Areca Nut Chewing and the Risk of Re-hospitalization and Mortality Among Patients With Acute Coronary Syndrome in Pakistan / 예방의학회지

OBJECTIVES: Areca nut is widely consumed in many parts of the world, especially in South and Southeast Asia, where cardiovascular disease (CVD) is also a huge burden. Among the forms of CVD, acute coronary syndrome (ACS) is a major cause of mortality and morbidity. Research has shown areca nut chewing to be associated with diabetes, hypertension, oropharyngeal and esophageal cancers, and CVD, but little is known about mortality and re-hospitalization secondary to ACS among areca nut users and non-users. METHODS: A prospective cohort was studied to quantify the effect of areca nut chewing on patients with newly diagnosed ACS by categorizing the study population into exposed and non-exposed groups according to baseline chewing status. Cox proportional hazards models were used to examine the associations of areca nut chewing with the risk of re-hospitalization and 30-day mortality secondary to ACS. RESULTS: Of the 384 ACS patients, 49.5% (n=190) were areca users. During 1-month of follow-up, 20.3% (n=78) deaths and 25.1% (n=96) re-hospitalizations occurred. A higher risk of re-hospitalization was found (adjusted hazard ratio [aHR], 2.05; 95% confidence interval [CI], 1.29 to 3.27; p=0.002) in areca users than in non-users. Moreover, patients with severe disease were at a significantly higher risk of 30-day mortality (aHR, 2.77; 95% CI, 1.67 to 4.59; p < 0.001) and re-hospitalization (aHR, 2.72; 95% CI, 1.73 to 4.26; p < 0.001). CONCLUSIONS: The 30-day re-hospitalization rate among ACS patients was found to be significantly higher in areca users and individuals with severe disease. These findings suggest that screening for a history of areca nut chewing may help to identify patients at a high risk for re-hospitalization due to secondary events.

Post-traumatic stress disorder - a psychological aspect of maxillofacial trauma

The purpose of this study is to find out the incidence of Post-Traumatic Stress Disorder in patients with maxillofacial trauma and to provide a circumstantial evidence for certain precautionary measures which will play a basic role in the prevention and management of Post-Traumatic Stress Disorder amongst such patients. The study was carried out at the Department of Oral and Maxillofacial Surgery, Khyber College with maxillofacial Pakhtunkhwa, Peshawar from June 2009 to May 2010. Two hundred and Ninety patients with maxillofacial trauma were recruited in this study. For the collection of data, Post-Traumatic Stress Disorder Checklist Civilian version consisting of 17 items was used. The collected data and all relevant information were analysed using SPSS Version 17.0. The results of the present study showed that out of 290 patients, 90 patients [31.03%] had Post-Traumatic Stress Disorder symptoms in which 40 [44.44%] were males and 50 [55.56%] were females. The largest age group suffered from Post-Traumatic Stress Disorder symptoms were 16-25 years and 26-35 years [33.33% each]. Thirty four patients [27.78%] scored 50 or above on Check list indicating severe symptoms, where 27 females [30%] had severe symptoms as compared to 7 males [7.78%]. Young patients between ages 16-35 were the most common group who suffered from severe symptoms. The severe symptoms of Post-Traumatic Stress Disorder were seen in victims of road traffic accidents and bomb injuries [22.22% and 13.33% respectively] with poor and middle socioeconomic status. The importance of psychological morbidity after major trauma is continuing to gain attention in trauma outcomes research. Taking into account the burden of psychological consequences of maxillofacial trauma, further research and preventive strategies are needed to cope with this hidden epidemic in our society