Objectives: Quality of life (QOL) among caregivers of cancer patients is often diminished. For lower-income caregivers, QOL deterioration may be of greater impact. The objectives of this study were ...to evaluate QOL among lower-income cancer caregivers in Delhi, India and to review previous investigations assessing QOL among lower-income caregivers internationally. Methods: A Hindi-version of the Caregiver Quality of Life Cancer (CQOLC) index was administered to 89 caregivers of lung cancer patients visiting a public referral center. Mean CQOLC index scores were correlated with baseline demographics and subdomain index scores were compared using two-tailed t-tests and analysis of variance. A systematic review of PubMed, EMBASE, and PsychInfo was undertaken to identify studies evaluating QOL of lower-income cancer caregivers.Results: Worse CQOLC index scores were found for caregivers from homes earning less than 175,000 Rs. annually per capita (p < 0.01) and caregivers providing aid for 4 months or longer (p < 0.01). Both subgroups met criteria for a clinically meaningful difference. Responses to items related to the burden subdomain contributed most to summative index scores (p < 0.01). Systematic review identified 11 studies meeting inclusion criteria. Selected studies convey that burden is increased among lower-income caregivers in Asia and the Middle East compared to those maintaining more financial flexibility. Significant evidence is lacking to suggest that lower-income caregivers in Africa, Europe, and North America share worse QOL.Conclusion: Lower-income caregivers suffer loss in QOL, particularly in the developing world. Resourceful interventions designed to alleviate caregiver burden are desirable.
Primary rhabdomyosarcoma of the prostate is a malignancy primarily of pediatric age group with most cases seen during infancy and childhood. Majority present with urinary symptoms but the case we ...report here presented at 16 years of age and had unusually nonspecific and temporally protracted nature of symptoms prior to the presentation. This remarkable unusualness lead to a delay in presentation and contributed to an eventually unfavorable outcome.
Pneumocystis jiroveci (also known as P. carinii) causes fatal pneumonia in patients with AIDS and other immunocompromised patients. Co-trimoxazole (trimethoprim + sulphamethoxazole, TMP-SMZ) is the ...drug of choice for treatment and prophylaxis. Widespread use of sulpha medication has raised the possible selection of resistant P. jiroveci strains worldwide. Non-synonymous polymorphisms associated with sulpha resistance have been observed in P. jiroveci dihydropteroate synthase (DHPS) gene at codons 55 and 57. In view of this, we investigated mutation at DHPS locus amongst P. jiroveci isolates obtained at a tertiary care hospital in north India.
Microscopic examination of P. jiroveci in 69 clinical samples obtained from patients suspected to have P. carinii pneumonia (PCP), was performed by Grocott's Gomori methenamine silver and direct fluorescent antibody staining. Molecular studies were carried out by polymerase chain reaction (PCR) using major surface glycoprotein (MSG) as the target gene. Investigations for DHPS mutations were carried at specific 55th and 57th codon using PCR-RFLP (restriction fragment length polymorphism) assay.
Microscopic examination detected P. jiroveci in four cases and MSG gene was amplified in five cases. Further, amplification of DHPS gene was successful in four of the five cases positive by MSG gene PCR. No point mutation was observed and all four isolates presented wild-type sequences at DHPS gene by RFLP analysis.
Although our findings suggest that in Indian subpopulation, point mutations in DHPS gene of P. jiroveci are not as common as in other parts of the developed world, further studies are needed.
Dyspnea is a common symptom in a patient with valvular heart disease. The mechanism underlying this disease is still uncertain. Respiratory muscle weakness has been proposed to be one of the ...mechanisms underlying dyspnea in heart failure, but this has not been adequately studied in valvular heart disease.
We prospectively studied 20 patients with rheumatic mitral valve stenosis who were candidates for percutaneous balloon mitral valvotomy. Respiratory muscle strength assessment by maximal static inspiratory mouth pressure and maximal static expiratory mouth pressure was done on all patients at baseline and at 1 week after the procedure. The severity of dyspnea in study participants was also studied by the 6-min walk test and visual analog scale.
Balloon valvotomy was followed by a significant improvement in the 6-min walking distance (from 219 +/- 30.15 to 237.55 +/- 32.25 m, P < 0.001), visual analog scale as a measure of dyspnea (from 60.95 +/- 12.16 to 44.4 +/- 13.71 mm, P < 0.001), inspiratory muscle strength (from 51.9 +/- 10.28 to 56.55 +/- 11.87 cmH2O, P < 0.001) and expiratory muscle strength (from 62.15 +/- 19.68 to 67.20 +/- 21.91 cmH2O, P < 0.001).
Improvement in dyspnea in mitral stenosis after balloon valvotomy is associated with significant improvement in respiratory muscle strength.
Background: Dyspnea is a common symptom in a patient with valvular heart disease. The mechanism underlying this is still uncertain.
Methods: We prospectively studied 20 patients with rheumatic mitral ...valve stenosis who were candidates for percutaneous balloon mitral valvotomy. Assessment of airway hyper-reactivity by histamine challenge test was done on all patients at baseline and at 1 week after the procedure. The provocative concentration of histamine solution required producing a 20% fall in forced expiratory volume in 1 second (FEV 1) (PC20) was recorded as a measure of airway hyper-reactivity. The severity of dyspnea in study subjects was also studied by the 6-minute-walk test and visual analog scale.
Results: After balloon valvotomy, a significant improvement was seen in the six minute walking distance (219±30.15 to 237.55±32.25; p < 0.001), visual analog scale as a measure of dyspnea (60.95±12.16 to 44.4±13.71; p < 0.001) and airway hyper-reactivity (PC20; 5.69±6.01 mg/ml to 10.16±7.93; p < 0.001).
Conclusions: Improvement in dyspnea in mitral stenosis after balloon valvotomy is associated with significant improvement in airway hyper-reactivity.
PDF
