Assessment of cardiovascular disease risk in depressed women of reproductive and menopausal age

It is well documented that depression increases the risk of cardiovascular disease [CVD]. Women of age 55 and younger with depression are more likely to have CVD. The present study aims to investigate CVD risk in depressed women of reproductive age [RA] and menopausal age [MA]. Adult women of RA and MA were divided in to two groups; healthy and depressed. Women were screened for depression [ICD-10 criteria] at outpatients department of local psychiatric hospital. Fasting serum cortisol, estradiol and lipid profile levels were determined. Data was analyzed using two-way ANOVA followed by Newman's Keuls q-test. Total cholesterol [TC], low-density lipoproteins [LDL] and triglycerides [TGs] were raised in MA women however high density lipoprotein [HDL] and estradiol were lower as compared to RA women. Depressed RA women showed increased TC, LDL and HDL but decreased estradiol as compared to healthy women of similar age group. MA depressed women showed increased TC and LDL but decreased HDL and estradiol as compared to healthy controls. We found that MA depressed women had low HDL and estradiol as compared to RA depressed women. Circulating cortisol levels were increased in both depressed RA and MA women compared to respective healthy controls. Low HDL/LDL ratio was found in both healthy and depressed MA women when compared with respective RA women. A significant negative correlation of estradiol and cortisol was found in depressed RA women. It is concluded that low HDL/LDL ratio and hypercortisolemia in both healthy and depressed MA women make them more vulnerable to CVD

Prevalence and pattern of self-medication in Karachi: a community survey

To study the prevalence and pattern of self-medication among adult males and females in Karachi, Pakistan. This cross-sectional community- based survey was carried out at five randomly selected towns of Karachi [Defence, Gulshan-e-lqbal, North Nazimabad, Mlir, Orangi town] over a period of 3 months [October, November and December 2012]. A sample size of 500 adult cases [250 males and 250 females], with systemic random selection from different towns of Karachi were inducted in this study. The city was divided in 5 zones and one town from each zone was selected by systemic randomization. First available male and female from each randomly selected house were included in the study. After consent and confidentiality assurance they were interviewed on semi-structured Performa designed for this purpose. Results were analyzed and tabulated through SPSS v14.0. The prevalence of self-medication in males and females in Karachi is found to be 84.8% [males 88.4% and females 81.2%]. The most frequent symptoms for which self-medication used were headache [32.7%], fever [23.3%] and the medicines used were painkillers [28.8%], fever reducer medicines [19.8%]. The most common reason 33.3% was previous experience with similar symptom. Self-medication is highly prevalent [84.8%] in Karachi. It was frequently used for headache followed by fever. Predominantly painkillers, fever reducer and cough syrups were used in the form of tablets and syrups. Main source of medicines for males were friends and for females were relatives

Accuracy of computed topography in characterizing the Paranasal Fungal Infection

Background: To determine the diagnostic accuracy of CT in characterizing the Paranasal fungal Infection

Methods: All patients suspected of having Paranasal fungal infection underwent CT scan examination on 4 slice Toshiba Asteion multislice CT scanner. Final diagnosis was based on smear analysis for fungal culture which was done subsequently. Statistical analysis was performed by SPSS version-17

Results: Out of 65 patients, 48 were confirmed having fungal sinusitis and remaining 17 were negative on the gold standard culture analysis. While on CT, 44 patients were positive for fungal sinusitis and four patients had a normal scan [false negative]. Out of 17 patients, 14 patients were also negative on CT and three were positive for fungal infection [false positive]. Sensitivity of CT was 93.6% and accuracy was 89.2%

Conclusion: CT scan is highly accurate in diagnosing and characterizing paranasal fungal infection. CT scan also guides in defining disease extent as well as aids in deciding the surgical approach to be used

Effect of denture cleansers on the color stability of heat cure acrylic resin

To compare the color stability of heat cure acrylic resin after immersion in distilled water and denture cleansers. In-vitro experimental study. Dr. Ishrat-ul-Ebad Khan Institute of Oral Health Sciences, Dow University of Health Sciences and Al-Karam Textiles, Karachi, from January to April 2012. Seventy two rectangular shaped specimens; 18 specimens were measured at baseline [control group] of the study [0 day], 18 specimens were immersed in distilled water. Eighteen [18] in Fittydent denture cleanser tablets for 10 minutes and eighteen [18] in Dentipur denture cleanser tablets for 10 minutes. Specimens were polished and stored in istilled water for 24 hours prior to experiment. After 60 days of immersion, the specimens were tested for color changes with spectrophotometer. SPSS 16 was used for statistical analysis. There was statistically significant difference in the color change [delta E] among all groups [p < 0.001] after 60 days of immersion. At baseline [0 day], trace amount of color change was observed whereas when specimens were immersed in Fittydent denture cleansers tablets for 60 days noticeable change in color was observed. Very slight change in color was bserved when specimens were immersed in distilled water and dentipur denture cleanser solution. The color stability of denture base acrylic resin was influenced by the type of denture cleansers used

Comparison of root canal treatment quality performed by house surgeons and postgraduate students

Endodontics is a challenging discipline, and includes technically demanding procedures in general dental practice. The objective of this study was to compare the quality of root canal treatment performed by house surgeons and postgraduate students, Comparative cross sectional study was carried out in the Department of Operative Dentistry, Lahore Medical and Dental College, Lahore [LMDC]. The duration of study was from 13th march 2008 to 12th September 2008. One hundred [100] single rooted teeth of patients reported to the Department of Operative dentistry of LMDC. Patients were randomly allotted and divided in to two groups. Root canal treatment of group A patients was performed by postgraduate students and that of group B by house surgeons. Quality of root canal treatment of both groups was assessed radiographically. A predetermined criterion for assessing quality used in earlier studies was employed. All quality assessment variables for evaluation of root canal which were lateral root seal, adequate length, transportation of apex and instrument fracture showed statistically significant difference between the two groups. The quality of root canal treatment performed by postgraduates was much better than the house surgeons

Knowledge, perception and choice of dental implants as a treatment option for patients visiting the university college of dentistry, Lahore - Pakistan

This study was done to assess the awareness about dental implant treatment to patients visiting the University College of dentistry, Lahore. Pakistan. It was a survey which employed a pre-existing questionnaire. The pre-existing questionnaire was in English but each question was translated into Urdu by the surveyors. It included 6 questions regarding patient knowledge about dental implants treatment, source of information, evaluation of satisfaction, willingness to get treatment and the need for insurance. All patients aged 16 years and above [random sampling] visiting University College of dentistry, Lahore were approached and invited to participate in the study. 181 participated in the survey, 69 were male and 112 females. Only 72[39.8%] of the respondents had heard of the method whereas 109 [60.2%] had never heard of the treatment method. Dentists were the major source of information about dental implants [65.2%]. Over 90% of the respondents thought dental implant treatment was very good or good. When given an option for treatment with dental implants willingness to get treatment 80[44.1%] were definite to get dental implant treatment, 66[36.4%] thought they would most likely get dental implant treatment. 93% of the respondents were of the opinion that insurance coverage should be provided. Awareness about dental implants in this sample population was very poor. Awareness programs should be employed in this regard so that more and more individuals may enjoy the benefits of this treatment option

Diagnostic cut-off levels of plasma brain natriuretic peptide to distinguish left ventricular failure in emergency setting

To determine the diagnostic cut-off values of brain natriuretic [BMP] peptide to establish left ventricular failure in patients presenting with dyspnoea in emergency department. Descriptive study. Ziauddin University Hospital, Karachi, from July to December 2011. BMP estimation was done on Axysm analyzer with kit provided by Abbott diagnostics, while the Doppler echocardiography was done on Toshiba istyle [UICW-660A] using 2.5 MHz and 5.0 MHz probes. Log transformation was done to normalize the original BNP values. A receiver operating curve was plotted to determine the diagnostic cut-off value of BNP which can be used to distinguish CHF from other causes of dyspnoea. Statistical analysis was performed by SPSS version 17. A total of 92 patients presenting with dyspnoea in the emergency department were studied. There were 38/92 [41.3%] males and 54/92 [58.7%] females, and the average age of the study population was 64 +/- 14.1 years. These patients had BNP levels and Doppler echocardiography done. The average BNP was found to be 1117.78 +/- 1445.74 pg/ml. In log transformation, the average was found to be 2.72 +/- 0.58. BNP value of 531 pg/ml was found to be the cut off to distinguish between cardiogenic and non-cardiogenic causes of dyspnoea. BNP value of 531 pg/ml can distinguish CHF from other conditions as a cause of dyspnoea in emergency

Inducible clindamycin resistance in staphylococcus species

To determine the frequency of inducible clindamycin resistance in clinical isolates of Staphylococcus species by phenotypic D-test. Observational study. Ziauddin University Hospital, Karachi, from July to December 2011. Consecutive clinical isolates of Staphylococcus species were collected and identified by conventional microbiological techniques. Antimicrobial susceptibility testing and inducible clindamycin resistance was carried out by performing D-test using CLSI criteria. Methicillin resistance was detected by using Cefoxitin disk as a surrogate marker. Statistical analysis was performed by SPSS version-17. A total of 667 clinical isolates of Staphylococcus species were obtained during the study period. In these isolates, 177 [26.5%] were Staphylococcus aureus, and 490 [73.5%] were coagulase negative Staphylococci. The total frequency of inducible clindamycin resistance among isolates of Staphylococcus species was 120/667 [18%]. Frequency of inducible clindamycin resistance among coagulase negative Staphylococci group and Staphylococcus aureus group were 18.57% and 16.38% respectively. Median age of patients in D-test positive group was 19.5 [1 - 54] years. The frequency of inducible clindamycin resistance among Staphylococcus species may differ in different hospital setup. Clinical microbiology laboratories should implement testing simple and effective D-test on all Staphylococcus species. D-test positive isolates should be reported clindamycin resistant to decrease treatment failure

Fatal primary meningoencephalitis caused by naegleria fowleri

Naegleria fowleri is a free living parasite which habitats in fresh water reservoirs. It causes a fatal nervous system infection known as primary amoebic meningoencephalitis by invading through cribriform plate of nose and gaining entry into brain. We report a case of primary amoebic meningoencephalitis caused by Naegleria fowleri in Karachi, Pakistan, in a 42 years old male poultry farm worker having no history of swimming. Clinical course was fulminant and death occurred within one week of hospital admission. Naegleria fowleri was detected by wet mount technique in the sample of cerebrospinal fluid collected by lumbar puncture of patient. This is a serious problem and requires immediate steps to prevent general population to get affected by this lethal neurological infection

Frequency and predictors of cognitive decline in patients undergoing coronary artery bypass graft surgery

To determine the frequency of cognitive impairment and its predictors in patients, who underwent first time coronary artery bypass graft surgery [CABGS]. An observational study. The National Institute of Cardiovascular Diseases [NICVD], Karachi, from December 2008 to December 2009. Study included patients > 18 years, who underwent first-time elective CABGS. Emergency CABGS, with additional cardiac procedures, myocardial infarction [MI] within one month and known psychiatric illness were excluded. Patients were evaluated for their socio-demographic profile, medical history, intra-operative, anesthetic and surgical techniques and postoperative complications/therapy in ICU. Cognitive functioning, before the surgery, at discharge, 6 weeks and 6 months post-CABG was evaluated by McNair's and MMSE scales. HDRS was added to see if depression was a confounding factor for cognitive decline. One hundred and thirty four patients were followed-up at discharge, 74 at 6 weeks and 73 at 6 months. There were 113 [84.3%] males and 21 [15.7%] females, with mean age of 53.7 +/- 8.36 years. Prevalence of cognitive disturbance at baseline was 44.8%, which increased to 54.5% at discharge, and improvement was seen at 6 months, it was 39.7%. Older age, female gender, higher bleeding episodes, and high post-surgery creatinine level were more frequently associated with cognitive decline. Postoperative cognitive deficit was common and remained persistent at short-term. Older age, females and high postoperative creatinine were identified as its important predictors. There was high frequency of acute depression before surgery with significant reduction over time

Bacteremia due to aeromonas hydrophila in acute lymphoblastic leukemia

Aeromonas hydrophila [A. hydrophila] is a low virulent organism but may cause devastating fatal infections in immunocompromised host especially in liver cirrhosis. It is rarely reported to cause septicemia in a patient with Acute Lymphoblastic Leukemia [ALL]. The mortality rate of septicemia due to A. hydrophila is 29% to 73%. We report a case of 59-year-old female patient who was a known case of ALL, presented with the complaints of fever, lethargy and generalized weakness for one month. After taking blood samples for investigations, empirical antimicrobial therapy was started. She did not improve after 48 hours of therapy. Meanwhile blood culture revealed pure growth of A. hydrophila. After sensitivity report was available, ciprofloxacin was started. Patient became afebrile after 48 hours of treatment with ciprofloxacin. It is very vital to correctly identified and treat bacteremia due to A. hydrophila especially in the underlying leukemic patient.

Activity of beta-lactam beta-lactamase inhibitor combinations against extended spectrum beta-lactamase producing enterobacteriaceae in urinary isolates

To determine the susceptibility pattern of beta-lactam beta-lactamase inhibitor combinations against extended spectrum beta-lactamase [ESBL] producing Enterobacteriaceae in urinary isolates. Observational study. Ziauddin University Hospital, Karachi, from February to October 2008. A total of 190 consecutive non-duplicate isolates of ESBL producing Enterobacteriaceae from urine samples of in-patients were included in the study. Urinary samples from out-patients, repeat samples and non-ESBL producing isolates were excluded. Detection of ESBL was carried out by double disk diffusion technique. Antimicrobial susceptibility testing was performed using modified Kirby Bauer's disk diffusion method according to CLSI guidelines. Statistical analysis was performed by SPSS version 10. Of the 190 ESBL isolates tested, 88 cases [46.31%] were sensitive and 6 cases [3.15%] were resistant to all three combinations, the rest 96 cases [50.52%] were resistant to at least one of the combinations. Susceptibility pattern of cefoperazone/sulbactam, piperacillin/tazobactam, and amoxicillin/clavulanic acid was 95.26, 92.10, and 44.31 percent respectively. Cefoperazone/sulbactam exhibited the best activity against ESBL producing Enterobacteriaceae followed by piperacillin/tazobactam. Hospital antibiotic policies should be reviewed periodically to reduce the usage of extended spectrum cephalosporins and replace them with beta-lactam beta-lactamase inhibitor combinations agent for treating urinary tract infections

Pleural empyema due to salmonella typhi

Salmonella serotypes most often produce gastroenteritis, enteric fever, bacteremia, vascular infection and chronic carrier state. Localized infection may occur at any site after Salmonella bacteremia. Pulmonary involvement due to Salmonella infection is rare. Empyema occurs usually in elderly patients or in patients with underlying diseases such as diabetes mellitus, malignancy, or pulmonary disease. We report the case of an 83-year-old male diabetic patient who presented with fever, productive cough, and difficulty in swallowing. The chest radiographs revealed soft shadowing mild atelactasis and pulmonary abscess on left side. CT-guided aspiration of pus was done. Salmonella enterica serotype typhi was isolated from pus sample. Pleural empyema or abscess usually requires surgical drainage in addition to antimicrobial therapy. After complete course of antimicrobial therapy, the patient improved

Frequency of extended spectrum beta lactamase producing enterobacteriaceae among urinary pathogen isolates

To determine the frequency of extended-spectrum beta lactamase [ESBL] producing Enterobacteriaceae in urinary isolates. Observational study. Ziauddin University Hospital, Karachi, from February to October 2008. All members of Enterobacteriaceae isolated from urinary samples of in-patients were included and identified using standard biochemical tests. Urinary samples from out-patients were excluded. Detection of ESBL was carried out by double disk diffusion technique. Statistical analysis was performed by SPSS version 10. A total of 289 isolates of Enterobacteriaceae were identified during the study period. Of those 190/289 [65.7%] of the isolates were found to be ESBL producing. ESBL positivity within individual organism group was highest in Klebsiella species 84.16%, followed by Escherichia coli 68.55%, Enterobacter species 36.84%, and Proteus mirabilis 28.55%. Mean age of patients with ESBL producing organisms was 58.69 +/- 18.97 years. ESBL production was almost similar in all age groups. A high frequency of ESBL producing organisms especially Klebsiella species and Escherichia coli amongst the hospital obtained urinary isolates was documented particularly in the older age group. The data points towards an urgent need for regular screening and surveillance for ESBL producing organisms in this region

Hyperglycemia and treatment with antipsychotics - a study from a tertiary care centre

To assess the frequency of hyperglycemia in chronic schizophrenics and describe its correlates. Cross-sectional study. This study was carried out in a Department of Psychiatry Jinnah Postgraduate Medical Center, Karachi, Karachi Pakistan in the summer of 2007. Fifty patients suffering from chronic schizophrenia [14 female and 36 male], between the ages of 18 and 60 years, who had been taking antipsychotic medication for the past two years or more were included. These patients were assessed on detailed history, physical examination supported with fasting blood sugar, checked by glucometer, BMI, blood pressure and mental state examination by psychiatrists. A Positive association was found between hyperglycemia and chronic schizophrenia. 10% of the patients were found to be suffering from hyperglycemia. Out of these 8% had been on atypical antipsychotics on an average of 4 years. There was no relationship found between gender and altered blood glucose levels. There have been countless studies on the antipsychotics induced hyperglycemia in the past. Though the sample size of our study was small, but it established the contributory relationship between atypical antipsychotics and hyperglycemia in this part of the world. More studies with a larger sample size should be conducted in the near future

Cognitive disturbance comparison among drug-naive depressed cases and healthy controls

To assess and compare cognitive disturbances among newly diagnosed depressed and healthy control cases on the McNair and Kahn auto-evaluation scale. Comparative, cross-sectional study. Out-patients Department of Psychiatry, Jinnah Postgraduate Medical Centre, Karachi, Pakistan, from February to May, 2007. All consecutive new cases reporting at the out patient department were screened for depressive illness. They were matched with healthy-controls aged between 18-40 years. Clinical assessment was carried out on the basis of detailed history, physical examination, mental state examination by psychiatrists. For diagnostic purpose, application of ICD-10 followed by administration of Scale for Cognitive Difficulties. Sixty subjects, 30 depressed patients [20 females and 10 males] and 30 healthy-controls [18 females and 12 males] were assessed. The age of cases with depressive disorder ranged 18-38 years. It was found that 63.3% [65% females and 60% males] depressed patients had cognitive difficulties compared to 3.3% of healthy-controls [p<0.001]. Proportions were compared using chi-square test with significance at p< 0.05. Depression is not merely an emotional [mood] disorder but has an impact on cognition domain as well. Attention/concentration was the most common domain of cognition affected, followed by memory disturbance among the drug-na‹ve depressed patients

Prevalence of chronic sinusitis among outdoor psychiatric patients

To assess the prevalence of chronic sinusitis among outdoor psychiatric patients as a number of patients with chronic sinusitis presents with psychiatric symptoms. 5043 cases. Cohort Study. Department of ENT in collaboration with department of Psychiatry, JPMC Karachi. The study duration was six years from January 2002 to December 2007. All cases of psychiatry consultation who agreed, were assessed for history, mental state examination and physical examination with laboratory and radiological investigation. The final diagnosis was based on criteria of ICD-10 for associated psychiatric diagnosis. Out of 5043 cases, 154 [30.05%] cases had chronic sinusitis. Out of 154 cases of chronic sinusitis 85 [55.2%] were male and 69 [44.8%] were female. Majority of the patients 57 [37%] were below primary level of education. As evident from this study, cases with chronic sinusitis can present psychiatric practice as the symptoms resemble or coexist with psychiatric disorders

Gender based response to fluoxetine hydrochloride medication in endogenous depression

To determine the gender based response to fluoxetine HCl medication in relation to tryptophan metabolism in depressed patients. Design: A comparative, analytical study. Place and Duration of Study: Clinical Biochemistry and Psychopharmacology Research Unit, Department of Biochemistry, University of Karachi during the year 2002 to 2003. Subjects and Sixteen adults depressed patients who were not having any other major comorbidity were selected from the outpatients department of local psychiatric clinic for the study. They were subjected to a semi-structured interview for associated clinical characteristics and diagnosis of depression according to ICD-10 criteria. A control group of normal health male and female individuals was identified for comparison with the depressed group.All the depressed patients were treated with fluoxetine hydrochloride [Prozac 20 mg/day] for four weeks. Healthy individual's data was compared with the depressed group and evaluated for gender based response to fluoxetine HCl medication. Significant decreases were found in total tryptophan concentrations [33%, p<0.01,56%, p<0.01] in depressed male and female patients respectively, in contrast, serum cortisol levels were increased by 68% and 98% in male and female depressed patients respectively as compared to healthy controls. Significant increases [23%, p<0.05] in albumin levels were found in females only. Four weeks treatment of male and female depressed group by Fluoxetine HCL [Prozac] 20 mg/kg/day, increased serum total tryptophan concentrations significantly by 32% [p<0.05] in males and by 83% [p<0.01] in females. Serum-free tryptophan concentrations were increased by 22% [p<0.05] in males only. In contrast serum cortisol concentrations were decreased by 31% [p<0.01] and 45.35% [p<0.01] in males and females respectively. Increases in tryptophan and decreases in cortisol concentrations were greater in females which may contribute to better response of the drug in females