simple integrated primary health care based model for detection of diabetic retinopathy in resource-limited settings in Pakistani population

Objective: To find out prevalence of Diabetic Retinopathy in general population of three districts in Pakistan

Methods:A community based cross-sectional survey was conducted in three large districts of Pakistan namely Rawalpindi in Punjab, Peshawar in Khyber Pakhtoonkhwa and Hyderabad in Sindh between January 2013 and August 2015. Lady Health Workers identified individuals at high risk for diabetes based on predefined criteria. High risk population was tested for dysglycemia. Fundoscopic evaluation for evidence of DR was performed in all individuals with a random blood glucose >190mg/dl. Individuals with the evidence of DR were referred to affiliated tertiary care ophthalmology departments

Results:A total of 42,629 individuals reported at the project sites and 63% [n=26,859] were female. Fifty one percent [n=21,989] individuals met high risk criteria. Out of these 21,989 individuals, dysglycemia was found in 3,869 [17.6%]. Fundoscopy showed evidence of DR in 1,042 [27%] individuals. Amongst high risk population, dysglycemia was significantly more common in females as compared to males. The frequency of DR in dysglycemic patients was comparable across both gender groups

Conclusion:The prevalence of DR in Pakistani population is alarmingly high. This preventable cause of blindness is largely undiagnosed in our population and a simple integrated model based on primary health care facilities can help identify and treat a large population of DR patients

Causes of short stature in Pakistani children found at an Endocrine Center

Background and Objective: Short stature is defined as height below 3[rd] centile. Causes of short stature can range from familial, endocrine disorders, chronic diseases to chromosomal disorders. Most common cause in literature being idiopathic short stature. Early detection and management of remedial disorders like malnutrition and vitamin D deficiency, Endocrine disorders like growth hormone deficiency and hypothyroidism can lead to attainment of expected height. Pakistani data shows idiopathic short stature as the most common cause of short stature. Our study aimed at detecting causes of short stature in children/adolescents at an Endocrine referral center

Methods: A retrospective study was conducted at WILCARE Center for Diabetes, Endocrinology and Metabolism, Lahore on 70 well-nourished children/adolescents. The patients had been evaluated clinically, biochemically and radiologically as needed. Biochemical testing included hormonal testing as well to detect endocrine causes. Data was entered and analyzed in SPSS 20.0

Results: Leading cause of short stature in our population was Growth Hormone [GH] deficiency seen in 48 out of 70 [69%] patients. Second most common endocrine abnormality seen in these patients was Vitamin D deficiency [44 out of 70 patients [63%]]. Primary hypothyroidism; pan-hypopituitarism and adrenal insufficiency were other endocrine causes. The weight for age was below 3rd percentile in 57 [81%] patients, with no association with other major causes

Conclusion: Growth hormone and Vitamin D deficiency constitute one of the major causes of short stature among well-nourished children with short stature in Pakistan

Risk factors for deliberate self-harm in patients presenting to the emergency departments of Karachi

To determine the risk factors for Deliberate Self-Harm [DSH] in patients presenting to the Emergency Departments [EDs] of three tertiary care hospitals of Karachi, Pakistan. Multicentre matched case control study. EDs of the Aga Khan University Hospital, Karachi, Civil Hospital, Karachi and Jinnah Postgraduate Medical Centre, Karachi, from March 2011 to February 2012. A total of 201 cases and 201 matched controls were taken from three hospitals situated in Karachi. All patients of 16 years and above presenting to the EDs of the hospitals with DSH attempt were invited to participate in the study. Controls were ED patients with complaints other than DSH. A control was matched with case for hospital, gender and age. Two questionnaires were used to collect information on the risk factors of DSH. Conditional Logistic Regression [CLR] was used to assess the association of various risk factors with DSH. Risk factors of DSH in Karachi included current history of mental disorder [OR = 4.53, 95% CI = 1.59 - 12.92], not sharing problems with someone [OR = 4.67, 95% CI = 2.4 - 9.0], living in rented houses [OR = 2.58, 95% CI = 1.37 - 4.84], Pathan ethnicity [OR = 5.05, 95% CI = 1.01-25.38] followed by others [OR = 3.88, 95% CI = 0.77 - 19.69] and Urdu speaking [OR = 2.71, 95% CI = 0.59 - 12.45]. Absence of physical illness in the past month had an inverse association with DSH [OR = 0.17, 95% CI = 0.07 - 0.37]. Mental illnesses, low socio-economic status and loneliness were the risk factors of DSH patients presenting to the three EDs of Karachi. Physical illness in the last month was protective against DSH in these patients. Psychiatric evaluation of DSH patients in the ED is important for early diagnosis and management of mental disorders

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