Psychological benefits of pre-conceptional and pre-marital genetic diagnosis in conservative societies

Introduction

Preconceptional genetic diagnosis help couples of genetic disorders carrier risk making an informed reproductive decision. The risk is considerably higher for consanguineous couples. Premarital screening can also offers a crucial health assessment of soon-to-be married couples with genetic risk factors based on specific family history. However, such approach is not usually easy to manage in conservative societies, particularly when the affected family refuse to deliver the necessary information about the genetic condition considered as a taboo.

Objectives

Here, we addressed the psychological benefits of preconceptional and premarital genetic diagnosis through a retrospective study about the preconceptional diagnosis inquiries in our genetic counselling.

Methods

In order to assess requests for autosomal recessive disorders during ten years of our genetic counselling activity at the medical university of Sfax, we reviewed 2500 medical files.

Results

Three couples were recorded for genetic preconceptional diagnosis. Another couple was documented for seeking a premarital screening for an unknown neuropathy before wedding engagement decision. This single case was referred to us because of a familial history of a severe neuropathy that was noted in the offspring of a shared cousin. The couple was unable to bring us more information about the genetic condition because of the familial repugnance.

Conclusions

Although our study is limited at the genetic level, it could be socially interesting because it showed the negative attitudes of the general population towards the genetic conditions and the familial responsiveness, as well as the reticence of physicians towards genetic preconceptional and premarital carrier diagnosis.

Disclosure

No significant relationships.

Depression among elderly cancer patients

Introduction

Depression is one of the most common mental illnesses in the elderly and its consequences are severe.

Aims

To measure the prevalence of depression in elderly cancer patients and subsequently determine the sociodemographic and clinical factors correlated with this disorder.

Methods

We conducted a descriptive and analytical cross-sectional study of patients aged over than 65 years old, suffering from cancer and who had no cognitive impairment, admitted in 2013 in the Oncology and palliative care unit of Gabes regional Hospital (Tunisia). We used a self-rating questionnaire to detect sociodemographics and clinical variables, the Geriatric depression scale (GDS) to assess depressive symptoms, and the Activity of Daily Living to determine the degree of autonomy.

Results

At the end of our investigation, we included 60 patients. The prevalence of depression was 48%. Depression was significantly correlated with: marital status (widower subjects were more depressed (74% vs. 34%, P = 0.007)), less degree of autonomy (80% vs. 38%, P = 0.04), fatigue (62% vs. 26%, P = 0.007), pain (59% vs. 26%, P = 0.02), family psychiatric history (80% vs. 20%, P = 0.02), family history of death by cancer (72% vs. 38%, P = 0.01), WHO condition (67% vs. 34%, P = 0.04) and the presence of co morbidity in particularly diabetes (69% vs. 41%, P = 0.05).

Conclusion

Depression is prevalent in oncogeriatric environments. This could compromise quality of support and care of these patients. Close collaboration between oncologist and psychiatrist is needed to support and relieve these patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Outcome of elderly patients with aggressive Non-Hodgkin's lymphoma refractory to or relapsing after first-line CHOP or CHOP-like chemotherapy: a low probability of cure

We retrospectively evaluated the outcome of 94 consecutive elderly patients treated at our center for an aggressive lymphoma without a low-grade component. Median survival was 26 months and 5-year overall survival was 39% (27-50%). We then evaluated the outcome of patients refractory to or relapsing after CHOP or CHOP-like chemotherapy. Twenty patients were refractory to first-line therapy and only 1/20 is alive with active lymphoma. Eight patients achieved a partial response and only 3 maintained the partial response while the other 5 patients died. Only 2 of the 27 patients who relapsed after a first complete remission achieved a second sustained complete remission. This study suggests that conventional-dose second-line chemotherapy yields disappointing results in elderly patients with aggressive lymphomas.

[Adenoid cystic carcinoma (cylindroma) of the nasopharynx with extension into the cavernous sinus]

INTRODUCTION

The adenoid cystic carcinoma or cylindroma of the nasopharynx is a rare tumour characterised by its slow progression, high risk of local recurrence and prolonged survival, even in the locally advanced and/or metastatic forms. Treatment is pluridisciplinary.

OBSERVATION

In a 30 year-old man consulting for right retroauricular pain, hypoacousia and epistaxis, diagnosis of a nasopharyngeal cylindroma was made in 1994. Treatment consisted first line surgery combined with loco-regional radiotherapy. Twenty-six months after complete remission had been obtained, a loco-regional relapse was revealed, combined with pulmonary metastases. The treatment combining radiotherapy, surgery and chemotherapy led to the stabilisation of the disease.

COMMENTS

The adenoid cystic carcinoma of the nasopharynx a rare neoplasia of the head and neck, characterised by its slow progression over time, a high risk of relapse and the progression of metastases at distance. The corner stone of its therapeutic management is surgery. Radiotherapy improves the local control of the disease and chemotherapy is helpful in treating the metastatic disease.

[Breast cancer prognosis in Tunisian women: analysis of a hospital series of 729 patients]

The objective of this study was to identify the anatomical-clinical aspects and determine the prognostic factors for breast cancer in the central region of Tunisia. This retrospective study involved 729 patients suffering from breast cancer, proven either by histology or cytology, diagnosed and treated between January 1990 and June 1998 at the F. Hached University Hospital in Sousse, Tunisia. The patients' average age was 50 years (ranging from 22-91). The average size of the cancer at the time of diagnosis was 49.1 mm; 90% were invasive duct carcinoma with high histo-prognostic SBR grade (level II-III: 86%). The overall survival rate was 50.5% after five years, and 50% after seven years. Using univariate analysis, significant predictive value was found with the following factors: tumor size, the clinical ganglionic level, metastases at diagnosis, the number of nodes invaded, nodal capsular rupture and lymphatic embolism, SBR grade and the delay in seeking consultation. The multivariate analysis (Cox model) isolated two prognostic factors: the initial size of the tumor (p = 0.001) and metastases at the time of diagnosis (p = 0.01). The study's results indicated that breast cancer prognosis in Tunisia remains poor primarily due to late diagnosis.