Prevalence and management of cancer pain in Srinagarind Hospital, Khon Kaen, Thailand.

OBJECTIVE: Cancer pain remains an invisible problem in cancer care and our study aimed to document its prevalence, characteristics, and patterns of management at a tertiary care teaching hospital. STUDY DESIGN: Descriptive, prospective, cohort study. MATERIAL AND METHOD: We recruited 335 consecutive adult patients diagnosed with cancers, admitted to Srinagarind Hospital, between February and April 2004. All of the participants were interviewed, and their pain evaluated by direct assessment using a numeric rating scale. RESULTS: The overall prevalence of cancer pain prior to admission was 56.5%, and within the first 24 hours of admission 41.5%. Three-quarters (74%) of patients with pain reported improvement; however one-third of those with pain never received any pain control intervention. Moreover; about half of those with persistent pain only received treatment by requesting it and then only received simple analgesics. CONCLUSION: Cancer pain remains under-detected and under-treated in many patients. Pain monitoring on a regular basis as well as a training program on pain management should be considered as first-line tools for improving pain control among cancer patients.

Use of lay health workers in a community-based chronic disease control program.

The increasing burden of non-communicable diseases in the developing world, and in particular diabetes, cancer and circulatory diseases, is an unfortunate fact of life. At the same time infection-related diseases, including sexually transmitted HIV-AIDS and HPV-dependent cervical cancer, remain important. One approach to alleviating the resultant stress on national health provision is to expand the knowledge base at the community level with contributions by lay health workers (LHWs). Here we take a brief look at the available literature and propose a model for intervention incorporating two way dialogue with the general populace to find effective means to package expertise in the medical/research community for lay consumption. Our argument is that particular attention should be paid to socioeconomic and behavioural aspects and to disease surveillance at the local level in order to be able to accurately assess the impact of interventions. For this purpose, we need to marshal volunteers from within communities taking account of their problems and motivations. Included are provision of assistance in setting up physical exercise programs, quit tobacco campaigns, alcohol awareness programs, running disease screening exercises and general help by providing advice as to risk and protective factors and clinical treatments, with an special focus on palliative care.

Translaryngeal retrograde wire-guided fiberoptic intubation for difficult airway: a case report.

The authors describe the special tracheal intubation technique used in two patients with a difficult airway. These are the translaryngeal retrograde wire-guided and fiberoptic intubation. The authors show how to use both to facilitate intubation. The authors modified the technique by passing a guide-wire in a retrograde manner from the trachea to the nose and then a fiberoptic laryngoscope within the endotracheal tube over the wire. The technique can be applied for use in any difficult airway situation.

Dysphagia after total laryngectomy resulting from hypocalcemia: case report.

Although hypocalcemia is a common postoperative complication of patients who have undergone a total laryngectomy with total thyroidectomy for treatment of laryngeal cancer or cancer of adjacent organs and hypocalcemia can produce the symptom of dysphagia, there has never been a report that hypocalcemia is the cause of dysphagia in these patients. The authors reported two cases who had hypocalcemia after total laryngectomy with total thyroidectomy and presented with sudden and severe dysphagia. However, the symptom of dysphagia was dramatically improved after calcium replacement therapy.

Small vocal cord polyps: completely resolved with conservative treatment.

Vocal fold polyps usually occur on the anterior or middle part of the membranous vocal fold and are the commonest laryngeal pathology requiring surgical removal. We report on six cases of small vocal polyps (4 cases angiomatous polyps and 2 gelatinous) that completely resolved using conservative treatment. Not every case of polyps requires surgical removal.

Serum antioxidant vitamin levels of people in Khon Kaen, northeastern Thailand.

Three antioxidant vitamins, the alpha- and beta-carotenes as well as vitamin E, were measured in sera of a normal population in Northeastern Thailand using HPLC. The mean serum beta-carotene level of females was significantly higher than the value for males, i.e, 37.55 (95%CI=34.59-40.51) versus 32.97 (95% CI=30.01-35.93) micro/dl. The beta-carotene level tended to decrease as age increased, particularly in the male population. The mean serum beta-carotene level was also higher in females than in males, i.e., 7.08 (95%CI=6.57-7.59) and 6.26 (95% CI=5.77-6.75) micro/dl, respectively. The average serum alpha-tocopherol (Vitamin E) level of the whole population was 1.08 (95% CI=1.04-1.12) micro/dl and did not show age or sex differences. In general, the serum antioxidant vitamins of smokers were lower than those of the non-smokers but a significant difference was observed only for alpha-tocopherol. Alcohol drinking resulted in slightly lower serum beta-carotene values, whereas coffee or tea drinking and betel nut chewing did not cause any differences with these three antioxidant vitamins. However, we report higher in serum beta-carotene levels of people in Ban Fang district than in Chonnabot district. The results from our study give the base line data of serum antioxidant vitamins in a Thai population and also suggest future intensive study on the relationship of dietary intake and cancer prevention.