Gender differences in burden of care and coping strategies among caregivers of schizophrenia patients.

Background: Caregivers of patients with schizophrenia have a considerable burden of care and develop different coping strategies to deal with the caregiving burden. Aim: The aim of this article is to assess gender differences in the burden of care and coping strategies used among caregivers of clinically stable patients with schizophrenia. Methods: In this cross-sectional study, a total of 57 caregivers (33 males and 24 females) of the patients with schizophrenia attending a psychiatric outpatient setting were included by purposive sampling. The caregivers were assessed with the Burden Assessment Schedule 20 items (BAS-20) and Brief Approach/Avoidance Coping Questionnaire (BACQ) to assess the burden of care and coping strategies, respectively. Results: Average BAS-20 score was comparable between the male and female caregivers. If the patient was a spouse, the male caregivers had a significantly higher burden of the marital relationship than the female caregivers. On the BACQ, the socio-emotional approach subscale was significantly higher in female caregivers. The avoidance-oriented coping score and socio-emotional avoidance subscale were significantly higher in male caregivers. A significant positive correlation was found between BAS-20 score and avoidance-oriented coping scores in all caregivers except the females where a significant negative correlation was found between BAS score and socio-emotional avoidance type of coping. Conclusion: There are no gender differences in the burden of care in caregivers of clinically stable patients with schizophrenia except the male caregivers have a higher burden in the domain of marital relationship. The socio-emotional approach type of coping is higher in females while the socio-emotional avoidance type of coping is lower in male caregivers.

Willis-Ekbom disease/restless legs syndrome in patients with opioid withdrawal.

INTRODUCTION: Many patients with opioid use disorder report symptoms similar to restless legs syndrome (RLS) during withdrawal. However, whether these symptoms are true RLS, their predictors and effect of treatment with pregabalin are still unknown. METHOD: A total of 19 consecutive patients with opioid use disorder who were admitted for detoxification were included in this study after obtaining informed consent. Information regarding addiction was noted, and they were screened for RLS every morning and evening. Patients were also asked to provide information regarding their sleep quality during the previous night. To control opioid withdrawal, they were prescribed buprenorphine. Pregabalin was prescribed to patients who developed RLS. For analysis, patients were divided in two groups: those with RLS and those without RLS. RESULTS: The average age of the subjects included in this study was 30.2 (±10.4) years. Mean duration of substance abuse was 56.8 (±38.4) months. Ten patients developed symptoms of RLS. Groups with RLS and without RLS were comparable with reference to demographics, laboratory parameters, and dose of buprenorphine that was required to control withdrawal symptoms. On average, RLS appeared after 1.7 days of abstinence. Patients described their symptoms such as crawling, creeping sensation in the muscles or "just pain". Eight out of 10 subjects reported symptoms limited to legs; however, two described similar problems in their upper limbs as well. A change in sleep pattern was observed with delayed sleep onset at night, delayed wake time in the morning, and spending a major proportion of day asleep. Pregabalin brought significant relief to the symptoms of RLS and sleep quality. CONCLUSION: RLS during opioid withdrawal was an independent illness seen in half of the patients. It appeared to be mediated through mu-receptors, with contributions from other factors. Pregabalin improved symptoms of RLS and quality of sleep in these patients.

Giant epidermoid cyst in the breast: A common benign lesion at a rare site-A case report.

INTRODUCTION: Epidermoid cyst is a common clinical entity and it can occur anywhere in the body. But its occurrence and huge size in the breast is very rare and more liable to develop complications, including malignant transformation. PRESENTATION OF CASE: We present here an unusual case of a giant epidermoid cyst in the breast, which is about 7cm in greatest dimension. After proper preoperative diagnosis by clinical, imaging and histopathological findings, it was managed by total excision. DISCUSSION: Imaging and fine needle aspiration cytology is essential for accurate preoperative diagnosis. However, it is often very difficult to differentiate it from other benign and malignant conditions of breast. Infection and malignant transformation are its potential complications. Total excision along with its capsule is the treatment of an epidermoid cyst. CONCLUSION: Epidermoid cyst is an important differential diagnosis while managing benign breast disease.

Study of Sleep Disorders among Young Children Using Hindi Translated and Validated Version of Pediatric Sleep Questionnaire.

OBJECTIVE: The objective of this study is to assess the prevalence of sleep disorders among children aging between 4 and 9 years using Hindi version of Pediatric Sleep Questionnaire (PSQ). METHODS: This study had two parts first, translation and validation of PSQ into Hindi language, and second, assessment of the prevalence of sleep disorders using PSQ Hindi version. Hindi PSQ was distributed in randomly chosen primary schools in a semi-urban area. The children were requested to get them filled by their parents. When the questionnaires were returned, responses were analyzed. RESULTS: Most of the items of the Hindi version had perfect agreement with original questionnaire in a bilingual population (κ =1). Totally, 435 children were included in the field study having average age of 6.3 years. Obstructive sleep apnea was reported in 7.5% children; symptoms suggestive of restless legs syndrome were reported by 2%-3%; teeth grinding by 13.9% and sleep talking by 22.6% children. CONCLUSION: PSQ Hindi version is a validated tool to screen for sleep disorders among children. Sleep disorders are fairly prevalent among young children in India.

Hindi translation of Berlin questionnaire and its validation as a screening instrument for obstructive sleep apnea.

BACKGROUND: Obstructive sleep apnea (OSA) is a fairly common problem with adverse health consequences. However, any screening questionnaire is not available in Hindi to screen sleep apnea. MATERIALS AND METHODS: Subjects undergoing video-synchronized in laboratory attended polysomnography were requested to participate in this study. They were screened with the help of Hindi version of Berlin questionnaire (BQ). Outcome of the BQ was tested against the gold standard polysomnography. Descriptive statistics, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of Hindi version were calculated. RESULTS: 38 patients with polysomnography diagnosed OSA and 12 controls were included in this study. Average body mass index (BMI) in the OSA group was 33.12 + 6.66 kg/m(2) whereas in the control group BMI was 25.01 + 4.20 kg/m(2). Average age in the OSA group was 48.9 + 10.2 years whereas the control group was older (56.9 + 12.1 years). Hindi version had sensitivity of 89% and specificity of 58%. PPV of the instrument was 0.87 whereas NPV was 0.63. CONCLUSION: Hindi version of BQ is a valid tool for screening the OSA irrespective of the literacy status of the subjects.

Phytochemical and in vitro biological investigations of methanolic extracts of Enhydra fluctuans Lour

Objective: To study the phytochemical and biological properties (antioxidant, anthelmintic and thrombolytic) of methanolic extracts of Enhydra fluctuans Lour., a plant belonging to the Asteraceae family. Methods:The phytochemical evaluation was carried out by qualitative analysis. In vitro antioxidant activity of extract was studied using free radical scavenging assay, ability of reduction, total phenol and total flavonoid contents determination assays. The anthelmintic activity was determined using paralysis and death time of Pheretima posthuma (earthworm) and thrombolytic activity by clot disruption assay. Results:The phytochemical evaluation showed significant presence of flavonoids, triterpenes,carbohydrate, reducing sugars, saponins, phenols, diterpenes, protein and tannin. The antioxidant activity was found significant [IC50=(135.20±0.56) μg/mL] as compared to ascorbic acid [(130.00±0.76) μg/mL]. The reducing power was increased with concentration. Total phenol and total flavonoid contents were (153.08±0.38) mg/mL and (172.04±0.56) mg/mL respectively. The paralysis and death time of earthworms for different concentrations of extract were determined and compared with albendazole. The results showed that 10 mg/mL of the crude extract had similar effect with albendazole. Additionally, the crude extract showed a concentration depended relationship with its anthelmintic property. The clot lysis activity of crude extract was compared to the standard streptokinase’s clot lysis (40.13%) activity and found significant (31%). Conclusions: The study proves that the crude methanolic extract of Enhydra fluctuans Lour. has significant antioxidant, anthelmintic and thrombolytic activity containing wide range of phytochemicals.