ABSTRACT
OBJECTIVES: This study aims to present an experience in the management and clinical features of 88 children presenting with diabetic ketoacidosis (DKA) from Pakistan. METHODS: A retrospective medical chart review of all patients, < or = 15 years of age, who presented to the Aga Khan University Hospital, Karachi, Pakistan in the last ten years with a diagnosis of diabetic ketoacidosis was carried out. Severity of DKA was defined as mild (venous pH < 7.30 or bicarbonate=15mEq/l), moderate (venous pH < 7.2 or bicarbonate = 10 mEq/l) and severe (venous pH < 7 or bicarbonate < 5 mEq/l). These classes correspond to 1st, 2nd and 3rd degrees of diabetic ketoacidosis severity respectively. Cases in which diabetic ketoacidosis had occurred at onset of diabetic diagnosis were not included in the study. RESULTS: Mean age was 7.5 +/- 3.6 years; 58 (66%) patients were male. Twenty six patients had mild diabetic ketoacidosis, 44 had moderate while 18 had severe diabetic ketoacidosis at the time of presentation. Severity of diabetic ketoacidosis was significantly associated with the presence of infection, history of omission of insulin, poor compliance, presence of shock at time of presentation, length of stay in the hospital, final outcome (p < 0.01 for each of these associations) and Glasgow Coma Scale score (p = 0.02). Mortality in this series was 3.4%. CONCLUSION: Poor compliance was associated with the severity of diabetic ketoacidosis. Paediatric endocrinologists' should ensure that patients and their parents understand the importance of the need for regular insulin injections and regular monitoring of blood glucose.
Subject(s)
Diabetes Mellitus, Type 1/complications , Diabetic Ketoacidosis/classification , Diabetic Ketoacidosis/therapy , Insulin/administration & dosage , Adolescent , Bicarbonates/blood , Blood Glucose/analysis , Child , Child, Preschool , Diabetes Mellitus, Type 1/therapy , Diabetic Ketoacidosis/blood , Female , Glasgow Coma Scale , Hospitals, University , Humans , Hydrogen-Ion Concentration , Insulin/blood , Length of Stay , Male , Pakistan , Patient Compliance , Retrospective Studies , Severity of Illness Index , Treatment OutcomeABSTRACT
OBJECTIVE: To explore patient's perspectives and expectations from physicians with respect to breaking of bad news. METHODS: A cross-sectional survey was carried out in the Community Health Centre of a tertiary care teaching hospital in Pakistan. All consenting individuals from 18 to 60 years of age were interviewed on the basis of a structured, pre-tested questionnaire. RESULTS: The response rate for this study was 91.3%. A total of 400 respondents completed the full interview. About 60% patients had a fairly accurate idea about the implications of the phrase "bad news". A big proportion (44.1%) of people reported that bad news had been broken to them previously with incomplete details. From their personal experience, most respondents quoted "disease diagnosis" and "chances of survival" as most commonly encountered bad news. Diagnosis of cancer or its recurrence was stated as the most likely example of bad news (35.5%). A significant majority of respondents (40.5%) stated that it's the patient's absolute right to know bad news. A significant association for the relationship between both age as well as the gender of the respondents and type of emotional response expressed on hearing bad news (p = 0.000) was observed. CONCLUSION: This study documents the perceptions and expectations of patients from their physicians with regards to breaking of bad news. Most of the respondents wanted their doctors to be honest and upfront during the process.
Subject(s)
Health Knowledge, Attitudes, Practice , Neoplasms , Physician's Role/psychology , Physician-Patient Relations , Truth Disclosure , Adolescent , Adult , Aged , Aged, 80 and over , Attitude of Health Personnel , Cross-Sectional Studies , Female , Hospitals, University , Humans , Male , Middle Aged , Neoplasms/diagnosis , Neoplasms/psychology , Pakistan , Patient Satisfaction , Perception , Surveys and Questionnaires , Young AdultABSTRACT
BACKGROUND: Obesity is an emerging problem in Pakistan. The authors sought to determine prevalence of obesity and malnutrition in school-going children, from grades 6(th) to 8(th) of different schools of Karachi and assess associations that affect the weight of the children. METHODOLOGY/PRINCIPAL FINDINGS: A cross sectional study design with children studying in grades 6(th) to 8(th) grade, in different schools of Karachi. We visited 10 schools of which 4 consented; two subsidized government schools and two private schools. A questionnaire was developed in consultation with a qualified nutritionist. Height and weight were measured on calibrated scales. A modified BMI criterion for Asian populations was used. Data was collected from 284 students. Of our sample, 52% were found to be underweight whereas 34% of all the children were normal. Of the population, 6% was obese and 8% overweight. Of all obese children, 70% belonged to the higher socio-economic status (SES) group, while of the underweight children, 63.3% were in the lower SES. Amongst obese children in our study, 65% ate meat every day, compared to 33% of normal kids. CONCLUSION: Obesity and undernutrition co-exist in Pakistani school-children. Our study shows that socio-economic factors are important since obesity and overweight increase with SES. Higher SES groups should be targeted for overweight while underweight is a problem of lower SES. Meat intake and lack of physical activity are some of the other factors that have been highlighted in our study.
