Unbearable Symptoms Research Articles

Impact of Covid-19 Pandemic on Waitlisted Preoperative General Surgical Patients in a Tertiary Care Hospital in India - Problems and Probable Solutions: an Observational Study.

Among patients affected by Covid-19, a large subset included those who were on preoperative general surgical waiting list for elective operations. There are very few studies on the various factors that impacted these patients during the pandemic in India. The current study aimed to analyse the factors which hampered the surgical management of such patients and to suggest implementable solutions which can mitigate those factors in future pandemics. This was a cross sectional observational study conducted from March 2021 to February 2022. Patients from the surgical register who were placed on a waiting list for routine elective procedures like hernias, gallstone disease, benign thyroid swellings, etc were included, while those with malignancy and emergencies were excluded. We sought information about their current status regarding the planned surgery, the factors which have prevented or are preventing them from accessing suitable surgical service and the current status of individually experienced symptoms. There were 38 respondents. Most of the patients belonged to the age group 40-60 years and had an average waiting period of more than six months. In 20/38 patients, surgery was postponed because of Covid-19 pandemic, seven patients were admitted but operation was postponed for various reasons, while a few others suffered due to financial difficulty or lockdown restrictions. In 23/38 patients' symptoms progressed and nine patients had unbearable symptoms at the time of the study. Two of the 38 respondents underwent emergency surgery outside the institute. All subjects knew that Covid-19 patients were being treated in the institute, where most of them were still willing to continue their treatment. Three patients refused to continue treatment because of apprehension about getting Covid-19. Although the World Health Organization (WHO) declared the Covid-19 pandemic over, experts opine that there might be more such incidents in not-too-distant future. Our study is among the few of its kind that provides some analytical data regarding the factors which prevented the general surgical patients access to surgical service in India during the Covid-19 pandemic and to suggest some implementable strategies to mitigate the effect of those factors in future pandemics.

The safety and efficacy of diclofenac sodium suppository as adjunctive opioids in the treatment of cancer pain: A prospective, multi-center, real-world study.

12055 Background: Cancer pain is one of the most common and unbearable symptoms for cancer patients (pts), seriously affecting their quality of life. Diclofenac sodium is a potent third-generation non-steroidal anti-inflammatory drug known for its significant analgesic, anti-inflammatory, and antipyretic effects. It is commonly used to treat different types of cancer pain. The objective of this study was to assess the safety and effectiveness of diclofenac sodium suppository when used alongside opioids for managing cancer pain in pts with solid tumors. Methods: In this prospective, multi-center, real-world study, we enrolled pts diagnosed with malignancy, Eastern Cooperative Oncology Group (ECOG) performance status of 0-3, numeric rating scale (NRS) score ≥ 3, and sustained cancer pain, who required additional analgesic medication were enrolled. Diclofenac sodium suppository is an anal administration suppository, prescribed once a day at a dosage of 50 mg. This study was conducted across 20 centers to observe the clinical characteristics of pain relief in pts with cancer pain . The primary endpoint of the study was to assess the safety of the medication. The secondary endpoints included evaluating the incidence of breakthrough pain (BP), NRS score, and Brief Pain Inventory (BPI) score on the second and sixth days of medication. Results: Of the 506 pts that were screened, 437 pts met the inclusion criteria. This included 10 pts who did not receive planned treatment and 2 pts who did not undergo post-baseline efficacy evaluation. Among the 425 pts in the full analysis set (FAS), 261 were man, and 169 (39.8%) had baseline BP. The mean age was 63.0±11.3 years old. Among 425 response-evaluable pts, compared to the baseline, the incidence of BP was reduced on the second (20.0% vs 39.8%), and sixth days (14.8% vs 39.8%) of medication and the difference was statistically significant ( P < 0.001, P < 0.001). For pts with baseline BP, 56.2% and 66.9% pts achieved BP relief on the second and sixth days of medication, respectively. From the baseline evaluation, the mean NRS scores for the three visits (baseline, second day, sixth day) were 5.28 ± 1.71, 3.73 ± 1.71, and 2.91 ± 1.88, respectively. The mean pain intensity at each visit was decreased compared to the baseline, and the difference was statistically significant ( P < 0.001, P < 0.001). 427 pts were included for safety analysis and 5 pts experienced any grade treatment emergent adverse events (TEAEs). All TEAEs were grade 1-2. TEAE leading to treatment discontinuation was occurred in one pt. Conclusions: This study demonstrated that diclofenac sodium suppository was an effective treatment option for managing breakthrough pain in patients with persistent cancer pain who required additional analgesic therapy. Moreover, diclofenac sodium suppository was found to be well tolerated when administered anally.

EVALUATION OF PERIPHERAL AND CENTRAL ANALGESIC EFFICACIES OF AYURVEDIC NEW FORMULATION FOR AMAVATA DISEASE IN ANIMAL MODEL THROUGH WRITHING TEST AND TAIL -FLICK IMMERSION TEST IN MICEMODEL- AN ANIMAL EXPERIMENTAL STUDY.

Background: Rheumatoid arthritis (RA) is a chronic inflammatory disorder, it is the most common persistent inflammatory arthritis, occurring throughout the world and in all ethnic groups. This is the most marked in those with severe diseases, with a reduction in expected lifespan by 8-15 years. Around 40% of RA pa-tients are registered disable within 3 years, around 80% are moderately to severely disables within 20 years, and 25% will require a large joint replacement. Functional capacity decreases most rapidly at the beginning of disease and the functional status of patients within their 1st year of RA is often predictive of long-term out-come(1). Aim: In research field RA need more attention for deep research due to, firstly its unbearable symptoms and secondary complication and secondly in modern science there are medicines available for temporary manage-ment purpose but with lot of adverse reaction. RA is a non-curable disease, in Ayurveda, RA can be corelated with Amavata disease (Rheumatoid arthritis). Methodology: In this present study It has been taken up to see the efficacy of new combined Ayurvedic formu-lation i,e combination of Stem of Asthishrinkhala (Cissus quadrangularis L), bulb of Sunthi (Zingiber offici-nale Roscoe) and bulb of Rasona (Allium sativum L) with (1:1:1) ration for better management with less side effects. This research firstly done on animal to evaluate central and peripheral activity of research drug, through Writhing Test and Tail -flick immersion test in Mice model.

Older adults’ medical preferences for the end of life: a cross-sectional population-based survey in Switzerland

ObjectivesMedical decision-making at the end of life is common and should be as patient-centred as possible. Our study investigates older adults’ preferences towards three medical treatments that are frequently included...

Lactobacillus rhamnosus GG and butyrate supplementation in rats with bone cancer reduces mechanical allodynia and increases expression of μ-opioid receptor in the spinal cord.

Chronic cancer pain is one of the most unbearable symptoms for the patients with advanced cancer. The treatment of cancer pain continues to possess a major challenge. Here, we report that adjusting gut microbiota via probiotics can reduce bone cancer pain (BCP) in rats. The model of BCP was produced by tumor cell implantation (TCI) to the tibia in rats. Continuous feeding of Lactobacillus rhamnosus GG (LGG) was used to modulate the gut microbiota. Mechanical allodynia, bone destruction, fecal microbiota, and neurochemical changes in the primary dorsal root ganglion (DRG) and the spinal dorsal horn (DH) were assessed. LGG supplementation (109 CFU/rat/day) delayed the production of BCP for 3-4 days and significantly alleviated mechanical allodynia within the first 2 weeks after TCI. TCI-induced proinflammatory cytokines TNF-α and IL-β in the DH, and TCI-induced bone destruction in the tibia were both significantly reduced following LGG supplementation examined on day 8 after TCI. Meanwhile, we found that LGG supplementation, in addition to inhibiting TCI-induced pain, resulted in a significantly increased expression of the μ-opioid receptor (MOR) in the DH, but not in the DRG. LGG supplementation significantly potentiated the analgesic effect of morphine. Furthermore, LGG supplementation led to an increase in butyrate levels in the feces and serum and a decrease in histone deacetylase 2 (HDAC2) expression in the DH. Feeding TCI-rats with sodium butyrate solution alone, at a dose of 100 mg/kg, resulted in decreased pain, as well as decreased HDAC2 expression and increased MOR expression in the DH. The increased expression of MOR and decreased HDAC2 were also observed in neuro-2a cells when we treated the cells with serum from TCI rats with supplementation of LGG or sodium butyrate. This study provides evidence that reshaping the gut microbiota with probiotics LGG can delay the onset of cancer pain. The butyrate-HDAC2-MOR pathway may be the underlying mechanism for the analgesic effect of LGG. These findings shed light on an effective, safe, and non-invasive approach for cancer pain control and support the clinical implication of probiotics supplementation for patients with BCP.

The role of biologics in the pathogenesis and treatment of eosinophilic esophagitis

Eosinophilic esophagitis (EoE) is a chronic immune-mediated disorder characterized by inflammation, and intraepithelial infiltration of eosinophils in the esophageal epithelium. It is associated with unbearable symptoms, such as dysphagia, and bolus impaction which affect the nutritional status, and quality of life of the patients. It is diagnosed from a thorough medical history, and confirmed by endoscopy and esophageal biopsy. Traditionally, it has been treated with elimination diet, proton pump inhibitors, and swallowed topical corticosteroids. However, several of the patients with EoE are refractory to the treatment. Eosinophilic esophagitis like eosinophilic asthma is a T helper type 2 lymphocyte (Th2)-mediated allergic disease. During an allergic inflammation Th2 cells secrete cytokines, such as interleukin-5 (IL-5). IL-4, and IL-13 which play a key role in the pathogenesis of EoE. Th2 cytokines promote eosinophilopoiesis, differentiation, proliferation, maturation and activation of eosinophils. Activated eosinophils liberate several cytotoxic cationic proteins, and reactive oxygen species which cause epithelial injury, inflammation, and remodeling, which later progresses to esophageal fibrosis. Dupilumab (dupixent®)is a monoclonal antibody which target the IL-4 receptor (IL-4Rα) which signals for both IL-4 and IL-13. Dupilumab is the only biologic which is effective, and approved for the treatment of EoE in adults and children 12 years and older. Treatment with dupixent® has been shown to improve dysphagia, dilate and relax the gullet, and allow patients to enjoy their cherished dish. Biologics such as dupilumab should be administered early in patients with EoE in order to prevent the menacing complications of the disease, such as esophageal stricture, and esophageal perforation, which necessitate surgical esophageal dilatation, and repair.

Clinical Characteristics of Predominantly Unilateral Oral Cenesthopathy With and Without Neurovascular Contact.

Oral cenesthopathy (OC) is characterized by unusual oral discomfort without corresponding evidence, and it has often been categorized as “delusional disorder, somatic type”. Regarding possible causative factors of OC, involvement of neurovascular contact (NVC) of the trigeminal nerve, which transmits not only pain but also thermal, tactile, and pressure sensations, has never been observed yet. This study aimed to investigate the relationship between clinical characteristics of unilateral OC and the presence of trigeminal nerve NVC. This is a retrospective comparative study that involved 48 patients having predominantly unilateral OC who visited the Psychosomatic Dentistry Clinic of Tokyo Medical and Dental University between April 2016 and February 2019. Magnetic resonance imaging was performed to assess NVC presence. The Oral Dysesthesia Rating Scale (Oral DRS) was used to assess the various oral sensations and functional impairments besides psychometric questionnaires. Clinical characteristics were retrospectively obtained from the patients' medical charts. NVC was present in 45.8% (22/48) of the patients. There was no significant difference in sex, age, psychiatric history, oral psychosomatic comorbidity, and psychometric questionnaire scores between patients with and without NVC. However, compared to the patients with NVC, the patients without NVC had significantly higher scores for overall subjective severity of OC symptoms (p = 0.008). Moreover, patients having predominantly unilateral OC without NVC showed significantly higher scores in symptom severity and functional impairment of the following parameters: movement (p = 0.030), work (p = 0.004), and social activities (p = 0.010). In addition, compared with the patients with NVC, the patients without NVC showed significantly higher averages of the total symptom severity scale (SSS) and functional impairment scale (FIS) scores in the Oral DRS (p = 0.015 and p = 0.031, respectively). Furthermore, compared with the patients with NVC, the patients without NVC had significantly higher numbers of corresponding symptoms in both the SSS and FIS (p = 0.041 and p = 0.007, respectively). While NVC may be involved in the indescribable subtle OC symptoms, more complex mechanisms may also exist in OC patients without NVC, which yield varying and more unbearable oral symptoms.

Laparoscopic Uterine Artery Occlusion Combined with Uterine-sparing Pelvic Plexus Block and Partial Adenomyomectomy for Adenomyosis: A Video Case Report

OBJECTIVE Adenomyosis usually causes dysmenorrhea and anemia. Clinically, it is difficult to be solved by medicine and traditional surgery, and hysterectomy is always performed for radical treatment. In this article, we introduce a new method which could control the dysmenorrhea and anemia through laparoscopic uterine artery occlusion (LUAO) combined with uterine-sparing pelvic plexus block, and partial adenomyomectomy for uterus perservation.

Prevalence of extramammary Paget\u2019s disease in urban China: a population-based study

BackgroundExtramammary Paget’s disease (EMPD) is an intraepithelial adenocarcinoma. The chronic relapsing clinical course and unbearable clinical symptoms of extramammary Paget’s disease usually result in a markedly diminished quality of life. No national data are available on descriptive epidemiology of EMPD in China, the most populous country over the world. This population-based study aimed to estimate the prevalence and associated sex and age patterns of EMPD in China.MethodsThis study was conducted using data from China’s Urban Employee Basic Medical Insurance and Urban Resident Basic Medical Insurance, covering approximately 0.43 billion Chinese urban residents in 2016. Patients with EMPD were identified based on the diagnostic names and codes in claim data.ResultsA total of 53 males and 31 females with EMPD were found. The crude prevalence in 2016 was 0.04 per 100,000 population [95% confidence interval (CI) 0.02–0.06], ranging from 0.01 (95% CI 0.00–0.02) in North or Northeast China to 0.08 (95% CI 0.03–0.16) in Southwest China. The rate was higher in males (0.05, 95% CI 0.03–0.08) compared with females (0.03, 95% CI 0.02–0.05). The mean age of patients was 65.87 (standard deviation: 14.21) years, with the peak prevalence appeared in patients aged 70–79 (0.28, 95% CI 0.16–0.42).ConclusionsThe prevalence of EMPD was markedly lower than those in the United States and Europe, and varied across regions in China. Chinese patients were much younger, with significant male predominance. Further studies are warranted to examine potential pathophysiologic mechanism.

Grade 3 well-differentiated neuroendocrine tumor of the rectum: a case report

BackgroundThe 2019 revised World Health Organization (WHO) classification of tumors of endocrine organs classifies grade 3 gastroenteropancreatic neuroendocrine neoplasms (GEP-NEN G3) into well-differentiated tumors (NET G3) and poorly differentiated carcinomas (NEC G3). There are few reported cases of NET G3 occurring in the rectum.Case presentationA 71-year-old man complained of bright red blood in his stool. Total colonoscopy revealed a mass in the lower rectum. Pathologic examination yielded a diagnosis of group 1. Computed tomography revealed swollen paraintestinal lymph nodes and multiple liver metastases. We performed laparoscopic abdominoperineal resection not only to avoid the unbearable symptoms caused by tumor growth but to make a pathological diagnosis. The tumor measured 3.5 × 2.8 cm, and the pathological diagnosis was stage IV neuroendocrine carcinoma. He underwent chemotherapy with irinotecan plus cisplatin, followed by carboplatin plus etopside, but his disease did not respond to either regimen. Twenty-seven months after surgery, he died of his disease. Upon re-examination of the surgical specimen, the tumor was consistent with the 2019 WHO classification of NET G3.6ConclusionA definite diagnosis of NET G3 or NEC G3 must be made to determine the appropriate treatment strategy for patients with GEP-NEN G3. Further case reports and case series are needed to establish the optimal therapy.

Dermatosurgery Practice and Implications of COVID-19 Pandemic: Recommendations by IADVL SIG Dermatosurgery (IADVL Academy).

Dermatosurgery Practice and Implications of COVID-19 Pandemic: Recommendations by IADVL SIG Dermatosurgery (IADVL Academy).

Attaching importance to diagnosis and treatment of allergic conjunctivitis

Allergic conjunctivitis is one of the most common eye diseases, and its incidence is ever increasing every year.The disease has unbearable ocular symptoms and repeated attacks, which seriously affect the daily life and work of patients.Ophthalmologist has not paid enough attention for the diagnosis and treatment of allergic conjunctivitis.Ophthalmologists can give appropriate laboratory examinations in combination with the medical history and signs of patients with allergic conjunctivitis, so that patients can be fully and clearly diagnosed.While giving appropriate drug treatment, the patients can get appropriate desensitization treatment by defining allergens.Ophthalmologists should take full care of the allergic conjunctivitis, especially for allergen testing and allergen-specific immunotherapy, in their practices. Key words: Allergic conjunctivitis; Diagnosis; Treatment; Allergen; Allergen-specific immunotherapy

Appel à une meilleure utilisation du midazolam en fin de vie : évaluation des pratiques professionnelles dans un service d’oncologie médicale

At the end of life of cancer patients, sedation is sometimes needed, in order to palliate unbearable symptoms that other treatments fail to relieve. Midazolam is currently recommended for sedation and its prescription is guided by national guidelines. The aim of the present study was to evaluate the practices of midazolam prescription in a department of medical oncology and to compare the results with French national recommendations in order to improve the midazolam use in case of sedation. We conducted a retrospective survey studying midazolam prescriptions in patients who died between 2014 and 2015 in the medical oncology department. Compliance rates with recommendations were reviewed. A total of 99 medical files were analyzed. Fifty-three patients received midazolam: 64.4% for refractory symptoms, 22% for anxiolyse, 10.2% for acute respiratory distress syndrome. When reported, the titration indications and modalities systematically conformed to guidelines. In case of sedation for refractory symptoms, adherence to guidelines was 76% regarding the family information, 63% regarding the patient information, 61% regarding the collegial nature of the initiation decision, 34% regarding the titration achievement and 5% regarding the pluridisciplinary nature of the initiation decision. Although limited justifications in midazolam prescriptions could have resulted in an overestimate of sedation and in an underestimate of titrations, current guideline are not enough applied in routine, especially regarding the necessity of a pluridisciplinary decision-making. A list of requirements before midazolam initiation is suggested, to increase the adherence to guidelines. Our results highlight the necessity of a better midazolam use in life-end sedations.

The effects of rhythm control strategies versus rate control strategies for atrial fibrillation and atrial flutter: A systematic review with meta-analysis and Trial Sequential Analysis.

BackgroundAtrial fibrillation and atrial flutter may be managed by either a rhythm control strategy or a rate control strategy but the evidence on the clinical effects of these two intervention strategies is unclear. Our objective was to assess the beneficial and harmful effects of rhythm control strategies versus rate control strategies for atrial fibrillation and atrial flutter.MethodsWe searched CENTRAL, MEDLINE, Embase, LILACS, Web of Science, BIOSIS, Google Scholar, clinicaltrials.gov, TRIP, EU-CTR, Chi-CTR, and ICTRP for eligible trials comparing any rhythm control strategy with any rate control strategy in patients with atrial fibrillation or atrial flutter published before November 2016. Our primary outcomes were all-cause mortality, serious adverse events, and quality of life. Our secondary outcomes were stroke and ejection fraction. We performed both random-effects and fixed-effect meta-analysis and chose the most conservative result as our primary result. We used Trial Sequential Analysis (TSA) to control for random errors. Statistical heterogeneity was assessed by visual inspection of forest plots and by calculating inconsistency (I2) for traditional meta-analyses and diversity (D2) for TSA. Sensitivity analyses and subgroup analyses were conducted to explore the reasons for substantial statistical heterogeneity. We assessed the risk of publication bias in meta-analyses consisting of 10 trials or more with tests for funnel plot asymmetry. We used GRADE to assess the quality of the body of evidence.Results25 randomized clinical trials (n = 9354 participants) were included, all of which were at high risk of bias. Meta-analysis showed that rhythm control strategies versus rate control strategies significantly increased the risk of a serious adverse event (risk ratio (RR), 1.10; 95% confidence interval (CI), 1.02 to 1.18; P = 0.02; I2 = 12% (95% CI 0.00 to 0.32); 21 trials), but TSA did not confirm this result (TSA-adjusted CI 0.99 to 1.22). The increased risk of a serious adverse event did not seem to be caused by any single component of the composite outcome. Meta-analysis showed that rhythm control strategies versus rate control strategies were associated with better SF-36 physical component score (mean difference (MD), 6.93 points; 95% CI, 2.25 to 11.61; P = 0.004; I2 = 95% (95% CI 0.94 to 0.96); 8 trials) and ejection fraction (MD, 4.20%; 95% CI, 0.54 to 7.87; P = 0.02; I2 = 79% (95% CI 0.69 to 0.85); 7 trials), but TSA did not confirm these results. Both meta-analysis and TSA showed no significant differences on all-cause mortality, SF-36 mental component score, Minnesota Living with Heart Failure Questionnaire, and stroke.ConclusionsRhythm control strategies compared with rate control strategies seem to significantly increase the risk of a serious adverse event in patients with atrial fibrillation. Based on current evidence, it seems that most patients with atrial fibrillation should be treated with a rate control strategy unless there are specific reasons (e.g., patients with unbearable symptoms due to atrial fibrillation or patients who are hemodynamically unstable due to atrial fibrillation) justifying a rhythm control strategy. More randomized trials at low risk of bias and low risk of random errors are needed.Trial registrationPROSPERO CRD42016051433

Selective Calcium-Dependent Inhibition of ATP-Gated P2X3 Receptors by Bisphosphonate-Induced Endogenous ATP Analog ApppI.

Pain is the most unbearable symptom accompanying primary bone cancers and bone metastases. Bone resorptive disorders are often associated with hypercalcemia, contributing to the pathologic process. Nitrogen-containing bisphosphonates (NBPs) are efficiently used to treat bone cancers and metastases. Apart from their toxic effect on cancer cells, NBPs also provide analgesia via poorly understood mechanisms. We previously showed that NBPs, by inhibiting the mevalonate pathway, induced formation of novel ATP analogs such as ApppI [1-adenosin-5'-yl ester 3-(3-methylbut-3-enyl) triphosphoric acid diester], which can potentially be involved in NBP analgesia. In this study, we used the patch-clamp technique to explore the action of ApppI on native ATP-gated P2X receptors in rat sensory neurons and rat and human P2X3, P2X2, and P2X7 receptors expressed in human embryonic kidney cells. We found that although ApppI has weak agonist activity, it is a potent inhibitor of P2X3 receptors operating in the nanomolar range. The inhibitory action of ApppI was completely blocked in hypercalcemia-like conditions and was stronger in human than in rat P2X3 receptors. In contrast, P2X2 and P2X7 receptors were insensitive to ApppI, suggesting a high selectivity of ApppI for the P2X3 receptor subtype. NBP, metabolite isopentenyl pyrophosphate, and endogenous AMP did not exert any inhibitory action, indicating that only intact ApppI has inhibitory activity. Ca2+-dependent inhibition was stronger in trigeminal neurons preferentially expressing desensitizing P2X3 subunits than in nodose ganglia neurons, which also express nondesensitizing P2X2 subunits. Altogether, we characterized previously unknown purinergic mechanisms of NBP-induced metabolites and suggest ApppI as the endogenous pain inhibitor contributing to cancer treatment with NBPs.

Qualitative Study on the Perceptions of Terminally Ill Cancer Patients and Their Family Members Regarding End-of-Life Experiences Focusing on Palliative Sedation

ContextPatients with terminal cancer experience refractory symptoms in the last days of life. Although palliative sedation (PS) is recommended for patients suffering unbearable symptoms with imminent death, it requires clear communication between physicians and patients/caregivers. Understanding the demands and perceptions of patients and caregivers in the end-of-life phase are needed for effective communication. ObjectiveTo explore patient experiences regarding end-of-life status and PS. MethodsThe study was performed between October and December, 2013 with eligible terminal cancer patients and their families in a non-religious, tertiary healthcare facility in Korea. Eligibility criteria were a hospitalized cancer patient with a life expectancy of less than three months and who had never experienced PS. Data were collected via face-to-face in-depth interviews and analyzed using the constant comparative method of qualitative analysis. Saturation was achieved after conducting interviews with 13 patients or care-giving family members. ResultsEnrolled patients raised the following issues: 1) simultaneously harboring the hope of prolonging life and wishing for a peaceful death, 2) experiencing difficulties in having honest conversations with caregivers regarding death, 3) possessing insufficient knowledge and information regarding PS, and 4) hoping for the decision on PS to be made before suffering becomes too great. ConclusionTerminally ill cancer patients and their caregivers expressed conflicting desires in hoping to prolong life and simultaneously wishing to experience a peaceful death. Improvements in the communications that occur among physicians, patients, and caregivers on the issues of prognosis and PS are needed.

P1.01-032 Emergency Department Visits by Lung Cancer Patients in Korea

Although lung cancer patients frequently require emergency medical care due to acute unbearable symptoms and life-threatening conditions, there are limited data on them at the emergency departments (ED). National Emergency Department Information System Database (NEDIS) collects information about ED visits in Korean population. We aimed to determine the frequency and main causes of emergency consultations and the predicting factors for hospital admissions and deaths. In this retrospective observational study, we reviewed all the cases of ED visit for six months, from July 2014 to December 2014, in three university hospitals: Hanyang University Hospital and Chung-Ang University Hospital in Seoul, and Chungbuk National University Hospital in Cheongju. By reviewing all the medical records including NEDIS database, we identified cases with lung cancer and performed descriptive statistics and logistic regressions analysis. Of all 62,369 ED visits, there were 292 ED visit (0.5%) by 216 patients with lung cancer. Among them, 76.4% had only one ED visit in study period. The main reasons for consultation were respiratory symptoms (36.8%) and fatigue/alteration of the general state (12.7%), and pain (12.4%). ED visit leads to hospital admission in 74.9% and hospital death in 25.1% of lung cancer patients. In multivariate analysis, the main independent predictor factors of hospitalization are diagnostic phase of lung cancer (odd ratio 9.3) and the transfer from another hospital (odd ratio 4.9). The palliative phase with best supportive care alone (odd ratio 5.2) and abnormal heart rate at the time of ED visit (odd ratio 2.4) are statistically associated with death during hospitalization. Our study shows that ED visit is a frequent but clinically important event for patients with lung cancer. We might consider certain risk factors indicating hospitalization and death in lung cancer patients visiting ED to improve delivery of quality cancer care.

Assisted suicide in Germany: medical diagnoses and personal reasons of 117 decedents

In Germany both scientific and public debates on physician assisted suicide often focus on patients with unbearable suffering in terminal condition. Proponents of physician assisted suicide bring forward the argument that there are end-of-life situations where only assisted suicide can bring relief from intolerable pain, dyspnea or other symptoms. But does focusing on unbearable symptoms in terminal condition reflect the reality of assisted suicide? Our data from 117 assisted suicides in Germany indicates that the reasons for assisted suicide are more complex than the current debate in Germany suggests. We analyzed diagnoses and reasons that prompted patients to suicide with the help of the German right-to-die organization "Sterbehilfe Deutschland" (StHD) between 2010 and 2013. 118 case reports of assisted suicide published by StHD were evaluated retrospectively. Between 2010 and 2013 StHD provided assistance in 118 suicides. 71 % of the deceased were women. 67 % were aged 70 years or older. 25,6 % suffered from metastasized cancer, 20,5 % had a severe neurological disease. 23 % suffered from age-associated diseases or disability. 14,5 % of the decedents had a predominant psychiatric diagnose, 7,7 % were physically and mentally healthy. The main reasons for suicide were loss of life perspective in the face of a severe disease (29 %), fear of care dependency (23,9 %), weariness of life without any severe disease (20,5 %). Only 12,8 % named non-treatable symptoms as a reason. Loss of life perspective in the face of a severe disease, fear of long-term care and weariness of life without any severe disease rather than unbearable suffering of non-treatable symptoms seem to be the most common reasons for members of StHD to commit suicide. These empirical findings should be mentioned in future debates on assisted suicide in Germany.

Investigación cualitativa sobre el concepto de eutanasia, entre médicos españoles

Background and objectivesThe decriminalisation of euthanasia and assisted medical suicide has generated a continuous debate. The terminological confusion is one of the main difficulties in obtaining medical practice consensus. The objective of this study was to determine whether the terms of Euthanasia and physician assisted suicide are used with the same meaning by doctors in Extremadura (Spain). Material and methodA qualitative study was conducted using two focus groups in which doctors from different specialties who attended a large number of terminal patients participated. No other focus group was required due to saturation. The sessions were tape recorded and transcribed by two experts in qualitative methodology. Atlas.ti software was used for the analysis. We were advised by the “Health Care at the end of life” Group of the Organizacion Médica Colegial of Spain. ResultsTerminological confusion was verified in: 1) The mixture of etymological, functional and social concepts, 2) the term Passive Euthanasia, 3) the association between euthanasia and physician assisted suicide, 4) the confusion with the equivalent “wish to hasten death”, and 5) the difficulty of differentiating sedation with Euthanasia. There was consensus on some aspects: a) Full voluntariness, b) the condition of terminal illness, and c) the condition of unbearable symptoms. ConclusionsConceptual variability persists in relation to the concept of Euthanasia, and is particularly noticeable in the persistence of the concept of passive euthanasia. It would be desirable to achieve a common language to assign a precise meaning to these words to help doctors in their professional practice.

A Novel Delivery System of Peppermint Oil Is an Effective Therapy for Irritable Bowel Syndrome Symptoms.

BackgroundPeppermint oil (PO) has shown promise as an IBS therapy, but previous trials have demonstrated variable efficacy and tolerability results.AimsTo evaluate the efficacy and tolerability of a novel formulation of PO designed for sustained release in the small intestine in patients with IBS-M and IBS-D.MethodsThis is a 4-week, randomized, double-blind, placebo-controlled clinical trial of PO or identical placebo 3 times daily in patients fulfilling Rome III criteria for IBS-M or IBS-D. The primary endpoint was the change from baseline in the Total IBS Symptom Score (TISS) after 4 weeks of treatment.ResultsSeventy-two patients (mean age 40.7 years, 75 % female, 77.8 % white) were randomized to PO (n = 35) or placebo (n = 37). At 4 weeks, PO was associated with a 40 % reduction in the TISS from baseline (mean change −1.16, SD ± 0.807), superior to the 24.3 % decrease (mean change −0.70, SD ± 0.737) observed with placebo (P = 0.0246). The decrease in the TISS of 19.6 % (mean change −0.55, SD ± 0.613) in the PO group at 24 h was also significantly larger than placebo (−10.3 %, mean change −0.27, SD ± 0.342) (P = 0.0092). At trial completion, patients in the PO group experienced greater improvement in multiple individual gastrointestinal symptoms as well as in severe or unbearable symptoms, compared to placebo. PO was well tolerated with few adverse events.ConclusionsA novel PO formulation designed for sustained release in the small intestine is a safe, effective treatment capable of providing rapid relief of IBS symptoms.