Post-traumatic stress disorder in patients with acute burn injury.

OBJECTIVE: To determine the risk of PTSD in patients with acute burn incidents. METHOD: This was an observational prospective cross-sectional study conducted in admitted patients in Burns Ward of Civil Hospital, Karachi during a period of 6 months from January 1 to June 30, 2011. Data was collected through questionnaire having socio demographic variables and the Impact of Event-Scale (IES-R) was used to determine the risk of PTSD. RESULTS: Out of 145 patients, 12 (77.3%) were at risk of PTSD with 75 (66.9%) males and 37 (33%) females. Out of these 112 cases, 50% belonged to age group 16-29 years. All burn patients with more than 60% total body surface area (TBSA) involved in injury were at risk. CONCLUSION: The study reports an astronomic number of burns patients with PTSD risk. PTSD drastically affects the quality of life. The earlier this disorder is diagnosed and assessed; better chances are there for enhanced treatment and better recovery.

Oesophageal duplication cyst presenting as haemoptysis.

Duplications of the alimentary tract include a variety of cysts, diverticula, and tubular malformations, all believed to have embryological origin. The cysts are most commonly found in children, and the diagnosis is made in infancy in the majority of patients. We report a case of a two-and-a-half year old child, presenting with the history of repeated episodes of haematemesis. Upper GI endoscopy was unremarkable and the chest x-ray showed no pathology. Computed tomography (CT) angiogram revealed soft tissue density lesion in the right chest at the level of T6. Right thoracotomy suggested a cystic mass close to the oesophagus which was shown on histopathology to be lined with gastric mucosa consistent with oesophageal duplication cyst. To the best of our knowledge, this is the first case of its kind reported from Pakistan.

Audit of custodial deaths in Karachi--an autopsy-based study.

OBJECTIVE: To assess the causes and manner of custodial deaths in Karachi, and to determine the factor of negligence on the part of the custodians behind such deaths. METHODS: The cross-sectional study involved the deaths in custody undergoing autopsy at Civil Hospital, Karachi, from January 2005 to December 2010. Autopsy was followed by histological examination, X-ray or CT scan wherever required. A proforma was also filled as per the standard autopsy protocol. RESULTS: There were 61 custodial deaths in Karachi during the six-year study period which met the inclusion criterion. There were 58 (95.1%) males and 3 (9.4%) females. Natural causes accounted for a majority of deaths (n = 36; 59%), the most common disease being coronary artery disease (n = 13; 21.3%). Unnatural causes accounted for 25 (41%) deaths, comprising 13 (21.3%) homicidal, 7 (11.5%) suicidal and 5 (8.2%) accidental. Deaths were more frequent in the age group ranging from 30-39 years (34.4%), while the overall age-range was from 19 to 75 years. DISCUSSION: Measures need to be taken to provide a wholesome environment for the prisoners. Code of conduct for the prisoners should be followed and judicial procedures shall be conducted at a quick pace. Torture should be avoided under all circumstances, and proper vigilance shall be kept to prompt suicidal deaths.

Audit of sharp weapon deaths in metropolis of Karachi--an autopsy based study.

BACKGROUND: Sharp weapons are one of the most violent and abhorrent means of deaths. This study assesses the frequency of sharp weapon deaths in Karachi. METHODS: This was a cross sectional study, and involves the deaths by sharp weapons autopsied in Karachi during Mar 2008-Feb 2009. RESULTS: This study reports that the frequency of sharp weapon deaths in Karachi is similar to some other studies conducted in different regions of Pakistan, yet it is very high as the population of Karachi is way more than any other metropolis of Pakistan. Our study reported that out of 2090 medico-legal deaths in Karachi during the study period, 91 deaths were due to sharp weapons, including 73 (80.2%) males and 18 (19.8%) females. 100% of the deaths were homicides, so none were suicides. Deaths were more frequent in age group ranging from 20-39 years (59.3%). CONCLUSION: Sharp weapon deaths continue to be a means of quite a number of deaths in Karachi. Such violence depicts intolerant and frustrated nature of the citizens.

Exhumation - Nuisance to the dead, justified?

OBJECTIVE: Exhumation stands as a very significant feature of forensic investigations. The legal excavation of dead bodies for ascertainment of the cause of death has always aided the law enforcement agencies to comprehend the anonymity of any suspicious case and further convict the criminal in cases of homicides. This study analyses the different aspects of the exhumations which were carried out and were autopsied in Karachi during the study period. METHOD: This was a cross-sectional study, and included all the exhumations carried out in Karachi during a period of 7 years and 7 months from 1 January 2004 to 31 July 2011. RESULTS: A total of 101 exhumations were carried out during the study period. Out of 101 cases, 63 were males (62.4%) and 38 females (37.6%) giving a male to female ratio of about 3:2. Causes of death were ascertained in 75 cases, thus the success rate was 74.3%. Head injury by hitting with hard blunt object was the most frequent cause of deaths (17.8%), followed by asphyxia due to strangulation (15.8%). DISCUSSION: Exhumations must be ordered by the Judiciary in suspicious cases as it aids in determining the actual causes of death and leads to convictions. It also brings a great deal of satisfaction for the relatives of the deceased and halts any doubts in their minds. As shown by our study, much attention is given to the cases in urban areas by the relatives who are determined to find the cause of death even after burial procedures.

Eating disorders in medical students of Karachi, Pakistan-a cross-sectional study.

BACKGROUND: To assess the incidence of high-risk population of medical students with eating disorders in Karachi by using validated self-administered questionnaires. The earlier these disorders are diagnosed and assessed, the better the chances are for enhanced treatment and fuller recovery. Therefore, we intended to undertake a study to find out the frequency of such disorders among medical students of Karachi and design strategies to overcome them. FINDINGS: A descriptive cross sectional study was conducted in 435 medical students of Karachi. Data was collected using 2 self administered questionnaires, the SCOFF Eating Disorders Questionnaire and the Eating Attitudes Test (EAT-26). Subjects' body mass indexes (BMI) were also calculated. The data was sorted and analyzed in SPSS version 16. According to EAT-26, 22.75% individuals were found to be at high-risk of eating disorders, with 87.9% females and 12.1% males. However, according to SCOFF questionnaire, 17% individuals were found to be at high-risk, with 78.4% females and 21.6% males. According to BMI calculation, 9% were severely underweight, 41.4% underweight, 41.1% normal, 7.6% overweight and 0.9% belonged to obese class 1. CONCLUSIONS: A significant fraction of medical students in Karachi are at high risk of development of eating disorders, females being more prone than males. Strategies should be designed to prevent occurrence of such disorders among medical students that would undoubtedly hamper the availability of dependable medical services in future.

Frequency of HBsAg positivity: a laboratory data analysis.

The objective of the study was to evaluate the current frequency ratio of HBsAg seropositivity in a laboratory-based setting. It was a retrospective study, conducted during September 2009 and November 2010 at Dr. Essa's Diagnostic Laboratory and its branches in Karachi, Pakistan. Blood samples of 8,648 individuals were screened for HBsAg using the BioRad EVOLIS EIA method. Pertinent questionnaires filled in by 50 practicing physicians were also evaluated. The 551 subjects (6.4%) that tested positive for HBsAg included 360 males (65.3%) and 191 females (34.6%). The highest frequency of HBsAg was noted in those aged 16 - 29 years (43.9%). HBsAg rate in the studied population has steadily increased and is more common in the sexually active age group, with males tending to be more often seropositive than females.