Patients' perceptions of blood transfusion risks in Karachi, Pakistan

OBJECTIVE

To evaluate the understanding of and attitudes toward risks of blood transfusions among transfusion recipients in Karachi.

METHODS

One hundred forty-one transfusion recipients from 13 major Karachi hospitals were interviewed. Indications for transfusion were obtained by reviewing the patients' medical records.

RESULTS

The most common indications for transfusion were surgical complications (n = 77, 55%), anemia (n = 34, 24%), and generalized weakness (n = 15, 11%). Most recipients (n = 103, 80%) had never heard of viral hepatitis, and 44 (31%) had never heard of acquired immunodeficiency syndrome (AIDS). Ninety-four recipients (66%) believed that generalized weakness was a valid indication for blood transfusion. Sixty-nine recipients (49%) were not willing to pay an increased price for blood that was screened for blood-borne pathogens.

CONCLUSIONS

Blood recipients in Karachi are unaware of the risks of transfusions, and the reasons given by the ordering physician for many of the transfusions were not consistent with international guidelines. Steps to educate the public about the risks of transfusions and practitioners about the indications for transfusion could prevent blood-borne virus transmission in Karachi.

Smoking in a Saudi community: prevalance, influencing factors, and risk perception

BACKGROUND AND OBJECTIVES

Smoking is a major preventable cause of morbidity and mortality all over the world, but little information is available about the prevalence of smoking in Saudi Arabia. This study determined the prevalence of and major factors influencing smoking in our community.

METHODS

We used a questionnaire to determine smoking prevalence of males over age 12 attending a primary care clinic in Saudi Arabia. The questionnaire included items about factors influencing the decision to start smoking, attempts to stop smoking, and awareness of the risks of smoking.

RESULTS

Of 634 subjects, 34.4% (218) were current smokers, 16.4% (104) were ex-smokers, and 49.2% (312) were nonsmokers. The most common (66%) reason for starting smoking was friends' influence. About 75% had thought of stopping smoking, and 55% had actually attempted to stop. The most common (34%) reason reportedforfailed attempts to stop smoking was lack of willpower Awareness regarding the harmful effects of smoking was high (97.2%). More than 80% thought that a special smoking clinic would be helpful for quitting smoking.

CONCLUSIONS

Smoking prevalence is high in our community in Saudi Arabia. Most of the smokers know that smoking is dangerous and want to quit smoking but fail to stop for various reasons. Interventions are needed to decrease the prevalence of smoking in Saudi Arabia.

Behind the counter: pharmacies and dispensing patterns of pharmacy attendants in Karachi

BACKGROUND

There is little literature available on dispensing patterns and unsupervised sale of medicines from pharmacies in developing countries.

OBJECTIVE

This study obtained background information on pharmacies, assessed the level of training, knowledge and dispensing patterns of pharmacy attendants in Karachi.

METHODOLOGY

This is a descriptive cross sectional study with convenient sampling. A structured questionnaire was used to interview pharmacy attendants.

RESULTS

Of the 219 pharmacies surveyed, 62% reported more than 50 customers daily and 20% also sold items of general provision. Mean operating hours were 13. Only 24 (11%) had a visible license. On an average 3 attendants were employed per pharmacy. We interviewed one in each. Amongst the 219 interviewed, 77 (35%) were intermediate qualified and only 26 (12%) pharmacologically trained. Correct frequency of ORS administration was not known by 167 (76%) and 21% incorrectly suggested an anti-diarrhoeal preparation for viral diarrhoea in children. The knowledge of those with pharmacological training was significantly better. For respiratory tract infection in children approximately 60% did not know the correct dose of Paracetamol and Amoxicillin. Only 13 (6%) knew that Propanalol was contraindicated in hypertensive asthamatics. For Cotrimoxazole, metronidazole and lomotil only 40%, 21% and 15% respectively, were aware that these could not be dispensed without prescription.

CONCLUSION

In the absence of trained pharmacists existing pharmacy attendants should be trained to improve drug-dispensing patterns.

Hypertension control in a community health centre at Riyadh, Saudi Arabia

OBJECTIVE

This study was carried out to determine the degree of control of hypertension and the most commonly used drugs for hypertensive patients attending our community health center.

METHODS

A cross sectional study carried out by randomly examining the case notes of patients attending our primary care clinics.

RESULTS

Case notes of 3747 patients were examined, 2064 (55%) females (mean age 23.76 years) and 1683 (45%) males (mean age 24.63 years). Prevalence of hypertension was 3% (108 patients), 3% (63 patients) and 3% (45 patients) for females and males respectively. Majority of patients 16 (35%) males and 32 (51%) females had blood pressure of 141-160/90-100 mmHg. Seventeen (37%) males and 15 (24%) female patients had blood pressure < 140/90 mm Hg. Among 108 hypertensive patients, 29 (65%) males and 44 (69%) females were on single drug. The most commonly used drugs were ACE inhibitors (35%), calcium channel blockers (17.5%) and beta- blockers (14%).

CONCLUSION

This study like some other studies shows that control of hypertension falls short of recommended goals. There is need to adopt a strategy that incorporates health education about life style and proper protocol as this has been found useful in other studies.

A study on fatty acid composition of fish oil from two marine fish, Eusphyra blochii and Carcharhinus bleekeri

Two species of marine fish found in coastal waters of Karachi (Pakistan) were studied, Eusphyra blochii (Hammer-headed Shark) and Carcharhinus bleekeri (Shark) for their fatty acid composition. The isolation, identification and characterization of these fatty acids were carried out by gas liquid chromatography (GLC) and a combination of TLC-GLC technique. A large variation was observed between hammer-headed shark liver oil and shark liver oil. Twenty five individual fatty acids from the oil of marine fish were analyzed among those the palmitic acid was a major saturated fatty acid while stearic acid was the other major constituent. Among unsaturated fatty acids monoenoic e.g. oleic and palmitoleic acids were the major constituents and traces of dienoic and trienoic fatty acids were also found. In addition medicinally important polyunsaturated fatty, acid eicosapentaenoic and docosahexaenoic acids were also identified.

Prevalence of hypertension in patients attending Al-Kharj Military Hospital

OBJECTIVE

This study was carried out to ascertain the prevalence of hypertension in our community with a view to forming a baseline and planning strategies for prevention and control.

METHODS

A cross sectional study carried out by collecting data from randomly selected case notes of 3747 patients (1683 males and 2064 females), regarding age, sex, blood pressure measurements and whether or not they were on treatment for hypertension.

RESULTS

The prevalence of hypertension in the total population was 3.1% (females 3.05% and males 2.67%). With regard to age group, the prevalence was highest in 65-74 years in both males and females.

CONCLUSION

There is a need for health education among our patients regarding the nature of hypertension and the relation between life style and hypertensive disease.

Prevalence of diabetes mellitus in a Saudi community

OBJECTIVE

The aim of this retrospective cross sectional study is to find out the prevalence of Diabetes Mellitus according to age and sex in the population attending the family and community medicine clinic in Al-Kharj Armed Forces Hospital.

METHODS

Total eligible patients of Al-Kharj Military Hospital are about 100,000. The case notes in Medical Records were selected randomly and examined. Data was collected from 3747 case notes. They were divided into different age groups and also separated into male and female groups.

RESULTS

The prevalence of Diabetes Mellitus in this study sample of 3747 (1,683 males and 2,064 females) was 2.55% in males and 5.32% in females. In the age group of 35 and above the prevalence in males was 8.52% and in females 19.48%.

CONCLUSION

A high prevalence of Diabetes Mellitus was noted in the population and particularly in females. There is need for comprehensive programs for the prevention of Diabetes Mellitus particularly in the adult population.

Effects of acute, moderate ethanol consumption on human platelet aggregation in platelet-rich plasma and whole blood

BACKGROUND

Platelet-inhibitory effects of alcohol potentially contribute to the reduced risk of coronary heart disease associated with moderate drinking. However, few studies have directly examined the effects of acute consumption of a moderate dose of alcohol on aggregation of platelets from healthy human subjects. In the present study, we examined those effects, with the use of multiple platelet agonists and two aggregation measurement techniques, as part of an ongoing series of studies that evaluate the actions of ethanol on platelet function.

METHODS

Human subjects consumed alcohol at a dose equivalent to one drink (0.25 ml/kg) or two drinks (0.5 ml/kg). One hour after ingestion, anticoagulated blood was collected and agonist-induced aggregation of platelets was measured in both whole blood and in platelet-rich plasma.

RESULTS

Inhibition of aggregation by ethanol consumption was observed in whole blood (measured as maximum change in impedance) and reached statistical significance (p < 0.05) in the 0.5 ml/kg alcohol group for two collagen concentrations (0.625 and 1.25 microg/ml) as well as for the highest concentration of adenosine diphosphate tested (p < 0.05). Inhibition was 15.4%, 22.6%, and 10.5%, respectively, for these three situations. In platelet-rich plasma, after consumption of 0.5 ml/kg ethanol, aggregation (measured as maximum change in optical density) in response to 1.25 microg/ml collagen was significantly inhibited (p < 0.05); no other significant inhibition was observed at either dose of alcohol in any other cases with platelet-rich plasma. In comparison of male and female subjects, there was a statistically significant difference (p < 0.05) in the degree of inhibition by ethanol consumption (0.5 ml/kg) of whole-blood platelet aggregation induced by collagen, whereby female aggregation was inhibited to a greater extent than male.

CONCLUSIONS

This study shows that alcohol, at physiologically relevant doses, below those investigated in most previous human studies, has a dose-dependent inhibitory effect on platelet aggregation. Such an effect could potentially contribute to the beneficial effects of alcohol consumption against coronary artery disease. The inhibitory action is most readily measured with whole-blood platelet aggregometry, with the use of collagen as the agonist. This observation is consistent with the view that alcohol reduces platelet sensitivity to thrombotic stimuli by inhibition of arachidonic acid release and, therefore, subsequent thromboxane synthesis.

A comparative study of omega-3-fatty acids obtained from marine fish and bezafibrate alone and in combination as hypolipidemic agents

The fish oil and its constituents have been studied in detail with special reference to ailments. The discovery of omega-3 fatty acids led to a detailed investigation about its effect and role as anti-cholesterolemic agents. The effect of fish oil alone and in combination with acid derivatives was found to be a potent cholesterol and triglycerides lowering agent. Comparative studies of fish oils and bezafibrate led to the formulation of new therapeutic combination having lesser side effects and toxicity.

Providencia stuartii genes activated by cell-to-cell signaling and identification of a gene required for production or activity of an extracellular factor

By utilizing reporter transposons, five Providencia stuartii genes that are activated by the accumulation of self-produced extracellular signals have been identified. These genes have been designated cma for conditioned medium activated. The presence of conditioned medium from stationary-phase cultures grown in rich media resulted in the premature activation of each gene in cells at early log phase, with activation values ranging from 6- to 26-fold. Preparation of conditioned medium from an M9 salts medium and fractionation by gel filtration chromatography resulted in fractions within the included volume which activated three of the cma fusions. In addition, depending on the reporter fusion, peak activity was found in different fractions. The partially purified factors activated in a dose-dependent manner. Characterization of the factors activating the cma fusions indicated that they were stable to heat, alkali, and acid. Furthermore, for each cma fusion, factor activity was not reproduced by the addition of homoserine lactone, homocysteine thiolactone, pyruvate, Casamino Acids, or alpha-ketoglutarate. The identities of three cma genes have been determined and revealed physiological roles in amino acid biosynthesis and nutrient import. To begin to address the pathways for production of or response to the extracellular factors, we have identified a locus, aarA, that is required for the activation of four cma fusions. The AarA product was required for factor activity in extracellular supernatants, indicating a possible role in biosynthesis or export.

Melanocortin 1 receptor variants in an Irish population

The identification of an association between variants in the human melanocortin 1 receptor (MC1R) gene and red hair and fair skin, as well as the relation between variants of this gene and coat color in animals, suggests that the MC1R is an integral control point in the normal pigmentation phenotype. In order to further define the contribution of MC1R variants to pigmentation in a normal population, we have looked for alterations in this gene in series of individuals from a general Irish population, in whom there is a preponderance of individuals with fair skin type. Seventy-five per cent contained a variant in the MC1R gene, with 30% containing two variants. The Arg151Cys, Arg160Trp, and Asp294His variants were significantly associated with red hair (p = 0.0015, p < 0.001, and p < 0.005, respectively). Importantly, no individuals harboring two of these three variants did not have red hair, although some red-haired individuals only showed one alteration. The same three variants were also over-represented in individuals with light skin type as assessed using a modified Fitzpatrick scale. Despite these associations many subjects with dark hair/darker skin type harbored MC1R variants, but there was no evidence of any particular association of variants with the darker phenotype. The Asp294His variant was similarly associated with red hair in a Dutch population, but was infrequent in red-headed subjects from Sweden. The Asp294His variant was also significantly associated with nonmelanoma skin cancer in a U.K. population. The results show that the Arg151Cys, Arg160Trp, and Asp294His variants are of key significance in determining the pigmentary phenotype and response to ultraviolet radiation, and suggest that in many cases the red-haired component and in some cases fair skin type are inherited as a Mendelian recessive.

The impact of health on retirement behaviour: empirical evidence from West Germany

In this paper, the relative importance of an individual's health status on retirement behaviour is analysed within the framework of a structural, discrete-time hazard rate model which is estimated using a balanced panel of elderly West German men. The results obtained reveal that the presence of chronic complaints or disability have a significant positive impact on the probability of early retirement. Moreover, the relative intensity of the individual preference for leisure appears to be, ceteris paribus, below average among public sector employees. Education, too, is shown to exert considerable influence on retirement behaviour, but the relationship between an individual's educational status and the probability of early retirement appears to be rather complex. A policy-related simulation experiment based on the estimates is carried out in order to assess the effects of changes in the incentive structure of the existing pension scheme.

Long-term survival and complications in patients with malignant ventricular tachyarrhythmias: treatment with a nonthoracotomy implantable cardioverter defibrillator with or without a subcutaneous patch

The Endotak lead system and ICD has been used to treat patients with malignant ventricular arrhythmias. We analyzed the clinical characteristics of 1,053 patients who underwent implantation of the Endotak lead system with or without a subcutaneous patch. Group A consisted of 567 patients receiving the Endotak lead with a subcutaneous patch; group B consisted of 486 patients receiving the Endotak lead alone. The 2-year survivals from sudden death, cardiac death, and total death in groups A and B were 97.6%/98.2% (P = 0.38), 88.6%/92.7% (P = 0.09), and 84.7%/86.8% (P = 0.06), respectively. Minimum tested effective defibrillation energy at implantation was 17.2 +/- 5.2 J for group A and 15.8 +/- 5.1 J for group B (P < 0.01). The operative mortality was 1.8% in group A and 0.6% in group B (P = 0.09). The incidence of lead dislodgment, malfunction, and infection was 6.7% for group A and 3.5% for group B (P < 0.01). Sudden death survival was excellent in both groups with less lead complications in group B. The Endotak lead alone may be the preferred choice of lead configuration in those patients who have adequate defibrillation thresholds at implant.

The pension incentive to retire: empirical evidence for West Germany

"In this paper, the impact of the West German pension system on the retirement decisions of elderly citizens is analyzed within the framework of a discrete-time hazard rate model deduced from a micro-economic decision rule. The model is estimated using a panel dataset of elderly West German citizens. In order to improve the precision of the estimates obtained, the data from the sample are combined with aggregate-level information on the labour force participation behaviour of the elderly. Policy simulations based on the estimates reveal that the probability of early retirement can be reduced significantly by appropriate changes in the pension system."

Escalating paclitaxel doses combined with carboplatin/etoposide and thoracic radiotherapy as preoperative or definitive treatment for stage III non-small cell lung cancer

We have evaluated escalating doses of paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) in combination with carboplatin, cisplatin, etoposide, and concurrent thoracic radiotherapy in patients with stage III non-small cell lung cancer. Dose-limiting toxicity was observed at paclitaxel 90 mg/m2. Subsequent modifications resulted in a new regimen, which consists of a 3-hour paclitaxel infusion on day 1 (three dose levels: 80, 100, and 120 mg/m2), etoposide 40 mg/m2 intravenously over 1 hour daily on days 2 to 5, and carboplatin given at an area under the concentration-time curve of 4 mg/mL x min on day 1 after paclitaxel. Treatment courses were repeated every 28 days. Eleven patients considered eligible for surgery received two courses. Nonsurgical patients (five) received three courses. No episodes of grade > or = 3 nausea and vomiting, dermatitis, anorexia, esophagitis, or thrombocytopenia were observed. The dose-limiting toxicity (grade 4 granulocytopenia) occurred in three of five patients at 120 mg/m2 paclitaxel (level 3). Grade 3 radiation pneumonitis was observed in three patients. Nine patients have undergone pulmonary resection: four pneumonectomies, four lobectomies, and one segmental resection. No operative deaths, respiratory insufficiency, or cardiovascular complications were observed. Clinical partial remissions have been observed in 11 of 16 patients overall, and two histologic complete remissions were achieved in nine surgical patients. Our preliminary results show that pulmonary resection is feasible following treatment with radiation and concurrent paclitaxel-containing chemotherapy. Although the maximum tolerated paclitaxel dose in the present study was relatively low, favorable initial responses warrant further study of paclitaxel-containing combination chemotherapy and concurrent radiation. We next plan to delete etoposide from our chemoradiotherapy regimen and escalate the paclitaxel dose.

Identification of a polymorphic nucleotide in oxyR specific for Mycobacterium bovis

Automated sequence analysis of a 410-bp region of the axyR gene in 105 Mycobacterium tuberculosis complex isolates identified a polymorphic nucleotide that differentiated Mycobacterium bovis isolates from other complex members. All 29 M. bovis isolates sequenced had an adenine residue at nucleotide 285, whereas all 76 other complex isolates had a guanine residue. PCR-restriction fragment length polymorphism analysis of oxyR with restriction endonuclease AluI in an additional 255 complex isolates from widespread intercontinental sources confirmed and extended the unique association of adenine at position 285 with M. bovis isolates.

Studies on the constituents of the leaves of Nerium oleander on behavior pattern in mice

Fresh, undried and uncrushed leaves of Nerium oleander were subjected to methanol extraction and bioassay directed fractionation. This led to the isolation of two purified fractions namely, B-1 and B-3. Fractions B-1 and B-3 were studied with respect to their actions on the central nervous system and behavior pattern in mice. Both fractions were found to produce reduction in locomotor activity, rota rod performance and potentiation of hexobarbital sleeping time. These fractions also showed analgesic activity. When tested against picrotoxin induced convulsions fraction B-1 showed 40% protection, while fraction B-3 exhibited 60% protection against bicuculline induced convulsions. These findings suggest that both fractions possess a CNS depressant action.

Isolation and characterization of Cajanus cajan lectin

Cajanus cajan lectin was isolated by ammonium sulfate fractionation and affinity chromatography on an IgM-Sepharose 6B column. Gel filtration and SDS-PAGE showed size homogeneity of the lectin. The lectin with M(r) 18,000 on SDS-PAGE had gel filtration behavior which was consistent with a molecular weight of 39 kDa and a Stokes radius of 2.74 nm. The results showed that the lectin is a dimer composed of identical subunits with N- and C-terminal residues of threonine and alanine, respectively. The glycoprotein lectin contained 3% concanavalin A-reactive neutral carbohydrates. Its amino acid composition is characterized by high contents of acidic amino acids. The number of tyrosine and tryptophan residues per mole of the lectin was determined to be 14 and 4, respectively, by spectrophotometry. Results on the effects of large numbers of saccharides on lectin-mediated hemagglutination and lectin-IgM precipitation showed that the C. cajan lectin was specific for mannose and glucose. A comparative study of the properties of C. cajan lectin and concanavalin A is also presented.