Spirituality and the quality of life of cancer patients: An antidepressant effect.

OBJECTIVES: Cancer is the second leading cause of mortality in the world, and represents an economic, social and psychological burden. Scientific studies have focused on psychosocial coping mechanisms of patients and on factors improving their quality of life. Thus, the aim of the present study is to analyze the influence that spirituality would have on the quality of life of Lebanese cancer patients and to identify whether the influence on quality of life is mediated through a decreased depression. METHODS: This is a cross-sectional study targeting cancer patients in the hemato-oncology department of the Hôtel-Dieu de France Hospital (Beirut, Lebanon). It is based on a questionnaire composed of three parts: EQ-5D-5L, PHQ-9, and FACIT-Sp-12. Likewise, a control group suffering from chronic diseases and treated in the hospital was questioned. Univariate and multivariate analysis were conducted to assess the relationship between the different questionnaires for controls and for cancer patients. RESULTS: Thirty-nine cancer patients and eight control patients were questioned. In the univariate analysis, there was no relationship between depression and spirituality nor for spirituality and quality of life. After controlling for depression, an inverse correlation between quality of life and spirituality was shown. CONCLUSIONS: Our study is a pilot study which for the first time investigates the implication of depression in a "spirituality-quality of life" association. There is no clear association of spirituality with quality of life. In fact, the physical and psychological burden of chronically ill patients could exceed and render insignificant a possible impact of spirituality on quality of life.

Trimethoprim-Sulfamethoxazole-induced Hepatotoxicity in a Renal Transplant Patient.

Drug-induced liver injury (DILI) represents liver damage from various therapeutic drugs. Antimicrobials are among the most common causes of DILI. We report a case of hepatic toxicity due to Trimethoprim-sulfamethoxazole (TMP-SMX) in a patient who underwent renal transplantation. Diagnosis has been made after a careful history taking, exclusion of competing etiologies and reversal of biochemical abnormalities after withdrawal of the antibiotic. TMP-SMX liver toxicity is well known but remains unpredictable and is rarely reported.

Validation of the Arabic version of the SCOFF questionnaire for the screening of eating disorders.

The high prevalence of eating disorders in Arab countries indicates a need for an Arabic language screening tool. This study aimed to validate an Arabic version (A-SCOFF) of the British SCOFF questionnaire, a brief tool for the screening of eating disorders in primary health care. After translation and back-translation the A-SCOFF was given to 123 female patients [mean age 32 (SD 8.8) years] visiting primary health-care centres in Beirut. Each patient was evaluated by an eating disorders specialist blinded to A-SCOFF results. The validated Arabic version of the Mini International Neuropsychiatric Interview and the DSM-IV criteria for eating disorders were used as diagnostic references. The best diagnostic threshold for the A-SCOFF was found to be at 2 positive answers with a sensitivity of 80.0%, a specificity of 72.7% and an area under the curve of 80.0%. The A-SCOFF questionnaire is accurate and reliable for the early detection of eating disorders in this high-risk population.

[Hemostatic embolization of hepatocellular carcinoma complicated by hemoperitoneum. Apropos of 2 cases and review of the literature]. / Embolisation hemostatique de carcinome hepatocellulaire complique D'hemoperitoine. A propos de deux cas et revue de la littérature.

Rupture of hepatocellular carcinoma is a severe complication that occurs in about 10% of patients. It may occur as a terminal event in patients with advanced disease or it may be the first presentation in a healthy individual. Various treatment options have been proposed, which include conservative treatment, transarterial embolization and operative hemostasis or liver resection. We report intraperitoneal hemorrhage and hypovolemia in two patients with spontaneous rupture of an hepatocellular carcinoma treated successfully by transarterial hepatic embolization. On follow-up, these patients died 7 and 8 months after this treatment respectively.

[24-hour esophageal pH monitoring in adults. Apropos of a series of 116 patients]. / La pH-metrie oesophagienne de 24 heures chez l'adulte. A propos d'une série de 116 malades.

Between June 1994 and June 1996, we performed a 24-hour oesophageal pH monitoring in 116 adult patients. A retrospective analysis of the data is hereby presented. The principal indications include a chronic cough, recurrent laryngitis and noncardiac chest pain. In 65.5% of our cases, a pathological gastroesophageal reflux was found during pH monitoring. The symptom-index (SI) concerning the digestive and ENT symptoms did correlate in 1/3 of the cases while it was significant in only 15% of the cases with pulmonary and cardiac symptoms. 24-hour pH monitoring remains the method of choice for the study of gastroesophageal reflux and analysis of the SI is indispensable to evaluate the correlation of symptoms with episodes of reflux.

[Multiple amebic liver abscess]. / Abcès amibiens multiples du foie.

We report a case of multiple hepatic amebic abcesses, in a young Lebanese male patient living in Abidjan. These abcesses were revealed by fever and an acute pain in the right upper quadrant of the abdomen. Biological, namely serological, and ultrasonographic and magnetic resonance imaging abnormalities were noted. The patient responded favorably to metronidazole, and the short term evolution was good. A literature review was done, since the hepatic amebic abcess is becoming rare in our country.

[Complications of endoscopic sclerotherapy of esophageal varices]. / Les complications de la sclérose endoscopique des varices oesophagiennes.

During the last decade, the endoscopic sclerotherapy has taken a prominent part in the treatment of digestive haemorrhage following up oesophageal varices rupture. Several complications have been reported after this method: Some of them are of no importance and frequent, occurring in 20 to 60% of cases, and essentially represented by retrosternal pains, dysphagia and fever. Others are major, observed in 16% of cases, with stenosis type or oesophagus perforation or pleuropulmonary lesions. Preventive measures, if well applied, could reduce the incidence of these complications observed after endoscopic sclerosis of oesophageal varices.

[Detection of Helicobacter pylori by the urease test in 244 patients]. / Recherche d'Hélicobacter pylori chez 244 patients par le test à l'uréase.

The authors report the results of the detection of Helicobacter Pylori (HP) in gastric mucosa by the urease test, in 244 patients between January 1989 and August 1991. The overall prevalence of HP was 38.1%. It was 19.5% in patients with normal upper gastrointestinal endoscopy (UE), 61% in duodenal ulcer (p < 0.001) and 68.7% in congestive antritis (p < 0.001), significantly higher than in controls. There was no significant difference between controls and patients with erosive antritis or healed duodenal ulcers. The prevalence of HP rises with age in all patients and in those with lesions at UE but not in those with normal UE. A rise of this prevalence seems to exist in the months of June and December. The authors conclude by pointing out the rise of the overall prevalence of HP in congestive antritis compared with erosive antritis, the similarity of prevalence in normal subjects and those with healed ulcer and the lack of influence of age on this prevalence in subjects with normal UE. These conclusions are in need of confirmation by further studies on much more longer series.

[Prevention of hemorrhagic recurrence in cirrhotic patients. Is sclerotherapy better than propranolol?]. / Prévention de la récidive hémorragique chez les cirrhotiques. La sclérothérapie fait-elle mieux que le propranolol?

The effectiveness of oral propranolol and sclerotherapy in preventing recurrent bleeding after an endoscopically proven haemorrhage from oesophageal varices was compared in Pugh's grade B and C patients divided into two successive therapeutic groups. Group I patients (n = 32) were given oral propranolol, while sclerotherapy was performed in group II patients (n = 32), 23 of whom simultaneously received propranolol. There was no difference between groups I and II in the severity of the initial bleeding and liver failure (Groups I/II, B 19/18, C 13/14), in the withdrawal of alcohol (group I 25, group II 17) and in compliance with either treatment (group I 25, group II 27). Obliteration of the oesophageal varices was achieved in 69 p. 100 of group II patients within a median number of 4 courses and 46 days, and in 84 p. 100 of the patients of this group who survived for more than 3 months. One year after the beginning of treatment rebleeding had occurred in 43 p. 100 of either group I or group II patients. The 1-year survival rate was 72 p. 100 in group I and 62 p. 100 in group II (non significant). The causes of death were the same in both groups. Irrespective of the treatment assigned, death was 2.1 times more frequent (P = 0.02) and rebleeding was 1.2 time more frequent (P = 0.08) in grade C than in grade B patients.