“Trapped in their Shame”: A Qualitative Investigation of Moral Injury in Forensic Psychiatry Patients

Individuals who engage in criminal behavior for which they are found not criminally responsible (NCR) may be at increased vulnerability to experience moral pain and, in extreme circumstances, moral injury after regaining insight into the consequences of their behavior. Yet, almost no research exists characterizing the nature, severity, or impact of moral pain in this population. Semi-structured interviews were conducted with nine forensic psychiatric patients and 21 of their care providers. Narratives were explored using thematic analysis. Findings demonstrate that NCR patients endorse symptoms consistent with moral injury, including feelings of guilt toward victims, shame for one’s behavior, and a loss of trust in one’s morality. Moral pain is a strong driver of behavior and must be understood as part of a constellation of factors influencing criminality, risk, and recovery. Future research must develop adequate tools to measure and characterize offense-related moral injury to understand its impact on this population

Frequency of iron deficiency anaemia in chronic kidney disease patients not on dialysis

Objective: To determine the frequency of iron deficiency anaemia in non-dialysis chronic kidney disease patients. Method: The observational, cross-sectional study was conducted at the Department of Nephrology, The Kidney Centre Post-Graduate Training Institute, Karachi, from April 27 to October 26, 2018, and comprised adult patients of either gender diagnosed with anaemia and estimated glomerular filtration rate <90ml/min. Patient with transferrin saturation <20% were labelled as having iron deficiency anaemia. Data was analysed using SPSS 21. Results: Of the 366 participants, 185(50.5%) were males and 181(49.5%) were females. The overall mean age was 54.47±14.93 years. The most prevalent comorbid was hypertension 263(71.9%), followed by diabetes mellitus 187(51.1%) and cardiovascular disease 54(14.8%). Besides, 192(52.5%) patients had CKD stage 5 followed by 115(31.4%) and 54(14.8%) with CKD stages 4 and 3, respectively. The mean haemoglobin was 9.17±1.57g/dL. Iron deficiency was found in 285(77.9%) patients. Conclusion: Iron deficiency anaemia was found to be highly prevalent and should be screened routinely and managed appropriately. Key Words: Iron deficiency, Anaemia, Chronic kidney disease

Assessment of nutritional status of hemodialysis patients by subjective global assessment score: a single centre study from Karachi, Pakistan

Objective: Despite being an important predictor of morbidity and mortality, routine screening for malnutrition in dialysis patients is not a common practice in Pakistan. Modified Subjective Global Assessment (SGA) is a convenient, inexpensive and practical method to assess nutritional status particularly in resource limited setup. Methods: This cross sectional study was conducted in The Kidney Center Post Graduate Training institute (TKC-PGTI). Patients on maintenance hemodialysis (MHD) were included through non-probability consecutive sampling. A one-time SGA score was calculated based on the history and physical examinations using modified SGA or Dialysis Malnutrition Score (DMS). Chi square test was applied to find association between variables, while to observe the amount of effect of factors on SGA score; binary logistic regression analysis was run. P value of ? 0.05 considered significant. Results: Mild-Moderately malnourished patients were the most frequent in our study 96(64%).None of patient had severe malnourishment. Females were 2.6 times more prone for malnourishment (p value=0.009). More than 5- years on hemodialysis also increased the risk of malnourishment by 12.5 times (p value <0.001). Overweight patients had 85 % less chance of being malnourished as compare to patients with normal weight (p value=0.004). Conclusion: Malnutrition is quite common in hemodialysis patients, which necessitates its regular assessment and monitoring. There is a need to assess the reasons of more malnourishment in female as compared to male. Similarly, the longer duration (> 5 years) on hemodialysis also need attention for prevention and cure of malnourishment.  Continuous..

Superscan on 18F-FDG PET-CT imaging for lymphoma: how frequent is it?

This retrospective study was conducted to evaluate the frequency of PET superscan in baseline staging scans of lymphoma patients.Thestudy was conducted at theShaukat Khanum Memorial Cancer Hospital, Lahore, from October 1, 2018 to August 31, 2019. A retrospective review of baseline PET-CT scans of 203 lymphoma patients, performed during the period of October 1, 2017 to  August31,2018, was done from the institutional database. Out of these 203 patients, PET superscan pattern was observed in 13 (6.4%) patients, 08 (61.5%) males and 05 (38.5%) females. Eight (61.5%) patients had Non-Hodgkin’s lymphoma, while 05 (38.5%)had Hodgkin’s lymphoma. Based on TNM staging 10 (76.9%) patients had stage IV disease, 01 (07.6%) had stage IIIS disease, and 2 (15.4%) had stage II disease. PET-CT superscan pattern is uncommon and is not dependent on the stage of the disease. It should be recognised in clinical practice as it suggests a poor prognosis. Keywords: PET-CTScan, Lymphoma, 18F-FDG