Relationship of caffeine regimen with osteopenia of prematurity in preterm neonates: a cohort retrospective study.

BACKGROUND: Caffeine is a routinely prescribed pharmacological active compound in neonatal intensive care units (NICU) for treating apnea of prematurity (AOP), which also decreases the risk of bronchopulmonary dysplasia and cerebral palsy in neonates. Caffeine-induced excessive calcium loss can promote the development of metabolic bone disease (MBD) in preterm neonates. This study aimed to evaluate the effect of the caffeine regimen on the development of osteopenia of prematurity (OOP), using serum alkaline phosphatase (serum-ALP) concentrations as a surrogate marker at the 4th week of life. METHODS: This retrospective cohort study was conducted including neonates of < 32 weeks gestational age (GA) and birth weight < 1500 g, admitted to NICU from April-2017 to December-2018 and received caffeine therapy till 28 days of life for AOP. Based on serum-ALP levels, formed the high and low-ALP groups. Neonatal characteristics, caffeine regimen, risk factors for OOP, including duration of parenteral nutrition (PN), exposure to medicines associated with MBD, and intake of essential vitamins and minerals, were compared in both groups. Predictors of OOP were analyzed through logistic regression. RESULTS: From the total of 268 participants, 52 (19%) developed OOP, mostly female (61.5%). In the high ALP group, the serum-ALP levels were significantly higher than in the low-ALP group (725.0 ± 143.8 vs 273.6 ± 55.0 units/L, p < 0.001). The high-ALP group received significantly (p < 0.001) higher daily and cumulative caffeine doses and were associated with a higher likelihood of developing OOP in this study cohort [cumulative dose (mg) (AOR = 1.082 95% CI 1.011 to 1.157) and daily dose (mg/kg/day) (AOR = 2.892 95% CI 1.392 to 6.007)]. Smaller GA was found directly related to OOP. Among the other medical risk factors, phosphorus intake was significantly low in the high-ALP group. No, significant relationship between duration of PN and use of steroids and diuretics, and intake of vitamins and minerals were identified. CONCLUSION: The daily and cumulative doses of caffeine and smaller GA are associated with the development of OOP in this study cohort. Clinical randomized control studies are needed to validate the outcomes and determine the range of safest and most effective caffeine doses for treating AOP in preterm neonates.

Frequency of generalised anxiety disorder and associated factors in an urban settlement of Karachi.

OBJECTIVE: The study was undertaken to find the frequency of Generalised Anxiety Disorder (GAD) along with associated factors in an urban settlement of Karachi. METHOD: A cross-sectional study was conducted at Defence Housing Authority (DHA), a posh area of Karachi. The sample population consisted of residents of ages between 18 and 65. The sample of 420 was completed by randomly going to residences in the DHA area. Self-administered questionnaires were handed out after taking informed consent. General Anxiety Disorder (GAD) 7 scale was used to estimate the anxiety level. The data was entered and analysed using SPSS version 16.0. Pearson's chi-square was used as the primary statistical test. RESULTS: The mean anxiety score of the total individuals selected was 5.1 +/- 3.79. Males reported a mean score of 4.99 +/- 4.01 while females reported a mean score of 5.25 +/- 3.42. A score of 5 is considered as the threshold for anxiety and anything below 5 is considered as normal. Based on this benchmark, out of the total sample size of 420, 211 (50.2%) individuals reported some degree of anxiety. Employment and education status were found to be significantly associated (p = 0.01) with anxiety among the participants. CONCLUSION: Based on the results, the high prevalence of anxiety in one of the most developed areas of Karachi is alarming. For 50.2% of the respondents to have anxiety is high considering the sample chosen represented individuals that were educated and had a high standard of living. The major factors responsible for anxiety cited by respondents were chronic diseases and emotional harm.

Relationship Of Suicide Attempt With Depression And Other Socio-Demographic Factors Among The Transgenders.

BACKGROUND: This study was conducted assess the frequency of suicide attempt among the transgender population and analyse the relationship of depression and other socio-demographic factors with the suicide attempt Cross-sectional study. METHODS: The sample population comprised of one hundred and forty-eight transgender people of Rawalpindi and Islamabad. Suicidal attempt was assessed by the simple question that "Have you ever performed an action with the intent to take your own life in your life time?" Answer of yes or no was recorded. Hamilton rating scale for Depression (HAM-D) was used to look for the presence of depression among the target population. Relationship of the age, smoking, family income, illicit substance use and depression was studied with the presence of suicidal attempt among these transgender population of twin cities of Pakistan. RESULTS: A total of 148 transgender people were included in the final analysis. Mean age of the study participants was 38.24±3.18. Out of these, 70.9% had no suicidal attempt in their whole life while 29.1% had one or more suicidal attempts during the course of their life. Twelve had more than one suicidal attempt while 19 had attempt in last one year. Fifty-five did not showed depression while 93 had depression on HAM-D. With binary logistic regression we found that presence of depression and low income had significant association with the presence of suicidal attempt among the target population. CONCLUSIONS: This study showed a high prevalence of suicidal attempts among the transgender population of twin cities of Pakistan. Routine screening for mental health problems should be performed on this high-risk group and adequate employment resources should be generated in order to enable them to earn their livelihood and prevent them from making attempts to take their own life.