Assessment of depression and anxiety in adult cancer outpatients: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>The prevalence of anxiety and depressive disorders in cancer patients and its associated factors in Pakistan is not known. There is a need to develop an evidence base to help introduce interventions as untreated depression and anxiety can lead to significant morbidity. We assessed the prevalence of depression and anxiety among adult outpatients with and without cancer as well as the effect of various demographic, clinical and behavioral factors on levels of depression and anxiety in cancer patients.</p> <p>Methods</p> <p>This cross-sectional study was carried out in outpatient departments of Multan Institute of Nuclear Medicine and Radiotherapy and Nishtar Medical College Hospital, Multan. Aga Khan University Anxiety and Depression Scale (AKUADS) was used to define the presence of depression and anxiety in study participants. The sample consisted of 150 diagnosed cancer patients and 268 participants without cancer (control group).</p> <p>Results</p> <p>The mean age of cancer patients was 40.85 years (SD = 16.46) and median illness duration was 5.5 months, while the mean age of the control group was 39.58 years (SD = 11.74). Overall, 66.0% of the cancer patients were found to have depression and anxiety using a cutoff score of 20 on AKUADS. Among the control group, 109 subjects (40.7%) had depression and anxiety. Cancer patients were significantly more likely to suffer from distress compared to the control group (OR = 2.83, 95% CI = 1.89-4.25, P = 0.0001). Performing logistic regression analysis showed that age up to 40 years significantly influenced the prevalence of depression and anxiety in cancer patients. There was no statistically significant difference between gender, marital status, locality, education, income, occupation, physical activity, smoking, cancer site, illness duration and mode of treatment, surgery related to cancer and presence of depression and anxiety. Cancers highly associated with depression and anxiety were gastrointestinal malignancies, chest tumors and breast cancer.</p> <p>Conclusions</p> <p>This study highlights high prevalence rates of depression and anxiety in cancer patients. Younger age was associated with a higher likelihood of meeting criteria for psychological morbidity. The findings support screening patients for symptoms of depression and anxiety as part of standard cancer care and referring those at a higher risk of developing psychological morbidity for appropriate care.</p

Clinical evaluation of efficacy and safety of α-keto analogs of essential amino acids supplementation in patients of chronic kidney disease

Background: The objective was to evaluate the efficacy and safety of α-keto analogs of essential amino acids (KAA) as a supplement in chronic kidney disease (CKD).Methods: A prospective comparative study was conducted in patients of CKD of a tertiary care center of North India. Patients were randomly divided into two interventional groups. Group I (control) was advised conservative management and placebo while Group II (KAA) given conservative management along with KAA (600 mg, thrice daily) for 12 weeks. Hemogram, renal function tests, lipid profiles were done, and adverse effects were recorded at 0, 4, 8, and 12 weeks of treatment.Results: There was progressive improvement in clinical features in both groups after 12 weeks of treatment, but KAA group showed more marked improvement as compared with the control group. Both groups showed gradual improvement in the biochemical parameters as compared to their pre-treated values, which was more marked in KAA supplemented group. There was a reduction in blood glucose, blood urea, serum creatinine, and 24 h total urine protein. There was an increase in hemoglobin, 24 h total urine volume and glomerular filtration rate. KAA group showed significant (p&lt;0.05) improvement in lipid profiles as compared with the control group. There was no statistical difference in two groups with respect to side-effects (p&gt;0.05).Conclusion: KAA supplementation along with conservative management is efficacious and safe in preventing the progression of disease in patients of CKD

Neurological complications in patients with plasmodium vivax malaria from Karachi, Pakistan

Background: Malaria remains an endemic disease in Pakistan with an estimated healthcare burden of 1.6 million cases annually, with Plasmodium vivax accounting for 67% of reported cases. P. vivax is the most common species causing malaria outside of Africa, with approximately 13.8 million reported cases worldwide. Method: We report a series of P. vivax cases with cerebral involvement that presented at Aga Khan University Hospital, Karachi, Pakistan. Results: The majority of the patients presented with high-grade fever accompanied by projectile vomiting and abnormal behaviour, seizures, shock and unconsciousness. Seven of 801 patients with P. vivax monoinfection presented or developed cerebral complications. P. vivax infections were diagnosed based on peripheral smears and rapid diagnostic testing. Conclusion: P. vivax infection can lead to severe complications, although not with the frequency of Plasmodium falciparum infection. Current cases highlight an increasing trend of cerebral complications caused by P. vivax

EVALUATION OF EFFICACY AND SAFETY OF NIGELLA SATIVA OIL SUPPLEMENTATION IN PATIENTS OF CHRONIC KIDNEY DISEASE

ABSTRACTObjective: To evaluate efficacy and safety of add-on therapy of Nigella sativa oil in patients of stage 3 and 4 of chronic kidney disease (CKD).Materials and Methods: The study was conducted in a tertiary care center of north India in stage 3 and 4 patients of CKD. It was a prospective,comparative, and open label study. Patients were randomly divided into two interventional groups. Group I (Control) received conservativemanagement of CKD while Group II (Test) received conservative management along with N. sativa oil (2.5 mL, per orally, once daily) for 12 weeks.Hemogram and renal function tests were done, and adverse events were recorded at 0, 6, and 12 weeks of treatment.Results: After 12 weeks of treatment, there was a progressive improvement in clinical features and biochemical parameters in both the groups, but itwas more marked in the test group compared to control group. Both groups showed gradual improvement in the biochemical parameters as comparedto their pre-treated values which were more marked in N. sativa oil supplemented group. There was a reduction in blood glucose, blood urea, serumcreatinine, and 24-hr total urine protein. There was an increase in hemoglobin, 24-hr total urine volume, and glomerular filtration rate.Conclusion: N. sativa oil supplementation along with conservative management is efficacious and safe in averting the progression of disease in stage 3and 4 patients of CKD.Keywords: Chronic kidney disease, Nigella sativa oil, End-stage renal disease, Glomerular filtration rate

Role of rhubarb and α-keto analogues of essential amino acids supplementation in halting progression of chronic kidney disease

Background: Chronic kidney disease (CKD) is an emerging chronic disease due to rapidly increasing incidence of diabetes and hypertension worldwide. Newer drugs are being searched which can stop nephron damage and are cost effective. This study was undertaken to compare the efficacy and safety profile of rhubarb and α-keto analogues of essential amino acids supplementation in patients of chronic kidney disease.Methods: A prospective comparative study was conducted in patients of chronic kidney disease attending Renal Clinic of a tertiary care centre. Randomization of patients was done into three interventional groups: conservative management along with placebo was given in first group (Control); conservative management along with Rhubarb capsule (350 mg, thrice daily) was given in second group (Rhubarb) and conservative management along with α-keto analogues of essential amino acids (600 mg, thrice daily) was given in third group (KAA). The treatment was given for 12 weeks. Clinical and biochemical parameters were assessed at 0, 4, 8 and 12 weeks of treatment.Results: Patients of all three groups showed gradual improvement in clinical features and biochemical parameters as compared to their pre-treated values which was more marked in KAA supplemented group. There was reduction in: fasting blood glucose (12.51%, 19.15% and 20.78%), PPBG (14.80%, 19.00% and 20.89%), serum creatinine (25.00%, 30.54% and 39.52%), blood urea (25.55%, 33.64% and 38.09%), and 24-hour total urine protein (TUP) (19.80%, 30.18% and 38.34%) in Group I, II and III respectively. There was increase in: haemoglobin level (12.64%, 14.99% and 19.77%), 24-hour total urine volume (TUV) (19.41%, 28.82% and 33.32%) and GFR (22.6%, 46.5% and 49.2%) in Group I, II and III respectively. Rhubarb and KAA supplementations were safe and well-tolerated.Conclusions: KAA is more effective than Rhubarb as add on therapy with conservative management in patients of chronic kidney disease

True prevalence of twin HDV-HBV infection in Pakistan: a molecular approach

Hepatitis Delta Virus (HDV) infects only patients that are already infected by hepatitis B virus (HBV) because this is sub satellite virus which depends on and propagate only in the presence of HBV. HDV causes co-infection or super infection with sever complication as compared to only HBV infection. No study on molecular level on HDV is available from this region; therefore, the aim of this study was to found out the molecular epidemiology of HDV (as a co-infection with HBV) in different geographical regions of Pakistan

Corrosion and heat treatment study of electroless nip-ti nanocomposite coatings deposited on hsla steel

Corrosion and heat treatment studies are essential to predict the performance and sustainability of the coatings in harsh environments, such as the oil and gas industries. In this study, nickel phosphorus (NiP)–titanium (Ti) nanocomposite coatings (NiP-Ti nanoparticles (TNPs)), containing various concentrations of Ti nanoparticles (TNPs) were deposited on high strength low alloy (HSLA) steel through electroless deposition processing. The concentrations of 0.25, 0.50 and 1.0 g/L TNPs were dispersed in the electroless bath, to obtain NiP-TNPs nanocomposite coatings comprising different Ti contents. Further, the effect of TNPs on the structural, mechanical, corrosion, and heat treatment performance of NiP coatings was thoroughly studied to illustrate the role of TNPs into the NiP matrix. Field emission scanning electron microscope (FESEM) and energy dispersive spectroscopy (EDX) results confirm the successful incorporation of TNPs into the NiP matrix. A substantial improvement in the mechanical response of the NiP matrix was noticed with an increasing amount of TNPs, which reached to its ultimate values (hardness 675 Hv, modulus of elasticity 18.26 GPa, and stffness 9.02 kN/m) at NiP-0.5TNPs coatings composition. Likewise, the electrochemical impedance spectroscopy measurements confirmed a tremendous increase in the corrosion inhibition efficiency of the NiP coatings with an increasing amount of TNPs, reaching ~96.4% at a composition of NiP-0.5TNPs. In addition, the NiP-TNPs nanocomposite coatings also unveiled better performance after heat treatment than NiP coatings, due to the presence of TNPs into the NiP matrix and the formation of more stable (heat resistant) phases, such as Ni3P, Ni3Ti, NiO, etc., during the subsequent processing.This publication was made possible by Qatar University Research Grant-IRCC-2020-006. The findings achieved herein are solely the responsibility of the authors

Low Temperature Synthesis of Superparamagnetic Iron Oxide (Fe3O4) Nanoparticles and Their ROS Mediated Inhibition of Biofilm Formed by Food-Associated Bacteria

In the present study, a facile environmentally friendly approach was described to prepare monodisperse iron oxide (Fe3O4) nanoparticles (IONPs) by low temperature solution route. The synthesized nanoparticles were characterized using x-ray diffraction spectroscopy (XRD), Raman spectroscopy, field emission scanning electron microscopy (FESEM) measurements, Fourier-Transform Infrared Spectroscopy (FTIR), and Thermogravimetric analysis (TGA) analyses. XRD patterns revealed high crystalline quality of the nanoparticles. SEM micrographs showed the monodispersed IONPs with size ranging from 6 to 9 nm. Synthesized nanoparticles demonstrated MICs of 32, 64, and 128 μg/ml against Gram negative bacteria i.e., Serratia marcescens, Escherichia coli, and Pseudomonas aeruginosa, respectively, and 32 μg/ml against Gram positive bacteria Listeria monocytogenes. IOPNs at its respective sub-MICs demonstrated significant reduction of alginate and exopolysaccharide production and subsequently demonstrated broad-spectrum inhibition of biofilm ranging from 16 to 88% in the test bacteria. Biofilm reduction was also examined using SEM and Confocal Laser Scanning Microscopy (CLSM). Interaction of IONPs with bacterial cells generated ROS contributing to reduced biofilm formation. The present study for the first time report that these IONPs were effective in obliterating pre-formed biofilms. Thus, it is envisaged that these nanoparticles with broad-spectrum biofilm inhibitory property could be exploited in the food industry as well as in medical settings to curtail biofilm based infections and losses

Seroprevalence of hepatitis C in type 2 diabetes: evidence for a positive association

<p>Abstract</p> <p>Background</p> <p>There is a growing body of literature on the relationship of Hepatitis C virus infection (HCV) and type 2 diabetes mellitus (T2DM). However, there are certain gaps in literature and the data is inconclusive. This study was, therefore, carried out to determine the prevalence of HCV infection in diabetic patients and to elucidate the presence of any possible relationship between HCV and T2DM in this region.</p> <p>Methods</p> <p>Serologic testing for anti-HCV antibody was done on a sample of 3000 individuals with T2DM visiting Diabetes Clinic of Nishtar Medical College Hospital, Multan and 10,000 volunteer blood donors visiting blood bank of the same hospital during the study period using Accurate rapid immunochromatographic kits which was later confirmed by using Chemelex S.A third generation ELISA kit for positive cases. Data about various variables was collected from diabetic patients using a structured questionnaire after taking informed consent.</p> <p>Results</p> <p>Prevalence rate of 13.7% for HCV infection was recorded among subjects having T2DM with seropositivity rate of 4.9% among the control group of volunteer blood donors without diabetes. The patients with T2DM were more likely to have HCV infection as compared to the control group (OR = 3.03, 95%CI = 2.64-3.48, p = 0.001). Diabetic patients with age above 55 years had higher prevalence rate as compared to younger individuals. Male patients had significantly high seropositivity as compared to female patients (15.3% vs. 12.4%, p = 0.02). Those with duration of diabetes 11 years and above and the ones with good glycemic control had higher seroprevalence rates of 18.2% and 18.7% respectively. There was no statistically significant difference among subjects when the distribution of HCV was studied on the basis of marital status, locality, or family history of diabetes.</p> <p>Conclusions</p> <p>The results show that there is a strong association between HCV and T2DM in the region as evident from significantly higher prevalence of HCV infection in diabetics as compared to the control group in the present study.</p

Evaluation of internet access and utilization by medical students in Lahore, Pakistan

<p>Abstract</p> <p>Background</p> <p>The internet is increasingly being used worldwide in imparting medical education and improving its delivery. It has become an important tool for healthcare professionals training but the data on its use by medical students in developing countries is lacking with no study on the subject from Pakistan. This study was, therefore, carried out with an aim to evaluate the pattern of internet access and utilization by medical students in Pakistan.</p> <p>Methods</p> <p>A structured pre-tested questionnaire was administered to a group of 750 medical students in clinical years studying at various public and private medical colleges in Lahore. The questions were related to patterns of internet access, purpose of use and self reported confidence in performing various internet related tasks, use of health related websites to supplement learning and the problems faced by students in using internet at the institution.</p> <p>Results</p> <p>A total of 532 medical students (70.9%) returned the questionnaire. The mean age of study participants was 21.04 years (SD 1.96 years). Majority of the respondents (84.0%) reported experience with internet use. About half of the students (42.1%) were using internet occasionally with 23.1%, 20.9% and 13.9% doing so frequently, regularly and rarely respectively. About two third of the students (61.0%) stated that they use internet for both academic and professional activities. Most of the participants preferred to use internet at home (70.5%). Self reported ability to search for required article from PubMed and PakMedinet was reported by only 34.0% of the entire sample. Students were moderately confident in performing various internet related tasks including downloading medical books from internet, searching internet for classification of diseases and downloading full text article. Health related websites were being accessed by 55.1% students to supplement their learning process. Lack of time, inadequate number of available computers and lack of support from staff were cited as the most common problems faced by students while accessing internet in the institution premises. There were significant differences among male and female students with respect to the place of internet use (p = 0.001) and the ability to search online databases for required articles (p = 0.014).</p> <p>Conclusions</p> <p>Majority of the medical students in this study had access to internet and were using it for both academic and personal reasons. Nevertheless, it was seen that there is under utilization of the potential of internet resources to augment learning. Increase in awareness, availability of requisite facilities and training in computing skills are required to enable better utilization of digital resources of digital resources by medical students.</p