [TNs] in one lobe [right, left or isthmus] and 39% had TNs in more than one location. About 55% had single TN and 45% had multiple TNs. 38% had TNs greater than 1cm while 57% had TNs smaller than 1 cm. 5% had TNs greater and smaller than 1 cm. TI was equally common in individuals of different ethinicities [P= 0.758]. Frequency of thyroid incidentalomas found in our study was higher than most of the other iodine sufficient states. Unlike other studies, incidentalomas were equally common in both the genders of our study. This may be due to the previous iodine deficient status of Pakistan which was prevalent. However further studies on the same topic will help us in identifying the correct status of thyroid incidentalomas if Pakistan retains it's status as an iodine sufficient state

Glycogen storage disorder

Glycogen Storage Disease [GSD, also called Glycogenosis and Dextrinosis] is the result of defects in the processing of glycogen synthesis or breakdown within muscles, liver, and other cell types. Patients usually present with low blood sugar, enlarged liver, slow growth, muscle cramps, seizures and anemia. Von Gierke disease is the most common type of glycogen storage disorder. Von Gierke[1] described the first patient with GSD type I in 1929 under the name hepatonephromegalia glycogenica. In 1952, Cori and Cori[2] demonstrated that glucose-6- phosphatase [G6Pase] deficiency was a cause of GSF type I. Other types are Pompe, Forbes, Con, Hers and Anderson types. GSD type 5 McArdle disease affects skeletal muscles[3]

Contribution of GLC3A locus to primary congenital glaucoma in Pakistani population

To check the contribution of GLC3A locus to primary congenital glaucoma in the Pakistani population. We enrolled twenty-nine sporadic cases and three families with multiple individuals affected with recessive primary congenital glaucoma in the year 2013. It was a genetic linkage study accomplished jointly in Department of Biotechnology of Lahore College for Women University and School of Biological Sciences, University of the Punjab, Lahore. Samples from all affected individuals were checked for homozygosity for alleles of microsatellite markers spanning CYP1B1 at GLC3A locus. Genotyping was performed with fluorescently labeled primers by capillary electrophoresis. For familial cases, linkage was evaluated by checking the co-segregation of the phenotype with the genotypes. Two-point LOD score was calculated for each microsatellite marker with MLINK. Our study revealed that GLCA3 may contribute to glaucoma in 17% of the sporadic cases and patients in 2 of the 3 families. This data suggests that the GLC3A may make an important contribution to autosomal recessive primary congenital glaucoma in the Pakistani population. Genotyping and Sequencing of more families will be helpful to identify the common mutations in CYP1B1 in future

Antibiotic Susceptibility and Molecular Analysis of Bacterial Pathogen Pasteurella Multocida Isolated from Cattle.

Pasteurella multocida is a Gram negative, non motile and coccobacillus bacterium. It has 5 strains i.e. A, B, D, E and F and 16 serotypes (1-16). In present study, we analyzed Pasteurella multocida B: 2 strains, responsible for Hemorrhagic Septicemia (HS) in cattle, on morphological/microbial, biochemical, molecular level and to check the antibiotic sensitivity of the Pasteurella multocida. Microbial analysis showed that while grown on Brain Heart Infusion agar plates and Blood Agar Base Medium, grayish lustrous colonies of Pasteurella multocida were observed. Gram staining showed that Pasteurella multocida are gram negative. Microscopic observations revealed it to be coccobacillus and it was non- motile. Identification was conducted by conventional biochemical tests and percentage identification of Analytical Profile Index was 96 %. Antibiotic sensitivity with different antibiotics was checked by disk diffusion method and was found resistant to Augmentin, Amoxicillin and Aztreonam and was more susceptible to Ceftiofur. On molecular level its DNA was extracted and was run with marker having range from 0.5 – 10 kb. Its DNA was found heavier than 10 kb. It was concluded that accurate laboratory diagnosis of Pasteurella multocida depends on isolation and identification of suspected bacterial colonies by microscopy and biochemical tests. Molecular analysis is a successful tool for differentiation of strains in a variety of bacterial infections.

Involvement and barriers to research amongst students of Khyber Medical College

To find the involvement in research amongst students of Khyber Medical College and to identify reasons for not doing research. A cross-sectional study was performed in which medical students [n=160] from different years of study were asked to fill a questionnaire. Stratified random sampling was done as 20 male students and 20 female students from each year answered the 10-question. Total positive score was calculated. One-hundred and sixty students completed the survey. There were equal male and female respondents [80 each]. The students were from 2[nd], 3[rd], 4[th] and final year. Among the respondents, only fifteen [9%] were involved in a research project; one hundred and thirty students [81.2%] believed that research is easy if proper guidance is given. One hundred and one students [63%] thought that research could enhance understanding of the subject. Most students disagreed with the idea that research could only be done by intelligent students [139, 86.8%]. One hundred and forty students [87.5%] replied that they are interested in doing research, provided proper guidance is given. In this study, we found out that very few students of Khyber Medical College are involved in research. Lack of awareness regarding importance of research and lack of guidance for undertaking research were identified as main barriers for doing research. The concerned authorities need to take steps to encourage students and should involve teachers to streamline the process

Chronic idiopathic urticaria and helicobacter pylori infection: effect of eradication therapy on the relief of symptoms

OBJECTIVE: To find out the correlation between Chronic Idiopathic Urticaria and H.pylori infection and to observe the effect of Eradication therapy

STUDY DESIGN: Observational study

MATERIALS AND METHODS: 20 patients giving history of Chronic Idiopathic Urticaria were enrolled in the study. Serological testing for the presence of H. pylori infection done and were given eradication therapy [Capsule Esomeprazole 40 mg o.d, Tablet Metronidazole 400 mg t.d.s and Tablet Clarithromycin 500 mg b.i.d] for a period of 2 weeks. Clinical assessment was done at day 0, 30, 60, 90 and 120 by a scoring system [symptom evaluation scale], H.pylori status was reassessed at day 60 to confirm eradication effectiveness or to see any relapse of symptoms

SETTING: The study was conducted by the Department of Pharmacology and Therapeutics, BMSI, JPMC with the collaboration of Department of Dermatology JPMC Karachi from May 2008 to August 2008

RESULTS: Among 20 patients, 19 were positive for H.pylori infection and were given eradication therapy. Eradication therapy was successful in 18 patients one patient could not complete the study and there was relapse in one patient The mean SES scores decreased from 3.73 +/- 0.45 on day 0 to 2.52 +/- 0.51 on day 30, 1.52 +/-0.51 on day 60, 1.15 +/- 0.51 on days 90 and 0.47 +/- 0.77 on day 120. A percentage change of 59.13% was observed with a p value of <0.002

CONCLUSION: There is a possible role of H.pylori infection in pathogenesis of chronic idiopathic Urticaria

Off pump coronary artery surgery and intraoperative safety-experience at AFIC/NIHD, Rawalpindi

Coronary Artery Bypass Grafting [CABG] with cardiopulmonary bypass [CPB] on one hand allows controlled haemodynamics with superior graft quality while on the other hand carries inherent risks of CPB which has renewed interest in Off-pump coronary artery bypass [OPCAB]. Haemodynamic instability and intraoperative dysrythmias are major procedural complications of OPCAB, threatening conversion to emergency on-pump surgery. The purpose of this study was to compare intraoperative dysrythmias and inotropic use for haemodynamic stabilization during OPCAB surgery against conventional CABG. Consecutive CABG cases operated between 1[st] June 2003 and 31[st] May 2006 were included while conversions were excluded. Primary end points were analyzed using chi square and t test and values described in percentages, means and probability [p value]. Six hundred and eighty-four cases were divided in group-A [on-pump, n=574] and B [OPCAB, n=97]. Conversion rate was 11.8%. Intraoperative dysrythmias [A, 3.5%, B, 15%, p<0.0001] and use of inotropic support was higher in group-B [A, 15.3%, B, 30.3%, p<0.0001]. Actual mortality in group-B was higher than the predictive value [A, 3.8%, B, 3.6%, Predictive value 3-5% and 0-3% respectively]. OPCAB leads to higher frequency of dysrythmias and inotropic use intraoperatively, highlighting lower procedural safety over conventional CABG

Depression in hemodialysis patients

To measure the frequency of depression and its risk factors in patients under going hemodialysis. It is a cross-sectional prospective study conducted at Hemodialysis unit of Shalamar Hospital and Shaikh Zayed Hospital, Lahore from 1[st] January 2006 to 30[th] April 2006. All patients getting regular hemodialysis for more than three months were included. Beck's Depression Inventory- II [BDI-II; adapted in Urdu] was administered on all the patients who were able to read or understand it. Blood sample were drawn at the same time for routine hematological, biochemical parameters and viral markers [Anti HCV and HbsAg]. Diagnosis was made as per Diagnostic and Statistical Manual of Mental Disorders, fourth edition [DSM IV] for correlation of psychological variables with clinical, hematological and biochemical parameters. Eighty nine patients were enrolled which included fifty two [58.4%] were male and seventy seven [86.5%] were married. Major causes of renal failure were diabetes, hypertension and chronic glomerulonephrotis. Duration of dialysis was from 03 to 49 months with mean of 19.64 +/- 11.7 months. Severity of depression was categorized in to mild, moderate and severe on the basis of BDI score. Majority of the patients fifty [56.1%] were moderately to severely depressed and there was no gender difference in the prevalence of depression. Majority of patients undergoing hemodialysis were depressed. Major risk factors for depression were marital status, illiteracy, number of children, socioeconomic factors, gender, hypertension and hypoalbuminemia. Patients with anemia, hyponatremia and hyperkalemia had suicidal tendency. Patients with hepatitis C and disturbed liver function have strong correlation with psychological parameters