Palliative care out patient consultation service in a teaching hospital in Bangladesh

Palliative care is a newly emerging subspecialty in Bangladesh. The aims of this study were i) to determine the characteristics, types of referral, disease pattern and insight about the disease and ii) to estimate the prevalence of pain and other common symptoms in a population of patients with advanced incurable state of cancer and attending the newly established palliative care out patient clinic. The data were collected at the outpatient clinic during first consultation using a modified structured data collection sheet from the Institute of Palliative Medicine (IPM) in Calicut, Keralla, India. Two hundred and three patients with mean age 50 years, diagnosed as suffering from incurable cancer were seen during a period of 21 months from October 2007 to June 2009. Most of the patients were from less privileged socioeconomic group (86%), stays with family (99%), already know about their disease status and prognosis (62%). Referred from other disciplines formed the major group (72%) of this population. All of them had been under treatment for variable period ranging from one month to four years. The most common five symptoms noted by the service providers were pain (89%), loss of appetite (61%), sleeplessness (55%), lack of energy (47%) and constipation (44%). Population based studies are required to determine the actual magnitude of sufferers and suffering in spite of the availability of global knowledge and skill to reduce these sufferings of the incurably ill members of the society.

The effect of air mass origin on the ambient concentrations of ⁷Be and ²¹⁰Pb in Islamabad, Pakistan

Concentration of radionuclides ²¹⁰Pb and ⁷Be, having half lives of 22.3 years and 53.29 days, respectively, in the surface air samples of Islamabad (33.38°N, 73.10°E and Altitude ∼536 m asl.) are measured. The non-destructive technique of gamma-spectrometry, with a high purity germanium HPGe detector, was employed for the analysis of all samples. The annual average concentrations of ²¹⁰Pb and ⁷Be in the surface air samples were determined as 0.284 ± 0.15 and 3.171 ± 1.14 mBq m⁻³, respectively. Our results have shown a seasonal variation of the concentration of ⁷Be in air samples with high values for the spring season. High concentrations for ²¹⁰Pb are obtained when air masses originate from plain areas of Pothohar region, located in the South-West, West and North West of Islamabad. Our values of concentrations show a nice agreement with the relevant reported results.

A randomised controlled trial: outcomes of bladder rehabilitation in persons with multiple sclerosis

OBJECTIVE

A stratified, randomised, waitlist controlled study over 12 months assessed the effectiveness of a 6 week bladder rehabilitation programme in persons with multiple sclerosis (pwMS) in an Australian community cohort.

METHODS

Patients with definite MS and bladder issues (n=74) recruited from a tertiary hospital database were randomised to a treatment group (n=40) for an individualised bladder rehabilitation programme or to a control waitlist group (n=34). The Urogenital Distress Inventory (UDI6), Neurological Disability Scale (NDS) and the American Urological Association Symptom Index (AUA) assessed bladder impairment and 'activity limitation'; a single Quality of life (QoL) item in the AUA and the Incontinence Impact Questionnaire (IIQ7) measured restriction in 'participation'. Primary outcome measures were assessed at baseline and at 12 months.

RESULTS

Analysis of per protocol data from 58 patients (treatment n=24, control n=34) showed reduced disability in the treatment group, with significant differences (p<0.001) and large effect sizes (>0.5) in post-treatment UDI6, NDS, AUA total, AUA QoL and IIQ7 scores for the two groups. The treatment group compared with the control group showed improvement: 78% versus 27% for UDI6 and 59% versus 17% improved for IIQ7. More patients in the control group deteriorated over the study period on the UDI6 (30% vs 0%; p<0.001) and IIQ7 (39 vs 0%; p=0.001).

CONCLUSION

A multifaceted, individualised bladder rehabilitation programme reduces disability and improves QoL in pwMS compared with no intervention after 12 months of follow-up. Information on specific interventions in different bladder types in MS and the impact on QoL need further evaluation. Australian Clinical trials Registry ACTRNO12605000676617.

Estimation of mean annual effective dose through radon concentration in the water and indoor air of Islamabad and Murree

Different samples of water, indoor air and soil gas have been collected from Islamabad (33 degrees 38'N, 73 degrees 09'E, altitude of 1760 ft.), the capital of Pakistan and Murree (33 degrees 53'N, 73 degrees 23'E, altitude of 7323 ft.), lying on a geological fault line and are analysed for the estimation of mean effective dose through radon concentrations by using RAD-7, a solid state alpha-detector. The variation of radon concentration in water, indoor air and soil gas in Islamabad region ranges from 25.90-158.40 kBq m(-3), 43.26-97.04 Bq m(-3) and 17.34-72.52 kBq m(-3), having mean values 88.63 kBq m(-3), 70.67 Bq m(-3) and 45.08 kBq m(-3)(,) respectively. It ranges from 1.64-10.20 kBq m(-3), 18.48-42.08 Bq m(-3) and 0.61-3.89 kBq m(-3) with mean values 4.38 kBq m(-3), 28.63 Bq m(-3) and 1.70 kBq m(-3)(,) respectively in Murree and its surroundings. The total mean annual effective doses from water and indoor air of Islamabad and Murree regions are 2.023 and 0.733 mSv a(-1), respectively. These doses are within the recommended limits of the world organisations.

Radon monitoring in water sources of Balakot and Mansehra cities lying on a geological fault line

This paper relates to a series of systematic studies regarding measurement of radon concentration in the earthquake-affected areas of northern Pakistan. Radon is a radioactive alpha-particle-emitting gas originating from the decay series of uranium and thorium and is found anywhere in soil, air and water. The nature of water does not matter with regard to the presence of radon, however, the level of radon concentration varies in different types of water. The present survey is carried out in water samples from the fault zone of Balakot and Mansehra regions, North West Frontier Province, Pakistan, which is important for geological consideration and protection from radiation hazards. The measurements were made on a Pylon system that is based on the radon gas measurement with a Lucas cell. In 72 water samples in the equilibrium state between radon and its progeny, the concentration level of radon is measured. The results show that the radon concentrations are in the range of 4.99-24.52 kBq/m(3), with an average value of 15.52 kBq/m(3) for all types of water taken in this survey.

Multiple sclerosis rehabilitation outcomes: analysis of a national casemix data set from Australia

Objective

To examine the outcomes of inpatient rehabilitation for persons with multiple sclerosis (pwMS), using the Australian Rehabilitation Outcomes Centre (AROC) database.

Method

Deidentified data from the AROC database were analyzed for all rehabilitation admissions during 2003–2007, using four classes for functional level. The outcomes included Functional Independence Measure (FIM) scores and efficiency, hospital length of stay (LOS), and discharge destination.

Results

Of 1010 case episodes, 70% were women, admitted from home ( n = 851) and discharged into the community ( n = 890), and 97% ( n = 986) were in the higher three classes for functional level (classes 216, 217, and 218). Majority of the more disabled pwMS were treated in the public hospital system, with a longer LOS compared with private facilities ( P < 0.001). The FIM for classes 216–218 showed significant functional improvement during the admission ( P < 0.001), and those in higher classes showed less change (likely due to higher FIM admission scores). FIM efficiency was significantly higher in class 217 than other classes ( P < 0.001). The year-on-year trend was toward reducing hospital LOS and FIM efficiency, but these did not reach significance ( P = 0.107, P = 0.634).

Conclusion

The AROC data set is useful for describing rehabilitation outcomes for pwMS. However, additional information needs to be collected to evaluate nature of services provided and service implications.

Characterization of lymphoid infiltrates in prostatectomy specimens post neoadjuvant hormonal therapy using quantitative immunofluorescence and RNA FISH

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Background: Immunotherapy for advanced prostate cancer requires an understanding of the host response including lymphocyte subsets and cytokine expression. Using quantitative immunofluorescence (IF), image analysis and RNA FISH we examined a series of prostatectomy specimens from patients, ± neoadvjuvant hormonal therapy (NHT) and determined their baseline immune characteristics. Methods: CD4,8,25,45,68,69,86 and Foxp3 were evaluated by IF and IFNg with RNA FISH on prostatectomy specimens from 40 patients with T1c-T3 prostate cancer; 20 control and 20 post long-term NHT. Sections were analyzed with three multiplex IF assays, triplicate images acquired with spectral imaging, digitally masked and processed with IF image analysis software. IFNg RNA transcript localization was performed on all 40 patients using published protocols. Results: There was a predominance of CD8 in both control and NHT patients with a high but variable level of CD86 and 69 across the entire cohort, reflecting T cell activation. CD68 appeared reduced in NHT, but this change was not statistically significant. Number of Treg (CD4+/CD25+/Foxp3+) cells were similar between groups; however, in NHT an increased Treg population was associated with an elevated preoperative PSA compared with controls (p<0.05). IFNg transcript activity was low in the entire cohort and limited to tumor epithelial cells. Conclusions: The prominent CD8 expression and low level of IFNg in both control and NHT groups suggest an ongoing but not overly active immune response. Multiplex IF and in situ RNA FISH are useful tools for developing a disease phenotype and provide the necessary parameters for evaluating gene-protein expression especially in pharmacodynamic studies.

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