Impact of nutrition status and body mass index on mortality in hospitalized general medical patients: A prospective observational study.

BACKGROUND: Malnutrition and low body mass index (BMI) are risk factors for mortality in hospitalized patients. Data substantiating this are unavailable for hospitalized general medical patients in our setting. We studied the prevalence of malnutrition among patients admitted to general medical wards in a tertiary care hospital and its role as a risk factor for 1-month mortality. We also investigated the association of BMI with mortality. METHODS: In this prospective observational study, nutrition assessment using Subjective Global Assessment (SGA) and anthropometric measurements was performed in 395 hospitalized general medical patients. Charlson Comorbidity Index (CCI) and Modified Early Warning System (MEWS) score were calculated. Clinical course and vital status at 1 month after discharge was noted. Factors associated with mortality were identified using logistic regression. RESULTS: The mean age of the study population was 46.2 + 16.1 years; 247 (62.5%) were males. Of 395 patients, 129 (32.7%) belonged to SGA A, 155 (39.2%) to SGA B, and 111 (28.1%) to SGA C. Mean (±SD) BMI was 23.38 (±5.33); 141 (35.6%) were obese. Mortality was observed in 61 (15.4%) patients. Patients in the lowest BMI quartile had the lowest mortality. The adjusted regression analysis showed that higher age and MEWS scores were independently associated with mortality. Severe malnourishment (SGA C) was another important predictor. Further, the odds of death increased consistently across the consecutive BMI quartiles. CONCLUSION: Higher age, higher MEWS scores, severe malnourishment, and higher BMI scores were independent risk factors for 1-month mortality in hospitalized general medical patients.

Procalcitonin and C-Reactive Protein as an Early Predictor of Infection in Elective Gastrointestinal Cancer Surgery-a Prospective Observational Study.

BACKGROUND: Postoperative infections are a common entity following elective gastrointestinal surgery among which intra-abdominal infection is notorious and life threatening. Early detection could reduce postoperative morbidity and permit safe and early discharge. This study was aimed to establish the usefulness of procalcitonin (PCT) and C-reactive protein (CRP) on postoperative day 3 as reliable markers for early detection of intra-abdominal infection and other postoperative infections following elective gastrointestinal cancer surgery. METHODS: A total of 125 patients following elective gastrointestinal cancer surgery were prospectively observed until discharge from January 2018 to December 2019. The incidence of intra-abdominal infections and other postoperative infections was recorded. Serum PCT and CRP were estimated on postoperative day 3 for all the patients. ROC analysis of PCT and CRP was performed to establish their predictability in detecting these infections. Risk factors for postoperative infections were also studied. RESULTS: The incidence of intra-abdominal infection (IAI) was 24%. The difference in PCT between the infected and non-infected patients was statistically significant (p = 0.001) but not in CRP (p = 0.223). On ROC analysis of CRP and PCT in detecting IAI, the areas under the curve were 0.494 and 0.615 respectively. CONCLUSION: Raised serum PCT values on postoperative day 3 indicate the presence of infections and should prompt the surgeon to consider other investigations to confirm the presence of IAI and other postoperative infections and plan early intervention thus expediting the postoperative recovery. CLINICAL TRIAL REGISTRATION NUMBER: CTRI/2018/12/016695.

Depressive Symptoms and Health-Related Quality of Life in Patients with Cardiovascular Diseases Attending a Tertiary Care Hospital, Puducherry-A Cross-Sectional Study.

Background Globally, coronary artery disease (CAD) was the leading cause of health losses. The emergence of revascularization has brought a major change in the management of CAD. Depression and cardiovascular diseases (CVD) are the two highly prevalent noncommunicable diseases (NCD), which lead to poor quality of life and high socio-economic loss for the patient. The rate of depressive episodes was higher in CAD population in comparison to population with other heart problems. Objectives The primary objective of the current study is to determine the proportion of those with depressive symptoms through Patient Health Questionnaire-9 (PHQ-9) among CAD patients in a tertiary care public hospital. Methods It was a cross-sectional analytical design, which assess the percentage of patients with depressive symptoms among CAD patients, using a pretested, semistructured questionnaire. The PHQ-9 and EuroQoL five-dimensional three-level (EQ-5D-3L) questionnaire, a quality-of-life instrument (five items), were used, which was validated in the Tamil version. Statistical Analysis Categorical variables was expressed as proportion. We used Chi-square as a statistical test to calculate the p value and risk estimation with 95% CI. Results Out of 541 patients, 159 (30%) patients had mild-to-moderate depressive symptoms, of which 144 (89%) participants were greater than 50 years. In EQ-5D-3L, around one-third of the participants reported pain or discomfort and anxiety or depression. Conclusion The study concludes that the assessment of health-related quality of life (HRQoL) is becoming increasingly important in the management of CAD patients. Studies have shown that depression predicts subsequent quality of life, while others have shown that HRQoL is a risk factor for ongoing depression. Treatment of depression may improve subsequent physical HRQoL; hence, it is vital to address both during their follow-up to improve outcomes among patients with CAD.

Assessment of the WHO Health Promoting Schools Framework among schools in selected villages of rural Puducherry, South India - a mixed method study.

BACKGROUND: The health of children and adolescents can be promoted through schools as they spend most of their time in school. The Health Promoting Schools (HPS) framework provides a set of policies to be followed in schools for improving the health status of school-going children and adolescents. The current study was done to assess this framework among schools in rural Puducherry. METHODS: Key informant interviews were done with the teachers under the six World Health Organisation (WHO) HPS framework domains to develop an observation checklist for the assessment of schools in the study area. After the survey, in-depth interviews were conducted as an approach to explore the existing health promotion activities, facilitating or hindering factors in the implementation of health promotion framework and suggestions for improving the same. RESULTS: A quantitative survey on nine schools showed that almost all the schools were lacking in domains such as health promotion policy, behaviour counselling and mental and social support. Physical education, facilities and policies for nutrition and community collaboration exist in only some of the schools. Qualitative interviews also showed similar findings and most of the teachers suggested to include training for general health emergencies and behaviour counselling. CONCLUSION: The current study showed that most of the schools were lacking in almost all the domains under the HPS framework. Hence, stakeholders at all levels should be made aware of this framework and develop a strategy for uniform implementation of it in all the schools in the region.

Prevalence and associated factors for social phobia among school-going adolescents in a rural area of Puducherry, South India.

BACKGROUND: The World Health Organisation has reported that mental disorders are one of the leading causes of disability worldwide. Social phobia is one such mental disorder that can have significant impact on the livelihood of adults if not detected at an early stage. There have been very few studies done on social phobia among adolescents in South India. Hence, this study was done to determine the prevalence of social phobia and factors associated with it among the school-going adolescents in rural Puducherry. METHODOLOGY: A community-based cross-sectional study was conducted among 1018 school going adolescents from December 2017 to January 2018 in rural Puducherry. Information on socio-demographic characteristics was collected by a pre-tested semi-structured questionnaire and social phobia was assessed using the validated Social Phobia Inventory (SPIN) questionnaire. RESULTS: Among 1018 participants, 738 (72.5%) belonged to early adolescence (10-13 years); 520 (51.1%) were boys; 557 (54.7%) were studying in a middle class; 931 (91.5%) were Hindus; 978 (96.1%) had siblings.The prevalence of social phobia among adolescents was found to be 22.9% (95% CI: 20.4-25.5%). The prevalence of mild social phobia was 18% [95% confidence interval (CI): 15.7-20.4%], moderate social phobia was 4% (95% CI: 2.9-5.4%), severe social phobia was 0.7% (95% CI: 0.3-1.3%) and very severe social phobia was 0.2% (95% CI: 0.03-0.64%). Higher age, female gender, lack of counselling services and specialist visits at school were found to be determinants of social phobia. CONCLUSION: The current study showed that one in every five adolescents was at risk of developing social phobia. Health education for students, teachers and family members needs to be given to make them aware of the importance of social phobia.