A study to evaluate pattern and purpose of smartphone usage and its dependence among medical students of government medical college in northern India

Background: Smartphone usage has become increasingly popular in recent decade. Though it’s of great utility in many aspects, excessive usage among youth has shown increased restlessness, careless lifestyles and greater susceptibility to stress. Aim & Objective: To assess the pattern and purpose of smartphone usage and its dependence among medical students. Methods & Material: A cross-sectional, descriptive study was conducted among 363 MBBS students of 1st, IInd and IIIrd professional year at a government medical college. A 20-item self-administrated questionnaire, focusing on purpose and pattern of use of smart phone and its dependence was filled by all the students. Data was collected, entered and analysed using SPSS Software. Result: Among 363 students, 53% participants were males and rest were females. 80% students were using smartphone for more than 2 years, while 60% were having daily usage of more than 3 hours. Significant association between severity of smartphone dependence and variables like MBBS professional year, daily phone call made and received, daily SMS received, daily WhatsApp message sent and received were observed. Dependence was mild in 8.8% of the students; Moderate in 72.2% while 19% were suffering from severe smartphone dependence. Conclusion: Smart phone dependence is an established and emerging psychological issue which needs attention and intervention. It is of serious concern that all medical students were suffering from smartphone dependence with varying grades of severity. Increased awareness regarding the harmful effects of smartphone addiction is the need of hour.

Does awareness of diagnosis influence health related quality of life in north Indian patients with lung cancer.

Background & objectives: Several patients with cancer in India are not aware of their diagnosis. We evaluated the impact of awareness of cancer diagnosis on health-related quality of life (HRQL) in newly diagnosed patients with lung cancer. Methods: A total of 391 treatment-naïve patients with lung cancer, seen at the Lung Cancer Clinic of a tertiary care hospital in north India, were categorized into those aware of their diagnosis (group A) and those not aware (group B). All patients answered Hindi versions of abbreviated World Health Organization Quality of Life questionnaire (WHOQOL-Bref) and European Organization for Research and Treatment of Cancer Quality of Life questionnaire (EORTC QLQ-C30), and its lung cancer module, EORTC QLQ-LC13. Various domain scores were computed and compared between the two groups. Analysis of covariance was used to determine significance of differences after adjustment for potential confounding factors. Results: Only 117 (29.9%) patients were aware of their diagnosis. Of all, 302 (77.2%) patients had non-small cell lung cancer, and 301 (77.0%) had advanced disease. All HRQL domain scores were similar between the two groups, except that group B patients had significantly poorer median (interquartile range) Physical [39.3 (28.6-50.0) vs 46.4 (28.6-57.1)] and Environment [46.9 (40.6-56.3) vs 53.1 (0.6-65.6)] domain scores of WHOQOL-Bref, and Physical function [60.0 (40.0-73.3) vs 66.7 (46.7-80.0)] and Fatigue [66.7 (55.6-77.8) vs 66.7 (44.4-66.7)] scores of QLQ-C30. After adjusting for gender, age, education, family income, and tumour extent, these differences were not significant. Interpretation & conclusions: Disclosure of cancer diagnosis, or lack of it, had no significant impact on HRQL in patients with lung cancer after adjustment of potential confounders.

Efficacy & safety of iodopovidone pleurodesis: a systematic review & meta-analysis.

Background & objectives: Chemical pleurodesis is an accepted therapy for patients with recurrent pleural effusions and pneumothorax. Iodopovidone has been shown to be safe and effective for chemical pleurodesis in several studies. The aim of this systematic review was to update a previously reported meta-analysis on the efficacy and safety of iodopovidone pleurodesis. Methods: Two databases MEDLINE and EMBASE were searched for a period (1952-2010), and studies that have reported success rates with iodopovidone pleurodesis were selected. The proportions with 95 per cent confidence interval (CI) were calculated to assess the outcomes in the individual studies and the results were pooled using a random effects model. Results: Thirteen eligible studies with 499 patients were included in the mata-analysis. The success rates varied from 70 to 100 per cent in different studies with the pooled success rate being 88.7 per cent (95% CI, 84.1 to 92.1). The success rate was not affected by the method (tube thoracostomy vs. thoracoscopy, 89.6 vs. 94.2%) or the indication of pleurodesis (pleural effusion vs. pneumothorax, 89.2 vs. 94.9%). The only significant complication reported was chest pain of varying degree. Systemic hypotension was reported in six patients across the studies. There were no deaths associated with iodopovidone pleurodesis. Statistical heterogeneity and publication bias were found. Interpretation & conclusions: Iodopovidone may be considered a safe and effective agent for chemical pleurodesis in patients with pleural effusions and recurrent pneumothoraces.

Blind transbronchial needle aspiration without an on-site cytopathologist: Experience of 473 procedures.

Background. Transbronchial needle aspiration (TBNA) is an established procedure for sampling the mediastinal lymph nodes. Data reported from India are limited on this routine procedure. We describe our experience of the efficacy, diagnostic accuracy and safety of TBNA. Method. We retrospectively reviewed all TBNAs done at our centre between 2006 and 2009. Under local anaesthesia, accessible lymph node stations were sampled thrice without fluoroscopy and without an on-site cytopathologist. Data are presented in a descriptive manner. Results. A total of 4513 diagnostic bronchoscopies were done, of which 473 (10.5%) underwent TBNA. There were 297 men (63%) and 176 women (37%) with a mean (SD) age of 46.2 (13.98) years. The most common clinical diagnoses were sarcoidosis (50.5%), lung cancer (26.8%), tuberculosis (8.7%) and others (14%). The overall efficacy of TBNA in sampling a mediastinal/hilar lymph node was 72%. The accuracy of TBNA in achieving a pathological diagnosis was 40.4%, whereas the diagnostic yield of a successful procedure was 56.8% (lymph nodes were successfully sampled in 193 of 340 procedures). The most common diagnoses on cytology were sarcoidosis and lung cancer. In patients with a clinical diagnosis of lung cancer, the diagnostic accuracy of TBNA was 46.5% (59 of 127), whereas in patients with sarcoidosis it was 38.1% (91 of 239). TBNA provided an additional diagnostic yield in 5.6% (12 of 215) of patients with sarcoidosis who also underwent transbronchial lung biopsy. There were no periprocedural complications. Conclusion. Blind TBNA is a safe and effective procedure that can be routinely done in the bronchoscopy suite.

Validation of a hindi translation of mini asthma quality of life questionnaire in North Indian patients with bronchial asthma.

Background and Objective. There is little information on validated health-related quality of life (HRQoL) instruments for use in Indian patients with bronchial asthma. We attempted to validate the Hindi translation of Juniper’s mini asthma quality of life questionnaire (MiniAQLQ) in north Indian patients with bronchial asthma. Methods. Hindi translation of MiniAQLQ, and abbreviated World Health Organization quality of life questionnaire (WHOQOL-Bref), were administered to 30 patients with bronchial asthma twice at a six-week interval. Clinical and physiological data were also recorded. Psychometric properties (acceptability, validity, reliability and responsiveness) of MiniAQLQ were assessed after calculating four domain (physical, psychological, social relationships and environment), and a total score. Results. Most questionnaires were returned without missing responses. MiniAQLQ had good convergent and discriminant validity, but moderate content and construct validity. All components (except emotional function domain) met standards for internal consistency (Cronbach’s alpha coefficient >0.70), but intra-class correlation coefficients were variable. Change in MiniAQLQ scores between two assessments correlated poorly with corresponding changes in lung function. The effect sizes ranged from 0.02 to 0.34 in 11 patients whose forced expiratory volume in the first second (FEV1) changed by >200mL and >12% from baseline, and were considered small. Conclusion. The Hindi translation of MiniAQLQ is a moderately good discriminative and a relatively poor evaluative instrument to assess health related quality of life (HRQoL) in north Indian patients with bronchial asthma.

Pleural effusions associated with pulmonary thromboembolism: A systematic review.

Objective. To perform a review of the incidence, pathogenesis, clinical presentation, diagnosis and management of pleural effusions associated with pulmonary embolism (PE). Methods. A search of the MEDLINE and EmBase databases from 1975 to 2007 was performed. A manual search was also performed of the references of each article. Results. Pleural effusions occur in 19% to 61% of patients with PE. The incidence is higher if computed tomography (CT) of the chest is used for detection of pleural effusion (28.1% with chest radiograph and 43.3% with CT chest). The pleural fluid is almost always an exudate. Although usually unilateral, the pleural effusion can also be bilateral. The effusions are maximal by the third day, be larger in size, may develop loculations and can be associated with high leukocyte counts. The presence of pulmonary infarction may not be associated with large effusions. Conclusions. Pleural effusions are a common occurrence in patients with PE. The possibility of PE should be entertained in any patient with undiagnosed exudative pleural effusion. The results of this review further suggest that many traditional concepts with PE, viz, unilateral small effusions, absence of loculations and transudative nature of the pleural fluid need reappraisal.

Pulmonary hypertension as a presenting manifestation of allergic bronchopulmonary aspergillosis.

The case of a 46-year-old lady who presented with respiratory failure and pulmonary hypertension in the absence of clinical signs of asthma or bronchiectasis, and in whom a diagnosis of allergic bronchopulmonary aspergilloma [ABPA] was made subsequently on the basis of radiological and laboratory investigations is reported. Symptomatic and objective improvement was seen with corticosteroid therapy. To the best of the authors' knowledge, such an occurrence has not been reported previously. This case highlights the importance of keeping a high index of suspicion while investigating a patient with pulmonary hypertension in whom the aetiology is not apparent on initial evaluation. Identification of the disease, in its early-stage, can prevent progression to bronchiectasis and fibrotic lung disease, and thus, patients can be saved from the morbidity related to end-stage disease.

Manifestations of pulmonary tuberculosis in the elderly: a prospective observational study from north India.

BACKGROUND: There is scarcity of published literature on manifestations of pulmonary tuberculosis (PTB) among elderly patients in India. The aim of the present study was to compare the clinical, radiological and laboratory manifestations of PTB among young and elderly patients. METHODS: This prospective study involved 100 human immunodeficiency virus (HIV) negative patients with PTB. The demographic, clinical, radiological and laboratory manifestations were compared between young (n=50; under 60 years of age) and elderly (n=50; aged 60 years and above) with PTB. RESULTS: Elderly patients, in comparison to younger patients, tended to be heavier smokers and had more co-morbidities (40% vs 8%; p < 0.05). They presented more frequently with constitutional symptoms (except fever) and less frequently with respiratory symptoms. The mean duration of symptoms and rate of sputum smear-positivity for acid-fast bacilli was similar in both groups. Both the groups were similar with respect to physical examination and chest radiograph findings. Median values of erythrocyte sedimentation rate and total leukocyte count were significantly higher and lower respectively in the elderly patients. CONCLUSIONS: The presentation of PTB in elderly patients differs from that of younger patients by the predominance of constitutional rather than respiratory symptoms. A high index of suspicion is required to make a timely diagnosis of tuberculosis in the elderly.

Aetiology and clinical profile of spontaneous pneumothorax in adults.

BACKGROUND: Limited information is available on epidemiology of spontaneous pneumothorax (SP) from India. The present study was aimed at studying aetiology and clinical profile of patients with SP. METHODS: All patients admitted at a tertiary care hospital with the diagnosis of SP between January 2001 and March 2002 were prospectively studied. Detailed demographic and clinical data were recorded. Patients were divided into two groups-primary spontaneous pneumothorax (PSP), if no underlying aetiology for pneumothorax was found, and secondary spontaneous pneumothorax (SSP), when an underlying respiratory disorder could be identified. The clinical features were compared between the two groups. RESULTS: Sixty patients (12 with PSP and 48 with SSP) were included in the study. Annual incidence of SP was calculated as 99.9 per 100,000 hospital admissions. Annual incidence figures for PSP and SSP were 20.0 and 80.0 per 100,000 hospital admissions respectively. Age distribution showed a biphasic pattern and the overall male to female ratio was 5 : 1. The most common cause of SSP was found to be pulmonary tuberculosis (41.7%). CONCLUSIONS: Pneumothorax is more common among men. In India, SSP is far more common than PSP, and the predominant underlying cause is pulmonary tuberculosis.

Applicability of commonly used Caucasian prediction equations for spirometry interpretation in India.

BACKGROUND & OBJECTIVE: The applicability of Caucasian prediction equations in interpreting spirometry data in Indian patients has not been studied. The present study was undertaken to see if Caucasian and north Indian prediction equations can be used interchangeably while interpreting routine spirometric data. METHODS: Forced vital capacity (FVC), forced expiratory volume in first second (FEV(1)), and FEV(1)/FVC ratio were recorded from 14733 consecutive spirometry procedures in adults. Predicted values and lower limits of normality were calculated using regression equations previously derived at this centre, and four commonly used Caucasian equations described by Knudson, Crapo, European Community for Coal and Steel (ECCS) and the Third National Health and Nutrition Examination Survey (NHANES III). For men, 90 per cent of predicted values were also derived. Kappa estimates were used to study agreement, and Bland Altman analysis was performed to quantify differences, between interpretations from Indian and Caucasian equations. Receiver operating characteristic (ROC) curves were constructed to assess utility of using a fixed percentage of Caucasian predicted values in categorizing FVC or FEV(1) as abnormal. RESULTS: The use of Caucasian prediction equations (and 90% of predicted values in men) resulted in poor agreement with Indian equation in most height and age categories among both men and women. Bland Altman analysis revealed a large bias and wide confidence limits between Caucasian and Indian equations, indicating that the two cannot be used interchangeably. ROC analysis failed to yield good results with use of any single fixed percentage of Caucasian predicted value while categorizing FVC or FEV(1). INTERPRETATION & CONCLUSION: Our results showed that the use of Caucasian prediction equations, or a fixed percentage of their predicted values, resulted in misinterpretation of spirometry data in a significant proportion of patients. There is a need to assess performance of more than one regression equation before choosing any single prediction equation.

Circulating D-dimers as a marker of disease activity in pulmonary sarcoidosis.

BACKGROUND AND AIMS: The search is on to find an easily measurable marker of disease activity in sarcoidosis. The present study was carried out to evaluate the utility of plasma D-dimer as a marker of disease activity in sarcoidosis. METHODS: Thirty newly diagnosed cases of sarcoidosis with clinical indications for treatment and an equal number of matched healthy controls were studied for the presence of D-dimers (DD) in the plasma before starting treatment with oral prednisolone and after clinical remission. Semi-quantitative estimations of DD were done using the latex agglutination slide test method (Commercial Kit - Diagnostica Stago, France) as per the manufacturer's recommendations. RESULTS: The mean age of cases and controls were 45.43 +/- 8.5 (range 34-60) and 46.16 +/- 8.07 (range 32-61) years, respectively. Of the 30 patients, nine (30%) were DD positive at baseline. The DD positive patients presented more often with dyspnoea, had radiological stage III (7 out of 9) disease and abnormal spirometry compared to patients with no detectable DD in their plasma. Of the 16 patients re-evaluated after clinical remission, eight (50%) were D-dimer positive. Two of the five patients initially DD positive had become negative and five additional patients who were negative at baseline had become positive. CONCLUSIONS: Plasma D-dimers, which were positive in 30% of untreated patients of sarcoidosis, indicate patients with significant pulmonary parenchymal involvement; but have no correlation with clinical disease remission.

The relationship between tobacco smoke & bronchial asthma.

Bronchial asthma is a common disease and an important cause of morbidity among both children and adults. Tobacco smoking, both active and passive i.e., exposure to environmental tobacco smoke (ETS) has got important effects on asthma. Smoking by adults causes bronchial irritation and precipitates acute episodes. It also increases bronchial responsiveness and causes airway sensitization to several occupational allergens. Smoking may also increase the disease severity. Continued smoking by adult asthmatics is the likely cause of irreversibility of airway obstruction and development of chronic obstructive pulmonary disease. ETS exposure affects asthma in a similar fashion. Parental smoking is commonly associated with increased asthma symptoms, respiratory infections, acute episodes and frequent hospitalization of children. Bronchial responsiveness and airway sensitization may also increase. Childhood exposure to smoking is also considered as a risk factor for the development of asthma. Similarly, in utero exposure to maternal smoking may be independently responsible for early onset asthma. ETS exposure in adult asthmatics from smoking by spouses, siblings or colleagues is equally troublesome. There is increased morbidity and poorer asthma control. Asthmatic symptoms sharply decline after the ETS exposure is reduced.

Role of simple needle aspiration in the management of pneumothorax.

OBJECTIVES: To determine the role of simple needle aspiration in the management of pneumothorax. DESIGN: All patients presenting with a pneumothorax requiring intervention were included in this prospective study. Patients who were very sick or had tension pneumothorax were treated with direct intercostal chest tube drainage (ICTD) and others were subjected to simple aspiration. The procedure was deemed successful, if after aspiration the lung expanded completely or symptoms were relieved with residual pneumothorax of less than 15% of hemithorax. In case of failed aspiration ICTD was carried out. RESULTS: Fifty-seven patients with 59 pneumothoraces were included in the study. Of these, 24 were treated with direct ICTD; 35 (12 spontaneous, 11 secondary and 12 iatrogenic pneumothoraces) were subjected to simple aspiration. Ten (83.3%) of the primary, 1 (9.6%) of the secondary and 11 (91.7%) of the iatrogenic pneumothoraces responded to simple aspiration. There were no significant complications. The pain perceived and the duration of hospital stay was significantly lesser in the simple aspiration group. CONCLUSIONS: Simple aspiration should be the initial modality of treatment for primary spontaneous and iatrogenic pneumothoraces. For secondary spontaneous pneumothorax and in conditions where pleurodesis is indicated, ICTD remains the treatment of choice.