Effect of salinity on growth, survival, and serum osmolality of red snapper, Lutjanus campechanus

Three trials were conducted to evaluate the performances of red snapper, Lutjanus campechanus, in low salinities. The median lethal concentration (96 h LC50) of salinity was determined by trimmed Spearman-Karber method using survival data of fish (18.9 ± 0.2 g) collected after 96 h from acclimation to 2, 4, 8, and 32 ppt salinities in 800 L tanks (n = 3), while the serum osmolality of fish (74.1 ± 3.9 g) was determined after 48 h from acclimation to 6, 8, 16, 24, and 32 ppt salinities in 150 L tanks (n = 3). The growth trial was conducted for 6 weeks in 800 L tanks to determine the growth and survival of fish (18.8 ± 0.2 g) at 8 ppt salinity compared to the control (32 ppt salinity). At the conclusion, the isosmotic point of fish was estimated as 357.2 mmol/kg (correspond to 11.0 ppt salinity), while the 96 h LC50 was estimated as 5.65 ppt salinity. No significant differences were noted for survival and FCR of fish reared in 8 and 32 ppt salinities. However, growth was significantly lower in fish reared in 8 ppt salinity compared to the fish reared in 32 ppt salinity. The reduced growth could be, at least partially, due to the increased osmoregulatory energy expenditure at lower salinities.

Reducing unnecessary preoperative testing in elective ENT surgery: clinical and financial implications

Guidelines on appropriate preoperative testing in elective surgery were published by the National Institute for Health and Care Excellence (NICE) in 2003. However, compliance has been poor, with frequent unnecessary tests being performed. We aimed to assess our trust's guideline compliance and to implement changes to optimise adherence. Preoperative investigations performed for elective ENT surgery during a three-month period were retrospectively audited. Unnecessary investigations were identified and costs calculated. A staff-training program was implemented and targeted written information was provided for clinics. A second audit cycle was conducted subsequently. Overall, 69.2% of blood tests were unnecessary (FBC 44.9%, U&Es 63.5%, clotting 99.2%), which equated to £1955.77 with an annual estimate of £7,823.08. None of the test results affected the management of the patient. Post-intervention, full compliance was achieved. It was concluded that preoperative investigations are overused in elective surgery, with obvious financial implications and causing unnecessary anxiety to patients. Through basic training and guideline dissemination, complete compliance can be achieved.

Diclofenac-associated hepatitis

This patient, who had a history of osteoarthritis, had severe hepatitis 5 weeks after being started on diclofenac for increasing pain in the joints. A week before the onset of hepatitis, the patient complained of upper gastrointestinal symptoms and was treated for gastritis. Seven days later, she had full-blown, severe hepatitis. Diclofenac was immediately stopped, leading to a complete restoration of liver functions over the course of the next few months. We highlight the importance of having a high index of suspicion for hepatic side effects of diclofenac and emphasize the need for increased awareness of this rare but potentially serious problem. We also review relevant literature regarding incidence and management.

Psychological disturbance and illness behaviour in a clinic for sexually transmitted diseases

Patients attending a sexually transmitted diseases (STD) clinic were asked to complete the General Health Questionnaire and the Illness Behaviour Questionnaire. Data were collected from 852 patients. One-third of the sample were found to score positively on the GHQ, indicating possible psychological disturbance. Women were more likely than men to score positively on the GHQ. On the General Hypochondriasis scale of the IBQ the sample's scores were higher than any other normative data except those obtained from psychiatric in-patients. On this scale homosexual and bisexual males scored significantly higher than heterosexual males. It is argued that the IBQ draws attention to important dimensions of psychological distress in STD clinics.

The assessment of patients' distress in genito-urinary medicine clinics

A sample of patients attending the clinic of a Department of Genito-Urinary Medicine in London completed The General Health Questionnaire, The Illness Behaviour Questionnaire and The Illness Concern Questionnaire. The doctor whom they consulted was also asked to complete rating scales regarding each patient's level of psychological disturbance. Thirty-eight percent of patients scored highly on the GHQ, indicating possible psychological disturbance. However, only one in five of such 'cases' were also rated by the doctor as possibly psychologically disturbed. A number of social variables are examined that may facilitate or limit the communication of psychological distress. No evidence of labelling of deviant groups is found. However, both the sample in general and specific sub-groups in particular scored highly on scales of hypochondriasis and distress in relation to health and such characteristics appeared relevant to doctors' judgements of patients' psychological states.