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IntroductionStudies have shown a high prevalence of psychiatric illnesses among patients in primary health care settings. Family physicians have a fundamental role in managing psychiatric illness with psychopharmacological medications. Providing information about the disease, its management and the potential adverse effects of the medications is an important part of the management of mental illnesses. Our objective was to determine if patients who were prescribed psychopharmacological drugs by family physicians at a community health center in Karachi, Pakistan were provided adequate education about their disease and its management.MethodsA cross-sectional study was conducted at the Community Health Centre (CHC), Aga Khan University Hospital Karachi, Pakistan. Details about the prescriptions and patient education were acquired from the patients after their consultations.ResultsA total of 354 adult patients were interviewed during 3 days. Among them, 73 (20.6%) were prescribed psychopharmacological medications. Among patients receiving psychopharmacological medicines, 37 (50.7%) did not know their diagnosis; 50 (68.5%) were unaware of the disease process; 52 (71.2%) were unaware of alternative treatments; 63 (86.3%) were not cautioned about the potential adverse effects of the drugs; 24 (32.9%) were unaware of the duration of treatment and in 60 (82.2%) of the participants an appropriate referral had not been discussed. For all aspects of education, patients prescribed psychopharmacological medications knew less as compared to those patients that were prescribed other medications.DiscussionThe practice of imparting information to patients who receive psychopharmacological medications seems to be inadequate in Pakistan. We have hypothesized about the possible reasons for our findings, and identified a need for further research to determine the cause for such findings and to address them accordingly. At the same time there is a need to educate family physicians in Pakistan about the special importance of providing adequate information to such patients.

Upper Gastrointestinal (GI) pseudomelanosis is an uncommon entity characterized by endoscopic visualization of speckled dark mucosal pigmentation. While described in the rectum and colon, ‘melanosis’ or more aptly ‘pseudomelanosis’ is rare in the duodenum and exceedingly rare in the stomach. Five cases of pseudomelanosis were encountered at our department. Four females and one male were diagnosed, with a mean age of 70 years. All patients exhibited duodenal pseudomelanosis, with one demonstrating gastric antral pseudomelanosis as well. Common features among these patients included iron deficiency anemia, hypertension, chronic kidney disease, hydralazine use and iron supplementation. Biopsy specimens stained at least partially positive for iron and stains for calcium and copper were negative. Histochemical analysis revealed the pigment of pseudomelanosis to be mainly iron sulfide, exhibiting unpredictable staining patterns, hypothesized to be secondary to varying sulfur content and iron oxidation. It is visualized as dark deposits in macrophages at the tips of the duodenal villi. Upper GI pseudomelanosis remains a poorly understood finding, weakly associated with chronic kidney disease, diabetes, hypertension, iron supplements and anti-hypertensive medications. While the pathogenesis, clinical and prognostic significance remains unclear, it is thus far considered a benign condition.

SUMMARYA 60-year-old man underwent surveillance colonoscopy that demonstrated five subcentimetre polyps, all of which were biopsied. One of the five polyps had histopathology consistent with small cell lung carcinoma (SCLC) metastasis from primary lung cancer. Subsequent imaging demonstrated a spiculated mass in the right upper lung lobe with metastasis to the brain, liver and spleen. He was immediately treated with palliative whole-brain irradiation followed by eight cycles of carboplatin and etoposide. Despite aggressive management, he had disease progression characterised by worsening performance status and development of transfusion-dependent anaemia, new blastic bone lesions and epidural disease. Given his liver failure, he was not considered a candidate for second-line topotecan. After discussion with the patient, family and palliative services, he was discharged with home hospice. This report describes a rare case of advanced SCLC presenting as a metastatic caecal polyp on surveillance colonoscopy. BACKGROUND

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