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GENERAL PRACTITIONER'S SECTION
FEW MORE INDICATIONS OF PULSE OXIMETER
OP Kapoor
Some patients of cirrhosis of the liver develop as the usual complication of arterio-venous shunts. Though the aetiology is not understood in detail, the patient complains of dyspnoea in sitting position, which is relieved by lying down. Thus, the SPO2 done in lying down position is normal, but falls after a few minutes in sitting position. This will favour the diagnosis of hepato-pulmonary syndrome in such patients. If a patient of congestive cardiac failure complains of so-called attacks of cardiac asthma in the middle of the night (which disturb the sleep) and the patient does not respond to the usual line of treatment of CCF, then "Cheyne "Hepato-Pulmonary Syndrome" which is not the same Stokes breathing" should be suspected.
In that case, the patient's relatives can use the pulse oximeter (supplied to them by the practitioner) and check the SPO2 readings during the attack of difficulty in breathing. A marked fall of SPO2 during the apnoea period of Cheyne Stokes breathing will confirm the diagnosis. Such patients will respond to CPAP treatment.
III. Finally, to diagnose very early, pneumocystic pneumonia in an AIDS patient who complains of fever, cough and dyspnoea with a normal Xray chest, if (i) the SPO2 is done in the resting position, and then (ii) after slight exertion, the fall of SPO2 is suggestive of the above condition.
STATINS REDUCE LIPID LEVELS BETTER THAN FIBRATES
Statins are better at lowering blood cholesterol concentration than fibrates, but they vary in their ability. In a cross sectional study Hippisley-Cox and colleagues compared the effects of lipid lowering drugs and fond that atorvastatin and simvastatin excelled. The survey revealed that 57% of the patients taking statins reached the target level of serum cholesterol compared with only 26% of those taking other lipid lowering drugs. The target value for cholesterol may not be realistic since the initial mean values in patients in primary care are higher than those in patients in clinical trials.
BMJ, 2003; 326 : 689.
