Profile of psychiatric patients presenting to a tertiary care emergency department of Karachi

This study reviewed the presentations of psychiatric patients admitted through the Emergency Department [ED], The Aga Khan University Hospital, Karachi. Psychiatric patients admitted through the ED to the psychiatry ward were compared to those admitted through the same units other than the psychiatry ward, from 2006 to 2010 using medical records. Psychiatric patients were defined as those in whom psychiatry consult was generated and 1127 cases were included in study. There were 550 [48.8%] female patients. Most common presentations in the ED were sleep-related problems [n=205, 15.9%] followed by aggressive behavior [n=191, 14.8%]. Depression was the most common diagnosis made in the ED [n=331, 29.3%] and at the time of discharge from the hospital [n=354, 29.5%]. Psychiatric patients presenting to the ED had signs and symptoms which one generally disregards. However, these minor indicators can lead to major events in a patient's life

Implementing WHO feeding guidelines for inpatient management of malnourished children

To evaluate the efficacy of adopting WHO feeding guidelines on weight gain and case fatality rate in malnourished children. Cross-sectional, observational study. Department of Pediatrics, Dow University of Health Sciences, Karachi, from 2009 to 2010. Patients above 6 months and less than 5 years of age with severe malnutrition were included during the study period, acute complications were treated and nutritional rehabilitation by WHO feeding formulae was done. Demographic details, clinical features, reasons for weight gain and risk factors of mortality were analyzed. A total of 131 children were included. Mean age of children was 22 +/- 18 months. There were 78% marasmic, 4% kwashiorkor and marasmic kwashiorkor 18% children. Resolution of edema took 8 +/- 4 days, dermatosis cleared in 11 +/- 3 days. Mean hospital stay was 10 +/- 8 days. Case fatality rate was 13%. Mean weight gain was 5.25 +/- 4.57 g/kg/day. Weight gain of > 5 gm/kg/day was associated with hospital stay of more than 7 days, acceptability and palatability of feed by the children and mothers and early clearance of infections. Implementation of WHO feeding guidelines resulted in adequate weight gain of inpatient malnourished children, however, adequate healthcare services are available at the therapeutic feeding centers

Pleural effusion in dengue. Karachi perspective

To study the presentation of pleural effusion among dengue patients in Pakistan and to explore limitations in the diagnosis of these patients by the physicians of a developing country. We conducted a cross-sectional study on patients admitted to Aga Khan University Hospital, Karachi, Pakistan from January 2005 to September 2008. Records of 663 dengue patients were reviewed. Demographic data, respiratory complaints, radiographic studies, and final outcome were studied. Presentation and radiological modality confirming the diagnosis of pleural effusion were noted. Descriptive statistics followed by Chi-Square test were applied, testing against an alpha of 0.05 and 95% confidence interval [CI]. Three hundred and fifty-four [53%] out of a total of 663 dengue syndrome patients did not complain of any respiratory symptoms at presentation, nor did their medical examination elicit any suspicion of PE. Hence, no radiological study was advised. Amongst the remaining 309 patients, 299 [97%] underwent chest x-ray and 10 [3%] had abdominal ultrasound. The pleural effusion was noted in 50 [16%] patients [31 male and 19 female patients, with a mean age of 32 +/- 15 years]. A right-sided pleural effusion was found in 23/50 [46%] patients, left sided in 9/50 [18%], and 18/50 [36%] patients had pleural effusion on both sides. Out of the radiologically confirmed pleural effusion dengue patients, 44/50 [88%] showed altered hemo-concentration with an insignificant odds ratio of 0.7 [p=0.56, 95% CI: 0.263-2.066]. Compared to other studies, fewer numbers of our patients suffered from pleural effusion. The diagnostic modality preferred by the physician was the chest X-ray

Malignant psoas abscess or pseudomyxoma extraperitonei

Primary adenocarcinoma of appendix is an uncommon gastrointestinal malignancy. Similarly, Psoas abscess is an entity, which sometimes requires extensive work-up to reach a diagnosis. Combined presentation of these two rare conditions is not only exceptional, but also diagnostically challenging. We present a case of a lady who presented with recurrent UTI secondary to right sided ureteric obstruction, referred right hip joint pain resulting from a Psoas abscess, which eventually turned out to be a consequence of metastatic adenocarcinoma of appendix, causing pseudomyxoma extraperitonei, with simultaneous intraperitoneal deposits

Investment in paediatric tuberculosis prevention in Pakistan: loss or gain?

To assess the effectiveness of paediatric tuberculosis prevention, by reevaluation factors in children exposed to tuberculosis from less privileged strata of Pakistan. This cross sectional descriptive study was conducted at National Institute of Child Health, from January 2004 to December 2005. Paediatric patients under 15 years of either gender, diagnosed with active tuberculosis were enrolled. Interviews were conducted with parents regarding common preventive measures and factors advocating tuberculosis spread. Later factors leading to non-compliance to safety recommendations were also evaluated. Fifty five [70%] children younger than 5 years, had index cases in direct contact within their own house. Fifteen [14%] patients contracted the infection from neighbours, with 11 being older than 5 years. There were 82 [51%] cases with Protein Calorie Malnutrition [PCM]. Total of 66 [41%] cases of PCM were <5 years age [p <0.005]. Data showed 123 [77%] children living in a family with 5 or more members. Sixty eight [55%] children of these large families had to live in a single room house. There is a high frequency of direct contact tuberculosis in children belonging to the lower socio-economic class. This is attributed to poor housing condition and over crowding. The current paediatric tuberculosis prevention strategies as adapted from World Health Organizations' Millennium Development Goals are ineffectual to make changes in children exposed to tuberculosis from less privileged strata of Pakistan. Our societal and demographic factors remain static, continually exposing our children to higher risk of tuberculosis exposure

Souls, going down the laboratory's drain

Assisted Reproductive Technology [ART] is a blessing but soon South Asian countries might turn into "human embryo markets" as lessons taught by "kidney transplant issues in South East Asia". In Marie Woolf's article in Times online, it was pointed out that per year "IVF clinics destroy 1m waste embryos". As many as 400,000 frozen embryos were present in USA in 2004. Some of the G7 countries are trying to make ethical and legal policies on it. We need to start making our own policies considering our own values, rather then try cleaning up the mess of unethical, soul-less healthcare personnel. With the vast variety of cultural diversity and variation of moral values and virtues of different nations, a universal policy for dealing with the extra embryos is no where to be found as yet

Euthanasia - views of an Islamic society

Euthanasia, doctor assisted suicide, mercy killing- all are interchangeable terms, but what do they actually mean? Euthanasia is a conflict-ridden subject because of differing religious and moral views. Legislation and national political movements from all over the world are trying to sort this issue. From the start of twentieth century, major efforts to legalize it in the US started. By 1994, Oregon Ballot Measure 16 established Oregon's Death with Dignity Act. Here is a pilot study of 35 Pakistani participants conducted in a tertiary care hospital, representing the Pakistani morals and cultural understanding