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Background: Thoracic spinal anaesthesia has emerged as one of the most promising anaesthetic techniques in the recent times. On the other hand, lumbar approach has been the conventional choice for orthopaedic surgeries since the advent of spinal anaesthesia. This study aimed at determining which approach is better suited for orthopaedic surgeries.Methods: Total 60 patients scheduled for orthopaedic surgeries were divided into two groups : group T and group L. Group T patients were given thoracic spinal anaesthesia at the T9-T10 / T10-T11 interspace using 1.5 ml of hyperbaric bupivacaine 0.5% (5 mg/ml) + 25µg (0.5 ml) of fentanyl. Group L patients received 2.5 ml of hyperbaric bupivacaine 0.5% (5 mg/ml) + 25 µg (0.5 ml) of fentanyl at LI-L2/L2-L3 interspace. Authors evaluated the degree of analgesia and motor block, haemodynamics and neurological complications.Results: Onset of analgesia was faster in thoracic group - 2min. The duration of sensory and motor block was shorter in thoracic group. There were no significant differences in haemodynamic variables and respiratory parameters between the two groups and no neurological complication in any patient.Conclusions: Thoracic spinal anaesthesia is preferable to lumbar spinal anaesthesia for orthopaedic surgeries.
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Objective: To assess the role of Intraperitoneal infiltration of Ropivacaine for post-op analgesia in open cholecystectomy in a low resource setting
Study Design: Randomized controlled trial
Place and Duration of Study: Study was conducted at department of Anesthesia, Scouts Hospital Chitral, from Jul 2014 to Jun 2016
Material and Methods: After taking approval from hospital ethical committee, total 126 patients were divided randomly in two groups. Group I [study group] was given intraperitoneal ropivacaine and group II [control group] was given routine standard analgesia. After complete recovery, pain was measure on VAS score [1-10] at 1 hour, 6 hour and 24 hour in all patients. Patients having pain score of 4 or more were managed with nalbuphine 5 mg IV bolus. Data was analyzed by SPSS version 16
Results: The comparison of pain score [after 1, 6and 24 hours of surgery], showed that study group had significantly [p-value<0.05] less mean pain score as compared with placebo group. Significant rate of nausea/vomiting was observed [p-value<0.05] higher [62%] in placebo group as compared with [38%] in study group. Statistically there was no significant difference [p-value>0.05] between groups on the basis of mean age [47.89 +/- 8.56 vs. 48.75 +/- 9.36], gender [Females 70% vs. 68%], duration of the surgery [88.54 +/- 12.34 minutes vs. 91.70 +/- 13.50 minutes] and American society of anesthesiologist [ASA] grades in study and placebo group patients respectively
Conclusion: Intraperitoneal ropivacaine infiltration helped in reducing the post op pain significantly in open cholecystectomy
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Objective: To detect the anti cyclic citrullinated peptide [Anti-CCP] antibody in rheumatoid arthritis [RA] patients to determine its diagnostic value in Pakistani patients
Study Design: Cross sectional study
Place and Duration of Study: Military Hospital [MH] Rawalpindi, from January 2013 to June 2015
Material and Methods: A total of 58 patients with complications of rheumatoid arthritis were recruited in the study using convenient sampling technique after their informed consent. Age and gender of the patients were recorded. Blood was collected from the patients subjected to ELISA based detection of anti-CCP and latex agglutination test for detection of Rheumatoid Factor [RF]. Data obtained were analyzed using Microsoft excel 2010
Results: Among the fifty eight RA patients, 40% were males and 60% were females. Age ranged between 12 to 80 years [mean age 49.74 +/- 16.81 years] of the males RA patients and was higher as compared to females [mean age 43.2 +/- 16.70 years]. ELISA based detection of anti-CCP antibody showed that about 91 percent of RA patients were positive for anti CCP antibody. About 72% were positive for anti CCP antibody alone, 19 percent were positive for both anti-CCP and RF and 9 percent were positive for RF
Conclusion: The results concluded that a higher percentage of the RA patients are positive for anti-CCP antibody marking its importance as a diagnostic marker. Anti-CCP has more sensitivity as compared to RF in RA patients
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To estimate the most prevalent age of patients and disease status and progression in terms of severity at different age groups in the Pakistani Rheumatoid Arthritis [RA] patients. A total of five hundred [500] RA patients were enrolled during October, 2009 to October, 2013. A screening questionnaire was filled for each patient satisfying America College of Rheumatology [ACR] criteria under the supervision of certified rheumatologists. Epidemiological and demographic variables were statistically analyzed for correlation with progression of the disease using SPSS ver 17.0.1 software. In general, rheumatoid arthritis preferentially affects women with female to male ratio of about 3:1; however, patients with above 60 years of age have equal female to male ratio. The most prevalent age is 45-60 years. The disease severity increases with increase in the age and reaches to its peak in above 60 years of age [p=0.001]. The pattern of progression of RA in the Pakistani patients is almost consistent with other relevant studies conducted on European and European derived populations
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Surveys and Questionnaires , Immune System Diseases , Disease ProgressionABSTRACT
Objective: To compare the efficacy of felodipine versus propranolol in patients of essential hypertension for Serum cholesterol, LDL cholesterol and HDL cholesterol
Study Design: Randomized controlled study
Place and Duration of Study: This study was conducted at the Accident and Emergency Department, Bahawal Victoria Hospital, Bahawalpur and Ansari Private Clinic Model Town B Bahawalpur from 1[st] July 2015 to 30[th] September 2015
Materials and Methods: Total 90 patients with essential hypertension having age range from 30 to 50 years were enrolled in this study for three months. Patient were randomly divided into three groups I, II and III, each group comprising 30 patients. Group I patients were treated with felodipine, Group II patients were treated with propranolol and group III patients were treated with placebo. Effects of these drugs on Lipid profile [Serum cholesterol, HDL cholesterol and LDL cholesterol] were compared
Result: Felodipine, treated patients exhibited markedly significant fall in the serum cholesterol [P<0.01], highly significant fall at the level of LDL cholesterol [P<0.001] and non-significant effect in HDL cholesterol. Whereas propranolol treated patients showed highly significant increase of serum cholesterol [P<0.001], markedly significant increase in LDL cholesterol [P<0.01] and markedly significant decreased in HDL cholesterol [P<0.01]
Whereas comparison of two drugs Felodipine and Propranolol displayed a highly increased [P<0.001] serum cholesterol, LDL cholesterol and markedly increased [P<0.01] HDL cholesterol
Conclusion: Result of this study showing that comparing the two drugs felodipine had significantly decreased Serum cholesterol and LDL Cholesterol, whereas propranolol increased the Serum cholesterol, LDL cholesterol and decreased HDL cholesterol. So felodipine prove its merit over propranolol
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Objective: To study the correlation of anti C1q antibodies with disease activity in patients with systemic lupus erythematosus [SLE]
Study Design: Cross sectional, observational study
Place and Duration of study: The Department of Immunology, Armed Forces Institute of Pathology, Rawalpindi in collaboration with Military Hospital, Rawalpindi, Pakistan Institute of Medical Sciences, Islamabad and Benazir Bhutto Hospital, Rawalpindi, from Jan 2012 to Dec 2013
Material and Methods: Patients with a clinical diagnosis of SLE were included in the study on fulfilling revised American College of Rheumatology [ACR] criteria [1997]. Main outcome measures were SLE disease activity index [SLEDAI] score and anti C1q antibody levels in serum. SLEDAI scores were calculated for each patient on the basis of physical examination, patient interviews and previous clinical records. Anti C1q antibody levels in the serum were determined by enzyme-linked immunosorbent assay [ELISA] and correlated with the SLEDAI scores by calculating Pearson's correlation coefficient 'r'. The cutoff value for anti C1q antibody positivity in the serum was determined by evaluating the serum levels of anti C1q antibodies in 25 healthy subjects and was 12 U/ml
Results: Six male and forty nine female SLE patients with an age range of 16-47 years [mean 34.5 years] and 8-70 years [mean 31.7 years] respectively were studied. The correlation between anti C1q levels and SLEDAI scores in all patients was demonstrated by calculating the correlation coefficient and was not significant [r=0.19, p=0.14]. However, there was an inverse correlation between anti C1q levels and SLEDAI scores in patients with severe disease and this was statistically significant [r=-0.448, p=0.037]. The difference in anti C1q antibody positivity between patients with and without nephritis was not significant. The anti C1q antibody levels correlated poorly with anti double stranded deoxyribonucleic acid [dsDNA] antibody positivity. A significantly higher percentage of patients with evidence of complement consumption was found to be positive for anti C1q antibodies [p=0.01]. This significance was only seen in patients with reduced C3 levels [p=0.04] and not reduced C4 levels [p=0.23] or both [p=0.23]. Anti C1q antibody levels had significant inverse correlation with serum C3 levels. [p=0.007]
Conclusion: A significant inverse correlation was found between SLEDAI scores and serum anti C1q antibody levels in patients with severe SLE. The anti C1q antibody positivity is significantly higher in patients with reduced C3 levels
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Objective: To determine frequency of hepatitis B and C virus infection in surgical patients and its relation to already reported risk factors
Study design: Case series
Place and Duration of Study: Department of Surgery Civil Hospital Karachi, from May 2012 to September 2012
Methodology: All patients who were scheduled for surgical procedures were screened for HBsAg and anti-HCV using immunochromatography [ICT]. The variables already known for the possible transmission were also inquired. The data was entered into a Performa and entered into SPSS version 17. Descriptive statistics were used for computation of the results
Results: Out of the total 662 patients, 325 [49.1%] were males and 337 [50.9%] females. Mean age of patients was 37.52 year. Hepatitis B surface antigen [HBsAg] was positive in 19 [2.9%] patients of whom 12 [63.15%] were males. Hepatitis C [anti-HCV] was found in 45 [6.8%] patients of whom 24 [53.33%] were females. Among HBsAg positive patients, 17 [89.47%] had history of intravenous injections; similar history was found in 44 [97.77%] anti-HCV positive patients
Conclusions: Frequency of hepatitis B was slightly more than hepatitis C in surgical patients. Routine serological screening prior to surgery should be made mandatory so that health care workers especially surgeons can take precautions before surgery
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Background: Gastroprotective effects of cuscuta reflexa may be considered as alterative to many currently used anti peptic ulcer drugs
Objective: To explore the in-vivo gastroprotective activity and antiulcer potential of crude extract of the indigenous medicinal plant, Cuscuta reflexa, belonging to the plant family 'Convolvulace
Methodology: This experimental study was conducted from 1[st] March to 1[st] July 2015 at faculty of pharmacy and alternative medicine, Islamia Universty Bahawalpur. The antiulcer activity of Cuscuta reflexa [Cs.Cr] was investigated in aspirin-induced ulcer models. Wistar Albino rats were divided into six groups, each consisting of six animals. Control and intoxicated groups received normal saline at the dose of 8 ml/kg, standard group received Cimetidine [100 mg/kg] and the test groups received three different doses [30, 100 and 300 mg/kg] of Cs.Cr oraly individually for seven days, with subsequent administration of aspirin [200 mg/kg oraly] for two consecutive days. At the end of the experimental period, rats were anaesthetized and sacrificed. The stomach was removed and incised to collect the gastric juice for determination of pH and acidity. The stomach from each group was evaluated for ulcer index and percent protection. Afterwards, stomachs were weighed and samples preserved in 10% formalin for histopathological studies. Acute toxicity studies were also performed in mice. The extract [Cs.Cr] was also analyzed phytochemically for the presence of various secondary metabolites
Results: Oral administration of the crude extract of Cuscuta reflexa [Cs.Cr] exhibited dose-dependent [30-300 mg/kg] significant protection [p<0.05] in the Aspirin-induced peptic ulcerated animals. The extract, Cs.Cr, was found to be safe up to the dose of 10 g/kg in mice. Phytochemical analysis showed the presence of several metabolites like glycosides, flavonoids, saponins, terpenes and tannins in the crude extract of the plant
Conclusion: The results of the study clearly showed that Cs.Cr possesses gastroprotective potential and caused the reversal of peptic ulceration which justify the traditional use of the plant in several gastric ailments like hyperacidity, gastro-esophageal reflux disease and ulcer. However, further investigations are needed to explore the exact mechanism[s] responsible for protective effects of the plant
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Background: Aerva Javanica, a traditional medicinal plant may have hepatoprotective effects
Objective: This study was carried out to assess the in-vivo hepatoprotective activity of 70% aqueous methanolic crude extract of Aerva javanica, belonging to the plant family 'Amaranthaceae'
Methodology: Wistar Albino rats were divided into six groups, each consisting of six animals. Control and intoxicated groups received normal saline at the dose of 2 ml/kg, standard group received Silymarin [25 mg/kg] and the test groups received three different doses [100, 300 and 1000 mg/kg] of Aj.Cr oral individually for three days. After half an hour of third day treatment, each animal of all the groups, except control, was treated with single per oral dose of 500 mg/kg of Paracetamol [PCM]. After 24 hours of intoxication, animals were anesthetized and sera were prepared from blood obtained by cardiac puncture method to assess biochemical parameters; SGOT, SGPT, SALP and total bilirubin [TB], using diagnostic kits. Livers were weighed and samples preserved in 10% formalin for histopathological studies. Acute toxicity studies were also performed in mice. The extract [Aj.Cr] was also analyzed phytochemically for the presence of various secondary metabolites
Results: Oral administration of the crude extract of Aerva javanica [Aj.Cr] showed dose-dependent [100-1000 mg/kg] significant reduction [p<0.05] in the Paracetamol-induced elevated levels of enzymes; Serum Glutamate Oxaloacetic Transaminase [SGOT], Serum Glutamate Pyruvic Transaminase [SGPT], Serum Alkaline Phosphatase [SALP] and Total Bilirubin [TB] in intoxicated animals. The extract, Aj.Cr, was found to be safe up to the dose of 10 g/kg in mice. Phytochemical analysis showed the presence of several metabolites like glycosides, flavonoids, saponins, terpenes and tannins in the crude extract of the plant
Conclusion: The results of the study showed that Aerva Javanica possesses hepatoprotective potential and caused the reversal of abnormal liver functions which justify the traditional use of the plant in liver complaints. However, further investigations are needed to explore the exact mechanism[s] responsible for protective effects of the plant
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The specter of road traffic injuries takes a greater toll on human life every day on our roads. To analyze the demographic and injury profile of autopsy cases with an alleged history of RTA [Road traffic accidents]. Retrospective study. Forensic Medicine Department of Nishtar Medical College, Multan. January 2010 to December 2013. 116 autopsy cases with an alleged history of RTA. Data collected pertaining to history, epidemiology, details of injuries and cause of death etc. was statistically analyzed on SPSS version17. Out of 116 autopsies on RTA victims, 46.55% victims were between 21-40 years with male: female ratio of 1.9:1. Maximum number of accidents occurred during day time between 6 am and 5:59 pm [62.06%]. 79.31% died at the site of accidents. Pedestrians were the commonest victims [81.89%]. Four wheelers caused most of RTA 51[43.96%]. The cause of death was opined to be head injury in 45.68% of cases. Addressing road safety in a comprehensive manner necessitates the involvement of multiple sectors, such as health, transport and police
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Objective: The aim of our study was to determine outcomes of fibrinolytics in patients of acute MI in a setup where streptokinase is the sole fibrinolytic used and where the facility of primary PCI is not available
Study Design: Descriptive cross sectional study
Place and Duration of Study: This study was conducted at the Department of Cardiology, Mardan Medical Complex Teaching Hospital, Mardan from January 2011 to December 2014
Materials and Methods: This study included 3,000 patients using non probability purposive sampling technique. The study was approved by the Hospital Ethical Committee. An informed written consent was obtained. Out of these, 2100 [70%] were non diabetic and 900 [30%]diabetics
Results: Those who presented within 6 hours of the index chest pain, streptokinase therapy was successful in 1709 [57%] patients and unsuccessful in 197 [6.6%] patients. Streptokinase was successful only in 771 [25.7%] patients and unsuccessful in 323 [10.8%] patients who presented in 6-12 hours of the index pain. Reinfarction occurred in 193 [6.4%] patients whereas 2807 [93.6%] were free of reinfarction. Hemorrhagic Stroke occurred 50 [1.7%] patients whereas 2 [0.1%] developed ischemic stroke
Conclusion: Our study convincingly showed that intra cranial hemorrhage was relatively low with this fibrinolytic
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Objective: To compare the efficacy of felodipine and propranolol in the treatment of essential hypertension
Study Design: Randomized controlled study
Place and Duration of Study: This study was conducted at Accident and Emergency Department,Bahawal VictoriaHospitalBahawalpurandAnsariPrivateClinicModelTownB,BahawalpurfromMarch2013toMay2013. Materials and Methods: Total 90 patients of mild to moderate essential hypertension both male and female between the ages of 30 to 55 years were enrolled to this study, for 90days patients were randomly divided intothree groups Group I, II and III. Efficiency of felodipine, propranolol and placebo tablets in the treatment essential hypertension wascompared
Results: Felodipine and propranolol both reduces the systolic blood pressure was highly significant [P<0.001] between day 0-15, day 0-30, day 0-45, day 0-60, day 0-75 and day 0-90. The placebo exhibited a non-significant effect on systolic blood pressure.In case of diastolic blood pressure patients treated with felodipine and propranolol the decrease of blood pressure was also significantly [P<0.001] for all time intervals. In placebo administered group the effect of diastolic blood pressure was non-significant at all-time intervals
Conclusion: Result of this study showing that both felodipine and propranolol significantly reduces blood pressure at all time of intervals. In addition felodipine has got an edge on propranolol that it is administered once daily
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Primary gastrointestinal lymphoma is an unusual disease and most commonly occurs in stomach but can involve any part of gastrointestinal tract from esophagus to rectum. Primary colorectal lymphoma is a very rare entity and accounts for 6-12% of gastrointestinal lymphoma. Historically, aggressive B-cell lymphomas have been the most common gastrointestinal lymphoma reported in the literature. Most patients with primary colorectal lymphoma present with abdominal pain but obstruction is unusual. Although the lesions may be evident on radiographic studies but the findings are generally nonspecific and definitive diagnosis relies on histopathological analysis. We present a case of 10 year old girl presented with lower abdominal pain, diarrhea and increased frequency of urine for the last one month. Her ultrasonography showed a mass in left iliac fossa. Barium enema examination and abdomino-pelvic CT scan revealed a presacral mass which on histopathology toned out to be a B cell lymphoma. The mass was surgically removed and chemotherapy was planned
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Dengue is among the most common mosquito-borne viral diseases that affect humans. It has now become a major public health dilemma, annually affecting approximately 50-100 million people worldwide. This study aimed to assess the knowledge, attitude and perception of dengue fever among university students of interior Sindh. A cross-sectional study was conducted during the period of April-June 2012. Four hundred and fifty students were surveyed. A structured pre-tested questionnaire was used to collect data. The data were analyzed using SPSS version 17. Overall, 94.6% of participants [43.3% male and 56.7% female, p-value 0.03] reported that they had heard about dengue, and 58.6% of participants reported "Aedes mosquito" as a vector of dengue virus, with gender difference [37.5% male vs 62.5% females with p-value <0.001]. The Aedes mosquito is "A small dark mosquito having white stripes on its leg" was reported by 54.8% students. The Aedes mosquito breeds in "Stagnant clean water" was reported by 47.6% [male 40.2% vs female 59.8%, p-value 0.003] and usually bites at "Dusk" by 44.7% and at "Dawn" by 51%. Regarding symptoms of dengue fever, "Prolonged high fever" was reported by 52.6%, "Muscular pain" by 39.6% [p-value 0.009], "Bleeding" by 41.3% [p-value 0.001] and "Headache, nausea and vomiting" by 44.7% [p-value 0.001]. Approximately half of the participants in our study were unable to correctly identify the Aedes mosquito as a transmission source [41.4%], its appearance [45.2%], its breeding place [52.4%] and its bite time [52.2%]. The enhancement of knowledge through different educational programs is needed to increase awareness of dengue fever
Subject(s)
Humans , Female , Male , Health Knowledge, Attitudes, Practice , Perception , Knowledge , Attitude , Universities , Students , Cross-Sectional StudiesABSTRACT
Globally, rape of women is a serious health, social and religious concern and is considered as a violation of women basic human right. The aim was to ascertain incidence of natural sexual offence [rape] in Punjab and to analyze the data with respect to sociodemographic characteristics, findings of medicolegal examination and results of evidence collected from victims of sexual assault. This retrospective study was conducted on 148 female victims of rape brought to Forensic Medicine Department of King Edward Medical University Lahore, Fatima Jinnah Medical College Lahore and Nishtar Medical College, Multan from January 2012 to December 2013 for medicolegal examination. Details pertaining to socio-demographic profile of the victim, incident, findings of medical examination and results of evidence collected were noted. Data was analyzed using SPSS version 20. The most affected age group was 11-20 years [60.8%]. Majority of victims were unmarried [70.9%], non- working [79.72%] and of lower socioeconomic class [71.6%] All were Muslims [100%]. The highest number of victims was examined on the second day [24.3%]. 31% cases were of gang rape. Majority knew the assailant [45.9%]. The commonest place of offence was an isolated place [66.2%] Extragenital injuries were seen in 10.8% cases. Hymen was intact in 3.3% victims. The tears of hymen were old in 77.6% and fresh in 22.3% cases. Semen was detected in 18.2% cases. 1.3% victims were pregnant and 4% were intoxicated. The study highlights the importance of addressing rape as an important health issue
Subject(s)
Humans , Female , Sex Offenses/ethics , Rape , JurisprudenceABSTRACT
Objectives: The aim of this study was to evaluate the surgical approach in post traumatic diaphragmatic hernia
Methods: This prospective cross-sectional study was conducted in the Department of cardiovascular and thoracic surgery, Sher-i- Kashmir Institute of Medical Sciences [SKIMS], Kashmir, India. We included all patients with post traumatic diaphragmatic hernia undergoing operation in our center from May 2009 to November 2011. A detailed history was taken for each patient along with comprehensive general, physical, systemic and local examination of all cases. Operative findings included associated intra-abdominal injuries, and herniated intra-abdominal organs. Post-operative complications, mortality and survival were recorded and reported
Results: The mean age of the patients was32+/-l years and there were 16 [76.1%] men and 5 [23.8%] women among the patients. Thoracotomy was performed in 14 patients [66.7%], laparotomy in 6 patients [28.6%] and combined procedure was used in 1 patient [4.7%]. The reduction of hernia contents with repair of diaphragmatic rent was done in 11 [52.2%] of the patients and splenectomy with repair of rent in 6 [28.6%]. Traumatic diaphragmatic hernia had 81.8% survival rate, no pre-operative mortality and 14.3% post operative mortality rate
Conclusion: Thoracotomy is the most common approach in post traumatic diaphragmatic hernia. Laparotomy is preferred in patients having acute trauma with associated intra-abdominal injuries
ABSTRACT
Background: The number of patients with CHD is increasing and psychosocial factors are now recognized as playing a significant and independent role in the development of CHD and its complications. Aims: The present study aimed at examining the association between alexithymia and Type A Behavior Pattern (TABP) in Coronary Heart Disease (CHD) patients. Methodology: The sample consisted of 150 participants, comprising 50 in the study group (drawn from the outpatient clinical services) and 50 in the control group (from the general population) from Kashmir. Further 50 controls from the general population of Haryana were included to study alexithymia in broader context. The tools used included Jenkins Activity Survey (JAS-C) and Toronto Alexithymia Scale (TAS-20). Statistical analysis was done using SPSS-12.0 and various descriptive and inferential statistics were applied. Results: The results revealed a high prevalence (40%) of alexithymia in our study group. However the association of alexithymia with CHD was not clearly indicated as the comparison of alexithymia between our study group and control group did not reveal any significant difference and paradoxically the prevalence in the control group was even higher. Further a comparison of the control group from Kashmir with that of Haryana revealed a highly significant difference. Thus, our study suggests that perpetual trauma and unending stress due to present prevailing condition in Kashmir together with the presence of some kind of mental disorders in a significant segment of Kashmiri population has rendered the whole population more vulnerable to developing alexithymia. Further, our findings did not reveal any association between Type A Behavior Pattern and CHD. Conclusion: This indicates a need for further clarification of the precise role of personality types in producing and preventing CHD.
Subject(s)
Affective Symptoms/epidemiology , Affective Symptoms/etiology , Affective Symptoms/psychology , Adult , Aged , Coronary Disease/complications , Coronary Disease/injuries , Coronary Disease/psychology , Humans , India/epidemiology , Male , Risk Factors , Type A Personality , Young AdultABSTRACT
Background: The experience of heart disease seems to contribute to risk for numerous psychiatric problems, especially depression, anxiety, and stress. Although, these psychosocial factors appear to be outside the immediate realm of medicine, they have a profound impact on morbidity and mortality in cardiac patients. Aims: Purpose of the present study was to assess psychological distress (depression, anxiety, perceived stress) in Coronary Heart Disease (CHD) patients and compare the levels of these constructs among CHD patients living in disturbed condition (Kashmir) and a normal place (Haryana). Methods: Hospital Anxiety Depression Scale (HADS) and Perceived Stress Scale (PSS-4) were administered to a total of 200 male participants, 100 (50 CHD Patients and 50 healthy controls) from Kashmir and 100 (50 CHD Patients and 50 healthy controls) from Haryana. Statistical analysis was done using SPSS- 12.0. Results: The results revealed a high prevalence of depression, anxiety and stress in our study groups from both the places. Unlike Haryana, the stress levels between the CHD patients and healthy controls in the Kashmiri population did not show any significant difference. Comparison of depression between the study groups of the two states also did not reveal any significant difference. Further comparison of anxiety and stress between the study groups of the two states revealed a highly significant difference. The levels of depression, anxiety and stress in the control groups of the 2 states also differed significantly with alarmingly higher levels of psychological distress in the Kashmiri population. Conclusions: Thus, our study suggests that increased exposure of the Kashmiri population to traumatic events and stressful conditions has increased their levels of emotional distress, adversely affecting the mental connotation of their chronic physical condition (CHD) as well as putting the whole population at a greater risk of developing psychological problems due to extremely high levels of psychological distress.
Subject(s)
Anxiety/epidemiology , Coronary Disease/complications , Coronary Disease/psychology , Depression/epidemiology , Humans , India/epidemiology , Population Groups , Prevalence , Risk Factors , Stress, Psychological/epidemiologyABSTRACT
Background: Chronic kidney disease [CKD] is a permanent condition which requires renal replacement therapy to maintain life. There are multiple modalities for the treatment of CKD including dialysis, non dialysis care and transplantation. Transplantation is not in reach of many patients and dialysis remains the only life saving treatment option for patients. Unfortunately, awareness is lacking in patients, even when they present with end stage renal disease with only immediate choice of hemodialysis
Objective: To assess the perception of renal failure patients regarding dialysis and treatment modalities, secondarily; to assess the status of medical counseling to these patients
Patients and methods: This descriptive study was conducted in medical ward and dialysis unit of Sheikh Zayed Medical College/Hospital from January to June, 2011. A total of 68 patients of chronic renal failure irrespective of sex were included in this study, all the patients with CKD were included in this study, those patients who did not give informed verbal consent were excluded. Data was analyzed in SPSS 15
Results: A total of 68 patients were included in study. The mean age of study subjects was 41 +/- 9.5 years and 65% were male. When the perception of patients regarding their health problem was assessed, 58[85.3%] were knowing that they have end stage renal disease. When asked about the source of information about treatment modalities and dialysis, 53% reported that doctors are the source of information, while 36% reported Paramedics/Hakims as sources of information. When asked about which treatment option would you prefer, 71% of patients answered "Medicines", 23% answered "Dialysis", whereas, only 6% answered "Kidney transplant". When asked about the perceived benefits of dialysis, it was noted that 53% have perception that it has no benefit, 26% reported some symptom improvement. When study subjects were asked about possible side effects of dialysis, 56% has no knowledge of side effects, 21% reported that it damages kidney, 15% reported that it leads to death once started its use as treatment, another 8% has opinion that life is reduced due to stoppage of kidney functioning after the patient is on dialysis
Conclusion: Misconceptions among CKD patients regarding treatment modalities and dialysis are high and status of medical counseling is poor. There should be a standardized, comprehensive patient information system and personalized decision support to facilitate modality selection and to enable patients to make fully informed treatment decisions
ABSTRACT
To determine the frequency of adverse effects attributed to Methotrexate [MTX] toxicity and serum minimum toxic concentration with low dose MTX in Rheumatoid Arthritis [RA] patients. Cross-sectional observational study. Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi, from March 2010 to March 2011. One hundred and forty adult patients of RA receiving low dose MTX [10 mg/week] for at least 3 months, were included by consecutive sampling. Blood samples were collected 2 hours after the oral dose of MTX. Serum alanine transaminase and creatinine were analyzed on Hitachi and blood counts on Sysmex analyzer. Serum MTX concentration was measured on TDX analyzer. Out of one hundred and forty patients; 68 males [49%] and 72 females [51%], 38 developed MTX toxicity [27%], comprising of hepatotoxicity in 12 [8.6%], nephrotoxicity in 3 [2.1%], anaemia in 8 [5.7%], leucopenia in 2 [1.4%], thrombocytopenia in 3 [2.1%], pancytopenia in 2 [1.4%], gastrointestinal adverse effects in 5 [3.6%] and mucocutaneous problems in 3 [2.1%]. Receiver operating characteristic curve revealed serum minimum toxic concentration of MTX at cutoff value of 0.71 micro mol/l with a sensitivity of 71% and specificity of 76%. Adverse effects of low dose MTX were found in 27% of RA patients, mainly comprising of hepatotoxicity and haematological problems. MTX toxicity can be detected by therapeutic drug monitoring of serum concentration of 0.71 micro mol/l with sensitivity of 71% and specificity of 76% in the patients on low dose MTX maintenance therapy