Commentary: How Long Do We Need to Follow-Up Our Hernia Patients to Find the Real Recurrence Rate?

A commentary on How long do we need to follow-up our hernia patients to find the real recurrence rate? by Köckerling F, Koch A, Lorenz R, Schug-Pass C, Stechemesser B and Reinpold W. Front Surg (2015) 2 :24 doi: 10.3389/fsurg.2015.00024 It was a pleasure to go through the manuscript by Ferdinand Köckerling focusing on hernia recurrence in Frontiers in Surgery (1). We would like to applaud the authors on two fronts. We had very peripheral awareness of the Herniamed registry, but having read this paper, we believe that the registry is a brilliant initiative by the German surgical society. Such data sharing will most definitely help to evolve and standardize practices in hernia surgery across the board. Second, the results and recommendations of this study are novel in nature. The recurrence rates followed over such a long interval have important implications for managing follow-up care for hernia patients

Prevalence and demographics of anxiety disorders: a snapshot from a community health centre in Pakistan

<p>Abstract</p> <p>Background</p> <p>The developing world is faced with a high burden of anxiety disorders. The exact prevalence of anxiety disorders in Pakistan is not known. There is a need to develop an evidence base to aid policy development on tackling anxiety and depressive disorders in the country. This is the first pilot study to address the prevalence of anxiety disorders and their association with sociodemographic factors in Pakistan.</p> <p>Methods</p> <p>A cross-sectional study was conducted among people visiting Aga Khan University Hospital (AKUH), a tertiary care facility in Karachi, Pakistan. The point prevalence of anxiety amongst the sample population, which comprised of patients and their attendants, excluding all health care personnel, was assessed using the validated Urdu version of the Hospital Anxiety and Depression Scale (HADS). The questionnaire was administered to 423 people. Descriptive statistics were performed for mean scores and proportions.</p> <p>Results</p> <p>The mean anxiety score of the population was 5.7 ± 3.86. About 28.3% had borderline or pathological anxiety. The factors found to be independently predicted with anxiety were, female sex (odds ratio (OR) = 2.14, 95% CI 1.36–3.36, p = 0.01); physical illness (OR = 1.67, 95% CI 1.06–2.64, p = 0.026); and psychiatric illness (OR = 1.176, 95% CI 1.0–3.1, p = 0.048). In the final multivariate model, female sex (adjusted odds ratio (AOR) = 2, 95% CI 1.28–3.22) and physical illness (AOR = 1.56, 95% CI 0.97–2.48) were found to be significant.</p> <p>Conclusion</p> <p>Further studies via nationally representative surveys need to be undertaken to fully grasp the scope of this emerging public health issue in Pakistan.</p

Mechanisms of Takotsubo Cardiomyopathy; Role of Microcirculatory Dysfunction

Takotsubo cardiomyopathy is characterized by reversible left ventricular dysfunction, typically preceded by an emotional or a physical stressor. The underlying pathophysiologic mechanisms include multivessel coronary vascular spasm, microvascular dysfunction, neurogenic stunning of the myocardium and catecholamine surge. Microcirculatory dysfunction may play a key role in the evolution of this syndrome especially in the acute phases of the illness. Severe invasive and noninvasive modalities are utilized to ascertain any compromise in coronary perfusion in Takotsubo cardiomyopathy, including Doppler guidewire technique, Thrombolysis in myocardial infarction (TIMI) frame count (TFC), TIMI myocardial perfusion grade (TMPG) and nuclear imaging techniques. TIMI frame count can be utilized as a diagnostic marker and clinical indicator in assessment of microvascular function or coronary flow in patients with Takotsubo cardiomyopathy