Integration of mental health into primary healthcare: perceptions of stakeholders in Pakistan

Background: In Pakistan, there is high prevalence of mental health disorders, but mental health services to address these are not well developed. To provide effective mental health services, the World Health Organization emphasizes the integration of mental health into primary health care [PHC]. Objectives: This study aimed to assess the views of key stakeholders about integration of mental health into PHC in Karachi, Pakistan. Methods: A qualitative, exploratory study was conducted between June and September 2013 among 15 decision-making [from the Department of Health] and implementation-level stakeholders [mental health and public health professionals and primary care staff] from both the public and private sectors. Face-to-face, in-depth interviews were conducted using a semi-structured interview guide. Data were collected until theoretical saturation was achieved and conventional content analysis was carried out. Results: Although there was general support among all the stakeholders for integration of mental health services within PHC, there were also a number of reservations. First was the perceived lack of support within the system in terms of resource allocation and acceptance from the community. Second was the lack of human resources in the field of mental health. In addition, resistance at the PHC level is likely as staff are already burdened with other preventive care services. Conclusions: The study suggests that strong political commitment, adequate human and financial resources, and strong advocacy are needed for the integration of mental health into PHC in Pakistan

To study the effects of simvastatin on lipid profile in obese patients with changing lifestyle

Simvastatin is a competitive inhibitor of HMG-CoA [3-hydroxy 3-Methyl glutaryl Coenzyme A] reductase. Present study proposed that the lipid lowering effect of simvastatin may be enhanced, if it was taken with fat free diet and morning walk. Cross Sectional Study. This study was conducted at Fatima Jinnah Medical College, Lahore for a period of six months from December 2009 to May 2010. 20 male and 20 female obese patients were selected. The obese patients were re-examined three times i.e. before giving the simvastatin, then after 6 and 12 weeks. The patients were advised to take fat free diet and a morning walk. Serum Cholesterol, serum Triglycerides and serum Lipoprotiens [HDL, LDL] were determined. This study shows that with use of simvastatin, serum cholesterol, serum triglycerides, and serum LDL-Cholesterol was reduced significantly and serum HDL-Cholesterol increased significantly in both sexes. It was also observed that the fat free diet and some exercise causes weight reduction. It is therefore concluded that simvastatin shows significant lipid lowering effects augment process of body weight reduction, if patients used calorie restricted diet with some morning walk

To study the role of serum biliurbin and lipoproteins in prediction of ischemic heart disease

An inverse relationship between the bilirubin level and ischaemic heart disease was accounted. Cross Sectional Study. This study was conducted at Dept. of Biochemistry, Fatima Jinnah Medical College, Lahore from Feb. 2007 to July 2007. Study was performed to determine if serum bilirubin, when combined with various risk factors like lipid and lipoprotein predict ischemic heart disease [IHD]. It is observed that the bilirubin is negatively correlated with hemoglobin, albumin, HDL and LDL-cholesterol. On the other hand a direct correlation with total lipid, cholesterol and ratio of cholesterol/HDL-cholesterol is also observed. High level of serum creatinine level was also found in the patients as compared to normal subject. Our study observed not a definite relationship between serum bilirubin and IHD. Hence the relationships between bilirubin and lipoproteins [risk factors of IHD] require further clarification, although abnormal intermediary metabolism and antioxidant deficiency may be possible linking factors

Pleural fluid estimation and tubercular infection in the people admitted with pleural effusion

We prospectively conducted this study to evaluate the diagnostic value of Pleural fluid estimation and find the rate of tubercular infection in the people with pleural effusion in city of Lahore. Pleural TB is a common form of extrapulmonary disease and may occur in the presence or absence of pulmonary parenchymal disease on the chest radiograph. Prospective Study. This study was conducted in the Biochemistry Department, FJMC, Lahore from May 2010 to Nov. 2010. This study to evaluate the diagnostic value of Pleural fluid estimation and tubercular infection in the people with pleural effusion. All patients aged 22 years and older with clinical and radiographic findings consistent with pleural effusion due to TB admitted to the hospital were evaluated consecutively. The studies were performed on pleural fluid samples: glucose and protein were estimated. Specific gravity was calculated. Cell count, differential cell count, bacterial culture, acid-fast bacilli smear were performed using standard procedures. Specimen was cultured, if effusion contains more than 150 WBC/cumm. It was observed that the level of fluid glucose was increased in both sexes as compared to the normal reported values. Level of fluid protein was more in both sexes as compared to the normal reported values. However level of pH was neutral in both sexes. Present study found that pleural TB is still a major cause of pleural effusion in the city of Lahore, and microbiological and biochemical investigation may be helpful in diagnosing the disease

Effect of weight reduction by dietary caloric restriction on serum glucose and insulin levels in non-diabetic and obese postmenopausal women

Reduction in body weight by energy-restrictive diet and/or by increased physical activity reduces several health hazards associated with obesity including insulin resistance, diabetes mellitus, hypertension, dyslipidemia, sleep apnoea, hypoxemia osteoarthritis, etc. the effect of weight loss by energy-restrictive diet on insulin sensitivity in postmenopausal women who are non-diabetic and obese, is not well-established. This study is based on the hypothesis that weight-reduction through caloric restriction may normalize the obesity-induced hyperinsuliemia or insulin resistance in postmenopausal obese women who are at a great risk of development of glucose intolerance. Twenty non-diabetic postmenopausal females aged 45 to 55 years with body mass index [BMI] 30 or above kg/m[2] were placed at a low caloric diet [1000-1400 kcal], for 60 days. Following 60-day dietary treatment BMI reduced from 32.94 +/- 1.68 [Mean +/- SD] to 30.09 +/- 1.72 kg/m[2] [P<0.001]. The reduction in BMI in our study population was associated with decrease in fasting levels of insulin [from 219.48 +/- 14.10 to 150.25 +/- 19.69. The findings of the present study suggest that weight reduction through caloric restriction is an effective measure to normalize the obesity-induced hyperinsulinemia in postmenopausal women who are non-diabetic and obese, hence decreasing the risk of development of insulin resistance and glucose intolerance

Effect of lithium carbonate on serotonin [5'HT] and creatine phosphokinase [CPK] in depressed patients

Depression is an illness that involves feelings of sadness lasting for two weeks or longer, often accompanied by a loss of interest in life, hopelessness, and decreased energy. It is a medical illness linked to changes in the biochemistry of the brain. Lithium is used for acute mania or prevention of recurrences of bipolar manic-depressive illness in adults. Lithium is a toxic drug and not metabolized in the body. Twenty patients with manic depression, 5 with hypomania and 5 hysteria were taken in the study. Effect of lithium on biochemical parameters like serotonin [5'hydroxy tryptamine], CPK and lithium were determined. Lithium treatment when applied to patients suffering from depression increases level of 5'HT, which is beneficial. However, increase in levels of serum CPK and lithium also occurs which may be toxic. Hence care needs to be taken in treatment to avoid brain damage to patients. It is therefore concluded that during lithium treatment careful monitoring of lithium blood level must be done to ensure adequate therapeutic efficacy without toxicity

Aminoglycosides induced nephrotoxicity and its protection by nigella sativa

The major obstacle limiting the use of aminoglycoside, antibiotics has been and continue to be the possibility of drug induced ototoxicity and nephrotoxicity. Changes in biochemical parameters related to nephropathy before and after of nigella sativa is observed. Five Rabbits were included in the study. Nephrotoxicity was induced with gentatamycin. Extract of Nigella Sativa was given for 20 days and estimated the biochemical changes related to kidney function. Blood samples were taken before and after the administration of Nigella Sativa [at 11 days and 21 days]. It is therefore concluded that although nigella sativa shows a significant effect on nephrotoxicity induced by gentamicin but its effect on the level of serum calcium and cholesterol may be dangerous. However further research is needed on large number of rabbits to reach on a definite

Frequency of known risk factors for stroke in poor patients admitted to Lahore general hospital in 2000

To study the risk factors of stroke in a poor hospital population. Design: Prospective, descriptive hospital based study. Setting: Medical Unit I, Lahore General Hospital, Lahore. Subjects and methods. All poor adults having treatment arranged by social welfare department through zakat admitted with features of stroke during the period January 2000 to December 2000 were included in the study. Type of stroke was identified by CT scan brain and risk factors for stroke and functional outcome at the time of discharge were noted on a proforma. Results. Out of 100 patients studied, 79% had cerebral infarction and 21% had cerebral hemorrhage. Most of the patients had more than one risk factor which included: hypertension 61%, smoking 53%, sedentary habits 38%, diabetes mellitus 33%, dyslipidaemia 32%, coronary artery disease 22%, obesity 11%, alcoholism 9% and carotid artery stenosis 8%. In-hospital mortality was 7% and most of them [89%] at discharge were dependent for their daily activities. Conclusions: Hypertension, smoking and diabetes mellitus are major risk factors for stroke in this poor population and should be the main targets for primary and secondary prevention of stroke. Availability of free medicines and developing stroke units can go a long way in reducing mortality and improving rehabilitation of such patients

Alterations in serum cholesterol levels in Benign colorectal tumours

Colorectal adenoma is the benign precursor of colorectal carcinoma. This study was designed to assess the relation between serum cholesterol levels and colorectal adenoma. Subjects were selected from males who underwent colonoscopy for various reasons. Among selected subjects, twenty were histologically confirmed cases of colorectal adenoma [constituting the patient group] and sixteen age- and body mass index [BMI]-matched were free from colorectal adenoma [constituting the control group]. Before any medical and surgical treatment, fasting blood samples were taken for the estimation of lipid fractions of various serum lipoproteins. Patients showed raised levels of serum cholesterol [P<0.05] and low density lipoprotein cholesterol [LDLc] [P<0.01], as compared to those in the control subjects. High-density lipoprotein cholesterol [HDLc] and triglycerides did not show statistically significant difference between patients and controls. The findings of the present study suggest that the patients with colorectal adenoma may have higher levels of total cholesterol and LDLc

Effect of uncomplicated membranous glomerulonephritis on serum lipid profile

Alterations in the serum lipids have been reported in various renal disorders. The present study was designed to examine the effect of uncomplicated [prior to development of renal failure] membranous glomerulonephritis [MGN] on serum lipids, before initiation of drug treatment. Eighteen histologically confirmed MGN patients, with urinary excretion of protein >3.5 g/24h, serum level of total protein <6 g/dL, and serum level of albumin <3 g/dL, were included in the study [constituting patient group]. Twenty age- and body mass index [BMI]-matched healthy subjects were selected as controls. The patients with MGN had elevated serum concentrations of total cholesterol [9.79 +/- 0.453 mmol/L [mean +/- SEM]], triglycerides [2.53 +/- 0.071 mmol/L], and LDLc [8.02 +/- 0.447 mmol/L] as compared to the control values 5.06 +/- 0.065, l.26 +/- 0.023, and 3.33 +/- 0.067 mmol/L, respectively, with P<0.001. However significantly low levels of HDLc were observed in MGN patients with P< 0.001 when compared with those in controls [1.27 +/- 0.039 vs I.48 +/- 0.018 mmol/L]. There was an inverse correlation between serum albumin, and total cholesterol [r = -0.6800; P<0.01] and triglycerides [r = -0.8644; P< 0.001]. From the findings of this study, it was concluded that there were statistically significant elevations in the levels of atherogenic fractions of serum lipids and declines in the antiatherogenic fraction of serum lipids, in patients with uncomplicated and untreated MGN

Changes in serum lipid, testosterone, LH and FSH levels in nephrotic patients with chronic renal failure

Chronic renal failure is associated with hypogonadism in males and nephritic syndrome is usually associated with dyslipidaemia. The aim of the present study was to examine the changes in lipid contents of various serum lipoprotein fractions and serum levels of testosterone, FSH [follicle stimulating hormone] and LH [luteinizing hormone] in the male nephrotic patients with chronic renal failure. Sixteen male patients [age 35.29 +/- 0.58; mean +/- SEM] with chronic renal failure and proteinuria [>3.5g/day] were selected. On the basis of histological findings of renal biopsy: membranoproliferative glomerulonephritis, 3 patients; focal segmental glomerulosclerosis,8 patients; and membranous nephropathy, 5 patients. Fourteen age- and weight-matched healthy male subjects were selected as controls. Serum levels of testosterone, FSH, LH, and lipid fractions of serum lipoproteins were determined in-patients and controls. Patients showed significantly lower levels of testosterone and FSH and higher levels of LH, when compared with those of patients [P<0.001]. All lipid fractions [except for HDLc] were significantly higher in-patients than those in controls [P<0.001]. In addition an inverse correlation was observed in the patients between albumin levels and total cholesterol [r=-0.6842, P<0.01], and serum albumin and triacylglycerols [r=-0.7489, P<0.001]. The findings of the present study suggest that chronic renal failure with nephrotic syndrome is associated with decreased levels of serum testosterone and FSH, and elevated levels of lipids excluding HDLc

Garlic [allium sativum] a review of controlled studies

Garlic has been claimed to be effective, without serious untoward effects, against a variety of diseases. Most studies on garlic have been primarily in the fields of cardiovascular and cancer research. In cardiovascular studies, the cardioprotective effects of garlic are related to its antiatherogenic [by lowering plasma cholesterol and triacylglycerol concentrations] and anti-thrombogenic activities [by inhibiting platelet aggregation]. In addition, the vasodilatory effect and antioxidant properties of some compounds present in the garlic extract contributes to cardioprotection. Anti-cancer effects of garlic and its constitutes have been widely investigated in vitro and in vivo. Epidemiological studies also suggest the significant role of garlic as a potent antitumour and anticarcinogenic substance

Risk of coronary heart disease and hydrogenated vegetable oils the role of trans-fatty acids: some basic concepts

In Pakistan, hydrogenated oils [commonly called ghee] are the predominant source of dietary fats. Several metabolic and epidemiological studies have contributed to concern about the adverse effects of the transisomers of fatty acids which are formed when liquid, vegetable oils are partially hydrogenated to form ghee, margarine, etc in Pakistan, palm oil is the main precursor for hydrogenation, to get semisolid form or ghee. Polyunsaturated fatty acid contents of palm oil are lower than those of other popular edible oils derived from soyabean, sunflower and corn. Physicians encourage vegetable oils rich in polyunsaturated fatty acids and discourage the use of animal fats because of their high contents of saturated fats and cholesterol. By many people the use of ghee and margarine derived from cholesterol free vegetable oils, is regarded as a healthy eating behaviour, as opposed to butter fat. These partially hydrogenated vegetable oils with high contents of the trans fatty acids, in fact, are even greater health hazards than the cholesterol containing dairy fat