Pretesh Rohan Kiran

Activating the knowledge-to-action cycle for geriatric care in India

Despite a rapidly aging population, geriatrics - the branch of medicine that focuses on healthcare of the elderly - is relatively new in India, with many practicing physicians having little knowledge of the clinical and functional implications of aging. Negative attitudes and limited awareness, knowledge or acceptance of geriatrics as a legitimate discipline contribute to inaccessible and poor quality care for Indias old. The aim of this paper is to argue that knowledge translation is a potentially effective tool for engaging Indian healthcare providers in the delivery of high quality geriatric care. The paper describes Indias context, including demographics, challenges and current policies, summarizes evidence on provider behaviour change, and integrates the two in order to propose an action plan for promoting improvements in geriatric care.

The Efficacy, Safety, and Cost Benefit of Olanzapine versus Aprepitant in Highly Emetogenic Chemotherapy: A Pilot Study from South India

Background. The efficacy, safety, and cost benefit of olanzapine (OLN) when compared to aprepitant (APR) in the prevention of chemotherapy induced nausea and vomiting (CINV) in patients receiving highly emetogenic chemotherapy (HEC) were evaluated. Methods. A prospective pilot study was done in chemotherapy-naive patients receiving HEC to compare OLN versus APR along with palonosetron and dexamethasone. 100 patients consented to the protocol and were randomized and evaluated for Complete Response (CR) (no emesis, no rescue). Results. CR was 86% for the acute period, 86% for the delayed period, and 80% for the overall period in 50 patients receiving the APD regimen. CR was 84% for the acute period, 88% for the delayed period, and 78% for the overall period for 50 patients receiving the OPD regimen. Patients without nausea were APD: 88% acute, 84% delayed, and 84% overall, and OPD: 84% acute, 88% delayed, and 84% overall. There were no significant grade 3 or 4 toxicities. OPD was comparable to APD in the control of CINV. Conclusion. In this study, there was no significant difference between olanzapine and aprepitant in preventing CINV with highly emetogenic chemotherapy. Olanzapine may thus be used as a potential, safe, and cost beneficial alternative to prevent nausea and vomiting in HEC.

Association of impairments of older persons with caregiver burden among family caregivers: Findings from rural South India

AIM In India, owing to cultural norms and a lack of formal long-term care facilities, responsibility for care of the older person falls primarily on the family. Based on the stress process model, we assessed the association of type and number of impairments of older persons (∼primary stressors) with caregiver burden among their family caregivers in rural South India. METHODS All impaired older persons (aged ≥60, with impairment in activities of daily living (ADL) or cognition or vision or hearing) residing in 8 villages in Bangalore district, Karnataka, India, and their primary informal caregivers were interviewed. Caregiver burden was measured using the Zarit Burden Interview (ZBI; higher score indicating greater perceived burden). Linear regression models, adjusting for background characteristics of older persons and caregivers, assessed the association of type of impairment (physical [Yes/No], cognitive [Yes/No], vision [Yes/No] and hearing [Yes/No]) and number (1 or 2 or 3 or 4) of older person impairments with caregiver burden. RESULTS A total of 140 caregivers, caring for 149 older persons, were interviewed. The mean (standard deviation) ZBI score was 21.2 (12.9). Of the various older person impairments, ZBI score was associated only with physical impairment (β=6.6; 95% CI: 2.1-11.1). Relative to caregivers of older person with one impairment, those caring for an older person with all 4 impairments had significantly higher ZBI score (β=13.9; CI: 2.5-25.4). CONCLUSION Caregivers of older persons with multiple impairments, especially physical impairment, are vulnerable.

Study on elder abuse and neglect among patients in a medical college hospital, Bangalore, India

Abstract Elder abuse and neglect is a problem that occurs across all settings and all populations. Elder abuse has many forms, such as abandonment, emotional or psychological abuse, financial or material exploitation, neglect, physical abuse, and sexual abuse. We conducted this research to determine the prevalence of various types of abuse and neglect and their associated factors among elderly patients attending the urban and rural geriatric clinics at a medical college hospital in Bangalore, India. A total of 200 elderly patients participated in the study. The overall prevalence of elder abuse or neglect was 32 (16%), comprised of: verbal abuse in 25 (12.5%); neglect in 22 (11%); financial abuse in 17 (8.5%); and physical abuse in 3 (1.5%). Hence, many elderly patients had experienced multiple forms of abuse. There was statistically significant association between elder abuse and total financial dependence, lack of social support, and depression among the elderly patients.

Assessment of Post-traumatic stress disorder among disaster affected children in a high school in Uttarkashi district, Uttarakhand, India

Introduction: Disasters are traumatic events, which when experienced may result in a wide range of mental and physical health consequences. Information on mental health disorders among adolescents following natural disasters from developing countries is scant. Objective: The objective was to determine the prevalence of post-traumatic stress disorder (PTSD) among disaster-affected children in a high school in Uttarkashi district, Uttarakhand. Materials and Methods: This was a cross-sectional study, at a high school in Uttarkashi district, Uttarakhand between October and November 2013, 3 months after the disaster. Two hundred and sixty-eight adolescents participated in the study. Institutional ethical clearance was obtained. After obtaining consent from the principal and assent from the students, the Trauma Screening Questionnaire was administered to assess PTSD, and a structured questionnaire was used to ascertain the socio demographic variables. Results: The mean age of the study population was 14.48 with a standard deviation 0.87 years. Of all the adolescents, 166 (61.9%) were males, and 102 (38.1%) were females. The prevalence of probable PTSD was found to be 32.8% with a mean score being 4.3 with a standard deviation of 2.61. There were no statistically significant association between PTSD and specific socio demographic factors. Conclusion: Of all the adolescents studied, 32.8% continued to suffer from trauma-related stress disorder after 3 months of the disaster. As victims continue to suffer from stress disorder even after 3 months, the need for screening continues to be significant especially so when the mental health care has not been in place from the beginning along with other disaster-related support. The findings of the study highlight the need for recognition of post-disaster stress disorders and subsequently providing interventions in adolescent victims in developing countries.

Prevalence of selected chronic disease and health-seeking behavior among elderly persons in an urban underprivileged area, Bengaluru city, India

Background: The share of the elderly in the Indian population is rising. Side-by-side, the country is witness to rapid urbanization, with large numbers of city dwellers living in underprivileged areas. Studying the burden of chronic disease among the urban underprivileged elderly and their health-seeking behavior will provide useful information to guide urban health policy. Objectives: This study aims to estimate the prevalence of selected chronic disease among elderly persons and assess their health-seeking behavior and factors associated. Materials and Methods: This was a cross-sectional study done among 265 elderly persons, selected by systematic random sampling in LR Nagar, an urban underprivileged area in Bengaluru city in the period June 2013–May 2014. Elderly persons who were recruited were administered a questionnaire (to assess the presence of known chronic disease and health-seeking behavior) followed by physical examination, glucometry, and sphygmomanometry. Results: The prevalence of hypertension was found to be 67.5%, of whom 38.4% were newly detected. 47.5% of the study group were detected with musculoskeletal disorders and 30.5% with cataract. Diabetes mellitus was present in 18.5% of the study population, of whom 3.8% were newly detected. 95.6% of subjects sought treatment when they fell ill, the majority of them (78.7%) from private clinics. The healthcare expenditure incurred by the subjects was met by their sons in the majority of the subjects (55.1%). Conclusion: Designing new models in the public sector for addressing the health problems of the urban underprivileged elderly are required, with emphasis on chronic illness.

Diffuse large B-cell lymphoma in elderly: Experience from a tertiary care oncology center in South India

Introduction: Diffuse large B-cell lymphoma (DLBCL) is the most frequent non-Hodgkins lymphoma in the elderly. With the rising proportion of older persons in India, it is important to study current patterns and management of this disease, given that data in this regard are scarce in Indian settings. The aim of this study was to document the clinical features of DLBCL among elderly patients and their outcome over 7 years at a tertiary care oncology center. Materials and Methods: This was a retrospective records review of 119 DLBCL cases between January 2007 and January 2015 aged 60 years and above done at Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India. Clinical staging was done according to Ann Arbor staging as modified by Cotswolds and International Prognostic Index (IPI) calculated. Results: The mean age was 69.54 years (±5.44) with male: female ratio of 1.52:1. B symptoms were seen in 33% of patients. Thirty-six percent of the patients had stage II disease. The advanced stage was seen in 12% and bulky disease in 9.5%. Bone marrow was involved in 12%. The most common extranodal site was the head and neck region. The distribution according to the IPI was as follows: Low risk 38 (31.93%), low-intermediate risk 53 (44.54%), high-intermediate risk 20 (16.80%), and high risk 8 (6.72%). Among 119 patients, 98 (64.7%) received treatment with either combination of rituximab, cyclophosphamide, adriamycin, vincristine, epirubicin, and prednisolone. Overall response rate was 63.26% with a complete response rate of 38.77%. The overall survival ranged from 2 to 123 months with the median being 9.5 months. Conclusion: In elderly, DLBCL is common in seventh decade and most of them present in an early stage and low IPI. The incorporation of rituximab to anthracycline based chemotherapy shows a significant improvement in survival in elderly DLBCL.

Myelomatous pleural effusion: A rare case entity reported from a tertiary care cancer center in South India

Multiple myeloma (MM) is a plasma cell neoplasm and constitutes 10% of hematologic malignancies. Malignant myelomatous pleural effusions are very rare and occur in <1% of cases of MM. In this article, we report a rare case of a patient who initially presented with pleural effusion and was subsequently found to be secondary to MM with an underlying raised IgG paraprotein. The patient symptomatically improved and was in partial remission with palliative radiotherapy, VTD chemotherapy, and bisphosphonates.

An unusual presentation of cardiac metastasis in breast cancer

Metastatic disease to the heart is a rare phenomenon. In this case report, we describe an unusual case of metastasis of breast cancer to the left side of the heart in an elderly lady, with its intracardiac location detected by means of transthoracic echocardiography. This is one of the few described case reports of breast cancer metastasizing to the left ventricle of the heart.

Gemcitabine-induced supraventricular tachycardia: A rare manifestation

Gemcitabine is a cytotoxic drug with superior toxicity profile and widely used in the management of various solid malignancies. The common side effects associated with gemcitabine are myelosuppression, diarrhea, and flu-like symptoms. Cardiac side effects due to gemcitabine are very rare. We present a case of an elderly female aged 69 years, diagnosed to have metastatic carcinoma gallbladder, and without any cardiac risk factors, who developed supraventricular tachycardia 3 days after gemcitabine infusion. We emphasize the need for careful and routine cardiac monitoring in an elderly patient who develops symptoms of tachyarrhythmia when on gemcitabine therapy.