A comparison of prophylactic antiemetic therapy with palonosetron and dexamethasone as single-agents or in combination in adult patients undergoing laparoscopic surgery: A randomized trial.

Background: The incidence of postoperative nausea and vomiting (PONV) is quite high after laparoscopic surgeries. This study endeavors to compare the efficacy of the combination of palonosetron and dexamethasone with that of either drug alone in the prevention of PONV in patients undergoing laparoscopic surgeries. Methods: This randomized, parallel-group trial was done on ninety adults of American Society of Anesthesiologists Grade I and II patients aged 18-60 years undergoing laparoscopic surgeries under general anesthesia. The patients were randomly divided into three groups of thirty patients each. Group P (n = 30) received palonosetron 0.075 mg intravenously (iv), Group D (n = 30) received dexamethasone 8 mg iv and Group P + D (n = 30) received palonosetron 0.075 mg and dexamethasone 8 mg iv. The primary outcome was incidence of PONV in 24 h, and the secondary outcome was a number of rescue antiemetics required. To compare the proportions in the groups, unpaired t-test, Mann-Whitney U-test, Chi-square test, or Fisher's exact test was applied. Results: We found that the overall incidence of PONV was 46.7% in Group P, 50% in Group D, and 43.3% in Group P + D during the first 24 h. Rescue antiemetic was required in 27% of the patients in Group P and Group D compared to 23% of the patients in Group P + D and twice in 3% of the patients in Group P, 7% of the patients in Group D, and none in Group P + D which were not significant. Conclusions: The combination therapy of palonosetron plus dexamethasone did not significantly reduce the incidence of PONV when compared with either drug alone.

Big five inventory-version 10: A two-minute personality measurement tool in Urdu.

OBJECTIVE: To translate into Urdu and validate the Big Five Inventory 10. METHODS: The study was conducted at a tertiary care hospital in Kharian Cantonment, and a university in Gilgit, Pakistan, from October to December 2020. Online video meetings were held for the translation process related to the Big Five Inventory 10. A systematic six-step process was followed for translation and validation. The volunteers recruited for the pilot and validation phases were from various different administrative regions of the country. Convergent and discriminant validity to assess construct validity, and Cronbach's alpha was calculated to assess the reliability of the scale. Data was analysed using SPSS 23. RESULTS: Of the 500 subjects, 358(71.6%) were males and 142(28.4%) were females. The overall age range was 18-48 years. The Urdu version was of the Big Five Inventory 10 was found to have a high level of construct validity supported by convergent and discriminant validity (p<0.05). The Cronbach alpha for all the sub-scales fell in the conventional range (0.71-0.88). Females scored higher on the 'agreeableness' subscale than the males (p<0.0). CONCLUSIONS: The Big Five Inventory 10 Urdu version was found to be a valid and reliable tool for researchers and clinicians having time constraints.

Community Screening for Psychiatric Morbidity in Four Remote Valleys of Hindu Kush and Karakoram Regions of Pakistan.

OBJECTIVE: To find out the frequency of psychiatric morbidity in patients reporting to general medical camps in the Hindu Kush and Karakoram ranges of Pakistan. STUDY DESIGN: A cross-sectional study. PLACE AND DURATION OF STUDY: Four different valleys of the region, with the Psychiatry Department, Combined Military Hospital, Gilgit as the base, from August 2015 to December 2016. METHODOLOGY: Consenting adults of either gender, reporting to medical camps for various health related issues were administered Bradford Somatic Inventory 21 (BSI 21) and Self Report Questionnaire (SRQ). Non-parametric statistical techniques including Mann-Whitney test, Kruskall-Wallis test, and Spearman correlation, along with median and inter quartile range, were used to analyse data. RESULTS: Out of a total of 478 (52.1% females) respondents, half [n=234 (48.9%) on BSI and n=243 (50.8%) on SRQ] reported positive psychiatric morbidity. Inter-valley differences were significant (BSI, X2=49.1, p <.001; SRQ, X2=66.5, p <.001). Females reported higher levels of psychiatric morbidity measured by BSI (p <.001) and SRQ (p <.001), as compared to males. Participants' occupation was significantly associated (BSI; X2=23.1, SRQ; X2=35.3, p <.001) while their age was not significantly associated (BSI, r=-.06, p >.05; SRQ, r=-.09, p >.05) with their psychiatric morbidity. CONCLUSION: Psychiatric morbidity was prevalent in the population studied, which may go unrecognized, overlooked, or mistreated by the locally available medical resources. There is a huge need for mental health services in these areas.

Urdu translation and validation of PHQ-9, a reliable identification, severity and treatment outcome tool for depression.

OBJECTIVE: To translate and validate the self-report brief version of Patient Health Questtionaire-9 in Urdu. METHODS: The descriptive study was carried out at the Combined Military Hospitals in Gilgit and Lahore, and Pakistan Naval Ship Shifa Hospital in Karachi, from February to May 2016, and comprised of patients recruited from primary healthcare centres of the three cities Standardised procedures including forward-translation, back-translation, expert panel discussion, face validation, pilot testing, and target population validation were done. SPSS 21 was used for statistical analysis. RESULTS: Of the 293 patients, 164(56%) were males and 129(44%) were females. Exploratory factor analysis revealed a single factor solution with minimum factor loading being 0.63. Cronbach's alpha for the scale was 0.91 and split-half reliability was 0.77. Females were more likely to have depressive symptoms compared to male participants (p<0.01). Participants' area of dwelling also influenced their reported symptoms (p<0.01). CONCLUSIONS: Patient Health Questtionaire-9 Urdu scale was found to be a valid and reliable tool to screen, rate and monitor outcomes of depressive illness in primary healthcare settings in Pakistan.

Mental health of cardiac patients in Gilgit, Pakistan: A cross-sectional study.

OBJECTIVE: To assess and compare mental health of cardiac patients with disease-free individuals. METHODS: This cross-sectional study was carried out at the Combined Military Hospital, Gilgit-Baltistan, Pakistan, from August to December 2016, and comprised cardiac patients in group A and healthy controls in group B. Data was collected using mental health inventory, a 38-item tool to measure general psychological distress and well-being. Cardiac patients' mental health was compared with illness-free individuals by applying descriptive and inferential statistical techniques. SPSS 21 was used for data analysis. RESULTS: Of the 80 participants, 40(50%) were patients and the rest were controls. The mean mental health inventory score in group B was 150.72±19.94 compared to 140.35±22.83in group A (p<0.05). Cardiac patients' mean score on psychological distress was 82.4±14.85 compared to 75.87±15.34in controls (p<0.05). The mean level of anxiety was 31.75±8.01 and that of depression was 14.58±3.58 in patients compared to 26.70±6.74 (p<0.01) and 12.65±4.34 (p<0.05) in the controls. CONCLUSIONS: Cardiac patients experienced higher level of depression and anxiety.

Urdu translation and validation of GAD-7: A screening and rating tool for anxiety symptoms in primary health care.

OBJECTIVE: To translate and validate Generalized Anxiety Disorder -7scale in Urdu, for use in Pakistan in the primary healthcare setups. METHODS: The validation study was conducted at the Combined Military Hospital, Gilgit, Pakistan, from February to May 2016.We followed a systematic six-step process to validate the Generalized Anxiety Disorder-7 scale in the target population. The instrument was translated independently and then fused together. Back-translation was followed by recommendations by an expert committee, and face validity improvement by a language expert. A pilot study was done to get user's feedback on the construct. Volunteers were administered the questionnaire for validation procedure, along with a well-being scale, at three different cities representing volunteers from four different administrative regions of Pakistan. RESULTS: There were 285 volunteers in the study. Principal component exploratory factor analysis supported unidimensional structure of the scale with an eigenvalue of 5.18 and it explained 64.8% of the total variance. Total score on the scale was negatively correlated with positive effect (r = -0.44, p<0.001) and life satisfaction (r = -0.49, p<0.001) subscales of a the well-being scale, while it was positively correlated with the negative affect (r = 0.63, p<0.001) subscale of the same, indicating a good level of convergent and discriminate validity. Cronbach's alpha for the scale was 0.92 and split-half reliability was 0.82, revealing a good level of reliability. CONCLUSIONS: The Generalized Anxiety Disorder -7 scale was found to be a validated, brief, self-administered Urdu tool to screen, rate, and monitor outcome of anxiety disorders in primary healthcare setups.

Mood changes at very high altitudes in Pakistan.

OBJECTIVE: To screen out psychiatric 'cases' and find the frequency of anxiety and depression symptoms in military volunteers performing duties at very high altitudes in the Karakoram ranges of Pakistan. METHODS: This was a descriptive study lasting from Jan 2015 to June 2015, on volunteers serving at very high altitude, using General Health Questionnaire-12 (GHQ-12) and Hospital Anxiety and Depression Scale (HADS), Urdu versions. Analysis involved descriptive, inferential techniques and Bonferroni test. Demographic variables were compared to the scores. RESULTS: A high percentage of the military volunteers screened positive for psychiatric 'caseness' and symptoms of anxiety and depression; mostly in the mild to moderate range, while very few of them reported severe symptoms. Demographic variables such as marital status, number of children, positive family psychiatric history, past medical history, duration at high altitude and educational levels were found to be significant risk factors for developing symptoms of anxiety and depression. CONCLUSIONS: Individuals performing duties at very high altitude, experience symptoms of anxiety and depression, their demographics are important in understanding their emotional problems.

Symptoms of Depression and Anxiety among Women attending Primary Health Care in Gilgit-Baltistan (GB), Pakistan.

OBJECTIVE: To assess symptoms of anxiety and depression among women reporting to primary health care (PHC women) in Gilgit Baltistan (GB), Pakistan. METHODS: This was a cross-sectional study conducted on PHC women belonging GB including other three provinces of Pakistan. PHQ-9 and GAD-7 were used to assess anxiety and depression. Descriptive and inferential statistical techniques were applied to analyze the collected data. RESULTS: PHC women from GB reported higher level of depressive symptoms (t=7.58, p=0.00) and lower level of anxiety symptoms (t=8.3, p=0.00) when compared with cut-off score. Insignificant differences were found in depressive (t=1.5, p>.05) and anxiety (t=1.2, p>.05) scores between GB women and women from rest of Pakistan. However, inter-province differences in depressive (F=5.78, p= 00) and anxiety (F=4.5, p=0.00) symptoms were significant. Increasing age and lack of education were found significant risk factors for GB PHC women's depressive and anxiety symptoms. CONCLUSIONS: PHC women from GB have higher level of depressive and lower level of anxiety symptoms like women from other provinces of Pakistan. Their demographics should be considered while addressing their emotional problems.

Intra-operative post-induction hyperthermia, possibly malignant hyperthermia: Anesthetic implications, challenges and management.

Malignant Hyperthermia is a pharmacogenetic disorder. Classical manifestations comprise of tachycardia, increase in expired carbon dioxide levels, muscle rigidity, hyperthermia (>38.8°C) and unexpected acidosis. Here we report a case of 16-year-old female patient, ASA-I with chronic rhino-sinusitis and slight strabismus of the left eye posted for functional endoscopic sinus surgery, developing a rise in ETCO2 and temperature immediately following anesthesia induction. She was aggressively managed to an uneventful recovery. We present a case of intra-operative post-induction hyperthermia possibly MH, its anesthetic implications, challenges encountered and its management.