Psychological distress and its association with intake of sugar-sweetened beverages, discretionary foods, and alcohol in women during the COVID-19 pandemic in Australia.

OBJECTIVES: This study aimed to explore psychological distress, lifestyle, and demographic factors, as well as their relationship to discretionary choices in women of reproductive age during the coronavirus disease 2019 pandemic in Australia. METHODS: Reproductive-aged women (18-50 y) in Australia participated in a national online survey. Psychological distress score (using a validated 10-item Kessler Psychological Distress Scale questionnaire) was the primary exposure of interest, and key outcomes were frequencies of discretionary choices (sugar-sweetened beverages [SSBs], alcohol, and discretionary foods). Sociodemographic and physical activity data were also collected. Logistic regression was used to report adjusted odds ratio (aOR) and 95% confidence interval to predict SSBs (less than weekly; most days/daily), total discretionary foods (none/<2 times/d; ≥3 times/d), and alcohol use (never/less than monthly; most weeks/daily). RESULTS: A total of 1005 women were included in the study, of whom 40% had a high level of psychological distress. Women with high psychological distress (aOR: 1.96; 95% CI, 1.32-2.91) and those who gained weight during the pandemic (aOR: 1.71; 95% CI, 1.10-2.65) were more likely to consume discretionary foods ≥3 times/d. There was no association between psychological distress and SSB intake or alcohol; however, Australian, New Zealander, or Pacific Islander background (aOR: 1.68; 95% CI, 1.21-2.33) and more hours of sitting time (aOR: 1.88; 95% CI, 1.07-3.29) were associated with SSB consumption on most days/daily. Older age (aOR: 1.70; 95% CI, 1.00-2.89), higher household income (aOR: 1.44; 95% CI, 1.08-1.92), and moderate or high physical activity (aOR: 1.75; 95% CI, 1.10-2.80) were associated with alcohol intake on most weeks/daily. CONCLUSIONS: Public health messaging to promote healthy eating should take into account the effect of psychological distress on health behavior. Messages aimed at maintaining a positive relationship between food intake and mental wellbeing, particularly among vulnerable groups, are warranted.

Haemodynamic response of intravenous tramadol and intravenous morphine during laryngoscopy and endotracheal intubation.

OBJECTIVE: To compare the haemodynamic response of equipotent analgesic doses of morphine and tramadol to laryngoscopy and endotracheal intubation. METHODS: A randomized double blind study of eighty ASA 1 and ASA II patients, age 18-50 years for elective surgery requiring endotracheal intubation was conducted. Forty patients were selected for each group, M (morphine) and T (tramadol). All patients received study drug three minutes prior to induction of anaesthesia RESULTS: Mean heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial blood pressure (MAP) between the groups and within the groups from base line and from preintubation period was significantly (p<0.05)different at different time intervals.. When compared from base line maximum increase in heart rate in group M and T was 11.86% and 28.92% and maximum decrease was 12.08% and 1.43% respectively. Mean maximum increase in SBP was 8.06% in group T. Decrease was 18%and 10.48% in group M and T respectively. Maximum increase and decrease in DBP and MAP follow the same pattern and increase in blood pressures remained below 15% of the baseline value. CONCLUSION: Morphine is a better drug as compared to tramadol for attenuation of laryngoscopy and endotracheal intubation response.

Haemodynamic effects of intrathecal bupivacaine for surgical repair of hip fracture.

OBJECTIVE: To determine the optimal dose of bupivacaine in providing adequate surgical anaesthesia with minimal haemodynamic disturbances. METHODS: Three different doses of spinal bupivacaine in combination with or without fentanyl for surgical repair of hip fracture were used. Sixty patients were randomly divided into three groups (A, B and C) to receive a spinal anaesthetic of bupivacaine 10mg, 8mg and 6mg respectively. In addition to bupivacaine, group B and C also received fentanyl 20 microg in spinal mixture. RESULTS: Intra operative heart rate was statistically insignificant in all three groups. Statistically significant drop in systolic blood pressure was found in group A & B at different study timings while statistically significant drop in diastolic blood pressure was only found in group A. Sensory block characteristics were similar among all three groups. Motor block pattern was found marginally significant in group C with highest time to achieve desired block. All patients had satisfactory level of surgical anaesthesia. CONCLUSION: This study concluded that low dose, 6 mg bupivacaine with 20 microg fentanyl provide adequate anaesthesia for surgical repair of hip fracture with stable haemodynamics.

Comparision between bed side testing of blood glucose by glucometer vs centralized testing in a tertiary care hospital.

BACKGROUND: To determine the accuracy, turnaround time and cost effectiveness of bedside monitoring of blood glucose levels by non-laboratory health care workers and centralized testing of blood glucose by automated analyzer in a tertiary care hospital. METHODS: The study was conducted in Section of Chemical Pathology, Department of Pathology and Microbiology and Section of Endocrinology Department of Medicine, Aga Khan University and Hospital Karachi, from April 2005 to March 2006. One hundred and ten patients were included in the study. The blood glucose levels were analyzed on glucometer (Precision Abbott) by finger stick, using Biosensor Technology. At the same time venous blood was obtained to analyze glucose in clinical laboratory on automated analyzer (SYNCHRON CX7) by glucose oxidase method. RESULTS: We observed good correlation between bed side glucometer and laboratory automated analyzer for glucose values between 3.3 mmol/L (60 mg/dl) and 16.7 (300 mg/dl). A significant difference was observed for glucose values less than 3.3 mmol/L (p = 0.002) and glucose values more than 16.67 mmol/l (p = 0.049). Mean Turnaround time for glucometer and automated analyzer were 0.08 hours and 2.49 hours respectively. The cost of glucose testing with glucometer was 48.8% lower than centralized lab based testing. CONCLUSION: Bedside glucometer testing, though less expensive does not have good accuracy in acutely ill patient with either very high or very low blood glucose levels.

Does Ramadan fasting affect expiratory flow rates in healthy subjects?

OBJECTIVE: To assess whether Ramadan fasting affects the expiratory flow rates in healthy subjects, and to know if these effects correlate to a change in other variables. METHODS: This unmatched case-control longitudinal study includes 46 non-smoking healthy subjects who undertook lung function testing at the Aga Khan University, Pakistan. Expiratory flow rates and body mass were measured in 3 Islamic months, corresponding to November 2001 to January 2002. RESULTS: There was a significant reduction in body mass in Ramadan compared to pre and post Ramadan. No significant changes in expiratory flows were seen during Ramadan as compared to the pre Ramadan period. However, forced expiratory flow rates at 75% of vital capacity (FEF(75)) and between 75% and 85% of vital capacity (FEF(75-85)) showed a significant increase in the post Ramadan period compared to Ramadan. Changes in FEF(75) were negatively correlated to changes in body mass between Ramadan and post Ramadan. CONCLUSION: This study shows that Ramadan fasting will not affect expiratory flow rates in healthy subjects. Post Ramadan values did show an increase in FEF(75) and FEF(75-85), possibly due to changes in body water and fat content. The reductions in body mass were most probably due to lack of nutrition and not dehydration as the fasts were performed in winter. Collection of reference values or early phase clinical trials measuring expiratory flow rates should not be affected by Ramadan fasting.

Correlation of serum cortisol levels and stress among medical doctors working in emergency departments.

OBJECTIVE: To assess and correlate serum cortisol levels and self-perceived work-related stress among medical doctors working in emergency departments in different tertiary care hospitals of Karachi. DESIGN: Cohort study. PLACE AND DURATION OF STUDY: The study was conducted in Section of Chemical Pathology, Department of Pathology and Microbiology, AKUH, from December 2004 to August 2005. SUBJECTS AND METHODS: A total of 64 doctors participated from one private and two public tertiary care hospitals of Karachi. Thirty-four doctors were from emergency departments and 30 from non-emergency departments. Serum cortisol levels were measured in the morning (between 8.00-8.30 am) and in the evening (between 8.00-8.30 pm). Cortisol was measured by Florescence Polarization Immunoassay (FPIA) technique. Two questionnaires, modified mental Professional Stress Scale (PSS) and Aga Khan University Anxiety and Depression Scale (AKUADS) were used to assess stress levels. RESULTS: Emergency room physicians (ERP) were 1.2-year younger than non-emergency room physicians (NERP). Mean evening cortisol of emergency physicians was 60.72nmol/L higher than non-emergency physicians. The difference between morning and evening cortisol was marginally significant (p = 0.051). Morning diastolic blood pressure was 3mmHg higher in emergency physicians. Forty-one percent of emergency physicians and 20% of non-emergency physicians had AKUADS more than or equal to 20, the difference was borderline significant (p = 0.068). Mean value of professional stress scale for emergency physicians was significantly higher than non-emergency physicians. Evening serum cortisol concentration was significantly associated with PSS (p = 0.011). The sub-scales such as work-load (p = 0.007) and lack of resources were highly significant with evening cortisol (p = 0.005). CONCLUSION: In this study, evening serum cortisol levels significantly correlated with work overload and lack of resources, however, there was marginally significant correlation between morning and evening serum cortisol difference. Study suggests that emergency physicians perceive more stress than non-emergency physicians. Work overload and lack of resources are major contributing factors for stress in these doctors.

Comparison between tramadol and pethidine in patient controlled intravenous analgesia.

OBJECTIVE: To compare the efficacy and side effects related to Tramadol with Pethidine in patient controlled intravenous analgesia (PCIA) after total abdominal hysterectomies. METHODS: A total of 60 patients were randomized to receive either Tramadol or Pethidine by PCIA (30 in each group) after total abdominal hysterectomy. Pain assessments were recorded one hour after starting the PCIA and then at 6, 12, and 24 hours by using visual analogue scale (VAS). Nausea vomiting score and sedation score were also recorded. Good attempts, total attempts and total drug consumption was noted from PCIA pump at the end of the study period. RESULTS: The analgesia achieved in Tramadol group was comparable to Pethidine. The incidence of nausea and vomiting was similar in both groups. Tramadol causes significantly less sedation than Pethidine (p < 0.05). Mean drug consumption, total attempts and good attempts were also significantly less in Tramadol group than Pethidine group (p < 0.05). CONCLUSION: Tramadol produces equivalent analgesia and less sedation and can be used as an alternative to Pethidine in Patient Controlled Intravenous Analgesiafor postoperative pain relief after Total Abdominal Hysterectomy (TAH).

The effect of Ramadan fasting on spirometry in healthy subjects.

OBJECTIVES: Lung function tests are an important investigative tool in diagnosing respiratory diseases, judging their severity and assessing prognosis. The primary aim of the present study was to assess whether Ramadan fasting affected normal lung function values. METHODOLOGY: Forty-six non-smoking healthy males, with a mean age of 24.2 years (SD 6.4 years) were investigated. Spirometry was performed according to the recommendations of the American Thoracic Society. Days between the 15th and 25th of three Islamic months (pre-Ramadan, Ramadan and post-Ramadan) were selected for spirometry. On all three occasions, FVC, FEV(1), FEV(1)/FVC%, maximum voluntary ventilation (MVV(indirect)), PEF, FEF(25--75%) and body mass were measured. Pre- and post-Ramadan readings were compared with the readings during Ramadan fasting. The results were analysed by repeated measures analysis of variance. RESULTS: No significant change was seen in lung function during Ramadan as compared to the pre-Ramadan period. FVC was decreased significantly in the post-Ramadan period compared to Ramadan and this period was associated with a significant increase in body mass. CONCLUSION: Relative to pre-Ramadan baseline values, there was no change in spirometry during Ramadan fasting in these subjects.