Patients' opinions about referral from a tertiary specialist psychiatric hospital to primary healthcare

Background: Referral of patients from tertiary specialist psychiatric hospitals to primary healthcare settings is a worldwide goal. This is of particular importance in South Africa with its considerable burden of mental disorders and limited resources. However, patients are often reluctant to be referred and studies have shown that patients may prefer a dedicated psychiatric service over an integrated primary healthcare service. Aim: This study explored the opinions of patients receiving care at a tertiary psychiatric hospital's outpatient department (OPD) about referral to a primary healthcare clinic (PHCC). Setting: The study was conducted at Weskoppies Psychiatric Hospital OPD. Methods: This was a qualitative study based on grounded theory. Participants were recruited through purposive-theoretical sampling. Data were collected by means of individual interviews and mini-essays. Results: From the 80 participants, 18 had individual interviews and 62 wrote mini-essays. Thirty-nine participants had previously attended a PHCC, while 41 had not. Perceived advantages of referral to PHCCs included: close proximity to participants' homes, resulting in saving on travelling time and transport costs, as well as the convenience of receiving psychiatric and other medical treatment at the same healthcare facility. Perceived disadvantages of PHCCs included: unavailability of treatment; lack of doctor-based care; lack of specialised care; loss of established relationships with hospital healthcare workers; mistreatment by PHCC nursing staff; longer waiting times; more stigmatisation. Conclusion: The perceived disadvantages of referral from a tertiary psychiatric hospital to a PHCC outweighed the perceived advantages. Nonetheless, participants expressed willingness for such a referral if their concerns were addressed

Development and validation of HPLC and UV spectrophotometric methods for the determination of lumiracoxib in tablets

In this study, two methods, based on high-performance liquid chromatography (HPLC) and UV spectrophotometry, were developed and validated for the quantitative determination of lumiracoxib in tablets. The HPLC was carried out on a column of propylsulfonic acid bonded to silica gel (250 x 4.6 mm; 5 mium), with a mobile phase of phosphate buffer (pH 7.4; 10 mM)-water-acetonitrile (10:40:50, v/v/v) fl owing at 1.0 mL/min and detection of the drug at 278 nm. The UV method was based on absorbance at 275 nm, with ethanol as solvent. Both assays were linear over the concentration range of 2–30 miug/mL (R approximate 0.999), as wellas accurate and precise, with recoveries between 98 and 100% and relative standard deviation (%RSD) smaller that 2.0%. The proposed methods are highly sensitive, precise and accurate and were successfully applied to the quantitation of lumiracoxib in the commercial formulation. The spectrophotometric method is a simple, cheap and less time-consuming method. However, the chromatographic method is selective for the determination of the degradation products of lumiracoxib.

Effects of chronic heart disease on skeletal muscle fiber size

Size changes in muscle fibers of subjects with chronic heart disease (CHD) have been reported, although a consensus has not been achieved. The aims of the present study were to investigate a possible association between CHD and fiber size changes in the brachial biceps compared to subjects without heart disease. Forty-six muscle samples were obtained in autopsies of individuals (13 to 84 years) without neuromuscular disorders, 19 (10 males and 9 females) with, and 27 (14 males and 13 females) without CHD. In all cases muscle sections were stained with hematoxylin and eosin and processed for the visualization of myofibrillar ATPase activity. The lesser diameter of type 1 and type 2 fibers was obtained tracing their outlines (at least 150 fibers of each type per sample) onto an image analyzer connected to a computer. The results were analyzed statistically comparing males and females with and without CHD. Type 1 fiber mean lesser diameters were 51.51 and 54.52 æm in males (normal range 34-71 æm) and 45.65 and 55.42 æm in females (normal range 34-65 æm) without and with CHD, respectively; type 2 fibers measured 54.31, 58.23, 41.15, and 49.57 æm, respectively (normal range 36-79 æm for males and 32-59 æm for females). No significant difference in fiber size was detected in 24 males with and without CHD, while in 22 females there was a significant increase in size in those with cardiomyopathy. We concluded that CHD does not determine significant changes in fiber size. However, in females, there is some hypertrophy which, despite within normal range, may reflect morphologic heterogeneity of the sample, or the daily life activities in the upper limbs as a compensatory mechanism to fatigability that affect predominantly the lower limbs in subjects with CHD.

Estudio comparativo de intubación con fibrolaringoscópio y laringoscopía directa en vía aérea difícil / Comparative study between direct laringoscopy and fibrolaringoscopy in difficult intubation

Se estudiaron 28 pacientes de ambos sexos que fueron sometidos a cirugía bajo anestesia general y en quienes se sospechó intubación difícil. Se dividieron al azar en dos grupos, al grupo I se les indujo anestesia general, se relajaron y se intubaron por laringospcopia directa, al grupo II se les realizó bloqueo del nervio laríngeo superior además de anestesia trópica y se intubaron despiertos con ventilación espontánea y fibrolaringoscopía, en ambos grupos se registró tiempo y número de intentos de intubación, sangrado en vía aérea, cianosis y cambios hemodinámicos. Aunque no se encontraron diferencias estadisticamente significativas (t>0.5) entre ambos grupos, sise observó que el tiempo (7.29 min vs 2.71 min) y numero de intentos de intubación (2.93 vs 1.36) fueron mayores en el grupo uno que en el grupo II. En el grupo uno se presentó un caso de cianosisi y siete de cambios hemodinámicos vs. ninguno del grupo dos. Por lo observado la intuvación con fibrolaringoscopía y bloqueo del n. laríngeo superior promete disminución de la morbi-mortalidad en los pacientes con vía aérea dificil sometidos a intubación traqueal y anestesia general

Curieterapia endobronquial de alta tasa de dosis / Endobronchial curietherapy of high rate of doses

A pesar del avance en el tratamiento del cáncer pulmonar, el pronóstico continua siendo pobre. En 1991, las estadísticas de la American Cancer Society mostraron 152,000 muertes en 161,000 pacientes diagnosticados con cáncer pulmonar. El tratamiento con cirugía radical es posible en uno de cuatro pacientes. Los resultados deben ser tratados mediante radioterapia y quimioterapia. Para mejorar la sobrevida de estos enfermos, deben ensayarse nuevos métodos terapéuticos. Los tratamientos sistémicos tienen que ser probados junto con nuevas tentativas de tratamientos locales. En este trabajo se presenta una revisión sobre el papel de la curieterapia en el control de las enfermedades oncológicas