Pakistan is 1 of 5 countries with the highest projected increase in prevalence of dementia in the Asia Pacific region (Access Economic, 2006), where there is a lack of structured support network for caregivers in general and for dementia caregivers in specific. The caregivers and other related individuals predominantly rely on traditional familial support for caregiving. This approach places immense burdens on the familial caregivers (Shaji, 2009). In Pakistan, there is paucity of research evidence on care of patients with dementia and the needs of caregivers dealing with such patients. This study explores awareness among caregivers, their attitudes toward family members suffering from dementia, and their experience of burden. In-depth interviews were conducted with 12 caregivers of patients diagnosed with dementia in Rawalpindi/Islamabad Pakistan. There was a considerable lack of awareness about dementia as an illness among the caregivers. They reported a conflict between emotional and religious commitments to nurture older adult relatives and their experience of psychological, physical, and economic burden, resulting in occasional episodes of carelessness and violence toward them. The study indicated that women, particularly those who were employed outside of the home, reported higher levels of stress. It is suggested that support from extended family in all forms was perceived as a concrete form of stress relief by the primary caregiver. The findings of this study indicate that the social and financial burden of dementia on families of caregivers in Pakistan may be exacerbated if they do not have support. This indicates a need for multipronged intervention from both government and nongovernment organizations, as well as the community, to develop programs for caregivers that are nested within the cultural context of filial piety in Pakistan. These strategies should also be gender sensitive, giving priority to more at-risk groups.

BackgroundMarital circumstances have been indicated to be a salient risk factor for disproportionately high prevalence of depression and anxiety among Pakistani women. Although social support is a known buffer of psychological distress, there is no clear evidence as to how different aspects of marital relations interact and associate with depression and anxiety in the lives of Pakistani married women and the role of social supports in the context of their marriage.MethodsTwo hundred seventy seven married women were recruited from Rawalpindi district of Pakistan using a door knocking approach to psychometrically evaluate five scales for use in the Pakistani context. A confirmatory factor analysis approach was used to investigate the underlying factor structure of Couple satisfaction Index (CSI-4), Locke-Wallace Marital Adjustment Test (LWMAT), Relationship Dynamic Scale (RDS), Multidimensional Scale for Perceived Social Support (MSPSS) and the Hospital Anxiety and Depression Scale (HADS). The interplay of the constructs underlying the three aspects of marital relations, and the role of social support on the mental health of married Pakistani women were examined using the Structural Equation Model.ResultsThe factor structures of MSPSS, CSI-4, LWMAT, RDS and HADS were similar to the findings reported in the developed and developing countries. Perceived higher social support reduces the likelihood of depression and anxiety by enhancing positive relationship as reflected by a low score on the relationship dynamics scale which decreases CMD symptoms. Moreover, perceived higher social support is positively associated with marital adjustment directly and indirectly through relationship dynamics which is associated with the reduced risk of depression through the increased level of reported marital satisfaction. Nuclear family structure, low level of education and higher socio-economic status were significantly associated with increased risk of mental illness among married women.ConclusionFindings of this study support the importance of considering elements of marital relationship: satisfaction, adjustment and negative interactions which can be prioritized to increase the efficiency of marital interventions. It also highlights the role of social support in the context of marital relationships among Pakistani women. Furthermore, the study presents the etiological models of depression and anxiety with reference to the above.

Structured light plethysmography (SLP) is a noncontact, noninvasive, respiratory measurement technique, which uses a structured pattern of light and two cameras to track displacement of the thoraco–abdominal wall during tidal breathing. The primary objective of this study was to examine agreement between tidal breathing parameters measured simultaneously for 45 sec using pneumotachography and SLP in a group of 20 participants with a range of respiratory patterns (“primary cohort”). To examine repeatability of the agreement, an additional 21 healthy subjects (“repeatability cohort”) were measured twice during resting breathing and once during increased respiratory rate (RR). Breath‐by‐breath and averaged RR, inspiratory time (tI), expiratory time (tE), total breath time (tTot), tI/tE, tI/tTot, and IE50 (inspiratory to expiratory flow measured at 50% of tidal volume) were calculated. Bland–Altman plots were used to assess the agreement. In the primary cohort, breath‐by‐breath agreement for RR was ±1.44 breaths per minute (brpm). tI, tE, and tTot agreed to ±0.22, ±0.29, and ±0.32 sec, respectively, and tI/tE, tI/tTot, and IE50/IE50SLP to ±0.16, ±0.05, and ±0.55, respectively. When averaged, agreement for RR was ±0.19 brpm. tI, tE, and tTot were within ±0.16, ±0.16, and ±0.07 sec, respectively, and tI/tE, tI/tTot, and IE50 were within ±0.09, ±0.03, and ±0.25, respectively. A comparison of resting breathing demonstrated that breath‐by‐breath and averaged agreements for all seven parameters were repeatable (P > 0.05). With increased RR, agreement improved for tI, tE, and tTot (P ≤ 0.01), did not differ for tI/tE, tI/tTot, and IE50 (P > 0.05) and reduced for breath‐by‐breath (P < 0.05) but not averaged RR (P > 0.05).

ITP (Immune Thrombocytopenia) is an autoimmune condition associated with multiple risk factors including viral infections (HBV/HCV/ CMV, HIV and recently SARS-CoV-2) and vaccines. Though immune mechanisms have been proposed to explain the pathogenesis of acute ITP, autoimmunity with Covid-19 vaccine is still unclear and needs further research. We report a case of acute ITP after administration of Pfizer-BioNTech mRNA Covid-19 vaccine in a patient with previously stable ITP.