Endocrinology

| Carcinoid tumors are part of a heterogeneous group of gastrointestinal and pancreatic endocrine tumors that are characterized by their capacity to produce and secrete hormones, 5-hydroxytryptamine, tachykinins and other mediators. These substances are thought to be responsible for the collection of symptoms, which include diarrhea, flushing and wheezing, that is known as carcinoid syndrome. Fibrosis that occurs either local to or distant from the primary tumor is one of the hallmarks of carcinoid tumors that originate from the midgut. The fibrotic process can occur in the mesentery as a desmoplastic response and may lead to obstruction of the small bowel, but it can also occur in the lungs, skin or retroperitoneum. importantly, up to onethird of patients develop cardiac valvulopathy. One or more products that are secreted by the tumor and enter into the circulation are likely to have a role in this process. This review discusses the incidence and prevalence of fibrosis in carcinoid syndrome and explores evidence to date for causative agents, in particular the roles of 5-hydroxytryptamine and elements of the downstream signaling pathway. improved understanding of the etiology of carcinoid-tumor-related fibrosis may lead to better treatments for this condition than those we currently have.

Two questionnaires were used to gather information about preclinical education concerning death and bereavement. One was mailed to Heads of Anatomy Departments of 26 UK medical schools. The other was distributed to 220 first-and 210 second-year preclinical students in Cambridge. Among curricular organizers (77% response rate), the motivation for giving such education was primarily to improve knowledge about dissection, and only secondarily and infrequently to prepare students for clinical practice or to address their attitudes or feelings. In contrast, the primary concern of students (response rate 54%) was preparation for encounters with death in clinical practice (61-85%), lesser concerns being to address their own fears and feelings (30-40%) or knowledge about the dissecting room, cadavers, etc. (23-37%). Students were also asked about their reactions to dissection in order to determine whether the dissecting room might provide an opportunity for teaching about death. Most (66%) admitted experiencing moderate to extreme apprehension in advance of dissection. Apprehension was associated, on starting dissection, with very strong reactions, which in some cases interfered with learning. Some (27%) dealt with this by depersonalization. The only previous experiences that showed a significant association with the occurrence during dissection of interfering andlor non-task-related thoughts and feelings were (i) for both men and women the occurrence and quality of handling of death experience(s) at school, and (ii) for a group of male students the experience of the death of more than one close non-family friend. A strategy for effective use of the dissecting room in studies on death is outlined.

Objectives: To understand emergency response in primary health care, to investigate the frequency and status of emergency preparedness at seven healthcare centres in Guyana with Family Residents. To enquire if the seven centres are equipped with human and other resources to respond to emergencies and to suggest measures to improve emergency responses at the seven centres. Design and Method: This study was based on a case-study research. The sample population consisted of 39 Family Residents and other Doctors whose experience with emergency preparedness at the facilities were analysed. Nurses, non-medical personnel and other staff at the Centres under study were excluded. The period of study was for one fiscal year-January-December 2018. Questionnaires were utilized as the primary research instrument and data was analyzed using SPPSS 23. Results: Emergency cases were very frequent 69,4 % of the respondents indicated that emergency cases were frequent with 1-3 cases per week. The most common emergencies were asthmatic attacks, chest pain and severe trauma and lacerations. Most of the respondents have 3-5 years of medical experience while 72% been fully registered. The study shows 88.9% of the respondents indicating that there are no existing emergency protocols at the centres and 5.6% conducted case simulations. Conclusion: There exist a need to better integrate and mainstream optimally emergency medical response at the seven centres. The centres are not prepared with the necessary drugs and equipment to respond to emergencies.

Objectives: To understand emergency response in primary health care, to investigate the frequency and status of emergency preparedness at seven healthcare centres in Guyana with Family Residents. To enquire if the seven centres are equipped with human and other resources to respond to emergencies and to suggest measures to improve emergency responses at the seven centres. Design and Method: This study was based on a case-study research. The sample population consisted of 39 Family Residents and other Doctors whose experience with emergency preparedness at the facilities were analysed. Nurses, non-medical personnel and other staff at the Centres under study were excluded. The period of study was for one fiscal year- January-December 2018. Questionnaires were utilized as the primary research instrument and data was analyzed using SPPSS 23. Results: Emergency cases were very frequent 69,4 % of the respondents indicated that emergency cases were frequent with 1-3 cases per week. The mos...