Post-traumatic stress disorder and its predictors in emergency medical service personnel: A cross-sectional study from Karachi, Pakistan

Background: Emergency medical service (EMS) personnel who work to provide emergency medical care at the scene and during transportation are exposed to various kinds of stressors and are particularly susceptible to developing stress-reactions. This study assesses symptoms of post-traumatic stress disorder and its predictors among the personnel of a selected EMS in Karachi, Pakistan.Methods: Data were gathered from 518 personnel working in an EMS setting from February to May 2014. Participants were screened for post-traumatic stress symptoms using the Impact of Event Scale-Revised (IES-R). Demographic and work-related characteristics, coping styles and the social support systems of the participants were assessed. Linear regression was used on the IES-R to identify predictors of post-traumatic stress symptoms.Results: The mean score of the IES-R was 23.9 ± 12.1. EMS personnel with a dysfunctional coping style (β = 0.67 CI 0.39 – 0.95), anxiety, and depression (β = 0.64 CI 0.52 – 0.75) were more likely to have increased severity of post-traumatic stress symptoms. Age was found to have an inverse relationship with stress symptoms (β = −0.17 CI 0.33 – -0.023), indicating the susceptibility of younger EMS personnel to stress.Conclusion: The EMS personnel in this setting were found to have a moderate level of post-traumatic stress symptoms. The significant predictors of post-traumatic stress symptoms in this EMS population were age, coping style, and levels of anxiety and depression. These predicting factors can be a potential avenue for interventions to improve the mental health of these frontline workers

Understanding unintentional childhood home injuries: pilot surveillance data from Karachi, Pakistan

<p>Abstract</p> <p>Background</p> <p>Childhood injuries, an important public health issue, globally affects more than 95% of children living in low-and middle-income countries. The objective of this study is to describe the epidemiology of childhood unintentional injuries in Karachi, Pakistan with a specific focus on those occurring within the home environment.</p> <p>Methods</p> <p>This was a secondary analysis of a childhood unintentional injury surveillance database setup in the emergency department of the Aga Khan Hospital, Karachi, Pakistan for 3 months. The data was collected by interviewing caretakers of children under 12 years of age presenting with an unintentional injury to the emergency departments of the four major tertiary care hospitals of Karachi, Pakistan.</p> <p>Results</p> <p>The surveillance included 566 injured children of which 409 (72%) injuries had taken place at/around home. Of 409 children, 66% were males and mostly between 5 and 11 years of age. Injuries commonly occurred during play time (51%). Fall (59%), dog bites (11%) and burns (9%) were the commonest mechanisms of injury. The majority of the children (78%) were directly discharged from the emergency room with predicted short term disability (42%). There were 2 deaths in the emergency department both due to falls.</p> <p>Conclusion</p> <p>Childhood injury surveillance system provides valuable in-depth information on child injuries. The majority of these unintentional childhood injuries occur at home; with falls, dog bites and burns being the most common types of unintentional childhood home injuries. Specific surveillance systems for child injuries can provide new and valuable information for countries like Pakistan.</p

Analysis of Petri Net Models through Stochastic Differential Equations

It is well known, mainly because of the work of Kurtz, that density dependent Markov chains can be approximated by sets of ordinary differential equations (ODEs) when their indexing parameter grows very large. This approximation cannot capture the stochastic nature of the process and, consequently, it can provide an erroneous view of the behavior of the Markov chain if the indexing parameter is not sufficiently high. Important phenomena that cannot be revealed include non-negligible variance and bi-modal population distributions. A less-known approximation proposed by Kurtz applies stochastic differential equations (SDEs) and provides information about the stochastic nature of the process. In this paper we apply and extend this diffusion approximation to study stochastic Petri nets. We identify a class of nets whose underlying stochastic process is a density dependent Markov chain whose indexing parameter is a multiplicative constant which identifies the population level expressed by the initial marking and we provide means to automatically construct the associated set of SDEs. Since the diffusion approximation of Kurtz considers the process only up to the time when it first exits an open interval, we extend the approximation by a machinery that mimics the behavior of the Markov chain at the boundary and allows thus to apply the approach to a wider set of problems. The resulting process is of the jump-diffusion type. We illustrate by examples that the jump-diffusion approximation which extends to bounded domains can be much more informative than that based on ODEs as it can provide accurate quantity distributions even when they are multi-modal and even for relatively small population levels. Moreover, we show that the method is faster than simulating the original Markov chain

Efficacy of Thermotherapy to Treat Cutaneous Leishmaniasis Caused by Leishmania tropica in Kabul, Afghanistan: A Randomized, Controlled Trial

BACKGROUND: Pentavalent antimony is the agent recommended for treatment of cutaneous leishmaniasis (CL). Its use is problematic, because it is expensive and because of the potential for drug-associated adverse effects during a lengthy and painful treatment course. METHODS: We tested the efficacy of thermotherapy for the treatment of CL due to Leishmania tropica in a randomized, controlled trial in Kabul, Afghanistan. We enrolled 401 patients with a single CL lesion and administered thermotherapy using radio-frequency waves (1 treatment of ≥1 consecutive application at 50°C for 30 s) or sodium stibogluconate (SSG), administered either intralesionally (a total of 5 injections of 25 mL every 57 days, depending on lesion size) or intramuscularly (20 mg/kg daily for 21 days). RESULTS: Cure, defined as complete reepithelialization at 100 days after treatment initiation, was observed in 75 (69.4%) of 108 patients who received thermotherapy, 70 (75.3%) of 93 patients who received intralesional SSG, and 26 (44.8%) of 58 patients who received intramuscular SSG. The OR for cure with thermotherapy was 2.80 (95% confidence interval [CI], 1.455.41), compared with intramuscular SSG treatment (P = .002). No statistically significant difference was observed in the odds of cure in comparison of intralesional SSG and thermotherapy treatments. The OR for cure with intralesional SSG treatment was 3.75 (95% CI, 1.867.54), compared with intramuscular SSG treatment (P 100 days, respectively; P = .003). CONCLUSIONS: Thermotherapy is an effective, comparatively well-tolerated, and rapid treatment for CL, and it should be considered as an alternative to antimony treatment

ADVERSE EFFECTS AND SIDE EFFECTS ON VITAMIN THERAPY: A REVIEW

Vitamins are essential to our day to day life. Its shortage in our body can cause many disorders, decreased enzyme activities also affects the genetic factors. Vitamins should be supplied through the diet in the required amount. If it is not supplied properly, vitamin tablets will be prescribed. And also vitamin tablets are the co-medication for therapies like anticancer, anti tubercular, anti viral anti HIV treatments. Many news papers reported that vitamin therapies are causing major health problems like nephro/ urolithiasis, it can increases mortality rates in smokers by increasing the risk of lung cancer, it can cause abortion when it is taken during pregnancy. Thus here we reviewed the adverse effects of vitamin therapy from various reported cases, books, instructions provided from various health organizations and also news papers and magazines. It can help health professionals to control and monitor the vitamin therapies and make awareness about the adverse effects and possible side effects of regular vitamin uptake to society

Rancangan Destination Brandingkabupaten Sinjai, Sulawesi Selatan

Kabupaten Sinjai belum memiliki branding khusus pariwisata sehingga dibutuhkan rancangan destination branding yang dapat menjadi alat promosi destinasi. Tujuan penelitian ini adalah 1) untuk mengetahui potensi pariwisata Kabupaten Sinjai; 2) untuk mengusulkan konsep perancangan destination branding Kabupaten Sinjai. Penelitian ini menerapkan pendekatan deskriptif kualitatif dengan pengumpulan data melalui wawancara, observasi dan penyebaran angket (kuesioner) yang dilakukan pada bulan September 2018. Hasil penelitian menunjukkan bahwa Kabupaten Sinjai memiliki potensi wisata alam dan budaya dan dibutuhkan cara untuk memperkenalkan potensi tersebut, salah satunya melalui rancangan branding destinasi. Setelah melakukan beberapa tahapan dalam destination branding, hasil penelitian menunjukkan bahwa ikon yang sesuai untuk dijadikan brand pariwisata untuk Kabupaten Sinjai adalah kuda dengan hasil persentase sebesar 72,7% dan keindahan alam yang dimiliki yang mencakup 3 dimensi. Penelitian ini merekomendasikan pentingnya menerapkan rancangan branding yang telah dilakukan hingga tahap interpretasi potensi serta value&nbsp; yang dimiliki Kabupaten Sinjai menjadi suatu brand. Selanjutnya, diharapkan agar melanjutkan ke tahap berikutnya yaitu menggunakan brand yang ada sebagai bahan promosi dan menarik wisatawan melalui brand tersebut. Kajian lanjutan sangat dibutuhkan khususnya yang berkaitan dengan bagaimana implementasi brand destinasi Sinjai yang diusulkan.