Frequency of depression in patients undergoing coronary artery bypass grafting surgery [CABGS], before the surgery, at discharge and at six months follow up

Introduction: Depression is much frequent in patients undergoing CABGS. However, severity was reduced post operatively. Counseling and psychosocial interventions can play an important role in recovery and functionality of patients

Objective: To compare the frequency of depression in patients undergoing coronary artery bypass grafting surgery [CABGS] before the surgery, at discharge and at six months follow up

Design: Prospective, observational study conducted from Dec 2008 to Dec 2009

Setting: National Institute of Cardiovascular Diseases [NICVD] Karachi

Methods: One hundred and thirty four [134] patients of 18+ years old who were consecutively listed for first time CABGS were included in the study after fulfilling the inclusion and exclusion criteria and addressing the ethical issues. ICD-10 criteria to diagnose and Hamilton Rating Scale for Depression [HAM-D] were applied to assess the frequency and severity of depressive disorder respectively. Results were analyzed using SPSS version 17.0

Results: One hundred and thirty four [134] patients undergoing CABGS fulfilled the criteria for Depressive disorder. One hundred and thirteen [84.3%] were male and 21 [15.7%] were female with age range 33 to 75 years [mean 53.7 +/-SD 8.57]. Preoperatively 132 [98.5%] patients and postoperatively 108 [80.6%] patients were depressed. At 6 months follow up which was available in 73 patients, only 12 [16.4%] were found depressed. Both genders were almost equally affected. Surprisingly age, ethnicity, education and co-morbids did not show a significant role

Conclusion: Depression is commonly reported before and after cardiac surgery procedures and it significantly influences the quality of life of the patients undergoing CABGS. The consequences can increase morbidity and mortality

Association of cutaneous malignancy with epidermodysplasia verruciformis: a clinicopathological study

To find out presence of nonmelanoma skin cancer [NMSC] in a series of 13 patients with diagnosis of epidermodysplasia verruciformis [EDV]. This prospective descriptive study detailed the clinical presentation of patients with EDV associated with nonmelanoma cutaneous malignancy between 2007 and 2010 presenting to Dermatology OPD Pakistan Institute of Medical Sciences, Islamabad. Patients were diagnosed on clinical basis. Patients with all ages and both sexes were included. Skin biopsies were taken from lesions with suspicion of malignancy, stained with hematoxylin and eosin and studied in collaboration with histopathologist. Different histopathological findings were recorded and results analyzed. 13 cases were studied for presence of NMSC. NMSC were found in 3 [23%] out of 13 patients. Actinic keratosis was found in 2 patients and one patient had seborrheic keratosis with suspicious lesions. The clinically suspicious lesions should always be biopsied, as cutaneous malignancy is a well-known, frequent and serious complication of EDV and there is high potential in these patients to develop premalignant conditions

Response to treatment of cutaneous leishmaniasis with intralesional chloroquine vs intralesional meglumine antimoniate

In Pakistan, cutaneous leishmaniasis [CL] is mostly caused by Leishmania major. For simple lesions which are few in number and where there is no risk of disfigurement or joint mobility restriction, topical application or local treatment e.g. intralesional antimony compounds are valuable. To compare the effect of intralesional chloroquine with meglumine antimoniate in the treatment of CL. In this quasi experimental study, 60 patients of CL with 1 to 3 lesions and aged >3years were divided into 2 treatment groups to receive either intralesional chloroquine [treatment group] or meglumine antimoniate [control group]. Both drugs were used Ice per cm[2] of lesion, once weekly for 8 weeks [8 injections]. 8 more injections were given to those who showed partial response. Both treatments showed 100% response; however, greater number of injections was required with meglumine antimoniate [p<0.05]. Both drugs were well tolerated. Intralesional chloroquine appears to be an effective, safe and cheap alternative to meglumine antimoniate in the treatment of CL

Granuloma formation in discoid lupuserythematosus: a novel microscopic feature

Lupus erythematosus is an autoimmune disease with marked pleotropism. If several systems are involved then the disease is named as systemic lupus erythematosus [SLE] and if skin is exclusively involved the term discoid lupus erythematosus [DLE] is used. One of the several histopathological features of DLE includes periappendageal inflammation. This may at times ; completely wipe out sebaceous glands forming sebaceous granulomas. To determine the frequency of sebaceous granulomas formation in discoid lupus erythematosus. In this prospective observational study was conducted at the Departments of Dermatology and Pathology, Pakistan Institute of Medical Sciences, Islamabad. 100 cases of DLE spanning over two years and with the age range of 3 years to 70 years were examined for the presence of sebaceous granuloma. Other features of DLE like hyperkeratosis, follicular plugging, epidermal atrophy, basal layer vacuolization, basement membrane deposits, pigmentary incontinence, perivascular inflammation, periappendageal inflammation, and collagen damage were also noted., Out of these 100 cases, 8 cases contained sebaceous granulomas. These granulomas were,, . composed of epithelioid cells, foreign body giant cells containing partially digested sebaceous material and a few lymphoctytes. Sebaceous granulomas formation was seen in 8% cases of DLE cases. This feature must be recognized both by dermatologists and pathologist so that diagnosis of DLE may not be distracted and erroneous diagnosis due to presence of granulomas may not be rendered

Sebaceous granulomas: a novel feature of discoid lupus erythematosus

To determine the frequency of sebaceous granulomas formation in discoid lupus erythematosus, Retrospective observational study. Departments of Dermatology and Pathology, Pakistan Institute of Medical Sciences, Islamabad. 100 cases of Discoid Lupus Erythematosus [DLE] spanning over two years and with the age range of 3 years to 70 years were examined for the presence of Sebaceous Granuloma. Other features of DLE like hyperkeratosis, follicular plugging, epidermal atrophy, basal layer vacuolization, basement membrane deposits, pigmentary incontinence, perivascular inflammation, periappendigeal inflammation, and collagen damage were also noted. Lupus erythematosus is an immune complex, type Ill hypersensitivity disease where antibodies are formed against native Deoxyribose Nucleic Acid [DNA]. The immune compexes are deposited in various organs and various sites causing marked pleotropism. If several systems are involved then the disease is named Systemic Lupus Erythematosus [SLE] and if skin is exclusively involve the term Discoid Lupus Erythematosus [DLE] is used. One of the several features of DLE includes periappengeal inflammation. This may at times completely wipe out sebaceous glands forming sebaceous granulomas. Out of these 100 cases 8 cases contained sebaceous granulomas. These granulomas were composed of epithelioid cells, foreign body giant cells containing partially digested sebaceous material and a few lymphoctytes. Sebaceous granulomas formation was seen in 8% cases of discoid lupus erythematosus. This feature must be recognized both by dermatologists and pathologist so that diagnosis of DLE may not be distracted and erroneous diagnosis due to presence of granulomas may not be rendered

Griscelli's syndrome in a young adult - a case report with the review of literature

Griscelli syndrome is a rare autosomal recessive disorder characterized by partial albinism with variable immunodeficiency. Silvery grey hair with large, clumped melanosomes on microscopy of hair shafts is diagnostic. The commonest complication leading to mortality includes lymphohistiocytic proliferation in various organs, including the brain. There are three types of this syndrome described. We present a young adult with classic clinical features and confirmatory findings of clumped melanosomes on microscopy of hair shaft

Knowledge of Radiographiers about radiation protection procedures

To assess the knowledge of radiographers radiation protection in diagnostic radiology. Questions were asked from radiographers of three tertiary care hospitals of Peshawar in November 2005. All radiographers were interviewed by the author according to pre-prepared questionnaire. Questions pertained to principles of radiation protection, permissible occupational dosage, permissible dose for general population, use of foot switch in fluoroscopy, advantage of collimation and effect of increasing Kilo Voltage Peak [KVp] on patient dose. Sampling was convenience sampling. Correct response was 8.8% on question on principles of radiation protection, 0% for question on permissible occupational dosage and dose for general population, 17.7% for query on use of foot switch in fluoroscopy, 77.7% on enquiry on advantage of collimation and 31% correct answers to effect of increasing Kilo Voltage Peak [KVp] on patient dose. Knowledge of radiographers regarding radiation protection procedures and principles was poor