Hypertension in a young boy: an energy drink effect

Background: Use of energy drinks has significantly increased in recent times. Besides athletes, teenagers and students are among the most common consumers. However, popularity is also increasing among the younger and older age groups. Most of the users believe that they are a good source of instant energy and are unaware of its high Caffeine content resulting in harmful effects on health.Case Presentation: We report the case of a young boy who presented with palpitations and high blood pressure as a result of energy drinks usage. He had been consuming a Sting energy drink on regular basis while studying for long hours during his O\u27 level Exams. His medical examination revealed Sinus tachycardia and high blood pressure. Rest of the examination and lab workup was within normal limits. His pulse and blood pressure returned to normal range after discontinuing Sting usage.Conclusion: Several studies have reported numerous health hazards including cardiac effects associated with energy drinks. Warning labeling should be done on these drinks regulating the content of Caffeine and its harmful effects on health

Mortality in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease with Lower and Higher Decaf Scores

Background: To determine diagnostic accuracy of DECAF score in predicting mortality in patients with acute exacerbation of chronic obstructive pulmonary disease having DECAF score <4 and within 7 days of hospital admission keeping actual mortality as gold standard. Methods: In this cross sectional validation study, 146 Patients with COPD were selected from emergency and OPD of Fauji Foundation Hospital Rawalpindi presenting with signs and symptoms of acute exacerbation of COPD from 15 may 2017-15 Nov. 2017.The procedure began after taking informed consent of the patients. Clinical features documented and investigations were sent. The expense of all the tests was borne by the hospital administration and not the patient. A specially designed Performa was used for data collection. RESULTS: Mean age (years) in the study is 64.90+0.93. Patients with DECAF score of 1, 2 and 3 are (2.7+26+35.6 =64.3) are 64 %. The cases with DECAF score of 4 are 26.7% and the cases with DECAF score of 5 and 6 are 8.9%. DECAF score versus mortality with different age groups and duration of smoking gave reasonably high values of sensitivity and, specificity. Also the PPV and NPV values are appropriate. The minimum diagnostic accuracy is 71.23% indicating that this test is appropriate in predicting the true status of the cases.CONCLUSION: The study concludes that DECAF score is a useful predictor of mortality in patients admitted with acute exacerbation of COPD. Patients admitted in hospital with high DECAF score of should be admitted in intensive care unit because they may require invasive ventilation due to respiratory failure and high mortality. KEYWORDS: Chronic obstructive pulmonary disease, acute e

Comparison of High Intensity Non-Invasive Ventilation With Low Intensity Non-Invasive Ventilation In Patients With Acute Copd Exacerbation

Objective: To determine the outcome of high intensity non-invasive positive pressure ventilation (HI-NPPV) as compared to low intensity non-invasive positive pressure ventilation (LI-NPPV) in patients with acute COPD exacerbations. Methodology: This Randomized controlled trial Department of PulmonologyFauji Foundation Hospital Rawalpindi from  31st December 2016 to 30thJune 2017. Arterial blood gases will be taken at admission. If values of pH and paCO2 meet the criteria for non-invasive ventilation then patients will be enrolled in the study. Patients will be randomly divided into two groups by lottery method. GROUP A and GROUP B. GROUP A will receive high intensity NIV (HI-NPPV) and GROUP B will receive low intensity NIV (LI-NPPV) by TRIOLOGY machine. Expiratory positive airway pressure (EPAP) will remain between 4 to 6 cmH2O.  Arterial blood gases (ABGs) will be done at baseline and then 72 hours after admission. Improvement in PaCO2, HCO3, and FEV1 will be recorded 72 hours from baseline and collected on proforma (attached). Results: Mean age (years) in the study was 55.54+3.81. There were 08 male patients included the study meeting the inclusion criteria. Of these, 05 and 03 male patients among both the groups respectively. Similarly, there were 92 female patients included the study meeting the inclusion criteria, of these, 45 and 47 female patients among both the groups respectively. Outcome of the study was assessed in terms of mean PaCO2 (mmHg), HCO3 (mmol/L) and FEV1 at baseline and after 72 hours. Mean PaCO2, HCO3 and FEV1 at baseline was 64.87+5.22, 33.75+4.17 and 0.66+0.04 respectively. After 72 hours, mean PaCO2 (mmHg) , HCO3(mmol/L), and FEV1 among both the groups was 63.98+6.58 vs 41.46+2.40, 33.10+4.81 vs 23.12+2.01, 0.66+0.05 vs 0.72+0.04 with following P value of (0,000, 0.000, 0.000) respectively. Conclusion: High intensity non-invasive positive pressure ventilation (HI-NPPV) has no different outcome as compared to low intensity non-invasive positive pressure ventilation (LI-NPPV) in patients with acute COPD exacerbations

Energy drinks consumption practices among medical students of a Private sector University of Karachi, Pakistan

Consumption of energy drinks has become popular among students and athletes over the past few years. To explore the phenomenon, a cross-sectional survey was conducted through a self-administered pilot-tested questionnaire. Frequency of energy drinks consumption was found to be 121(52%) in a sample of 233 medical students. Red bull was the most common brand consumed 101(43%). The major reasons reported for its usage were to gain/replenish energy by 36(15.4%), and studying for examination by 34(14.6%). Television was reported as the major source of information 153(66%) followed by friends 113(48%). There was a high frequency of energy drinks\u27 consumption among medical students of a private university. There is a strong need to create awareness regarding these drinks, especially among adolescents and teenagers

Comparison of the WHO Retreatment Regimen with the Six Drugs Regimen in Patients of Pulmonary Tuberculosis

Objective: To compare the frequency of early response of WHO retreatment regimen with the six drugs regimen in pulmonary tuberculosis retreatment Category patients.Study design: Randomized control trial (RCT)Place and Duration: Chest Department, Fauji Foundation Hospital Rawalpindi from 22nd May 2016 to 22nd November 2016.Methodology: Patients who had previously been treated for pulmonary tuberculosis for at least 1 month duration and is a failure, relapse or defaulter case presenting in Fauji Foundation Hospital Rawalpindi, both indoor and outdoor were enrolled in the study. Patients were randomized by lottery method to either of the two treatment arms; WHO retreatment regimen or six drug formulations. Clinical features were documented, baseline investigations, AFB smear, Gene Xpert and AFB Culture were sent. Drugs were given on once daily dosage. AFB smear and AFB culture were repeated at 3rd month of treatment. They had a regular follow up in Chest OPD and had monthly visits to the ophthalmology department for visual acuity, fundoscopy and to ENT department for audiometry. Their chest X-ray was done baseline then 3 months. Blood complete picture and liver function tests, serum uric acid, renal function tests were performed baseline, at 2 weeks then 3 months. After their treatment was completed they were followed to look for relapse.Results: Total 490 patients were included according to the inclusion criteria of the study. Patients were divided into two equal groups. Mean age (years) in the study was 40.00+21.10. There were 33 (6.7) male and 457 (93.3) female patients whereas the frequency of early response of WHO retreatment regimen with the six drugs regimen in pulmonary tuberculosis retreatment category patients was 187 (76.3) and 211 (86.1) respectively which was statistically significant (p-value 0.000).Conclusion: The study concludes that six drug regimen was superior to WHO standard regimen in the success rate of pulmonary tuberculosis retreatment category patients which useful in bringing new facts regarding management of retreatment category patient in our country as well as worldwide because of the limited research was done on this category of tuberculosis

The Prevalence & Severity of Depression in patients with chronic obstructive airway disease

Objective:  To determine the Prevalence & Severity of depression in Chronic Obstructive Airway Diseases (COPD) patients. Background: Chronic Obstructive Airway Disease is a chronic heterogeneous disease that is also progressive. Depression is a common entity in chronic diseases. COPD causes long-term respiratory symptoms and depression is commonly found in these patients. The symptoms of these two diseases are overlapping and depression in COPD patients’ needs to be diagnosed and adequately treated. Untreated patients lead to poor control of respiratory symptoms and further deterioration of the illness. Our study aimed to determine prevalence and severity of depression in COPD patients using HAM-D score. Material and Methods: This study was conducted in Medicine & Pulmonology OPD, Fuji Foundation Hospital, Rawalpindi from August 2019 to February 2021. Using a cross sectional study design, a total of 169 cases of COPD were recruited and tested for the presence of absence of depression using the HAM-D rating scale and observations were recorded. Results: Total 169 patients recruited in this study with female & male percentage of 59% and 47% respectively.  The Mean duration of illness was 11.5 years ± 6.48. The incidence of Anxiety & Depression was high (45% and 36%) in moderate to severe disease with total prevalence of 54 % among participants in the study. Conclusion: Anxiety & depression is commonly prevalent in COPD patients. Female patients are found to have more psychological disturbance irrespective to their COPD severity. Psychological impairment must be carefully evaluated in patients having COPD.

Psychological Assessment of Health Care Workers in Intensive Care Units During the COVID-19 Pandemic

ABSTRACT Background Fear and depression are common to any pandemic particularly in healthcare workers as they are in the front line to treat the diseased. Such a state directly affects the performance of the health system and the patients who are seeking care. This study aimed at assessing the psychological effect of COVID-19 among the healthcare workers in the intensive care units of two tertiary care hospitals of Rawalpindi & Islamabad.   Methods It was a descriptive cross-sectional study, conducted over five months i.e., 1st July 2020 to 1st November 2020. Non-probability consecutive sampling technique was used for recruiting health care workers. PHQ-9 tool was used including 9 questions (items) related to the depression due to COVID-19. Other tool Fear of COVID-19 scale was based on 5 points Likert scale as ‘strongly disagree’, ‘disagree’, ‘neutral’, ‘agree’ and ‘strongly agree’. Besides descriptive frequencies, mean and standard deviation, Spearman correlation (r) was applied to check the correlation between fear of COVID-19 with age (years) and professional experience (years).   Results Out of 382 healthcare workers (doctors, nurses & other staff) recruited in the study, around 50% were found to be suffering from severe depression and have developed a fear of the disease. A significant positive correlation was observed between the age of the healthcare worker and the degree of fear of COVID-19 (p<0.05). Similarly, a significant positive correlation was observed between the number of professional experience and the fear of COVID-19 (p<0.05).   Conclusion It is concluded that healthcare workers in ICU are at risk of depression because of fear of COVID-19. The current situation highlights the areas that need attention. Special training or orientation must be arranged for a situation of an outbreak or a pandemic and skills for keeping one’s psychological wellbeing and mental health must be imparted. KEYWORDS: Fear; Depression; Psychological impact; COVID-19, Healthcare workers, Pakista

Situational Analysis of Household Energy and Biomass Use and Associated Health Burden of Indoor Air Pollution and Mitigation Efforts in Pakistan

Biomass fuel burning leads to high levels of suspended particulate matter and hazardous chemicals in the indoor environment in countries where it is in common use, contributing significantly to indoor air pollution (IAP). A situational analysis of household energy and biomass use and associated health effects of IAP was conducted by reviewing published and un-published literature about the situation in Pakistan. In addition to attempt to quantify the burden of ill health due to IAP, this paper also appraises the mitigation measures undertaken to avert the problem in Pakistan. Unfortunately, IAP is still not a recognized environmental hazard in Pakistan and there are no policies and standards to control it at the household level. Only a few original studies related to health effects of IAP have been conducted, mainly on women’s health and birth outcome, and only a few governmental, non-governmental and academic institutions are working to improve the IAP situation by introducing improved stoves and renewable energy technology at a small scale. Control of IAP health hazards in Pakistan requires an initial meeting of the stakeholders to define a policy and an action agenda. Simultaneously, studies gathering evidence of impact of intervention through available technologies such as improved stoves would have favorable impact on the health, especially of women and children in Pakistan