Frequency of depression and anxiety in patients attending a diabetes clinic.

BACKGROUND: Depression is very common among people with type-2 diabetes and is associated with poor treatment compliance and outcome. This study was done to see the frequency of depression in patients with established type-2 diabetes attending a diabetes clinic in a tertiary care hospital. METHODS: One hundred and ten patients with chronic type-2 diabetes were included in this cross sectional study, excluding type-1 diabetics, patients with severe co-morbid illness with type-2 diabetes and patients with some psychiatric illness. Hospital Anxiety and Depression Scale was used to assess depression and anxiety in these patients. RESULTS: Almost 50% of patients were found to have anxiety and depression in our study. Female gender, lack of education and housewives were found to be ffected'more -hile duration of diabetes, treatment and control of diabetes have little effect on anxiety and depression in patients with chronic type-2 diabetes patients. CONCLUSION: There is a high incidence of depression and anxiety in patients with chronic type-2 diabetes and clinicians must screen regularly for better care of these patients.

Brain tuberculomas mimicking intracranial metastasis in a patient presenting with fits.

Brain tuberculosis is still prevalent in many developing countries, especially Asian countries. Tuberculomas should always be considered in the differential diagnosis of enhancing intra-axial lesions of the brain. Brain tuberculomas can present in many different clinical and radiological patterns clinically like headache, fits, cranial nerve palsies and very rarely as brain tuberculomas. We describe the case of a 48 years old male patient presenting with persistent headache and fits, referred for workup of brain metastasis or primary brain neoplasm. On further imaging, it turned out to be multiple tuberculomas of brain which resolved on anti-tuberculous treatment along with symptoms relief.

Her-2/neu gene overexpression in breast carcinoma and its association with clinicopathological characteristics of the disease.

OBJECTIVE: To assess the frequency of Her-2/neu gene amplification in breast cancer and its association with clinicopathologic characteristics of the disease. STUDY DESIGN: Cross-sectional comparative study. PLACE AND DURATION OF STUDY: Study was carried out at Surgical Unit I, Holy Family Hospital, Rawalpindi, from January 2005 to December 2006. METHODOLOGY: A total of 50 patients diagnosed of having breast cancer on biopsy of breast lump were included in the study. All patients underwent mastectomy and samples were submitted to AFIP (Armed Forces Institute of Pathology, Rawalpindi) for histopathology and determination of estrogen and progesterone receptors and Her-2/neu gene amplification. Moreover, association of Her-2/neu amplification to other characteristics like tumour size, node involvement, histological grade and presence of estrogen and progesterone receptors were also studied. RESULTS: Out of 50 patients, 18 (36%) were positive for Her-2/neu overexpression. Among the various prognostic factors, age showed a statistically significant relation to Her-2/neu positivity (p=0.001). The Her-2/neu positive cancers were larger in size (mean size of 7.9 +/- 3.615 and 5.4 +/- 1.906 cm in Her-2/neu positive and negative cases respectively; p=0.002). Her-2/neu positive cases had statistically significant relation to number of involved lymph nodes (mean number of 9.9 and 4.4 lymph nodes in Her-2/neu positive and negative cases respectively; p=0.001). Tumour grade and nuclear grade had no statistically significant relation to Her-2/neu status (p=0.19 and 0.434 respectively). Both estrogen and progesterone receptors are inversely related to Her-2/neu positivity (p=0.028 and 0.006 respectively). CONCLUSION: The pathological and clinical characteristics of Her-2/neu positive and negative subsets differ, and Her-2/neu overexpression was associated with other poor prognostic factors of age, tumour size and number of nodes involved. There was an inverse relation of Her-2/neu status and hormone receptor.

Frequency of depression and anxiety in patients attending a rheumatology clinic.

OBJECTIVE: This study was done to find out the frequency of anxiety and depression among patients with common rheumatic disorders and determine the possible relationship of different demographic and clinical variables with anxiety and depression. STUDY DESIGN: Cross-sectional, analytical study. PLACE AND DURATION OF STUDY: The study was carried out at Fauji Foundation Hospital, Rawalpindi, during April to August 2006. METHODOLOGY: Patients attending the rheumatology outpatient department, with more than 2 years duration of rheumatic disorder were selected. A proforma regarding the demographic details was filled for all the patients. A physician made the assessment regarding the rheumatological disorder. Urdu version of Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety and depression. Clinical assessment was done by two psychiatrists according to International Classification of Diseases-10 (ICD-10). Data was analyzed on SPSS10 and p-value was calculated using Chi-square test as test of significance. RESULTS: There were 108 patients mostly females (90%), mean age 44.7 + 11 years, majority (72%) were married and 51% were uneducated. Almost 80% of the patients had rheumatoid arthritis. Two-third of the patients had persistent symptoms. According to the HADS, scoring 56% of the patients had more than the cut off score for depression and 65.7% patients had scores falling in the category of cases. Regarding the clinical diagnosis, 42% of the patients were found to be depressed. Considering the factors which might be associated with depression or anxiety; only gender was found to be significantly associated with depression (p=0.03). CONCLUSION: Depression and anxiety is high in patients being treated for chronic rheumatological disorders. A close liaison between rheumatologist and mental health professionals could prove beneficial for these patients.

Leiomyoma of the urinary bladder with bladder stone.

Leiomyoma of the urinary bladder is a rare benign mesenchymal tumour. We describe here a case of leiomyoma of the urinary bladder in a 65-year-old gentleman who presented with haematuria, passage of clots and combined obstructive and irritative urinary symptoms. The investigations revealed a vesical calculus and a mass on the left lateral wall of the urinary bladder. Cystolitholapaxy and transurethral resection of the tumour was performed. Histopathological report of the resected tumour revealed a leiomyoma of the urinary bladder. So far, a leiomyoma of the urinary bladder and a concomitant vesical calculus have not been described in literature.

Malignant hypertension in a patient with end of stage renal disease (ESRD) treated by renal transplant.

Control of hypertension is often a problem in the management of end stage renal disease (ESRD). Multiple modalities of treatment are required to prevent cardiovascular and cerebrovascular mortality and morbidity. These include fluid and salt restriction, multidrug regimes and dialysis. We report a case of young 25 years old patient, admitted with chronic renal failure, complicated by malignant and refractory hypertension, not responding to hemodialysis and antihypertensive agent. During stay in hospital, patient also had intracerebral hemorrhage, fits due to uncontrolled hypertension requiring ventilatory support followed. Renal transplant was considered to be the final therapeutic modality. After gradual recovery, a successful live-related renal transplant was performed. As soon as good graft was established, the blood pressure settled and 4 of the 5 antihypertensives were withdrawn. After 2 weeks, patient was discharged in a stable condition with a total stay of about 2 months.

Renal transplant in a patient with augmentation cystoplasty.

A 20 years old girl, had undergone surgery for meningocele six weeks after birth, suffered from neurogenic bladder dysfunction. She underwent an augmentation ileocystoplasty and was trained to perform clean intermittent self catheterization (CISC). After two years she developed renal failure secondary to recurrent urinary tract infections and she was started on chronic hemodialysis. On account of repeated line sepsis, a live related donor renal transplant was performed. About three months after renal transplantation she reported in emergency with an episode of graft rejection secondary to severe infection and later on complicated by leakage of urine from the renal pelvis of the allograft into the peritoneal cavity suggestive of a rent. A percutaneous nephrostomy of the allograft was performed which facilitated healing of the rent in the renal pelvis. The nephrostomy was withdrawn and patient started voiding through urethral catheter and gradually returned to CISC.