Incidence Of Panic Attacks In Patients Presenting To The Emergency Department Of A Tertiary Care Hospital In Karachi,Pakistan

Background: The DSM-IV outlines a panic attack as a distinct period of intense fear or discomfort which is accompanied by a minimum of 4 out of 13 listed somatic or cognitive symptoms. This is often associated with a sense of impending doom and the urge to escape which may leave ones psychological and physical functioning impaired. These are all signs of several Anxiety disorders. The aim of the study is to investigate the incidence of Panic attacks amongst patients presenting to an Emergency Department in a tertiary care hospital of Karachi, Pakistan. Methods: This cross-sectional study was conducted at the Emergency Department, Ziauddin University Hospital Clifton. Patients included in the study were those who had no previous co-morbid or psychiatric disorders except for Panic attacks, and who displayed a minimum of four signs for a Panic attack according to the DSM -4 criteria of Panic attacks. Patients included in the study were between the ages of 15-50 years. The total sample size fitting the aforementioned requirements came to 1506 patients. Results: The prevalence of Panic attacks amongst patients in the Emergency Department was an astonishing 9.49%. Division according to sex demonstrated a female predominance at 62.9% while males made up 37.1% of the total. The age group which was most effected was 30-34 years of age. Variation with relevance to time of day displayed that 44.8% of cases presented in the night time followed by evening and morning. Conclusion: It is evident that Panic attacks are a common finding amongst patients in an Emergency Department, be it due to new onset Panic Disorder, social phobias or other causes .Keeping the prevalence of mental disorders in mind, specifically Anxiety Disorders of which Panic attacks are a subset, further research into the causes, immediate and comparatively effective treatment needs to be done as well as emphasis on accurate diagnosis at the primary care level. Key Words: Panic attack, Anxiety, Emergency Department, prevalence, Pakistan, DSM-I

Automated Versus Manual Blood Pressure Measurement: A Randomized Crossover Trial in the Emergency Department of a Tertiary Care Hospital in Karachi, Pakistan: Are Third World Countries Ready for the Change?

BACKGROUND: Hypertension has proven to be a strong liability with 13.5% of all mortality worldwide being attributed to elevated blood pressures in 2001. An accurate blood pressure measurement lies at the crux of an appropriate diagnosis. Despite the mercury sphygmomanometer being the gold standard, the ongoing deliberation as to whether mercury sphygmomanometers should be replaced with the automated oscillometric devices stems from the risk mercury poses to the environment.AIM: This study was performed to check the validity of automated oscillometric blood pressure measurements as compared to the manual blood pressure measurements in Karachi, Pakistan.MATERIAL AND METHODS: Blood pressure was recorded in 200 individuals aged 15 and above using both, an automated oscillometric blood pressure device (Dinamap Procare 100) and a manual mercury sphygmomanometer concomitantly. Two nurses were assigned to each patient and the device, arm for taking the reading and nurses were randomly determined. SPSS version 20 was used for analysis. Mean and standard deviation of the systolic and diastolic measurements from each modality were compared to each other and P values of 0.05 or less were considered to be significant. Validation criteria of British Hypertension Society (BHS) and the US Association for the Advancement of Medical Instrumentation (AAMI) were used. RESULTS: Two hundred patients were included. The mean of the difference of systolic was 8.54 ± 9.38 while the mean of the difference of diastolic was 4.21 ± 7.88. Patients were further divided into three groups of different systolic blood pressure <= 120, > 120 to = 150 and > 150, their means were 6.27 ± 8.39 (p-value 0.175), 8.91 ± 8.96 (p-value 0.004) and 10.98 ± 10.49 (p-value 0.001) respectively. In our study 89 patients were previously diagnosed with hypertension; their difference of mean systolic was 9.43 ± 9.89 (p-value 0.000) and difference of mean diastolic was 4.26 ± 7.35 (p-value 0.000).CONCLUSIONS: Systolic readings from a previously validated device are not reliable when used in the ER and they show a higher degree of incongruency and inaccuracy when they are used outside validation settings. Also, readings from the right arm tend to be more precise

Impact of diabetes-related knowledge and medication adherence on quality of life among type 2 diabetes patients in a tertiary health facility in Multan, Pakistan

Purpose: To assess the impact of drug adherence and diabetes-related knowledge on the quality of life (QoL) of type 2 diabetes patients in a hospital in Pakistan.Methods: A cross-sectional study was conducted in City Hospital, Multan, Pakistan between March and September 2020. A total of 151 patients diagnosed with type 2 diabetes mellitus (T2DM) were recruited. Medication adherence, diabetes-related knowledge, and QoL were assessed by Drug attitude inventory-10 (DAI-10), the Michigan Diabetes Knowledge Test (MDKT), and EQ-5D-3L tools, respectively. The association between sociodemographic data and study variables was assessed by independent t-test and one-way ANOVA.Results: Among the 151 patients, 53 % were males. The mean MDKT score was 0.33 ± 0.18, indicating poor knowledge of diabetes. An overall moderate level of adherence was observed among the participants (mean adherence score, 6.14 ± 1.39). Mean QoL score was 1.31 ± 0.28, and the Visual Analog Scale score (VAS) was 59.6 ± 12.21, indicating a good to moderate QoL among the study participants. Study participants with a longer duration of diabetes and poor adherence to their medications showed poor QoL (p = 0.01, p = 0.004 respectively).Conclusion: Overall, the patients reported poor knowledge, moderate adherence, and good to moderate QoL. Moreover, patients with poor adherence to medication, longer duration of diabetes, and poorly controlled HbA1c showed poor QoL

Role of Repeat Transurethral Resection of Bladder Tumours after Primary Resection: A Retrospective Cross-sectional Study

Introduction: Bladder Cancer (BC) is the second most common cancer of the urinary tract. Initial treatment by Transurethral Resection of Bladder Tumour (TURBT) helps guide treatment. In High Grade (HG) and invasive cancers, improved staging is achieved by performing a repeat (rTURBT). Aim: To examine the outcome, residual disease, complications, outcomes and quality of procedure of repeat TURBTs at the study tertiary center. Materials and Methods: This was a retrospective study conducted at the Department of Urology in Government Medical College, Srinagar, Jammu and Kashmir, India between October 2018 and December 2019. A total of 123 TURBT’s were performed during the study period, of which 34 were repeat TURBT’s. Case records were examined for each of these patients. Student t-test and Chi-square tests were used to compare data sets. Results: Data was complete for 30 out of 34 patients. There was residual disease in 12 (40%) patients. Upstaging was seen in 2/12 (17%) of patients, down-staging in 0/12, and same stage in 10/12 patients (83%). No disease was seen in 18/30 (60%) of patients. No major surgical complications occurred. In 12 patients of non-invasive, High Grade (HG) tumours, who underwent rTURBTs, 6 (50%) were found to have residual disease. Conclusion: rTURBTs should be performed in all patients with high-grade or T1 tumours. Further studies are required to analyse risk-factors for residual disease which may narrow the indications of rTURBT, thus saving time and costs, and reducing need for an additional procedure

Microalbuminuria as a marker for prediction of early mortality in acute STEMI

Background: Microalbuminuria is gaining recognition as a simple and inexpensive marker in predicting cardiovascular mortality and CVD events, independent of traditional risk factors. Microalbuminuria associated with acute MI is attributed to a systemic increase in vascular permeability, including renal vasculature, as part of early anti inflammatory process which accompanies MI. Objectives: To examine whether and how long microalbuminuria increases after acute MI and to report on the predictive power of microalbuminuria for early mortality in these subjects. Methods: OF 175 patients studied, 110 patients had STEMI, 44 had NSTEMI and 21 had unstable angina. Patients having STEMI were taken a study group while patients having NSTEMI and unstable angina were taken as control group. Urinary albumin excretion level (UAEL) was assessed in three sport urinary samples performed on the 1st, 3rd and 7th day. Method used was MICRAL dipstick test. UAEL was expressed in mg/l. Patients with UAEL 20 – 100 mg/l were said to have microalbuminuria. Results: our results showed a marked increase in UAEL in acute phase of STEMI. After an initial rise, urinary albumin levels progressively fell towards normal during the week after admission to the hospital. Significantly elevated UAEL was observed in 52% of STEMI patients especially on day 1 (p=0.000), the subsequent level of UAEL on day 3 (p = 0.384) and day 7 (p = 0.840) equated in proportion to insignificance. Mortality was eventful due to elevated UAEL on day 1, 3 &7 respectively, difference was significant all through (p = 0.001, 0.000, 0.005) respectively. Conclusions: The measurement of UAEL is inexpensive, readily available prognostic index in patients with STEMI. Moreover, UAEL < 20mg/l in the initial days of MI is associated with a low mortality and these patients can be early discharged from hospital

Intravesical explosion during transurethral resection of prostate: Prevention and management

The blast during transurethral surgery is a rare but known complication of transurethral resection of prostate (TURP) or transurethral resection of bladder tumors. It may lead to bladder rupture, which can be either extra- or intra-peritoneal requiring urgent laparotomy. It occurs due to the generation and trapping of explosive gases under the dome of the bladder. Even though this complication is rare, but the morbidity associated with this complication is high. Here, we present an interesting case report of an intravesical explosion during TURP leading to bladder rupture to remind urologists of this rare complication with suggestions on how to manage and prevent this complication

Soil organic carbon pools and carbon management index under different land use systems in North western Himalayas

Current study was conducted to evaluate the effect of important land uses and soil depth on soil organic carbon pools viz. total organic carbon, Walkley and black carbon, labile organic carbon, particulate organic carbon, microbial biomass carbon and carbon management index (CMI) in the north Western Himalayas, India. Soil samples from five different land uses viz. forest, pasture, apple, saffron and paddy-oilseed were collected up to a depth of 1 m (0–30, 30–60, 60–90 cm). The results revealed that regardless of soil depth, all the carbon pools differed significantly (p < 0.05) among studied land use systems with maximum values observed under forest soils and lowest under paddy-oilseed soils. Further, upon evaluating the impact of soil depth, a significant (p < 0.05) decline and variation in all the carbon pools was observed with maximum values recorded in surface (0–30 cm) soils and least in sub-surface (60–90 cm) layers. CMI was higher in forest soils and lowest in paddy-oilseed. From regression analysis, a positive significant association (high R-squared values) between CMI and soil organic carbon pools was also observed at all three depths. Therefore, land use changes and soil depth had a significant impact on soil organic carbon pools and eventually on CMI, which is used as deterioration indicator or soil carbon rehabilitation that influences the universal goal of sustainability in the long run