Cognitive behaviour therapy for white coat hypertension-causing latrophobia in adults: randomized controlled trial.

OBJECTIVE: To see whether cognitive behaviour therapy improves blood pressure-oriented latrophobia in adults to manage white coat hypertension. METHODS: Present study was conducted at the Kidney Centre, Sialkot, Pakistan from December 2017 to November 2018, and comprised latrophobic attendees of kidney patients without initially exploring the reason of phobia. Either of the intervention or control group was allotted, randomly. The intervention group underwent 20 weekly sessions of the therapy. Pre- and posttherapy systolic blood pressure (at home and medical clinic) of both the groups was recorded alongside self-perceived level of phobia in subjects of only treatment group. RESULTS: Of 30 subjects of intervention group, 22 (73.3%) completed the therapy. However, control (N = 30) stayed intact. Age statistics were, as: M = 38.2, SD = 11.8, range 20-56 years with male predominance. Moreover, 12 (54.4%) or 20 (90.9%) of them reported severe latrophobia or onset of phobia after childhood, respectively. After therapy, 17 (77.3%) subjects communicated improvement in fear. A significant decline in mean systolic blood pressure was noted in pre- to posttherapy record (149 vs.142 mm of Hg, respectively; t(21)= 8.829, p = 0.0001). CONCLUSION: Generally, cognitive behaviour therapy improves blood pressure-oriented latrophobia in adults.

Hemodialysis Internal jugular vein versus Subclavian vein Catheters: Complications, patients' comfort, tolerance and cost-effectiveness.

OBJECTIVE: To compare hemodialysis (HD) internal jugular vein (IJV) versus subclavian vein (SCV) catheters in terms of procedural complications, patients' comfort, tolerance and cost effectiveness. METHODS: Sixty six consecutive eligible adult patients planned for hemodialysis @ 3 sessions/ week for maximum 42 days in a private hospital at Sialkot, Pakistan were documented between March 2017 and April 2018. A group, IJV or SCV catheter was allotted to alternate subjects. The catheters were inserted as per practice guidelines. Record of catheter-related complications (CRCs) was computerized. Similarly, patients' uncomfortability and expenditures on management of CRCs were recorded. RESULTS: Of 66 cases, 62 (93.9%, 31/group) successfully completed the study. Baseline information showed male predominance (n = 47, 75.8%), age (M = 47, range 24-75 years) or catheter stay time (M = 40 days). The rate of vein damage or artery puncture was found higher in IJV than SCV group [(13.9 vs. 6.5%) or (9.7 vs. 3.2%), respectively] during catheterization. The difference also existed in late CRCs such as bacterial infection (32.3 vs. 16.1%), or device dysfunctioning (9.7 vs. 3.2%) with an exception of mechanical kinking. All the patients of IJV or SCV group with missed (19.4 vs. 6.5%) or shortened HD sessions (22.6 vs. 12.9%) reported CRCs-based discomfort as a cause of the regularity. Moreover, the participants of IJV group consumed 69% of the total expenditures on CRCs management. CONCLUSION: SCV is a better site for HD catheterization as it has comparatively lesser likelihood of complications, patients' feel comfortable and it is also cost-effective.than IJV.