Personality and coping styles in medical internees: a cross-sectional study

Background and aims: Medical education is an elaborate course requiring knowledge assimilation, skill development, and academic perfection. Emerging out of the course successfully is a strenuous process which tests students’ psychological domains like personality, coping skills, and so on. The present study was planned with this primary objective of assessing the personality traits, psychoactive-substance use, and coping skills in the medical students and the secondary objective of finding the impact of personality and psychoactive-substance use on coping styles. Methods: The study was conducted on internees, recruited on individual approach over a period of one year. Ethical clearance was taken. Consenting candidates were administered sociodemographic proforma, the Eysenck Personality Inventory, and the coping checklist. Pearson’s correlation and independent t-test were used for analysis. Results: A total of 167 internees took part in study. On personality assessment, mean score of extraversion was 12.56 (±3.78) suggesting ambiversion and neuroticism was 9.36 (±4.89) suggesting mixed neurotic traits. Thirty four (20%) used psychoactive-substance. Problem-solving, distraction-positive, and acceptance-redefinition were frequently used coping styles. Extraversion correlated positively with distraction-negative (p<0.01) and negatively with acceptance-redefinition (p=0.03). Neuroticism had significant positive correlation with problem-solving (p=0.03), distraction-positive (p<0.01), distraction-negative (p<0.01), faith-religion coping (p<0.001), and blame-denial coping (p<0.001). On gender-wise assessment, males used more of distraction-negative (p=0.02) and females used more of faith-religion coping styles (p=0.02). Psychoactive-substance users elaborated more of distraction-negative and less of acceptance-redefinition coping. Conclusion: Internees had ambiversion and mixed neurotic personality traits. Their personality and substance use had significant influence on the types of coping styles used. There is need of training to effectively manage stress using appropriate coping strategies based on their personality.

Bilateral Optic Neuritis due to Isoniazid (INH).

Optic nerve involvement is a rare side effect of isoniazid (INH) and has not been described in children. We describe this adverse reaction in a 10-year-old boy, who was treated for tuberculous meningitis. The patient showed almost complete resolution following withdrawal of INH and administration of pyridoxine and steroids.

Restenosis after coronary stenting--incidence and predictors.

OBJECTIVE: To determine the intermediate term outcome after coronary artery stenting. METHODS: The six month angiographic and clinical follow-up of 92 consecutive patients (94 lesions) undergoing successful coronary stenting was performed. Multiple variables were analyzed for predicting restenosis. RESULT: The mean age was 49.7 +/- 8.5 years. There were 73 males and 19 females. Coronary artery involvement was left anterior descending artery (LAD) in 67%, left circumflex artery (LCx) in 16.5% and right coronary artery (RCA) in 16.5%. The pre-procedure mean reference diameter was 3.1 +/- 0.38 mm, minimal luminal diameter (MLD) was 0.47 +/- 0.28 mm and percentage diameter stenosis (DS) was 85 +/- 9%. Post procedure MLD improved to 3.1 +/- 0.4 mm with an acute gain of 2.6 +/- 0.4 mm and residual DS of only 3 +/- 3%. Clinical and angiographic variables were correlated with restenosis assessed as both binary and continuous variables. Angiographic follow-up could be obtained in 55 out of 92 patients (60%) and 86 patients (88%) had a clinical follow-up. Angiographic restenosis (> 50% diameter stenosis) was present in 12 (22%) patients, seven of whom required a repeat angioplasty procedure. There was no death. At follow-up, the MLD was 2.1 +/- 0.93 and the DS was 32 +/- 29% with a lumen loss of 0.92 +/- 0.84 mm. Only 14 (16%) of patients had angina and stress test was positive in 21 (23%). Hypercholesterolemia (p < 0.001) and female gender (p < 0.05) were independently associated with high lumen loss. CONCLUSION: Intracoronary stenting in an unselected patient group is associated with a 22% restenosis rate. Hypercholesterolemia and female gender are associated with higher restenosis.

Is dietary fiber beneficial in chronic ischemic heart disease?

OBJECTIVES: To evaluate the benefit of a dietary fiber preparation (Fibernat) in patients with chronic ischemic heart disease (IHD). METHODS: From January 1997 to March 1998, 114 consecutive patients with chronic IHD were enrolled in this prospective double blind randomized placebo controlled trial. The fiber (F) and placebo (P) groups were comparable at baseline. All patients were given advice regarding dietary and lifestyle modifications. Concomitant drug therapy was not altered. The drug (consisting of soluble and insoluble fibers obtained from fenugreek, guar gum and wheat bran) and placebo were administered for six months (10 grams twice daily). RESULTS: The following parameters improved in both groups: HDL cholesterol (32 to 39 mg/dl, p < 0.0009 in F and 33 to 38, p < 0.007 in P), total: HDL cholesterol ratio (6.7 to 5.6, p < 0.0007 in F and from 7.0 to 6.0, p < 0.01 in P) and weight (64.0 to 63.0 kg, p < 0.002 in F and 60.3 to 59.5, p < 0.002 in P). The Apolipoprotein B increased (101 to 129 mg/dl, p < 0.00001 in F and 98 to 127, p < 0.0008 in P). The following parameters improved only in group F: LDL cholesterol (146 to 134, p < 0.027), Apolipoprotein A-1 (105 to 139, p < 0.001), body mass index (24.9 to 24.5, p < 0.03) and waist circumference (37.2 to 36.7, p < 0.03). Total cholesterol, VLDL cholesterol, triglycerides, hip circumference, W:H ratio, exercise time and blood sugar were unchanged in both groups. CONCLUSIONS: Fibernat is well tolerated, safe and had favorable effects on LDL cholesterol, Apolipoprotein A-1, body mass index and waist circumference.

Anthropometry, lipid profile and dietary pattern of patients with chronic ischaemic heart disease.

The anthropometry, lipid profile and dietary characteristics of 114 patients with chronic ischaemic heart disease (IHD) were evaluated. There were 91 (80%) men and the mean age was 56 +/- 9 years. The body mass index was near normal (24.4 +/- 3.4), but the waist: hip ratio was high (0.94 +/- 0.06) suggesting central obesity. This was well in accordance of the step II recommendations of the NCEP guidelines as regards their caloric intake and its break-up in terms of carbohydrate, protein and fat (including saturated, mono-unsaturated and poly-unsaturated fatty acids) content. Their daily cholesterol intake (31 +/- 32 mg/day, range 4-180) was very low. The total cholesterol (212 +/- 37 mg%) was marginally elevated, HDL cholesterol (33 +/- 7.5 mg%) was low, LDL cholesterol (148 +/- 39 mg%) was high and the total: HDL ratio (6.8 +/- 2.0) was significantly abnormal. The serum triglyceride level (154 +/- 68 mg%) was on the higher side of normal. These observations give further credence to the recently evolving view that there are different and hitherto unrecognised risk factors of IHD in Indians, who seem to have the highest incidence of IHD amongst all ethnic groups of the world despite consuming a diet low in fat and cholesterol content.

Pre-natal echocardiographic diagnosis and neonatal balloon dilatation of severe valvar pulmonic stenosis.

A case is presented below where pre-natal echocardiographic diagnosis of critical pulmonic valvar stenosis was made at 36 weeks of gestation. In view of the severe heart failure, successful balloon valvotomy was performed on day 4 of life. The child was asymptomatic at one month follow-up.

Risk factors and protective factors of pelvic inflammatory disease: a case-control study.

Risk factors and some protective factors for pelvic inflammatory disease (PID) in women were assessed in a case control study. Use of intrauterine device (OR = 3.98, p < 0.0001), sexual activity with multiple partners and younger age (ORs = 3.97, 1.9 and p = 0.0003, 0.0034, respectively), history of previous PID (OR = 4.08, p = 0.004) and history of minor gynecologic operation (OR = 3.07, p = 0.0158) were significant risk factors for PID. Pregnancy was a significant protective factor (OR = 0.25, p = .0074). Sterilisation had a significant protective effect (OR = 0.37, p = 0.0443) on multivariate analysis but not significant on univariate analysis. The results indicated that, almost half of the PID load on the population can be reduced by proper handling of four risk factors namely, use of IUD, sexual activity with multiple partners, history of previous PID and history of minor gynecologic operation (PARP = 0.2146, 0.1101, 0.0824 and 0.0794, respectively).

Is haemorrhagic myocardial infarction more common with streptokinase?

Autopsy reports and clinical data of 226 consecutive myocardial infarction deaths in whom postmortem studies could be carried out during the period 1980 to 1996 were analyzed retrospectively for the presence of haemorrhagic myocardial infarction (HMI). Of 53 autopsies done from 1980 to 1986 [prior to use of streptokinase (SK) therapy in our institution] none of the specimens showed haemorrhagic infarction. Of 173 autopsies done from 1987 to 1996 (intravenous SK therapy was utilised in this period), 20 specimens showed haemorrhagic infarctions. Sixteen of these 20 patients had received SK, while 66 of the remaining 153 non-haemorrhagic myocardial infarction patients received SK (statistically significant association of SK with HMI, p < 0.005). Acute mechanical complications [ventricular septal rupture (n = 10), papillary muscle rupture (n = 2), cardiac free wall rupture (n = 7)] were seen in 19 cases. Of these, 16 were HMIs and 14 of these patients had received streptokinase. These observations suggest a strong association of HMI with SK therapy and with acute mechanical complications.

Sequential pattern of non-medical drug use in the drug career of opiate dependents in Nagpur, India.

A study was carried out in a group of opiate addicts who reported to various centers in Nagpur city, India, to know the sequential pattern of nonmedical drug use in the drug career of opiate dependents in Nagpur. The mean age of the study group was 28.2 years, the majority were males, educated up to 10th standard, employed in various occupations like petty business, vehicle driving, etc, with an average monthly income of Rs. 316. The average number of drugs ever used per person was 3.7 +/- 1.2, those recently used was 2.6 +/- 0.9 and currently used was 2.2 +/- 0.6. The study group experienced 13 drug types in their addict careers. Beedi¿cigarette was the first drug abused by the majority. Drug careers starting with beedi¿cigarette, progressing to alcohol and then to canabis and finally to heroin were observed in a majority of subjects. There appeared to be a shift from multidrug use to the singular combination of heroin and beedi¿cigarette currently. Use of all other drugs declined in favor of heroin as the career progressed. The study indicates that preventive programs should be directed at reducing the use of initial drugs like beedi¿cigarette and alcohol and also reducing the social acceptability of these drugs as measure for preventing progression to hard drugs like heroin.

Acute hemodynamic response to vasodilators in primary pulmonary hypertension.

Acute hemodynamic effects of high flow oxygen (O2) inhalation, sublingual isosorbide dinitrate (ISDN), intravenous aminophylline (AMN) and sublingual nifedipine (NIF) were studied in 32 patients with primary pulmonary hypertension (PPH). In 30 out of 32 patients the basal ratio of pulmonary to systemic vascular resistance (Rp/Rs) was > 0.5 (mean = 0.77 +/- 0.20). Oxygen caused significant decrease in the mean resistance ratio to 0.68 +/- 0.20 (p = 0.005). ISDN, AMN and NIF caused increase in the resistance ratio to 0.79 +/- 0.26; 0.78 +/- 0.26; and 0.80 +/- 0.23 respectively. O2, ISDN, AMN and NIF caused a fall of Rp/Rs in 21 (65.6%), 10 (31.2%), 10(31.2%) and 9(28.1%) patients respectively. Thus, of the four drugs tested high flow O2 inhalation resulted in fall of Rp/Rs in two thirds of patients whereas ISDN, AMN and NIF caused a mean rise in Rp/Rs. One third of patients did respond acutely to the latter three drugs. Acute hemodynamic studies are useful before prescribing vasodilators in patients with PPH since more of the commonly used drugs like ISDN, AMN, NIF could have detrimental hemodynamic responses in some patients. However, great caution should be exercised before performing hemodynamic study as the procedure has definite mortality and morbidity.