Program to Enhance Well-being and Psychospiritual Understanding Implications in Indian Medical Care Perspective

Background: Spirituality is an important dimension of life. The medical practitioner’s well-being is an under-appreciated priority in India. As research on spirituality is minimal, this study attempts to introduce an online 6-week Eastern spirituality-based educational program for physicians. The primary aim was to see the effects of the intervention on the well-being of the participants. The secondary aim was to form an opinion about an extension to medical practice. Materials and methods: A total of 60 medical practitioners were randomized into two groups— one attended the spirituality sessions while the other placebo “self-care” sessions. Quantitative outcome measures were Warwick-Edinburg Mental Well-being Scale (WEMWBS) and World Health Organization (WHO) Well-being Index (WHO-5) noted pre and postprogram. Qualitative data was collected to support the quantitative outcomes. Statistical tests used were unpaired and paired t-tests for quantitative data. A 5-point Likert scale and Cochran’s Q test were used for the qualitative data. Results: In the spirituality group, postsession WEMWBS and WHO-5 scores improved with p < 0.0001 and p = 0.0033, respectively. Regarding qualitative data, 94.44% of physicians “agreed/strongly agreed” in favor of the benefits of sessions with p = 0.0242 and Q = 5.0793. A total of 86.67% of physicians felt the sessions have helped them to understand other’s spirituality-related problems and made them more confident to discuss spirituality with others. Conclusion: The online Eastern spirituality program had a positive impact on the well-being of Indian medical practitioners. There appears to be a potential for extension to the medical care setting. The results need to be substantiated by further studies.

Detection Of Treatment Adherence, Disease Control and Its Predictors in Asthma Patients by Rural Community Level Health Workers

Background: Despite the availability of effective therapy, disease control in Asthma remains suboptimal with high morbidity. Objectives: To assess treatment adherence, asthma control and its influencing fac-tors.Methodology: A prospective, observational study was conducted among 152 adult asthma patients re-porting consecutively to a BPHC for twelve months. Patients were followed up by trained healthcare workers to assess their treatment adherence and disease control using a predesigned, pretested and val-idated questionnaire.Results: Mean age was 49.6 years (SD=+14.0), males reported more cases (73.7%), addiction to tobacco was high (48.7%). 40.8% patients had high treatment adherence. Only 37.5% patients reported good asthma control of which 68.4% showed high adherence. The mean Asthma Control Test (ACT) score was 18.75 ± 4.8 SD. Increasing age (aOR=0.96, 95% CI= 0.93-0.99), tobacco smoking (aOR=2.90, 95% CI=1.20-6.99), dust allergy (aOR= 7.92, CI =3.15-19.91) and low treatment adherence (aOR=5.33, 95% CI=2.22-12.82) were found to be significant predictors of poor disease control.Conclusions: Non adherence to treatment and poor disease control was high among rural asthma pa-tients. Patient education for tobacco cessation and treatment compliance along with periodic monitoring undertaken by trained health workers can be an effective strategy to reduce disease burden in the com-munity.

Vertical Distribution of TOC, TN and Other Important Soil Attributes and Their Relationship in Alfisol and Entisol of West Bengal

A study to assess the profile distribution of important soil attributes in Alfisols and Entisols of West Bengal was conducted during 2016-17. Purposefully selected random sampling was carried out to collect the soils from different locations of two study sites, viz., Kalinagar (25º27'33.9"N, 88º19'10.2"E) from Malda district and Durganagar (26º09'62.7"N, 89º53'51.7"E) from Cooch Behar district of West Bengal at 0-15, 15-30, 30-45 and 45-60 cm depths. Understanding of vertical distribution of soil fertility indicators like soil organic carbon (SOC), total nitrogen (TN) and other important properties in two different soil and climatic conditions will provide an insight regarding the behaviour of soil with the change in environmental conditions. Soil bulk density (BD), porosity, pH, SOC, TN, C:N ratio and texture were determined using standard laboratory procedures and computations. Obtained results were subjected to statistical analyses. Soils of Kalinagar sites were slightly acidic in nature while soils of Durganagar were neutral in nature. Kalinagar soils were silt clay loam in texture where Durganagar soils classified as loam to sandy loam. Soil BD values increased with depth in both Kalinagar (Alfisol) and Durganagar (Entisol). The porosity percentage progressively decreased with an increase in depth. Soils of Durganagar reported higher soil porosity at all the depths studied. An increase in soil pH with increasing depth was observed in both the sites. The mean total organic carbon (TOC) content recorded maximum in surface soil and its concentration decreased with the depth. Kalinagar soils observed 7.63% higher TOC (17.94 g kg-1) content than Durganagar (16.57 g kg-1) at surface depth (0-15 cm) and its accumulation at the lower depths was also maximum in former soil. Mean TN values were also found to decrease by increasing the depth. The accumulation of total nitrogen at the subsequent depths was relatively higher in Kalinagar than Durganagar. Increase in C:N ratio with increasing depth was noticed in Kalinagar site but the opposite trend was accorded in case of Durganagar. Accumulation of SOC and TN throughout the soil depth was found to be greater in Alfisol (Kalingar) due to higher clay and silt fractions as compared to Entisol (Durganagar). There was a significant positive relation of TOC with clay and silt (r = 0.285, p<0.05, r = 0.314, p<0.01, respectively) and of TN with clay and silt (r = 0.328, p<0.01, r = 0.262, p<0.05, respectively) irrespective of soil orders. Alfisols with high bulk density have a greater capacity to accumulate SOC and TN throughout the soil profile due to higher clay and silt fractions in comparison to Entisols with loose textural properties.

Prevalence of diabetes and impaired fasting glucose in a selected population with special reference to influence of family history and anthropometric measurements--the Kolkata policeman study.

AIMS AND OBJECTIVES: The aim of this study was to estimate the prevalence of diabetes as well as IFG in a population of policemen and to evaluate the possible influence of some risk factors. MATERIAL AND METHODS: It was an epidemiological study on a group of policemen in Kolkata. Diagnosis of diabetes was based on history and fasting plasma glucose. The study population was divided in three categories: normoglycaemic, IFG and diabetes. BMI, waist circumference, WHR and waist-to-height ratio were estimated. RESULTS: Out of 2160 subjects with a mean age of 36.4 yrs (between 20 and 60 yrs), diabetes was found in 11.5% (10.4% known and 1.1% newly diagnosed) and 6.2% had IFG. Prevalence of diabetes was found to be increasing with age (p < 0.001). There was no statistically significant difference in BMI when compared between groups (normoglycaemic, IFG and diabetes). Waist circumference, waist-to-height ratio and WHR of normoglycaemic group were significantly less than those with IFG and diabetes; however there was no statistically significant difference between the diabetes and IFG groups. Parental history had significant influence on the prevalence of diabetes; a 37.5% prevalence was found in persons with history of biparental diabetes and 20.8% with uniparental diabetes, whereas it was only 9.9% without any family history (p < 0.01 and p < 0.05, respectively.). CONCLUSION: The prevalence of diabetes in the study population was high and was strongly influenced by family history, age and abdominal adiposity, without having any appreciable impact of BMI.

A comparative study of classical vs. desmoplastic medulloblastomas.

Classical and desmoplastic medulloblastomas (MBs) have been suspected to be biologically different, though comparative studies on markers of biological aggressiveness in these two variants are sparse in the literature. 87 classical and 43 desmoplastic variants of MB were studied with respect to clinical and histological characteristics, MIB-1 labeling index (MIB-1 LI), apoptotic index (AI), ratio of AI to MIB-1 LI, expression of p53 and Bcl-2 protein and 3-year progression-free survival. The only differences documented between the variants were with regard to age distribution and location. Thus, classical histology cases occurred predominantly in children and 80% were midline in location. In contrast, lateral location was seen more frequently with tumors of desmoplastic histology, which occurred in an almost equal distribution between children (56%) and adults (44%). No difference was noted between the variants with regard to proliferation index, apoptotic index, their ratio on or their molecular controls (p53 and Bcl-2). This was reflected in the clinical outcome wherein no significant difference was observed in the 3-year progression-free survival between the variants. It is concluded that the two histological variants of medulloblastoma are not different with regard to biological parameters of aggressiveness. The growth rate and clinical outcome in medulloblastomas have no correlation with the histological variant.

Diabetic care in general practice--a survey.

Prevalence of diabetes mainly type-2 is growing astronomically. Multiple insulin delivery systems are on trial from jet to pump, nasal spray, oral insulin and rectal suppository with success and failures to have insulin pen--which is growing popularly. Two studies have shown that non-insulin dependent diabetes mellitus patients needed insulin for good glycaemic control. To see the knowledge of these developments among general practitioners, a set of questions with possible answers were distributed among 48 doctors selected from different areas. Twelve doctors showed no interest. Majority (65%) answered they see less than 5 new diabetics a week, whereas 35% see more than 5 a week. Most clinicians (58%) rarely use insulin. A sizeable section (46%) has not heard of any other insulin administration advices other than syringe and needle. So in the context of the questionnaire with answers, it can safely be presumed that concept of diabetes care needs a continuous update.

Aptitude of doctors about cardiopulmonary resuscitation--a survey.

Cardiopulmonary resuscitation is applied to extremely moribund cases with cardiac or respiratory arrest. General practitioners are mostly resuscitator outside hospital. With the idea to see the aptitude of this manoeuvre, 16 prefixed questions on this manoeuvre were selected for answers among 50 general practitioners. Only 2(4%) answered all the questions correctly and most (80%) of them answered 4 questions correctly. The results evoked a worrisome outcome. So it is suggested to update the practical patient care training like cardiopulmonary resuscitation among the doctors and paramedical personnel.

Primary gastrointestinal lymphoma--disease spectrum and management: a 15-year review from north India.

OBJECTIVE: To analyze retrospectively the disease spectrum and outcome of primary gastrointestinal lymphoma (PGIL) in a tertiary referral center in north India. MATERIAL: Seventy five patients presenting with PGIL between January 1971 and December 1985 were evaluated. RESULTS: The 49 males and 26 females were aged 3.5-69 years (mean 34) at presentation. Abdominal pain, weight loss and vomiting were cardinal symptoms at presentation; the stomach was the most common site of involvement. Histologically, a majority of patients were classified as having diffuse poorly-differentiated lymphocytic lymphoma (46.7%) and diffuse histiocytic type (30.7%). Twenty seven (36%) patients had stage I disease, 31 (40%) stage II, 11 (14.7%) stage III, and 6 (8%) stage IV. At laparotomy, primary resection and anastomosis was carried out in 66 patients, while only biopsies were taken in nine. Forty eight patients received adjuvant radiation with or without chemotherapy. The mean follow-up was 3.9 years (range 1-14). The 5-year actuarial survival was 34%, 25% and 16% for stages I, II, and higher-stage disease, respectively. The survival was significantly better (p < 0.01) for gastric location (44%) compared to other sites (24%). CONCLUSION: PGIL was more common in the 3rd and 4th decades of life, with the stomach being the predominant site of involvement. Survival was better among patients with stages I and II disease, and gastric location of lesion.

Postcardiac injury rheumatism.

The incidence, clinical comparison, laboratory features, therapeutic choices with outcomes of early and late postcardiac injury rheumatism (PIR) were studied prospectively. Out of the 249 patients who survived cardiac surgery, 20 (8%) and 22 (9%) patients had early and late PIR respectively. Earlier onset (within two weeks of surgery), milder articular involvement, absence of constitutional features and laboratory abnormalities and good response to analgesics were characteristics of early PIR. In contrast, late PIR which occurred between the third and fourteenth week after surgery was associated with more marked articular involvement along with systemic and laboratory abnormalities and required longer analgesic therapy, steroid support or prolonged physiotherapy in different combinations. We conclude that two distinct rheumatic syndromes with different clinical dimensions and therapeutic options can occur after cardiac surgery.

Hypertension care in general practice: an opinion survey.

An opinion survey was conducted among 60 general practitioners from different parts of West Bengal with 6 prefixed questions covering some practical issues of hypertension. Fifty-eight doctors responded. In the opinion of the majority, 160 mm of Hg (systolic) and 90 mm of Hg (diastolic) are the cut off pressure to diagnose hypertension. Forty-eight per cent of the practitioners opined that a period of observation is necessary before antihypertensives were started. Eighty-seven per cent of the practitioners would start their patients on antihypertensive drugs well before the blood pressure reached 160/104 mm of Hg. High diastolic pressure was thought to be dangerous by 50% doctors and both high systolic and diastolic pressures were thought to be dangerous by 43% doctors. Fifty-two per cent practitioners opined that 140/90 mm of Hg should be the target blood pressure after treatment. Most of them (63%) opined that antihypertensive treatment should be continued life long. Practitioner's opinion were analysed in the light of current international literatures on basic therapeutic approaches to hypertension with emphasis on certain issues of controversy.