Awareness of palliative medicine among Pakistani doctors: a survey

Objectives: To establish the awareness of palliative medicine in Pakistani doctors through a questionnaire

Methods: A questionnaire was developed after consultation with the professionals working in palliative medicine. It was distributed, by hand, to a convenience sample of doctors who worked at various teaching hospitals in Pakistan. The distribution and collection of questionnaires was carried out within six months

Results: The results suggested that 74% doctors felt that cancer was the commonest reason for the palliative care teams to be involved. Forty five percent mentioned tht pain control was their prime job; 54% said that they had some experience of palliative medicine; 64% wanted to be involved in palliative medicine; 60% thought that they broke bad news properly to the patients; 59% were satisfied with their own performance while dealing with an incurable patient [57% said that they had heard about a hospice]. There was a wide range of drugs for the cancer pain

Conclusion: Amongst Pakistani doctors, there is a lack of training in palliative medicine. A significant number of doctors are interested and they are willing to have more training in pain control, breaking bad news, communication skills and terminal care

Impact of helicobacter pylori eradication on dyspeptic symptoms in the community

Eradication of Helicobacter pylori [Hp] will cure most Hp positive duodenal ulcers [DU]. However, after such treatment, patients often continue to get dyspeptic symptoms. The effects of Hp eradication in patients with proven DU on gastro-oesophageal reflux disease [GORD] symptoms are controversial. Aims: To study any changes in patient's symptoms following eradication of Hp in the setting of chronic DU and its effects on the need for continuing treatment for acid suppression. Eighty out of 85 patients [94%] from general practice with documented successfully eradicated Hp with a week long triple therapy regimen. Their symptoms and requirement for acid suppression treatment were studied at enrolment and after successful eradication of Hp for a median of 17 months. Eighty one% patients had improvement in ulcer-type symptoms. 21% developed new GORD symptoms. 68% discontinued long-term acid-suppression treatment. 79% requiring continued acid suppression therapy had new or continued GORD symptoms. Patients in the community with Hp positive DU disease after eradication, 81% patients got symptomatic improvement, two third discontinued their acid suppressing therapy but 21% developed new GORD symptoms. Among those who required continued acid suppression, 79% had GORD symptoms

Diagnosis and eradication of helicobacter pylori in patients with duodenal ulceration in the community

To determine the value of Helicobacter pylori [Hp] serology in diagnosis of active Hp infection in patients with documented duodenal ulcer [DU] and to directly compare the efficacy and side-effects profiles of metronidazole or tinidazole in a triple therapy regimen to eradicate active Hp infection. Prospective, single-blinded, randomised trial. One hundred patients from General Practice with documented DU and Hp seropositivity had a C14 Urea Breath Test [UBT]. Those who tested positive were randomised to receive one-week, twice daily omeprazole 20 mgs and clarithromycin 250 mgs in combination with metronidazole 400 mgs [OCM] or tinidazole 500 mgs [OCT]. Eradication was confirmed by a repeat UBT. Eighty five sero-positive patients had a positive pre-treatment UBT. On intention to treat basis, OCT [100%] had a significantly better eradication rate than OCM [87.8%], p = 0.023. There was no difference in side effects. [1] Positive Hp serology in patients with DU does not always mean active infection and [2] for patients in the community with active Hp and DU disease OCT is significantly better than OCM for eradicating Hp

Health profile of workers in the paint industry

In paint manufacture, there is unacceptably high chemical exposure with consequent effects on health. Raw materials used to manufacture paints constitute major chemical hazards to workers as a result of mechanical operations. This study is conducted on a group of workers in a paint industry in an attempt to assess the impact of the paints and coatings on health and on the clinical and laboratory parameters. Due to the high concentration of solvents in this industry, high incidence of renal impairment has been observed. The liver was less affected as evidenced by the serum transaminases level, though these were considered unreliable measures being unrelated to sub-clinical affection. Chest examination revealed the presence of some cases of chronic bronchitis and others with frequent asthmatic attacks. Immunological assessment revealed statistically significant elevation in the serum immunoglobulin E [IgE] among the exposed population. Contrarily, the IgG was not significantly elevated though positively correlating with the IgE level. The paint industry is, therefore, one of the most hazardous industries that need further investigations to keep the levels of toxic dust to minimum and set the precautions to protect the working population

Some haemodynamic and biochemical effects of captopril, metoprolol and their combination: low-dose regimen

In this study, renal hypertension was experimentally induced in male Sprague Dowely rats by applying a silver clip on the left renal artery. Low doses of captopril and /or metoprolol were intravenously injected to study their effects on blood pressure [B.P.] and heart rate [H.R.], or orally administered for 15 days for biochemical studies. Captopril [1.4 mg/kg i.v.] produced significant drop in B.P. with no change in H.R. while metoprolol [1.4 mg/kg i.v.] produced also marked drop in B.P. but with significant lowering in H.R. Their combination [1 and 2 mg/kg, respectively, i.v.] produced initially more lowering in B.P. which decreased later on, and significant lowering in H.R. After subchronic oral administration [5 mg/kg/day for 15 days], captopril produced a significant and marked decrease in angiotensin converting enzyme [ACE] activity, and a significant increase in plasma renin activity [PRA], but no significant change in plasma aldosterone [ALD] concentration. Metoprolol [5 mg/kg/day orally for 15 days] concentration. Captopril combined with metoprolol [each 2.5 mg/kg/day for 15 days orally] produced significant decreases in both serum ACE and plasma ALD. These results showed that with the small doses used, these drugs produced the usual hemodynamic effects, but somewhat different effects on the components of the renin- angiotensin-aldosterone system. Results were discussed in view of the effects of one drug on the hemodynamic response to the other drug

Interactions of calcium and amrinone on norepinephrine induced contractions of isolated rabbit aortic strips

In the present study, the interaction of calcium and amrinone was examined on isolated rabbit aorta by using different calcium concentrations in the bathing solution. Norepinephrine-induced contractions were then recorded both in the absence and in the presence of amrinone. The present data show that the responses of rabbit aortic strips to each of NE and amrinone depended not only on ambient Ca2+ concentration, but also on the sequence of exposure of the vessel to the different drugs. This may have implications in clinical practice in cardiac patients with hypocalcemia who require both calcium and amrinone infusions; the resultant hemodynamic effect would depend on which of the infusions was started first

Effect of glucose and insulin infusion on glucose, sodium and potassium levels in uremic patients

The effect of infusion of 500 cc. glucose solution [25%] with 30 IU insulin [Leo neutral, 20 IU/ml] and 500 cc glucose solution [5%] with 6 IU insulin was studied on ten chronic renal failure patients. Four samples were taken from each patient, during fasting, one hour after the start of infusion, at the end of infusion [2nd hour sample] then one hour after stopping the infusion [3rd hour sample]. Each sample was tested for plasma glucose, serum potassium and sodium concentrations. The results showed that infusion of both high and low dose glucose solution plus insulin had the ability to lower the blood potassium concentration constantly and persistently over the infusion time [2 hours]. Serum Potassium started to rise again one hour after stopping the infusion. Serum sodium was not altered in all samples. Blood glucose rose markedly with 25% glucose solution infusion, while it was not significantly changed with 5% glucose solution. So, the use of 5% glucose solution with 6 IU insulin infusion in the treatment of hyperkalaemia in cases of chronic renal failure is recommended