Profile differences between overdose and non-overdose suicide attempts in a multi-ethnic Asian society.

BACKGROUND: This study explores differences in characteristics of overdose (OD) and non-overdose (NOD) suicide attempts in Singapore. METHODS: Four hundred eighty-five medical records of people who attempted suicide were extracted from a local general hospital patient database and classified into OD and NOD groups. Differences in socio-demographic factors, suicide characteristics and hospital admission types between both groups were examined. RESULTS: Indians were more likely than the Chinese and Malays to employ OD method in their attempts. More suicide attempts in the OD group than NOD group were self-reported. The most likely place for suicide attempts for both groups was at home, though more NOD suicide attempts were in public areas as compared to the OD group. Analgesics were the most used substance in the OD group. Those who attempted suicide using OD had a higher number of psychiatric ward admissions than the NOD group. Risk and protective factors varied between both groups. CONCLUSION: Differences in socio-demographics, suicide characteristics and admission characteristics between OD and NOD groups were observed. Recommendations for suicide prevention in the community are discussed. Further studies on the mediators and moderators of these trends and characteristics of suicide attempts are necessary to ensure maximal efficacy of prevention and management.

Bispectral index in assessment of adequacy of general anaesthesia for lower segment caesarean section.

Awareness among parturients during general anaesthesia for caesarean section, though now uncommon, remains a concern for obstetric anaesthetists. We examined the adequacy of our general anaesthetic technique for avoiding explicit awareness by determining the depth of anaesthesia using Bispectral Index (BIS) monitoring. Twenty ASA1 parturients having general anaesthesia for lower segment caesarean section were studied. The drugs and doses used for each anaesthetic were similar Intraoperative Bispectral Index, haemodynamic parameters, end-tidal isoflurane concentration and inspired nitrous oxide fraction were measured and the postoperative incidence of explicit awareness was assessed. All anaesthetists were blinded to the Bispectral Index value throughout the operation. The depth of anaesthesia at various stages of the operation was evaluated by recording the Bispectral Index. Patients were interviewed for any intraoperative recall or awareness at the end of operation. A median BIS of 70 or below was recorded on most occasions during surgery. The range was 52 to 70, with values reaching 60 and below at intubation, uterine incision and delivery. Haemodynamic stability was satisfactory and there was no case of uterine atony, fetal compromise or postpartum haemorrhage. No patient experienced intraoperative dreams, recall or awareness. Our current general anaesthetic technique appeared inadequate to reliably produce BIS values of less than 60 that are associated with a low risk of awareness. However, no patients experienced explicit awareness.

A case report on the treatment of intractable anal pain from metastatic carcinoma of the cervix.

INTRODUCTION: Cancer pain in the terminally ill often poses great therapeutic dilemma. Opioids, whilst being useful in most cases, often leaves a patient heavily sedated and constipated at high doses and sometimes, in persistent agony from cancer pain. CLINICAL PICTURE: An Indian lady who suffered from metastatic carcinoma of the cervix experienced tremendous pain and disability despite high doses of narcotics and membrane stabilizers. TREATMENT: A ganglion of impar block and superior hypogastric plexus block were performed with a neurolytic agent. OUTCOME: The patient's pain and opioids usage were markedly reduced. CONCLUSION: Neurolytic nerve block can offer a great therapeutic option in selected cancer patients.