A study to assess the prevalence of substance abuse and its impact among medical students in a medical college

Background: Psychoactive drug is an emerging global problem. This is a disturbing matter, especially in the case of medical students, affecting their health and academic performance, which in turn affects the health outcomes of patients. The objectives of our study were to assess the prevalence and impact of substance abuse among medical students. Methods: This was cross-sectional study conducted in tertiary care center. A pretested semi structured questionnaire was used to collect the data. Medical students who were available during the study period and who were willing to participate were included in the study. A total of 301 students were interviewed. Data was entered and analysed in SPPSS version 22.0. Descriptive statistics and inferential statistics were used for the statistical analysis. Results: We had a total of 301 responders. Among them, only 70(23.3%) have been a subject to substance abuse. Alcohol was the most abused substance (19.3%). The most common reason for starting these substances was out of curiosity (15.6%). 24.6% of the students have either thought of or tried stopping, however majority of them have not. Out of these students, 10 (3.3%) have experienced withdrawal symptoms. Conclusions: The substance abuse among youngsters in medical colleges is a highly alarming situation. Proper counselling with planned policies should be implemented to root out this evil among the future doctors which will help in providing better health care services to the people.

Essential drug list for cardiovascular diseases in a tertiary health care centre

Background: Essential medicines are those that satisfy the priority health care needs of a population. The latest version of NLEM is the 23rd list, published in September 2022, and contains 384 essential drugs, of which 29 are cardiovascular drugs. The drugs in the list may be huge or small according to the local needs. The objectives of our study are to prepare the essential drug list for cardiovascular disease in a tertiary care hospital and to confirm the essential drug list provided and its availability in the pharmacy. Methods: We interviewed around 28 consultants from various departments who prescribe these cardiac drugs. The names, doses and dosage forms were noted. The list was verified with the NLEM 2022 and counterchecked in the hospital pharmacy. Results: Most consultants adhered to NLEM, but an additional 42 drugs were prescribed, amounting to 71 drugs. There are four drugs Warfarin, Rivaroxaban, Furosemide and Torsemide which may be considered for the hospital pharmacy list. Conclusions: Too many drugs other than those present in the NLEM list are prescribed, which can be reduced by adequately training the consultants to adhere to the prescribed list.

Clinical, Bacteriological and Radiological Study of Community Acquired Pneumonia - A Hospital based Study

Introduction: Pneumonia is one of the leading causes of deathand morbidity, both in developing and developed countriesand is the commonest cause (10%) of hospitalization. CAPmortality is variable depending on the site of care; it is lessthan 1% in the outpatient setting, around 5% in inpatients notrequiring ICU care, up to 25% in intubated patients, and near50% in ICU patients requiring vasopressors. The aim of thisstudy was to analyse the mode of presentation of pneumonias,its clinical features, bacteriological and radiological featuresfor the early detection of disease, the causative agent and tofind out the complications.Material and methods: This was a prospective study whichincluded total 50 cases. Patient with acute onset of feverassociated chills and rigors and patients with chest pain,breathlessness and cough with expectoration were selected aspneumonia patients. Blood for WBC Count and DifferentialCount were done. Sputum for gram stain, AFB, and Culturewere done. Chest X-ray PA view were performed to know thesite of consolidation. ELISA was also done to rule out HIVinfection.Results: The age group in this study group varied from 18-85years, most of them were between 30- 70 years of which 56.0%were <60 years. The incidence of CAP was most common inmen (74%) compared to female (26%). The associated diseasesin this study were COPD (22.0%). The commonest presentingsymptoms were fever (100%), cough (100%), expectoration(92%); other symptoms include dyspnoea (78%), and chestpain (62%).Conclusion: In our study prognosis was good with mortalityof 8%, about 4 patients died due to respiratory failure. Mostof the patients recovered without any complications, expect inpatients with COPD, symptoms were not completely reducedand were advised for follow-up.

Assessment of fatigability, depression, and self-esteem among head-and-neck carcinoma patients in a tertiary care hospital in South India

Background: Head and Neck Carcinoma (HNCs) are the most common form of cancer in India. Patients with head-and-neck carcinomas often suffer from various distressing symptoms. The exact cause of these symptoms, as to whether disease or treatment or other factor induced, needs to be established. Objectives: This study was done to assess fatigability, depression, and self-esteem among HNC study group before start, during, and in postradiation period and to find out the determinants of these parameters. Materials and Methods: Seventy newly diagnosed HNC patients and equivalent number of age- and gender-matched controls were interviewed using standardized questionnaires, before start of concurrent chemoradiotherapy (CCRT). The study group patients were interviewed again in the 4th week and postcompletion of CCRT in the 7th week. Results: Mean age of the study group was 55.1 ± 11.3 years. Three-fourth of them (52 [74.3%]) were males. Majority of them (26 [37.1%]) had oral carcinomas. Baseline fatigue (P < 0.001) and depression scores (P < 0.001) were significantly more, while self-esteem scores (P = 0.004) were significantly less among the study group compared to controls before the onset of radiation. Mean fatigue and depression scores were found to significantly increase (P < 0.001), while self-esteem scores were found to significantly deteriorate (P < 0.001) over the course of CCRT among these patients. There was significant positive correlation (P < 0.001) between fatigue and depression scores and negative correlation (P < 0.001) of these parameters with self-esteem scores before, during, and after CCRT. There was no association between age and gender of the study group with any of these parameters. Multivariate analysis showed that baseline fatigue was significant (P < 0.001) and, depression after completion of the entire course of CCRT was significantly influenced by baseline depression levels (P = 0.011). Conclusions: Fatigue and depression need to be periodically screened among HNC study group on CCRT so as to initiate prompt remedial measures for its alleviation

Development of a Modified Disability Questionnaire for Evaluating Disability Caused by Backache in India and Other Developing Countries

STUDY DESIGN: Prospective observational study. PURPOSE: To evaluate the disability domains relevant to Indian patients with low backache and propose a modified disability questionnaire for such patients. OVERVIEW OF LITERATURE: The Oswestry Disability Index (ODI) is a self-reported measurement tool that measures both pain and functional status and is used for evaluating disability caused by lower backache. Although ODI remains a good tool for disability assessment, from the Indian perspective questions related to weight lifting and sexual activity of ODI are questioned in some of the earlier studies. Activities of daily living in Indian patients vary substantially from those in other populations and include activities like bending forwards, sitting in floor and squatting which are not represented in the ODI. METHODS: In this prospective observational study, a seven-step approach was used for the development of a questionnaire. Thirty patients were interviewed to identify the most challenging issue they faced while performing their daily activities (by free listing) and understand how important the questionnaire items were in terms of the standard ODI. Thus, a comprehensive disability questionnaire comprising 14 questions was developed and administered to 88 patients. Both qualitative (interviews) and quantitative methods (to establish the validity, reliability, and correlation with the Visual Analog Scale [VAS] and Rolland Morris disability questionnaire) were used to identify the 10 questions that best addressed the disability domains relevant to Indian patients. RESULTS: According to free listing, four new questions pertaining to bending forward, sitting on the floor, walking on uneven surfaces, and work-related disabilities were included. In the second phase, wherein the questionnaire with 14 items was used, 56.8% patients did not answer the questions related to sexual activity, whereas 23.8% did not answer those related to walking on uneven surfaces. The modified questionnaire demonstrated good internal consistency (Cronbach's alpha=0.892) and correlation with the Rolland Morris questionnaire (Cronbach's alpha=0.850, p>0.05), as well as with the VAS score for disability (Cronbach's alpha=0.712, p>0.05) and pain (Cronbach's alpha=0.625, p>0.05). CONCLUSIONS: A modified disability questionnaire that was designed by adding two questions related to bending forward and work status and removing questions related to sexual activity and weight lifting or traveling (depending on the occupation) can help evaluate disability caused by back pain in Indian population.

Proportion of Refractive Error and Its Associated Factors among High School Students in South India.

Background: School children are a high risk population for refractive errors (REs). Uncorrected REs can adversely affect the learning abilities and mental development of school children. Objectives: This cross sectional study was conducted to observe the proportion of cases diagnosed with REs, to determine factors associated with it, to find out the practices of students in preventing these risk factors and to assess the perception towards visual aids among students with REs in schools of an urban area. Methods: This study was done in Mangalore city in February 2013. 482 high school children were interviewed using a structured interview schedule. RE was ascertained based on records of previous diagnosis by Ophthalmologist. Data was analyzed by Chi-square test and binary logistic regression analysis. Results: The prevalence of already diagnosed cases of RE was 94(19.5%). Most of these cases had myopia 92(97.9%). Two cases were of hypermetropia. Mean age of onset of RE was 10.2±2.1 years. Only 19(20.2%) cases were first detected in schools in spite of functioning school health services at all the surveyed schools. RE cases were significantly more in private schools in comparison to government schools (P<0.001). Risk factors significantly associated with RE were history of RE among siblings (P<0.001), inadequate reading distance (P=0.011) and doing homework with inadequate illumination (P=0.021). One third of students with RE were irregular in eye examinations. Conclusion: Proportion of REs was high among school students. Education of students on healthy postural habits and good illumination while studying at home is essential to prevent REs in this population.

Perception towards Problem Based Learning among Medical Students of a Private Medical College in South India.

Introduction: Meeting the changing demands in medical education requires implementation of innovative teaching methods. Problem based learning (PBL) was introduced for the first time for teaching Community Medicine at Kasturba Medical College, Mangalore. The objective of this study was to obtain students’ perception towards this learning experience so as to evaluate its potential benefits. Study Design: Cross sectional study. Place and Duration of Study: This study was done in a private medical college between June to November 2014. Methods: It was conducted among final year medical students. PBL was introduced to a randomly chosen group of students and their perception towards this learning experience was obtained. The assessment was done using a standardized questionnaire containing responses in a five point Likert scale ranging from strongly agreement to strongly disagreement. Results: Mean age of the 54 participants was 21.4±1.0 years. Majority were females 33(61.1%) and were Indians 45(83.3%). Majority of students strongly agreed to most parameters under application of knowledge base, clinical reasoning, decision making skills, self-directed learning and collaborative work experience in PBL tutorials. Similarly feedback regarding standard of PBL exercise, self/peer performance and facilitator performance in the PBL tutorials was strongly agreed to be satisfactory by majority of participants. However 24(44.4%) of them found PBL to be time consuming. Greater proportion of males felt that their contribution was not satisfactory during sessions (p=0.049). Conclusion: Students feedback towards PBL was found to be satisfactory in all aspects. Few barriers like demotivation on the part of male participants needs to be resolved by facilitators so as to improve output in PBL sessions.