Is depression a concern among medical students: a cross sectional study in different academic years of a private medical college in Bangladesh

Background: Depression is not uncommon among medical students all over the world. Few studies have been conducted so far in Bangladesh to depict its actual prevalence and severity. So, the aim of this study was to assess the severity of depression and the level of difficulty faced by medical students in different academic years.Methods: This cross-sectional study was conducted in North East medical college of Bangladesh from January 2018 to June 2018 involving 443 students from 1st year to 5th year. Students were instructed to fill up the patient health questionnaire (PHQ-9) which incorporates diagnostic and statistical manual of mental disorders (DSM-IV) depression diagnostic criteria categorized as no, mild, moderate, moderately severe, and severe depression and also evaluates their level of function.Results: The prevalence of depression was quite high (79.68%). 196 (44.24%) and 157 (35.44%) students had mild and major depression respectively, while 90 (20.32%) showed no depression. Students with major depression were scored as moderate depression 24.38%, moderately severe depression 8.35%, and severe depression 2.71%. Moderate depression was significantly higher in year 1 and year 2 students in comparison to year 3, 4 and 5. Students from year 1 to year 5 with mild, moderate, moderately severe and severe depression experienced varying degree of difficulty in their daily activities. Almost all the students in all years with severe depression found themselves very difficult or extremely difficult to cope.Conclusions: High prevalence of depression among medical students is really alarming and underlying factors need to be addressed.

Leadership and early strategic response to the SARS-CoV-2 pandemic at a COVID-19 designated hospital in South Africa

While many countries are preparing to face the COVID-19 pandemic, the reported cases in Africa remain low. With a high burden of both communicable and non-communicable disease and a resource-constrained public healthcare system, sub-Saharan Africa is preparing for the coming crisis as best it can. We describe our early response as a designated COVID-19 provincial hospital in Cape Town, South Africa (SA).While the first cases reported were related to international travel, at the time of writing there was evidence of early community spread. The SA government announced a countrywide lockdown from midnight 26 March 2020 to midnight 30 April 2020 to stem the pandemic and save lives. However, many questions remain on how the COVID-19 threat will unfold in SA, given the significant informal sector overcrowding and poverty in our communities. There is no doubt that leadership and teamwork at all levels is critical in influencing outcomes

Comparative study of Bacillus clausii and multistrain probiotics in the management of acute diarrhoea in children

Background: Diarrhoea is the second most common cause of under-five mortality especially in developing world. Many studies have been conducted so far using different probiotic strains with variable outcome. So, the aim of the present study was to compare the clinical efficacy of Bacillus clausii and multi strain probiotic formulation as adjunct treatment of acute diarrhoea.Methods: This prospective single blind randomized controlled clinical trial included 300 infants and children between 6 months to 6 years of age admitted in a tertiary care hospital Sylhet, Bangladesh with acute watery diarrhoea having varied dehydration status ranging from no to severe dehydration excluding shocked state. Cases were randomly assigned to three groups which were group I (n=100) comprised of children who were treated with standard treatment (according to WHO guideline) only as control group, group II (n=100) who received standard treatment plus Bacillus clausii and group III (n=100) who received standard treatment plus multi strain probiotic formulation (Lactobacillus casei, Lactobacillus rhamnosus, Lactobacillus acidophilus, Lactobacillus bulgaricus, Bifidobacterium breve, Bifidobacterium infantis, Streptococcus thermophilus). Primary outcome variables were duration, frequency of diarrhoea and consistency of stool. Secondary outcome variable was duration of hospital stay.Results: Mean duration of diarrhoea was significantly shorter (p=0.001) in group III (2.62 days) compared to group I (3.26 days) and group II (3.22 days). Frequency of diarrhoea was significantly lower on day 3 of probiotic administration in group III (p <0.05) and on day 5 of treatment in group II (p <0.05). Stool consistency significantly improved on day 3 in group III (p <0.05) while it was on day 4 in group II. The duration of diarrhoea, hospital stay, stool consistency and frequency of stool on day 3 were not statistically significant (p >0.05) in group II in comparison to group I and group III.Conclusions: Multistrain probiotic formulation is effective in reducing the duration, frequency of diarrhoea and duration of hospital stay.

Calcific uraemic arteriolopathy (calciphylaxis) in patients on renal replacement therapy

Background. Calcific uraemic arteriolopathy (calciphylaxis) is an unusual and potentially fatal condition characterised by small-vessel calcification and ischaemic skin necrosis. It mainly affects patients with end-stage renal disease (ESRD) on haemodialysis, but may rarely occur in the absence of ESRD in conditions such as primary hyperparathyroidism, malignancy, alcoholic liver disease and connective tissue disease.Methods. We reviewed the records of all patients diagnosed with calciphylaxis while on renal replacement therapy at Tygerberg Hospital, Cape Town, South Africa, between 1990 and 2014, to describe its presentation, course and final outcome.Results. Nineteen patients developed calciphylaxis over this period. Their median age was 34 years and 13 (68.4%) were female. Fifteen (78.9%) had received a kidney transplant. All patients had painful skin lesions that rapidly progressed to infarction. Small-vessel calcification was seen on skin biopsy in 13 patients. Twelve patients had hyperparathyroidism. Several of the transplanted patients had been treated for graft rejection in the year preceding the diagnosis. Treatment consisted of good wound care and efforts to normalise serum calcium and phosphate levels. Five patients received an urgent parathyroidectomy. The outcome was fatal in 17 patients, with sepsis being the main cause of death.Conclusions. In our patients, calciphylaxis carried a worse prognosis than previously reported internationally. It should always be considered in the differential diagnosis of painful skin lesions in the dialysis or transplant patient

Evaluation and Management of Patients Referred to a Tertiary-Level Hypertension Clinic in Cape Town; South Africa

Background. Hypertension remains a global health burden; with a high incidence of long-term morbidity and mortality.Objective. To evaluate blood pressure (BP) control; factors associated with poor BP control; target organ damage (TOD); white-coat hypertension; treatment-resistant hypertension and secondary hypertension in patients referred to a tertiary-level hypertension clinic.Method. This was a prospective case-control study of patients referred for specialist hypertension management. Patient parameters recorded included age; gender; body mass index; uric acid; cholesterol; screening BP; follow-up BP; TOD and medications. We also recorded causes of secondary hypertension. Net BP change and the percentage achieving target BP were calculated in all patients followed up.Results. A total of 175 patients were sampled (72 males and 103 females; mean age 46.5 years). Of the patients 16.6% had a normal screening BP; 62.9% of patients were followed up; and 43.6% of these achieved BP control. After intervention; there was a net drop of 13.2 mmHg (range 7.9 - 18.4) in systolic BP and of 3.8 mmHg (4.4 - 12.0) in diastolic BP. Of all the patients; 12.6% had resistant hypertension; 49.1% had evidence of left ventricular hypertrophy and 18.3% had microalbuminuria; 13.1% of the patients were diagnosed with secondary hypertension. Conclusion. Specialist intervention was useful in identifying patients with white-coat and secondary hypertension; as well as in improving hypertension control in patients with apparent treatment-resistant hypertension. However; a significant percentage of patients did not reach target BP; and further efforts are required to identify the underlying causes for this

Provider-initiated HIV counselling and testing (PICT) in the mentally ill

The prevalence of HIV infection is substantially higher in mentally ill individuals than in the general population. Despite this; HIV testing is not yet standard practice among the mentally ill population; and many mental health settings do not encourage HIV testing. This paper discusses provider-initiated HIV counselling and testing (PICT) and some of the ethical dilemmas associated with it; on the basis that PICT may be used to increase the number of mentally ill persons tested for HIV. The authors conclude that PICT should be promoted to all psychiatric admissions and mentally ill individuals receiving outpatient services; and that this is within the parameters of existing policies and legislations in South Africa

A review of the applications for involuntary admissions made to the Mental Health Review Boards by institutions in Gauteng in 2008

Aim. To review applications for involuntary admissions made to the Mental Health Review Boards (MHRBs) by institutions in Gauteng. Method. A retrospective review of the register/database of the two review boards in Gauteng for the period January - December 2008. All applications for admissions (involuntary and assisted inpatient) and outpatient care (involuntary and assisted), and periodic reports for continued care (inpatient or outpatient care) were included. Results. During the study period the two MHRBs received a total of 3 803 applications for inpatient care, of which 2 526 were for assisted inpatient care (48.1 regional hospitals, 29.6 specialised psychiatric hospitals, 22.2 tertiary academic hospitals). Of the applications for involuntary inpatient care, 73.1 were from the specialised psychiatric hospitals (65.2 from Sterkfontein Hospital). Applications for outpatient care; treatment and rehabilitation (CTR) numbered 1 226 (92 assisted outpatient CTR). Although the health establishments in northern Gauteng applied for more outpatient CTR compared with those in southern Gauteng (879 v. 347; respectively), the ratios of assisted to involuntary outpatient applications for CTR for each region were similar (approximately 12:1 and 9:1, respectively). The boards received 3 805 periodic reports for prolonged CTR (93.5 inpatient, 6.5 outpatient) in the majority of cases for assisted CTR. Conclusion. The study suggests that in the 4 years since the promulgation of the Mental Health Care Act (MHCA) in 2004, there have been significant strides towards implementation of the procedures relating to involuntary admission and CTR by all stakeholders. Differences in levels of implementation by the various stakeholders may result from differences in knowledge, perceptions, attitudes and understanding of their roles and therefore indicate the need for education of mental health care professionals and the public on a massive scale. The Department of Health also needs to invest more funds to improve mental health human resources and infrastructure at all health establishments

HIVin South Africa - depression and CD4 count

Objective: Published studies on the prevalence of depressive symptoms using rating scales and the relationship between depression and immune status offer inconsistent results. Depressive symptoms are common and impact on functioning; quality of life; and health status; highlighting the importance of diagnosis and treatment of patients with HIV infection. The aim of the study was to determine the occurrence of depression among HIV-positive patients using the Beck's Depression Inventory (BDI) and to determine a relationship; if any; between depressive symptoms and CD4 count. Method: 41 patients aged 18 years or more were recruited from an HIV outpatient clinic in South Africa [date not given]. All the subjects completed the 21-item BDI and their CD4 counts were determined. Patients who had a score of 10 or more on the BDI were considered positive for a depressive disorder. Results: More than half (56) of the study sample had a BDI of =10 indicating significant symptoms of depression. There was no significant difference in the CD4 counts between the depressed and non-depressed groups (p0.05); and no correlation between CD4 counts and BDI scores in the total study sample (r=0.27; p0.05). The affective components of the BDI contributed significantly to the overall BDI score compared with the somatic component (p0.05). Conclusion: The evidence from the study supports the BDI as a suitable measure for identifying those patients who meet the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for minor or major depression. The HIV epidemic is the most serious health challenge in South Africa and it is imperative that HIV-infected patients who complain of fatigue or insomnia be screened routinely for major depression; followed by a structured interview to confirm the diagnosis

Histopathological spectrum in cutaneous leishmaniasis: a study in Oman.

Cutaneous leishmaniasis presents a spectrum of manifestations both clinically and histologically. Several previous studies have established the value of histological examination in the diagnosis of cutaneous leishmaniasis. Different reaction patterns have been reported. Forty cases of cutaneous leishmaniasis were studied in the Sultanate of Oman, with particular reference to the different histological features. Clinical features were correlated with the histological patterns. Four histological patterns were identified-1) diffuse macrophage infiltration without necrosis, 2) macrophage infiltration with necrosis. 3) early reactive granuloma and 4) established epitheloid granuloma. LD bodies were identified in 65% of cases. Epidermal features were nonspecific. Though the patterns could be correlated with the duration and the clinical type of lesion in a few cases, the correlation was not consistent.