Depression;

Abstract

Background: Acute kidney injury (AKI) in pregnant women is commonly seen indeveloping countries. It is associated with significant morbidity, social and personal implications.We conducted a study to assess the prevalence and severity of depression in patients withpregnancy related AKI (PRAKI) in a tertiary care center. Methodology: Patients with PRAKIadmitted from 1-16 to 6-16 under Nephrology service, Jinnah Hospital, Lahore were included inthis cross-sectional study. The Hamilton Rating scale for depression (HAM-D) version translatedand adapted in Urdu, was used to assess the study population. These patients were interviewedwith the HAM-D questionnaire on their first encounter with Nephrology department. Previoushistory of psychiatric illness was excluded. The diagnosis of AKI was based on the classificationof the Acute Kidney Injury Network group. Results: The mean age of the patients was 24±5years. Seventeen (57%) patients were multipara and 13(43%) patients were primigravida. Of the30 patients with AKI, 8 (27%) presented before 28 weeks and 22 (63%) presented after 28 weeksof gestation. The causes of AKI included postpartum hemorrhage in 9 (30%), sepsis in 8 (27%),preeclampsia/eclampsia in 6(20%), shock in 4 (13%) and coagulopathy in 3 (10%) patients.Alive and healthy fetus was found in only 15 (50%) patients. Twenty-one (70%) patients receivedaverage of 5-8 hemodialysis sessions during their hospital stay. Twenty-three (76%) had nodepression (0-7 score), 2 (7%) had mild (8-13 score), 3 (10%) had moderate (14-18 score) and2 (7%) had severe (19-22 score) depression according to HAM-D score. Conclusions: Ourstudy depicted considerable depression of varying degrees in women with PRAKI, increasedawareness and effective monitoring for depression should be integrated into regular maternalcare to decrease morbidity associated with it.

Sarcoidosis: A Case Report of an Often-Misdiagnosed Clinical Entity from Bangladesh

“…Sarcoidosis is a multisystem chronic granulomatous disorder of unknown etiology which is mostly a disease of exclusion and goes on to affect the lungs, lymphoid system, skin, eyes, joints, kidney, heart, exocrine glands and the central nervous system [1,2]. While it affects people of all ages, gender and ethnicities but manifestations show a variable range owing to the genetic and environmental factors [2,3].…”

“…While it affects people of all ages, gender and ethnicities but manifestations show a variable range owing to the genetic and environmental factors [2,3]. However, the highest incidence is evidenced among African-Americans which is [7-35/1,00,000] and the lowest among the Asians [1-3/1,00,000] depicting a female and male ratio 2:1 mostly prevalent in non-smokers hailing from rural area [1][2][3]. Despite having no concrete evidence of the exact etiology there is believed to be a strong association with genetic factors, environmental triggers, infections and autoimmunity.…”

“…Despite having no concrete evidence of the exact etiology there is believed to be a strong association with genetic factors, environmental triggers, infections and autoimmunity. It is often believed to have associations with Mycobacteria, Mycoplasma, Leptospira, Chlamydia and Borrelia [1,2]. Clinical manifestations range from patients being asymptomatic for years to presenting with non-specific manifestations such as nausea, fatigue, fever, loss of weight and occasional night sweats.…”

“…There may be involvement of salivary glands most common being parotid. Lymph nodes mostly involved include cervical, epitrochlear and inguinal.GI manifestations range from vague features of nausea, vomiting and diarrhoea to gross impairment of liver function, hepatosplenomegaly, cholestasis and portal hypertension [1,2,4,5]. It is mostly a disease of exclusion since it has a large number of mimics.…”

“…However, the lack of typical features calls for biopsy, exclusion of other granulomatous disease and proof of involvement of another organ as represented by Figure 1. Histopathology reveals non-caseating granulomas although one biopsy isn't confirmative, it does add to the diagnosis in case typical features aren't evident [1,4]. Glucocorticoids remain the main stay of treatment most commonly used of them being prednisolone which is tapered slowly over a period of months.…”