Impulsivity in patients with attempted suicide presenting at a tertiary care hospital in Karachi

OBJECTIVE: To determine the prevalence of impulsivity in patients who attempted suicide presenting at a tertiary care hospital, Karachi. STUDY DESIGN: Cross sectional study. STUDY SETTING: Study was led in the Psychiatry Department, Abbasi Shaheed Hospital, Karachi. DURATION OF STUDY:Six month after approval of synopsis. SUBJECTS AND METHODS: Data was prospectively collected from patients after taking verbal consent. Permission was taken from ethical review committee. 95 patients presenting to the Psychiatry Department who met the inclusion criteria were included. A brief history about suicide attempt and demographic data was taken from the patient and confirmed by an attendee. The researcher himself interviewed the patient in a conducive environment assuring the patient\u27s confidentiality. The Barratt Impulsiveness Scale (BIS-11) which consists of 30 self administered questions, marked out of 120 and rated from 0-4 was used to measure impulsivity. Demographic data was presented as simple descriptive statistics giving mean and standard deviation and qualitative variables was presented as frequency and percentages. Effect modifiers were controlled through the stratification of age, gender, marital status, educational status, socioeconomic status and occupational status to see the effect of these on the outcome variable. Post stratification chi square test was applied, taking p-value of ≤0.05 as significant

Pilot study of a culturally adapted psychoeducation (CaPE) intervention for bipolar disorder in Pakistan.

Background: Despite the use of maintenance medication, recurrence rates in bipolar affective disorder (BPAD) are high. To date, there are no clinical trials that have investigated the use of psychological interventions in bipolar disorder in Pakistan. / Aim: The purpose of the study was to assess the feasibility and acceptability of a culturally adapted bipolar psychoeducation programme (CaPE) in Pakistan. / Methods: Thirty-four euthymic bipolar I and II outpatients were randomized to either 12 weekly sessions of individual psychoeducation plus Treatment As Usual (Intervention) or Treatment As Usual (TAU) (Control). Outcomes were assessed using the Young Mania Rating Scale (YMRS), Beck Depression Inventory (BDI), EuroQoL (EQ-5D), Bipolar Knowledge and Attitudes and Questionnaire (BKAQ), and a self-reported measure of medication adherence (Morisky Medication Adherence Scale-4 items, MMAS-4). Effect sizes were derived from baseline adjusted standardized regression coefficients. / Results: Retention in the study was good, 80% of patients in the TAU follow-up assessment and 100% of patients in the CaPE group attended all 12 sessions. Patient satisfaction was higher in the CaPE group relative to control (ES = 1.41). Further, there were large effect sizes shown for CaPE versus TAU for medication adherence (MMAS-4: ES = 0.81), knowledge and attitudes towards bipolar (BKAQ: ES = 0.68), mania (YMRS: ES = 1.18), depression (BDI: ES = 1.17) and quality of life measures (EQ-5D: ES ⇒ 0.88). / Conclusions: Culturally adapted psychoeducation intervention is acceptable and feasible, and can be effective in improving mood symptoms and knowledge and attitudes to BPAD when compared with TAU. Larger scale studies are needed to confirm our findings. / Trial registration. Clinicaltrials.gov identifier NCT0221039

Coronary Artery Diameter Related to Calcium Scores and Coronary Risk Factors as Measured With Multidetector Computed Tomography: a Substudy of the Accuracy Trial

Arterial remodeling, an early change of atherosclerosis, can cause dilated arterial diameter. We measured coronary artery diameter with use of noncontrast 64-slice multidetector computed tomography (MDCT), and studied its association with coronary artery calcium levels and traditional coronary risk factors. We included 140 patients from the ACCURACY trial whose noncontrast MDCT images showed measurable coronary arteries. Using 3 measurements of left main coronary artery (LMCA) and right coronary artery (RCA) diameters within 3 mm of the ostium, we associated the results with traditional coronary risk factors and calcium scores. The prevalence of LMCA and RCA calcium was 22% and 51%, respectively. Mean arterial diameters were 5.67 ± 1.18 mm (LMCA) and 4.66 ± 1.08 mm (RCA). Correlations for LMCA and RCA diameters in 50 randomly chosen patients were 0.91 and 0.93 (interobserver) and 0.98 and 0.93 (intraobserver). Adjusted odds ratios for the relationship of LMCA and RCA diameters to calcium in male versus female patients were 5.65 (95% confidence interval [CI], 2.78–11.5) and 4.35 (95% CI, 2.24–8.47), respectively. Adjusted ratios and 95% CIs for the association of larger RCA diameter with age, hypertension, and body mass index were 1.36 (1.00–1.86), 3.13 (1.26–7.78), and 1.60 (1.16–2.22), respectively. Arterial diameters were larger in women and patients with higher calcium levels, and body mass index and hypertension were predictors of larger RCA diameters. These findings suggest a link between arterial remodeling and the severity of atherosclerosis

Central aortic valve coaptation area during diastole as seen by 64-multidetector computed tomography (MDCT)

As multiple new procedures now require better visualization of the aortic valve, we sought to better define the central aortic valve coaptation area seen during diastole on multi-detector row cardiac computed tomography (MDCT). 64-MDCT images of 384 symptomatic consecutive patients referred for coronary artery disease evaluation were included in the study. Planimetric measurements of this area were performed on cross-sectional views of the aortic valve at 75% phase of the cardiac cycle. Planimetric measurement of central regurgitation orifice area (ROA) seen in patients with aortic regurgitation and Hounsfield units of the central aortic valve coaptation area were performed. Mean area of the central aortic valve coaptation area was 5.34 ± 5.19 mm2 and Hounsfield units in this area were 123.69 ± 31.31 HU. The aortic valve coaptation area (mm2) measurement in patients without AR was: 4.90 ± 0.17 and in patients with AR: 10.53 ± 0.26 (P = <0.05). On Bland–Altman analysis a very good correlation between central aortic valve coaptation area and central ROA was found (r = 0.80, P = <0.001). Central aortic valve coaptation area is a central area present at the coaptation of nodules of arantius of aortic cusps during diastole; it is incompetent and increased in size in patients with aortic regurgitation