Elder mistreatment in a rural area in Egypt

Aim: Mistreatment of the elderly is a hidden problem frequently cloaked under the shroud of family secrecy. The aim of the present study was to determine the extent of mistreatment of older people living at their homes in the rural area of Mansoura city, Dakahlia governorate, Egypt. Methods: The present cross‐sectional study was carried out on 1106 respondents, 518 men (mean age 67.6 ± 6.3 years) and 588 women (mean age 68.5 ± 8.4 years), who answered face‐to‐face survey questionnaires. The questionnaires used were; Questionnaire to elicit elder abuse, Actual abuse tool, Elder Assessment Instrument, Risk of abuse tool, Katz index and Geriatric depression scale 15 items. Results: Of the respondents, 43.7% reported mistreatment by family members. The predominant type of reported mistreatment was neglect (42.4%) followed by physical abuse (5.7%), psychological abuse (5.1%) and financial abuse (3.8%). Conclusions: The independent risk factors for overall mistreatment of the elderly were older age, insufficient pension and caregiver other than spouse. Although being dependent, the number of children being three or less and caregiver other than spouse were significant independent attributes for “neglect” as a form of elder mistreatment. Geriatr Gerontol Int 2012; 12: 532–537.     

Epidemiology and Outcomes of Deep Surgical Site Infections Following Lung Transplantation

We conducted a retrospective study of deep surgical site infections (SSIs) among consecutive patients who underwent lung transplantation (LTx) at a single center from 2006 through 2010. Thirty‐one patients (5%) developed SSIs at median 25 days after LTx. Empyema was most common (42%), followed by surgical wound infections (29%), mediastinitis (16%), sternal osteomyelitis (6%), and pericarditis (6%). Pathogens included Gram‐positive bacteria (41%), Gram‐negative bacteria (41%), fungi (10%) and Mycobacterium abscessus, Mycoplasma hominis and Lactobacillus sp. (one each). Twenty‐three percent of SSIs were due to pathogens colonizing recipients' native lungs at time of LTx, suggesting surgical seeding as a source. Patient‐related independent risk factors for SSIs were diabetes and prior cardiothoracic surgery; procedure‐related independent risk factors were LTx from a female donor, prolonged ischemic time and number of perioperative red blood cell transfusions. Mediastinitis and sternal infections were not observed among patients undergoing minimally invasive LTx. SSIs were associated with 35% mortality at 1 year post‐LTx. Lengths of stay and mortality in‐hospital and at 6 months and 1 year were significantly greater for patients with SSIs other than empyema. In conclusion, deep SSIs were uncommon, but important complications in LTx recipients because of their diverse microbiology and association with increased mortality.     

Robotic-Assisted Hysterectomy for the Management of Severe Endometriosis: A Retrospective Review of Short-Term Surgical Outcomes

Objectives:

The primary objective was to examine the safety and feasibility of robotic-assisted laparoscopy in a cohort of women treated surgically for stage III and IV endometriosis. The secondary objective was to explore whether the stage of endometriosis affected surgical outcome.

Methods:

In this cohort study, 43 women with severe endometriosis were treated with robot-assisted laparoscopic hysterectomy with unilateral or bilateral salpingo-oophorectomy for stage III (n = 19) or stage IV (n = 24) disease.

Results:

Histopathologic evaluation confirmed endometriosis in all patients, and fibroids were also shown in 12 patients. The median actual operative time was 145 min (range, 67–325 min), and the median blood loss was 100 mL (range, 20–400 mL). All but one of the procedures were completed successfully robotically. The length of hospital stay was 1 d for 95% of patients (41 of 43), and 2 patients had prolonged stays of 4 d and 5 d, respectively. One patient was readmitted for a vaginal cuff abscess; this represented the only complication identified in this series.

Conclusions:

Robot-assisted laparoscopic surgery appears to be a reasonably safe and feasible method for the definitive surgical management of women with severe endometriosis.     

Association of microRNAs genes polymorphisms with rheumatoid arthritis in Egyptian female patients

ObjectiveTo investigate whether miRNA-499 (rs3746444) and miRNA-146a (rs2910164) genes polymorphisms are independent factors for rheumatoid arthritis (RA) in Egyptians, and whether they influence disease severity and activity.MethodsTwo hundred and seventeen RA patients and 245 healthy controls were enrolled in this study. Polymorphisms of miRNA-146a and miRNA-499 genes were detected using polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP).ResultsThe miRNA-499 CT genotype was an independent factor of RA. The miRNA-499 CT, CC genotypes and C allele frequencies were significantly increased in erosive RA group. Moreover, the heterozygote CT had more severe and more active form of the disease compared with homozygote CC or TT. However, we did not find any significant association of miRNA-146a polymorphism with RA risk, severity, and activity.ConclusionThe miRNA-499 polymorphism is an independent factor of RA, and influences disease severity and activity.     

Croyances dysfonctionnelles liées au craving : évolution auprès des patients en post-cure d’alcoologie

Among patient with alcohol use disorders (AUD), cognitions (beliefs, thoughts, schemas) play an important role in alcohol abuse and in craving, defined as a strong and irresistible urge to consume a product. Various types of beliefs, said to be dysfunctional, were specifically identified among AUD patient as being able to favor a relapse. The aim of this research concerns the comorbidity (qualitative part of the research) and the dysfunctional beliefs relative to the craving (quantitative part of the research). The evolution of craving related beliefs are analyzed during a post-cure care. Ten French patients in post-cure care for AUD were received in clinical interview, and in structured interview (MINI). They also filled the French form of the Craving Beliefs Questionnaire at the two moments: At the beginning of post-cure care, then at the end. On the quantitative part, the results show that the irrational beliefs decrease among every patient. However, this evolution is not correlated with the number of post-cure care from which they benefit. A hypothesis is whether it is the global residential care in itself that influences the cognitions-beliefs.     

Prevalence of Bell’s palsy in Qena Governorate,Egypt

Background and purpose: There have been few studies to estimate the prevalence of Bell’s palsy (BP) in Arab countries. A community-based study was conducted to estimate the prevalence, incidence rates, precipitating factors, and outcome of BP in Qena Governorate, Egypt.

Subjects and methods: A door-to-door survey was carried out, with random sampling of 10 districts, involving 9303 inhabitants, 51.1% males and 48.9% females. Seventeen subjects were positive in screening questionnaire and referred to Qena University hospital and were subjected to a full clinical examination, House Brackmann’s Facial grading system.

Results: In a total population of 9303 individuals, 15 cases were confirmed as having BP giving a prevalence rate (PR) 161/10⁵ for all ages 95%CI (80–243). It was slightly but not significantly higher among women and the rural community. The incidence rate of BP was 107/10⁵. The highest age-specific rate was 40–49 years age. The most frequent precipitating factors for an episode of BP were exposure to air draft in 40%, physical stress (13.3%), and upper respiratory tract infection (13.3%). Moreover, 46.7% had predisposing risk factors, DM and hypertension in 33.3%. Sixty percent of cases had complication and poor outcome.

Conclusion: The overall prevalence and incidence rates of BP in Qena governorate were high. This could be related to the variation in day and night temperature in our community and the susceptibility to air draft exposure during the night. The high frequency of poor outcome among studied cases suggests that better local guidelines should be implemented to recognize and treat BP.     

Catechol-O-methyltransferase Val158Met polymorphism and hyperactivity symptoms in Egyptian children with autism spectrum disorder

Catechol-O-methyltransferase (COMT) plays an important role in the catabolism of brain dopamine and norepinephrine, which have been implicated in the pathogenesis of Autism spectrum disorder (ASD) as well as in other neuropsychatric disorders. We aimed to investigate the association of COMT Val158Met gene polymorphism with ASD and to examine the influence of such genotypes on hyperactivity symptoms in ASD patients. Eighty ASD patients (mean age 9 ± 1.9 years) and 100 control children (mean age 8.9 ± 1.9 years) were examined. COMT Val58Met polymorphism was genotyped using Tetra-primer ARMS-PCR method. The clinical diagnosis of ASD and ADHD were confirmed according to the DSM-IV criteria for research. We found no significant difference in genotypes or alleles’ frequencies of COMT Val158Met polymorphism between ASD patients and control group. There was a significant association between COMT (Val/Val) genotype and both increasing CARS (p = 0.001) and hyperactivity scores (p = 0.006). Regarding Conner's Score, the DSM-IV hyperactive impulsive were significantly higher in Val/Val genotype than both Met/Val and Met/Met genotypes (p = 0.03). Our data suggested an association between COMT Val58Met polymorphism and hyperactivity symptoms in Egyptian children with ASD.