The stresses of volunteering in a hospice: a qualitative study

OBJECTIVES: This study examined the stresses associated with hospice volunteering, ways of coping and perception of available support. METHODS: Two focus groups were conducted comprising 17 volunteers. The data obtained were transcribed and analysed using thematic analysis. RESULTS: Reported stressors included losing patients and dealing with disfigurement. However, informants generally reported the work as satisfying and generally stress-free. Coping strategies ranged from keeping a distance from clients, religious faith, to the realization that death was a merciful end and was not necessarily painful. Informants generally perceived support to be adequate. CONCLUSIONS: The implications of these findings for training volunteers are discussed, especially the need to educate volunteers about the symptoms and signs of cancer.     

Pulmonary arterial pulse pressure and mortality in pulmonary arterial hypertension

In the Framingham studies, systemic arterial pulse pressure correlated linearly with morbidity and mortality. Right ventricular (RV) systolic dysfunction and pulmonary circulation stiffening result in abnormalities of pulmonary arterial (PA) pulse pressure in PA hypertension (PAH). We investigated the prognostic potential of PA pulse pressure in 67 patients with PAH diagnosed between January 1996 and March 2004 (33 idiopathic PAH, 34 PAH-connective tissue disease). The population was arbitrarily divided into tertiles of PA pulse pressure (= systolic-diastolic PA pressure) and 5-year mortality was assessed using the Kaplan-Meier method. The extent of RV systolic dysfunction and pulmonary circulation stiffening within each tertile was assessed by comparing the mean cardiac index and alpha (a recently described measure of pulmonary circulation distensibility) in each. Independent predictors of mortality were identified by Cox regression. Five-year mortality rates in patients with low, intermediate and high pulse pressures were 40%, 91% and 54%, respectively. Pulse pressure did not independently predict mortality, but cardiac index, 6-min walk test distance and mixed venous oxygen saturation did. Pulse pressure correlated with circulation stiffening (alpha) but did not correlate with cardiac index which tended to be lower in patients with intermediate pulse pressure and high mortality. PA pulse pressure correlated with pulmonary circulation stiffening but did not predict mortality in this study. RV dysfunction provided better prognostic information and probably explains the higher mortality seen in patients with intermediate pulse pressure.     

Beneficial effect of the leaves of Murraya koenigii (Linn.) Spreng (Rutaceae) on diabetes-induced renal damage in vivo

Ethnopharmacological relevance

Murraya koenigii (Linn.) Spreng (curry leaf) is widely used as a nephroprotective agent in kidney's infirmities among diabetics by the traditional practitioners in Malaysia. However, the latter role of curry leaf has been grossly under reported and is yet to receive proper scientific evaluation.

Aim of the study

The present study was designed to investigate the beneficial effect of the leaves of Murraya koenigii (Linn.) on diabetes-induced renal damage in vivo with regard to prove its efficacy by local traditional practitioners in the treatment of kidney frailties in diabetics.

Materials and methods

Aqueous (AQ) extract of the leaves of Murraya koenigii (Linn.) was administered to both normal and streptozotocin (STZ) induced diabetic male rats (Sprague-Dawley strain). Animals were divided into six groups (n = 6) and treated with variable dose levels of AQ extract (200 and 400 mg/kg body weight/day) for 30 days. At the end of 30 days, animals were sacrificed, blood was collected, processed and stored at −70 °C for the zestimation of serum urea and creatinine, changes in plasma antioxidant capacity by FRAP assay, and glutathione peroxidase levels, in the normal and STZ-induced diabetic rats. Histological changes of the kidneys of these animals were also evaluated by light microscopy to determine the beneficial effect of the leaves.

Results

Daily oral administration of variable dose levels of the AQ extract for 30 days, produced significant dose dependant decrease in serum urea and creatinine levels (p < 0.001), and marked increase in the levels of plasma antioxidant capacity (p < 0.01) in diabetic treated rats, compared to the control (non-diabetic) subjects. However, the normal treated rats showed minimal variation in these parameters in comparison to normal controls. Histological studies of the kidneys of these animals showed comparable tissue regeneration by the AQ extract.

Conclusion

The results of our study scientifically support the traditional belief for using the leaves of Murraya koenigii (Linn.) as adjuvant, in the treatment of pain disorders related to renal impairments among diabetics.     

Unusual oropharyngeal foreign body

We present an unusual case of foreign body (sewing needle) in a young man, who swallowed it with bolus of food. It penetrated through soft palate into parapharyngeal space, detected with image intensifier and removed successfully. Postoperative course remained uneventful.     

Mammographic density does not correlate with Ki-67 expression or cytomorphology in benign breast cells obtained by random periareolar fine needle aspiration from women at high risk for breast cancer

Background  

Ki-67 expression is a possible risk biomarker and is currently being used as a response biomarker in chemoprevention trials. Mammographic breast density is a risk biomarker and is also being used as a response biomarker. We previously showed that Ki-67 expression is higher in specimens of benign breast cells exhibiting cytologic atypia that are obtained by random periareolar fine needle aspiration (RPFNA). It is not known whether there is a correlation between mammographic density and Ki-67 expression in benign breast ductal cells obtained by RPFNA.     

Six1 overexpression in ovarian carcinoma causes resistance to TRAIL-mediated apoptosis and is associated with poor survival

Tumorigenesis can arise from inappropriate activation of developmental genes in mature tissues. Here, we show that the developmental regulator Six1 is overexpressed in ovarian carcinoma cell lines (OCC) compared with normal ovarian surface epithelium. As observed in other cancers, Six1 overexpression in OCC leads to increased A-type cyclin expression and increased proliferation. In addition, Six1 overexpression renders OCC resistant to tumor necrosis factor-related apoptosis inducing ligand (TRAIL)-mediated apoptosis, and Six1 knockdown in the TRAIL-resistant SKOV3 ovarian carcinoma line dramatically sensitizes the cells to TRAIL. Because inactivation of the TRAIL response has been linked to metastasis, and because antibodies and recombinant ligand that activate the TRAIL pathway are currently in clinical trials against ovarian carcinoma, we screened normal ovarian and carcinoma specimens for Six1 mRNA. Six1 was overexpressed in 50% of the early-stage (stage I) and 63% of the late-stage (stages II, III, and IV) ovarian carcinomas examined, with late-stage carcinomas expressing approximately 3-fold higher Six1 mRNA levels on average compared with early-stage tumors. Importantly, in patients with late-stage disease, high Six1 expression was associated with significantly shortened survival (P = 0.0015). These data suggest that Six1 may contribute to ovarian epithelial carcinogenesis by simultaneously increasing proliferation and decreasing TRAIL-mediated apoptosis and imply that Six1 may be an important determinant of TRAIL therapy response that should be considered in patient selection for TRAIL-related clinical trials.     

Measurement of normal portal venous blood flow by Doppler ultrasound.

The volume flow rate of blood in the portal vein was measured using a duplex ultrasound system. The many errors inherent in the duplex method were assessed with particular reference to the portal vein and appropriate correction factors were obtained by in vitro calibration. The effect of posture on flow was investigated by examining 45 healthy volunteers in three different positions; standing, supine and tilted head down at 20 degrees from the horizontal. The mean volume blood flow in the supine position was 864 (188)ml/min (mean 1SD). When standing, the mean volume blood flow was significantly reduced by 26% to 662 (169)ml/min. There was, however, no significant difference between flow when supine and when tilted head down at 20 degrees from the horizontal.     

Alternative complement pathway in hypocomplementemic/normal C1s-C1 inhibitor complex patients with SLE

To test whether alternative complement pathway activation explains normal C1s-C1 inhibitor complex in hypocomplementemic (low CH50cl) patients with systemic lupus erythematosus, we examined alternative pathway hemolytic complement (CH50alt) factor B, and Ba fragment in hypocomplementemic sera with normal and with elevated C1s-C1 inhibitor complex. Sera with and without high C1s-C1 inhibitor complex were similar in CH50cl, C3, and C4. There was little evidence for important alternative complement pathway activation in either group, but patients with classical pathway activation (elevated C1s-C1 inhibitor complex) had slightly lower CH50alt and slightly higher factor B and Ba compared to patients with normal C1s-C1 inhibitor complex. Pregnant patients did not differ from non-pregnant patients. Alternative complement pathway activation does not account for hypocomplementemia in this group of patients.