Clinical manifestations and outcome of patients with primary amoebic meningoencephalitis in Pakistan. A single-center experience.

Primary amoebic meningoencephalitis (PAM) is a rapidly progressing central nervous system (CNS) infection caused by Naegleria fowleri, a free-living amoeba found in warm freshwater. The disease progression is very rapid, and the outcome is nearly always fatal. We aim to describe the disease course in patients admitted with PAM in a tertiary care center in Karachi, Pakistan between the periods of 2010 to 2021. A total of 39 patients were included in the study, 33 males (84.6%). The median age of the patients was 34 years. The most frequent presenting complaint was fever, which was found in 37 patients (94.9%) followed by headache in 28 patients (71.8%), nausea and vomiting in 27 patients (69.2%), and seizures in 10 patients (25.6%). Overall, 39 patients underwent lumbar puncture, 27 patients (69.2%) had a positive motile trophozoites on CSF wet preparation microscopy, 18 patients (46.2%) had a positive culture, and 10 patients had a positive PCR. CSF analysis resembled bacterial meningitis with elevated white blood cell counts with predominantly neutrophils (median, 3000 [range, 1350-7500] cells/µL), low glucose levels median, 14 [range, 1-92] mg/dL), and elevated protein levels (median, 344 [range, 289-405] mg/dL). Imaging results were abnormal in approximately three-fourths of the patients which included cerebral edema (66.7%), hydrocephalus (25.6%), and cerebral infarctions (12.8%). Only one patient survived. PAM is a fatal illness with limited treatment success. Early diagnosis and prompt initiation of treatment can improve the survival of the patients and reduce mortality.

Angiographic profile and outcomes of Pakistani women with ST elevation myocardial infarction.

OBJECTIVE: To evaluate the angiographic profile and outcome of primary percutaneous coronary intervention in female patients with acute myocardial infarction. METHODS: The cross-sectional study was conducted at the National Institute of Cardiovascular Diseases, Karachi, from July 1, 2017, to March 31, 2018, and comprised of female patients presenting with acute myocardial infarction who underwent primary percutaneous coronary intervention and got enrolled in the National Cardiovascular Data Registry. Follow-up calls were made 1 year post-intervention and outcomes were noted. Data were analysed using SPSS 21. RESULTS: Of the 522 female patients with a mean age of 57.41±11.14 years, 334(64%) were hypertensive, 202(38.7%) diabetic, 16(3.1%) had a family history of coronary artery disease, and 9(1.7%) were smokers. Single-vessel disease was observed in 183(35.1%) patients, and three-vessel disease in 144(27.6%). Post-procedure thrombolysis in myocardial infarction flow (0-II) was observed in 29(5.6%) patients, bleeding in 2(0.4%), and in-hospital mortality was in 22(4.2%). Telephonic follow-up was successfully conducted in 436(87.5%) of the discharged patients, and, of them 15(3.4%) had expired and recurrence was reported by 10(2.3%) patients and 8(80%) of them underwent re-intervention. CONCLUSIONS: More than half the female patients had multi-vessel disease and bifurcation lesion was observed in more than three-fourth of the sample.

Acute ST-Elevation Myocardial Infarction Before and During the COVID-19 Pandemic: What is the Clinically Significant Difference?

Background In the current coronavirus disease-2019 (COVID-19) pandemic, the pattern of hospital admissions for acute ST-elevation myocardial infarction (STEMI) is changing, and increased mortality and morbidity is being noted in these patients. Cardiac manifestations of COVID-19 are complex and include STEMI, myocarditis, myocardial injury, and cardiomyopathy. The objective of our study was to compare the data of patients with STEMI presenting in COVID-19 versus the non-COVID-19 era.  Methods We analyzed the clinical and angiographic characteristics of STEMI patients undergoing primary percutaneous coronary intervention (PCI) at our center. The primary outcome variables were admission rate for STEMI, mean total ischemic time (TIT), coronary artery disease burden, mean ejection fraction, and in-hospital mortality for three defined groups. Group A consisted of patients who underwent primary PCI from March through April 2020. Group B included patients who underwent primary PCI from January to February 2020. Group C consisted of patients who underwent primary PCI from March to April 2019. We then compared the data among the three groups and calculated any significant p-value (p<.001). Results In Group A, 1139 patients were admitted for primary PCI. The mean admission rate was 18.6 ± 4.36 admissions per day. There were 1535 patients in Group B and an admission rate of 26.01 ± 4.90 (p<.001 compared to Group A). In Group C, there were 1537 patients and an admission rate of 24.8 ± 4.55 (p<.001, compared to Group A). The mean TIT was 429.25±272.16 minutes for Group A, 359.78±148.04 minutes for Group B, and 346.75±207.31 minutes for Group C (p<.001). A higher mortality rate was noted in Group A (COVID-19 era) versus Group C (non-COVID-19 era; p<.001). Conclusions A lower admission rate, higher TIT, and higher mortality rates were noted in patients with acute STEMI during the COVID-19 pandemic compared to the pre-COVID era. During the COVID-19 pandemic, physicians should bear in mind that patients with STEMI have increased mortality and morbidity. Where possible, efforts should be made for timely management of these critical patients to decrease mortality.

Acute and sub-acute stent thrombosis: Frequency, predictors and features in patients undergoing primary percutaneous intervention at a tertiary care cardiac centre.

OBJECTIVES: To assess the frequency of early (acute and sub-acute) stent thrombosis (ST) after primary percutaneous coronary intervention (pPCI) and to identify its potential predictors. BACKGROUND: ST is a serious clinical event associated with a high mortality rate. A very limited data are available regarding the incidence rate of early ST after pPCI and its predictors, especially for Pakistani population. METHODS: Study included consecutive patients who underwent primary PCI. Telephonic follow-ups were made to obtain 30-days outcomes including ST, mortality, and re-occurrence of symptoms. ST was defined as per the standardized definition proposed by the Academic Research Consortium and classified as acute (during the procedure) and sub-acute (within 30 days). RESULTS: A total of 569 patients were included with 80.5% (485) male patients. The stent thrombosis (acute or sub-acute) was observed in 33 (5.8%) patients out of which 3 (9.1%) were definite ST while remaining 30 (90.9%) were probable ST. Patients who develop ST were predominantly male, hypertensive, diabetic, with reduced pre PCI LVEF (%) and Killip Class. A significantly higher in-hospital mortality rate was observed in patients with ST as compared to without ST, 36.4% (12/33) vs. 0.2% (1/536); p-value < 0.001 respectively. Killip Class (III-IV) was found to be the independent predictor of ST with an adjusted odds ratio of 5.2 [1.76-15.32]. CONCLUSIONS: Early stent thrombosis (ST) is relatively frequent in patients undergoing primary PCI. Diabetic and hypertensive patients are at an increased risk of ST and presentation of patients in Killip Class III-IV is an independent predictor of early ST.

An exploratory research on the role of family in youth's drug addiction.

Most of the researches in Pakistan are concerned with the aetiological factors of drug addiction among the youth. However, few studies seek to explore the social aspects of this phenomenon. The present study aimed to explore the role of family, the influence of parental involvement, and communication styles in youth's drug addiction in a qualitative manner. Twenty drug addicts (age range 18-28 years) were taken as a sample from drug rehabilitation centres in Rawalpindi and Islamabad, Pakistan. A structured interview guide was administered comprising questions related to the individual's habits, relationship with family and friends, and modes of communication within the family. Case profiles of the participants were also taken. The rehabilitation centres offered family therapy and the researcher, as a non-participant, observed these sessions as part of the analysis. The demographic information revealed that majority of the participants were poly-substance abusers (80%) and the significant reasons for starting drugs were the company of peers and curiosity. The thematic analysis revealed parental involvement and emotional expressiveness as two major components in family communication. It was found that parents were concerned about their children, but were not assertive in the implementation of family rules. It was also found that the major life decisions of the participants were taken by their parents, which is a characteristic of collectivist Pakistani society.

Attitudes about honour killing among men and women--perspective from Islamabad.

BACKGROUND: The concept of honour has cultural, social and moral underpinnings that determine its expression and perseveration. Women are viewed as the bearers of family honour with chastity equated with abstinence from premarital or extramarital relationships and obeying norms determined and dictated by traditions and societies. The objective of this study was to determine the opinions of men and women pertaining to killing in the name of and saving one's honour. METHODS: A cross-sectional survey with convenience sampling was conducted among the 18 years and older (range 18-71) men and women. Respondents were approached in markets, bus-stops, hospitals, and various other public places in Islamabad from April 12th to June 27th 2006. A structured, interviewer-administered, and pretested questionnaire was used with both open and close-ended questions on demographics and attitudes about honour killing based on a vignette that was slowly read out in Urdu, in a neutral and judgment-free tone of voice to potential respondents. Responses to close-ended questions based on the vignette provided, and pattern among men and women were compared using Pearson Chi-square test to determine associations between the dichotomous variables and gender, while responses to one open-ended question were summarised based on the observed similarities and bivariate associations with gender were determined. RESULTS: We approached 630 conveniently selected individuals at various public places in the city of Islamabad. Six hundred and one agreed to participate and completed the questionnaire, i.e., the response rate was 95.4%. Three hundred and seven respondents were male (51.1%), and 294 (48.9%) were females. Three hundred forty-three 343 (57.1%) respondents believed that the man in the vignette did the right thing by killing his wife upon finding her in bed with another man. Divorcing one's wife rather than resorting to killings, after having found her with another man was approved by 220 (36.6%) respondents, while the rest answered as 'don't know'. CONCLUSION: Majority of men as well as women considered it justifiable and acceptable to kill one's wife as a mean to save one's honour. The most significant finding was the fact that overwhelming number of men and women did not believe in either forgiveness or divorcing one's wife who has engaged in extramarital sexual relationship.

Internet access and utilization for health information among university students in Islamabad.

BACKGROUND: Internet has changed the way we live and work. Advent of this technology has fundamentally transformed our lives the way invention of automobile changed how our lives and cities looked and worked before. Practically no information is available on the use of Internet for health by the people of Pakistan. The Objectives of the study were to assess the access and utilization pattern of Internet by university students in Islamabad, with emphasis on the healthcare information seeking. METHODS: An anonymous, self-administered, and pre-tested questionnaire with questions on the access, and usage pattern of Internet, seeking health care information online, and belief about reliability of such information; was distributed to only those students who were enrolled in masters or higher degree programs. RESULTS: A total of 600 students were approached and 598 (99.7%) completed the questionnaires. The mean age of students was 23.5 years (range 19-40). The majority of students (423) were enrolled in masters program. Four hundred and sixty-eight students (78.26%) students had access to the computer either at home or at their university hostel. While 304 (50.84%) students had Internet access at home or in their university hostel. Out of 304 students who reported having access to Internet in the past three months, one hundred and thirty-nine (43.4%) students replied affirmatively to the question of having used Internet for seeking health care information. And 109 (78.4%) thought that such information was reliable. Out of 139 students who had used Internet for seeking health information, 35 (25.2%) students replied affirmatively to the question of having discussed health information obtained from Internet with their doctor/physician whom they visited for any illness/treatment. CONCLUSION: Majority of Islamabad university students in this study had access to computer and Internet. Young and healthy state of this educated age group perhaps accounts for limited use of Internet for seeking healthcare related information. However, high reliability of Internet obtained health information needs to be further studied in terms of websites utilized for seeking such information.

Prescribing privileges for psychologists among university students in Islamabad.

Psychologists as part of a team, make important contributions for the treatment of psychiatric disorders. New Mexico and Louisiana in United States have recently granted prescribing privileges to psychologists who have successfully completed additional training. This study determined the opinions of conveniently selected university students in Islamabad on clinical psychologists being granted similar prescribing privileges after additional training and certification by the Pakistan Medical and Dental Council (PMDC). Four hundred and five students completed the questionnaires; with 51 students enrolled in Psychology departments who were excluded from the reported analysis. One hundred and sixty-five respondents were male (46.6%), and 189 (53.4%) were female. Two hundred and seventy-six (78%) students were enrolled in masters, while the rest in higher degree programme. Cumulatively, 272 (76.8%) students believed that after additional training, clinical psychologists may be allowed to prescribe drugs for the treatment of psychiatric disorders by the PMDC. This viewpoint was reinforced by the act that 264 (74.6%) students replied affirmatively to the question that they would feel comfortable in referring a friend or taking a family member to a clinical psychologist who is trained in prescribing drugs. Results of our study demonstrated that university students in our study were overwhelmingly in favour of prescribing privileges for psychologists in Pakistan. Professional bodies like PMDC and Pakistan Psychological Association need to broach this subject for greater access to psychiatric services in the country.