No abstract

Different individuals use different coping styles to cope with their problems. In patients with anxiety and/or depression, these have important implications. The primary objective of our study was to estimate the frequency of different coping mechanisms used by patients with symptoms of anxiety and depression. A descriptive, cross-sectional survey was conducted and patients with symptoms of anxiety and depression were identified using the Aga Khan University's Anxiety and Depression Scale (AKUADS). Coping styles were determined by using the 28-item Brief COPE inventory. We were able to recruit 162 people. The prevalence of anxiety and depression was found to be 34%. Females were more than 2 times likely to have anxiety and depression (P value = 0.024, OR = 2.62). In patients screening positive for AKUADS, “religion” was the most common coping mechanism identified. “Acceptance”, “Use of instrumental support”, and “Active coping” were other commonly used coping styles. Our findings suggest that religious coping is a common behavior in patients presenting with symptoms anxiety and depression in Pakistan. Knowledge of these coping styles is important in the care of such patients, as these coping methods can be identified and to some extent modified by the treating clinician/psychiatrist.

Cutaneous leishmaniasis (CL) is a rising epidemic in Pakistan. It is a major public health problem in the country especially alongside regions bordering the neighboring Afghanistan and cities that have had the maximum influx of refugees. The purpose of our paper is to highlight the diverse clinical manifestations of the disease seen along with the geographic areas affected, where the hosts are particularly susceptible. This would also be helpful in presenting the broad spectrum of the disease for training of health care workers and help in surveillance of CL in the region. The increased clinical diversity and the spectrum of phenotypic manifestations noted underscore the fact that the diagnosis of CL should be not only considered when dealing with common skin lesions, but also highly suspected by dermatologists and even primary care physicians even when encountering uncommon pathologies. Hence, we would strongly advocate that since most of these patients present to local health care centers and hospitals, primary care practitioners and even lady health workers (LHWs) should be trained in identification of at least the common presentations of CL.

H uman leishmaniasis is a vectorborne disease occurring mostly in Central and South America, the Europe/Africa Mediterranean area, the Middle East, and the Indian subcontinent. This disease is caused by parasites in the Leishmania subgenera Viannia and Leishmania, affects ≈2.5 million persons, and causes 60,000 deaths yearly worldwide (1). The disease has 3 main clinical forms: cutaneous leishmaniasis (CL), the most prevalent form and caused by species in both Viannia and Leishmania subgenera; mucocutaneous leishmaniasis, caused by species in the subgenus Viannia; and visceral leishmaniasis, caused by L. (L.) donovani and L. (L.) infantum. These syndromes might lead to social stigma because of permanent scars, skin disfi gurement, and partial/total destruction of oral/ nasopharyngeal mucosa and can result in systemic symptoms including splenomegaly, wasting, and even death (2).Species-specifi c Leishmania identifi cation is critical in clinical management and epidemiologic investigations (2). Detection and identification of Leishmania parasites were traditionally done through microscopic and multilocus enzyme electrophoresis analysis. Currently, PCR-based methods and multilocus DNA sequence analyses (MLSA) combined with next-generation sequencing, have improved phylogenetic resolution and provided insights into parasite identifi cation, classifi cation, genetic polymorphism, virulence, and drug resistance (3,4).Leishmania parasites are emerging in previously nonendemic areas (5); traditional and exotic Leishmania species/strains have been reported in focal areas of the Americas, Europe, Africa, Asia, and the Western Pacifi c (6). In the United States, leishmaniasis is mostly nonreportable and historically considered a travel-associated disease. However, the activity of natural vectors of Leishmania and occurrence of autochthonous zoonotic cases of CL and visceral leishmaniasis caused by L. (L.) mexicana or L. (L.) infantum have been reported in several states, including Alabama,

Emergency peripartum hysterectomy (EPH) is associated with significant morbidity and mortality worldwide. The purpose of our paper was to determine the incidence, morbidity, and mortality of EPH done at our institution; the largest tertiary care government hospital in the city of Quetta, Pakistan. During the study period there were 12,642 deliveries, out of which 46 women had undergone an EPH, translating into an incidence of ∼4 per 1,000 births. Disturbingly, 82.6% of these patients had received no antenatal care prior to their presentation. There were 4 (8.7%) maternal deaths and 31 (67.4%) perinatal deaths. The commonest indication noted was uterine rupture in 21 (45.7%) cases. Lack of antenatal care is indeed a modifiable factor that needs to be addressed to help reduce maternal and fetal morbidity/mortality not only from emergency hysterectomies but also from all other preventable causes.

Background/Aims. Basal cell carcinoma (BCC) is the most common malignant tumor of the skin in humans. The diagnosis of BCC is made clinically, which can then be confirmed microscopically. Biopsy or surgical excision of the lesion provides the specimen for histopathological examination, which is the mainstay for diagnosis. Fine-needle aspiration cytology (FNAC) on the other hand is an even simpler procedure, which can provide accurate diagnosis to confirm or exclude the malignancy. Methods. Here, we present our experience on the role of FNAC in diagnosing BCC. We were able to recruit 37 patients, of which 35 had BCC. Both FNAC and biopsy were obtained and then interpreted independently of one another. Results. Cytology correlated with histopathology in all cases except for 2 in which the yield was deemed inadequate. The sensitivity and specificity of fine-needle aspiration cytology for basal cell carcinoma were 94.3% and 100%, respectively. Conclusions. We, therefore, recommend this technique for the initial evaluation of a patient with suspected BCC or in cases of recurrence. The technique is cheap, quick, less invasive, and highly accurate for the diagnosis of BCC. The limitation of the technique is low yield in some of the cases.

Background Herpes simplex virus (HSV)-1 is a highly prevalent, non-oncogenic virus that has higher morbidity in immunocompromised hosts. Its most common clinical manifestation is superficial ulceration of the integument or mucus membranes. Case presentation A 65-year-old woman with a history of acute myelogenous leukemia treated with allogenic peripheral blood stem cell transplant presented for resection of an ulcerated buccal squamous cell carcinoma. We report a case of HSV-1-infected malignant cells discovered on histopathological examination of the carcinoma specimen ultimately treated with valacyclovir. Conclusions HSV-1 is not considered an oncogenic virus itself but may increase risk of malignant progression. Cancer cells are vulnerable to superimposed viral infections, including HSV-1, which likely led to the findings in this case.

Background Invasive candidiasis carries an increased risk of morbidity and mortality. The rates of non‐albicans Candida species (NAC) infections are on the rise secondary to frequent azole antifungal use. NAC incidence and risk amongst solid organ transplant (SOT) recipients in Arizona receiving prolonged azole course for coccidioidomycosis prophylaxis have not been well elucidated. Methods We retrospectively evaluated SOT recipients hospitalised between 2017 and 2021 with a positive Candida spp. culture. Results There were 66 SOT recipients with 74 hospitalisations and 79 Candida spp. isolates. The median age was 59 (IQR 45–66), 68% were male, 58% were non‐Hispanic White, and the most common SOT 38/74 (51%) was a liver transplant. Median time from transplant to the identification of any NAC (infection or colonisation) was significantly shorter, 8 months (IQR 3–78) vs 128 months (IQR 10–282) for Candida albicans isolates, p = .03. Prior use of azoles was significantly higher in NAC‐associated post‐transplant colonisation and invasive disease hospitalisations (83%) than in those with C. albicans (17%), p < .001. There were 59 hospitalisations with invasive disease, with the majority having NAC isolates of 49 (83%). Conclusion The universal azole prophylaxis has reduced the incidence of coccidioidomycosis complications amongst SOT recipients in Arizona; however, there is an increased risk of developing NAC colonisation and infections, which can complicate the care of the SOT recipients with invasive candidiasis. Future studies are needed to investigate methods of reducing the risk of NAC infections whilst preventing coccidioidomycosis amongst SOT recipients.