Life satisfaction and strain among informal caregivers of patients with traumatic brain injury in Malaysia

Purpose: This study aims to determine the life satisfaction and strain on informal caregivers when caring for traumatic brain injury (TBI) patients and to examine the factors predicting the level of strain among the informal caregivers.

Method: A cross-sectional survey on a purposive sampling was performed in a single centre in Malaysia recruiting caregivers of patients with TBI. Life Satisfaction Questionnaire-9 and Caregiver Strain Index questionnaires were used to ascertain the life satisfaction and strain of caregivers respectively. Relationship between life satisfaction and strain was analysed, together with factors significantly associated with strain.

Results: A total of 141 caregivers (77.3% women, average age of 46.1 years?±12.8 and mean duration of caregiving of 24.8 months?±?14.3) were included in the analysis. Most caregivers (75%) were satisfied with their lives but more than half claimed to have strain (57%). There was a significant relationship between life satisfaction and strain among the caregivers (p?p?=?0.04), presence of patient’s neurobehavioural disturbances (OR 4.48, 95% CI 1.60–12.55, p?=?0.004) and cognitive dysfunctions (OR 31.72, 95% CI 10.27–97.96, p?Conclusion: Caregivers with lower monthly income and caring for TBI patients with cognitive and neurobehavioural disturbances are at higher risk of developing strain. Rehabilitation interventions post-discharge should aim at supporting the caregivers at risk.

• Implications for Rehabilitation

• Informal caregivers of patients with traumatic brain injury who are not satisfied with their lives are most likely experiencing strain.

• Caregivers in Malaysia who are at high risk of experiencing strain are those with lower monthly income and care for patients with significant cognitive and neurobehavioural disturbances.

• Efforts to reduce strain in caregivers at risk should be included in the post-discharge rehabilitation programme in Malaysia.

     

Emerging Drug Use Trends in Kelantan,Malaysia

The primarily rural and agrarian Kelantan province of Malaysia has high rates of drug use and is characterized by unique sociocultural factors. Combining qualitative and ethnographic methods, we investigated drug use and treatment needs of people who use drugs (PWUD) in rural areas of Kelantan. In February 2014, field visits, participant observation, and focus group discussions (FGDs) with 27 active PWUD were conducted in rural areas surrounding the capital city of Kelantan. The findings indicate a high prevalence of opiate and amphetamine type stimulants (ATS) use in these areas. FGD participants reported initiating drug use at early ages due to peer influences, to relieve boredom, to cope with problems, and a high saturation of villages with other PWUD was reported as a major contributor to their own continued drug use. They reported a trend of drug use initiation at younger ages and increased drug use among females. Participants were interested in treatment; however, their limited knowledge about treatment options and perceived limited availability of services were barriers to treatment seeking. Easy access to drugs, primarily from Thailand and facilitated by the use of mobile phones, resulted in an expanding prevalence of drug use that underscores the need to bolster education and prevention efforts and accessibility of treatment services in Kelantan.     

Diffuse peritoneal lymphomatosis simulating peritoneal carcinomatosis

Burkitt's lymphoma is a form of Non-Hodgkin's B-cell lymphoma. We report a case of Burkitt's lymphoma mimicking peritoneal carcinomatosis. We will discuss the imaging and clinical findings that differentiate between peritoneal carcinomatosis and Burkitt's lymphoma. A 26-year-old man presented with nonspecific abdominal pain, vomiting and diarrhea associated with significant amount of loss of weight. Computed tomography images showed extensive peritoneal and mesenteric mass associated generalized lymphadenopathy. Core biopsy of the mass confirmed Burkitt's lymphoma. CT scan features are helpful indicator to differentiate Burkitt's lymphoma and peritoneal carcinomatosis. Focal or diffuse nodular thickening of the bowel wall with extensive lymphadenopathy are likely to be lymphomatosis over carcinomatosis. However, final and confirmatory diagnosis is histopathology examination.     

Piper sarmentosum enhances fracture healing in ovariectomized osteoporotic rats: a radiological study

INTRODUCTION:

Osteoporotic fractures are common during osteoporotic states. Piper sarmentosum extract is known to possess antioxidant and anti-inflammatory properties.

OBJECTIVES:

To observe the radiological changes in fracture calluses following administration of a Piper sarmentosum extract during an estrogen-deficient state.

METHODS:

A total of 24 female Sprague-Dawley rats (200-250 g) were randomly divided into 4 groups: (i) the sham-operated group; (ii) the ovariectomized-control group; (iii) the ovariectomized + estrogen-replacement therapy (ovariectomized-control + estrogen replacement therapy) group, which was supplemented with estrogen (100 µg/kg/day); and (iv) the ovariectomized + Piper sarmentosum (ovariectomized + Piper sarmentosum) group, which was supplemented with a water-based Piper sarmentosum extract (125 mg/kg). Six weeks after an ovariectomy, the right femora were fractured at the mid-diaphysis, and a K-wire was inserted. Each group of rats received their respective treatment for 6 weeks. Following sacrifice, the right femora were subjected to radiological assessment.

RESULTS:

The mean axial callus volume was significantly higher in the ovariectomized-control group (68.2±11.74 mm³) than in the sham-operated, estrogen-replacement-therapy and Piper sarmentosum groups (20.4±4.05, 22.4±4.14 and 17.5±3.68 mm³, respectively). The median callus scores for the sham-operated, estrogen-replacement-therapy and Piper sarmentosum groups had median (range, minimum - maximum value) as 1.0 (0 - 2), 1.0 (1 - 2) and 1.0 (1 - 2), respectively, which were significantly lower than the ovariectomized-control group score of 2.0 (2 - 3). The median fracture scores for the sham-operated, estrogen-replacement-therapy and Piper sarmentosum groups were 3.0 (3 - 4), 3.0 (2 - 3) and 3.0 (2 - 3), respectively, which were significantly higher than the ovariectomized-control group score of 2.0 (1 - 2) (p<0.05).

CONCLUSION:

The Piper sarmentosum extract improved fracture healing, as assessed by the reduced callus volumes and reduced callus scores. This extract is beneficial for fractures in osteoporotic states.