Choosing a Reliable Cognitive Test for Community Screening of Dementia in Pakistan

Cognitive testing is an essential component of geriatric assessment. No test of memory currently exists in Pakistan that caters to the socio-demographic needs of its people. With growing numbers of elderly, the need to identify an appropriate screening test of cognition becomes necessary. A literature review was conducted to identify existing tests available for screening of dementia in the community. Two tests (The Mini-Cog and 6- CIT) were selected based on their validity for community screening and low dependence on language and education level. 90 consenting participants age 60 and older visiting the out-patient setting of a tertiary care hospital in Karachi were selected through convenience sampling and given both tests. Analysis was done using SPSS 17. Time and rates of completion were calculated and individual tests items were assessed. Reliability was checked for 6-CIT and Mini-Cog using Cronbach’s alpha. Completion rates of the Mini-cog were almost half that of 6-CIT. Dementia rates were found to be 22 % and 26 % respectively for the Mini-Cog (complete group) and 6-CIT. Almost half i.e.48 % of participants were unable to perform the clock draw test in the Mini-Cog. 6-CIT had a 100 % completion rate and was found to be more reliable in our setting with a Cronbach’s Alpha of 0.7 compared to 0.14 for the Mini-Cog test. The 6-CIT is the most reliable test for community screening of dementia in our setting.     

Intra-articular steroids in knee osteoarthritis: a comparative study of triamcinolone hexacetonide and methylprednisolone acetate

The aim of this study was to compare the effectiveness of triamcinolone hexacetonide (THA) and methylprednisolone acetate (MPA), given via the intra-articular route at equipotent dosage to patients with symptomatic knee OA with effusion, in a double-blind randomized comparative trial. Consecutive hospital-referred patients who fulfilled the American College of Rheumatology criteria for knee OA (clinical and radiographic) were randomly allocated to receive either THA 20 mg (1 ml) or MPA 40 mg (1 ml). All patients had synovial fluid aspirated from their knee joint at the time of injection. Assessments were made at 0, 3 and 8 weeks by a second operator, thus blinding both patient and assessor. Outcomes measured at each visit were: knee pain in the previous 48 h (expressed on a 100 mm visual analog scale; VAS), stair climb time (SCT) and Lequesne index score (LEQ). Changes in VAS, SCT and LEQ were compared between the groups using a Students paired t test. Fifty-seven patients were studied (44 female, 13 male) with a mean age of 62.5 years. Both steroids gave significant pain relief (VAS) at week 3 (p<0.01) but only MPA showed an effect on VAS and LEQ scores at week 8 compared to baseline (p<0.05). THA was more effective than MPA at pain reduction at week 3 (p<0.01); this difference was lost at week 8 (p=0.17). There was no significant difference between the two drugs in functional endpoints (SCT, LEQ) at either 3 or 8 weeks. Both THA and MPA offer at least temporary symptomatic benefit in knee OA. THA is more effective than MPA at week 3, but its effect is lost by week 8. MPA still has an effect at week 8.Abbreviations i.a. Intra-articular - LEQ Lequesne index score - OA Osteoarthritis - MPA Methylprednisolone acetate - SCT Stair climb time - THA Triamcinolone hexacetonide - VAS Visual analog scale     

Advanced training in pediatric emergency medicine in the United States, Canada, United Kingdom, and Australia: an international comparison and resources guide

Pediatric emergency medicine is an important subspecialty of pediatrics and emergency medicine. It is a well-established subspecialty in some countries and less well developed or evolving in others. We set out to develop a resource guide and document the current status of pediatric emergency medicine training across 4 countries (United States, Canada, United Kingdom, and Australia). This article also aims to provide a starting point for pediatric or emergency physicians charged with the development of pediatric emergency medicine training programs in countries without such programs.     

Analysis of mood change during and following sleep deprivation therapy

Recent work suggest that depriving endogenous depressives of sleep for 1 night may be followed by an alleviation of their illness. In order to facilitate further study of the mechanisms underlying this effect, hourly self-rated measurements of mood were obtained throughout the sleepless night and the time of onset of any response noted. Of the patients who improved, some did so during the day following sleep deprivation; in others the response did not occur untill after the next night's sleep. The two groups of responders differed in terms of self-reported emotional arousal during the course of the sleepless night. The implications of these findings are discussed in relation to further studies of sleep deprivation therapy.