Massive Fluid Requirements and an Unusual BUN/Creatinine Ratio for Pre-Renal Failure in Patients with Cholera

Background: Cholera is an important infectious cause of secretory diarrhea. The primary symptom of infection is the sudden onset of watery diarrhea with subsequent volume depletion causing renal insufficiency. The objective of this research is to study the level of dehydration at presentation and subsequent fluid management in Patients with cholera. Methods: This study was conducted on 191 Patients of Cholera admitted at a tertiary care hospital in Karachi, Pakistan during the period of 5 years. Medical charts were evaluated retrospectively for initial hydration status, baseline lab investigations on admission and discharge and fluid therapy given to all the Patients while their stay in the hospital and the data was analyzed on SPSS 15.0. Results: Out of the 191 Patients, 83(43%) were males and 108 (57%) were females with mean age of 42.3 years (SD+/-18.34). The average duration of symptoms was 3.75 days (SD+/-2.04). Of 191 Patients, 175 (92.1%) presented with dehydration, 80 (42.3%) were given Ringer\u27s Lactate (R/L) + Normal Saline (N/S), 45 (24%) Patients were given R/L + N/S + Oral Rehydration Therapy (ORS), 27 (14.3%) of the Patients were kept on R/L only and remaining were given various combinations of R/L, N/S, ORS and Dextrose Saline (D/S). On admission mean Blood Urea Nitrogen (BUN) was 24.54 (SD+/-16.6), mean creatinine was 2.47 (SD+/-2.35) and mean BUN/Creatinine ratio was 11.63 (SD+/-5.7). Conclusion: Aggressive fluid rehydration remains the cornerstone of management of cholera. Instead of presenting with a classical BUN/Creatinine ratio of \u3e20:1, Patients with pre-renal failure in cholera may present with a BUN/Creatinine ratio of \u3c15:1

Awareness and Use of Benzodiazepines in Healthy Volunteers and Ambulatory Patients Visiting a Tertiary Care Hospital: A Cross Sectional Survey

Background: Indiscriminate prescription of Benzodiazepines in Pakistan and subsequent availability over-the-counter without prescription is a major public health problem, requiring systematic inquiry through research. Additionally, there is limited data on the awareness and use of Benzodiazepines from developing countries making it impossible to devise meaningful health policies. Methodology/Principal Findings: This was an Observational, Cross-Sectional study. conducted at Aga Khan University. A total of 475 (58.5 % males, 41.5 % females) people visiting a tertiary care hospital were interviewed by means of a structured questionnaire. The results showed that majority of population was aware of one or more Benzodiazepines (80.4%) and 30.4 % had used them at some point in life. 42.4 % of the users had been using it for more than a year. Commonest reason for use was sleep disturbance. Frequency of usage was higher for females, married individuals, educated (.Grade12), high socioeconomic status and housewives. More (59%) were prescribed than not and of them most by GP (58.5%). Only 36.5% of them were particularly told about the long-term addiction potential by the use of these drugs. Conclusion: Easy availability, access to re-fills without prescription and self prescription compounded with the lack of understanding of abuse potential of benzodiazepines constitutes a significant problem demanding serious consideratio

Pakistani Urban Population Demonstrates a Poor Knowledge About Cancers: A Pilot Survey

Background: This cross-sectional study was carried out to assess the perceptions and level of knowledge of a Pakistani urban population regarding presentations, risk factors, and screening of cancers. Methods: From 4 tertiary care hospitals, 439 subjects were recruited through convenient sampling method and interviewed using a standard questionnaire. Results: More than 90% of subjects demonstrated poor knowledge. Good knowledge was associated with female gender, being married, higher socioeconomic status, and level of education. Conclusions: Our sample demonstrates an inadequate knowledge regarding the presentations, risk factors, and screening of cancers. Efforts aiming to correct these deficiencies might result in a successful and cost-effective model for primary and secondary prevention of major cancers in Pakistan

Demographic Distribution (n = 475)

<p>Demographic Distribution (n = 475)</p

Blood Urea Nitrogen and Creatinine levels and ratios.

<p>Blood Urea Nitrogen and Creatinine levels and ratios.</p

Quantity of fluids given.

<p>Quantity of fluids given.</p

Type of fluid therapy adminstered.

<p>N/S  =  Normal saline.</p><p>R/L  =  Ringer's lactate.</p><p>ORS  =  Oral Rehydration Solution.</p><p>D/S  =  Dextrose Saline.</p