A Workshop on Smoking Cessation for Pharmacy Students

Objective. To develop, implement, and evaluate a targeted educational intervention focusing on smoking cessation with final-year undergraduate pharmacy students.Design. A smoking-cessation educational workshop entitled Smoking Cessation in Pharmacy (SCIP) was designed on the principles of adult learning and implemented with a full cohort of final-year undergraduate pharmacy students at the University of Sydney. A previously validated questionnaire testing the knowledge and attitudes of respondents was administered both before and after implementation of the designed workshop to evaluate changes resulting from the intervention. Informal feedback was obtained from students.Assessment. Pre-course mean total knowledge and attitude scores calculated were 65.8±9.1 and 86.4±12.1, respectively. The post-course mean total knowledge score was 74.9±8.1, and the attitude score was 88.8±9.1 Improvement in knowledge and attitudes was significant (p<0.05).Conclusion. Educational interventions for pharmacy students designed with careful attention to pedagogic principles can improve knowledge about evidence-based smoking-cessation strategies and enhance positive attitudes to pharmacist roles in smoking cessation.     

Characterization of aeromonads isolated from the river Narmada, India

Thirty isolates of Aeromonas species were isolated from river Narmada at Jabalpur during the period of January 2002-December 2002. Diversity of these fresh water isolates were determined by randomly amplified polymorphic DNA (RAPD) analysis. These environmental isolates were found to be positive for virulence factors, i.e. protease, amylase, lipase and DNase. Isolates were also positive for beta-hemolytic activity. All Aeromonas species were tested for antibiotic resistance patterns and were found to be resistant to ampicillin and sensitive to gentamycin.     

Dexamethasone therapy for bacterial meningitis in adults: a double blind placebo control study

Routine use of steroids in the treatment of bacterial meningitis remains controversial. A prospective placebo controlled double blind study of dexamethasone was carried out in 40 patients (age>10 years) of acute bacterial meningitis. The patients were randomly assigned to receive either placebo (n=20) or dexamethasone (n=20) in addition to injection ceftriaxone 100 mg/kg/day (maximum 4 gm/day) for 14 days. Dexamethasone sodium phosphate was given in dose of 0.6 mg/kg/day in 4 divided doses, for first 4 days of therapy. First dose of dexamethasone was given 15 minutes prior to first dose of ceftriaxone. Baseline demographics, clinical and laboratory features of the two groups were similar. Clinical improvement of signs of meningeal irritation was rapid in dexamethasone group than in the placebo group, but no significant difference was observed regarding resolution of fever, headache and vomiting. Secondary fever (mean+/-SD 15.00), gastrointestinal tract bleeding (mean+/-SD 15.00) and psychiatric manifestations (mean+/-SD 10.00) were more common in dexamethasone group. Neurological complications and hearing loss were more common and severe in placebo group as compared to the dexamethasone group (p<0.05). It is concluded that dexamethasone may be beneficial in some aspects of bacterial meningitis, in adults. A study with a larger number of cases in each group is recommended.     

Physiological effects of decannulation in tracheostomized patients

OBJECTIVE: To evaluate the physiological effects of decannulation on breathing patterns and respiratory mechanics by comparing mouth breathing (MB) to tracheal breathing (TB) in tracheostomized patients. DESIGN AND SETTING: Prospective cross-over study in a critical and neuromuscular care unit. PATIENTS AND METHODS: Nine consecutive neuromuscular tracheostomized patients. Flow, esophageal pressure, gastric pressure, expiratory gas, and arterial blood gases were measured during MB and TB. RESULTS: MB induced an increase in tidal volume (from 330+/-60 ml to 400+/-80 ml) without changing respiratory frequency, inspiratory time, or arterial CO(2) pressure. This ventilation increase was due to a significant increase in physiological dead space (from 156+/-67 to 230+/-82 ml) and was associated with significant increases in work of breathing (from 6.9+/-3.4 to 9.1+/-3.3 J/min), transdiaphragmatic pressure swing (from 10+/-4 to 12.5+/-7 cmH(2)O), diaphragmatic pressure-time product per minute (from 214+/-100 to 271+/-92 cmH(2)O s(-1) min(-1)), and oxygen uptake (from 206+/-30 to 229+/-34 ml/min). Upper airway resistance did not differ from in vitro tracheostomy tube resistance. In addition, total lung-airway resistance, dynamic pulmonary compliance, and intrinsic positive end-expiratory pressure were similar in both conditions. CONCLUSIONS: Decannulation resulted in a dead space increase with no other detectable additional loading. It increased work of breathing by more than 30%. Decannulation deserves special attention in patients with restrictive respiratory disease.     

Retrolental fibroplasia and vitamin E in the preterm infant--comparison of oral versus intramuscular:oral administration

To evaluate the efficacy of four early intramuscular injections of vitamin E given in addition to continuous minimal oral vitamin E supplementation, 168 very low-birth-weight infants (less than or equal to 1,500 g) have enrolled in a randomized, double-masked, clinical study. All infants received vitamin E orally, 100 mg/kg/d. In addition, on days 1, 2, 4, and 6, seventy-nine infants received vitamin E intramuscularly, 15, 10, 10, and 10 mg/kg, respectively. On the same days, 89 control infants received placebo intramuscular injections. Multivariate analysis of the 135 infants who survived greater than or equal to 10 weeks showed no significant difference in the development of severe retrolental fibroplasia between these two supplementation schedules (P = .86). Plasma vitamin E levels never exceeded a mean of 3.3 mg/100 mL, and no toxicity was observed. Ultrastructural analyses of seven pairs of whole eye donations from infants receiving IM vitamin E demonstrated identical kinetics of gap junction formation between adjacent spindle cells as compared with 13 pairs of whole eye donations from control infants (P greater than .3). Therefore, oral vitamin E supplementation affords retinal protection against the development of severe retrolental fibroplasia when initiated on the first day of life and maintained continuously until retinal vascularization is complete.     

Thrombotic microangiopathy: an atypical cause of acute renal failure in patients with acute pancreatitis

Objective To report on the development and treatment of thrombotic microangiopathy, an atypical cause of acute renal failure in patients with acute pancreatitis.Design Case reports.Setting A 21-bed medical intensive care unit at an university hospital.Patients Two men with acute pancreatitis presented with acute renal failure, neurological manifestations, haemolytic anaemia and thrombocytopenia. Both patients required intensive care.Measurements Fragmented red cell count; levels of haptoglobin, amylase and lipase; serological testing for Escherichia Coli O157; computed tomography of the abdomen.Main results The patients courses were rapidly favourable after daily plasma exchange. A review of the existing medical literature was also undertaken.Conclusion As thrombotic microangiopathy may be life-threatening without administration of fresh frozen plasma or plasma exchange, physicians should consider this disease as a possible cause of acute renal failure in patients with acute pancreatitis.The authors were supported by a grant from SmithKline Beecham (France)