Factors Influencing Scales of Burden, Coping Mechanisms, and Quality of Life in Caregivers of Hemodialysis Patients in Andhra Pradesh, India.

BACKGROUND: Evaluation of factors influencing scales of burden, coping mechanisms, and quality of life (QOL) in caregivers of hemodialysis (HD) patients may lead to the revision of interventions aimed at the betterment of QOL of caregivers of HD patients. In this study, we investigated the influence of demographic, social, and clinical variables on burden, coping mechanisms, and QOL in caregivers of HD patients. METHODS: In this prospective study, 150 caregivers of HD patients were recruited. Assessment of burden, coping strategies, and QOL were made by the Zarit Burden Interview, Revised Ways of Coping, and Short Form-36 QOL. The role of age, gender, and social and clinical variables on these constructs was investigated using multivariate analysis of variance. RESULTS: The mean age was 43.86 ± 1.11 years. Males outnumbered females. Most were Hindu, married, primary school educated, unemployed, spouses, caring the patients, and suffering from chronic diseases for <5 years. In multivariate analysis of variance, effect of age on physical functioning (PF), general health (GH), and physical component summary (PCS) score (P < 0.01); gender on burden, distancing, seeking social support, role limitation due to emotional problem, and pain (P < 0.05); role limitations due to physical health, energy/fatigue (EF), emotional well-being, PCS, and mental component summary (MCS) score (P < 0.01); religion on PF (P < 0.05); marital status on burden and GH (P < 0.05); PF and PCS (P < 0.01); relationship of caregiver with the patient on PCS (P < 0.05); EF and MCS (P < 0.01); and presence of chronic diseases on GH and social functioning (P < 0.01) were observed. CONCLUSION: The role of demographic, social, and clinical variables should be taken into consideration while initiating therapies for reducing the burden and improving the QOL of caregivers.

Effect of Variables on Quality of Life among Caregivers of Patients Undergoing Peritoneal Dialysis.

BACKGROUND: Most of the studies carried out abroad showed the effect of one or two variables on the constructs of burden, coping strategies, and quality of life (QOL) but nil in India context. These constructs change by cultural factors. The evaluation of variables influencing these constructs may be helpful in fine tuning the interventions to reduce the burden and to improve the QOL of caregivers of patients undergoing peritoneal dialysis (PD). AIM: The aim of this study was to investigate the impact of demographic, social and clinical variables on burden, coping strategies, and QOL in caregivers of patients undergoing PD. MATERIALS AND METHODS: In this prospective study, we recruited 100 caregivers of patients undergoing PD and made assessment on burden, coping strategies, and QOL and evaluated the effect of demographic, social, and clinical variables on these constructs. RESULTS: None of the studied variables showed effect on burden and coping strategies. Age, gender, duration of caregiving, presence of chronic disease, and duration of the presence of chronic disease showed a significant effect on QOL. CONCLUSION: The impact of demographic and clinical variables on QOL suggests these variables should be given adequate attention while developing interventions for alleviating the burden and improving the QOL of caregivers of patients undergoing PD.

Characteristics of Burden, Coping Strategies, and Quality of Life: The Effect of Age, Gender, and Social Variables in Caregivers of Renal Transplanted Patients from Southern Andhra Pradesh, India.

BACKGROUND: Evaluation of burden, coping strategies, and quality of life (QOL) in caregivers may lead to specific interventions to reduce the burden among caregivers. METHODS: In this prospective study, characteristics of burden, coping strategies, and QOL in caregivers was investigated and also studied the effect of age, gender, and social variables on these concepts. RESULTS: Mean burden score of the caregivers was 28.66 ± 2.02. Thirty percent of caregivers had mild-to-moderate burden followed by moderate-to-severe burden (20%). Seeking social support was the dominant coping strategy used by the caregivers. Role limitations due to the physical health (RLDPH) and role limitations due to emotional problem (RLDEP) were compromised subscales of QOL. The mean score of RLDPH (P = 0.007) and RLDEP (P = 0.014) were found to be significantly higher in males than that of females. Marital status, education, type of relationship with the patient, religion, occupation, and duration of care giving showed significant effect on burden, coping strategies, and QOL. Lower emotional well-being (P = 0.003) and escape avoidance (P = 0.000) in males and lower physical component (PC) (P = 0.002) in females and lower PC (P = 0.000) and escape avoidance (P = 0.001) were found to be the significant predictors of burden in caregivers of renal transplanted patients. CONCLUSION: Predictors of burden and QOL subscales varies by gender. Social and clinical variables influence the QOL subscales. Gender- and social group-specific interventions rather than global interventions may reduce the burden of caregivers.

Predictors of quality of life among adolescents with epilepsy in the state of Andhra Pradesh.

OBJECTIVES: Assessment of quality of life (QOL) reveals the impact of diseases and factors responsible for the impairment of quality of life. The purpose of this study was to evaluate the QOL among adolescents with epilepsy (AWE) in the state of Andhra Pradesh. MATERIALS AND METHODS: One hundred and fifty AWE aged 13-19 years were evaluated for QOL using the Telugu version of the Quality of Life in Epilepsy Inventory for Adolescents (QOLIE) AD-48 and the data were analyzed to predict the factors responsible for determining the QOL. RESULTS: The mean age of AWE was 15.86 ± 2.14 years. The age at onset of seizures among AWE was 9.28 ± 4.90 years. Generalized (45%) and partial seizures (34%) were the predominant types of seizures. The majority of AWE (77%) were taking anti epileptic medication for 1-8 years, were on monotherapy (55%), and were seizure free for the last 1 year (56%). The mean total QOL score in AWE was 72 ± 15. The high school-educated, seizure-free, and monotherapy-taking AWEs showed a significantly higher mean total QOL when compared to the primary school- educated, seizure-frequent, and polytherapy-taking AWEs (P < 0.01). Education (standardized beta [Sß] = 0.163 P < 0.05), seizure frequency (Sß-0.603; P < 0.01), and poly therapy (Sß-0.08; P < 0.01) were significant predictors of QOL in AWE. CONCLUSIONS: The results of the study suggest that in addition to seizure control, encouraging monotherapy and enhancing the education level may improve the QOL in AWE.

Histopathological changes due to the effect of selenium in experimental cockerels.

BACKGROUND & OBJECTIVES: Selenium usually acts as an antioxidant at optimal levels in the body and increased levels are toxic. In this study an attempt was made to evaluate the effect of an optimum dose (0.14 mg) of selenium on histopathological changes in experimental hypercholesterolemia in cockerels. METHODS: The effect of selenium (0.14 mg) was investigated on histopathological changes in four tissues namely liver, kidney, heart, and descending aorta in cockerel animal model. Animals were either fed with stock diet (group C), stock diet with cholesterol (group CH), stock diet with selenium (group Se), stock diet, selenium and cholesterol (group CH+Se) for six months. Animals were sacrified and the tissues were isolated and subjected to histopathological study. RESULTS: Xanthochromatic collections in liver were observed in group CH; hydropic degeneration in group Se and lobular disarray, hydropic degeneration and kuppfer cell hyperplasia in group CH+Se were observed. In kidney, mild mononuclear infiltration was observed in interstitium in groups CH, Se and CH+Se. myocyte disruption, and mononuclear infiltration in group CH and c0 H+Se, and disruption of muscle bundles with vascular congestion in group Se were observed. Smooth muscle proliferation in the media of blood vessel was observed in groups CH, Se and CH+Se. INTERPRETATION & CONCLUSIONS: The results of the present study suggested that the optimum dose of (140 µg/day) feeding induced atherogenesis by inflammation and smooth muscle proliferation in cockerels with experimentally induced hypercholesterolaemia.

Assessment of endothelial function by brachial artery flow mediated dilatation in microvascular disease.

BACKGROUND: Cardiac syndrome X is an important therapeutic and diagnostic challenge to physician. Study of Csx patients may help to understand the pathophysiology of coronary microcirculation and to gain an insight on the management of these group patients. METHODS: We measured the flow mediated dilation of the brachial artery both endothelium dependent and independent vasodilatation by high resolution ultrasound in 30 cardiac syndrome X patients and matched with 30 healthy control subjects. RESULTS: Significantly decreased flow mediated dilatation was observed in patients when compared to control (9.42±7.20 vs 21.11±9.16 p<0.01) but no significant difference was observed between groups in response to nitroglycerin (25.39±6.82 vs 28.87±8.69). Receiver operator characteristic analysis showed that value of <11.11 had sensitivity of 80%, specificity 86.67%, positive predictive value 76.66%, negative predictive value 83.33%. In total, 46% of subjects had endothelial dysfunction and of them, CSX subjects had higher prevalence (76% vs 16% p<0.01) than control subjects. Higher mean values of body mass index, systolic blood pressure and diastolic blood pressure was observed in subjects with FMD<11.11 than >11.11(p<0.01). In logistic regression analysis, FMD was significantly associated with systolic blood pressure (Odds ratio 1.122 95% CI 1.053-1.196 p<0.01) and body mass index (Odds 1.248 95%CI 0.995-1.56 p<0.05). CONCLUSIONS: The study suggests impairment of endothelial function in cardiac syndrome X patients. Increased Systolic blood pressure and body mass index may increase the risk of impairment of endothelial function in this group of patients.

Overview of genomics and post-genomics research on type 2 diabetes mellitus: Future perspectives and a framework for further studies.

In this review, we briefly outlined salient features of pathophysiology and results of the genetic association studies hitherto conducted on type 2 diabetes. Primarily focusing on the current status of genomic research, we briefly discussed the limited progress made during the post-genomic era and tried to identify the limitations of the post-genomic research strategies. We suggested reanalysis of the existing genomic data through advanced statistical and computational methods and recommended integrated genomics-metabolomics approaches for future studies to facilitate understanding of the gene-environment interactions in the manifestation of the disease. We also propose a framework for research that may be apt for determining the effects of urbanization and changing lifestyles in the manifestation of complex genetic disorders like type 2 diabetes in the Indian populations and offset the confounding effects of both genetic and environmental factors in the natural way.

Burden, coping mechanisms, and quality of life among caregivers of hemodialysis and peritoneal dialysis undergoing and renal transplant patients.

CONTEXT: Investigations on burden, coping, and quality of life (QOL) in caregivers of hemodialysis (HD) and peritoneal dialysis (PD) undergoing and renal transplant (RT) patients may lead to the well-being of caregivers, and these studies are sparse and nil in Indian context. AIM: This study aims to comparatively evaluate the burden, coping mechanisms, and QOL among caregivers of HD and PD undergoing and RT patients. SETTING AND DESIGN: Tertiary care hospital, cross-sectional and descriptive study. SUBJECTS AND METHODS: Burden, coping mechanisms, and QOL in caregivers of HD and PD undergoing and RT patients were investigated using Zarit burden interview, revised ways of coping and short-form 36 in 30 each caregivers of HD and PD undergoing and RT patients. RESULTS: Moderate to severe burden, mild to moderate burden, and no burden were observed in the majority of caregivers of HD and PD undergoing and RT patients. Significantly higher mean burden score in caregivers of HD undergoing than RT patients (P < 0.01); accepting responsibility in caregivers of RT than PD undergoing patients; social functioning in caregivers of HD than PD undergoing patients; and general health in caregivers of RT than HD undergoing patients, was observed. Lower physical component was common in each group, whereas accepting responsibility in HD, self-controlling in PD, and age and escape avoidance in RT were found to be the specific predictors of the burden score. CONCLUSIONS: Caregivers of HD and PD undergoing and RT patients have different levels of burden, use different mechanisms to cope, and showed different predictors of burden score.

Utility of anthropometric traits and indices in predicting the risk of coronary artery disease in the adult men of southern Andhra Pradesh.

BACKGROUND/AIM: Optimal cutoff values are influenced by ethnicity, geography, lifestyles, and physical activity, and hence, there is a need for establishing population- and disease-specific cutoff values to screen individuals/populations. Therefore, the present study was carried out to determine the optimal cutoff values of anthropometric variables for coronary artery disease (CAD) for the population of southern Andhra Pradesh. METHODS: One hundred sixty five patients with CAD and 87 controls were recruited, and 52 anthropometric variables were measured for them. RESULTS: Higher means in 22 anthropometric variables covering circumferences, skinfold thickness (sft), and indices were observed in patients than those in controls. Receiver operator curve analysis revealed that 18 variables including circumference, sft, and fat measures with an area under curve ranging from 0.61 to 0.72 were found to have the ability of predicting the risk of CAD. A stepwise discriminant analysis showed 9 variables to correctly classify 87.4% of subjects into CAD and controls. In logistic regression analysis, among these 9 variables, only circumferences of abdomen and foot; sft of supratellar, thigh and calf; and sum of subscapular/suprailiac, waist-hip ratio and lean body mass were associated with CAD and explained 73.4% of its variation. CONCLUSIONS: Eighteen anthropometric variables were found to have the ability of predicting the risk of CAD. Longitudinal studies are needed to confirm the use of anthropometric variables in predicting the risk of CAD.

Prevalence of coronary artery disease and coronary risk factors in an urban population of Tirupati.

AIMS AND OBJECTIVES: To determine the prevalence of coronary heart disease and its risk factors in the urban population of Tirupati. METHODS: The urban population of Tirupati is spread into 20 wards. Thirteen wards were selected randomly and systematic random sampling was done to identify the sampling unit household. A total of 1519 subjects (539 males and 980 females) 20 years of age formed the sample of the study. Demographic (age, sex, occupation, education and income), behavioral (smoking), anthropometric (height, weight, waist and hip circumferences) and physiological (blood pressure) parameters were noted and recorded and biochemical parameters (serum glucose, total cholesterol, triglycerides, HDL cholesterol levels) were assayed. Coronary artery disease was diagnosed based on history and ECG changes suggestive of ST-segment depression (Minnesota 4-1 to 4-2) or Q wave changes (Minnesota codes 1-1-1 to 1-1-7) or T wave changes (Minnesota codes 5-1 to 5-3). RESULTS: The overall prevalence in the study population was 12.63 (192 cases). In males it was 6.86 (37 cases) and in females 15.81 (155 cases). The major risk factors in this population were central obesity 1003 (66%) [male 320 (59.4%) and females 683 (41.12%)], low HDL cholesterol 709 (46.67%) [male 284 (52.69%) and females 425 (43.36%)], obesity 588 (38.07%) [males 187 (34.32%) and females 403 (41.12%)], high triglyceride levels (>or= 150 mg/dl) 444 (29.22%)[(males 173 (32.09%) and females 272 (27.75%)], high cholesterol levels (>or= 200mg/dl) [(males 127 (23.56%) and females 278 (28.36%)] and hypertension 396 (26.06) [(males 149 (27.64%) and females 247 (25.20%)]. Around a fraction of subjects had metabolic syndrome 371 (24.42%) [(males 90 (16.69%) and females 281 (28.64%)]. In multivariate regression analysis, age (OR 1.05 95% CI 1.01-1.09 p<0.01) and high serum LDL cholesterol level (OR 4.62 95% CI 2.29-9.32 p<0.001) in males and serum triglycerides (OR 1.003 95% CI 1.000-1.005) in females were associated with CAD. CONCLUSIONS: Association of age, high LDL cholesterol in males and triglycerides in females with CAD shows the importance of these risk factors in this population. This was only a cross-sectional study done at one point of time. Clinical importance of these risk factors needs to be tested in the longitudinal study.

Differential expression of alkaline phosphatase gene in proliferating primary lymphocytes and malignant lymphoid cell lines.

Alkaline Phosphatase (APase) activity has been shown to be enhanced specifically in mitogen stimulated B lymphocytes committed to proliferation, but not in T lymphocytes. APase gene expression was analyzed in proliferating murine and human primary lymphocytes and human malignant cell lines using reverse transcriptase and real time PCR. In mitogen stimulated murine splenic lymphocytes, enhancement of APase activity correlated well with an increase in APase gene expression. However, in mitogen stimulated murine T lymphocytes and human PBL despite a vigorous proliferative response, no increase in APase enzyme activity or gene expression was observed. A constitutive expression of APase activity concomitant with APase gene expression was observed inhuman myeloma cell line, U266 B1. However, neither enzyme activity nor gene expression of APase were observed in human T cell lymphoma, SUPT-1. The results suggest a differential expression of APase activity and its gene in proliferating primary lymphocytes of mice and humans. The specific expression of APase activity and its gene only in human myeloma cells, but not in proliferating primary B cells can be exploited as a sensitive disease marker.

Association of serum antioxidants and risk of coronary heart disease in South Indian population.

BACKGROUND AND AIM: Higher prevalence of coronary heart disease (CHD) has been reported in south Indian population, which cannot be accounted for by the traditional risk factors like hyperlipidemia. Identification of new risk factors may help in treatment and prevention of CHD in this part of the world. In an attempt to investigate the causes of increased incidence of CHD in this part of the world, we intended to look for oxidative stress in our patients as a possible risk factor. As an initial step in this perspective, a case- control study was conducted to find out the serum antioxidant levels and their association with CHD in south Indian population. SETTINGS AND DESIGN: A tertiary care hospital; Case--control study. MATERIALS AND METHODS: One hundred thirty nine angiographically proven CHD patients (aged 29-75 years) were studied against 59 population based healthy controls (aged 29-72 years) free of CHD. Fasting serum cholesterol, triglycerides, HDL cholesterol, erythrocyte and plasma glutathione peroxidase and superoxide dismutase were estimated on automated clinical chemistry analyzer. LDL cholesterol and VLDL cholesterol were calculated. Vitamins A and E were estimated using high performance liquid chromatography (HPLC). STATISTICAL ANALYSIS: Unpaired t test was used to compare means. Binary logistic regression was done to find out the association between dependent and independent variables. RESULTS: Significantly higher levels of Total Cholesterol/HDL cholesterol and LDL cholesterol/HDL cholesterol ratio and lower HDL cholesterol levels were observed in patients when compared to controls. No significant difference of plasma and erythrocyte glutathione peroxidase and superoxide dismutase activity was observed between patients and controls. Significantly lower levels of vitamin E in patients than in controls was observed (P<0.001). Serum vitamin E was inversely associated with coronary heart disease even after controlling for age and other coronary risk factors (Odds ratio 0.898, 95% CI 0.826-0.976 P=0.01). CONCLUSIONS: The results of present study suggest that deficiency of vitamin E may be an independent risk factor of CHD. This study brings out the need for long- term monitoring of vitamin E supplementation as a preventive measure for CHD in the population studied.

Seroprevalence of IgG antibodies to Chlamydia pneumoniae and Helicobacter pylori among coronary heart disease patients and normal individuals in South Indian population.

In recent years, the role of infectious agents in the aetiology of atherosclerotic disease has come to the forefront. In the present study, seroprevalence (IgG) of chlamydia pneumoniae and helicobacter pylori in patients with atherosclerotic coronary heart disease was compared to normal healthy adults. Out of a total of 117 patients 101 had unstable angina (UA) and 16 had chronic stable angina (CSA). C. pneumoniae seropositivity was found in 66% of patients with UA and 94% of CSA patients. The corresponding figures for H. pylori were 58% and 56% respectively. In comparison, 81% of healthy adults were seropositive for C. pneumoniae and 53% for H.pylori. No significant association was found between CHD and the infectious agents. However, this study has revealed a high infection by C. pneumoniae as well as H.pylori in this part of India.

Lipoprotein (A): Better assessor of coronary heart disease risk in south Indian population.

In an attempt to search for risk factors which can explain the increasing prevalence of coronary heart disease (CHD) in Indian population, we conducted a case-control study to assess the association of Lipoprotein (a)(Lp(a)) with CHD. One hundred and fifty one consecutive patients with clinical and angiographic evidence of CHD and forty-nine healthy controls were drawn for the study. Triglycerides, very low density cholesterol (VLDL-C), total cholesterol (total-C)/high density cholesterol (HDL-C) ratio, low density cholesterol (LDL-C)/HDL cholesterol ratio and Lp(a) were found to be higher in patients than controls. In female sex and in those with family history of CHD, higher total and LDL cholesterol levels were observed to be associated with higher Lp(a) levels. Lp(a) levels were also found to be higher in triple vessel disease than other vessel disease patients. Significant difference in Lp(a) levels were observed between normal coronaries vs. single and triple vessel disease(P<0.05) and also between single vs. double and triple vessel disease (P<0.01).Lp(a) levels correlated positively with vessel severity(P<0.005). Lp(a) levels >25 mg/dl were associated with coronary heart disease (Odds ratio 1.98 P<0.05 95% CI 0.007-1.18). Our findings suggest a cut-off level of 25mg/dl for determination of risk of CHD. Studies from different areas involving larger sample size are needed to confirm the findings of the present study.