Background: We conducted an observational study to determine the delay in presentation to hospital, and its associates among patients experiencing first Acute Myocardial Infarction (AMI) in Karachi, Pakistan.

Objectives:To assess the frequency of Depression, Anxiety and Stress (DAS) among the undergraduate physiotherapy students.Methods:A descriptive cross sectional study was conducted in various Physiotherapy Institutes in Sindh, Pakistan among undergraduate physiotherapy students. The total duration of this study was 4 months from September, 2016 to January, 2017. Data was collected from 267 students with no physical and mental illness; more than half were female students 75.3%. They were selected through Non probability purposive sampling technique. A self-administered standardized DASS (depression, anxiety and stress scale) was used to collect data and result was analyzed using its severity rating index. Data was entered and analyzed by using SPSS version 21. Descriptive statistics including the frequency of depression, anxiety, stress and demographic characteristic of the participant was collected.Results:The mean age of students was 19.3371±1.18839 years. The Frequency of depression, anxiety and stress found among undergraduates Physiotherapy students was 48.0%, 68.54% and 53.2%, respectively.Conclusions:It was observed that the frequency of depression, anxiety and stress among physiotherapy undergraduates students were high. It suggests the urgent need of carrying out evidence based Psychological health promotion for undergraduate Physiotherapy students to control this growing problem.

IntroductionStress among medical students induced by academic pressures is on the rise among the student population in Pakistan and other parts of the world. Our study examined the relationship between two different systems employed to assess academic performance and the levels of stress among students at two different medical schools in Karachi, Pakistan.MethodsA sample consisting of 387 medical students enrolled in pre-clinical years was taken from two universities, one employing the semester examination system with grade point average (GPA) scores (a tiered system) and the other employing an annual examination system with only pass/fail grading. A pre-designed, self-administered questionnaire was distributed. Test anxiety levels were assessed by The Westside Test Anxiety Scale (WTAS). Overall stress was evaluated using the Perceived Stress Scale (PSS).ResultsThere were 82 males and 301 females while four did not respond to the gender question. The mean age of the entire cohort was 19.7±1.0 years. A total of 98 participants were from the pass/fail assessment system while 289 were from the GPA system. There was a higher proportion of females in the GPA system (85% vs. 59%; p<0.01). Students in the pass/fail assessment system had a lower score on the WTAS (2.4±0.8 vs. 2.8±0.7; p=0.01) and the PSS (17.0±6.7 vs. 20.3±6.8; p<0.01), indicating lower levels of test anxiety and overall stress than in students enrolled in the GPA assessment system. More students in the pass/fail system were satisfied with their performance than those in the GPA system.ConclusionBased on the present study, we suggest governing bodies to revise and employ a uniform assessment system for all the medical colleges to improve student academic performance and at the same time reduce stress levels. Our results indicate that the pass/fail assessment system accomplishes these objectives.

BackgroundThe diagnosis of chronic obstructive pulmonary disease (COPD) is confirmed with spirometry demonstrating persistent airflow obstruction.AimTo evaluate the clinical characteristics and management of patients in primary care on COPD registers with spirometry incompatible with COPD.Design and settingA primary care audit of Welsh COPD Read-Coded patient data from the Quality and Outcomes Framework (QOF) COPD register in Wales.MethodPatients on the QOF COPD register with incompatible spirometry (post-bronchodilator forced expiratory lung volume in 1 second/forced vital capacity [FEV1/FVC] ratio ≥0.70) were compared with those with compatible spirometry (FEV1/FVC <0.70).ResultsThis audit included 63% of Welsh practices contributing 48 105 patients. Only 19% (n = 8957) of patients were post-bronchodilator FEV1/FVC Read-Coded and were included in this study. Of these, 75% (n = 6702) had compatible spirometry and 25% (n = 2255) did not. Patients with incompatible spirometry were more likely female (P = 0.009), never-smokers (P<0.001), had higher body mass index (P<0.001), and better mean FEV1 (P<0.001). Medical Research Council (MRC) breathlessness scores, exacerbation frequency, and asthma co-diagnosis were similar between groups. Patients in both groups were just as likely to receive inhaled corticosteroid (ICS) and long-acting beta-agonists (LABAs), but patients with incompatible spirometry were less likely to receive long-acting muscarinic antagonists (LAMAs) (P<0.001) or LABA/ICS (P = 0.002) combinations.ConclusionPatients on the COPD QOF register with spirometry incompatible with COPD are symptomatic and managed using significant resources. If quality of care and effective resource use are to be improved, focus must be given to correct diagnosis in this group.

This article provides research of cardiac biomarkers being drawn in the prehospital setting compared with the emergency department (ED) on intervals critical to the diagnosis of acute myocardial infarction. This is a retrospective chart review of patients brought to the ED of a single, urban teaching hospital by a single emergency medical service (EMS) agency with a chief complaint of “chest pain.” We abstracted specific patient characteristics, intervals, positive troponin values, and rates of hemolysis from hospital records utilizing a custom data abstraction tool designed for this study through consensus of the authors. Data were compared between patients who did and did not have prehospital laboratory work performed for cardiac biomarkers utilizing parametric and nonparametric tests when appropriate. Of the initial 49 patients identified, 41 met inclusion criteria; 20 patients (49%) did not have prehospital EMS laboratory results drawn while 21 (51%) patients did have prehospital laboratory results drawn. Overall, 17% (7/41) had positive cardiac biomarkers. The groups were similar with regard to age, gender, race, and medical history. Median time (interquartile range) in minutes, from ED arrival to laboratory results available was shorter for patients with EMS laboratory results compared with those without EMS laboratory results: 53 (45-64) versus 71 (54-95) (P = .02). Time from ED arrival to disposition decision (P = .39) and total ED length of stay (P = .12) were similar between groups. In this preliminary study, prehospital laboratory results were associated with shorter times from ED arrival to the results being available.