Prevalence and predictors of depression and anxiety among the elderly population living in geriatric homes in Cairo, Egypt

Anxiety and depression are common in the elderly and affect their quality of life. The rates of depression and anxiety are higher among those living in institutional settings and are usually undiagnosed. The aim of the study was to determine the prevalence and predictors of depression, anxiety and mixed form [i.e. depression and anxiety] in the elderly living at geriatric homes. A cross-sectional study was conducted on 240 elderly participants from four randomly selected geriatric homes in Cairo. A pretested interview questionnaire was used to collect data. A short version of the Geriatric Depression Scale [GDS-15], the Hamilton Anxiety Scale, the Katz scale for Activity of Daily living, the three-item loneliness scale and the Personal Well being Index Scale were used. The prevalence of depression, anxiety and mixed disorder among the studied group were 37.5, 14.2 and 30%, respectively. Old age and the presence of comorbidities were predictors for depression and/or anxiety. Female sex, a lower social class, insufficient income, partial independence and loneliness feeling are significant predictors for depression. Being married and loneliness feeling are significant predictors for anxiety, whereas the functional status is a significant predictor for mixed depression and anxiety. Depression and/or anxiety were found in more than 80% of the studied group. An older age, female sex, insufficient income, a lower social class, a partially independent functional status, the presence of comorbidities, more frequent loneliness feeling and being married or divorced were found to be significant predictors for these problems. This study reflects the need for the screening of the elderly in geriatric homes for depression and/or anxiety, especially among high-risk groups, and developing interventions to prevent and control such problems

Assessment of the role of paraoxonase gene polymorphism [Q192R] and paraoxonase activity in the susceptibility to atherosclerosis among lead-exposed workers

Lead exposure is a well known cause of cardiovascular damage, including atherosclerosis. Paraoxonase 1 [PON1], a high-density lipoprotein-associated antioxidant enzyme, is capable of hydrolyzing oxidized lipids and thus it protects against atherosclerosis. The mechanism by which heavy metals inhibit serum PON1 activity is still not clear. Our aim was to detect the association between lead exposure and serum PON1 activity and lipid profile and also to study the polymorphism of the PON1 gene. A case-control, cross-sectional study conducted from June 2008 until May 2009. Male workers [n=100] in a lead battery manufactory were recruited for this study. They were compared with 100 male age-matched workers not exposed to lead [control group]. Serum lipid profile, paraoxonase activity and lead were measured in blood samples. The DMA was extracted for detecting the Q192R polymorphism of the PON1 gene by polymerase chain reaction followed by restriction fragment length polymorphism. There was significant difference in triglycerides, total cholesterol and high-density lipoprotein cholesterol [HDL-C] [P=.01,.05 and.04, respectively] between cases and controls. Multiple linear regression analysis showed that blood lead levels were significantly associated with decreased serum paraoxonase activity [P=.03] in lead workers. The paraoxonase genotype QR was the most prevalent in 34/53 subjects [64%] among the leadexposed groups, while the genotype QQ was more prevalent in the control group, in 1 5/25 subjects [60%], with a significant difference between the control and other groups [P<.05]. Lead exposure is associated with increased triglycerides, total cholesterol and low-density lipoprotein cholesterol and decreased HDL-C. Because of the protective role of PON1 in the development of atherosclerosis, a decrease in serum PON1 activity due to lead exposure may render individuals more susceptible to atherosclerosis

Predictors of stroke outcome in Egyptian patients following acute stroke

Stroke is a major public health problem. Certain clinical factors can predict the prognosis of functional outcome of acute stroke. Identify factors which predict the outcome of stroke Egyptian patients. Hospital-based prospective study included 220 patients with stroke. Data collection was carried out using a pretested questionnaire. The questionnaire was used to record the demographic data, clinical data, the pre hospital delay. Neurological examination with special emphasis on the muscle power was done. The patients were followed up till their time of discharge to record the length of hospital stay, and the functional outcome at time of discharge which was assessed by modified Rankin Scale [mRS]. The mean age of the studied patients was 59.8 +/- 13.2, males constituted 64.1%. Hypertension was the main co morbidity detected in 65%. The degree of weakness of the patient recorded complete paralysis in 6.8%. The median prehospital delay was 6 hours, while median the length of hospital stay was 6 days. 53.2% were independent according to mRS [good outcome] and 46.3% were dependent [bad outcome]. Forward logistic regression analysis demonstrated that motor weakness, older age, female sex and prehospital delay were the only significant predictors with prediction change in the odds equal [12.9, 7.8, 2.6,4.6 respectively]. Our data confirmed that old age, female sex, pre hospital delay, lower manual muscle strength testing score were the independent predictor of poor outcome in Egyptian stroke patients

Compliance of diabetic patients. Pros and cons

Diabetes is a major public health problem allover the world. Compliance refers to a patient both agreeing to and then undergoing some part of their treatment program as advised by their doctor or other health care workers. This study was conducted to demonstrate the pattern of compliance among diabetic patients, its determinants and reasons beyond noncompliance. This cross section descriptive study was conducted at the outpatient Clinic of Diabetes, Kasr Al-Aini. Their compliance pattern were assessed using special scoring. Improper compliance to diet was more prevalent [104[34.7%]]. The significant determinants of improper compliance to diet were younger age, type 1 diabetes, long duration of illness, absence of complication, positive family history, receiving 3 or more drugs per day and improper compliance to drugs. Financial constraints and depression were beyond improper diet and drugs compliance. Compliance to appointment and drugs were better than compliance to diet. Cost and psychological depression were among the main reasons of improper compliance

Altered serum lipids and paraoxonase activity: a step toward at herosclerosis among lead exposed Egyptian workers

A vast amount of evidence during the past decade, has confirmed that lead is associated with lipid and lipoprotein abnormalities which play a major role in the pathogenesis and progression of atherosclerosis and cardiovascular diseases. This study aimed: to investigate the relationship between chronic occupational lead exposure, lipid profile, and serum PON1 activity as one of the mechanisms of atherosclerosis. Male workers [n=100] in lead battery manufactory were recruited for this study. They were compared with 100 male age matched non-lead workers. Serum lipid profile and paraoxonase activity were done to their samples. Serum Lead was determined vsing atomic absorption spectroscopy. There was significant differences regarding triglycerides, total cholesterol, and HDL- c [p=0.01, 0.05 and 0.04, respectively] between both groups. A cumulative effect of blood lead on lipid profile was significantly detected. Multiple linear regression analysis showed that blood lead level was the only negative significant predictors to serum paraoxonase activity [p=0.03] in lead workers. lead exposure is associated with increased triglycerides, total cholesterol and LDL-c and decrease HDL-c. Because of the protective role of PON1 in the development of atherosclerosis, decrease in serum PON1 activity due to lead exposure may render individuals more susceptible to atherosclerosis

extent of computer literacy among medical students and their attitude regarding its use in medical education

Developments in information and communication technology occur at an astonishing rate. The need for medical students to be computer literate is no longer an issue for debate. Assess computer literacy and skills among medical students and explore their attitude regarding the computer and internet usage to facilitate the educational process. This cross sectional descriptive study was conducted in medical college of Cairo University [Kasr Alaini] and concluded 450 medical students from 1[st], 3[rd], and 5[th] grades [150 students from each grade]. Data was collected using a self administrated questionnaire covering the following elements: Computer availability, Computer skills, Web navigation, Attitude toward use of computer and internet in medical education. The study concluded that 81.3% of the included students had access to computer at their homes, and 82.1% of them used the computer as one of their daily norms. The prevalence of computer literacy was 94.9%. Basic skills showed higher score than other skills. As regard internet usage; 60% of the entire sample used it in the last 2 weeks hut for medically irrelevant reasons. Most of the students encouraged the application of computer and internet in medical education especially in lectures. Computer ownership was widely distributed among medical students who showed high level of competency in basic skills. All the students were in favor of use of the computer and internet in medical education process

Epidermal growth factor receptor [Egfr] and C-erbB-2 Expression in colorectal adenoma and adenocarcinoma

The incidence of colorectal cancer [CRC] has been rising worldwide. Discovery of new prognostic markers in CRC patients is necessary to improve the outcome of disease and to select appropriate treatment. The epidermal growth factor receptor [EGFR] is a trans- membrane glycol-protein. An abnormal expression of the EGFR has been described in many human tumors and implicated in the development and prognosis of malignancies. C-erbB-2 is a proto oncogene. Several studies have demonstrated the value of c-erbB-2 in predicting the biological behavior of tumors. Forty five patients were included in our study. Thirty were having colorectal adenocarcinoma [21 male and 9 female] and fifteen having adenoma [11 male and 4 female] with median age of 63 years. EGFR and c-erbB-2 over expression was immunohistochemically analyzed in colorectal adenoma and colorectal adenocarcinomas in order to determine whether there was a relationship between these two proteins and various histological and clinical characteristics with their respective impact on prognosis and to study their potential usage in early diagnosis of colorectal cancer. In the current study the expression of c-erbB-2 was significantly higher in preneoplastic lesions [93.3%] than colorectal cancer [60%] p<0.001. EGFR showed an inverse pattern to c-erbB-2 expression was significantly inversely associated with low grade tumor [GI] p 0.05]. As regards, tumor location only, c-erbB-2 expression was frequently expressed in rectal cancer versus colon cancer cases [p<0.05]. From this study we can conclude that c-erbB-2 can be potentially used in early diagnosis of colorectal cancer and considered as a significant predictor of the occurrence of colorectal carcinoma while EGFR expression is considered as a prognostic tool for prediction of cancer behavior and clinical outcome in CRC cases

Evaluation of the role of ultrasonography versus immunologic tests in diagnosis of chronic hepatosplenic sechistosomiasis

This study aims to evaluate the sensitivity of different EL1SA techniques versus ultrasonography as a 'stablished tool in diagnosis of chronic hepatosplenic schisosomiasis and assessment of different degrees of morbidity. Based on clinical, sonographic md laboratory testing 100 patients enrolled in this study were devided into 4 main groups: Group I with simple intestinal schistosomiasis, group II with periportal fibrosis with or without organomegaly, group III with hepatosplenomegaly and portal hypertension and group IV with advanced morbidity and end stage liver disease. All patients were subjected to ultrasonographic evaluation and serological assessment using Two techniques of ELISA conventional versus Dot ELISA with two types of antigens crude adult worm and soluble egg antigens assessing both IgG and IgM antibodies. The positivity of different ELISA techniques decreases with the advance of morbidity being 95% in group [compared to 15% in group 4 for conventional ELISA and 75% in group I compared to 10% in group 4 for the Dot ELISA. Ultrasonographic evaluation proved to have the main role with the advance of the degree of morbidity and there is no relation between different stages of the disease and the degree of antibody positivity. Antibody burden was higher in the earlier stages of the disease compared to stages of advanced morbidity. IgM antibodies are more prevalent in the earlier stages of the disease while IgG antibodies are more consistent in different stages of the disease being also higher in the [earliest stages of the disease. Based on the conditions of antigen preparations used conventional ELISA was more Sensitive compared to dot ELISA [88% versus 80%] for the conventional using adult worm and soluble egg antigen in group 1 and [68% versus 60%] for the dot ELISA using the Be types of antigens. Conventional ELISA is more sensitive than Fdot ELISA with the adult worm antigen more sensitive than isoluble egg antigens. With advance of morbidity of the disease the sensitivity of both tests as well as the antibody burden decreases that may be attributed to decrease of the intensity of infection as well as low immune status of the individual and this spotlight on the role of ultrasonography with the advance of morbidity. Targeting treatment and control programmes for earlier stages of the disease is essential to reduce heavy antigenic burden that might be responsible for intense immune reaction and progression of the disease state to advanced irreversible morbidity.

Nuclear accumulation of beta-catenin is a common and early event during neoplastic progression of Barrett esophagus

The majority of the adenocarcinomas arising in Barrett esophagus manifest clinically at an advanced stage and have a poor prognosis. As a result of this, much attention has been directed toward the exploration of markers for neoplastic progression in Barrett esophagus. The objective of the present study was to evaluate the role of beta-catenin expression in the progression of Barrett esophagus to adenocarcinoma by immunohistochemical analysis in 25 cases with adenocarcinoma and premalignant lesions and to examine its relationship to various prognostic factors. In our study, abnormal beta-catenin expression consisting of the loss of membranous staining and the appearance of the nuclear staining was found in 23 cases of esophageal adenocarcinoma [92%]. Of patients with the 23 tumors showing abnormal beta-catenin expression. 16 cases [64%] nuclear staining was present. This nuclear reaction was associated significantly with progression from metaplasia to low-grade dysplasia [P = 0.01]. In addition, in glands with clear histological transition from metaplasia to low-grade dysplasia. focal nuclear accumulation of beta-catenin was found only in the low-grade dysplastic areas. Also, we proved that the prevalence of reduced expression of beta-catenin on the membrane with or without nuclear staining increased significantly from low-grade to high-grade dysplasia to adenocarcinoma [P > 0.05]. According to clinicopathological correlation, abnormal beta-catenin expression was highly expressed in high grade tumors [G[3]] and tumors with lymph node metastasis with equal incidence 100%. Also, we found no gross difference in beta-catenin expression between Tis-T[1] and T[2]-T[3] tumors. 88.9% and 93.75%. respectively. These results indicate that abnormal expression of beta-catenin is a common and early event during neoplastic progression in Barrett esophagus and could be a valuable prognostic marker. Also it could be used to identify patients with Barrett esophagus who run a high risk of disease progression

Immunohistochemical study of cell proliferation and tumor suppressor gene status in hyperplastic and neoplastic prostatic lesions

Predicting the clinical behavior of prostatic carcinoma could be difficult. One approach is to identify the molecular prognostic markers, therefore we evaluate the proliferative rate [MIB-1 antibody] and expression of tumor suppressor gene [P[53] protein] in 30 cases of prostatic adenocarcinoma. Values were correlated with histo-pathological parameters [Gleason score, stage and age of the patients]. Results were compared with the same studies on benign prostatic hyperplasia [n = 2], adenosis [n = 5], prostatic intraepithelial neoplasia [n = 5]. MIB-1 proliferation index was lowest in BPH, followed by adenosis,low grade [PIN], low grade cancer, high grade PIN and high grade cancer. Results of our study showed that MIB-1 proliferation index is highly correlated with tumor grade and clinical stage with percentage 100% and 62.5% respectively. As regard the expression of P[53], our results proved that it was confined to prostatic cancer especially high grades with overall incidence 70%. Also, it was found, that P[53] expression was correlated with tumor grade with incidence [83.3%], clinical stage [87.5%] and patients age> 50ys [75%]. These results provide additional evidence that adenosis is a histological small acinar proliferation more akin to BPH than high-grade PIN or adenocarcinoma.While high grade PIN showed strong correlation with prostatic carcinoma according to cell proliferation. Abbreviations: [PIN] prostatic intraepithelial neoplasm, [BPH], benign prostatic hyperplasia

Genes regulating apoptosis: an immunohistochemical study of BCL-2 and P53 expression in colorectal adenomas and carcinomas

Evidence is accumulating for the failure of apoptosis as an important factor in the evolution of colorectal cancer and its poor response to adjuvant therapy. The proto-oncogene Bcl-2 is a known inhibitor of apoptosis that may allow the accumulation and propagation of cells containing genetic alterations. Inactivation of P[53] the tumour suppressor gene are common in human colorectal cancer.This study aimed at evaluating the expression of Bcl-2 and P[53] proteins in colorectal adenomas versus carcinomas for better understanding of their role in the process of colorectal carcinogenesis and correlate their expression with the clinicopathologic features of these tumours. So we analyzed the expression of these markers in 11 colorectal adenomas and 14 carcinomas with the adjacent normal mucosa. Staining patterns were assessed semiquantitatively and correlated with each other and with age, sex, tumour size, site, tumour differentiation and Dukes' classification. A higher proportion of adenomas [54.5%] than carcinomas [36.4%] expressed BCL-2, Bcl-2 expression was more frequent in well differentiated carcinomas than moderately and poorly differentiated carcinomas. A lower proportion of adenomas [35.7%] than carcinomas [64.3%] expressed P[53] A total of [18.2%] of adenomas and [13.3%] of carcinomas expressed both markers. We suggested that Bcl-2 provides a survival advantage in the proliferative compartment of normal crypts of colorectal neoplasms, however, its expression is lost during the evolution from adenomas to carcinomas, whereas P[53] expression is increased. Although P[53] expression doesn't delineate aggressive behaviour and tumour progression in colorectal cancer, Bcl-2 provides a favorable marker for good differentiation in these tumours