Clinical factors associated with mortality in dengue infection at a tertiary care center

We conducted a cross-sectional study to investigate the clinical factors associated with mortality in Patients with dengue viral infection at a tertiary care center over a 3 year period. Six hundred ninety-nine Patients with a clinical diagnosis of dengue fever (DF), dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) during the study period were included in the study. Data were collected with a predesigned form comprised of demographics, duration of fever, associated symptoms, diagnosis of DF, DHF and DSS, and laboratory parameters [complete blood count, coagulation tests, creatinine, serum glutamic pyruvic transaminase (SGPT)], dengue IgM was checked in all Patients by ELISA Outcomes (survival/mortality) and complications were recorded. Mortality was the primaryoutcome measure. DF constituted 86 4% (604), DHF constituted 11.6% (81) and DSS constituted 2% (14) of Patients. The mortality rate was 2 7% (19). The mean white blood cell count in those who died was 13 3, in those who survived was 5.3, the difference was significant (p=0 02) The mean BUN in those who died was 33 2, those who survived was 13.8, (p=0.007). The mean bicarbonate level in those who died was 17 1, those who survived was 185 (p 300 mg/dl, bleeding, an altered mental status and shock at presentation were all significantly associated with mortality in Patients with dengue virus infection (p=0 008, p001, p001, p001, respectively

The learners\u27 perspective on internal medicine ward rounds: a cross-sectional study

Background: Ward rounds form an integral part of Internal Medicine teaching. This study aimed to determine the trainees\u27 opinions regarding various aspects of their ward rounds, including how well they cover their learning needs, how they would like the rounds to be conducted, and differences of opinion between medical students and postgraduates. Methods: A cross-sectional study was conducted on a total of 134 trainees in Internal Medicine, comprising medical students, interns, residents and fellows, who were asked to fill in a structured, self-designed questionnaire. Most of the responses required a rating on a scale of 1-5 (1 being highly unsatisfactory and 5 being highly satisfactory). Results: Teaching of clinical skills and bedside teaching received the lowest overall mean score (Mean +/- SD 2.48 +/- 1.02 and 2.49 +/- 1.12 respectively). They were rated much lower by postgraduates as compared to students (p \u3c 0.001). All respondents felt that management of Patients was the aspect best covered by the current ward rounds (Mean +/- SD 3.71 +/- 0.72). For their desired ward rounds, management of Patients received the highest score (Mean +/- SD 4.64 +/- 0.55), followed by bedside examinations (Mean +/- SD 4.60 +/- 0.61) and clinical skills teaching (Mean +/- SD 4.50 +/- 0.68). The postgraduates desired a lot more focus on communication skills, counselling and medical ethics as compared to students, whose primary focus was teaching of bedside examination and management. A majority of the respondents (87%) preferred bedside rounds over conference room rounds. Even though the duration of rounds was found to be adequate, a majority of the trainees (68%) felt there was a lack of individual attention during ward rounds. Conclusions: This study highlights important areas where ward rounds need improvement in order to maximize their benefit to the learners. There is a need to modify the current state of ward rounds in order to address the needs and expectations of trainees

Threshold primary tumour sizes for nodal and distant metastases in papillary and follicular thyroid cancers.

Abstract BACKGROUND: In papillary and follicular thyroid cancers (PTC, FTC), nodal and distant metastasis are generally considered important determinants of recurrence and survival, respectively. However, there is no consensus about the threshold primarytumour size (PTS) for these determinants. The aim of this study was to assess size relationships for developing nodal, pulmonary, bone and overall distant metastases. METHODS: This prospective study covered 139 (93 females and 46 males) consecutive biopsy proven patients with PTC (114/139, mean age 41.0 ± 15.7 years, M: F, 35%:65%) and FTC (25/139, mean age 39.2 ± 14.3 years, M: F: 24%:76%). RESULTS: Average primary tumor size was 23.4 ± 11.1 mm and 26.5 ± 13.1 mm for PTC and FTC respectively (p value=0.223). Nodal metastasis was found more common in PTC than FTC (49% vs 28%, p value \u3c0.05), whereas overall distant metastasis was approximately the same (13% and 24%, p value =0.277); however, bone metastasis was significantly higher in FTC than PTC (24% vs 5%, p value \u3c0.05). Cumulative risk for nodal and distant metastases for FTC and PTC starts at PTS \u3c20 mm and may indicate an unusual aggressive tumor behavior in the studied population. Highest cumulative risk for nodal and pulmonary metastases in PTC and for bone metastasis in FTC was found to be ≥ 50 mm PTS. CONCLUSION: We conclude that a PTS of \u3c20 mm may indicate an unusual aggressive tumor behavior with highest cumulative risk for nodal and pulmonary metastases in PTC and for bone metastasis in FTC with a cutoff of ≥ 50 mm

The learners' perspective on internal medicine ward rounds: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Ward rounds form an integral part of Internal Medicine teaching. This study aimed to determine the trainees' opinions regarding various aspects of their ward rounds, including how well they cover their learning needs, how they would like the rounds to be conducted, and differences of opinion between medical students and postgraduates.</p> <p>Methods</p> <p>A cross-sectional study was conducted on a total of 134 trainees in Internal Medicine, comprising medical students, interns, residents and fellows, who were asked to fill in a structured, self-designed questionnaire. Most of the responses required a rating on a scale of 1-5 (1 being highly unsatisfactory and 5 being highly satisfactory).</p> <p>Results</p> <p>Teaching of clinical skills and bedside teaching received the lowest overall mean score (Mean ± SD 2.48 ± 1.02 and 2.49 ± 1.12 respectively). They were rated much lower by postgraduates as compared to students (p < 0.001). All respondents felt that management of patients was the aspect best covered by the current ward rounds (Mean ± SD 3.71 ± 0.72). For their desired ward rounds, management of patients received the highest score (Mean ± SD 4.64 ± 0.55), followed by bedside examinations (Mean ± SD 4.60 ± 0.61) and clinical skills teaching (Mean ± SD 4.50 ± 0.68). The postgraduates desired a lot more focus on communication skills, counselling and medical ethics as compared to students, whose primary focus was teaching of bedside examination and management. A majority of the respondents (87%) preferred bedside rounds over conference room rounds. Even though the duration of rounds was found to be adequate, a majority of the trainees (68%) felt there was a lack of individual attention during ward rounds.</p> <p>Conclusions</p> <p>This study highlights important areas where ward rounds need improvement in order to maximize their benefit to the learners. There is a need to modify the current state of ward rounds in order to address the needs and expectations of trainees.</p

Diabetes self management: education can make a difference

Background: According to current figures in Pakistan 7.1 million people suffer from diabetes, making it the seventh highest population of diabetic patients in the world .Education is the cornerstone of diabetes care. Lack of awareness can lead to patients suffering from diabetes complications. This project was conducted to determine the knowledge and practices of the patients and make them indepent through continue education so they can participate their Diabetes management programme. Objective: To evaluate the impact and effectiveness of a structured multidisciplinary group education programme for diabetic patients about their disease; psychosocial factors and lifestyle measures. Method: This data was collected from endocrine clinic at the Aga Khan University hospital from year 2011- 2012. A total number of 17 patients, 8 males and 9females, 3 with type-1 and 14 with type-2 diabetes mellitus (DM) were included in the project .Data was retrieved from pre & post questionnaire sheets which were recorded during patients visit in the “Diabetes Modular Classes”. The questionnaire was designed which contained10 questions about of Diabetes, ranging from the correct knowledge about disease, misconception regarding dietary measures, sign& symptoms of hypo & hyperglycemia & the normal values of their targets. Result: The comparison of pre and post knowledge assessment of approx 17 patients, who attended all four modules, revealed that their pre knowledge score were 67.6% where as their post results after attended all sessions were 87.3%. Conclusion: Comparison of pre & post quiz results shows that multidisciplinary well planned group education programme have better impact on patient’s .The knowledge impart via these classes make patients independent regarding their self management of disease process & life style modification Keywords: Diabetes, Hypoglycemia, Hyperglycemia, Multidisciplinary structured grou

Clinical factors associated with mortality in dengue infection at a tertiary care center. Southeast Asian J Trop Med Public Health

Abstract. We conducted a cross-sectional study to investigate the clinical factors associated with mortality in patients with dengue viral infection at a tertiary care center over a 3 year period. Six hundred ninety-nine patients with a clinical diagnosis of dengue fever (DF), dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) during the study period were included in the study. Data were collected with a predesigned form comprised of demographics, duration of fever, associated symptoms, diagnosis of DF, DHF and DSS, and laboratory parameters [complete blood count, coagulation tests, creatinine, serum glutamic pyruvic transaminase (SGPT)]; dengue IgM was checked in all patients by ELISA. Outcomes (survival/mortality) and complications were recorded. Mortality was the primary outcome measure. DF constituted 86.4% (604), DHF constituted 11.6% (81) and DSS constituted 2% (14) of patients. The mortality rate was 2.7% (19). The mean white blood cell count in those who died was 13.3, in those who survived was 5.3, the difference was significant (p=0.02). The mean BUN in those who died was 33.2, those who survived was 13.8, (p=0.007). The mean bicarbonate level in those who died was 17.1, those who survived was 18.5 (p &lt;0.001). Mean activated partial thromboplastin time in those who died was 56.8, those who survived was 36.8 (p=0.01). The mean SGPT in those who died was 802, those who survived was 176 (p=0.01). Those who died were significantly (p &lt;0.001) more likely to have severe hepatitis (63%) than those who survived (13.8%). On multivariate logistic regression analysis, having an SGPT &gt; 300 mg/dl, bleeding, an altered mental status and shock at presentation were all significantly associated with mortality in patients with dengue virus infection (p=0. 008, p&lt;0.001, p&lt;0.001, p&lt;0.001, respectively)