Pediatric leukemia related depression in Pakistan

The purpose of this letter is to describe the problem facing during and after the treatment of pediatric leukemia. Depression and anxiety are the most leading challenges faced by children and its family. Anti-depressant used to cope this problem but they have many side effects. So, timely proper diagnosis, good healthy behavior of health care professionals and nurses and positive psychological therapy may be useful to reduce the stress level, effectiveness of social stigma, anxiety and hopelessness in Pediatric leukemia survivor children. By implementation of positive psychological therapy in government hospitals of Pakistan rate of better progression recovery after chemotherapy in pediatric leukemic patients towards the stress free life could be possible.Pediatric leukemia is preponderant malignancy in children under age 18 in Punjab, Pakistan. It is most eminent cancer among the children in which body produces abnormal immature lymphoblast which do not form a mature lymphocyte for normal functioning of body [1]. Leukemia is an assemblage of disorders that affect the blood making tissues in spleen and in many other parts such as bone marrow and lymphatic system. The leukemia means “white blood” because it is specifically associated with the white blood cell (leukocytes) proliferation. Production of specified blood cells from stem cells are formed according to requirement of body by hematopoiesis process. In leukemia myeloid or lymphoid cells are defected.According to Punjab Cancer Registry report 2018, 3.5% leukemia frequently reported in all age groups in both genders, 3.4% in adult males and 14.9% acute lymphoblastic leukemia in children age group less than 18 years old. This is a most common cancer among children in 2018 [1]. From 2018 to 2022 the rate of leukemia is increased among all groups such as 3.9% in all age groups including both genders and 25% (acute lymphoblastic leukemia) in childrenPediatric type of cancers such as leukemia are mostly treated by parental expenses and many variables related to family, are strongly associated with the health outcome, morbidity and mortality of children. Its diagnosis and therapies may have confrontational psychological executes on child and his family. Anxiety is first significant problem faced by Leukemic patient and its parents at post diagnosis of disease and depression is continuous mental state during treatment [3]. Cancer survivors have deep fear of loneliness, hopelessness, depression, anxiety and social stigma. Family caregivers are the hidden sufferer of this psychological disorder. Their social, economic and emotional life are strongly disturbed and neurotic [4, 5]. The whole process from duration of treatment of children to their survival after illness is challenging task for both parents and children, physically and psychologically which influenced the family structure and function [6].Mostly people in developing countries like Pakistan has no formal care on this issue, this can lead towards depressed life even after successful treatment. Pharmacological treatments such as antidepressant drugs are used to cure for depression. But due to side effects of anti-depressant, patients are not adhering to this type of cure and prefer to choose non pharmacological treatments to reduce the anxiety. Positive thinking is one of the best psychiatric treatments [7]. Positive psychotherapy relief the patients from stress by encouraging more positive emotions and meetings rather direct targeting the symptoms of depression and anxiety [8].Positive psychological conciliation and healthy behavior of health care professionals is the good contrivance for cultivating positive behavior, emotions and cognition for healthy quality of life in leukemia survival. Psycho educational programs are eloquently escalated hope in child and his family and return towards the healthy happy life after depressed process of treatment [9]. Routine mental screening for anxiety and evaluation of parental functioning are significant methods which is helpful to identify the target patient with family who suffered with high level of depression. Psychological assessment surveys and distress thermometer may be important useful tool can be used by health care professional or nurses during checkup for better evaluation [10]. A significant number of leukemia patients in different hospitals of Pakistan experienced with disturbed depressed psychological mental state. Government of Pakistan should take all these approaches with positive psychological conciliation, practically in hospitals in different phases of cancer such as pediatric leukemia treatment, to help the child to cope with depression and escalating stress-free life expectancy.Keywords: Leukemia; Depression   

Diagnostic accuracy of Calypte HIV-1 Urine EIA kit in Pakistan

Background: HIV is one of the major public health issues of modern world. The elevation in numbers calls for increased and efficient diagnostic testing protocols. A great number of HIV diagnostic tests have been approved and in use in the developed world but developing countries are still lagging in terms of testing HIV. These reasons are the motives behind this study which is aimed at testing the accuracy and use of Calypte HIV-1 Urine EIA in the Pakistani population.Methods: 516 subjects are included in the study from different HIV centers of Pakistan. The test results of Calypte-HIV-1 Urine EIA were compared with the routinely used 3-kit method.Results: The results exhibited 100% specificity but low sensitivity (74.67%). However, the positive predictive value and negative predictive value were 100% and 52.94%, respectively. Overall accuracy result for this kit was observed to be 81.40% for Calypte HIV-1 Urine EIA in the selected sample.Conclusion: Pakistan has a low population prevalence of HIV and keeping in view of the WHO recommended guidelines for HIV testing, the use of Calypte HIV-1 Urine EIA is not ideal in the current scenario. Even though the test can be of great value in high prevalence populations and can be an excellent means of surveillance procedures, it is not as fit to be used in diagnostic settings in the current situation in developing countries

Hyperhomocysteinemia: The independent risk factor of cardiovascular diseases

Hyperhomocysteinemia (Hcy) is an independent risk factor for cardiovascular diseases (CVD) and associated with primary causes of mortality and morbidity throughout the world. Association between Hcy and CVD has been a question for biologists over the last five decades. The circulating levels of Hcy can be increased by defects in enzymes involved in the metabolism of several B and therefore for homocysteine.  Although researchers have yielded conflicting findings on the link between homocysteine and CVD risk, but there is convincing evidence on link between B vitamin deficiencies and increased CVD risk. This review identifies the research conducted on this subject matter and provides a framework for the factors associated with Hcy and CVD.Keywords: Hyperhomocysteinemia; CVD; Methionine; Homocystein

A cross-sectional study about knowledge and attitudes toward multidrug-resistant and extensively drug-resistant tuberculosis in a high-burden drug-resistant country

AbstractObjective/BackgroundTuberculosis (TB) is a leading cause of death worldwide, with new threats of multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB. Pakistan is the fifth highest among high-burden TB countries and the fourth highest among high-burden drug-resistant-TB countries. Pakistan is the sixth most populous country in the world, and Pakistani youth is the highest population group in Pakistan and second in the world. This study was aimed at assessing the understanding, awareness, and mindset of university students toward TB, MDR TB, and XDR TB in Lahore.MethodsA cross-sectional questionnaire-based study was performed on 1137 individuals from three major public-sector universities in Lahore, Pakistan. Information regarding their knowledge and attitude toward MDR and XDR TB was gathered using a structured questionnaire. Data collected was analyzed using SPSS version 20.ResultsMale (531) and female (606) students were asked about different aspects of MDR and XDR TB. Although 80.47% students had good knowledge about simple TB, a very small fraction had awareness and appropriate knowledge about MDR/XDR-TB. Considering TB as a stigma, only 9.3% students disclosed that they had household TB contact. Only 25% students knew about XDR TB.ConclusionOur results indicated that a small fraction of people knew the exact definition and treatment duration of MDR TB and XDR TB in our society. There is a need to increase the awareness and knowledge status of university students about MDR and XDR TB

Varied presentation of celiac disease in Pakistani adults

he objective of this retrospective study was to evaluate presentation of celiac disease in adults. It included 77 patients, 41 (53.2%) males with median age 26 years and median body mass index of 18 (16 � 22) kg/m2. Typical presentation with gastrointestinal symptoms was seen in 76.6%. Atypical presentation with extra intestinal complaints in 7.8% and silent presentation in 15.6%. Major symptoms were diarrhea in 64.9%, weight loss 36.4%, abdominal pain 35.1%, vomiting 32.5%, pallor 24.7%, and weakness 13%. Iron deficiency was documented in 20.8%, B12 deficiency in 9.1%, folic acid deficiency in 6.5% and vitamin D deficiency in 10.4%. Half of the patients had haemoglobin less than 11 g/dl. Osteoporosis and osteomalacia, hypothyroidism, diabetes and atrophic gastritis were seen in 2.6% each. Raised alanine aminotransferase was documented in 23.4%. Duodenal biopsy, done in 39 patients, revealed increased intraepithelial lymphocytes in 11, along with crypt hyperplasia in 3, partial villous atrophy in 15 and sub-total villous atrophy in 10. In conclusion, celiac disease in adults should be looked for in patients with chronic diarrhea or irritable bowel syndrome like symptoms, underweight, anaemic, or having nutritional deficiencies

Irritable bowel syndrome in health care professionals in Pakistan

Objective: To evaluate the symptomatology of irritable bowel syndrome (IBS) among health care professionals attending an IBS symposium in a tertiary care university hospital. Method: A questionnaire designed to incorporate Manning and Rome II criteria was distributed among participants of an IBS symposium, most of them were health care professionals. A total of 100 questionnaires were distributed, 41 had symptoms fulfilling criteria of IBS. In these patients male: female ratio was 28:13 with age range 18-68. Results: The predominant symptom was abdominal pain 87.8 % (36/41) which was aggravated post-prandially 72.2% (29/41), relieved following defecation in 87 % (35/41) with a sense of incomplete evacuation 85.3% (35/41) and distention after defecation in 80.4 % (33/41). Anxiety and depression was present in 80% (33/41) as an extra intestinal symptom. Conclusion: Irritable bowel syndrome is common in health care workers with intestinal and extraintestinal manifestations being equally common (JPMA 53:405;2003