Prospective comparative study of video assisted thoracoscopic surgery versus conventional thoracostomy drainage in emyema thoracis in paediatric age group

Background: Approximately 1.2 million people per year are affected by pneumonia in the United States. In paediatric patients, thoracis empyema complicates pneumonia 36% to 57% of the time with a range of incidence between 0.4 and 6.0 cases per 1000 paediatric admissions. Many retrospective case series have suggested that children who experience failure of conventional chest tube therapy exhibit improvement after thoracotomy or video assisted thoracoscopic surgery (VATS), especially if the procedure is performed early, based on these reports, many paediatric surgeons have come to consider primary VATS a better approach for children suffering from thoracis empyema, A recent meta-analysis suggested that primary surgical intervention for paediatric thoracis empyema effusions was best which was prospective, randomized study done by Waite et al in adults.Methods: The present prospective study was conducted in a large teaching hospital that is a tertiary centre, department of surgery pediatric surgery unit, Pt. J. N. M. medical college & Dr. B.R Ambedkar hospital, Raipur (C.G.), India, in the year 2010. Using a random number method, patients were assigned either to a primary conventional thoracostomy arm or to a VATS arm. Those randomly assigned to the conventional thoracostomy arm had chest rube placement within 24 hours of empyema detection. If the chest radiograph obtained within 24 hours of the procedure showed significant clearing, then the thoracostomy tube was left in place until it drained 24 hours. If there was incomplete resolution of the effusion on the follow-up chest radiograph [obvious locations] and the patient was not clinically improving, then the patient was evaluated for rescue VATS or open thoracotomy. A sample size of 30 was chosen to have an 80% power to detect a predicted deference of 4 days in the mean length of hospitalization.Results: In this study, 30 patients included between 0 to 18 years of age youngest patient was 1 year and the oldest was 14 years. Six patients (20%) were between 2 to 3 years of age. In this study, 20 (67%) were male and 10 (30%) patients were females. Out of all 30 patients, in this study 20 (67%) were male and 10 (30%) patients were females. [Sixteen (53.3%) patients had right sided disease and fourteen (46.6%) had left sided disease, no patient was found having bilateral disease. All the thirty patients were empyema Thoracis. Using a random number method, patients were assigned either to a primary conventional thoracostomy arm or to a VATS arm.Conclusions: In the present study we found that empyema thoracis can be successfully treated by thoracoscopic decortications if encountered in early phase of the disease process. To conclude early intervention of empyema thoracis with thoracoscopic decortications seems to be the worldwide accepted modality of choice.

Pattern of Tobacco Use and Perceived Risk of COVID-19 Following Tobacco Use among the COVID-19 Patients of a Tertiary Health Care Institution in Eastern India

Background: COVID-19 presented an unprecedented situation in which behavioural factors including tobacco use were believed to increase the risk of morbidity and mortality. The objective of the present study was to find the tobacco use pattern among the COVID-19 patients and the perceived risk of developing severe COVID-19 following tobacco use.Methods: This hospital-based, cross-sectional, analytical study was conducted among 300 COVID-19 patients at the All India Institute of Medical Sciences (AIIMS), Patna, India, during November and December 2020 using a semi-structured, pretested questionnaire. Descriptive and univariate analyses were performed using statistical software and the results were presented as proportion and percentage.Findings: About 27% and 16% of the COVID-19 patients were ever and current tobacco users, respectively. Quit attempts were found to have increased during the COVID-19 pandemic. A majority (65%) of current tobacco users had reduced their amount of tobacco use. Nearly 2 in every 3 patients perceived high risk of developing severe COVID-19 following tobacco use. Perceived risk was significantly higher among tobacco non-users, patients who were aware of the ill health effects of tobacco use, and patients who had noticed anti-tobacco messages or had been advised to quit tobacco. Among the current tobacco users, a significantly higher proportion of patients who perceived high risk of developing severe COVID-19 following tobacco use had made quit attempts or had reduced tobacco consumption during the pandemic (76.7% vs. 40%; P = 0.032).Conclusion: A high proportion of COVID-19 patients believed that tobacco use aggravated the COVID-19 condition. Increased quit attempts and reduction in tobacco consumption during this pandemic is a positive sign for tobacco contro

Risk of secondhand smoke exposure and severity of COVID-19 infection: multicenter case–control study

IntroductionExposure to secondhand smoke (SHS) is an established causal risk factor for cardiovascular disease (CVD) and chronic lung disease. Numerous studies have evaluated the role of tobacco in COVID-19 infection, severity, and mortality but missed the opportunity to assess the role of SHS. Therefore, this study was conducted to determine whether SHS is an independent risk factor for COVID-19 infection, severity, mortality, and other co-morbidities.MethodologyMulticentric case–control study was conducted across six states in India. Severe COVID-19 patients were chosen as our study cases, and mild and moderate COVID-19 as control were evaluated for exposure to SHS. The sample size was calculated using Epi-info version 7. A neighborhood-matching technique was utilized to address ecological variability and enhance comparability between cases and controls, considering age and sex as additional matching criteria. The binary logistic regression model was used to measure the association, and the results were presented using an adjusted odds ratio. The data were analyzed using SPSS version 24 (SPSS Inc., Chicago, IL, USA).ResultsA total of 672 cases of severe COVID-19 and 681 controls of mild and moderate COVID-19 were recruited in this study. The adjusted odds ratio (AOR) for SHS exposure at home was 3.03 (CI 95%: 2.29–4.02) compared to mild/moderate COVID-19, while SHS exposure at the workplace had odds of 2.19 (CI 95%: 1.43–3.35). Other factors significantly related to the severity of COVID-19 were a history of COVID-19 vaccination before illness, body mass index (BMI), and attached kitchen at home.DiscussionThe results of this study suggest that cumulative exposure to secondhand cigarette smoke is an independent risk factor for severe COVID-19 illness. More studies with the use of biomarkers and quantification of SHS exposure in the future are needed

IJCM_118A: Pathway of healthcare for breast cancer: A mixed method study among women with breast cancer attending a tertiary healthcare institute in Bihar

Background: Breast cancer is the most common cancer among women; however, the majority of them visit hospitals at an advanced stage. Knowledge of pathway of care will aid in timely intervention and better prognosis. Objectives: To find the pathway of health care for breast cancer and its correlates among the patients who have attended AIIMS Patna. To identify the reasons for seeking delayed definitive care. Methodology: A mixed-method cross-sectional design with quantitative and qualitative parts was conducted at AIIMS Patna between March 2021 and December 2022 among breast cancer patients. A total of 171 breast cancer patients were enrolled in this study. Piloted study tools were used. Descriptive analysis for quantitative part and manual thematic analysis for qualitative part were performed. Results: Out of total 171 participants, 88.9% (83.3–92.77%) had visited AIIMS Patna indirectly. About 60 (20.6%) visited informal providers or quacks, and 60 (39.5%) of the study participants visited more than one hospital before arriving at AIIMS Patna. The place of residence, treatment delay, and stage of cancer were found to be independent predictors of the pathway of healthcare for breast cancer. The reasons behind seeking delayed definitive care were identified under two major themes: presentation delay (misunderstanding or difficulty in identifying symptom, neglect of disease, lack of awareness about the disease, family support, financial constraints) and treatment delay (misdiagnosis, multiple referrals, dissatisfaction with the treatment, COVID-19 lockdown, informal providers/quacks) Conclusion: 9 out of 10 breast cancer patients had not come directly for definitive care, and among them, 3 out of 5 had visited multiple healthcare providers. So, it is important to educate the public on breast cancer, make systematized referral pathways, orient the private sector, and have trained manpower for screening purposes

Clinico-epidemiological and vaccination profile of patients attending flu clinic of a tertiary health care institution in Eastern India during the third wave of COVID-19 pandemic

Introduction and aim. With the third wave of COVID-19 hitting the country, there is an urgent need to systematically document the clinical-epidemiological and vaccination details of the patients to formulate evidence-based decisions. So, this study was planned to describe the profile of patients attending the flu clinic of a tertiary care hospital in eastern India. Material and methods. This hospital-based cross-sectional study was done for 6 weeks (Jan-Feb 2022) among 623 patients using a pre-tested, structured questionnaire related to COVID-19. An unadjusted odds ratio was calculated and statistical significance was attributed to a p-value <0.05. Results. Out of 623 patients, almost 90% of the patients were vaccinated against COVID-19 with at least one dose of any vaccine. Cough (57.8%) was the most common complaint. Patients aged > 60 years and those having one or more than one comorbidity suffered from moderate-severe COVID-19 infection when compared to their counterparts (p<0.001). Also, 2.1% of fully vaccinated, 3.8% of one dose vaccinated and 10.9% of unvaccinated patients suffered from moderate-severe COVID-19. Conclusion. During the third wave of the COVID-19 pandemic, a smaller number of elderlies compared to the previous two waves were affected indicating age shifting. The severity of COVID-19 was less among vaccinated individuals compared to unvaccinated highlighting the importance of COVID-19 vaccination

A study on estimate of Iodine Deficiency Disorders and adequacy of Iodized Salt Consumption in Begusarai district of Bihar, India

Background: Iodine Deficiency Disorder is major public health problem causing increased perinatal mortality, mental retardation and goiter and all these morbidities are preventable. Most effective and inexpensive mode to prevent IDD is consumption of iodized salt. Objectives: To estimate the proportion of households using adequately iodized salt in Begusarai district, to assess the knowledge of households on consumption and storage of salt and to estimate Total Goitre Rate (TGR). Material and Methods: Community- based cross sectional study carried out on 412 household from 30 cluster in Begusarai district using cluster sampling technique. Children (6-12 years) were examined clinically for goitre status and sample of household salt was collected for testing iodine content. Iodine content estimation was done both quantitatively by titration and qualitatively by MBI kit. Statistical analysis was performed using SPSS version 22. Result: The respondents were mainly female (92.8%) of mean age 34 years. Three- fifth (61.6%) participants used packaged crushed salt for cooking purpose, followed by packaged crystal (30.5%). Only 12.1 % of the respondents gave affirmative answer for presence of label and logo. Storage of salt in container with lid was 78.5%. The proportion of household using adequately iodized salt was 78%. The sensitivity MBI kit was 61% and the Total goiter rate was 9.3%. Conclusion: The Begusarai district falls in mild public health problem for IDD as TGR is more than 5% and even after many decades of effort towards achieving an adequately salt iodization of more than 90%, it is 79% only

Level of happiness among medical students in Bihar-An online survey

BACKGROUND: Happiness is a state of mental well-being and influences the learning and performance of an individual. Medical education due to its academic culture and longer course duration affects the performance and happiness of the students. So, this study was done to assess the level of happiness and the factors associated with it among medical students in Bihar.MATERIALS AND METHODS: A cross-sectional online survey was conducted among 321 medical students of all academic years from various medical colleges in Bihar. This study used a self-administered study tool using the online Google Form platform for data collection and assessed the level of happiness using Oxford Happiness Questionnaire. A multivariable binary logistic regression analysis was done to find out the predictors of happiness.RESULTS: A total of 34.6% (95% CI: 29.5–39.9%) medical students were happy. Male (38.2%) students were found to be happier than female (29.2%) students. Age, place of stay, physical activity, meditation and yoga, frequent socialization, absence of psychiatric illness, and stressful situation in the family were the independent predictors of happiness. Around 42.4% of students had another career option, and 32.1% had a second thought about a career due to the COVID-19 pandemic. The presence of any psychiatric illness had a significant effect on the happiness level of the students.CONCLUSION: Only one in three medical students is happy. Promotion of physical activity, meditation and yoga, and socialization will improve the happiness and thereby learning among medical students