PURPOSE:Valproate is an efficacious treatment for several neurologic and psychiatric disorders, but it carries a grave risk of teratogenicity. Despite warnings from regulatory bodies, prescribing guidelines from professional associations, and expert opinion against the practice, the medication continues to be commonly prescribed to persons with childbearing potential for psychiatric indications. METHODS:A quality improvement focused educational intervention on the conduct and documentation of informed consent and contraceptive counseling when prescribing the teratogen valproate to individuals aged 12-55 who may become pregnant was implemented in the Psychiatry Department of an urban community hospital. Documentation from 3 months before and after the intervention was qualitatively assessed for notation of informed consent, including the patient's expressed understanding of risks as well as specific counseling on teratogenicity and the need for contraception, in acute care and outpatient charts that had a prescription from a psychiatric provider for valproate in that time frame. RESULTS:While statistically significant improvement was found in the documentation of general informed consent and patients' responses to counseling in outpatient charts, there was no improvement in acute care charts and no significant increase in valproate-specific counseling in charts from either care setting. CONCLUSION:The minimal impact of an educational initiative on documentation of informed consent in the present study suggests that education alone may not be sufficient to address the crucial safety concern of valproate prescribing practices in psychiatric patients who may become pregnant.
Background: Asthma is a chronic respiratory condition characterized by episodes of airway construction, inflammation and mucus production. It affects millions of people worldwide and is influenced by various environmental factors such as air pollution. Objective: The objective of the article is to determine how asthmatic student health is impacted by air pollution, how asthma affects students' daily tasks and the awareness among asthma students about the risks caused by air pollution. Method: The results presented were obtained through a qualitative phenomenological study. The study was conducted on university students who are asthma patients. The sample consisted of 30 students patients with asthma experiences. Result: The findings revealed that effects of air pollution is one of the leading cause of asthma; triggering asthma and other respiratory health conditions. Conclusion: People with asthma especially students and young patients, will be further exposed to the threat of air pollution, and suffer from more serious health consequences. There have to be detailed assessments connected to the main air pollutants particulate matter (PM) and their causal relationship with respiratory disease, more in each country.
Background: Asymptomatic individuals with type 2 diabetes mellitus (T2DM) face a significantly elevated risk of atherosclerotic cardiovascular disease (ASCVD), often underestimated by traditional risk calculators. Coronary artery calcium scoring (CACS) is a noninvasive imaging method for quantifying subclinical atherosclerosis and enhancing cardiovascular risk stratification. Objective: To evaluate the utility of CACS in asymptomatic T2DM patients in Pakistan and review recent literature on its prognostic role in this population. Methods: This multicenter study is designed with a mixed-method approach , combining cross-sectional data collection at baseline and prospective follow-up over a 24-month period,600 asymptomatic T2DM patients aged 40–75 were enrolled from two tertiary hospitals in Lahore and Karachi. Participants underwent coronary computed tomography for CACS calculation using the Agatston method. Patients were stratified into four categories: 0, 1–100, 101–400, and >400. Clinical and biochemical data were collected, and multivariable logistic regression was used to identify predictors of high CACS (≥100). Major adverse cardiovascular events (MACE)—including myocardial infarction, revascularization, and death—were tracked over 24 months. Results: The mean age was 57.0 ± 5.5 years; 58% were male. Prevalence of hypertension, dyslipidemia, and smoking was 62%, 55%, and 24%, respectively. CACS was 0 in 40%, 1–100 in 35%, 101–400 in 15%, and >400 in 10% of patients. Higher CACS was associated with older age, higher BMI, elevated LDL cholesterol, and longer diabetes duration. No MACE occurred in the CACS 0 group, while 20 events occurred in higher strata. Age, systolic blood pressure, LDL cholesterol, and diabetes duration independently predicted high CACS and MACE. Conclusions: CACS effectively identified subclinical atherosclerosis and predicted future cardiovascular events in asymptomatic T2DM patients. Incorporating CACS into routine assessment could guide preventive therapy in high-risk diabetic populations.
