Tumour lysis syndrome in haematological malignancies

Objectives: this study was conducted to determine the frequency of tumor lysis syndrome [TLS] in hematological malignancies

Materials and methods: this descriptive study was conducted at Liquate National Postgraduate Medical Centre from October 2005 to April 2006 over a period of six months. Total 50 patients with diagnosed hematological malignancies were included in the study and data were collected by non-probability convenient sampling. Patients pretreated for their malignancy were excluded from the study. Venous samples for serum uric acid, LDH, phosphorus, calcium, potassium and creatinine were collected on admission, before starting chemotherapy and then for four days after starting the chemotherapy. All patients received adequate hydration, allopurinol and induction chemotherapy. Data were analyzed by statistical package for social sciences [SPSS] version16.0

Results: out of 50 patients 10 fulfilled the criteria for TLS. Six patients developed laboratory tumor lysis syndrome [LTLS], whereas 4 developed clinical tumourlysis syndrome. Acute renal failure was observed in 4 out of 10 patients. Overall 3 patients died because of TLS. Hyperuricemia and lactate dehydrogenase above 2000 IU were the most prominent findings in patients with TLS

Conclusion: it is concluded that 20% of the patients developed TLS [including both laboratory and clinical TLS and despite all measures of prevention it can occur and result in devastating clinical effects

Electroencephalography changes during change blindness disorder

Background/objective: the electroencephalogram [EEG] is the process of recording electrical potentials produced by neurons in the brain. For understanding the neuro-physiological mechanism of various cognitive and neurological disorders, EEG has been proved a vital technique for many years. The change blindness which is incapability of brain to notice substantial visual changes is among such disorders. This study investigates the complexity in information process of EEG signals during the change blindness disorder using the two different measures called entropy and correlation dimension functions

Methods: the EEG data of change blindness disorder was recorded from 22 subjects while they were performing change detection and change blindness trials for two types of stimuli. These were [1] single stimulus followed by another matching stimulus, [2] single stimulus followed by another non-matching stimulus. The measure of complexity in recorded EEG was estimated using both correlation dimension and approximate entropy functions

Results: the results have shown significant decrease in values of approximate entropy and correlation dimension at frontal position of electrodes for change blindness trials

Conclusion: the neurophysiological implication of these results provide the possibility that the increase of brain complexity, which can be interpreted as increase of information process and integration, was not sustained in frontal position of brain during the change blindness disorder

Which antipsychotics would mental health professionals from a low income country choose for themselves?

To determine which antipsychotics mental health professionals from a low income country would choose for themselves. Cross-sectional study. This study was conducted in 8 cities in Pakistan from February to August 2008. Responses from 268 mental health professionals, including psychiatrists and nurses were obtained using a semi-structured questionnaire. All together 80% of doctors chose an atypical antipsychotic; risperidone was the most popular choice. Half of nurses did not know which antipsychotic to choose and the remaining chose haloperidol [21%] and risperidone [19%]. Efficacy and safety were the two most important factors influencing their decision. Both doctors and nurses in Pakistan considered efficacy and safety/tolerability to be important factors for choosing an antipsychotic; this is in line with National Institute of Clinical Excellence [NICE] guidelines 2009. Mental health training for nurses was identified as a major service deficiency

Effect of pregnancy on the disease activity in ulcerative colitis

To study the effects of pregnancy on the disease activity in ulcerative colitis. This experimental study was conducted at department of Medicine at Sultan Qaboos University Hospital Oman from July 2002 to December 2004. A total 60 diagnosed cases of ulcerative colitis proven on colonoscopy and biopsy and fairly well controlled disease at the time of enrollment were included in the study. Those who conceived and delivered during the study period were inducted as experimental group [total 30 patients], and those who did not conceive during the study period were inducted as control group [total 30 patients]. Out of total 60 patients, 30 patients who were included in the study group, 24 remained well with mild exacerbation requiring only increased dose of mesalamine, four patients had moderate disease exacerbation requiring oral steroids along with mesalamine. Two patients had severe exacerbation that was controlled on parental steroids. Among control group, 25 had mild exacerbation, 4 had moderate exacerbation and 1 had severe exacerbation during the study period. The eventual out come was good in all patients. It is thus concluded that a planned pregnancy when the disease is well controlled minimizes the risk of complications in patients of ulcerative colitis and also has got favorable outcome of pregnancy

Psychiatric morbidity in psychoactive substance users- a multicenter study in Hyderabad

Objective: To study the pattern of psychiatric morbidity in psychoactive substance users at Sir Cowasjee Jehangir Institute of Psychiatry and Combined Military Hospital Hyderabad

Setting: This descriptive study was done at Sir Cowasjee Jehangir Institute of Psychiatry and Combined Military Hospital Hyderabad simultaneously from 10[th] Jan 2009 to 10[th] July 2009

Patients and Method: Total 150 patients presented with history of psychoactive substance use since last 1 year and showing psychiatric morbidity on PSE [urdu version] were selected by non-probability convenient sampling. Patients having psychiatric morbidity before substance use were excluded from the study. Demographic variables were collected on a semi-structured proforma. Psychiatric symptomatology was collected using PSE [urdu version]. Diagnosis of psychiatric morbidity was made by using ICD -10 criteria for mental and behavioral disorders due to psychoactive substance use. Proportions of psychiatric morbidity were calculated by SPSS version 10.0

Results: Out of 150 subjects 72 used cannabis, 28 used Heroin, alcohol intake in 25 cases, Benzodiazepine tablets in 13 cases, Gutka in 2 cases. Poly drug abuse was found in 30 cases abusing alcohol and benzodiazepines. Dependence syndrome [35%] followed by anxiety disorders [22%] acute and transient psychotic episode [39%] was main morbidity in bannabis. Dependence syndrome [46%] followed by antisocial personality disorder [10%] depression [25%] and anxiety disorders [16%] were main morbidity in heroin abuse. Depression [42%] followed by anxiety disorders [30%], dependence syndrome [10%] and antisocial personality disorder [8%] was main morbidity in alcohol abuse. Dependence syndrome [42%] depression [23%] anxiety disorders [20%] dissociative disorder [10%] and deliberate self harm [5%] were psychiatric morbidities in benzodiazepine abuse

Conclusion: This study showed that there is significant psychiatric morbidity associated with various types of psychoactive substance abuse. These morbidities not only pose a diagnostic dilemma but also have importance in management and prognosis of psychoactive substance use

Comparison between helicobacter pylori fecal antigen detection and endoscopic gastric biopsy in diagnosis of H. Pylori infection in 50 adult cases

Objective: To compare the effectiveness of fecal antigen detection test with gastric biopsy via upper GI endoscopy for H pylori

Design: Comparative, observational, non- randomized

Place and Duration of Study: Sultan Qaboos University Hospital, Oman. February 2005 - February 2006

Patients and Methods: Fifty patients with epigastric pain and heart burn were subjected to upper GI endoscopy and gastric biopsy for H. pylori and at the same time stool was sent for fecal antigen detection for H. pylori

Results: Out of 30 females, 12 had biopsy proven H. pylori while 5 had positive fecal antigen test. In 20 male patients, 15 had positive biopsy while 12 had fecal antigen proven H. pylori

Conclusion: This study doesn't prove the effectiveness of fecal antigen detection test in comparison with upper GI endoscopy and biopsy, which is the gold standard test for H. pylori. Hence we cannot recommend the test to replace upper GI endoscopy and biopsy despite of the low cost and less trouble to the patient

Use of intravenous vs. intramuscular hepatitis B immunoglobulin in prevention of relapse of hepatitis B in post liver transplant patients

Object: To see the response of HBIg in post liver transplant patients in prevention of hepatitis B relapse by using two different routes of administration

Study Design: prospective comparative study

Place and Duration of Study: Sultan Qaboos University Hospital, Oman. From December 2001 - December 2007

Patients and Methods: Total 32 patients who underwent cadavaric liver-transplantation due to hepatitis B related end-stage liver disease were included in this study. Patients were divided into two groups by simple random technique. HBIg was administered through intravenous route to subjects of Group 1, whereas to subjects of Group II it was administered through intramuscular route. All patients received full recommended dose of HBIg with oral lamirudine for the prevention of relapse. Subjects were followed up for 30-months to record any event of relapse in both groups

Results: There were 24 [75%] males and 8 [25%] females, with median age of 37 years. Pretreatment HBV - DNA was detected in 28 [87.5%] and anti-HBS levels were <10-IU in all patients. During the course of treatment HBV-DNA found to be un-detectable and anti-HBS levels were maintained >100 in all patients. None of the study subjects in both groups had relapse of Hepatitis B

Conclusion: Intramuscular route of administrating HBIg in post liver transplant cases secondary to hepatitis B was found to be as effective as intra venous route

Preferred antipsychotic by mental health professionals of Sindh and Balauchistan

Objective: To determine the preferred antipsychotic drug of mental health professionals

Material and Methods: This cross-sectional survey was conducted among mental healthcare professionals of 25 public/private healthcare facilities of Sindh and Blochistan provinces form April 2007 to March 2008. After approval from ethical committee of Dow University of Health Sciences mental health professionals [trainees, consultants with experience only and consultant with postgraduate qualification] present on the day of visit to a facility were approached and asked to fill a semi-structured questionnaire to determine the preferred antipsychotic for patient as well as for themselves if they got ill and the factors they consider while choosing that antipsychotic. Descriptive analysis of the data was performed by SPSS v. 14

Results: One-hundred five mental health professionals were divided in 3 groups i.e. trainees [29], experienced doctors [24] and consultants psychiatrists [52]. They have almost equal experience of using typical [48%] and atypical [49%] antipsychotic, but when asked to chose antipsychotic for themselves, atypical [81%] were preferred over typical [14%] antipsychotic with Risperidone as the most common choice [55%] followed by quetiapine, olanzapine and clozapine. Regarding the factors influencing prescription, efficacy and safety were most considered factor while choosing antipsychotic for themselves as compare to efficacy and cost while experiencing prescription for patients

Conclusion: Clinical approach varies while prescribing anti-psychotic drug for the patients and for themselves between typical and atypical. Efficacy and safety were considered while choosing for themselves, whereas efficacy and cost while prescribing for patients

Extra-intestinal manifestations of ulcerative colitis in Omani population: a study of 100 cases

Object: to identify the extra intestinal manifestations of Ulcerative Colitis in Omani population

Study design: observational study

Place and duration of study: Sultan Qaboos University Hospital, Oman from January, 2002 to January, 2006

Patients and Methods: inclusion Criteria: All patients seen in Gastroenterology out patient's clinic with bleeding per rectum and diagnosis of ulcerative colitis by colonoscopy and subsequent confirmation by biopsy. Exclusion Criteria: All patients with other systemic illness

Results: total 100 Patients were included in the study, among them 61 were males. Extra intestinal manifestations were observed in 6 males and 5 females. Among 6 male patients 2 had more than one complication while 4 had only one complication. Among 5 female patients 2 had more than one, while 3 had only one complication

Conclusion: it is thus concluded that incidences and severity of extra intestinal manifestation is much less in the Omani population as compared to the Western population

Birth order and depressive disorder

Objective: to determine any relationship of birth order with depressive disorder

Method: this is a retrospective study from record of twelve hundred and eight patients who attended psychiatric department in OPD and wards of Isra University Hospital Hyderabad between January 2002 and February 2004 out of which 626 were diagnosed as cases of Depressive Disorder who were compared with the rest of the population. These were also studied with reference to gender, catchment area, and family type. Data were analyzed on 13th version of SPSS

Results: cases with depressive disorder were clustered in birth order-two; 36.42% of depression patients were found out to be birth order-two. The pattern remains almost the same irrespective of gender, catchment area, and family type

Conclusion: birth-order two is found to be more vulnerable to depressive disorder in our sample

Correlation of Urdu version of hospital anxiety depression scale and Hamilton depression rating scale in quantifying depression among post-myocardial infarction patients

Objective: to validate the use of Urdu Version of Hospital Anxiety Depression Scale as screening as well as quantifying tool for depression among non-psychiatric hospital population

Material and methods: this retrospective study was conducted at National Institute of Cardiovascular Disease [NICVD] Karachi and Civil Hospital Karachi [CHK] from 23rd October to 22nd November 1998. We searched the record of a previous study on the patients on myocardial infarction. A comparison of scores of Hospital Anxiety Depression Scale and Hamilton Depression Rating Scale, done on the patients with first myocardial infarction at an interval of about two weeks during hospitalization and after their discharge, was made

Results: correlation co-efficient between Hospital Anxiety Depression Scale scores and Hamilton Depression Rating Scale scores was found to be statistically significant [r =55; p<0.001]

Conclusion: results suggest that Hospital Anxiety Depression Scale can be used as an effective tool to screen and quantify depression

Spectrum of complications in post liver transplant patients: a study of 30 cases

Objective: To study the complications encountered in post liver transplant patients performed due to different etiologies leading to end stage liver disease. Study Design: Cohort and observational study. Place and Duration of Study: Sultan Qaboos University Hospital, Oman. From Dec 2001- July 2006

Patients and Methods: The study was conducted on all patients having cadavaric liver transplantation outside Oman. All patients were followed up for at least 18 months after enrolling in the study. They all had certain routine tests at the start of the study and were repeated according to the requirement of the individual patients. All patients had tacrolimus as an immunosuppressive agent. Patients with hepatitis B had hepatitis B immunoglobulin, alongwith lamivudine for relapse prophylaxis

Results: Complications of liver transplantation was observed in 21 patients, out of total 30 patients. Thirteen patients developed new onset diabetes mellitus, among them 7 had other complications as well. Eight patients had different hepatic complications and 7 had non hepatic problems. Total 5 patients expired during our follow up

Conclusion: The complications of liver transplantation can be controlled and managed if diagnosed promptly and treated early

Correlation of obsessive compulsive disorder with birth order - one

Objective: The study sought to explore, whether Obsessive Compulsive Disorder has any relation with birth order-one

Method: This a retrospective study from record of twelve hundred and eight patients who attended psychiatric department of Isra University Hospital Hyderabad, out of which 138 were OCD; who were compared with the rest of the population. These were also studied with reference to gender, catchment area and family type

Results: Cases with obsessive compulsive disorder were clustered in birth order-one. Total 44% of OCD patients were found out to be birth order-one as compared to 19.40% of the rest of the psychiatric population

Conclusion: Current study supports the hypothesis that in our sample birth order-one is correlated with Obsessive Compulsive Disorder

Socio-demographic correlates of stigma attached to mental illness

Objective: To identify socio-demographic correlates of stigma attached to psychiatric illnesses

Method: This is a retrospective study. Data of the patients who had attended psychiatry department; either as a referral or direct consultation; and as in-patient or outpatient; at Isra University Hospital at Hyderabad during the years 2001 to 2004, were reviewed and presence or absence of stigma feelings were compared to their socio-demographic backgrounds. Demographic characteristics of a total of 1208 patients with different psychiatric illnesses were recorded. Data obtained, was subjected to analysis using SPSS 13[th] version

Results: Feelings of stigma was present in forty seven percent of the studied population. Males had slightly more feelings of stigma. People from urban areas were also carrying more feelings of stigma but it was statistically insignificant. Apart from people with no formal education who had maximum stigma feelings; education level was found to increase such feelings, in the population studied

Conclusion: In our studied population, feeling of stigma seems to prevail in every demographic class; this is specially so among neurotics, male gender, urban patients. Level of education has interesting relation with the feeling of Stigma, which is found to increase with level of education