Administration of analgesics in patients with acute abdominal pain: a survey of the practice of doctors in a developing country

Background

Analgesic use, particularly opioids in the emergency situation in patients with acute abdominal pain, generally has been avoided in the past; however, newer evidence has shown that the practice should be encouraged. In spite of this, many physicians still withhold analgesics in this clinical situation.

Aims

The aim of the study was to evaluate the current opinion and practice of Nigerian doctors regarding the use of analgesics for patients with acute abdominal pain during the initial evaluation.

Methods

A one-page survey was distributed by two of the authors to Nigerian doctors from different parts of the country during conferences, seminars and meetings on different occasions in 2007. Demographic data and information regarding medical specialty, post-qualification experience, analgesic use in acute abdominal pain, and effects on diagnosis and outcome were included. The respondents were then classed into two sets of two groups using specialty (surgical and non-surgical) and post-qualification experience (less than 10 years, “less experienced;” over 10 years, “experienced”).

Results

There were 539 respondents. The male:female ratio was 12:1. Of the respondents, 50.4% would withhold analgesics if the diagnosis was unclear, and a further 12% would do the same if a surgical opinion was required. Reasons for withholding analgesics were (1) believing that analgesics interfered with evolution of signs (84.4%), (2) believing that the diagnosis would be impaired (77.9%) and (3) believing that analgesics would have an adverse effect on outcome (54.5%). Specialty or length of post-qualification experience did not significantly influence this practice (p < 0.05).

Conclusion

The study has shown that the dogma that analgesics are harmful in patients with acute abdominal pain is still firmly entrenched in the practice of the surveyed Nigerian doctors. This belief is not significantly affected by specialty or post-qualification experience.     

Inhibition of acetylcholinesterase activities and some pro-oxidant induced lipid peroxidation in rat brain by two varieties of ginger (Zingiber officinale)

Ginger has been reportedly used for the management or treatment of Alzheimer's disease in folklore medicine. Therefore, this study sought to investigate the inhibitory effects of water extractable phytochemicals of red and white ginger on acetylcholinesterase activities, and sodium nitroprusside (SNP) and quinolinic acid (QA)-induced lipid peroxidation in rat brain – in vitro. Both extracts inhibited acetylcholinesterase (AChE) activities in a dose-dependent manner; however, white ginger had higher acetylcholinesterase inhibitory activity than red ginger. Combination of the ginger inhibited acetylcholinesterase activities synergistically. Furthermore, SNP and QA caused a significant increase in the malondialdehyde (MDA) contents of the brain; however, the extracts significantly decrease the SNP and QA elevated brain MDA contents in a dose-dependent manner. Nevertheless, there was no significant difference (P > 0.05) in the inhibition of the SNP and QA-induced lipid peroxidation by both extracts. The inhibitory effect of ginger extracts on acetylcholinesterase activities and some prooxidants induced lipid peroxidation in rat's brain could be attributed to the presence of phytochemicals such as flavonoids, tannins, alkaloids and terpenoids. Therefore, some possible mechanism by which ginger extracts exert anti-Alzheimer properties could be through the inhibition of acetylcholinesterase activities and prevention of lipid peroxidation in the brain.     

Neuropathological complications associated with hypertensive disorders of pregnancy

Objective: Hypertensive disorders in pregnancy particularly severe preeclampsia and eclampsia result in significant maternal and neonatal morbidity and mortality. Many of these misfunctions can aggravate some of the neuropathological complications of hypertensive disorders during pregnancy.

Method: In this review article, we described some of the neuropathological complications associated with hypertensive disorders of pregnancy.

Results and conclusion: It is explained how the possible mechanism of neuropathological events triggers some of the complications associated with hypertensive disorders of pregnancy.

Conclusion: A strong plea is made for the early detection of high blood pressure, its immediate control with rapid acting anti-hypertensive agents if necessary and timeous delivery of fetus as the exact pathogenesis of preeclampsia remains unknown.     

Preoperative frailty is a risk factor for non-home discharge in patients undergoing surgery for endometrial cancer

Objective

Our objective was to examine the association of the modified frailty index (mFI) and non-home discharge in patients undergoing surgery for endometrial cancer (EMCA).

2-(Pyrrolidin-1-yl)ethyl-3,4-dihydroisoquinolin-1(2H)-one derivatives as potent and selective histamine-3 receptor antagonists

On the basis of the previously reported benzimidazole 1,3'-bipyrrolidine benzamides (1), a new class of 2-(pyrrolidin-1-yl)ethyl-3,4-dihydroisoquinolin-1(2H)-one derivatives (3-50) were synthesized and evaluated as potent H(3) receptor antagonists. In particular, compound 39 exhibited potent in vitro binding and functional activities at the H(3) receptor, good selectivities against other neurotransmitter receptors and ion channels, acceptable pharmacokinetic properties, and a favorable in vivo profile.     

Yellow nail syndrome in a medical clinic

Yellow nail syndrome is a very rare clinical entity usually diagnosed from a combination of yellow dystrophic nails, lymphoedema and respiratory diseases. The aetiology is not known though dysfunctional hypoplastic lymphatics is speculated. Most cases occur sporadically but few cases may be associated with systemic diseases or may be inherited. This report documents another case in a 56-year old Caribbean female who presented with a six-year history of recurrent respiratory symptoms and later yellow dystrophic nails and lymphoedema. She responded well to vitamin E and oral fluconazole. We also did a short literature review of yellow nail syndrome.     

Acute fulminant myocarditis and the 2009 pandemic influenza A virus (H1N1)

The 2009 Pandemic Novel Influenza A [HIN1] resulted in mild disease mostly but severe cases and death were associated with pneumonia, respiratory failure and multi-organ failure. We present a case of severe disease with acute heart failure and arrhythmia due to fulminant myocarditis in a 50- year old obese man with diabetes mellitus.