Variables influencing the toxic response to organophosphates in humans.

Concerns and doubts associated with the predictable health effects in humans following exposure to xenobiotics is primarily due to the failure to consider the variables influencing the toxic response in each instance. Lack of correlation between laboratory data, animal experiments and clinical findings in man associated with exposure to organophosphates (OPs) is an example. We have reviewed the literature to identify the variables that need to be considered following exposure to OPs. These include factors related to the OP (physico-chemical properties, solvents, impurities), duration and routes of exposure, and factors related to the individual(s) exposed. Individual variables include variations in metabolic, sequestration and excretory processes and health status (age, gender, environmental factors, concurrent medications, cholinergic status). The assessment of ill-health following exposure is critical to the development and compliance with guidelines and to the adoption of the best instrumentation. We have suggested a schematic assessment that needs to be applied for each exposure associated with organophosphates and provided the reasons for the development of this format. Exposure to xenobiotics through the environment, occupation or following therapy is an unavoidable aspect of modern life. Application of the principles discussed to each xenobiotic exposure is necessary to provide accurate and adequate information to advance the prevention or minimising toxicity.

General anesthesia for disabled patients in dental practice.

We reviewed the cases of 91 consecutive patients with disabilities who required general anesthesia at a tertiary referral center for dental treatment with a view to determining the factors that create difficulties in the anesthetic management. The more important of these are the special difficulties involved in making preoperative assessments of these patients and the difficulty in establishing monitoring. Other difficulties in anesthesia for these patients involve problems with gaining intravenous access, problems in determining when there has been adequate recovery from anesthesia, and problems in determining the degree of discomfort or pain the patients experience after dental treatment. Another potential hazard in this group of patients is the risk of drug interactions. We emphasize the need to train anesthetists in the care of disabled patients.

Respiratory failure following envenomation.

Respiratory failure may occur after envenomation. We report our experiences of a patient who required ventilatory care after krait bite. The krait (Bungarus) venom is known to contain bungarotoxins which act at the neuromuscular junction. No cardiac, renal or coagulation disorders were associated with the muscle paralysis after the snake bite. Ventilatory care was easy to institute and was life saving.

Young doctors' preferences in the Third World

The views of Sri Lankan intern house officers on health administration, appointments, career prospects, facilities for higher studies and related matters have been examined. In the light of the findings, an attempt is made to identify how medical graduates in Third World countries could contribute to a more equitable service. Particular attention is given to the need to encourage general practice and the service specialties within a framework of multidisciplinary care

Attitudes of the 1984 medical graduates of Sri Lanka to anaesthesia.

A total of 196 intern medical officers who had graduated from the four medical schools in Sri Lanka in 1984 indicated their attitudes towards anaesthesia as a medical specialty in response to a postal questionnaire. Eighty per cent of the graduates considered anaesthesia to be an established specialty in Sri Lanka, while 17% felt that the specialty had limited clinical application. A total of 62% of the graduates were not aware, prior to their entry to medical school, that anaesthesia was related to medical practice. All the graduates indicated that the intra-operative role of the anaesthetist was on a par with that of the surgeon, but 40% felt that the pre- and post-operative roles were of a secondary nature. Overall, 42% considered that an anaesthetist acts as an assistant to the surgeon. The graduates were of the opinion that only 35% of the patients undergoing surgery were appreciative of the services rendered by an anaesthetist. Fifty per cent of the graduates considered exposure to the specialty in the undergraduate curriculum as inadequate. Anaesthesia was chosen as the first career preference by 1.5%. The dominant reasons for not selecting anaesthesia as a career specialty were: minimal patient contact and patient recognition (62%), and lack of recognition of the specialty by society (54%). Anaesthetists in Sri Lanka are challenged to alter the perceptions associated with the specialty, which are probably a result of chronic staff shortages restricting practice to the confines of operating theatres.

Career preferences of the 1984 medical graduates of Sri Lanka.

A total of 196 graduates from the four medical schools in Sri Lanka responded to a postal questionnaire on their career preferences and factors influencing the choice of specialty. Medicine (38%), surgery (21%), paediatrics (15%) and obstetrics (12%) were the most popular choices. 'Service' specialties such as anaesthesia (1.5%), pathology (1.5%) and radiology (1%) were strikingly less attractive. Community medicine (2%) and general practice (2%) were similarly unattractive; medical administration (0.5%) was the least popular choice. In the choice of a career, opportunity for direct contact with patients (59%) was the most important determinant when compared to financial reward (12%), social prestige (10%) and fixed hours of work (12%). Research prospects (6%) and teaching opportunity (5%) were relatively unimportant considerations. The graduates preferred employment in the state health service (65%) to teaching in the clinical departments of medical schools (26%) and full-time private practice (7%). Pre- and paraclinical departments of medical schools attracted only 2% of the graduates. A total of 80% of the graduates wished to practise in the capital city or a major provincial city, while 10% chose to seek employment overseas. These results will be useful in planning undergraduate and postgraduate education, and in designing policies to attract manpower to the scarcity and high priority disciplines, so that the imbalances encountered would be minimal in the future.