Predictors determining the duration of hospital stay among patients admitted with singlefractures / Predictores que determinan la duración de la estancia hospitalaria en pacientes ingresados con fracturasúnicas

Introduction: Fractures pose a tremendous burden on the health care systems due to the prolonged duration of admission. Addressing various determinants that prolong hospital stay will help minimize the cost of treatment. Objective: To study the determinants associated with the duration of hospital stay among patients admitted with fractures. Methods: This was a retrospective observational study conducted at a private tertiary care hospital in Mangalore. A semi-structured proforma was used for collecting data from the medical records. Results: The mean age of the 124 patients were 48.3±21.4 years. The majority were males [69(55.6 por ciento)] and were from urban areas [86(69.3 por ciento)]. Co-morbidities were present among 69(55.6 por ciento) patients. Out of the total patients, 8(6.4 por ciento) were alcoholics, and 10(8.1 por ciento) were tobacco smokers. The majority [50(40.3 por ciento)] had fracture of the femur. Five (4 por ciento) patients developed complications during the post-operative period. Seventy-eight (62.9 por ciento) patients had medical insurance facilities. The mean duration of hospital stay was 9.6±3.2 days among the patients. The mean duration of hospital stay among patients (n=115) before surgery was 2.4±1.6 days. Increased pre-operative stay, increasing age, rural residential status, open type of fracture, and being given general anaesthesia for the operative procedure were significant predictors determining the period of stay among patients in the hospitals. Alcoholic status independently influenced the period of stay in the pre-operative period. Conclusion: Both patient and treatment characteristics were important determinants associated with the duration of hospital stay. Targeting these predictors will help to manage in-patients better and shorten their duration of hospital stay(AU)

Introducción: Las fracturas suponen una enorme carga para los sistemas sanitarios debido a la duración prolongada del ingreso. Abordar varios determinantes que prolongan la estadía en el hospital ayudará a minimizar el costo del tratamiento. Objetivo: Estudiar los determinantes asociados a la duración de la estancia hospitalaria en pacientes ingresados con fracturas. Métodos: Este es un estudio observacional retrospectivo realizado en un hospital privado de atención terciaria en Mangalore. Se utilizó una proforma semiestructurada para la recolección de datos de las historias clínicas. Resultados: La edad media de los 124 pacientes fue de 48,3±21,4 años. La mayoría eran hombres [69 (55,6 percent)] y de áreas urbanas [86 (69,3 percent)]. Las comorbilidades estuvieron presentes en 69 (55,6 percent) pacientes. Del total de pacientes, 8 (6,4 percent) eran alcohólicos y 10 (8,1 percent) fumadores. La mayoría [50 (40,3 percent)] tenía fractura de fémur. Cinco (4 percent) pacientes desarrollaron complicaciones durante el postoperatorio. Setenta y ocho (62,9 percent) pacientes tenían seguro médico. La duración media de la estancia hospitalaria fue de 9,6±3,2 días entre los pacientes. La duración media de la estancia hospitalaria de los pacientes (n=115) antes de la cirugía fue de 2,4±1,6 días. El aumento de la estancia preoperatoria, el aumento de la edad, el estado residencial rural, el tipo de fractura abierta y la anestesia general para el procedimiento quirúrgico fueron predictores significativos que determinaron el período de estancia entre los pacientes en los hospitales. El estado alcohólico influyó de forma independiente en el tiempo de estancia en el preoperatorio. Conclusión: Tanto las características del paciente como las del tratamiento fueron determinantes importantes asociadas con la duración de la estancia hospitalaria. Abordar estos predictores ayudará a manejar mejor a los pacientes hospitalizados y acortar la duración de su estadía en el hospital(AU)

Clinical profile of patients with inter vertebral disc disorders / clínica de pacientes con trastornos de los discos intervertebrales

Introduction: Intervertebral disc disorders (IDDs) are being commonly observed nowadays among the young and middle aged population. Objectives: This hospital record based study was done to study the risk factors, clinical presentation, imaging findings and management practices among patients with all types of IDDs. Methods: A validated proforma was used to obtain information of patients confirmed with IDDs over the past three years. Results: Mean age at onset of disc disorders among the 219 patients was 44.7±14.2 years. History of poor exercising habits were present among 72(32.9 percent) patients. The most common site of disc involvement was L4-L5 [151(68.9 percent)]. 143(65.3 percent) patients had single site disc involvement. The most common clinical symptom was lower back pain [180(82.2 percent)]. Nerve root compression was present among 154(70.3 percent) patients. Disc bulge, protrusion, extrusion and sequestration were present among 116(53 percent), 90(41.1 percent), 52(23.7 percent) and 4(1.8 percent) patients respectively. Age at onset >65 years (p=0.035), age at onset ≤55 years (p=0.004) and history of direct impact to the neck region (p=0.017) were associated with disc prolapse at L2-L3 level, L4-L5 level and C5-C6 level respectively, among patients with single site disc involvement. Risk of multiple level disc involvement was found to increase after 35 years (p<0.001). It was seen more involving cervical vertebrae (p=0.0068). Lumbar (p<0.0001) and lumbosacral vertebrae (p<0.0001) involvement were seenmore among patients with single site disc involvement. NSAIDs [155(70.8 percent)] were the most the commonly used medication. Microdiscectomy was done among 35(76.1 percent) out of the 46 patients who underwent surgical management. Conclusions: Exercising habits need to be encouraged among people for the prevention of IDDs. The various high risk groups identified in this study need to be periodically screened for IDDs(AU)

Introducción: Actualmente, los trastornos de los discos intervertebrales (TDI) son frecuentes en la población joven y de mediana edad. Objetivos: Este estudio hospitalario de las historias clínicas se realizó para examinar los factores de riesgo, la presentación clínica, los hallazgos imagenológicos y las prácticas de tratamiento entre los pacientes con todos los tipos de trastornos de los discos intervertebrales. Métodos: Se utilizó una proforma validada para obtener información de los pacientes confirmados con trastornos de los discos intervertebrales en los últimos tres años. Resultados: La edad media de aparición de los trastornos discales entre los 219 pacientes fue de 44,7 ± 14,2 años. El historial de malos hábitos de ejercicio estuvo presente en 72 (32,9 por ciento) pacientes. El sitio más común de afectación del disco fue L4-L5 [151 (68,9 por ciento)]. 143 (65,3 por ciento) pacientes tenían compromiso de disco en un solo sitio. El síntoma clínico más frecuente fue el dolor lumbar [180(82,2 por ciento)]. La compresión de la raíz nerviosa estuvo presente en 154 (70,3 por ciento) pacientes. Se mostró presencia de protuberancia, protrusión, extrusión y secuestro discal en 116 (53 por ciento), 90 (41,1 por ciento), 52 (23,7 por ciento) y 4 (1,8 por ciento) pacientes, respectivamente. La edad de inicio >65 años (p=0,035), la edad de inicio ≤55 años (p=0,004) y el antecedente de impacto directo en la región del cuello (p=0,017) se asociaron con prolapso discal a nivel L2-L3, L4- Nivel L5 y nivel C5-C6 respectivamente, entre pacientes con compromiso discal en un solo sitio. Se encontró que el riesgo de afectación del disco en múltiples niveles aumenta después de 35 años (p<0,001). Se vio más involucradas las vértebras cervicales (p=0,0068). La afectación de las vértebras lumbares (p<0,0001) y lumbosacras (p<0,0001) se observó más entre los pacientes con afectación del disco en un solo sitio. Los fármacos anti-inflamatorios no esteroideos (AINE) [155 (70,8 por ciento)] fueron los medicamentos más utilizados. La microdiscectomía se realizó en 35 (76,1 por ciento) de los 46 pacientes que se sometieron a manejo quirúrgico. Conclusiones: Es necesario fomentar hábitos de ejercicio entre las personas para la prevención de los TDI. Los diversos grupos de alto riesgo identificados en este estudio deben someterse a pruebas periódicas de IDD(AU)

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

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.

Assessment and determinants of emotional intelligence and perceived stress among students of a medical college in south India.

Emotional intelligence (EI) is the ability to identify, assess, and control the emotions of oneself, of others, and of groups. Stress resulting from having to meet professional demands is common in the medical student's life. The perceived stress (PS) can be either an input or an outflow of EI or the lack thereof. This study was done to assess EI levels and to find out its association with sociodemographic variables and PS among medical students. Data were collected using a self-administered questionnaire from 198 first-year and 208 second-year medical students. EI scores were found to increase with age (r = 0.169, P = 0.004). PS scores were found to be higher among first-year students (P = 0.05). PS scores were found to decrease with increase in EI scores (r = −0.226, P < 0.001). Hence, if sufficient measures to improve EI are provided in the beginning, it would make students more stress-free during their training years at medical schools.

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.

A study of the socio-demographic profile and treatment outcome of paediatric tuberculosis patients in Bangalore Mahanagar Palike area.

Background: Tuberculosis (TB) continues to be one of the most devastating and widespread infections in the world. Of the nine million annual tuberculosis cases, about one million (11%) occur in children (under 15 years of age). Childhood tuberculosis is a neglected aspect of the tuberculosis epidemic. Objectives: To know the socio-demographic profile, type of tuberculosis and treatment outcome in paediatric tuberculosis patients Methodology:The study was conducted in nine Tuberculosis units of Bangalore city from January 2009 to December 2009. Five Tuberculosis units from the nine tuberculosis units were selected by simple random sampling, paediatric patients diagnosed as having TB and registered under RNTCP were included in the study till the sample size of 209 was reached. Data regarding socio-demographic profile and type of TB was collected and the patients were followed up to assess treatment outcome. Results: Most of the patients coming to the RNTCP centres belong to the under-privileged group. Most of the patients were in the age group of 1 to <6 years, (37.7 %), male to female ratio was observed to be 0.6:1. Majority of the patients lived in nuclear families (73.2%), belonged to low socio-economic status (95.5%) and dwelled in overcrowded houses (89.5%). 23% reported history of contact with tuberculosis patients. More than half of the patients (57.4%) were undernurished. In the study, 56.5% had pulmonary TB and 43.5 % had extra-pulmonary TB. 94.7% of the patients completed treatment. Conclusion:Paediatric tuberculosis still continues to be a major problem in one-five years of age who are undernourished and belonging to low socio-economic status.

Morbidity among infants in south India: A longitudinal study.

To study the incidence and types of morbidity in the first year of life in a birth cohort, a longitudinal study. This study was undertaken in northern part of Karnataka state in India. Birth cohort consisted of all the children born during first six months of the study period. They were assessed at the time of enrollment and monthly follow up was done till they attained one yr of age. Out of the 194 newborns, 46.4% were boys and 53.6% were girls. 24.8% of newborns were of low birth weight and 5.1% were preterm. Four (2.1%) had congenital anomalies and 2.5% developed birth asphyxia. Diarrhea (10.8%) and skin diseases (8.2%) were the commonest morbidities in the neonatal period. The incidence of morbidity was 3.28 per infant per yr. It was more among boys and in the second half of infancy. Commonest morbidities during infancy were respiratory tract infection (62.4%), diarrhea 42.8% and skin diseases (21.6%). Incidence of disease in infancy highlights the need to improve and plan health programmes.