Living arrangements of older adults in Lebanon: correlates of living with married children

Rapid increases in the proportion of older adults in the population present major challenges to policy-makers worldwide. Using a nationally representative sample from the PAPFAM survey in Lebanon, this study examined the living arrangements of older adults [aged . 65 years], and their correlates, with a focus on co-residence with married children. Of 1774 older adults 17.1% co-resided with their married children: 28.1% of the 559 unmarried [widowed/divorced/single] and 11.3% of the 1071 married older adults. Among both the married and unmarried, the likelihood of co-residence was significantly lower in regions outside the capital and decreased with increasing socioeconomic status. Among the unmarried elderly, co-residence with a married child was also significantly associated with increasing age and availability of sons, as well as presence of a vascular disorder and speech problems. While solitary living has traditionally been the focus for policy-makers, older people living with a married child may also be a vulnerable group.

Combined intravitreal bevacizumab with phacoemulsification in visually significant cataract and visually significant exudative maculopathy

We investigated the visual outcome of combined phacoemulsification with intravitreal bevacizumab, in eyes with dense cataract and visually significant exudative maculopathy. Prospective longitudinal pilot study of consecutive patients treated by two surgeons in 2006, using intravitreal bevacizumab at the end of phacoemulsification. The historical control group consisted of consecutive subjects with exudative maculopathy and dense cataract treated by the same surgeons with the help of phacoemulsification without intravitreal bevacizumab prior to 2006. Thirty-one treated patients had the mean [SD] logMar best corrected visual acuity improving from - 1.48 [0.50] preoperatively to - 0.67 [0.38] in the first postoperative week [p< 0.001], to - 0.64 [0.40] in the first postoperative month [p< 0.001], and to - 0.62 [0.42] [p< 0.001] on the last follow-up [mean 4.2 months, range 1 - 9 months]. Fourteen control patients had the mean [SD] log Mar best corrected visual acuity improving from - 1.78 [0.79] preoperatively, to - 0.91 [0.53] in the first postoperative week [p< 0.001], to - 0.86 [0.45] in the first postoperative month [p< 0.001], and to - 0.90 [0.47] [p< 0.001] on the last follow- up [mean 19.6 months, range 1 - 49 months]. Initial visual acuities, final visual acuities, and percentage of visual improvement at one month were all not significantly better in the intervention compared to the control group at one month. In the study group, the fovea was flattened at the one-month follow-up, by 90-diopter slit lamp examination and / or Optical coherence tomography. The combination of intravitreal bevacizumab and phacoemulsification is beneficial for maximal visual rehabilitation in the first postoperative month

Hazards of nitrous oxide administration in presence of venous air embolism

Nitrous oxide administration in presence of venous air embolism results in its volume augmentation. The present case report of a 50-year old patient undergoing posterior fossa tumor excision in the sitting position demonstrates the hazards of nitrous oxide in presence of venous air embolism. Administration of 66% nitrous oxide 140 minutes after the incidence of air embolism resulted in a significant decrease of end-tidal carbon dioxide tension, moderate hypotension, and tachycardia, suggesting volume augmentation of the air embolism. The results of our case report are in contrast to that by Shapiro et al who noted that nitrogen washout following administration of 100% oxygen was complete 65 minutes after the occcurrence of venous air embolism. Shapiro and colleagues suggest the use of nitrous oxide challenge as a diagnostic aid in deciding when lung excretion of intravascular air is complete. However, our case report implies that nitrogen washout was not complete 140 minutes after venous air embolism incidence. Accordingly, we recommend to stop nitrous oxide administration once air embolism is suspected and to refrain from its readministration throughout the rest of surgery