Prevalence of Depression in Caregivers of Stroke Patients in Karachi, Pakistan

ABSTRACT Background and Objective: Caregivers of patients with chronic debilitating illnesses are at risk of developing mental health problems. The objective of this study is to determine the frequency of depression in caregivers of stroke patients at a tertiary care teaching hospital in Karachi, Pakistan. Methods: A cross-sectional study was conducted among caregivers of stroke, who were recruited from the Aga Khan University Hospital between January 2018 to October 2018. Data was collected through the Urdu Hamilton rating scale for depression (HAM-D-U) and it was analyzed using descriptive and inferential statistics. Results: A total of 136 caregivers participated in the study. Among them, 44.1 % were male and 55.9% were female. The mean age of caregivers was 45.38 ± 10.33 years. Using the HAM-D-U scale, depression was present in 64 (47.1%) of caregivers. Out of them (n=64), 46 (33.8%) had mild depression whereas 18 (13.2%) had moderate depression. Depression was found to have a significant relationship with the age of the patient (p=0.002), education level of caregiver (p= 0.012), employment status of caregiver (p=0.012), being a sole caregiver (p=0.039), and monthly family income (p=0.016). Conclusion: Caring for patients with neurological disorders is highly challenging and demanding. The need for this role may arise unexpectedly in one’s life leaving little space for adjustment and coping. Caregiver depression can be debilitating especially if moderate to severe in intensity. Depression in stroke caregivers can be missed as patients are the center of management . Hence, strategies should be designed and reinforced to screen caregivers for depression with a pathway for easy and timely referral

Catatonia in The General Hospital: A Case Series Wading Through Diagnostic & Management Challenges

ABSTRACT Catatonia is a cluster of affective, behavioral, and motor symptoms. Its causes are multifactorial ranging from severe and untreated psychiatric illnesses to neurological diseases and other general medical conditions. It is estimated that 20% of catatonia causes are due to medical conditions out of which two thirds are due to an underlying neurological condition which might include encephalitis, neural injury, developmental disorders, structural brain pathology, or seizures. Symptoms of catatonia can wax and wane, fluctuating between the retarded and the excited type within hours making it more difficult to identify and diagnose. If left untreated, catatonia can lead to multiple medical complications which can lead to significant long-term morbidity and mortality. The initial complications include dehydration, malnourishment, electrolyte imbalance, deep venous thrombosis, pulmonary embolism, pneumonia, urinary tract infection, and retention. In the long run, patients can have sepsis, rhabdomyolysis, DIC, decubitus ulcers, arrhythmia, renal failure, and liver dysfunction. This article will describe three patients (adolescent & adult) that presented to Aga Khan University Hospital (AKUH), Karachi with challenging presentations of catatonia. Their diagnostic and management difficulties will be discussed

31st Annual Meeting and Associated Programs of the Society for Immunotherapy of Cancer (SITC 2016) : part two

Background The immunological escape of tumors represents one of the main ob- stacles to the treatment of malignancies. The blockade of PD-1 or CTLA-4 receptors represented a milestone in the history of immunotherapy. However, immune checkpoint inhibitors seem to be effective in specific cohorts of patients. It has been proposed that their efficacy relies on the presence of an immunological response. Thus, we hypothesized that disruption of the PD-L1/PD-1 axis would synergize with our oncolytic vaccine platform PeptiCRAd. Methods We used murine B16OVA in vivo tumor models and flow cytometry analysis to investigate the immunological background. Results First, we found that high-burden B16OVA tumors were refractory to combination immunotherapy. However, with a more aggressive schedule, tumors with a lower burden were more susceptible to the combination of PeptiCRAd and PD-L1 blockade. The therapy signifi- cantly increased the median survival of mice (Fig. 7). Interestingly, the reduced growth of contralaterally injected B16F10 cells sug- gested the presence of a long lasting immunological memory also against non-targeted antigens. Concerning the functional state of tumor infiltrating lymphocytes (TILs), we found that all the immune therapies would enhance the percentage of activated (PD-1pos TIM- 3neg) T lymphocytes and reduce the amount of exhausted (PD-1pos TIM-3pos) cells compared to placebo. As expected, we found that PeptiCRAd monotherapy could increase the number of antigen spe- cific CD8+ T cells compared to other treatments. However, only the combination with PD-L1 blockade could significantly increase the ra- tio between activated and exhausted pentamer positive cells (p= 0.0058), suggesting that by disrupting the PD-1/PD-L1 axis we could decrease the amount of dysfunctional antigen specific T cells. We ob- served that the anatomical location deeply influenced the state of CD4+ and CD8+ T lymphocytes. In fact, TIM-3 expression was in- creased by 2 fold on TILs compared to splenic and lymphoid T cells. In the CD8+ compartment, the expression of PD-1 on the surface seemed to be restricted to the tumor micro-environment, while CD4 + T cells had a high expression of PD-1 also in lymphoid organs. Interestingly, we found that the levels of PD-1 were significantly higher on CD8+ T cells than on CD4+ T cells into the tumor micro- environment (p < 0.0001). Conclusions In conclusion, we demonstrated that the efficacy of immune check- point inhibitors might be strongly enhanced by their combination with cancer vaccines. PeptiCRAd was able to increase the number of antigen-specific T cells and PD-L1 blockade prevented their exhaus- tion, resulting in long-lasting immunological memory and increased median survival

Cultural considerations in providing trauma care to female, childhood sexual abuse survivors: Experiences from Pakistan

Abuse is associated with short and long term psychiatric consequences. There is a need to develop more culturally competent treatment, especially in the South Asian context. We present an account of our clinical experience with hospital-based therapeutic strategies that we found to be successful in a largely conservative, developing country

Initiating psychiatry teleclinics during the COVID-19 pandemic in a tertiary care hospital in Karachi, Pakistan

The COVID-19 pandemic has overwhelmed hospitals all over the world. To reduce the risk of transmission of COVID-19 and meet the increasing mental health demands due to this trauma, psychiatry outpatient services have gone online in various countries. We describe steps taken at a tertiary care hospital in Karachi, Pakistan, to start these services during this pandemic. We also discuss the obstacles faced. (PsycInfo Database Record (c) 2020 APA, all rights reserved)

An overview of autism: is it treatable in Pakistan?

Autism Spectrum Disorder (ASD) is a clinically complex, pervasive neurodevelopmental disorder with early appearing social communication deficits and repetitive sensory–motor behaviors.1 Although affected individuals differ significantly from one another, typically the disorder is characterized by impairment in social reciprocity and communication. Children usually have speech delays or lack of social interaction including: lack of eye contact, limited response to name, decreased interest in peers, and restricted shared attention with parents.1 Autistic individuals also exhibit repetitive behaviors like flapping, lining, or stacking objects and narrowly focused rigid interests such as paying particular attention to spinning objects.1 It usually manifests before 3 years of age and has a male predominance.2 Unavailability of reliable biomarkers makes it a purely clinical diagnosis3 and interestingly social skills impairment and inflexible behaviors are universally present in autistic children from different ethnic, social and cultural backgrounds including those diagnosed in Pakistan

Psychiatric Manifestations of Dengue Fever- A Case Report from Pakistan

A 29-year-old male presented to Aga Khan University Hospital with complaints of fever, body-aches, vomiting and one episode of gum bleeding. A Dengue antigen test done prior to presentation was positive. He was admitted for medical management. During hospital stay, the patient developed manic symptoms including over-talkativeness, expansive mood, disinhibited behavior, excessive planning, paranoia and aggression. He remained oriented to time, place and person and neurological examination was unremarkable. He was managed with anti-psychotics and benzodiazepines, and his psychiatric symptoms improved with improvement in his medical condition. This case highlights the possibility of psychiatric manifestations occurring in context of a dengue infection

Experiences from implementing an Lessons from teaching psychiatry trainees at a tertiary care hospital in Karachi, Pakistan

Early childhood trauma can have adverse effects on brain development. This results in higher rates of mental health and medical problems in adults. Unfortunately, psychiatry trainees are not adequately trained in dealing with trauma survivors. Hence, we implemented an online trauma curriculum and assessed its efficacy. Socratic methods of teaching, flipped classroom approach, brainstorming, role play, and case-based discussions were utilized. Participants were able to exhibit good knowledge and clinical skills as assessed through summative assessment and communication skills assessment. This curriculum showed online training can help with clinical skill development along with improving knowledge when dealing with trauma survivors

A need for trauma informed care curriculum: Experiences from Pakistan

Trauma is a major global health problem. Currently a trauma curriculum, from a psychological perspective, has not been uniformly incorporated in medical education. Nonetheless, professionals from various medical disciplines have an integral role in providing trauma care to survivors. The current COVID-19 pandemic only underscores the relevance and urgent need of this training, as studies show an uptick in mental health disorders due to this trauma. This article will present a discussion on the need for trauma curriculum for health care professionals, using information gained through trauma informed care workshops for healthcare personnel at Aga Khan University Hospital Pakistan

Caregiver strain and its associated factors in autism spectrum disorder in Karachi, Pakistan

Objective: To determine the frequency of caregiver strain and its associated factors in Autism Spectrum Disorder (ASD) at a tertiary care teaching hospital in Karachi, Pakistan. Study design: An analytical cross-sectional study. Place and Duration of the Study: Psychiatry inpatient and outpatient units at The Aga Khan University Hospital, Karachi, Pakistan, from December 2018 to December 2019. Methodology: The study participants were caregivers of ASD. Data were collected from the inpatient and outpatient departments using Caregiver Strain Questionnaire (CGSQ), and a demographic questionnare. Data were analysed using descriptive and inferential analysis. Results: A total of 76 caregivers participated in the study. Among them, 61 (80.3%) were females and 15 (19.7%) were males, with mean age of 37.09±6.91 years. The overall caregiver strain (both subjective and objective) was reported to be severe by 11.8%, moderate by 47.4% and low by 40.8%. About 50% of the participants had a low objective strain on CGSQ whereas 59.2% of the participants subjectively felt the strain to be at moderate level. An association was found between the gender of the participants and subjective strain (p=0.016), and gender with internalised subjective strain (p =0.002). Conclusion: Parenting of a child with ASD involves challenges and demands support. This study supports the recommendation that the caregivers need access to appropriate means to channelize their strain and manage their role productively