Tobacco use, attitudes and cessation practices among healthcare workers of a city health department in Southern India.

OBJECTIVE: To assess tobacco use, attitudes and cessation practices among healthcare workers of a municipal health department in southern India. MATERIALS AND METHODS: We undertook a cross-sectional epidemiologic study to investigate 558 healthcare workers from three groups (doctors, auxiliary nurses and community link workers (LWs)) employed by the Bangalore city corporation in southern India. Outcomes included self-reported tobacco use status and attitudes (for all workers), and (for doctors) self-report of performance of "5-A" tobacco cessation interventions: Asking, advising, assessing, assisting, or arranging follow-up for tobacco control, in their client population. RESULTS: Doctors reported higher tobacco use rates (6.9%) compared to LW (2%) and nurses (<1%) but were less interested in further tobacco control training (77%) compared to the others (>95%). Many doctors reported asking (100%) and advising (78%) about tobacco use but much fewer were assessing intention/motivation to quit (24%), assisting with quitting (19%), and arranging follow-up for quitting and relapse prevention (9%). CONCLUSION: Tailored training in tobacco control would enable doctors, nurses and outreach workers involved in primary healthcare delivery to be better equipped to deal with a major cause of morbidity and mortality among urban communities in the 21(st) century.

Acute thermal ulceration of the epiglottis.

Thermal injury to the epiglottis as a result of ingestion of hot food should be considered in the differential diagnosis of earache, severe throat pain and odynophagia. We report a case of a 48-year-old physician, who developed acute, severe throat pain, odynophagia and earache after inadvertent ingestion of hot food. This case is unique, as the physician performed the endoscopy on himself and diagnosed thermal epiglottitis. The epiglottitis responded to a short course of steroids and antibiotics. The physician has remained symptom free since treatment.

Subtotal colectomy for intestinal Behcet's disease: a histopathological surprise.

A 40-year-old male who was diagnosed to be having ileocaecal tuberculosis by colonoscopy elsewhere was put on antitubercular treatment. Despite therapy over three months patient had recurrent bouts of lower abdominal pain and was admitted repeatedly with features of subacute intestinal obstruction. CT- abdomen revealed concentric large bowel thickening at multiple sites with features of stenosing lesions. Patient underwent an exploratory laparotomy and subtotal colectomy was done for the diseased large bowel. Post operative histopathological examination revealed it to be Behcet's disease. We report a rare case of intestinal Behcet's disease requiring subtotal colectomy.

A case of pharmacobezoar in a patient with ileostomy.

We report a case of a 59-year-old white male who presented with right-sided abdominal pain of 6 months duration. The patient had a total colectomy and Brooks continent ileostomy 20 years ago for severe ulcerative colitis. A CT scan of the abdomen and pelvis revealed large number of pills (pharmacobezoar) in the small bowel, just proximal to the ileostomy pouch. The patient underwent a laparotomy and enterotomy, which resulted in extraction of more than 50 pills from the small bowel. He had no symptoms during the subsequent follow up visits.

Outcome of patients with prenatally detected duplex system ureterocele; natural history of those managed expectantly.

PURPOSE: We assessed the outcome of patients treated for prenatally detected duplex system ureterocele with particular reference to those treated expectantly. MATERIALS AND METHODS: We reviewed the records of 52 consecutive patients treated between 1984 and 1999 with a median followup of 8 years (range 1 to 16.2). RESULTS: Of the 38 patients who underwent surgical treatment 13 subsequently required unplanned secondary procedures. A total of 14 cases satisfying currently defined criteria, including less than 10% upper renal pole function, an unobstructed lower pole (absent nonrefluxing hydroureteronephrosis), lower pole vesicoureteral reflux not exceeding grade III and unobstructed bladder outflow, were managed expectantly with a median followup of 8 years (range 1.6 to 12.8). In this group of patients prophylactic antibiotics were routinely prescribed until the completion of toilet training or age 5 years in those with persistent reflux on repeat cystography. None has required surgery or had symptoms or urinary infection. In 6 cases followup ultrasonography showed substantial resolution of upper pole hydronephrosis with a collapsed ureterocele. Furthermore, 7 of the 38 patients who underwent surgical treatment early in our series would have been treated expectantly had the current criteria been applied. CONCLUSIONS: In 14 of the 52 patients (approximately 27%) with prenatally detected duplex system ureterocele the natural history of the complaint is essentially benign within the currently available followup.

Efficacy of an anti-tobacco community education program in India.

In a study on 'Assessment of Efficacy of an Anti-Tobacco Community Education Program' on Kolar District of Karnataka, India, an experimental and two control areas were chosen based on comparable population, health, and socioeconomic parameters. The two main objectives were to prevent individuals from taking up the tobacco habit among those who currently did not smoke or chew tobacco, and to stop the tobacco habit in those who did smoke or chew tobacco. A baseline tobacco-habit survey of the population was followed by anti-tobacco education of the community in the experimental area only. Two years later, a repeat survey of the population was conducted, followed by a final survey after a further three years. Methods of health education of the community included screening of films, exhibits, and personal contact with a display of photographs of the harmful effects of tobacco. The results were evaluated through changes in prevalence rates, quitters' rates, and initiation rate. The final survey showed that in the experimental area, the decline in the prevalence rate in the combined sample compared with the baseline rates was 10.2 percent in males and 16.3 percent in females, with a corresponding quitter's rate of 26.5 percent in males and 36.7 percent in females. Among men, a higher proportion (30.2 percent) had given up chewing compared with smoking (20.4 percent).

Prevalence of delta virus infection in high risk population and hepatitis B virus related liver diseases.

Two hundred and fifty four high risk persons or patients with hepatitis B virus related liver disease (209 men, 45 women; age range 1-78 years) were tested for anti-delta antibody and IgM anti-HBc to determine the prevalence of delta agent coinfection and superinfection. The prevalence of delta infection was as follows: acute viral hepatitis 23/148 (16%) and chronic liver disease 17/92 (19%), and asymptomatic HBsAg carriers 1/6 (17%). In the high risk population, the delta antibody prevalence was as follows: multiple transfusion recipients 3/8 (38%), patients with chronic renal failure 1/5 (20%) and medical professionals 2/7 (29%). Of 44 patients (34 men, 10 women; age 3-63 years) with delta infection, 26 (59%) had coinfection and 18 (41%) had superinfection. Six patients with anti-delta antibody had received blood transfusion(s) and six others gave history of parenteral exposure.

Intensive respiratory care service. Organisation, orientation, system and future. Our experience of management of 288 cases.

Between Jan. 1983 and Dec. 1986, 288 patients with acute respiratory failure of varied aetiologies were admitted to tetanus and respiratory care ward. One hundred and twenty patients (41.66%) had primary respiratory diseases, 107 (37.15%) of poisoning, 24 (8.3%) had neuromuscular diseases and 37 (12.48%) had miscellaneous disorders. Ventilatory support was given for more than 6 hours to 118 patients. The overall survival was 61.81% and on ventilator 38.13%. The mortality was high with ARDS (100%), miscellaneous (100%) pneumonia with septicaemia (75%) and COAD (54.28%). Patient with COAD had high mortality with acidosis (pH less than 7.1, P less than 0.01), hypotension (systolic BP less than 90 mm of Hg, p less than 0.05) and oliguria (urine out put less than 400 ml/24 hours, p less than 0.05). Organophosphorus compound was the commonest poison (89.75%) and patients who had moderate to severe hypoxia (pO2 less than 60 mm of Hg), hypotension and an interval of more than 4 hours between the consumption of poison and admission (all P less than 0.05) expired; 68.18% expired within the first 72 hours. All the patients with primary neuromuscular paralysis and bronchial asthma survived. Hospital acquired infections (160 patients), retained secretions (108 patients) and hypotension (64 patients) were the commonest complications seen in the 288 patients. Staphylococcus aureus (32.14%) was the commonest organism isolated. Financial constraints, drug shortages and frequent failure of machines were other major problems in the intensive respiratory care unit.