Family functioning in the caregivers of patients with dementia

BACKGROUND: Caregiver burden has been extensively studied in the dementia population. The marital relationship has been suggested as a mediational model through which variables influence the caregiver and contribute to the experience of burden or reward. OBJECTIVES: This study examines family functioning, caregiver burden and reward and quality of life in 38 family members caring for a relative with dementia. METHODS: Caregivers of out-patients with dementia completed self report questionnaires. RESULTS: 63% of caregivers were female with a mean age of 62 years. Patient mean age was 73 years. The average number of caregiving years was 3.1. Caregivers were more likely to be spouses (61%) than children (29%) or other relatives (11%). Despite the fact that caregivers reported that their relatives were moderately disabled, they perceived more reward than burden. Caregivers who reported poor family functioning had higher ratings of strain and burden. Family functioning in these caregivers was poorest in the dimensions of affective responsiveness, problem solving and communication but it was also impaired in roles and affective involvement. CONCLUSIONS: Assessing a family's functioning may be an important factor in the care of the dementia patient and his/her family.     

Waist-hip ratio and low HDL predict the risk of coronary artery disease in Pakistanis

OBJECTIVE: To establish risk factor causal associations for coronary artery disease (CAD) in the native Pakistani population. METHODS: We conducted a hospital-based, case-control study of 200 cases with angiographically documented CAD and 200 age- and sex-matched controls without angiographic evidence of CAD. Patients on lipid lowering therapy were excluded. Lifestyle, anthropometric and biochemical risk factors were assessed in both groups. RESULTS: The presence of CAD was associated with current, past or passive smoking, a history of diabetes and high blood pressure, a positive family risk factors in this study; levels were below history of CAD, body fat percentage, waist-hip ratio (WHR), low apolipoprotein A1 or low HDL, lipoprotein (a), glucose, insulin, insulin resistance, C-reactive protein (CRP), total cholesterol to HDL ratio (TC/HDL) and creatinine on univariate conditional logistic regression analysis. In multiple regression analysis, significant independent associations were found with low HDL (OR 0.11; 95% CI 0.04-0.34; p < 0.001) positive family history (OR 1.79; 95% CI 1.09-2.93; p = 0.02), CRP (OR 1.45; 95% CI 1.19-1.75; p < 0.001) and WHR (OR 1.04; 95% CI 1.01-1.08; p = 0.01). Angiograms were also quantified for the extent and severity of CAD by the Gensini scoring system. Quantitative angiographic data showed associations with age (p = 0.01), the duration of diabetes (p = 0.04), WHR (p = 0.06), low HDL (p < 0.001), lipoprotein (a) (p = 0.001), creatinine (p < 0.001) and CRP (p = 0.007). Results indicate that total and LDL cholesterol were not significant currently accepted thresholds for treatment. CONCLUSIONS: The cardiovascular risk profile in this population is consistent with metabolic syndrome where low HDL and WHR can be used to predict the risk of CAD. Results suggest the need to redefine the currently practised approach to CAD management in this population to fit local needs.     

Cellular schwannoma of the paranasal sinuses: initial report of a case

Cellular schwannomas are a benign variant of classic schwannomas. Their histologic appearance closely mimics that of malignant peripheral nerve-sheath tumors, which are high-grade sarcomas. In this article, we describe what to our knowledge is the first reported case of a cellular schwannoma of the paranasal sinuses and only the 33rd reported case of any schwannoma at this site. We also discuss the histology and management of cellular schwannomas and review the pertinent literature.     

The COX-2 inhibitors: new analgesic and anti-inflammatory drugs

Selective COX-2 inhibitors offer a therapeutic alternative to the conventional nonselective NSAIDs. Rofecoxib has been demonstrated to be a valuable therapeutic agent in the management of acute orofacial pain. Selective COX-2 inhibitors are also indicated in patients who are likely to undergo surgery or invasive procedures in the near future because these drugs do not prolong the bleeding time. The efficacy of these drugs in the management of chronic orofacial pain is yet to be evaluated. The pharmacoeconomic impact of COX-2 inhibitors must also be considered, as the cost of selective COX-2 inhibitors is considerably higher than the other commonly used NSAIDs. Although it is clear that COX-2 inhibitors offer some advantages over the nonselective NSAIDs in terms of a lower risk of GI toxicity with long-term use, the effects following short-term use are still unclear. Until more data are available, COX-2 inhibitors should be avoided or used with the same caution as for conventional NSAIDs in patients with compromised renal and cardiac function.     

Ethnic differences and determinants of proteinuria among South Asian subgroups in Pakistan

BACKGROUND: Hypertension, diabetes, increasing age, and smoking are known risk factors for proteinuria. Prevalence of proteinuria is high in South Asians. However, ethnic subgroup differences and determinants of proteinuria within the South Asian population have not been explored. METHODS: The National Health Survey of Pakistan conducted between 1990 and 1994 was used to explore ethnic subgroup variation in proteinuria. Distinct ethnic subgroups, the Muhajir, the Punjabi, the Sindhi, the Pashtun, and the Baluchi, were defined by mother tongue. We report results in individuals aged >or=15 years (N = 9442). Proteinuria was defined as dipstick positive for protein on random urine sample. RESULTS: Increasing age, high consumption of meat, and presence of hypertension and diabetes were each independently associated with proteinuria. The age-standardized prevalence of proteinuria was 4.6% (4.2% to 5.1%) and varied among ethnic subgroups (P < 0.001). The highest was among the Sindhi (men 9.5%, women 10.3%), then the Muhajir (men 8.2%, women 4.7%), the Punjabi (men 3.2% women 3.5%), and lowest among the Baluchi (men 2.4%, women 4.2%) and the Pashtun (men 2.7%, women 1.2%). The ethnic differences persisted after adjusting for the above-mentioned sociodemographic, dietary, and clinical risk factors [adjusted odds ratio (OR) (95% CI)] were 6.42 (3.97 to 10.38) for the Sindhis, 3.58 (2.22 to 5.79) for the Muhajirs, 2.03 (1.25 to 3.29) for the Punjabis, and 1.75 (0.79 to 3.88) for the Baluchis compared to the Pashtuns). CONCLUSION: We conclude that unmeasured environmental or genetic factors account for ethnic variations in proteinuria, and deserve further study.     

Laparoscopic aspects of peritoneal tuberculosis. Report of 163 cases

The aim of this study is to report the results, the complications and limits of laparoscopy in patients with tuberculous peritonitis. In a retrospective study of 163 laparoscopy realized from 1970 to 1998. All the patients had exsudative ascites with predominantly of lymphocytes. Miliary nodules were found in 87% of cases, adhesions between the peritoneum and organs were found in 69% of cases and congestion in 63% of cases. Laparoscopically guide peritoneal biopsies detected caseating granulomas in 87% of cases. Laparoscopic appearance of the peritoneum mimicking a carcinosis in 15% of cases. One patient had complication as a bowel perforation. Miliary nodules and adherences are the more frequent appearances into peritoneal cavity in tuberculous peritonitis. With peritoneal biopsies, laparoscopy is always the best method for definitively and rapidly diagnosis of tuberculous peritonitis.     

The place of endoscopic sphincterotomy in the treatment of acute biliary pancreatitis: report of 78 cases

In this retrospective study, 78 patients with acute biliary pancreatitis underwent endoscopic retrograde cholangio-pancreatography (31 men, 47 women; median age 61 years). It was a severe pancreatitis in 70% cases. The median time from admission to endoscopic sphincterotomy was 4 days. Endoscopic sphincterotomy was performed in 73 patients (93.3%). Bile duct clearance was achieved in 69 patients (88.37%). Overall, the complication rate was 7%. All the patients recovered after endoscopic sphincterotomy. Surgery was necessary in 40% cases.     

Nodular fasciitis of the breast: a case report

Nodular fasciitis is a soft tissue lesion that in rare instances occurs in the breast. It can clinically and radiologically mimic malignant tumor. We describe a case of nodular fasciitis of the breast in a young woman that was misdiagnosed as phyllodes tumor. The histologic features and a review of the literature are presented. Awareness of such an entity in the breast obviates the need for unnecessary surgical intervention.     

Multiple hydatid cysts of the neck,the nasopharynx and the skull base revealing cervical vertebral hydatid disease

Hydatid disease is caused by the parasitic tapeworm Echinococcus. This parasite in larval stage can thrive in many parts of the body, most commonly in the liver and the lung. Hydatid disease in the head and neck is uncommon and hydatid cyst presents rarely as a cervical mass. Cervical vertebral echinococcosis is rare. We report a 14-year-old girl with multiple cervical spine hydatid cysts of the C1-C2 vertebrae that spread into the surrounding paravertebral tissues and involve the nasopharynx and the skull base particularly the left jugular foramen. This process has caused a progressive swelling in the left side of the neck located in the retrostyloid compartment of the parapharyngeal space with paralysis of cranial nerves (VI, IX, X, XI, XII). The diagnosis was made based on the image obtained from CT and MRI examinations. Characteristics of this rare disease, diagnosis and treatment difficulty are discussed.