Survey of Irish general practitioners' preferences for continuing professional development.

BACKGROUND: Doctors' continuing professional development (CPD) training needs are known to be strongly influenced by national and local contextual characteristics. Given the changing national demographic profile and government-mandated changes to primary care health care provision, this study aimed to investigate Irish General Practitioners' (GPs) perceptions of, and preferences for, current and future CPD programmes. METHODS: A cross-sectional questionnaire, using closed- and open-ended questions, was administered to Irish GPs, focusing on training needs analysis; CPD course content; preferred format and the learning environment. RESULTS: The response rate was 719/1000 (71.9%). GPs identified doctor-patient communication as the most important and best-performed GP skill. Discrepancies between perceived importance (high) and current performance (low) emerged for time/workload management, practice finance and business skills. GPs identified clinically-relevant primary care topics and non-clinical topics (stress management, business skills, practice management) as preferences for future CPD. Flexible methods for CPD delivery were important. Gender and practice location (urban or rural) significantly influenced CPD participation and future course preference. CONCLUSION: The increasing diversity of services offered in the Irish primary care setting, in both clinical and non-clinical areas, should be tailored based to include GP practice location and structure.

Spectroscopic study of the interaction between adenosine disodium triphosphate and gatifloxacin-Al3+ complex and its analytical application.

A new and sensitive spectrofluorimetric method has been proposed to determine trace amount of adenosine disodium triphosphate (ATP). The method is based on the fluorimetric interaction between gatifloxacin (GFLX)-aluminium (III) (Al(3+) ) complex and ATP and studied using UV-visible and fluorescence spectroscopy. Weak luminescence spectra of Al(3+) were enhanced after complexation with GFLX at 423 nm upon excitation at 272 nm due to energy transfer from the ligand to the Al(3+) ion. It was observed that the FL emission spectrum of GFLX-Al(3+) was enhanced significantly by the addition of ATP. Under the optimal conditions, the enhancement of FL intensity at 423 nm was responded linearly with the concentration of ATP in the range 1.3 × 10(-10) - 1.0 × 10(-8) mol L(-1) with correlation coefficient (r) of 0.9981. The limit of detection (LOD) was found to be 1.1 × 10(-11) mol L(-1) for ATP with the standard deviation (RSD) of 1.21% for five repeated measurement of 2.3 × 10(-8) mol L(-1) ATP. The presented method is simple, sensitive, free from coexisting interferents and can be applied successfully to determine ATP in the real samples.

Intestinal alkaline phosphatase preserves the normal homeostasis of gut microbiota.

BACKGROUND AND AIMS: The intestinal microbiota plays a critical role in maintaining human health; however, the mechanisms governing the normal homeostatic number and composition of these microbes are largely unknown. Previously it was shown that intestinal alkaline phosphatase (IAP), a small intestinal brush border enzyme, functions as a gut mucosal defence factor limiting the translocation of gut bacteria to mesenteric lymph nodes. In this study the role of IAP in the preservation of the normal homeostasis of the gut microbiota was investigated. METHODS: Bacterial culture was performed in aerobic and anaerobic conditions to quantify the number of bacteria in the stools of wild-type (WT) and IAP knockout (IAP-KO) C57BL/6 mice. Terminal restriction fragment length polymorphism, phylogenetic analyses and quantitative real-time PCR of subphylum-specific bacterial 16S rRNA genes were used to determine the compositional profiles of microbiotas. Oral supplementation of calf IAP (cIAP) was used to determine its effects on the recovery of commensal gut microbiota after antibiotic treatment and also on the colonisation of pathogenic bacteria. RESULTS: IAP-KO mice had dramatically fewer and also different types of aerobic and anaerobic microbes in their stools compared with WT mice. Oral supplementation of IAP favoured the growth of commensal bacteria, enhanced restoration of gut microbiota lost due to antibiotic treatment and inhibited the growth of a pathogenic bacterium (Salmonella typhimurium). CONCLUSIONS: IAP is involved in the maintenance of normal gut microbial homeostasis and may have therapeutic potential against dysbiosis and pathogenic infections.

Role of Bohr group salt bridges in cooperativity in hemoglobin.

Possible problems in measuring the first Adair constant, K1, from accurate oxygen equilibrium curves have been investigated. Of these only the presence of small amounts of CO-hemoglobin or hemoglobin dimers had a significant effect. The former can be eliminated by treatment with oxygen, the latter by measuring the concentration-dependence of K1 or working at high protein concentrations. K1 values have been measured for normal hemoglobin at pH 7 and 9, hemoglobin specifically reacted with cyanate at Val 1alpha (alphac2beta2) and des(His 146beta) hemoglobin at pH 7. K1 is equal to KT, the oxygen affinity of the T state of hemoglobin, for all these hemoglobins and was increased in all of them when compared to normal hemoglobin at pH 7. This shows that the breakage of the Bohr group salt bridges by increasing pH or specific modification changes KT. Hence the Bohr group salt bridges break on ligation of the T state and are partially responsible for the free energy of cooperativity.

Coronary heart disease risk-factor profile in a lower middles class urban community in Pakistan.

We determined the risk-factor profile and prevalence of coronary heart disease in Metroville, a lower middle class urban community in Karachi, and compared them to the Pakistan health survey PNHS 1990-94, and the US health and nutrition survey 1988-94 NHANES111. Subjects < 18 years and pregnant women were excluded as were people with extreme ranges BMI [corrected] heart rate, height and waist. The prevalence of hypertension was 23% in men and women, hypercholesterolaemia was 17% in men and 22% in women (P < 0.001). Hyperglycaemia was present in 5% of men and women and obesity in 33% of men and 47% of women (P < 0.001). Compared to PNHS, the prevalences of obesity, hypertension, hypercholesterolaemia and WHR were higher in our population. Mean values of BMI [corrected] cholesterol, WHR were higher in the US population while mean values were lower for diastolic blood pressure and blood glucose.

Prognosis in hypertrophic cardiomyopathy: role of age and clinical, electrocardiographic and hemodynamic features.

Retrospective analysis of the clinical course of 254 patients with hypertrophic cardiomyopathy, followed up for 1 to 23 years (mean 6), disclosed that 58 had died, 32 of them suddenly. The 196 survivors were compared with the 32 patients who died suddenly and with the 38 who died suddenly or with heart failure. The combination of young age (14 years or less), syncope at diagnosis, severe dyspnea at last follow-up and a family history of hypertrophic cardiomyopathy and sudden death best predicted sudden death (false negative rate 30 percent, false positive rate 27 percent). A "malignant" family history was associated with poor prognosis, particularly in the younger patients; a family history of hypertrophic cardiomyopathy without sudden death was more frequent in the survivors (12 percent) than in the dead (5 percent). Patients who had a diagnosis in childhood were usually asymptomatic, had an unfavorable family history and a 5.9 percent annual mortality rate. In those aged 15 to 45 years at diagnosis, there was a 2.5 percent annual mortality rate and syncope was the only prognostic feature. Among those diagnosed between age 45 and 60 years, dyspnea and exertional chest pain were more common in the patients who died, and the annual mortality rate was 2.6 percent. Poor prognosis was better predicted by the history at the time of diagnosis and by changes in symptoms during follow-up than by an electrocardiographic or hemodynamic measurement.

Coronary artery diameter in a cohort of adult Pakistani population.

OBJECTIVE: To study the diameter of coronary arteries in a cohort of adult Pakistani population and to compare these with the diameters of Caucasians mentioned in the literature. METHODS: A study of 220 adult patients referred to National Institute of Cardiovascular Disease (NICVD) for diagnostic coronary angiography between May 2000 to December 2000. RESULTS: The mean diameter of Right Coronary Artery (RCA) was found to be 3.08 + 0.78 mm with a 95% CI of 2.9 - 3.2, and of Left Main Coronary Artery (LMCA), 4.28 +/- 0.82 with a 95% CI of 4.2 - 4.4. While the mean diameter of Left Anterior Descending Artery (LAD) was 3.22 +/- 0.74 with a 95% CI of 3.1 - 3.33, and that of the Circumflex Artery (CX) 3.02 + 0.75 with a 95% CI 2.9 - 3.1. The total coronary area (TCA), diameter of three vessels was 9.32 + 1.68 with a 95% CI of 9.1 - 9.5, while the sum of 4 vessels diameter was 13.6 + 2.26 with a 95% CI of 13.3 - 13.9. CONCLUSION: The diameters of coronary arteries of Pakistani population are not significantly different from that of Caucasians and the cause of increased mortality in the people of South Asians origin seems to be other than the diameter of coronary arteries.

Experience of direct coronary stenting at National Institute of Cardiovascular Diseases.

OBJECTIVE: To assess the efficacy, safety and advantage of direct coronary stenting versus traditional angioplasty and stenting. METHODS: From May 2000 to June 2001, 486 patients underwent PTCA procedure. One hundred fifteen (24%) were considered candidates for direct stenting. Out of 150 coronary lesions, 119 (79%) had direct coronary stenting. In 5% patients stent could not be passed across the lesion. These stents were withdrawn without stent damage and after predilatation the same were successfully deployed. RESULTS: Primary success rate was 95%. Angiographically assessed success was achieved in all patients with immediate TIMI 111 flow in 97%. The vessels directly stented were LAD 53%, RCA 27% and LCX 18%. Two saphenous vein grafts were also directly stented. The coronary lesions stented were type A 36%, B1 54% and B2 10%. In borderline lesions IVUS was used for quantification of stenosis. There was no in-hospital death, MI or emergency CABG. Compared to traditional stenting there was 46% reduction in procedure time, 62% reduction in radiation exposure time and 35% decrease in use of contrast media. There was also significant (18%) cost benefit in direct stenting. CONCLUSION: This study supports the view that direct coronary stenting is feasible and a safe procedure in our population with additional benefits of cost reduction by 18%. We recommend direct stenting in appropriately selected patients.

Evaluation and comparison of coronary heart disease risk factor profiles of children in a country with developing economy.

OBJECTIVE: To define the risk factors (RF) profile and prevalence rates of high risk factors in an urban Pakistani community and compare it to the RF profile and prevalence rates of Pakistan National Health Survey. METHODS: The present study included RF relevant data of 400 house hold children selected by open invitation as a part of Metroville Health Study (MHS), a risk factor modification study which was a cooperation between National Heart Lung Blood institute (NHLBI) USA and National Institute of Cardiovascular Diseases Pakistan. The base line data of 389 girls and 417 boys age 5-17 was included. PMRC data of 5067 and NHANES III survey data of 10,252 US children was used for comparison with MHS. RF analyzed were height weight, SBP, DBP, BMI and serum cholesterol. Comparisons between MHS and PMRC and US were made by using two tailed student t test and of high RF were defined as those exceeding US standards and expressed as percentages. RESULTS: The RF factor profile of urban Metroville children was worse than the national average of PMRC children. Except for diastolic blood pressure in both boys and girls and SBP in PMRC boys, all other RF were less than US children. Prevalence rates were higher in urban Metroville community, i.e., MHS compared to the PMRC which represents national average data. CONCLUSION: RF profile of Pakistani children has been presented and effect of urbanization demonstrated by comparing the PMRC and MHS RF profile. Hypertension in Pakistani children has emerged as a single most important RF requiring urgent prevention.

Efficacy of CVD risk factor modification in a lower-middle class community in Pakistan: the Metroville Health Study.

The Metroville Health Study aimed to reduce consumption of total cooking fats by 33%, salt by 25% and replace ghee with vegetable oil in a lower middle class urban community in Pakistan. Households (n=403) were randomly assigned to Intervention and Control groups. A baseline screening collected data on CVD risk factors, knowledge and attitudes and household consumption of cooking fats and salt. Intervention households received information about CVD and regular visits by social workers who measured cooking fats and salt and counselled cooks on the goals of intervention. Two years later, 291 households were re-screened. Intervention households reduced consumption of fats and salt compared to differences were total fat, 48% (p<0.0001); ghee, 37% (p=0.005); vegetable oil, 33% (p=0.0001); and salt, 41% (p=0.011). Household visits by trained social workers were effective in achieving reductions in consumption of cooking fat and salt in a lower class urban community.

Prevalence, risk factors and awareness of hypertension in India: a systematic review.

Indians have high rates of cardiovascular disease. Hypertension (HTN) is an important modifiable risk factor. There are no comprehensive reviews or a nationally representative study of the burden, treatments and outcomes of HTN in India. A systematic review was conducted to study the trends in prevalence, risk factors and awareness of HTN in India. We searched MEDLINE from January 1969 to July 2011 using prespecified medical subject heading (MeSH) terms. Of 3372 studies, 206 were included for data extraction and 174 were observational studies. Prevalence was reported in 48 studies with sample size varying from 206 to 167 331. A significant positive trend (P<0.0001) was observed over time in prevalence of HTN by region and gender. Awareness and control of HTN (11 studies) ranged from 20 to 54% and 7.5 to 25%, respectively. Increasing age, body mass index, smoking, diabetes and extra salt intake were common risk factors. In conclusion, from this systematic review, we record an increasing trend in prevalence of HTN in India by region and gender. The awareness of HTN in India is low with suboptimal control rates. There are few long-term studies to assess outcomes. Good quality long-term studies will help to understand HTN better and implement effective prevention and management programs.

Successful percutaneous removal of cardiac foreign body afer 13 months in situ.

We have reported the uncomplicated percutaneous removal of an embolized polyethylene catheter that had remained in the right ventricle for 13 months. This case suggests that transvenous catheterization technics should be attempted before resorting to more invasive measures in retrieving embolized catheters from the heart, regardless of time in situ.