Journal of General Practice

Thalassaemia instigates an enormous health problem all over the world, due to the palliative nature of life long treatment and the cost involved. The available preventive strategies are not simple and not universally acceptable. The concept of “safe marriage” proposed for thalassaemia prevention in Sri Lanka recommends to ensure that one partner in a couple be a non-carrier. Thereby the option of screening at least one of the partners becomes the minimal essential requirement for a safe marriage. The process of screening, counselling and decision on selecting partners is voluntary and health education programmes only promote this. However to establish such a practice in society, the wide spread practice of screening and counselling should be established. Stringent monitoring to evaluate and take remedial action in the programme would also be essential.

Pulmonary Aspergilloma is a saprophytic colonization of a lung cavity by Aspergillus spp most often by Aspergillus fumigatus. It is usually secondary i.e. it occurs in a pre-existing cavity often as a result of old healed pulmonary tuberculosis. Pulmonary Aspergilloma complicating active tuberculosis is rare. We report a case of sputum positive tuberculosis complicated by pulmonary Aspergilloma.

Background: Belief innon-medical remedies such as ‘folk’ cures and faith healing are likely to impact on patients’ relationship with health care, and one area of particular current interest is adherence to medication. Aim: The aim was to explore the impact of such beliefs and patients’ satisfaction with healthcare on self-reported adherence to medication. Method: A survey using questionnaire measures assessed 766 participants (326 males and 440 females) ranging in age from 18-69 years. Results: Results showed that self-reported adherence was significantly correlated with satisfaction with medical interviews but when the individual dimensions of satisfaction were explored it was distress relief and rapport rather than communication that accounted for the variance. Intention to use non-medical treatments was correlated with self-reported non-adherence and was the single significant predictor from multiple regression analysis. Conclusions: It was concluded that cultural beliefs related to non-medical treatments are intricately linked to patients’ interaction with health care. The existence of such beliefs needs to be fully integrated into an analysis of health and illness behaviours, particularly in regard to adherence to medication.

This retrospective study reviewed the clinical and histopathological features of ophthalmic onchocerciasis. The 30-year laboratory records of all the patients of the Igbo ethnic group, whose surgical specimens were received at a Central Pathology Laboratory service in south-eastern Nigeria, West Africa, were reviewed. The cases with the histopathologic diagnosis of onchocerciasis involving ophthalmic tissues were obtained. The data analyzed included age at diagnosis, sex, location and size of specimen, clinical description of lesion and operative diagnosis. There were twenty patients. The male: female ratio was 2.3: 1. The ages ranged from 3 to 50 years, (mean 13 years). The nodule was present from birth in 2 (10.2%_ patients and was acquired in the rest. It occurred most commonly in the eyelid in 6 patients. There was diagnosis also commonly in terms of cyst rather than nodulation. Accordingly, onchocerca should be included in the differential diagnoses of lesions showing ophthalmic presentation even at birth–the time frame being in consonance with transplacental transmission.

Neurological manifestations are common in primary Sjogrens syndrome (SS). Neurological involvement in Sjogrens Syndrome may be manifested in the central nervous system (CNS) and/or peripheral nervous system (PNS). Motor Neuron disease (MND) is very rare in Sjogrens syndrome. Treatment is steroids.

Difficulty in swallowing (dysphagia) is common among all age groups, especially for geriatric and paediatric patients. Oral dispersible tablets (ODT) constitute an innovative dosage form that overcome the problems of swallowing and provides a quick onset of action. The aim of the present research was to prepare oral dispersible tablets by sublimation method. The technique is to increase the porosity of the tablet whereby subliming material was sublimed from the tablets by exposing the tablets to vacuum and to investigate the effects of super disintergrants (Kollidon & Ac-Di-Sol). Acyclovir is an antiviral drug used for the treatment of herpes simplex virus (HSV), mainly HSV-1 and HSV-2 and varicella zoster virus. It is a BCS class III drug. Hence an orally disintegrating tablet formulation of acyclovir was prepared by direct compression,which was taken as the model drug for the study.The drug and finalized formulation were characterized using FTIR studies revelled that there is no interaction between drug and excipients. The powder blend was examined for angle of repose, bulk density, tapped density, compressibility index and Hausner’s ratio and prepared tablets were evaluated for general appearance, content uniformity, hardness, friability, wetting time, In-vitro disintegration and dissolution studies were found to be acceptable according to standard limits, In-vitro release studies were performed using USP apparatus-II (paddle method) in 500 ml of distilled water at 50rpm. The highest drug dissolved was obtained from SF4 (100.2%). Tablet with 5% of camphor 5% Crospovidone 4% Croscarmellose sodium shows quick dissolution, disintegration, and good dispersion pattern. It is concluded that Oral disintegrating acyclovir tablets could be prepared by direct compression using sublimation method.

Background: Hidradenitis suppurativa (HS) is a chronic debilitating skin disease with a diagnostic delay of 7 years. The general practitioner (GP) is often the first physician consulted by the HS patients, and often provide the initial treatment.

Early diagnosis by GP is of major importance and may help to better control the course of the disease.

Aim: To describe GP’s recognition and management of HS.

Methods: GPs in Belgium and Denmark were invited to complete a questionnaire constructed to describe general knowledge about HS.

Results: 103 Belgian and 51 Danish participated. Demographic characteristics were similar in both groups.

Danish GPs estimated the disease to be more common: 0%/21.6% Belgian/Danish GPs seeing more than 20 patients with HS per week and conversely 28.2%/3.9% seeing no patients with HS per week.

Belgian GPs were less likely to consider HS a chronic disease than the Danish GPs (41.7%/84.3%), and antibiotics were more commonly associated with HS by Danish GPs (31.4% versus 3.9%).

Interestingly, Belgian and Danish GPs consider HS as an inflammatory (respectively 44.7%/58.8%) but also as an infectious disease (respectively 62.1%/64.7%).

Conclusions: The early diagnosis and a correct management is a crucial step to improve the prognosis of the disease. This pilot study has attempted to assess the general knowledge about HS of Belgian and Danish GPs.

Important differences have appeared, suggesting a need for more information to facilitate the management of the patients. A multidisciplinary approach is suggested for the management of this often debilitating disease.

Our pilot study evaluates for the first time the knowledge of GPs about Hidradenitis Suppurativa. Unfortunately the disease is often misdiagnosed and we have reported a mean diagnosis delay of 7 years.

An early diagnosis by GPs could greatly improve the course and the management of the disease.

Purpose: Cardiopulmonary resuscitation is a lifesaving procedure, performed to preserve patients’ life until further management is going to follow. Having basic knowledge of CPR will be a crucial task of medical care providers. This study was done to evaluate knowledge, attitude, and practice and associated factors among clinical year medical students. Participants and Methods: Institutional based cross-sectional study was conducted to assess knowledge, attitude, practice and factors associated with cardiopulmonary resuscitation among clinical year medical students in Jimma University. A simple random sampling was used to assess the students. Structured questionnaire of a question about knowledge, attitude and practice of Cardiopulmonary resuscitation was used to collect the data. The collected data was filled on cleared for completeness, analyzed using SPSS windows version 16 and Chi-square and P-value was calculated. All P-values from 0.05 and below were considered significant. Results: The total response rate for this study is 98%. About 93.3% of the respondents had good knowledge about CPR of which, fifth year (36.2%), fourth year (34.1%) and interns (23%) respectively. Among studied participants (80.7%) students were not practiced CPR. Conclusion: Clinical year medical students had a better knowledge, attitude and practice score towards CPR. Overall, however, the majority of students’ knowledge, attitude and practices toward to CPR in Jimma University were not sufficient, favorable and safe enough.

Background: Evaluating health-related quality of life is knowing the impact a disease has on patients’ perception of their well-being. Health perception worsens with age and an increasing number of chronic diseases, which occurs with metabolic syndrome, whose prevalence reaches 40-50% after menopause. Thus, knowing the repercussion of this disease on life´s quality will permit to adopt strategies to improve the health results. Objective: Determining the health perception of menopausal women with metabolic syndrome and the factors implicated. Methods: Cross-sectional study in Primary Health Care in the province of Cuenca (Spain). By random sampling, 400 menopausal women aged ≥45 years with metabolic syndrome (NCEP-ATP III) were selected. Survey SF-12 was used to evaluate physical and mental health´s general aspects. Results: Health perception was regular for 52% but good for 40.5%. The mean score of the physical summary component was below the mean for the Spanish population, while the mental component was over the mean for patients over 65 years. ANOVA showed significant differences for the physical summary component for age (p<0.001). Women in the 45-54 age groups obtained a better result for this component than those aged over 65. No differences were found for age groups in the mental component. Conclusions: Menopausal women with metabolic syndrome have a regular health perception being the physical health worse than the mental one. Physical health is better in younger women with studies, without obesity, diabetes, osteoarthritis, osteoporosis or bronchial pathology. Mental health is better in women without hypertriglyceridaemia or psychic disease.

Aim and Objective: To observe pattern of disease and death in elderly as a reflection of epidemiological transition reported by WHO. Material and Methods: The study was cross sectional and hospital based. All deaths reported in the hospital for one year were reviewed for demographic details, diagnosis, and course of disease and cause of death. Whenever post mortem details were available, they were also recorded. Results: Among 275 deaths, 43% was observed in patients above 60 years. Heart related ailments and diabetes with complications were leading causes of death followed by infections. Malignancy and liver related disorders including alcoholic liver disease were third common causes of death. The other causes included renal conditions, trauma and poisoning. Comment and Conclusions: The pattern is consistent with changes seen globally. The impact of urbanization probably reflects in alcoholic liver disease being the third common cause of death. Trauma as a cause of death was the least common compared to patients below 60 years. The pattern implies a significant burden on the economy as there is a paradigm shift in diagnostics and management. As geriatric population increases, continuous modification of health care services is required to address needs created by changing pattern of disease and death.

Introduction: In order to properly educate residents about the communication components involved in effective handoff delivery, interventions that promote demonstration of skill with real-time feedback are essential. Our institution developed a focused intervention for all residency programs to improve handoff education by implementing standardized written and verbal templates throughout all specialties. We decided upon a common framework for education and evaluation of resident handoff competency: the objective simulated handoff evaluation (OSHE) originally developed by Farnan et al. Handoffs are critically important for patient quality of care and safety. Methods:Residents completed the objective simulated handoff evaluation in pairs where the junior resident completed a verbal and written hand off using a simulated case to a senior resident in the same specialty. The senior residents provided feedback on the verbal handoff and faculty scored the written templates. The junior residents were surveyed pre-and-post to assess resident handoff education prior to the exercise and to gather feedback. Results: Residents rated their ability to pick up a new service significantly higher after the objective simulated handoff evaluation, (Mdn=4), U=308, p=0.005, r=0.34, in contrast to their initial rating (Mdn=3). Additionally, residents reported higher confidence in making contingency plans, (Mdn=4), U=311, p=0.005, r=0.35, compared to baseline (Mdn=3). Performing a read back showed improvement, (Mdn=4), U=321, p=0.01, r=0.31, when compared to the pre-survey (Mdn=3). Finally, when to perform a read-back also improved post-objective simulated handoff evaluation, (Mdn=4), U=323, p=0.01, r=0.32, when compared to the baseline (Mdn=3). Conclusion: Our institution-wide focus on standardization demonstrated that residency programs can collaborate productively despite their specialty-specific differences in transfers of care. Handoff education is essential in positively affecting patient care.

Children with hematological malignancies frequently undergo invasive procedures such as bone marrow aspiration and lumbar punctures. Although various methods of sedation are currently used for these procedures, no standard has been established to date. midazolam and ketamine (midazolam/ketamine) have been used for procedural sedation in our department. Since both of these drugs have a long half-life, sedation may persist for an excessively long time after the procedure has been completed. Propofol is an intravenously administered anesthetic that is characterized by the easy control of the depth of anesthesia and rapid recovery. Although side effects such as hypoxia and hypotension have been associated with sedation by propofol, their severities may be reduced using slow infusions. Therefore, we herein used slowly infused propofol (0.5 mg/kg over 20 seconds) for these procedures and retrospectively compared its effects with those of midazolam/ketamine. Recovery time was significantly shorter in the propofol group. Although the frequency of side effects such as hypotension was significantly higher in the propofol group, severe side effects were not observed. This may have been because propofol was slowly infused. Although the sample size is too small, the results of the present study suggest that slowly infused propofol might be effective and safe for invasive procedures on pediatric patients. A prospective study is required to further investigate appropriate methods of sedation